Sociodemographic and obstetric factors associated with the interruption of breastfeeding within 45 days postpartum - Maternar Cohort Study

Santos, Vanessa Luciani; Holand, Bruna Luiza; Drehmer, Michele; Bosa, Vera Lúcia

doi:10.1590/1806-93042021000200013

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Instituto de Medicina Integral Prof. Fernando Figueira 21 (2) • Apr-Jun 2021 • https://doi.org/10.1590/1806-93042021000200013 copy

Sociodemographic and obstetric factors associated with the interruption of breastfeeding within 45 days postpartum - Maternar Cohort Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to evaluate and identify the prevalence of interruption of breastfeeding (BF) in the period of up to 45 days postpartum and the associated sociodemographic and obstetric factors.

Methods:

cohort of 622 puerperal women, selected between 2018 and 2019 in a reference maternity hospital in the South Brazil. Data collection was carried out in two phases, the first in the maternity hospital during hospitalization of the puerperal woman and the newborn and the second through a telephone call, which occurred 60 days after birth. Poisson regressions with robust variance were performed to identify the factors associated with interruption of BF in the first 45 days of life. The variables that presented p<0.20 in the crude analysis were included in the adjusted analysis.

Results:

the interruption of BF at 45 days was identified in 14% of the sample. Higher maternal age (PR= 0.46; CI95%= 0.22-0.93), eight years or less of education (PR= 2.11; CI95%= 1.05-4.25), support from the maternal grandmother (PR= 1.91; CI95%= 1.20-3.06) and receiving complement at the maternity hospital (PR= 1.53; CI95%= 1.04-2.25) were factors related to the interruption of BF in the 45-day postpartum period.

Conclusion:

maternal age ≥35 was a protective factor, and less education, the support of the maternal grandmother and receiving complement at the maternity hospital were predictors of early breastfeeding abandonment.

Key words:
Breastfeeding; Weaning; Risk factors; Postpartum period

Characteristics	Included (n=622)		Loss of follow-up (n=147)		p^# # Pearson's chi-square test; R$= Real, Brazilian currency.
Characteristics	n	%	n	%
Maternal age (years)					0.455
19-25	258	41.5	61	41.5
26-34	241	38.7	63	42.9
>35	123	19.8	23	15.6
Maternal skin color					0.138
White	351	56.4	74	50.3
Non-white	271	53.6	73	49.7
Maternal education					0.004
< 8	170	27.3	56	38.1
9 - 11	322	51.8	75	51.0
> 12	130	20.9	16	10.9
Per capita income (R$)					0.072
< 351.0	190	30.5	59	40.1
352 - 602	212	34.1	46	31.3
> 603	220	35.4	42	28.6
Occupation					0.790
Paid	308	49.5	71	48.3
Unpaid	314	50.5	76	51.7
Marital status					0.334
With companion	520	83.6	118	80.3
No companion	102	16.4	29	19.7
Family support network					0.045
Companion	287	46.1	55	37.4
Mother	106	17.0	22	15.0
Mother-in-law	36	5.8	9	6.1
Companion and mother	156	25.1	43	29.3
Others	37	5.9	18	12.2
Parity					0.077
Primiparous	261	42.0	50	34.0
Multiparous	361	58.0	97	66.0
Previous breastfeeding experience					0.127
Yes	329	52.9	88	59.9
No	293	47.1	59	40.1
Early onset of prenatal care					0.029
Yes (< 12 weeks of gestation)	419	67.4	85	57.8
No (> 12 weeks of gestation)	203	32.6	62	42.2
Number of prenatal consultations					0.127
<6	80	12.9	26	17.7
>6	542	87.1	121	82.3
Receiving information on prenatal
breastfeeding					0.691
Yes	247	39.7	61	41.5
No	375	60.3	86	58.5
Participation in a group of pregnant
women in prenatal care					0.798
Yes	68	10.9	132	89.8
No	554	89.1	15	10.2
Type of childbirth					0.466
Normal	380	61.1	85	57.8
Cesarean	242	38.9	62	42.2
Breastfed in the first hour of life					0.601
Yes	356	52.2	48	55.2
No	326	47.8	39	41.3
Offer of complement at the maternity
hospital					0.541
Yes	224	36.0	49	33.3
No	398	64.0	98	66.7
Gestational age at childbirth (weeks)					0.115
<37	85	13.7	13	8.8
37 - 42	537	86.3	134	91.2

Characteristics	Interruption of BF within 45 days after childbirth (n=87)
Characteristics	N	%	CI95%
Age, average 26.9 ± 5.5
19-25	41	15.9	11.4 - 20.4
26-34	37	15.3	10.8 - 19.9
>35	9	7.3	2.6 - 11.9
Maternal skin color
White	54	15.4	11.6 - 19.2
Non-white	33	12.2	8.3 - 16.1
Maternal education, average of 10.5 ± 2.0
< 8	26	15.3	9.8 - 20.8
9 - 11	50	15.5	11.5 - 19.5
> 12	11	8.5	3.6 - 13.3
Per capita income (R$), median 468.5 IQ: 281.1 - 780.8
< 351.0	24	12.6	7.9 - 17.4
352 - 602	32	15.1	10.2 - 19.9
> 603	31	14.1	9.5 - 18.7
Occupation
Paid	48	12.7	8.9 - 16.4
Unpaid	39	15.3	11.3 - 19.3
Marital status
With companion	71	13.6	10.7 - 16.6
No companion	16	15.6	8.5 - 22.9
Family support network (n=86)^* * The category "Others" of the variable "Family support network" was excluded from these analyses for presenting only one individual.
Companion	34	11.8	8.1 - 15.6
Mom	26	24.5	16.2 - 32.8
Mother-in-law	5	13.9	2.0 - 25.7
Companion and mother	21	13.5	8.1 - 18.9
Parity
Primiparous	41	15.7	11.3 - 20.1
Multiparous	46	12.7	9.3 - 16.2
Previous breastfeeding experience
Yes	53	10.3	7.0 - 13.6
No	34	18.1	13.7 - 22.5
Early onset of prenatal care, average 11.0 ± 4.9
Yes (< 12 weeks of gestation)	58	13.8	10.5 - 17.2
No (> 12 weeks of gestation)	29	14.3	9.4 - 19.1
Number of prenatal consultations, average 9.4 ± 3.7
<6	11	13.7	6.0 - 21.5
>6	76	14.0	11.1 - 16.9
Receiving information on prenatal breastfeeding
Yes	38	15.4	10.5 - 19.9
No	49	13.1	9.6 - 16.5
Participation in a group of pregnant women in prenatal care
Yes	14	20.6	10.7 - 30.4
No	73	13.2	10.3 - 16.0
Type of childbirth
Normal	36	13.4	9.9 - 16.9
Cesarean	51	14.9	10.4 - 19.4
B reastfed in the first hour of life
Yes	39	13.2	9.3 - 17.1
No	48	14.7	10.9 - 18.6
Offer of complement at the maternity hospital
Yes	42	18.7	13.6 - 23.9
No	45	11.3	8.2 - 14.4
Gestational age at childbirth, average 38.4 ± 1.7
<37	11	12.9	5.7 - 20.2
37 - 42	76	14.1	11.2 - 17.1

Characteristics	Interruption of BF within 45 days after childbirth (n=87)
Characteristics	Crude PR (CI95%)	Adjusted PR (CI95%)
Maternal age (years)
19-25	1.03 (0.69 - 1.56)	0.79 (0.51 - 1.23)
26-34	1	1
>35	0.47a (0.23 - 0.95)	0.46a (0.22 - 0.93)
Maternal skin color
White	1
Non-white	0.79 (0.52 - 1.18)
Maternal education
< 8	1.80 (0.92 - 3.52)	2.11a (1.05 - 4.25)
9 - 11	1.83 (0.98 - 3.41)	1.83 (0.99 - 3.37)
> 12	1	1
Per capita income (R$)
< 351.0	0.89 (0.54 - 1.47)
352 - 602	1.07 (0.67 - 1.69)
> 603	1
Occupation
Paid	1
Unpaid	1.20 (0.81 - 1.78)
Marital status
With companion	0.87 (0.52 - 1.43)
No companion	1
Family support network (n=86)^* * The category "Others" of the variable "Family support network" was excluded from these analyzes because it presents only one individual.
Companion	1	1
Mom	2.07a (1.30 - 3.27)	1.91a (1.20 - 3.06)
Mother-in-law	1.17 (0.49 - 2.80)	1.27 (0.55 - 2.92)
Companion and mother	1.13 (0.68 - 1.88)	0.98 (0.59 - 1.63)
Parity
Primiparous	1.23 (0.83 - 1.82)
Multiparous	1
Previous breastfeeding experience
Yes	1	1
No	1.75a (1.17 - 2.61)	1.56a (1.00 - 2.44)
Early onset of prenatal care
Yes (< 12 weeks of gestation)	1
No (> 12 weeks of gestation)	1.03 (0.68 - 1.56)
Number of prenatal consultations
<6	0.98 (0.54 - 1.76)
>6	1
Receiving information on prenatal breastfeeding
Yes	1
No	0.84 (0.57 - 1.25)
Type of childbirth
Normal	1
Cesarean	1.10 (0.74 - 1.64)
Breastfed in the first hour of life
Yes	1
No	1.11 (0.75 - 1.65)
Offer of complementat the maternity hospital
Yes	1.65a (1.12 - 2.44)	1.53a (1.04 - 2.25)
No	1	1
Gestational age at childbirth (weeks)
<37	0.91 (0.50 - 1.64)
37 - 42	1

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[1] Authors’ contribution

Santos VL participated in the choice of the theme, data acquisition and writing of the manuscript. Holand BL did the study design, analysis and interpretation of the data, and review of the manuscript. Drehmer M participated in the interpretation of the data and review of the manuscript. Bosa VL contributed as a supervisor and reviewer of the manuscript. All authors approved the final version of the article.