Breastfeeding patterns and factors associated with early weaning in the Western Amazon

Martins, Fernanda Andrade; Ramalho, Alanderson Alves; Andrade, Andréia Moreira de; Opitz, Simone Perufo; Koifman, Rosalina Jorge; Silva, Ilce Ferreira da

doi:10.11606/s1518-8787.2021055002134

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002134 copy

Breastfeeding patterns and factors associated with early weaning in the Western Amazon

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre.

METHODS:

This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning.

RESULTS:

The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06–3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59–3.94), pacifier use (HR = 6.23; 95%CI 4.52–8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25–2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10–1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34–2.90).

CONCLUSION:

Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

DESCRIPTORS:
Breast Feeding; Weaning; Infant Nutrition; Child Health; Health Status Indicators

Variable (n)^a a The differences when compared with the total are due to lack of information in the variable.	Category	n (%)
Maternal age (years)
	≥ 35	95 (11.4)
	20-34	519 (62.3)
	< 20	219 (26.3)
Maternal skin color
	Brown/Mixed race	694 (83.4)
	White	82 (9.9)
	Others	56 (6.37)
Maternal education^b b The categories refer to the level of education.
	Up to middle school	203 (24.4)
	High school	438 (52.6)
	Higher education	192 (23.0)
Marital status
	With partner	706 (84.8)
	Without partner	127 (15.2)
Working mother before pregnancy
	Yes	285 (36.0)
	No	507 (64.0)
Quit working after birth delivery
	No	323 (46.3)
	Yes	375 (53.7)
Socioeconomic status
	A and B	170 (20.6)
	C, D and E	655 (79.4)
Beneficiary of income transfer program (Bolsa Família)
	No	639 (81.2)
	Yes	148 (18.8)
Number of child’s siblings
	3 or more	244 (29.4)
	1 or 2	251 (30.2)
	None	335 (40.4)
Planned pregnancy
	Yes	530 (63.9)
	No	300 (36.1)
Smoking in pregnancy
	No	761 (91.4)
	Yes	72 (91.34)
Alcohol consumption during pregnancy
	No	726 (87.9)
	Yes	100 (12.1)
Prenatal care sector
	Public	690 (85.1)
	Private	121 (14.9)
Number of prenatal appointments
	≤ 5	252 (30.5)
	6	138 (16.7)
	> 6	435 (52.7)
Type of delivery
	Normal	425 (51.0)
	Cesarean section	408 (49.0)
Baby gender
	Boy	406 (48.7)
	Girl	427 (51.3)
Prematurity
	No	762 (92.0)
	Yes	66 (8.0)
Low birth weight
	No	767 (92.5)
	Yes	62 (7.5)
Breastfeeding in the first hour of life
	Yes	471 (58.0)
	No	341 (42.0)
Hospital assistance in the management of breastfeeding
	No	398 (48.2)
	Yes	427 (51.8)
Intended breastfeeding timing
	> 6 months	399 (48.8)
	6 months	339 (41.5)
	< 6 months	79 (9.7)
Cross-breastfed babies
	No	688 (82.6)
	Yes	145 (17.4)
Cross-breastfed other women’s infants
	Yes	155 (18.6)
	No	678 (81.4)
Pacifier use
	No	494 (59.5)
	Yes	336 (40.5)
Positive paternal participation in breastfeeding
	Yes	681 (82.0)
	No	149 (18.0)
Complementation to breastfeeding in the hospital
	Yes	125 (15.0)
	No	708 (85.0)
Breastfeeding status at discharge
	EBF	795 (95.4)
	BF	38 (4.6)

Variable		Kaplan-Meier Analysis		Hazard Ratio (HR)
Variable		1-Survival	log-rank p-value	crude HR [95%CI]
Maternal age			0.225
	≥ 35 years	22.1		1
	20-34 years old	28.9		1.19 (0.72–1.97)
	< 20 years	24.7		1.41(0.90–2.22)
	Maternal skin color		0.285
	Brown/Mixed race	26.1		1
	White	34.1		1.36 (0.91–2.03)
	Others	28.6		1.13 (0.68–1.89)
Maternal Education^a a The categories refer to the level of education.			0.134
	Up to middle school	21.7		1
	High school	29.7		1.40 (1.00–1.97)
	Higher education	26.6		1.23 (0.82–1.84)
Marital status			0.307
	With partner	26.5		1
	Without partner	29.9		1.20 (0.84–1.70)
Working mother before pregnancy			0.417
	Yes	28.8		1
	No	25.6		0.90 (0.68–1.18)
Quit working after birth delivery			0.198
	No	23.8		1
	Yes	28.5		1.21 (0.90–1.62)
Socioeconomic status			0.694
	A and B	28.2		1
	C, D and E	26.6		0.94 (0.69–1.30)
Beneficiary of income transfer program (Bolsa Família)			0.827
	No	28.0		1
	Yes	26.4		0.97 (0.70–1.37)
Number of child’s siblings			0.180
	3 or more	23.0		1
	1 or 2	27.5		1.23 (0.87–1.75)
	None	29.6		1.35 (0.98–1.88)
Planned pregnancy			0.063
	Yes	23.9		1
	No	29.1		1.30 (0.98–1.72)
Smoking in pregnancy			0.054
	No	26.3		1
	Yes	34.7		1.50 (0.99–2.26)
Alcohol consumption during pregnancy			0.005
	No	25.6		1
	Yes	37.0		1.62 (1.14–2.31)
Prenatal care sector			0.232
	Public	25.7		1
	Private	31.4		1.23 (0.87–1.75)
Number of prenatal appointments
	≤ 5	25.8	0.958	1
	6	26.8		0.05 (0.70–1.57)
	> 6	27.6		1.04 (0.77–1.40)
Type of delivery			0.406
	Normal	25.6		1
	Cesarean section	28.4		0.90 (0.70–1.16)
Prematurity			0.454
	No	27.4		1
	Yes	22.7		0.82 (0.48–1.39)
Low birth weight			0.109
	No	26.3		1
	Yes	35.5		1.42 (0.91–2.20)
Breastfeeding in the first hour of life			0.016
	Yes	23.8		1
	No	31.1		1.38 (1.05–1.80)
Hospital assistance in the management of breastfeeding			0.027
	No	23.9		1
	Yes	30.2		1.34 (1.03–1.75)
Intended breastfeeding timing			0.012
	6 months	22.8		1
	6 months	28.6		1.29 (0.98–1.72)
	< 6 months	38.0		1.80 (1.19–2.71)
Breastfeeding status at discharge			0.001
	EBF	26.0		1
	BF	47.4		2.24 (1.38–3.63)
Cross-breastfed babies			0.078
	No	28.3		1
	Yes	20.7		0.71 (0.48–1.05)
Cross-breastfed other women’s infants			p < 0.001
	Yes	13.5		1
	No	30.1		2.46 (1.57–3.86)
Pacifier use			p < 0.001
	No	10.1		1
	Yes	51.2		6.28 (4.60–8.57)
Positive paternal participation in breastfeeding			0.009
	Yes	25.3		1
	No	34.2		1.50 (1.10–2.05)

Variable		Weaning in the first six months of life
Variable		crude HR (95%CI)	adjusted HR^a a HR adjusted for age and maternal education, breastfeeding status at discharge, cross-breastfed other women’s infants, pacifier use, period of breastfeeding, breastfeeding in the first hour of life, alcohol consumption during pregnancy. (95%CI)
Breastfeeding status at discharge
	EBF	1	1
	BF	2.24 (1.38–3.63)	1.82 (1.06–3.11)
Cross-breastfed other women’s infants
	Yes	1	1
	No	2.46 (1.57–3.86)	2.50 (1.59–3.94)
Pacifier use
	No	1	1
	Yes	6.28 (4.60–8.57)	6.23 (4.52–8.60)
Intended breastfeeding timing
	> 6 months	1	1
	6 months	1.29 (0.98–1.72)	1.26 (0.93–1.70)
	< 6 months	1.80 (1.19–2.71)	1.93 (1.25–2.98)
Breastfeeding in the first hour of life
	Yes	1	1
	No	1.38 (1.05–1.80)	1.45 (1.10–1.92)
Alcohol consumption during pregnancy
	No	1	1
	Yes	1.62 (1.14–2.31)	1.88 (1.34–2.90)

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[1] Correspondence: Fernanda Andrade Martins Universidade Federal do Acre. Centro de Ciências da Saúde e do Desporto. BR 364, km-04, Distrito Industrial 69915-900, Rio Branco, AC, Brasil. E-mail: fernanda.martins@ufac.br