Factors influencing breastfeeding initiation, duration, and early cessation: a focus on maternal and infant characteristics.

Abstract

Background: Although breastfeeding provides well-documented benefits for both mothers and infants, breastfeeding rates remain suboptimal in many countries. Despite most women initiating breastfeeding, a significant proportion cease within the first six months, falling short of the recommendations by health authorities. Previous studies have primarily focused on sociodemographic or health-system-related factors; however, the influence of maternal emotional status and infant characteristics has received comparatively less attention. A more integrative approach is needed to understand the complex interplay of factors influencing breastfeeding initiation, early cessation, and duration. This study aims to examine how maternal sociodemographic characteristics, prenatal lifestyle habits, emotional well-being during the perinatal period, and infant characteristics contribute to breastfeeding decisions, early cessation, and duration.

Methods: A longitudinal cohort study followed 397 mother-infant dyads in Tarragona (Spain) from pregnancy through the child's fourth year. The study was conducted between years 2014 and 2021. During pregnancy, we assessed maternal sociodemographic characteristics, health habits, lifestyle factors, and emotional status. At 40 days postpartum, infant temperament was assessed using the Early Infant Temperament Questionnaire. Additional variables were collected throughout the perinatal period, including mode of birth, breastfeeding initiation, early cessation, and total duration of breastfeeding.

Results: Non-smoking during pregnancy (OR:0.239; CI 95%:0.128-0.445) and higher emotional stability in the third trimester (OR:1.066; CI 95%:1.001-1.134) were associated with the decision to initiate breastfeeding. Conversely, lower infant birth weight (OR:0.999; CI 95%:0.998-1.000), lower postpartum emotional stability (OR:0.913; CI 95%:0.840-0.992), and lower infant rhythmicity (OR:0.621; CI 95%:0.386-0.998) were related early cessation of breastfeeding within during the firsts 40 days postpartum. Longer breastfeeding duration was predicted by older maternal age (β:0.370; CI 95%:0.020-0.720), maternal cultural background (β:5.086; CI 95%:0.759-9.413), higher emotional stability (β:0.474; CI 95%:0.074-0.875), infant rhythmicity (β:2.568; CI 95%:0.350-4.784) and infant mood (β:2.915; CI 95%:0.399-5.431).

Conclusion: These findings emphasize the importance of maternal emotional health during the perinatal period and the influence of early infant temperament on breastfeeding outcomes. Interventions aimed at supporting breastfeeding should integrate psychological support for mothers and consider infant behavioral characteristics. A more holistic and personalized approach could improve breastfeeding rates and better align maternal intentions with breastfeeding experiences.