Induction of labor is not associated with decreased rates of breastfeeding in late preterm pregnancies

Abstract

Background

Some studies suggest that induction of labor at term is associated with lower rates of breastfeeding than spontaneous labor.

Objective

Our objective was to evaluate whether late preterm medically indicated induction of labor is associated with decreased rates of breastfeeding and/or increased rates of breastfeeding complications at the time of discharge from the delivery hospitalization.

Study Design

This secondary analysis of a randomized trial of individuals at high risk for late preterm delivery, defined as delivery between 34+0 and 36+6 weeks, included nonanomalous, singleton pregnancies and excluded those with unlabored cesareans or preterm prelabor rupture of membranes. The parent study collected detailed data on breastfeeding and the presence of breastfeeding difficulties, defined as issues in milk production or infant feeding. Subjects with incomplete breastfeeding data were additionally excluded. Participants undergoing late preterm indicted inductions were compared to those who presented with spontaneous preterm labor. The primary outcome, the rate of breastfeeding, was compared between groups. Breastfeeding difficulties were also compared. Baseline demographics were compared using bivariable analyses. We fit logistic regression models to adjust for confounders related to breastfeeding.

Results

Two thousand one hundred thirty participants were included. Spontaneous and induction groups were similar in age, tobacco use, gestational diabetes, and insurance type but the induced group had higher body mass index, rates of chronic hypertension and hypertensive disorders of pregnancy (HDP). The rate of breastfeeding did not differ in induced vs spontaneous participants (69.0% vs 68.7%, P=.90). However, breastfeeding difficulties were more common in the induced group in unadjusted analyses (38.8% vs 32.3%, P=.01). After adjusting for confounders, neither breastfeeding rates nor breastfeeding difficulties were different between groups. Of note, government insurance was an independent risk factor for low breastfeeding rates and induction was associated with a decreased rate of cesarean delivery

Conclusion

Medically indicated late preterm labor induction was not associated with decreased rates of breastfeeding or increased breastfeeding problems at time of discharge from the delivery hospitalization. Those with government funded insurance may need additional breastfeeding support.