Prevalence of Antenatally Identified Lactation Risk Factors and Risk of Not Fully Breastfeeding at 6 to 8 Weeks Postpartum.

Introduction: Several anatomical and endocrine factors have been linked to breastfeeding difficulties, yet there is limited evidence for their prevalence and associated postpartum breastfeeding outcomes. Knowledge of the prevalence and impact of nonmodifiable lactation risk factors can inform clinical care. We examined the prevalence of antenatally identifiable lactation risk factors and associated breastfeeding outcomes at 6 to 8 weeks postpartum.

Methods: A retrospective study examined matched antenatal lactation risk screening data and infant feeding method at 6 to 8 weeks postpartum in a cohort of Australian women who gave birth at term gestation. The prevalence of lactation risk factors, associated full breastfeeding rates, and risk ratios for not fully breastfeeding at 6 to 8 weeks postpartum were calculated.

Results: Screening data were obtained for 519 women; 408 were complete, and 296 had matched lactation outcome data. One lactation risk factor was identified in 65.4% (267 of 408) of women. Of those with no risk factors, 77.1% (81 of 105) were fully breastfeeding compared with 60.2% (115 of 191) with one risk factor, with a relative risk of not fully breastfeeding at 6 to 8 weeks of 1.69 (95% CI, 1.14-2.50). Other significant risk factors included gestational diabetes (GDM) (relative risk, 1.70; 95% CI, 1.24-2.34) and prepregnancy body mass index greater than or equal to 25 (relative risk, 1.74; 95% CI, 1.30-2.34); coexistence of these factors more than doubled the risk of not fully breastfeeding at 6 to 8 weeks postpartum (relative risk, 2.18; 95% CI, 1.58-3.01).

Discussion: Nonmodifiable lactation risk factors may be identified in half of pregnant women. Previously identified risks of GDM and increased body mass index are compounded when they coexist, posing significant risks to early full breastfeeding outcomes. Antenatal identification of lactation risk factors offers opportunities to proactively educate and support women at risk to optimize breastfeeding and subsequent maternal and child health outcomes.