A few weeks ago I wrote about the plethora of research in 2012 on breastfeeding and maternal obesity.
One of the conclusions I think you could reach in reading this new research is that, while obesity does seem to be associated with poorer breastfeeding outcomes, due at least in part to things like delayed lactogenesis II, it can’t all be physiologic. Several studies I wrote about showed an effect of educational level, prior breastfeeding experience, or other demographic variables on breastfeeding outcomes. The headline: Obesity seems to increase the risk of breastfeeding problems, but it’s also not destiny.
So I was especially interested in a new study on an educational breastfeeding intervention for obese and overweight women.
This study, conducted by the University of Connecticut, the Hispanic Health Council of Hartford, and the Baby Friendly Hartford Hospital (a remarkable partnership I’ve profiled before), involved 154 overweight/obese, low income women who planned to breastfeed andwere randomly chosen to receive either standard breastfeeding care and support or specialized peer counseling support. The participating mothers were predominately (82%) Latina and half of the Latinas were of Puerto Rican heritage.
The peer counseling support included 3 prenatal visits, daily in-hospital support, and up to 11 postpartum home visits which promoted exclusive breastfeeding and addressed obesity-related issues.
The peer counselors who provided this support received 20 hours of specialized training on obesity and exclusive breastfeeding, in addition to the standard peer counselor training. Obesity-related topics included: “breastfeeding after cesarean delivery, delayed lactogenesis, body image sensitivity, positioning for large breasts, discreet breastfeeding techniques, and research updates on maternal weight loss and childhood obesity in relation to breastfeeding.”
Breastfeeding initiation was 99% in both study groups. The specialized breastfeeding peer counselor intervention, targeting overweight/obese low-income women, had no significant impact on exclusive breastfeeding rates during the first 6 months, and was associated with an increased rate of any breastfeeding only at 2 weeks after birth. Analysis of secondary outcomes reveals that the intervention was associated with increased breastfeeding intensity at 2 weeks after birth and lower rates of infant hospitalization at 3 and 6 months.
This result was positive, but a far cry from the results of a prior study of this intervention with a general population (not all overweight or obese), which found that moms who got this support were 15 times more likely to breastfeed exclusively for three months than those who didn’t.
One thing to note is that the “standard breastfeeding care and support” the mothers in the control group received is not what most of us would think of as standard. Hartford Hospital is Baby Friendly and also employs peer counselors to support mothers, so the care the control group received was likely significantly superior to the “standard care” mothers receive in the U.S. as a whole. This raises a question about whether there was a ‘victim of one’s own success’ factor at play.
So, what to make of the current study’s results? The authors state that “Our results…suggest that the breastfeeding barriers experienced by overweight and obese women have not been fully addressed and that further research is needed to understand the etiology of their poor breastfeeding outcomes.”
I had the opportunity to pose a few questions to Dr. Donna Chapman, study co-author and Associate Research Scientist in Chronic Disease Epidemiology at Yale University.
You write that this study demonstrates that “further research is needed to understand the etiology of [overweight and obese women's] poor breastfeeding outcomes.” What are some factors you’d like to see investigated?
We need to identify the barriers faced by these overweight and obese, low-income women. For example, is body image a factor which limits their breastfeeding success? Are there concerns about privacy and the adequacy of support in the hospital? In addition to understanding these barriers, we really need to further explore how hormonal differences in overweight and obese women are related to breastfeeding success.
Was there any indication that mothers appreciated having support from peer counselors who understood obesity-related breastfeeding issues, such as delayed lactogenesis, body image sensitivity, or positioning for large breasts?
Although we didn’t have the space to address this in the manuscript, the mothers were asked to rate their satisfaction with the peer counselors. The overwhelming majority were very appreciative of the specialized support they received.
Was there any indication that extent of pre-pregnant overweight or obesity was a factor? In other words, did mothers with lower BMI scores have different outcomes that mothers with higher BMI scores?
Our statistical analyses controlled for maternal BMI, but showed no relationship between BMI and breastfeeding success in this population of overweight and obese women. It is possible that obese women may have more breastfeeding difficulty than overweight women, but our study was not designed to test this hypothesis.
Image credit: Wikimedia Commons