Trends in breastfeeding initiation, continuation, and exclusivity by maternal prepregnancy weight: 2004-2011

To examine trends in breastfeeding initiation, continuation, and exclusivity by prepregnancy weight from 2004 to 2011 and the associations between these outcomes and prepregnancy weight.

Data from the 2004 to 2011 Pregnancy Risk Assessment Monitoring System, a survey of women with a recent live birth from 34 states and New York City, were used. Trends in breastfeeding initiation, continuation, and exclusivity at 12 weeks postpartum were evaluated by prepregnancy BMI. Logistic regression was used to identify the association between prepregnancy BMI and the breastfeeding outcomes.

Among 244,196 women, with increasing BMI, a decreasing number of women initiated, continued, and breastfed exclusively. From 2004 to 2011, the rates of breastfeeding initiation increased significantly for women of all weight classes (P < 0.01), and the disparity between normal-weight women and women with obesity class III narrowed. Among all women, breastfeeding continuation increased significantly for women of almost all weight classes (P < 0.01), although the disparity between normal-weight women and women with obesity class III worsened. From 2009 to 2011, among all women, exclusive breastfeeding increased significantly among women with normal and overweight BMI (P < 0.01) but decreased among obese class III; the disparity between women with normal and obese class III BMI worsened.

Our results highlight the need for more concentrated efforts on breastfeeding continuation and exclusivity, particularly for women with obesity.