Trajectory of breastfeeding among Chinese women and risk prediction models based on machine learning: a cohort study

Breastfeeding is the optimal source of nutrition for infants and young children, essential for their healthy growth and development. However, a gap in cohort studies tracking breastfeeding up to six months postpartum may lead caregivers to miss critical intervention opportunities.

This study conducted a three-wave prospective cohort analysis to examine maternal breastfeeding trajectories within the first six months postpartum and to develop risk prediction models for each period using advanced machine learning algorithms. Conducted at a leading Maternal and Children's hospital in China from October 2021 to June 2022, data were gathered via self-administered surveys and electronic health records.

Of the 3307 women recruited, 3175 completed the surveys, yielding a 96% effective response rate. Breastfeeding(BF) rates were observed at 100%, 96%,93% and 83% at discharge, 42 day, 3 month and 6 month postpartum, respectively. Exclusively breastfeeding(EBF) rates were recorded at 91%, 64%,72% and 58% for the same intervals. Among the five machine learning methods employed, Random Forest (RF) demonstrated superior accuracy in predicting breastfeeding patterns, with classification accuracies of 0.629 and an area under the receiver operating characteristic curve (AUC) of 0.8122 at 42 days, 0.925 and an AUC of 0.9800 at 3 months, and 0.836 and an AUC of 0.9463 at 6 months postpartum, respectively. Key predictive factors for breastfeeding at 42 days postpartum included the newborn's birth weight and the mother's pre-delivery and prenatal weights. Predictors for feeding type at 3 months and 6 months postpartum included early feeding types and the scores from the Breastfeeding Self-Efficacy Scale-short Form (BSES-SF) at 6 months. The predictive model based on follow-up data showed strong performance.

Breastfeeding rates slightly declined from discharge to 6 months postpartum. The breastfeeding context in this region is comparatively optimistic both within China and internationally. Factors such as newborn's birth weight, gestational age, maternal weight management before and during pregnancy, early support and breastfeeding success, breastfeeding knowledge and self-efficacy are intricately linked to long-term breastfeeding outcomes. This study highlights critical, modifiable risk factors for early breastfeeding stages, providing valuable insights for enhancing breastfeeding intervention programs and informed decision-making.