Breastfeeding initiation according to the severity of Class 3 obesity

Area of Science:

• Maternal-Fetal Medicine
• Obesity Medicine
• Lactation Science

Background:

• Class 3 obesity includes morbid (BMI 40-49 kg/m²) and extreme (BMI ≥ 50 kg/m²) subgroups.
• Adverse perinatal outcomes are linked to obesity, but breastfeeding initiation data is limited for these subgroups.

Purpose of the Study:

• To compare breastfeeding initiation rates and comorbidities between women with morbid and extreme obesity.
• To identify disparities in breastfeeding support and outcomes for women with severe obesity.

Main Methods:

• Retrospective cohort study of 1780 women delivering singletons at ≥ 34 weeks gestation (2013-2021).
• Matched 890 women with morbid obesity to 890 with extreme obesity by race, parity, and delivery year.
• Excluded women with bariatric surgery or infants with major malformations.

Main Results:

• Extreme obesity group had higher rates of gestational diabetes, pregestational diabetes, chronic hypertension, severe preeclampsia, obstructive sleep apnea, asthma, and cesarean deliveries.
• Breastfeeding initiation (57% vs 64%), exclusive breastfeeding (23% vs 34%), and intention to breastfeed (64% vs 71%) were lower in the extreme obesity group.
• Both groups were similar in primiparity, age, race, smoking status, gestational hypertension, PCOS, GERD, and anemia.

Conclusions:

• Women with extreme obesity face a higher burden of comorbidities, impacting breastfeeding initiation.
• Targeted antenatal, intrapartum, and postpartum interventions are crucial to improve breastfeeding benefits for mothers and infants in extreme obesity.
• Further research is needed to understand and address barriers to breastfeeding in severe obesity.