Evaluating an Association Between Prenatal Smoking Behavior and Exclusive Breastfeeding: A Population-Based Study

Background: Prenatal smoking is consistently associated with adverse breastfeeding outcomes. We aimed to evaluate the association of smoking cessation or continuation during pregnancy with exclusive breastfeeding in a representative sample of the general Canadian population. Methods: We used the pooled sample of 9860 females with pregnancy experience of last under-five child from the Canadian Community Health Surveys 2015-2018 public use microdata file. We categorized self-reported prenatal smoking status as continuing, quitting, or no smoking. We evaluated the association between exclusive breastfeeding for 6 months or more with prenatal smoking status using multivariable logistic regression, adjusted for socio-demographic variables. Results: With the pooled prevalence of 33.2% (95% CI 31.7, 34.8), 34.4% (95% CI 32.8, 36.1) of non-smokers, 25.7% (95% CI 20.2, 32.2) of those who quit and 15.7% (95% CI 10.8, 22.2) of those who continued smoking reported exclusive breastfeeding for 6 months or more. Continuing smoking had lower odds of exclusive breastfeeding (aOR .47; 95% CI 0.30,0.75) but quitting smoking had no difference (aOR .78;95% CI 0.56,1.08) when compared to non-smokers. Conclusion: Continuing smoking during pregnancy was associated with lower rates of exclusive breastfeeding of infants for 6 months or more. Smoking cessation interventions during prenatal visits may improve exclusive breastfeeding rates.