Maternal Leave Practices and Health Outcomes After Prolonged Postnatal Infant Hospitalization

To assess the association between paid leave and breastfeeding and mental health among mothers of infants with prolonged postnatal hospitalization.

Data were obtained from 13 states participating in the Centers for Disease Control and Prevention's Pregnancy Risk Assessment and Monitoring System from 2016 to 2021. Prolonged postnatal hospitalization was defined as hospitalization >14 days. Maternal leave-taking was categorized as paid, unpaid, or no leave. The primary outcomes included breastfeeding initiation and continuation at 4 weeks, and postpartum depressive symptoms. We fit adjusted logistic regression models to estimate adjusted odds ratios (aORs, 95% CI) and marginal probabilities of the outcomes.

Among 2622 mothers whose infants had a prolonged hospitalization, 53% reported paid leave, 39% unpaid, and 7.3% no leave. Mothers with paid leave were more likely to have at least some college education, private insurance, and identify as White. No leave was associated with significantly decreased odds of ever breastfeeding (aOR 0.34 [95% CI 0.15, 0.76]) and breastfeeding at 4 weeks postpartum (aOR 0.38 [95% CI 0.19, 0.76]) compared with paid leave; comparisons with unpaid leave were similar. Associations with postpartum depressive symptoms were not statistically significant (no leave compared with paid leave aOR 1.31 [95% CI 0.65, 2.65]).

Significant disparities exist in utilization of paid leave among mothers of infants with prolonged postnatal hospitalizations. Given the association between leave-taking and breastmilk provision, policies to support maternal leave-taking may promote breastfeeding in this population.