Breastfeeding in term and preterm infants with and without growth restriction: A 50-year analysis of incidence and
Achim Fieß1, Alica Hartmann1, Eva Mildenberger2
1Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Insights
Breastfeeding rates have risen over 50 years, but preterm birth and fetal growth restriction remain barriers. Infants born small for gestational age (SGA) face reduced breastfeeding incidence and delayed initiation, highlighting a need for targeted support.
Area of Science:
- Perinatal Medicine
- Maternal-Infant Health
- Public Health Nutrition
Background:
- Breastfeeding is crucial for infant health and development.
- Preterm birth and fetal growth restriction are known to impact infant feeding practices.
- Understanding long-term trends in breastfeeding is essential for public health initiatives.
Purpose of the Study:
- To analyze trends in breastfeeding rates and duration over five decades.
- To investigate the association between breastfeeding and preterm birth, fetal growth restriction, and demographics.
- To identify risk factors for reduced breastfeeding incidence and delayed initiation.
Main Methods:
- Retrospective cohort study of 1559 individuals and their parents.
- Categorization by gestational age (extremely preterm to term) and birth weight percentile (SGA, AGA, LGA).
- Data collected via interviews, questionnaires, and medical records; 940 mothers' data analyzed.
Main Results:
- Breastfeeding rates and duration significantly increased over 50 years.
- Low gestational age (≤32 weeks) and being born small for gestational age (SGA) were associated with reduced breastfeeding.
- Delayed breastfeeding initiation was more common in preterm and SGA infants; higher maternal education correlated positively with breastfeeding.
Conclusions:
- Despite overall increases, preterm birth and fetal growth restriction are linked to lower breastfeeding rates and delayed initiation.
- Being born SGA is an independent risk factor for reduced breastfeeding, independent of gestational age.
- Increased awareness and tailored support are needed for mothers of SGA infants to improve breastfeeding outcomes.
Objective:
The aim of the present study was to analyze breastfeeding rates and duration in relation to preterm birth, fetal growth restriction, and demographics over five decades.
Methods:
This retrospective cohort study included 1559 individuals (aged 4-52 years) and their parents from the University Medical Center Mainz, Germany. Participants were categorized by gestational age (extremely preterm ≤28 weeks, very preterm 29-32 weeks, moderately preterm 33-36 weeks, term ≥37 weeks), and birth weight percentile (small for gestational age [SGA] <10th, appropriate for gestational age [AGA] 10th-90th, large for gestational age [LGA] >90th). Data were collected via interviews, questionnaires, and medical records.
Results:
Data from 940 mothers were analyzed. Breastfeeding rates and duration significantly increased over 50 years. However, low gestational age, particularly ≤28 weeks and 29-32 weeks and being born SGA were significantly associated with reduced breastfeeding incidence. Delayed breastfeeding initiation was more frequent in preterm and SGA-born infants. Additionally, there was a significant positive association between year of birth and breastfeeding rates and duration. Higher maternal educational level correlated positively with breastfeeding initiation and duration.
Conclusion:
Breastfeeding rates and duration significantly increased over the past 50 years. However, both preterm birth and fetal growth restriction were associated with lower breastfeeding incidence and delayed initiation. Notably, being born SGA was independently linked to reduced breastfeeding, even after accounting for gestational age. While the association between prematurity and breastfeeding challenges is well established, our findings suggest that being born SGA may represent a similarly important but less widely recognized risk factor. This underlines the need for increased awareness and tailored breastfeeding support for this specific group.
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