Risk prediction model for non-exclusive breastfeeding within 6 weeks postpartum in primiparous women

To examine the occurrence of non-exclusive breastfeeding within 6 weeks postpartum in primiparous women and to establish a risk prediction model for early identification of women at high risk.

In this single-center prospective cohort study, primiparous women who delivered at a tertiary general hospital in Shanghai, China, between July 2024 and July 2025 were consecutively recruited by convenience sampling. Baseline information was collected during postpartum hospitalization, and infant feeding patterns were followed weekly for 6 weeks after discharge. Candidate predictors were derived from self-designed questionnaires and standardized scales. Univariable analyses and multivariable logistic regression were performed to identify factors associated with non-exclusive breastfeeding within 6 weeks postpartum. Model performance was assessed by the likelihood ratio test, Hosmer-Lemeshow goodness-of-fit test, and receiver operating characteristic analysis.

Among the 650 primiparous women included in the study, 322 developed non-exclusive breastfeeding within 6 weeks postpartum, corresponding to an incidence of 49.53%. Immediate postpartum latching, amniotic fluid abnormality, Social and Professional Support, Positive Breastfeeding Sentiment, total breastfeeding behavior score, total infant feeding intention score, and total breastfeeding knowledge score were independently associated with non-exclusive breastfeeding within 6 weeks postpartum (all p < 0.05). The model demonstrated good fit (likelihood ratio χ² = 258.368, p < 0.001; Hosmer-Lemeshow χ² = 10.601, p = 0.330) and good discrimination (AUC = 0.841, 95% confidence interval: 0.811-0.871).

Non-exclusive breastfeeding within 6 weeks postpartum was common in primiparous women. The proposed prediction model showed good performance and may provide a useful tool for early risk stratification and targeted breastfeeding support in clinical practice.