Elsevier

The Journal of Pediatrics

Volume 203, December 2018, Pages 190-196.e21
The Journal of Pediatrics

Original Articles
Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis

https://doi.org/10.1016/j.jpeds.2018.08.008Get rights and content
Under a Creative Commons license
open access

Objective

To use a quantitative approach to evaluate the literature for quantity, quality, and consistency of studies of maternal and infant characteristics in association with breastfeeding initiation and continuation, and to conduct a meta-analysis to produce summary relative risks (RRs) for selected factors.

Study design

A systematic review using PubMed and CINAHL through March 2016 was conducted to identify relevant observational studies in developed nations, reporting a measure of risk for 1 or more of 6 quantitatively derived, high impact factors in relation to either breastfeeding initiation or continuation. One author abstracted data using a predesigned database, which was reviewed by a second independent author; data evaluation and interpretation included all co-authors. These factors were summarized using standard meta-analysis techniques.

Results

Six high impact factors were identified (smoking [39 papers], mode of delivery [47 papers], parity [31 papers], dyad separation [17 papers], maternal education [62 papers], and maternal breastfeeding education [32 papers]). Summary RR from random-effects models for breastfeeding initiation were highest for high vs low maternal education (RR 2.28 [95% CI 1.92-2.70]), dyad connection vs not (RR 2.01 [95% CI 1.38-2.92]), and maternal nonsmoking vs smoking (RR = 1.76 [95% CI 1.59-1.95]); results were similar for breastfeeding continuation.

Conclusions

Despite methodological heterogeneity across studies, relatively consistent results were observed for these perinatally identifiable factors associated with breastfeeding initiation and continuation, which may be informative in developing targeted interventions to provide education and support for successful breastfeeding in more families.

Keywords

breastfeeding
meta-analysis

Abbreviations

P-h
P value for heterogeneity
RR
Relative risk
SES
Socioeconomic status
WIC
Women, infants, and children

Cited by (0)

Funded by Nestlé Nutrition in the form of a research contract to EpidStat Institute (to S.C., D.A., C.B., E.L.). Nestlé Nutrition scientists were collaborators on the study and had input in the study design; the collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the manuscript for publication (P.E., N.H., M.T., J.S.). S.C., E.L., and D.A. received research funding from Nestlé Nutrition. P.E., N.H., M.T., and J.S. are employees of Nestlé Nutrition. M.C. served as a consultant for Nestlé Nutrition and is an Editorial Board member for The Journal of Pediatrics. B.Y. and N.K. declare no conflicts of interest.