Elsevier

The Journal of Pediatrics

Volume 208, May 2019, Pages 169-175.e2
The Journal of Pediatrics

Original Article
Breastfeeding Persistence at 6 Months: Trends and Disparities from 2008 to 2015

https://doi.org/10.1016/j.jpeds.2018.12.055Get rights and content

Objective

To assess trends and disparities in breastfeeding by maternal characteristics (race and ethnicity, age at delivery, obesity, parity, and level of education) and the relative importance among these for breastfeeding at 6 months.

Study design

This retrospective birth cohort study included 195 861 live singleton children born at 32-42 weeks of gestation from 2008 to 2015 within a single integrated healthcare system. All children had healthcare coverage during the first year of life. Maternal characteristics and breastfeeding status at 6 months of age were extracted from electronic medical records. Trends over time of any breastfeeding ≥6 months were evaluated for the 5 maternal characteristics. Robust Poisson regression models were used to estimate breastfeeding rate differences associated with each of the 5 characteristics. The relative importance among them associated with breastfeeding ≥6 months was assessed by comparing model quasi-likelihood information criteria.

Results

Rates of breastfeeding ≥6 months significantly increased overall and among groups defined by the maternal characteristics. However, there was little improvement over time in closing disparities associated with maternal race and ethnicity, age at delivery, prepregnancy obesity status, and level of education. Education level contributed to the greatest disparity in breastfeeding ≥6 months. Maternal age was the second factor, followed by prepregnancy obesity and maternal race and ethnicity.

Conclusions

Breastfeeding outreach programs focusing on women with less than a college education, women <25 years old, and women from non-Hispanic black or Hispanic race and ethnicity may help to reduce disparities and improve breastfeeding persistence rates within integrated healthcare systems.

Section snippets

Methods

This retrospective cohort study included singleton children who were born at 32-42 weeks of gestation at Kaiser Permanente Southern California (KPSC) hospitals between January 1, 2008 and December 31, 2015. KPSC is a large healthcare organization that provides comprehensive care and uses an electronic medical record system (EMR). The membership includes commercial, Medicare, Medi-Cal, Children's Health Insurance Program, and charitable coverage insurance. Demographic distribution of KPSC

Results

The cohort included in this report is comprised of 50% Hispanic, 26% non-Hispanic white, 8% non-Hispanic black, and 14% Asian and Pacific Islanders (Table I). Over 90% of the children were born to women age 20-39 years; 28% and 26% of the mothers were overweight or obese, respectively, at the onset of pregnancy. About one-third of the children were the first child and one-third were the second child in a family. About 40% of women had college or higher education, and 31% had some college

Discussion

Data from this large and multi-ethnic clinical cohort within an integrated healthcare system demonstrated a significant increase in rates of breastfeeding ≥6 months from 2008 to 2015 overall, and among each group (maternal race and ethnicity, age at delivery, prepregnancy obesity, parity, and level of education). Overall, the rate of breastfeeding ≥6 months increased from 46% in 2008 to 72% in 2015, a ∼56% increase over an 8-year period. However, disparities continued to exist over time for

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    Supported by Kaiser Permanente Southern California Direct Community Benefit funds. The funding agencies had no role in the design or conduct of the study; in the analysis or interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors declare no conflicts of interest.

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