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      Early Cessation of Breastfeeding and Determinants: Time to Event Analysis

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          Abstract

          Background

          The onset of breastfeeding has a high success rate in most countries, but the time for termination of breastfeeding varies between countries.

          Objective

          This survey was aimed to determine the effective factors on the early termination of breastfeeding.

          Methods

          This study was conducted in 2018, in Iran. About 410 mothers were enrolled in the study. All considered factors were evaluated as factors influencing the continuity of breastfeeding. Survival analysis was used to analyze data.

          Results

          The mean age of the mothers was equal to 29.48 ± 5.8 years. The frequency of termination of breastfeeding before the first 2 years was equal to 34%. The mean of breastfeeding duration was equal to 21.49 ± 5.3 months. The percentage of infants who had been breastfed for 24 months was equal to 65.8%. An infant's birth weight (2500–4000 gr) (hazard ratio: 0.54), neonatal birth order (hazard ratio: 0.69), neonatal pathologic jaundice (hazard ratio: 1.52), starting time of using complementary food (hazard ratio: 2.45), using pacifier (hazard ratio: 2.82), and the status of using artificial milk (hazard ratio: 3.29) were significantly associated with cessation of breastfeeding before 24 months of age. The probability of termination of breastfeeding at 6, 12, 18, and 24 months of age was reported by 6%, 8%, 15%, and 34%, respectively.

          Conclusions

          There were notifiable variations in breastfeeding rates both in national and international levels. Nevertheless, in this study, the mean of breastfeeding duration was longer compared to a number of countries and previous national studies.

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          Reasons for earlier than desired cessation of breastfeeding.

          Erika Odom, Ruowei Li, Kelley Scanlon … (2013)
          To describe the prevalence and factors associated with not meeting desired breastfeeding duration. Data were analyzed from 1177 mothers aged ≥18 years who responded to monthly surveys from pregnancy until their child was 1 year old. When breastfeeding stopped, mothers were asked whether they breastfed as long as they wanted (yes or no) and to rate the importance of 32 reasons for stopping on a 4-point Likert scale. Multiple logistic regressions were used to examine the association between the importance of each reason and the likelihood of mothers not meeting their desired breastfeeding duration. Approximately 60% of mothers who stopped breastfeeding did so earlier than desired. Early termination was positively associated with mothers' concerns regarding: (1) difficulties with lactation; (2) infant nutrition and weight; (3) illness or need to take medicine; and (4) the effort associated with pumping milk. Our findings indicate that the major reasons why mothers stop breastfeeding before they desire include concerns about maternal or child health (infant nutrition, maternal illness or the need for medicine, and infant illness) and processes associated with breastfeeding (lactation and milk-pumping problems). Continued professional support may be necessary to address these challenges and help mothers meet their desired breastfeeding duration.
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            Predictors of breastfeeding duration: evidence from a cohort study.

            Jane A. Scott, Colin Binns, Wendy H. Oddy … (2006)
            To report the duration of breastfeeding among a population of Australian women and to identify factors that are associated with the duration of full breastfeeding to 6 months and any breastfeeding to 12 months. Participants were 587 women who were recruited from 2 maternity hospitals in Perth and completed a baseline questionnaire just before or shortly after discharge from the hospital. Women were followed up by telephone interview at 4, 10, 16, 22, 32, 40, and 52 weeks postpartum. Data collected included sociodemographic, biomedical, hospital-related, and psychosocial factors associated with the initiation and the duration of breastfeeding. Cox's proportional hazards model was used to identify factors that were associated with the risk for discontinuing full breastfeeding before 6 months and any breastfeeding before 12 months. At 6 months of age, fewer than one half of infants were receiving any breast milk (45.9%), and only 12% were being fully breastfed. By 12 months, only 19.2% of infants were still receiving any breast milk. Breastfeeding duration was independently, positively associated with maternal infant feeding attitudes and negatively associated with breastfeeding difficulties in the first 4 weeks, maternal smoking, introduction of a pacifier, and early return to work. Relatively few women achieved the international recommendations for duration of full and overall breastfeeding. Women should receive anticipatory guidance while still in the hospital on how to prevent or manage common breastfeeding difficulties and should be discouraged from introducing a pacifier before 10 weeks, if at all. Improved maternity leave provisions and more flexible working conditions may help women to remain at home with their infants longer and/or to combine successfully breastfeeding with employment outside the home.
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              Breastfeeding and maternal and infant health outcomes in developed countries.

              Stanley Ip, Mei Chung, Gowri Raman … (2007)
              We reviewed the evidence on the effects of breastfeeding on short- and long-term infant and maternal health outcomes in developed countries. We searched MEDLINE(R), CINAHL, and the Cochrane Library in November of 2005. Supplemental searches on selected outcomes were searched through May of 2006. We also identified additional studies in bibliographies of selected reviews and by suggestions from technical experts. We included systematic reviews/meta-analyses, randomized and non-randomized comparative trials, prospective cohort, and case-control studies on the effects of breastfeeding and relevant outcomes published in the English language. Included studies must have a comparative arm of formula feeding or different durations of breastfeeding. Only studies conducted in developed countries were included in the updates of previous systematic reviews. The studies were graded for methodological quality. We screened over 9,000 abstracts. Forty-three primary studies on infant health outcomes, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies were included in this review. We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. There was no relationship between breastfeeding in term infants and cognitive performance. The relationship between breastfeeding and cardiovascular diseases was unclear. Similarly, it was also unclear concerning the relationship between breastfeeding and infant mortality in developed countries. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression. There was no relationship between a history of lactation and the risk of osteoporosis. The effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear. A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings. Also, there is a wide range of quality of the body of evidence across different health outcomes. For future studies, clear subject selection criteria and definition of "exclusive breastfeeding," reliable collection of feeding data, controlling for important confounders including child-specific factors, and blinded assessment of the outcome measures will help. Sibling analysis provides a method to control for hereditary and household factors that are important in certain outcomes. In addition, cluster randomized controlled studies on the effectiveness of various breastfeeding promotion interventions will provide further opportunity to investigate any disparity in health outcomes as a result of the intervention.
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                Author and article information

                Contributors
                Marzieh Nojomi:
                ORCID: https://orcid.org/0000-0003-4330-3522
                Journal
                Journal ID (nlm-ta): J Nutr Metab
                Journal ID (iso-abbrev): J Nutr Metab
                Journal ID (publisher-id): JNME
                Title: Journal of Nutrition and Metabolism
                Publisher: Hindawi
                ISSN (Print): 2090-0724
                ISSN (Electronic): 2090-0732
                Publication date Collection: 2020
                Publication date (Electronic): 17 April 2020
                Volume: 2020
                Electronic Location Identifier: 3819750
                Affiliations
                1Preventive Medicine and Public Health Research Center, Student Research Committee, Iran University of Medical Sciences, 1449614542 Tehran, Iran
                2Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, 1449614542 Tehran, Iran
                3Department of Nursing, Faculty of Nursing, Khoy University of Medical Sciences, 1449614542 Khoy, Iran
                Author notes

                Academic Editor: C. S. Johnston

                Author information
                https://orcid.org/0000-0001-7969-9122
                https://orcid.org/0000-0003-4330-3522
                Article
                DOI: 10.1155/2020/3819750
                PMC ID: 7210562
                PubMed ID: 32399288
                SO-VID: 951b3ec1-f3bd-4a2e-b13f-619c934d4c3e
                Copyright © Copyright © 2020 Ebrahim Babaee et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 August 2019
                Date accepted : 31 March 2020
                Funding
                Funded by: Research Council and Student Research Committee
                Funded by: Iran University of Medical Sciences
                Award ID: 14062
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Nutrition & Dietetics
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics

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