While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity.
Materials and Methods:
A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences.
Results:
For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers.
Conclusions:
Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.
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References
1.
National Center for Health Statistics, Final Natality Data. Very low birthweight by race/ethnicity: United States, 2011–2013. Available at www.marchofdimes.org/Peristats (accessed July22, 2015).
2.
VohrBR, PoindexterBB, DusickAM, et al.Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics, 2006; 118:e115–e123.
3.
LeeHC, GouldJB. Factors influencing breast milk versus formula feeding at discharge for very low birth weight infants in California. J Pediatr, 2009; 155:657–662.e1–e2.
4.
SchanlerRJ, ShulmanRJ, LauC. Feeding strategies for premature infants: Beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics, 1999; 103:1150–1157.
5.
SiskPM, LoveladyCA, DillardRG, et al.Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol, 2007; 27:428–433.
6.
PatelAL, JohnsonTJ, EngstromJL, et al.Impact of early human milk on sepsis and health care costs in very low birth weight infants. J Perinatol, 2013; 33:514–519.
7.
JohnsonTJ, PatelAL, BiggerHR, et al.Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology, 2015; 107:271–276.
8.
StuebeAM. The risks of not breastfeeding for mothers and infants. Rev Obstet Gynecol, 2009; 2:222–231.
9.
VictoraCG, BahlR, BarrosAJ, et al.Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet, 2016; 387:475–490.
10.
SiskPM, LoveladyCA, DillardRG, et al.Lactation counseling for mothers of very low birth weight infants: Effect on maternal anxiety and infant intake of human milk. Pediatrics, 2006; 117:e67–e75.
11.
BiggerHR, FoggLJ, PatelA, et al.Quality indicators for human milk use in very low birth weight infants: Are we measuring what we should be measuring?. J Perinatol, 2014; 34:287–291.
12.
HobanR, BiggerH, PatelAL, et al.Goals for human milk feeding in mothers of very low birth weight infants: How do goals change and are they achieved during the NICU hospitalization?. Breastfeed Med, 2015; 10:305–311.
13.
RileyBS, SchoenyM, RogersL, et al.Barriers to human milk feeding at discharge of VLBW infants: Evaluation of neighborhood structural factors. Breastfeed Med, 2016; 11:335–342.
14.
PurdyIB, SinghN, LeC, et al.Biophysiologic and social stress relationships with breast milk feeding pre- and post-discharge from the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs, 2012; 41:347–357.
15.
BriereCE, McGrathJ, CongX, et al.An integrative review of factors that influence breastfeeding duration for premature infants after NICU hospitalization. J Obstet Gynecol Neonatal Nurs, 2014; 43:272–281.
16.
Nommsen-RiversLA, ChantryCJ, CohenRJ, et al.Comfort with the idea of formula feeding helps explain ethnic disparity in breastfeeding intentions among expectant first-time mothers. Breastfeed Med, 2010; 5:25–33.
17.
SiskPM, QuandtS, ParsonN, et al.Breast milk expression and maintenance in mothers of very low birth weight infants: Supports and barriers. J Hum Lact, 2010; 26:368–375.
18.
FabiyiC, RankinK, NorrK, et al.The association of low social support with breast milk expression in low-income mother-preterm infant dyads. J Hum Lact, 2015; 31:490–497.
19.
ColaizyTT, SaftlasAF, MorrissFHJr.Maternal intention to breast-feed and breast-feeding outcomes in term and preterm infants: Pregnancy risk assessment monitoring system (PRAMS), 2000–2003. Public Health Nutr, 2012; 15:702–710.
20.
LiR, FridingerF, Grummer-StrawnL. Public perceptions on breastfeeding constraints. J Hum Lact, 2002; 18:227–235.
21.
PatelAL, JohnsonTJ, RobinB, et al.The direct and indirect influence of own mother's milk on bronchopulmonary dysplasia and costs. Arch Dis Child Fetal Neonatal Ed, 2016. [Epub ahead of print]; DOI: 10.1136/archdischild-2016-310898.
22.
MeierPP, EngstromJL, RossmanB. Breastfeeding peer counselors as direct lactation care providers in the neonatal intensive care unit. J Hum Lact, 2013; 29:313–322.
JonesKM, PowerML, QueenanJT, et al.Racial and ethnic disparities in breastfeeding. Breastfeed Med, 2015; 10:186–196.
25.
SiskPM, LoveladyCA, DillardRG, et al.Maternal and infant characteristics associated with human milk feeding in very low birth weight infants. J Hum Lact, 2009; 25:412–419.
26.
DunnRL, KalichKA, FedrizziR, et al.Barriers and contributors to breastfeeding in WIC mothers: A social ecological perspective. Breastfeed Med, 2015; 10:493–501.
27.
ArnoldA, LewisJ, MaximovichA, et al.Antecedents and consequences of caregiving structure on young mothers and their infants. Matern Child Health J, 2011; 15:1037–1045.
28.
Gaskin-ButlerVT, EngertT, MarkievitzM, et al.Prenatal representations of coparenting among unmarried first-time African American mothers. Fam Process, 2012; 51:360–375.
29.
BlackMM, NitzK. Grandmother co-residence, parenting, and child development among low income, urban teen mothers. J Adolesc Health, 1996; 18:218–226.
30.
ReevesEA, Woods-GiscombeCL. Infant-feeding practices among African American women: Social-ecological analysis and implications for practice. J Transcult Nurs, 2015; 26:219–226.
31.
FurmanLM, BanksEC, NorthAB. Breastfeeding among high-risk inner-city African-American mothers: A risky choice?. Breastfeed Med, 2013; 8:58–67.
32.
SpencerB, WambachK, DomainEW. African American women's breastfeeding experiences: Cultural, personal, and political voices. Qual Health Res, 2015; 25:974–987.
33.
JohnsonA, KirkR, RosenblumKL, et al.Enhancing breastfeeding rates among African American women: A systematic review of current psychosocial interventions. Breastfeed Med, 2015; 10:45–62.
34.
SubletteC, SubletteN. The American Slave Coast: A History of the Slave-Breeding Industry. Chicago, IL: Chicago Review Press, 2015.
35.
AsioduI, FlaskerudJ. Got milk? A look at breastfeeding from an African American perspective. Issues Ment Health Nurs, 2011; 32:544–546.
36.
GrossTT, PowellR, AndersonAK, et al.WIC peer counselors' perceptions of breastfeeding in African American women with lower incomes. J Hum Lact, 2015; 31:99–110.
37.
SellersK, BlackMM, BorisNW, et al.Adolescent mothers' relationships with their own mothers: Impact on parenting outcomes. J Fam Psychol, 2011; 25:117–126.
38.
OdomEC, LiR, ScanlonKS, et al.Reasons for earlier than desired cessation of breastfeeding. Pediatrics, 2013; 131:e726–e732.
39.
LeeHJ, IloIT, McCollumKF, et al.Racial/ethnic differences in breastfeeding initiation and duration among low-income, inner-city mothers. Soc Sci Q, 2009; 90:1251–1271.
40.
MeierPP, PatelAL, BiggerHR, et al.Supporting breastfeeding in the neonatal intensive care unit: Rush mother's milk club as a case study of evidence-based care. Pediatr Clin North Am, 2013; 60:209–226.
