Comparison of Breastfeeding Practices Between Mothers With Term and Preterm Births

Background: Preterm birth (< 37 weeks) is one of the primary causes of infant mortality and occurs in over 10% of annual births in Oklahoma. Infants born preterm are particularly susceptible to necrotizing enterocolitis, sepsis, retinopathy of prematurity, and bronchopulmonary dysplasia, all of which have reduced incidence when these babies are breastfed or fed human milk.

Aims: To examine and compare the prevalence of breastfeeding initiation and duration among mothers who gave birth term or preterm, and investigate disparities in breastfeeding duration by the mother's age, race and Hispanic origin.

Narrative: Oklahoma Pregnancy Risk Assessment Monitoring System data were analyzed from 2016 to 2019 (N = 6,182; weighted response rate = 56.1%). Bivariate and multivariate associations between breastfeeding duration and term and preterm birth as well as selected maternal demographics were assessed using prevalence rates and adjusted risk ratios with 95% confidence intervals. Gestational age at delivery was obtained from the birth certificate. Live births with gestational ages less than 37 weeks were considered preterm. All analyses were conducted using SAS callable SUDAAN.

The prevalence of breastfeeding initiation was similar for mothers who gave birth term or preterm. Adjusting for maternal age, race and Hispanic origin, education, and income, mothers with preterm births were less likely to breastfeed to 8 weeks or more (ARR = 0.69; 95% CI [0.5, 0.9] and were also less likely to breastfeed exclusively to 8 weeks or more (ARR = 0.65; 95% CI [0.5, 0.9]. When stratified by level of prematurity (very preterm: 20–31 weeks; moderate preterm: 32–34 weeks; late preterm: 35–36 weeks), very preterm infants were more likely to initiate breastfeeding than moderate or late preterm (95.6% vs. 92.9% and 82.0%) and were less likely to continue breastfeeding to 8 weeks or more (43.0% vs. 49.8% and 52.0%). See Figure 1. Teen preterm mothers had the most significant drop in breastfeeding from initiation to 8 weeks (95.1%–48.9%) versus 20–29 years (85.1%–52.1%) and 30 years and over (86.5%–47.6%). Non-Hispanic American Indian and Black preterm mothers were less likely to initiate or continue breastfeeding to 8 weeks (75.5% and 83.0% initiation and 42.9% and 47.2% to 8 weeks, respectively) compared to Hispanic, non-Hispanic other and non-Hispanic white (89.1%, 86.9%, 87.7% initiation and 60.8%, 47.4%, 49.2% respectively).

Conclusion: Mothers of preterm infants initiate breastfeeding, but are less likely to continue with either any breastfeeding or exclusive breastfeeding to 8 weeks or more. Mothers of very preterm infants were more likely to initiate and less likely to continue to 8 weeks or more when compared to moderate or late preterm infants. Non-Hispanic American Indian and non-Hispanic Black mothers and older mothers in general have lower rates of breastfeeding. Factors that influence breastfeeding duration in the hospital and after discharge for preterm mothers need to be identified and addressed to improve breastfeeding rates and, ultimately, long-term health outcomes, including infant mortality, for these vulnerable babies.

Figure 1.

Breastfeeding Stratified by Level of Prematurity.