Breastfeeding at Hospital Discharge among High Risk Obstetrical Patients

Background: In the United States, at the time of discharge from the hospital, approximately 79% of the general maternal population started breastfeeding their infants. Less is known about breastfeeding among women with diverse high risk obstetrical (HROB) conditions, a group at high risk for low breastfeeding rates. Objective: To determine infant feeding preference and breastfeeding at the time of hospital discharge among HROB women who attended prenatal subspecialty clinics and delivered during 2012-2014. Design/Methods: A total of 308 HROB women included 112 with diabetes (DM), 80 who were treated for substance abuse (SA), 75 with miscellaneous (MISC) high risk conditions (i.e., chronic hypertension, extreme non-diabetic obesity, etc.) and 41 with a history of preterm labor or preterm delivery (PTL). Infant feeding preference was ascertained prenatally. At the time of discharge, breastfeeding was considered started if feedings were exclusive (100%), partial (50%-74%) or predominantly (≥ 75%) of maternal milk. Results: Preference to breastfeed by HROB group was 79% DM, 71% SA, 71% MISC, and 78% PTL. Breastfeeding was observed in 42% DM, 50% SA, 44% MISC, and 44% PTL. There were 228 multiparous, of them 116 (51%) had prior breastfeeding experience, however, only 67 (57%) started breastfeeding. Conclusions: In spite of the heterogeneity of their morbidities women with HROB conditions intended to breastfeed at a rate similar to that of the general population. However, breastfeeding rates among women with diverse HROB conditions including those with prior experience are low and may require specific educational strategies in order to improve outcomes. literature [3-5]. In addition to traditionally recognized barriers to breastfeeding, maternal morbidities such as diabetes, substance abuse, pre-term labor and other high risk obstetrical (HROB) conditions may also interfere with or delay breastfeeding [1-5]. Recently, we reported breastfeeding rates by the time of hospital discharge of 76% in women with severe preeclampsia [6], 54% in women with gestational diabetes mellitus (GDM) [7], 55% in women with pre-gestational diabetes mellitus (PGDM) [8] and 56% in extremely obese non-diabetic women [9]. Breastfeeding rates at the time of discharge ranging from 24% to 50% have been reported among women whose infants developed neonatal abstinence syndrome (NAS) [10,11]. In spite of supportive hospital practices, exclusive breastfeeding at one week postpartum was lower among women with medically complex pregnancies who intended to breastfeed [12]. Intention to breastfeed is a strong predictor of breastfeeding initiation even among women with HROB conditions [6-9]. However, there is a significant discordance between intention to breastfeed and breastfeeding during the postpartum period [6-9,13]. Hundalani, et al. [13] characterized the discordance between intention and actual breastfeeding as a missed opportunity for targeted intervention. In spite of the above, scarce and conflictive information is available on breastfeeding by the time of hospital discharge among women with HROB conditions.