Patterns of breastfeeding at 3 months postpartum in the Alberta Pregnancy Outcomes and Nutrition (APrON) study
Authors: Jarman Megan , Robson Paula J , Shen Ye , Madsen Mette , Bell Rhonda C ,   APrON Study Team, Team ENRICH 
Published: November 2023

Infant feeding patterns are often characterized in simple ways, such as exclusive breast or formula feeding and mixed feeding (i.e. a combination of these 2 methods). However there is a paucity of information about how accurately these simple groupings reflect how women feed their infants. The purpose of this study was to examine patterns of breastfeeding from 3‐day prospective feeding diaries to describe how women feed their babies and to compare documented feeding patterns to intentions to breastfeed. The APrON study is a prospective study of women during pregnancy and their children. Women completed the Intentions to Breastfeed questionnaire in their 3rd trimester from which a total score was calculated, with a higher score indicating stronger intentions. At 3 months postpartum women also completed a prospective breastfeeding diary which collected information on number of feeds, and duration and method of every feed over 3 days. A total of 1028 women completed both assessments. Women reported feeding their babies using combinations of up to 4 different methods (at breast, expressed breastmilk in a bottle, formula, mixed breastmilk and formula in the same bottle) in any one day. For the ongoing analyses women were categorized into 5 groups based on the number and type of feeds reported/day: 1) at breast only (n=584), 2) at breast and expressed breastmilk (n=214), 3) formula only (n=14), 4) mixed feeding using 2 methods (n=113) and, 5) mixed feeding using 3 or 4 methods (n=103). Higher intention to breastfeed scores were observed in women who reported feeding at breast only in the diaries, compared to all other feeding groups (all P=<0.01). There were no differences in the average number of daily feeds between the 5 method groups. However, the average daily duration of at breast feeds was longer in women who fed at breast only compared to those in any other method group. Women who fed ‘at breast and expressed milk’, ‘mixed feeding of 2 methods’ and ‘mixed feeding of 3 or 4 methods’ fed, on average, for 18 minutes, 17 minutes and 27 minutes less at breast per day, respectively, compared to women who fed at breast only (all P=<0.01). Women use many different combinations of methods within a day to feed their 3 month old babies. Using fewer groups to classify women ignores the ‘real life’ complexity of feeding patterns. Our data showed that those who used a combination of methods to feed their babies spent less time feeding at breast which could have consequences on their energy expenditure and therefore postpartum weight loss. The impact of these complex feeding patterns on maternal and child outcomes is an important area for further research.Support or Funding InformationMegan Jarman is supported by a postdoctoral fellowship from Alberta Innovates Health Solutions. Analyses reported in this abstract were also funded by Alberta Innovates‐Health Solutions through a Collaborative Research Innovation Opportunities Program Grant awarded to the ENRICH study team