Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts.
breastfeeding duration
lactation outcomes
maternal metabolism
maternal obesity
Journal
The American journal of clinical nutrition
ISSN: 1938-3207
Titre abrégé: Am J Clin Nutr
Pays: United States
ID NLM: 0376027
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
08
03
2022
revised:
07
03
2023
accepted:
03
04
2023
pmc-release:
18
05
2024
medline:
7
7
2023
pubmed:
6
7
2023
entrez:
5
7
2023
Statut:
ppublish
Résumé
Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned. We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts. We analyzed 5120 singleton pregnancies from mother-child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator. Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = -0.79 mo, 95% CI: -1.17, -0.40; obese β = -1.75 mo 95% CI: -2.25, -1.25; exclusive: overweight β = -0.30 mo, 95% CI: -0.42, -0.16; obese β = -0.73 mo, 95% CI: -0.90, -0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding. Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.
Sections du résumé
BACKGROUND
Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned.
OBJECTIVES
We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts.
METHODS
We analyzed 5120 singleton pregnancies from mother-child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator.
RESULTS
Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = -0.79 mo, 95% CI: -1.17, -0.40; obese β = -1.75 mo 95% CI: -2.25, -1.25; exclusive: overweight β = -0.30 mo, 95% CI: -0.42, -0.16; obese β = -0.73 mo, 95% CI: -0.90, -0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding.
CONCLUSIONS
Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.
Identifiants
pubmed: 37407164
pii: S0002-9165(23)46333-2
doi: 10.1016/j.ajcnut.2023.04.004
pmc: PMC10493413
pii:
doi:
Substances chimiques
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
255-263Subventions
Organisme : NIEHS NIH HHS
ID : P30 ES007048
Pays : United States
Organisme : NICHD NIH HHS
ID : R01 HD034568
Pays : United States
Organisme : NIEHS NIH HHS
ID : R01 ES029944
Pays : United States
Organisme : NIEHS NIH HHS
ID : R01 ES030364
Pays : United States
Organisme : NIEHS NIH HHS
ID : P30 ES023515
Pays : United States
Organisme : NIEHS NIH HHS
ID : R21 ES029681
Pays : United States
Organisme : NIH HHS
ID : UH3 OD023286
Pays : United States
Organisme : NIEHS NIH HHS
ID : R01 ES030691
Pays : United States
Organisme : NICHD NIH HHS
ID : T32 HD098061
Pays : United States
Organisme : NIEHS NIH HHS
ID : R21 ES028903
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.
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