(497) Barriers to Immediate Postpartum Breastfeeding Initiation

We performed a prospective cohort study among 5,393 pregnant individuals between January 1, 2019 and December 31, 2021 in a county hospital system. We collected a variety of obstetrical and neonatal variables, including EPDS scores collected during the immediate postpartum period (≤ 3 days of postpartum hospital stay after parturition). Chart review and ICD-10 codes were also used for data collection. Chi square and Fisher’s exact tests were used for categorical variables. Multivariable Poisson regression models with robust error variance were used to examine variables associated with breastfeeding initiation (yes vs no). Adjusted relative risk and 95% confidence intervals were reported.

Results:

Demographic, obstetric and neonatal characteristics of the population are demonstrated in Table 1. After multivariable adjustment, race and ethnicity (white: aRR 0.73, 95% CI [0.54-0.98] and black: 0.80, 95% CI [0.69-0.93]), BMI ≥ 30 (aRR 0.92, 95% CI [0.85-0.99]), gestational age at admission < 37 weeks (aRR 0.55, 95% CI [0.44-0.68]), and NICU admission (aRR=0.75, 95% CI [0.70-0.80]) were significantly associated with reduced likelihood to initiate breastfeeding during the immediate postpartum period (Table 2).  Interestingly, postpartum EPDS scores were not significantly associated with breastfeeding initiation during the immediate postpartum period (aRR 0.88, 95% CI [0.75-1.05]).

Conclusion: Although our study did not observe a significant association between postpartum mood disorders and breastfeeding initiation, we identified several modifiable factors that are associated with breastfeeding initiation. Interventions to improve these factors may lead to increased breastfeeding initiation.