372 - Self-reported breastfeeding problems in the 6 months after birth

Publication Number: 3359.372

EMILY GREGORY, Children's Hospital of Philadelphia, PHILADELPHIA, PA, United States; Meg Kawan, Children's Hospital of Philadelphia, Media, PA, United States; Zia Huballah, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Gabrielle DiFiore, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Maura A. Powell, CHOP, Malvern, PA, United States; Katie McPeak, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Alexander G. Fiks, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Background: Breastfeeding (BF) rates in the US fall rapidly after birth, with observed socioeconomic and racial disparities. Problems with BF are associated with early BF cessation, however most data on BF problems in the US was reported after BF cessation.

Objective: Prospectively assess associations between early BF problems and subsequent BF behavior to determine whether associations drive observed socioeconomic and racial disparities.

Design/Methods: This retrospective cohort study used EHR data from a primary care network from 3/2023 – 2/2025. Parents reported information on BF and problems with latch, pain, or supply via a pre-visit screen at well visits from 17 days to 6 months. We obtained EHR data on infant gestational age at birth, sex, race, ethnicity, and insurance payer. We assessed BF behaviors and problems at 1 month (17 – 40 days), 2 months (41 – 90 days), 4 months (91 – 150 days), and 6 months (151 – 210 days). For those with 2 consecutive screens, we assessed the proportion who reported problems at the earlier time who were still BF at the subsequent time. Logistic regression included the subgroup who reported any BF on a 1- or 2-month screen and completed a 6-month screen. Regression tested for an association between early BF problems and 6-month BF behavior, adjusting for prematurity, sex, race and ethnicity, and ever using Medicaid, as a proxy for socioeconomic status. Because race, ethnicity, and Medicaid are correlated in our population, we used stratified regression to examine associations within subgroups.

Results: 28,565 individuals completed ≥1 screen (mean 2.5). Infants were 26% Black non-Hispanic, 44% White non-Hispanic, and 11% Hispanic race and ethnicity, 10% were born preterm, and 40% used Medicaid insurance. The proportion of BF individuals reporting problems decreased with increasing infant age (Table 1). Latch and supply problems were reported more frequently than pain at all times. Those with Medicaid insurance had higher rates of BF cessation. Most individuals who reported BF problems continued to BF at the subsequent time point (1m to 2m 87%, 2m to 4m 81%, 4m to 6m 81%). In logistic regression (N=9,075), early BF problems were associated with decreased BF at 6 months (OR 0.80, 95% CI 0.72 – 0.89). In stratified regressions (Table 2), this association was not observed among those with Medicaid insurance.

Conclusion(s): Addressing BF problems could increase rates of sustained BF, especially among privately insured families. Additional barriers, aside from the BF problems assessed, may contribute to known socioeconomic disparities in sustained BF.

Table 1: Breastfeeding and breastfeeding problems over time
pas_bfprob_table1_20251026.pdf

Table 2: Association between early breastfeeding problems (at 1 or 2 months) and 6-month breastfeeding
pas_bfprob_table2_20251026.pdf