Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study

Silva, Laís Araújo Tavares; Oliveira, Maria Inês Couto de; Costa, Ana Carolina Carioca da; Santos, Samira Fernandes Morais dos; Gama, Silvana Granado Nogueira da; Fonseca, Vânia de Matos

doi:10.1016/j.jped.2021.12.009

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Sumário

Original article • J. Pediatr. (Rio J.) 98 (5) • Sep-Oct 2022 • https://doi.org/10.1016/j.jped.2021.12.009 copy

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals.

Method

Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach.

Results

In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula.

Conclusions

Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

Keywords
Infant formula; Breastfeeding; Newborn

Variables	n (%)	Use of infant formula (%)	OR crude (95% CI)	p-value
Geographic region				0.071
North	1,775 (12.2)	13.3	1
Midwest	937 (6.4)	30.8	2.88 (1.48-5.60)
South	1,990 (13.7)	21.0	1.72 (0.94-3.13)
Northeast	4,349 (29.9)	19.7	1.58 (0.84-2.97)
Southeast	5.482 (37.7)	23.3	1.97 (1.48-5.60)
Area of residence				0.705
Capital	5,692 (39.2)	21.9	1
Interior	8,839 (60.8)	20.7	0.92 (0.62-1.37)
Self-reported skin color				< 0.001
White	4,581 (31.5)	25.3	1.41(1.19-1.67)
Non-white	9,946 (68.5)	19.3	1
Maternal age				< 0.001
12-19 years	2,971 (20.4)	15.6	0.66 (0.56-0.78)
20-34 years	10,198 (70.2)	21.8	1
≥ 35 years	1,358 (9.4)	28.5	1.43 (1.24-1.64)
Education				< 0.001
Incomplete primary education	4,058 (28.1)	15.0	0.30 (0.21-0.43)
Complete primary education	3,888 (26.9)	17.3	0.35 (0.25-0.49)
Complete secondary education	5,499 (38.0)	25.7	0.59 (0.44-0.78)
Complete higher education plus	1,017 (7.0)	36.8	1
Parity				< 0.001
Primipara	6,593 (45.4)	25.4	1
Multipara	7,938 (54.6)	17.7	0.63 (0.55-0.71)
Economic class				< 0.001
A or B	3,085 (21.4)	30.2	1
C	7,641 (53.0)	21.1	0.61 (0.47-0.79)
D or E	3,683 (25.6)	14.0	0.37 (0.27-0.51)
Head of the family (the woman herself)				0.848
Yes	1,532 (10.7)	21.4	1.02 (0.78-1.35)
No	.12,749 (89.3)	21.0	1
Marital status				0.659
Without a partner	2,739 (18.9)	20.5	0.95 (0.76-1.18)
With a partner	11,777 (81.1)	21, 3	1

Variables	n (%)	Use of infant formula (%)	OR crude (95% CI)	p-value
Number of PN queries				< 0.001
1-3 consultations	1,372 (9.7)	18.3	0.76 (0.60-0.96)
4-5 consultations	2,664 (18.9)	16.8	0.68 (0.57-0.81)
≥6 consultations	10,048 (71.3)	22.7	1
Guidance in PN care on breastfeeding in the first hour of life				0.579
Yes	9,368 (65.4)	21.4	1
No	4,952 (34.6)	20.8	0.96 (0.82-1.11)
Type of PN care				< 0.001
Public service	10,924 (76.1)	16.6	1
Private service	2,870 (20.0)	37.2	2.97 (2.27-3.88)
Public and private service	555 (3.9)	28.7	2.02 (1.53-2.66)
Health professional who provided most of the PN consultations				< 0.001
Doctor	10,236 (72.2)	23.8	1
Nurse	3,942 (27.8)	14.9	0.56 (0.42-0.74)
Anti-HIV exam during pregnancy				< 0.001
Yes	8,593 (80.7)	20.7	1
No	2,058 (19.3)	15.4	0.69 (0.52-0.91)
Delivery type				< 0,001
Cesarean	6,427 (44.2)	30.7	2.80 (2,25-3.48)
Vaginal	8,104 (55.8)	13.6	1
Type of pregnancy				< 0.001
Single	14,438 (99.4)	20.9	1
Multiple	93 (0.6)	65.2	7.08 (4.18-12.01)
Breastfed in the delivery room				< 0.001
Yes	3,045 (21.2)	12.9	1
No	11,341 (78.8)	22.9	1.99 (1.58-2.51)
Companion during hospitalization after delivery				< 0.001
Yes	9,027 (80.7)	23.1	1
No	2,161 (19.3)	17.9	0.72 (0.55-0.95)
Type of birth hospital				< 0.001
Private	1,465 (10.1)	44.7	3.80 (2.36-6.13)
Mixed	5,982 (41.2)	19.7	1.15 (0.76-1.75)
Public	7,084 (48.8)	17.5	1
Baby-Friendly Hospital status				< 0.001
Yes/ In process	7,127 (49.4)	17.0	1
No	7,291 (50.6)	25.5	1.67 (1.18-2.36)
Gestational age				< 0.001
Preterm	869 (6.0)	31.8	1.80 (1.50-2.17)
Term	13.283 (91. 4)	20.5	1
Post-term	375 (2.6)	19.3	0.92 (0.55-1.53)
Sex of newborn				0.176
Male	7,432 (51.2)	20.6	1
Female	7,093 (48.8)	21.8	1.07 (0.96-1.19)
Birth weight				< 0.001
< 2,500 g	624 (4.3)	38.2	2.47 (1.98-3.08)
2,500-4,000 g	13,123 (91.1)	20.0	1
≥ 4,000 g	660 (4.6)	28.8	1.62 (1.30-2.01)

Variables	Use of infant formula
	aOR	95% CI	p-value
*Distal level*
Maternal age			< 0.001
12-19 years	0.651	(0.550-0.769)^a a p< 0.05.
20-34 years	1
≥35 years	1.515	(1.309-1.753)^a a p< 0.05.
Education			< 0.001
Incomplete elementary school	0.579	(0.431-0.777)^a a p< 0.05.
Complete primary education	0.585	(0.450-0.762)^a a p< 0.05.
Complete secondary education	0.765	(0.615-0.953)^a a p< 0.05.
Complete higher education plus	1
Parity			< 0.001
Primipara	1
Multipara	0.588	(0.510-0.678)^a a p< 0.05.
Economic class			0.002
A or B	1
C	0.794	(0.642-0.981)^a a p< 0.05.
D or E	0.565	(0.415-0.769)^a a p< 0.05.

Intermediate level ^b b Adjusted for distal level variables.
Type of PN care			< 0.001
Public service	1
Private service or health plan	2,221	(1.729-2.852)^a a p< 0.05.
Public and private service	1.670	(1.247-2.237)^a a p< 0.05.

Proximal level ^c c Adjusted for distal and intermediate level variables.
Delivery type			< 0.001
Caesarean	1.837	(1.414-2.385)^a a p< 0.05.
Vaginal	1
Pregnancy type			< 0.001
Single	1
Multiple	3.786	(2.028- 7.066)^a a p< 0.05.
Breastfed in the delivery room			< 0.001
Yes	1
No	1.780	(1.430-2.216)^a a p< 0.05.
Type of hospital at birth			0.246
Private	1.695	(1.026-2.798)^a a p< 0.05.
Mixed	0.985	(0.609-1.591)
Public	1
Gestational age			0.006
Preterm	1.656	(1.326-2.068)^a a p< 0.05.
Term	1
Post-term	1.045	(0.586-1.865)
Birth weight			< 0.001
< 2.500 g	2.084	(1.585-2.741)^a a p< 0.05.
2,500-4,000 g	1
≥ 4,000 g	1.672	(1.318-2.119)^a a p< 0.05.

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[1] ⁎ Corresponding author. E-mail:laisaraujots@gmail.com (L.A. Silva).