Prevalence and predictors of breastfeeding in the MINA-Brazil cohort

Mosquera, Paola S.; Lourenço, Bárbara H.; Matijasevich, Alicia; Castro, Marcia C.; Cardoso, Marly A.

doi:10.11606/s1518-8787.2023057005563

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Original Article • Rev. Saúde Pública 57 (Suppl 2) • 2023 • https://doi.org/10.11606/s1518-8787.2023057005563 copy

Prevalence and predictors of breastfeeding in the MINA-Brazil cohort

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To describe the prevalence and factors associated with exclusive (EBF) and continued breastfeeding (BF) practices among Amazonian children.

METHODS:

Data from 1,143 mother-child pairs recorded on the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) birth cohort were used. Information on EBF and BF was collected after childbirth (July 2015–June 2016) and during the follow-up visits at 1 and 6 months postpartum, 1, 2, and 5 years of age. For longitudinal analysis, the outcomes were EBF and BF duration. Probability of breastfeeding practices were estimated by Kaplan-Meier survival analysis. Associations between baseline predictors variables and outcomes among children born at term were assessed by extended Cox regression models.

RESULTS:

EBF frequencies (95% confidence interval [95%CI]) at 3 and 6 months of age were 33% (95%CI: 30.2–36.0) and 10.8% (95%CI: 8.9–12.9), respectively. Adjusted hazard ratio for predictors of early EBF cessation were: being a first-time mother = 1.47 (95%CI: 1.19–1.80), feeding newborns with prelacteals = 1.70 (95%CI: 1.23–2.36), pacifier use in the first week of life = 1.79 (95%CI: 1.44–2.23) or diarrhea in the first two weeks of life = 1.70 (95%CI: 1.15–2.52). Continued BF frequency was 67.9% (95%CI: 64.9–70.8), 29.3% (95%CI: 26.4–32.4), and 1.7% (95%CI: 0.9–2.8) at 1, 2 and 5 years of age, respectively. Adjusted hazard ratio for predictors of early BF cessation were: male sex = 1.23 (95%CI: 1.01–1.49), pacifier use in the first week of life = 4.66 (95%CI: 2.99–7.26), and EBF less than 3 months = 2.76 (95%CI: 1.64–4.66).

CONCLUSIONS:

EBF and continued BF duration among Amazonian children is considerably shorter than recommendations from the World Health Organization. Significant predictors of breastfeeding practices should be considered for evaluating local strategies to achieve optimal breastfeeding practices.

DESCRIPTORS:
Breastfeeding; Survival Analysis; Risk Factors; Cohort Studies

Mother's characteristics		Total of participants n = 1,143^a a Totals may differ due to missing values.	Child's characteristics		Total of participants n = 1,143^a a Totals may differ due to missing values.
Mother's characteristics		n (%)	Child's characteristics		n (%)
Maternal age at delivery (years)			Sex
	< 19	207 (18.1)		Female	572 (50.1)
	≥ 19	936 (81.9)		Male	571 (49.9)
Maternal schooling (years)			Preterm birth
	≤ 9	382 (34.4)		Yes (< 37 weeks)	88 (7.7)
	> 9	730 (65.6)		No (≥ 37 weeks)	1,055 (92.3)
Maternal self-reported skin color			Low birth weight
	White	138 (12.4)		Yes (< 2,500 grams)	79 (6.9)
	Black, brown, indigenous, and yellow	975 (87.6)		No (≥ 2,500 grams)	1,063 (93.1)
Woman living with her partner			Small for gestational age
	Yes	860 (77.3)		Yes	94 (8.2)
	No	253 (22.7)		No	1,048 (91.8)
Household wealth index			Breastfeeding within the first hour
	Below average	558 (50.1)		Yes	956 (88.6)
	Above average	555 (49.9)		No	123 (11.4)
Parity			Prelacteal feeding
	Primiparous	517 (46.5)		Yes	149 (13.1)
	Multiparous	596 (53.5)		No	994 (86.9)
Antenatal care visits			Pacifier use in the first week of life
	< 6	256 (22.6)		Yes	128 (12.2)
	≥ 6	879 (77.4)		No	920 (87.8)
Smoking during pregnancy			Diarrhea in the first 15 days of life
	Yes	51 (4.6)		Yes	32 (3.6)
	No	1,062 (95.4)		No	856 (96.4)
Malaria during pregnancy			Fever in the first 15 days of life
	Yes	79 (6.9)		Yes	62 (7.0)
	No	1,064 (93.1)		No	826 (93.0)
Pre-pregnancy body mass index^b b According to the World Health Organization standards (WHO, 1995).			Wheezing in the first 15 days of life
	<25 Kg/m²	678 (64.8)		Yes	153 (17.2)
	≥ 25 Kg/m²	369 (35.2)		No	735 (82.8)
Gestational weight gain^c c According to the Institute of Medicine Guidelines, 2009.			Dry cough in the first 15 days of life
	Not excessive	688 (65.8)		Yes	30 (3.4)
	Excessive	357 (34.2)		No	858 (96.6)
Type of delivery			Bottle use in the first 6 months
	Vaginal	612 (53.5)		Yes	806 (83.4)
	Cesarean	531 (46.5)		No	161 (16.6)
Breast problems in the puerperium^d d Sore breast, cracked nipples or both.
	Yes	509 (57.4)
	No	378 (42.6)

Characteristics	Crude HR (95%CI)	Distal level	Distal intermediate level	Proximal intermediate level	Proximal level
Characteristics	Crude HR (95%CI)	HRa (95%CI)	HRa (95%CI)	HRa (95%CI)	HRa (95%CI)
Maternal age at delivery < 19 years	1.29 (1.08–1.53)	0.98 (0.79–1.21)
Maternal schooling ≤ 9 years	1.14 (0.99–1.32)	1.15 (0.98–1.35)
Maternal non-white self-reported skin color	1.09 (0.87–1.35)	1.03 (0.82–1.28)
Woman living with her partner	0.77 (0.65–0.90)	0.84 (0.71–1.00)
Household Wealth Index below mean	1.12 (0.97–1.28)	1.07 (0.93–1.24)
Primiparous mother^a a Time-varying covariates.	1.63 (1.34–1.97)	1.62 (1.32–2.00)	1.73 (1.41–2.13)	1.72 (1.41–2.10)	1.47 (1.19–1.80)
Antenatal care visits < 6	1.21 (1.02–1.43)		1.34 (1.11–1.62)	1.30 (1.09–1.56)	1.17 (0.97–1.41)
Smoking during pregnancy	1.25 (0.90–1.72)		1.37 (0.96–1.96)
Malaria during pregnancy	1.07 (0.83–1.38)		1.11 (0.84–1.46)
Pre-pregnancy body mass index^b b According to the World Health Organization standards. > 25 kg/m²	1.04 (0.90–1.20)		1.08 (0.93–1.27)
Excessive gestational weight gain^c c According to the Institute of Medicine Guidelines, 2009.	1.05 (0.90–1.21)		1.07 (0.92–1.25)
Cesarean delivery	0.81 (0.70–0.93)			0.89 (0.76–1.03)
Male baby	1.11 (0.97–1.27)			1.12 (0.97–1.29)
Low birth weight	0.93 (0.61–1.41)			0.79 (0.49–1.28)
Small for gestational age	1.08 (0.84–1.39)			1.08 (0.81–1.44)
Breastfeeding within the first hour	1.33 (1.02–1.73)			1.32 (1.00–1.74)
Prelacteal feeding^a a Time-varying covariates.	1.35 (1.00–1.83)			1.48 (1.05–2.08)	1.70 (1.23–2.36)
Breast problems in the puerperium^d d Sore breast, cracked nipples or both.	1.22 (1.04–1.41)				1.11 (0.94–1.30)
Pacifier use in the first week of life	1.70 (1.40–2.07)				1.79 (1.44–2.23)
Diarrhea in the first 15 days of life	1.55 (1.06–2.26)				1.70 (1.15–2.52)
Fever in the first 15 days of life	1.27 (0.96–1.68)				1.20 (0.98–1.66)
Wheezing in the first 15 days of life	1.25 (1.03–1.51)				1.25 (0.94–1.66)
Dry cough in the first 15 days of life	0.96 (0.64–1.44)				0.81 (0.53–1.24)

Characteristics	Crude	Distal level	Distal intermediate level	Proximal intermediate level	Proximal level
Characteristics	HR (95% CI)	HRa (95%CI)	HRa (95%CI)	HRa (95%CI)	HRa (95%CI)
Maternal age at delivery < 19 years	1.13 (0.91–1.40)	1.12 (0.87–1.44)
Maternal schooling ≤ 9 years	0.96 (0.80–1.14)	0.97 (0.80–1.18)
Maternal non-white self-reported skin color	0.79 (0.63–1.00)	0.78 (0.62–0.99)	0.78 (0.62–1.00)	0.82 (0.64–1.04)	0.76 (0.57–1.03)
Woman living with her partner	0.79 (0.65–0.95)	0.79 (0.64–0.96)	0.76 (0.62–0.92)	0.79 (0.65–0.97)	0.87 (0.70–1.09)
Household Wealth Index below mean	0.88 (0.75–1.03)	0.87 (0.73–1.04)
Primiparous mother	1.01 (0.86–1.19)	0.91 (0.75–1.10)
Antenatal care visits < 6	0.91 (0.74–1.13)		0.90 (0.71–1.13)
Smoking during pregnancy	1.09 (0.74–1.60)		1.03 (0.69–1.54)
Malaria during pregnancy	0.97 (0.71–1.33)		1.01 (0.73–1.40)
Pre-pregnancy body mass index^a a According to the World Health Organization standards. > 25 kg/m²	0.94 (0.79–1.12)		0.92 (0.77–1.10)
Excessive gestational weight gain^b b According to the Institute of Medicine Guidelines, 2009.	0.99 (0.83–1.18)		1.00 (0.84–1.20)
Cesarean delivery	0.91 (0.77–1.07)			0.90 (0.75–1.07)
Male baby	1.29 (1.09–1.51)			1.29 (1.09–1.53)	1.23 (1.01–1.49)
Low birth weight	1.27 (0.81–1.99)			1.16 (0.69–1.92)
Small for gestational age	1.12 (0.91–1.60)			1.08 (0.79–1.51)
Breastfeeding within the first hour	1.06 (0.78–1.43)			1.12 (0.80–1.50)
Prelacteal feeding^c c Time-varying covariates.	1.30 (0.80–2.10)			1.40 (0.84–2.35)
Breast problems^d d Sore breast, cracked nipples or both.	1.10 (0.91–1.33)				1.03 (0.84–1.26)
Pacifier use in the first week of life^c c Time-varying covariates.	4.70 (3.15–7.00)				4.66 (2.99–7.26)
Diarrhea in the first 15 days of life	1.10 (0.67–1.68)				1.03 (0.64–1.68)
Fever in the first 15 days of life	1.30 (0.92–1.83)				1.42 (1.00–2.02)
Wheezing in the first 15 days of life	1.01 (0.80–1.28)				0.91 (0.70–1.17)
Dry cough in the first 15 days of life	1.57 (0.96–2.55)				1.22 (0.70–2.12)
Exclusive breastfeeding < 3 months^c c Time-varying covariates.	2.82 (1.92–4.13)				2.76 (1.64–4.66)
Bottle use while breastfeeding	1.55 (1.16–2.06)				1.28 (0.91–1.81)

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[1] Correspondence: Marly A. Cardoso Universidade de São Paulo. Faculdade de Saúde Pública Departamento de Nutrição Avenida Doutor Arnaldo, 715 01246-904 São Paulo, SP, Brasil E-mail: marlyac@usp.br