Breastfeeding in the first six months of life for babies seen by Lactation Consulting

Moraes, Bruna Alibio; Strada, Juliana Karine Rodrigues; Gasparin, Vanessa Aparecida; Espirito-Santo, Lilian Cordova do; Gouveia, Helga Geremias; Gonçalves, Annelise de Carvalho

doi:10.1590/1518-8345.3538.3412

Bruna Alibio Moraes

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

https://orcid.org/0000-0003-0573-1366

Juliana Karine Rodrigues Strada

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-9523-4584

Vanessa Aparecida Gasparin

Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

Universidade do Estado de Santa Catarina, Departamento de Enfermagem, Chapecó, SC, Brazil.

https://orcid.org/0000-0002-4266-3668

Lilian Cordova do Espirito-Santo

Universidade Federal do Rio Grande do Sul, Departamento de Enfermagem Materno Infantil, Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-2577-9079

Helga Geremias Gouveia

Universidade Federal do Rio Grande do Sul, Departamento de Enfermagem Materno Infantil, Porto Alegre, RS, Brazil.

https://orcid.org/0000-0003-4980-4141

Annelise de Carvalho Gonçalves

Universidade Federal do Rio Grande do Sul, Departamento de Enfermagem Materno Infantil, Porto Alegre, RS, Brazil.

https://orcid.org/0000-0002-8770-0653

Corresponding author: Bruna Alíbio Moraes. E-mail: brunaalibiom@gmail.com

Associate Editor: Maria Lúcia Zanetti

Authors’ Contribution

Study concept and design: Bruna Alibio Moraes, Juliana Karine Rodrigues Strada, Vanessa Aparecida Gasparin, Lilian Cordova do Espirito-Santo, Annelise de Carvalho Gonçalves. Obtaining data: Bruna Alibio Moraes, Juliana Karine Rodrigues Strada, Vanessa Aparecida Gasparin, Annelise de Carvalho Gonçalves. Data analysis and interpretation: Bruna Alibio Moraes, Juliana Karine Rodrigues Strada, Vanessa Aparecida Gasparin, Annelise de Carvalho Gonçalves. Statistical analysis: Bruna Alibio Moraes, Juliana Karine Rodrigues Strada, Annelise de Carvalho Gonçalves. Obtaining financing: Bruna Alibio Moraes, Juliana Karine Rodrigues Strada, Vanessa Aparecida Gasparin, Lilian Cordova do Espirito-Santo, Annelise de Carvalho Gonçalves. Drafting the manuscript: Bruna Alibio Moraes, Annelise de Carvalho Gonçalves. Critical review of the manuscript as to its relevant intellectual content: Bruna Alibio Moraes, Juliana Karine Rodrigues Strada, Vanessa Aparecida Gasparin, Lilian Cordova do Espirito-Santo, Helga Geremias Gouveia, Annelise de Carvalho Gonçalves.

All authors approved the final version of the text.

Conflict of interest: the authors have declared that there is no conflict of interest.

Variables	Sample (n=158) n (%)	Losses (n=73) n (%)	p-value
Maternal age			0.405
< 20 years old	36 (22.8)	15 (20.5)
20 to 35 years old	103 (65.2)	53 (72.6)
≥ 35 years old	19 (12.0)	5 (6.8)
Self-declared skin color			0.578
White	97 (61.4)	42 (57.5)
Black/Brown	61 (38.6)	31 (42.5)
Years of complete schooling of the woman			0.600
< 8 years	32 (20.3)	17 (23.3)
≥ 8 years	126 (79.7)	56 (76.6)
Working outside the home			0.485
Yes	68 (43.0)	35 (47.9)
No	90 (57.0)	38 (52.1)
Has a partner			0.360
Yes	139 (88.0)	61 (83.6)
No	19 (12.0)	12 (16.4)
Years of complete schooling of the partner			0.219
< 8 years	24 (15.2)	11 (15.1)
≥ 8 years	107 (67.7)	50 (68.5)
Did not know how to inform	8 (5.1)	0 (0.0)
Lives with^* * The results can exceed 100% as there may be more than one answer;
Partner	129 (92.8)	56 (91.8)	0.804
Mother	36 (22.8)	21 (28.8)	0.327
Mother-in-law	19 (13.7)	3 (4.9)	0.069
Family income^† † According to the 2017 minimum wage (R$ 954,00);			0.860
< 2 minimum wages	47 (29.7)	22 (30.1)
2 to 4 minimum wages	66 (41.8)	28 (38.4)
> 4 minimum wages	45 (28.5)	23 (31.5)
Prenatal consultations^‡ ‡ Disregarding women who did not have a prenatal booklet;			0.657
< 6 consultations	13 (8.4)	7 (10.3)
≥ 6 consultations	141 (91.6)	61 (89.7)
Information on breastfeeding in the prenatal and/or group			0.580
Yes	61 (38.6)	23 (31.5)
No	95 (60.1)	49 (67.1)
Did not do prenatal/group	2 (1.3)	1 (1.4)
Smoking during pregnancy			0.166
Yes	26 (16.5)	7 (9.6)
No	132 (83.5)	66 (90.4)
Drug use during pregnancy			0.948
Yes	2 (1.3)	1 (1.4)
No	156 (98.7)	72 (98.6)
Breastfeeding time of the last child			0.092
No previous child	108 (68.4)	49 (67.1)
< 6 months	34 (21.5)	10 (13.7)
≥ 6 months	16 (10.1)	14 (19.2)
Route of birth			0.778
Vaginal	94 (59.5)	42 (57.5)
Cesarean section	64 (40.5)	31 (42.5)
Gender of the baby			0.123
Female	63 (39.9)	37 (50.7)
Male	95 (60.1)	36 (49.3)
Baby classification^§ § According to Lubchenco's Curve(14);			0.280
AGA^\|\| \|\| AGA = Adequate for gestational age;	127 (80.4)	60 (82.2)
SGA^¶ ¶ SGA = Small for gestational age;	11 (11.0)	8 (11.0)
BGA^ BGA = Big for gestational age	20 (12.7)	5 (6.8)

Variables	15 days (n = 213)	30 days (n = 191)	60 days (n = 171)	120 days (n = 160)	180 days (n = 158)
Variables	n (%)	n (%)	n (%)	n (%)	n (%)
Baby on breastfeeding
Yes	209 (98.1)	173 (90.6)	141 (82.5)	109 (68.1)	101 (65.9)
No^* * Cumulative percentage over the follow-ups;	4 (1.9)	18 (9.4)	30 (17.5)	51 (31.9)	57 (36.1)
Reasons^† † The values may exceed 100%, as there could be more than one answer;
Milk dried/Low production	3 (75.0)	7 (50.0)	4 (33.3)	-	1 (16.7)
Difficulty in the technique	1 (25.0)	5 (35.7)	2 (16.7)	1 (4.8)	6 (100)
Baby's disinterest	-	1 (7.1)	5 (41.7)	10 (47.6)	3 (50.0)
Engorgement	-	1 (7.1)	-	-	-
Baby bottle started	-	1 (7.1)	-	-	-
Anatomy of the nipple	-	2 (14.3)	2 (16.7)	1 (4.8)	-
Maternal absence	-	-	1 (8.3)	-	3 (50.0)
Allergy	-	-	-	1 (4.8)	-
Professional guidance	-	-	-	2 (9.5)	-
Breastfeeding on demand
No	49 (23.4)	39 (22.5)	21 (14.9)	18 (16.5)	7 (6.9)
Yes	160 (76.6)	134 (77.5)	120 (85.1)	91 (83.5)	94 (93.1)
Baby receives^† † The values may exceed 100%, as there could be more than one answer;
Tea	10 (4.7)	47 (24.6)	56 (32.7)	61 (38.1)	65 (41.1)
Water	1 (0.5)	9 (4.7)	27 (15.8)	54 (33.8)	69 (43.7)
Juice	-	-	-	14 (8.8)	36 (22.8)
Other milk	66 (31.0)	80 (41.9)	78 (45.6)	81 (50.6)	76 (48.1)
Baby receives liquids by means of^† † The values may exceed 100%, as there could be more than one answer;
Baby bottle	62 (89.9)	92 (95.8)	97 (97)	98 (98)	81 (93.1)
Cup/Spoon/Syringe	12 (17.4)	7 (7.3)	4 (4)	3 (3)	2 (2.3)
Family support for BF^‡ ‡ BF = Breastfeeding;	166 (79.4)	115 (60.2)	86 (50.3)	61 (38.1)	48 (30.4)
Baby using pacifier	91 (42.7)	110 (57.6)	122 (71.3)	131 (81.9)	135 (85.4)
Difficulty in BF^‡ ‡ BF = Breastfeeding;	183 (85.9)	120 (62.8)	81 (47.4)	66 (41.25)	32 (20.3)
Smoking^§ § 15 women already had the habit of smoking during pregnancy and only one woman reported having started after being discharged from hospital	16 (7.5)	17 (8.9)	15 (8.8)	12 (7.5)	8 (5.1)

Variables	Bivariate HR (95% CI)	p-value	Multivariate HR (95% CI)	p-value
Vaginal delivery	0.71 (0.51 - 0.98)	0.039	0.84 (0.56 - 1.24)	0.375
Baby classification^* * According to Lubchenco's Curve(14);
AGA^† † AGA = Adequate for gestational age;	1.00		1.00
SGA^‡ ‡ SGA = Small for gestational age;	0.86 (0.46 - 1.59)	0.621	1.01 (0.54 - 1.89)	0.974
BGA^§ § BGA = Big for gestational age;	1.60 (0.98 - 2.60)	0.059	1.49 (0.89 - 2.50)	0.132
White color	1.01 (0.72 - 1.41)	0.976	-	-
Maternal age
< 20 years old	0.94 (0.62 - 1.42)	0.767	0.92 (0.57 - 1.46)	0.711
20 to 34 years old	1.00		1.00
≥ 35 years old	181 (1.10 - 2.97)	0.019	1.73 (1.03 - 2.90)	0.037
Having a partner	0.95 (0.59 - 1.54)	0.844	-	-
Living with
Partner	1.41 (0.66 - 3.02)	0.381	-	-
Mother	0.86 (0.58 - 1.28)	0.460	-	-
Mother-in-law	0.93 (0.54 - 1.60)	0.804	-	-
Family income
< 2 minimum wages	1.18 (0.76 - 1.84)	0.460	-	-
2 to 4 minimum wages	1.07 (0.72 - 1.59)	0.726	-	-
> 4 minimum wages	1.00		-	-
Years of complete schooling of the woman
< 8 years	0.97 (0.65 - 1.46)	0.898	-	-
≥ 8 years	1.00		-	-
Years of complete schooling of the partner
< 8 years	1.13 (0.62 - 2.08)	0.689	-	-
≥ 8 years	1.00		-	-
Working outside the home	1.01 (0.73 - 1.40)	0.954	-	-
Maternity leave (months)	0.99 (0.92 - 1.06)	0.673	-	-
PN consultations^\|\| \|\| PN = Prenatal;	0.97 (0.61 - 1.5)	0.890	-	-
< 6 consultations	1.35 (0.78 - 2.36)	0.288	-	-
≥ 6 consultations	1.00		-	-
Information on BF^¶ ¶ BF = Breastfeeding; in the PN^\|\| \|\| PN = Prenatal; or in the group of pregnant women	0.60 (0.15 - 2.49)	0.483	-	-
Smoking during pregnancy	1.68 (1.09 - 2.59)	0.019	1.66 (1.05 - 2.61)	0.029
Drug use during pregnancy	2.07 (0.51 - 8.39)	0.311	-	-
BF time^¶ ¶ BF = Breastfeeding; last child
Primiparous	1.14 (0.67 - 1.93)	0.635	1.18 (0.67 - 2.06)	0.568
< 6 months	1.92 (1.05 - 3.50)	0.033	1.37 (0.75 - 2.49)	0.314
≥ 6 months	1.00
Dairy complement in the hospital	1.57 (1.13 - 2.19)	0.007	1.34 (0.94 - 1.92)	0.107
Maternity leave at 15 days	0.95 (0.68 - 1.32)	0.756	-	-
Fixed time for BF^¶ ¶ BF = Breastfeeding;	1.08 (0.74 - 1.59)	0.681	-	-
Pacifier use during follow-up	1.99 (1.38 - 2.87)	*< 0.001^ * According to Lubchenco's Curve(14);**	1.76 (1.21 - 2.58)	0.003
Difficulty in BF^¶ ¶ BF = Breastfeeding; in hospitalization	0.96 (0.30 - 3.00)	0.939	-	-
Difficulty in BF^¶ ¶ BF = Breastfeeding; after hospital discharge	2.48 (1.54 - 3.98)	*< 0.001^ * According to Lubchenco's Curve(14);**	2.09 (1.29 - 3.41)	0.003
Sought professional assistance due to breastfeeding difficulties^ Human Milk Bank, outpatient lactation consulting, primary health care	2.93 (2.10 - 4.09)	*< 0.001^ * According to Lubchenco's Curve(14);**	2.45 (1.69 - 3.54)	< 0.001

[1] Corresponding author: Bruna Alíbio Moraes. E-mail: brunaalibiom@gmail.com

Brasil

Brasil

Objective:

Method:

Results:

Conclusion: