Research Article: Influence of weight concerns on breastfeeding: Evidence from the Norwegian mother and child cohort study

Date Published: November 27, 2017

Publisher: John Wiley and Sons Inc.

Author(s): Seung‐Yong Han, Alexandra A. Brewis.


High body mass index (BMI) often predicts truncated breastfeeding, although why is unclear. We test a proposed mediating role of body concerns on breastfeeding initiation and child’s age at weaning using longitudinal data for 55,522 mothers from the Norwegian Mother and Child Cohort Study (MoBa).

A linear regression‐based mediation analysis with bootstrapping estimates the indirect effects of BMI on breastfeeding decisions (ever‐initiation of breastfeeding, child’s age at weaning, and duration of any breastfeeding beyond six months) through the variables of concern around prepregnancy weight and weight gains due to pregnancy.

Contrary to prediction, Norwegian mothers with greater prepregnancy weight concerns had a higher likelihood of initiating breastfeeding. Concerns about weight gain during pregnancy, however, predicted earlier weaning. This relationship was the same for higher and lower BMI mothers.

In this very large sample, body image affects some breastfeeding decisions. However, this effect is independent of mother’s body size.

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Obesity has been posed as a predictor of lower likelihood of initiating and continuing to breastfeed (Amir & Donath, 2007; Anstey & Jevitt, 2011; Kachoria, Moreland, Cordero, & Oza‐Frank, 2015; Manios et al., 2009; Mäkelä, Vaarno, Kaljonen, Niinikoski, & Lagström, 2014; Turcksin, Bel, Galjaard, & Devlieger, 2014; Verret‐Chalifour et al., 2015). Reasons include difficult births and delayed lactogenesis II related to having high body fat (see Babendure, Reifsnider, Mendias, Moramarco, & Davila, 2015 for review). However, breastfeeding decisions are driven to a large extent by maternal intention and decision‐making. In this journal, Hauff and Demerath (2012) suggested and demonstrated a further mechanism: body issues. Following 257 primiparous women in Minnesota, USA, for six months postpartum, they found that women with high prepregnancy body mass index (BMI) had reduced breastfeeding duration, and this was seemingly mediated by women’s body discomfort. Another study by Brown, Rance, and Warren (2015) followed 128 pregnant women in the U.K. for six months postpartum and found negative associations between three different types of body image concerns and breastfeeding duration. The main reported reasons for stopping breastfeeding were embarrassment regarding public feeding and the impact of breastfeeding on breast shape. A qualitative study of Keely, Lawton, Swanson, and Denison (2015) echoed this finding: lack of privacy for breastfeeding discouraged new mothers from continued breastfeeding. By contrast, a case‐control study by Zanardo et al. (2014) of 25 overweight/obese and 25 nonoverweight/obese Italian mothers found women with higher BMI had more body dissatisfaction, yet were more likely to still be breastfeeding at six months postpartum. However, analysis of longitudinal data for 2824 women in the Infant Feeding Practices Study II showed overweight/obese women had similar intention to breastfeed as peers, but were less likely to initiate breastfeeding, and terminated breastfeeding sooner (Hauff, Leonard, & Rasmussen, 2014).

The Norwegian Mother and Child Cohort Study (MoBa) is a prospective population‐based pregnancy cohort study conducted by the Norwegian Institute of Public Health. Participants were recruited across Norway from 1999 to 2008. The cohort now includes 114,500 children, 95,200 mothers, and 75,200 fathers. The current study is based on version 8 of the quality‐assured data files released for research on the breastfeeding behavior of Norwegian mothers (Magnus et al., 2016).

The proportion of new mothers initiating breastfeeding was 82% for nonoverweight/obese women compared to 81% for overweight/obese women; this was statistically significant given the very large sample size (z statistic = 3.2620, p‐value = .0011). Average duration of breastfeeding was 9 months for nonoverweight/obese women, and 8 months for overweight/obese women, also a significant difference (t statistic = −13.8944, p‐value < .0001). The results confirm that Norwegian mothers with greater concern about their weight before pregnancy had better breastfeeding outcomes. That is, they were more likely to initiate breastfeeding and to wean later. For initiation of breastfeeding, this effect was observed in both higher and lower BMI women. Overweight/obese mothers, on average, weaned sooner. But body issues did not mediate this relationship. Overweight/obese mothers with greater prepregnancy weight concerns breastfeed for longer.   Source:


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