Predictors and moderators of delayed lactogenesis II and duration of breastfeeding.

Preusting, I. (Irma) (2014) Predictors and moderators of delayed lactogenesis II and duration of breastfeeding. thesis, Medicine.

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Abstract

Objectives To determine what proportion of obese women experiences self-reported delayed lactogenesis II (DLII), to analyze risk factors for delayed lactogenesis II, to analyze other risk factors that are related with delayed lactogenesis II and to assess women’s breastfeeding behavior at six weeks postpartum. Design An ongoing prospective observational cohort study in which participants were divided into two groups, women with a Body Mass Index (BMI) <30 and women with a BMI ≥30. Data was collected through written and verbal questionnaires and medical chart review. DLII was defined as an onset of lactogenesis II after 72 hours postpartum. We analyzed multiple covariates for the association with DLII through chi-square and Fisher’s exact test. Continuous variables were analyzed by correlation tests. At 6 weeks postpartum, participants were analyzed for their breastfeeding behavior and various covariates were analyzed as a predictor for early cessation of breastfeeding. Results A total of 134 participants were included. The mean onset of lactogenesis II was 73.8 hours. The prevalence of DLII was 47.9% for non-obese participants (n=94) and 52.2% for obese participants (n=40). Higher BMI at the time of delivery was significant associated with a later onset of lactogenesis II (in hours, p<0.05). We found a significant increase in DLII for patients that used epidural anesthesia during vaginal delivery and patients with flat nipples (p<0.05). Higher age was also significantly correlated with a later onset of lactogenesis II. At 6 weeks postpartum, 62.9% of the participants was still exclusively breastfeeding, with the main reason for the cessation of breastfeeding being a low milk supply. Predictors and/or risk factors for an early cessation of breastfeeding were obesity, excess weight gain during pregnancy, a LATCH-score <8 and nipple pain during breastfeeding (p<0.05). Conclusion Higher maternal BMI at the time of delivery is correlated with a later onset of lactogenesis II. Although the majority of the women were still breastfeeding at 6 weeks postpartum, over a third of women that had stopped breastfeeding did this within the first week. Risk factors such as excessive weight gain in pregnancy, low latch score and nipple pain are potentially modifiable and therefore should be considered when making a clinical assessment of women at risk of early breastfeeding cessation. More risk factors for DLII may be revealed upon completion of this study.

Item Type:	Thesis (Thesis)
Supervisor name:	Louis, J. MD and Brumley, J. CNM and Young, C. MSN and Berg, P.P. van den MD and Tampa General Hospital and University of South Florida and Tampa, United States of America
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2175

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