Background
Methods
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Medline via PubMed (8 February 2007) 767 items, 24 were relevant;
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CINAHL (Cumulative Index to Nursing & Allied Health Literature) (8 February 2007) 103 items, 11 relevant (1 additional);
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Australian Breastfeeding Association's Lactation Resource Centre database was searched for 'obesity' (21 January 2007); 172 items, 10 relevant (3 additional).
Authors, Year of Publication, Country, and Year(s) of Study | Participants | Definitions | Results |
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Barnes et al, 1997 [34], Bristol, UK, 1991-112 | Birth cohort, (Avon Longitudinal Study of Parents and Children) n = 11,907 Multivariate analysis, n = 8431 for 1st week and n = 8392 for 4 months | Intention: asked at 32 weeks (4 time periods, 4 options for each) Eating Disorder Examination Questionnaire, including 'shape concern' and 'weight concern' items (> 2 indicated marked concern) |
Intention to bf 1 week old infant:
Shape concern normal OR 1.22 (95%CI: 1.10, 1.35) Weight concern normal OR 1.20 (95%CI, 1.07, 1.35)
Intention to bf infant up to 4 months:
Shape concern normal OR 1.30 (95%CI: 1.19, 1.42) Weight concern normal OR 1.26 (95%CI: 1.14, 1.40) Multivariate analysis:
Intention to bf 1 week old infant:
Shape concern normal OR 1.25 (95%CI: 1.09, 1.42) Weight concern normal NS
Intention to bf infant up to 4 months:
Shape concern normal OR 1.26 (95%CI: 1.13, 1.42) Weight concern normal OR 1.16 (95%CI: 1.02, 1.32) (Adjusted for demographic variables, smoking, maternal attitudes to baby) |
Foster et al 1996 [41], Manchester, UK, yr of study not stated | Antenatal cohort n = 38 | Eating Disorder Examination: Shape Concern (SC). Body Satisfaction Scale: General Satisfaction (GS). Measurement of BMI not mentioned in text |
Bf intention and BMI: NS
Shape concern:
Intended to bf median 0.29 Intended to formula feed median 1.05 (i.e. higher concern) (p = 0.02)
General Satisfaction:
Intended to bf median 38.5 Intended to formula feed median 47.5 (i.e. higher dissatisfaction) (p = 0.004)
Multivariate analysis: body shape satisfaction independent predictor of infant feeding intention. (Adjusted for social class, GS, SC and maternal-fetal attachment) |
Hilson et al 2004 [42], Cooperstown, NY, USA, 1998 | Antenatal cohort Eligibility: intended to bf, singleton infant n = 114 | IOM definition of obesity Self-reported height and weight | Planned intention (months, mean, sd) Underweight/normal weight 9.3 (5.7) Overweight 9.8 (3.0) Obese 6.9 (4.6) (p < 0.05) |
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Initiation (the infant's first intake of breast milk)
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Intensity (the degree of exclusiveness of breast milk as the source of nourishment for the infant) and
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Total duration (the total length of time that an infant receives any breast milk at all [38].
Authors, Year of Publication, Country, and Year(s) of Study | Participants | Definition of obesity | Results |
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Donath & Amir 2000 [13], Australia, 1992–95 | 1995 National Health Survey Children up to years 4 old n = 2612 | BMI calculated from self-reported height and weight at time of interview WHO definition of obesity | % (95% CI) Underweight 89.0 (85.8, 92.2) Normal weight 89.2 (87.4, 91.0) Overweight 86.9 (84.0, 89.9) Obese 82.3 (77.6, 87.0) OR* overweight 1.25 OR* obese 1.78 |
Grjibovski et al 2005 [43], Severodvinsk, Russia, 1999 | Antenatal community-based cohort n = 1078 | Pre-pregnancy weight defined as under- normal and over-weight based on "doctor's diagnosis" [82] | Underweight 98.3% Normal 98.7% Overweight 100.0% NS |
Hilson et al 1997 [12] Cooperstown, NY, USA, 1992–94 | Medical record review Eligibility: intended to bf (= bf at birth), healthy singleton infant n = 1109 | IOM definition of obesity BMI calculated from pre-pregnancy weight and height |
Quit bf by hospital discharge 2 d after birth:
Normal 4.3% Overweight 8.9% Obese 12.2% OR* overweight 2.17 OR* obese 3.09
Not bf at discharge (of women who attempted bf at birth): Odds Ratio
Overweight 2.54 (p < 0.05) Obese 3.65 (p = 0.0007) |
Hilson et al 2006 [39] Cooperstown, NY, USA, 1988–97 | Expanded previous review of medical records [12] Eligibility: intended to bf (= bf at birth), singleton infant, no contraindications to bf, no diabetes n = 2783 | IOM definition of obesity BMI calculated from pre-pregnancy weight and height |
Breastfeeding at 4 days:
Underweight 89.0% Normal 90.1% Overweight 88.4% Obese 82.58% Obese women different from underweight and normal weight women OR* overweight 1.19 OR* obese 1.92 |
Kugyelka et al 2004 [40] upstate New York, 1999–2000 | Medical record review, including paediatric record to 6 months of age, all women of 'Hispanic ethnicity' (n = 235) or 'Black race' (n = 263) Eligibility: healthy mothers (BMI > 19) with healthy single, term infant, who attempted to breastfed | IOM definition BMI calculated from pre-pregnancy weight and height |
Baby put to breast < 2 h:
Hispanic women: Black women Normal 71.8% 75.1% Overweight 66.7% 69.2% Obese 61.5% 63.8% (p < 0.05) (p < 0.05)
Fed formula only during last 5 feeds in hospital:
Hispanic women: Black women: Normal weight 9.6% 5.1% Overweight 12.2% 8.0% Obese 12.4% 6.9% Hispanic women OR* overweight 1.48 OR* obese 1.50 Black women OR* overweight 1.62 OR* obese 1.38
Multivariate analysis:
Hispanic women: obese OR 1.92 (95% CI 1.20, 3.08) of formula and breast in last 5 feeds before discharge compared to breast only (adjusted for maternal age, education, parity, gestation, birth wt, smoking and birth) Other groups NS |
Li et al 2002 [83] USA, 1988–1994 | The Third National Health and Nutrition Survey (NHANES III), children aged 2 mo to 6 yrs n = 8765 94% response for these children; 99% data of bf available | BMI calculated from self-reported ht and wt at time of interview. WHO definition of obesity |
Ever breastfed:
Normal 58.1% Overweight 46.4% Obese 44.8% OR* overweight 1.60 OR* obese 1.71 |
Li et al 2003 [49] USA, 1996–98 | Pediatric Nutrition Surveillance System and the Pregnancy Nutrition Surveillance System, children aged < 5 years n = 51,329 | BMI calculated from self-reported pre-pregnancy wt IOM definition of obesity | Obese women more likely to never breastfeed (p < 0.01) OR 1.28 estimated from Figure 1 |
Oddy et al 2006 [44] Australia, 1989–1991 | Western Australian Pregnancy Cohort Study. Pregnant women recruited from King Edward Memorial Hospital, Perth, WA n = 1803 | BMI calculated from pre-pregnancy weight and height (measured by research midwives) WHO definition of obesity |
Never breastfed:
Normal weight 8.2% Overweight 11.4% Obese women 12.4% NS OR* overweight 1.33 OR* obese 1.47 |
Scott et al 2006 [45] Australia, 2002–2003 | 2nd Perth Infant Feeding Study, cohort of women recruited in hospital. n = 587 | Measurement of maternal weight and height not reported WHO definition of obesity |
Any breastfeeding at hospital discharge:
Normal weight 95.6% Overweight 91.5% Obese 90.7% OR 0.45 (95% CI 0.19, 1.09) OR* overweight 2.02 OR* obese 2.23
Exclusive breastfeeding at hospital discharge:
Multivariate analysis, Adjusted OR (95% CI): Normal weight 1 (ref) Overweight 0.50 (0.28, 0.89) Obese 0.63 (0.33, 1.20) (adjusted for maternal age, smoking, marital status, occupation, country of birth, parity, antenatal classes, timing of infant feeding decision, delivery, birth weight, special care nursery, mothers' infant feeding attitude, fathers' infant feeding preference, grandmothers' infant feeding preference, whether grandmother had bf) OR* overweight 2.00 OR* obese 1.59 |
Sebire et al 2001 [14] UK, 1989–1997 | St Mary's Maternity Information system database, North West Thames region n = 325,395 | BMI calculated from weight at antenatal booking Normal BMI 20-<25 Moderately obese 25-<30 Very obese BMI > 30 (BMI < 20 = underweight - excluded from study) |
Bf at hospital discharge:
Multivariate analysis, Adjusted OR (99% CI): Normal weight 1 (ref) Mod obese 0.86 (0.84, 0.88) Very obese 0.58 (0.56, 0.60) (adjusted for ethnic group, parity, age, history of hypertension, diabetes) OR* overweight 1.16 OR* obese 1.72 |
Authors, Year of Publication, Country, and Year(s) of Study | Participants | Definition of obesity | Results |
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Chapman & Perez-Escamilla 1999 [15] USA 1996–1997 | Hartford Hospital, Connecticut Healthy, single, term infant n = 192 | Women's bodies were classified as slim, average, heavy or obese | Delayed lactogenesis (> 72 hours) Slim/average build 26.4% Heavy/obese build 52.2%
Multivariate analysis
Heavy/obese build OR 3.2 (95 CI% 1.5, 6.7) (adjusted for birth weight, method of birth, ethnicity, serious medical condition, parity, formula feeding day 2) |
Chapman & Perez-Escamilla 2000 [46] USA 1997–1998 | Connecticut Healthy mothers with a healthy, single, term infant n = 57 | Definition of obesity: at least 2 of 3: 1. BMI at 72 h > 30, 2. subscapular skin fold thickness at 72 h > 33.7 mm (> 85%ile) 3. heavy/obese build on day 1. | Multivariate analysis
Onset -Milk transfer at 60 h (< or > 9.2 g/feed)
Obese: OR 6.14 (95%CI: 1.10, 37.41, p = 0.05) compared to non-obese
Onset – Maternal perception (< or > 72 h)
Obese: OR 1.97 (95%CI: 0.29, 13.41, p = 0.49) compared to non-obese
Non-obese:
Women who bf more frequently had higher milk transfer values and earlier onset of lactogenesis, than women who bf less frequently
Obese:
No relationship between these variables |
Dewey et al 2003 [47] USA 1999 | Davis, California Healthy, single, term infants, planning to bf > 1 m n = 280 | BMI measured 2 weeks postpartum BMI > 27.0 taken as overweight/obese |
Delayed lactogenesis (> 72 hours)
Normal 16% Overweight/obese 33% p < 0.05
Multivariate analysis for delayed lactogenesis:
Overweight/obese: RR 2.46 (95%CI: 1.45, 3.64) (adjusted for C-section, parity, flat nipples, birth weight):
Multivariate analysis for suboptimal infant feeding behaviour on day 7:
Overweight/obese: RR 2.58 (95%CI: 1.07, 5.22). |
Hilson et al 2004 [42] USA 1998 | Bassett Hospital, Cooperstown, NY Intended to bf, singleton infant n = 114 | BMI calculated from pre-pregnancy weight and height IOM definition of obesity | Delayed lactogenesis (> 72 hours) Normal 18.5% Overweight 30.8% Obese 33.3% Univariate analysis NS Multivariate analysis NS {not enough power to show a difference} |
Rasmussen et al 2004 [16] USA Years of study not stated | Bassett Healthcare, Cooperstown, NY n = 40 | Pre-pregnancy BMI from medical records IOM definition of obesity |
Duration of feed at 7 days postpartum:
Overweight/obese women: infants fed for longer: 23.2 (sd 5.6) mins, compared to 15.3 (sd 6.1) mins for normal weight women (p < 0.005)
Prolactin response to suckling (ng/ml):
48 hours
Normal women 26.0 (sd 61.5) Overweight/obese women -10.3 (sd 28.3) p < 0.05
Prolactin response to suckling (ng/ml):
7 days
Normal women 80.9 (sd 67.6) Overweight/obese women 57.1 (sd 60.2) NS Other hormones (insulin, estradiol, progesterone): NS difference between groups. However, insulin levels were 44% higher in overweight/obese women at 7 days (non-fasting levels and inadequate power). Path analysis: effect of pre-pregnant BMI on prolactin response at 7 days: -30.9 ng/ml. |
Authors, Year of Publication, Country, and Year(s) of Study | Participants | Definition of obesity | Results |
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Amine et al 1989 [51] Kuwait, Year of study not given | Multistage, stratified sample, mothers of children < 3 years old n = 2833 | Height and weight recorded at interview Results expressed as % of reference standard weight for height (Nutrition Institute in Cairo, Egypt) | Mean duration of breastfeeding (month): Weight as % reference median: 80% 4.48 (sd 2.3) 85–119% 5.46 (sd 3.1) 120% 6.36 (sd 3.6) |
Baker 2004 [50] Denmark, 1996 onwards | National Birth Cohort Excluded infants <2500 g, <37w gestation, illnesses or conditions expected to negatively affect growth, mother <18y, never breastfeed, mother diabetic n = 3768 | BMI calculated from pre-pregnant weight and height WHO definition of obesity |
Full breastfeeding
Underweight 15.5 wk Normal weight 16.3 wk Overweight 15.6 wk Obese 14.9 wk
Any breastfeeding
Underweight 29.5 wk Normal weight 31.3 wk Overweight 29.2 wk Obese 27.3 wk NS |
Chapman & Perez-Escamilla 2000 [46] USA, 1997–1998 | Connecticut Healthy mothers with a healthy, single, term infant, Caesarean section n = 57 | Definition of obesity: at least 2 of 3: 1. BMI at 72 h > 30, 2. subscapular skin fold thickness at 72 h > 33.7 mm (> 85%ile) 3. heavy/obese build on day 1 | Multivariate analysis, likelihood of not bf: Non-obese: OR 2.28 (95%CI: 1.02, 5.11) compared with obese women (adjusted for maternal intention, milk transfer and other variables, Table 3, model 1) {Sample too small for multivariate analysis} |
Donath & Amir 2000 [13] Australia, 1992–1995 | National Health Survey, 1995 Children up to 4 years old Multivariate analysis: n = 1991 | BMI calculated at time of interview WHO definition of obesity | Mean duration % (95% CI) Normal 28.7 (27.7, 29.8) Overweight 26.1 (24.3, 28.0) Obese 22.7 (20.1, 25.2)
Multivariate analysis
Normal 1 Overweight 1.15 (1.01, 1.31) Obese 1.36 (1.15, 1.61) p < 0.05 (adjusted for maternal education, marital status, low income, home ownership) |
Forster et al 2006 [48] Australia, 1999–2001 | Cohort of public patients, Melbourne n = 764 | BMI calculated from self-reported height and weight WHO definition of obesity |
Any breastfeeding at 6 months:
Underweight 60.0% Normal 57.0% Overweight 51.9% Obese 37.2%
Multivariate analysis: OR (95% CI) Underweight 1.15 (0.70, 1.88) Normal 1 Overweight 0.70 (0.43, 1.12) Obese 0.49 (0.28, 0.85) (adjusted for intention, breastfed as a baby, maternal age, smoking, region of birth, attended childbirth education, had formula in hospital, maternal anxiety/depression) |
Grjibovski et al 2005 [43] Russia, 1999 | Community-based cohort, all pregnant women at antenatal clinics, Severodvinsk n = 1078 | Pre-pregnancy weight Defined as under-, normal and over-weight based on "doctor's diagnosis" [82] |
Median duration (months, 25th, 75
th
percentile):
Underweight 5.50 (3.00, 12.00) Normal 5.00 (3.00, 9.00) Overweight 4.25 (2.00, 8.00) NS
Multivariate analysis NS |
Hilson et al 1997 [12] USA, 1992–1994 | Medical record review. Bassett Hospital, Cooperstown, NY Healthy singleton infant n = 1109 | BMI calculated from pre-pregnancy weight and height IOM definition of obesity |
Exclusive breastfeeding:
Proportional hazards regression: Overweight RR 1.42, p < 0.04 Obese 1.43, p < 0.02
Any breastfeeding:
Proportional hazards regression: Overweight RR 1.68, p < 0.006 Obese 1.73, p < 0.001 (adjusted for maternal age, smoking, education, gestation, WIC, parity, birth weight, C. section, diabetes) |
Hilson et al 2004 [42] USA, 1998 | Bassett Hospital, Cooperstown, NY Intended to bf, singleton infant. n = 114 | BMI calculated from pre-pregnancy weight and height IOM definition of obesity |
Exclusive breastfeeding (wks, mean, sd) Underweight/normal 3.6 (3.9) Overweight 2.6 (3.2) Obese 2.7 (2.3)
Any breastfeeding (wks, mean, sd) Underweight/normal 7.3 (8.9) Overweight 5.6 (5.4) Obese 4.6 (4.6) RR discontinuing bf: obese 2.43 (95%CI: 1.40, 4.20, p = 0.002) cf to underweight/normal wt women Exclusive bf: NS
Multivariate analysis: RR = 2.03 (95%CI: 1.07, 4.5, p = 0.03) (adjusted for infant feeding intention, work/school, satisfaction with appearance, indifference to bf) |
Hilson et al 2006 [39] USA, 1988–1997 | Expanded previous review of medical records [12]. Bassett Hospital, Cooperstown, NY Intended to bf, singleton infant. No contraindications to bf, no diabetes. n = 2783 | BMI calculated from pre-pregnancy weight and height IOM definition of obesity EBF = last time mother feed only breast milk, without adding non human milk, juice, solids ABF = last feeding of any breast milk to infant |
Median duration of EBF (wks):
Underweight 1.7 Normal 2.0 Overweight 1.7 Obese 1.1 p < 0.05
Median duration of ABF (wks): Underweight 8.0 Normal 8.0 Overweight 7.0 Obese 2.0 p < 0.05
Multivariate analysis: HR of stopping bf: Obese 1.50 (95%CI 1.11, 2.03) for normal wt gain in pregnancy (adjusted for education, smoking, maternal age, parity, WIC, birth) |
Kugyelka et al 2004 [40] USA, Hispanic women: 1998–2000; Black women: 1999–2000 | Medical record review, upstate New York, all women of 'Hispanic ethnicity' (mainly Puerto Rican) (n = 235) or 'Black race' (n = 263) Healthy mothers who attempted to breastfeed with healthy single, term infant | BMI calculated from pre-pregnancy height and weight recorded on New York State prenatal form (could be measured or self-reported) IOM definition of obesity EBF = last time mother feed only breast milk, without adding non human milk ABF = last feeding of any breast milk to infant |
Hispanic women:
Obesity assoc with shorter duration of EBF (RR: 1.5; 95%CI: 1.1, 2.0) and ABF (RR: 1.6; 95%CI: 1.1, 2.1) compared to normal wt women
Black women:
No effect of BMI on duration of EBF or ABF |
Li et al 2002 [83] USA 1988–1994 (exclusive bf: Phase II, 1991–1994) | The Third National Health and Nutrition Survey (NHANES III) n = 7712 | BMI calculated from self-reported ht and wt at time of interview WHO definition of obesity |
Exclusive breastfeeding at 2 months:
Normal 35.4% Overweight 28.2% Obese 25.9%
Breastfeeding at 6 months:
Normal 25.0% Overweight 17.3% Obese 16.9%
Breastfeeding at 12 months:
Normal 10.0% Overweight 5.7% Obese 5.6% |
Li et al 2003 [49] USA 1996–1998 | Pediatric Nutrition Surveillance System and the Pregnancy Nutrition Surveillance System Children aged < 5 years n = 124,151 (n for multivariate analysis of women who initiated breastfeeding = 13,234) | BMI calculated from self-reported pre-pregnancy weight IOM definition of obesity |
Adjusted breastfeeding duration (weeks):
Underweight 13.3 Normal weight 13.6 Overweight 13.1 Obese 11.8 (p < 0.01) (adjusted for gestational weight gain, birth weight, gestation, parity, maternal age, education, marital status, race, smoking, prenatal care, poverty-income ratio) |
Oddy et al 2006 [44] Australia 1989–1991 | Western Australian Pregnancy Cohort Study. Antenatal cohort, King Edward Memorial Hospital, Perth, WA n = 1803 | BMI calculated from pre-pregnancy weight and height (measured by research midwives) WHO definition of obesity |
Breastfeeding < 2 months:
Normal weight 24.0% Overweight 33.6% Obese women 41.6% p < 0.0005
Breastfeeding < 4 months:
Normal weight 37.9% Overweight 50.2% Obese women 57.5% p < 0.0005
Breastfeeding < 6 months:
Normal weight 49.0% Overweight 59.7% Obese women 62.8% p = 0.001 Multivariate Cox hazards regression model: HR (adj) = 1.18 (95%CI 1.05, 1.34) for breastfeeding per month (adjusted for education, maternal age, pregnancy problems, older siblings, smoking, solids before 4 months). |
Rutishauser & Carlin 1992 [11] Australia 1984–1985 | Primiparas breastfeeding > 14 days Barwon region, Victoria n = 739 (N for multivariate analysis between 570 and 600) | BMI calculated from maternal ht and wt recorded at 1 month postpartum Normal = BMI < 26, Above normal = BMI > 26 |
Duration of breastfeeding associated with BMI (p < 0.05)
Multivariate analysis (Cox proportional hazards): HR 1.50 (95%CI 1.11, 2.04) (adjusted for smoking, maternal age, time to first breastfeed) |
Scott et al 2006 [84] Australia 2002–2003 | 2nd Perth Infant Feeding Study, cohort of women recruited in hospital. n = 587 | Measurement of maternal weight and height not reported WHO definition of obesity |
Any breastfeeding at 6 months (other time periods also given): Normal 49.0, sd 5.2 Overweight 48.3, sd 9.5 Obese: 35.7, sd 10.1 p < 0.05
Multivariate analysis NS |