Body image concerns and reduced breastfeeding duration in primiparous overweight and obese women

Objectives: To test differences in breastfeeding duration by prepregnant maternal weight status, and determine whether body image concerns mediate any differences. Methods: A prospective longitudinal cohort of primiparous women was followed from pregnancy to, at minimum, 6 months postpartum. Questionnaire responses on body concerns were obtained during pregnancy and at 4 months postpartum. Kaplan-Meier curves compared breastfeeding duration in overweight/obese and normal weight groups. Cox proportional hazard regression was used to determine whether body image variables mediated the relationship between maternal weight and duration. Results: Although intended duration was similar between groups, overweight/obese women had a shorter median duration of any breastfeeding (38.6 weeks) compared to normal weight women (48.9 weeks) (P < 0.01) and they experienced higher risk of breastfeeding cessation over the entire first year postpartum [hazard risk (HR) = 1.43; confidence interval (CI) = 1.02-2.01; P < 0.05]. Overweight/obese women reported lack of body comfort/confidence postpartum more frequently than normal BMI women (P < 0.01). Lack of body comfort/confidence postpartum was negatively associated with duration after adjusting for maternal BMI (P = 0.01). Thus, the effect of BMI on duration was reduced by this variable (HR = 1.31; CI = 0.93, 1.86; P = 0.13), suggesting mediation. Conclusions: Women with high prepregnant BMI have reduced lactation duration that is mediated by lack of comfort/confidence with one's body. Further research into the interplay between body image, weight status, and breastfeeding outcomes may point to behavioral targets amenable to intervention and modification that may in turn improve breastfeeding outcomes for overweight/obese women and their infants.