Prenatal Care and Breastfeeding Outcomes: A Retrospective Chart Review
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Date
2017-05
Authors
Coneys, Olivia
Shumila, Lindsey
Azad, Meghan
Nickel, Nathan
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Abstract
Background: The nutritional and non-nutritional benefits of breastfeeding to both infant and maternal health are well established. International guidelines recommend that healthy infants should be exclusively breastfed for 6 months with continued breastfeeding for up to two years, or beyond. While breastfeeding is a natural act, it is also a learned behaviour and therefore requires both anticipatory guidance prenatally, as well as peri/postnatal support to the mother and infant in order to sustain adequate breastfeeding practices. Initiation rates of breastfeeding in Canada have remained stable, yet duration and exclusivity at 6 months remain suboptimal. Limited and conflicting evidence exists regarding the association between utilization of prenatal care and breastfeeding outcomes, and therefore the purpose of this study was to further examine this relationship.
Methods: The study was a retrospective chart review of mother-infant dyads with available charts who delivered at the Health Sciences Centre (HSC) in Winnipeg, Manitoba, Canada between January and September 2016. Exposures analyzed included the both the number of prenatal visits attended by the mother as well as adequacy of care as defined using the R- GINDEX. Outcomes evaluated included both prenatal feeding intention and actual feeding method at discharge from hospital, and were classified as exclusive breast, both breast and formula or exclusive formula. An exploratory analysis of parity and breastfeeding intentions and practices was also done. Chi-Square Test was used to determine associations
Results: Of mothers who attended <5 prenatal care visits, 50% intended on formula feeding as compared to 23% of those who attended ≥12 prenatal care visit (p-trend = 0.07). Rates of
prenatal intention to breastfeed were similar amongst all groups (p = 0.418). Mothers who attended ≥12 prenatal care visits were more likely to breastfeed at discharge when compared to mothers who attended <5 prenatal care visits (94% vs. 67%) (p-trend = 0.036), and were nearly twice as likely to exclusively breastfeed (39% vs. 20%), although the trend was not statistically significant (p = 0.220). Women who were found to have received inadequate care were more likely to intend on formula feeding (p = 0.090), and were less likely to breastfeed at discharge (74%) when compared to those who received adequate care (91%) (p-value 0.063). An exploratory analysis of parity and breastfeeding outcomes was carried out and found that women of higher parity (≥ 3) were more likely to intend on formula feeding when compared to those of lower parity (p-trend 0.040), and while this trend was maintained into feeding at discharge, the statistical significance was not (p-trend = 0.420).
Conclusion: Women who attended a greater number of prenatal care visits demonstrated a significant linear trend towards improved rates of any breastfeeding at discharge when compared to mothers who attended fewer prenatal visits. Women who attended fewer prenatal care visits, those of increased parity (≥ 3) and those found to have received inadequate care were all more likely, prenatally, to intend on formula feeding their infants peri/postnatally. Prenatal care provides a platform for healthcare professionals to provide anticipatory guidance to help promote and support mothers in order to sustain breastfeeding practices in the perinatal and postpartum period.
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Keywords
Prenatal Care, Breastfeeding