The perceptions and experiences of women with a body mass index ≥ 30 kg m2 who breastfeed: A meta-synthesis

Is Maternal Body Weight or Composition Associated with Onset of Lactogenesis II, Human Milk Production, or Infant Consumption of Mother's Own Milk? A Systematic Review and Meta-Analysis

Maternal adiposity impacts lactation performance, but the pathways are unclear. We conducted a systematic review to understand whether maternal adiposity (body mass index [BMI] or percentage fat mass) is associated with onset of lactogenesis II (copious milk; hours), human milk production (expressed volume/24 h), and infant consumption of mother's own milk (volume/24 h). We used random-effects standard meta-analyses to compare the relative risk (RR) of delayed lactogenesis II (>72 h) between mothers classified as underweight (BMI <18.5 kg/m2), healthy weight (BMI, 18.5-24.9 kg/m2), and overweight/obese (BMI ≥25 kg/m2) and random-effects meta-regressions to examine associations with hours to lactogenesis II and infant milk consumption. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. We included 122 articles. Mothers with underweight (RR: 0.64; 95% CI: 0.49, 0.83; I2 = 39.48%; 8 articles/data points) or healthy weight status (RR: 0.67; 95% CI: 0.57, 0.79; I2 = 70.91%; 15 articles/data points) were less likely to experience delayed lactogenesis II than mothers with overweight/obesity. We found no association between maternal BMI and time to onset of lactogenesis II (β: 1.45 h; 95% CI: -3.19, 6.09 h; P = 0.52, I2 = 0.00%; 8 articles, 17 data points). Due to limited data, we narratively reviewed articles examining BMI or percentage fat mass and milk production (n = 6); half reported an inverse association and half no association. We found no association between maternal BMI (β: 6.23 mL; 95% CI: -11.26, 23.72 mL; P = 0.48, I2 = 47.23%; 58 articles, 75 data points) or percentage fat mass (β: 7.82 mL; 95% CI: -1.66, 17.29 mL; P = 0.10, I2 = 28.55%; 30 articles, 41 data points) and infant milk consumption. The certainty of evidence for all outcomes was very low. In conclusion, mothers with overweight/obesity may be at risk of delayed lactogenesis II. The available data do not support an association with infant milk consumption, but the included studies do not adequately represent mothers with obesity. This study was registered in PROSPERO as 285344.

Midwives' experiences of discussing health behaviour change within routine maternity care: A qualitative systematic review and meta-synthesis

PROBLEM

Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination non-adherence may lead to adverse pregnancy outcomes.

BACKGROUND

Pregnancy has been identified as an opportune time for midwives to support women to make health behaviour changes.

AIM

To synthesise existing qualitative research exploring midwives' experiences of discussing health behaviour change with women within routine care.

METHODS

A systematic search was conducted across: Maternity and Infant Care, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Thematic analysis was used to synthesise the data. A professional and public advisory group provided feedback during the synthesis stage.

FINDINGS

Twenty-two studies, published between 2005 and 2023, which represented findings from eight countries, were included in the review. The meta-synthesis revealed three themes: The midwife-woman relationship; Reflective and tailored behaviour change communication; Practical barriers to behaviour change conversations. This led to one overarching theme: Although midwives recognised the importance of behaviour change discussions, these conversations were not prioritised in clinical practice.

CONCLUSION

Health behaviour change discussions were de-prioritised in midwives' clinical practice. Future research should explore intervention development to support midwives with their health behaviour change communication.

Meta-ethnography on the Experiences of Women From Around the World Who Exclusively Breastfed Their Full-Term Infants

OBJECTIVE

To synthesize evidence from qualitative studies on the experiences of women from around the world who exclusively breastfed their full-term infants.

DATA SOURCES

CINAHL Plus, PubMed, APA PsycInfo, Scopus, and ProQuest Dissertation & Theses Global.

STUDY SELECTION

We selected reports of qualitative studies that were conducted in high-, middle-, and low-income countries; published between January 2001 and February 2022 in English; and focused on the experiences of women who exclusively breastfed their full-term infants.

DATA EXTRACTION

We extracted the following data from included studies: methodological characteristics (i.e., country of origin, authors' disciplines, research design, sample size, sampling, data collection, and data analysis method), participants' demographics (i.e., age, parity, marital status, education, and exclusive breastfeeding duration) and direct participant quotes, and key concepts and themes about women's experiences of exclusive breastfeeding. We managed and stored extracted data using a Microsoft Excel spreadsheet.

DATA SYNTHESIS

We synthesized reciprocal translations using Noblit and Hare's approach to meta-ethnography. Five overarching themes emerged from the meta-synthesis: Favorable Conditions, Not a Smooth Journey,Support, Determination and Perseverance, and Reflections on Benefits.

CONCLUSION

In the included studies, participants experienced challenges with exclusive breastfeeding; however, they also recounted benefits. We recommend 6-month maternity leave and support from family and health care professionals to improve rates of exclusive breastfeeding.

Exploring Successful Breastfeeding Behaviors Among Women Who Have High Body Mass Indices

BACKGROUND

Women with high body mass indices are at risk of lower breastfeeding rates but the drivers of successful breastfeeding in this population are unclear.

RESEARCH AIM

We aimed to (a) explore the barriers and enablers to breastfeeding among women with high body mass indices and (b) map specific behaviors suitable for intervention across the antenatal to postpartum periods.

METHODS

This was a prospective, cross-sectional qualitative study. We conducted semi-structured interviews with women with high body mass indices who successfully breastfed for 6 months or more (n =20), partners (n = 22), and healthcare professionals (n =19) in Ireland during 2018. Interviews were audio recorded, and transcribed verbatim. Data were inductively coded using reflexive thematic analysis and deductively mapped within the Capability, Opportunity, Motivation-Behavior model.

RESULTS

The three themes developed were knowledge, support, and self-efficacy. Knowledge supported a participant's psychological and physical capability to engage in breastfeeding. Support was related to the social and physical opportunity to enable performance of breastfeeding behaviors. Self-efficacy influenced reflective and automatic motivation to perform breastfeeding behaviors. A multifactorial intervention design is needed to support successful breastfeeding.

CONCLUSION

The barriers and enablers identified for participants with high body mass indices were similar to those for the broader population; however, the physicality and associated social bias of high body mass indices mean that additional support is warranted. Antenatal and postpartum breastfeeding services need a multifaceted, inclusive, and high-quality program to provide the necessary support to women with higher body mass indices.

Exploring psychological factors associated with breastfeeding in women with a BMI ≥ 30 kg/m2

OBJECTIVE

Women with a BMI ≥ 30 kg/m² are less likely to initiate and maintain breastfeeding compared to normal-weight women. Psychological factors have been linked with breastfeeding, but their influence on women with a BMI ≥ 30 kg/m² experiences needs further exploration. The aim of this study was to investigate whether psychological factors are voiced by women with a BMI ≥ 30 kg/m², and how these factors influence their breastfeeding.

DESIGN

A secondary analysis of eighteen semi-structured interviews with women with a BMI ≥ 30 kg/m² who had breastfed.

MAIN OUTCOME MEASURES

Deductive thematic analysis was used to apply a framework of psychological factors to the data, and investigate the extent to which they feature within the women's breastfeeding experiences.

RESULTS

All psychological factors were reported as part of women's experiences. Planning to breastfeed, planning short durations and having high confidence, factual and social knowledge positively influenced initiation and maintenance. Believing in their ability to produce nutritionally adequate and sufficient milk, that breastfeeding would assist weight loss, and that others around them approved of breastfeeding also had a positive impact. Novel relationships between psychological factors were found.

CONCLUSIONS

Psychological factors influence women's breastfeeding experiences. A model of breastfeeding in women with a BMI ≥ 30 kg/m² has been developed, and can inform future intervention development.

The Association Between Covariates, with Emphasis on Maternal Body Mass Index, and Duration of Exclusive and Total Breastfeeding

Objective: The aim of this study was to evaluate the association between possible covariates, with emphasis on maternal body mass index (BMI), on exclusive breastfeeding and on total breastfeeding during the first postnatal year. Design: A longitudinal study encompassing 723 women who were followed during the first postnatal year Methods: Data concerning pregnancy, delivery, neonatal period, and breastfeeding were extracted from respective medical records. Sociodemographic data on the participants were self-reported. The Cox Proportional Hazard Model was used for investigating the effects of different covariates. Results: Compared with women with BMI <25.0, obese women ran a higher risk of ceasing exclusive breastfeeding prematurely (Hazard ratio [HR] = 1.38, p = 0.009). Multiparous women had a lower risk of ceasing the exclusive breastfeeding prematurely, than primiparous women (HR = 0.78, p = 0.009). Concerning exclusive breastfeeding as well as total breastfeeding, the risk of prematurely ceasing the breastfeeding decreased with increasing age (p = 0.028 and p ≤ 0.001, respectively). Median duration of exclusive breastfeeding was shorter among obese women compared with women with BMI <30.0 (3.0 months versus 6.0 months). Corresponding figures for total breastfeeding were 4.0 months versus 8.0 months. Concerning parity and exclusive breastfeeding, there was no difference in median duration between primiparous women and multiparous women (4.0 months), whereas multiparous women had a longer median duration of total breastfeeding, than primiparous women (8.0 months versus 7.0 months). Conclusion: The risk of ceasing exclusive breastfeeding prematurely is high among obese women. This result indicates the need for targeted supportive interventions, individualized according to BMI. With increasing age, the risk of ceasing breastfeeding prematurely decreases, and compared with primiparous women, multiparous women run a lower risk of ceasing exclusive breastfeeding prematurely.

The perceptions and experiences of women with a body mass index ≥ 30 kg m2 who breastfeed: A meta-synthesis

Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance among women with a body mass index (BMI) ≥ 30 kg m² are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature that explored the perceptions and experiences of women with a BMI ≥ 30 kg m² who breastfed. The search identified five eligible papers, and a meta‐ethnographic approach was taken to synthesise the findings. One theme was identified: “weight amplifies breastfeeding difficulties,” revealing that women with a BMI ≥ 30 kg m² experience common breastfeeding difficulties to a greater degree. In particular, women with a BMI ≥ 30 kg m² struggle with the impact of medical intervention, doubt their ability to breastfeed, and need additional support. These findings can inform understanding of breastfeeding models, future research directions, intervention development, and antenatal and post‐natal care for women with a BMI ≥ 30 kg m².