Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sarah N. Taylor

Abstract

Background: Chronic disease in pregnancy, including hypertensive disease, diabetes, and mental health disorders, is associated with adverse mother and infant health outcomes. Breastfeeding offers well-documented benefits, but currently, little evidence exists on how maternal chronic disease impacts the duration of breastfeeding postpartum, especially multiple chronic disease diagnoses. Objectives: To examine associations between maternal chronic disease and (1) duration of any breastmilk feeding through six months postpartum, (2) in-hospital infant feeding patterns, and (3) the impact of in-hospital breastmilk exposure on postpartum duration of breastmilk feeding among women with a chronic disease. Methods: This retrospective cohort study analyzed 1,294 maternal-infant records from full-term births at a single hospital (Sept 2021–Apr 2023), with pediatric and postpartum follow-up at a federally qualified health center. Infants with prolonged hospitalization (>7 days), death before six months, or required parenteral nutrition were excluded. Cox proportional hazard and Poisson models were used to address the study aims, adjusting for confounders. Results: Any chronic disease (adj HR = 1.66, 95%CI [1.33-2.07]), hypertensive disease (HR = 1.34, 95%CI [1.08-1.67]), mental health disorder (HR = 1.70, 95% CI [1.39-2.08]), and multiple diagnoses (HR = 1.27, 95% CI [0.98-1.63]) were associated with earlier cessation of postpartum breastmilk feeding. These diagnoses were also associated with lower in-hospital breastmilk feeding rates (e.g., any chronic disease adj RR = 0.97, 95%CI [0.94-1.00]) and higher formula feeding. Exclusive breastfeeding at discharge was linked to prolonged breastmilk feeding postpartum in all groups except those with diabetes (e.g., any chronic disease adj HR = 0.48, 95%CI [0.36-0.64]). Conclusions: Maternal chronic disease was associated with a shorter duration of breastmilk feeding and reduced exclusive breastfeeding. In-hospital breastmilk exposure improved postpartum duration. Future research is needed to understand better the factors contributing to early cessation of breastfeeding in this population.

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This is an Open Access Thesis.

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