The role of personality and other factors in a mother's decision to initiate breastfeeding

Five-factor model personality traits, exclusive breastfeeding, and self-efficacy: a mediational analysis

BACKGROUND

Despite the World Health Organization's (WHO) emphasis on exclusive breastfeeding, the documents show a declining trend worldwide. Studies assert that the mother's personality traits appear to have an impact on this issue. This study aimed to investigate the potential influence of personality traits on exclusive breastfeeding, which might be channeled by self-efficacy as a mediator variable.

METHODS

Data were analyzed from the cross-sectional study. The exclusive breastfeeding scale, the breastfeeding self-efficacy questionnaire, and the Five-Factor Model questionnaire (as follows: neuroticism, extraversion, openness experience, agreeableness, and conscientiousness) were completed by120 Iranian volunteer mothers with an infant aged 6-12 months referred to health centers in Shiraz (a major city in southern Iran) between May to December 2019. The structural equation modeling (SEM) approach was used to obtain the direct and indirect effects of personality traits and self-efficacy on exclusive breastfeeding.

RESULTS

The study showed the significant direct effect of some personality traits (agreeableness, extraversion, and consciousness) and self-efficacy on exclusive breastfeeding. The indirect effect of extraversion on exclusive breastfeeding through self-efficacy was also obtained from the result of SEM analysis. The model fit the data satisfactorily, according to the fit indices criteria extracted from the mediational analysis.

CONCLUSIONS

Self-efficacy appears to be a significant predictor of exclusive breastfeeding. Therefore, exclusive breastfeeding could be enhanced by safe education in pregnancy, reinforcing the self-efficacy of pregnant women and considering their personality traits.

A repeated cross-sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement

Despite a number of public health and policy-based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid-West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross-sectional study analysed breastfeeding initiation trends in the Mid-West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose '10 Priorities' to increase the breastfeeding initiation rates in Ireland.

Examining exclusive breastfeeding in Iranian mothers using the five-factor model of personality traits

Objectives

The initiation of exclusive breastfeeding and its continuation plays a vital role in maternal and child health. This study investigates the prediction of exclusive breastfeeding in Iranian mothers using the five-factor model.

Methods

A descriptive correlational study was conducted using cluster random sampling. and 120 mothers with children aged 6 to 12 months, referred to health centres of Shiraz University of Medical Sciences in Valfagr and Enghelab in Iran, participated in this cross-sectional study. The participants were requested to fill 3 questionnaire containing demographic questionnaire, the exclusive breastfeeding scale, and the Big Five factors (BFF) questionnaire of personality traits. The data were collected between May and December 2019 and analysed using Pearson's correlation coefficient and multiple regression.

Results

The results showed that the agreeableness trait had the highest score (mean score = 16.13, SD = 2.10) and the neuroticism trait had the lowest score (mean score = 12.13, SD = 2.68). The main results indicated a significant relationship between the extraversion trait and exclusive breastfeeding (r = 0.36, p < 0.01). In the regression analysis, the results were indicative of the positive prediction of exclusive breastfeeding for the extraversion (p < 0.01, β = 0.43) and the conscientiousness traits (p < 0.05, β = 0.18).

Conclusions

Personality traits may potentially affect exclusive breastfeeding and could be a useful tool in reducing impediments to exclusive breastfeeding and in identifying mothers who need more mental support.

An investigation of the relationship between mother's personality traits, breastfeeding self-efficacy, and perception of insufficient milk supply

The researchers planned this study as a descriptive-correlational study to determine the relationship between mothers' personality traits, breastfeeding self-efficacy, and perception of insufficient milk supply. This descriptive, cross-sectional, and analytical study involved 429 mothers in Turkey's Sakarya province who applied to a training and research hospital between February-June 2020. It was found that self-control and openness to development affected breastfeeding self-efficacy positively, while neuroticism affected breastfeeding self-efficacy negatively (p < 0.05). Breastfeeding self-efficacy had a significant negative effect on the perception of insufficient milk supply (p < 0.001). Breastfeeding self-efficacy is an important determinant of the amount of milk perceived by mothers.

The Safety of Mother's Milk® Tea: Results of a Randomized Double-Blind, Controlled Study in Fully Breastfeeding Mothers and Their Infants

BACKGROUND

Various natural products are reported to improve maternal milk supply yet are not necessarily safe for infants. Researchers have not systematically studied galactagogue teas for safety.

RESEARCH AIM

This study evaluates the safety of a galactagogue tea in breastfeeding women and their infants, assessing short- and long-term adverse effects.

METHODS

Healthy, exclusively/fully breastfeeding women ( N = 60) with no milk insufficiency were randomized into (1) an all-natural tea containing fruits of bitter fennel, anise, and coriander; fenugreek seed; and other herbs (Mother's Milk^® herbal tea; test) group or (2) a lemon verbena leaf (placebo) group. Maternal diaries captured self-reported maternal and infant adverse effects, tea consumed, and perceived infant satisfaction. Maternal quality of life and psychological state were assessed at baseline and 2 and 4 weeks. Poststudy calls assessed adverse effects through the infants' age of 12 months.

RESULTS

No adverse effects attributable to the interventions were reported at any time point. No differences were found between test and placebo groups in sociodemographic characteristics, maternal or infant adverse symptoms, quality of life, breastfeeding self-efficacy, maternal psychological measures, infant growth, and infant satisfaction (all p >.05).

CONCLUSIONS

This double-blind, randomized controlled trial (RCT) of an herbal galactagogue versus placebo among healthy, exclusively/fully breastfeeding mothers and infants found no adverse events associated with the test tea across the 30-day study or the first year of their infant's life. This composite tea appears to present no safety risk for mothers or their young babies.

Personality Traits Predict Meeting the WHO Recommendation of 6 Months' Breastfeeding: A Prospective General Population Cohort Study

BACKGROUND

Although personality as well as anxiety and depression are recognized as predictors for breastfeeding initiation, evidence of an association of these factors with 6 months' exclusive breastfeeding as recommended by the World Health Organization (WHO) is sparse.

PURPOSE

The purpose of this study was to investigate the associations of personality and symptoms of anxiety and depression during and after pregnancy with meeting the WHO recommendation of 6 months' exclusive breastfeeding.

METHODS

In their first trimester of pregnancy, 5784 pregnant women were enrolled in Dutch primary obstetric care centers and hospitals, of which 2927 completed the breastfeeding assessments 6 months postpartum. We performed logistic regression analyses to test the associations of "big five" personality traits (NEO Five Factor Inventory), anxiety (State-Trait Anxiety Inventory), and depression (Edinburgh Postnatal Depression Scale) symptom levels during pregnancy and postpartum with meeting the WHO recommendation of 6 months' exclusive breastfeeding.

RESULTS

Agreeableness (odds ratio [OR] = 1.18, P = .006) and openness (OR = 1.31, P < .001) were positively associated with meeting the WHO recommendation, whereas extraversion (OR = 0.83, P = .005) and neuroticism (OR = 1.18, P = .006) were negatively associated. After adjustment for both antenatal and postpartum symptom levels of anxiety and depression, the associations of the agreeableness, extraversion, and openness personality traits remained strong and statistically significant (P < .05).

IMPLICATIONS FOR PRACTICE

Patient-centered care should take personality into account in an effort to tailor interventions to optimize breastfeeding behavior.

IMPLICATIONS FOR RESEARCH

In contrast to earlier findings, personality traits may be of greater importance than symptoms of anxiety and depression for meeting the WHO recommendation of 6 months' exclusive breastfeeding.

Maternal Personality and Psychosocial Variables Associated with Initiation Compared to Maintenance of Breastfeeding: A Study in Low Obstetric Risk Women

INTRODUCTION

The benefits of breastfeeding are well known for mother and child. Research about the predictive factors related to the initiation and maintenance of breastfeeding is of great interest to public health.

AIM

To analyze the factors associated with the timely initiation of breastfeeding at immediate postpartum and the variables that facilitate their maintenance 4 months after birth.

MATERIALS AND METHODS

A longitudinal prospective design was used, including four stages: first trimester of pregnancy (personality), third trimester (childbirth expectations, breastfeeding intention, pregnancy worries, and coping strategies), immediately after childbirth (initiation of breastfeeding and childbirth satisfaction), and 4 months after birth (continuation of breastfeeding).

RESULTS

A sample of 116 women took part in the study from the first trimester to 4 months after birth. Timely initiation of breastfeeding is associated with vaginal birth (p < 0.000) and with variables related to the absence of stress factors: fewer worries regarding childbirth (p = 0.009), higher satisfaction during birth in relation to holding the baby (p > 0.000), and the meeting of expectations (p = 0.017). These associations disappear when the type of birth is introduced. Maintenance of breastfeeding is associated with maternal personality and psychosocial variables: openness to experience (p = 0.007), increased worries about coping with the baby (p = 0.046), relationship with partner (p = 0.047), and overt emotional expression (p = 0.040).

CONCLUSION

Different factors are associated with initiation and maintenance of breastfeeding. Specific prevention strategies are needed, aimed toward health care staff for improving breastfeeding initiation and to empower women during the entire pregnancy for breastfeeding maintenance.

Intensive Parenting: Fertility and Breastfeeding Duration in the United States

Using 30 years of longitudinal data from a nationally representative cohort of women, we study the association between breastfeeding duration and completed fertility, fertility expectations, and birth spacing. We find that women who breastfeed their first child for five months or longer are a distinct group. They have more children overall and higher odds of having three or more children rather than two, compared with women who breastfeed for shorter durations or not at all. Expected fertility is associated with initiating breastfeeding but not with how long mothers breastfeed. Thus, women who breastfeed longer do not differ significantly from other breastfeeding women in their early fertility expectations. Rather, across the life course, these women achieve and even exceed their earlier fertility expectations. Women who breastfeed for shorter durations (1–21 weeks) are more likely to fall short of their expected fertility than to achieve or exceed their expectations, and they are significantly less likely than women who breastfeed for longer durations (≥22 weeks) to exceed their expected fertility. In contrast, women who breastfeed longer are as likely to exceed as to achieve their earlier expectations, and the difference between their probability of falling short versus exceeding their fertility expectations is relatively small and at the boundary of statistical significance (p = .096). These differences in fertility are not explained by differences in personal and family resources, including family income or labor market attachment. Our findings suggest that breastfeeding duration may serve as a proxy for identifying a distinct approach to parenting. Women who breastfeed longer have reproductive patterns quite different than their socioeconomic position would predict. They both have more children and invest more time in those children.

The Influence of Maternal Personality and Risk Factors for Impaired Mother-Infant Bonding on Breastfeeding Duration

INTRODUCTION

Throughout the world, in delivery departments having the accreditation "Baby-Friendly Hospital," breastfeeding is encouraged upon delivery. Numerous studies have been carried out to assess the relationship between breastfeeding and socioeconomic, psychosocial, and perinatal factors.

AIM

To explore the influence of maternal personality and mother-infant bonding impairment on breastfeeding duration according to the World Health Organization (WHO) recommendations.

METHODS

Written informed consent was obtained from mothers whose children were patients in a primary pediatric practice in Croatia. The mothers had stopped breastfeeding, and 303 of them were included in the research. The study was performed using validated instruments for the assessment of personality traits and mother-infant bonding impairment risk factors. Structured questionnaires were used for the examination of basic sociodemographics, breastfeeding duration, and the most common and relevant perinatal factors.

RESULTS

Significant positive correlations were found with the personality traits of "openness" and "agreeableness" (p = 0.008, p = 0.002), while "neuroticism" was significantly negatively correlated with breastfeeding duration (p = 0.047). Twin pregnancy was the only perinatal factor influencing the discontinuation of breastfeeding before the end of the 6-month period (p < 0.001). In regression analysis, "anxiety about care" as a bonding impairment remained the most important risk factor influencing the minimally recommended breastfeeding duration (odds ratio [OR] 0.78; 95% confidence interval, 0.65 - 0.94).

CONCLUSION

It is important to conduct further studies to explore whether the early identification of at-risk mothers, and the availability of psychological support in the immediate postpartum period, would allow them to benefit from these interventions and, thus, address breastfeeding duration.

The Relation of Pre and Postnatal Depression and Anxiety with Exclusive Breastfeeding

Introduction

Studies on the relationship between prenatal psychosocial risk factors and breastfeeding are disjointed. Maternal health status has a great influence on breastfeeding, growth, and general health of the neonates. The aim of this study was to ascertain the relation between maternal mental health and breastfeeding status of mothers in Kazerun (Fars province, Iran).

Methods

This cross-sectional study was conducted on a total of 92 pregnant women recruited from clinics in Kazerun in 2015. Participants were divided into two groups subject to exclusive breastfeeding. Spielberger Anxiety Inventory, Beck Depression Inventory and Edinburgh Postnatal Depression Scale (EPDS) were used for data collection. Data analysis was performed by the SPSS version 16 using descriptive statistics, Chi-square, and Fisher’s exact test.

Results

The average of state anxiety score according to Spielberger Anxiety Inventory was 1.97±0.51 in the exclusive breastfeeding group versus 1.77±0.66 in the non-exclusive breastfeeding group (p = 0.229). The mean trait anxiety score according to Spielberger Anxiety Inventory was 1.98±0.44 in the exclusive breastfeeding group versus 2.22±0.44 in the non-exclusive breastfeeding group (p=0.132). An average of Beck Depression Inventory score was 1.35±0.84 totally (1.33±0.81 in the exclusive breastfeeding group vs. 1.33±1.00, P=0.584). An average of EPDS score was 1.65±1.11, 1.64±1.11, and 1.44±0.88 in total, in the exclusive breastfeeding and non-exclusive breastfeeding groups, respectively (p=0.604).

Conclusions

Screening anxiety and depression before and during pregnancy appeared to be necessary.

Breastfeeding and maternal sensitivity predict early infant temperament

AIM

Research findings are inconclusive when it comes to whether breastfeeding is associated with the mother-infant relationship or infant temperament. We examined the association between breastfeeding at three months postpartum and infant temperament at 18 months postpartum and whether this link was affected by the mothers' anxiety and mediated by her sensitivity.

METHODS

We assessed 170 mothers for breastfeeding and anxiety using the Spielberger State-Trait Anxiety Inventory (STAI) at three months postpartum, maternal sensitivity using the Ainsworth Sensitivity Scale at six months postpartum and infant temperament using the Early Childhood Behaviour Questionnaire at 18 months postpartum.

RESULTS

Mothers who breastfed at three months postpartum were more sensitive in their interactions with their infants at six months postpartum, and elevated sensitivity, in turn, predicted reduced levels of negative affectivity in infant temperament at 18 months postpartum. This indirect mediation persisted after controlling for confounders (effect ab = -0.0312 [0.0208], 95% CI = -0.0884 to -0.0031). A subsequent analysis showed that the mediation through sensitivity only occurred in women experiencing higher anxiety, with a STAI score ≥33.56 at three months (ab = -0.0250 [0.0179], 95% CI = -0.0759 to -0.0013).

CONCLUSION

Our results suggest that breastfeeding and maternal sensitivity may have a positive impact on the early development of infant temperament.

A twin study of breastfeeding with a preliminary genome-wide association scan

Breastfeeding has been an important survival trait during human history, though it has long been recognized that individuals differ in their exact breastfeeding behavior. Here our aims were, first, to explore to what extent genetic and environmental influences contributed to the individual differences in breastfeeding behavior; second, to detect possible genetic variants related to breastfeeding; and lastly, to test if the genetic variants associated with breastfeeding have been previously found to be related with breast size. Data were collected from a large community-based cohort of Australian twins, with 3,364 women participating in the twin modelling analyses and 1,521 of them included in the genome-wide association study (GWAS). Monozygotic (MZ) twin correlations (r MZ = 0.52, 95% CI 0.46-0.57) were larger than dizygotic (DZ) twin correlations (r DZ = 0.35, 95% CI 0.25-0.43) and the best-fitting model was the one composed by additive genetics and unique environmental factors, explaining 53% and 47% of the variance in breastfeeding behavior, respectively. No breastfeeding-related genetic variants reached genome-wide significance. The polygenic risk score analyses showed no significant results, suggesting breast size does not influence breastfeeding. This study confers a replication of a previous one exploring the sources of variance of breastfeeding and, to our knowledge, is the first one to conduct a GWAS on breastfeeding and look at the overlap with variants for breast size.

Gender, health, and initiation of breastfeeding

The aim of this study was to explore the associations of health, gender, and motherhood with the decisions about breastfeeding. The sample consisted of 265 pregnant women (mean age: 32.34, SD: 4.01 years) who were recruited in healthcare centers and hospitals in southeast Spain between 2010 and 2011. Mental health was measured by the 12-Item General Health Questionnaire and gender by the Conformity to Feminine Norms Inventory. Women in our sample showed a higher conformity to gender norms than women surveyed in the adaptation of the inventory to the Spanish population (t = 11.25, p < 0.001, effect estimate (Cohen's d) = 0.59). After adjustment for covariates, women who exclusively breastfed did not differ significantly in their conformity to gender norms from those who used partial breastfeeding or bottle feeding. Although good, our expectant mothers had worse mental health than the women aged 15-44 years in the Spanish National Health Survey (t = 2.96, p < 0.001, d = 0.26). Those who partially breastfed had significantly better mental health values. Gender norms were modulators in a model of factors related to initiation of breastfeeding. This study provides information about health and social construction of gender norms.

The association of postpartum maternal mental health with breastfeeding status of mothers: a case-control study

Background:

Maternal health status might have an important effect on breastfeeding, growth, and general health of the infants.

Objectives:

This study was conducted to assess the association between maternal mental health and breastfeeding status of mothers in Kashan province.

Patients and Methods:

This case-control study was conducted on 458 mothers in two groups of unsuccessful breastfeeding (case) and successful breastfeeding (control) attending Kashan province health clinics. In this study, the GHQ questionnaire and clinical interview were employed to collect data. The data were statistically analyzed using Chi-square and Fisher’s exact tests.

Results:

It was found that mothers of the case group had a greater susceptibility to depression than those of the control group, that is, breastfeeding status was directly associated with susceptibility to depression (P = 0.001, OR = 5.48). Furthermore, there was a significant association between basic characteristics such as maternal occupational status (P = 0.04) or their educations (P = 0.006) with breastfeeding. Besides, clinical interview revealed that mixed depression and anxiety disorder was the most prevalent type of psychological disorder in the case group.

Conclusions:

Screening depression during pregnancy and postpartum period appeared to be necessary and it should be incorporated into prenatal and postnatal care due to its influence on mothers’ successful breastfeeding.

Heritability of initiation and duration of breastfeeding behavior

Breastfeeding is considered the best and most natural way of feeding infants during the first months of life. Breastfeeding has multiple short- and long-term benefits for the health of the mother and babies, and from an evolutionist standpoint, it would be a behavior worth preserving throughout time. The aim of the present study was to explore the relative influence of genetic and environmental factors in this behavior. Three hundred and ninety pairs of adult female twins provided information about whether they breastfed their children and for how long. Three variables were analyzed: initiation and duration for the first baby, and mean duration for the complete offspring. Polychoric correlations were consistently higher for monozygotic twins, supporting a role for genetic factors (0.50 [corrected] vs. 0.22 for initiation; 0.44 vs. 0.22 for duration in the first newborn; and 0.52 vs. 0.31 for duration on average). Model-fitting analyses found that in the best-fitting model, variance was explained by additive genetic and non-shared environmental factors, with estimated heritabilities ranging from 0.44 to 0.54 [corrected] in the measures studied. The rest of the variance would be due to unique environmental factors. We conclude that genetic factors have a significant impact on the complex behavior of breastfeeding.

A Household Study of Self-Regulation in Children

Delay of gratification (DoG) and delay discounting (DD) are behavioral measures of self-regulation and impulsivity. Whereas DoG refers to the postponement of gratification, DD involves the devaluation of a reward over time. Previous studies have demonstrated associations between paternal self-control, paternal personality traits, parenting styles, maternal intelligence, and children’s self-regulation. The present study explored intergenerational links between mothers’ and child’s self-regulation and maternal antecedents of children’s DoG. We analyzed 267 mother-child dyads in the German Socio-Economic Panel (SOEP) Children’s Study. Measures included an experiment using gummy bears as rewards to assess DoG in children and monetary choice procedures to assess DD in mothers. Additionally, cognitive abilities and personality traits of mothers and children were assessed. The main result was that the children’s age and breastfeeding were significant predictors of DoG in children, even when we controlled for other influences such as maternal cognitive abilities and personality traits. We explain the result in the context of previous findings concerning attachment security, bonding, maternal sensitivity, children’s self-regulation of energy intake, neuroscientific evidence, and breastfeeding. Further studies should use equivalent measures of DoG in children and parents to further explore this link between breastfeeding and DoG in a genetically sensitive design.

Do breastfeeding intentions of pregnant inner-city teens and adult women differ?

OBJECTIVE

This study compared the breastfeeding intentions and attitudes of pregnant low-income inner-city teens (age ≤19 years) and non-teens (age ≥20) to determine if age is a significant determinant of intent to breastfeed in this population.

PATIENTS AND METHODS

We used structured interviews to examine the feeding intentions and attitudes of consecutive healthy pregnant women receiving obstetrical care at the Women's Health Center, MacDonald Women's Hospital, Cleveland, OH (June 1-July 31, 2007). The primary outcome measure was rate of intent to breastfeed among teen versus non-teen participants. Attitudes and self-assessed knowledge regarding breastfeeding were compared between teens and non-teens, and multiple logistic regression analysis was used to examine the effect of age on breastfeeding intent.

RESULTS

We interviewed 176 pregnant women (95% African-American, 94% single marital status, median age 22 years [range, 15-41 years], 46 [26%] teens) at a median of 27 weeks of pregnancy. There were no significant differences between teens and non-teens in race, marital status, or timing of first prenatal visit or interview. Rate of intent to breastfeed and planned duration and exclusivity of breastfeeding, as well as most measured attitudes about breastfeeding including "back to work" plans, were not significantly different between groups. Significant determinants of feeding intent included primiparity, good self-assessed knowledge about breastfeeding, and having support from the father of the baby.

CONCLUSIONS

In a population at high risk for choosing not to breastfeed, we found no significant explanatory effect of age on breastfeeding intention, implying that an inclusive targeted breastfeeding intervention program may be effective for both teens and non-teens in a low-income inner-city population. We also found that the support of the father of the baby significantly influenced breastfeeding intent among our participants, suggesting that paternal involvement will be integral to the success of breastfeeding.

Personality and illness: genetic connections?

Illness is strongly influenced by genetics. Personality traits are influenced by genetics and have linkages with, at least, affective illness. Because genetics influences both personality and illness, we studied by literature review the genes that illness and personality traits share and, by office assessment, our patient population's illnesses and personality traits. This led to the following hypothesis: illness is related to more Submissive than Dominant personality trait and thus to lower norepinephrine activity. Patient affect and personality are often noted to be subdued in chronic illness, but whether from cause or effect is difficult to determine. After reviewing the literature on wellness, personality and genes, we endeavored to explore and better delineate our impressions of illness and personality relationships and to set the stage for a genetic hypothesis by using an online personality test in an ob-gyn practice to determine which traits could be used as proxies for personality trait genes. We thus confirmed our clinical impression that women with psychiatric and/or medical illness have more Submissive personality. The medical literature on gene markers shared by Submissive personality and illness in our population suggests the hypothesis that this relationship could be mediated by genetically lower neurotransmitter activity. Both norepinephrine activity and monoamine oxidase A, the enzyme controlling its catabolism, are in concert to blunt neuronal activity in such diverse states as depression, asthma, obesity, autoimmune illness, and in smokers. Conversely, norepinephrine activity is enhanced in breastfeeders and in other settings known to be related to good health. A point for possible divergence from the hypothesis is that African-Americans have enhanced norepinephrine activity yet poorer health outcomes although the effect of environmental risk factors in African-Americans is considered prominent by researchers. The possible importance of this hypothesis is that it changes emphasis slightly from one of splitting diagnoses to one of grouping them to achieve fresh insight. If we assess what is found in common in diverse illnesses of mind and body, we have yet another tool to assess causation. Although this hypothesis is offered somewhat in a boldness of spirit to take a new look at our many perplexing clinical problems, it is also offered with humility in light of the complexity with which we deal in patient care.

Mothers' negative affectivity during pregnancy and food choices for their infants

OBJECTIVE

The objective of this study was to analyze whether maternal negative affectivity assessed in pregnancy is related with subsequent infant food choices.

DESIGN

The study design was a cohort study.

SUBJECTS

The subjects were mothers (N=37 919) and their infants participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health.

MEASUREMENTS

Maternal negative affectivity assessed prepartum (Hopkins Symptom Checklist 5 (SCL-5) at weeks 17 and 30 of pregnancy), introduction of solid foods by month 3 and feeding of sweet drinks by month 6 (by the reports of the mothers) were analyzed.

RESULTS

Mothers with higher negative affectivity were 64% more likely (95% confidence interval 1.5-1.8) to feed sweet drinks by month 6, and 79% more likely (95% confidence interval 1.6-2.0) to introduce solid foods by month 3. These odds decreased to 41 and 30%, respectively, after adjusting for mother's age, body mass index (BMI) and education.

CONCLUSION

The maternal trait of negative affectivity is an independent predictor of infant feeding practices that may be related with childhood weight gain, overweight and obesity.

What do pregnant low-income women say about breastfeeding?

BACKGROUND

Although low socioeconomic status and African-American race have been shown to be risk factors for low rates of breastfeeding, maternal reasons for selection of infant feeding method are not well understood in these populations.

METHODS

Healthy women > or =15 years of age receiving routine obstetrical care from nurses and nurse midwives at the outpatient clinic of MacDonald Women's Hospital, Case Medical Center, Cleveland, OH were surveyed using a questionnaire interview including Likert-scaled and open-ended questions. All responses to the six open-ended queries were transcribed. Content analysis was used to categorize these responses into three to seven descriptive themes for each question. The authors and two other clinically experienced reviewers participated in theme development, which involved categorization by individual reviewers and then by the group; a full consensus was achieved at each stage. University Hospitals Institutional Review Board approved the study.

RESULTS

Of 186 eligible women, 179 (96%) consented, and 176 (95%) were interviewed. Median age was 22 years (range, 15-41 years), 68 (41%) had greater than a high school education, 167 (95%) were African-American, 167 (non-identical 95%) were unmarried, and 87 (49%) were multiparous. When interviewees were asked, "What is the biggest reason you want to breastfeed?," responses included maternal reasons, infant-related reasons, and advice of others. When women were asked, "What would stop you from breastfeeding?," responses included lifestyle reasons, pain-related reasons, lactation process issues, hypothetical medical reasons, and maternal reluctance.

CONCLUSIONS

Expectant low-income African-American inner-city women appear well informed about the benefits of breastfeeding. Obstacles to breastfeeding that may be susceptible to intervention include fear of pain, lifestyle issues, and lactation process concerns. "I want to breastfeed because I don't want to get up in the middle of the night." "I wouldn't breastfeed if it hurt." "He [the father of my baby] does not want me to breastfeed because the baby might want to suck on his nipples."

Exploring the influence of psychological factors on breastfeeding duration, phase 1: perceptions of mothers and clinicians

Breastfeeding duration rates in Australia are low, prompting a search for modifiable factors capable of increasing the duration of breastfeeding. In this study, participants were asked which psychological factors they believed influence breastfeeding duration. Participants included 3 groups of mothers who had breastfed for varied lengths of time (n = 17), and 1 group of breastfeeding clinicians (n = 4). The nominal group technique was employed, involving a structured group meeting progressing through several steps. Analyses included collation of individual and group responses, group comparisons, and a thematic analysis of group discussions. Forty-five psychological factors thought to influence the duration of breastfeeding were identified. Factors considered most important included the mother's priorities and mothering self-efficacy, faith in breast milk, adaptability, stress, and breastfeeding self-efficacy. In addition to informing the design of phase 2 of this study, these results add to our knowledge of this emerging research area.

The influence of psychological factors on breastfeeding duration

AIM

This paper reports on a study examining the relationship between women's psychological characteristics and breastfeeding duration, after controlling for socio-demographic factors.

BACKGROUND

The literature suggests that psychological factors may influence breastfeeding behaviour, but studies are few. Existing evidence and the results of phase 1 of our study were used to construct a list of psychological factors, which were tested for their association with breastfeeding duration in the current design.

METHOD

Participants were postnatal inpatients in one of two regional hospitals between October and December 2005 and they completed the initial questionnaire within 14 days of giving birth (n = 375). Infant feeding method at 6 months and the timing of introduction of other food(s), where relevant, were ascertained by telephone interview.

FINDINGS

Forty-four per cent of the sample showed signs of postnatal distress in the 14 days following the birth. Breastfeeding duration was statistically significantly associated with psychological factors including dispositional optimism, breastfeeding self-efficacy, faith in breastmilk, breastfeeding expectations, anxiety, planned duration of breastfeeding and the time of the infant feeding decision. As a set, these psychological factors were more predictive of breastfeeding duration than was the set of socio-demographic characteristics. The duration of any breastfeeding was uniquely predicted by faith in breastmilk, planned breastfeeding duration and breastfeeding self-efficacy.

CONCLUSION

This increased knowledge of the factors influencing breastfeeding will assist in identifying women at risk of early weaning and in constructing programmes capable of increasing the length of time for which women breastfeed.

Maternal self-concept and breastfeeding

To test the hypothesis that mothers with high self-concept will be more likely to breastfeed their infants than those with lower self-concept, 2 cohorts of mothers of term newborns were assessed by different forms of the Tennessee Self-Concept Scale. In study 1, mothers exclusively breastfeeding at 1 month postpartum had significantly higher self-concept than those exclusively formula feeding. In study 2, exclusively breastfeeding mothers had higher scores for total self-concept compared with those exclusively formula feeding. Exclusively breastfeeding mothers also scored higher on several individual dimensions of self-concept, notably those reflecting self-satisfaction, behavior, moral worth, value as a family member, and physical appearance. Mothers partially breastfeeding had intermediate levels of self-concept in both studies. Even after controlling for demographic and social factors and for breastfeeding initiation in regression analyses, self-concept remained significantly associated with exclusive breastfeeding in both studies. Thus, compared with mothers who exclusively formula feed their infants, exclusively breastfeeding mothers have higher levels of self concept.

The impact of maternal negative affectivity and general self-efficacy on breastfeeding: the Norwegian Mother and Child Cohort Study

OBJECTIVE

To assess the degree to which mothers' prepartum personality traits predict breastfeeding status at 6 months postpartum.

STUDY DESIGN

This prospective cohort study is part of the Norwegian Mother and Child Cohort Study, conducted at the Norwegian Institute of Public Health. A total of 27,753 mothers completed assessment of negative affectivity (NA) and general self-efficacy (GSE) at gestation weeks 17 and 30 and completed a questionnaire about infant feeding at 6 months postpartum. Feeding status was classified with a cutoff at 6 months in the categories of predominant breastfeeding, mixed breastfeeding, and bottle-feeding.

RESULTS

After adjusting for maternal smoking, age, education, cesarean section, preterm birth, primiparity, and external daycare, NA increased the odds of mixed breastfeeding (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.03 to 1.32) and bottle feeding (OR, 1.32; 95% CI, 1.14 to 1.53) compared with predominant breastfeeding. GSE decreased the odds of bottle feeding (OR, 0.90; 95% CI, 0.84 to 0.97) but not of mixed breastfeeding (OR, 0.98; 95% CI, 0.92 to 1.04) compared with predominant breastfeeding. The adjusting variables were also predictors of breastfeeding behavior in their own right.

CONCLUSIONS

Our results show that NA and GSE are important antenatal predictors of breastfeeding status at 6 months postpartum.

Characterization of human milk donors

The primary objective of this research was to create a detailed characterization of human milk donors, including descriptive information about demographics and lifestyle, involvement with the milk bank, reasons for donating, problems encountered while breastfeeding and pumping milk, barriers to donating milk, affective experiences, and personal values. Data were collected via telephone interview of 87 donors and 19 nondonor controls. Few relationships were found between the descriptive information and amount of milk donated. Donors reported fewer problems pumping milk than nondonors. Strategies for recruiting new donors and strategies for increasing donation amounts are presented.