In-hospital formula cuts likelihood of breastfeeding

First-time mothers who use formula supplementation in the hospital are likely to breastfeed for a shorter time, even if their intention is to exclusively breastfeed, according to a new study in The Journal of Pediatrics.

Researchers from University of California – Davis assessed the strength of prenatal breastfeeding intentions among a cohort of expectant mothers and followed infant feeding practices through day 60. They determined predictors, reason, and characteristics of in-hospital formula supplementation, and calculated the intention-adjusted relative risk (ARR) of not fully breastfeeding at days 30 to 60 and ceasing breastfeeding by day 60 associated with the supplementation (n = 393).

During the hospital stay, 210 infants (53%) were fed exclusively through breastfeeding, while 183 (47%) received in-hospital formula supplementation. The most common reasons given by the mothers for the use of formula included: perceived insufficient milk supply (18%), signs of inadequate intake (16%), and poor latch or breastfeeding (14%). The prevalence of not fully breastfeeding in days 30 to 60 was 67.8% vs 36.7% (ARR 1.8, 95% confidence interval [CI], 1.4 – 2.3) for in-hospital formula supplementation vs exclusive breastfeeding, respectively. Prevalence of cessation of breastfeeding by day 60 was 32.8% vs 10.5%, (ARR 2.7, 95% CI, 1.7 – 4.5) in the two groups, respectively. The more formula-supplemented feeds during the maternity stay, the greater the odds of not fully breastfeeding on days 30-60 (P= .003) and of breastfeeding cessation (P = .011).

Investigators concluded that women intending to breastfeed had a 2-fold greater risk of not fully breastfeeding on days 30-60 and a 3-fold risk of breastfeeding cessation by day 60 after exposure to in-hospital formula supplementation, even if they had a strong intention to breastfeed. The researchers said that hospitals should avoid unnecessary in-hospital supplementation and strongly support breastfeeding in the event that in-hospital formula is unavoidable. 

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