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Q&A

Clinical Obstetrics

Poster Session 3

(670) Peripartum factors associated with breastfeeding after cesarean birth

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Anna Palatnik, MD

    Medical College of Wisconsin
    Milwaukee, WI, United States

Objective: Cesarean birth has been associated with lower rates of breastfeeding (BF) initiation, yet it is unknown what specific peripartum clinical factors are associated with likelihood of BF following a cesarean. Our objective was to analyze a large prospective and diverse contemporary cohort of cesarean births in the US and identify what factors among patients who had a cesarean are associated with lower rates of BF initiation. We hypothesized that perioperative anemia and postpartum hemorrhage (PPH) will be positively associated, and that receipt of tranexamic acid (TXA) will not be associated with BF initiation following cesarean birth.

Study Design: Secondary analysis of participants with BF data who were enrolled in a randomized trial of tranexamic acid for prevention of postpartum hemorrhage at the time of cesarean. Those who experienced neonatal death within 24 hours of birth, delivery < 34 weeks, or had multifetal gestations were excluded. The primary exposures included third-trimester anemia (hemoglobin < 10g/dL), PPH (defined as estimated blood loss at >1L or receipt of packed RBCs intraoperatively), and receipt of TXA as the study drug. Multivariable logistic regression was performed adjusting for baseline maternal covariates and available social determinants of health.

Results:

Of 10,293 participants included in this analysis, 8119 (78.9%) initiated BF in the hospital. Those who did were older, more likely to be nulliparous, married, of White race, Hispanic ethnicity, and privately insured (p< 0.001 for all). Among those with third trimester anemia (n=915), the rate of starting BF in the hospital was 66.7% versus 80.1% among those without anemia (n=9371). In multivariable modeling, third-trimester anemia was associated with lower frequency of BF initiation (adjusted OR 0.68, 95% CI 0.58-0.80). Receipt of TXA and PPH were not (Table).

Conclusion:

Third-trimester anemia, a modifiable risk factor, was associated with 32% lower odds of BF initiation after cesarean birth, but PPH and receipt of TXA were not.