1. Factors associated with early cessation of breastfeeding in a multicentre Australian cohort.
Julie Quinlivan1,2,3, Sonia Kua3, Robert Gibson1,
Andrew McPhee1, Maria Makrides1, 4
1Women’s and Children’s Health Research Institute, University of Adelaide, Australia
2University of Notre Dame Australia Institute Health Research, Fremantle, Australia
3Joondalup Health Campus, Joondalup, Australia
4 South Australian Health and Medical Research Institute, Australia

2. Background
WHO and NHMRC (Australia) recommend exclusive breastfeeding of infants for at least 6 months.
>90% of Australian babies are breastfed when discharged from hospital.
By six months rates have dropped to 50%.
ABS. Available:  Brand E et al. J Perinat Educ 2011;20:36-44; Henderson & Redshaw. Child Care Health Dev 2011;37:

3. Benefits of breastfeeding
Maternal benefits:
Short-term benefits
Less postpartum bleeding;
More post partum weight loss;
Longer lactational amenorrhoea (greater intervals between children.)
Long-term benefits
Less ovarian and breast cancer,
Less osteoporosis and hip fracture.
ABS Available:  Brand E et al. J Perinat Educ 2011;20:36-44.; Henderson J, Redshaw M.. Child Care Health Dev 2011;37: ; Gartner LM, Morton J, Lawrence RA et al. Pediatrics 2005;115: ; Horta BL, Victora CG: World Health Organisation; c2013[cited 2013 Jun 15]. Available from:  Anderson JW, Johnstone BM, Remley DT.  Am J Clin Nutr1999;70:

4. Benefits of breastfeeding
Baby benefits:
Short terms benefits:
Protects against infections (bacterial meningitis, GIT, respiratory tract, UTI, Otitis media);
Decreased morbidity from atopic disease (dermatitis, asthma).
Long-term benefits
Reduction in diabetes mellitus, obesity and lymphoma and leukaemia.
ABS Available:  Brand E et al. J Perinat Educ 2011;20:36-44.; Henderson J, Redshaw M.. Child Care Health Dev 2011;37: ; Gartner LM, Morton J, Lawrence RA et al. Pediatrics 2005;115: ; Horta BL, Victora CG: World Health Organisation; c2013[cited 2013 Jun 15]. Available from:  Anderson JW, Johnstone BM, Remley DT.  Am J Clin Nutr1999;70:

5. Study rationale
Early discontinuation of breastfeeding neutralises many of the potential benefits.
A clearer understanding of the factors associated with early cessation of breastfeeding may assist in targeting interventions.

6. Aim
The aim of the present study was to identify factors associated with early cessation of breastfeeding .
(i.e. before six months postpartum).

7. Methods Ethics committee approval.
Subjects were recruited from five Australian perinatal centres in the antenatal period.
A trial coordinator monitored data collection, which was facilitated by a web-based management information system.

8. Methods: Antenatal assessments
Baseline demographic and obstetric characteristics of the mother; and
Assessments of
social support,
depressive symptomatology,
smoking and
alcohol use
were established using validated tools that have been previously utilised in obstetric studies.
Pascoe JM, French J. Fam Med 1990;22: Pascoe JM et al. Fam Med 1988;20: Sokol RJ et al. AmJ Obstet Gynecol 1989;160: Chang G et al. 2005;105: Quinlivan JA et al. J Pediatr Adolesc Gynaecol 2004;17: Pascoe JM et al. Arch Pediatr Adolesc Med 1995;149:

9. Methods: Postnatal assessments
Pregnancy data in respect to
infant gender,
gestational age at birth,
preterm birth and very preterm birth and
birthweight
were abstracted from the hospital medical record.
Boyce P et al. Aust NZ J Psychiatry 1993;27(3):472-6.; Cox JL et al. Br J Psychiatry 1987;150:782-6.

10. Methods: Classification of infant feeding
A research nurse reviewed each study participant six months postpartum.
Based on information supplied, feeding was coded as:
Breastfeeding.
Formula.

11. Methods: Power calculation
Hypothesis: Lower levels of maternal education would be a leading predictor of early discontinuation of breastfeeding.
We predicted that 70% of women who continued to breastfeed would have post secondary education, against a background rate of 60%.
To achieve power of 90% and alpha error of 0.05, a sample size of 496 was required in each group.

12. Methods: Study analysis
Discrete variables analysed using Chi Square tests to generate p-values and Odd Ratio with 95% confidence intervals.
Continuous variables compared using T-tests or Mann Whitney U tests.
Factors significantly associated with early cessation of feeding (p-value <0.1) were included in a multivariate regression model.
Statistical significance was set at 0.05.

13. Results: 2399 women enrolled. 2148 (90%) breastfed
at hospital discharge.
6 months:
877 (41%) breastfed
Partially (N=262; 12%);
Fully (N=615; 29%).
1271 (59%) formula fed.

14. Feeding patterns six months postpartum

15. Results: Maternal factors
Variable
Early cessation (Formula)
Still breastfeeding (Breastfeeding)
P-value
Age
28.0 (5.6)
30.3 (5.3)
<0.0001
Secondary Ed
691 (54.4%)
683 (77.9%)
Further Ed
628 (49.4%)
665 (75.8%)
History depression
335 (26.4%)
184 (21%)
0.004
Pre-pregnancy smoker
509 (40.1%)
161 (18.4%)
Smoking in pregnancy
280 (22.0%)
65 (7.4%)

16. Results: Newborn factors
Variable
Early cessation (Formula)
Still breastfeeding (Breastfeeding)
P-value
Preterm birth
(<37 wks)
90 (7.1%)
36 (4.1%)
0.004
Birthweight (gms)
3399 (571)
3532 (498)
<0.0001

17. Results: Not significant
Antenatal
Gavidity
Parity
Race
Pre-pregnancy or pregnancy alcohol
Postnatal
Infant gender
Maternal depression scores at 6 weeks and 6 months
Social support scores
Return to work

18. Results: Multivariate analysis
Significant variables:
Smoking
before pregnancy.
during pregnancy.
Incomplete secondary education.
No further education.
Preterm birth.
Lower birth weight.

19. Conclusion: Identified factors

20. Future work
Women start breastfeeding but cease before advantages are realized.
Target information to women at risk.
We need to support the ambition to breastfeed.

21. Education is the key