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Abstract：
Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned.
We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts.
We analyzed 5120 singleton pregnancies from mother-child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator.
Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = -0.79 mo, 95% CI: -1.17, -0.40; obese β = -1.75 mo 95% CI: -2.25, -1.25; exclusive: overweight β = -0.30 mo, 95% CI: -0.42, -0.16; obese β = -0.73 mo, 95% CI: -0.90, -0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding.
Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.
We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts.
We analyzed 5120 singleton pregnancies from mother-child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator.
Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = -0.79 mo, 95% CI: -1.17, -0.40; obese β = -1.75 mo 95% CI: -2.25, -1.25; exclusive: overweight β = -0.30 mo, 95% CI: -0.42, -0.16; obese β = -0.73 mo, 95% CI: -0.90, -0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding.
Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.
摘要：
背景：母亲肥胖与较短的母乳喂养时间有关，但对解释这种关联的中介因素知之甚少。重要的是评估不同人群的这些关系，因为母乳喂养是文化模式。
目的：我们在3个文化不同的国际队列中调查了孕前孕妇体重指数（BMI）与母乳喂养结局的关系以及这种关系的潜在中介因素。
方法：我们分析了来自西班牙母子队列的5120例单胎妊娠（INfanciayMedioAmbiente），希腊(Rhea),和美国（Viva计划）。结果变量是任何纯母乳喂养的持续时间。孕妇孕前BMI与母乳喂养相关的先验假设介质是出生体重（BW），母体产前C反应蛋白(CRP),剖宫产,孕妇膳食炎症指数（DII），分娩时的胎龄，和妊娠期糖尿病（GDM）。我们使用校正混杂因素的线性回归估计BMI与母乳喂养持续时间之间的关联。中介分析估计了母亲超重/肥胖对每个中介者母乳喂养的直接和间接影响。
结果：超重和肥胖的女性与正常体重的女性相比，母乳喂养的时间更短（任何：超重β=-0.79个月，95％CI：-1.17，-0.40；肥胖β=-1.75个月95％CI：-2.25，-1.25；排除：超重β=-0.30个月，95%CI：-0.42，-0.16；肥胖β=-0.73个月，95%CI：-0.90，-0.55）。这种关联的显著介质(效应估计的%变化)是较高的CRP(不包括:5.12%),剖宫产（任何：6.54％；排除：7.69％），和更高的DII（任意：6.48%；不包括：7.69%）。GDM,胎龄,和BW不能介导产妇体重状况与母乳喂养之间的关系.
结论：孕前BMI较高与任何纯母乳喂养持续时间较短有关。母体饮食炎症，全身性炎症,交付模式可能是该关联的关键可修改介体。介体的识别为改善母乳喂养结果的干预措施提供了潜在的目标。
目的：我们在3个文化不同的国际队列中调查了孕前孕妇体重指数（BMI）与母乳喂养结局的关系以及这种关系的潜在中介因素。
方法：我们分析了来自西班牙母子队列的5120例单胎妊娠（INfanciayMedioAmbiente），希腊(Rhea),和美国（Viva计划）。结果变量是任何纯母乳喂养的持续时间。孕妇孕前BMI与母乳喂养相关的先验假设介质是出生体重（BW），母体产前C反应蛋白(CRP),剖宫产,孕妇膳食炎症指数（DII），分娩时的胎龄，和妊娠期糖尿病（GDM）。我们使用校正混杂因素的线性回归估计BMI与母乳喂养持续时间之间的关联。中介分析估计了母亲超重/肥胖对每个中介者母乳喂养的直接和间接影响。
结果：超重和肥胖的女性与正常体重的女性相比，母乳喂养的时间更短（任何：超重β=-0.79个月，95％CI：-1.17，-0.40；肥胖β=-1.75个月95％CI：-2.25，-1.25；排除：超重β=-0.30个月，95%CI：-0.42，-0.16；肥胖β=-0.73个月，95%CI：-0.90，-0.55）。这种关联的显著介质(效应估计的%变化)是较高的CRP(不包括:5.12%),剖宫产（任何：6.54％；排除：7.69％），和更高的DII（任意：6.48%；不包括：7.69%）。GDM,胎龄,和BW不能介导产妇体重状况与母乳喂养之间的关系.
结论：孕前BMI较高与任何纯母乳喂养持续时间较短有关。母体饮食炎症，全身性炎症,交付模式可能是该关联的关键可修改介体。介体的识别为改善母乳喂养结果的干预措施提供了潜在的目标。
