The Association Between Cumulative Stressful Life Events and Breastfeeding Outcomes in the United Kingdom: The Modifying Roles of Pregnancy Intention and Social Support.

BACKGROUND

Breastfeeding rates in the United Kingdom are low, and cumulative stressful life events (SLEs) experienced over time influence health behaviors including breastfeeding. Yet extant breastfeeding studies have neither considered cumulative SLEs, time-to-breastfeeding events, nor social support and pregnancy intention as moderators. We address these limitations.

METHODS

We analyzed a cross-section of 14,953 new mothers from the UK Millennium Cohort's first wave (10,001 initiated breastfeeding). We fit logistic and Cox proportional hazards regression models to assess associations between cumulative SLEs and breastfeeding initiation, and between cumulative SLEs and time to any/exclusive breastfeeding (EBF) cessation. We also assessed pregnancy intention, emotional and financial support as moderators of the main association(s).

RESULTS

Cumulative SLEs were not significantly associated with breastfeeding initiation but directly associated with any/exclusive breastfeeding cessation. Effects of ≥5 SLEs on EBF cessation were higher (HRa = 1.37; 95% confidence interval = 1.07-1.75) among mothers with unintended pregnancies versus planned pregnancies (HRa = 1.24; 0.98-1.58). Mothers with 3-4 SLEs faced a 64% risk of stopping EBF (HRa = 1.64; 0.99-2.87) among those without emotional support compared to a 10% risk among those with emotional support (HRa = 1.10; 1.00-1.21). SLEs affected initiation and any breastfeeding equally, regardless of pregnancy intention, emotional and financial support.

CONCLUSIONS

SLEs are detrimental to breastfeeding. Planned pregnancies and emotional support buffer adverse SLE effects on EBF but not initiation and any breastfeeding. To identify highly stressed mothers with low support who would benefit from EBF support, cumulative SLEs and pregnancy intention screenings should be integrated into routine prenatal/obstetric care from 1 week postpartum.