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Kortney Richardson

Breastfeeding Difficulties and Exclusivity Among Late Preterm and Term Infants:
Results from the All Our Babies Study
The purpose of this study was to determine whether breastfeeding difficulties
were more prevalent among late preterm infants as opposed to term infants. A preterm
birth is defined as an infant that is born before thirty-seven weeks of gestation. About
10% of all births are classified as preterm births. There are three preterm birth
subcategories. Very early preterm refers to infants who were born at less than thirty-two
weeks gestation; early preterm refers to infants who were born between thirty-two and
thirty-three weeks gestation; and late preterm refers to infants who were born between
thirty-four and thirty-six weeks gestation. Late preterm infants constitute the largest
subgroup of preterm babies. Preterm infants have a higher risk for morbidity because they
are not fully developed. Some conditions that are common in late preterm infants include
temperature instability, hypoglycemia, respiratory distress, and difficulty feeding. The
main objective of this study is see how late preterm birth as an independent factor affects
breastfeeding difficulties experienced by the mother and baby, and to look at exclusive
breastfeeding at four months postpartum of late preterm infants as compared to those of
term infants.
This study was a prospective cohort study, called the All Our Babies Study, which
was based in Calgary, Alberta. The All Our Babies Study began collecting data in 2008.
This study used 2,977 women who were having a singleton infant. It used bivariate and
multivariable analyses, which are used to identify various factors including demographic,
obstetric, maternal and infant health indicators that are associated with breastfeeding
outcomes. To conduct the study each participant had to answer several questionnaires.
These questionnaires were to be completed at three different times during the
participants pregnancy. The first two questionnaires were completed during the prenatal
periodonce at less than twenty-five weeks gestation and again between thirty-four and
thirty-six weeks gestation. The third questionnaire was completed at about four months
postpartum. At the end of the study, women who delivered infants with a gestational age
between thirty-four and thirty-six weeks were compared with women who delivered
infants with a gestational age of thirty-seven weeks. What the study was focusing on was
breastfeeding difficulties experienced by the baby and breastfeeding difficulties
experienced by the mother. Examples of difficulties experienced by the baby include
trouble latching on or being too tired to feed, and examples of difficulties experienced by
the mother include not producing enough milk or having flat or inverted nipples. The
study was also assessing for breastfeeding exclusively at four months postpartum. Several
risks factors were assessed in this study. These include income, ethnicity, foreign-born
status, number of previous pregnancies, Cesarean or natural birth, hospital stay in the
Neonatal Intensive Care Unit, overnight hospital stay for the infant, and the mothers
postpartum emotional and physical health and social support.
This study used a multivariable logistic regression model. It allowed for the
effects of breastfeeding difficulties on late preterm infants and the exclusivity of
breastfeeding at four months postpartum to be looked at and compared to breastfeeding
difficulties and exclusivity of term births. This multivariable model examined these
results while controlling for any of the possible risk factors that could affect the outcome.

Kortney Richardson
Of the 2,977 women in this cohort study, 2,778 delivered term infants, 173
delivered late preterm infants, and twenty-six women were missing in the study. When
comparing the mothers of late preterm infants with the mothers of term infants, LP
mothers were more likely to be non-Caucasian, foreign, and had lower income. At four
months postpartum, it was also more common for late preterm mothers to have poor
emotional health. It should also be noted that it was more common for late preterm
infants to stay overnight in the hospital or to stay in the Neonatal Intensive Care Unit as
opposed to term infants. It is more likely for late preterm infants to experience difficulties
breastfeeding at four months postpartum than term infants. As for difficulties
breastfeeding that were experienced by the mother, the infant being a late preterm baby
was not the only factor that contributing factor. Now, as for exclusivity, the findings
showed that it was more likely for women of term infants than for women of late preterm
infants to breastfeed exclusively at four months postpartum.
There are many suggested reasons as to why late preterm infants experience more
breastfeeding difficulties. One of the breastfeeding difficulties experienced by late
preterm infants is inadequate feeding skills and lower levels of milk intake. This is
because late preterm infants are not developmentally mature yet; they have low energy
stores and high energy needs; sucking, swallowing, and breathing mechanism are not
coordinated, and they do not breastfeed for a long duration due to tiring quickly. Because
of the difficulties breastfeeding with late preterm infants, it is no surprise that exclusively
breastfeeding at four months is more common in term infants. For this reason more
support should be given to late preterm mothers to improve breastfeeding at four months
postpartum. There are several limitations to this study that also needs to be noted. One
limitation is that the mothers reported the gestational age of their infants, which could
cause some inaccuracies. A second limitation is that only women who could answer the
questionnaires in English were included in the study. There were also a few strengths in
this study. The first strength is that data was collected in a prospective manner, which will
decrease recall bias. A second strength is that a population-based sample was used. This
allows the finding to be generalized for pregnant women.
In conclusion, late preterm infants tend to have more breastfeeding difficulties
then term infants. Also mothers of late preterm infants are less likely to breastfeed
exclusively at four months postpartum. Extra support and care for late preterm mothers is
needed in order to improve breastfeeding, which will in turn improve the growth and
development to the baby.

Kortney Richardson
Reference
1. Nagulesapillai T, McDonald SW, Fenton TR, Mercader HG, Tough SC. Breastfeeding
Difficulties and Exclusivity Among Late Preterm and Term Infants: Results From the All
Our Babies Study. Can J Public Health 2013;104(4):e351-e356

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