An investigation of prepregnancy body mass index, ethnicity and health-related quality of life as predictors of breastfeeding exclusivity during early postpartum period: Cross sectional survey.

BACKGROUND

Identifying and understanding the determinants of breastfeeding exclusivity during early postpartum period are crucial for sustainable breastfeeding. Few researchers have examined the association among prepregnancy body mass index, ethnicity and exclusive breastfeeding. As a result, whether or not these factors exhibit different relationship patterns across body mass index groups remains unclear.

OBJECTIVES

This study was performed to: (1) test the relationships among prepregnancy body mass index, ethnicity, health-related quality of life, maternal and obstetric characteristics and exclusive breastfeeding; and (2) compare the relationships among these study variables for two body mass index groups.

DESIGN

Exploratory cross-sectional research design.

SETTING

Two postnatal wards of a university-affiliated hospital.

PARTICIPANTS

A total of 715 postpartum multi-ethnic women in Singapore.

METHODS

We used structural equation modelling with multigroup analysis to examine our hypothetical model, which integrated the concepts of breastfeeding initiation and health-related quality of life conceptual models. A 12-item short form health survey was used to assess the health-related quality of life.

RESULTS

The structural equation modelling showed that women with following factors were significantly less likely to initiate exclusive breastfeeding: being Chinese (β = -0.10, p <  0.05), having high body mass index (β = -0.11, p <  0.01), living with low household income (β = -0.08, p <  0.05) and exhibiting poor health-related quality of life scores (β = 0.17, p <  0.001). Multigroup analysis showed no difference (critical ratio = 0.061) between the parameter estimates of health-related quality of life on exclusive breastfeeding in the two body mass index groups. Health-related quality of life (β = 0.17, p <  0.001) and monthly household incomes (β = -0.11, p < 0.05) were the only significant factors in the normal body mass index group. All structural equation modelling values satisfactorily fitted the data (Goodness of Fit Index = 0.937-0.954, Incremental Fit Index = 0.937-0.945, Tucker-Lewis Index = 0.906-0.917, Comparative Fit Index = 0.936-0.942 and Root Means Square Error of Approximation = 0.027-0.040).

CONCLUSIONS

Enhancing postpartum health-related quality of life and prepregnancy weight management are crucial to initiate exclusive breastfeeding. Our findings can guide the development of promising health promotion strategies among Chinese women with low household income.