Background:
Early-term birth is defined as birth occurring between 37 to <39 weeks’ gestation (American College of Obstetricians and Gynecologists, 2013a). Early-term birth is associated with adverse neonatal outcomes (Parikh et al., 2014; Sengupta et al., 2013; Tita et al., 2009). The American College of Obstetrics and Gynecologists (ACOG) recommends that elective cesarean section should not be performed before 39 weeks’ gestation (American College of Obstetricians and Gynecologists, 2013b). Breastfeeding provides numerous benefits to infants (Victora et al., 2016)and could potentially offset the adverse neonatal effects of early-term birth. However, the majority of existing studies show that early-term birth is associated with early breastfeeding cessation (Fan, Wong, Fong, Lok, & Tarrant, 2018). The Baby-friendly Hospital Initiative (BFHI) is one of the most effective strategies for prolonging breastfeeding duration and exclusivity (Spaeth, Zemp, Merten, & Dratva, 2018; Tarrant et al., 2016). BFHI was implemented by the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) in 1991. It consists of 10 steps that aim to protect, support and promote breastfeeding in maternity-care facilities (World Health Organization & UNICEF, 1989). Only a few studies have examined differences in exposure to Baby-friendly practices in early-term and term infants (Goyal, Attanasio, & Kozhimannil, 2014)and if the effect of these practices on breastfeeding duration varies by gestational age.
Purposes:
The objectives of the study were to examine the association between gestational age and exposure to Baby-friendly hospital practices, and to examine the effect of Baby-friendly hospital practices on breastfeeding duration in early-term and term infants.
Methods:
A two-phase prospective cohort study was conducted in four geographically distributed public hospitals in Hong Kong in 2006-2007 and 2011-2012. In total, 2560 healthy mother-infant pairs were recruited from the postnatal wards in the immediate postnatal period. A self-administered questionnaire was completed by each participant. The questionnaire collected information on basic sociodemographic characteristics, breastfeeding intentions and experiences, family members’ infant feeding preferences, and attendance at antenatal childbirth and breastfeeding classes. Maternal and infant data and the exposure to Baby-friendly hospital practices were collected from the hospital medical records by a research nurse. Participants were followed up for 12 months postpartum or until they stopped breastfeeding, whichever came first.
Statistical analysis
Chi-square tests were used to examine the characteristics of the early-term and term infants. Bivariable and multivariable logistic regression was used to examine exposure to Baby-friendly practices. Unadjusted and adjusted Cox proportional hazards regression was used to assess the effect of Baby-friendly Hospital practices on breastfeeding duration in early-term and term infants. Hierarchical regression was used in all models.
Results:
There were no significant differences in exposure of Baby-friendly steps between early-term and term infants. Approximately one-third of participants initiated breastfeeding within one hour and were exclusively breastfed in hospital. Exclusive breastfeeding during postpartum hospital stay decreased the risk of early breastfeeding cessation in early-term (Hazard ratio [HR]=0.70; 95% confidence interval [CI]=0.56-0.89) and term infants (HR=0.71; 95% CI=0.60-0.84). Breastfeeding initiation within the first hour after birth was associated with a decreased risk of breastfeeding cessation in term infants only (HR=0.87; 95% CI 0.77-0.99). However, no significant effect was found in early-term infants.
Conclusion:
Study findings show no difference in exposure to Baby-friendly hospital practices between early-term and term infants. However, our results reinforce the importance of supportive hospital practices and highlight the importance of exclusive breastfeeding during the postpartum hospital stay on breastfeeding continuation. The implementation of supportive hospital practicesis equally important for early-term and term infants.