QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hruschka, D. J. Articles by Martorell, R. Search for Related Content PubMed PubMed Citation Articles by Hruschka, D. J. Articles by Martorell, R.

---

Community and International Nutrition

Delayed Onset of Lactation and Risk of Ending Full Breast-Feeding Early in Rural Guatemala

Daniel J. Hruschka^*, Daniel W. Sellen, Aryeh D. Stein^,** and Reynaldo Martorell

^* Departments of Anthropology, International Health and ^** Epidemiology, Emory University, Atlanta, GA 30322

²To whom correspondence should be addressed. E-mail: dsellen{at}emory.edu.

Mothers of infants (n = 328) born between 1996 and 1999 in four Guatemalan communities were interviewed every 2 wk until 6 mo postpartum (pp) to collect prospective breast-feeding data and assess the association between delayed (>3 d pp) onset of lactation (OL) and the risk of ending full breast-feeding. Cox proportional hazards regression was used to examine the association between delayed OL and the hazard of ending full breast-feeding in the first 6 mo, adjusted for potential confounders and effect modifiers. A significant interaction with community was found (community-specific hazard ratios: HR_A = 2.87, 95% CI = 1.25, 6.60; HR_B = 3.43, 95% CI = 1.55, 7.59; HR_C = 0.26, 95% CI = 0.06, 1.14; HR_D = 1.11, 95% CI = 0.44, 2.77). Supplementation before OL (preonset supplementation) was associated with delayed OL [odds ratio (OR) = 4.87, 95% CI = 2.29, 10.36] and an increased risk of ending full breast-feeding (HR = 1.49, 95% CI = 1.05, 2.11). In the two communities in which mothers who experienced delayed OL had a significantly greater risk of ending full breast-feeding than did mothers experiencing normal OL, the association between delayed OL and full breast-feeding was mediated in part by preonset supplementation. Further analyses suggest that this was due to delayed OL leading to nonbreast milk feeds, rather than to introduction of supplements delaying OL. We conclude that some mothers who experience delayed OL are less likely to continue full breast-feeding in the first 6 mo and that further research should examine the contextual factors that modify this relationship.

KEY WORDS: • full breast-feeding • lactogenesis • onset of lactation • predominant breast-feeding • survival analysis.

This article has been cited by other articles:

				A. L. Webb, D. W. Sellen, U. Ramakrishnan, and R. Martorell Maternal Years of Schooling but Not Academic Skills Is Independently Associated With Infant-Feeding Practices in a Cohort of Rural Guatemalan Women J Hum Lact, August 1, 2009; 25(3): 297 - 306. [Abstract] [PDF]

				M. Chisenga, L. Kasonka, M. Makasa, M. Sinkala, C. Chintu, C. Kaseba, F. Kasolo, A. Tomkins, S. Murray, and S. Filteau Factors Affecting the Duration of Exclusive Breastfeeding Among HIV-Infected and -Uninfected Women in Lusaka, Zambia J Hum Lact, August 1, 2005; 21(3): 266 - 275. [Abstract] [PDF]