BREASTFEEDING AND OBESITY OR PCOS
Women with overweight and obesity have lower breastfeeding initiation rates and there is greater risk of early breastfeeding cessation. For example in Australia, breastfeeding initiation was 95% for normal-weight women, 93% for overweight women and 87% for obese women. At 6 months, 64% of normal-weight women were breastfeeding, compared with 54% of overweight and 44% of obese women. Obese women are at particularly high risk of stopping breastfeeding in the first week (odds ratio of 2.5, adjusted for caesarean birth and other factors).
Key themes to explain lower breastfeeding initiation and maintenance are:
3. Specific difficulties with positioning and attachment due to larger breasts
4. Delayed onset of lactation
5. Reduced uptake of specialist breastfeeding support (which might be due to feeling of stigma, body image and privacy)
Support from healthcare professionals and family members influenced breastfeeding outcomes. Breastfeeding support services need to explicitly consider the needs of overweight and obese women.
Polycystic ovary syndrome (PCOS) affects up to 18% of pregnant women and is associated with obesity. There have been suggestions that PCOS may be a risk factor for lower breastfeeding initiation and duration, but it is not clear that this is separate from the affect of obesity. In addition it has been suggested that metformin may improve breastfeeding outcomes in PCOS but no robust evidence is available.