Obesity

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Mothers 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 those who were normal-weight, 93% for those who were overweight and 87% for those who were obese. At 6 months, 64% of "normal-weight" mothers were breastfeeding, compared with 54% of overweight and 44% of obese people. Obese mothers are at particularly high risk of stopping breastfeeding in the first week (odds ratio of 2.5, adjusted for caesarean birth and other factors).

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Key themes to explain lower breastfeeding/chestfeeding initiation and maintenance are:

 

1. Impact of birth complications (covered in another page)

2. Lack of privacy in hospital alongside negative body image, embarrassment at feeding in public and feeling of stigma

3. Specific difficulties with positioning and attachment due to larger breasts

4.  Delayed onset of lactation

5. Reduced uptake of specialist feeding support (which might be due to feeling of stigma, body image and privacy)

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Insulin resistance has been associated with delayed onset of lactation in the context of type II diabetes, which is likely to be a contributing factor in obesity. In this study an overweight/obese group of people with normal glucose tolerance test did not have delayed onset of lactation or reduced exclusive breastfeeding/chestfeeding at hospital discharge compared to normal weight non diabetic controls, whereas people with type II diabetes did have delayed onset, associated with their level of insulin resistance. However the rate of exclusive breastfeeding/chestfeeding at 4 months postpartum in the non insulin resistant overweight/obese group was still lower than that of normal weight controls, showing that there are multiple factors acting at different stages of lactation.

 

Support from healthcare professionals and family members influenced breastfeeding outcomes. Breastfeeding/chestfeeding support services need to explicitly consider the needs of overweight and obese parents.

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PCOS

Polycystic ovary syndrome (PCOS) affects up to 18% of pregnant mothers/people 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/chestfeeding outcomes in PCOS but no robust evidence is available.