Population Perspective on the Association Between Exclusive Breastfeeding and Postpartum Smoking

Background: Maternal postpartum smoking increases the risk for poor infant health outcomes while exclusive breastfeeding has been shown to support infant health. Limited population-based research has been published on the interaction between maternal smoking and exclusive breastfeeding.

Purpose: The purpose of the study was to describe the factors associated with postpartum smoking and exclusive breastfeeding among a representative sample of women in the United States.

Methods: Secondary data analysis was conducted using the cross-sectional survey data from the 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS). Stratified analyses were used to examine the associations between interaction variables, maternal smoking, and exclusive breastfeeding among a sample of 72,861 women who gave birth to a singleton infant during the time period.

Results: 17.1% of the study participants smoked cigarettes during the postpartum period. In the multivariable model, postpartum smoking was an independent factor associated with reduced likelihood of exclusive breastfeeding at 12 weeks. There was a significant interaction between postpartum smoking and education, race/ethnicity, Medicaid, and diabetes on exclusive breastfeeding. Based on sociodemographic characteristics, there was a significantly reduced odds of exclusive breastfeeding for non-Hispanic blacks (OR 95% CI 0.52; 0.37 - 0.74) and for women with less than 12 years of education (OR 95% CI 0.31; 0.22 - 0.43).

Conclusions: Prenatal smoking negatively influences exclusive breastfeeding, especially among at-risk women. Identification of women at high risk for not exclusively breastfeeding is important for targeting populations in need of appropriate and timely support for prenatal and postpartum smoking cessation and breastfeeding promotion. Considering the opportune time of prenatal care, healthcare providers may use pregnancy to promote comprehensive long-term health behavior modification related to smoking and breastfeeding.