Barriers to Exclusive Breastfeeding Among Women With Gestational Diabetes Mellitus in the United States

Abstract Objective To identify differences in breastfeeding-related knowledge, attitudes, beliefs, and experiences between women with gestational diabetes mellitus (GDM) and women without GDM. Design Cross-sectional and prospective cohort study. Setting Secondary analysis of data from the U.S. Infant Feeding Practices Study II. Participants Pregnant women with GDM ( n  = 195) and pregnant women without GDM ( n = 2,815) were included in cross-sectional analyses. For prospective analyses, complete data were available at the postpartum time point for 107 women with and 1,626 women without GDM. Methods We compared women with and without GDM for breastfeeding knowledge, attitudes, and beliefs during pregnancy and hospital experiences and problems with breastfeeding after birth. We used multivariate logistic regression to estimate associations between GDM and dependent variables. Results Women with GDM were less likely to say that breastfeeding is the best way to feed an infant (adjusted odds ratio [aOR] = 0.62, 95% confidence interval [CI] [0.46, 0.85]), more likely to say that the fathers of their infants prefer formula feeding (aOR = 1.74, 95% CI [1.02, 2.97]) or mixed feeding (aOR = 1.78, 95% CI [1.21, 2.61]), and more likely to say their physicians prefer formula (aOR = 2.82, 95% CI [1.17, 6.79]). Women with GDM were less likely to report feeling comfortable breastfeeding in front of female friends (aOR = 0.70, 95% CI [0.50, 0.98]). Newborns of women with GDM were less likely to stay in their mothers' hospital rooms (aOR = 0.55, 95% CI [0.36, 0.85]). Conclusion We identified differences in breastfeeding-related knowledge, attitudes, beliefs, and experiences between women with GDM and women without GDM that could be targets for further research and intervention.