Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts

Madeline Keyes; Chloe Andrews; Vishal Midya; Paula Carrasco; Mònica Guxens; Alba Jimeno-Romero; Mario Murcia; Cristina Rodriguez-Dehli; Dora Romaguera; Loreto Santa-Maria; Marina Vafeiadi; Lida Chatzi; Emily Oken; Martine Vrijheid; Damaskini Valvi; Sarbattama Sen

doi:10.1016/j.ajcnut.2023.04.004

Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts

Madeline Keyes^*, Chloe Andrews, Vishal Midya, Paula Carrasco, Mònica Guxens, Alba Jimeno-Romero, Mario Murcia, Cristina Rodriguez-Dehli, Dora Romaguera, Loreto Santa-Maria, Marina Vafeiadi, Lida Chatzi, Emily Oken, Martine Vrijheid, Damaskini Valvi, Sarbattama Sen

^*Corresponding author for this work

Child and Adolescent Psychiatry / Psychology

Research output: Contribution to journal › Article › Academic › peer-review

10 Citations (Scopus)

Abstract

Background:
Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned.

Objectives:
We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts.

Methods:
We analyzed 5120 singleton pregnancies from mother–child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator.

Results:
Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = −0.79 mo, 95% CI: −1.17, −0.40; obese β = −1.75 mo 95% CI: −2.25, −1.25; exclusive: overweight β = −0.30 mo, 95% CI: −0.42, −0.16; obese β = −0.73 mo, 95% CI: −0.90, −0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding.

Conclusions:
Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.

Original language	English
Pages (from-to)	255-263
Number of pages	9
Journal	American Journal of Clinical Nutrition
Volume	118
Issue number	1
DOIs	https://doi.org/10.1016/j.ajcnut.2023.04.004
Publication status	Published - Jul 2023

Bibliographical note

Funding Information:
This study was supported by T32 grant HD 098061 (MK) and P30ES023515 (DV, VM). The Project Viva cohort was funded by R01 HD 034568 (EO) and UH3 OD 023286 (EO). The INfancia y Medio Ambiente (INMA) cohort was funded by Grants from Instituto de Salud Carlos III and Spanish Ministry of Health (Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314 and 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090, and CPII18/00018), Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and Fundación Roger Torné. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. The “Rhea” project was financially supported by European projects (EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7 ENV.2007.1.2.2.2. Project No 211250 Escape, EU FP7-2008-ENV 1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009-single-stage CHICOS, EU FP7 ENV.2008.1.2.1.6. Proposal No. 226285 ENRIECO, EU-FP7-HEALTH-2012 Proposal No. 308333 HELIX) and the Greek Ministry of Health (Program of Prevention of Obesity and Neurodevelopmental Disorders in Preschool Children, in Heraklion District, Crete, Greece: 2011–2014; “Rhea Plus”: Primary Prevention Program of Environmental Risk Factors for Reproductive Health, and Child Health: 2012–2015). The Rhea study was also funded by Karolinska Institutet and the Swedish Research Council (Project No. 2015-03655). Additional funding from the National Institute of Environmental Health Science (NIEHS) supported LD (R01-ES029944, R01-ES030691, R01-ES030364, R21-ES028903, R21-ES029681, and P30-ES007048).

Funding Information:
This study was supported by T32 grant HD 098061 (MK) and P30ES023515 (DV, VM) . The Project Viva cohort was funded by R01 HD 034568 (EO) and UH3 OD 023286 (EO). The INfancia y Medio Ambiente (INMA) cohort was funded by Grants from Instituto de Salud Carlos III and Spanish Ministry of Health ( Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314 and 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090, and CPII18/00018 ), Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and Fundación Roger Torné. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program ( CEX2018-000806-S ), and support from the Generalitat de Catalunya through the CERCA Program. The “Rhea” project was financially supported by European projects ( EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7 ENV.2007.1.2.2.2. Project No 211250 Escape, EU FP7-2008-ENV 1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009-single-stage CHICOS, EU FP7 ENV.2008.1.2.1.6. Proposal No. 226285 ENRIECO, EU-FP7-HEALTH-2012 Proposal No. 308333 HELIX ) and the Greek Ministry of Health (Program of Prevention of Obesity and Neurodevelopmental Disorders in Preschool Children, in Heraklion District, Crete, Greece: 2011–2014; “Rhea Plus”: Primary Prevention Program of Environmental Risk Factors for Reproductive Health, and Child Health: 2012–2015). The Rhea study was also funded by Karolinska Institutet and the Swedish Research Council (Project No. 2015-03655 ). Additional funding from the National Institute of Environmental Health Science (NIEHS) supported LD ( R01-ES029944, R01-ES030691, R01-ES030364, R21-ES028903, R21-ES029681, and P30-ES007048 ).

Publisher Copyright:
© 2023 American Society for Nutrition

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10.1016/j.ajcnut.2023.04.004

Cite this

Keyes, M., Andrews, C., Midya, V., Carrasco, P., Guxens, M., Jimeno-Romero, A., Murcia, M., Rodriguez-Dehli, C., Romaguera, D., Santa-Maria, L., Vafeiadi, M., Chatzi, L., Oken, E., Vrijheid, M., Valvi, D., & Sen, S. (2023). Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts. American Journal of Clinical Nutrition, 118(1), 255-263. https://doi.org/10.1016/j.ajcnut.2023.04.004

@article{ff3658381ff94e7a860ccee7b2419778,

title = "Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts",

abstract = "Background: Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned. Objectives: We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts. Methods: We analyzed 5120 singleton pregnancies from mother–child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator. Results:Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = −0.79 mo, 95% CI: −1.17, −0.40; obese β = −1.75 mo 95% CI: −2.25, −1.25; exclusive: overweight β = −0.30 mo, 95% CI: −0.42, −0.16; obese β = −0.73 mo, 95% CI: −0.90, −0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding. Conclusions: Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.",

author = "Madeline Keyes and Chloe Andrews and Vishal Midya and Paula Carrasco and M{\`o}nica Guxens and Alba Jimeno-Romero and Mario Murcia and Cristina Rodriguez-Dehli and Dora Romaguera and Loreto Santa-Maria and Marina Vafeiadi and Lida Chatzi and Emily Oken and Martine Vrijheid and Damaskini Valvi and Sarbattama Sen",

note = "Funding Information: This study was supported by T32 grant HD 098061 (MK) and P30ES023515 (DV, VM). The Project Viva cohort was funded by R01 HD 034568 (EO) and UH3 OD 023286 (EO). The INfancia y Medio Ambiente (INMA) cohort was funded by Grants from Instituto de Salud Carlos III and Spanish Ministry of Health (Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314 and 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090, and CPII18/00018), Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and Fundaci{\'o}n Roger Torn{\'e}. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. The “Rhea” project was financially supported by European projects (EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7 ENV.2007.1.2.2.2. Project No 211250 Escape, EU FP7-2008-ENV 1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009-single-stage CHICOS, EU FP7 ENV.2008.1.2.1.6. Proposal No. 226285 ENRIECO, EU-FP7-HEALTH-2012 Proposal No. 308333 HELIX) and the Greek Ministry of Health (Program of Prevention of Obesity and Neurodevelopmental Disorders in Preschool Children, in Heraklion District, Crete, Greece: 2011–2014; “Rhea Plus”: Primary Prevention Program of Environmental Risk Factors for Reproductive Health, and Child Health: 2012–2015). The Rhea study was also funded by Karolinska Institutet and the Swedish Research Council (Project No. 2015-03655). Additional funding from the National Institute of Environmental Health Science (NIEHS) supported LD (R01-ES029944, R01-ES030691, R01-ES030364, R21-ES028903, R21-ES029681, and P30-ES007048). Funding Information: This study was supported by T32 grant HD 098061 (MK) and P30ES023515 (DV, VM) . The Project Viva cohort was funded by R01 HD 034568 (EO) and UH3 OD 023286 (EO). The INfancia y Medio Ambiente (INMA) cohort was funded by Grants from Instituto de Salud Carlos III and Spanish Ministry of Health ( Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314 and 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090, and CPII18/00018 ), Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and Fundaci{\'o}n Roger Torn{\'e}. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program ( CEX2018-000806-S ), and support from the Generalitat de Catalunya through the CERCA Program. The “Rhea” project was financially supported by European projects ( EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7 ENV.2007.1.2.2.2. Project No 211250 Escape, EU FP7-2008-ENV 1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009-single-stage CHICOS, EU FP7 ENV.2008.1.2.1.6. Proposal No. 226285 ENRIECO, EU-FP7-HEALTH-2012 Proposal No. 308333 HELIX ) and the Greek Ministry of Health (Program of Prevention of Obesity and Neurodevelopmental Disorders in Preschool Children, in Heraklion District, Crete, Greece: 2011–2014; “Rhea Plus”: Primary Prevention Program of Environmental Risk Factors for Reproductive Health, and Child Health: 2012–2015). The Rhea study was also funded by Karolinska Institutet and the Swedish Research Council (Project No. 2015-03655 ). Additional funding from the National Institute of Environmental Health Science (NIEHS) supported LD ( R01-ES029944, R01-ES030691, R01-ES030364, R21-ES028903, R21-ES029681, and P30-ES007048 ). Publisher Copyright: {\textcopyright} 2023 American Society for Nutrition",

year = "2023",

month = jul,

doi = "10.1016/j.ajcnut.2023.04.004",

language = "English",

volume = "118",

pages = "255--263",

journal = "American Journal of Clinical Nutrition",

issn = "0002-9165",

publisher = "Elsevier",

number = "1",

}

Keyes, M, Andrews, C, Midya, V, Carrasco, P, Guxens, M, Jimeno-Romero, A, Murcia, M, Rodriguez-Dehli, C, Romaguera, D, Santa-Maria, L, Vafeiadi, M, Chatzi, L, Oken, E, Vrijheid, M, Valvi, D & Sen, S 2023, 'Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts', American Journal of Clinical Nutrition, vol. 118, no. 1, pp. 255-263. https://doi.org/10.1016/j.ajcnut.2023.04.004

TY - JOUR

T1 - Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts

AU - Keyes, Madeline

AU - Andrews, Chloe

AU - Midya, Vishal

AU - Carrasco, Paula

AU - Guxens, Mònica

AU - Jimeno-Romero, Alba

AU - Murcia, Mario

AU - Rodriguez-Dehli, Cristina

AU - Romaguera, Dora

AU - Santa-Maria, Loreto

AU - Vafeiadi, Marina

AU - Chatzi, Lida

AU - Oken, Emily

AU - Vrijheid, Martine

AU - Valvi, Damaskini

AU - Sen, Sarbattama

N1 - Funding Information: This study was supported by T32 grant HD 098061 (MK) and P30ES023515 (DV, VM). The Project Viva cohort was funded by R01 HD 034568 (EO) and UH3 OD 023286 (EO). The INfancia y Medio Ambiente (INMA) cohort was funded by Grants from Instituto de Salud Carlos III and Spanish Ministry of Health (Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314 and 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090, and CPII18/00018), Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and Fundación Roger Torné. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. The “Rhea” project was financially supported by European projects (EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7 ENV.2007.1.2.2.2. Project No 211250 Escape, EU FP7-2008-ENV 1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009-single-stage CHICOS, EU FP7 ENV.2008.1.2.1.6. Proposal No. 226285 ENRIECO, EU-FP7-HEALTH-2012 Proposal No. 308333 HELIX) and the Greek Ministry of Health (Program of Prevention of Obesity and Neurodevelopmental Disorders in Preschool Children, in Heraklion District, Crete, Greece: 2011–2014; “Rhea Plus”: Primary Prevention Program of Environmental Risk Factors for Reproductive Health, and Child Health: 2012–2015). The Rhea study was also funded by Karolinska Institutet and the Swedish Research Council (Project No. 2015-03655). Additional funding from the National Institute of Environmental Health Science (NIEHS) supported LD (R01-ES029944, R01-ES030691, R01-ES030364, R21-ES028903, R21-ES029681, and P30-ES007048). Funding Information: This study was supported by T32 grant HD 098061 (MK) and P30ES023515 (DV, VM) . The Project Viva cohort was funded by R01 HD 034568 (EO) and UH3 OD 023286 (EO). The INfancia y Medio Ambiente (INMA) cohort was funded by Grants from Instituto de Salud Carlos III and Spanish Ministry of Health ( Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2, PI061756; PS0901958; FIS-FEDER 03/1615, 04/1509, 04/1112, 04/1931, 05/1079, 05/1052, 06/1213, 07/0314 and 09/02647; FIS-PI041436, FIS-PI081151, FIS-PI06/0867, FIS-PS09/00090, and CPII18/00018 ), Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Department of Health of the Basque Government (2005111093 and 2009111069), the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), and Fundación Roger Torné. ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program ( CEX2018-000806-S ), and support from the Generalitat de Catalunya through the CERCA Program. The “Rhea” project was financially supported by European projects ( EU FP6-2003-Food-3-NewGeneris, EU FP6. STREP Hiwate, EU FP7 ENV.2007.1.2.2.2. Project No 211250 Escape, EU FP7-2008-ENV 1.2.1.4 Envirogenomarkers, EU FP7-HEALTH-2009-single-stage CHICOS, EU FP7 ENV.2008.1.2.1.6. Proposal No. 226285 ENRIECO, EU-FP7-HEALTH-2012 Proposal No. 308333 HELIX ) and the Greek Ministry of Health (Program of Prevention of Obesity and Neurodevelopmental Disorders in Preschool Children, in Heraklion District, Crete, Greece: 2011–2014; “Rhea Plus”: Primary Prevention Program of Environmental Risk Factors for Reproductive Health, and Child Health: 2012–2015). The Rhea study was also funded by Karolinska Institutet and the Swedish Research Council (Project No. 2015-03655 ). Additional funding from the National Institute of Environmental Health Science (NIEHS) supported LD ( R01-ES029944, R01-ES030691, R01-ES030364, R21-ES028903, R21-ES029681, and P30-ES007048 ). Publisher Copyright: © 2023 American Society for Nutrition

PY - 2023/7

Y1 - 2023/7

N2 - Background: Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned. Objectives: We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts. Methods: We analyzed 5120 singleton pregnancies from mother–child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator. Results:Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = −0.79 mo, 95% CI: −1.17, −0.40; obese β = −1.75 mo 95% CI: −2.25, −1.25; exclusive: overweight β = −0.30 mo, 95% CI: −0.42, −0.16; obese β = −0.73 mo, 95% CI: −0.90, −0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding. Conclusions: Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.

AB - Background: Maternal obesity has been associated with shorter breastfeeding duration, but little is known about mediating factors explaining this association. It is important to assess these relationships across diverse populations because breastfeeding is culturally patterned. Objectives: We investigated the association of prepregnancy maternal body mass index (BMI) with breastfeeding outcomes and potential mediators of this relationship in 3 culturally diverse international cohorts. Methods: We analyzed 5120 singleton pregnancies from mother–child cohorts in Spain (INfancia y Medio Ambiente), Greece (Rhea), and the United States (Project Viva). Outcome variables were duration of any and exclusive breastfeeding. A priori hypothesized mediators in the association of maternal prepregnancy BMI with breastfeeding were birthweight (BW), maternal prenatal C-reactive protein (CRP), cesarean delivery, maternal dietary inflammatory index (DII) during pregnancy, gestational age at delivery, and gestational diabetes mellitus (GDM). We estimated the association between BMI and breastfeeding duration using linear regression adjusting for confounders. Mediation analysis estimated direct and indirect effects of maternal overweight/obesity on breastfeeding for each mediator. Results:Women with overweight and obesity had shorter duration of any and exclusive breastfeeding compared with normal-weight women (any: overweight β = −0.79 mo, 95% CI: −1.17, −0.40; obese β = −1.75 mo 95% CI: −2.25, −1.25; exclusive: overweight β = −0.30 mo, 95% CI: −0.42, −0.16; obese β = −0.73 mo, 95% CI: −0.90, −0.55). Significant mediators (% change in effect estimate) of this association were higher CRP (exclusive: 5.12%), cesarean delivery (any: 6.54%; exclusive: 7.69%), and higher DII (any: 6.48%; exclusive: 7.69%). GDM, gestational age, and BW did not mediate the association of maternal weight status with breastfeeding. Conclusions: Higher prepregnancy BMI is associated with shorter duration of any and exclusive breastfeeding. Maternal dietary inflammation, systemic inflammation, and mode of delivery may be key modifiable mediators of this association. Identification of mediators provides potential targets for interventions to improve breastfeeding outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85163662417&partnerID=8YFLogxK

U2 - 10.1016/j.ajcnut.2023.04.004

DO - 10.1016/j.ajcnut.2023.04.004

M3 - Article

C2 - 37407164

AN - SCOPUS:85163662417

SN - 0002-9165

VL - 118

SP - 255

EP - 263

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 1

ER -

Mediators of the association between maternal body mass index and breastfeeding duration in 3 international cohorts

Abstract

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