XXXX , psychological factors, and breastfeeding initiation.

@entity1 @entity308 @entity148 @entity28
OBJECTIVE: @entity28 has been associated with lower initiation of breastfeeding, but reasons for why this association exists have not been well studied. In this study, we examined associations among prepregnancy @entity28 , psychological factors during pregnancy, and breastfeeding initiation. METHODS: Data came from the postpartum component of the Pregnancy, Infection, and Nutrition study, a prospective cohort study. Pregnant @entity1 were recruited from the University of North Carolina hospitals between January 2001 and June 2005. This analysis used data from 688 @entity1 followed from pregnancy to 3 months postpartum. Multivariable binomial regression was used to determine the association between having a body mass index (BMI) >26   kg/m(2) before pregnancy and breastfeeding initiation. We tested for mediation of the association between pregravid BMI and breastfeeding initiation by certain psychological factors during pregnancy ( @entity308 symptoms, perceived stress, @entity148 , and self-esteem). RESULTS: @entity1 who began pregnancy overweight or @entity28 (BMI >26   kg/m(2)) had almost four times the risk of not initiating breastfeeding compared with underweight or normal weight @entity1 (BMI  <=26   kg/m(2)) (risk ratio   =   3.94 [95% confidence interval 2.17, 7.18]) after adjusting for race, poverty level, education level, and marital status. @entity308 , perceived stress, @entity148 , and self-esteem levels during pregnancy were not found to mediate the association between pregravid BMI and breastfeeding initiation. CONCLUSIONS: @entity1 who started pregnancy either overweight or @entity28 were more likely to not initiate breastfeeding. Contrary to expectations, pregnancy-related psychological factors did not influence this relationship.
