An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation.

This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.

Cross-lagged models of health-related quality of life and breastfeeding across different body mass index groups: A three-wave prospective longitudinal study.

BACKGROUND: Bidirectional relationships between health-related quality of life (HRQoL) and breastfeeding outcomes during the perinatal period across different body mass index (BMI) groups have not been investigated. Understanding the nature of such relations can provide strategies the for development of targeted interventions. OBJECTIVES: This study aims to longitudinally (1) investigate the patterns of HRQoL during the perinatal period across different BMI groups; (2) explore bidirectional associations between HRQoL, breastfeeding attitude, and positive breastfeeding status during the perinatal period, and (3) compare the aforementioned relationships across four BMI groups. METHODS: A three-wave prospective longitudinal design was adopted in the second and third trimesters and six weeks postpartum. Cross-lagged panel analysis was used to examine reciprocal relations between two domains of HRQoL, breastfeeding attitudes, and positive breastfeeding status from antenatal to postnatal periods. Multi-group analyses were conducted to determine whether different patterns exist in these relationships according to the four BMI groups. The BMI was self-reported. Breastfeeding attitude and HRQoL were measured by the Iowa Infant Feeding Attitude Scale and the Medical Outcomes Study Short Form Health Survey, respectively. RESULTS: A total of 781 perinatal multi-ethnic women were recruited in Singapore. Our results showed that the physical HRQoL scores were the lowest at Wave 2 compared with those at Waves 1 and 3, whereas the mental HRQoL scores were the lowest at Wave 3 compared with those at Waves 1 and 2 across different BMI groups. Multigroup cross-lagged path analyses showed that breastfeeding attitudes were an antecedent of physical HRQoL in women with underweight. A cross-lagged relationship was found between breastfeeding attitudes and physical HRQoL scores across Waves 1 and 2 in women with obesity. Chi-square difference tests suggested that two paths (breastfeeding attitudes to Wave 2 physical HRQoL, and Wave 2 mental HRQoL to Wave 3 positive breastfeeding status) were significantly different across the four BMI groups. CONCLUSIONS: Physical and mental HRQoL patterns were different during the perinatal period, pre-conception counselling and perinatal care should be tailored to women's physical and mental health care needs. Reciprocal relations between physical HRQoL and breastfeeding attitudes during pregnancy were found in women with obesity. A flexible and individualised approach should provide for the woman with obesity in a respectful manner.

An investigation of prepregnancy body mass index, ethnicity and health-related quality of life as predictors of breastfeeding exclusivity during early postpartum period: Cross sectional survey.

BACKGROUND: Identifying and understanding the determinants of breastfeeding exclusivity during early postpartum period are crucial for sustainable breastfeeding. Few researchers have examined the association among prepregnancy body mass index, ethnicity and exclusive breastfeeding. As a result, whether or not these factors exhibit different relationship patterns across body mass index groups remains unclear. OBJECTIVES: This study was performed to: (1) test the relationships among prepregnancy body mass index, ethnicity, health-related quality of life, maternal and obstetric characteristics and exclusive breastfeeding; and (2) compare the relationships among these study variables for two body mass index groups. DESIGN: Exploratory cross-sectional research design. SETTING: Two postnatal wards of a university-affiliated hospital. PARTICIPANTS: A total of 715 postpartum multi-ethnic women in Singapore. METHODS: We used structural equation modelling with multigroup analysis to examine our hypothetical model, which integrated the concepts of breastfeeding initiation and health-related quality of life conceptual models. A 12-item short form health survey was used to assess the health-related quality of life. RESULTS: The structural equation modelling showed that women with following factors were significantly less likely to initiate exclusive breastfeeding: being Chinese (ß = -0.10, p < 0.05), having high body mass index (ß = -0.11, p < 0.01), living with low household income (ß = -0.08, p < 0.05) and exhibiting poor health-related quality of life scores (ß = 0.17, p < 0.001). Multigroup analysis showed no difference (critical ratio = 0.061) between the parameter estimates of health-related quality of life on exclusive breastfeeding in the two body mass index groups. Health-related quality of life (ß = 0.17, p < 0.001) and monthly household incomes (ß = -0.11, p < 0.05) were the only significant factors in the normal body mass index group. All structural equation modelling values satisfactorily fitted the data (Goodness of Fit Index = 0.937-0.954, Incremental Fit Index = 0.937-0.945, Tucker-Lewis Index = 0.906-0.917, Comparative Fit Index = 0.936-0.942 and Root Means Square Error of Approximation = 0.027-0.040). CONCLUSIONS: Enhancing postpartum health-related quality of life and prepregnancy weight management are crucial to initiate exclusive breastfeeding. Our findings can guide the development of promising health promotion strategies among Chinese women with low household income.

Breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women: A multi-group structural equation approach.

BACKGROUND: Identifying the factors influencing breastfeeding attitude is significant for the implementation of effective promotion policies and counselling activities. To our best knowledge, no previous studies have modelled the relationships among breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women; the current study attempts to fill this research gap. OBJECTIVES: This study investigated the relationships among maternal characteristics, health-related quality of life and breastfeeding attitude amidst normal weight and overweight/obese pregnant women using a multi-group structural equation modelling approach. DESIGN: Exploratory cross-sectional design was used. SETTING: Antenatal clinics of a university-affiliated hospital PARTICIPANTS: Pregnant women were invited to participate; 708 (78.8%) agreed to participate in the study. METHODS: We examined a hypothetical model on the basis of integrating the concepts of a breastfeeding decision-making model, theory of planned behaviour-based model for breastfeeding and health-related quality of life model among 708 multi-ethnic pregnant women in Singapore. The Iowa Infant Feeding Attitude Scale and Medical Outcomes Study Short Form Health Survey were used to measure breastfeeding attitude and health-related quality of life, respectively. RESULTS: Two structural equation models demonstrated that better health-related quality of life, higher monthly household income, planned pregnancy and previous exclusive breastfeeding experience were significantly associated with positive breastfeeding attitude among normal and overweight/obese pregnant women. Among normal weight pregnant women, those who were older with higher educational level were more likely to have positive breastfeeding attitude. Among overweight/obese pregnant women, Chinese women with confinement nanny plan were less likely to have positive breastfeeding attitude. No significant difference existed between normal weight and overweight/obese pregnant women concerning estimates of health-related quality of life on breastfeeding attitude (Critical Ratio=-0.193). The model satisfactorily fitted the data (Incremental Fit Index=0.924, Tucker-Lewis Index=0.905, Comparative Fit Index=0.921 and Root Means Square Error of Approximation=0.025). Health-related quality of life was found to affect breastfeeding attitude in multi-ethnic pregnant women. CONCLUSIONS: This relationship implied the importance of early culturally specific interventions to enhance health-related quality of life for improving positive breastfeeding attitude among pregnant women across different ethnic groups.

Psychometric Evaluation of 5- and 4-Item Versions of the LATCH Breastfeeding Assessment Tool during the Initial Postpartum Period among a Multiethnic Population.

OBJECTIVES: The aim of this study was to evaluate the internal consistency, structural validity, sensitivity and specificity of the 5- and 4-item versions of the LATCH assessment tool among a multiethnic population in Singapore. METHODS: The study was a secondary analysis of a subset of data (n = 907) from our previous breastfeeding survey from 2013 to 2014. The internal consistency of the LATCH was examined using Cronbach's alpha. The structural validity was assessed using an exploratory factor analysis (EFA), and the proposed factors were confirmed by confirmatory factor analysis (CFA) using separate samples. Receiver operating characteristic analysis was used to evaluate the sensitivity and specificity of the LATCH score thresholds for predicting non-exclusive breastfeeding. RESULTS: The Cronbach's alpha values of the 5- and 4-item LATCH assessments were 0.70 and 0.74, respectively. The EFA demonstrated a one-factor structure for the 5- and 4-item LATCH assessments among a randomized split of 334 vaginally delivered women. Two CFA of the 4-item LATCH demonstrated better fit indices of the models compared to the two CFA of the 5-item LATCH among another randomized split of 335 vaginally delivered women and 238 cesarean delivered women. Using cutoffs of 5.5 and 3.5 were recommended when predicting non-exclusive breastfeeding for 5- and 4-item versions of the LATCH assessment among vaginally delivered women (n = 669), with satisfactory sensitivities (94% and 95%), low specificities (0% and 2%), low positive predictive values (25%) and negative predictive values (20% and 47%). A cutoff of 5.5 was recommended to predict non-exclusive breastfeeding for 5- and 4-item versions among cesarean delivered women (n = 238) with satisfactory sensitivities (93% and 98%), low specificities (4% and 9%), low positive predictive values (41%) and negative predictive values (65% and 75%). Therefore, the tool has good sensitivity but poor specificity, positive and negative predictive values. CONCLUSIONS: We found that the 4-item version demonstrated sound psychometric properties compared to the 5-item version. Health professionals can use the 4-item LATCH as a clinical tool because it is a concise, easy-to-use and valid tool for assessing breastfeeding techniques among a multiethnic population.

Psychometric Properties of the Iowa Infant Feeding Attitude Scale among a Multiethnic Population during Pregnancy.

BACKGROUND: The Iowa Infant Feeding Attitude Scale (IIFAS) was developed to measure maternal attitudes toward infant feeding, but a number of validated studies on the IIFAS found that it was subject to methodological limitations. OBJECTIVE: The purpose of this study was to evaluate the psychometric properties of the IIFAS among a multiethnic population in Singapore. METHODS: A cross-sectional research design was used on a sample of 417 antenatal women. The internal consistency and stability of the IIFAS were evaluated using Cronbach's α and test-retest reliability. Known-group comparisons discriminated certain group differences in a predictable way. A series of exploratory factor analyses (EFAs) was conducted to test the factor structure of the IIFAS using the maximum likelihood and principal axis factoring. The number of factors was selected according to theoretical and statistical considerations. A confirmatory factor analysis (CFA) was further performed to validate the factor structure constructed in the prior EFA. RESULTS: The IIFAS had a Cronbach's α and Pearson correlation of 0.79 and 0.85, respectively. The known-group comparisons among certain groups were supported. The EFA results showed that the 3-factor structure produced the most interpretable and theoretical sense. A second-order CFA was conducted to confirm the construct dimensionality of the 15-item IIFAS, with satisfactory fit indices found. CONCLUSION: The 15-item IIFAS is a psychometrically sound measurement tool that health care professionals can use to understand the diverse infant feeding attitudes and knowledge among different ethnic groups in order to provide breastfeeding interventions that are culturally sensitive.

Maternal, Infant Characteristics, Breastfeeding Techniques, and Initiation: Structural Equation Modeling Approaches.

OBJECTIVES: The aim of this study was to examine the relationships among maternal and infant characteristics, breastfeeding techniques, and exclusive breastfeeding initiation in different modes of birth using structural equation modeling approaches. METHODS: We examined a hypothetical model based on integrating concepts of a breastfeeding decision-making model, a breastfeeding initiation model, and a social cognitive theory among 952 mother-infant dyads. The LATCH breastfeeding assessment tool was used to evaluate breastfeeding techniques and two infant feeding categories were used (exclusive and non-exclusive breastfeeding). RESULTS: Structural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation. A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation. Breastfeeding techniques were significantly positively associated with exclusive breastfeeding initiation in the entire sample and in the vaginal deliveries group. However, breastfeeding techniques were not significantly associated with exclusive breastfeeding initiation in the cesarean section group. Maternal age, maternal race, gestations, birth weight of infant, and postnatal complications had no significant impacts on breastfeeding techniques or exclusive breastfeeding initiation in our study. Overall, the models fitted the data satisfactorily (GFI = 0.979-0.987; AGFI = 0.951-0.962; IFI = 0.958-0.962; CFI = 0.955-0.960, and RMSEA = 0.029-0.034). CONCLUSIONS: Multiparity and jaundice of an infant were found to affect breastfeeding technique and exclusive breastfeeding initiation respectively. Breastfeeding technique was related to exclusive breastfeeding initiation according to the mode of birth. This relationship implies the importance of early effective interventions among first-time mothers with jaundice infants in improving breastfeeding techniques and promoting exclusive breastfeeding initiation.