Factors associated with early weaning in the human milk bank of a university hospital

Conceição, Francilidia Oliveira Vitorino de Assunção; Zanin, Luciane; Araújo Neto, Ari Pereira de; Pinheiro, Feliciana Santos; Flório, Flávia Martão

doi:10.1590/1806-9304202300000450

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 23 • 2023 • https://doi.org/10.1590/1806-9304202300000450 copy

Factors associated with early weaning in the human milk bank of a university hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to identify the sociodemographic, obstetric, and breastfeeding factors associated with early weaning in a human milk bank.

Methods:

data from maternal and child evaluation forms of women assisted at the human milk bank of the Federal University of Maranhão university hospital in 2016, 2017 and 2018 were compiled.

Results:

of the 1,276 forms evaluated, 1,275 (99.9%) had information about early weaning (outcome variable), which was identified in 30.6% of assisted pairs. The frequency of early weaning was higher among mothers who had already breastfed (169-31%) [p=0.0235, OR=4.03; CI95%=1.21-13.46] and among mothers who had “household” occupation (204-36%) [p<0.0001, OR=1.58, CI95%=1.24-2.00]. The other independent variables evaluated did not show significant association (p>0.05).

Conclusions:

among the evaluated characteristics, only maternal occupation and previous breastfeeding experience were associated with early weaning.

Key words
Breastfeeding; Weaning; Patient care continuity; Milk Bank; Health promotion

Variable	N	%
Marital status
Married	353	27.7
Single	388	30.4
Widowed	1	0.08
Consensual union	530	41.6
No information	3	0.2
Schooling
Illiterate	1	0.08
Incomplete elementary school	70	5.5
Complete elementary school	79	6.2
Incomplete High-school	174	13.6
Complete High-school	638	50.0
Incomplete higher education	145	11.4
Complete higher education	163	12.8
No information	5	0.4
Occupation
Housewife	567	44.5
Formal job	410	32.2
Self-employed	130	10.2
Student	168	13.2
Income (minimum wage)
No income	157	12.3
<1	375	29.4
1	146	11.4
1-3	462	36.2
3-5	95	7.7
5-7	15	1.2
>7	10	0.8
No information	12	0.9
Age (years)
$\bar{x}$ ±SD	27.4±6.9
Median (minimum and maximum)	27.0 (13.0-47.0)

Variable	N	%
Gender
Male	662	51.9
Female	609	47.8
No information	4	0.3
Breastfed in the delivery room
Yes	831	65,2
No	424	33.2
No information	20	1.6
Birth weight (grams)
$\bar{x}$ ±SD	3,216.6±501.4
Median (minimum and maximum)	3,205.0 (1,730.0 - 6,630.0)

Variable	N	%
Prenatal care
Yes	1,268	99.4
No	7	0.6
Where
HUUFMA	568	44.6
Other public services	536	42.0
Private services	135	10.6
No information	37	2.9
Received guidance on breastfeeding during prenatal care
Yes	635	49.8
No	621	48.7
No information	19	1.5
Received guidance on breastfeeding in the maternity ward
Yes	1,065	83.5
No	205	16.1
No information	5	0.4
Where the infant was born
HUUFMA	1,067	83.7
Other public services	128	10.0
Private services	68	5.3
Outros	5	0.4
No information	7	0.6
Type of delivery
Vaginal	654	51.3
Cesarean session	617	48.4
Forceps	1	0.08
No information	3	0.2
Breastfed other children
Yes	546	42.8
No	30	2.4
Not applicable (1^st pregnancy)	677	53.1
No information	22	1.7
Family support for breastfeeding the previous child
Yes	495	38.8
No	62	4.9
Not applicable (1^st pregnancy)	685	53.7
No information	33	2.6
How many pregnancies
$\bar{x}$ ±SD	2.1±1.4
Median (minimum and maximum)	2.0 (0.0-12.0)
How many deliveries
$\bar{x}$ ±SD	1.8±1.1
Median (minimum and maximum)	1.0 (0.0-10.0)
How many abortions
$\bar{x}$ ±SD	0.4±0.8
Median (minimum and maximum)	0.0 (0.0-6.0)
Number of prenatal consultations
$\bar{x}$ ±SD	7.2±2.4
Median (minimum and maximum)	7.0 (0.0-20.0)

Variable	N	%
Early weaning
Yes	390	30.6
No	885	69.4
Posture was observed
Yes	1.220	95.7
No	42	3.3
No information	13	1.0
Mother relaxed and comfortable
Yes	749	58.8
No	473	37.1
No information	53	4.2
Infant close, facing the breast
Yes	600	47.1
No	623	48.9
No information	52	4.1
Infant’s head and body aligned
Yes	553	43.4
No	659	51.7
No information	63	4.9
Infant’s chin touching the breast
Yes	1.002	78.6
No	211	16.6
No information	62	4.9
Infant’s buttocks supported
Yes	646	50.7
No	561	44.0
No information	68	5.3
Mouth wide open
Yes	690	54.1
No	524	41.1
No information	61	4.8
Bottom lip turned out
Yes	724	56.8
No	490	38.4
No information	61	4.8
Tongue attached around the breast
Yes	670	52.6
No	532	41.7
No information	73
Round cheeks		5.7
Yes	935	73.3
No	273	21.4
No information	67	5.2
More areola around the infant’s mouth
Yes	782	61.3
No	421	33.0
No information	72	5.6
Slow and deep sucks, episodes and pauses
Yes	901	70.7
No	313	24.6
No information	61	4.8
Swallowing can be heard
Yes	916	71.8
No	274	21.5
No information	85	6.7

Variable	N	%	Early weaning				^$Crude OR (#CI95%)	p	^$Adjusted OR (#IC95%)	p
			^* * Event for the outcome variable. # Median of the sample. OR = Odds ratio; CI = Confidence Interval; AIC (empty model) =1541.37; AIC (final model) = 1524.45. Yes		No
			n	%	n	%
Maternal characteristics
Age (years)
^&Up to 27	628	49.2	192	30.6	436	39.4	0.96 (0.75-1.22)	0.7198	-
Above 27	606	47.5	191	31,5	415	68.5	Ref
No information	41	3.2	7	17,1	34	82.9	-
Marital status
Partner	883	69.2	258	29.2	625	70.8	Ref		-
No partner	389	30.5	131	33.7	258	66.3	1.23 (0.95-1.59)	0.1122
No information	3	0.2	1	33.3	2	66.7	-
Schooling
^&Up to complete high school	962	75.4	299	31.1	663	68.9	1.09 (0.82-1.45)	0.5377	-
Above complete high school	308	24.2	90	29.2	218	70.8	Ref
No information	5	0.4	1	0.3	4	0.4	-
Occupation
Housewife	567	44.5	204	36.0	363	64.0	1.58 (1.24-2.00)	0.0002	1.64 (1,28-2.09)	<0.001
Others	708	55.5	186	26.3	522	73.7	Ref		Ref
Income (MW)
^&Up to one	678	53.2	212	32.3	466	68.7	1.06 (0.83-1.34)	0.6498	-
Above one MW	585	45.9	176	30.1	409	69.9	Ref
No information	12	0.9	2	16.7	10	83.3	-
Maternal obstetric and breastfeeding history
Amamentou outros Filhos
Yes	546	42.8	169	31.0	1377	69.0	4.03 (1.21-13.46)	0.0235	4.04 (1.21-13.55)	0.0236
No	30	2.4	3	10.0	27	90.0	Ref		Ref
Not applicable (1st pregnancy)	677	53.1	209	30,9	468	69.1	4.01 (1.20-13.37)	0.0236	4.32 (1.29-14.44)	0.0176
No information	22	1.7	9	40.9	13	59.1	-
Family support for breastfeeding the previous child
Yes	495	38.8	159	32.1	336	67.9	Ref		-
No	62	4.9	15	24.2	47	78.8	0.68 (0.37-1.24)	0.2066
Not applicable (1st pregnancy)	685	53.7	210	30.7	475	69.3	0.93 (0.73-1.20)	0.5924
No information	33	2.6	6	18.2	27	81.8	-
How many pregnancies
^&Up to two	919	72.1	284	30.9	635	69.1	1.06 (0.81-1.38)	0.6963	-
More than two	356	27.9	106	29.8	250	70.2	Ref
Number of births
^&Up to one	681	53.4	211	31.0	470	69.0	1.04 (0.82-1.32)	0.7429	-
More than one	594	46.6	179	30.1	415	69.9	Ref
Number of abortions
^&None	950	74.5	296	31.2	654	68.8	Ref		-
At least one	325	25.5	94	28.9	231	71.1	0.90 (0.68-1.18)	0.4505
Prenatal care
Yes	1.268	99.4	387	30.5	881	69.5	Ref		-
No	7	0.6	3	42.9	4	57.1	1.71 (0.38-7.67)	0.4849
Number of appointments
^&Less than seven	499	39.1	145	29.1	354	70.9	0.88 (0.69-1.13)	0.3276	-
At least seven	742	58.2	235	31.7	507	68.3	Ref
No information	34	2.7	10	29.4	24	70.6	-
Where
HUUFMA	568	44.6	176	31.0	392	69.0	1.44 (0.94-2.23)	0.0970	-
Other public services	535	42.0	170	31.8	365	68.2	1.50 (0.97-2.32)	0.0691
Private Services	135	10.6	32	23.7	103	76.3	Ref
No information	37	2.9	12	32.4	25	67.6	-
Guidance on breastfeeding during prenatal care
Yes	635	49.8	191	30.1	444	69.9	Ref		-
No	621	48.7	193	31.1	428	68.9	1.05 (0.82-1.33)	0.7005
No information	19	1.5	6	31.6	13	68.4	-
Guidance on breastfeeding in the maternity ward
Yes	1.065	83.5	324	30.4	741	69.6	Ref		-
No	205	16.1	64	31.2	141	68.8	1.04 (0.75-1.43)	0.8197
No information	5	0.4	2	40.0	3	60.0	-
Where the infant was born
HUUFMA	1.067	83.7	335	31.4	732	68.6	3.00 (1.47-6.12)	0.0025	-
Other public services	128	10.0	43	33.6	85	66.4	3.32 (1.50-7.32)	0.0030
Private Services	68	5.3	9	13.2	59	86.8	Ref
Others	5	0.4	2	40	3	60.0	4.37 (0.64-29.86)	0,1326
No information	7	0.6	1	14.3	6	85.7	-
Type of delivery
Vaginal	655	51.4	203	31.0	452	69.0	Ref		-
Cesarean section	617	48,4	187	30.3	430	69.7	0.97 (0.76-1.23)	0.7914
No information	3	0.2	0	-	3	100.0	-
Characteristics of the newborn
Gender
Male	662	51.9	196	29.6	466	70.4	Ref		-
Female	609	47.8	193	31.7	416	68.3	1.10 (0.87-1.40)	0.4207
No information	4	0.3	1	25.0	3	75.0	-
Birth weight (g)
^&Up to 3205	638	50.0	200	31.4	438	68.6	1.08 (0.85-1.38)	0.5038	-
Above 3205	628	49.2	186	29.6	442	70.4	Ref
No information	9	0.7	4	44.4	5	55.6	-
Breastfed in the delivery room
Yes	831	65.2	261	31.4	570	68.6	Ref		-
No	424	33.2	125	29.5	299	70.5	0.91 (0.71-1.18)	0.4843
No information	20	1.6	4	20.0	16	80.0	-
Breastfeeding observation
It was observed that
Yes	1.220	95.7	377	30.9	843	69.1	Ref		-
No	42	3.3	7	16.7	35	83.3	0.45 (0.20-1.02)	0.0546
No information	13	1.0	6	46.2	7	53.8	-
Mother relaxed and comfortable
Yes	749	58.8	541	32.2	508	67.8	Ref		-
No	473	37.1	140	29.6	333	70.4	0.89 (0.69-1.14)	0.3435
No information	53	4.2	9	17.0	44	83	-
Infant close
Yes	600	47.1	187	31.2	413	68.8	Ref		-
No	623	48.9	195	31.3	428	68.7	1.00 (0.79-1.28)	0.9598
No information	52	4.1	8	15.4	44	84.6	-
Head and body aligned
Yes	553	43.4	170	30.7	383	69.3	Ref		-
No	659	51.7	209	31.7	450	68.3	1.05 (0.82-1.34)	0.7160
No information	63	4.9	11	17.5	52	82.5	-
Chin touching breast
Yes	1.002	78.6	318	31.7	684	68.3	Ref		-
No	211	16.6	59	28.0	152	72.0	0.84 (0.60-1.16)	0.2821
No information	62	4.9	13	21.0	49	79.0	-
Supported buttocks
Yes	646	50.7	206	31.9	440	68.1	Ref		-
No	561	44.0	168	30.0	393	70.0	0.91 (0.72-1.17)	0.4669
No information	68	5.3	16	23.5	52	76.5	-
Mouth wide open
Yes	690	54.1	218	31.6	472	68.4	Ref		-
No	524	41.1	160	30.5	364	69.5	0.95 (0.74-1.22)	0.6932
No information	61	4.8	12	19.7	49	80.3	-
Bottom lip turned out
Yes	724	56.8	228	31.5	496	68.5	Ref		-
No	490	38.4	150	30.6	340	69.4	0.96 (0,.75-1.23)	0.7458
No information	61	4.8	12	19.7	49	80.3	-
Tongue attached around the breast
Yes	670	52.6	218	32.5	452	67.5	Ref		-
No	532	41.7	160	30.1	372	69.9	0.89 (0.70-1.14)	0.3613
No information	73	5.7	12	16.4	61	83.6	-
Round cheeks
Yes	935	73.3	299	32.0	636	68.0	Ref		-
No	273	21.4	79	28.9	194	71.1	0.87 (0.64-1.16)	0.3407
No information	67	5.2	12	17.9	55	82.1	-
More areola around the mouth
Yes	782	61.3	246	31.5	536	68.5	Ref		-
No	421	33.0	131	31.1	290	69.9	0.98 (0.76-1.27)	0.9032
No information	72	5.6	13	18.1	59	81.9	-
Deep slow sucks
Yes	901	70.7	290	32.2	611	67.8	Ref		-
No	313	24.6	89	28.4	224	71.6	0.84 (0.63-1.11)	0.2175
No information	61	4.8	11	18	50	82.0	-
Swallowing can be heard
Yes	916	71.8	301	32.9	615	67.1	Ref		-
No	274	21.5	73	26.6	201	73.4	0.74 (0.55-1.00)	0.0523
No information	85	6.7	16	18.8	69	81.2	-

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[1] Associated Editor: Lygia Vanderlei