Infant Feeding Practices in a Multi-Ethnic Cohort of Vulnerable Women Registered in the Canada Prenatal Nutrition Program

• Main Author: Mildon, Alison Margaret
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2022
• Subjects: Developmental biology; Nutrition; Obstetrics; Obstetrics and gynecology
• ISBN: 9798835526321

Background: Breastfeeding rates are lower among socio-economically vulnerable women in Canada. Improved access to skilled lactation support is one priority action to address these disparities. The Canada Prenatal Nutrition Program (CPNP) aims to support breastfeeding among vulnerable women but little is known about participants’ infant feeding practices or effective models for delivering postnatal lactation support through the CPNP. Objectives: Data from a Toronto cohort of CPNP participants were examined to determine : 1) breastfeeding intensity levels at seven time points to six months postpartum, frequency of breastmilk supplement use by time point, and intervals of exclusive breastfeeding; 2) prevalence of expressed breastmilk use and associations between its use at two weeks postpartum and breastfeeding practices (any and exclusive) to six months; 3) prevalence of household food insecurity at six months postpartum and associations with continued and exclusive breastfeeding.Methods: A pre/post study of a postnatal lactation support intervention was implemented at two CPNP sites but suspended prematurely due to the COVID-19 pandemic. Post-hoc analyses were conducted using the available dataset (study 1; n=151) and pooling it with data from a related study at another CPNP site providing free, in-home skilled lactation support (studies 2 and 3; n=337). Results: At least 60% of study 1 participants provided breastmilk for >75% of daily milk feeds at all time points and 48% exclusively breastfed for at least three consecutive months, despite only 18% doing so for six months. In the pooled cohort, in-hospital formula supplementation was common (57%) and 34% used expressed breastmilk in the first two weeks postpartum. These early feeding practices were associated with breastfeeding cessation before six months and non-exclusive breastfeeding to both four and six months. Household food insecurity was highly prevalent (44%) in the pooled cohort but was not associated with breastfeeding practices. Conclusions: Findings showed high rates of breastfeeding but a continued need for skilled lactation support from birth to improve exclusive breastfeeding. These findings inform adaptations to the redesign of the planned intervention study. Comprehensive assessment of infant feeding practices and household food insecurity in the national CPNP is also needed to shape future program delivery.