Poster #158 - Breastfeeding Behaviors and Maternal Interaction Quality in a Low-Income, Ethnic Minority Population

• In Event: 1-115 - Poster Session 03
  In Poster Session: PS 03 Section - Parenting & Parent-Child Relationships

Integrative Statement

Breastfeeding initiation and duration have been associated with increased maternal sensitivity and more secure mother-infant attachment. Though correlations between mother-infant interaction quality and infant feeding choices have been well established in the literature, little research has conclusively demonstrated the directionality of those relationships or the mechanisms by which they operate. For instance, more sensitive or responsive mothers may have stronger intentions to breastfeed or be more successful at meeting those intentions. Alternatively, breastfeeding may help mothers respond more sensitively to their infants.

There remain basic unanswered questions regarding which features of the breastfeeding relationship (i.e., initiation vs. duration vs. intensity) are related to the mother-infant relationship, and by exploring this nuance, we hope to generate hypotheses about mechanism and directionality. Furthermore, the majority of studies exploring these relationships have taken place either outside of the United States or in higher-income U.S. communities, potentially limiting their generalizability to more diverse populations at risk for health disparities.

We sought to determine associations between breastfeeding intensity and exclusivity and observed maternal interaction quality during a videotaped play interaction at 6 months old in a low-income racially and ethnically diverse sample spanning two U.S. cities: NYC and Pittsburgh. We analyzed this observational data collected as part of an ongoing randomized controlled trial integrating two evidence-based interventions: 1) a universal primary prevention strategy (Video Interaction Project); and 2) a targeted secondary/tertiary prevention strategy (Family Check-Up) for families identified as having additional psychosocial risks. Participants were predominantly African American (44.9%) and Hispanic (43.4%). Dependent variables were global scales of maternal interaction quality during a 5-minute videotaped, free-play task based on the Parent-Child Interaction Rating Scales-Infant Adaptation, and the Infant StimQ parental verbal responsivity subscale. We estimated linear associations between breastfeeding initiation, intensity, and exclusivity with maternal interaction quality and verbal responsivity, controlling for infant and family covariates.

At infant age 6 months old, 53% of mothers reported exclusive formula feeding and 26% reported exclusive breastfeeding, with the remaining 22% combination feeding. Breastfeeding initiation marginally predicted increased maternal sensitivity (β=0.35, p=0.050) and decreased maternal intrusiveness (β=-0.37, p=0.083). There was no significant association between breastfeeding initiation and detachment (β=0.03, ns) or verbal responsiveness (β=-0.11, ns). After controlling for initiation, higher intensity breastfeeding predicted increased sensitivity (β=0.12, p=0.004) and decreased intrusiveness (β=-0.11, p=0.032). Breastfeeding exclusivity at 6 months significantly predicted increased maternal sensitivity (β=0.38, p=0.011) and decreased maternal intrusiveness (β=-0.39, p=0.028) after controlling for initiation. Extensive sensitivity checks established that these associations were not moderated by observable characteristics.

Higher breastfeeding intensity and exclusive breastfeeding were independent predictors of maternal high sensitivity and low intrusiveness at 6 months, above and beyond breastfeeding initiation, potentially supporting the theory that breastfeeding itself – specifically exclusive breastfeeding to at least 6 months – may lead to more sensitive or responsive parenting. Understanding the nature of the relationship between breastfeeding and interaction quality in diverse populations has the potential to widen our understanding about the directionality and mechanisms by which breastfeeding relates to interaction quality, and to inform health interventions in low-income communities.

Group Authors

Smart Beginnings Team

Authors

• Mackenzie Danielle Marie Whipps, New York Univeristy
  Presenting Author

• Elizabeth B Miller, New York Univeristy
  Non-Presenting Author

• Debra L. Bogen, University of Pittsburgh School of Medicine
  Non-Presenting Author

• Alan L. Mendelsohn, New York University School of Medicine
  Non-Presenting Author

• Pamela A. Morris, New York Univeristy
  Non-Presenting Author

• Daniel S. Shaw, University of Pittsburgh
  Non-Presenting Author

• Rachel Gross, New York University School of Medicine
  Non-Presenting Author