{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T17:57:11Z","timestamp":1790445431513,"version":"4.1.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2012,10,11]],"date-time":"2012-10-11T00:00:00Z","timestamp":1349913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Breastfeeding Medicine"],"published-print":{"date-parts":[[2013,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Many perinatal stressors, including high prepregnancy body mass index, preterm birth, and cesarean section, increase the risk for short breastfeeding duration. Few studies, however, have investigated the mechanism in the relationship between perinatal determinants and breastfeeding duration. This study aimed to test the hypothesis that delayed onset of lactation (OL) could mediate the negative effect of perinatal biopsychosocial stress on breastfeeding duration and to evaluate the impact of new perinatal factors with potentially hazardous effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Subjects and Methods:<\/jats:title>\n                    <jats:p>Maternal demographic characteristics, health status, and psychological stress during pregnancy were assessed by structured questionnaires and medical records. The information of lactation was collected in the hospital within 1\u20133 days after delivery. Data on breastfeeding behaviors were obtained through the telephone interview at 2 months after delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The risk of delayed OL increased in women who had experienced severe life event stress in the first trimester of pregnancy (adjusted risk ratio [RR] 2.59, 95% confidence interval [CI] 1.52, 4.40), had undergone cesarean section (adjusted RR 2.11, 95% CI 1.46, 3.05), whose gestational body mass index gain were not less than 7.62 (adjusted RR 1.90, 95% CI 1.27, 2.86), and whose breastfeeding frequency was less than three times in the first day after childbirth (adjusted RR 2.14, 95% CI 1.57, 2.91). The final model of structural equation modeling indicated that women with cesarean section, preterm birth, greater gestational body mass index gain, higher scores of stressful life events in the first trimester, and less breastfeeding frequency in the first day after delivery were more likely to experience delayed OL, which could result in an earlier breastfeeding termination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Delayed OL, as a negative biological event resulted from the perinatal biopsychosocial stress, is a key mediator linking perinatal factors to breastfeeding duration. More attention should to be paid to underweight before pregnancy and severe life events during pregnancy, which are regarded as novel and remarkable risk factors of delayed OL and short breastfeeding duration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/bfm.2012.0010","type":"journal-article","created":{"date-parts":[[2012,10,11]],"date-time":"2012-10-11T12:47:25Z","timestamp":1349959645000},"page":"151-158","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":44,"title":["New Insight into Onset of Lactation: Mediating the Negative Effect of Multiple Perinatal Biopsychosocial Stress on Breastfeeding Duration"],"prefix":"10.1177","volume":"8","author":[{"given":"Peng","family":"Zhu","sequence":"first","affiliation":[{"name":"Anhui Medical University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahu","family":"Hao","sequence":"additional","affiliation":[{"name":"Anhui Medical University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaomin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Hefei Maternal and Child Health Hospital","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Huang","sequence":"additional","affiliation":[{"name":"Anhui Medical University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangbiao","family":"Tao","sequence":"additional","affiliation":[{"name":"Anhui Medical University","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2012,10,11]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4757-4242-8_7"},{"key":"e_1_3_3_3_2","volume-title":"Global Strategy on Infant and Young Child Feeding","author":"World Health Organization","year":"2003","unstructured":"World Health Organization. Global Strategy on Infant and Young Child Feeding. World Health Organization: Geneva, 2003."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-2491"},{"key":"e_1_3_3_5_2","first-page":"275","article-title":"Exclusive breastfeeding and growth of infants under 4 months in China [in Chinese]","volume":"29","author":"Fu Z","year":"2000","unstructured":"Fu Z, , Chang S, , He W et al. Exclusive breastfeeding and growth of infants under 4 months in China [in Chinese] Wei Sheng Yan Jiu, 2000; 29:275\u2013278.","journal-title":"Wei Sheng Yan Jiu"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/1746-4358-4-1"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2009.01335.x"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2007.133215"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/131.10.3055"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/77.4.931"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/089033449801400114"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1991"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/133.8.2592"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/089033449901500207"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.112.3.607"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/68.2.335"},{"key":"e_1_3_3_17_2","first-page":"2954","article-title":"Suppression of hypothalmic-pituitary-adrenal axis responses to stress in lactating women","volume":"80","author":"Altemus M","year":"1995","unstructured":"Altemus M, , Deuster PA, , Galliven E et al. Suppression of hypothalmic-pituitary-adrenal axis responses to stress in lactating women. J Clin Endocrinol Metab, 1995; 80:2954\u20132959.","journal-title":"J Clin Endocrinol Metab"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-4522(99)00433-9"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/1025389021000048638"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-4522(99)00433-9"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/86.2.404"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/136.1.140"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/0890334406297283"},{"key":"e_1_3_3_24_2","first-page":"98","article-title":"Theoretical principle and application of social support scale","volume":"4","author":"Xiao SY","year":"1994","unstructured":"Xiao SY. Theoretical principle and application of social support scale. J Clin Psychiatry, 1994; 4:98\u2013100.","journal-title":"J Clin Psychiatry"},{"issue":"34","key":"e_1_3_3_25_2","first-page":"E1","article-title":"Prenatal life events stress: Implications for preterm birth and infant birthweight","volume":"203","author":"Zhu P","year":"2010","unstructured":"Zhu P, , Tao F, , Hao J et al. Prenatal life events stress: Implications for preterm birth and infant birthweight. Am J Obstet Gynecol, 2010; 203,34:E1\u2013E8.","journal-title":"Am J Obstet Gynecol"},{"key":"e_1_3_3_26_2","volume-title":"Obesity: Preventing and Managing the Global Epidemic","author":"World Health Organization","year":"1998","unstructured":"World Health Organization. Obesity: Preventing and Managing the Global Epidemic. World Health Organization: Geneva, 1998."},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/130.12.2972"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1080\/10705519909540118"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1740-8709.2007.00096.x"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8223(99)00109-1"},{"key":"e_1_3_3_31_2","volume-title":"Nutrition During Pregnancy: Part I, Weight Gain; Part II, Nutrient Supplements","author":"Institute of Medicine (Subcommittees on Nutritional Status Weight Gain During Pregnancy Dietary Intake Nutrient Supplements During Pregnancy Committee on Nutritional Status During Pregnancy Lactation, Food, Nutrition Board)","year":"1990","unstructured":"Institute of Medicine (Subcommittees on Nutritional Status Weight Gain During Pregnancy Dietary Intake Nutrient Supplements During Pregnancy Committee on Nutritional Status During Pregnancy Lactation, Food, Nutrition Board). Nutrition During Pregnancy: Part I, Weight Gain; Part II, Nutrient Supplements. National Academies Press: Washington, DC, 1990."},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2007.00602.x"}],"container-title":["Breastfeeding Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/bfm.2012.0010","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/bfm.2012.0010","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/bfm.2012.0010","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:00:04Z","timestamp":1777381204000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/bfm.2012.0010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,10,11]]},"references-count":31,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2013,4,1]]}},"alternative-id":["10.1089\/bfm.2012.0010"],"URL":"https:\/\/doi.org\/10.1089\/bfm.2012.0010","relation":{},"ISSN":["1556-8253","1556-8342"],"issn-type":[{"value":"1556-8253","type":"print"},{"value":"1556-8342","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,10,11]]}}}