{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T04:20:46Z","timestamp":1745986846507,"version":"3.40.4"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>During the 2013\u201321 period, 674 primiparous women with Class 3 obesity delivered in our institution. Their antenatal infant feeding preference on admission was: 518 (77%) intended to breastfeed (BF) only, 101 (15%) intended to feed formula only and 55 (8%) intended to BF and formula feed combined. Intention to BF only is a predictor of BF initiation, however, data concerning this relationship is limited.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To determine the perinatal variables that influence success or failure of BF among primiparous women with Class 3 obesity who antenatally declared their intention to only BF.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Retrospective cohort study of women who delivered live singletons without major malformations at \u2265 34 weeks gestation.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The 518 women who prenatally intended to BF only, were categorized at discharge as exclusive BF <jats:italic>(EBF)<\/jats:italic> 197 (38%), any BF (<jats:italic>ABF<\/jats:italic>) 212 (41%) and formula feeding (<jats:italic>FF<\/jats:italic>) 109 (21%). A lower prevalence of gestational diabetes (10,17 vs 17%), chronic hypertension (16,31 vs 18%), severe preeclampsia (12,22 vs 30%), cesarean delivery (37,55 vs 55%), late preterm (6,17 vs 14%), neonatal hypoglycemia (8,26 vs 22%) and NICU admission (11,25 vs 20%) was present in the <jats:italic>EBF<\/jats:italic> group as compared to <jats:italic>ABF<\/jats:italic> and <jats:italic>FF<\/jats:italic>. African American women were more likely to only <jats:italic>FF<\/jats:italic>. Regression analysis showed that the stronger predictors of failure to initiate BF were public healthcare assistance, African American race, preeclampsia, cesarean delivery, neonatal hypoglycemia, prematurity and NICU admission.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Among primiparous women with class 3 obesity who intended to BF only but failed to do so, the increased prevalence and severity of maternal and neonatal morbidities are likely obstacles to BF their first infant.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0322232","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T17:47:57Z","timestamp":1745948877000},"page":"e0322232","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primiparity, class 3 obesity, intention to breastfeed and breastfeeding 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