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The Relationship Between Infant Feeding Outcomes and Maternal Emotional Well-being Among Mothers of Late Preterm and Term Infants

A Secondary, Exploratory Analysis

Tully, Kristin P., PhD; Holditch-Davis, Diane, PhD, RN, FAAN; Silva, Susan, PhD; Brandon, Debra, PhD, RN, CNNS, FAAN

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000322
Original Research

Background: Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth.

Purpose: The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being.

Methods: Participants were 105 mother–infant dyads (54 late preterm and 51 term) at a southeastern US medical center. Face-to-face data collection and telephone follow-up occurred during 2009-2012.

Results: Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at 1 month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety than among those exclusively providing formula and (2) exclusive provision of human milk at 1 month was associated with less severe depressive symptoms than among those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point.

Implications for Practice: Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated healthcare needs.

Implications for Research: Prospective research is critical to document women's intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding goals.

Center for Developmental Science and Carolina Global Breastfeeding Institute, University of North Carolina at Chapel Hill (Dr Tully); and School of Nursing, Duke University, Durham, North Carolina (Drs Holditch-Davis, Silva, and Brandon).

Correspondence: Kristin P. Tully, PhD, Center for Developmental Science and Carolina Global Breastfeeding Institute, University of North Carolina at Chapel Hill, 100 East Franklin St, Ste 200, Campus Bldg 8115, Chapel Hill, NC 27599 (

The name of the institution where the study was conducted: Duke University.

This research was supported by 2KR251106 from the North Carolina Translational and Clinical Science Institute awarded to Kristin P. Tully and Duke University School of Nursing support to the other 3 authors. The Eunice Kennedy Shriver National Institute for Child Health and Human Development Training grant T32HD007376 funded Kristin P. Tully. The authors thank Richard Sloane for statistical support.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Dr. Brandon, who is a co-editor for Advances in Neonatal Care and the coauthor and mentor to the primary author, was not involved in the editorial review or decision to publish this article. The entire process from submission, referee assignment, and editorial decisions was handled by other members of the editorial team for the journal.

© 2017 by The National Association of Neonatal Nurses