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Personality Traits Predict Meeting the WHO Recommendation of 6 Months' Breastfeeding

A Prospective General Population Cohort Study

Verbeek, Tjitte, MD, PhD; Quittner, Loes, MSc; de Cock, Paul, PhD; de Groot, Nynke, MSc; Bockting, Claudi L. H., PhD; Burger, Huibert, MD, PhD

doi: 10.1097/ANC.0000000000000547
Oral Feeding Strategies: Special Series

Background: Although personality as well as anxiety and depression are recognized as predictors for breastfeeding initiation, evidence of an association of these factors with 6 months' exclusive breastfeeding as recommended by the World Health Organization (WHO) is sparse.

Purpose: The purpose of this study was to investigate the associations of personality and symptoms of anxiety and depression during and after pregnancy with meeting the WHO recommendation of 6 months' exclusive breastfeeding.

Methods: In their first trimester of pregnancy, 5784 pregnant women were enrolled in Dutch primary obstetric care centers and hospitals, of which 2927 completed the breastfeeding assessments 6 months postpartum. We performed logistic regression analyses to test the associations of “big five” personality traits (NEO Five Factor Inventory), anxiety (State-Trait Anxiety Inventory), and depression (Edinburgh Postnatal Depression Scale) symptom levels during pregnancy and postpartum with meeting the WHO recommendation of 6 months' exclusive breastfeeding.

Results: Agreeableness (odds ratio [OR] = 1.18, P = .006) and openness (OR = 1.31, P < .001) were positively associated with meeting the WHO recommendation, whereas extraversion (OR = 0.83, P = .005) and neuroticism (OR = 1.18, P = .006) were negatively associated. After adjustment for both antenatal and postpartum symptom levels of anxiety and depression, the associations of the agreeableness, extraversion, and openness personality traits remained strong and statistically significant (P < .05).

Implications for Practice: Patient-centered care should take personality into account in an effort to tailor interventions to optimize breastfeeding behavior.

Implications for Research: In contrast to earlier findings, personality traits may be of greater importance than symptoms of anxiety and depression for meeting the WHO recommendation of 6 months' exclusive breastfeeding.

Departments of General Practice (Drs Verbeek and Burger), Epidemiology (Ms de Groot), and Clinical Psychology (Dr Bockting), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Midwifery Science, AVAG and EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands (Ms Quittner); Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, Northern Ireland (Dr de Cock); Department of Obstetrics & Gynecology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands (Ms de Groot); and Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands (Dr Bockting).

Correspondence: Tjitte Verbeek, MD, PhD, Department of General Practice, University Medical Center Groningen, University of Groningen, HPC FA21, Hanzeplein 1, 9700 RB Groningen, the Netherlands (

The study was supported by a grant from the Netherlands Organization for Health Research and Development (ZonMW, 120520013). The authors thank all gynecologists, midwives, and research nurses for the screening of participants, and all women for their participation.

There is no conflict of interest.

© 2019 by The National Association of Neonatal Nurses