Am J Perinatol
DOI: 10.1055/a-2211-1787
Original Article

Predictors of Breastfeeding among Patients Admitted with Preterm Prelabor Rupture of Membranes

Carmen M.A. Santoli
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
Ian A. Taylor-Cho
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
Alice J. Darling
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
Melissa N. Montoya
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
Jennifer B. Gilner
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
Sarah K. Dotters-Katz
1   Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
› Author Affiliations
Funding None.


Objective We sought to describe rates of breastmilk feeding (BF) at hospital discharge and 6 weeks postpartum and to identify risk factors for noninitiation or cessation among pregnancies complicated by preterm prelabor rupture of membranes (PPROM).

Study Design Retrospective cohort study of pregnant persons with PPROM admitted to a single tertiary center (2013–2019). Patients with deliveries complicated by intrauterine or neonatal demise or with incomplete BF data were excluded. Demographic, antepartum, and delivery characteristics were evaluated. Primary analysis identified rate of BF initiation at maternal discharge and factors associated with noninitiation. Secondary analysis evaluated BF continuation and factors associated with cessation at 6 weeks postpartum. Bivariate statistics were used to compare characteristics and logistic regression was used to estimate adjusted odds ratios (aOR).

Results Of 397 patients with PPROM, 342(86%) initiated BF prior to discharge. Those reporting tobacco use in pregnancy were less likely to initiate BF (aOR: 0.32; 95% confidence interval [CI]: 0.16, 0.64). In contrast, private insurance (aOR: 2.53; 95% CI: 1.19, 5.37) and pregnancy latency ≥ 14 days (aOR: 3.02; 95% CI: 1.09, 8.38) were associated with BF initiation at hospital discharge. Of the 293 patients with postpartum follow-up, only 214 (73%) had BF continuation at 6 weeks postpartum. Maternal age <20 years (aOR: 0.07; 95% CI: 0.01, 0.68) and multiparity (aOR: 0.54; 95% CI: 0.29, 0.99) were associated with BF cessation. Patients with private insurance were observed to have increased odds of BF continuation (aOR: 2.10; 95% CI: 1.07, 4.12).

Conclusion Among patients with PPROM, tobacco use may be associated with noninitiation of BF prior to discharge, whereas age < 20 years and multiparity were associated with cessation by 6 weeks postpartum. Longer pregnancy latency ≥ 14 days was associated with BF initiation prior to discharge. Private insurance was associated with increased rates of BF initiation and continuation postpartum. BF education and support should be offered to all patients admitted for PPROM.

Key Points

  • Tobacco use may be associated with BF noninitiation.

  • Young age and multiparity are linked with BF cessation.

  • Private insurance resulted in BF initiation and continuation.


A virtual poster on this topic was presented at the 68th annual Society for Reproductive Investigation in July 2021.

Supplementary Material

Publication History

Received: 19 April 2023

Accepted: 10 November 2023

Accepted Manuscript online:
15 November 2023

Article published online:
05 December 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129 (03) e827-e841
  • 2 Ip S, Chung M, Raman G. et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep) 2007; (153) 1-186
  • 3 Belfort MB, Knight E, Chandarana S. et al. Associations of maternal milk feeding with neurodevelopmental outcomes at 7 years of age in former preterm infants. JAMA Netw Open 2022; 5 (07) e2221608-e2221608
  • 4 Parker MG, Stellwagen LM, Noble L, Kim JH, Poindexter BB, Puopolo KM. SECTION ON BREASTFEEDING, COMMITTEE ON NUTRITION, COMMITTEE ON FETUS AND NEWBORN. Promoting human milk and breastfeeding for the very low birth weight infant. Pediatrics 2021; 148 (05) e2021054272
  • 5 Tudehope DI. Human milk and the nutritional needs of preterm infants. J Pediatr 2013; 162 (3, suppl): S17-S25
  • 6 Underwood MA. Human milk for the premature infant. Pediatr Clin North Am 2013; 60 (01) 189-207
  • 7 Akerström S, Asplund I, Norman M. Successful breastfeeding after discharge of preterm and sick newborn infants. Acta Paediatr 2007; 96 (10) 1450-1454
  • 8 Callen J, Pinelli J. A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants. Adv Neonatal Care 2005; 5 (02) 72-88 , quiz 89–92
  • 9 Demirci JR, Sereika SM, Bogen D. Prevalence and predictors of early breastfeeding among late preterm mother-infant dyads. Breastfeed Med 2013; 8 (03) 277-285
  • 10 Mulready-Ward C, Sackoff J. Outcomes and factors associated with breastfeeding for <8 weeks among preterm infants: findings from 6 states and NYC, 2004-2007. Matern Child Health J 2013; 17 (09) 1648-1657
  • 11 Zachariassen G, Faerk J, Grytter C, Esberg B, Juvonen P, Halken S. Factors associated with successful establishment of breastfeeding in very preterm infants. Acta Paediatr 2010; 99 (07) 1000-1004
  • 12 Prelabor rupture of membranes: ACOG practice bulletin, number 217. Obstet Gynecol 2020; 135 (03) e80-e97
  • 13 Prediction and Prevention of Spontaneous Preterm Birth. Prediction and prevention of spontaneous preterm birth: ACOG practice bulletin, number 234. Obstet Gynecol 2021; 138 (02) e65-e90
  • 14 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
  • 15 Henderson JJ, McWilliam OA, Newnham JP, Pennell CE. Preterm birth aetiology 2004-2008. Maternal factors associated with three phenotypes: spontaneous preterm labour, preterm pre-labour rupture of membranes and medically indicated preterm birth. J Matern Fetal Neonatal Med 2012; 25 (06) 642-647
  • 16 Manuck TA, Rice MM, Bailit JL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016; 215 (01) 103.e1-103.e14
  • 17 Cohen SS, Alexander DD, Krebs NF. et al. Factors associated with breastfeeding initiation and continuation: a meta-analysis. J Pediatr 2018; 203: 190-196.e21
  • 18 Furman L, Minich N, Hack M. Correlates of lactation in mothers of very low birth weight infants. Pediatrics 2002; 109 (04) e57
  • 19 Tanda R, Chertok IRA, Haile ZT, Chavan BB. Factors that modify the association of maternal postpartum smoking and exclusive breastfeeding rates. Breastfeed Med 2018; 13 (09) 614-621
  • 20 Liu J, Rosenberg KD, Sandoval AP. Breastfeeding duration and perinatal cigarette smoking in a population-based cohort. Am J Public Health 2006; 96 (02) 309-314
  • 21 Baxter J, Cooklin AR, Smith J. Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study. Acta Paediatr 2009; 98 (08) 1274-1277
  • 22 Lussier MM, Tosi L, Brownell EA. Predictors of mother's own milk feeding at discharge in preterm infants. Adv Neonatal Care 2019; 19 (06) 468-473
  • 23 Sankar MN, Weiner Y, Chopra N, Kan P, Williams Z, Lee HC. Barriers to optimal breast milk provision in the neonatal intensive care unit. J Perinatol 2022; 42 (08) 1076-1082
  • 24 Oras P, Thernström Blomqvist Y, Hedberg Nyqvist K. et al. Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants. Acta Paediatr 2016; 105 (07) 783-789
  • 25 Robinson K, Garnier-Villarreal M, Hanson L. Effectiveness of centering pregnancy on breastfeeding initiation among African Americans: a systematic review and meta-analysis. J Perinat Neonatal Nurs 2018; 32 (02) 116-126
  • 26 Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birth weight infants: effect on maternal anxiety and infant intake of human milk. Pediatrics 2006; 117 (01) e67-e75
  • 27 Darling A. et al. 809 Pregnancy latency among patients with preterm prelabor rupture of membranes attending inpatient centering groups. Am J Obstet Gynecol 2021; 224: S503-S504