Intergenerational breastfeeding practices among parents and children: 1993 Pelotas (Brazil) birth cohort

Abstract

The objective of this study was to investigate intergenerational breastfeeding practices according to parental sex and age at delivery in the 1993 Pelotas (Brazil) birth cohort study. This is a prospective birth cohort study, and at the 22-year follow-up, a substudy with all children of the cohort members who had become parents was conducted (93Cohort-II). First generation breastfeeding data were collected at 3 months and 4-year-old follow-ups. In the 93Cohort-II, parents answered a questionnaire about their children's breastfeeding practices. Adjusted Tobit and Poisson regression models with robust variance were applied to estimate the association between predominant parental breastfeeding duration and exclusive breastfeeding duration of the children at 3 and 6 months. Out of 3,810 cohort participants, 955 (25%) had delivered at least one live-born infant, and 1,222 children were assessed. Fifty-four percent of parents were ≤19 years old. Direct effects of predominant parental breastfeeding duration on exclusive breastfeeding duration of their children were only observed when data were stratified by parental age: children born to parents aged ≥20 years old and who were predominantly breastfed for at least 3 months presented higher exclusive breastfeeding duration and higher prevalence of being exclusively breastfed for at least 3 months. When analyses were stratified by mothers and fathers, the result remained significant only among mothers. Longer predominant breastfeeding duration in the first generation was associated with longer exclusive breastfeeding duration in the second generation, but only among older mothers. Education and social support surrounding breastfeeding should be intensified among fathers and younger parents to create a positive environment supportive of breastfeeding.

Keywords: birth studies; breast feeding; child; infant; parents; prospective studies.

FIGURE 1

Flow chart of the first and second generation of the 1993 Pelotas birth cohort study. ^†Black boxes indicate follow‐ups that all cohort members were eligible to participate. ^§Eligibility refers to 5,249 out of 5,265 cohort members whose mothers provided consent to participate in the recruitment phase (perinatal). Mothers of the remaining 16 refused to participate. ^‡First generation proportion of completed follow‐up considering members who participate, added to those known to have die; ^||1,212 refer to the second generation children with completed assessments at the research clinic unit. A further 44 children received home visits, and parents answered a brief questionnaire. ^¶Second generation proportion of completed follow‐up considering children who participate. ^††Final sample of second generation children, starting from a number of 1,222 children with available breastfeeding data, excluding those who were still being exclusively breastfed (n = 203) and those whose exclusive breastfeeding duration was greater than 6 months (n = 72). ^‡‡Present study proportion of participants, considering 947 children in relation to the total eligible

FIGURE 2

Association between first generation's predominant breastfeeding duration and second generation's exclusive breastfeeding duration measured by Tobit regression. Note: adjusted for family income in 1993, grandmother's education and skin colour, maternal/paternal birthweight, age and sex, and second generation delivery type, prematurity, and birthweight

FIGURE 3

Association between first generation's predominant breastfeeding duration and second generation's exclusive breastfeeding at 3 months measured by Poisson regression. Note: adjusted for family income in 1993, grandmother's education and skin colour, maternal/paternal birthweight, age and sex, and second generation delivery type, prematurity, and birthweight