Stressful Life Events Within 12 Months Before Delivery and Exclusive Breastfeeding at Four and Eight Weeks Postpartum in the United States


Author/Creator ORCID




Public Health and Policy


Doctor of Public Health

Citation of Original Publication



Exclusive breastfeeding (EBF) from birth to six months of age is recommended as the optimal method of infant feeding because it is related to decreased morbidity and mortality. In recent years, EBF rates have climbed steadily in the United States; still only 25% of newborns are exclusively breastfed as recommended by the American Academy of Pediatrics. Multiple risk factors are associated with low EBF rates, but there is a need to evaluate new factors. Stressful life events (SLE), a proxy for stress, is one such novel factor. This study sought to assess association between 14 SLE within 12 months before childbirth and EBF at four and eight weeks postpartum among new mothers in the United States who all breastfed at birth. The study design was cross-sectional and utilized data from the Pregnancy Risk Assessment Monitoring System (PRAMS) collected between 2012 and 2015. The study sample was 16,117 mothers. Majority were 25-34 years old (61.6%); Non-Hispanic Whites (61.2%); and had ≥16 years education (46.4%). EBF prevalence was 57.3% at four weeks and 49.2% at eight weeks. Two-thirds (66.7%) reported at least one SLE. The SLE were grouped into four domains: financial, emotional, partner-associated, or traumatic based on a previous principal component analysis. Cumulative SLE measures (total count of SLE experienced and of domains present) were assessed. Adjusted regression models revealed cumulative SLE, but not individual domains were associated with decreased EBF. At four weeks, individuals with one to two SLE had 10% lower odds (aOR=0.90, 95% CI=0.81-0.99) of EBF compared to those with no SLE. Effect modification was observed only in the less than high school educational category, for cumulative SLE, and financial and traumatic domain. At four weeks, financial domain SLE was associated with 29% lower odds (aOR=0.71, 95% CI=0.52-0.97) of EBF while traumatic domain SLE was associated with 43% lower odds (aOR=0.57, 95% CI=0.35-0.92). To improve EBF rates, public health interventions and policy solutions be directed toward improving the plight of mothers who experience financial and traumatic SLE. In addition, there is need to improve educational attainment if we want to further improve EBF rates for all.