(OR23-01-26) Prenatal WIC Participation and Psychosocial Factors Associated With Breastfeeding Continuation Following Infant Hospitalization: PRAMS (2016–2022)

Objectives: Infant hospitalization may challenge breastfeeding continuation, particularly among mothers experiencing psychosocial vulnerability. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), provides breastfeeding education, that may help sustain breastfeeding. This study examined pre-pregnancy maternal psychosocial factors (anxiety and depressive symptoms) and prenatal WIC participation and associations of each with breastfeeding continuation, among mothers whose infants experienced hospitalization.

Methods: A secondary analysis of cross-sectional Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2016–2022 was conducted. Analyses were restricted to respondents who initiated breastfeeding. Breastfeeding continuation, the dependent variable, was defined as still breastfeeding at the time of survey completion. Independent variables included maternal pre-pregnancy anxiety and depressive symptoms, prenatal WIC participation, and infant hospital length of stay (LOS). Interaction terms tested whether WIC participation moderated associations between psychosocial factors and breastfeeding continuation. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals.

Results: Maternal pre-pregnancy anxiety (aOR=0.658; 95% CI: 0.634–0.683) and depressive symptoms (aOR=0.780; 95% CI: 0.753–0.807) were associated with lower odds of breastfeeding continuation. Prenatal WIC participation moderated the association between maternal anxiety and breastfeeding continuation (aOR=1.311; 95% CI: 1.188–1.447). Longer infant hospital LOS was also associated with lower odds of breastfeeding continuation (aOR=0.845; 95% CI: 0.833–0.857).

Conclusions: Consistent with prior research, maternal pre-pregnancy anxiety and depressive symptoms were associated with shorter breastfeeding continuation. The finding that prenatal WIC participation, an important component of which is breastfeeding education, suggests a potentially important mechanism that may buffer anxiety-related barriers. Research using appropriate study designs is needed to clarify this relationship.

Funding Sources: No external funding