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The Relationship Between Perinatal Weight Stigma and Breastfeeding Outcomes: A Mixed-Methods Study

Dieterich, Rachel (2021) The Relationship Between Perinatal Weight Stigma and Breastfeeding Outcomes: A Mixed-Methods Study. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Background/Significance: Despite compelling evidence of protective effects of breastfeeding on obesity-related morbidity in mothers and children, individuals with increased body mass indices (BMIs) have poor breastfeeding outcomes compared to those of normal weight. Sub-par breastfeeding rates among overweight and obese individuals are attributed to a multitude of physiological, psychological, and support barriers. One potential contributing factor to BMI-related breastfeeding disparities may be weight-related stigma, which surfaces during patient-professional communication and is internalized. Obstetric and perinatal healthcare professionals endorse discomfort interacting and providing health advice to individuals with BMIs ≥ 25 - who report feeling stigmatized during obstetric contacts due to weight. This communication breakdown may result in fewer opportunities for healthcare professionals to offer breastfeeding promotion and assistance, and concomitantly, less enthusiasm and greater reservations among overweight and obese parents to initiate and maintain breastfeeding. No known research currently exists examining the potential association of weight stigma (both perceived and internalized by pregnant and postpartum individuals) and breastfeeding outcomes.
Purpose: In this prospective cohort mixed methods study, we examined the relationship between weight stigma and breastfeeding outcomes among individuals with pre-pregnancy BMIs ≥25 during the perinatal period. Specifically, we: 1) examined the temporal variation of internalized weight stigma at 28-40 weeks of pregnancy and 1 month postpartum, 2) explored the predictive relationship between prenatal internalized weight stigma and breastfeeding outcomes (initiation, continuation, exclusivity) and 3) explored postpartum individual’s perceptions about weight stigma experienced during healthcare professional interactions in pregnancy, labor, and postpartum and its perceived impact on their breastfeeding experience.
Methods: A purposeful sample of 110 individuals with BMIs ≥25 who planned to breastfeed were recruited for Aims 1 and 2 at 28-40+ weeks of pregnancy. Participants completed a validated weight stigma questionnaire during the third trimester and at 1 month postpartum, at which time they were also surveyed on their breastfeeding practices. Additional breastfeeding data from the birth hospitalization were collected from the electronic medical record. For Aim 1, a repeated measures t-test was used to determine if differences existed among weight stigma scores during and after pregnancy. For aim 2, we used regression analysis to examine the predictive relationship between weight stigma and breastfeeding initiation, continuation and exclusivity. For Aim 3, we conducted semi-structured telephone interviews at one month postpartum with individuals purposively selected from Aims 1 and 2 regarding their experiences with weight stigma and breastfeeding. Interviews continued until we reached data saturation. A qualitative descriptive approach was utilized in the coding and interpretation of interviews to further explore how individuals perceive weight stigma in the obstetric setting and its influence on their breastfeeding outcomes.
Implications: This study set forth the groundwork for development of nursing interventions to mitigate experienced and perceived weight stigma and promote optimal patient-professional communication and breastfeeding among overweight/obese perinatal individuals. The study had immediate clinical implications for obstetric providers and nursing staff who may be unaware of their unconscious biases in the care of birthing individuals with high BMIs. This research has the potential to lead to improved breastfeeding rates and, consequently, improved health outcomes among overweight and obese perinatal individuals.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Dieterich, Rachelrrd26@pitt.edurrd26
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDemirci, Jilljvr5@pitt.edujvr5
Committee CoChairDanford, Cindydanfordc@pitt.edudanfordc
Committee MemberChang,
Committee MemberScott, Paulpws5@pitt.edupws5
Date: 19 February 2021
Date Type: Publication
Defense Date: 9 February 2021
Approval Date: 19 February 2021
Submission Date: 18 February 2021
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 106
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Weight stigma, obesity, overweight, breastfeeding, Pregnancy
Date Deposited: 19 Feb 2021 14:48
Last Modified: 19 Feb 2021 14:48


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