Prenatal Subjective Social Status as a Predictor of Breastfeeding Outcomes

Introduction: Subjective social status (SSS), which describes one's perceived hierarchical rank, may provide a more accurate prediction of health than traditional socioeconomic measures. The specific relationship between SSS and breastfeeding outcomes is understudied. Our objectives were to: (1) investigate factors associated with SSS, (2) assess the relationship between prenatal SSS and any or exclusive breastfeeding at 3 and 6 months, and (3) evaluate the relationship between prenatal SSS and breastfeeding duration. Methods: Overall, 2,870 participants from the Canadian Healthy Infant Longitudinal Development birth cohort data were included. Prenatal SSS was self-ranked at 18 weeks' gestation using the MacArthur Scale and categorized as low (1-5), moderate (6-7), and high (8-10) SSS. Any and exclusive breastfeeding were categorized at 3 and 6 months postpartum, along with breastfeeding duration. Multivariable logistics and linear regression were conducted. Results: After adjusting for race, education, income, marital status, employment, and parity, the odds of exclusive breastfeeding at 3 months were 1.51 times higher [95% confidence interval (CI): 1.18, 1.94] in the high SSS group than in the low SSS group. The likelihood of any breastfeeding at 6 months was 1.45 times higher [95% CI: 1.10, 1.92] in the moderate SSS group than the low SSS group. Women with high SSS breastfed for approximately 42 days longer than women with low SSS. Conclusion: SSS was associated with exclusive breastfeeding at 3 months, any breastfeeding at 6 months, and breastfeeding duration. SSS may offer a more patient-centered indicator of health, informing targeted interventions for individuals at risk of suboptimal breastfeeding outcomes.