Evaluating and predicting exclusive breastfeeding behaviour based on an energy vitality model during women’s lactation: a longitudinal study

BACKGROUND: Exclusive breastfeeding is the best nutritional choice for infants. However, the factors influencing exclusive breastfeeding behaviour are multifaceted. According to an energy and vitality model, identifying the factors that reduce or increase vitality and developing related strategies could improve exclusive breastfeeding behaviour. Our study aimed to clarify the related factors that affect exclusive breastfeeding behaviour and their impacts on the risk of exclusive breastfeeding termination, and further develop an effective nomogram to predict the risk of ceasing exclusive breastfeeding behaviour within 6 months. METHODS: A total of 570 women were recruited for this study at a baby-friendly hospital in Nanjing, China. A total of 529 women completed a 6-month follow-up and their sociodemographic characteristics, breastfeeding motivation scores, fertility motivation scores, mother's child care stress scores, social support scores, and infant feeding data were collected. Three classical regression methods (Logistic, COX and Lasso regression) were used to identify significant predictors of exclusive breastfeeding. The nomogram was built on the basis of a multivariable COX regression model, and the performance was evaluated by rigorous testing. RESULTS: The average duration of exclusive breastfeeding was (4.08 ± 2.12) months. With the extension of exclusive breastfeeding, mother's child care stress increases. Relative to not familiar with breastfeeding knowledge, familiarity with breastfeeding knowledge can reduce the risk of stopping exclusive breastfeeding at 6 months. Longer maternity leave duration, autonomous breastfeeding motivation, social support, and fertility motivation (nurturance) can improve the level of 6-month exclusive breastfeeding. Mother's child care stress reduces the possibility of exclusive breastfeeding at 6 months. Support from the husband for breastfeeding, planned pregnancy, autonomous breastfeeding motivation, social support and fertility motivation (nurturance and positive exposure) can prolong the duration of exclusive breastfeeding. However, mothers with child care stress cannot sustain exclusive breastfeeding. The nomogram integrated and quantified the seven predictive factors (husband's attitude towards breastfeeding, planned pregnancy, mother's child care stress, positive exposure, nurturance, autonomous breastfeeding motivation, social support) into specific scores to predict the termination risk of exclusive breastfeeding within 6 months. The nomogram was robust and practical under the performance evaluation. CONCLUSIONS: Women's breastfeeding motivation, fertility motivation, the child care stress, and social support during lactation are factors that need attention to support exclusive breastfeeding. Moreover, an easy-to-use nomogram that predicts the termination risk of exclusive breastfeeding within 6 months was developed. This model could be an effective tool for professionals to develop precision exclusive breastfeeding intervention measures.