Breastfeeding Cessation Across Gestational Ages Among First-Time U.S. Mothers before and During the COVID-19 Pandemic, 2016–2021

Background: The early COVID-19 pandemic period, with contact restrictions that affected in-hospital supports, provides a unique opportunity to examine changes in population-based breastfeeding cessation rates across the full spectrum of gestational age (GA) among first-time U.S. mothers. Methods: Using serial cross-sectional data from the Pregnancy Risk and Assessment Monitoring System (2016–2021), we included women from 19 U.S. jurisdictions who reported ever breastfeeding and cessation reasons (weighted N = 1,724,352). Weighted multivariable Cox regression compared cessation rates by GA between pre-COVID (2016–2019) and during-COVID (2020–2021) periods. Cessation reasons were assessed by prematurity using weighted Chi-square analysis (weighted N = 689,756). Results: During pre-COVID years, cessation rates among mothers of extremely preterm (EP) infants were 31% lower (adjusted hazard ratio [aHR]: 0.69, 95% confidence interval [CI]: 0.53–0.89) compared to term mothers; very or moderately preterm (VMP) and late preterm (LP) mothers had higher cessation rates compared to term and EP mothers. Between periods, a 47% increase was observed among EP mothers (aHR: 1.47, 95% CI: 0.97–2.27). Only LP mothers had higher cessation rates relative to term mothers during COVID (aHR: 1.25, 95% CI: 1.06–1.46). Compared to mothers of EP (9.8%) and term (11.8%) infants, more mothers of VMP (16.2%) and LP (16.6%) infants reported too many household duties (p < 0.001). Conclusion: This study found that first-time U.S. mothers of VMP and LP infants breastfed for a shorter duration than their EP and term counterparts before COVID-19. The first two pandemic years were the most disruptive for EP mothers, highlighting the importance of in-hospital breastfeeding support.