O3187: Associations Between Breastfeeding and Post-perinatal Infant Deaths Across the United States

Background: Infant mortality in the United States is a significant public health problem. The initiation of breastfeeding has been associated with reduced post-perinatal infant mortality. Although most states have initiatives to protect, promote, and support breastfeeding, no analysis of the association of breastfeeding and infant mortality has been conducted at the state and regional level.

Methods: To understand the associations between breastfeeding and post-perinatal infant mortality, we analyzed the initiation of breastfeeding with post-perinatal infant mortality by geographic region and individual states within each region. A prospective cohort analysis linking US national birth and post-perinatal infant death data for nearly 10 million infants born in 2016-2018, were followed for one year after their birth.

Results: A total of 9,711,567 live births and 20,632 post-perinatal infant deaths from 48 states and District of Columbia were included in the final analysis. Multiple logistic regression analysis controlling for a number of confounding factors revealed that the overall adjusted odds ratio (AOR) and 95% Confidence Intervals (CI) for the association of breastfeeding initiation with post-perinatal infant mortality was 0.67 (0.65-0.69, p< 0.0001) for days 7-364. All 7 US geographic regions had significant reductions in total post-perinatal infant deaths associated with breastfeeding initiation; the Mid-Atlantic and Northeast regions had the largest reductions with AOR=0.56 (0.51-0.61, p< 0.001; 0.50-0.63, p< 0.001, respectively), while the Southeast region had the smallest but still significant reduction with AOR=0.79 (0.75–0.84, p< 0.001). Statistically significant results were also noted for 35 individual states for reduction in total post-perinatal infant deaths. Figure 1

Conclusion: This study affirms previous US-based studies that identified the association of breastfeeding initiation with reduced post-perinatal infant death rate. Although regional and state variation in the magnitude of the association of breastfeeding and infant mortality exists, the consistency of a reduced risk suggests improving breastfeeding be included as a strategy in infant mortality reduction initiatives.