Coresponden: Regina Vidya Trias Novita*
Email: [email protected]�
�
INTRODUCTION
Obesity is a
condition of a person who experiences overnutrition, especially fat
accumulation which causes the body to weigh more than normal body weight,
indicated with a Body Mass Index (BMI) of more than 29.9 kg/m2 according to the
Institute of Medicine (IOM). (Farpour-Lambert et al., 2018) �states that 55% of women of reproductive age
in America are obese and the rate increases 0.5% points per year. (Wojcicki, 2011) states that
more reproductive-age women are obese than men in the United States, which has
become a global issue in recent years. A similar pattern is also found in
Indonesia where the prevalence of women of reproductive age with obesity is
29.3%, which is more than that of obese men that is 14.5% (RISKESDAS, 2018).
Obesity in women
can pose several maternal risks for both mothers and their babies. In pregnant
women, it can increase the occurrence of gestational diabetes mellitus,
hypertension in pregnancy, pre-eclampsia, macrosomia, and labor complications.
The risk to a fetus from an obese mother can cause neonatal trauma, such as
head trauma and shoulder dystocia, and in the long run can cause childhood
obesity (Farpour-Lambert et al., 2018).
(Oddy et al., 2006) states that
pre-pregnancy obesity is at risk of pregnancy and labor, which can cause the
failure of exclusive breastfeeding, indicated with early cessation of
breastfeeding. One of the possible causes of early breastfeeding cessation is
the hormonal factors, where the lactogenesis process, that is the process of
breast milk production and secretion, is delayed. Another factor is the
difficulty in breastfeeding techniques, such as positioning and attachment.
Psychological factors that affect the occurrence of breastfeeding failure are
changes in body shape where mothers feel ashamed to breastfeed in public places
(Wojcicki, 2011).
According to
Rasmussen and Dewey in (Oddy et al., 2006), women with
pre-pregnancy obesity have a reduced prolactin response to breastfeeding and an
increase in progesterone which interferes with the early lactation process. In
general, women with obesity experience a decrease in prolactin response on the
seventh day.
According to (Marshall et al., 2019), it is
implicated as the cause of delayed lactogenesis which contributes to the
dysfunction of lactation due to insufficient breast milk production. An
increase in pre-pregnancy BMI and body fat percentage in early pregnancy is
linked to a significant reduction in exclusive breastfeeding at 6-week
postpartum. (Ramji et al., 2016) states that
obese women are less likely to start and continue breastfeeding, due to
anatomical differences, low prolactin response, and delays in the process of
lactogenesis II.
Several pieces
of research on the correlation between obesity and the duration of
breastfeeding that has been carried out found other factors that influence
exclusive breastfeeding, such as psychological, sociocultural, mother's
intention of breastfeeding, and maternal sociodemographic factors. In (Boudet‐Berquier et al., 2018), it is stated
that the duration of breastfeeding is influenced by the social environment,
especially social norms about breastfeeding and public support after comparing
the differences in the average duration in several countries. (O�Sullivan et al., 2015) states that
multiparous women who are significantly obese are closely related to financial
conditions, mother's education, type of delivery methods, and breastfeeding
knowledge.
Research on the
influence of these factors has also been carried out in Indonesia. (Mabud et al., 2014) states that
parity is a factor that correlates with exclusive breastfeeding based on the
mother's experience. (Yuliawati et al., 2018) states that a
mother's education influences breastfeeding success, the higher the mother's
education, the better the knowledge. This is because mothers with higher
education know that giving exclusive breastfeeding for their babies is the best
choice, according to the information that respondents received from health
workers.
It is also
possible that maternal age is one factor that influences the success of
exclusive breastfeeding. The results of (Conita, 2014) state that
mothers who are at healthy reproductive age (20-35 years) have a higher success
rate of breastfeeding compared to mothers under 20 years of age, associated
with mental maturity and pregnancy-related conditions.
Government
Regulation Number 33 the year 2012 recommends that breast milk be given to
newborns for up to six months to meet their nutritional needs, without adding
and or replacing with other food or drinks (except medicine, vitamins, and
minerals). Breast milk is a living liquid containing colostrum which is rich in
antibodies because it contains protein for the body's immune system and a high
amount of germ killers so that it can reduce the risk of death in infants.
Yellow colostrum is produced from the first day to the third day. Breast milk
contains less immunoglobulin, protein, and lactose than colostrum but has
higher fat and calories with white color from the fourth to the tenth day.
Breast milk also contains absorbent substances in the form of separate enzymes
that will not interfere with enzymes in the intestines (INDONESIA, 2012)
The success rate
of exclusive breastfeeding in Indonesia is quite good, reaching 67.74% and The
Special Region of Yogyakarta (DIY Province) has reached 77.50% (RISKESDAS, 2018). However, the
exclusive breastfeeding coverage rate in Yogyakarta City has the lowest
percentage compared to other districts in DIY, which is 61.1%. The number of
exclusive breastfeeding coverage in Yogyakarta has also experienced a decrease
from the previous year which was 66.1%. The percentage of obese women of their
reproductive age in Yogyakarta is quite high, which is 66% (Dinkes Kota Jogja,
2019). Based on the above phenomenon, the researchers are interested in proving
the influence of pre-pregnancy obesity and maternal characteristic factors on
the success of exclusive breastfeeding.
METHOD
This research used a quantitative method with an
analytical observational type of research that aimed to get a depiction of a
population and find out the correlation between cause and effect or risk
factors with effects. The design used for this research was a retrospective
cross-sectional design. This research was conducted in May � July 2021 in the
work area of the Yogyakarta City Health Office, in the province of Yogyakarta
Special Region. The sampling method used was non-probability sampling, and the
sampling was done by using purposive sampling. The inclusion criteria were
mothers who gave birth in 2019 and were domiciled in Yogyakarta. The samples
obtained were 300 mothers with the proportion of 150 mothers with normal BMI as
a control variable and 150 mothers with obese BMI. The research instrument was
a brief questionnaire containing the data on maternal weight before the last
pregnancy, mother�s last education, age, parity, duration of breastfeeding, and
the time when the additional food was given to the babies for the first time. Data
collection was carried out in May � July 2021 in all Public Health Centers in
the Yogyakarta City Health Office area. The researchers carried out data
collection by conducting short online interviews. In some areas of the public
health center, the researchers were assisted by cadres in collecting samples by
distributing online questionnaires. This research used the Chi-Square test and
T-test analysis to determine the relationship between pre-pregnancy BMI and
maternal characteristic factors with breastfeeding duration, with a
significance level of α =� 0.05 and
if t-count > t-table. A linear regression test was conducted to determine
the most influential variable on the duration of breastfeeding. The analysis of
this research used the SPSS version 21 program.
RESULTS AND DISCUSSION
Table 1 shows that the research respondents
ranged from 17 � 48 years old with the majority of respondents (81.3%) being of
reproductive age (20 � 35 years) and the average age is 29.47. The majority of
respondents in this research were primiparous (56.3%) and the majority of
mothers had higher education (93.7%). Mother's pre-pregnancy BMI ranged from
17.30 � 43.40 with an average value of 25.68 where this number refers to obese
BMI. Based on the data containing the duration of breastfeeding that has been collected,
the majority of mothers managed to breastfeed exclusively (64.3%) with a
duration range of 0-6 months. Respondents breastfed exclusively for 4.65 months
on average.
Table 1. The Frequency Distribution of
Respondents� Characteristics in Yogyakarta
|
Characteristics
|
n
|
%
|
Mean
|
Min
|
Max
|
|
Age
< 20 yo
20 yo � 35 yo
>35 yo
|
9
244
47
|
3
81.3
15.7
|
�
|
�
|
�
|
|
29.47
|
17
|
48
|
|
Parity
Primi
Multi
Grande
|
169
126
5
|
56.3
42
1.7
|
|
|
|
|
1.74
|
1
|
5
|
|
Education
Low
High
|
19
281
|
6.3
93.7
|
|
|
|
|
-
|
-
|
-
|
|
Pre-pregnancy BMI
Normal BMI
Obese BMI
|
150
150
|
50
50
|
25.68
|
17.30
|
43.40
|
|
Breastfeeding Duration
≤
2 months
4 months
6 months
|
90
17
193
|
30
5.7
64.3
|
|
|
|
|
4.65
|
0
|
6
|
|
Total
|
300
|
100
|
�
|
�����������������������������������������������������������
Source: Data primer, 2021
Table 2. The
Effect of Pre-pregnancy BMI on the Duration
�of Breastfeeding during Exclusive
Breastfeeding
|
BMI
|
Breastfeeding duration
|
Total
|
BMI
|
t- value
|
p- value
|
|
≤ 2 months
|
4 months
|
6 months
|
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
|
Normal
|
32
|
21.3
|
4
|
2.7
|
114
|
76
|
150
|
100
|
21.57
|
112.5
|
.000
|
|
Obese
|
58
|
38.7
|
13
|
8.7
|
79
|
52.7
|
150
|
100
|
29.80
|
69.4
|
.000
|
Source: Data Primer, 2021
Table 2 shows the results of
the bivariate analysis of the pre-pregnancy BMI variable. 76% of mothers with
normal BMI had the longest breastfeeding duration of 6 months, and 21.3% of
mothers with normal BMI did not succeed in exclusive breastfeeding with a
breastfeeding duration of ≤ 2 months. The average value of BMI in mothers
with normal BMI is 21.57. The result of the statistical test on mothers with
normal BMI had a significance value of 0.00 and the analysis of t-value was
112.5 > 1,968 which means that normal BMI corresponds to the duration of breastfeeding
during exclusive breastfeeding and has 112.5 chances for exclusive
breastfeeding.
Data on mothers with obese BMI showed that 58
(38.7%) mothers had breastfeeding duration of ≤ 2 months, 13 (8.7%)
mothers exclusively breastfed for up to 4 months, and 79 (52.7%) obese mothers
managed to breastfeed for 6 months. The average value of BMI in obese mothers
is 29.80. The results of the chi-square statistical test showed that mothers
with obesity showed a p-value of 0.00 and from the analysis of the t-value of
69.3 > 1.968, it showed that obese BMI corresponds to the duration of
breastfeeding with 69.3 chances of exclusive breastfeeding.
Table 3. The
Effect of Characteristics on the Success of Exclusive Breastfeeding
|
Characteristics
|
Breastfeeding Duration
|
Total
|
t-
value
|
p-
value
|
|
≤ 2 months
|
4 months
|
6 months
|
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
|
Age
<20 year
20-45 ear
>35 year
|
90
|
30
|
17
|
5.7
|
193
|
64.3
|
300
|
100
|
89.02
|
.001
|
|
5
|
55.6
|
2
|
22.2
|
2
|
22.2
|
9
|
100
|
|
78
|
32
|
15
|
6.1
|
151
|
61.9
|
244
|
100
|
|
7
|
14.9
|
0
|
0
|
40
|
85.1
|
47
|
100
|
|
Education
Low
High
|
90
|
30
|
17
|
5.7
|
193
|
64.3
|
300
|
100
|
137.49
|
.004
|
|
0
|
0
|
0
|
0
|
19
|
100
|
19
|
100
|
|
90
|
32
|
17
|
6
|
174
|
61.9
|
281
|
100
|
|
Parity
Primi
Multi
Grande
|
90
|
30
|
17
|
5.7
|
193
|
64.3
|
300
|
100
|
47.39
|
.000
|
|
74
|
43.8
|
13
|
7.7
|
82
|
48.5
|
169
|
100
|
|
16
|
12.7
|
4
|
3.2
|
106
|
84.1
|
126
|
100
|
|
0
|
0
|
0
|
0
|
5
|
100
|
5
|
100
|
Source: Data Primer, 2021
Table 3 shows the
characteristics of the mothers, while the age factor shows that mothers who are
in reproductive age (20-35 years) have a success rate of breastfeeding for 6
months, with the percentage of 61.9%, mothers with age > 35 years also show
a fairly high percentage of breastfeeding duration up to 6 months that is equal
to 85.1%. In mothers aged < 20 years, it was discovered that 55.6% did not
give exclusive breastfeeding with a breastfeeding duration of ≤ 2 months.
The result of statistical tests using the chi-square test found a p-value of
0.000; therefore, the significance level was <0.05 and the t-value is
89.02> 1.968, which means that research shows a correlation between age
characteristics and breastfeeding duration.
In terms of educational characteristics, most of
the respondents have a high level of education, from a total of 300 respondents
only 19 respondents have a low level of education. Mothers with low education
were all successful in exclusive breastfeeding (100%), while mothers with high
levels of education had a percentage of 61.9% for breastfeeding with a duration
of 6 months. The results of statistical tests using the t-test showed that the
t-value was 66,499 > 1,968 and the chi-square test found a p-value of 0.001.
Therefore, it is concluded that there is a correlation between a mother's
education and the duration of breastfeeding.
The results of parity factor analysis showed that
mothers who had given birth previously had a high success rate of exclusive
breastfeeding. Multigravida mothers have a success rate of 84.1% and all grand
multigravida mothers are successful in giving exclusive breastfeeding (100%).
Mothers who gave birth for the first time (primigravida) showed the highest
failure rate in exclusive breastfeeding compared to other groups of mothers,
which was 43.8% with a breastfeeding duration of ≤ 2 months. The result
of statistical tests using the chi-square test found a p-value of 0.000
<0.05 and the result of the t-test value was 14,784> 1,968, which means
it can be concluded that there is a correlation between maternal parity and
duration of breastfeeding.
Table 4. The
result of the Linear multivariate regression test with the Backward method
between characteristics and Pre-pregnancy BMI on the Duration of Breastfeeding
in Exclusive Breastfeeding
|
|
|
|
95% C.I for EXP (B)
|
|
Sig.
|
Coef (B)
|
T
|
Lower
|
Upper
|
|
Pre-pregnancy BMI
|
.000
|
-.222
|
-4.162
|
-.594
|
-.212
|
|
Age
|
.072
|
.108
|
1.803
|
-.022
|
.497
|
|
Education
|
.022
|
-.122
|
-2.298
|
-.847
|
-.066
|
|
Parity
|
.000
|
.285
|
4.741
|
.286
|
.692
|
|
Constant
|
.000
|
|
5.485
|
1.677
|
3.554
|
Source: data primer, 2021
Table 4 is the result of the
linear regression analysis, two variables have a significance of > 0.05,
which are the educational variable with a value of 0.22 and age with a value of
0.072. This means that both age and education do not have a significant effect
on the duration of breastfeeding during exclusive breastfeeding; therefore,
both variables are excluded from the characteristic factor.
In the pre-pregnancy BMI variable and the parity
variable, both have the same significance level of 0.00, therefore the
significance level is <0.05, it is concluded that the pre-pregnancy and
parity BMI variables have a strong significant effect on the duration of
breastfeeding during exclusive breastfeeding. Both variables have the same
significance level, based on the value of the B coefficient, it can be
concluded that parity is a more positive factor affecting the success of
exclusive breastfeeding where the B coefficient is 0.285 and the T-value is
4.741, while the B coefficient on pre-pregnancy BMI is -0.222 with a T value of
- 4.162 which means, the higher the value of a mother's pre-pregnancy BMI, the
shorter the duration of breastfeeding during exclusive breastfeeding.
Research data show that mothers with obesity
before pregnancy have a lower success rate of exclusive breastfeeding compared
to mothers with normal weight. The results of this research are in alignment
with infants of obese mothers may have (Donath & Amir, 2008) and (Boudet‐Berquier et al., 2018) which show that obese women are inclined not to
exclusively breastfeed. The results of the research conducted by (Donath & Amir, 2008) entitled "Maternal Obesity and Initiation and
Duration of Breastfeeding: Data from the longitudinal study of Australian
Children" state that obese women stop breastfeeding in the first week of
birth compared to women of normal weight and those who manage to breastfeed for
1 week tends to stop before 6 months. (Boudet‐Berquier et al., 2018) entitled "Association between maternal pre-pregnancy obesity and
breastfeeding duration: Data from a nationwide prospective birth cohort"
also has the same results where obese women tend to give mixed formula milk
earlier than women with normal BMI. The results of this research state that 83%
of obese mothers started giving additional food or a mixture of formula milk to
their babies at the age of 3 months. Pre-pregnancy obesity is thought to be the
strong cause of the failure of exclusive breastfeeding compared to mothers who
experience excessive weight gain during pregnancy. Women who are obese long
before pregnancy tend to have a disturbance in insulin balance which results in
impaired protein in the body that can affect breast development which leads to
obese women's breasts being inclined to have thicker fat tissue and fewer
mammary glands (Guyton & Hall, 2007).
In contrast to (Bartok et al., 2012) and (O�Sullivan et al., 2015) research stating that the BMI of obese mothers was
not an independent risk factor in the failure of exclusive breastfeeding, the
last multivariable factor that influenced the success of exclusive
breastfeeding the most was how long the mother planned to breastfeed her baby
and the low self-efficacy factor.
Mothers with pre-pregnancy obesity also
experience insulin resistance, which is known that in early childbirth, milk
production and secretion are regulated by the endocrine and require insulin.
The insulin resistance found in obese mothers inhibits milk production which
causes delays in the process of lactogenesis II in obese mothers (�Obesity as a Predictor of Delayed
Lactogenesis II,� 2017). Adipose tissue or thick fat in obese women allows
higher levels of progesterone because the storage of progesterone occurs in
fat. It is known that high progesterone levels will hold or inhibit breast milk
secretion (Marshall et al., 2019). The delay in the process of lactogenesis II and
disturbances in the production of breast milk make obese mothers unable to meet
the needs of their baby's milk at the beginning of birth.
High levels of fat in obese mothers increase
leptin secretion. High levels of leptin increase the performance of estrogen
receptor alpha (ERɑ), thus causing high levels of estrogen in the body of
obese mothers; therefore, it interferes with or reduces breast milk production (Chamberlin et al., 2017). Research done by (Oddy et al., 2006), states that infants of obese mothers may have high
energy needs. The problem of low milk production and high needs for
breastfeeding for infants makes the infants� satisfaction with breastfeeding
unfulfilled, allowing obese mothers to stop exclusive breastfeeding even though
they have successfully breastfed in the early weeks of birth and there is a
possibility that mothers will start making mixed nutrition with formula milk.
Based on the results of this research, the
researchers assume that pre-pregnancy obesity influences exclusive
breastfeeding. This is likely to happen because mothers with pre-pregnancy
obesity have different breast anatomy conditions and hormonal patterns. This
will affect milk production. 38.7% of obese mothers stopped breastfeeding after
≤ 2 months, this may be due to a lack of milk production in the early
postnatal period that leads to mothers feeling their milk is not coming out and
deciding to stop breastfeeding. The results of data analysis show that mothers
with obesity have 96 opportunities to exclusively breastfeed, this is probably
supported by the maternal characteristics in this research, the majority of
whom are of reproductive age and have higher education.
In terms of age characteristics, this research is
in alignment with the research conducted by (Conita, 2014) which states that age has an indirect correlation
with breastfeeding success after linking the age factor with the level of
emotional maturity of the mother in taking care of her baby. In her research,
respondents aged < 20 years had the lowest success rate of breastfeeding.
Failure in exclusive breastfeeding possibly happens because they are not
physically, psychologically, and socially ready, this can disrupt the
psychological balance that can affect breast milk production resulting in
mothers being unable to care for their baby optimally.
Several other studies state that age does not
correlate with breastfeeding. (Ulfah & Nugroho, 2020) which examines the correlation between age,
occupation, and mother's education in exclusive breastfeeding states that age
does not have a significant correlation with exclusive breastfeeding with a
p-value of 0.413. The same thing was also shown in (Fakhidah & Palupi, 2018) which stated that there was no difference in the
proportion of breastfeeding for mothers aged 20-30 years, aged <20 years,
and aged >35 years.
(Arini, 2012) states that maternal age greatly determines
maternal health because it is related to the conditions of pregnancy,
childbirth, and postpartum, as well as how to breastfeed the baby. In this
research, the success rate of exclusive breastfeeding was mostly found in the
reproductive age group. Mothers who are of a healthy reproductive age have more
mature physical conditions and can manage emotions; therefore, they are more
prepared to face pregnancy, childbirth, and take care of their babies. As
mentioned by (Wawan & Dewi, 2011), that the older a person is, the better their level
of maturity and strength to think and work will be.
According to (Arini, 2012), older mothers whose age is at risk for giving
birth experience a decrease in hormone production, resulting in a decreased
lactation process. At this age, giving birth is considered a risk because it is
closely related to nutritional anemia which can affect breast milk production.
In this research, the success rate of breastfeeding in older mothers is quite
high. This is possible because of another factor where the older the mother,
the more emotionally mature, the more knowledge and experience she has, and the
higher her awareness and responsibility will be; therefore, it affects
breastfeeding patterns (Conita, 2014).
Based on the analysis above, the researchers
assume that age characteristic factors are indirectly related to the duration
of breastfeeding. Data showed that 80.1% of mothers aged > 35 years had a
6-month duration of breastfeeding; therefore, physiological factors in older
mothers did not have a significant impact on the duration of breastfeeding. In
mothers aged < 20 years, 55% of mothers stopped breastfeeding exclusively
when the baby was ≤ 2 months old; therefore, it can be concluded that age
correlates with the duration of breastfeeding, due to the maturity and mental
readiness of the mother in taking care of her baby.
In this research, education is correlated with
the duration of breastfeeding, this is in alignment with (Yuliawati et al., 2018) which states that mother's education has a
correlation with breastfeeding failure, where the higher the mother's education
level, the knowledge will be better and it will be easier to accept a new idea.
(Conita, 2014) also states the same thing, that the higher a
person's level of education, the higher their ability to absorb knowledge;
however, a high level of education without adequate knowledge of breastfeeding
does not guarantee successful breastfeeding.
This is in contrast to (Ulfah & Nugroho, 2020) which stated that there was no correlation between
the mother's level of education and the success of breastfeeding. (Fakhidah & Palupi, 2018) also stated similar results that there was no
correlation between education and the success of exclusive breastfeeding.
According to her research, mothers with low education levels were no less
proficient than mothers with higher education in seeking information through
electronic media and information from cadres or midwives.
In general, maternal education is something that
can support exclusive breastfeeding. Mothers with higher education will have
broader knowledge than mothers with lower education. Education can also
encourage a mother to seek experiences that she has not previously had which
can then increase her knowledge. Improved knowledge is not only obtained
through formal education, aside from that, the support from family is also a
supporting factor in exclusive breastfeeding (Elinofia & Roma, 2011).
In this research, it was discovered that 100% of
mothers with low education levels (elementary and junior high school) had a
6-month breastfeeding duration, while there were still 32% of mothers with high
education levels who breastfed with the duration of ≤ 2 months. The
researchers assume that mothers with low education levels do not also mean
having less knowledge. Knowledge is not always obtained through formal
education; easy access to information can be used to improve mothers�
knowledge.
The data of this research indicate that mothers
who have given birth before (multipara and grand multigravida) have a higher
success rate of breastfeeding compared to mothers who have given birth for the
first time (primipara). This is in alignment with the research done by (Ngo et al., 2019), which states that the experience of mothers in
breastfeeding is a fast and strong foundation of successful breastfeeding, has
higher self-efficacy than those who have not had breastfeeding experience;
therefore, the success rate of exclusive breastfeeding is higher compared to
mothers who just gave birth for the first time.
In contrast to (Untari, 2017)� which stated
that parity had nothing to do with the duration of breastfeeding, as there may
be socio-cultural differences, mothers� and family�s lack of knowledge, and
inadequate health services. Similar results were also found in (Fauzi, 2019), which stated that parity was not related to the
duration of breastfeeding. The family support factor is thought to be an
influence on the mother's decision to breastfeed; therefore, mothers who have
had previous breastfeeding experiences do not necessarily have a positive
influence on the duration of breastfeeding.
Primiparous mothers have a small number of
prolactin receptors which causes reduced prolactin stimulation that can
interfere with milk production. Primiparous mothers will experience problems
when it comes to caring for their babies because of the lack of experience.
Education and experience from others will play an important role in primiparous
mothers, if the mother gets poor experience and education, it can cause doubts
in the implementation of breastfeeding (International Lactation Consultant
Association in (Hasianah et al., 2014).
Based on the results of the analysis above, the
researchers assumed that parity is a characteristic factor associated with the
duration of breastfeeding, as seen from the data in this research which showed
that multiparous mothers (84.1%) and grand multigravida (100%) had a 6-month
breastfeeding duration. Previous experience factors have a positive impact on
breastfeeding. This is likely because mothers who have previous breastfeeding
experience have a higher level of confidence in caring for their babies compared
to primigravida mothers who have no experience at all, which can trigger
anxiety or doubts when breastfeeding their babies.
Based on the linear regression test, the
pre-pregnancy BMI and parity variables were the most influential factors on the
duration of breastfeeding, but the parity variable had a greater influence with
a B coefficient of 0.285. The results of this research are in alignment with
Ervina�s research (2018) which states that the parity factor is related to
exclusive breastfeeding, which shows that primiparous mothers have a 3-fold
risk of not giving exclusive breastfeeding compared to multiparous mothers. The
results of the interview concluded that primiparous mothers have no experience,
lack knowledge, and have the assumption that breastfeeding can make the breasts
saggy. Multiparous mothers already have experience and knowledge from previous
parity; therefore, they have a greater chance of giving exclusive
breastfeeding� (Mabud et al., 2014).
This is in contrast to (Hastuti et al., 2015) and (Untari, 2017) research, which stated that parity did not affect
exclusive breastfeeding. According to their research, parity did not affect
exclusive breastfeeding, but there may be socio-cultural factors, mothers� and
family�s lack of knowledge, unsupportive health lines, as well as family
support factors. If the mother has had experience with children before, but
there were no supporting factors, it would affect the mother's decision to give
exclusive breastfeeding.
The obesity variable is also statistically proven
to affect exclusive breastfeeding. These results are in alignment with the
research done by (Boudet‐Berquier et al., 2018), which states that obese women tend to stop breastfeeding before 6
months. Berquirer divided obese mothers into two groups, namely obese
primiparous mothers and obese multiparous mothers. In obese primiparous
mothers, the failure of exclusive breastfeeding occurs due to the low prolactin
response and the delay in the lactogenesis process, while the failure of
exclusive breastfeeding in the group of obese multiparous mothers depends on
the method of delivery and weight gain during pregnancy.
�Based on
the analysis above, the writer assumes that the pre-pregnancy BMI and parity
are two interrelated variables. Primiparous mothers have a small number of
prolactin receptors and lack of experience coupled with obesity conditions that
allow for disturbances in breastfeeding, such as hormone disorders, imperfect
breast growth, and delays in the process of lactogenesis II, thereby increasing
the failure of exclusive breastfeeding in primiparous mothers with obesity (Donath & Amir, 2008); (Guyton & Hall, 2007); (Hasianah et al., 2014); (Ngo et al., 2019).
�Multiparous mothers with obesity have a lower
risk of exclusive breastfeeding failure due to the factor of a greater number
of prolactin receptors and having had breastfeeding experience in previous
childbirths (Ngo et al., 2019). According to (Hastuti et al., 2015), multiparous mothers who have previously breastfed
for > 3 months will breastfeed their next children for a longer duration.
CONCLUSION
In conclusion, pre-pregnancy BMI and parity are the most influential
factors on the duration of breastfeeding for mothers during exclusive
breastfeeding, where the higher the BMI value, the lower the probability of
exclusive breastfeeding is, and the higher the parity of the mother, the higher
the probability of exclusive breastfeeding is. These two variables are
interrelated, primiparous mothers who are obese have a risk of failure to
exclusively breastfeed compared to multiparous mothers who are obese, due to
the factors of breastfeeding experience and disruption of lactation processes..
REFERENCES
Arini. (2012). Seorang
Ibu Harus Menyusui. FlashBooks.
Bartok, C. J., Schaefer,
E. W., Beiler, J. S., & Paul, I. M. (2012). Role of body mass index and
gestational weight gain in breastfeeding outcomes. Breastfeeding Medicine,
7(6), 448�456. https://doi.org/10.1089/bfm.2011.0127
Boudet-Berquier, J.,
Salanave, B., Desenclos, J. C., & Castetbon, K. (2018). Association between
maternal prepregnancy obesity and breastfeeding duration: Data from a
nationwide prospective birth cohort. Maternal and Child Nutrition, 14(2).
https://doi.org/10.1111/mcn.12507
Chamberlin, T., D�Amato,
J. v., & Arendt, L. M. (2017). Obesity reversibly depletes the basal cell
population and enhances mammary epithelial cell estrogen receptor alpha
expression and progenitor activity. Breast Cancer Research, 19(1). https://doi.org/10.1186/s13058-017-0921-7
Conita, Destia. A.
(2014). Perbedaan Pertumbuhan Bayi Usia 3-6 Bulan Yang Diberi Asi Eksklusif Dan
Yang Tidak Diberi Asi Eksklusif Di Puskesmas Gang Sehatkecamatan Pontianak
Selatandestia Ayu Conitai 111 09 025program Studi Pendidikan Dokterfakultas
Kedokteran Universitas Tanjungpurapontianak2014. Jurnal Mahasiswa PSPD FK
Universitas Tanjungpura, 1(1).
https://jurnal.untan.ac.id/index.php/jfk/article/download/5495/5669
Donath, S. M., Amir, L.
H., & Research, C. H. (2008). Maternal obesity and initiation and duration
of breastfeeding: data from the longitudinal study of Australian children. In
Maternal and Child Nutrition (Vol. 4).
Ervina, A. (2018).
Hubungan� Paritas dengan� ASIEksklusif pada� Bayi Usia 7-12 Bulan. Jurnal Obstretika
Scienta, 6(1), 170�178.
Fakhidah, L. N., &
Palupi, F. H. (2018). Analisis Faktor yang Mempengaruhi Pemberian ASI
Eksklusif. Jurnal Kebidanan, 10(2), 103�205. http :
/www.journal.stikeseub.ac.id
Farpour-Lambert, N. J.,
Ells, L. J., Martinez de Tejada, B., & Scott, C. (2018). Obesity and Weight
Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions
to Inform Maternal and Child Health Policies. In Frontiers in Endocrinology
(Vol. 9). Frontiers Media S.A. https://doi.org/10.3389/fendo.2018.00546
Fauzi, F. K. (2019).
Hubungan Antara Dukungan Keluarga, Status Pekerjaan dan Paritas Ibu Dengan
Perilaku Pemberian ASI Eksklusif. Jurnal Keperawatan Muhammadiyah, 239�243.
http://journal.um-surabaya.ac.id/index.php/JKM
Guyton, A. C., &
J.E., H. (2007). Buku Ajar Fisiologi Kedokteran (9th ed.). EGC.
Hasiana, S. T., Ivone,
J., & Rentian, N. (2014). Pengaruh Sectio Caesarea Terhadap Keberhasilan
Asi Eksklusif The Effects Of Cesarean Delivery To The Success Of Exclusive
Breastfeeding. http://repository.maranatha.edu/12827/
Hastuti, B. W., Machfudz,
S., & Febriani, T. B. (2015). Hubungan Pengalaman Menyusui dan Tingkat
Pendidikan Ibu dengan Pemberian ASI Eksklusif di Kelurahan Barukan, Kecamatan
Manisrenggo, Kabupaten Klaten. JKKI, 6(4), 179�187.
Peraturan Pemerintah
Republik Indonesia, (2012).
http://hukor.kemkes.go.id/uploads/produk_hukum/PP%20No.%2033%20ttg%20Pemberian%20ASI%20Eksklusif.pdf
Mabud, N., Mandang, J.,
& Mamuaya, T. (2014). Hubungan Pengetahuan, Pendidikan, Paritas dengan
Pemberian ASI eksklusif di Puskesmas Bahu Kecamatan Malalayang Kota Manado.
Jurnal Ilmiah Bidan , 2(2), 51�56.
Marshall, N. E., Lau, B.,
Purnell, J. Q., & Thornburg, K. L. (2019). Impact of maternal obesity and
breastfeeding intention on lactation intensity and duration. Maternal and Child
Nutrition, 15(2). https://doi.org/10.1111/mcn.12732
Ngo, L. T. H., Chou, H.
F., Gau, M. L., & Liu, C. Y. (2019). Breastfeeding self-efficacy and
related factors in postpartum Vietnamese women. Midwifery, 70, 84�91.
https://doi.org/10.1016/j.midw.2018.12.014
Oddy, W. H., Li, J.,
Landsborough, L., Kendall, G. E., Henderson, S., & Downie, J. (2006). The
association of maternal overweight and obesity with breastfeeding duration.
Journal of Pediatrics, 149(2), 185�191. https://doi.org/10.1016/j.jpeds.2006.04.005
O�Sullivan, E. J.,
Perrine, C. G., & Rasmussen, K. M. (2015). Early breastfeeding problems
mediate the negative association between maternal obesity and exclusive
breastfeeding at 1 and 2 months postpartum1-3. Journal of Nutrition, 145(10),
2369�2378. https://doi.org/10.3945/jn.115.214619
Preusting, I., Brumley,
J., Odibo, L., Spatz, D. L., & Louis, J. M. (2017). Obesity as a Predictor
of Delayed Lactogenesis II. Journal of Human Lactation, 33(4), 684�691.
https://doi.org/10.1177/0890334417727716
Ramji, N., Quinlan, J.,
Murphy, P., & Crane, J. M. G. (2016). The Impact of Maternal Obesity on
Breastfeeding. Journal of Obstetrics and Gynaecology Canada, 38(8), 703�711.
https://doi.org/10.1016/j.jogc.2016.03.013
RISKESDAS. (2018). Hasil
Utama RISKESDAS 2018.
Ulfah, H. R., &
Nugroho, F. S. (2020). Hubungan Usia, Pekerjaan Dan Pendidikan Ibu Dengan
Pemberian Asi Eksklusif. Jurnal Ilmiah Keperawatan, 8(1).
https://doi.org/https://doi.org/10.52236/ih.v8i1.171
Ulina, R., &
Doveriyanti, R. (2011). Hubungan Pendidikan." Pengetahuan, Pekerjaan, dan
Dukungan Keluarga dengan Pemberian ASI Eksklusif di Puskesmas Sawah Lebar Kota
bengkulu Tahun 2011.
Untari, J. (2017). Hubungan
Antara Karakteristik Ibu Dengan Pemberian Asi Eksklusif Di Wilayah Kerja
Puskesmas Minggir Kabupaten Sleman The Correlation Between Mother�s
Characteristic With Exclusive Breastfeeding In The Working Area Of Puskesmas
Minggir District Sleman. Jurnal Formil (Forum Ilmiah) KesMas Respati, 2(1).
Wawan, A., & Dewi, M.
(2011). Teori� dan Pengukuran� Pengetahuan,�
Sikap,� dan Perilaku� Manusia. Nuha Medika.
Wojcicki, J. M. (2011).
Maternal Prepregnancy Body Mass Index and Initiation and Duration of
Breastfeeding: A Review of the Literature. Journal of Women�s Health, 20(3),
341�347. https://doi.org/10.1089jwh.2010.2248
Yuliawati, R.,
Kurniasari, L., & Maryam, S. (2018). Hubungan antara pendidikan dan
dukungan keluarga dengan kegagalan asi eksklusif. JHeS (Journal of Health
Studies), 2(2), 73�80. https://doi.org/10.31101/jhes.390
