Understanding Breastfeeding Practices Among ECHO Cohort Participants Before and During/After the COVID-19 Pandemic

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PROJECT SUMMARY Exclusive breastfeeding is widely recommended because it provides important maternal and child health benefits including protection against obesity and infectious disease. While many women intend to breastfeed, they often fail to reach their goal. This could be due to physiological conditions, such as obesity, or due to public health crises like the COVID-19 pandemic and the underlying systemic inequities in our society. Thus, it is important to address the impact of highly prevalent exposures including maternal obesity and contemporary situations including the COVID-19 pandemic on the perinatal outcomes of breastfeeding initiation and duration as well as on child health outcomes including obesity. Obesity, shortened duration of breastfeeding, and SARS-CoV-2 infection all disproportionately impact black families. Therefore, any attempts to address these important issues will also help to eliminate existing health disparities. The purpose of this research is twofold. First, using data from multiple ECHO cohorts, we aim to determine if the duration of exclusive breastfeeding protects against risk for childhood obesity among those exposed to maternal obesity while in utero. Second, we will estimate, both quantitatively and qualitatively, the impact of the SARS-CoV-2 pandemic on women's breastfeeding practices and experiences. The combination of quantitative and qualitative approaches will enable a more comprehensive understanding of the determinants of breastfeeding before and during/after the pandemic. As a supplement to UH3OD023285 Prenatal Exposures and Child Health Outcomes: A Statewide Study, this project complements Aim 2 of the parent grant, which is to assess the effect of maternal nutritional and weight status in pregnancy on cognitive outcomes and childhood obesity. The parent grant is focused on nutrition during pregnancy whereas this project is focused on infant nutrition. Furthermore, this project will provide important training for a postdoctoral candidate as she prepares to become a faculty member at a research-intensive university. She will use this project to continue to develop specific training in perinatal and pediatric epidemiological research design and analytic methods. While this research will leverage the local ECHO cohort, the project is designed to engage ECHO team science through two distinct but complementary ECHO-wide analysis concept proposals. The project is significant because it addresses three highly prevalent problems that disproportionately disadvantage black families: shortened duration of breastfeeding, SARS-CoV- 2 infection, and obesity.