Barriers to Continued Provision of Human Milk for Black Mothers of VLBW Infants

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DESCRIPTION (provided by applicant): The objective of this study is to identify why a disproportionate proportion of Black mothers of premature very low birth weight infants (VLBW, birth weight <1500g or 3 lbs. 5 oz.) discontinue human milk (HM; breast milk from the infant's own mother) provision prior to their infants' discharge from the neonatal intensive care unit (NICU), despite initiating HM provision at the same rates as non-Black (White and Hispanic) mothers. In the United States, Black women give birth to VLBW infants 3.4 times more often than non-Hispanic White (White) women, yet significantly fewer Black premature infants receive HM compared to non-Black premature infants. This racial disparity increases the risk of short and long term prematurity-related serious complications for Black VLBW infants, including infections, necrotizing enterocolitis, rehospitalizations, and neurodevelopmental delay because HM feedings reduce the risk of these costly and handicapping complications in a dose-response manner. With state-of-the art, evidence-based lactation care, 96% of Black mothers of VLBW infants in the NICU initiated lactation, a rate similar to that found in non-Black mothers of VLBW infants. However, although the vast majority (87%) of Black mothers stated that they would like to continue to provide HM after their infant's discharge from the NICU, only a minority of them continued to provide HM during the prolonged NICU hospitalization, with only 28%providing HM at NICU discharge compared to 50% of non-Black mothers. These data suggest that the barriers to maintaining HM supply throughout the NICU hospitalization may be different for Black compared to non-Black women. This study will examine the extensive preexisting detailed database from a large recent prospective VLBW infant cohort study to identify barriers contributing to early discontinuation of HM provision by Black mothers. The study will investigate four categories of factors while controlling for maternal demographics: a. Neighborhood Structural Factors: distance to NICU, access to public transportation, lactation resources, concentrated disadvantage, and crime b. HM Pumping Factors: type of breast pump, time to pumping initiation after birth, pumping frequency, minutes spent pumping daily, and HM volume produced daily over the NICU hospitalization c. Maternal Health Factors: pre-pregnancy BMI, diabetes mellitus, hypertension and/or preeclampsia, mode of delivery, multiple gestations d. Social Factors: maternal education, friend/familial/partner support, return to work or school, HM feeding goal closest to NICU discharge, previous HM feeding experience, previous formula feeding experience The results of these analyses will inform the future development of interventions targeting the most relevant barriers identified.