Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Early Lactation Success in a Multi-Ethnic Population

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Project Number: R40MC04294
Grantee: University of California, Davis
Department/Center: Department of Nutrition
Project Date: 01/01/2005
Principal Investigator: Kathryn Dewey

Final Report

Early Lactation Success in a Multi-Ethnic Population Final Report (PDF) Exit Disclaimer


  • Women/Maternal
  • Perinatal/Infancy (0-12 months)

Targeted/Underserved Population

  • African American
  • Hispanic/Latino


Increasing the duration of exclusive breastfeeding is a health priority in the U.S., because of the many health benefits for mothers and infants. Campaigns to encourage mothers to attempt breastfeeding have resulted in increased rates of breastfeeding initiation, but the percentage predominantly breastfeeding at 10 wk postpartum has not improved. A major reason for this is that many mothers who initiate breastfeeding begin to supplement with formula or cease breastfeeding entirely within the first few weeks due to lactation difficulties. Thus, the most urgent need is to ensure that mothers who attempt breastfeeding are able to overcome these barriers. In a cohort of 280 predominantly Caucasian women who were highly motivated to breastfeed, the investigators found that more than 80% encountered problems during the first week postpartum such as delayed onset of milk production, sub-optimal infant breastfeeding behavior, or sore/cracked nipples. The investigators predict that these problems are at least as common in other ethnic groups, and that their effect on rates of exclusive breastfeeding are particularly strong among women with lower motivation to breastfeed. The specific aims are to: 1) compare the Incidence of early breastfeeding problems among primiparous African-American, Hispanic and non-Hispanic white women; 2) identify risk factors associated with delayed onset of milk production, sub-optimal infant breastfeeding behavior and sore nipples, with a focus on factors such as maternal and infant stress during labor and delivery, maternal overweight, infant characteristics and feeding patterns; and 3) assess factors associated with exclusive breastfeeding at I mo postpartum within each of the three main ethnic groups, with a focus on the interaction between two key sets of potential predictors: a. prenatal breastfeeding intentions and self-efficacy, and b. breastfeeding problems during the first week postpartum. This will be a multi-ethnic prospective study of 660 urban mother-infant pairs in Sacramento, CA. Mothers will be recruited prenatally and interviewed within 24 hours of giving birth (considered "day 0") as well as on days 3, 7, 14, 30 and 60 postpartum. The long-term goal is to develop culturally appropriate, evidence-based strategies to reduce the incidence of breastfeeding problems and assist mothers to breastfeed exclusively.


Listed is descending order by year published.

Murase M, Wagner EA, J Chantry C, Dewey KG, Nommsen-Rivers LA. The relation between breast milk sodium to potassium ratio and maternal report of a milk supply concern. J Pediatr. 2017 Feb;181:294-297.e3.

Chantry CJ, Dewey KG, Peerson JM, Wagner EA. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr. 2014;164(6):1339-1345.e5.

Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and feeding status at 2 months. Pediatrics. 2013;132(4):e865-75.

Chantry CJ, Nommsen-Rivers LA, Peerson JM, Cohen RJ, Dewey KG. Excess weight loss in first-born breastfed newborns relates to maternal intrapartum fluid balance. Pediatrics. 2011;127(1):e171-9.

Chantry CJ. Supporting the 75%: overcoming barriers after breastfeeding initiation.Breastfeed Med. 2011;6:337-339.

Marshall AM, Nommsen-Rivers LA, Hernandez LL, Dewey KG, Chantry CJ, Gregerson KA, Horseman ND. Serotonin transport and metabolism in the mammary gland modulates secretory activation and involution. J Clin Endocrinol Metab.2010;95(2):837-846.

Nommsen-Rivers LA, Chantry CJ, Cohen RJ, Dewey KG. Comfort with the idea of formula feeding helps explain ethnic disparity in breastfeeding intentions among expectant first-time mothers. Breastfeed Med. 2010;5(1):25-33.

Nommsen-Rivers LA, Chantry CJ, Peerson JM, Cohen RJ, Dewey KG. Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding. Am J Clin Nutr. 2010;92(3):574-584.

Nommsen-Rivers LA, Cohen RJ, Chantry CJ, Dewey KG. The Infant Feeding Intentions scale demonstrates construct validity and comparability in quantifying maternal breastfeeding intentions across multiple ethnic groups. Matern Child Nutr. 2010;6(3):220-227.


Breastfeeding, Postpartum, Stress, Labor & Delivery, Obesity & Weight

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