Peer-reviewed article
Prelacteal feeding and its relationship with exclusive breastfeeding and formula consumption among infants in low- and middle-income countries
Paulo Augusto Ribeiro Neves, Nancy Armenta-Paulino, Luisa Arroyave, Luiza Isnardi Cardoso Ricardo, Juliana dos Santos Vaz et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how giving babies any food or fluids other than breast milk in the first three days after birth affects exclusive breastfeeding and formula use among infants under six months in low- and middle-income countries. Using data from 85 national surveys covering over 91,000 children, researchers found that prelacteal feeding was associated with 40% lower rates of exclusive breastfeeding and nearly twice the likelihood of formula consumption. The associations remained strong even after accounting for other factors like antenatal care and birth assistance. The study recommends strengthening pro-breastfeeding support during pregnancy and in maternity facilities.
Key points
- One-third of infants (33.9%) received prelacteal feeds in the first three days after birth across low- and middle-income countries
- Children given prelacteal feeds were 40% less likely to be exclusively breastfed (adjusted prevalence ratio 0.62)
- Children given prelacteal feeds were nearly twice as likely to receive formula by six months (adjusted prevalence ratio 1.72)
- Milk-based prelacteal feeds had stronger negative effects than water-based prelacteal feeds
- The negative associations with exclusive breastfeeding were consistent across all regions and income levels
Limitations
This retrospective analysis cannot establish causation, only association; unmeasured confounding factors related to maternal intent to breastfeed or infant feeding challenges may explain some of the observed associations. The study describes practices at a single time point and cannot track individual infants' feeding trajectories over time.
Abstract
Background: Early feeding practices are important determinants of optimal feeding patterns later in life. We aimed to investigate if giving any fluids or foods other than breast milk during the first three days after birth (prelacteal feeds) affects exclusive breastfeeding and consumption of formula among children under six months of age in low and middle-income countries (LMICs). Methods: We conducted a retrospective cohort study using data from 85 nationally representative Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) in LMICs (2010-2019). We considered three exposures: any prelacteal feeding (PLF), milk-based only prelacteal feeding (MLK), and water-based only prelacteal feeding (WTR), according to the DHS/MICS definition. The outcomes were exclusive breastfeeding, based on the World Health Organization definition, and consumption of formula among infants under six months of age. We used Poisson models adjusting for sociodemographic indicators, antenatal care, birth assistance, and early initiation of breastfeeding to estimate the effects of the exposures on the outcomes. Findings were grouped by each country, as well as by regions of the world and national income classification. Results: We included data from 91 282 children. PLF, MLK, and WTR had a prevalence of 33.9% (95% confidence interval (CI) = 33.6-34.2), 22.2% (95% CI = 21.9-22.4), and 9.4% (95% CI = 9.2-9.6), respectively. Exclusive breastfeeding and consumption of formula had a prevalence of 35.2% (95% CI = 34.9-35.5) and 27.7% (95% CI = 27.4-28.0), respectively. In the crude analysis, children who were given PLF were 40% less likely to be exclusively breastfed (prevalence ratio (PR) = 0.60; 95% CI = 0.56-0.64) and nearly twice more likely to receive formula (PR = 1.89; 95% CI = 1.72-2.08); the direction of the associations was the same across income groups and regions of the world. In the adjusted analysis, the observed crude effects were only slightly reduced (exclusive breastfeeding - PR = 0.62; 95% CI = 0.59-0.66, consumption of formula - PR = 1.72; 95% CI = 1.59-1.85). MLK showed a stronger impact on the outcomes than PLF, especially for formula consumption (adjusted PR = 1.81; 95% CI = 1.67-1.97) and in low-income countries. WTR was only negatively associated with exclusive breastfeeding (adjusted PR = 0.69; 95% CI = 0.63-0.75), but not with formula consumption (adjusted PR = 1.09; 95% CI = 0.99-1.20). Conclusions: Feeding babies prelacteal foods shortens exclusive breastfeeding duration and increases the likelihood of formula consumption in children under six months of age in LMICs. Pro-breastfeeding interventions must be prioritized during antenatal care and throughout the stay in the maternity facility to properly protect, support, and promote exclusive breastfeeding since birth.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Elimination of prelacteal feeding (any fluids or foods other than breast milk in the first three days after birth) through pro-breastfeeding interventions during antenatal care and maternity facility stays
- Population
- Infants under six months of age in low- and middle-income countries (91,282 children from 85 nationally representative surveys)
Key finding
Children with any prelacteal feeding were 40% less likely to be exclusively breastfed (adjusted PR = 0.62; 95% CI = 0.59-0.66)
Neves et al. · Prof. Linda Richter (OpenAlex works) · 23 Dec 2022