Women Who Pump Breastfeed for 21 Weeks Longer, Study Finds

Deanna Nardella, MD

Credit: Yale School of Medicine

According to research The Journal of Pediatrics, pump use was linked to longer breastfeeding durations, especially among Native American and non-Hispanic Black women, 2 groups who have been historically disproportionately impacted by breastfeeding inequities.¹

To better understand the impact of pump use on breastfeeding duration, investigators performed a cross-sectional analysis of weighted data collected from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System from Maine, Michigan, New Mexico, and Utah. The study evaluated information on breastfeeding and pump use between the years 2016 and 2021. Eligible participants had given birth, began breastfeeding, and reported complete data for pump use and breastfeeding duration.¹

The hazard of breastfeeding cessation and median duration—calculated in weeks—of breastfeeding by pump use was quantified using Cox proportional hazard regression. Investigators hypothesized pump use would be vary by race and ethnicity.1

A 2021 Morbidity and Mortality Weekly Report (MMWR) report further solidified this hypothesis by demonstrating large racial and ethnic disparities among breastfeeding initiation rates both nationally and at the state level, with rates ranging from 90.3% among Asian mothers to 73.6% among Black mothers. Further, the states that exhibited the lowest breastfeeding initiation rates were more likely to have a higher prevalence of racial and ethnic breastfeeding disparities compared with states with higher rates.³

In a recent article published in the Yale Journal of Biology and Medicine, Deanna Nardella, MD, a research fellow in the Department of Pediatrics at Yale School of Medicine, discussed how promoting breastfeeding among the groups with the lowest rates “could improve the health of dyads with the greatest health risk and facilitate more equitable, person-centered lactation outcomes.”⁴

Rising morbidity and mortality rates among mother-infant dyads especially affect socially and economically marginalized communities, including non-Hispanic Black and Native American women. Breastfeeding could improve these outcomes as it is linked to a reduced risk of cardiovascular disease and sudden infant death.⁴

Despite this, and the Patient Protection and Affordable Care Act (ACA)’s expansion of access to pumps, there has been little done to assess when and how to appropriately use pumps to optimize the outcomes of breastfeeding.4

In the currently study, among the nationally representative sample of women, approximately 91% of respondents reported ever using a breast pump._¹

"This statistic demonstrates the near ubiquitous practice of pump use among breast and chestfeeding families in the US today," Nardella, who is also the lead investigator of the current analysis, stated.² "Our findings support the need for further research that improves our understanding of effective and safe pump use to better support the many US families in reaching their personal infant feeding goals and using this medical equipment appropriately."

The sample included 19,719 mothers with a mean age of 29.5 years. Lower pump use was observed in mothers aged < 18 years, those with a race and ethnicity other than non-Hispanic White, those with a lower income or education, those who were unmarried, and those with Medicaid enrollment (P <.001).¹

However, pump use was linked to a 37% lower hazard of ending breastfeeding (adjusted hazard ratio 0.63; 95% confidence interval [CI]: 0.56 - 0.70). It was also associated with 21 additional weeks of continued breastfeeding on average.¹

A stratified analysis showed the lowest hazard of breastfeeding cessation among Native American and non-Hispanic Black mothers who used pumps (adjusted hazard ratio 0.51 [0.37 - 0.70] and 0.47 [0.40 - 0.54], respectively).¹

"Ensuring access to pumps for US families could help mitigate known inequities in breastfeeding duration rates,” Nardella concluded.²

References

1. ^{Nardella D, Canavan M, Sharifi M, Taylor S. Quantifying the Association between Pump Use and Breastfeeding Duration. J Pediatr. Published online July 14, 2024. doi:10.1016/j.jpeds.2024.114192}
2. ^{Yale School of Medicine. U.S. women who utilized a pump found to breastfeed. Newswise. August 1, 2024. Accessed August 12, 2024. https://d.newswise.com/articles/women-utilizing-breast-pumps-breastfeed-21-weeks-longer-on-average-study.}
3. ^{Chiang KV, Li R, Anstey EH, Perrine CG. Racial and Ethnic Disparities in Breastfeeding Initiation ─ United States, 2019. MMWR Morb Mortal Wkly Rep. 2021;70(21):769-774. Published 2021 May 28. doi:10.15585/mmwr.mm7021a1}
4. ^{Nardella D. Pumps: A Possible Tool to Promote More Equitable Lactation Outcomes. Yale J Biol Med. 2024;97(1):99-106. Published 2024 Mar 29. doi:10.59249/MWYW7163}