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IntroductionWe assessed awareness of the maternal health benefits of lactation among a sample of nulliparous pregnant individuals in the United States, identified variables associated with awareness of these benefits, and examined whether awareness of these benefits impacts breastfeeding attitudes or intentions.MethodsWe administered a web-based survey to nulliparous U.S.-born individuals carrying a singleton gestation of at least 28 weeks. We assessed awareness of the maternal health benefits of lactation using 10 items to create a summative score. We examined variation in awareness of these benefits by demographic characteristics, health insurance, and personal or family health history and used multivariable models to estimate associations between awareness of the maternal health benefits of lactation and breastfeeding intentions.ResultsOf the 675 individuals invited to complete surveys, 451 (67%) responded. Only 50% were aware that breastfeeding lowers maternal risk of breast cancer; fewer were aware that breastfeeding lowers the risk of ovarian cancer (35%), diabetes (27%), and hypertension and heart disease (26%). Awareness of the maternal benefits of lactation did not vary by age or race/ethnicity. However, significant regional variation was noted. In multivariable models, scores of awareness of the maternal health benefits of breastfeeding were significantly associated with intentions to breastfeed for at least 12 months (adjusted odds ratio, 1.23; 95% confidence interval, 1.11, 1.37).ConclusionsEfforts to increase awareness of the maternal health benefits of lactation are still needed. Increasing awareness of the maternal health benefits of lactation may strengthen intentions to breastfeed as recommended.

Objective: To assess the effects of prenatal counseling about the maternal health benefits of lactation on postpartum knowledge, breastfeeding intentions, and infant feeding behaviors. Materials and Methods: We conducted a randomized trial with 411 nulliparous U.S.-born women carrying a singleton gestation. Participants were recruited online; after completing a baseline survey that assessed breastfeeding knowledge and intentions, participants were randomized to receive a 10-minute virtual counseling session about the benefits of breastfeeding or attention-control counseling about smoke-free homes. We collected data on breastfeeding knowledge, intentions, and infant feeding behaviors through 12 months postpartum and conducted an intention-to-treat analysis. Results: On enrollment, awareness of the maternal health benefits of lactation was similarly low in both study groups. Postpartum, participants who received this prenatal counseling intervention had significantly greater awareness that breastfeeding decreases maternal risk of breast cancer, ovarian cancer, diabetes, heart disease, and rheumatoid arthritis (p

Introduction: The lactational amenorrhea method (LAM) of postpartum contraception is more effective than typical use of condoms or birth control pills. However, LAM may be underutilized due to incomplete perinatal counseling. Methods: We compared perceptions of the effectiveness of postpartum contraceptives including LAM among U.S.-born nulliparous pregnant women recruited using social media for a trial (NCT04601987). We used descriptive statistics to summarize data. Results: Of 760 individuals screened, 627 were invited to participate, and 451 (72%) were enrolled. Most (81%) had a college degree; 79% intended to breastfeed for at least 1 month. Only 8% believed exclusive breastfeeding reduces the chance of pregnancy "a lot" within 6 months of delivery and 2% indicated that exclusive breastfeeding is typically more effective than birth control pills or condoms. Compared with those planning to use other postpartum contraceptives, the 17% of respondents who planned to use LAM were more likely to know that breastfeeding delays return of menses (84% versus 44%, p ≤ 0.0001) and provides protection from pregnancy until menses return (54% versus 22%, p ≤ 0.0001). Although 25% of those planning to use LAM believed exclusive breastfeeding reduces pregnancy risk by "a lot," only 5% thought LAM is more effective than birth control pills and only 9% thought that it is more effective than condoms. Conclusions/Implications: First-time U.S. mothers are often unaware of breastfeeding's effects on menses and fertility. Clinicians providing counseling about postpartum contraceptive options should include more information on LAM.

INTRODUCTION:: Rates of breastfeeding in the US remain suboptimal. Public health campaigns encouraging breastfeeding have focused on health benefits for infants, despite over 60 years of data demonstrating breastfeeding reduces maternal risk of breast cancer with more recent data indicating breastfeeding lowers maternal risk of ovarian cancer, diabetes, hypertension and heart disease. METHODS:: To assess awareness of the effects of lactation on maternal health, we used social media to recruit a prospective cohort of US-born nulliparous women carrying a singleton pregnancy of 28+ weeks’ gestation in 2021. Participants were compensated a $20 gift card for completing an online survey. Institutional review board (IRB) approval was obtained. RESULTS:: Of 152 respondents, a family history of breast cancer (9%), diabetes (23%), hypertension (26%), and heart disease (9%) was reported by some; fewer (5%) were diagnosed with gestational diabetes or a hypertensive disorder of pregnancy (2%), and 76% were college educated. Most respondents were aware that breastfeeding benefits infant health; 23% strongly (and 42% somewhat) felt that breastfed babies are healthier than formula fed babies. Most (91%) believed breastfeeding will save their family money. Most strongly (67%) or somewhat (23%) agreed that breastfeeding their baby was important. However, fewer than half were aware that breastfeeding lowers maternal risk of breast cancer (47%), ovarian cancer (32%), diabetes (25%), and hypertension or heart disease (28%). CONCLUSION:: Few US pregnant women are aware of the maternal health benefits of breastfeeding. Counseling pregnant women about the beneficial effects of lactation on maternal, in addition to infant, health may help increase breastfeeding rates.

INTRODUCTION:: Lactational amenorrhea method (LAM) is a temporary postpartum contraceptive method that is typically more effective than use of condoms or birth control pills. However, this method may be underutilized due to incomplete knowledge. METHODS:: To assess perceptions of the effectiveness of LAM compared to other postpartum contraceptives in 2021, we used social media to recruit US-born nulliparous pregnant women carrying a singleton pregnancy of 28+ weeks’ gestation. Participants were compensated a $20 gift card for completing an online survey. Institutional review board (IRB) approval was obtained. RESULTS:: Of 152 respondents, 76% were college-educated, 90% wanted to breastfeed, and 7% indicated they planned to rely on LAM as their sole method of contraception in the first 6 months postpartum. However, less than half (48%) were aware that breastfeeding would delay the return of menses after the baby is born, and only 47% believed exclusive breastfeeding reduces the chance of pregnancy within 6 months of delivery. Only 9% (95% CI 5%-14%) knew breastfeeding prevents pregnancy when their infant is exclusively breastfed, while 27% (95% CI 20%-35%) knew breastfeeding only protects mothers from pregnancy until menstrual periods have returned. No respondents indicated that exclusive breastfeeding is typically more effective than condoms and only 2% (0%-6%) indicated that exclusive breastfeeding is typically more effective than birth control pills. CONCLUSION:: Few US pregnant women are aware of LAM criteria or the effectiveness of LAM compared with other postpartum contraceptive options, suggesting that patients may be receiving incomplete counseling from their health care providers regarding their options for postpartum contraception.