Breastfeeding in term and preterm infants with and without growth restriction: A 50‐year analysis of incidence and duration

OBJECTIVE: The aim of the present study was to analyze breastfeeding rates and duration in relation to preterm birth, fetal growth restriction, and demographics over five decades. METHODS: This retrospective cohort study included 1559 individuals (aged 4-52 years) and their parents from the University Medical Center Mainz, Germany. Participants were categorized by gestational age (extremely preterm ≤28 weeks, very preterm 29-32 weeks, moderately preterm 33-36 weeks, term ≥37 weeks), and birth weight percentile (small for gestational age [SGA] 90th). Data were collected via interviews, questionnaires, and medical records. RESULTS: Data from 940 mothers were analyzed. Breastfeeding rates and duration significantly increased over 50 years. However, low gestational age, particularly ≤28 weeks and 29-32 weeks and being born SGA were significantly associated with reduced breastfeeding incidence. Delayed breastfeeding initiation was more frequent in preterm and SGA-born infants. Additionally, there was a significant positive association between year of birth and breastfeeding rates and duration. Higher maternal educational level correlated positively with breastfeeding initiation and duration. CONCLUSION: Breastfeeding rates and duration significantly increased over the past 50 years. However, both preterm birth and fetal growth restriction were associated with lower breastfeeding incidence and delayed initiation. Notably, being born SGA was independently linked to reduced breastfeeding, even after accounting for gestational age. While the association between prematurity and breastfeeding challenges is well established, our findings suggest that being born SGA may represent a similarly important but less widely recognized risk factor. This underlines the need for increased awareness and tailored breastfeeding support for this specific group.