Program

Nurse-Midwifery M.S.

Number of Pages

38

Year Approved

2026

First Advisor

Brooke Eischens

Second Reader

Paige Hardy

Third Reader

Cassidy Hemphill

Abstract

Introduction: It has been well documented that exclusive breastfeeding provides benefits for infants and postpartum individuals, yet rates remain suboptimal in the United States, particularly among those with elevated pre-pregnancy body mass index (BMI). Evidence suggests that elevated BMI is associated with shorter breastfeeding duration and may be influenced by physiologic, social, and structural factors. This integrative review synthesizes existing literature to clarify the relationship between elevated BMI and exclusive breastfeeding duration among postpartum individuals.
Methods: An integrative review was conducted following Whittemore and Knafl’s (2005) framework and PRISMA 2020 guidelines. A systematic search of PubMed, CINAHL, and Nursing & Allied Health, was performed to identify studies that met inclusion criteria. Seventeen studies were identified and were comprised of prospective and retrospective cohort studies, and longitudinal designs. Data were extracted using a structured literature matrix and appraised with the John Hopkins Nursing Evidence-Based Practice tool. Findings were interpreted through the Social Ecological Model (SEM) to contextualize individual, interpersonal, societal, and healthcare influences (Bronfenbrenner, 1979).
Results: Across studies, elevated BMI was consistently associated with shorter exclusive breastfeeding duration. Breastfeeding initiation rates were similar across BMI categories, but patterns emerged in the immediate postpartum period and persisted through six months. Individuals with an elevated BMI were less likely to exclusively breastfeed at discharge, early postpartum, three months, and six months. BMI remained an independent predictor after adjustment for covariates. Social determinants such as lower socioeconomic status, younger participant age, and racial disparities influence outcomes, though BMI remained independently associated with reduced breastfeeding duration.
Discussion: Postpartum individuals with elevated BMI face challenges in sustaining exclusive breastfeeding despite similar intention and initiation rates. Advanced practice providers play a crucial role in addressing these gaps through early individualized lactation support and awareness of weight related stigmas. Future research should focus on consistent measurement of breastfeeding duration, stratification by obesity classes, physiologic mechanisms, and interventions to improve breastfeeding outcomes in this population.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis

Terms of Use and License Information

Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

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