Open Access Open Badges Research article

Predictors of exclusive breastfeeding: observations from the Alberta pregnancy outcomes and nutrition (APrON) study

Mahsa Jessri1, Anna P Farmer235*, Katerina Maximova4, Noreen D Willows2, Rhonda C Bell2 and APrON Study Team

Author Affiliations

1 Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON M5S 3E2, Canada

2 Human Nutrition Division, Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada

3 The Center for Health Promotion Studies, University of Alberta, Edmonton, AB, Canada

4 Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada

5 Human Nutrition Division, Alberta Institute for Human Nutrition, and Center for Health Promotion Studies, Edmonton Clinic Health Academy 4-370, University of Alberta, Edmonton, AB T6G 1C9, Canada

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BMC Pediatrics 2013, 13:77  doi:10.1186/1471-2431-13-77

Published: 16 May 2013



Despite growing evidence that supports the importance of 6-month exclusive breastfeeding, few Canadian mothers adhere to this, and early weaning onto solids is a common practice. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding to 3 and 6 months.


This prospective cohort study was part of the Alberta Pregnancy Outcomes and Nutrition study (APrON). From an initial sample of 600 pregnant women recruited from Edmonton and Calgary, 402 mothers provided complete details at 3 months postpartum; 300 stayed on to provide information at 6 months postpartum. During pregnancy and at 3 and 6 months postpartum, data on maternal and infant socio-demographic, behavior, and feeding were collected.


Even though there was a high rate of “ever having breastfed” (98.6%), exclusive breastfeeding rates for 3 and 6 months were 54.0% and 15.3%, respectively. After controlling for potential confounders, the study showed that mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree (95% CI: 1.30-10.92; p = 0.015). In addition, mother of previous children were more likely to breastfeed exclusively for 6 months (OR: 2.21, 95% CI: 1.08-4.52; p = 0.031). Mothers who were in the highest quartile of the Iowa Infant Feeding Attitude Score were 4.29 and 5.40 times more likely to breastfeed exclusively for 3 months (95% CI: 1.31-14.08; p-trend < 0.001) and 6 months (95% CI: 2.75-10.60; P-trend < 0.001), respectively.


The 6-month exclusive breastfeeding rate in Alberta is considerably below national and international breastfeeding recommendations. Professional advice that focuses on prenatal maternal knowledge, attitudes, and misperceptions may promote adherence to World Health Organization breastfeeding guidelines. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, primiparous women may help health practitioners focus their support and education for this group.

Exclusive breastfeeding; Predictors; Canada; Alberta pregnancy outcomes; Nutrition study