Background: Relatively little work has quantified associations between prenatal food insecurity and breastfeeding practices; however, understanding the implications of prenatal food insecurity may support food insecurity screening recommendations during prenatal care. Therefore, the purpose of this study was to investigate associations between prenatal food insecurity and breastfeeding initiation and duration until 3 months postpartum. Method: This study utilized data from a prospective Michigan pregnancy cohort. Women were recruited during their first prenatal visit with planned follow-up through early childhood. Prenatal food insecurity was assessed during pregnancy, and breastfeeding initiation and duration were assessed at the 3-month postpartum visit. Multiple logistic regression models were used to evaluate associations between prenatal food insecurity and the two primary outcomes: breastfeeding initiation and breastfeeding status at 3-months postpartum. Cox proportional hazard ratios were used to assess differences in the risk of breastfeeding cessation until 3 months postpartum by food insecurity status. An adversity index was created to stratify women into higher- and lower-risk groups for not breastfeeding. Associations between food insecurity and breastfeeding at 3 months postpartum (yes/no) were assessed via Fisher's Exact test within each group. Results: In the unadjusted models, women who reported food insecurity during pregnancy were less likely to initiate breastfeeding (OR = 0.39; 95% CI: 0.21-0.69) and continue breastfeeding until 3 months postpartum (OR = 0.35; 95% CI: 0.20-0.61) compared to food secure women, but the associations were no longer significant after adjustment for sociodemographic and health-related factors. Prenatal food insecurity was not associated with breastfeeding at 3 months postpartum in analyses stratified into high- and low-adversity groups. Conclusions: Prenatal food insecurity is a strong predictor of breastfeeding practices. Though not significantly associated with breastfeeding practices after adjustment, screening for prenatal food insecurity may help clinicians identify women who may need more supports to initiate and maintain breastfeeding.
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