***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Obese women often have difficulties breastfeeding . OBJECTIVE We evaluated whether telephone-based support could increase the duration of breastfeeding in obese women and , thereby , reduce offspring growth . DESIGN We recruited 226 dyads of obese mothers and their singleton , healthy , term infants . The women were r and omly assigned to 6 mo of breastfeeding support or st and ard care controls . At 6 mo , there were 207 dyads in the study ; 105 dyads received support , and 102 dyads were control subjects . One International Board Certified Lactation Consultant carried out the intervention , which was based on structured interviews and consisted of encouraging telephone calls . RESULTS The support group breastfed exclusively for a median of 120 d ( 25th-75th percentiles : 14 - 142 d ) compared with 41 d ( 3 - 133 d ) for control subjects ( P = 0.003 ) . Any breastfeeding was maintained for a median of 184 d ( 92 - 185 d ) for the support group compared with 108 d ( 16 - 185 d ) for control subjects ( P = 0.002 ) . Support increased the adjusted ORs for exclusive breastfeeding at 3 mo and the ratios for partial breastfeeding at 6 mo to 2.45 ( 95 % CI : 1.36 , 4.41 ; P = 0.003 ) and 2.25 ( 95 % CI : 1.24 , 4.08 ; P = 0.008 , respectively ) . Although the duration of exclusive breastfeeding was inversely associated with infant weight ( β = -4.39 g/d ; 95 % CI : -0.66 , -8.11 g/d ; P = 0.021 ) and infant length at 6 mo ( β = -0 . 012 cm/d ; 95 % CI : -0.004 , -0.02 cm/d ; P = 0.004 ) , the breastfeeding support did not achieve a significant effect on infant growth at 6 mo ( n = 192 ) . CONCLUSIONS Telephone-based advisory support was very effective in prolonging breastfeeding  in obese mothers who often terminate the breastfeeding of their infants prematurely . A longer duration of breastfeeding may decrease risk of noncommunicable diseases in these infants . This trial was registered at clinical trials.gov as NCT01235663 BACKGROUND Psychosocial factors influence breastfeeding outcomes , but little is known about these characteristics and how they influence breastfeeding behavior of obese women , who are a group that experiences poor breastfeeding outcomes . OBJECTIVES Our objectives were to determine whether 1 ) maternal prepregnancy body mass index ( BMI ) is associated with social knowledge of , social influence toward , maternal confidence in , and behavioral beliefs about breastfeeding ; 2 ) BMI and these psychosocial factors predict outcomes of intention to breastfeed , ever breastfed , and the duration of breastfeeding ; and 3 ) BMI and psychosocial factors are associated with these breastfeeding outcomes independent of each other . DESIGN Participants ( n = 2824 ) in the Infant Feeding Practice s Study II provided data on psychosocial characteristics and breastfeeding outcomes . In this prospect i ve cohort study , data were analyzed by using logistic and proportional hazards regression models . RESULTS Prepregnancy BMI was associated with confidence in ( P < 0.0001 ) , social influence toward ( P = 0.02 ) , and social knowledge of ( P < 0.0001 ) breastfeeding but not with behavioral beliefs about breastfeeding ( P = 0.45 ) . Obese women did not differ from under- and normal-weight women in the intention to breastfeed ( P = 0.07 ) but had lower odds of ever breastfeeding ( P = 0.04 ) and were at greater risk of an earlier cessation of exclusive ( P = 0.0009 ) and any ( P = 0.03 ) breastfeeding . Only the association with exclusive breastfeeding remained significant after controlling for psychosocial factors ( P = 0.01 ) . All psychosocial factors were positively associated with each breastfeeding outcome . CONCLUSIONS Despite their intentions to breastfeed , women with high prepregnancy BMI had psychosocial characteristics associated with poor breastfeeding outcomes . However , these characteristics did not fully explain the association between maternal obesity and breastfeeding outcomes OBJECTIVE Maternal obesity is associated with poor breastfeeding outcomes , yet no intervention has been developed to improve them . To ascertain whether increased breastfeeding support or provision of a breast pump is a feasible , effective intervention to improve breastfeeding , we enrolled obese women who intended to breastfeed in two r and omized trials . METHODS In Bassett Improving Breastfeeding Study ( BIBS ) 1 , 40 women received targeted breastfeeding support in the hospital  and via telephone or usual care .  Information regarding breastfeeding was collected via telephone for 7 days after delivery and at 30 and 90 days postpartum . In BIBS 2 , 34 obese mothers received a manual or electric breast pump to use for 10 - 14 days or no pump ; data collection was similar . RESULTS In both experiments , r and omization failed to distribute women of differing postpartum body mass index adequately among the treatment groups . When analyses were adjusted for this , there was no difference in BIBS 1 between targeted and usual care groups and in BIBS 2 among the treatment groups in the proportion of women still breastfeeding at the times studied . CONCLUSIONS In future studies of obese women , stratified r and omization may be necessary . Further development of interventions to help obese women achieve optimal breastfeeding outcomes is required OBJECTIVE : To evaluate a specialized breastfeeding peer counseling ( SBFPC ) intervention promoting exclusive breastfeeding ( EBF ) among overweight/obese , low-income women . METHODS : We recruited 206 pregnant , overweight/obese , low-income women and r and omly assigned them to receive SBFPC or st and ard care ( controls )  at a Baby-Friendly hospital . SBFPC included 3 prenatal visits , daily in-hospital support , and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers . St and ard care involved routine access to breastfeeding support from hospital personnel , including staff peer counselors . Data collection included an in-hospital interview , medical record review , and monthly telephone calls through 6 months postpartum to assess infant feeding practice s , demographics , and health outcomes . Bivariate and logistic regression analyses were conducted . RESULTS : The intervention had no impact on EBF or breastfeeding continuation at 1 , 3 , or 6 months postpartum . In adjusted posthoc analyses , at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding ( adjusted odds ratio [ aOR ] : 3.76 [ 95 % confidence interval ( CI ) : 1.07–13.22 ] ) , and giving at least 50 % of feedings as breast milk ( aOR : 4.47 [ 95 % CI : 1.38–14.5 ] ) , compared with controls . Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth ( aOR : 0.24 [ 95 % CI : 0.07–0.86 ] ) . CONCLUSIONS : In a Baby-Friendly hospital setting , SBFPC targeting overweight/obese women did not impact EBF practice s but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth BACKGROUND The potential that obesity in pregnancy has to affect symptoms associated with eating disorders and breastfeeding is unclear . AIM This study analyzed symptoms of eating disorders and breastfeeding practice s in obese mothers . STUDY DESIGN Prospect i ve , case-control study . SUBJECTS Participants included 25 obese ( BMI > 30 kg/m(2 ) ) and 25 normal-weight puerperae , matched for parity and delivery route . OUTCOME MEASURES The participants completed the Eating Disorders Inventory ( EDI-2 ) , investigating cognitive , emotional , and behavioral symptoms of eating disorders before they were discharged from the maternity hospital and later participated in telephone interviews concerning breastfeeding practice s which were classified according to WHO definitions . RESULTS Although none of the scores fell in the pathological range , the obese mothers had more and more pronounced symptoms of eating disorders in all EDI-2 subscales with respect to normal-weight mothers . They had , in particular , significantly higher scores in body dissatisfaction ( p<.0001 ) , ineffectiveness ( p=.004 ) , interoceptive awareness ( p=.005 ) , and maturity fear ( p=.007 ) . Finally , while breastfeeding practice s were similar in the two groups , the obese mothers were more likely to maintain full breastfeeding at 6 months ( 20 vs 8 % ) and their tendency to postpone weaning was found to be significant ( p<.04 ) . CONCLUSIONS While the obese mothers studied have more pronounced symptoms of eating disorders with respect to their normal-weight counterparts , they tended to maintain breastfeeding longer , postponing weaning Purpose This study analyzed body image perceptions and breastfeeding practice s in obese mothers . Methods Prospect i ve , case – control study on 25 obese ( BMI > 30 kg/m2 ) and 25 normal-weight puerperae , matched for parity and delivery route . The participants completed the Body Uneasiness Test , a two-part , self-report question naire , investigating body image perception before they were discharged from hospital and participated in telephone interviews concerning breastfeeding practice s. Results Obese women demonstrated body image dissatisfaction related to their obesity . On average , they reported significantly higher scores on Global Severity Index ( p < 0.0001 ) and on all of the BUT-A subscales : Weight Phobia ( p < 0.02 ) , Body Image Concerns ( p < 0.0001 ) , Avoidance ( p < 0.0001 ) , Compulsive Self-Monitoring ( p < 0.01 ) , and Depersonalization ( p = 0.002 ) than did normal-weight puerperae . Moreover , they also had higher BUT-B scores and the Positive Symptom Total was significantly higher ( p < 0.002 ) . Finally , while breastfeeding practice s at discharge were similar in the two groups , the obese mothers were more likely to maintain full breastfeeding at 6 months ( p < 0.04 ) . Conclusions Obese mothers have negative body image perceptions but they maintain full breastfeeding longer OBJECTIVE Breastfeeding confers many health benefits to mothers and infants , while depression negatively affects mothers and infants . The aims of this study were to determine relationships between ( 1 ) major depressive disorder ( MDD ) and depressive symptom severity during pregnancy and breastfeeding intention ; ( 2 ) MDD and depressive symptom severity during pregnancy and breastfeeding initiation and status at 2 and 12 weeks ; and ( 3 ) serotonin reuptake inhibitor ( SRI ) use and breastfeeding intention , initiation , and status at 2 and 12 weeks . METHOD Women were followed prospect ively from pregnancy through 12 weeks postpartum for infant feeding intention ( breast , breast and formula , formula , and uncertain ) , feeding practice s and MDD ( Structured Clinical Interview for DSM-IV Disorders ) , and depressive symptom severity ( Hamilton Depression Rating Scale ) . Bivariate analyses and multivariable regression modeling were conducted . The study was conducted from July 2004 to September 2007 . RESULTS Study participants ( intention n = 168 , initiation n = 151 , 2 weeks n = 137 , 12 weeks n=103 ) were well educated ( 63 % college degrees ) , older ( 49 % ≥ or = 31 years ) , and predominantly white ( 77 % ) . At enrollment , 23 % had MDD , 21 % had significant depressive symptoms , and 16 % were taking an SRI . Neither MDD nor depressive symptom severity in pregnancy was related to breastfeeding intention , initiation or duration at 2 and 12 weeks . Intention to exclusively breastfeed was the most significant predictor of breastfeeding initiation and duration . SRI use in pregnancy was negatively associated with breastfeeding intention . SRI use at 2 weeks was negatively associated with 12-week breastfeeding status . CONCLUSION Pregnancy is the optimal time to intervene to increase breastfeeding rates . Future research should identify strategies to overcome breastfeeding barriers posed by SRI use OBJECTIVE to investigate the psychosocial variables associated with the ability to  exclusively breastfeed to six months postpartum . Additionally , to evaluate a conceptual model of psychosocial correlates of exclusive breastfeeding duration . DESIGN online , retrospective question naire . SETTING the question naire was placed online and participants accessed it through social networking sites including groups relating to breastfeeding , motherhood and parenting . Participants were also able to share the link with their own networks . This online setting facilitated recruitment of a wide range of Australian and international participants . PARTICIPANTS 174 women aged 18 years and older who had given birth between six months to two years prior . Participants completed an online question naire , which asked them to report on three time points : pre-pregnancy , during pregnancy and during the first six months postpartum . Data were collected from June to December 2011 . ME 
    Output:
    
Five psychological factors were associated with breastfeeding behaviours : intentions to breastfeed , belief in breast milk 's nutritional adequacy and sufficiency , belief about other 's infant feeding preferences , body image and social knowledge .