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Variations in breastfeeding rates for very preterm infants between regions and neonatal units in Europe: results from the MOSAIC cohort
  1. Mercedes Bonet1,2,
  2. Béatrice Blondel1,2,
  3. Rocco Agostino3,
  4. Evelyne Combier4,
  5. Rolf F Maier5,
  6. Marina Cuttini6,
  7. Babak Khoshnood1,2,
  8. Jennifer Zeitlin1,2,
  9. MOSAIC research group
  1. 1INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and Infants' Health, Villejuif, France
  2. 2UPMC, Université Paris 06, Paris, France
  3. 3Department for Mother's and Infant's Health, Hospital S. Giovanni Calibita–Fatebenefratelli, Rome, Italy
  4. 4Centre d’épidémiologie des populations (CEP), University of Burgundy, Hôpital du Bocage, Dijon, France
  5. 5Department of Neonatology, University Hospital Marburg, Marburg, Germany
  6. 6Unit of Epidemiology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
  1. Correspondence to M Bonet, INSERM U953, Epidemiological Research Unit on Perinatal Health and Women's and Infants' Health, 16 Avenue Paul-Vaillant Couturier, 94807 Villejuif, France; mercedes.bonet-semenas{at}


Objectives To compare breastfeeding rates at discharge for very preterm infants between European regions and neonatal units, and to identify characteristics associated with breast feeding using multilevel models.

Methods Population-based cohort of 3006 very preterm births (22–31 weeks of gestation) discharged home from neonatal units in eight European regions in 2003.

Results Breastfeeding rates varied from 19% in Burgundy to 70% in Lazio, and were correlated with national rates in the entire newborn population. Women were more likely to breast feed if they were older, primiparous and European; more premature, smaller and multiple babies or those with bronchopulmonary dysplasia were breast fed less. Variations across regions and neonatal units remained statistically significant after adjusting for maternal, infant and unit characteristics.

Conclusion It is possible to achieve high breastfeeding rates for very preterm infants, but rates varied widely across regions and neonatal units throughout Europe.

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  • The MOSAIC Research Group Belgium, Flanders: E Martens, G Martens, P Van Reempts; Denmark, Eastern Denmark: K Boerch, T Weber, B Peitersen; France, Ile-de-France: G Bréart, JL Chabernaud, D Delmas, PH Jarreau, E Papiernik; France, Burgundy: H Charreire, F Michaud, C Ferdynus, E Combier, JB Gouyon; Germany, Hesse: L Gortner, W Künzel, RF Maier, B Misselwitz, S Schmidt; Italy, Lazio: R Agostino, D Di Lallo, R Paesano; Netherlands, Eastern and Central: L den Ouden, L Kollée, G Visser, J Gerrits, R de Heus; Poland, Wielkopolska and Lubuskie: G Breborowicz, J Gadzinowski, J Mazela; Portugal, Northern Region: H Barros, I Campos, M Carrapato; UK, Trent Region: E Draper, D Field, J Konje; UK, Northern Region: A Fenton, D Milligan, S Sturgiss; INSERM U953, Paris: G Bréart, B Blondel, H Pilkington, J Zeitlin; external contributors: M Cuttini, S Petrou.

  • Funding The MOSAIC project was partially funded by a grant from the European Commission Research Directorate (QLG4-CT-2001-01907) and coordinated by Assistance Publique-Hôpitaux de Paris. The Burgundy cohort was funded with a grant from IRESP (Institut de Recherche en Santé Publique/Pubic Health Research Institute). MB was supported by a research grant from the French Ministry for Higher Education and Research.

  • Competing interests None.

  • Ethics approval All regions obtained ethics approval in accordance with national guidelines for research.

  • Provenance and peer review Not commissioned; externally peer reviewed.