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Early lactation failure and formula adoption after elective caesarean delivery: cohort study
  1. Vincenzo Zanardo1,
  2. Anna Pigozzo2,
  3. Gary Wainer3,
  4. Diego Marchesoni4,
  5. Antonella Gasparoni5,
  6. Sandra Di Fabio6,
  7. Francesco Cavallin2,
  8. Arturo Giustardi2,
  9. Daniele Trevisanuto2
  1. 1Pediatric Department, Padua University, Padua, Italy
  2. 2School of Medicine, Padua University, Padua, Italy
  3. 3Neonatal-Perinatal Medicine, St. Joseph Mercy Hospital Ann Arbor, Ann Arbor, Michigan, Houston, USA
  4. 4Institute of Obstetrics and Gynecology and Reproductive Sciences, University of Udine, Udine, Italy
  5. 5Department of Pediatrics, University of Brescia, Brescia, Italy
  6. 6Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
  1. Correspondence to Vincenzo Zanardo, Padua University, Pediatric Department, Via Giustiniani 3 Padua, 35128, Italy; zanardo{at}


Objective To investigate the effects of elective primary and elective repeat caesarean deliveries on lactation at hospital discharge.

Design Cohort study.

Setting Four Italian teaching hospitals – Padua, Brescia, L'Aquila and Udine.

Interventions Deliveries were classified as vaginal, elective caesarean (primary and repeat) or emergency caesarean. A total of 2296 (24.7%) infants born by caesarean section (CS), 816 of which (35.5%) classified as primary elective CS and 796 (34.7%) as repeat elective CS, were studied. Moreover, 30.2% of the elective CS deliveries took place before 39 weeks.

Main outcome measures Feeding modalities at discharge: formula, complementary and breastfeeding.

Results At discharge, 6.9% of the vaginal delivery mothers, 8.3% of the emergency CS mothers, 18.6% of the elective CS mothers, 23.3% of the primary CS mothers and 13.9% of the repeat CS mothers were using infant formula exclusively. Multivariate analysis (OR; 95% CI) identified primary elective delivery (3.74; 3.0 to 4.60), lower gestational age (1.16; 1.10 to 1.23), and place L'Aquila versus Udine (1.42; 1.01 to 2.09) and of Brescia versus Udine hospitals (6.16; 4.53 to 8.37) as independent predictors of formula feeding at discharge.

Conclusions These findings provide new information about the risks of breastfeeding failure connected to elective CS delivery, particularly if primary and scheduled before 39 weeks of gestation.

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The local ethics committees (University of Padua, Brescia, Udine, and L'Aquila granted approval.

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