Internalized Weight Stigma, Breastfeeding Difficulties, and Self‐Efficacy as Mediators Between Pre‐Pregnancy Overweight/Obesity and Exclusive Breastfeeding at 6 Months Postpartum

A Prospective Cohort Study in China

Bibliographic Data

ID15536796
AuthorsZiqi Ren (0000-0002-6390-2437, Nanjing Jiangning Hospital), Huiting Tang (Nanjing Jiangning Hospital), Xuemei Fan (0000-0002-0662-7790, Nanjing Maternity and Child Health Care Hospital), Jingyi Feng (0000-0001-6415-0911, Hong Kong Polytechnic University), Aixia Zhang (0000-0002-1266-0925, Nanjing Maternity and Child Health Care Hospital, corresponding author)
Year2026
Volume22
Issue1
Pagese70168-e70168
Publication date2026-01-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueMaternal and Child Nutrition (JOURNAL)
Journal identifiersISSN: 1740-8695 • E-ISSN: 1740-8709
PublisherWiley (PUBLISHER • GB)
DOI10.1111/mcn.70168
PMID41642186
OpenAlexW7127941658
LanguageEN
References cited45

This prospective cohort study aims to explore the mechanisms by examining the independent and sequential mediation effects of internalized weight stigma, breastfeeding difficulties, and breastfeeding self-efficacy in the relationship between pre-pregnancy overweight/obesity and exclusive breastfeeding at 6 months postpartum. In Nanjing, China, 296 primiparous women were stratified by pre-pregnancy body mass index (BMI) into two groups: pre-pregnancy overweight/obese (n = 146) and normal BMI (n = 150). Data were collected via questionnaires during the antenatal period and at 6 months postpartum. Women with pre-pregnancy overweight/obesity reported significantly higher levels of internalized weight stigma (M = 30.73, SD = 5.71) compared to their normal-weight counterparts (M = 22.42, SD = 3.75). Path analysis with bias‐corrected bootstrapping was used to test mediation, adjusting for baseline covariates. The study confirmed a negative correlation between pre-pregnancy overweight/obesity and exclusive breastfeeding at 6 months postpartum. Significant indirect paths were identified from pre-pregnancy overweight/obesity to exclusive breastfeeding at 6 months postpartum via internalized weight stigma, breastfeeding difficulties, and breastfeeding self-efficacy. A significant serial indirect path through breastfeeding difficulties and self-efficacy was also identified. This study highlights the critical mediating roles of internalized weight stigma, breastfeeding difficulties, and breastfeeding self-efficacy in the relationship between pre-pregnancy overweight/obesity and exclusive breastfeeding. The findings provide healthcare professionals with evidence-based targets for intervention, emphasizing the need to address weight stigma in prenatal care and enhance breastfeeding support strategies. Future studies in more diverse populations are warranted to confirm generalizability. Trial Registration: Registered at the Chinese Clinical Trial Registry (registry number: ChiCTR2200057038), trial registration date February 26, 2022

Body mass index · Breast feeding · Breastfeeding · Cohort · Cohort study · Overweight · Path analysis (statistics · Prospective cohort study · Bariatric Surgery and Outcomes · Eating Disorders and Behaviors · Obesity and Health Practices

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