Twin Challenges in Türkiye: Exclusive Breastfeeding Rates and Predictors of Breastfeeding Duration in a Tertiary Care Center
Abstract
1. Introduction
2. Materials and Methods
2.1. Research Design and Study Setting
2.2. Participants and Selection Process
2.3. Data Collection Methods
2.4. Ethical Aspecst of the Research
2.5. Data Analysis
2.6. Terminology and Study Definitions
3. Results
3.1. Participants’ Sociodemographic Characteristics
3.2. Breastfeeding Information
3.3. Twin-Related Factors and Breastfeeding Outcomes
3.4. Maternal Factors and Breastfeeding Outcomes
3.5. Cultural and Social Factors and Breastfeeding Outcomes
3.6. Breastfeeding Outcomes by Gestational Age Group
3.7. Multiple Linear Regression Analysis of Breastfeeding Duration
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | |
---|---|
Child age (year) * | 3.44 ± 1.82 |
Child age group N (%) | |
1–2 years | 112 (36.6) |
3–4 years | 106 (34.6) |
≥5 years | 88 (28.8) |
Child gender N (%) | |
Female | 133 (43.7) |
Male | 173 (56.3) |
Mother’s age (year) * | 34.33 ± 4.67 |
Mother’s age group n (%) | |
<35 years | 84 (54.9) |
≥35 years | 69 (45.1) |
Mother’s education level n (%) | |
<High school | 29 (19) |
≥High school and higher | 124 (81) |
Mother’s employment n (%) | |
Unemployed | 47 (30.7) |
Employed | 106 (69.3) |
Father’s age (year) * | 37.14 ± 5.24 |
Father’s age group n (%) | |
<35 years | 48 (31.4) |
≥35 years | 105 (68.6) |
Father’s education level n (%) | |
<High school | 7 (4.6) |
≥High school and higher | 146 (95.4) |
Father’s employment n (%) | |
Officer | 39 (25.5) |
Worker | 19 (12.4) |
Health professional | 33 (21.6) |
Freelance | 20 (13.1) |
Others | 42 (27.5) |
Mother’s Parity n (%) | |
Primiparous | 75 (49) |
Multiparous | 78 (51) |
Household income n (%) | |
Low income | 20 (13.1) |
Middle income | 65 (42.5) |
High income | 68 (44.4) |
Living in n (%) | |
Urban | 111 (72.5) |
Rural | 42 (27.5) |
Family type n (%) | |
Nuclear | 132 (86.3) |
Extended | 21 (13.7) |
Twins’ Gestational Age N (%) | |
<34 w | 88 (28.8) |
34–36 + 6 w (late preterm) | 142 (46.4) |
≥37 w (term) | 76 (24.8) |
Delivery type n (%) | |
Vaginal birth | 11 (7.2) |
Cesarean section | 142 (92.8) |
Twins’ Birth Weight (g) * | 2274 ± 544 |
Twins’ Birth Weight Group N (%) | |
<1500 g | 25 (8.2) |
1500–2499 g | 170 (55.5) |
≥2500 g | 111 (36.3) |
ART use n (%) | 60 (39.2) |
Planned pregnancy n (%) | 126 (82.4) |
Admission into NICU N (%) | 188 (61.4) |
Respiratory support N (%) | 156 (51) |
NICU stay (day) ** | 13.5 (min 1, max 98) |
Respiratory support (day) ** | 5 (min 1, max 85) |
Variable | |
---|---|
Duration of breastfeeding (month) * | 10.5 ± 8.3 |
Exclusive breastfeeding N (%) | 46 (15) |
Initiation of breastfeeding N (%) | |
<1 h | 106 (34.6) |
1–24 h | 64 (20.9) |
≥24 h | 136 (44.4) |
Perceived onset of lactation n(%) | |
1st day | 77 (50.3) |
2nd day | 39 (25.5) |
3rd day and after | 37 (24.2) |
Formula feeding N (%) | 272 (88.9) |
Formula starting time N (%) | |
1st day | 130 (47.8) |
2–7 days | 44 (16.2) |
1–4 weeks | 38 (14) |
2–3 months | 38 (14) |
4–5 months | 10 (3.6) |
≥6 months | 8 (4.4) |
Initiator of formula feeding N (%) | |
Mother | 68 (25) |
Health professional (doctor, nurse, lactation consultant, etc.) | 200 (73.5) |
Others (family, etc.) | 4 (1.5) |
Antenatal breastfeeding counseling n (%) | 29 (19) |
Postnatal breastfeeding counseling n (%) | 110 (71.9) |
Skin-to-skin contact at birth N (%) | 136 (44.4) |
Tandem breastfeeding n (%) | 105 (68.6) |
Husband support n (%) | 120 (78.4) |
Family support n (%) | |
No | 23 (15) |
Yes, but not enough | 47 (30.7) |
Enough | 83 (54.2) |
Nipple problem n (%) | 84 (54.9) |
Engorgement | 38 (45.2) |
Nipple fissure | 50 (60.7) |
Mastitis | 37 (44) |
Breast abscess | 6 (7.1) |
Others | 8 (9.5) |
Pumping breast milk n (%) | 135 (88.2) |
Methods of breast milk pumping n (%) | |
Hand expression | 25 (18.5) |
Manual pumping | 30 (22.2) |
Single/double electric pumping | 99 (73.3) |
Hospital-grade pumping | 40 (29.6) |
Others | 4 (3) |
Breast refusal N (%) | 172 (56.2) |
Breast refusal time (month) ** | 3.5 |
Return-to-work time among employed mothers (month) ** | 9 |
Pacifier use N (%) | 218 (71.2) |
Bottle use N (%) | 268 (87.6) |
Total | |
n (%) | 153 (100) |
N (%) | 306 (100) |
Variable | Exclusive Breastfeeding | p-Value | Duration of Breastfeeding (Months) (Mean ± SD) | p-Value | |
---|---|---|---|---|---|
Yes N/n(%) | No N/n(%) | ||||
Gender | |||||
Girl (N = 133) | 21 (15.8) | 112 (84.2) | 0.281 | 10.95 ± 8.63 | 0.554 |
Boy (N = 173) | 25 (14.5) | 148 (85.5) | 10.18 ± 8.14 | ||
Gestational age | |||||
<34 w (N = 88) | 10 (11.4) | 78 (88.6) | 0.451 | 7.66 ± 5.16 | 0.028 |
34–36 + 6 (late preterm) (N = 142) | 20 (14.1) | 122 (85.9) | 10.97 ± 9.35 | ||
≥37 w (term) (N = 76) | 16 (21.1) | 60 (78.9) | 12.91 ± 8.53 | ||
Delivery type | |||||
Vaginal birth (n = 11) | 1 (9.1) | 10 (90.9) | 0.567 | 14.91 ± 8.06 | 0.054 |
Cesarean section (n = 142) | 22 (15.5) | 120 (84.5) | 10.16 ± 8.28 | ||
Birth weight (1st twin) | |||||
LBW (n = 96) | 13 (13.5) | 83 (86.5) | 0.503 | 10.1 ± 8.02 | 0.511 |
NBW (n = 57) | 10 (17.5) | 47 (82.5) | 11.07 ± 8.86 | ||
Birth weight (2nd twin) | |||||
LBW (n = 99) | 12 (12.1) | 87 (87.9) | 0.172 | 9.74 ± 7.63 | 0.156 |
NBW (n = 54) | 11 (20.4) | 43 (79.6) | 11.87 ± 9.39 | ||
Admission into NICU | |||||
Yes (N = 188) | 30 (16) | 158 (84) | 0.686 | 8.96 ± 7.12 | 0.015 |
No (N = 118) | 16 (13.6) | 102 (86.4) | 12.95 ± 9.53 | ||
Respiratory support | |||||
Yes (N = 156) | 26 (16.7) | 130 (83.3) | 0.564 | 8.87 ± 7.09 | 0.029 |
No (N = 150) | 20 (13.3) | 130 (86.7) | 12.2 ± 9.19 | ||
Suckling ability at birth | |||||
No (N = 88) | 18 (20.5) | 70 (79.5) | 0.480 | 7.65 ± 6.64 | 0.003 |
Poor (N = 166) | 22 (13.3) | 144 (86.7) | 9.6 ± 7.79 | ||
Normal (N = 52) | 6 (11.5) | 46 (88.5) | 13.87 ± 9.25 | ||
Pacifier use | |||||
Yes (N = 218) | 22 (10.1) | 196 (89.9) | 0.007 | 8.72 ± 7.41 | <0.001 |
No (N = 88) | 24 (27.3) | 64 (72.7) | 14.91 ± 8.93 | ||
Bottle use | |||||
Yes (N = 268) | 22 (8.2) | 246 (91.8) | <0.001 | 8.81 ± 6.75 | <0.001 |
No (N = 38) | 24 (63.2) | 14 (36.8) | 22.42 ± 8.83 |
Variable | Exclusive Breastfeeding | p-Value | Duration of Breastfeeding (Months) (Mean ± SD) | p-Value | |
---|---|---|---|---|---|
Yes N/n(%) | No N/n(%) | ||||
Mother’s age | 0.775 | 0.531 | |||
<35 years (n = 84) | 12 (14.3) | 72 (85.7) | 9.54 ± 6.7 | ||
≥35 years (n = 69) | 11 (15.9) | 58 (84.1) | 11.67 ± 9.89 | ||
Mother’s education level | |||||
<High school (n = 29) | 4 (13.8) | 25 (86.2) | 0.836 | 7 ± 6.68 | 0.005 |
≥High school and higher (n = 124) | 19 (15.3) | 105 (84.7) | 11.32 ± 8.49 | ||
Mother’s employment | |||||
Housewife (n = 47) | 6 (12.8) | 41 (87.2) | 0.601 | 7.6 ± 6.48 | 0.005 |
Employed (n = 106) | 17 (16) | 89 (84) | 11.79 ± 8.75 | ||
Parity | |||||
Primiparous (n = 75) | 11 (14.7) | 64 (85.3) | 0.901 | 11.15 ± 8.86 | 0.425 |
Multiparous (n = 78) | 12 (15.4) | 66 (84.6) | 9.87 ± 7.8 | ||
Initiation of breastfeeding | |||||
<1 h (N = 106) | 14 (13.2) | 92 (86.8) | 0.718 | 14.02 ± 9.25 | 0.001 |
1–24 h (N = 64) | 8 (12.5) | 56 (87.5) | 8.55 ± 7.46 | ||
≥24 h (N = 136) | 24 (17.6) | 112 (82.4) | 8.68 ± 7.09 | ||
Smoking status | |||||
Never smoked (n = 111) | 19 (17.1) | 92 (82.9) | 0.430 | 11.64 ± 8.78 | 0.028 |
Postpartum smoker (n = 38) | 4 (10.5) | 34 (89.5) | 7.32 ± 5.74 | ||
Always smoked (n = 4) | 0 | 4 (100) | 9 ± 5.04 | ||
Nipple problem | |||||
Yes (n = 84) | 12 (14.3) | 72 (85.7) | 0.775 | 9.55 ± 7.99 | 0.167 |
No (n = 69) | 11 (15.9) | 58 (84.1) | 11.28 ± 8.57 |
Variable | Exclusive Breastfeeding | p-Value | Duration of Breastfeeding (Months) (Mean ± SD) | p-Value | |
---|---|---|---|---|---|
Yes N/n (%) | No N/n (%) | ||||
Household income | |||||
Low income (n = 20) | 4 (20) | 16 (80) | 0.030 | 9.30 ± 9.07 | <0.001 |
Middle income (n = 65) | 4 (6.2) | 61 (93.8) | 7.45 ± 5.86 | ||
High income (n = 68) | 15 (22.1) | 53 (77.9) | 13.77 ± 9 | ||
Living in | |||||
Urban (n = 111) | 17 (15.3) | 94 (84.7) | 0.874 | 11 ± 8.56 | 0.197 |
Rural (n = 42) | 6 (14.3) | 36 (85.7) | 9.17 ± 7.63 | ||
Family type | |||||
Nuclear (n = 132) | 21 (15.9) | 111 (84.1) | 0.692 | 10.07 ± 8.32 | 0.416 |
Extended (n = 21) | 2 (9.5) | 19 (90.5) | 11.71 ± 6.92 | ||
Pregnancy plan | |||||
Planned (n = 126) | 21 (16.7) | 105 (83.3) | 0.222 | 10.93 ± 8.49 | 0.107 |
Unplanned (n = 27) | 2 (7.4) | 25 (92.6) | 8.48 ± 7.37 | ||
Using ART | |||||
Yes (n = 60) | 10 (16.7) | 50 (83.3) | 0.650 | 11.32 ± 9.32 | 0.613 |
No (n = 93) | 13 (14) | 80 (86) | 9.97 ± 7.63 | ||
Skin-to-skin contact at birth | |||||
Yes (N = 136) | 32 (18.8) | 138 (81.2) | 0.142 | 11.02 ± 8.38 | 0.423 |
No (N = 170) | 14 (10.3) | 122 (89.7) | 10.08 ± 8.32 | ||
Antenatal breastfeeding counseling | |||||
Yes (n = 29) | 4 (13.8) | 25 (86.2) | 0.836 | 13.38 ± 9.46 | 0.048 |
No (n = 124) | 19 (15.3) | 105 (84.7) | 9.83 ± 7.94 | ||
Postnatal breastfeeding counseling | |||||
Yes (n = 110) | 13 (11.8) | 97 (88.2) | 0.075 | 10.97 ± 8.43 | 0.258 |
No (n = 43) | 10 (23.3) | 33 (76.7) | 9.27 ± 8.03 | ||
Tandem breastfeeding | |||||
Yes (n = 105) | 20 (19) | 85 (81) | 0.040 | 13.13 ± 8.30 | <0.001 |
No (n = 48) | 3 (6.3) | 45 (93.8) | 4.75 ± 4.74 | ||
Husband support | |||||
Yes (n = 120) | 19 (15.8) | 101 (84.2) | 0.59 | 10.7 ± 8.4 | 0.471 |
No (n = 33) | 4 (12.1) | 29 (87.9) | 9.76 ± 8.15 | ||
Family support | |||||
No (n = 23) | 6 (26.1) | 17 (73.9) | 0.273 | 10.17 ± 8.41 | 0.861 |
Yes, but not enough (n = 47) | 6 (12.8) | 41 (87.2) | 9.55 ± 6.85 | ||
Enough (n = 83) | 11 (13.3) | 72 (86.7) | 11.13 ± 9.08 |
Variable | <34 w (n = 44, N = 88) | 34–36 + 6 w (Late Preterm) (n = 71, N = 142) | ≥37 w (Term) (n = 38, N = 76) | p-Value |
---|---|---|---|---|
EBF rate (%) | 11.4 | 14.1 | 21.1 | 0.451 |
Breastfeeding duration (months) ¶ | 7.66 ± 5.16 | 10.97 ± 9.35 | 12.91 ± 8.53 | 0.013 |
NICU admission (%) | 97.7 | 59.2 | 23.7 | <0.001 |
NICU stay (days) ¶ | 40 ± 21.25 | 22.2 ± 19.65 | 10.7 ± 7.97 | <0.001 |
Respiratory support (%) | 86.4 | 49.3 | 13.2 | 0.001 |
Respiratory support (days) µ | 7.0 | 3.0 | 3.0 | 0.002 |
Skin-to-skin contact at birth (%) | 29.5 | 42.3 | 65.8 | 0.004 |
Early BF initiation (<1 h) (%) | 9.1 | 33.8 | 65.8 | <0.001 |
Pacifier use (%) | 77.3 | 73.2 | 60.5 | 0.218 |
Bottle use (%) | 95.5 | 85.9 | 81.6 | 0.139 |
Tandem breastfeeding (%) | 68.2 | 69.0 | 68.4 | 0.995 |
Antenatal breastfeeding counseling (%) | 11.4 | 23.9 | 18.4 | 0.246 |
Postnatal breastfeeding counseling (%) | 56.8 | 76.1 | 81.6 | 0.026 |
Formula use (%) | 93.2 | 88.7 | 84.2 | 0.435 |
Breast refusal (%) | 68.2 | 52.1 | 50 | 0.162 |
Nipple problem (%) | 56.8 | 53.5 | 55.3 | 0.941 |
Husband support (%) | 77.3 | 78.9 | 78.9 | 0.976 |
Family support (%) | 45.5 | 54.9 | 63.2 | 0.191 |
Variable | β | SE | 95% CI | p-Value |
---|---|---|---|---|
Maternal age (≥35 vs. <35) | 1.60 | 1.10 | −0.56 to 3.75 | 0.148 |
Maternal employment (employed vs. unemployed) | 1.70 | 1.43 | −1.10 to 4.51 | 0.236 |
Maternal education (≥high school vs. <high school) | 0.34 | 1.55 | −2.70 to 3.38 | 0.827 |
Monthly income (high vs. low) | 0.46 | 0.99 | −1.48 to 2.39 | 0.643 |
Bottle use (yes vs. no) | −9.49 | 1.73 | −12.88 to −6.10 | <0.001 |
Pacifier use (yes vs. no) | −2.20 | 1.22 | −4.59 to 0.18 | 0.072 |
Antenatal breastfeeding counseling (yes vs. no) | 1.15 | 1.36 | −1.52 to 3.81 | 0.401 |
Initiation of breastfeeding (≥1 h vs. <1 h) | −0.45 | 0.85 | −2.12 to 1.21 | 0.592 |
Tandem breastfeeding (yes vs. no) | 5.80 | 1.17 | 3.51 to 8.10 | <0.001 |
Nipple problems (yes vs. no) | 1.12 | 1.03 | −0.90 to 3.14 | 0.280 |
Delivery type (cesarean vs. vaginal) | 0.44 | 2.11 | −3.70 to 4.58 | 0.835 |
Birth weight (low vs. normal) | −0.11 | 0.96 | −1.99 to 1.76 | 0.905 |
NICU admission (yes vs. no) | −1.12 | 1.50 | −4.07 to 1.82 | 0.456 |
Smoking status (smoker vs. non-smoker) | −1.43 | 1.06 | −3.49 to 0.64 | 0.179 |
Constant | 11.60 | 5.42 | 0.98 to 22.22 | 0.034 |
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Kömürlüoğlu, A.; Çıplak, G. Twin Challenges in Türkiye: Exclusive Breastfeeding Rates and Predictors of Breastfeeding Duration in a Tertiary Care Center. Children 2025, 12, 735. https://doi.org/10.3390/children12060735
Kömürlüoğlu A, Çıplak G. Twin Challenges in Türkiye: Exclusive Breastfeeding Rates and Predictors of Breastfeeding Duration in a Tertiary Care Center. Children. 2025; 12(6):735. https://doi.org/10.3390/children12060735
Chicago/Turabian StyleKömürlüoğlu, Ayça, and Gökçe Çıplak. 2025. "Twin Challenges in Türkiye: Exclusive Breastfeeding Rates and Predictors of Breastfeeding Duration in a Tertiary Care Center" Children 12, no. 6: 735. https://doi.org/10.3390/children12060735
APA StyleKömürlüoğlu, A., & Çıplak, G. (2025). Twin Challenges in Türkiye: Exclusive Breastfeeding Rates and Predictors of Breastfeeding Duration in a Tertiary Care Center. Children, 12(6), 735. https://doi.org/10.3390/children12060735