Breastfeeding knowledge and body image affect breastfeeding attitude of pregnant women: a cross-sectional study

The exclusive breastfeeding rate of Chinese infants aged up to six months was lower than 50%. This study aimed to assess the infant feeding attitude of pregnant women, and investigate associations between breastfeeding knowledge, body image and infant feeding attitude. This study designed as a multi-center cross-sectional study was conducted from November 1, 2024 to December 5, 2024 in two maternal hospital of China. The Iowa infant feeding attitude scale, breastfeeding knowledge questionnaire and body image in pregnancy scale were used. Multiple linear regression analysis and the restricted cubic spline (RCS) analysis were performed to analyze their associations. Totally 568 pregnant women with high breastfeeding knowledge were more likely to favor to breastfeeding (β = 0.443, p < 0.01), while pregnant women with high body image had a negative attitude toward breastfeeding (β = -0.076, p < 0.05). The RCS analyses further identified that breastfeeding knowledge and body image had a statistical association with infant feeding attitude in pregnant women. Besides, a positive breastfeeding attitude appeared at when breastfeeding knowledge was ≥ 13 score (p_overall < 0.0001, p_non-linear = 0.1142, β = 0.467) or body image was ≤ 98 score (p_overall < 0.001, p_non-linear = 0.6253, β = -0.288). Overall, healthcare staff need to pay more attention to the breastfeeding knowledge and body image in pregnancy, and then perform targeted interventions for pregnant women to improve a positive attitude toward breastfeeding in pregnant women and then promote their breastfeeding practice behavior.