Breastfeeding self-efficacy, milk output, and influencing factors in mothers of preterm infants: a prospective cohort study in the NICU

Breastfeeding self-efficacy (BSE) is a critical predictor of lactation success, yet its role among mothers of preterm infants remains understudied, especially during the early postpartum period. This study aimed to (1) examine the association between BSE, feeding choices, and milk output in preterm mothers within 3–14 days postpartum, and (2) identify factors influencing BSE. A prospective cohort study was conducted with 200 mothers of preterm infants in a Chinese NICU. Data on demographics, social support, breastfeeding behaviors, and BSE (measured via the BSES-SF scale) were collected longitudinally at 3, 7, and 14 days postpartum. Multivariate logistic and linear regression analyses were used. Higher BSE correlated with increased milk output (6.28–6.85 mL per 1-point BSE increase) and preference for exclusive breastfeeding. Key positive influencers included social support (OR: 0.2–0.3), prenatal breastfeeding plans (OR: 0.24), and reliable lactation knowledge (OR: 0.26). Negative factors were pregnancy complications (OR: 2.83) and breastfeeding difficulties (OR: 2.73). Early BSE dynamically shapes lactation outcomes, yet Chinese preterm mothers exhibited suboptimal BSE scores (50/70), signaling urgent needs for targeted interventions. Social support and prenatal education emerged as modifiable drivers, aligning with global evidence but highlighting regional gaps in clinical practice. Enhancing BSE through structured support and education during the first two weeks postpartum may improve breastfeeding rates in preterm populations.