Associated factors of nipple fissures in early postpartum women: A retrospective case-control study

Breastfeeding-associated nipple trauma can compromise feeding effectiveness and contribute to early discontinuation. This single-center retrospective case-control study enrolled breastfeeding mothers who attended routine lactation consultation visits at our institution between June 2022 and June 2025, including 56 mothers with clinically documented nipple fissures and 56 controls without fissures. Maternal demographic, obstetric, infant, and feeding-related variables were extracted from electronic medical records and standardized lactation assessment forms. Analyses were conducted using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk). Continuous variables are reported as mean ± standard deviation or median (interquartile range ), and categorical variables as n (%). Group comparisons used the Welch t test, Mann-Whitney U test, chi-square test, or Fisher exact test as appropriate. Univariate and multivariable logistic regression models were used to identify factors associated with nipple fissures, reporting odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Baseline characteristics were largely comparable; postpartum weight change differed between groups (P = .011). Mothers with nipple fissures reported less exclusive breastfeeding (P = .005), shorter feeding duration (P < .001), and more frequent poor latch and pain during suckling (both P < .001). In univariate analyses, exclusive breastfeeding and longer feeding duration were associated with lower odds of fissures, whereas poor latch, pain, and early bottle introduction were associated with higher odds. In multivariable analysis, shorter feeding duration (per 5-minute increase: aOR = 0.510, 95% CI 0.301-0.863; P = .012), pain during suckling (aOR = 3.826, 95% CI 1.143-12.808; P = .030), and early bottle introduction (aOR = 3.063, 95% CI 1.020-9.192; P = .046) remained independently associated with the presence of nipple fissures; however, given the retrospective design, these findings should be interpreted as associations rather than causal relationships. The retrospective single-center design and potential temporal ambiguity limit causal inference.