Validation of maternal recall on exclusive breastfeeding 12 months after childbirth

Objective: We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth. Design: A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant's diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated. Setting: Pelotas, Brazil. Participants: 3700 mothers of participants of the Pelotas 2004 Birth Cohort. Results: The prevalence of EBF at 3 months was 27 center dot 8 % (95 % CI 26 center dot 4, 29 center dot 3) and 49 center dot 0 % (95 % CI 47 center dot 4, 50 center dot 6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98 center dot 3 % (95 % CI 97 center dot 4, 99 center dot 0), specificity 70 center dot 0 % (95 % CI 68 center dot 2, 71 center dot 7), PPV 55 center dot 8 % (95 % CI 53 center dot 4, 58 center dot 1), NPV 99 center dot 1 % (95 % CI 98 center dot 6, 99 center dot 5) and accuracy 77 center dot 9 % (95 % CI 76 center dot 6, 79 center dot 2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64 center dot 4 to 81 center dot 8 %. Conclusions: EBF recalled at the end of the first year of infant's life is a valid measure to be used in epidemiological investigations.