Stress and Feeding Choices: How Do Socio-Demographic Factors Shape Formula Use Among Polish Mothers?

Agnieszka Czerwińska - Osipiak^1*Anna Weronika Szablewska¹Krzysztof Jurek²Wiktoria Karasek¹Conceição Santiago^3,4

• ¹Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Institute of Nursing and Midwifery, Department of Obstetric and Gynaecological Nursing, Medical University of Gdansk, Gdańsk, Poland
• ²Institute of Sociological Sciences, Faculty of Social Sciences, Katolicki Uniwersytet Lubelski Jana Pawla II, Lublin, Poland
• ³Higher School of Health, Santarém Polytechnic University, Instituto Politecnico de Santarem Escola Superior de Saude, Santarem, Portugal
• ⁴Research and Innovation in Health – RISE-Health, Faculty of Medicine, University of Porto, Portugal

Background: Breastfeeding is widely recognized as the gold standard in infant nutrition, yet many women discontinue exclusive breastfeeding earlier than recommended. Maternal stress has been identified as a potential factor contributing to breastfeeding difficulties; however, its interaction with socio-demographic variables remains insufficiently explored. In Poland, where breastfeeding initiation rates are high but exclusive breastfeeding drops to only 4% by six months postpartum, understanding these interactions is essential to improve breastfeeding outcomes. Objective: In this study, it was examined whether maternal stress moderates the relationship between socio-demographic factors and the introduction of formula supplementation among Polish mothers. Methods: An observational, cross-sectional study was conducted among 1,092 mothers of infants ≤6 months. Data were collected via an anonymous online questionnaire assessing socio-demographic characteristics, feeding practices and maternal stress using the Perceived Stress Scale (PSS-10). Logistic regression models were applied separately for low/moderate and high stress groups. Results: Socio-demographic influences on formula supplementation were moderated by maternal stress level. In high-stress mothers, older age (AOR ≈ 1.81, p = 0.026) was associated with higher odds of supplementation, whereas parity (AOR ≈ 0.52, p = 0.030) and better housing conditions (AOR ≈ 0.50, p = 0.010) were connected with lower odds (Nagelkerke R² ≈ 0.084). In the low/moderate stress group, the model was not significant. Conclusions: Maternal stress plays a moderating role in the relationship between socio-demographic variables and infant feeding practices. These findings provide novel evidence that psychological and environmental factors jointly shape feeding decisions. Integrating stress assessment and psychosocial support into postnatal and breastfeeding care may strengthen public health inter-ventions aimed at sustaining exclusive breastfeeding in Poland.