Optimal duration of exclusive breastfeeding

Human milk-sharing practices and infant-feeding behaviours: A comparison of donors and recipients

Human milk sharing (HMS) is growing in popularity as an infant-feeding strategy in the United States. HMS families are a hidden population because HMS is a nonnormative and stigmatized behaviour. Thus, gaining access to HMS participants is challenging, and research on this topic remains limited. In particular, little is known about the broader infant-feeding behaviours of HMS parents. This study aimed to describe and compare the infant-feeding behaviours and HMS practices among a network of HMS donors and recipients. A detailed online survey was distributed to HMS parents in the Washington, DC region. Bivariate analyses were used to summarize the data by donor/recipient status when possible. Group differences were tested using analysis of variance for continuous variables and χ² tests for categorical variables. Donors and recipients did not differ in their sociodemographic characteristics. Recipients were significantly more likely than donors to have experienced complications of labour and delivery, traumatic birth, postpartum depression or a negative breastfeeding experience. Donors and recipients did not differ significantly in their duration of lactation or HM-feeding. Interestingly, 30% of recipients ever produced excess milk and 21% of donors ever had difficulty producing enough milk for their child. Compared with donors, recipients faced numerous maternal health challenges, but were still able to achieve a long duration of HM-feeding. HMS recipients represent a vulnerable group who may benefit from additional psychosocial and lactation support to improve their health and breastfeeding outcomes. Additional research is needed to investigate the associations between HMS participation, infant-feeding behaviours and lactation outcomes.

Association Between Nutrition Social Behavior Change Communication and Improved Caregiver Health and Nutrition Knowledge and Practices in Rural Tanzania

Background

Efforts to improve infant and young child feeding practices include the use of nutrition behavior change communication among caregivers of children under 5 years. We assessed the association between monthly participation in community-level nutrition group meetings on caregiver health and nutrition knowledge and practices (KPs).

Methods

Data from a community-based cross-sectional survey conducted in the Eastern and Southern Highland Zones of Tanzania were used. Indices were developed for caregivers' knowledge of nutrition, health and childcare, household (HDD) and young child dietary diversity (CDD), and vitamin A (VA) intakes. The comparison of means and proportions was assessed using Student's t-test and the Chi-square test, respectively, between the caregivers participating in nutrition group meetings and non-participants. The impact of the number of nutrition meeting attendance on caregiver KPs scores was examined using multiple regression.

Results

Of 547 caregivers surveyed, 49.7% attended nutrition group meetings and received information on nutrition social behavior change communication (SBCC). Overall, 28% of participating women had a moderate level of nutrition knowledge, 62% had a high level of VA knowledge, and 57% had a high level of health and childcare knowledge. Participation in nutrition group meetings was significantly associated with the health and childcare knowledge score (HKS), HDD and CDD scores, and household and young child VA intake; the magnitude of the associations was greater for caregivers who attended at least four meetings.

Conclusion

The findings emphasize the need for programs that seek to address the issues present in the use of nutrition SBCC at the community level to improve maternal or caregiver KPs and subsequently the nutrition status of infants and young children.

Experiences of young Australian mothers with infant feeding

BACKGROUND

Despite the overwhelming evidence of health and other benefits of breastfeeding and recommendations to breastfeed by peak health bodies, breastfeeding rates are significantly lower than recommended in Australia and globally. Young mothers are identified as being at high risk of not breastfeeding their infants according to infant feeding recommendations. This study aimed to gain an in-depth understanding of young Australian mothers' experiences of infant feeding, and to explore the factors which facilitated or hindered adherence to recommended breastfeeding practices.

METHODS

Purposive and snowball sampling were used to recruit young mothers in Australia (n = 17) aged 18-25 years who had given birth to their first child within the last two years. Data were collected through semi-structured interviews via online videoconferencing. Interviews were audio-recorded, transcribed verbatim, coded, and subsequently analysed. Thematic analysis was conducted using Quirkos, a qualitative data management and analysis software.

RESULTS

Four major themes were identified: Breastfeeding is challenging; Feeling judged about infant feeding choices; Experiences with breastfeeding support; and Experiences and views on breastfeeding education. Most mothers reported experiencing breastfeeding challenges, particularly those arising from lactation difficulties, yet many were able to overcome these challenges through their determination to breastfeed. Many mothers expressed perceiving judgement from others for breastfeeding in public. Some mothers who were bottle feeding their infants, whether with expressed breast milk or infant formula, felt that they were being judged for using a bottle. Many mothers reported professional, partner, family, and peer support as critical facilitators to the continuation of breastfeeding. Most mothers shared positive experiences of attending breastfeeding education sessions, but indicated the need for community education to reduce judgement toward mothers' infant feeding decisions.

CONCLUSIONS

The barriers and enablers to infant feeding experienced by young mothers are similar to those experienced by mothers of all ages. Young mothers experience significant breastfeeding challenges and need support from partner, family, peers, and professionals to continue breastfeeding in line with recommendations. Breastfeeding campaigns to support young mothers should be aimed at the wider community to increase awareness of breastfeeding challenges, reduce stigma associated with breastfeeding in public, and to support mothers in their infant feeding decisions.

Patterns and Predictors of Breast Milk Feeding from Birth to Age 4 Months among Primiparous African American Mother–Infant Dyads

The health benefits of breast milk feeding have been well-established, yet disparities exist, with African American mothers having the lowest breast milk feeding rates in the United States. This prospective, longitudinal study examined infant feeding (breast milk and/or infant formula) from birth to age 16 weeks, predictors of any breast milk feeding by age 1 week, and predictors of cessation of any breast milk feeding by ages 3, 8, and 16 weeks among primiparous African American mothers. This secondary analysis included 185 mother–infant dyads from the Sleep SAAF (Strong African American Families) study, a randomized clinical trial testing a responsive parenting vs. child safety control intervention. Mothers reported sociodemographic and psychosocial characteristics at age 1 week and infant feeding practices at ages 1, 3, 8, and 16 weeks. Rates of any breast milk feeding decreased from 66.5% at 1 week to 23.3% at 16 weeks. Bivariate logistic regression models showed that prepregnancy BMI (OR = 1.09), working prepregnancy (OR = 2.25), and food insecurity (OR = 2.49) significantly increased the odds of mothers feeding any breast milk by 1 week, whereas Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation (OR = 0.21) significantly decreased the odds. Bivariate logistic regression models showed that Supplemental Nutrition Assistance Program (SNAP) participation (OR = 2.86) and racial discrimination (OR = 2.14) significantly increased the odds of cessation of any breast milk feeding by 3 weeks. SNAP (OR = 2.33) and WIC (OR = 2.38) participation significantly increased the odds of cessation of any breast milk feeding by 8 weeks, whereas higher prepregnancy BMI (OR = 0.95) decreased the odds. Higher mother’s age (OR = 0.92) significantly decreased the odds of cessation of any breast milk feeding by 16 weeks. The findings can be used to inform targeted interventions to promote mothers feeding any breast milk and help reduce breast milk feeding disparities among African American mothers.

Mothers' hygiene experiences in confinement centres: A cohort study

Introduction

Ethnic Malaysian Chinese used to observe the 1-month postpartum confinement period at home and many families would engage a traditional postpartum carer to help care for the mother and newborn. A recent trend has been the development of confinement centres (CCs) which are private non-healthcare establishments run by staff not trained in health care. Concerns about hygiene in CCs arose after infections were reported. We describe the practice of hand hygiene observed in CCs, the availability of resources for hygiene, and the prevalence of health-related problems in CCs.

Methods

This is a cohort study of ethnic Chinese mothers intending to breastfeed their healthy infants. They were recruited post-delivery along with a comparison group who planned to spend their confinement period at home. After their 1-month confinement period, they were contacted for a structured telephone interview about their experience. To avoid any alteration in behaviour, mothers were not told at recruitment that they had to observe hygiene practices. Multiple logistic regression was used to assess the effect of place of confinement on rates of infant health problems.

Results

Of 187 mothers, 88(47%) went to 27 different CCs while 99(53%) stayed at home. Response rates for the 1-month interviews were 88%(CC) versus 97%(home). Mothers in CC group stayed in one to four-bedded rooms and 92% of them had their baby sleeping separately in a common nursery described to have up to 17 babies at a time; 74% of them spent less than six hours a day with their babies; 43% noticed that CC staff had inadequate hand hygiene practices; 66% reported no hand basins in their rooms; 30% reported no soap at hand basins; 28% reported inexperienced or inadequate staff and 4% reported baby item sharing. Among the mothers staying at home, 35% employed a traditional postpartum carer for her baby; 32% did not room-in with their babies, but only 11% spent less than 6 hours a day with their babies. Of mothers who employed traditional postpartum carers, 32% did not know if their carer washed hands after changing diapers and 18% reported that their carer did not. Health problems that were probably related to infection (HPRI) like fever and cough were similar between the groups: 14%(CC) versus 14%(home) (p = 0.86). Multiple logistic regression did not show that CCs were a factor for HPRI: aOR 1.28 (95% CI 0.36 to 4.49). Three mothers reported events that could indicate transmission of infection in CCs.

Conclusion

We found unsatisfactory hygiene practices in CCs as reported by mothers who spent their confinement period there. Although we were not able to establish any direct evidence of infection transmission but based on reports given by the mothers in this study, it is likely to be happening. Therefore, future studies, including intervention studies, are urgently needed to establish an appropriate hygiene standard in CCs as well as the best method to implement this standard. Training CC staff with hygiene knowledge so that they can be empowered to contribute to the development of these standards would be important.

Immunomodulatory Properties of Human Breast Milk: MicroRNA Contents and Potential Epigenetic Effects

Infants who are exclusively breastfed in the first six months of age receive adequate nutrients, achieving optimal immune protection and growth. In addition to the known nutritional components of human breast milk (HBM), i.e., water, carbohydrates, fats and proteins, it is also a rich source of microRNAs, which impact epigenetic mechanisms. This comprehensive work presents an up-to-date overview of the immunomodulatory constituents of HBM, highlighting its content of circulating microRNAs. The epigenetic effects of HBM are discussed, especially those regulated by miRNAs. HBM contains more than 1400 microRNAs. The majority of these microRNAs originate from the lactating gland and are based on the remodeling of cells in the gland during breastfeeding. These miRNAs can affect epigenetic patterns by several mechanisms, including DNA methylation, histone modifications and RNA regulation, which could ultimately result in alterations in gene expressions. Therefore, the unique microRNA profile of HBM, including exosomal microRNAs, is implicated in the regulation of the genes responsible for a variety of immunological and physiological functions, such as FTO, INS, IGF1, NRF2, GLUT1 and FOXP3 genes. Hence, studying the HBM miRNA composition is important for improving the nutritional approaches for pregnancy and infant's early life and preventing diseases that could occur in the future. Interestingly, the composition of miRNAs in HBM is affected by multiple factors, including diet, environmental and genetic factors.

Mixed Milk Feeding: A New Approach to Describe Feeding Patterns in the First Year of Life Based on Individual Participant Data from Two Randomised Controlled Trials

'Mixed Milk Feeding' (MMF), whereby infants are fed with both breastmilk and infant formula during the same period, is a common feeding practice. Despite its high prevalence, knowledge regarding MMF practices and their association with (health) outcomes is limited, potentially because MMF behaviours are highly variable and difficult to standardise longitudinally. In this paper, we applied a statistical clustering algorithm on individual infant feeding data collected over the first year of life from two clinical trials: 'TEMPO' (n = 855) and 'Venus' (n = 539); these studies were conducted in different years and world regions. In TEMPO, more than half of infants were MMF. Four distinct MMF clusters were identified: early exclusive formula feeding (32%), later exclusive formula feeding (25%), long-term MMF (21%), and mostly breastfeeding (22%). The same method applied to 'Venus' resulted in comparable clusters, building trust in the robustness of the cluster approach. These results demonstrate that distinct MMF patterns can be identified, which may be applicable to diverse populations. These insights could support the design of future research studying the impact of infant feeding patterns on health outcomes. To standardise this in future research, it is important to establish a unified definition of MMF.

Environmental Impact of Feeding with Infant Formula in Comparison with Breastfeeding

Young children have unique nutritional requirements, and breastfeeding is the best option to support healthy growth and development. Concerns have been raised around the increasing use of milk-based infant formulas in replacement of breastfeeding, in regards to health, social, economic and environmental factors. However, literature on the environmental impact of infant formula feeding and breastfeeding is scarce. In this study we estimated the environmental impact of four months exclusive feeding with infant formula compared to four months exclusive breastfeeding in a Norwegian setting. We used life-cycle assessment (LCA) methodology, including the impact categories global warming potential, terrestrial acidification, marine and freshwater eutrophication, and land use. We found that the environmental impact of four months exclusive feeding with infant formula was 35–72% higher than that of four months exclusive breastfeeding, depending on the impact category. For infant formula, cow milk was the main contributor to total score for all impact categories. The environmental impact of breastfeeding was dependant on the composition of the lactating mother’s diet. In conclusion, we found that breastfeeding has a lower environmental impact than feeding with infant formula. A limitation of the study is the use of secondary LCA data for raw ingredients and processes.

Contamination of breast milk with lead, mercury, arsenic, and cadmium in Iran: a systematic review and meta-analysis

Breast milk is a complete food for the development of the newborn, but it can also be an important route for environmental pollutants transmission to the infants. This study was aimed to evaluate the status of heavy metals including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As) in the breast milk of Iranian mothers. The international databases including Scopus, PubMed, Web of Science and the Persian electronic databases including Scientific Information Database, IranMedex and Magiran were examined to find relevant articles published until July 2021. A total of 23 studies examined the levels of toxic metals in Iranian breast milk samples. According to the findings, the pooled average concentrations (µg/L) of Pb, Cd, Hg and As were 25.61, 2.40, 1.29 and 1.16, respectively. The concentration of Hg and Pb in colostrum milk was more than twice of mature milk. The Hg mean concentration in the breast milk of mothers with at least one amalgam-filled tooth was approximately three times that of mothers without amalgam-filled teeth. Risk assessment analysis indicated that the intake of Pb and Hg by infants through breastfeeding can be considered a health concern in Iran. It seems necessary to reduce the Pb exposure of pregnant and lactating women in Iran. However, more extensive studies are needed to clarify the toxic metals' exposure status of infants through breast milk in other parts of the country.

The Role of Motor Coordination, ADHD-Related Characteristics and Temperament among Mothers and Infants in Exclusive Breastfeeding: A Cohort Prospective Study

Although exclusive breastfeeding is recommended for the first 6 months of life, breastfeeding rates are low. Motor skills and ADHD-related characteristics have not yet been examined as breastfeeding barriers. The aim of this study was to explore whether mothers' and infants' motor skills, mothers' ADHD-related characteristics and infants' temperament are associated with exclusive breastfeeding at 6 months after birth. Participants were 164 mothers and their infants recruited 2 days after birth. Mothers completed a demographic and delivery information questionnaire, the Infant Feeding Intentions Scale and the Iowa Infant Feeding Attitude Scale. At 6 months, mothers completed the Adult DCD (developmental coordination disorder)/Dyspraxia Checklist, the Adult ADHD (attention deficit hyperactivity disorder) Self-Report Scale Symptom Checklist-v1.1, and the Infant Characteristics Questionnaire, and provided information about their breastfeeding status. They were then divided into two groups accordingly: EBF (exclusive breastfeeding) and NEBF (non-exclusive breastfeeding). Infants were observed using the Test of Sensory Functions in Infants and the Alberta Infant Motor Scale. At 6 months, NEBF mothers reported higher prevalence of DCD (10.2% vs. 1.9%, χ2 = 5.561, p = 0.018) and ADHD (20.3% vs. 8.6%, χ2 = 4.680, p = 0.030) compared to EBF mothers. EBF infants demonstrated better motor coordination (t = 2.47, p = 0.016, d = 0.511), but no temperament differences compared to NEBF infants. Maternal DCD, ADHD and poor infant motor coordination are associated with non-exclusive breastfeeding and may become exclusive breastfeeding barriers. These findings may assist in identifying women at risk of not exclusively breastfeeding and encourage tailoring interventions for achieving higher exclusive breastfeeding rates.

Use of breast milk in infants with uncomplicated gastroschisis: A retrospective cohort study

BACKGROUND

Infants with gastroschisis often experience slow return of bowel function following closure. The purpose of this study was to determine whether exclusive breast milk is associated with decreased time to enteral autonomy.

METHODS

We conducted a retrospective cohort study of infants with uncomplicated gastroschisis from a tertiary pediatric hospital. The primary outcome was enteral autonomy, defined as days from initiating enteral feeds to stopping parenteral nutrition. Secondary outcomes included days of parenteral nutrition, length of stay, positive culture, necrotizing enterocolitis, cholestasis, additional surgery, readmission, and mortality.

RESULTS

We identified 100 infants with gastroschisis treated from 2005 to 2019. Twenty-five were excluded due to gestational age <32 weeks, birth weight <1500 g, or gastroschisis-associated complications (e.g., intestinal atresia). Seventy-five were included in the analysis. Mean gestational age was 36 weeks, 48% were female, and all were diagnosed antenatally. Sixty-five infants (87%) received exclusive maternal (n = 64) or donor (n = 1) breast milk, while 10 others (13%) were fed formula for 1-16 days (mean 7 days). Two infants received formula only. Demographics and gastroschisis prognostic scores were similar between groups. Infants who were given breast milk exclusively demonstrated decreased time to enteral autonomy (median 18 versus 25 days, p = 0.023) and shorter duration of parenteral nutrition (median 20 versus 26 days, p = 0.037).

CONCLUSION

Exclusive breast milk may be associated with improved outcomes among infants with gastroschisis. Further research is needed to evaluate the economic impact of this association and explore possible confounders. These efforts may expand the role of donor breast milk for these patients.

Educating fathers to improve exclusive breastfeeding practices: a randomized controlled trial

BACKGROUND

Fathers' involvement is crucial for promoting breastfeeding. There are a few studies on the effectiveness of fathers' educational programs to promote exclusive breastfeeding. This study aims to assess the effectiveness of a fathers' educational program on their support for breastfeeding, mothers' breastfeeding practice, and exclusive breastfeeding status.

METHODS

This was a randomized controlled trial on 76 fathers who were randomly assigned to two groups of intervention and control, in a selected health center in Iran, 2018. The tools for data collection were: 1) a questionnaire for "Demographic and Maternal-Infant Information"; 2) a questionnaire to assess "Fathers' support for Breastfeeding", and 3) an observational checklist to assess "Mothers' Breastfeeding Practice"; and 4) a questionnaire to assess "Exclusive Breastfeeding Status". The questionnaires were filled up through an interview. The checklist was completed through observation by the researcher. The fathers (with the mothers) of the intervention group were educated using individual face-to-face education and counseling, in two sessions, with the duration of about 40 min and one-week interval, whereas, the fathers of the control group did not receive any education and only mothers were educated with the same instruction. The content of the education was: fathers' education about "benefits of breast milk" and "the supporting ways for breastfeeding including the women encouragement". Then, the scores of "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" were compared before and after 4 months of intervention in each group, and also between groups. Data were analyzed using SPPS-23, and t- and paired-tests, Chi-square, and Generalized-Estimating-Equations (GEE) tests.

RESULTS

The results showed two groups were not significantly different regarding the demographic and any other possible confounding variables before the intervention (P < 0.05). The before and after comparisons also demonstrated significant improvements in the two variables including "father's support for breastfeeding", and "mothers' breastfeeding practice after 4 months, in the intervention group (Paired t-test: P<0.001 and P<0.0001, respectively) however, there was a significant decrease in "father's support for breastfeeding" and no improvement in "mothers' breastfeeding practice" after 4 months in the control group (Paired t-test: P < 0.001 and P = 0.07, respectively). Between groups comparison showed also significant higher scores for "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" in the intervention group comparing to the control group, after 4 months (T-test: P < 0.001 and P < 0.0001; Chi2: P < 0.001, respectively). The interaction effects of time and group were significant in the GEE test for the fathers' support for breastfeeding (B-group = 31.93, B-time = 22.15, p < 0.001) and mothers' breastfeeding practice (B-group = 26.32, B-time = 12.86, p < 0.0).

CONCLUSION

The results showed that the father's education improves mothers' breastfeeding practice and increases the rate and continuity of exclusive breastfeeding.

TRIAL REGISTRATION

IRCT201508248801N10. "31/08/2016".

Lactational Changes of Phospholipids Content and Composition in Chinese Breast Milk

Phospholipids are pivotal polar lipids in human milk and essential for infants’ growth and development, especially in the brain and cognitive development. Its content and composition are affected by multiple factors and there exist discrepancies in different studies. In this study, we determined five major phospholipids classes (phosphatidylethanolamine, phosphatidylinositol, phosphatidylserine, phosphatidylcholine, and sphingomyelin) in 2270 human milk samples collected from 0 to 400 days postpartum in six regions of China. The high-performance liquid chromatography coupled with an evaporative light scattering detector (HPLC-ELSD) was performed to quantify the phospholipids. Total phospholipid median (IQR) content was in a range between 170.38 ± 96.52 mg/L to 195.69 ± 81.80 mg/L during lactation and was higher concentrated in colostrum milk and later stage of lactation (after 200 days postpartum) compared with that in the samples collected between 10 to 45 days postpartum. Variations in five major sub-class phospholipids content were also observed across lactation stages (phosphatidylethanolamine: 52.61 ± 29.05 to 59.95 ± 41.74 mg/L; phosphatidylinositol: 17.65 ± 10.68 to 20.38 ± 8.55 mg/L; phosphatidylserine: 15.98 ± 9.02 to 22.77 ± 11.17 mg/L; phosphatidylcholine: 34.13 ± 25.33 to 48.64 ± 19.73 mg/L; sphingomyelin: 41.35 ± 20.31 to 54.79 ± 35.26 mg/L). Phosphatidylethanolamine (29.18–32.52%), phosphatidylcholine (19.90–25.04%) and sphingomyelin (22.39–29.17%) were the dominant sub-class phospholipids in Chinese breast milk during the whole lactation period. These results updated phospholipids data in Chinese human milk and could provide evidence for better development of secure and effective human milk surrogates for infants without access to breast milk.

Association Between Breastmilk Microbiota and Food Allergy in Infants

Regulating the composition of human breastmilk has the potential to prevent allergic diseases early in life. The composition of breastmilk is complex, comprising varying levels of oligosaccharides, immunoactive molecules, vitamins, metabolites, and microbes. Although several studies have examined the relationship between different components of breastmilk and infant food allergies, few have investigated the relationship between microorganisms in breastmilk and infant food allergy. In the present study, we selected 135 healthy pregnant women and their full-term newborns from a cohort of 202 mother-infant pairs. Among them, 69 infants were exclusively breastfed until 6 mo after birth. At follow-up, 11 of the 69 infants developed a food allergy in infancy while 22 showed no signs of allergy. Thirty-three breastmilk samples were collected within 1 mo after delivery, and 123 infant fecal samples were collected at five time points following their birth. These samples were analyzed using microbial 16S rRNA gene sequencing. The abundance and evenness of the milk microbiota and the number of differential bacteria were higher in the breastmilk samples from the non-allergy group than in those from the food allergy group. The non-allergy group showed relatively high abundance of Bifidobacterium, Akkermansia, Clostridium IV, Clostridium XIVa, Veillonella, and butyrate-producing bacteria such as Fusobacterium, Lachnospiraceae incertae sedis, Roseburia, and Ruminococcus. In contrast, the abundance of Proteobacteria, Acinetobacter, and Pseudomonas in breastmilk was higher in the food allergy group. A comparison of the changes in dominant differential breastmilk microbiota in the intestinal flora of the two groups of infants over time revealed that the changes in Bifidobacterium abundance were consistent with those in the breastmilk flora. Functional pathway prediction of breastmilk microflora showed that the enhancement of the metabolic pathways of tyrosine, tryptophan, and fatty acids was significantly different between the groups. We suggest that changes in the breastmilk microbiota can influence the development of food allergies. Breastmilk contains several microbes that have protective effects against food allergies, both by influencing the colonization of intestinal microbiota and by producing butyrate. This study may provide new ideas for improving infant health through early intervention with probiotics.

Gestational weight gain and patterns of breastfeeding among patients with class III obesity

BACKGROUND

Maternal obesity is associated with delayed lactogenesis and shorter duration of breastfeeding compared to patients with a normal BMI.

RESEARCH AIM/QUESTION

We investigated the impact of excessive gestational weight gain, defined as greater than the Institute of Medicine guidelines (>9.1 kg), on the initiation and duration of breastfeeding in patients with class III obesity.

METHODS

Retrospective cohort of patients with body mass index ≥40 in first trimester, delivering a singleton term infant at a tertiary care center between July 2013 and December 2017. Primary outcome was exclusive breastfeeding at discharge and at postpartum visit. Secondary outcomes included any breastfeeding at discharge and postpartum visit, and cessation of breastfeeding by the postpartum visit. Descriptive statistics were used to compare those whose gestational weight gain exceeded (eIOM) versus met (mIOM) Institute of Medicine guidelines. Regression models were performed to adjust for baseline confounding factors.

RESULTS

Of 294 women included, 117(39.8%) were in the eIOM group. These women were more likely to be primigravida, have a higher delivery BMI, greater delivery blood loss, and have a neonate admitted to the intensive care unit. Exclusive breastfeeding at discharge was not different between eIOM and mIOM (66.7% vs 70.9%, p = .44), nor did eIOM impact likelihood of exclusive breastfeeding at postpartum visit (40.1% vs 34.2%, p = .31). When controlling for confounding factors, breastfeeding at discharge (aOR 1.54 95% CI [0.68-3.49]) or postpartum visit (aOR 0.67[0.31-1.47]) did not differ between eIOM compared to mIOM.

CONCLUSIONS

Among women with class III obesity, excessive gestational weight gain did not impact the rate of exclusive breastfeeding at discharge or postpartum visit.

Effectiveness of aloe fomentation for nipple-related complications during the early puerperium period: a randomized, controlled, interventional study

Objective

Nipple-related complications are major factors that prevent breastfeeding for many new mothers. Hence, we tested the effects of aloe arborescens fomentation applied to the nipples as a treatment for nipple-related complications.

Results

This study included 60 women who breastfed for the first time on day 1 after delivery. Every 24 h, all women breastfed six times and bottle-fed two times (at night). Women were classified into an intervention group (aloe arborescens fomentation) and a control group (no treatment). Aloe fomentation was applied after breastfeeding six times per day. We observed the nipples three times per day for 5 days after delivery. The most common nipple-related complication in this study was redness. A significant decrease was observed for women in the intervention group.

Trial Registration Retrospectively Registered to registry: UMIN; Registration no.: UMIN000044514; Registered on: 11th June 2021.

Association of Breastfeeding Duration with 12-Month Postpartum Blood Lipids in a Predominately Lower-Income Hispanic Pregnancy Cohort in Los Angeles

Breastfeeding may protect women’s long-term cardiovascular health; however, breastfeeding-related postpartum lipid changes remain unclear. We aim to examine associations of breastfeeding duration with maternal lipids at 12 months postpartum. In a subsample (n = 79) of the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort, breastfeeding status and duration at 3, 6, and 12 months postpartum were self-reported. Serum levels of lipids, including total cholesterol, triglycerides (TG), high-, low-, and very low-density lipoprotein cholesterol (HDL-C, LDL-C, VLDL-C), were measured from blood samples collected at 12 months postpartum. We used linear regression models to compare lipids by breastfeeding duration, adjusting for potential confounders. Women who were breastfeeding at 12 months had higher HDL-C (mean: 41.74 mg/dL, 95% CI: 37.27−46.74 vs. 35.11 mg/dL, 95% CI: 31.42−39.24), lower TG (80.45 mg/dL, 95% CI: 66.20−97.77 vs. 119.11 mg/dL, 95% CI: 98.36−144.25), and lower VLDL-C (16.31 mg/dL, 95% CI: 13.23, 20.12 vs. 23.09 mg/dL, 95% CI: 18.61−28.65) compared to women who breastfed for <6 months. No lipids were significantly different between women who breastfed for 6−11 months and for <6 months. Each month’s increase in breastfeeding duration was significantly, inversely associated with TG and VLDL-C and positively with HDL-C. Adjusting for fasting status, demographics, pre-pregnancy body mass index, breastfeeding frequency, and pregnancy complications did not appreciably change effect estimates. Breastfeeding at 12 months postpartum and a longer duration of breastfeeding in the first year postpartum were both associated with increased HDL-C and decreased TG and VLDL-C at 12 months postpartum.

Persistent Organic Pollutants in Human Milk: Exposure Levels and Determinants among Lactating Mothers in Lebanon

ABSTRACT

Exposure of newborns to persistent organic pollutants (POPs) is a public health concern. The objective of this study was to assess the prevalence of POPs in human milk collected from lactating mothers in Lebanon and to investigate the sociodemographic, nutritional, and other lifestyle determinants. Fifty-four breast milk samples were collected as per World Health Organization guidelines. A survey was used to assess the anthropometric and demographic characteristics of participants. Dietary habits were evaluated based on a semiquantitative food frequency questionnaire. Organochlorine pesticides and polychlorinated biphenyls were measured in milk samples with liquid-liquid extraction and gas chromatography. Among the screened POPs, dichlorodiphenyldichloroethylene (DDE) was the only POP detected in breast milk samples and was found in only 17.9% of the samples, with a mean (SD) of 11.6 (5.0) μg/L and a range of 5.7 to 21.4 μg/L. Prepregnancy body mass index and age were positively associated with DDE contamination in breast milk. Women who consumed cereals at least two times per week had detectable DDE contamination in their breast milk. Consumption of potatoes and beans at least once per week was also associated with DDE contamination. Our study is the first to assess the presence of POPs in breast milk in Lebanon. The benefits of breastfeeding compensate for the low prevalence of DDE in the breast milk. Our findings highlight the high need to implement monitoring policies, good agricultural practices, and education programs for breastfeeding mothers.

HIGHLIGHTS

Factors associated with the knowledge about breastfeeding among antenatal and postnatal women in selected rural villages of Chengalpattu, Tamil Nadu: A community-based cross-sectional study

BACKGROUND

Addressing good breastfeeding practices among antenatal and postnatal mothers is important as it helps in bringing about a positive change in the behavior, attitude, and practice with appropriate health education. Hence, this study was done to determine the awareness level of antenatal and postnatal mothers about the breastfeeding practices and benefits and identify the factors associated with it in rural Chengalpattu, Tamil Nadu, India.

MATERIALS AND METHODS

We conducted this community-based cross-sectional study among 377 antenatal and postnatal mothers in the selected rural villages of Chengalpattu between October 2019 and September 2020. Details regarding the sociodemographic characteristics and awareness/knowledge about the breastfeeding were collected using pretested semistructured questionnaire. Knowledge adequacy was summarized as proportion with 95% confidence interval (CI), and factors associated with knowledge were interpreted as adjusted prevalence ratio (aPR) with 95% CI using log-binomial regression.

RESULTS

About 19.6% (95% CI: 15.7%-24.0%) mothers had inadequate knowledge about breastfeeding. Women who were unemployed (aPR = 1.60; 95% CI: 1.02-2.51), belonging to the lower socioeconomic status (aPR = 2.62; 95% CI: 1.80-3.82), belonging to Muslim religion (aPR = 1.63; 95% CI: 1.14-2.35), and living in joint family (aPR = 1.58; 95% CI: 1.12-2.21) had significant higher risk of inadequate knowledge about breastfeeding practices compared to those who were employed, belonging to puper socioeconomic status, Hindu religion, and living in nuclear family.

CONCLUSION

We found that almost one-fifth of the antenatal and/or postnatal mothers had inadequate knowledge about the breastfeeding benefits and practices. Health education sessions are required to promote the awareness about breastfeeding during antenatal and postnatal check-ups.

Development and validation of scale assessing the knowledge about breast feeding benefits and practices among antenatal and postnatal mothers in South India

BACKGROUND

Developing a scale to address the breastfeeding benefits and practices among antenatal and postnatal mothers is important as it helps in evaluating the change in the behavior, attitude, and practice with appropriate health education.

AIM

This study was done to develop and validate a scale to assess the knowledge about the breastfeeding benefits and practices in Tamil language among antenatal and postnatal mothers belonging to rural areas of Chengalpattu, South India.

METHODS

We developed a scale to assess the knowledge about the benefits and practices of breastfeeding through literature review and expert opinion. Final version was administered among 377 antenatal and postnatal mothers in selected villages of rural Chengalpattu, South India. Construct validation was evaluated through principal component analysis (PCA). Confirmatory factor analysis was performed to check the goodness-of-fit of results. Internal consistency was evaluated through the Cronbach's alpha co-efficient.

RESULTS

A total of 11 questions were finalized in the questionnaire following face and content validity. In PCA, three factor models were obtained with the eigen values of 4.18, 1.91 and 1.48, respectively. These three factors were able to explain for about 68.9% of the variance. Goodness-of-fit indices revealed satisfactory comparative fit indices (0.81), Tucker-Lewis Index (0.73), standardized root mean square residual (0.11), and root mean square error of approximation (0.14). The reliability co-efficient for the questionnaire was 0.80.

CONCLUSION

We have developed an internally valid and reliable tool for evaluating the knowledge about breastfeeding benefits and practices. The scale should thus facilitate and fast-track the development of a structured breastfeeding educational program for antenatal and postnatal mothers receiving care at the primary health care level.

RELEVANCE FOR PATIENTS

This questionnaire allows for the objective monitoring of effectiveness of educational activities and also help in comparing the efficiency of various educational models targeting the antenatal and postnatal mothers.

Father support for breastfeeding mothers who plan to utilize childcare: A qualitative look at Mothers' perspectives

Breastfeeding exerts many health benefits for the infant and the benefit is affected by exclusivity and duration, however, most mothers in the U.S. breastfeed for a shorter duration than recommended. First-time mothers who return to work outside the home, utilize childcare, and pump to continue to provide human milk, all of which have been found to reduce breastfeeding duration individually, represent a subset of breastfeeding mothers facing several known barriers to breastfeeding continuation and at risk for early breastfeeding cessation. The aim of this study is to understand and describe the perceptions of first-time mothers with prenatal intentions to breastfeed and utilize childcare, of paternal support for the breastfeeding experience. A semi-structured interview guided data collection with 24 first-time breastfeeding mothers and responses were analyzed using thematic analysis. Two main themes from mothers' experiences highlight the perceptions of first-time mothers, who had prenatal intentions to breastfeed and utilize childcare, were shaped by the actions, behaviors, and beliefs of their partners throughout the breastfeeding process, as well as illustrate both mothers and fathers lack knowledge of how to optimally involve fathers in breastfeeding. Our findings extend evidence for two existing models of father support to promote breastfeeding as relevant to mothers who return to work outside the home and utilize childcare, and additionally identify an area of support not included in either model. Early and improved education that situates breastfeeding within the co-parenting relationship and includes paternal support for pumping has the potential to improve mothers' breastfeeding experience and breastfeeding duration through mothers' return to work and infants' transition to childcare.

Factors influencing exclusive breastfeeding for 6 months postpartum: A systematic review

PURPOSE

This systematic review aims to identify factors influencing exclusive breastfeeding (EBF) up to 6 months.

METHODS

The databases including PubMed, MEDLINE, CINAHL, Scopus, EMBASE, CNKI, and WANFANG were searched to retrieve studies. Quantitative research were extracted and the preferred reporting items for systematic reviews were followed. Critical appraisal checklists of Joanna Briggs Institute were used to evaluate the quality of the included studies.

FINDINGS

A total of 16 papers were eligible for this systematic review, comprising five cohort studies and 11 cross-sectional studies. Moderate to strong evidence supported that 6-month exclusive breastfeeding is affected by maternal working status, breastfeeding knowledge, delivery mode, parity, perception of insufficient human milk, mothers' infant feeding attitude, breastfeeding self-efficacy, and intention.

CONCLUSIONS

Factors influencing EBF up to 6 months postpartum play a key role in promoting mothers' health and reducing diseases in their infants.

IMPLICATIONS FOR NURSING PRACTICE

Interventions based on related factors should be developed and taken into practice to assist mothers in exclusive breastfeeding for up to 6 months. Additional studies from different countries in different populations with high quality are needed to provide more reliable and richer findings.

Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review

Vitamin A deficiency is a major health risk for infants and children in low- and middle-income countries. This scoping review identified, quantified, and mapped research for use in updating nutrient requirements and upper limits for vitamin A in children aged 0 to 48 months, using health-based or modelling-based approaches. Structured searches were run on Medline, EMBASE, and Cochrane Central, from inception to 19 March 2021. Titles and abstracts were assessed independently in duplicate, as were 20% of full texts. Included studies were tabulated by question, methodology and date, with the most relevant data extracted and assessed for risk of bias. We found that the most recent health-based systematic reviews and trials assessed the effects of supplementation, though some addressed the effects of staple food fortification, complementary foods, biofortified maize or cassava, and fortified drinks, on health outcomes. Recent isotopic tracer studies and modelling approaches may help quantify the effects of bio-fortification, fortification, and food-based approaches for increasing vitamin A depots. A systematic review and several trials identified adverse events associated with higher vitamin A intakes, which should be useful for setting upper limits. We have generated and provide a database of relevant research. Full systematic reviews, based on this scoping review, are needed to answer specific questions to set vitamin A requirements and upper limits.

Determinants of wasting among South Sudanese 6- to 59-month-old children in Okugo refugee camp, Gambella Region, South-Western Ethiopia: Unmatched case-control study

INTRODUCTION

Wasting among refugee children continues to be a serious public health problem particularly in conflict and in situations when people are displaced. Evidence of risk factors in the refugee context is crucial to successfully prevent malnutrition and its consequences. However, little information is known about the determinants of wasting in a refugee setting. Hence, this study was aimed to identify determinants of wasting among South Sudanese 6- to 59-month-old children in Okugo refugee camp, South-Western Ethiopia.

METHODS

Institutional-based unmatched case-control study was conducted on 99 acute malnutrition children (cases) and 297 children who are not malnourished (control) from 6 April to 2 May 2019. The study participant was selected by systematic random sampling and data on exposure variables were collected by face-to-face interview using a structured questionnaire. Data were entered into Epi data version 3.1 and was exported to SPSS version 25 for further analysis. Descriptive, bivariable, and multivariable analyses were done to compute summary statistics and to identify determinants of wasting.

RESULT

The mean age of the cases and controls with standard deviation (SD) was 13.8 (±6.9) and 19.2 (±8.7) months, respectively. Multi-variable analysis revealed that mothers who were unable to read and write (adjusted odds ratio = 3.26, 95% confidence interval (1.07-7.93)), fathers only decision-maker to use donations items in the household (adjusted odds ratio = 3.75, 95% confidence interval (1.28-10.85)), not used all donated refugee food and non-food items (adjusted odds ratio = 2.57; 95% confidence interval (1.17-5.66)), the incidence of diarrhea 2 weeks preceding the survey (adjusted odds ratio = 5.28, 95% confidence interval (2.31-12.04)), and mother's smoking habit (adjusted odds ratio = 2.98, 95% confidence interval (1.19-7.44)) were significant determinants of wasting.

CONCLUSION

The finding shows that mothers who are unable to read and write, father only decision-maker, parents' smoking habit, not using all donated refugee food items, and diarrheal disease were found to be independent determinants of wasting. Hence, interventions on acute malnutrition which are focused on empowering women through training and strengthening their control over the household assets, proper utilization of donated food, and non-food items will play a paramount role.

Preschool-children's height, trend, and causes: Japanese national surveys 1990-2010

We observed trends in the height of children aged 3 to 6 in Japan using data from the National Growth Survey on Preschool Children in the years 1990, 2000, and 2010. Average standard deviation (SD) scores of height decreased from 0.39 (SD 1.02) in 1990 (n = 3,684) to 0.37 (SD 1.05) in 2000 (n = 2,981) and 0.33 (SD 1.07) in 2010 (n = 2,027). Mothers of children in later waves were taller, older, and more likely to be primiparous; children in later waves had shorter gestational age, lower birth weight, and were less likely to have been fed less with formula or solid foods before 6 mo. The only factor that consistently contributed to a reduction in children’s height for both 1990–2000 and 2000–2010 was a reduction in birthweight SD score (indirect effect on height –1.5 [95% CI: –1.9, –1.1] mm for 1990–2000 and –1.2 [95% CI: –1.8, –0.8] mm for 2000–2010). Factors that contributed, although not significantly or consistently between the two periods, were changes in pre-pregnancy BMI, smoking during pregnancy, multiple pregnancies, gestational age, BMI at birth, and use of formula and solid foods before 6 mo. Secular increases in maternal age, height, and primiparity contributed to increasing children’s height.

Exclusive breastfeeding frequency at 30 days of life: review of longitudinal studies

Abstract Early life feeding can affect children’s development and survival. Adherence to breastfeeding practices and regular monitoring is essential. This study aims to conduct an integrative review of longitudinal studies on the frequency of exclusive breastfeeding (EBF) at 30 days of life. Articles were retrieved from the PubMed and LILACS databases. The combination of descriptors used was: “prospective study” and “breast feeding.” The search was limited to articles published between 2015 and 2020 in English, Spanish, and Portuguese. We selected 17 original studies. Despite their methodological differences regarding sample size and type, follow-up period, and EBF definition and measurement method, results indicated a high rate of breastfeeding initiation (≥86%) and a wide variation in the occurrence of EBF at 30 days of life (4.5% - 86%) with substantial decline (<60%) in 63% of the investigated areas. These results are far from complying with the recommendation from the World Health Organization of maintaining EBF up to the sixth month of a child’s life and point to the need for further investigations with a standardized methodology to allow for comparisons within and between countries, aiming at planning actions which support breastfeeding.

Frequência do aleitamento materno exclusivo aos 30 dias de vida: revisão de estudos longitudinais

Resumo A nutrição adequada no início da vida pode afetar o desenvolvimento e a sobrevivência infantil, por isso a adesão às práticas de aleitamento materno e o seu monitoramento regular tornam-se essenciais. Este artigo objetiva realizar uma revisão integrativa da literatura sobre a frequência do aleitamento materno exclusivo (AME) aos 30 dias de vida, divulgada em estudos longitudinais. Para isso, foram identificados artigos nas bases de dados PubMed e LILACS. A combinação dos termos de pesquisa foi “estudo prospectivo” e “aleitamento materno”. A busca limitou-se aos artigos em inglês, espanhol e português, e compreendeu as publicações entre os anos 2015 e 2020. Foram selecionados 17 estudos originais. Apesar das diferenças metodológicas entre eles, em relação ao tipo e tamanho de amostra, a definição do AME e método de mensuração, os resultados indicam alta taxa de início da amamentação (≥86%) e ampla variação da ocorrência de AME aos 30 dias de vida (4,5%-86%), com declínio substancial (<60%) em 63% dos locais investigados. Esses resultados distam do cumprimento da recomendação da Organização Mundial da Saúde de AME até o sexto mês de vida, e indicam a necessidade de investigações, com metodologia padronizada, para comparação dentro dos e entre os países, visando ao planejamento de ações para incentivo à amamentação.

Media use in gynecological and obstetric care and women’s perceived level of education received of lifestyle-related risks: A cross-sectional study

Objective:

The application of media on lifestyle-related risk factors (LRRFs) by healthcare providers to educate women may improve women’s adherence, health literacy, and awareness of LRRFs, as well as offspring’s health outcomes. This study investigated whether exposure to media-based education in gynecological and obstetric care is associated with LRRFs perceived levels of education received during pregnancy and lactation.

Methods:

We conducted a cross-sectional, observational study across 14 randomly generated sample points in the 12 most populated cities in Baden-Württemberg, southwest Germany. Women were recruited from gynecological and obstetric institutions. Participants were 219 women who met our inclusion criteria and completed the quantitative questionnaire. We applied ordinal logistic regression analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of women’s perceived level of education received related to healthcare providers’ exposure to media-based education.

Results:

Media-based education on LRRFs during pregnancy through gynecologists and/or midwives were significantly associated with women’s perceived level of education received (gynecologists: OR = 4.26 (95% CI: 2.04, 8.90; p < .001); midwives: OR = 3.86 (95% CI: 1.66, 8.98; p = .002)). Similar results were found for media-based education through gynecologists and/or midwives on LRRFs during lactation and its association with women’s self-assessed level of perceived level of education received (gynecologists: OR = 4.76 (95% CI: 2.15, 10.56; p < .001); midwives: OR = 7.61 (95% CI: 3.13, 18.53; p < .001)).

Conclusions:

This study suggests that the exposure to media-based education in gynecological and obstetric care increases women’s perceived level of education received of LRRFs during pregnancy and lactation. Therefore, it is recommendable to apply media in gynecological and obstetric care settings.

What Women Really Think About Breastfeeding and Breast Pumping: A Qualitative Analysis of Women Who Deliver at a Baby-Friendly Hospital

Introduction: The Baby-Friendly Hospital Initiative has had a positive impact on breastfeeding initiation; however, posthospital exclusive breastfeeding (EBF) rates remain low. We aimed to analyze thoughts and attitudes toward breastfeeding at the postpartum visit among women who deliver at a Baby-Friendly hospital. Methods: Women ≥14 years who delivered a live-born infant at our center were eligible. Participants completed an infant feeding questionnaire at the postpartum visit recording patient and delivery characteristics, antepartum care and infant feeding details, reasons for breastfeeding discontinuation or formula initiation, workplace environment, and cultural beliefs about breastfeeding. Thematic coding via line-by-line analysis of the free responses was performed using NVivo12 by QSR international. Results: Of 263 participants, 110 responded to the open-ended question. Of these, 53 and 46 were negative-toned and positive-toned, respectively. Negative breastfeeding responses related to the mother addressed the need for more support, low milk supply, pressure to breastfeed and feelings of guilt if unsuccessful, maternal health issues, painful breastfeeding, and high time requirements. Negative breastfeeding responses about the baby included concerns about infant health, latching issues, and disinterest. Positive responses focused on the support system, maternal weight loss, health benefits for baby, and mom-baby bonding. Some women (27) commented specifically on pumping. Negative comments noted that pumping led to less milk production, was time consuming, and was too much work. Positive comments about pumping noted that it is a convenient alternative to breastfeeding. Conclusion: Efforts to improve posthospital EBF rates in accordance with national guidelines must acknowledge the complex experience of breastfeeding mothers.

Does COVID-19 Policy Affect Initiation and Duration of Exclusive Breastfeeding? A Single-center Retrospective Study

Purpose

It assessed the effect of a COVID-19 policy that involved maternal-neonatal separation on early initiation and duration of exclusive breastfeeding (EBF) at two weeks, three, and six months postpartum during the peak of the COVID-19 pandemic in 2020.

Patients and Methods

This retrospective study included consecutive mother-newborn dyads with deliveries between mid-March and the end of December 2020 who agreed to participate and were eligible according to the following criteria: full-term pregnancy, singleton birth, and healthy newborn. Participants were called at least twice during the study period to inquire about exclusive breastfeeding status at two weeks, three, and six months postpartum. Multivariate logistic regression analysis was carried out to identify associated factors with EBF.

Results

A total of 454 eligible mother-infant dyads were included. Mean maternal age (in years), gestational age (in weeks), birth weight (in kilograms), and 5-min Apgar score was, respectively, 32±5.4 years, 39±1.3 weeks, 3.1±0.42 kg, and 9.24±0.6. Most of the mothers (86.1%) had no known chronic diseases and had a normal spontaneous vaginal delivery (NSVD, 91.4%). Approximately 44.7% of the sample initiated breastfeeding either directly or with expressed breastmilk during their hospital stay. Prevalence of EBF during the first two weeks, three, and six months postpartum was, respectively, 30%, 19.8%, and 31.7%. EBF was associated with birth weight, hospital breastfeeding and EIBF at early postpartum period, while EBF at six months was associated with parity and method of delivery.

Conclusion

During the peak of the COVID-19 pandemic, the prevalence of breastfeeding initiation and EBF in the first six months postpartum were low among Saudi mothers. However, multicenter, prospective, cohort studies with adjustment for known confounding factors are required to explore the impact of infection control policies on breastfeeding. Meanwhile, these policies should support early and safe breastfeeding practices, especially with new and evolving information regarding the current pandemic.

Allergic diseases in infancy: I - Epidemiology and current interpretation

Objective

Among non-communicable diseases, the prevalence of allergic diseases has increased significantly in the new millennium. The increase of allergic diseases is linked to the changing environment of infants.

Methods

This narrative review summarizes the discussions and conclusions from the 8^th Human Milk Workshop. Information from the fields of pediatrics, epidemiology, biology, microbiology, and immunology are summarized to establish a framework describing potential avenues for the prevention of allergic diseases in the future.

Results

Several environmental circumstances are linked to the development of allergic diseases. While cesarean section is increasing the risk of allergies, early childhood exposure to a farm environment has a protective effect. From their analysis, nutritive and non-nutritive factors influencing the allergy risk in later life have been identified. The effect of breastfeeding on food allergy development is non-univocal. Human milk components including immunoglobulins, cytokines, and prebiotics have been indicated as important for allergy prevention.

Conclusion

Many factors linked to the western lifestyle have been associated with the development of allergic diseases. This suggests several theories that may serve as a basis for new protective interventions. While it is indubitable that mother's milk protects from infectious diseases, its role in the prevention of allergic diseases is to be elucidated.

Dysphoric Milk Ejection Reflex: The Psychoneurobiology of the Breastfeeding Experience

Breastfeeding, given its biochemical and physiological basis, is known for its many benefits for both the lactating mother and the infant. Among the many challenges new breastfeeding mothers experience is the feeling of aversion in response to their newborn's suckling which has been termed dysphoric milk-ejection reflex (D-MER). Characterized by intense feelings of dysphoria which may eventually interfere with the mother's ability to breastfeed regularly, evidence suggests both the neurobiological and psychological basis of D-MER in an attempt to explain its complexity. Biologically, breastfeeding is expressed by the intracerebral release of oxytocin, an increased expression of oxytocin receptors in specific brain regions, increased mesocorticolimbic reward region activation, the secretion of prolactin and possibly the inhibition of dopamine. Hence, different theories explain D-MER in terms of disrupted neurotransmitter and hormonal activity. Breastfeeding has also proven to influence mood and stress reactivity in nursing mothers with a potential link with postpartum depression. Psychological theories attempt to explain D-MER from a sociopsychosexual lense shedding light on the significance of mother-infant attachment, the sexualization of the female body and the motherhood experience as a developmental stage in a woman's lifespan. The aim of this review is to provide a literature update of D-MER incorporating both neurobiological and psychological theories calling for raising awareness about the complexity of breastfeeding and for the need for mother-centered interventions for the management of D-MER and other postpartum-specific conditions.

Effect of Breastfeeding and Its Duration on Impaired Fasting Glucose and Diabetes in Perimenopausal and Postmenopausal Women: Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2019

BACKGROUND AND OBJECTIVES

To examine the effect of maternal breastfeeding on the subsequent risk of diabetes in parous Korean women aged >50 years.

MATERIALS AND METHODS

A total of 14,433 participants from the Korea National Health and Nutrition Examination Survey (KNHANES) were included. The subjects were divided into three groups: normal, impaired fasting glucose, and diabetes. The adjusted odds ratios (ORs) for impaired fasting glucose (IFG) and diabetes were assessed using multivariate logistic regression.

RESULTS

A total of 2301 (15.94%) women were classified as having diabetes, and 3670 (25.43%) women were classified as having impaired fasting glucose. Breastfeeding was associated with an OR for diabetes of 0.76 (95% confidence interval (CI): 0.61, 0.95) compared with non-breastfeeding after adjustment for possible confounders in the multivariable logistic regression analysis. Breastfeeding for 13-24 months was associated with an OR of 0.68 (95% CI, 0.5, 0.91), and breastfeeding for 25-36 months was associated with an OR of 0.68 (95% CI, 0.52, 0.87) for diabetes compared with breastfeeding for <1 month in the multivariable logistic regression analysis.

CONCLUSIONS

Our results suggest that long-term breastfeeding, particularly breastfeeding for 13-36 months, may be associated with a lower risk for diabetes later in life.

Coherence for nutrition: insights from nutrition-relevant policies and programmes in Burkina Faso and Nigeria

There is consensus that policy coherence is necessary for implementing effective and sustainable approaches to tackle malnutrition. We look at whether policies and programmes provide a coherent pathway to address nutrition priorities and if programmes are designed to deliver interventions aligned to the nutrition policy agenda in Nigeria and Burkina Faso. A systematic desk review was performed on nutrition-relevant policy and programme documents, obtained through grey literature searches and expert recommendations. We developed a framework with an impact pathway structure that includes five process steps, which was used to guide coding, data reduction and synthesis and structure the analysis. We assessed internal coherence along process steps within a given document and external coherence across process steps for explicitly linked policy/programme pairs. The majority of policies and programmes had partial internal coherence for both countries. The identification of relevant nutrition interventions to address challenges and reach objectives was the strongest connection within policies (16 out of 45 had complete coherence), while among programmes, the strongest connection was coverage indicators that measure interventions (9 out of 21 had complete coherence). Eight programmes explicitly referenced at least one nutrition-relevant policy, with a total of 16 linked policy/programme pairs (13 pairs for Burkina Faso and 3 for Nigeria) across health, nutrition, agriculture and social focus areas. However, none of the linked pairs were assessed to have complete external coherence, suggesting that priorities at the policy level are not fully realized nor translated at the programme level. This study offers a new approach for the assessment of policy and programme coherence and specifically examines policy and programme linkages. We conclude that improved leadership on country priority setting and better alignment for nutrition within and across sectors is needed to enhance the effectiveness of nutrition investments.

Examining patterns of postnatal feeding in relation to infant's weight during the first year

BACKGROUND

There is mixed evidence regarding specific infant feeding behaviors and later risk for overweight and obesity. We sought to detect underlying patterns in duration of breastfeeding, introduction of solid foods and sweetened beverages, in order to understand the relation to later weight.

METHODS

Patterns of postnatal feeding were examined among infants enrolled in the Infant Feeding Practices Study II (N = 3033). At monthly intervals, mothers reported on the duration of any and exclusive breastfeeding, age of solid food and sweetened beverage introduction, and reported infant weight at ages 9- and 12-months. Latent profile analysis was used to empirically derive patterns of postnatal feeding and examine associations with weight z-scores at 9 and 12 months.

RESULTS

Two profiles emerged: (1) Short breastfeeding duration and early introduction to solid foods and sweetened beverages (Short BF/Early Introduction; 53%) and (2) longer breastfeeding duration and later introduction to solid foods and sweetened beverages (Longer BF/Later Introduction; 43%). Infants in the Shorter BF/Early Introduction profile had significantly greater weight z-scores at 9 (M = 0.18) and 12 months (M = 0.26), compared to those in the Longer BF/Later Introduction profile (M = -0.21; M = -0.17, respectively).

CONCLUSIONS

Overall, shorter BF duration and earlier food and sweetened beverage introduction is associated with higher weight z-scores at 9 and 12 months. Early intervention should aim to promote breastfeeding and later introduction of solids and discourage consumption of sweetened beverages. These postnatal patterns of feeding behaviors provides important context to inform targeted interventions aimed at reducing risk for later obesity.

Exploring the Prescribing Process of Domperidone for Low Milk Supply: A Qualitative Study Among Mothers, IBCLCs, and Family Doctors

BACKGROUND

When mothers are confronted with milk supply problems, taking domperidone is regularly suggested. However, domperidone has been associated with sudden cardiac death and caution in prescribing is advised. In 2016, a multidisciplinary group of authors from a tertiary academic hospital (Erasmus MC) published a clinical protocol in a leading Dutch physicians' journal to support Dutch family physicians in prescribing domperidone to stimulate lactation.

RESEARCH AIM

To explore consumer and health care provider perspectives and experiences regarding the prescribing of domperidone for lactation insufficiency following publication of a national clinical protocol.

METHODS

A cross-sectional qualitative study was performed using semi-structured interviews (N = 40) based on a topic list covering the prescribing process. Participants were mothers (n = 18) who had been advised to try domperidone to boost their milk supply between November 2016 and May 2018, their International Board Certified Lactation Consultants (n = 9), and their family physicians (n = 15). Another group of participants (mothers; n = 6) answered short questionnaires. All interviews were recorded, transcribed and analyzed using ATLAS.ti software. The resulting list of codes was organized according to the topics.

RESULTS

In the process leading to domperidone use to stimulate lactation, participant family physicians relied on the IBCLC, pharmacist, or mother to guide the prescription of domperidone, often citing the published national clinical protocol as back up. The medical safeguards incorporated in the protocol (e.g., taking medical history, physical exam, performing electrocardiograms, limiting dosage) were usually not implemented.

CONCLUSIONS

Though the availability of a national clinical protocol in which the prescribing of domperidone for lactation is supported appeared to increase the willingness of participant family physicians to prescribe, gaps were identified between clinical practice and this clinical protocol for prescribing domperidone.

Breastfeeding Supportive Services in Baby-Friendly Hospitals Positively Influenced Exclusive Breastfeeding Practice at Hospitalization Discharge and Six Months Postpartum

BACKGROUND

Studies have shown that implementing the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative can protect, promote, and support breastfeeding. However, few studies have valuated the quality of breastfeeding supportive services provided by Baby-Friendly Hospitals from the perspective of service users.

METHODS

This was a hospital-based prospective study, conducted at eight Baby-Friendly Hospitals with a total of 707 pregnant women in Shanghai, China between October 2016 and September 2021. Breastfeeding supportive services during hospitalization were assessed at childbirth discharge using a 12-question questionnaire based on the Chinese "Baby-Friendly Hospital Evaluation Standards". Women were followed up on six months postpartum. The impact of breastfeeding supportive services during hospitalization on the exclusive breastfeeding at discharge and six months postpartum were assessed.

RESULTS

Of the 707 mothers who completed the survey at discharge, 526 were followed up on six months after delivery. The overall exclusive breastfeeding rate among participants was 34.4% at discharge and 52.1% at six months postpartum. Mothers who received better breastfeeding supportive services during hospitalization were more likely to practice exclusive breastfeeding at hospitalization discharge compared with mothers who received poorer services (aOR: 3.00; 95% CI: 2.08, 4.35; p < 0.001). Furthermore, they were also more likely to exclusively breastfeed at six months postpartum (aOR: 1.50; 95% CI: 1.03, 2.22; p = 0.033).

CONCLUSION

Better breastfeeding supportive services during hospitalization were significantly associated with higher rate of exclusive breastfeeding at discharge and six months postpartum. More effective measures should be adopted to improve the implementation of the breastfeeding supportive services in Baby-Friendly Hospitals to promote exclusive breastfeeding and better maternal and child health.

Availability of Lactation Accommodation Information for Urology Residency Programs

OBJECTIVE

To assess whether urology residency programs publish information about lactation accommodations online. Although residencies are required to provide lactation accommodations, there is limited data on whether programs disclose this information.

MATERIALS AND METHODS

Webpages of U.S. urology residency programs were assessed for presence of information about lactation. Program characteristics were noted, as were mentions of resident wellness and diversity. Associations between program characteristics and published lactation accommodations were determined by univariate analysis and development of a multivariate logistic regression model.

RESULTS

Of 145 urology residency programs, 72.4% included information about lactation accommodations anywhere on the institution's website There was great variability in ease of accessing information and of quality of information available. Information was most commonly on graduate medical education websites (28.3%) followed by human resources (24.1%), press releases (7.6%), or other sections (11.0%), and least likely to be found on urology residency websites (1.4%). Programs with lactation accommodations anywhere on the institution website were more likely to be larger (p < 0.001), university-based (p < 0.001), and to publish information about resident wellness (p < 0.001), diversity and inclusion (p < 0.001). On multivariate analysis, only university-based setting presence of wellness information were predictors of availability of lactation accommodation information.

CONCLUSION

Lactation accommodation information is usually not available on urology residency websites and most online information is found elsewhere. Predictors of publishing lactation accommodation information were university-based setting and information about resident wellness. Efforts to recruit and retain female urologists should include making this information more easily accessible.

Testing an Incentive-Based and Community Health Worker Package Intervention to Improve Maternal Health and Nutrition Outcomes: A Pilot Randomized Controlled Trial

OBJECTIVES

In order to address South Africa's maternal and infant mortality and morbidity rates, patient and community-level preventable factors need to be identified and addressed. However, there are few rigorously implemented and tested studies in low- and middle-income countries that evaluate the impact of community-level interventions on maternal and infant health outcomes. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on maternal depressive symptoms, maternal nutrition and intention to exclusively breastfeed.

METHOD

The intervention was tested using a pilot randomised controlled trial consisting of 72 (39 treatment and 33 control) adult women, implemented in a low-income, peri-urban area in Cape Town, South Africa. Data was collected using a baseline questionnaire conducted shortly after recruitment, and an end line questionnaire conducted a week after giving birth.

RESULTS

The intervention resulted in a 0.928-point drop in the maternal depressive symptom scale (which ranges from 1 to 8). We find no evidence that the intervention has either a sizeable or precisely estimated impact on maternal nutrition, measured using middle-upper arm circumference. While the intervention has almost no effect on the infant feeding intention of women who own refrigerators, it has a very large positive effect of 3.349-points (on a scale ranging from 1 to 8) for women without refrigerators.

CONCLUSION

A package intervention consisting of psycho-social support, additional tailored health information, and an incentive to utilise public antenatal care services has the potential to increase exclusive breastfeeding intention and reduce maternal depressive symptoms among the economically vulnerable.

Exploring Challenges and Opportunities for Breastfeeding in Hawai'i During the COVID-19 Pandemic

Increasing exclusive breastfeeding rates is an established public health strategy to reduce chronic disease and protect infants from illness. The role of breastfeeding in addressing health disparities takes on new significance as the COVID-19 pandemic has disproportionately impacted some communities in Hawai'i, and those with chronic conditions face increased risk of hospitalization and death. However, there are myriad policy, systemic, and environmental barriers that make it difficult for parents to breastfeed, some of which have been exacerbated by the COVID-19 pandemic. This editorial discusses the importance of breastfeeding in reducing chronic disease, reviews the status of breastfeeding in Hawai'i, explores the challenges parents face in breastfeeding their infants, especially in the time of COVID-19, and presents opportunities for improved access to lactation care to reduce health disparities.

Breastfeeding and risk of childhood asthma: a systematic review and meta-analysis

OBJECTIVE

To investigate the relationship between breastfeeding and the development of paediatric asthma.

METHODS

A systematic review and meta-analysis was conducted with MEDLINE, Embase, CINAHL and ProQuest Nursing and Allied Health source databases. Retrospective/prospective cohorts in children aged <18 years with breastfeeding exposure reported were included. The primary outcome was a diagnosis of asthma by a physician or using a guideline-based criterion. A secondary outcome was asthma severity.

RESULTS

42 studies met inclusion criteria. 37 studies reported the primary outcome of physician-/guideline-diagnosed asthma, and five studies reported effects on asthma severity. Children with longer duration/more breastfeeding compared to shorter duration/less breastfeeding have a lower risk of asthma (OR 0.84, 95% CI 0.75-0.93; I2 = 62.4%). Similarly, a lower risk of asthma was found in children who had more exclusive breastfeeding versus less exclusive breastfeeding (OR 0.81, 95% CI 0.72-0.91; I2=44%). Further stratified analysis of different age groups demonstrated a lower risk of asthma in the 0-2-years age group (OR 0.73, 95% CI 0.63-0.83) and the 3-6-years age group (OR 0.69, 95% CI 0.55-0.87); there was no statistically significant effect on the ≥7-years age group.

CONCLUSION

The findings suggest that the duration and exclusivity of breastfeeding are associated with a lower risk of asthma in children aged <7 years.

Cohort profile: National Investigation of Birth Cohort in Korea study 2008 (NICKs-2008)

BACKGROUND

An adequate large-scale pediatric cohort based on nationwide administrative data is lacking in Korea.

PURPOSE

This study established the National Investigation of Birth Cohort in Korea study 2008 (NICKs-2008) based on data from a nationwide population-based health screening program and data on healthcare utilization for children.

METHODS

The NICKs-2008 study consisted of the Korean National Health Insurance System (NHIS) and the National Health Screening Program for Infants and Children (NHSPIC) databases comprising children born in 2008 (n=469,248) and 2009 (n=448,459) in the Republic of Korea. The NHIS database contains data on age, sex, residential area, income, healthcare utilization (International Classification of Diseases-10 codes, procedure codes, and drug classification codes), and healthcare providers. The NHSPIC consists of 7 screening rounds. These screening sessions comprised physical examination, developmental screening (rounds 2-7), a general health questionnaire, and age-specific anticipatory guidance.

RESULTS

During the 10-year follow-up, 2,718 children (0.3%) died, including more boys than girls (hazard ratio, 1.145; P<0.001). A total of 848,048 children participated in at least 1 of the 7 rounds of the NHSPIC, while 96,046 participated in all 7 screening programs. A total of 823 infants (0.1%) weighed less than 1,000 g, 3,177 (0.4%) weighed 1,000-1,499 g, 37,166 (4.4%) weighed 1,500-2,499 g, 773,081 (91.4%) weighed 2,500-4,000 g, and 32,016 (5.1%) weighed over 4,000 g. There were 23,404 premature babies (5.5%) in 2008 compared to 23,368 (5.6%) in 2009. The developmental screening test indicated appropriate development in 95%-98% of children, follow-up requirements for 1%-4% of children, and recommendations for further evaluation for 1% of children.

CONCLUSION

The NICKs-2008, which integrates data from the NHIS and NHSPIC databases, can be used to analyze disease onset prior to hospitalization based on information such as lifestyle, eating habits, and risk factors.

Dietary intake and nutritional status of Korean children and adolescents: a review of national survey data

In Korea, several national cross-sectional surveys monitor the diet, nutritional status, and health status of children. This continual dedicated national surveillance system contributes to the identification of nutritional and health issues, establishment of public health policies, and development of nutrition recommendations. This paper provides recent information about the Korea National Health and Nutrition Examination Survey and the Korean Youth Risk Behavior Web-based Survey and describes key nationwide survey findings published in the last 5 years on infant feeding practices and the dietary intake and nutritional status of Korean infants, children, and adolescents. There have been increasing trends in children, and teenagers who skip breakfast, eat fast food, consume sugary drinks, have vitamin D deficiency, and are obese. This review will inform pediatricians, nutritionists, and other health care practitioners who track children's growth and development. It may also help researchers and policymakers identify diet-related policies and strategies for chronic disease prevention in Korean infants, children, and adolescents.

Exclusive Breastfeeding Practice in Indonesia: A Population-Based Study

BACKGROUND

It is a well-known fact that exclusive breastfeeding benefits both mothers and their babies. The aim of this study is to assess the associated factors influencing exclusive breastfeeding of babies until 6 months of age.

METHODS

The study used data from the 2017 Indonesia Demographic and Health Survey. Overall, 1,542 women who had infants aged below 6 months were included in the study. Sociodemographic and maternal health service utilization factors were examined for association with exclusive breastfeeding, using logistic regression for a complex sample design.

RESULTS

The proportion of exclusive breastfeeding was 52.3% (95% confidence interval [CI], 0.498-0.548). Parity, antenatal care visits, early initiation of breastfeeding, low-income households, and rural areas were significant factors associated with the increased likelihood of exclusive breastfeeding. However, working status (adjusted odds ratio [aOR], 0.70; 95% CI, 0.57-0.86) and caesarean delivery or C-section (aOR, 0.75; 95% CI, 0.57-0.99) were factors for a lower likelihood of exclusive breastfeeding.

CONCLUSION

Working women are at risk of discontinuation of exclusive breastfeeding. Mothers who had a normal vaginal delivery and practiced early initiation of breastfeeding had a higher rate of exclusive breastfeeding. These findings have important implications for developing comprehensive guidance and resources for women regarding the importance of exclusive breastfeeding during the early postpartum period.

Infant feeding in diverse families; the impact of ethnicity and migration on feeding practices

OBJECTIVE

To investigate differences in infant feeding practices and styles by maternal migration status.

DESIGN

Prospective cohort study.

SETTING

Maternity unit of a large hospital in Northern England PARTICIPANTS: Women recruited to the Born in Bradford longitudinal cohort study MEASUREMENTS: Breastfeeding initiation; breastfeeding at six months; breastfeeding at twelve months; timing of introduction of complementary feeding; maternal feeding style at twelve months.

FINDINGS

Migrant women were more likely to initiate breastfeeding and continue breastfeeding for longer compared to native women. Native women also introduced complementary feeding earlier than migrant women. There was evidence of feeding practices among second= generation migrants becoming increasingly more aligned with those of native women, with lower breastfeeding rates and earlier introduction of complementary feeding compared to first-generation migrants. Migrant women were more likely to adopt a 'Demanding' feeding style, with the strongest associations seen in first-generation migrants.

KEY CONCLUSIONS

Migration status is an important factor to consider in reference to infant feeding practices. This is particularly important in considering intergenerational changes in families with migration backgrounds and the potential of culture to impact on family practices.

IMPLICATIONS FOR PRACTICE

Interventions to maintain cultural norms around infant feeding in families with migration backgrounds would be beneficial, due to the observed higher rates of breastfeeding in first-generation migrants. Targeted interventions to improve breastfeeding in white British native women should consider the role that culture can play in encouraging positive health behaviours.

Breastmilk Feeding during the First 4 to 6 Months of Age and Childhood Disease Burden until 10 Years of Age

BACKGROUND

Breastfeeding is recommended due to its beneficial effects on human health. However, the effect of breastfeeding on health differs, resulting in various childhood diseases.

OBJECTIVE

Our purpose was to investigate the association between breastfeeding at least in the first 4 months and the subsequent development of 15 certainly defined childhood diseases until 10 years of age, the all-cause hospitalization rate and growth at 6-7 years of age.

METHODS

Participants included propensity-score matched 188,052 children born between January 2008 and December 2009, who were followed up till 10 years of age. Data were taken from the National Investigation of birth Cohort in Korea study 2008 database. Risk ratios were obtained using a modified Poisson regression and weighted risk differences using binomial regression.

RESULTS

Compared to formula feeding, breastfeeding was associated with decreased risks of febrile convulsion, attention deficit hyperactivity disorder and autism spectrum disorder, pneumonia, acute bronchiolitis, hypertrophic pyloric stenosis, asthma, all-cause hospitalization, overweight/obesity and short stature. Exclusive breastfeeding at 4 to 6 months of age had similar results to exclusive breastfeeding over 6 months of age.

CONCLUSIONS

Breastfeeding in early infancy reduces the risk for various childhood diseases, all-cause hospitalization rate, obesity, and short stature during childhood.

Children and Multidimensional Poverty: Four Measurement Strategies

Empirically, official multidimensional measures of poverty often show children to be the poorest age group. Such poverty measures and their analysis can be used to directly inform policies to reduce children’s multiple deprivations. This paper introduces methods to produce official national statistics on multidimensional poverty that inform child-focused anti-poverty policies. In doing so, it recognises the importance of parsimonious, consistent measures, given practical constraints such as policy makers’ time. The paper does not recommend constructing several disjoint poverty measures which cannot be straightforwardly interpreted and used alongside one another, as these may create confusion or dilute policy attention. To create a compact and high-information measurement platform, the paper introduces four measurement strategies that have been used to directly uncover policy-relevant data on children’s experience of multidimensional poverty, and that are consistent with official population-level statistics. The four are as follows: (1) Include children’s deprivations as indicators of multidimensional poverty in national measures. (2) Disaggregate multidimensional poverty indices and their associated information platform to compare children and adults. (3) Analyse individual child deprivations and explore gendered and intra-household inequalities. (4) Construct an individual measure of child multidimensional poverty that is directly linked to the official national measure, but contains additional indicators across the life course of children. The paper illustrates these four strategies and the child-relevant statistics they yield, using examples from official poverty measures and previous research. It discusses the strengths and challenges of each method from conceptual, policy, and technical perspectives, and examines how they can be used for descriptive and prescriptive purposes in line with the Sustainable Development Goals.

Breastfeeding knowledge in university nursing students. A multicentre study in Spain

BACKGROUND

Exclusive breastfeeding is one of the main health and infant survival elements. To start and maintain breastfeeding, health professionals must receive culturally sensitive evidence-based breastfeeding training to offer future mothers the required information and support. While studying the nursing degree, acquiring the necessary knowledge and skills to successfully perform this work is essential.

OBJECTIVE

Study the level of nursing students' breastfeeding knowledge at three Spanish public universities; explore which variables are related to acquire this knowledge.

DESIGN

An observational, descriptive, cross-sectional multicentre study.

METHODS

Participants were the students registered for the 4 nursing degree years at the three participating universities (N = 1540). They were asked about their breastfeeding knowledge with the self-administered AprendeLact Questionnaire; breastfeeding-related socio-demographic variables were included.

RESULTS

The overall mean score of the 684 returned questionnaires was 4.659 (±2.377) out of 10. The year-4 students from the Castellón university obtained significantly higher mean scores and had been on practicals in maternity or neonatology units, belonged to breastfeeding associations and were artificially fed as infants. University belonged to, current academic year and placements in maternity or neonatology units were relevant factors for acquiring breastfeeding knowledge.

CONCLUSIONS

Syllabi based on progressive transversal learning, and participating in real maternity-related health settings, could be facilitating strategies to acquire a suitable level of breastfeeding knowledge.