Optimal duration of exclusive breastfeeding

Evaluating an Association Between Prenatal Smoking Behavior and Exclusive Breastfeeding: A Population-Based Study

Background: Prenatal smoking is consistently associated with adverse breastfeeding outcomes. We aimed to evaluate the association of smoking cessation or continuation during pregnancy with exclusive breastfeeding in a representative sample of the general Canadian population. Methods: We used the pooled sample of 9860 females with pregnancy experience of last under-five child from the Canadian Community Health Surveys 2015-2018 public use microdata file. We categorized self-reported prenatal smoking status as continuing, quitting, or no smoking. We evaluated the association between exclusive breastfeeding for 6 months or more with prenatal smoking status using multivariable logistic regression, adjusted for socio-demographic variables. Results: With the pooled prevalence of 33.2% (95% CI 31.7, 34.8), 34.4% (95% CI 32.8, 36.1) of non-smokers, 25.7% (95% CI 20.2, 32.2) of those who quit and 15.7% (95% CI 10.8, 22.2) of those who continued smoking reported exclusive breastfeeding for 6 months or more. Continuing smoking had lower odds of exclusive breastfeeding (aOR .47; 95% CI 0.30,0.75) but quitting smoking had no difference (aOR .78;95% CI 0.56,1.08) when compared to non-smokers. Conclusion: Continuing smoking during pregnancy was associated with lower rates of exclusive breastfeeding of infants for 6 months or more. Smoking cessation interventions during prenatal visits may improve exclusive breastfeeding rates.

Mitigating the Impact of Intergenerational Risk Factors on Stunting: Insights From Seven of the Most Food Insecure Districts in South Africa

A large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height-for-age z-scores (HAZ) and stunting among children under 5 years of age in seven of the most food-insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors-specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01-0.03; stunting: OR 0.96, 95% CI 0.94-0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16-0.43; stunting: OR 0.5, 95% CI 0.35-0.72) and asset-based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10-0.24; stunting: OR 0.77, 95% CI 0.67-0.89)-were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.

Perinatal Intimate Partner Violence and Maternal-Infant Bonding in Women With Anxiety Symptoms in Pakistan: The Moderating Role of Breastfeeding

Intimate partner violence (IPV) during the perinatal period can negatively affect both a woman's health and the bonding with her infant. Research on IPV among pregnant women experiencing psychological distress in South Asia is limited. We examined associations between perinatal exposure to IPV and postnatal maternal-infant bonding in Pakistani women with symptoms of anxiety and assessed if breastfeeding practices moderated these associations. Postnatal data were collected from 720 Pakistani women who reported at least mild levels of anxiety symptoms in pregnancy. We performed Poisson regression with robust variance analyses to examine the associations between IPV during pregnancy or within 6 weeks after delivery (i.e., the perinatal period) and maternal-infant bonding. Interaction terms between IPV and breastfeeding practices were included in the analytic models to examine the moderating effects. About 27% of women were exposed to at least one type of perinatal IPV. Women who were exposed to IPV were more likely to have moderate to severe postpartum anxiety (n = 57, 28.9% of IPV-exposed women), compared to those without IPV (n = 65, 12.4% of unexposed women; p value < .001). Compared to women not reporting IPV, women exposed to any IPV showed a 38% increase in Postpartum Bonding Questionnaire scores, suggesting higher likelihood of impaired bonding (risk ratio [RR] = 1.38, 95% confidence interval [CI] [1.21, 1.56]). Among women who initiated breastfeeding later than 1 hr post-delivery, IPV was associated with impaired bonding (RR = 1.09, 95% CI [1.06, 1.20]), whereas no association was present for women who initiated breastfeeding within 1 hr (RR = 1.03, 95% CI [0.98, 1.08]). In addition to the efforts to reduce IPV, encouraging IPV-exposed women to adhere to the breastfeeding guidelines (e.g., early breastfeeding) may enhance maternal-infant bonding.

Timing of Complementary Feeding and Infant Growth Trajectories in Prospective Cohort Studies: A Systematized Review and Analysis of Socioecological Variation

Complementary feeding (CF) before 6 months of age is associated with both infant growth faltering and rapid growth. This disparity may reflect reverse causality and local norms. We conducted a systematized review of prospective studies examining infant growth and CF. We examined the potential for reverse causality and socioecological factors that appeared to influence feeding and growth outcomes. In 22 studies that met inclusion criteria, growth trajectories following earlier CF largely tracked prior growth. Earlier CF was generally associated with slower growth in lower resource populations, and more rapid growth in higher resource contexts. Local norms and caregivers' perceptions of growth were often discussed as factors impacting feeding decisions, but were not explicitly modeled. Future research may benefit from bioethnographic approaches that integrate contextual understanding of local dynamics to more comprehensively examine interactions between growth trajectories, caregiver perceptions, local norms, and health risks that influence CF timing and growth outcomes.

Factors affecting breastfeeding initiation among mothers in Riyadh primary healthcare clinics: a cross-sectional study

BACKGROUND

This study examined the prevalence, timing, and factors associated with breastfeeding practices among Saudi mothers. Breastfeeding is integral to infant health, and understanding cultural and demographic influences on initiation timing is crucial for developing effective interventions.

METHODS

A cross-sectional study was conducted, recruiting 449 Saudi mothers from four primary healthcare centers in Riyadh between January 2022 and January 2023. The inclusion criteria were mothers with children under the age of two. Data were collected via a validated self-administered questionnaire. The sample size calculation considered an anticipated prevalence of 43.6% based on previous research. Ethical approval was obtained from the IRB of the King Abdullah International Medical Research Center.

RESULTS

Breastfeeding prevalence was high (86.6% of mothers), which aligns with global breastfeeding promotion efforts. However, variations were observed in the initiation timing, with only 46.0% of the patients initiating breastfeeding within the first hour. While no statistically significant factors influenced initiation, notable trends emerged. Older mothers and those with lower educational levels demonstrated higher rates of early initiation, suggesting cultural and generational influences. Working mothers faced challenges with breastfeeding continuation due to the lack of designated breastfeeding time at work.

CONCLUSION

This study provides insights into the prevalence of breastfeeding practices among Saudi mothers and the factors influencing them. High breastfeeding prevalence indicates a positive cultural commitment to breastfeeding, whereas variations in initiation timing and continuation underscore the need for targeted interventions such as implementing breastfeeding clinics that inhance practice and education among mothers. Workplace support and educational campaigns are recommended to enhance breastfeeding initiation, particularly among working mothers.

Effectiveness of a new breastfeeding counselling intervention on breastfeeding prevalence, infant growth velocity and postpartum weight loss in overweight women: a randomized controlled trial

BACKGROUND

Maternal overweight is a risk factor for child obesity. Breastfeeding may decrease this risk, but breastfeeding prevalence is low in overweight or obese mothers.

METHODS

We conducted a randomized trial in 90 overweight/obese pregnant women in Bogotá-Colombia during 2019, to evaluate the effects of a new exclusive breastfeeding (EBF) counselling intervention for overweight/obese mothers, based on Carl Rogers' client-centered theory. The Intervention included individualized breastfeeding counseling, empowerment sessions, and a set of problem-solving strategies based on Carl Rogers' client-centered theory, conducted during late pregnancy, first week postpartum, 1 and 3 months postpartum. Primary outcomes were EBF during the last 24 h prevalence at 4 months postpartum, infant growth, and maternal weight loss at 4 months postpartum; secondary outcomes were serum and breast milk prolactin concentration, breast milk energy and macronutrient content, estimated breast milk volume at 1 and 4 months and EBF prevalence at interim time-points. Mothers were randomised in late pregnancy to intervention (new breastfeeding counselling; IG) or control group (standard breastfeeding support; CG).

RESULTS

The IG had significantly higher EBF prevalence at 4 months (82.8%) compared to the CG (30.6%) (Prevalence ratio or PR = 2.7; 95% CI = 1.6, 4.5). There were no intervention effects on infant growth velocity, maternal weight loss or secondary outcomes.

DISCUSSION

The intervention, which could be implemented in primary care settings, was highly effective for increasing the prevalence of EBF in overweight/obese mothers at 4 months postpartum. The results should, however, be interpreted in the context of the small sample size, short follow-up period and loss to follow-up. Further evaluation of the intervention is required in a larger sample including longer-term infant follow-up.

TRIAL REGISTRATION

(UTN) U1111-1228-9913 20 February 2019; ISRCTN15922904, retrospectively registered.

Breastfeeding duration and neurodevelopment: insights into autism spectrum disorders and weaning practices

This paper examines the complex relationship between breastfeeding duration and the incidence of autism spectrum disorders (ASDs), focusing on identifying the most beneficial weaning period and its subsequent effects on child development. Breastfeeding is widely recognized for its role in promoting early health, strengthening the immune system, and supporting neurodevelopment. However, the debate over its optimal duration persists. Integrating insights from current scientific studies with interpretations of Qur'anic teachings, this study advocates for a breastfeeding duration of 21 months. This duration balances the benefits of extended breastfeeding with potential risks associated with prolonged exposure, reflecting both ancient wisdom and contemporary evidence. Key findings suggest that breastfeeding may play a preventive role in mitigating ASD symptoms and enhancing neurodevelopment through mechanisms such as immune regulation, microbiome diversity, and hormonal pathways. These insights underline the need for further specialized research to explore the long-term impacts of breastfeeding on ASD-related outcomes.

An extension of the theory of planned behaviour to predict exclusive breastfeeding among Australian mother-father dyads using structural equation modelling

OBJECTIVES

The objective of this paper was to examine the predictors of breastfeeding exclusivity at two time-points (6 and 26 weeks postpartum) using a dyadic mother-father extended model of the theory of planned behaviour.

DESIGN/METHOD

A sample of 1139 first-time Australian mother-father dyads completed measures of each of the Theory of Planned Behaviour variables (intention, attitudes, subjective norms, and perceived behavioural control) and additional psychosocial and behavioural predictors of breastfeeding, including problems with breastfeeding, psychological distress, childcare stress, partner support, and the frequency and time of first public breastfeed. Confirmatory factor analyses were used to determine the factor structures of the latent constructs to be included in the structural model. Structural equation modelling was used to model pathways between variables.

RESULTS

Breastfeeding exclusivity at 6 weeks was significantly predicted by breastfeeding self-efficacy at 6 weeks, intention to exclusively breastfeed, and frequency of public breastfeeding over the month prior, whereas childcare stress, partner support, time of first public breastfeed, and fathers' variables (attitudes and subjective norms) had little influence. Self-efficacy mediated the relationship between mothers' attitudes, psychological distress, and breastfeeding problems with breastfeeding exclusivity at 6 weeks. Breastfeeding exclusivity at 26 weeks was significantly predicted by mothers' attitudes, self-efficacy, breastfeeding exclusivity at 6 weeks, and frequency of public breastfeeding in the month prior.

CONCLUSIONS

The results highlight the importance of breastfeeding self-efficacy and confidence to breastfeed in public as crucial constructs in promoting long-term exclusive breastfeeding and provides support for an extended theory of planned behaviour model in predicting breastfeeding outcomes.

Kidney disease and reproductive health

Understanding the relationship between reproductive health and kidney function is important to provide holistic care for people living with kidney disease. Chronic kidney disease (CKD) has negative impacts on both male and female fertility owing to factors including inflammation, hormonal dysregulation, reduced ovarian reserve, reduced sperm quality and sexual dysfunction. However, pregnancy is achievable for most cisgender women with kidney disease, including kidney transplant recipients and patients on dialysis. CKD in pregnancy is associated with health risks to the mother and child, including increased risk of progression of kidney disease, hypertensive complications of pregnancy, and neonatal complications including fetal growth restriction, preterm birth and stillbirth. However, with appropriate pre-pregnancy counselling, fertility assessment and support, health optimization, and evidence-based antenatal care, the majority of patients will achieve a good outcome. Medication safety should be reviewed before and during pregnancy and lactation, weighing the risk of disease flare against potential adverse effects on the offspring. Important areas for further research include the optimal timing of delivery and the short- and long-term cardiovascular and renal impacts of pregnancy in patients with CKD, as well as long-term kidney and cardiovascular outcomes in their offspring.

Mothers' Gender-role Ideologies and Exclusive Breastfeeding in Western Rural China: A Cross-Sectional Study

BACKGROUND

Shifts in women's maternal roles may contribute to the global low prevalence of exclusive breastfeeding.

RESEARCH AIM

To investigate the association between maternal gender-role ideologies and exclusive breastfeeding in rural China.

METHODS

Cross-sectional studies were conducted in 10 counties in Shaanxi Province using random sampling in 2021 and 2023. Data on breastfeeding practices, maternal gender-role ideology, and expected educational attainment from 586 rural participants were collected through structured questionnaires. Multivariable regression analysis was employed to explore the association between maternal gender-role ideology and exclusive breastfeeding.

RESULTS

The prevalence of exclusive breastfeeding within 6 months in rural western China was 18.8%. Women with more egalitarian gender-role ideologies were more likely to engage in exclusive breastfeeding (OR = 1.34, 95% CI [1.04, 1.72]), particularly for female infants (OR = 1.63, 95% CI [1.09, 2.43]). Furthermore, women with stronger egalitarian gender-role ideologies were found to exhibit a greater propensity for financial investment in their children (Beta = 0.20, 95% CI [0.01, 0.40]) and hold higher educational expectations for their daughters (OR = 1.50, 95% CI [1.00, 2.25]).

CONCLUSION

Maternal gender-role ideology positively correlates with exclusive breastfeeding. More policies should be implemented on gender equality in rural China, and cultural perspectives should be incorporated into the analysis of breastfeeding practice.

Nutritional management of the child with chronic kidney disease and on dialysis

While it is widely accepted that the nutritional management of the infant with chronic kidney disease (CKD) is paramount to achieve normal growth and development, nutritional management is also of importance beyond 1 year of age, particularly in toddlers, to support the delayed infantile stage of growth that may extend to 2-3 years of age. Puberty is also a vulnerable period when nutritional needs are higher to support the expected growth spurt. Inadequate nutritional intake throughout childhood can result in failure to achieve full adult height potential, and there is an increased risk for abnormal neurodevelopment. Conversely, the rising prevalence of overweight and obesity among children with CKD underscores the necessity for effective nutritional strategies to mitigate the risk of metabolic syndrome that is not confined to the post-transplant population. Nutritional management is of primary importance in improving metabolic equilibrium and reducing CKD-related imbalances, particularly as the range of foods eaten by the child widens as they get older (including increased consumption of processed foods), and as CKD progresses. The aim of this review is to integrate the Pediatric Renal Nutrition Taskforce (PRNT) clinical practice recommendations (CPRs) for children (1-18 years) with CKD stages 2-5 and on dialysis (CKD2-5D). We provide a holistic approach to the overall nutritional management of the toddler, child, and young person. Collaboration between physicians and pediatric kidney dietitians is strongly advised to ensure comprehensive and tailored nutritional care for children with CKD, ultimately optimizing their growth and development.

The Onset of Steatosis Occurs as Early as Seven Days and Progresses to Nonalcoholic Steatohepatitis in a Pediatric Pig Model of Nonalcoholic Fatty Liver Disease

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a chronic and progressive condition that afflicts patients of all ages, including neonates. Previously, we reported that neonatal pigs fed formulas rich in medium-chain (MCFA), compared with those fed formulas rich in long-chain fatty acid (LCFA) for 21 d, developed panacinar steatosis with no changes in whole-body adiposity.

OBJECTIVES

The objective of this study was to examine the temporal onset and development of NAFLD in neonatal pigs in response to MCFA feeding.

METHODS

Neonatal pigs (n = 18) were fed isocaloric MCFA or LCFA formulas. Six pigs from each group were killed following 7, 14 or 21 d of feeding. Body composition was assessed before initiation and at the end of the feeding period using dual-energy X-ray absorptiometry. Liver fat content and liver morphologic features were determined from photomicrographs and evaluated for NAFLD by a pathologist.

RESULTS

Lean mass and fat mass as a percentage of body weight were not different between formulas. However, liver weight (P = 0.001) and liver fat mass (P < 0.001) were greater for pigs in the MCFA than those for pigs in the LCFA group. Steatosis developed as early as 7 d in the MCFA compared with the LCFA fed pigs (P < 0.001). In addition, steatosis progressed in a portal-to-venous direction as MCFA feeding duration increased (P = 0.02). Pigs diagnosed with NASH (P < 0.001) and greater nonalcoholic fatty liver disease scores were those in the MCFA group (P < 0.001).

CONCLUSIONS

These results suggest that the onset and progression of NAFLD from steatosis to nonalcoholic steatohepatitis occurs rapidly in response to MCFA feeding. Moreover, periportal steatosis is the initial feature in the development of NAFLD before its progression to nonalcoholic steatohepatitis. The development of NAFLD in neonates seems to occur independently of whole-body adiposity.

Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study

BACKGROUND

Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries.

OBJECTIVE

This study investigated the association between breastfeeding duration and children's educational attainment in rural Southwest Uganda.

METHODS

We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics.

RESULTS

Most mothers breastfed for more than a year. Just over one-third breastfed for 18-23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7-12, 13-17, 18-23, and > 23 months compared to those breastfed for 0-6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses.

CONCLUSION

Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children's health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.

Breast refusal: an analysis of frequency, onset timing, recovery status, and their interplay with breastfeeding self-efficacy and maternal depression

OBJECTIVES

This cross-sectional study aimed to explore the frequency of breast refusal (BR), associated factors including postpartum depression and breastfeeding self-efficacy, and investigate the recovery status following BR.

METHODS

The survey comprised four sections, to investigate the sociodemographic characteristics of mothers and their babies, Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), the Edinburgh Postnatal Depression Scale (EPDS) of mothers, and features associated with BR. The survey was administered online to those with babies aged 0-24 months. Specific questions related to BR were directed to mothers who experienced it within the first 12 months.

RESULTS

The study encompassed 651 mothers, with a mean age of 30.5 ± 3.6 years, and revealed that 35.6% experienced BR. The presence or history of BR was associated with monthly household income, nurse-midwife support during the first breastfeeding, nipple shape, co-sleeping practices, mother-in-law's support in child care, and BSES-SF scores. Notably, mothers facing breastfeeding-related challenges such as engorgement, pressured milk issues, and infants with gas-related concerns, -excluding low milk supply, pacifier or bottle use-, demonstrated higher recovery from BR.

CONCLUSIONS

Some sociodemographic factors, social support, mothers characteristics were associated with the BR. In addition, several challenges were present in BR recovery. Mothers need to be supported in child care and house work to prevent and improve BR and restore breastfeeding. Additinal cohort studies with the possible related factors for BR are necessary to implement targeted interventions to prolong breastfeeding duration.

Exclusive breastfeeding: an exploratory thematic analysis of the perspectives of breastfeeding mothers and significant others in the Tamale metropolis of Northern Ghana

INTRODUCTION

Exclusive breastfeeding is widely recognized as the optimal way to feed infants due to its numerous health benefits for both the child and the mother. Despite its advantages, Ghana is still far from attaining World Health Organization (WHO) recommended rates. This study is aimed at exploring the knowledge attitude and practices, where the practices hinged on facilitators, barriers, and sociocultural perspectives of breastfeeding mothers and significant others on exclusive breastfeeding.

METHODS

This study employed an ethnographic thematic analysis framed by the socioecological model (SEM). Thematic analysis was paired with focus group discussions (FGDs). The study participants were recruited purposively by employing a snowball sampling technique with the assistance of community health volunteers. Three (3) FGDs were formed, with 10 participants in each group, to gather perspectives from breastfeeding mothers and significant others (partners and grandmothers) in three communities with Community-based Health Planning and Services (CHPS) compounds within the Tamale metropolis. With an interview guide, all FGDs were audio-taped, transcribed verbatim, and translated from local dialects to English. The emerging themes were used in writing a narrative account, guided by the principles of thematic analysis.

RESULTS

This study identified three thematic areas: knowledge of exclusive breastfeeding (EBF); attitudes toward EBF and practices of EBF (facilitators, barriers, and sociocultural practices). There was some knowledge disparity among lactating mothers despite the overall high knowledge and subpar attitudes of some mothers. The practice of exclusive breastfeeding was substandard. The major hindrances identified were cultural barriers propagated by partners/husbands and grandmothers; the belief that the weather here does not support EBF; and the need for spiritual herbs in infancy. Supportive healthcare providers helped increase the practice of exclusive breastfeeding. Some support also came from partners and husbands, and some mothers showed unique positive behaviors by exclusively breastfeeding.

CONCLUSION

This study revealed that while exclusive breastfeeding education has been ongoing for decades, sociocultural norms still influence mothers to deviate from WHO recommendations. Public education is recommended to dispel misconceptions surrounding exclusive breastfeeding, develop a food galactagogue to help with breastmilk volumes and create a supportive environment that empowers mothers and families to make informed choices that optimize the health and well-being of both infants and mothers.

The drospirenone only pill as a contraceptive option for breastfeeding women: First data on users' acceptability and newborn development

BACKGROUND

Progestin-only pills (POPs) have been used for contraception in breastfeeding women for years. The existing guidelines allow the use of these contraceptives.

METHODS

Multicenter study with a single visit and retrospective data review. The study involved 100 women who used a drospirenone-only pill (DRSP) for contraception for at least 5 months during breastfeeding. The study aimed to analyze for those successful users the impact on new-born development, the bleeding profile and evaluate user satisfaction.

RESULTS

Analysis of the newborns showed that their growth parameters length and weight, were within the expected range of standard development. The mean birth weight was 3368 g, with the lowest recorded weight being 2860 g and the highest 5040 g. The median length of the newborns was 55 cm, ranging from 35 to 65 cm. All new-borns demonstrated appropriate growth within the established percentiles. Acceptability with the bleeding profile was rated with a VAS score: the mean acceptability rating was 82.8. Women aged 35 years or older reported significantly higher acceptability compared to younger women (≥35 years: mean = 88.4, SD = 16.5; <35 years: mean = 80.3, SD = 20.2) (p = 0.02). Sixty-one patients (N = 61; 61.0%; 95% CI: 50.7 - 70.4%) expressed willingness to continue using DRSP after breastfeeding.

CONCLUSION

Among those patients who continued the use of the DRSP only-pill for 5 months, this study shows no negative impact for new-borns, with no clinical influence observed on their growth. Additionally, those users expressed high satisfaction with the bleeding profile of the pill.Clinical trial registration number: DRKS00028438 .

Breastfeeding and Children's Cognitive Development up to the Age of 4 Years: The Japan Environment and Children's Study

Objective: Breastfeeding, depending on its duration, has been suggested to benefit children's cognitive development. We aimed to examine this issue by using the Japan Environment and Children's Study, a nationwide prospective birth cohort study. Methods: We evaluated the relationship between feeding methods and cognitive development in 2- and 4-year-old children. We classified the children based on the following feeding method during the first 6 months postpartum: (1) exclusive breastfeeding group, solely breastfeeding; (2) partial breastfeeding group, solely breastfeeding for ≤5 months and combination of breastfeeding/formula for the rest of months; (3) formula-fed group, solely formula feeding for ≥4 months; and (4) others. Cognitive development was assessed by trained testers using the Kyoto Scale of Psychological Development 2001. Results: Data on 1,329 boys and 1,398 girls were analyzed. Multiple regression analysis was performed using the exclusive breastfeeding group as the reference. Boys of age 2 years in the formula-fed group had significantly lower developmental quotients (DQs) in the language-social developmental (L-S) area (partial regression coefficient [B]: -4.624, p = 0.01), whereas no significant difference was observed in those of age 4 years. Girls of age 2 and 4 years in the formula-fed group had significantly lower L-S area DQ (B: -3.637, p = 0.03 and B: -3.414, p = 0.03, respectively). In the partial breastfeeding group, no significant differences in the L-S area DQ were observed in 2- and 4-year-old boys and girls. Conclusions: Exclusive breastfeeding for the first 6 months postpartum may be more beneficial for verbal cognitive development in 4-year-old girls than solely formula feeding for ≥4 months. Furthermore, breastfeeding combined with formula for the first 6 months postpartum may not have a disadvantage on cognitive development in boys and girls of age ≥ 2 years, when compared with that observed with exclusive breastfeeding during the first 6 months postpartum.

A systematic review and meta-analysis of breastfeeding and neurodevelopmental outcomes in preterm infant

Background

Prematurity significantly impacts neonatal health worldwide, necessitating effective interventions to improve outcomes for these vulnerable infants. While breastfeeding has emerged as a cornerstone of preterm care, its precise impact on neurodevelopment remains a subject of ongoing inquiry and debate. This systematic review aims to investigate the existing evidence in this area.

Methods

On December 17, 2023, online databases including PubMed, The Cochrane Library, Embase, Web of Science, CNKI, VIP, CBM, and Wan Fang Data were searched. Comparisons were classified into several categories: never breastfeeding (Never-BF) versus exclusive breastfeeding, Never-BF versus any breastfeeding (Any-BF), predominant preterm formula (Pre-PTF) versus predominant breastfeeding (Pre-BF), and Pre-PTF versus predominant donor breast milk (Pre-DBM) groups. Randomized controlled trials and observational studies were analyzed separately through meta-analyses. Each study's risk of bias was assessed, and the GRADE system was utilized to evaluate the certainty of the findings.

Results

Sixteen studies met the inclusion criteria, comprising one RCT and 15 cohort studies. The key findings indicated that infants in the Any-BF groups demonstrated superior long-term cognitive scores compared to those in the Never-BF groups, particularly evident in infants assessed before 18 months in the Pre-BF groups versus Pre-PTF groups. A reduced risk of neurodevelopmental impairment was also observed in preterm infants in the Any-BF groups. Evidence regarding the effect of breastfeeding on motor development was inconclusive, except for potential motor improvement in extremely low birth weight infants in the Any-BF groups. Neither exclusive breastfeeding nor pre-DBM exhibited clear superiority over Pre-PTF in terms of neurodevelopmental outcomes for preterm infants. Caution is warranted due to potential publication bias impacting the assessment of breastfeeding's impact on motor skills.

Conclusion

Our systematic review supports current recommendations for breastfeeding in preterm infants, emphasizing its positive effects on cognitive abilities and reduced risk of neurodevelopmental disorders. Further studies are needed to clarify if DHM provides neurodevelopmental benefits comparable to maternal milk, as current evidence does not sufficiently address this question. Additionally, future investigations should prioritize refining our understanding of the influence of breastfeeding on motor development in this vulnerable population.

Systematic review registration

PROSPERO, identifier CRD42023492274, Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023492274.

Factors associated with exclusive breastfeeding for the first six months among caregivers of children under five years in northern Ghana: A cross-sectional study

Despite consistent evidence highlighting the benefits of exclusive breastfeeding (EBF) for the first six months, EBF duration sometimes falls short of six months or exceeds it. This research seeks to explore factors influencing the practice of optimal duration of EBF and identify factors associated with suboptimal EBF durations. A cross-sectional survey was conducted in 16 districts across four Northern regions of Ghana with 2000 caregivers of children under five years old. The analysis specifically focused on a subset of 1761 biological mothers. Logistic regression was conducted to discern socio-demographic, care-seeking, and behavioral determinants influencing the practice of EBF for a six-month duration. Additionally, multinomial logistic regression was used to identify factors associated with suboptimal EBF durations, categorized as less than and beyond six months. All biological mothers breastfed their youngest child, varying in durations: 75% exclusively breastfed for six months, 19.2% for less than six months, and 5.9% for beyond six months. Several behavioral determinants influenced EBF for six months, with biological mothers ' confidence in their ability to EBF (aOR: 6.8 95% CI, 4.13-11.33), willingness to recommend EBF practice to friends and family (aOR: 10.5 95% CI, 4.13-26.62) and perception of practicing EBF as normative in the community showing statistically significant associations (aOR: 6.3, 95% CI, 4.41-9.10). Education and religion of biological mothers were also significantly associated with EBF for six months. While there was overlap in behavioral factors associated with EBF for less than and beyond six months, the socio-demographic characteristics of biological mothers associated with these suboptimal durations of EBF differed. Among the factors included in this study, social norms, caregiver confidence, and approval of EBF were key factors influencing the recommended duration of EBF practices. These findings highlight the importance of community and cultural contexts in shaping biological mothers' behavior and emphasize the need to address socio-cultural barriers and facilitators that influence EBF practices, as well as empower biological mothers to adopt and sustain these practices.

Effects of Nurse-Led Intervention for Mother-Infant Dyads on Breastfeeding, Infant Health Outcomes

AIM

This study aimed to investigate the efficacy of nurse-led interventions in enhancing breastfeeding women's knowledge and practices and in preventing diarrhea among their infants.

METHODS

The study was conducted in rural areas of Haryana, India, and used the survey design and pre-experimental research design in Phase I and Phase II, respectively. Mothers who had recently delivered a baby were identified using the birth register at the panchayat office, and 200 mothers who met the inclusion criteria were chosen using purposive sampling technique. The data were collected by interview approach using the knowledge questionnaire on breastfeeding, observational checklist on practice of breastfeeding, diarrhea assessment tool, and the duration of data collection was between May to August 2022. In Phase I, exclusive and non-exclusive breastfeeding mothers were surveyed regarding the occurrence of diarrhea among infants. In Phase II, non-exclusive breastfeeding mothers' knowledge and practice were assessed, and then nurseled intervention on breastfeeding was administrated and on 30th, 60th, and 90th days, post-test was done.

RESULTS

The study's findings demonstrate that the knowledge and practice scores varied significantly across different tests, from pre-test 1 (6.73 ± 1.94) to post-test 3 (16.19 ± 3.04), (F=294.11, p < .000) for knowledge, and for practice pre-test 1 (23.41 ± 8.90) to post-test 3 (101.81 ± 22.4), (F=535.98, p < .000) in the intervention group. Further, in the intervention group, there was decrease in diarrhea occurrence among various observations (Q=60.609, p < .000).

CONCLUSION

The nurse-led intervention of breastfeeding is an effective teaching technique to improve the knowledge and practice of mothers, as well as it helps to reduce the occurrence of diarrhea among infants, there by it can contribute to reducing the infant mortality rate.

Biological effects of combinations of structurally diverse human milk oligosaccharides

Human milk oligosaccharides (HMOs) are a diverse group of structures and an abundant bioactive component of breastmilk that contribute to infant health and development. Preclinical studies indicate roles for HMOs in shaping the infant gut microbiota, inhibiting pathogens, modulating the immune system, and influencing cognitive development. In the past decade, several industrially produced HMOs have become available to fortify infant formula. Clinical intervention trials with manufactured HMOs have begun to corroborate some of the physiological effects reported in preclinical studies, especially modulation of the gut microbiota in the direction of breastfed infants. As more HMOs become commercially available and as HMOs have some shared mechanisms of action, there is a need to better understand the unique and differential effects of individual HMOs and the benefits of combining multiple HMOs. This review focuses on the differential effects of different HMO structural classes and individual structures and presents a scientific rationale for why combining multiple structurally diverse HMOs is expected to exert greater biological effects.

Impact of Maternal Body Composition, Hydration, and Metabolic Health on Breastfeeding Success: A Comprehensive Review

It is well established that breastfeeding provides significant health benefits for both the mother and the infant. The World Health Organization recommends initiating breastfeeding within the first hour after birth and continuing exclusive breastfeeding for 6 months. Successful breastfeeding is influenced not only by the proper physiological preparation of the body and the action of pregnancy-related hormones but also by the mother's overall health status. However, the role of maternal body composition and metabolic condition in breastfeeding success has received little attention. To better understand the impact of these factors on breastfeeding effectiveness, we reviewed the latest research on this topic, with particular emphasis on the role of hydration and lipid metabolism. Our narrative review indicates that the amount and distribution of water and adipose tissue are crucial for successful lactation and that various hormonal imbalances and metabolic disorders increase the risk of delayed breastfeeding initiation, shortened breastfeeding duration, or insufficient milk production. In light of our findings, measurement methods for assessing described parameters were also introduced. This article aims to review the effects of maternal body composition, hydration status, and metabolic and social factors on lactation and breastfeeding.

Human milk and breastfeeding during ketogenic diet therapy in infants with epilepsy: Clinical practice guideline

Ketogenic diet therapy (KDT) is a safe and effective treatment for epilepsy and glucose transporter type 1 (GLUT1) deficiency syndrome in infancy. Complete weaning from breastfeeding is not required to implement KDT; however, breastfeeding remains uncommon. Barriers include feasibility concerns and lack of referrals to expert centres. Therefore, practical strategies are needed to help mothers and professionals overcome these barriers and facilitate the inclusion of breastfeeding and human milk during KDT. A multidisciplinary expert panel met online to address clinical concerns, systematically reviewed the literature, and conducted two international surveys to develop an expert consensus of practical recommendations for including human milk and breastfeeding in KDT. The need to educate about the nutritional benefits of human milk and to increase breastfeeding rates is emphasized. Prospective real-world registries could help to collect data on the implementation of breastfeeding and the use of human milk in KDT, while systematically including non-seizure-related outcomes, such as quality of life, and social and emotional well-being, which could improve outcomes for infants and mothers. WHAT THIS PAPER ADDS: Human milk and breastfeeding can be incorporated safely into ketogenic diet therapy. With expert guidance, human milk and breastfeeding do not reduce diet effectiveness. We show two strategies for clinical practice to include human milk. Mothers can be encouraged to continue breastfeeding.

Why do mothers mix milk feed their infants? Results from a systematic review

CONTEXT

Combining or supplementing breastfeeding with formula feeding, also called mixed milk feeding (MMF), is a common infant feeding practice. However, there is no well-established MMF evidence-base for informing and guiding parents. A better understanding of the reasons why mothers practice MMF may facilitate identification of efficient strategies for supporting exclusive breastfeeding, and/or opportunities to prolong breastfeeding, at least partially.

OBJECTIVE

An updated systematic literature review was undertaken with the primary aim of gaining a deeper understanding of the reasons why mothers choose MMF.

DATA SOURCES

Six databases were searched for relevant articles published in English from January 2012 to January 2022.

DATA EXTRACTION

Two reviewers independently performed the screenings and data extraction, and any differences were resolved by a third reviewer. Data from 138 articles were included, 90 of which contained data on MMF reasons/drivers, and 60 contained data on infant age and/or maternal demographic factors associated with MMF.

DATA ANALYSIS

A total of 13 different unique MMF drivers/reasons were identified and categorized according to whether the drivers/reasons related to perceived choice, necessity, or pressure. Risk of bias was evaluated using the Quality Assessment Tool of Diverse Studies and the JBI Systematic Reviews tool. Several different terms were used to describe and classify MMF across the studies. The most commonly reported reasons for MMF were related to a perception of necessity (39% of drivers, eg, concerns about infant's hunger/perceived breast milk insufficiency or breastfeeding difficulties), followed by drivers associated with perceived choice (34%; eg, having more flexibility) and perceived pressure (25%; eg, returning to work or healthcare professionals' advice). This was particularly true for infants aged 3 months or younger.

CONCLUSION

The key global drivers for MMF and their distribution across infant age and regions were identified and described, providing opportunities for the provision of optimal breastfeeding support. A unified definition of MMF is needed in order to enable more comparable and standardized research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022304253.

Predictors of Direct Breastfeeding in Preterm Infants

Objective: Rates of mother's own milk (MOM) provision in the neonatal intensive care unit (NICU) vary widely, despite acceptance as the gold standard for nutrition in preterm infants. Direct breastfeeding (DBF) supports long-term provision of MOM, but factors that support DBF in preterm infants are unknown. The purpose of this study was to identify factors that predict DBF at oral feeding initiation and at NICU discharge. Methods: This was a retrospective cohort study of preterm infants born at ≤ 32 weeks who were receiving MOM at 32 weeks corrected gestational age (cohort 1) and at discharge to home (cohort 2). The primary outcomes were rates of DBF at oral feeding initiation (cohort 1) and at hospital discharge (cohort 2). We examined bivariate associations between infant characteristics, maternal sociodemographic factors, and hospital practices (e.g., lactation visit timing and frequency) with DBF outcomes and then built logistic regression models to determine the adjusted odds ratio and 95% confidence interval ([adjusted odds ratio [aOR] [95%CI]) for independent predictors of the DBF outcomes. Results: Sixty-four percent of eligible infants initiated DBF, and 51% were DBF at discharge. Sociodemographic, NICU, and lactation support factors were associated with both outcomes. Post hoc analysis showed that similar factors also influenced lactation support provision. Conclusions: Lactation support, NICU and sociodemographic variables influence DBF initiation and DBF at discharge. Interventions that optimize efficient use of available lactation support, address bias, and provide ample opportunity for DBF practice could improve rates.

A microbial symphony: a literature review of the factors that orchestrate the colonization dynamics of the human colonic microbiome during infancy and implications for future health

Since the advent of new sequencing and bioinformatic technologies, our understanding of the human microbiome has expanded rapidly over recent years. Numerous studies have indicated causal links between alterations to the microbiome and a range of pathological conditions. Furthermore, a large body of epidemiological data is starting to suggest that exposure, or lack thereof, to specific microbial species during the first five years of life has key implications for long-term health outcomes. These include chronic inflammatory and metabolic conditions such as diabetes, asthma, inflammatory bowel disease (IBD), and obesity, with the effects lasting into adulthood. Human microbial colonisation during these first five years of life is a highly dynamic process, with multiple environmental exposures recently being characterised to have influence before the microbiome stabilises and resembles that of an adult at 3-5 years. This short period of time, known as the window of opportunity, appears to "prime" immunoregulation for later life. Understanding and appreciating this aspect of human physiology is therefore crucial for clinicians, scientists, and public health officials. This review outlines the most recent evidence for the pre- and post-natal environments that order the development of the microbiome, how these influences metabolic and immunoregulatory pathways, and their associated health outcomes. It also discusses the limitations of the current knowledge base, and describes the potential microbiome-mediated interventions and public health measures that may have therapeutic potential in the future.

Induced lactation in a transgender woman: case report

BACKGROUND

Breastfeeding offers significant health benefits, but its practice and success can vary. While research on induced lactation in cisgender women has been documented, there is limited research on lactation induction in transgender women.

CASE PRESENTATION

A 50-year-old transgender woman undergoing hormone therapy and living with a pregnant partner sought to co-feed using induced lactation. After approval by the hospital ethics committee, a regimen of estradiol, progesterone, and domperidone was initiated, accompanied by nipple stimulation. Lactation was successfully induced and maintained, with milk composition analysis indicating high levels of protein and other key nutrients. This case, the seventh reported, highlights the complexity of lactation induction in transgender women, considering factors such as age, obesity, and insulin resistance. The nutrient profile of the milk suggests its suitability for infant feeding, despite some differences from typical human milk.

CONCLUSIONS

Induced lactation is feasible in transgender women, expanding the understanding of non-puerperal lactation and its potential in diverse family structures. Further research is warranted to optimize lactation induction protocols in transgender women.

Direct breastfeeding frequency of late preterm and term infants in the neonatal intensive care unit and availability of mother's own milk at six months of age. a retrospective cohort study

BACKGROUND

Mother's Own Milk (MOM) reduces the risk of complications in premature infants. Breastfeeding rates for late preterm and term infants in the neonatal intensive care unit (NICU) are significantly lower than that of breastfed healthy term newborns at 6 months of age.

DESIGN

This was a retrospective cohort study of neonates born at 34 weeks 0 days or later. Infants who were directly breastfed in the NICU and were discharged on breast milk were included. Logistic regression modeling was used to determine the significance of association.

RESULTS

171 mother-infant dyads were included. After adjusting for confounders, the number of breastfeeding attempts during the NICU stay was significantly associated with the availability of MOM at six months of age (p = 0.003, 95% CI 1.02 to 1.14).

CONCLUSION

This study is the first to show an association between the number of direct breastfeeding attempts in the NICU and availability of MOM at six months of age.

Relationship between Infant Feeding and the Microbiome: Implications for Allergies and Food Intolerances

Childhood is a critical period for immune system development, which is greatly influenced by the gut microbiome. Likewise, a number of factors affect the gut microbiome composition and diversity, including breastfeeding, formula feeding, and solid foods introduction. In this regard, several studies have previously demonstrated that breastfeeding promotes a favorable microbiome. In contrast, formula feeding and the early incorporation of certain solid foods may adversely affect microbiome development. Additionally, there is increasing evidence that disruptions in the early microbiome can lead to allergic conditions and food intolerances. Thus, developing strategies to promote optimal infant nutrition requires an understanding of the relationship between infant nutrition and long-term health. The present review aims to examine the relationship between infant feeding practices and the microbiome, as well as its implications on allergies and food intolerances in infants. Moreover, this study synthesizes existing evidence on how different eating habits influence the microbiome. It highlights their implications for the prevention of allergies and food intolerances. In conclusion, introducing allergenic solid foods before six months, alongside breastfeeding, may significantly reduce allergies and food intolerances risks, being also associated with variations in gut microbiome and related complications.

Effect and Concern of Breastfeeding in Infants

Human breast milk is considered the optimal source of nutrition for infants and is recommended as the exclusive nutrient source for term infants during the first six months of life. Existing evidence strongly supports the direct benefits of breastfeeding, encompassing benefits for nutrition, gastrointestinal function, and protection against acute illness in both term and preterm infants. Previously, we demonstrated a notable reduction in a urinary marker of oxidative DNA damage in breastfed term and preterm infants compared to formula-fed infants. While long-term benefits of breastfeeding on neurodevelopmental outcomes and adult health have been reported, the effects may be relatively modest and limited.

Augmenting Telepostpartum Care With Vision-Based Detection of Breastfeeding-Related Conditions: Algorithm Development and Validation

BACKGROUND

Breastfeeding benefits both the mother and infant and is a topic of attention in public health. After childbirth, untreated medical conditions or lack of support lead many mothers to discontinue breastfeeding. For instance, nipple damage and mastitis affect 80% and 20% of US mothers, respectively. Lactation consultants (LCs) help mothers with breastfeeding, providing in-person, remote, and hybrid lactation support. LCs guide, encourage, and find ways for mothers to have a better experience breastfeeding. Current telehealth services help mothers seek LCs for breastfeeding support, where images help them identify and address many issues. Due to the disproportional ratio of LCs and mothers in need, these professionals are often overloaded and burned out.

OBJECTIVE

This study aims to investigate the effectiveness of 5 distinct convolutional neural networks in detecting healthy lactating breasts and 6 breastfeeding-related issues by only using red, green, and blue images. Our goal was to assess the applicability of this algorithm as an auxiliary resource for LCs to identify painful breast conditions quickly, better manage their patients through triage, respond promptly to patient needs, and enhance the overall experience and care for breastfeeding mothers.

METHODS

We evaluated the potential for 5 classification models to detect breastfeeding-related conditions using 1078 breast and nipple images gathered from web-based and physical educational resources. We used the convolutional neural networks Resnet50, Visual Geometry Group model with 16 layers (VGG16), InceptionV3, EfficientNetV2, and DenseNet169 to classify the images across 7 classes: healthy, abscess, mastitis, nipple blebs, dermatosis, engorgement, and nipple damage by improper feeding or misuse of breast pumps. We also evaluated the models' ability to distinguish between healthy and unhealthy images. We present an analysis of the classification challenges, identifying image traits that may confound the detection model.

RESULTS

The best model achieves an average area under the receiver operating characteristic curve of 0.93 for all conditions after data augmentation for multiclass classification. For binary classification, we achieved, with the best model, an average area under the curve of 0.96 for all conditions after data augmentation. Several factors contributed to the misclassification of images, including similar visual features in the conditions that precede other conditions (such as the mastitis spectrum disorder), partially covered breasts or nipples, and images depicting multiple conditions in the same breast.

CONCLUSIONS

This vision-based automated detection technique offers an opportunity to enhance postpartum care for mothers and can potentially help alleviate the workload of LCs by expediting decision-making processes.

Sertraline, citalopram and paroxetine in lactation: passage into breastmilk and infant exposure

Objectives

This study aimed to investigate the plasma and breastmilk concentrations for sertraline, citalopram and paroxetine for assessment of the Milk/Plasma (M/P) ratio and Absolute Infant Dose (AID), and to determine actual infant drug exposure through breastfeeding. Subsequently, informed recommendations will be formulated regarding the advisability of breastfeeding in women undergoing treatment with the three most widely used antidepressants.

Methods

A pharmacokinetic study in lactating women and their infants using sertraline, citalopram or paroxetine was performed. Paired breastmilk and plasma samples and single point infant plasma samples were collected to determine antidepressant concentrations. An Area Under the Curve (AUC) based approach with the trapezoidal rule was used to calculate M/P ratios and AID for all three antidepressants by combining all measured concentrations for the same dose.

Results

Thirty-seven lactating women and their infants participated in this study. 111 paired breastmilk and plasma samples and 37 single point infant plasma samples were collected. Detectable concentrations of sertraline, citalopram and paroxetine were present in all breastmilk samples. For sertraline and citalopram M/P ratio is above one, indicating higher breastmilk than plasma concentrations, however, drug exposure by breastmilk did not lead to detectable plasma drug levels in any of the 15 infants for sertraline, for nine (out of 13) infants for citalopram and for eight (out of nine) infants for paroxetine.

Conclusion

Given the well-known benefits of breastfeeding, our findings support breastfeeding of infants by mothers who are taking sertraline, citalopram or paroxetine is safe. Sertraline and paroxetine are the preferred antidepressants during breastfeeding, reaching mostly undetectable infant drug levels.

Identifying Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD): a Public Health Concern and Opportunity

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders with significant individual and societal negative impacts of the disorder continuing into adulthood (Danielson et al. in Journal of Clinical Child and Adolescent Psychology, in press; Landes and London in Journal of Attention Disorders 25:3-13, 2021). Genetic and environmental risk (e.g., modifiable exposures such as prenatal tobacco exposure and child maltreatment) for ADHD is likely multifactorial (Faraone et al. in Neuroscience & Biobehavioral Reviews 128:789-818, 2021). However, the evidence for potentially modifiable contextual risks is spread across studies with different methodologies and ADHD criteria limiting understanding of the relationship between early risk factors and later childhood ADHD. Using common methodology across six meta-analyses (Bitsko et al. in Prevention Science, 2022; Claussen et al. in Prevention Science 1-23, 2022; Dimitrov et al. in Prevention Science, 2023; Maher et al. in Prevention Science, 2023; Robinson, Bitsko et al. in Prevention Science, 2022; So et al. in Prevention Science, 2022) examining 59 risk factors for childhood ADHD, the papers in this special issue use a public health approach to address prior gaps in the literature. This introductory paper provides examples of comprehensive public health approaches focusing on policy, systems, and environmental changes across socio-ecological contexts to improve health and wellbeing through prevention, early intervention, and support across development using findings from these meta-analyses. Together, the findings from these studies and a commentary by an author independent from the risk studies have the potential to minimize risk conditions, prioritize prevention efforts, and improve the long-term health and wellbeing of children and adults with ADHD.

Association of Food Security With Breastfeeding Practices: A Scoping Review

Breastfeeding is the fundamental, physiological, and psychosocial process by which the mother feeds the newborn. Early initiation of breastfeeding is recommended within the first hour of life and exclusive breastfeeding up to six months of age due to its optimal contribution of nutrients for the development of the newborn. Despite this, there are factors that affect this process which involve the nutritional, physical, and psychological state of the mother, such as food security or food insecurity, however, it is unknown if it will have a decisive impact on these factors concerning the cessation of breastfeeding or total duration of breastfeeding. This study is an in-depth review of the available information related to food security as a determinant in breastfeeding practices. We did a scoping review between December 2022 - January 2023. The principal inclusion criteria were: the use of the English language, qualitative and quantitative methods, and analytical studies. All the articles were available in full text and the manuscripts ranged from 1997 and 2022. Twelve studies were included: eight quantitative, two qualitative, and two mixed. In the quantitative studies, significant positive and negative associations were found between food insecurity, exclusive breastfeeding, early initiation of breastfeeding, cessation of breastfeeding, and total duration of breastfeeding. For their part, qualitative and mixed studies describe that women with severe food insecurity tend to feel weak and may have a poor perception of their diet and, consequently, their breastfeeding practices are lower. Moreover, there are qualitative studies that mention that the higher the food insecurity, the more frequently breastfeeding occurs. The inconsistency in the results may be due to factors involving the characteristics of each population, the instrument used to measure food security, and the variables by which the models were adjusted. It is necessary to carry out more studies on the subject since it is obvious that the relationship between the variables needs to be clarified.

Pre-labor and post-labor cesarean delivery and early childhood adiposity in the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study

BACKGROUND/OBJECTIVES

Delivery by cesarean section (CS) compared to vaginal delivery has been associated with increased risk of overweight in childhood. Our study examined if the presence or absence of labor events in CS delivery altered risk of overweight in early childhood (1-5 years) compared to vaginal delivery and if this association differed according to infant sex.

SUBJECTS/METHODS

The study included 3073 mother-infant pairs from the CHILD Cohort Study in Canada. Data from birth records were used to categorize infants as having been vaginally delivered, or delivered by CS, with or without labor events. Age and sex adjusted weight-for-length (WFL) and body mass index (BMI) z scores were calculated from height and weight data from clinic visits at 1, 3 and 5 years and used to classify children as overweight. Associations between delivery mode and child overweight at each timepoint were assessed using regression models, adjusting for relevant confounding factors including maternal pre-pregnancy BMI. Effect modification by infant sex was tested.

RESULTS

One in four infants (24.6%) were born by CS delivery; 13.0% involved labor events and 11.6% did not. Infants born by CS without labor had an increased odds of being overweight at age 1 year compared to vaginally delivered infants after adjustment for maternal pre-pregnancy BMI, maternal diabetes, smoking, infant sex and birthweight-for-gestational age (aOR 1.68 [95% CI 1.05-2.67]). These effects did not persist to 3 or 5 years of age and, after stratification by sex, were only seen in boys (aOR at 1 year 2.21 [95% CI 1.26-3.88]).

CONCLUSION AND RELEVANCE

Our findings add to the body of evidence that CS, in particular CS without labor events, may be a risk factor for overweight in early life, and that this association may be sex-specific. These findings could help to identify children at higher risk for developing obesity.

Preservation of Anti-SARS-CoV-2 Neutralizing Antibodies in Breast Milk: Impact of Maternal COVID-19 Vaccination and Infection

Objectives: To investigate specific immunoglobulin A (sIgA), specific immunoglobulin G (sIgG), and neutralizing antibodies (NAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in breast milk and compare immunity in mothers with hybrid immunity (infection and vaccination) versus those solely vaccinated (coronavirus disease [COVID]-naïve). Methods: A longitudinal study was conducted among lactating mothers who received at least two doses of the coronavirus disease 2019 (COVID-19) vaccine or tested positive for SARS-CoV-2. Details of vaccination and infection were collected through questionnaires and interviews. Fifteen milliliters of breast milk samples, self-collected at 1, 3, and 6 months postvaccination or infection, were sent to analysis for sIgA, sIgG, and NAbs using enzyme-linked immunosorbent assay. Results: In total, 119 lactating mothers (202 milk samples) were enrolled; 82 participants had hybrid immunity, and 32 were COVID-19-naïve. Two-thirds received a combination of different vaccines and booster shots. Breast milk retained sIgA, sIgG, and NAbs for up to 6 months post-COVID vaccination or infection. At 3 months, mothers with hybrid immunity had significantly higher sIgA and NAbs compared with COVID-naïve mothers (geometric mean [95% confidence interval (CI)] of sIgA 2.72 [1.94-3.8] vs. 1.44 [0.83-2.48]; NAbs 86.83 [84.9-88.8] vs. 81.28 [76.02-86.9]). No differences in sIgA, sIgG, and NAbs were observed between lactating mothers receiving two, three, or more than or equal to three doses, regardless of hybrid immunity or COVID-naïve status. Conclusion: sIgA, sIgG, and NAbs against SARS-CoV-2 in breast milk sustained for up to 6 months postimmunization and infection. Higher immunity was found in mothers with hybrid immunity. These transferred immunities confirm in vitro protection, supporting the safety of breastfeeding during and after COVID-19 vaccination or infection.

Does planning to mixed feed undermine breastfeeding?

Continued breastfeeding is important for infants' health, but it is unclear whether mixed feeding increases the risk of breastfeeding cessation. We aimed to explore associations of mixed feeding and lactation problems with early cessation of breastfeeding. We analysed data from mothers who completed the Scottish National Maternal and Infant Feeding Survey and had previously breastfed their infants. At age 8-12 weeks, mothers (N = 1974) reported their feeding history and intentions, lactation problems and reasons for giving formula milk. The main outcome measure was cessation of breastfeeding before 6-8 weeks and time to cessation. By 6 weeks, 65% had mixed fed at some point, 32% had ceased breastfeeding, 22% were currently mixed feeding and 46% were exclusively breastfeeding. Lactation problems before 2 weeks were common (65%), and strongly associated with stopping breastfeeding (relative risk [RR]: 3.23, 95% confidence interval [CI]: 2.0-5.3) and with mixed feeding (RR: 3.14, 95% CI: 2.5-4.0). However, even after adjustment for breastfeeding problems mothers who planned to mixed feed (RR: 3.39, 95% CI: 2.4-4.9) and those who introduced formula for practicalities (RR: 3.21, 95% CI: 2.3-4.4) were more likely to stop breastfeeding. These variables also predicted later lactation insufficiency (planned mixed feeding RR: 1.39, 95% CI: 1.0-2.0; formula for practicalities RR: 1.76, 95% CI: 1.3-2.3). Mothers who received specialist lactation support were less likely to cease breastfeeding (RR: 0.63, 95% CI: 0.5-0.9) but nonspecialist input was unrelated to risk of cessation (RR: 1.06, 95% CI: 0.2-4.9). In conclusion, choosing to mix feed an infant is strongly associated with stopping breastfeeding, even in the absence of lactation problems.

Late Preterm Newborns: Breastfeeding and Complementary Feeding Practices

BACKGROUND

The aim of this study is to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of complementary feeding; Methods: Prospective cohort study was conducted of infants born at 34+0 to 36+6 weeks gestational age in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics during 2020-2021. Families were followed up until the infants reached 12 months of age. Average breastfeeding initial time, average breastfeeding duration time, prevalence of exclusive breastfeeding and average solid-food feeding initiation time were examined. The correlations among factors that might affect breastfeeding rates were calculated using the chi-square test (p < 0.05); Results: In our study with 222 eligible participants, we observed a statistically significant delay in breastfeeding initiation only in the 34+0+6 gestational age group (p < 0.001). At discharge, the 36+0+6 group exhibited a significantly higher exclusive breastfeeding rate (p < 0.001). Over the first year, breastfeeding rates varied, with no correlation found between duration of exclusive breastfeeding and gestational age. Initial solid-food feeding times were similar across groups, and all infants were introduced to vegetables first; Conclusions: Vaginal delivery, skin-to-skin contact after birth, early rooming-in, and breastfeeding within 2 h after birth statistically significantly causes earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid-food feeding at an average age of 5 months, with vegetables being the primary food choice.

Comparative lipidome study of maternal plasma, milk, and lamb plasma in sheep

Lipids play a critical role in neonate development and breastmilk is the newborn's major source of lipids. Milk lipids directly influence the neonate plasma lipid profile. The milk lipidome is dynamic, influenced by maternal factors and related to the maternal plasma lipidome. The close inter-relationship between the maternal plasma, milk and neonate plasma lipidomes is critical to understanding maternal-child health and nutrition. In this exploratory study, lipidomes of blood and breast milk from Suffolk sheep and matched lamb blood (n = 13), were profiled on day 34 post birth by untargeted mass spectrometry. Comparative multivariate analysis of the three matrices identified distinct differences in lipids and class of lipids amongst them. Paired analysis identified 346 differential lipids (DL) and 31 correlated lipids (CL) in maternal plasma and milk, 340 DL and 32 CL in lamb plasma and milk and 295 DL and 16 CL in maternal plasma and lamb plasma. Conversion of phosphatidic acid to phosphatidyl inositol was the most active pathway in lamb plasma compared to maternal plasma. This exploratory study illustrates the partitioning of lipids across maternal plasma, milk and lamb plasma and the dynamic relationship between them, reiterating the need to study these three matrices as one biological system.

Trans isomeric fatty acids in human milk and their role in infant health and development

It is well known that long chain polyunsaturated fatty acids (LCPUFAs) play an important role in neurodevelopment in the perinatal life. The most important source of these fatty acids is the diet, however, they can also be formed in the human body from their shorter chain precursors, the essential fatty acids. Since the WHO recommends exclusive breastfeeding for the first six months after birth, the exclusive source of these fatty acids for breastfed infants is human milk, which can be influenced by the mother's diet. Unsaturated fatty acids can have either cis or trans configuration double bond in their chain with distinct physiological effects. Cis isomeric unsaturated fatty acids have several beneficial effects, while trans isomers are mostly detrimental, because of their similar structure to saturated fatty acids. Trans fatty acids (TFAs) can be further subdivided into industrial (iTFA) and ruminant-derived trans fatty acids (rTFA). However, the physiological effects of these two TFA subgroups may differ. In adults, dietary intake of iTFA has been linked to atherosclerosis, insulin resistance, obesity, chronic inflammation, and increased development of certain cancers, among other diseases. However, iTFAs can have a negative impact on health not only in adulthood but in childhood too. Results from previous studies have shown that iTFAs have a significant negative effect on LCPUFA levels in the blood of newborns and infants. In addition, iTFAs can affect the growth and development of infants, and animal studies suggest that they might even have lasting negative effects later in life. Since the only source of TFAs in the human body is the diet, the TFA content of breast milk may determine the TFA supply of breastfed infants and thus affect the levels of LCPUFAs important for neurodevelopment and the health of infants. In this review, we aim to provide an overview of the TFA content in human milk available in the literature and their potential effects on infant health and development.

Medium-Chain Fatty Acid Feeding Reduces Oxidation and Causes Panacinar Steatosis in Livers of Neonatal Pigs

BACKGROUND

Medium-chain fatty acids (MCFAs) are commonly used to enhance the caloric content of infant formulas. We previously reported that pigs fed MCFA developed hepatic steatosis when compared to those fed isocaloric long-chain fatty acid (LCFA) rich formula.

OBJECTIVES

The objectives of this study were to investigate: 1) whether MCFA and LCFA feeding affect hepatic fatty acid oxidation, and 2) how fat type alters the expression of hepatic fatty acid metabolic genes.

METHODS

Twenty-six, 7-d-old pigs were fed a low-energy control (CONT) formula, or 2 isocaloric high-energy formulas rich in LCFA or MCFA for 22 days. Livers were collected for examining ex vivo fatty acid oxidation, fatty acid content, and mRNA expression of fatty acid metabolic genes.

RESULTS

Liver fat was 20% for pigs in the MCFA compared with 2.9% and 4.6% for those in the CONT and LCFA groups (P < 0.05). MCFA-fed pigs had greater amounts of hepatic laurate, myristate, palmitate, and palmitoleate (14, 34, 49, and 9.3 mg · g-1) than those fed LCFA and CONT (1.8, 1.9, 19, 1.5 mg · g-1) formulas (P ≤ 0.05). Hepatic laurate and palmitate oxidation was reduced for pigs fed MCFA (29 mmol · mg-1 · h-1) compared with those fed CONT (54 mmol · mg-1 · h-1) and LCFA (51 mmol · mg-1 · h-1) formulas (P < 0.05). Expression of fatty acid synthase 3 (FASN-3), fatty acid binding protein 1 (FABP-1), and acetyl-CoA carboxylase 1 (ACACA-1) were 8-, 6-, and 2-fold greater for pigs in the MCFA than those in the LCFA and CONT groups (P < 0.05).

CONCLUSIONS

Feeding MCFA resulted in hepatic steatosis compared with an isocaloric formula rich in LCFA. Steatosis occurred concomitantly with reduced fatty acid oxidation but greater mRNA expression of fatty acid synthetic and catabolic genes.

Early feeding and nutritional status of Portuguese children in the first 36 months of life: EPACI Portugal 2012-a national representative cross-sectional study

Background

Early feeding practices have a critical role in the future not only in health but also in modulating eating habits. This study aimed to assess breastfeeding and complementary feeding practices and the nutritional status of Portuguese toddlers aged 0-36 months.

Methods

EPACI Portugal 2012 is a cross-sectional study of a national representative sample. Trained interviewers collected data about early feeding practices and anthropometrics. Body mass index was classified according to World Health Organization criteria. Frequencies and survival analysis were used to characterize variables.

Results

More than 90% of children were initiated breastfeeding, around 20% were exclusively breastfed for six months, and about 20% were breastfed at 12 months while complementary feeding was taking place. Exclusive breastfeeding was determined by maternal prepregnancy body mass index (HR 1.01; 95% CI 1.00, 1.03, P=.03) and low birth weight (HR 1.61; IC 95% 1.21, 2.15, P=.001) of the infants. About 90% were initiated complementary feeding between four and six months, and almost 10% were introduced to cow's milk before 12 months. In the second year of life, 83.2% and 61.6% of toddlers have already consumed nectars and sweet desserts, respectively. About one-third of Portuguese toddlers showed a body mass index z-score >1, and 6.6% were overweight/obese (z-score >2). No association was found between the duration of breastfeeding or timing of complementary feeding and the body mass index z-score in children.

Conclusions

Despite the low prevalence of exclusive breastfeeding at six months, Portuguese infants effectively comply with dietary recommendations during the first year of life. The transition to the family diet must be carefully made. There is a high prevalence of Portuguese toddlers at least at overweight risk. The duration of breastfeeding or timing of complementary feeding was not associated with the expression of overweight/obesity.

Relationship between Nutrition and Development of the Jaws in Children: A Pilot Study

Craniofacial growth and development have been shown to be influenced by various environmental factors that impact child development. This study aims to analyze the different patterns of feeding during early childhood, starting from birth, and assess the variability of nutrition during the first stage of childhood, along with the habits developed, to study their impact on jaw development. The study was conducted on a sample of twenty-five patients aged 3 to 5, following approval from the ethics committee of the Catholic University of Valencia. Informed consent was obtained from the fathers, mothers, and/or legal guardians, who were administered surveys on habits and diet. Cephalometric measurements within the parameters of ideal occlusion were subsequently taken. While previous studies examined this subject, the findings are challenging to evaluate. However, this study identified significant associations (p = 0.001) between clinical measurements and children's eating habits. The growth and development of the craniofacial cavity are influenced by multiple factors, including a child's diet and habits. Nonetheless, further research is required to determine whether diet can be considered a determining factor in proper jaw growth.

Infant feeding-a scoping review for Nordic Nutrition Recommendations 2023

The 2012 edition of the Nordic Nutrition Recommendations (NNR) included recommendations on breastfeeding, based on the most recent guidelines and recommendations from major national food and health authorities and organizations, systematic reviews, and some original research. For NNR 2023, the scope has been expanded and also includes formula feeding and the introduction of solid food. The main focus in this scoping review is on infants aged 0-12 months but also considers parts both before and beyond the first year, as the concept of 'the first 1000 days' emphasizes the importance of factors during pregnancy and the first 2 years of life for immediate and later health: physical as well as emotional and mental health. Breastmilk is the natural and sustainable way to feed an infant during the first months of life. Numerous studies have indicated immediate as well as long-term beneficial effects of breastfeeding on health for both the infant and the breastfeeding mother, and from a public health perspective, it is therefore important to protect, support, and promote breastfeeding. For full-term, normal weight infants, breastmilk is sufficient as the only form of nutrition for the first 6 months, except for vitamin D that needs to be given as supplement. The World Health Organization (WHO) and several other authoritative bodies therefore recommend exclusive breastfeeding during the first 6 months. Starting solids at about 6 months is necessary for both nutritional and developmental reasons. According to the European Food Safety Authority (EFSA) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN), solid foods are safe to give from 4 months although exclusive breastfeeding until 6 months is the desirable goal. Breastfeeding can continue together with complementary foods as long as it is mutually desired by the mother and child. If breastfeeding is not enough or for some reason discontinued before the infant is 4 months of age, the infant should be fed infant formula, and, when possible, breastfeeding should be continued alongside the formula feeding. If the infant is 4 months or older, starting with solids together with continued breastfeeding and/or formula feeding is an option. Infant formulas have been developed for infants who are not breastfed or do not get enough breastmilk. Home-made formula should not be given.

Advancing breastfeeding promotion: leveraging integrative natural galactagogues and unveiling their potential roles-Insights from a 19-year Taiwan nationwide registry to address lactation insufficiency in postpartum women

Background

Lactation insufficiency is a prevalent challenge for nursing mothers globally. There is a growing interest in the use of herbal galactagogues for enhancing lactation, but their therapeutic efficacy and underlying mechanisms need thorough investigation. This study aims to investigate the efficacy and mechanisms of action of herbal galactagogues in addressing lactation insufficiency by utilizing real-world data and employing a network analysis approach.

Methods

Our retrospective study used Taiwan's Longitudinal Health Insurance Database 2000 (LHID2000) to identify 490 patients diagnosed with lactation insufficiency from 2000 to 2018. We analyzed demographic characteristics, co-existing diseases, and prescription patterns for both users and non-users of Chinese herbal products (CHP). Additionally, we utilized a network analysis approach to explore potential compounds and targets in the most frequently used CHP, the Wang Bu Liu Xing and Lu Lu Tong herb pair (WLHP) combination.

Results

Out of 490 patients, 81% were CHP users. There were no significant differences in demographic characteristics between CHP users and non-users, but we observed a notable divergence in the prevalence of co-existing diseases. A detailed examination of CHP prescriptions revealed the predominance of WLHP, prompting further investigation. Comprehensive analysis identified 29 major compounds in WLHP, which were associated with 215 unique targets. Intersection analysis revealed 101 overlapping targets between WLHP and lactation, suggesting their potential as therapeutic targets for lactation insufficiency treatment. Topological analysis of the protein-protein interaction (PPI) network identified 13 hub genes potentially crucial for the therapeutic effect of WLHP. Functional enrichment analysis showed that these targets were involved in critical lactation regulation pathways, including the PI3K-Akt signaling pathway, prolactin signaling pathway, estrogen signaling pathway, and AMPK signaling pathway.

Discussion

This study emphasizes the potential of CHP, specifically the WLHP combination, in managing lactation insufficiency. The multi-compound, multi-target approach of WLHP and its interaction with key biological processes and signaling pathways offer valuable insights into the underlying mechanisms of its therapeutic effects. These findings warrant further experimental validation and can guide future research and clinical applications of CHP in lactation insufficiency treatment.

Black carbon particles in human breast milk: assessing infant's exposure

Background/Aim

Human breast milk is the recommended source of nutrition for infants due to its complex composition and numerous benefits, including a decline in infection rates in childhood and a lower risk of obesity. Hence, it is crucial that environmental pollutants in human breast milk are minimized. Exposure to black carbon (BC) particles has adverse effects on health; therefore, this pilot study investigates the presence of these particles in human breast milk.

Methods

BC particles from ambient exposure were measured in eight human breast milk samples using a white light generation under femtosecond illumination. The carbonaceous nature of the particles was confirmed with BC fingerprinting. Ambient air pollution exposures (PM2.5, PM10, and NO2) were estimated using a spatial interpolation model based on the maternal residential address. Spearman rank correlation coefficients were obtained to assess the association between human breast milk's BC load and ambient air pollution exposure.

Results

BC particles were found in all human breast milk samples. BC loads in human breast milk were strongly and positively correlated with recent (i.e., 1 week) maternal residential NO2 (r = 0.79; p = 0.02) exposure and medium-term (i.e., 1 month) PM2.5 (r = 0.83; p = 0.02) and PM10 (r = 0.93; p = 0.002) exposure.

Conclusion

For the first time, we showed the presence of BC particles in human breast milk and found a robust association with ambient air pollution concentrations. Our findings present a pioneering insight into a novel pathway through which combustion-derived air pollution particles can permeate the delicate system of infants.

Exclusive breastfeeding practices and its determinants in Indian infants: findings from the National Family Health Surveys-4 and 5

BACKGROUND

The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) in infants for the first 6 months of life. This analysis aims to estimate the proportion of Indian infants exclusively breastfed for the first 6 months using the National Family Health Surveys (NFHS)-4 and 5, and further, determine factors associated with EBF practices.

METHODS

EBF for this analysis was defined as when infants received only breast milk and no complementary feeds (solid food, water, animal milk, baby formula, juice, and fortified food) in the last 24 h prior to the survey. The proportion of infants exclusively breastfed was plotted from birth to 6 months as per the age of children at the time of the survey, and this was computed for individual states, union territories, and overall, for India. Univariate and multivariable logistic regression analyses were performed to examine factors influencing EBF in Indian infants.

RESULTS

The proportion of Indian infants exclusively breastfed for 6 months was 31.3% (1280/4095; 95% CI 29.9, 32.7) and 43% (1657/3853; 95% CI 41.4, 44.6) as per the NFHS-4 and 5 surveys, respectively. In NFHS-5, infants of scheduled tribes (aOR 1.5; 95% CI 1.2, 1.9) and mothers who delivered at public health facilities (aOR 1.3; 95% CI 1.1, 1.5) showed an increased odds of being exclusively breastfed at 6 months of life compared to their counterparts. Further, infants of mothers aged < 20 years (aOR 0.5; 95% CI 0.4, 0.7), low birth weight infants (aOR 0.6; 95% CI 0.4, 0.8), and infants in whom breastfeeding was initiated one hour after birth (aOR 0.8; 95% CI 0.7, 0.9) showed a reduced odds of being exclusively breastfed at 6 months compared to their counterparts.

CONCLUSIONS

The overall EBF practice showed an increasing trend in the NFHS-5 compared to the NFHS-4 survey. However, a vast gap remains unaddressed in the Indian setting with > 50% of the population still not exclusively breastfeeding their infants for the WHO recommended duration of first 6 months. Behavioral studies dissecting the complex interplay of factors influencing EBF within the heterogenous Indian population can help plan interventions to promote and scale-up EBF in Indian infants.

Cost-benefit analysis of a multicomponent breastfeeding promotion and support intervention in a developing country

Background

Studies evaluating breastfeeding promotion and support interventions suggest some economic benefits. This study assessed the direct and indirect costs of a multicomponent breastfeeding promotion and support intervention during the first two years of the infant's life.

Methods

This is a cost-benefit analysis of data generated from a randomized controlled trial that aimed at investigating whether provision of a multicomponent breastfeeding promotion and support intervention to Lebanese mothers in the first six months postpartum would improve breastfeeding rates compared to standard obstetric and pediatric care. Data on 339 participants included information on maternal socio-demographics and health, infant nutrition and health, and direct and indirect costs of the intervention. The primary outcome was the benefit-cost ratio (BCR) of the intervention at one, six, 12, and 24 months. Secondary outcomes included the overall costs of infant nutrition and infant-mother dyad health costs during the first two years. Multiple linear regression models investigated the effect of the multicomponent intervention (independent variable) on the overall infant nutrition cost and the overall mother-infant health costs (as dependent variables), adjusting for monthly income and number of children (confounders) at different time points in the first two years. Similar regression models investigated the association between infant nutrition type (exclusive breastfeeding, mixed feeding, artificial milk) and infant nutrition costs and infant-mother health costs. Intention to treat analyses were conducted using SPSS (version 24). Statistical significance was set at a p-value below 0.05.

Results

The prevalence of Exclusive/Predominant breastfeeding among participants declined from 51.6% in the first month to 6.6% at the end of second year. The multicomponent breastfeeding intervention incurred 485 USD more in costs than the control group during the first six months but was cost-efficient by the end of the first year (incremental net benefits of 374 USD; BCR=2.44), and by the end of the second year (incremental net benefits of 472 USD; BCR=2.82). In adjusted analyses, the intervention was significantly associated with fewer infant illness visits in the first year (p=0.045). Stratified analyses by the type of infant nutrition revealed that infants who were on Exclusive/Predominant, or Any Breastfeeding had significantly more favorable health outcomes at different time points during the first two years (p<0.05) compared to infants receiving Artificial Milk only, with health benefits being highest in the Exclusive/Predominant breastfeeding group. Moreover, Exclusive/Predominant and Any Breastfeeding had significantly lower costs of infant illness visits, hospitalizations, and infant medications during the two years (p<0.05), but had additional cost for maternal non-routine doctor visits due to breastfeeding (all p values <0.05). Whereas the overall cost (direct and indirect) during the first six months was significantly lower for the Exclusive/Predominant breastfeeding infants (p=0.001), they were similar in infants on Mixed Feeding or Artificial Milk.

Conclusions

Breastfeeding is associated with significant economic and infant health benefits in the first two years. In the context of the current economic crisis in Lebanon, this study provides further evidence to policymakers on the need to invest in national breastfeeding promotion and support interventions.

Effects of dietary PUFA patterns and FADS genotype on breast milk PUFAs in Chinese lactating mothers

BACKGROUND

Breastfeeding affects the growth and development of infants, and polyunsaturated fatty acids (PUFAs) play a crucial role in this process. To explore the factors influencing the PUFA concentration in breast milk, we conducted research on two aspects: dietary fatty acid patterns and single nucleotide polymorphisms (SNPs) in maternal fatty acid desaturase genes.

METHODS

Three hundred seventy Chinese Han lactating mothers were recruited. A dietary semi-quantitative food frequency questionnaire (FFQ) was used to investigate the dietary intake of lactating mothers from 22 to 25 days postpartum for 1 year. Meanwhile, breast milk samples were collected from the participants and tested for the concentrations of 8 PUFAs and 10 SNP genotypes. We sought to determine the effect of dietary PUFA patterns and SNPs on breast milk PUFAs. We used SPSS 24.0 statistical software for data analysis. Statistical tests were all bilateral tests, with P < 0.05 as statistically significant.

RESULTS

Under the same dietary background, PUFA contents in breast milk expressed by most major allele homozygote mothers tended to be higher than that expressed by their counterparts who carried minor allele genes. Moreover, under the same gene background, PUFA contents in breast milk expressed by the mother's intake of essential PUFA pattern tended to be higher than that expressed by their counterparts who took the other two kinds of dietary.

CONCLUSIONS

Our study suggests that different genotypes and dietary PUFA patterns affect PUFA levels in breast milk. We recommend that lactating mothers consume enough essential fatty acids to ensure that their infants ingest sufficient PUFAs.

Evaluating interactive weekly mobile phone text messaging plus motivational interviewing for breastfeeding promotion among women living with HIV, giving normal birth at a primary healthcare facility in South Africa: a feasibility randomised controlled trial

OBJECTIVES

We assessed the feasibility of an appropriately powered randomised trial by evaluating whether participants could be recruited and retained, and sought preliminary information on exclusive breastfeeding rates.

SETTING

Primary healthcare facility, serving a rural community.

PARTICIPANTS

Women initiating breast feeding within 24 hours of giving birth, on antiretroviral treatment and aged ≥18 years.

INTERVENTIONS

We randomised mother-infant pairs to receive weekly text messaging encouraging exclusive breast feeding plus in-person individual motivational interviews post partum at weeks 2, 6 and 10, or standard infant feeding counselling.

OUTCOME MEASURES

The feasibility endpoints included number of participants who consented to participate and number with complete evaluation of infant feeding practices at study visits. Exploratory endpoints included number of participants who exclusively breast fed at 24 weeks post partum and number of participants adhering to study protocol.

RESULTS

Of 123 mothers screened, 52 participants consented for participation. We recruited an average of five participants per month over 11 months. Most participants were unemployed (75%), had some high school education (84%) and had disclosed their HIV status to someone close (88%). About 65% participants completed outcome evaluation at week 10, decreasing to 35% at week 24. Twenty participants had the week 24 visit planned between 20 March and August 2020, during COVID-19 lockdown. Of these, 4 completed the visit telephonically, 16 were lost to follow-up. Exclusive breastfeeding rate remained relatively high across both groups through week 24. The difference in exclusive breastfeeding rates between the intervention and control groups was minimal: rate difference 22.2% (95% CI -20.1% to 64.5%).

CONCLUSIONS

With a large eligible target population, recruitment targets could be achieved for a large trial. Strategies to retain participants, such as remote monitoring and in-person follow-up visits, will be essential.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT02949713) and Pan African Clinical Trial Registry (PACTR201611001855404).