Breastfeeding behavior among adolescents: initiation, duration, and exclusivity

Maternal depression, psychosocial stress and race/ethnicity: examining barriers to breastfeeding for young mothers

BACKGROUND

Breastfeeding has a positive impact on child and maternal health outcomes. Black and Latina women and adolescent mothers have lower rates of breastfeeding initiation and continuance in the U.S. Maternal depression and psychosocial stressors may contribute to reduced rates of breastfeeding. The current study aims to better understand behaviours and associated factors related to breastfeeding in a diverse group of adolescent mothers attending a teen-tot clinic for postpartum and infant well care.

METHODS

Participants were 191 mother-infant dyads. Mother's age ranged from 13 to 25, and 54% of mothers identified as Latina, 22% Black, 11% more than one race and 5% white. Demographic information and breastfeeding behaviour were abstracted from the medical record. Rates of postpartum mood/anxiety symptoms and psychosocial stressors were obtained from screening measures completed at medical visits.

RESULTS

Analyses revealed that 87% of adolescent mothers in the sample initiated breastfeeding at birth and the racial/ethnic breakdown of those mothers closely mirrored the overall population (58% Hispanic or Latina, 17% Black, 10% more than one race, 5% white). At 2 months postpartum, only 41% of the population was still breastfeeding. Mothers with significant mood/anxiety symptoms at the newborn visit were more likely to be breastfeeding at the 1- and 2-month visits. Mothers with psychosocial stressors at the newborn visit were less likely to be breastfeeding at the 1- and 2-month visits.

CONCLUSION

Efforts to promote health equity through breastfeeding for at-risk mothers must occur within the first few weeks postpartum and must consider associated factors including postpartum mood/anxiety symptoms and psychosocial stressors.

Effect of teach-back method on breastfeeding success: A single blind randomized controlled study

In this study, authors aimed to evaluate the effect of breastfeeding education on breastfeeding success by using teach back method described in the information. The study was conducted with randomized controlled experimental research design and performed with 80 primiparous women as intervention (n: 40) and control (n: 40) groups. Independent t-test, multivariate and one-way analysis of variance, Bonferroni-matched paired t-test were used to evaluate the data. There was a statistically significant difference between the intervention and control groups in terms of both LATCH and Breastfeeding Self-Efficacy Scale mean scores, group, time and group * time interaction (p < 0.05). It has been concluded by the authors that breastfeeding education provided with teach-back method can be used as an effective method for breastfeeding self-efficacy and breastfeeding performance.

Investigating the Effect of Supportive Interventions on Initiation of Breastfeeding, Exclusive Breastfeeding, and Continuation of Breastfeeding in Adolescent Mothers: A Systematic Review and Meta-Analysis

Introduction: The initiation of breastfeeding, exclusive breastfeeding, and its duration for 2 years in adolescent mothers is less than adult mothers. The purpose of this study is to determine the effect of supportive interventions on the initiation of breastfeeding, exclusive breastfeeding, and continuation of breastfeeding in adolescent mothers. Methods: Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, ProQuest, SID, Iranmedex, and Google Scholar were searched to find English and Persian clinical trial studies without time limit. The Cochrane checklist was used to check the bias of the articles. Data analysis was done using STATA version 11. I-squared index was used to check the heterogeneity, and funnel plot and Begg test were used to examine the publication bias. The combined odds ratio (OR) and random effects model were used to combine the studies and perform meta-analysis. Results: Of 492 articles, 11 articles were entered to the systematic review. Of 11 articles, three articles were entered to the meta-analysis. The supportive interventions included educational and counseling interventions, home visit, and peer support. The results of the present random effects meta-analysis model showed that the combined OR was 3.38 with 95% confidence interval (1.66-6.88, p = 0.001), thus that, breastfeeding initiation in the intervention group was higher than the control group. Conclusion: Supportive interventions such as educational and counseling interventions, home visits, and peer support are suitable strategies to promote breastfeeding in adolescent mothers. Therefore, it is suggested to integrate these strategies in prenatal and postpartum care of adolescent mothers.

Maternal age at birth and child attention-deficit hyperactivity disorder: causal association or familial confounding?

BACKGROUND

Causal explanations for the association of young motherhood with increased risk for child attention-deficit hyperactivity disorder (ADHD) remain unclear.

METHODS

The ABCD Study recruited 11,878 youth from 22 sites across the United States between June 1, 2016 and October 15, 2018. This cross-sectional analysis of 8,514 children aged 8-11 years excluded 2,260 twins/triplets, 265 adopted children, and 839 younger siblings. We examined associations of maternal age with ADHD clinical range diagnoses based on the Child Behavior Checklist and NIH Toolbox Flanker Attention Scores using mixed logistic and linear regression models, respectively. We conducted confounding and causal mediation analyses using genotype array, demographic, socioeconomic, and prenatal environment data to investigate which genetic and environmental variables may explain the association between young maternal age and child ADHD.

RESULTS

In crude models, each 10-year increase in maternal age was associated with 32% decreased odds of ADHD clinical range diagnosis (OR = 0.68; 95% CI [0.59, 0.78]) and 1.09-points increased NIH Flanker Attention Scores (β = 1.09; 95% CI [0.76, 1.41]), indicating better child visual selective attention. However, adjustment for confounders weakened these associations. The strongest confounders were family income, caregiver education, and ADHD polygenic risk score for ADHD clinical range diagnoses, and family income, caregiver education, and race/ethnicity for NIH Flanker Attention Scores. Breastfeeding duration, prenatal alcohol exposure, and prenatal tobacco exposure were responsible for up to 18%, 6%, and 4% mediation, respectively.

CONCLUSIONS

Socioeconomic disadvantages were likely the primary explanation for the association of young maternal age with child ADHD, although genetics and modifiable environmental factors also played a role. Public policies aimed at reducing the burden of ADHD associated with young motherhood should target socioeconomic inequalities and support young pregnant women by advocating for reduced prenatal tobacco exposure and healthy breastfeeding practices after childbirth.

The Relationship of Adolescent Motherhood to the Macronutrient Content of Breast Milk

Objective: Breast milk is the best nutrient for newborns due to its rich dietary content, immunological factors, ease of accessibility, and affordability. Given the fact that adolescent birth rate in Turkey is high, this study examines the effects of adolescent motherhood with regard to macronutrient contents in breast milk. Study Design: We collected colostrum samples from mothers staying at our hospital. Gestational ages were ≥37 weeks. Demographic characteristics of the patients were registered. The MIRIS (Mid-Infrared Human Milk Analyzer) device was operated to analyze breast milk, adopting a spectroscopy method for measurements. Protein, fat, carbohydrate, and energy levels of the hindmilk samples were measured; thus, study groups were compared. Results: The study included 224 mothers, of whom 49 were adolescents and 125 were adults. Maternal weight and maternal body mass index, weight gain during pregnancy, mode of delivery and gestational age, as well as birth weight and gender of the infants were similar. As breast milk contents were compared, we found out that fat content levels in the colostrum of adolescent mothers were significantly higher, with respect to the other group. Protein and carbohydrate levels were lower in adolescents, even if they were not statistically significant. There was no difference between the groups in terms of energy levels. Conclusion: Adolescent motherhood may have negative influences on infant welfare. However, in terms of breast milk content quality, adult mothers are not superior to adolescents.

Female Genital Mutilation/Cutting and Breastfeeding Outcomes: The Modifying Effects of Healthcare Access and Women’s Attitudes to FGM/C

The prevalence of female genital mutilation/cutting (FGM/C) in Nigeria is on the rise, although the practice has no known medical/health benefits. This study aims to assess FGM/C’s effect on breastfeeding outcomes and to identify the role of women’s attitudes and their access to healthcare services on these relationships. Associations between FGM/C and breastfeeding outcomes were measured using multi-logistic regression. About 32% of women underwent FGM/C, and 23% believed FGM/C should continue. Women exposed to FGM/C were less likely to initiate early breastfeeding (OR = 0.56, [95% CI = 0.47–0.66]) or to breastfeed exclusively (0.64, [0.57–0.73]). FGM/C acceptance reduced odds of early initiation of breastfeeding (0.57, [0.45–0.73]) (p for interaction < 0.001) and exclusive breastfeeding (0.65, [0.59–0.78]) (p for interaction < 0.001). Four or more antenatal care visits while pregnant modified the associations between FGM/C and early initiation (1.55, [1.26–1.90) (p for interaction < 0.001) or exclusive breastfeeding (2.01, [1.73–2.330]) (p for interaction < 0.001), respectively. FGM/C is associated with breastfeeding outcomes, but this association may be improved with healthcare access and attitudinal changes towards FGM/C. Targeted public health education interventions raising awareness about FGM/C and breastfeeding and policy changes increasing access to prenatal healthcare services in underserved areas are recommended.

Intimate Partner Violence and Breastfeeding Behaviors: Does the Source of Breastfeeding Information Affect the Associations Between Prepregnancy or Prenatal IPV and Breastfeeding Behaviors of Women in the United States? A PRAMS 2018 Study

Background: Most countries do not meet World Health Organization's breastfeeding recommendations, and exposure to intimate partner violence (IPV) hinders positive breastfeeding behaviors. One in four U.S. women (43.6 million women) experiences IPV. This study aims to assess relationships between IPV, and breastfeeding initiation, duration, and early cessation among women in 42 U.S. states; and to evaluate possible modifying effect(s) of different breastfeeding information sources. Methods: Centers for Disease Control and Prevention's 2016-2018 Pregnancy Risk Assessment Monitoring System data (n = 105,230) were used to assess relationships between prepregnancy/prenatal IPV and breastfeeding initiation, duration, and early cessation; and modify effects of various breastfeeding information sources on study associations using multilogistic regression models. Results: About 1.4% of women experienced prenatal IPV with reduced odds of breastfeeding for 6 months or more (odds ratio [OR] = 0.74; 95% confidence interval = 0.58-0.94). Receiving breastfeeding information from baby's doctor modified early cessation (0.37 [0.18-0.78]) (p for interaction = 0.009) with prenatal IPV exposure. Among women exposed to prenatal IPV, breastfeeding initiation was stronger in women who received breastfeeding information from family/friends (2.46, [1.24-4.88]) (p for interaction = 0.010) or from breastfeeding support groups (3.03 [1.17-7.88]) (p for interaction = 0.023) compared to those who did not. Breastfeeding information from family/friends modified association between prepregnancy IPV and breastfeeding duration (0.67 [0.45-0.99]) (p for interaction = 0.042). Conclusions: Prenatal IPV is a risk factor for short-duration breastfeeding. Receiving information from doctors, nurses, support groups, and family/friends may improve breastfeeding behavior among IPV-exposed women. Interventions promoting breastfeeding information dissemination by family/friends, support groups, and doctors/nurses during hospital visits are encouraged.

A Health Behavior and Lifestyle Intervention Pilot Trial for Childbearing Adolescents

We pilot tested a multiple health behavior change (MHBC) intervention to improve breastfeeding rates, healthy eating/active living, and depression prevention among pregnant and parenting adolescent mothers. We also assessed utility of the MHBC mHealth approach by examining health behavior coaction and intervention acceptability. We used a longitudinal randomized controlled trial to compare the tablet-delivered momHealth to a control condition (usual care). Delivered between 32 weeks of pregnancy and one month postpartum, momHealth included nine multi-media education modules, simultaneous daily educational text messaging, and weekly videoconferences for individual and group support. Main outcomes included “any” and “exclusive” breastfeeding initiation and continuation for 5 weeks and 3 months postpartum; number of fruit and vegetable servings; minutes of moderate/vigorous physical activity per day; and depressive symptoms. Sixty-two adolescents aged 16–19 having their first baby were randomized. Compared to Control, more momHealth participants were still breastfeeding at 5 weeks (chi-square = 3.91, df = 1, P = .048). Mothers who breastfed for 3 months were more likely to eat adequate daily fruits/vegetables. Participants positively rated the intervention. momHealth positively affected early breastfeeding continuation and trended toward positive outcomes in healthy living and depressive symptoms. A fully powered trial is planned to test the intervention more effectively.

Parental Cohabitation and Breastfeeding Outcomes Among United States Adolescent Mothers

AbstractBackground: Adolescent mothers in the United States experience disproportionately lower rates of breastfeeding compared to older mothers. Evidence suggests that paternal support helps improve breastfeeding outcomes; however, support is difficult to quantify. Parental cohabitation is easy to identify and could be used to quantify paternal support. Research Aim: Our study is to investigate the association between parental cohabitation and breastfeeding initiation and duration among US adolescent mothers. Materials and Methods: Data from the 2011-2017 National Survey of Family Growth were used. Our study sample included primipara, adolescent mothers (aged 15-19 years) who gave birth to a singleton (n = 1,867). Multivariate logistic regression and Cox Proportional Hazards models were used to analyze the relationship between cohabitation and breastfeeding initiation and duration, respectively. All models were subsequently stratified by race/ethnicity due to evidence of effect modification. Results: After adjusting for all a priori confounders, cohabiting with the infant's father at birth was associated with increased odds of breastfeeding initiation compared to noncohabiting adolescent mothers (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.08-2.16). After stratifying by race/ethnicity, both Hispanic and non-Hispanic white adolescent mothers were more likely to initiate breastfeeding if cohabiting with the infant's father (OR_Hispanic: 1.9, 95% CI: 1.10-3.35; OR_{Non-Hispanic white}: 1.7, 95% CI: 1.05-2.87). We found no evidence of an association between parental cohabitation and breastfeeding duration. Conclusions: Our study found evidence that cohabitation status at birth increases the odds of breastfeeding initiation in adolescent mothers. Practitioners should consider cohabitation status when working with adolescent mothers.

A Qualitative Systematic Review of Family Support for a Successful Breastfeeding Experience among Adolescent Mothers

BACKGROUND: Family support for adolescent mothers is vital in making breastfeeding decisions and sustaining the feeding since many of these women struggle with identity crises. Therefore, it is essential to synthesize qualitative evidence about the types of family support provided to these young women. AIM: This study aims to identify, synthesize, and recognize the qualitative evidence of family support for successful breastfeeding among teen mothers. METHODS: A systematic review of qualitative studies was identified in six electronic databases published from 2000 to 2020. The quality of the reviewed studies was checked using The Critical Appraisal Skills Programs. The data were extracted by two investigators and analyzed using thematic analysis with three steps: coding the text line-by-line, developing the descriptive themes, and generating the analytical themes. RESULTS: This review includes eight eligible studies. The review founds that family significantly affect the success of breastfeeding practices among adolescent mothers through their appraisal, instrumental, emotional, and informational support. The family strengthens the adolescence’s breastfeeding decisions and confidence, provide financial assistance, share positive breastfeeding information and experience, encourage them to continue the feeding and motivate theme to pursue their study. CONCLUSION: Breastfeeding a baby and becoming a mother at a young age is not an easy process and need family support for a successful feeding. Health care professionals should actively involve the family in supporting adolescent mothers to breastfeed their babies optimally.

What predicts the knowledge of breastfeeding practices among late adolescent girls? evidence from a cross-sectional analysis

INTRODUCTION

Breastfeeding is one of the most effective ways to ensure infant health and survival. Inadequate breastfeeding practices, and knowledge among adolescent mothers have led to unprecedented infant and child morbidity and mortality. Given, the high global prevalence of adolescent mothers it is imperative to understand how the knowledge of breastfeeding practices operates among adolescent girls across different socio-economic settings.

MATERIALS & METHODS

Data was carried out from Understanding the Lives of Adolescents and Young Adults (UDAYA) survey, conducted in 2015-16. Descriptive statistics along with bivariate analysis was done to examine the preliminary results. For analysing the association between the binary outcome variable and other explanatory variables, binary logistic regression method was used. The explanatory variables were educational status of the respondent, media exposure, working status, ever pregnant status (only for married adolescent girls), sex and age of the household head, educational status of the head of the household, caste, religion, wealth index, residence and states.

RESULTS

About 42%, 50%, and 42% of married adolescent girls had knowledge of immediate breastfeeding, yellowish milk, and exclusive breastfeeding respectively. The odds of knowledge about immediate breastfeeding [married-AOR: 1.57; CI: 1.09-2.28 and unmarried-AOR: 1.30; CI: 1.08-1.55], yellowish milk feeding [married-AOR: 2.09; CI: 1.46-3.01 and unmarried-AOR: 1.39; CI: 1.17-1.66], and exclusive breastfeeding [married-AOR: 1.74; CI: 1.2-2.52 and unmarried-AOR: 1.46; CI: 1.22-1.76] were significantly more among adolescent girls aged 19 years old compared to 15 years old girls. Adolescent married and unmarried girls with 10 & above years of schooling were 1.82 times [AOR: 1.82; CI: 1.52-2.18] and 2.69 times [AOR: 2.69; CI: 2.08-3.47] more likely to have knowledge about immediate breastfeeding, 1.74 times [AOR: 1.74; CI: 1.45-2.09] and 2.10 times [AOR: 2.10; CI: 1.68-2.62] more likely to have knowledge about yellowish milk feeding, and 3.13 times [AOR: 3.13; CI: 2.6-3.78] and 3.87 times [AOR: 3.87; CI: 2.95-5.08] more likely to have knowledge about exclusive breastfeeding respectively than girls with no schooling.

CONCLUSION

Breastfeeding practices and interpersonal counselling from elders in the household should be encouraged. Ongoing breastfeeding promotion programs of the government should promote high education of adolescent girls. Mass media interventions should be encouraged.

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.

Time trends and determinants of breastfeeding practices among adolescents and young women in Nigeria, 2003-2018

Introduction

Optimal breastfeeding practices have far-reaching health and economic benefits. Evidence suggests disparities in breastfeeding practices by maternal age-groups, with younger mothers often having lower rates of breastfeeding initiation, continuation and exclusivity compared with older mothers. There is limited knowledge of trends and factors associated with breastfeeding practices, particularly among adolescent and younger mothers in Nigeria. We examine key breastfeeding practices in Nigeria over a 15-year period, comparing adolescent mothers to young women.

Methods

We used four Nigeria Demographic and Health Surveys collected between 2003 and 2018. We constructed six key breastfeeding indicators to cover the time period of breastfeeding from initiation to child age 24 months in women of three maternal age groups at the time of birth: young adolescents (<18 years), older adolescents (18–19.9 years) and young women (20–24.9 years). We used logistic regression to examine the association between maternal age group and select breastfeeding behaviours on the 2018 survey.

Results

Analysis showed an increase in optimal breastfeeding practices across the four surveys and among all maternal age groups examined. Adolescent mothers had consistently lower prevalence for three of the six key breastfeeding indicators: early initiation of breastfeeding, exclusive breastfeeding <6 months and no prelacteal feed. Compared with young women, adolescent mothers had a higher prevalence of continued breastfeeding at 1 and 2 years. In multivariate analysis, we found that maternal age group was not associated with early breastfeeding initiation or with exclusive breastfeeding <6 months. However, several sociodemographic (ethnicity, region of residence) and healthcare-related (mode of delivery, antenatal care, postnatal breastfeeding counselling) factors were strongly associated with these two practices.

Conclusions

In Nigeria, there is need to better support breastfeeding and nutritional practices in adolescents and young women focusing on ethnic groups (Hausa, Fulani, Kanuri/Beriberi) and geographic regions (South East) that are lagging behind.

Intimate partner violence, breastfeeding, breastmilk substitutes and baby bottle use in the first year of life

This article aims to investigate the relationship between intimate partner physical violence (IPPV) and breastfeeding (BF), use of breastmilk substitutes (BMS) and bottle-feeding among children aged 12 to 15 months. This is a cross-sectional study with mothers in primary care facilities of the city of Rio de Janeiro. IPPV was identified by the Brazilian version of the Conflict Tactics Scales 1-Form R and feeding practices were identified by a 24-hour Dietary Recall. Associations were verified by logistic regression with odds ratio (OR) estimates and 95% confidence intervals. BF was offered to 58.5% of the children and BMS to 88.5%. Also, 70.5% of the children used a baby bottle. Physical violence was observed in 26.7% of couples. Households where couples physically abuse each other are more likely to not breastfeed (OR=2.14, p-value=0.030), to use breastmilk substitutes (OR=5.15, p-value=0.03) and bottle-feed (OR=2.71; p-value=0.01), when compared to households without physical violence. The results highlight the need to investigate intrafamily relationships in cases where inadequate breastfeeding practices are identified, and to enable health professionals to support families in conflict situations.

Intimate partner violence and exclusive breastfeeding of infants: analysis of the 2013 Nigeria demographic and health survey

BACKGROUND

Existing knowledge on the relationship between intimate partner violence (IPV) and exclusive breastfeeding (EBF) in the context of Nigeria is minimal and limited to a lifelong measure of IPV experience. An abuse experienced a long time ago may not have as much negative effect as that encountered at a more proximal time to the breastfeeding phase. To this effect, we examined this relationship with maternal IPV experienced around the time of pregnancy and postpartum.

METHOD

We analyzed data from the 2013 Nigeria Demographic and Health Survey. The sample includes 2668 breastfeeding mothers having a child aged under 6 months. The outcome variable was EBF or mixed-feeding (24 h recall). The exposure variables were: the maternal experience of psychological, physical, and sexual intimate partner violence. Also, there was an experience of any form of IPV and frequency score of intimate partner violence. Analysis includes chi-square and t-test bivariates, complete case and imputed logistic regressions for binary outcome.

RESULTS

In the imputed analysis, compared to mothers who experienced no IPV, those who experienced IPV had a 26% reduced likelihood of EBF practice (AOR 0.74; 95% CI 0.55, 1.00). Also, a unit dose of maternal IPV experience was associated with a 5% reduced likelihood of EBF practice (AOR 0.69; 95% CI 0.49, 0.98). Among the three forms of IPV, physical IPV had the highest effect size. Physical IPV was associated with a 37% reduced likelihood of EBF practice (AOR 0.63; 95% CI 0.44, 0.90), while psychological IPV was associated with a 34% reduced likelihood of EBF practice (AOR 0.66; 95% CI 0.47, 0.92), when compared to the respective reference groups. On the other hand, those who reported sexual IPV were just as likely to breastfeed as those who did not (AOR 0.94; 95% CI 0.62, 1.41).

CONCLUSIONS

In this study, maternal IPV is associated with EBF practice. Policies aimed at promoting EBF should also be framed to combat IPV against pregnant women and nursing mothers.

Mother-role development program and postpartum health-service utilization by adolescent mothers: A randomized, controlled trial

AIM

To evaluate the impact of a mother-role development program on postpartum health-service utilization by adolescent mothers.

METHODS

A single center, parallel, randomized, controlled, open-label trial using a computer-generated sequence was conducted at Siriraj Hospital. In all, 120 teenage mothers who delivered February 2015-December 2016 were randomized into experimental and control groups. The experimental group participated in a 2-year, mother-role development program at the Young Family Clinic. The two groups' characteristics, pregnancy outcomes and postpartum follow-up details over the 2-year period were compared. The main outcome measure was the utilization of maternal healthcare services (MHS).

RESULTS

The teenage mothers were randomized into two groups of 60 participants each. Many were progressively lost to follow-up, leaving only 37 (experimental group, 19; control group, 18) for the intention-to-treat analysis. The results demonstrated a higher MHS utilization by the experimental group, but only at the 6-week postpartum follow-up. The usage of long-acting, reversible contraception (birth control implants and intrauterine devices) rose from 53.3% (immediate postpartum) to 95.5% (2 years postpartum). The two groups also had identical repeat pregnancy rates (6.67%; four participants in each), a marked decrease from 20% in a prior study. The breastfeeding rate was consistently higher among the mothers undertaking the mother-role development program.

CONCLUSION

The program increased both MHS utilization during the initial postpartum period and the breastfeeding duration. Access to immediate postpartum contraception and long-acting, reversible contraception was associated with a reduction in repeat teen pregnancies. Having a multidisciplinary team was key to the health-service improvements.

Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach

BACKGROUND

Evidence suggests that inadequate hospital practices, as well as sociocultural and community factors have detrimental effects on timely initiation as the first breastfeed within first hour after birth, and exclusive breastfeeding. The purpose of the study was to examine the factors that influence timely initiation of breastfeeding and exclusive breastfeeding at birth and 1 month postpartum in Mexican women delivering in public and private hospitals.

METHODS

Mixed methods were conducted between May and July 2017, including surveys (n = 543) and semi-structured interviews (n = 60) in the immediate (7 h) and intermediate (30 days) postpartum periods. Participants were women aged 15-49 years, in public and private hospitals, of urban and rural municipalities of Chihuahua and Puebla, Mexico.

RESULTS

Timely initiation was reported by 49.4% of mothers, and 34.7% reported that their children received infant formula at the hospital. Only 44.8% of women reported exclusive breastfeeding at 1 month postpartum. Timely initiation of breastfeeding was higher in women with vaginal delivery (62.1 vs 35.5%; p < 0.05) and those who received information during pregnancy (OR 1.07; p = 0.018). Exclusive breastfeeding at 1 month postpartum was related to older maternal age (OR 1.05; p < 0.001) and the fact that the mothers had received more information about breastfeeding during pregnancy (OR 1.13; p = 0.0001). Infant formula use was less associated with timely initiation (OR 0.46; p = 0.001). Participants in qualitative data identified the emotional, physical and economic benefits of breastfeeding, however, the perception about insufficient production of human milk, and the belief that infant formula is recommended, persists.

CONCLUSIONS

Modification of hospital practices, such as decreasing the number of cesarean and the use of infant formula, as well as the support of the initiation and continuation of exclusive breastfeeding by health personnel and family members, could help increase breastfeeding practices in Mexican women.

Recurrent Violence, Violence with Complications, and Intimate Partner Violence Against Pregnant Women and Breastfeeding Duration

Background: Few studies have investigated the association between violence against pregnant women in terms of recurrence, complications, and perpetrators of violence, and breastfeeding duration. This study verifies whether recurrent violence, violence with pregnancy complications, and intimate partner violence (IPV) against pregnant women are associated with shorter exclusive breastfeeding up to the infant's 6th month and breastfeeding up to the 12th month of life. Materials and Methods: A cohort study with a convenience sample of 1,146 pregnant women was performed. Follow-up assessments were conducted at birth, and at 12-36 months. Survival analysis was used to verify whether recurrent violence, violence with pregnancy complications, and IPV were associated with reduced duration of exclusive breastfeeding and breastfeeding. Results: The adjusted Cox regression revealed no difference regarding exclusive breastfeeding duration among mothers exposed or not exposed to violence and according to who perpetrated the violence. The risk of an infant not being breastfed within the first 12 months of life increased in cases of violence before/during pregnancy (95% confidence interval [CI] = 1.03-1.88), recurrent psychological/physical/sexual violence during pregnancy (95% CI = 1.11-1.92), recurrent psychological violence (95% CI = 1.05-1.96), and recurrent physical/sexual violence (95% CI = 1.01-2.39). Violence with pregnancy complications (95% CI = 0.94-2.22) was not associated with breastfeeding interruption. Similar risks of breastfeeding interruption were observed for IPV (95% CI = 0.96-1.87) and violence perpetrated by other family members (95% CI = 0.83-1.89). Conclusions: We observed a shorter breastfeeding duration up to 12 months of life in cases of recurrent violence.

Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I² = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I² = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I² = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I² = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

Intimate partner violence and subsequent premature termination of exclusive breastfeeding: A cohort study

Objective

The objective of this study was to examine whether exposure to Intimate Partner Violence (IPV) is associated with premature termination of Exclusive Breastfeeding (EB). Per WHO recommendations, this was defined as ceasing breastfeeding or supplementing with other foods or liquids before the child was 6 months old.

Method

It is a prospective cohort study set in Moshi, Tanzania consisting of 1128 pregnant women with live singleton births. Women were enrolled during pregnancy and followed up with interviews during pregnancy, after birth and 2–3 years postpartum, using structured questionnaires. Emotional, physical and sexual IPV exerted by the current partner was assessed at 34 weeks gestational age with WHO questionnaires. Months of EB was assessed 2–3 years postpartum. Premature termination of EB was defined as less than 6 months of EB. Analyses were made using a logistic regression model adjusted for maternal age, education, HIV-status, alcohol use during pregnancy and parity. Confounding variables were determined using a theoretical framework approach, i.e. a Directed Acyclic Graph model to minimize bias.

Results

Women who were exposed to IPV had more than 50% higher odds of terminating EB before the child was 6 months old compared to women who were not exposed (aOR = 1.62, 95%CI: 1.27–2.06).

Women exposed to all three types of IPV had twice the odds of early termination of EB (aOR = 1.95, 1.12; 3.37). Furthermore, the odds were tripled if exposure happened specifically during the index pregnancy (aOR = 2.93 95%CI: 1.3; 6.6). Stratified analyses showed the most severely affected groups were the mothers older than 30 and those who gave birth to girls.

Conclusions

The results indicated that exposure to IPV is associated with increased risk of premature termination of EB. The odds increase with multiple types of the IPV, especially when exposed during the index pregnancy.

Exploring Indonesian adolescent women's healthcare needs as they transition to motherhood: A qualitative study

BACKGROUND

Marriage and underage childbirth is a phenomenon of increasing incidence globally. Adolescent mothers simultaneously encounter multiple developmental challenges related to transition into adulthood, marriage, pregnancy and mothering responsibilities. Despite this, studies investigating postpartum care needs for adolescent mothers are limited.

AIMS

The aim of this study was to explore adolescent mothers' postnatal inpatient experiences and healthcare needs as they moved towards their maternal roles.

METHODS

A descriptive qualitative design was adopted to better understand experiences of adolescent mothers during their transition to becoming mothers. Data were collected using in-depth interviews with eleven adolescent mothers in hospital settings in South Sulawesi, Indonesia and analysed using thematic analysis.

RESULTS

Four major themes emerged: (1) breastfeeding problems, (2) disempowerment in caring for the baby, (3) health care encounters, and (4) health care needs for adolescent motherhood transition.

DISCUSSION

Breastfeeding problems and feeling disempowered in caring for their babies after birth was experienced by all adolescent mothers in this study. Furthermore, the health care provided was limited to mandatory hospital tasks with staff failing to recognize adolescent mothers' broader needs. The findings suggest that adolescent mothers need compassionate health education, support and psychological care from midwives in the postpartum ward before hospital discharge.

CONCLUSION

The results highlight important issues in postnatal care provision for adolescent mothers in improving their maternal roles during the transition period. Specific, appropriate interventions for adolescent mothers are needed to support their transition and adaptation to their new roles.

Maternal Prepregnancy Body Mass Index, Gestational Weight Gain, and Cessation of Breastfeeding: A Systematic Review and Meta-Analysis

Background: Suboptimal breastfeeding, a major factor of maternal and child morbidity and mortality, has been reported around the world. Maternal weight status, as a significant variable influencing breastfeeding outcomes, needs to be studied sufficiently. Objective: This review is to explore the effect of different prepregnancy BMI and gestational weight gain (GWG) categories on breastfeeding initiation and cessation. Materials and Methods: Cohort studies were systematically searched in Embase, Web of Science, PubMed, and CINAHL databases from database establishment to February 2019. Summary risk ratio (RR) on breastfeeding initiation and cessation was estimated with the use of a random-effects model. Results: Thirty cohort studies were included in meta-analysis. Prepregnancy obesity was a risk factor for breastfeeding initiation (RR 1.49, 95% CI [1.33-1.67]), exclusive and any breastfeeding (ABF) duration (RR 1.26, 95% CI [1.17-1.36]; RR 1.34 95% CI [1.16-1.56]). Inadequate GWG was a risk factor for breastfeeding initiation (RR 1.27, 95% CI [1.08-1.49]). Excessive GWG was a risk factor for ABF duration when women were prepregnancy overweight and obese (RR 1.42 95% CI [1.32-1.53]; RR 1.89 95% CI [1.13-3.17]). Conclusion: If women are obese before pregnancy or gain excessive/inadequate weight during pregnancy, they are less likely to initiate and continue breastfeeding according to recommendation time. Hence, guidance about proper weight management to reproductive age women and consultation about recommended GWG to pregnant women should be fully implemented to improve breastfeeding practices. Besides, future research needs to find out the association between prepregnancy underweight status and breastfeeding outcomes.

Prepregnancy Depression and Breastfeeding Duration: A Look at Maternal Age

Background

In the United States, major depressive disorder affects one in five women aged 20-40 years. During these childbearing years, depression can negatively impact maternal behaviors that are crucial for infant growth and development. This study examined the relationship between prepregnancy depression and breastfeeding duration by maternal age.

Methods

Data from Phase 7 (2012-2013) of the Pregnancy Risk Assessment Monitoring System (N=62,483) were analyzed. Prepregnancy depression was dichotomized while breastfeeding duration was categorized as never breastfed, breastfed 8 weeks or less, and breastfed more than 8 weeks. Maternal age was a significant effect modifier; therefore, results were stratified by maternal age. Multinomial logistic regression was used to obtain odds ratios and 95% confidence intervals (CI).

Results

For women aged 20-24, 25-29, and 30-34 years with prepregnancy depression, the odds of never breastfeeding and breastfeeding 8 weeks or less were significantly higher than in women with no history of prepregnancy depression. Notably, among women aged 25-29 with prepregnancy depression, the odds of never breastfeeding and breastfeeding 8 weeks or less were 93% (adjusted odds ratio (AOR) = 1.93, 95% CI =1.57-2.37) and 65% (AOR = 1.65, 95% CI = 1.37-1.99) higher compared to women with no history of prepregnancy depression, respectively.

Conclusions

Having a history of poor mental health before pregnancy may increase the likelihood of premature breastfeeding cessation. A woman's mental health status before pregnancy should be considered in reproductive and prenatal care models. Efforts should be made to understand challenges women of specific age groups face when trying to breastfeed.

Effect of breastfeeding on postpartum depressive symptoms among adolescent and young adult mothers

PURPOSE

To describe the association between breastfeeding and postpartum depressive symptoms among a sample of adolescent and young adult mothers and to determine whether breastfeeding difficulty moderates this association.

MATERIALS AND METHODS

Data were derived from a prospective cohort of pregnant adolescent and young adult females (ages 14-21) as they transitioned to parenthood. This analysis uses data collected during pregnancy and at 6 months postpartum among mothers (n = 137) who initiated breastfeeding. Multivariable linear regression was used to adjust for prenatal depressive symptoms and other potential confounders.

RESULTS

Postpartum depressive symptoms were not significantly associated with breastfeeding duration or breastfeeding at 6 months. Early breastfeeding difficulty moderated the association between depressive symptoms and breastfeeding at 6 months. Among young mothers who were still breastfeeding at 6 months, those who reported no early breastfeeding difficulties had the lowest depressive scores and those who reported much early breastfeeding difficulty had the highest depressive scores at 6 months.

CONCLUSIONS

Minimizing challenges with breastfeeding may help improve postpartum mental health among adolescent and young adult mothers. Health care providers should help young pregnant women manage expectations about breastfeeding and ensure that they are linked to appropriate professional breastfeeding support during the early postpartum period.

Factors associated with the maintenance of breastfeeding for 6, 12, and 24 months in adolescent mothers

BACKGROUND

Previous studies have demonstrated that adolescent mothers present a higher risk of not breastfeeding or of early interruption of this practice. Considering the scarcity of studies investigating the determining factors of breastfeeding in adolescent mothers, and the absence of studies exploring the determining factors of breastfeeding maintenance for different periods of time in a single population of adolescent mothers, the aim of this research was to identify factors associated with breastfeeding maintenance for at least 6, 12, and 24 months in adolescent mothers.

METHODS

Data analysis from a randomised control trial involving adolescent mothers recruited at a university hospital in southern Brazil. Participants were followed through the first year of life of their infants and reassessed at 4-7 years. Factors associated with any breastfeeding for at least 6, 12, and 24 months were assessed using multivariate Poisson regression.

RESULTS

Data for 228, 237, and 207 mothers were available, respectively. Breastfeeding maintenance for at least 6, 12, and 24 months was observed in 68.4, 47.3, and 31.9% of the sample, respectively. Only one factor was associated with breastfeeding maintenance at all outcomes: infant not using a pacifier showed a higher probability of breastfeeding maintenance in the first 2 years. Maternal grandmother breastfeeding support and exclusive breastfeeding duration were associated with breastfeeding maintenance for 6 and 12 months. The other factors evaluated were associated with breastfeeding maintenance at only one of the time points assessed: 6 months, maternal skin color (black/brown); 12 months, female infant and partner breastfeeding support; and 24 months, older paternal age and multiparity.

CONCLUSIONS

The present findings shed light upon barriers and facilitators of breastfeeding practices among adolescent mothers. In order to contribute to the challenge of increasing BF duration among adolescent mothers interventions aimed at boosting breastfeeding maintenance among this population should take into consideration the determining factors here identified. Additionally, breastfeeding education and support should be provided continuously as factors influencing these practices vary with time. Thus, support for adolescent mothers during the different stages of breastfeeding need to be tailored to have a positive impact on breastfeeding experience.

Trends and factors associated with early initiation of breastfeeding in Namibia: analysis of the Demographic and Health Surveys 2000-2013

BACKGROUND

Early initiation of breastfeeding (EIBF) lowers the risk for all-cause mortality in babies, including those with low birth weight. However, rates of neonatal mortality and delayed initiation of breastfeeding remain high in most low- and middle-income countries. This study aimed to assess the trends and factors associated with EIBF in Namibia from 2000 to 2013.

METHODS

An analysis of EIBF trends was conducted using data from three Namibia Demographic Health Surveys. The present sample included singleton children younger than 2-years from 2000 (n = 1655), 2006-2007 (n = 2152) and 2013 (n = 2062) surveys. Descriptive statistics were used to analyse respondents' demographic, socioeconomic and obstetric characteristics. Factors associated with EIBF were assessed using univariate analysis and further evaluated using multivariable logistic regression analysis.

RESULTS

EIBF significantly decreased from 82.5% (confidence interval [CI]: 79.5-85.0) in 2000 to 74.9% (72.5-77.2) in 2013. Factors associated with EIBF in 2000 were urban residence (adjusted odds ratio 0.58, 95% CI: 0.36-0.93), poorer household wealth index (1.82, 1.05-3.17), lack of antenatal care (0.14, 0.03-0.81), small birth size (0.38, 0.24-0.63) and large birth size (0.51, 0.37-0.79). In 2013, factors associated with EIBF were maternal age of 15-19 years (2.28, 1.22-4.24), vaginal delivery (2.74, 1.90-3.93), married mothers (1.57, 1.16-2.14), delivery assistance from health professionals (3.67, 1.23-10.9) and birth order of fourth or above (1.52, 1.03-2.26).

CONCLUSIONS

Namibia has experienced a declining trend in EIBF rates from 2000 to 2013. Factors associated with EIBF differed between 2000 and 2013. The present findings highlight the importance of continued commitment to addressing neonatal health challenges and strengthening implementation of interventions to increase EIBF in Namibia.

Intimate partner violence and breastfeeding practices: a systematic review of observational studies

OBJECTIVE

To review the association between intimate partner violence and breastfeeding practices in the literature.

DATA SOURCES

The search was carried out in five databases, including MEDLINE, LILACS, SCOPUS, PsycoINFO, and Science Direct. The search strategy was carried out in February 2017. The authors included original studies with observational design, which investigated forms of intimate partner violence (including emotional, physical, and/or sexual) and breastfeeding practices. The quality of the studies was assessed based on the bias susceptibility through criteria specifically developed for this review.

SUMMARY OF DATA

The study included 12 original articles (10 cross-sectional, one case-control, and one cohort study) carried out in different countries. The forms of intimate partner violence observed were emotional, physical, and/or sexual. Breastfeeding was investigated by different tools and only assessed children between 2 days and 6 months of life. Of the 12 studies included in this review, eight found a lower breastfeeding intention, breastfeeding initiation, and exclusive breastfeeding during the first six months of the child's life, and a higher likelihood of early termination of exclusive breastfeeding among women living at home where violence was present. The quality varied between the studies and six were classified as having low bias susceptibility based on the assessed items.

CONCLUSIONS

Intimate partner violence is associated with inadequate breastfeeding practices of children aged 2 days to 6 months of life.

Association Between Intimate Partner Violence and Breastfeeding Duration: Results From the 2004-2014 Pregnancy Risk Assessment Monitoring System

BACKGROUND

Intimate partner violence is a major public health problem that disproportionately affects women. Current literature investigating the relationship between intimate partner violence and breastfeeding is inconsistent. Research aim: This study aims to investigate the relationship between physical intimate partner violence that occurs in the preconception or prenatal period and any breastfeeding duration.

METHODS

Data from the retrospective, cross-sectional 2004-2014 Pregnancy Risk Assessment Monitoring System were analyzed ( N = 195,264). The outcome, breastfeeding duration, was categorized as never breastfed, breastfed 8 weeks or less, and breastfeed more than 8 weeks. Multinomial logistic regression was used to obtain crude and adjusted odds ratios and 95% confidence intervals.

RESULTS

Approximately 6% ( n = 11,766) of survey respondents reported preconception and/or prenatal intimate partner violence, and 36.3% ( n = 67,667) of women reported never breastfeeding. The odds of discontinuing breastfeeding before 8 weeks were 18% higher among women who reported experiencing abuse 12 months before pregnancy compared with women who did not report intimate partner violence (adjusted odds ratio = 1.18; 95% confidence interval [1.01, 1.37]). All other estimates showed an overlapping 95% confidence interval.

CONCLUSION

Breastfeeding is essential in improving maternal and child health; however, women in abusive relationships may face additional barriers to breastfeeding. Further research is needed to better understand the impact of violence on breastfeeding behaviors to inform healthcare practices and interventions.

Pacifiers and Exclusive Breastfeeding: Does Risk for Postpartum Depression Modify the Association?

BACKGROUND

Postpartum depression is associated with lower rates of breastfeeding. Evidence describing the effect of pacifiers on breastfeeding is inconsistent, and previous research suggests that pacifiers may help vulnerable mothers breastfeed. Research aim: This study aimed to determine (a) how receiving a pacifier in the hospital affects exclusive breastfeeding (EBF) at 1 week and 3 months postpartum and (b) whether this association is modified by risk for postpartum depression (PPD).

METHODS

Data were derived from Listening to Mothers III. We included participants ( n = 1,349) who intended to breastfeed and delivered at term. Mothers were considered at high risk for PPD if they reported feeling the need to receive treatment for depression during pregnancy. We used weighted multivariable logistic regression models to adjust for covariates.

RESULTS

Receiving a pacifier in the hospital was not significantly associated with EBF at 1 week (odds ratio [ OR] = 0.84, 95% confidence interval [CI] [0.62, 1.12]) but was significantly associated with lower odds of EBF at 3 months postpartum ( OR = 0.72, 95% CI [0.54, 0.95]). Risk for PPD modified this association. Among mothers at high risk for PPD, receiving a pacifier was significantly associated with increased odds of EBF ( OR = 3.31, 95% CI [1.23, 8.97] at 1 week and OR = 5.27, 95% CI [1.97, 14.12] at 3 months); however, among mothers who were at lower risk for PPD, receiving a pacifier was associated with decreased odds of EBF ( OR = 0.75, 95% CI [0.56, 1.02] at 1 week and OR = 0.62, 95% CI [0.46, 0.82] at 3 months).

CONCLUSION

Pacifiers may help protect against early cessation of EBF among mothers at high risk for depression. Additional research is needed to better understand this association.

Hospital practices to promote breastfeeding: The effect of maternal age

BACKGROUND

Breastfeeding rates are disproportionately low among young mothers in the United States. Although the use of hospital practices to promote breastfeeding is widely supported, the extent to which these practices help explain breastfeeding disparities by maternal age is unclear. Accordingly, we aimed to explore how maternal age may affect (1) receipt of hospital practices and (2) associations between these practices and exclusive breastfeeding.

METHODS

Data were derived from participants (n = 1598) of Listening to Mothers III, a national survey administered to mothers of singleton births in United States hospitals from July 2011 to June 2012. We used multivariable logistic regression models and interaction terms to examine maternal age as an effect modifier.

RESULTS

Compared with mothers aged 30 and older, mothers aged 18-19 had lower odds of reporting that nurses helped them initiate breastfeeding when ready (OR 0.59 [95% CI 0.35-0.99]), they roomed-in with their baby (OR 0.32 [95% CI 0.19-54]) and they did not receive a pacifier (OR 0.53 [95% CI 0.32-0.90]). Many associations with breastfeeding were stronger among mothers aged 18-19 and 20-24 than mothers aged 25-29 and 30 and older. Additionally, compared with receiving a pacifier, not receiving a pacifier was associated with greater odds of exclusive breastfeeding at 1 week among mothers aged 30 and older (OR 1.47 [95% CI 1.02-2.11]) but lower odds among mothers aged 18-19 (OR 0.26 [95% CI 0.10-0.70]).

CONCLUSIONS

Hospital practices to promote breastfeeding may be differentially implemented by maternal age. Encouraging teenage mothers to room-in with their babies may be particularly important for reducing breastfeeding disparities. Pacifier use among babies of teenage mothers requires further exploration.

Using a Music Video Parody to Promote Breastfeeding and Increase Comfort Levels Among Young Adults

BACKGROUND

North Americans are not meeting the World Health Organization's breastfeeding recommendations. Young adults understand that breastfeeding is healthy but are uncomfortable seeing breastfeeding. Research aim: The aim of the current project was to determine if a music video parody promoting breastfeeding is perceived by young adults to be an effective means of promotion and if exposure to such a video could increase comfort levels.

METHODS

Young adults rated how comfortable they felt looking at breastfeeding and bottle-feeding images (pretest). Two months later, a subset of participants watched the music video parody "Breastfeeding My Baby." In Phase 1, participants completed the picture-rating task again (posttest) after a 2-month delay, plus a survey to assess memory and perception of the video. In Phase 2, participants were reminded of the video before completing the comfort ratings, and in the final phase, posttest measures were administered only 1 week after exposure to the video.

RESULTS

Across all phases, the video was perceived to be effective and was memorable. Breastfeeding comfort ratings were comparable at pretest across participant groups; comfort ratings improved at posttest for participants who saw the video but only if they were reminded of seeing it before providing their ratings. At shorter intervals between seeing the video and completing the posttests, comfort ratings for breastfeeding images increased for all participants, highlighting the general importance of exposure to breastfeeding.

CONCLUSION

Young adults are receptive to using a music video parody to promote breastfeeding, which can help to increase comfort levels with breastfeeding.

[Effect of a healthy eating intervention on compliance with dietary recommendations in the first year of life: a randomized clinical trial with adolescent mothers and maternal grandmothers]

The objective was to evaluate the effect of a healthy eating intervention targeting adolescent mothers and maternal grandmothers on compliance with dietary recommendations in the first year of life. This was a randomized clinical trial involving 320 adolescent mothers, their infants, and 169 maternal grandmothers (when the three generations were living together), randomly assigned to the intervention versus control group. The intervention consisted of six counseling sessions on healthy feeding during the child's first year of life, the first of which held at the maternity ward and the others at 7, 15, 30, 60, and 120 days, at the homes. Information on the infant's diet was obtained monthly during the first 6 months and then every 2 months until the child reached 12 months of age, using a Food Frequency Questionnaire, in addition to questions on mealtimes, consistency of the foods, hygiene, preparation of meals, conservation of foods, and the mother's or grandmother's approach to the child's diet in the presence of illness. The outcome was defined as meeting the Ten Steps to a Healthy Diet: A Food Guide for Children Under Two Years Old, assessed by a score. The mean sum of the scores for each step obtained in the intervention group was higher than in the control group; the intervention doubled the odds of the total score being greater than or equal to the median. Living with grandmother did not influence the score either in the intervention group or the control group. The proposed intervention had a positive effect on meeting the Ten Steps, independently of participation by the maternal grandmother, showing that educational interventions can improve quality of diet for children in the first year of life.

Breastfeeding is Natural but Not the Cultural Norm: A Mixed-Methods Study of First-Time Breastfeeding, African American Mothers Participating in WIC

OBJECTIVE

Identify facilitators, barriers, and needs to increase breastfeeding (BF) support.

DESIGN

Semistructured interviews based on the Theory of Planned Behavior, Iowa Infant Feeding Attitude Scale, and Breastfeeding Self-Efficacy Scale-Short Form to measure attitudes and self-efficacy, respectively.

SETTING

One WIC clinic in central Illinois.

PARTICIPANTS

First-time BF African American mothers enrolled in WIC (n = 15).

PHENOMENON OF INTEREST

BF facilitators and barriers in the African American community.

ANALYSIS

Descriptive coding and inductive thematic analysis.

RESULTS

Six themes emerged: normative infant feeding behavior within the sociocultural context; cultural beliefs about maternal nutrition and BF; time and costs associated with BF; managing and integrating BF while maintaining a social life; necessity of social support from significant others and female role models; and suboptimal support from institutions (hospitals, schools, workplace, and community). A novel finding was that participants believed that BF was expensive, because they believed that mothers must eat healthy to breastfeed. In addition, BF was considered natural but not the cultural norm. Mean Iowa Infant Feeding Attitude Scale score (n = 15) was 70 (SD = 7), indicating a positive attitude toward BF. Breastfeeding Self-Efficacy Scale-Short Form mean score of 62 indicated a relatively high level of self-efficacy.

CONCLUSIONS AND IMPLICATIONS

Interventions should focus on providing social support (emotional, tangible, informational, and encouragement) to African American mothers and their social networks to promote a BF-friendly environment.

Breastfeeding in Infancy Is Associated with Body Mass Index in Adolescence: A Retrospective Cohort Study Comparing American Indians/Alaska Natives and Non-Hispanic Whites

BACKGROUND

American Indians and Alaska Natives have the highest obesity prevalence in the United States, but the influence of early childhood variables on body mass index (BMI; calculated as kg/m2) is not well understood. Previous studies have investigated the association between breastfeeding in infancy and offspring BMI, but rarely included American Indians and Alaska Natives.

OBJECTIVE

This study investigated the association between breastfeeding in infancy and BMI in American Indians and Alaska Native and non-Hispanic white adolescents and young adults.

DESIGN

Longitudinal analysis based on data from the National Longitudinal Study of Adolescent to Adult Health (1994 to 2008).

PARTICIPANTS

Adolescent respondents who self-identified as American Indians and Alaska Native or non-Hispanic white, and whose parents completed the parental questionnaire, reported their height and weight. The final sample included 655 American Indians and Alaska Native and 10,305 non-Hispanic white respondents.

STATISTICAL ANALYSES PERFORMED

Generalized estimating equations were used to measure the mean differences, 95% CIs, and P values of the association between breastfeeding in infancy and offspring BMI in adolescence, stratifying by race, and adjusting for demographic and socioeconomic variables.

RESULTS

The length of breastfeeding was inversely associated with BMI in both populations. American Indians and Alaska Natives that were breastfed for 6 to 12 months or for more than 12 months had a mean BMI of 2.69 (95% CI -3.46 to -1.92; P<0.01) and 1.54 (95% CI -2.75 to -0.33; P<0.05) units lower than those that were never breastfed. Non-Hispanic whites that were breastfed for 3 to 6 months, 6 to 12 months, or more than 12 months had a mean BMI of 0.71 (95% CI -0.93 to -0.50; P<0.01), 0.68 (95% CI -0.87 to -0.50; P<0.01), and 0.85 (95% CI -1.09 to -0.62; P<0.01) units lower than those that were never breastfed. The association between the length of breastfeeding and offspring BMI varied by race (P<0.01).

CONCLUSIONS

Breastfeeding in infancy is associated with lower mean BMI. Future research should investigate causal pathways and whether interventions promoting breastfeeding in American Indians and Alaska Natives can prevent increasing BMI.

Factors Influencing the Breastfeeding Practices of Young Mothers Living in a Maternity Shelter: A Qualitative Study

BACKGROUND

Young mothers have the lowest breastfeeding rates in Canada. Young mothers and their infants who access maternity shelters are especially at risk for poor outcomes, some of which breastfeeding may help to mitigate, yet little is known of the breastfeeding practices of this population. Research aim: The purpose of this study was to answer the research question, "What factors influence the breastfeeding practices of young mothers who live or have lived in a maternity shelter?"

METHODS

The study was conducted using interpretive description methodology and inductive content analysis. Data were collected by means of one-on-one interviews, with the participants recruited from a maternity shelter in Ontario, Canada.

RESULTS

Nine young mothers ages 17 to 24 years, who had initiated breastfeeding and resided at a maternity shelter, were interviewed. The five themes that emerged from the data were as follows: (a) choice, (b) special, (c) importance of early postpartum support, (d) being part of the "in crowd," and (e) importance of ongoing supports. The participants in this study took ownership of their choice to breastfeed. Hospital postpartum nurses and lactation consultants had a critical role in the establishment of early breastfeeding, and ongoing, accessible, and nonjudgmental peer, family, and community support were important to breastfeeding duration.

CONCLUSION

A combination of emotional and practical supports from multiple trusted sources, including professional and peer supports on an ongoing basis, enabled young mothers to reach their breastfeeding goals.

Exploring the influence of psychosocial factors on exclusive breastfeeding in Bangladesh

Exclusive breastfeeding is a proven benefit for both mothers and infants and is, therefore, an important public health priority. Intimate partner violence (IPV) is regarded as one of the potential psychosocial risk factors that may negatively affect exclusive breastfeeding (EBF). This study aimed to explore the influence of psychosocial factors including IPV on EBF. Cross-sectional survey data was collected from October 2015 to January 2016 in Chandpur District of Bangladesh from 426 married women, aged 15-49 years, who had at least one child 6 months of age or younger. Multivariate logistic regression models were used in order to investigate whether women who experienced IPV after childbirth, as well as other risk factors such as postpartum depression (PPD) and childhood sexual abuse, were more likely to face difficulties with EBF compared with women who had not experienced these same risk factors. Whilst the initiation rate of breastfeeding was 99.3%, at the time of the woman's interview, the overall EBF rate had fallen to 43.7%. Based on the adjusted model, women who experienced physical IPV (AOR 0.17, 95% CI [0.07, 0.40]) and psychological IPV (AOR 0.51, 95% CI [0.26, 1.00]) after childbirth and women who reported childhood sexual abuse (AOR 0.32, 95% CI [0.13, 0.80]) and PPD (AOR 0.20, 95% CI [0.09, 0.44]) were significantly less likely to exclusively breastfeed their infants than those who had not reported these experiences. Moreover, women with an intended pregnancy and high social support exhibited a higher likelihood of EBF. Our results suggest that preventing or reducing the occurrence of physical IPV, PPD and childhood sexual abuse may improve the EBF duration. Support from family members can assist in this process.

Changes in breastfeeding initiation at hospital discharge between first and second births in Nova Scotia: a population-based cohort study

BACKGROUND

Breastfeeding has well-recognized health benefits for infants and mothers. However, little research has been conducted to investigate changes in breastfeeding from one pregnancy to another. This study was conducted to describe rates of breastfeeding initiation at hospital discharge for women's first and second births and to identify factors associated with changes in initiation at the second birth.

METHODS

We conducted a longitudinal, population-based cohort study involving women residing in Nova Scotia who delivered a first and second live-born singleton between 2007 and 2013. Separate analyses were conducted among women who breastfed their first infant and among women who did not breastfeed their first infant.

RESULTS

Of the 9643 (82.6%) mothers who initiated breastfeeding in the first birth, 973 (10.3%) did not initiate breastfeeding in the second birth. Of first-birth noninitiators, 526 (26.3%) initiated breastfeeding in the second birth. With the exception of smoking and cesarean births, factors that were associated with breastfeeding initiation in the second birth depended on breastfeeding initiation status in the first birth. These factors were associated with increased odds of not breastfeeding in the second birth among the subset of mothers who breastfed in the first birth, and decreased odds of breastfeeding in the second birth among the subset of mothers who did not breastfeed in the first birth.

INTERPRETATION

Most women continue the same method of infant feeding after their first and second births. Identifying factors associated with change in breastfeeding status between the first and second births may help to inform interventions for optimal breastfeeding initiation in the second birth.

Maternal weight status, diet, and supplement use as determinants of breastfeeding and complementary feeding: a systematic review and meta-analysis

CONTEXT

Infant feeding practices are influenced by maternal factors.

OBJECTIVE

The aim of this review is to examine the associations between maternal weight status or dietary characteristics and breastfeeding or complementary feeding.

DATA SOURCES

A systematic literature search of the Embase, Cochrane Library, Google Scholar, MEDLINE, PubMed, and Web of Science databases was performed.

STUDY SELECTION

Interventional and cohort studies in healthy mothers and infants that reported on maternal weight status, diet, or supplement use were selected.

DATA EXTRACTION

Outcomes assessed included delayed onset of lactogenesis; initiation, exclusivity, duration, and cessation of breastfeeding; and timing of complementary feeding.

DATA ANALYSIS

Eighty-one studies were included. Maternal underweight, diet, and supplement use were not associated with infant feeding practices. Obese women had a relative risk of failure to initiate breastfeeding (risk ratio [RR] = 1.23; 95%CI, 1.03-1.47) and a delayed onset of lactogenesis (RR  =  2.06; 95%CI, 1.18-3.61). The RR for breastfeeding cessation was 1.11 (95%CI, 1.07-1.15) per increase in category of body mass index.

CONCLUSIONS

Prevention of obesity in women of reproductive age, as well as counseling of obese women after delivery, could be targeted to improve infant feeding practices.

Which factors influence women in the decision to breastfeed?

OBJECTIVE

Identify the factors that influence women in the decision to breastfeed.

METHODS

Integrative review. Information was gathered from original articles, case studies, theoretical studies, consensus and systematic reviews published between 2007-2013 in Spanish, Portuguese and English and recovered in the databases MEDLINE and LILACS. The descriptors used in this study were: breastfeeding, maternal behavior, risk factors, lactation and newborn.

RESULTS

Were included 30 articles, grouped into five categories. Factors influencing the decision of the breastfeeding woman are a convergence of breastfeeding's advantages, benefits and justifications, family, social and professional support, sociodemographic and clinical characteristics of women, personal experience and family tradition and personal choice.

CONCLUSION

The decision to breastfeed by women is influenced by a convergence of factors. It is essential the role of nursing to encourage women in the decision to initiate and maintain breastfeeding her child.

Past and recent abuse is associated with early cessation of breast feeding: results from a large prospective cohort in Norway

OBJECTIVE

Breast feeding provides a wide range of health benefits for both infants and mothers. Few studies have examined the impact of past and recent abuse of women on breastfeeding behaviour. The aims of our study were to examine whether exposure to past and recent emotional, sexual or physical abuse was associated with early breastfeeding cessation, and to assess whether a potential association differed for known and unknown perpetrators.

DESIGN

Prospective cohort study.

SETTING

Norway, years 1999-2006.

PARTICIPANTS

53,934 mothers participated in the Norwegian Mother and Child Cohort Study. We included mothers with singleton pregnancy who had responded to three questionnaires (weeks 18 and 30 in pregnancy, and 6 months postpartum) and had answered minimum one of the abuse questions in week 30.

MAIN OUTCOME MEASURE

ORs were estimated by binary logistic regression with cessation of any (all) breast feeding before 4 months as the outcome, and abuse including subcategories of abuse, as the exposure.

RESULTS

Nearly all women initiated breast feeding, but 12.1% ceased any breast feeding before 4 months and 38.9% ceased full breast feeding before 4 months, but continued partial breast feeding. Overall, 19% of the women reported any adult abuse and 18% reported any child abuse. The highest risk of any breast feeding cessation before 4 months was seen in women exposed to three types of adult abuse (emotional, sexual or physical), with adjusted OR being 1.47 (95% CI 1.23 to 1.76) compared with no abuse. Recent abuse and exposure from known perpetrator resulted in nearly 40% and 30% increased risk, respectively. The OR of any breast feeding cessation for women exposed to any child abuse was 1.41 (95% CI 1.32 to 1.50) compared with no abuse in childhood.

CONCLUSIONS

Past and recent abuse of women is strongly associated with early cessation of breast feeding. Abused mothers comprise a key group to target for extra support and breastfeeding assistance.

Prevalence and determinants of exclusive breastfeeding among adolescent mothers from Quito, Ecuador: a cross-sectional study

Background

Exclusive breastfeeding (EBF) is the optimal way to feed children during their first six months of life, having important benefits for them and their mothers. However, the proportion of Ecuadorian mothers who continue to exclusively breastfeed their infants during the recommended six-month period has been reported to remain below the World Health Organization’s goal set of 90 %. Little is known regarding factors influencing adolescent mothers to decide whether to practice EBF or not. Furthermore, there is no data about the EBF rates among adolescent mothers in Quito, Ecuador.

Methods

This cross-sectional study took place from April to November 2013 in the largest maternity ward in Quito, Ecuador (Hospital Gineco Obstétrico Isidro Ayora). Adolescent mothers parenting an infant between 6 and 24 months of age (n = 375) were interviewed using a structured questionnaire about EBF knowledge, beliefs and practices. Bivariate and multivariate analyses were used to identify the independent predictors of EBF.

Results

In our sample, 62.9 % of adolescent mothers raising infants between 6 to 24 months of age chose EBF. Knowledge about the maternal benefits of breastfeeding and awareness of appropriate time frame for EBF were statistically associated with increasing the likelihood of choosing EBF. Adolescent mothers who were acquainted with the recommended duration of EBF were more likely to practice EBF (adjusted odds ratio (AOR) = 1.73; 95 % confidence interval (CI) 1.003, 2.98) as well as those who knew that breastfeeding is a protective factor against breast cancer (AOR = 5.40; 95 % CI 1.19, 24.56).

Conclusions

Although adolescent mothers may be more prone to discontinuing EBF before their infants reach six months of age, the prevalence of EBF among adolescent mothers interviewed was higher than the rate reported for Ecuadorian mothers in other age groups. Our data underscores the importance of emphasizing the correct practice of BF and its benefits in breastfeeding education programs provided to Ecuadorian mothers, in order to promote the extension of breastfeeding duration to the recommended levels.

Factors Associated with Breastfeeding Initiation in Adolescent Pregnancies: A Cohort Study

PURPOSE

Adolescent mothers have a lower breastfeeding rate than adult women. The objective is to determine the association between multiple high-risk characteristics of pregnant adolescents with intention and initiation of breastfeeding.

METHODS

We conducted a retrospective population-based cohort study in Ontario (2006-2012) using the Better Outcomes Registry & Network (BORN) database. Breastfeeding outcomes of adolescent women (younger than 20 years) with a singleton live-born infant at term gestation (37 weeks or greater) were analyzed. The χ(2) and independent-sample t tests were used where appropriate. A multivariate logistic regression analysis was also performed.

RESULTS

This study included 22,023 adolescent women with complete breastfeeding information. Almost half (48.8%, n = 10,749) exclusively breastfed their infant at time of hospital discharge. Breastfeeding was significantly more likely in the older adolescents (odds ratio 1.10); other factors significantly associated with breastfeeding included intention to breastfeed, prenatal classes attendance, living in a higher-income neighborhood, having a spontaneous vaginal delivery, being a nonsmoker, not using substances during pregnancy, and not having any preexisting health problems or obstetrical complications (P < .0001). A significant interaction between smoking and intention to breastfeed was identified. Intention to breastfeed was found to be protective against the reduction in breastfeeding seen with smoking.

CONCLUSION

This large-cohort study confirms that high-risk factors are associated with lower breastfeeding in Canadian adolescent term singleton births. Breastfeeding intention is a very important driver of breastfeeding. These findings highlight the importance of early multidisciplinary adolescent pregnancy care targeting these risks factors and education in order to improve breastfeeding rates in this population.

Fatores associados ao aleitamento materno exclusivo entre mães adolescentes

ResumoObjetivoAnalisar os fatores associados ao aleitamento materno exclusivo entre mães adolescentes até o terceiro mês pós-parto, em Teresina, no Piauí.MétodosEstudo transversal com 202 adolescentes três meses após o parto em quatro maternidades, em 2006. Foi realizada análise multivariável por meio de regressão logística binomial para cálculo de odds ratio ajustado (ORaj) e intervalos de confiança de 95% (IC 95%).ResultadosAfirmaram amamentar a criança 88,2% das adolescentes, sendo que apenas 38,2% amamentavam exclusivamente no terceiro mês pós-parto. Adolescentes que estudavam apresentaram chances 14% maiores de terem interrompido o aleitamento exclusivo três meses pós-parto (ORaj=0,14, IC95%=0,0-0,5, p=0,004). Contudo, o recebimento de suporte para cuidados de si e da criança aumentou em três vezes as chances de manter o aleitamento exclusivo (ORaj=3,12, IC95%=1,0-9,0, p=0,037).ConclusãoSão necessárias medidas para incentivar o aleitamento materno entre mães adolescentes, particularmente o apoio da família para que as adolescentes possam continuar estudando sem deixar de realizar o aleitamento.

Breastfeeding among adolescent mothers: a systematic review of interventions from high-income countries

Despite growing evidence of the benefits of breastfeeding, rates of breastfeeding remain disproportionately low among adolescent mothers compared with older mothers in the United States. Current interventions primarily target adult women, and little evidence is available for breastfeeding promotion among young women. Accordingly, we aim to review interventions designed to improve breastfeeding rates among adolescents to make recommendations for future research and practice. We searched MEDLINE and PsycINFO for articles that evaluated interventions aiming to improve rates of breastfeeding initiation, duration, or exclusivity among adolescents. Inclusion criteria included interventions targeting pregnant or postpartum adolescents (mean/median age <22 years) that were conducted in high-income settings. Six interventions met our inclusion criteria; of these, 4 interventions aimed to increase breastfeeding initiation, 5 aimed to increase breastfeeding duration, and 4 aimed to increase breastfeeding exclusivity. Interventions included school-based programs, home visits, and telephone support that were implemented by a combination of peer counselors, nurse clinicians, doulas, and lactation consultants. Only 1 intervention, a combination of education and counseling provided by a lactation consultant-peer counselor team, significantly improved both breastfeeding initiation and duration. Other results were mixed, and studies were subject to several methodological limitations. We recommend that more interventions should be developed and evaluated. In addition, interventions should be less resource intensive, be more theoretically driven, and specifically include mothers and partners of adolescents to successfully promote breastfeeding among adolescent mothers.

Emotion Expression and Substance Use in Newly Parenting Adolescents and Young Adults

OBJECTIVE

Deficits in emotion expression skills have been associated with alcohol and substance use, but the mechanisms through which these associations occur are not well understood. The current study investigated (a) associations between emotion expression and substance use (i.e., alcohol, cigarettes, and marijuana) in newly parenting adolescents and young adults and (b) whether symptoms of depression and stress mediate these associations in young mothers and fathers.

METHODS

Participants recruited from obstetrics and gynecology clinics completed the Center for Epidemiological Studies-Depression Scale, Perceived Stress Scale, Emotion Expression Scale for Children, and substance use items.

RESULTS

Path analysis indicated that lower emotion expression at 6 months postpartum was significantly associated with more alcohol and marijuana use at 12 months postpartum for males but not females. Also among males, stress levels at 6 months postpartum partially mediated associations between emotion expression and alcohol and marijuana use at 12 months postpartum.

CONCLUSIONS

Findings suggest that poor emotion expression skills are related to more substance use in young fathers, and levels of stress may partially account for this association.