Barriers to breast-feeding in obese women: A qualitative exploration

A longitudinal investigation of breastfeeding planning, initiation, and duration among individuals with pre-pregnancy overweight or obesity

Individuals with a body mass index (BMI)≥25 kg/m2 are less likely to initiate and continue breastfeeding than are those with BMIs<25. Given the intergenerational health benefits of breastfeeding, it is important to understand breastfeeding behaviors and their correlates among individuals with BMIs≥25. Thus, in an observational cohort with BMI≥25 (N = 237), we aimed to characterize longitudinal relationships among breastfeeding planning, initiation, and duration and their sociodemographic/clinical correlates and determine if pre-pregnancy BMI predicts breastfeeding planning, initiation, and duration. Breastfeeding behaviors, weight/BMI, and sociodemographic/clinical characteristics were assessed in early, mid, and late pregnancy, and at six-months postpartum. Most participants planned to (84%) and initiated (81%) breastfeeding, of which 37% breastfed for ≥6 months. Participants who were married, first-time parents, higher in education/income, and had never smoked tobacco were more likely to plan, initiate, and achieve ≥6 months of breastfeeding. Higher pre-pregnancy BMI was not associated with breastfeeding planning or initiation but was associated with lower adjusted odds of breastfeeding for ≥6 months relative to <6 months. Findings suggest that support aimed at extending breastfeeding among those with elevated pre-pregnancy BMI may be warranted. Future interventions should also address sociodemographic and clinical inequities in breastfeeding.

Prepregnancy Obesity and Breastfeeding in the First Month of Life: A Birth Cohort

Objective: This study aimed to investigate the association between prepregnancy obesity and disruption of exclusive breastfeeding (EBF) within the first month of life. Materials and Methods: This was a prospective cohort study conducted among Brazilian mothers and their babies born between February and December 2017. Research was conducted in all maternity hospitals in Vitória da Conquista, Brazil. Data collection started in the maternity hospitals of the city and, subsequently, an interview was conducted during a home visit on the 30th day of the child's life. Survival analysis was performed using Kaplan-Meier curves and a log rank test was applied to compare the curves. The association between independent variables and the response variable was assessed using Cox regression, following the conceptual model created for the study. Results: The study analyzed 329 pairs of mothers and babies. The prevalence of prepregnancy obesity was 12%. The prevalence of EBF disruption in the first month of life was 41.1% in nonobese mothers (confidence interval [95% CI]: 35.3-46.9) and 52.6% in obese mothers (95% CI: 36.3-68.4), with a shorter survival time among mothers with prepregnancy obesity (log rank p < 0.05). The risk of EBF disruption in the first month of life was 83% higher among mothers with prepregnancy obesity, after adjusting for confounding variables-demographic, socioeconomic, prenatal maternal data, and childbirth variables (hazard ratio = 1.84; 95% CI: 1.08-3.11). Conclusions: We observed an association between pregestational obesity and disruption of EBF in the first month of life. This finding reinforces the need for a thorough professional approach to the practice of breastfeeding in this population in the prenatal period as well as early puerperium.

Prepregnancy Body Mass Index Is Associated with Time-Dependent Changes in Secretory Activation Measures During the First 7 Days Postpartum in Breast Pump-dependent Mothers of Premature Infants

Background: Little is known about the biology of secretory activation (SA) in overweight and obese (OW/OB) mothers who are breast pump dependent with a premature infant in the neonatal intensive care unit. Objective: To compare time-dependent changes in daily pumped milk volume, maternal milk sodium (Na) concentration, and Na-to-potassium (K) ratios (Na:K) in the first 14 days postpartum in breast pump-dependent mothers with prepregnancy body mass index (BMI) <27 and BMI ≥27 kg/m². Design/Methods: This secondary analysis for 39 subjects, 44% (n = 17) with prepregnancy BMI <27 and 56% (n = 22) with BMI ≥27, included transformed data of outcome measures, chi-square, t-tests, and growth curve models. Results: For days 1-7, daily pumped milk volume increased significantly more rapidly for mothers with BMI <27 (65.82 mL/d) versus BMI ≥27 (33.08 mL/d), but the daily rate of change in pumped milk volume during days 8-14 was not statistically different. Daily milk Na concentration decreased significantly faster in BMI <27 (-3.93 mM/d) versus BMI ≥27 (-2.00 mM/day) during days 1-7, but was not significantly different for days 8-14. No statistical differences were noted for Na:K ratio for either time period. Conclusion: These data add biologic evidence to previous research, suggesting delayed or impaired SA in OW/OB mothers, and suggest that the window of opportunity for research and clinical interventions is days 1-7 postpartum in this population.

Determinants of time-trends in exclusivity and continuation of breastfeeding in India: An investigation from the National Family Health Survey

Breastfeeding is an essential key factor for reducing child mortality and the risk of disease. Therefore, to ensure health and wellbeing for all (Sustainable Development Goal 03), and to reduce inequalities in child health status (SDG 10), understanding the determinants of breastfeeding is essential. Our research aims to investigate determinants of different breastfeeding practices from 2005-06 (NFHS-3) to 2015-16 (NFHS-4), and changes in different breastfeeding practices among various demographic, social, religious, and economic groups during this decade. We have used a multivariate binary logistic regression model to estimate significant determinants of different breastfeeding practices. The results show an 8.4% hike in Exclusive Breastfeeding (EBF), along with a 3.3% and 1% drop in the Continuation of Breastfeeding (CBF) up to one and two years respectively during this decade in India. Significant variation has been found in EBF, CBF1 and CBF2 among various categories of child's birth interval, place of residence, social groups, economic communities, and geographic regions. Maternal nutritional status and anemia levels had significant influence on CBF1 and CBF2, and gender of the children on EBF and CBF2 from 2005-06 to 2015-16. There was no significant variation in CBF1 and CBF2 among children born in different birth orders, whereas EBF was significantly less among higher birth orders children. A dramatic improvement in EBF was found among first birth ordered children, teenage and/or highly educated mother, rich families, and in north India, and CBF2 was significantly raised only among higher educated mothers. The estimation of determinants throughout the decade is essential for improving government policies related to supporting and encouraging breastfeeding. The study suggests more initiatives and investment for the promotion, support and improvement of CBF for one and two years, and reduction of inequality among various demographic and socio-economic groups and geographic regions.

Women's Perceptions and Experiences of Breastfeeding: a scoping review of the literature

BACKGROUND

Despite public health efforts to promote breastfeeding, global rates of breastfeeding continue to trail behind the goals identified by the World Health Organization. While the literature exploring breastfeeding beliefs and practices is growing, it offers various and sometimes conflicting explanations regarding women's attitudes towards and experiences of breastfeeding. This research explores existing empirical literature regarding women's perceptions about and experiences with breastfeeding. The overall goal of this research is to identify what barriers mothers face when attempting to breastfeed and what supports they need to guide their breastfeeding choices.

METHODS

This paper uses a scoping review methodology developed by Arksey and O'Malley. PubMed, CINAHL, Sociological Abstracts, and PsychInfo databases were searched utilizing a predetermined string of keywords. After removing duplicates, papers published in 2010-2020 in English were screened for eligibility. A literature extraction tool and thematic analysis were used to code and analyze the data.

RESULTS

In total, 59 papers were included in the review. Thematic analysis showed that mothers tend to assume that breastfeeding will be easy and find it difficult to cope with breastfeeding challenges. A lack of partner support and social networks, as well as advice from health care professionals, play critical roles in women's decision to breastfeed.

CONCLUSION

While breastfeeding mothers are generally aware of the benefits of breastfeeding, they experience barriers at individual, interpersonal, and organizational levels. It is important to acknowledge that breastfeeding is associated with challenges and provide adequate supports for mothers so that their experiences can be improved, and breastfeeding rates can reach those identified by the World Health Organization.

Self-conscious emotions and breastfeeding support: A focused synthesis of UK qualitative research

Research on women's experiences of infant feeding and related moral discourse suggests that self‐conscious emotions may be highly relevant to breastfeeding support interactions. However, the emotional impact of receiving support has not been fully explored. The aim of this review is to re‐examine qualitative UK research on receiving breastfeeding support, in order to explore the role of self‐conscious emotions and related appraisals in interactions with professional and peer supporters. From 2007 to 2020, 34 studies met criteria for inclusion. Using template analysis to identify findings relevant to self‐conscious emotions, we focused on shame, guilt, embarrassment, humiliation and pride. Because of cultural aversion to direct discussion of self‐conscious emotions, the template also identified thoughts about self‐evaluation, perceptions of judgement and sense of exposure. Self‐conscious emotions were explicitly mentioned in 25 papers, and related concerns were noted in all papers. Through thematic synthesis, three themes were identified, which suggested that (i) breastfeeding ‘support’ could present challenges to mothering identity and hence to emotional well‐being; (ii) many women managed interactions in order to avoid or minimise uncomfortable self‐conscious emotions; and (iii) those providing support for breastfeeding could facilitate women's emotion work by validating their mothering, or undermine this by invalidation, contributing to feelings of embarrassment, guilt or humiliation. Those supporting breastfeeding need good emotional ‘antennae’ if they are to ensure they also support transition to motherhood. This is the first study explicitly examining self‐conscious emotions in breastfeeding support, and further research is needed to explore the emotional nuances of women's interactions with supporters.

Exploring psychological factors associated with breastfeeding in women with a BMI ≥ 30 kg/m2

OBJECTIVE

Women with a BMI ≥ 30 kg/m² are less likely to initiate and maintain breastfeeding compared to normal-weight women. Psychological factors have been linked with breastfeeding, but their influence on women with a BMI ≥ 30 kg/m² experiences needs further exploration. The aim of this study was to investigate whether psychological factors are voiced by women with a BMI ≥ 30 kg/m², and how these factors influence their breastfeeding.

DESIGN

A secondary analysis of eighteen semi-structured interviews with women with a BMI ≥ 30 kg/m² who had breastfed.

MAIN OUTCOME MEASURES

Deductive thematic analysis was used to apply a framework of psychological factors to the data, and investigate the extent to which they feature within the women's breastfeeding experiences.

RESULTS

All psychological factors were reported as part of women's experiences. Planning to breastfeed, planning short durations and having high confidence, factual and social knowledge positively influenced initiation and maintenance. Believing in their ability to produce nutritionally adequate and sufficient milk, that breastfeeding would assist weight loss, and that others around them approved of breastfeeding also had a positive impact. Novel relationships between psychological factors were found.

CONCLUSIONS

Psychological factors influence women's breastfeeding experiences. A model of breastfeeding in women with a BMI ≥ 30 kg/m² has been developed, and can inform future intervention development.

Adiposity, psychomotor and behaviour outcomes of children born after maternal bariatric surgery

BACKGROUND

Bariatric surgery before pregnancy can result in improved maternal fertility. However, long-term data on the consequences at childhood age are currently lacking.

METHODS

EFFECTOR is a prospective cohort study of children (aged 4 to 11 years) born to mothers who underwent bariatric surgery (BS) before pregnancy (n = 36), controls with overweight/obesity (OW/OB) matched on pre-pregnancy BMI (n = 36) and normal weight controls (NL) (n = 35). We performed prospective collection of anthropometric data, data on psychomotor development, school functioning and behaviour (Strengths and Difficulties Questionnaire (SDQ), Child Behaviour Checklist (CBCL)).

RESULTS

The children born after bariatric surgery (BS) presented with the highest body-weight SDS (0.70 vs 0.14 in OW/OB and -0.09 in NL; P = .006) and BMI SDS (0.47 vs -0.02 in OW/OB and -0.42 in NL; P = .01). A higher excess in body fat percentage and waist circumference SDS were found in the BS group (5.7 vs 1.4 in OW/OB and -0.1 in NL; P < .001 and 0.61 vs 0.16 in OW/OB and -0.15 in NL; P = .04). The SDQ questionnaires revealed a higher amount of overall problems in the BS offspring (11.1 vs 7.5 in OW/OB and 8.1 in NL; P = .03), with a higher externalizing score at the CBCL (52.0 vs 44.2 in OW/OB and 47.0 in NL; P = .03).

CONCLUSION

Maternal bariatric surgery does not appear to protect the offspring for childhood overweight and obesity. Parents reported more behaviour problems in these children, especially externally of nature.

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.

Conceptual and operational definition of nursing outcomes regarding the breastfeeding establishment

OBJECTIVE

to construct conceptual and operational definitions of Nursing Outcomes "Breastfeeding establishment: infant (1000)" and "Breastfeeding establishment: maternal (1001)".

METHOD

integrative literature review in the following databases: PUBMED (United States National Library of Medicine); LILACS (Latin American and Caribbean Health Sciences Literature); CINAHL (Cumulative Index to Nursing and Allied Health Literature); SciVerse SCOPUS; Web of Science; BDENF (Brazilian Nursing Database) and EMBASE (Excerpta Medica Database). The gray literature was explored to elucidate topics not covered by the articles. Of 3242 articles, 96 were selected to be read in full, and 43 were used for constructing the definitions. Five theses, three dissertations, three books and two manuals were selected.

RESULTS

all the results were reviewed. The definitions facilitated the improvement of the content proposed by the Nursing Outcomes Classification, favoring its application in clinical practice and supporting the development of research and teaching.

CONCLUSION

it was proposed to change the definition of the two outcomes, as well as to change the title of one of them to "Breastfeeding establishment: newborn & infant" (1000), modifying seven of its indicators and excluding one. For the outcome related to the mother, it was proposed to modify two indicators and exclude one.

Weight Stigma Related to Pregnancy: A Concept Analysis

The aims of this article are to (1) present a shared definition of weight stigma related to pregnancy and (2) develop a definition to inform valid and reliable nursing research addressing weight stigma in the obstetric setting. Weight stigma is increasingly prevalent in society, especially among women with prepregnancy overweight or obesity. However, a universally accepted definition of weight stigma related to pregnancy has yet to be identified. We followed Walker and Avant's concept analysis methodology using an iterative approach to ensure a robust and conceptually sound definition of weight stigma related to pregnancy.

Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence-based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.

Learning from Women with a Body Mass Index (Bmi) ≥ 30 kg/m2 who have Breastfed and/or are Breastfeeding: a Qualitative Interview Study

Objectives Women with a BMI ≥ 30 kg/m² are less likely to initiate and maintain breastfeeding compared to women with a BMI ≤ 30 kg/m². Reasons for this disparity are not understood. Therefore, this qualitative interview study aimed to learn from women with a BMI ≥ 30 kg/m² who have breastfed. Methods Eighteen women participated in a semi-structured telephone interview. Participants were required to have had a BMI ≥ 30 kg/m² at the start of their pregnancy, and have breastfed and/or be currently breastfeeding. An inductive thematic analysis was used to analyze data. Results Two themes were identified: ‘personal control over breastfeeding behavior’ and ‘realistic expectations of the breastfeeding journey’. To achieve their breastfeeding goals, women described the importance of feeling in control of their behaviors, and having realistic expectations, when facing social and practical barriers. They gained this control and formed realistic expectations by seeking support and information. In particular, gaining support from other breastfeeding women with a BMI ≥ 30 kg/m², and information about alternative positioning, and compatible clothing and nutrition helped women to breastfeed. Conclusions for Practice Having adequate information and support in order to feel in control of breastfeeding behavior and form realistic expectations are vital contributors to breastfeeding behaviors in women with a BMI ≥ 30 kg/m². Future work is necessary to develop suitable interventions and to investigate their feasibility.

The perceptions and experiences of women with a body mass index ≥ 30 kg m2 who breastfeed: A meta-synthesis

Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance among women with a body mass index (BMI) ≥ 30 kg m² are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature that explored the perceptions and experiences of women with a BMI ≥ 30 kg m² who breastfed. The search identified five eligible papers, and a meta‐ethnographic approach was taken to synthesise the findings. One theme was identified: “weight amplifies breastfeeding difficulties,” revealing that women with a BMI ≥ 30 kg m² experience common breastfeeding difficulties to a greater degree. In particular, women with a BMI ≥ 30 kg m² struggle with the impact of medical intervention, doubt their ability to breastfeed, and need additional support. These findings can inform understanding of breastfeeding models, future research directions, intervention development, and antenatal and post‐natal care for women with a BMI ≥ 30 kg m².

A systematic review examining the association between female body image and the intention, initiation and duration of post-partum infant feeding methods (breastfeeding vs bottle-feeding)

A systematic review was conducted to examine female body image in relation to the intention, initiation and duration of post-partum infant feeding methods. A search of 10 databases was conducted to identify studies. A total of nine studies were included in the systematic review. All studies were of a non-randomised control design with a total of 13,046 participants. Findings suggest that exclusive breastfeeding is more likely in pregnant women with a higher body image, while those with body concerns had less intention to breastfeed or initiate, with those who start having a shorter duration.

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.

Comparing barriers to breastfeeding success in the first month for non-overweight and overweight women

Background

Women who enter pregnancy overweight or obese tend to have poorer breastfeeding outcomes compared to non-overweight women. Women’s experiences of specific breastfeeding-related problems and reasons for use of formula have not been systematically investigated according to pre-pregnancy BMI. The aim of this study was to compare self-reported breastfeeding problems in non-overweight and overweight women and identify the main reasons for use of infant formula during the first month postpartum.

Methods

The present study involved a cross-sectional secondary analysis of data collected as part of a hospital-based longitudinal study of women that commenced in pregnancy (~ 16 weeks). At ~ 4 months postpartum Australian women (N = 477) self-reported breastfeeding problems and reasons for use of infant formula during the first month postpartum. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. Binary logistic regression analyses were used to compare pre-pregnancy weight status groups (“non-overweight” [BMI < 25 km/m²] and “overweight” [BMI ≥25 km/m²]) on self-reported breastfeeding problems and reasons for use of infant formula. Analyses were adjusted for covariates that differed between groups (P < .1).

Results

Frequency of self-reported breastfeeding problems was similar across weight status groups. “Not enough milk” was the predominant reason for giving infant formula. Overweight women were more likely than non-overweight women to agree that infant formula was as good as breastmilk.

Conclusions

Overall it does not appear that overweight women are more likely to experience a range of specific breastfeeding problems in the first months compared to non-overweight women. However, the severity and duration of the problems needs to be examined. Breastfeeding interventions need to addresses concerns around milk supply as these are common and are likely to be of universal benefit however overweight women in particular may benefit from guidance regarding the benefits of breastfeeding for both themselves and their infants.

Experiences and Perspectives About Breastfeeding in "Public": A Qualitative Exploration Among Normal-Weight and Obese Mothers

BACKGROUND

Women face societal and cultural barriers to breastfeeding. These challenges have been investigated in international studies and U.S. public opinion polls; however, mothers' experiences with breastfeeding in public in the United States remain unexplored. Research aim: The aim of this study was to describe the experiences of obese and normal-weight women with breastfeeding in public in central New York.

METHODS

Pregnant women ( N = 26) in central New York who intended to breastfeed and were either normal weight or obese were enrolled during their third trimester. A longitudinal, qualitative study was conducted to obtain information about women's experiences from birth through 3 to 6 months postpartum. Interviews were audio recorded, transcribed, and verified for accuracy. Transcripts were analyzed iteratively using conventional content analysis.

RESULTS

The concept of "public" was situational rather than a set of physical places; women experienced challenges while breastfeeding around others in private locations that were indistinguishable from those they encountered in places typically considered public. Women experienced social and physical awkwardness including perceived lack of acceptability, fear of confrontation, exposure, and positioning difficulties. They used strategies to reduce awkwardness, for example, being "discreet" and minimizing breastfeeding around other people. Obese women experienced similar challenges but to a greater degree than normal-weight women.

CONCLUSION

"Breastfeeding around others" described mother's experiences more accurately than "breastfeeding in public" and was experienced as awkward both socially and physically, particularly by obese women. Strategies are needed to normalize breastfeeding in the United States and to prepare mothers for the challenges of breastfeeding around others.

Mothers' Concerns for Personal Safety and Privacy While Breastfeeding: An Unexplored Phenomenon

BACKGROUND

Preliminary qualitative research in upstate NY shows new mothers are worried about safety while breastfeeding. Little is known regarding prevalence of these concerns and their effect on breastfeeding outcomes.

OBJECTIVES

(1) Determine frequency of breastfeeding safety and privacy concerns; (2) Explore their association with breastfeeding outcomes.

METHODS

Mothers were surveyed immediately and 1-month postpartum about breastfeeding goals; both surveys addressed privacy and safety concerns at home, work, and in public. Outcome data included breastfeeding intent, exclusivity, and duration. Breastfeeding/non-breastfeeding mothers were compared using Chi-square and multivariate analyses.

RESULTS

A total of 279 women enrolled. Of these 82.8% initiated breastfeeding; at 1-month 72% provided any breast milk, and 44% were exclusively breastfeeding. About 99% felt safe breastfeeding at home; 25% reported privacy concerns; and 5% felt "vulnerable or unsafe" while breastfeeding. At 1-month, 49% agreed there was a safe place to breastfeed/express milk at work (20% unsure). Non-breastfeeding mothers expressed more safety concerns outside home/at work: 18% breastfeeding versus 28% non-breastfeeding outside home; 27% breastfeeding versus 40% non-breastfeeding at work. Nearly 54% who reported feeling vulnerable/unsafe with breastfeeding initiated breastfeeding, compared with 86% not reporting this concern (p = 0.008). Fewer women initiating breastfeeding reported vulnerability/safety (3% breastfeeding versus 14% non-breastfeeding, p = 0.008) or privacy (22% breastfeeding versus 40% non-breastfeeding, p = 0.19) concerns. Associations held after controlling for age, race, parity, insurance, geography, and marital-status. Significant associations between initiation, privacy, and safety concerns did not extend to duration or exclusivity.

CONCLUSION

Many breastfeeding women reported safety and privacy concerns, especially outside the home and at work, which may influence breastfeeding initiation. Further study may identify methods to address these issues, potentially increasing breastfeeding rates.

"You just need to leave the room when you breastfeed" Breastfeeding experiences among obese women in Sweden - A qualitative study

BACKGROUND

The benefits of breastfeeding for the infant as well for the mother are well-known. It is recognized that obese (Body Mass Index ≥30 kg/m²) women may have less antenatal intention to breastfeed, and shortened duration of breastfeeding compared with normal-weight women. This may result in adverse short- and long-term health for both mother and child, such as a shortened lactational amenorrhoea and decreased protection against breast cancer for the women, and an increased risk for infectious diseases and overweight/obesity among the children. Therefore, it is important to gain more knowledge and understanding of obese women's experiences of breastfeeding in order to attain good health care. Hence, the aim of this study was to identify and describe obese women's experiences of breastfeeding.

METHODS

This is an explorative study. Data was collected 2 - 18 months after childbirth through semi-structured face-to-face interviews with 11 obese women with breastfeeding experience. The interviews were recorded and transcribed verbatim. Thematic analysis was used.

RESULTS

Three themes emerged from the data analysis: Breastfeeding - a part of motherhood, the challenges of breastfeeding, and support for breastfeeding. The women described an antenatal hope for breastfeeding, the body's ability to produce milk fascinated them, and the breast milk was seen as the best way to feed the child and also as promoting the attachment between mother and child. Breastfeeding was described as a challenge even though it is natural. The challenges concerned technical difficulties such as the woman finding a good body position and helping the child to achieve an optimum grip of the nipple. Another challenge was the exposure of the body connected to public breastfeeding. Support of breastfeeding was described as the importance of being confirmed as an individual behind the obesity, rather than an individual with obesity, and to obtain enough professional breastfeeding support.

CONCLUSIONS

Breastfeeding was experienced as a natural part of being a mother. There were practical challenges for obese women concerning how to manage breastfeeding and how to handle the public exposure of the body. There was a need for realistic information about breastfeeding concerning both the child and the woman.

Influence of weight concerns on breastfeeding: Evidence from the Norwegian mother and child cohort study

Objectives

High body mass index (BMI) often predicts truncated breastfeeding, although why is unclear. We test a proposed mediating role of body concerns on breastfeeding initiation and child's age at weaning using longitudinal data for 55,522 mothers from the Norwegian Mother and Child Cohort Study (MoBa).

Methods

A linear regression‐based mediation analysis with bootstrapping estimates the indirect effects of BMI on breastfeeding decisions (ever‐initiation of breastfeeding, child's age at weaning, and duration of any breastfeeding beyond six months) through the variables of concern around prepregnancy weight and weight gains due to pregnancy.

Results

Contrary to prediction, Norwegian mothers with greater prepregnancy weight concerns had a higher likelihood of initiating breastfeeding. Concerns about weight gain during pregnancy, however, predicted earlier weaning. This relationship was the same for higher and lower BMI mothers.

Conclusion

In this very large sample, body image affects some breastfeeding decisions. However, this effect is independent of mother's body size.

LncRNA as ceRNAs may be involved in lactation process

The main function of the mammary gland is to secret milk for newborn growth. Milk production process is regulated by hormones, growth factors, noncoding RNAs and other factors locally. Long non-coding RNAs (lncRNAs), one type of recently discovered non-coding RNA, have been found in mammary gland and some studies suggested lncRNA may play important roles in mammary gland development. Competing endogenous RNAs (ceRNAs) are emerging to compete for miRNA binding and, in turn, regulate each other. In the current study, we sequenced mRNA, miRNA and lncRNA in goat mammary tissue at 2 points in lactation (early and mature). All data were co-expressed together from the same samples. Our data showed that the ceRNAs up-regulated during the mature lactation phase were associated with lipid, protein, carbon and amino acid synthesis and metabolism. This correlates with the function of the mature lactation phase: i.e. the continuous production of large amounts of milk, rich in proteins, lipids, amino acids and other nutrients. Alternately, the ceRNAs up-regulated during early lactation were associated with PI3K-AKT pathways and ECM-receptor interactions; these fulfil the functional role of preparing the mammary gland for full lactation. Therefore, the results suggest that ceRNAs work synergistically during different developmental stages to regulate specific functions associated with lactation control. This study suggests that ceRNAs (lncRNA-mRNA) may be involved in lactation process.

Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: discoveries from a longitudinal, qualitative study

Obese women are at risk for shorter breastfeeding duration, but little is known about how obese women experience breastfeeding. The aim of this study was to understand obese women's breastfeeding experiences. We enrolled pregnant women in upstate New York, who were either obese [n = 13; body mass index (BMI) ≥30 kg/m² ] or normal weight (n = 9; BMI 18.5-24.9 kg/m² ) before conception and intended to breastfeed. A longitudinal, qualitative study was conducted from February 2013 through August 2014 with semi-structured interviews during pregnancy and at specific times post-partum through 3 months. Interviews were audio recorded, transcribed and analyzed using content analysis. Themes that emerged in analysis were compared between obese and normal-weight women. Differences were identified and described. Prenatally, obese women expressed less confidence about breastfeeding than normal-weight women. Post-partum, obese women and their infants had more health issues that affected breastfeeding, such as low infant blood glucose. Compared with normal-weight women, they also experienced more challenges with latching and positioning their infants. Breastfeeding required more time, props and pillows, which limited where obese women could breastfeed. Obese women also experienced more difficulty finding nursing bras and required more tangible social support than normal-weight women. In conclusion, obese women experienced more challenges than women of normal weight; some challenges were similar to those of normal-weight women but were experienced to a greater degree or a longer duration. Other challenges were unique. Obese women could benefit from targeted care prenatally and during the hospital stay as well as continued support post-partum to improve breastfeeding outcomes. © 2016 John Wiley & Sons Ltd.

Views of fathers in Ireland on the experience and challenges of having a breast-feeding partner

OBJECTIVE

this study investigated the relationship between fathers and breast feeding in Ireland.

DESIGN AND METHOD

a cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions was posted to 1398 men with an Irish partner who had given birth 4-7 months previously. Fathers who specified that their partner breast fed their last or only child were questioned about their: influence on the breast feeding decision; ability to assist with breast feeding challenges; preferred type of information on breast feeding; perceived advantages and disadvantages to breast feeding; and views on breastfeeding in public. Data from closed-ended questions on breast feeding were presented using frequencies and associated percentages. Answers to open-ended questions on breast feeding were categorised into themes using content analysis. Each theme was assigned a numerical code and the themes developed were quantitatively counted and presented as frequencies and percentages.

FINDINGS

of the 583 respondents (42% response rate), 417 (71.5%) had a partner who had breast-fed their last or only child. Most of the 417 fathers were employed (95.7%, n399), college-educated (76.7%, n320) and married (87.8%, n366). Most (75.5%, n315) fathers were involved in the breast feeding decision. The majority (77.5%, n323) of fathers were unprepared for at least one aspect of breast feeding, most commonly that their partner encountered difficulties in establishing breast feeding. Of those fathers with a partner who experienced difficulties with breastfeeding (56.8%, n237), half (49.4%, n117) were unable to help their partner to overcome her breast feeding difficulties. Two-fifths (41.0%, n133) of fathers felt deprived of bonding time. Almost one in ten (9.4%, n39) fathers felt uncomfortable with an unrelated woman breast feeding in public, and this increased to three in ten or one third (34.3%, n143) if the woman in question was their partner.

KEY CONCLUSION

while fathers in a well-educated and socially advantaged sample are largely supportive of breast feeding, significant challenges remain in terms of their ability to support breast feeding in an informed and practical manner.

IMPLICATIONS FOR PRACTICE

women who are practically and emotionally supported by their partners are more likely to successfully breast feed, but the male perspective of breast feeding in Ireland has been given little attention. This study supports earlier and more effective engagement of fathers throughout the breast feeding process, and highlights areas of concern with respect to the role of fathers in breast feeding.

Maternal pre-pregnancy BMI, gestational weight gain and breastfeeding

BACKGROUND/OBJECTIVES

The aims were to investigate the association of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with breastfeeding (BF) duration and BF pattern at 3 months of age.

SUBJECTS/METHODS

This was a prospective cohort study of 4231 children who were enrolled at birth and were followed-up at 3, 12, 24 and 48 months of age to gather information on maternal and offspring characteristics including BF patterns and BF duration. Maternal pre-pregnancy BMI was categorized according to the WHO classification and GWG according to the 2009 Institute of Medicine recommendations. Cox's proportional hazards model was used to assess whether pre-pregnancy BMI and GWG were associated with BF and exclusive breastfeeding (EBF) duration. Predicted probabilities of BF patterns at 3 months were estimated by multinomial logistic regression.

RESULTS

Information on BF was available to 4011 infants. The total BF and EBF median durations were 7.0 months and 1.5 months, respectively. There were no differences in duration of any BF or EBF according to pre-pregnancy BMI or GWG categories. There was an increased predicted probability for weaning before the age of 3 months among infants from obese women, compared with those from mothers with normal pre-pregnancy BMI, with margins adjusted predictions of 0.36 (95% confidence interval (CI) 0.31-0.41) and 0.23 (95% CI 0.21-0.25), respectively.

CONCLUSIONS

Infants from pre-pregnancy overweight/obese mothers presented higher probability of early weaning compared with infants from normal-weight mothers. Obese/overweight pregnant women need supplementary guidance about BF benefits to infant health during prenatal and postnatal care.

Physiological mechanisms, behavioral and psychological factors influencing the transfer of milk from mothers to their young

This article is part of a Special Issue "Parental Care".Producing milk to support the growth of their young is a central element of maternal care in mammals. In spite of the facts that ecological constraints influence nursing frequency, length of time until weaning and the composition of milk, there is considerable similarity in the anatomy and physiology of milk production and delivery across mammalian species. Here we provide an overview of cross species variation in nursing patterns and milk composition as well as the mechanisms underlying mammary gland development, milk production and letdown. Not all women breastfeed their infants, thus in later sections we review studies of factors that facilitate or impede the initiation and duration of breastfeeding. The results of these investigations suggest that the decisions to initiate and maintain breastfeeding are influenced by an array of personal, social and biological factors. Finally, studies comparing the development of breastfed and formula fed infants as well as those investigating associations between breastfeeding, maternal health and mother/infant interaction are reviewed. Leading health agencies including the World Health Organization and CDC advocate breastfeeding for at least the first 6months postpartum. To achieve these rates will require not only institutional support but also a focus on individual mother/infant dyads and their experience.