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Jankowsky J, Nixon K, Ryan M, Mainwaring J, Savin M. Best Practices for the Care of Breastfeeding Patients Requiring Local or General Anesthesia. Nurs Womens Health 2023; 27:231-236. [PMID: 37116542 DOI: 10.1016/j.nwh.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/16/2023] [Accepted: 03/25/2023] [Indexed: 04/30/2023]
Abstract
The care of breastfeeding patients who require anesthesia presents unique challenges; therefore, caregivers must be knowledgeable regarding drugs' pharmacodynamic and pharmacokinetic profiles to ensure the safety of the breastfed infant. Although most anesthetic drugs are compatible with breastfeeding, health care providers continue to advise patients to "pump and dump." This advice can lead to undesirable outcomes, including interruption or cessation of breastfeeding, creating possible physical and psychological challenges for parents and their neonates. This article outlines best practices for the care of breastfeeding patients receiving anesthesia.
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Sharaf-Alddin R, Almathkoori R, Kostakis H, Albatineh AN, Al-Taiar A, Akpinar-Elci M. Obesity during Adolescence and Feeding Practices during Infancy: Cross-Sectional Study. EPIDEMIOLOGIA 2023; 4:106-116. [PMID: 36975619 PMCID: PMC10048365 DOI: 10.3390/epidemiologia4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Breastfeeding is proposed to play a role in reducing the risk of obesity throughout life. Kuwait has an extremely high prevalence of childhood obesity (45% of adolescents are overweight/obese) and extremely low breastfeeding indicators, particularly exclusive breastfeeding. In fact, little is known about the association between breastfeeding and obesity from Kuwait and the broader Middle East. AIMS To estimate the prevalence of overweight/obesity in female adolescents in Kuwait and assess its association with breastfeeding during infancy. METHODS This is a cross-sectional study that included 775 girls randomly selected from public and private high schools in Kuwait. The primary exposure was breastfeeding in the first four months of life, and the outcome was overweight/obesity during adolescence. Multivariable logistic regression was used to assess the association between breastfeeding and overweight/obesity while adjusting for potential confounders. RESULTS Approximately 45% of adolescent girls were either overweight/obese. We found no significant association between breastfeeding (exclusive/mixed breastfeeding and formula feeding/no breastfeeding) and overweight/obesity neither in univariable analysis (Crude Prevalence Ratio: 1.14, 95%CI [0.92-1.36] & Crude Prevalence Ratio: 1.29, 95%CI [0.86-1.68]; p = 0.293) for mixed feeding and no breastfeeding respectively, nor in multivariable analysis (Adjusted Prevalence Ratio: 1.14, 95%CI [0.85-1.42] & Adjusted Prevalence Ratio: 1.20, 95%CI [0.68-1.68]; p = 0.589) for mixed feeding and no breastfeeding respectively. CONCLUSION Breastfeeding during infancy was not significantly associated with overweight/obesity during adolescence. However, breastfeeding should be encouraged for its indisputable benefits for infants and their mothers alike. Further prospective studies are needed to assess the association.
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Affiliation(s)
| | - Radhia Almathkoori
- Department of Public Health, Ministry of Health, Kuwait City 13001, Kuwait
| | - Hara Kostakis
- London School of Hygiene & Tropical Medicine, University of London, London WC1E 7HT, UK
| | | | - Abdullah Al-Taiar
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23508, USA
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3
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Quinn EA, Sobonya S, Palmquist AE. Maternal perceptions of human milk expression output: An experimental design using photographs of milk. Soc Sci Med 2023; 324:115871. [PMID: 37023658 DOI: 10.1016/j.socscimed.2023.115871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/20/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The widespread use of breast pumps in the United States is a recent phenomenon that is reshaping how individuals understand and perceive lactation. In the 1990s, adequacy of milk supply was primarily measured indirectly by infant weight gain and/or diapers; now >95% of all lactating persons in the United States use breast pumps and are seeing their milk regularly. How seeing milk impacts the perception of lactation sufficiency is an important area of research. Research aim/question: To understand personal and intersubjective influences of seeing expressed human milk on perceptions of milk supply among participants who express milk for their infants. METHODS We surveyed 805 lactating participants from the United States about their pumping practices using an online survey. Participants described pumping practices, milk output, and beliefs. They were then randomized to view one of three photographs of expressed milk (<2 oz, 4 oz, >6oz) and asked to imagine they had just pumped that amount and provide a written response; this created 4 exposure groups (2 increase and 2 decrease) and a control group (no difference). RESULTS Participants randomized to a higher volume reported more positive feelings and used the terms "good", "great", and "accomplished" to describe emotional responses to output. Participants randomized to lower milk volumes reported more feelings of "bad" or "depressed." A subset of participants reported feeling "annoyed" about small volumes of milk. CONCLUSIONS Participants in this study were very conscious of the volume of milk pumped each session; both increases and decreases were associated with emotional responses that could contribute to decisions about pumping practices, perceived milk supply, and lactation duration.
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Jarman M, Shen Y, Yuan Y, Madsen M, Robson PJ, Bell RC. Applying suggested new terminology and definitions for human milk feeding in the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal pregnancy cohort. Appl Physiol Nutr Metab 2023; 48:17-26. [PMID: 36137297 DOI: 10.1139/apnm-2021-0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The complexity of human milk-feeding behaviours may not be captured using simpler definitions of "exclusive" and "non-exclusive" breastfeeding. New definitions have been suggested to describe variation in these behaviours more fully but have not been widely applied. We applied the new definitions to data derived from 3-day human milk-feeding diaries. Participants (n = 1091) recorded the number, beginning/end time, and modes of feeding of infants aged 3 months. Data were used to create six exclusive groups according to feeding mode(s): (1) human milk at-breast only; (2) human milk at-breast and human milk in a bottle; (3) human milk at-breast and infant formula in a bottle; (4) human milk at-breast and human milk and infant formula mixed in the same bottle; (5) human milk at-breast, human milk in a bottle, and infant formula in a bottle (not mixed); and (6) a bottle that sometimes contained human milk and sometimes infant formula (not mixed), never at-breast. Differences in maternal and infant characteristics were examined among groups. Fifty-seven percent fed at-breast only (Group 1). Those in Group 1 spent a similar amount of time feeding directly at-breast (median 132 (IQR 98-172) min/day) as those in Groups 2 (124 (95-158)), 3 (143 (100-190)), and 5 (114 (84-142)) (p > 0.05), indicating that adding bottle feeding did not always reduce the time infants were fed at-breast. Applying new suggested definitions to describe human milk-feeding behaviours from the mothers' perspective highlights the complexity of patterns used and warrants further application and research to explore impacts on health outcomes.
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Affiliation(s)
- Megan Jarman
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Psychology, College of Health and Life Science, Aston University, Birmingham, UK
| | - Ye Shen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton AB, Canada
| | - Mette Madsen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Paula J Robson
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton AB, Canada.,Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
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Kapa HM, Litteral JL, Keim SA, Jackson JL, Schofield KA, Crerand CE. Body Image Dissatisfaction, Breastfeeding Experiences, and Self-Efficacy in Postpartum Women with and Without Eating Disorder Symptoms. J Hum Lact 2022; 38:633-643. [PMID: 35139671 DOI: 10.1177/08903344221076529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Women during the postpartum period undergo significant changes which affect body image, eating behaviors, and, potentially, breastfeeding. There is limited research about relationships among these variables, particularly related to breastfeeding experiences and self-efficacy. RESEARCH AIMS To determine: (1) the associations between eating disorder symptoms and body image, breastfeeding self-efficacy, and breastfeeding experiences; and (2) the differences in body image, breastfeeding self-efficacy, breastfeeding experiences, and breastfeeding status of postpartum women with and without clinically significant eating disorder symptoms. METHODS A secondary data analysis using a 2-group correlational, cross-sectional online survey design was used. Participants with infants 2-6 months old who had breastfed their infant at least once (N = 204) were recruited nationally to complete a cross-sectional survey assessing breastfeeding and postpartum physical and mental health using validated measures. Linear and logistic regression evaluated differences between participants with and without eating disorder symptoms regarding their body image, breastfeeding experience and self-efficacy, and breastfeeding status (continued vs. discontinued) at 2 months postpartum. RESULTS Clinical eating disorder symptoms were reported by 9.8% (n = 20). Participants with clinical eating disorder symptoms reported lower appearance evaluations (B = -0.53, 95% CI [-0.93, -0.14]) and body image satisfaction (B = -0.55, 95% CI [-0.87, -0.23]); reduced odds of breastfeeding at 2 months postpartum (AOR = 0.15, 95% CI [0.04, 0.56]); and lower breastfeeding self-efficacy (B = -7.70, 95% CI [-14.82, -0.58] relative to participants without clinical symptoms. No differences between groups were observed for breastfeeding experiences. CONCLUSIONS Participants with clinically significant eating disorder symptoms are at risk for early breastfeeding discontinuation and lower breastfeeding self-efficacy. Our findings have implications for future research and clinical care practices, including screening for body image concerns and eating disorder symptoms and supporting breastfeeding self-efficacy.
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Affiliation(s)
- Hillary M Kapa
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer L Litteral
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kyle A Schofield
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA
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Fan HSL, Fong DYT, Lok KYW, Tarrant M. The Association Between Breastfeeding Self-Efficacy and Mode of Infant Feeding. Breastfeed Med 2022; 17:687-697. [PMID: 35763837 DOI: 10.1089/bfm.2022.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: It is well established that low breastfeeding self-efficacy is associated with early breastfeeding cessation. Over the past several decades, expressed human milk feeding has increased among parents of healthy infants. Researchers have hypothesized an association between maternal breastfeeding confidence and expressed human milk feeding, but it has not been empirically examined. Therefore, the primary objective of this study was to assess the associations between breastfeeding self-efficacy and human milk expression practices. The secondary objective was to assess the effect of breastfeeding self-efficacy on breastfeeding duration and exclusivity. Methods: This study used a prospective cohort design. From 2017 to 2018, we recruited 821 healthy mothers with term births in two public hospitals in Hong Kong. Participants completed a self-administered questionnaire in the immediate postpartum period, which gathered information about sociodemographic characteristics and Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Participants were followed up for 6 months or until infants were weaned. The proportion and type of infant feeding were assessed at telephone follow-up. Results: The overall mean BSES-SF score in our sample was 46.5 (standard deviation = 10.1). Every one-point increase in the BSES-SF score was associated with 4-5% lower risk of any expressed human milk feeding and 4-7% higher odds of breastfeeding continuation across the first 6 months postpartum. Conclusion: Higher breastfeeding self-efficacy is associated with a lower risk of expressed human milk feeding and a longer duration of any and exclusive breastfeeding. Further studies should explore how improving breastfeeding self-efficacy may affect the mode of human milk feeding.
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Affiliation(s)
- Heidi Sze Lok Fan
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong
| | - Marie Tarrant
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
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7
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Rosenbaum KA. Exclusive breastmilk pumping: A concept analysis. Nurs Forum 2022; 57:946-953. [PMID: 35716155 PMCID: PMC9546173 DOI: 10.1111/nuf.12766] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/24/2022] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
Aim To analyze and examine the concept of exclusive breast pumping (EP). Background Breastmilk is the ideal nutrition for infants, yet when breastfeeding is unsuccessful, parents resort to informal breastmilk sharing, artificial formula feeding, or EP. A growing proportion of families exclusively pump yet they often receive guidance from social media rather than healthcare providers because healthcare providers are uninformed about this feeding method. Data Source Cumulative Index of Nursing and Allied Health Literature, PubMed, and Google Scholar databases were searched using the following keywords: human milk express*, breast express*, breast milk express, breastmilk express*, exclusive pump, exclusive breast pumping, and exclusive expression. Review Methods Concept analysis design using Walker and Avant's method. Results Three defining attributes of (1) absence of direct breastfeeding, (2) breastmilk expression, (3) and an enduring infant feeding pattern of feeding expressed breastmilk only via a bottle were identified. All three attributes are required to confirm the presence of the concept of exclusive pumping. Definitions, antecedents, consequences, and empirical referents are described. Model and contrary cases are discussed. Conclusion This exclusive pumping concept analysis allows for consistency in terminology in practice and research. EP is a feeding method which can increase the proportion of infants who are fed breastmilk and may reduce the risks that arise from artificial formula feeding.
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Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Di Ruggiero E, Dennis CL, Kiss A, O'Connor DL, Sellen DW. Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada. BMJ Open 2022; 12:e055830. [PMID: 35676013 PMCID: PMC9185489 DOI: 10.1136/bmjopen-2021-055830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months. DESIGN Pooled data from two prospective cohort studies SETTING: Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada. PARTICIPANTS 337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum. EXCLUSIONS pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Main exposure variable: any use of expressed human milk at 2 weeks postpartum. OUTCOMES cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum. RESULTS All participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84). TRIAL REGISTRATION NUMBERS NCT03400605, NCT03589963.
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Affiliation(s)
- Alison Mildon
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Francis
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Yi Man Ng
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Pediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Daniel W Sellen
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Anthropology, Faculty of Arts and Sciences, University of Toronto, Toronto, Ontario, Canada
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An Active Image-Based Mobile Food Record Is Feasible for Capturing Eating Occasions among Infants Ages 3–12 Months Old in Hawai‘i. Nutrients 2022; 14:nu14051075. [PMID: 35268049 PMCID: PMC8912647 DOI: 10.3390/nu14051075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
The ability to comprehensively assess the diet of infants is essential for monitoring adequate growth; however, it is challenging to assess dietary intake with a high level of accuracy. Infants rely on surrogate reporting by caregivers. This study aimed to determine if surrogate reporters (e.g., caregivers) could use an image-based mobile food record adapted (baby mFR) to record infants’ eating occasions, and via caregiver feedback, could assess the usability and feasibility of the baby mFR in recording infants’ diets. This was a cross-sectional study in which surrogate reporters (e.g., caregivers) recorded all food and beverage intake (including human milk) of the infant over a 4-day period. Trained research staff evaluated all images submitted during data collection for different indicators of quality. All surrogate reporters were asked to complete a usability questionnaire at the end of the 4-day data collection period. Basic descriptive analyses were performed on the infants 3–12 months of age (n = 70). A total of 91% (n = 64) of surrogate reporters used the baby mFR to record their infants’ eating occasions. The mean number of images submitted daily per participant via the mFR was 4.2 (SD 0.2). A majority of submitted images contained the fiducial marker and the food and/or beverage was completely visible. The mFR was found to be easy to use; however, suggestions were provided to increase utility of the application such as the inclusion of a bottle button and reminders. An image-based dietary assessment method using a mobile app was found to be feasible for surrogate reporters to record an infant’s food and beverage intake throughout the day.
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Griffin S, Watt J, Wedekind S, Bramer S, Hazemi-Jebelli Y, Boyle R, Weaver G, Shenker NS. Establishing a novel community-focussed lactation support service: a descriptive case series. Int Breastfeed J 2022; 17:7. [PMID: 35033128 PMCID: PMC8760776 DOI: 10.1186/s13006-021-00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Although breastfeeding is widely acknowledged as protecting both infant and maternal health postnatally, a partial or complete shortfall of maternal milk can occur for a range of reasons. In this eventuality, the currently available options for feeding infants are screened donor human milk (DHM), infant formula or unscreened shared human milk. In the UK, DHM has only been widely available in specific clinical contexts for the last 40 years, mainly to reduce the risk of necrotising enterocolitis in extremely preterm infants alongside optimal support for maternal lactation and breastfeeding. The Hearts Milk Bank (HMB) was established in 2017 as an independent, non-profit human milk bank that aimed to ensure equitable, assured access to screened DHM for neonatal units. As a result of the generosity of mothers, a surplus of DHM rapidly became available and together with lactation support, has since been provided to families with a healthcare referral. This programme has now been formalised for families facing lactational challenges, and DHM stocks are permanently maintained to meet their needs. Case series This case series describes the clinical paths of four families who accessed lactation support and DHM from the HMB, along with a description of the process for community provision. To date, the HMB has supported over 300 families. Working collaboratively with key stakeholders, the HMB team has developed a prioritisation strategy based on utilitarian ethical models, protocols that ensure safe handling and appropriateness of use, broader donor recruitment parameters that maintain safety with a pragmatic approach for full term healthy infants, and a process to ensure parents or carers have access to the knowledge needed to give informed consent and use DHM appropriately. Conclusions Stakeholders, including parents, healthcare professionals, and milk banks, will need to discuss priorities for both DHM use and research gaps that can underpin the equitable expansion of services, in partnership with National Health Service (NHS) teams and third-sector organisations that support breastfeeding and maternal mental health.
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Affiliation(s)
- Samantha Griffin
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK
| | - Jo Watt
- The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK
| | - Sophie Wedekind
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK
| | - Solange Bramer
- Imperial College London Medical School, St Mary's Hospital, London, W2 1NY, UK
| | | | - Robert Boyle
- Department of Paediatrics, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
| | - Gillian Weaver
- The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK
| | - Natalie S Shenker
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK. .,The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK.
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11
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Affiliation(s)
- Arthur I Eidelman
- -Arthur I. Eidelman, MD, FABM, Editor-in-Chief, Breastfeeding Medicine
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12
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Bigalky J, Dietrich Leurer M, McCabe J, Mackey A, Laczko D, Deobald V. Advice from Canadian Mothers Who Express Human Milk: An Interpretive Description Qualitative Study. Matern Child Health J 2021; 26:342-350. [PMID: 34609705 DOI: 10.1007/s10995-021-03237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Human milk expression has become an increasingly common means for providing milk to an infant, with women expressing to address breastfeeding problems or to allow for flexible feeding options. This study explored the experiences and recommendations of mothers who expressed human milk, with this paper reporting on the advice mothers would offer to other mothers to address common challenges. METHODS Interpretive description was used in this qualitative project. Using purposive sampling, mothers of infants aged 0-24 months who expressed human milk were recruited to participate from two health regions in western Canada. Individual, audio-taped interviews were completed with 35 women. NVIVO™ software was used for data analysis. RESULTS Mothers reported the desire to offer experiential advice to other mothers navigating milk expression and encouraged other mothers to seek guidance from health care professionals such as lactation consultants, peer support online, and from family and friends. Experiential knowledge shared included: (a) product recommendations, (b) expression tips, (c) support for workplace expression, (d) encouragement to seek help, and (e) moral support. CONCLUSIONS Healthcare professionals should include evidence-based expression information as part of routine lactation support, while recognizing the importance of mother-to-mother knowledge transfer and emotional support. Services that assist mothers to determine and access pumps appropriate to their unique breastfeeding needs and goals should be offered, and the opportunity for peer support through creation of, or referral to, appropriate in-person or online support groups should be made available.
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Affiliation(s)
- Jodie Bigalky
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada.
| | - Marie Dietrich Leurer
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
| | - Janet McCabe
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - April Mackey
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
| | | | - Virginia Deobald
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
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Abstract
Supplemental digital content is available in the text. Background Neonatal abstinence syndrome (NAS) rates have dramatically increased. Breastfeeding is a nonpharmacological intervention that may be beneficial, reducing NAS symptom severity and thus the need for and duration of pharmacological treatment and length of hospital stay. Objectives Conduct meta-analysis to determine whether breastfeeding results in better outcomes for NAS infants. Variables included symptom severity, need for and duration of pharmacological treatment, and length of hospital stay. Methods PubMed, Scopus, Embase, and Cochrane Library were searched from 2000 to 2020, and comparative studies examining breastfeeding for NAS infants were extracted. Randomized trials and cohort studies were included. Data were extracted and evaluated with Review Manager Version 5.3. A random-effects model was used to pool discontinuous outcomes using risk ratio and 95% confidence intervals. Continuous outcomes were evaluated by mean differences and 95% confidence intervals. Results Across 11 studies, 6,375 neonates were included in the meta-analysis. Using a random-effects analysis, breastfeeding reduced initiation of pharmacological treatment, reduced duration of pharmacological treatment, and reduced length of stay. No differences were detected for severity of NAS symptoms. Most studies only reported one to two variables of interest. For most studies, these variables were not the primary study outcomes. All studies were found to be of low risk and good quality based on the Cochrane Risk Assessment Tools. Varying breastfeeding definitions limit generalizability. Discussion Breastfeeding is associated with decreased initiation and duration of pharmacological treatment and length of stay.
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Bartick M, Stehel EK, Calhoun SL, Feldman-Winter L, Zimmerman D, Noble L, Rosen-Carole C, Kair LR. Academy of Breastfeeding Medicine Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender. Breastfeed Med 2021; 16:587-590. [PMID: 34314606 PMCID: PMC8422264 DOI: 10.1089/bfm.2021.29188.abm] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Melissa Bartick
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth K. Stehel
- Department of Pediatrics, University of Texas Medical Center, Dallas, Texas, USA
| | - Sarah L. Calhoun
- Department of Family & Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Lori Feldman-Winter
- Children's Regional Hospital, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Deena Zimmerman
- Maternal-Child and Adolescent Division, Public Health Service, Israel Ministry of Health, Jerusalem, Israel
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City Health + Hospitals/Elmhurst, Elmhurst, New York, USA
| | - Casey Rosen-Carole
- University of Rochester School of Medicine & Dentistry, Departments of Pediatrics and Obstetrics and Gynecology, Rochester, New York, USA
| | - Laura R. Kair
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, California, USA
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15
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Fan HSL, Fong DYT, Lok KYW, Tarrant M. Association between expressed breast milk feeding and breastfeeding duration in Hong Kong mothers. Women Birth 2021; 35:e286-e293. [PMID: 34238703 DOI: 10.1016/j.wombi.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Expressed breast milk feeding has increased substantially in the past two decades. Once used primarily for preterm infants, feeding expressed breast milk is now more common in mothers giving birth to healthy term infants. However, the effect of expressed breast milk feeding on breastfeeding duration is unclear. OBJECTIVES To assess the association between breast milk expression practices and breastfeeding duration in women giving birth to healthy infants. METHODS From 2017 to 2018, we recruited 821 new mothers from two public hospitals in Hong Kong. Participants were followed up at 1.5, 3, and 6 months postpartum or until they stopped breastfeeding. The proportion, type, and mode of all milk feeding were assessed at each follow-up. RESULTS At 1.5 months postpartum, 47.9%, 37.7%, and 14.4% of participants were feeding by direct breastfeeding only, mixed-mode feeding, and expressed breast milk only, respectively. Participants feeding expressed breast milk only were more likely to be supplementing with infant formula. When compared with participants who provided only direct breastfeeding, participants who gave only expressed breast milk at 1.5 months had 57% lower odds of breastfeeding continuation at three months postpartum. After stratification by infant formula supplementation, expressed breast milk feeding only at 1.5 months was associated with an increased risk of breastfeeding cessation in participants supplementing with infant formula (adjusted hazard ratio [aHR] = 1.86, 95% CI = 1.17-2.95). CONCLUSION In the first six months postpartum, giving only expressed breast milk is associated with early breastfeeding cessation, especially in participants who are also supplementing with infant formula.
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Affiliation(s)
- Heidi Sze Lok Fan
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
| | - Marie Tarrant
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
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16
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Sim SM, Rothfus M, Aston M, Kirk SFL, Frank L, Jefferies K, Macdonald M. Breastfeeding experiences among mothers living with food insecurity in high resource, Western countries: a qualitative systematic review protocol. JBI Evid Synth 2021; 19:675-681. [PMID: 33074987 DOI: 10.11124/jbies-20-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objectives of this review are to identify, appraise, and synthesize the qualitative evidence on the breastfeeding experiences of mothers living with food insecurity in high-resource, Western countries. INTRODUCTION Breastfeeding and food insecurity are inter-related health issues. Globally, breastfeeding augments food security at individual, household, and community levels, but a growing body of evidence from high-resourced countries also suggests that a mother's breastfeeding practice may be negatively impacted by the additional experience of food insecurity. This protocol outlines a systematic approach to understanding the experiences of breastfeeding from the perspective of mothers living with food insecurity. Findings will provide much-needed evidence toward guiding policies and practices that support mothers to breastfeed. INCLUSION CRITERIA The review will consider studies that explore the breastfeeding experiences of mothers aged 18 years and older who self-identify, or are classified using a screening tool, as food insecure. Papers that will be included in this review will consider all qualitative methodologies and will be limited to studies from countries identified as being within the United Nations classification of Western European and Other States Group (WEOG). METHODS The authors will conduct a three-step search process across both published and gray literature to identify relevant studies for inclusion. A preliminary search using the PubMed database was undertaken in January 2020. Studies published in English from 1981 to 2020 will be included. The recommended JBI methodology for qualitative systematic review for study selection, critical appraisal, data extraction, and data synthesis will be followed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020183652.
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Affiliation(s)
- Sarah Meaghan Sim
- Healthy Populations Institute, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health Authority Research, Innovation and Discovery, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Melissa Rothfus
- WK Kellogg Health Sciences Library, Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Megan Aston
- Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sara F L Kirk
- Healthy Populations Institute, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Lesley Frank
- Department of Sociology, Faculty of Arts, Acadia University, Wolfville, NS, Canada
| | - Keisha Jefferies
- Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marilyn Macdonald
- Aligning Health Needs and Evidence for Transformative Change (AHNET-C): A JBI Centre of Excellence, Halifax, NS, Canada.,School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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17
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Becker GE. Marketing Breast feeding Substitutes: A Discussion Document. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249239. [PMID: 33321893 PMCID: PMC7764067 DOI: 10.3390/ijerph17249239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Abstract
Marketing influences knowledge, attitudes, and decisions related to infant and young child nutrition, safety, development, parental confidence, and other aspects of health and wellbeing of the child. These attitudes and behaviours of parents, health workers, policy makers, and other influencers have short- and long-term effects on the child. There is an International Code of Marketing of Breast-Milk Substitutes. Is it time to have a code of marketing of breastfeeding substitutes?
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18
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Expressed breast milk feeding practices in Hong Kong Chinese women: A descriptive study. Midwifery 2020; 91:102835. [DOI: 10.1016/j.midw.2020.102835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022]
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19
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Castro-Blanco KA, Marks RM, Geraghty SR, Felice JP, Rasmussen KM. Information Available Online That Answers Common Questions About Breast Pumping: A Scoping Review. Breastfeed Med 2020; 15:689-697. [PMID: 32845741 DOI: 10.1089/bfm.2020.0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: In light of the widespread use of breast milk pumping, or, "pumping," mothers are seeking clear, adequate breast pumping guidelines. We aimed at characterizing the information in web pages that mothers might find online when searching for answers related to breast pumping. Materials and Methods: We used Google to search for answers to 10 questions about pumping that mothers might ask. This search used Boolean search. We screened the first three pages of search results for each computer Google search. Each eligible hit (web pages) was evaluated for accuracy, readability, and credibility of its source. Results: Our search strategy produced 241 hits eligible for analysis. The majority of these contained accurate, readable information and were authored by credible sources. The proportion of eligible hits from questions that had a quantifiable (numeric) answer, (e.g., number of days that refrigerated milk remains safe for consumption) differed significantly (p = 0.024) from searches that did not. Search inquiries related to milk supply adequacy produced a disproportionately high number of inaccurate hits. Conclusion: Our findings indicate that accurate and credible information about breast pumping is accessible on the internet. However, practitioners should be aware that inaccurate information is present among mothers' likely hits. Our findings also underscore the fact that there are aspects of breast pumping that do not yet have guidelines available, and that these areas warrant further research. In addition, there is a need for guidelines that reflect the individual nature of the experience of breast pumping.
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Affiliation(s)
| | - Rachel M Marks
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Sheela R Geraghty
- Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Julia P Felice
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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20
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Dietrich Leurer M, McCabe J, Bigalky J, Mackey A, Laczko D, Deobald V. "We Just Kind of Had to Figure It Out": A Qualitative Exploration of the Information Needs of Mothers Who Express Human Milk. J Hum Lact 2020; 36:273-282. [PMID: 31710816 DOI: 10.1177/0890334419883203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Human milk expression, primarily by pump, is practiced by the majority of breastfeeding mothers in affluent countries. Existing literature is focused on determining prevalence and duration rates and the factors behind this trend. There is less research exploring mothers' perspectives and experiences related to expression. RESEARCH AIM To gather the experiential wisdom of mothers with a focus on their information needs and sources related to human milk expression. METHODS Audiotaped interviews were conducted with 35 mothers of infants, aged birth to 24 months, who had expressed milk at least once in western Canada. This study was guided by interpretive description, an applied qualitative research approach. RESULTS Registered nurses and international board-certified lactation consultants were the most common sources of information, with Internet, friends/family, and other mothers also important. Inconsistent expression advice was confusing for participants, and many reported health care providers did not address all their expression learning needs. Desired topic areas included practical advice on how to express, determining expression frequency/timing/duration, milk storage guidelines, the influence of expression on milk supply, product information, and general support/encouragement. CONCLUSIONS Assessment of expression learning needs should be part of routine lactation support at each encounter. Nonjudgmental, factual guidance will assist mothers in making evidence-informed decisions related to expression practices that are consistent with their unique breastfeeding goals. This should be supplemented by reputable online resources that provide timely and accurate information as well as efforts to connect mothers with peer support groups.
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Affiliation(s)
| | - Janet McCabe
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
- University of Ontario Institute of Technology
| | - Jodie Bigalky
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
| | - April Mackey
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
| | - Dana Laczko
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
- Saskatchewan Polytechnic
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21
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Fallon A, Biesty L, van der Putten D, Millar S, Meaney T, Moroney S. Supporting Women From the Travelling Community in Ireland to Breastfeed: Overcoming the Challenges of High-risk Screening for Classical Galactosaemia. J Hum Lact 2019; 35:813-817. [PMID: 31310723 DOI: 10.1177/0890334419864977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Anne Fallon
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Linda Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | - Sally Millar
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Teresa Meaney
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Samantha Moroney
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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22
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Dinour LM. Speaking Out on "Breastfeeding" Terminology: Recommendations for Gender-Inclusive Language in Research and Reporting. Breastfeed Med 2019; 14:523-532. [PMID: 31364867 DOI: 10.1089/bfm.2019.0110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The term "breastfeeding" has recently been critiqued for its ambiguity, as it has come to mean both (1) feeding an infant at the breast and (2) feeding expressed human milk to an infant. In addition, "breastfeeding" is nearly always associated with mothers and women, yet there are individuals who feed their infants human milk and do not identify as such. By using gendered language when conducting and publishing lactation-related research, we risk both alienating an already marginalized population and inhibiting our ability to gather valid, high-quality surveillance data. For example, of 15 U.S. surveys measuring breastfeeding rates, practices, and public opinions, 33% only sampled mothers, and another 33% made assumptions regarding the gender or sex identity of the person giving birth or breastfeeding. In addition, a review of 20 scholarly journals that publish lactation-related research found that only one requires specific language for breastfeeding in their instructions for authors. In response, I recommend several additions to recently proposed terms that describe human milk feeding and associated behaviors. Acceptance and consistent usage of these linguistically inclusive or nongendered terms by researchers will further enhance the quality of future data collection and research dissemination through the representation of all individuals choosing to provide human milk to their infants.
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Affiliation(s)
- Lauren M Dinour
- Department of Nutrition and Food Studies, Montclair State University, Montclair, New Jersey
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23
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Keim SA, Smith K, Ingol T, Li R, Boone KM, Oza-Frank R. Improved Estimation of Breastfeeding Rates Using a Novel Breastfeeding and Milk Expression Survey. Breastfeed Med 2019; 14:499-507. [PMID: 31509466 PMCID: PMC6909394 DOI: 10.1089/bfm.2018.0258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Increasing the proportion of infants who are breastfed and extending breastfeeding duration are high-priority U.S. goals. Evaluation of progress is based on federal survey data, but federal survey questions do not reflect contemporary feeding practices. Materials and Methods: Our objective was to evaluate the Brief Breastfeeding and Milk Expression Recall Survey (BaByMERS) in estimating breast milk feeding and milk expression practices and compare to estimates from simultaneously administered federal survey questions. We surveyed women with child(ren) younger than the age of 6 years attending a large children's hospital for urgent or primary care. We estimated the proportions who participated in various breast milk feeding and milk expression practices and the durations of each and examined agreement between the surveys. We compared respondents with high versus low disagreement using log-binomial regression. Results: Of 225 respondents, 51% had less than a Bachelor's degree, and 44% identified as a race other than white. Similar proportions on each survey reported ever having breastfed or fed breast milk (84%). Proportions still breastfeeding or feeding breast milk at 6 and 12 months differed slightly by survey. Dyads (9%) who fed at the breast and fed expressed milk for nonidentical periods had estimates for the duration of breastfeeding or feeding breast milk that were lower per the federal survey. Respondents who answered the federal survey before the BaByMERS were more likely to provide discrepant responses (risk ratio = 3.40, 95% confidence interval: 1.18-9.80). Conclusions: This study offers further validation of brief interviewer-administered questions to collect quality data recalled about infant feeding and lactation for research purposes.
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Affiliation(s)
- Sarah A Keim
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Katie Smith
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Taniqua Ingol
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Rui Li
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly M Boone
- Schoenbaum Family Center and Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus, Ohio
| | - Reena Oza-Frank
- Ohio Department of Health, Columbus, Ohio.,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio
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24
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Cassar-Uhl D, Liberatos P. Use of shared milk among breastfeeding mothers with lactation insufficiency. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 6:e12594. [PMID: 30592167 DOI: 10.1111/mcn.12594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/03/2017] [Accepted: 12/11/2017] [Indexed: 11/30/2022]
Abstract
Social media platforms have facilitated the use of shared breast milk for infant feeding since 2010. This study aims to assess the prevalence of shared milk use among breastfeeding mothers with insufficient milk supply; and compare shared milk users with non-users. Data were collected from breastfeeding mothers with low milk supply through an anonymous Internet-based survey in 2013. Shared milk users were those who used shared milk for at least 10% of their infant's needs; the rest were considered non-users. Chi-square comparisons between these groups assessed reasons and information sources for supplementation options; breastfeeding and supplement choice satisfaction; and breastfeeding duration. One hundred thirty-eight (29.1%) of 475 participants reported shared milk use. Healthfulness and reduced risk were most important to users (p < .001), whereas non-users cited convenience and lack of knowledge about other options (p < .001). Users reported receiving information from medical/breastfeeding professionals and online discussion forums, whereas non-users were more likely to not seek information about supplementation options. Users of shared milk were significantly more likely to provide breast milk at 6 months (59.3% vs. 39.6%, p = .001) and be satisfied with their supplementation choice (p < .001) compared with non-users. For women with self-reported lactation insufficiency, this study found that shared milk users were more likely to breastfeed longer, seek resources, identify healthful options, and report greater satisfaction with their supplementation choice than non-users. Importantly, shared milk may play a role in achieving U.S. Healthy People 2020 targets for breastfeeding duration.
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Affiliation(s)
- Diana Cassar-Uhl
- Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Penny Liberatos
- Department of Epidemiology & Community Health, School of Health Sciences & Practice, New York Medical College, Valhalla, New York, USA
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25
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Perrin MT, Fogleman AD, Davis DD, Wimer CH, Vogel KG, Palmquist AEL. A pilot study on nutrients, antimicrobial proteins, and bacteria in commerce-free models for exchanging expressed human milk in the USA. MATERNAL AND CHILD NUTRITION 2019; 14 Suppl 6:e12566. [PMID: 30592165 DOI: 10.1111/mcn.12566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
Abstract
Expressed human milk can be donated or sold through a variety of channels, including human milk banks, corporations or individuals, or peer-to-peer milk sharing. There is a paucity of research regarding the nutrient and bioactive profiles of expressed human milk exchanged through commerce-free scenarios, including peer-to-peer milk sharing. The study objective was to evaluate the macronutrient, antimicrobial protein, and bacteria composition in expressed human milk acquired via commerce-free arrangements. Expressed human milk samples were collected from the following commerce-free scenarios: milk expressed for a mother's or parent's own infant (MOM; N = 30); unpasteurized milk donated to a non-profit milk bank (BANKED; N = 30); milk expressed for peer-to-peer milk sharing (SHARED; N = 31); and health professional-facilitated milk sharing where donors are serologically screened and milk is dispensed raw (SCREENED; N = 30). Analyses were conducted for total protein, lactose, percent fat and water, lysozyme activity, immunoglobulin A (IgA) activity, total aerobic bacteria, coliform, and Staphylococcus aureus. No bacterial growth was observed in 52/121 samples, and 15/121 had growth greater than 5.0 log colony-forming units/mL. There was no evidence of differences by groups (p > .05) in lactose, fat, water, lysozyme activity, sIgA activity, aerobic bacteria, coliforms, and S. aureus. Mean protein values (95% confidence interval) were 1.5 g/dL (1.4, 1.6) for BANKED, 1.4 g/dL (1.3, 1.5) for MOM, 1.6 g/dL (1.5, 1.7) for SCREENED, and 1.5 g/dL (1.4, 1.6) for SHARED, which was not significantly different (p = .081). This research contributes to growing literature on the risks and benefits of uncompensated, peer-to-peer milk sharing.
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Affiliation(s)
- Maryanne T Perrin
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, North Carolina, USA.,Department of Nutrition, University of North Carolina Greensboro, Greensboro, North Carolina, USA
| | - April D Fogleman
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, North Carolina, USA
| | - Destiny D Davis
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, North Carolina, USA
| | - Courtney H Wimer
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, North Carolina, USA
| | - Kenneth G Vogel
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, North Carolina, USA
| | - Aunchalee E L Palmquist
- Department of Sociology and Anthropology, Elon University, Elon, North Carolina, USA.,Department of Maternal and Child Health, Carolina Global Breastfeeding Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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26
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O'Sullivan EJ, Geraghty SR, Cassano PA, Rasmussen KM. Comparing Alternative Breast Milk Feeding Questions to U.S. Breastfeeding Surveillance Questions. Breastfeed Med 2019; 14:347-353. [PMID: 30939039 DOI: 10.1089/bfm.2018.0256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Most mothers in the United States express their milk, which is then bottle fed to their infants. The National Immunization Survey (NIS), used to report national breastfeeding prevalence, asks about infant breast milk consumption, regardless of whether it is consumed at the mother's breast or from a bottle. The NIS data are often erroneously interpreted, however, to mean prevalence of at-the-breast feeding. We hypothesized that over half of infants classified as breastfed at 3, 6, and 12 months by the NIS questions would also be consuming expressed breast milk. Materials and Methods: A convenience sample of 456 mothers of infants 19-35 months of age recruited through ResearchMatch.org completed an online infant-feeding questionnaire. The questionnaire included both the NIS questions and more-detailed questions about feeding mode, distinguishing between at-the-breast and bottle. Results: Based on responses of our sample to the NIS questions, it could be interpreted that 74%, 64%, and 39% of mother-infant dyads were at-the-breast feeding at 3, 6, and 12 months, respectively. However, at each time point, most infants consumed at least some breast milk from a bottle. As infants got older, the proportion of breast milk consumed from a bottle increased. Conclusions: In this U.S. sample, the predominant breast milk feeding style involves both at-the-breast and expressed breast milk feeding. Future research and national surveillance should consider including separate measures of maternal breast milk expression and infant consumption of expressed breast milk to enable meaningful exploration of maternal and infant outcomes associated with these asynchronous behaviors.
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Affiliation(s)
- Elizabeth J O'Sullivan
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York.,2 School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Sheela R Geraghty
- 3 Cincinnati Children's Center for Breastfeeding Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Patricia A Cassano
- 1 Division of Nutritional Sciences, Cornell University, Ithaca, New York
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28
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Azad MB, Vehling L, Chan D, Klopp A, Nickel NC, McGavock JM, Becker AB, Mandhane PJ, Turvey SE, Moraes TJ, Taylor MS, Lefebvre DL, Sears MR, Subbarao P. Infant Feeding and Weight Gain: Separating Breast Milk From Breastfeeding and Formula From Food. Pediatrics 2018; 142:peds.2018-1092. [PMID: 30249624 DOI: 10.1542/peds.2018-1092] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Studies addressing breastfeeding and obesity rarely document the method of breast milk feeding, type of supplementation, or feeding in hospital. We investigated these practices in the CHILD birth cohort. METHODS Feeding was reported by mothers and documented from hospital records. Weight and BMI z scores (BMIzs) were measured at 12 months. Analyses controlled for maternal BMI and other confounders. RESULTS Among 2553 mother-infant dyads, 97% initiated breastfeeding, and the median breastfeeding duration was 11.0 months. Most infants (74%) received solids before 6 months. Among "exclusively breastfed" infants, 55% received some expressed breast milk, and 27% briefly received formula in hospital. Compared with exclusive direct breastfeeding at 3 months, all other feeding styles were associated with higher BMIzs: adjusted β: +.12 (95% confidence interval [CI]: .01 to .23) for some expressed milk, +.28 (95% CI: .16 to .39) for partial breastfeeding, and +.45 (95% CI: .30 to .59) for exclusive formula feeding. Brief formula supplementation in hospital did not alter these associations so long as exclusive breastfeeding was established and sustained for at least 3 months. Formula supplementation by 6 months was associated with higher BMIzs (adjusted β: +.25; 95% CI: .13 to .38), whereas supplementation with solid foods was not. Results were similar for weight gain velocity. CONCLUSIONS Breastfeeding is inversely associated with weight gain velocity and BMI. These associations are dose dependent, partially diminished when breast milk is fed from a bottle, and substantially weakened by formula supplementation after the neonatal period.
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Affiliation(s)
- Meghan B Azad
- Departments of Pediatrics and Child Health and .,Developmental Origins of Chronic Diseases in Children Network, (DEVOTION) Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Lorena Vehling
- Departments of Pediatrics and Child Health and.,Developmental Origins of Chronic Diseases in Children Network, (DEVOTION) Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Deborah Chan
- Departments of Pediatrics and Child Health and.,Developmental Origins of Chronic Diseases in Children Network, (DEVOTION) Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Annika Klopp
- Departments of Pediatrics and Child Health and.,Developmental Origins of Chronic Diseases in Children Network, (DEVOTION) Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Nathan C Nickel
- Developmental Origins of Chronic Diseases in Children Network, (DEVOTION) Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Jonathan M McGavock
- Departments of Pediatrics and Child Health and.,Developmental Origins of Chronic Diseases in Children Network, (DEVOTION) Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Allan B Becker
- Departments of Pediatrics and Child Health and.,Developmental Origins of Chronic Diseases in Children Network, (DEVOTION) Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | - Stuart E Turvey
- Department of Pediatrics, Child and Family Research Institute and British Columbia Children's Hospital, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Mark S Taylor
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.,Department of Public Health, Faculty of Health Care and Social Work, University of Trnava, Trnava, Slovakia; and
| | | | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
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29
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Bell S, Yew SSY, Devenish G, Ha D, Do L, Scott J. Duration of Breastfeeding, but Not Timing of Solid Food, Reduces the Risk of Overweight and Obesity in Children Aged 24 to 36 Months: Findings from an Australian Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040599. [PMID: 29587447 PMCID: PMC5923641 DOI: 10.3390/ijerph15040599] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 12/13/2022]
Abstract
This study aimed to determine whether breastfeeding duration and the timing of solid food were independently associated with being overweight or obese in early childhood. Subjects were 953 children participating in the Study of Mothers and Infants Life Events Affecting Oral Health (SMILE) birth cohort study, based in Adelaide, Australia. Socio-demographic information and data on breastfeeding duration and age of introduction of solid food were collected at birth, 3, 4, 6, 12, and 24 months via mailed or online questionnaires completed by mothers. The weight and height of children were measured at a dental examination when children were aged between 24 and 36 months. Body mass index was calculated, and children were categorised into weight groups according to the World Health Organization growth standards. Multivariable logistic regression analysis was conducted, adjusting for maternal age at birth, education, socio-economic status, pre-pregnancy weight, smoking in pregnancy, method of delivery, and child’s birthweight. Risk of overweight/obesity was independently associated with maternal pre-pregnancy BMI, smoking in pregnancy, and birthweight. Children that were breastfed for 12 months or more had a significantly lower risk of being overweight/obese than those breastfed for less than 17 weeks (AOR 0.49; 95%CI 0.27, 0.90; p for trend =0.009). Age of introduction of solid food, however, was not associated with the risk of being overweight/obese at 24 to 36 months. This study provides further evidence of an inverse relationship between breastfeeding and risk of overweight/obesity, however, no association with the timing of solid food was detected.
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Affiliation(s)
- Sarah Bell
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Sarah Siau Yi Yew
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Gemma Devenish
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
| | - Diep Ha
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA 5000, Australia.
| | - Loc Do
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA 5000, Australia.
| | - Jane Scott
- School of Public Health, Curtin University, Perth, WA 6845, Australia.
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