Maternal anthropometry and infant growth with exclusive breast feeding in La Paz, Bolivia

Maternal nutritional status mediates the linkage between household food insecurity and mid-infancy size in rural Bangladesh

Household food insecurity (HFI) is a major concern in South Asia. The pathways by which HFI may reduce child growth remain inadequately understood. In a cohort study of 12 693 maternal-infant dyads in rural Bangladesh, we examined association and likely explanatory pathways linking HFI, assessed using a validated nine-item perception-based index, to infant size at 6 months. Mothers were assessed early in pregnancy for anthropometric status, dietary diversity and socio-economic status. Infants were assessed for weight, length, and arm, chest and head circumferences and breast and complementary feeding status at birth and 6 months of age. Extent of HFI shared a negative, dose-response association with all measures of infant size at 6 months and odds of wasting and stunting; 57-89 % of variances in the unadjusted models were explained by prenatal factors (maternal nutritional status and dietary diversity), and birth size adjusted for gestational age. Postnatal infant breast and complementary feeding and morbidity exposures explained the remaining fraction of the significant association between HFI and differences in infant arm and chest circumferences and odds of underweight. Contextual (i.e. socio-economic) factors finally brought remaining non-significant fractions of the food insecurity-related mid-infancy growth deficit to practically zero. Improving food security prior to pregnancy and during gestation would likely improve infant growth the most in rural Bangladesh.

Maternal weight loss during exclusive breastfeeding is associated with reduced weight and length gain in daughters of HIV-infected Malawian women

Maternal weight loss during exclusive breastfeeding may influence the growth of exclusively breast-fed infants through impaired quality or quantity of breast milk. This study evaluated how maternal weight loss from 2 to 24 wk postpartum was related to infant weight and length gain in 1309 lactating HIV-infected mothers and their exclusively breast-fed infants. Malawian mother-infant pairs in the Breastfeeding, Antiretrovirals, and Nutrition Study were randomized with a 2 × 3 factorial design to a 2-arm nutritional intervention with a lipid-based nutrient supplement (LNS), meeting nutritional needs of lactation, or no LNS and a 3-arm antiretroviral (ARV) intervention (maternal, infant, or no ARV regimen). Linear regression models were used to relate maternal weight loss (weight loss vs. no weight loss) to infant weight and length gain from birth to 24 mo, stratifying by gender and controlling for maternal BMI at 2 wk (mean ± SD: 23.2 ± 3.0 kg/m(2)) and interacting maternal BMI with weight loss. In adjusted models, compared with daughters of women who did not lose weight, length and weight gain were lower in daughters whose mothers had a lower BMI at 2 wk postpartum coupled with the weight loss. For example, among mothers with an initial BMI of 18 kg/m(2), daughters of those who lost weight gained less weight [β = -0.29 kg (95% CI: -0.53, -0.06)] and length [β = -0.88 cm (95% CI: -1.52, -0.23)] from birth to 24 wk than daughters of those who gained weight. Though effects were only observed in girls, suggesting possible gender differences in suckling and feeding behavior, these findings indicate that maternal weight loss with low energy reserves represents a risk factor for poor infant growth outcomes.

Breastfeeding intentions, patterns, and determinants in infants visiting hospitals in La Paz, Bolivia

BACKGROUND

Recent ecological research from Latin America has shown that infant health could be promoted through exclusive breastfeeding in infants aged 0-3 months and partial breastfeeding throughout the remainder of infancy.

METHODS

In a cross-sectional study in 1995, the author interviewed 518 mothers with infants leq; 1 year in La Paz, Bolivia, to describe the breastfeeding pattern and its determinants including socio-economic, religious and ethnic background.

RESULTS

The rate of any breastfeeding remained above 85% during the first year. Exclusive breastfeeding rates fell from 89% at one week of age to 45% as early as one month of age, and then gradually declined to 20-25% in 6-month-old infants. The overall exclusive breastfeeding rate in infants < 4 months was 46% (n = 246). The use of prelacteal feeds (p < 0.0001, n = 436), not feeding the infant colostrum (p = 0.0008, n = 436), and Latin ethnicity (p = 0.0091, n = 436) were associated with a shorter duration of exclusive breastfeeding. Rural mothers were four times more likely to discard the colostrum than urban mothers (p = 0.0110, n = 501). Actual exclusive breastfeeding duration was shorter than what the mothers reported to be the ideal duration of exclusive breastfeeding for the infant.

CONCLUSIONS

The rate of exclusive breastfeeding in Bolivian infants fell rapidly during the first months of life. Avoidance of prelacteal feeding and use of colostrum were associated with improved breastfeeding patterns.

Breastfeeding in Bolivia - information and attitudes

BACKGROUND

The main objective of the present study was to investigate the relationship between the attitudes of the mother and her family towards breastfeeding and the actual feeding pattern in a Bolivian population. A second objective was to study the relationship between breastfeeding information, specified according to source and timing, and feeding pattern.

METHODS

Cross-sectional interviews with 420-502 Bolivian mothers with an infant less than or equal to 1 year of age. Duration of exclusive breastfeeding, use of prelacteal food and/or colostrum were the main outcome measures.

RESULTS

The attitudes of the mother, her partner (the infant's father) and the infant's grandmother towards breastfeeding did not influence the infant feeding pattern. Women who had received breastfeeding information from health care personnel before birth or on the maternity ward breastfed exclusively for a longer duration (adjusted p = 0.0233) and avoided prelacteal food to a greater extent (adjusted odds ratio (AOR) = 0.42; 95% confidence interval for adjusted odds ratio (95% CI AOR) = 0.23-0.72). Information from a doctor before birth or on the maternity ward was associated with less use of prelacteal food (AOR = 0.53; 95% CI AOR = 0.31-0.93), an increased use of colostrum (AOR = 3.30; 95% CI AOR = 1.16-9.37), but was not linked to the duration of exclusive breastfeeding (p = 0.1767).

CONCLUSION

The current study indicates that breastfeeding information delivered by health care personnel in a non-trial setting may affect the infant feeding pattern including the use of prelacteal foods and colostrum. There was no evidence that the attitudes of the mother, or the infant's father or grandmother influenced actual feeding behavior. The lack of a "negative or neutral attitude" towards breastfeeding in the participants of the current study does, however, diminish the chances to link attitude to feeding behavior.

Effect of lactation on maternal body weight: a systematic review

The impact of lactation on maternal weight after delivery remains unclear. To address this question, we performed a systematic review of the literature. We searched PubMed, POPLINE, EMBASE, and LILACS computerized databases for relevant articles and classified the evidence using the U.S. Preventive Services Task Force rating system. We found 42 studies, of which 28 contained relevant information: 15 prospective cohort studies, 1 retrospective cohort study, 1 cross-sectional study, and 11 case-series reports. The methods used in these studies varied widely, thus precluding aggregation of results. Level II-2 and III evidence supports a class "C" recommendation: insufficient evidence exists to support an effect of lactation on maternal weight after delivery. Better longitudinal studies with a clear definition of breast-feeding; clear, specific outcome measures; study periods extending 1 or 2 years after delivery; and better control of potentially confounding factors will be needed to resolve this question.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader will be able to compile the literature on the effect of lactation on maternal weight, to compare the various studies, and to summarize the data on the effect of lactation on maternal weight gain.

Impact of lactation on maternal body weight and body composition

Women worldwide generally lose weight and body fat during lactation. This loss, although increased by longer, more intensive breastfeeding, is modest and may be reduced by increased food intake and decreased activity. Higher parity and older age are associated with greater weight loss postpartum among poorly nourished women. Well-nourished women or those who breastfeed only for a limited time may not return to their prepregnant weight or body composition by the end of the lactation period. Those who are overweight or obese may have difficulty initiating or maintaining lactation. For the majority of women in the world, lactation is unlikely to represent a threat to their health. To advise women on how to optimize their health and lactational performance, one must consider all of the changes in maternal nutritional status that occur during a reproductive cycle, which may or may not compensate for the modest decreases in body weight associated with lactation.

Body composition changes during lactation are highly variable among women

Changes in body weight and composition in response to the metabolic load imposed by lactation are highly variable among and within diverse populations. In most reports, rates of weight loss did not differ between lactating and nonlactating women. Despite differences in the hormonal milieu between lactating and nonlactating women, only subtle short-term differences were observed in postpartum changes in body composition. Regional patterns of fat deposition and mobilization did not differ between lactating and nonlactating women in most studies. Changes in body composition during lactation are responses to a sequence of complex neuroendocrine and biochemical stimuli that may be significantly modified by environmental factors. Gestational weight gain was the strongest determinant of postpartum weight and fat mass change, which supports the premise that biological mechanisms are aimed at restoring prepregnancy body weight and composition.

The growth and nutritional status of the breast-fed infant

The literature on the relationship between early infant feeding and growth shows that after the first 3 or 4 months, breast-fed infants in the developed world are lighter than formula-fed infants with markedly lower adiposity. There is some evidence of a slightly lower rate of linear growth over the first year or so. These differences in weight and length do not apparently persist beyond the first few years of life. In the developing world the situation is very different. The growth curves of breast-fed infants of malnourished mothers may falter between the third and sixth month of life. However, the generally poor quality of the supplementary foods offered in the developing world and the increased risk of diarrhoeal infections mean that supplementary feeding before the age of 6 months is unlikely to lead to a growth advantage and may well lead to growth faltering.

Determinants of postnatal weight in infant rhesus monkeys: implications for the study of interindividual differences in neonatal growth

This paper provides an analysis of infant body weights obtained from a sample of 38 rhesus monkey infants (Macaca mulatta) aged 29-165 days, i.e., animals still nutritionally dependent on their mothers. We examine the data on neonatal weights in relation to a number of factors, most notably, the sex of the infants, and the age and adiposity of their mothers. The infant body weights represent cross-sectional rather than longitudinal data; because they were mostly free-ranging animals, the infants were weighted just once each. Nevertheless, the results of our analysis strongly suggest that early postnatal growth in free-ranging rhesus is dependent on both maternal fatness and age. They also suggest that, although male infants are generally heavier than like-aged female infants, they do not grow any faster during the early postnatal period. Here, we speculate that the associations between infant size and both maternal age and adiposity are the result of between-mother differences in lactational output.