Maternal education and the incidence and duration of breast feeding: a prospective study

Influence of Food Desert Residence on Breastfeeding Initiation

Introduction: Breastfeeding is associated with improved health outcomes. Several social drivers of health impact breastfeeding initiation (BFI). Prior research using ecological data demonstrated that food desert residence (FDR) is associated with lower rates of BFI. The primary objective was to assess the relationship between FDR and BFI using individual-level data. The secondary objective was to assess the relationship between FDR and BFI at the county level. Methods: Individual-level birth data from the Florida Department of Health were linked to food access data from the United States Department of Agriculture Food Access Research Atlas in 2010, 2015, and 2019. Food deserts were identified per the United States Department of Agriculture definition. Adjusted risk ratios (aRR) and 95% confidence intervals (CI) were calculated using modified Poisson regression models in 573,368 births. Models were adjusted for confounders and stratified by race/ethnicity. We assessed the association between the percent of the population in low-income and low-access census tracts aggregated to the county level and the percent of mothers initiating breastfeeding per county in Florida (Center for Disease Control and Prevention) using Pearson's correlation and a bivariate map. Results: FDR was associated with BFI (aRR: 1.23, CI: 1.20-1.27). The adjusted risk of not-initiating breastfeeding for those living in a food desert was greatest among non-Hispanic Black women (aRR: 1.29, CI: 1.24-1.35) and Hispanic women (aRR: 1.29, CI: 1.21-1.37). Maternal education was the most significant predictor of BFI. Women who had 9th through 12th-grade education but without a diploma were five times (aRR: 4.96, CI: 4.72-5.20) less likely to initiate breastfeeding relative to college graduates. There was no association between FDR and BFI at the county level, though regional trends were noted. Conclusions: FDR is an important risk factor for not-initiating breastfeeding. Among Floridians, education was the most significant risk factor. Understanding how FDR influences breastfeeding can help target interventions to improve breastfeeding outcomes.

Malnutrition in infants aged 6-23 months in China's poorest rural counties from 2016 to 2021: cross sectional study

OBJECTIVES

To assess trends and differences in child malnutrition by population subgroups among infants aged 6-23 months in China's poorest rural counties.

DESIGN

Six consecutive cross sectional surveys were conducted annually.

SETTING

The study was conducted in 116 counties in 19 provinces from 2016 to 2021, representing China's 832 poorest counties.

PARTICIPANTS

A total of 210 088 participants were selected through a multistage cluster sampling procedure; all participants were infants aged 6-23 months.

MAIN OUTCOME MEASURES

Prevalence of anaemia, stunting, wasting, overweight, and growth status in children (measured by length-for-age and weight-for-length z scores).

RESULTS

Four main malnutrition forms were prevalent in 2016: anaemia (prevalence 18.3%), stunting (7.5%), wasting (4.7%), and overweight (3.1%). The prevalence of any two coexisting malnutrition forms was low. All four forms of malnutrition decreased from 2016 to 2021. Anaemia decreased by more than half, with an annual reduction rate of 9.11% (95% confidence interval (CI) 4.83% to 13.20%). Stunting was reduced by over a third, with an annual reduction rate of 10.44% (7.56% to 13.22%), which is faster than the World Health Organization's target of 3.9%. Differences in child growth by county gross domestic product quarters were small and decreased over time, but growth differences related to education persisted. Infants whose mothers completed education up to primary school level had approximately twice the risk of stunting (adjusted rate ratio 2.29 (95% CI 1.87 to 2.81)) and wasting (1.73 (1.40 to 2.13)) compared with children whose mothers had an education level of a college degree or above. Boys had poorer growth and higher anaemia than did girls. For all outcomes, differences related to sex and education were greatest at 6 months of age.

CONCLUSIONS

Education related inequalities in growth of infants persists, with these differences particularly affecting children whose mothers completed education only up to primary school level.

Promoting maternal self efficacy and paternal attitudes towards breastfeeding: a randomized controlled trial

BACKGROUND

Counseling is one of the ways to improve the quantity and quality of breastfeeding. The present study was conducted to investigate the effect of couple-centered counseling on fathers' attitudes and mothers' self-efficacy towards breastfeeding.

METHODS

This randomized controlled trial study was conducted on 60 primigravida pregnant women and their spouses who were randomly selected among the pregnant women referred to the two maternity hospitals of Malayer City, a city in the province Hamadan in western Iran. Data collection tools included the demographic characteristics questionnaire, Breastfeeding Self-Efficacy Questionnaire, and Iowa Infant Feeding Attitude Scale. The intervention was performed according to the principles of GATHER counseling (Greet, Ask, Tell, Help, Explain, and Return). Mothers' self-efficacy and fathers' attitudes toward breastfeeding were assessed before the intervention and 4 weeks after birth in both groups. Data were analyzed with SPSS version 23 software and using a significance level of p = 0.05.

RESULTS

The participants of the control and test groups were homogeneous in terms of demographic characteristics. The change in mothers' breastfeeding self-efficacy score after intervention in the test group had a statistically significant difference compared to the control group (30.43 ± 2.53; 95%CI: 25.41,35.44), and the change in the score of fathers' attitude towards breastfeeding had a statistically significant difference after the intervention in the test group compared to the control group (19.3 ± 2.05; 95%CI: -23.36, -15.23). In the test group, the change in fathers' attitude towards breastfeeding after the intervention was significant compared to before the intervention (30.36 ± 2.38; 95%CI: 25.43, 35.25).

CONCLUSIONS

Appropriate counseling programs can change fathers' attitudes toward breastfeeding and increase mothers' breastfeeding self-efficacy, so couples' presence in breastfeeding counseling is recommended.

Association of maternal pre-pregnancy BMI and breastfeeding with NAFLD in young adults: a parental negative control study

BACKGROUND

The importance of the maternal-infant dyad in the genesis of nonalcoholic fatty liver disease (NAFLD) is of increasing interest. The Avon Longitudinal Study of Parents and Children (ALSPAC) showed that at age 24, 1 in 5 had NAFLD measured by transient elastography and controlled attenuation parameter (CAP). Our aim was to investigate the association between breastfeeding duration and maternal pre-pregnancy BMI on offspring NAFLD in young adulthood.

METHODS

4021 participants attended clinic for FibroScan and CAP measurement using Echosens 502 Touch®. 440 participants with Alcohol Use Disorders were excluded. Offspring of 100 non-singleton pregnancies were excluded. 2961 valid CAP measurements for NAFLD were analysed. Exposures of interest were breastfeeding of any duration, ≥6months exclusive breastfeeding, and maternal pre-pregnancy BMI. Multivariable regression models estimated the odds of NAFLD at 24 years. We performed a paternal negative control test to explore residual confounding in the analyses of pre-pregnancy BMI.

FINDINGS

There was a modest inverse association of exclusive and non-exclusive breastfeeding ≥6 months having a protective effect on NAFLD in offspring (OR 0·92 [95%CI 0·66-1·27] and OR 0·90 [0·67-1·21] respectively).The odds of offspring NAFLD in overweight pre-pregnancy maternal BMI and paternal BMI was OR 2·09 [1·62-2·68] and OR 1·33 [95%CI 1·07-1·65] respectively, with the ratio of effect sizes OR 1·57 [1·11-2·22]. Similarly, odds of offspring NAFLD with obese pre-pregnancy maternal BMI and paternal BMI was OR 2·66 [1·71-4·14] and OR 1·35 [0·91-2·00] respectively, with the ratio of effect sizes OR 1·98 [1·05-3·74].

INTERPRETATION

Higher maternal pre-pregnancy BMI was associated with offspring NAFLD, having accounted for shared parental confounding. We did not replicate previous work that found a strong association between breastfeeding and NAFLD.

FUNDING

Medical Research Council UK, Alcohol Research UK, David Telling Charitable Trust.

The Association between the Type of Delivery and Factors Associated with Exclusive Breastfeeding Practice among Polish Women-A Cross-Sectional Study

The type of delivery influences breastfeeding, both in terms of initiation and duration. The aim of the study was to determine the association between the type of delivery and factors associated with exclusive breastfeeding (EBF) practice among Polish women. Data on sociodemographic variables, pre-pregnancy weight, height, course of pregnancy, type of delivery and duration of breastfeeding were collected using a Computer-Assisted Web Interview. Of the 1024 breastfeeding women who participated in the study, 59.9% gave birth vaginally and 40.1% gave birth by caesarean section. The chance of starting EBF [OR: 0.478; 95% Cl: 0.274, 0.832] and continuing it for four months [OR: 0.836; 95% Cl: 0.569, 0.949] was lower in the case of caesarean delivery. Starting EBF was negatively affected by pre-pregnancy overweight status and obesity in the case of caesarean delivery. EBF practice for four months was negatively affected by age [18–24 years and 25–34 years], elementary education and average income [2001–4000 PLN] in the case of caesarean delivery. A negative impact on the chance of EBF for six months was also observed for younger age [18–24 years], elementary and secondary education and average income [2001–4000 PLN] in the case of caesarean delivery. There was no association between starting EBF and age, net income, place of living, pregnancy complications or the child′s birth weight category in the case of both subgroups, as well as between education and previous pregnancies in the case of vaginal delivery. These results suggest that women who deliver by caesarean section need additional breastfeeding support.

Factors associated with duration of breastfeeding in Bangladesh: evidence from Bangladesh demographic and health survey 2014

BACKGROUND

Breastfeeding for optimum duration is one of the most effective ways to reduce infant morbidity and mortality and confirms expected growth and development of children. The aim of this study was to determine the effect of socio-demographic and anthropometric determinants on duration of breastfeeding (DB) among mothers in Bangladesh.

METHODS

The data was extracted from the Bangladesh Demographic and Health Survey (BDHS)-2014. A total of 3541 married non-pregnant and currently non-breastfeeding Bangladeshi mothers in reproductive age who had at least one child aged 6-36 months were included in this study. Independent sample t-test and one-way analysis of variance (ANOVA) were used to find the significance difference in DB between two and more than two groups respectively. Multiple linear regression model was utilized to determine the effect of socio-economic, demographic, anthropometric and health related variables on DB.

RESULTS

This study revealed that the mean and median of DB among Bangladeshi mothers were 18.91 (95% CI: 18.65-19.17) and 19.00 months respectively. Independent sample t-test and ANOVA showed that DB among Bangladeshi mothers was significantly influenced by (i) ANC visits, (ii) religion, (iii) mode of delivery, (iv) place of delivery, (v) parents' education, (vi) geographical location, (vii) mothers' occupation and (viii) household wealth quintile. Multiple regression analysis demonstrated that mothers' age, total number of children, mothers' age at first birth, ANC visits, mothers' occupation and geographical location were important predictors of DB.

CONCLUSIONS

Healthcare providers and decision makers can consider these findings to make plan for counseling of mothers and family members to promote optimum DB practice in first 2 years of baby's life.

Factors associated with exclusive breastfeeding practice among mothers in nine community health centres in Nanning city, China: a cross-sectional study

BACKGROUND

The prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China.

METHODS

The cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0-5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices.

RESULTS

In the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice.

CONCLUSIONS

Exclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged.

The effect of an Empowerment-Based Human Centered Educational Program on early weaning

Aim:

To determine the effects of an Empowerment-Based Human Centered Educational Program on early weaning.

Background:

Exclusive breastfeeding (EBF) means that the infant receives only breast milk during the first six months of life. It is essential for the healthy growth of the infants and is supported by the main health organizations all around the world. Intervention studies performed within the antenatal period suggest that the education extends the duration of breastfeeding and increases the frequency of EBF.

Methods:

This is a semi-randomized control study. An interactive training module including role-plays which contain traditional patterns, short films, short presentations, and group practice with models was prepared. The participants were recruited in the study based on the voluntary participation of pregnant women followed up for antenatal care in a total of four family health centers in Pendik, a district of Istanbul. The pregnant women of one center formed the control group while others constituted the intervention group. All of them were certified as “Baby Friendly” institution. A pretest and a posttest have been performed to measure breastfeeding knowledge in the intervention group. The mothers of the intervention group have been randomized into two subgroups: one group for reminder call and the other for routine follow-up. All the participants including control group were called at the end of the postpartum sixth month to determine the rates of EBF.

Results:

Statistically significant increase in the rates of EBF at the end of six months showed the effectiveness of the education module (42.9 versus 22.2%, P = 0.001). Supplementary food taking time was earlier in the control group (18.5 ± 8 versus 15 ± 9.5 week, P = 0.03). The main reason of early weaning reported by the mothers was “the insufficiency of the mother’s milk.”

Conclusion:

The group training and postnatal reminders were found to be more effective than the individual training provided at the baby-friendly health institutions in terms of the effectiveness on increasing the frequency of EBF.

Parental education and inequalities in child mortality: a global systematic review and meta-analysis

BACKGROUND

The educational attainment of parents, particularly mothers, has been associated with lower levels of child mortality, yet there is no consensus on the magnitude of this relationship globally. We aimed to estimate the total reductions in under-5 mortality that are associated with increased maternal and paternal education, during distinct age intervals.

METHODS

This study is a comprehensive global systematic review and meta-analysis of all existing studies of the effects of parental education on neonatal, infant, and under-5 child mortality, combined with primary analyses of Demographic and Health Survey (DHS) data. The literature search of seven databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Scopus, and Web of Science) was done between Jan 23 and Feb 8, 2019, and updated on Jan 7, 2021, with no language or publication date restrictions. Teams of independent reviewers assessed each record for its inclusion of individual-level data on parental education and child mortality and excluded articles on the basis of study design and availability of relevant statistics. Full-text screening was done in 15 languages. Data extracted from these studies were combined with primary microdata from the DHS for meta-analyses relating maternal or paternal education with mortality at six age intervals: 0-27 days, 1-11 months, 1-4 years, 0-4 years, 0-11 months, and 1 month to 4 years. Novel mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among the studies and to adjust for study-level covariates (wealth or income, partner's years of schooling, and sex of the child). This study was registered with PROSPERO (CRD42020141731).

FINDINGS

The systematic review returned 5339 unique records, yielding 186 included studies after exclusions. DHS data were compiled from 114 unique surveys, capturing 3 112 474 livebirths. Data extracted from the systematic review were synthesized together with primary DHS data, for meta-analysis on a total of 300 studies from 92 countries. Both increased maternal and paternal education showed a dose-response relationship linked to reduced under-5 mortality, with maternal education emerging as a stronger predictor. We observed a reduction in under-5 mortality of 31·0% (95% CI 29·0-32·6) for children born to mothers with 12 years of education (ie, completed secondary education) and 17·3% (15·0-18·8) for children born to fathers with 12 years of education, compared with those born to a parent with no education. We also showed that a single additional year of schooling was, on average, associated with a reduction in under-5 mortality of 3·04% (2·82-3·23) for maternal education and 1·57% (1·35-1·72) for paternal education. The association between higher parental education and lower child mortality was significant for both parents at all ages studied and was largest after the first month of life. The meta-analysis framework incorporated uncertainty associated with each individual effect size into the model fitting process, in an effort to decrease the risk of bias introduced by study design and quality.

INTERPRETATION

To our knowledge, this study is the first effort to systematically quantify the transgenerational importance of education for child survival at the global level. The results showed that lower maternal and paternal education are both risk factors for child mortality, even after controlling for other markers of family socioeconomic status. This study provides robust evidence for universal quality education as a mechanism to achieve the Sustainable Development Goal target 3.2 of reducing neonatal and child mortality.

FUNDING

Research Council of Norway, Bill & Melinda Gates Foundation, and Rockefeller Foundation-Boston University Commission on Social Determinants, Data, and Decision Making (3-D Commission).

The Impact of Socio-Demographic Factors on Breastfeeding: Findings from the "Mamma & Bambino" Cohort

Background and objectives: The World Health Organization (WHO) recommends women (1) to initiate breastfeeding within one hour of birth; (2) to exclusively breastfeed for the first six months; and (3) to continue breastfeeding until two years of age. However, women do not always adhere to these recommendations, threatening the health of their children. The present study aims to evaluate breastfeeding status and the main maternal factors associated with exclusive breastfeeding for six months among women from the "Mamma & Bambino" study, a prospective cohort settled in Catania, Italy. Materials and Methods: We used data from 220 women (median age = 37 years) enrolled in the "Mamma & Bambino" cohort during prenatal obstetric counselling. Self-reported breastfeeding status was collected during the follow-up interviews at 1 and 2 years, referring to breastfeeding status (i.e., yes or no) and type of breastfeeding (i.e., exclusive or predominant). We also collected data about duration of breastfeeding to classify women into those who adhered to the WHO recommendation and those who did not. Results: In the general population, we noted that the proportion of women who have breastfed increased with increasing educational level. Accordingly, logistic regression analysis demonstrated that medium (OR = 3.171; 95% CI = 1.285-7.822; p = 0.012) and high educational levels (OR = 4.549; 95% CI = 1.525-13.570; p = 0.007) were positively associated with breastfeeding if compared to low educational level. Among women who have breastfed, instead, the proportion of adherents to the WHO recommendation was higher among those with medium-high educational level and those who were employed. In line with this, we demonstrated that full-time employment (OR = 2.158; 95% CI = 1.033-4.508; p = 0.041) and medium educational level (OR = 4.632; 95% CI = 1.227-17.484; p = 0.024) were positively associated with exclusive breastfeeding for the first six months. Conclusions: Socio-demographic factors should be taken into account through public health strategies for improving maternal knowledge about health benefits of exclusive breastfeeding.

The relationship between the perception of breast milk of parents with term infants and exclusive breastfeeding in the postnatal first six months

Objective

Breast milk is the ideal food that meets all kinds of nutritional contents of babies. The World Health Organization recommends that all babies be fed exclusively breastfeeding for the first 6 months. This study aimed to evaluate the relationship between the perception of breast milk of mothers and fathers with term babies and exclusively breastfeeding status in the first 6 months and to investigate the factors affecting exclusively breastfeeding status.

Material and Methods

Our longitudinal type study includes healthy/term infants and their parents born between 1 July-30 September 2018. In the postpartum period "adult's perception level of breast milk scale" was completed by the parents. The nutritional properties of the babies were recorded by reaching the families by phone when they were 2, 4, and 6 months old. Of the 341 families that participated in the study, 332 were evaluated and the study was completed with 304, 297, and 292 families at the 2^nd, 4^th, and 6^th months, respectively.

Results

Exclusively breastfeeding ratio was 85.5%, 68%, and 50% in the 2^nd, 4^th, and 6^th months, respectively. The mean score of the mothers on perception level of milk scale was significantly higher than the fathers (133.97±10.01 vs 123.91±13.41, p<0.001, respectively). The scale score of the mothers receiving breastfeeding training was significantly higher than the mothers without training (135.19±8.55 vs 130.91±12.25, respectively, p=0.008). The mode of delivery is related to the level of perception of breast milk of mothers and fathers. Mothers who had the last cesarean section had lower scale scores than those who delivered normally (131.71±12.11 vs 134.94±8.80, respectively, p=0.007). In the fathers whose spouse had a cesarean section, the scale scores were significantly higher than those whose spouses had normal delivery (126.42±12.73 vs 122.83±13.57, p=0.026, respectively). There was no correlation between exclusively breastfeeding status and breastmilk perception levels of the parents in the first 6 months. The mother's breastfeeding her previous child for ≥6 months and the use of pacifier/baby bottle were associated with exclusively breastfeeding status in the first 6 months.

Conclusion

Fathers should be included in breastmilk and breastfeeding training.

The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

Duration of Breastfeeding and Maternal-Related Factors in Iran, Systematic Review and Meta-Analysis

BACKGROUND

Although the benefits of breastfeeding are commonly approved, there remains a significant discrepancy between maternal practices and World Health Organization (WHO) guidelines in some countries.

OBJECTIVES

We had two aims in this study; average duration of breastfeeding, and its maternal determinants.

DATA SOURCES

A web-based citation index was used for citing documents.

STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS

We included observational studies evaluating breastfeeding duration among children who were at least two years old and not older than five were included in Iran.

SYNTHESIS METHODS

The pooled mean and mean differences were considered. Heterogeneity was evaluated with the I² statistic.

RESULTS

The pooled mean of breastfeeding duration was calculated at 17.31 months. Children with younger mothers and lower birth orders had shorter durations of breastfeeding. Women with a high school and higher education level had early cessation of breastfeeding in comparison with less educated women.

LIMITATIONS

The main limitation of the current study was lack of librarian assistance.

CONCLUSIONS

The pooled mean of breastfeeding duration in Iranian children aged 2-5 was less than WHO recommendations. Accurate identification of the effect a mother's level of education has on duration of lactation requires standardized categorization.

IMPLICATIONS OF KEY FINDINGS

Raising awareness among women can be an effective strategy in increasing the duration of lactation.

Antenatal survey of women's birthing choices in Qatar

Objectives Attitudes towards labour care and women's choices for their preferred mode of delivery are documented in studies from the around the world, however less is known about women's birth choices in the Middle East. This study was designed with the aim of exploring beliefs and attitudes in this region. Methods Voluntary participation in an ethics-approved survey was offered to pregnant women attending the antenatal clinic at Sidra Medicine from August 2018 to January 2019 with no exclusion criteria. Results Of the 346 respondents, 58.1% were Arabic and the remainder expatriates. This group composition allowed comparison between women native and non-native to the Gulf region. Arabic and non-Arabic women differed significantly in previous birth experiences: the Arabs had had more doctor-led deliveries (45 vs. 34%), epidurals (56.6 vs. 45%) and episiotomies (65.7 vs. 54%). 70.2% of the respondents chose a normal delivery as their preferred birth mode though a smaller majority of the Arabic subgroup did (63.2 %). 60.4% preferred delivery by doctors and longer hospital stays (47.6), more so Arabic participants (64.7 and 68.6 %). Significantly less Arabs, would choose husbands as birth partners (51.2 vs. 86.2%) and more expressed a gender preference for doctors. Other group choices are presented. Conclusions Though women in this region made comparable choices about mode of delivery as their Western counterparts, they demonstrated an expectation of a culturally distinct and more medicalized approach to care in labour. The findings highlight the need for further studies to inform regional obstetric care and health education interventions as well as tailoring maternity care services.

A Qualitative Exploration of the Determinants of Exclusive Breastfeeding (EBF) Practices in Wajir County, Kenya

Background

The World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya.

Method

This study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences.

Results

The exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding.

Conclusions

Deeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law’s and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders.

Relationship between caesarean section and breastfeeding: evidence from the 2013 Turkey demographic and health survey

Background

The mode of delivery influences breastfeeding practices. High rates of caesarean section and low breastfeeding rates are important public health concerns for all developing countries. This study aimed to determine the relationship between caesarean section and early breastfeeding practices among primiparae.

Methods

Data for primiparae with a singleton birth (N = 777) obtained from the 2013 Turkey Demographic and Health Survey were used in this retrospective cohort study. Early initiation of breastfeeding within one hour of delivery and exclusive breastfeeding during the first three days following birth were evaluated. Standardised incidence rates and standardised rate ratios of non-early initiation of breastfeeding and non-exclusive breastfeeding were calculated according to the mode of delivery.

Results

The late initiation of breastfeeding and non-exclusive breastfeeding incidence rates were 42.7 and 41.0%, respectively. The standardised incidence rate of late initiation of breastfeeding among women with vaginal delivery was 35.34%, versus 50.49% among those with caesarean delivery. The standardised rate ratios for late initiation of breastfeeding and non-exclusive breastfeeding were 1.428 (95% confidence interval (CI): 1.212–1.683) and 1.468 (95% CI: 1.236–1.762), respectively. Women who underwent caesarean section had a higher risk of late initiation of breastfeeding and non-exclusive breastfeeding during the three days following delivery, after controlling for sociodemographic and delivery-related factors.

Conclusions

This study provides useful evidence for the implementation of strategies to prevent unnecessary caesarean sections, which negatively affect not only maternal health but also neonatal health. The promotion of mother-friendly policies by healthcare institutions, implemented in a baby-friendly manner, is essential.

Association between maternal education and breast feeding practices in China: a population-based cross-sectional study

OBJECTIVE

To investigate the association between maternal education and breast feeding in the Chinese population, with a consideration of household income and health-seeking behaviours.

DESIGN

A nationally representative population-based cross-sectional study.

SETTING

77 counties from 12 geographically distinct regions in China.

PARTICIPANTS

10 408 mothers with children from 0 to 12 months of age, aged 15-53 years old (mean: 29.15, SD: 5.11) were classified into primary school or below group (n=781), middle school group (n=3842), high school/vocational school group (n=1990), college or above group (n=3795), according to their highest completed education.

OUTCOMES

Five breastfeeding outcomes, including early initiation of breast feeding (EIB), exclusive breast feeding (EBF) under 6 months, predominant breast feeding under 6 months, current breast feeding and children ever breast fed, were calculated based on the standardised questionnaire from the WHO and Wellstart International's toolkit for monitoring and evaluating breastfeeding activities.

RESULTS

The absolute risk of EIB and EBF in the lowest maternal education level was 64.85% and 26.53%, respectively, whereas the absolute risk of EIB and EBF in the highest maternal education level was 77.21% and 14.06%, respectively. A higher level of maternal education was positively associated with EIB (risk ratio (RR): 1.22; 95% CI: 1.12 to 1.30) and was inversely associated with EBF (RR: 0.59; 95% CI: 0.38 to 0.88). Stratified by household income, a positive association with EIB was observed only in the group with the highest household income and an inverse association with EBF was found in both low household and high household income groups.

CONCLUSIONS

Mothers with a higher education were more likely to initiate early breast feeding when they were also from a high-income household while also being less likely to exclusively breast feed their babies. Routine and successful nursing is crucial for the health of infants and is influenced by maternal education. Future public health interventions to promote breast feeding should consider the issues related to the educational level of mothers.

Boys, Girls, and Grandparents: The Impact of the Sex of Preschool-Aged Children on Family Living Arrangements and Maternal Labor Supply

In this study, we consider household decision-making on living arrangements and maternal labor supply in extended families with young children. In such a context, decision-making is driven by the concerns that the companionship of children is a household public good and that family members share childcare and related domestic duties. The incentive to share children's companionship is affected by son preference, whereas the economic motive of labor division hinges on the potential wage rate of the mother. Both channels play important roles in households with mothers whose wage rates are high, while sharing the companionship of (grand) sons is the main driving force in households with mothers whose wage rates are low. Using China Health and Nutrition Survey (CHNS) data, we find that among less-educated mothers, the incidence of a family coresiding with the paternal grandmother is at least 8.6 percentage points higher if the firstborn is a boy. At the same time, maternal labor supply increases by 2.9 days per month. By contrast, for educated mothers, the propensity for coresidence is higher, the working hours are longer, and the impact of the child's sex is not significant. Our study not only provides a better understanding of the demographic and economic factors determining coresidence and intrahousehold time allocations but also lends empirical support to policies aiming to increase female labor supply and improve the well-being of girls.

Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006-2016)

OBJECTIVE

Breast-feeding is an important determinant of health of mothers and their offspring. The present study aimed to compare breast-feeding rates across Europe disaggregated by maternal education and establish what proportion achieves at least 50 % exclusive breast-feeding (EBF) at 6 months.Design/SettingSecondary analysis of national or sub-national studies' breast-feeding data for EU Member States plus Norway and Iceland, published in 2006-2016. Nineteen EU Member States plus Norway reported rates of EBF and any breast-feeding disaggregated by maternal education, of which only thirteen could be matched to the International Standard Classification of Education.ParticipantsMothers and their infants aged 0-12 months.

RESULTS

Data on EBF rates at 6 and 4 months were found in only four and six countries, respectively. At 6 months, EBF rates of 49 % in Slovakia and 44 % in Hungary were closest to WHO's target of at least 50 % EBF. At 4 months, mothers with high education level in Denmark, the Netherlands and Germany had the highest EBF rates (71, 52 and 50 %, respectively). Mothers with low education level were less likely to initiate breast-feeding and cessation occurred early. The inequality gap ranged from 63 % in Irish mothers to no gap or very low levels of inequality in Poland, Sweden and Norway.

CONCLUSIONS

More mothers with high, compared with low, education initiate breast-feeding and practise EBF for longer. More European policies should be targeted to protect, support and promote breast-feeding, especially among mothers with only mandatory education.

Investigation of the factors affecting mother's exclusive breastfeeding for six months

AIM

The aim of this study is to investigate the socio-demographic characteristics and psychopathologic features of mothers living in Cukurova, Adana and to investigate the effect of these characteristics on exclusive breastfeeding status for the first six months.

MATERIAL AND METHODS

This is a cross sectional study. 284 randomly selected women were reached in the study, between November 2015-February 2016. A questionnaire consisting of 27 questions which determine sociodemographic characteristics and brief symptom inventory were applied. As for the statistical evaluation, SPSS 19 Package Software for Windows was used. For the statistical analysis; frequency tables, average scores from the brief symptom inventory, chi square test, Mann-Whitney U and Multiple logistic regression analysis were used.

RESULTS

37.0% of the mothers gave exclusive breastfeeding for first six months. Those who graduated from high school and upper school, those who were educated in breastfeeding, those who breastfed for the half hour after birth, and those who did not work had a significantly higher rate of giving only breast milk for the six months. However, the rate of breastfeeding in first six months was significantly lower for women those who lived together with their elders and smokers. The mean scores from brief symptom inventory were significantly higher in mothers who did not give breast milk only during first six months.

CONCLUSION

Exclusive breastfeeding rate was 37% in the first six months of our study. The postpartum period is a period in which the risk of psychiatric discomfort increases and the mother should be supported.

EARLY REGULATION IN CHILDREN WHO ARE LATER DIAGNOSED WITH AUTISM SPECTRUM DISORDER. A LONGITUDINAL STUDY WITHIN THE DANISH NATIONAL BIRTH COHORT

Studies have shown that children later diagnosed with autism spectrum disorders (ASD) in their first years of life might show symptoms in main developmental areas and that these signs might be sensed by the parents. The present study investigated in a large birth cohort if children later diagnosed with ASD had deviations at 6 and 18 months in areas such as the ability to self-regulate emotions, feeding, and sleeping. The study was based on prospective information collected from 76,322 mothers who participated in the Danish National Birth Cohort. When the children reached an average age of 11 years, 973 children with ASD and a control group of 300 children with intellectual disability (IDnoASD) were identified via Danish health registries. Associations were found between short periods of breast-feeding and the children later diagnosed with ASD and IDnoASD as well as associations at 18 months to deviations in regulation of emotions and activity. The similarities in these associations emphasize how difficult it is to distinguish between diagnoses early in life.

Intervention based on BASNEF model increases exclusive breastfeeding in preterm infants in Iran: a randomized controlled trial

BACKGROUND

The objective of this study is to determine the effect of a consultation model, Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF), and the counselling steps using GATHER-Greet clients, Ask clients about themselves, Tell clients about their choices, Help clients choose, Explain what to do, and Return for follow-up-on the continuation rates of exclusive breastfeeding in mothers of premature infants.

METHODS

This is a randomized controlled clinical trial carried out on 124 mothers with premature infants hospitalized in Fatemieh Hospital, city of Hamadan, in 2014. Participants were randomly assigned to either the intervention or control groups. The initial demographic questionnaire carried out in both groups included three questions about the continuation of exclusive breastfeeding, BASNEF, a checklist related to the lactation performance documented by mothers and the weight gain of their infants. Five breastfeeding consultation sessions based on the BASNEF model and counselling steps using GATHER, were held for the mothers in the intervention group for five consecutive days. Then follow-up weight gain and the questionnaire completion were performed in both groups at 1, 2, 3 and 4 months after the intervention.

RESULTS

Baseline characteristics were similar in the two groups. There were no significant differences between both groups in the rate of exclusive breastfeeding, lactation performance and infant weight at baseline. The intervention group had significantly higher rates of exclusive breastfeeding, 72.6% versus the control group of 16.1%, at the end of the 4 month follow-up. Also the intervention group had significantly higher mean scores of lactation performance (8.62 ± 2.08 vs 6.40 ± 1.84 in the control group) and infant weight (5694.80 ± 779.43 vs 4760.17 ± 859.12 in the control group) at the end of the 4 month follow-up.

CONCLUSION

Breastfeeding consultation of mothers based on the BASNEF model and using GATHER counselling steps increased the rate of exclusive breastfeeding, lactation performance and weight gain of premature infants. Therefore, breastfeeding counselling sessions are recommended for all mothers of premature infants.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials number IRCT2014111013405N6 and date registered, January 5, 2015.

Determinants of Exclusive Breast Feeding in sub-Saharan Africa: A Multilevel Approach

BACKGROUND

The study aimed to provide an overall picture of the general pattern of exclusive breast feeding (EBF) in sub-Saharan Africa (SSA) by examining maternal sociodemographic, antenatal and postnatal factors associated with EBF in the region, as well as explore countries variations in EBF rates.

METHODS

We utilised cross-sectional data from the Demographic Health Surveys in 27 SSA countries. Our study sample included 25 084 infants under 6 months of age. The key outcome variable was EBF in the last 24 h. Due to the hierarchical structure of the data, a multilevel logistic regression model was used to explore factors associated with EBF.

RESULTS

The overall prevalence of EBF in SSA was 36.0%, the prevalence was highest in Rwanda and lowest in Gabon. In the multilevel regression model, factors that were associated with increased likelihood of EBF included secondary and above maternal education, mothers within the ages of 25-34 years, rural residence, richer household wealth quantile, 4+ antenatal care visit, delivering in a health facility, singleton births, female infants, early initiation of breast feeding (EIBF), and younger infants. However, countries with higher gross national income per capita had lower EBF rates.

CONCLUSIONS

To achieve a substantial increase in EBF rates in SSA, breast-feeding interventions and policies should target all women but with more emphasis to mothers with younger age, low educational status, urban residence, poor status, multiple births, and male infants. In addition, there is a need to promote antenatal care utilisation, hospital deliveries, and EIBF.

Pathways of equality through education: impact of gender (in)equality and maternal education on exclusive breastfeeding among natives and migrants in Belgium

Even though breastfeeding is typically considered the preferred feeding method for infants worldwide, in Belgium, breastfeeding rates remain low across native and migrant groups while the underlying determinants are unclear. Furthermore, research examining contextual effects, especially regarding gender (in)equality and ideology, has not been conducted. We hypothesized that greater gender equality scores in the country of origin will result in higher breastfeeding chances. Because gender equality does not operate only at the contextual level but can be mediated through individual level resources, we hypothesized the following for maternal education: higher maternal education will be an important positive predictor for exclusive breastfeeding chances in Belgium, but its effects will differ over subsequent origin countries. Based on IKAROS data (GeÏntegreerd Kind Activiteiten en Regio Ondersteunings Systeem), we perform multilevel analyses on 27 936 newborns. Feeding method is indicated by exclusive breastfeeding 3 months after childbirth. We measure gender (in)equality using Global Gender Gap scores from the mother's origin country. Maternal education is a metric variable based on International Standard Classification of Education indicators. Results show that 3.6% of the variation in breastfeeding can be explained by differences between the migrant mother's country of origin. However, the effect of gender (in)equality appears to be non-significant. After adding maternal education, the effect for origin countries scoring low on gender equality turns significant. Maternal education on its own shows strong positive association with exclusive breastfeeding and, furthermore, has different effects for different origin countries. Possible explanations are discussed in-depth setting direction for further research regarding the different pathways gender (in)equality and maternal education affect breastfeeding. © 2016 John Wiley & Sons Ltd.

Changing Societal and Lifestyle Factors and Breastfeeding Patterns Over Time

BACKGROUND

Breastfeeding is an important determinant of early infant immune function and potentially future health. Although numerous studies have reported rising breastfeeding initiation rates and duration, few longitudinally investigated the impact of shifting societal and lifestyle factors on breastfeeding patterns in developed nations.

METHODS

The Ulm Birth Cohort Study (UBCS) and Ulm SPATZ Health Study (SPATZ) cohorts consist of newborns and their mothers recruited, respectively, from 2000 to 2001 and 2012 to 2013 at the University Medical Center Ulm, Germany. Cox proportional hazards models were used to estimate crude and mutually adjusted hazard ratios for study effect (time trend) and individual risk factors on noninitiation and duration of predominant and total breastfeeding.

RESULTS

Compared with UBCS mothers, SPATZ mothers had lower cessation rates of both predominant breastfeeding by 4 months and total breastfeeding by 6 months: hazard ratio (95% confidence interval) 0.79 (0.67-0.93) and 0.71 (0.60-0.82), respectively. However, this crude time trend was limited to mothers with higher educational achievement. Similar time trend effects were observed among less educated mothers only after adjustment for early cessation risk factors. Mutually adjusted hazard ratios for individual risk factors were similar in both studies: low education, high BMI, smoking within 6 weeks of delivery, and cesarean delivery were associated with early breastfeeding cessation beginning at 6 weeks. In addition, actively abstaining from drinking alcohol was associated with lower rates of early cessation.

CONCLUSIONS

Our results suggest widening socioeconomic disparity in breastfeeding and potentially subsequent child health, which may require new targeted interventions.

Childhood Health and Developmental Outcomes After Cesarean Birth in an Australian Cohort

BACKGROUND AND OBJECTIVES

Concerns have been raised about associations between cesarean delivery and childhood obesity and asthma. However, published studies have not examined the long-term neurodevelopmental outcomes or fully addressed confounding influences. We used data from the LSAC (Longitudinal Study of Australian Children) to explore the relationship between cesarean delivery and physical and socio-emotional outcomes from 0 to 7 years, taking into account confounding factors.

METHODS

Data were from 5 waves of LSAC representing 5107 children born in 2003 and 2004. Outcome measures included: global health, asthma, BMI, use of prescribed medication, general development, medical conditions and/or disabilities, special health care needs, and socio-emotional development. Models adjusted for birth factors, social vulnerability, maternal BMI, and breastfeeding.

RESULTS

Children born by cesarean delivery were more likely to have a medical condition at 2 to 3 years (odds ratio: 1.33; P = .03), use prescribed medication at 6 to 7 years (odds ratio: 1.26; P = .04), and have a higher BMI at 8 to 9 years (coefficient: 0.08; P = .05), although this last effect was mediated by maternal obesity. Parent-reported quality of life for children born by cesarean delivery was lower at 8 to 9 years (coefficient: -0.08; P = .03) but not at younger ages. Contrasting this finding, cesarean delivery was associated with better parent-reported global health at 2 to 3 years (odds ratio: 1.23; P = .05) and prosocial skills at age 6 to 7 years (coefficient: 0.09; P = .02).

CONCLUSIONS

Cesarean delivery was associated with a mix of positive and negative outcomes across early childhood, but overall there were few associations, and these were not consistent across the 5 waves. This study does not support a strong association between cesarean delivery and poorer health or neurodevelopmental outcomes in childhood.

Genetic variation in CD38 and breastfeeding experience interact to impact infants' attention to social eye cues

Attending to emotional information conveyed by the eyes is an important social skill in humans. The current study examined this skill in early development by measuring attention to eyes while viewing emotional faces in 7-mo-old infants. In particular, we investigated individual differences in infant attention to eyes in the context of genetic variation (CD38 rs3796863 polymorphism) and experiential variation (exclusive breastfeeding duration) related to the oxytocin system. Our results revealed that, whereas infants at this age show a robust fear bias (increased attention to fearful eyes), their attention to angry and happy eyes varies as a function of exclusive breastfeeding experience and genetic variation in CD38. Specifically, extended exclusive breastfeeding duration selectively enhanced looking preference to happy eyes and decreased looking to angry eyes. Importantly, however, this interaction was impacted by CD38 variation, such that only the looking preferences of infants homozygous for the C allele of rs3796863 were affected by breastfeeding experience. This genotype has been associated with reduced release of oxytocin and higher rates of autism. In contrast, infants with the CA/AA genotype showed similar looking preferences regardless of breastfeeding exposure. Thus, differences in the sensitivity to emotional eyes may be linked to an interaction between the endogenous (CD38) and exogenous (breastfeeding) availability of oxytocin. These findings underline the importance of maternal care and the oxytocin system in contributing to the early development of responding to social eye cues.

Factors associated with breast milk intake among 9-10-month-old Malawian infants

Exclusive breastfeeding is recommended during the first 6 months of life; thereafter, continued breastfeeding along with nutritious complementary foods is recommended. Continued breastfeeding contributes a substantial proportion of nutrient needs and promotes healthy growth and development, but the quantity of breast milk consumed may be highly variable and little is known about the factors associated with breast milk intake after 6 months of age. The present study was conducted to assess factors associated with breast milk intake of Malawian infants at 9-10 months of age. Breast milk intake was measured using the dose-to-mother deuterium oxide dilution method in a subsample of 358 Malawian infants who were participating in a randomized controlled trial of lipid-based nutrient supplements. Regression analysis was used to assess associations between breast milk intake and several maternal and infant variables. Mean (standard deviation) breast milk intake was 752 (244) g day(-1) . In multiple regression, breast milk intake was positively associated with infant weight (+62 g per kg body weight, P < 0.01) and maternal height (P < 0.01) and negatively associated with maternal education and age (P < 0.01). There was a non-significant (P = 0.063) inverse association between energy from non-breast milk sources and breast milk intake. In this rural Malawian population, infant weight is the main predictor of breast milk intake, even after the first 6 months of life.

Association between Breastfeeding and Childhood Obesity: Analysis of a Linked Longitudinal Study of Rural Appalachian Fifth-Grade Children

INTRODUCTION

Although breastfeeding is associated with improving numerous health outcomes for the child, its role in reducing childhood obesity is contested. Despite this controversy, both the CDC and the US Department of Health and Human Services promote breastfeeding as one of the strategies for reducing childhood obesity. Rural Appalachia has one of the highest rates of childhood obesity and low rates of breastfeeding, compared to rest of the nation. The aim of this study was to examine the association between breastfeeding and childhood obesity at 11 years in the rural Appalachian state of West Virginia (WV).

METHODS

The study used linked data from two cross-sectional data sets to examine this relationship longitudinally in fifth-grade WV children. The main outcome variable was BMI adjusted percent (BMI%) and the main exposure was defined as occurrence of breastfeeding. Mean BMI% of children who were not breastfed was significantly higher, compared to children who were breastfed.

RESULTS

The result of the multiple regression analysis showed that breastfeeding significantly predicted BMI% of children after controlling for maternal education, health insurance, family history of hypercholesterolemia and diabetes, child's asthma status, and birth weight of the infant.

CONCLUSIONS

Our results are consistent with other studies that have shown a significant, but small, inverse association between breastfeeding and childhood obesity. Findings from this study suggest the need to improve breastfeeding rates in the rural Appalachian state of WV as one of the potential strategies to prevent obesity during childhood and adolescence.

Antenatal Depressive Symptoms and Breastfeeding: A Prospective Cohort Study

INTRODUCTION

Globally many women suffer from depression during pregnancy. This study investigated the impact of antenatal depressive symptoms on the duration of breastfeeding up to 6 months among women in Sabah, Malaysia.

SUBJECTS AND METHODS

A prospective cohort study of 2,072 women was conducted in Sabah during 2009-2010. Participants were recruited at 36-38 weeks of gestation and followed up at 1, 3, and 6 months postpartum. Depressive symptoms were assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale (EPDS). Cox regression analyses were performed to determine the relationship between antenatal EPDS scores and cessation of breastfeeding before 6 months postpartum.

RESULTS

In total, 1,078 (52%) women with complete information on breastfeeding duration were included in the final sample. Approximately 99% of mothers were breastfeeding at discharge, and 87% of them continued to breastfeed at 6 months postpartum. Women with an antenatal EPDS score of 8 or above were twice more likely to stop breastfeeding before 6 months (adjusted hazards ratio=1.95; 95% confidence interval, 1.26, 3.01) than those who scored less than 4 on the EPDS.

CONCLUSIONS

Depressive symptoms during pregnancy appeared to be associated with early breastfeeding cessation for mothers residing in Sabah.

Validity and reliability of the infant breastfeeding assessment tool, the mother baby assessment tool, and the LATCH scoring system

AIM

We aimed to evaluate the validity and reliability of the Infant Breastfeeding Assessment Tool (IBFAT), the Mother Baby Assessment (MBA) Tool, and the LATCH scoring system.

SUBJECTS AND METHODS

Mothers who delivered healthy, full-term infants in the Obstetrics & Gynecology Service of Gazi University, Ankara, Turkey, between December 2013 and January 2014 and their infants were included in the study. Forty-six randomly selected breastfeeding sessions were monitored and scored simultaneously by three researchers (Raters 1, 2, and 3) using LATCH, IBFAT, and the MBA Tool. Researchers put the score sheets in an envelope in order to hide them from each other. The compatibility of the scores given by three researchers was assessed by statistical methods.

RESULTS

We found positive and significant correlation coefficients between 0.81 to 0.88 for the total MBA score, between 0.90 to 0.95 for the total IBFAT score, and between 0.85 to 0.91 for the total LATCH score. Correlation coefficients testing these three tools ranged from 0.71 to 0.88, with the minimum value being noted for the correlation between LATCH and IBFAT scores and the maximum value being noted for the correlation between LATCH and MBA scores.

CONCLUSIONS

We found positive and significant correlations between researchers' scores for 46 observations using the three assessment tools. This study showed that these above-mentioned tools were compatible for the assessment of the efficiency of breastfeeding.

Mothers' expectations and other factors affecting breastfeeding at six months in Greece

The objective of this study is to determine the factors influencing breastfeeding duration in Greece. A total of 145 women were interviewed, on the third day post-partum. Women were followed up by telephone interviews at three and six months post-partum. Chi-square test and binomial sequential logistic regression analysis were used for statistical analysis. Results from this study show that baby-friendly hospital, antenatal courses, mother's perception of her capability to successfully breastfeed her infant, mother's intention to breastfeed for a duration of six months or more, mother's and father's education level, introduction of complementary foods or fluids, caesarean delivery, smoking and ethnicity were significantly associated with the duration of breastfeeding. In conclusion, additional antenatal and postnatal framework is necessary. Mothers' prediction of the duration of breastfeeding is an additional tool for identification of women with a high probability for early weaning.

Effects of breastfeeding on weight loss and recovery of pregestational weight in adolescent and adult mothers

BACKGROUND

Exclusive breastfeeding (EBF) in adolescent mothers has been associated with greater postpartum maternal weight loss.

OBJECTIVE

To assess the associations between EBF and weight loss in adolescent and adult mothers and between EBF and weight and length gain of their children.

METHODS

A cohort of 68 adolescent mothers (15 to 19 years), 64 adult mothers (20 to 29 years), and their infants were studied. Anthropometric measurements were performed at 15, 90, 180, and 365 days postpartum in the mothers and children. EBF was defined as consumption of human milk without supplementation of any type (water, juice, nonhuman milk, or food) for 4 months.

RESULTS

Sixty-five percent of mothers sustained EBF for 4 months. There were no significant differences in the weight or length of the infants of adolescent and adult mothers at 365 days postpartum. Among infants of adult mothers, there was a significant difference between the weight gain of those were exclusively breastfed and those who were not exclusively breastfed (6,498 +/- 1,060 vs 6,096 +/- 1,035 g, p < .050) at 365 days postpartum, according to the parameters for weight gain and length established by the World Health Organization (WHO). Among both adult and adolescent mothers, those who practiced EBF lost more weight than those who did not practice EBF (-2.9 kg, 95% interquartile range, -5.7 to 0.8 kg, vs -1.8 kg 95% interquartile range -2.8 to 2.2 kg; p = .004). Gestational weight gain, duration of EBF, and recovery menstruation explained 21% of the variance (F = 28.184, p = .001) in change in postpartum maternal weight (in kilograms) from 0 to 365 days postpartum in all mothers. Pregestational weight, duration of EBF, and maternal age were factors that explained 14% (F = 22.759, p = .001) of the change in the weight and length of the infants from 0 to 365 days of life.

CONCLUSIONS

EBF in adolescent and adult mothers influences postpartum weight loss and provides adequate infant growth in accordance with the WHO 2006 standards.

A Household Study of Self-Regulation in Children

Delay of gratification (DoG) and delay discounting (DD) are behavioral measures of self-regulation and impulsivity. Whereas DoG refers to the postponement of gratification, DD involves the devaluation of a reward over time. Previous studies have demonstrated associations between paternal self-control, paternal personality traits, parenting styles, maternal intelligence, and children’s self-regulation. The present study explored intergenerational links between mothers’ and child’s self-regulation and maternal antecedents of children’s DoG. We analyzed 267 mother-child dyads in the German Socio-Economic Panel (SOEP) Children’s Study. Measures included an experiment using gummy bears as rewards to assess DoG in children and monetary choice procedures to assess DD in mothers. Additionally, cognitive abilities and personality traits of mothers and children were assessed. The main result was that the children’s age and breastfeeding were significant predictors of DoG in children, even when we controlled for other influences such as maternal cognitive abilities and personality traits. We explain the result in the context of previous findings concerning attachment security, bonding, maternal sensitivity, children’s self-regulation of energy intake, neuroscientific evidence, and breastfeeding. Further studies should use equivalent measures of DoG in children and parents to further explore this link between breastfeeding and DoG in a genetically sensitive design.

Task-oriented and bottle feeding adversely affect the quality of mother-infant interactions after abnormal newborn screens

OBJECTIVE

To examine effects of newborn screening and neonatal diagnosis on the quality of mother-infant interactions in the context of feeding.

METHODS

Study compared the quality of mother-infant feeding interactions among 4 groups of infants classified by severity of newborn screening and diagnostic results: cystic fibrosis (CF), congenital hypothyroidism, heterozygote CF carrier, and healthy with normal newborn screening. The Parent-Child Early Relational Assessment and a task-oriented item measured the quality of feeding interactions for 130 dyads, infant ages 3 to 19 weeks (M = 9.19, SD = 3.28). The Center for Epidemiologic Studies Depression Scale and State-Trait Anxiety Inventory measured maternal depression and anxiety.

RESULTS

Composite Indicator Structure Equation Modeling showed that infant diagnostic status and, to a lesser extent, maternal education predicted feeding method. Mothers of infants with CF were most likely to bottle feed, which was associated with more task-oriented maternal behavior than breastfeeding. Mothers with low task-oriented behavior showed more sensitivity and responsiveness to infant cues, as well as less negative affect and behavior in their interactions with their infants than mothers with high task-oriented scores. Mothers of infants with CF were significantly more likely to have clinically significant anxiety and depression than the other groups. However, maternal psychological profile did not predict feeding method or interaction quality.

CONCLUSIONS

Mothers in the CF group were the least likely to breastfeed. Research is needed to explicate long-term effects of feeding methods on quality of mother-child relationship and ways to promote continued breastfeeding after a neonatal CF diagnosis.

Influência da disfunção oral do neonato a termo sobre o início da lactação

OBJETIVO: verificar a associação entre a disfunção oral e os fatores socioeconômicos, variáveis relacionadas à mãe e ao recém-nascido com o desempenho da mamada, durante as primeiras 48 horas de vida. MÉTODOS: estudo transversal, analítico, realizado em uma maternidade pública do Recife-PE. Foram entrevistadas todas as mães de crianças nascidas a termo entre abril e julho de 2008, perfazendo 588 binômios mãe/recém-nascido. A avaliação do sistema sensório motor oral do neonato e avaliação da mamada foram elaboradas, codificando-se como zero quando o item era "esperado/normal" e um quando "não esperado/de risco". A soma total dos itens "não esperados/de risco" resultou em um Índice de Disfunção Oral e um Índice de Avaliação da Mamada. RESULTADOS: verificou-se que 57,3% dos binômios mães/recém-nascidos apresentavam alteração da mamada, 43,9% apresentavam 1 e/ou 2 alterações e 13,4% maior número de alterações. A frequência de disfunção oral foi de aproximadamente 30%. Na análise de regressão logística entre as variáveis incluídas, apenas a disfunção oral manteve-se associada significativamente com o insucesso da mamada. Crianças com maior número alterações da função oral apresentaram chance 4 vezes maior de ter alteração da mamada. CONCLUSÕES: sendo as disfunções orais uma das causas para o não estabelecimento da lactação, estas devem ser identificadas precocemente, visto que podem ser corrigidas, evitando o desmame. As maternidades devem possuir equipe capacitada no manejo do aleitamento, com um profissional que dê atenção especial às alterações do sistema sensório motor oral.

Choice of environmental components for a longitudinal birth cohort study

Various aspects of the environment of the mother and child may have major influences on the health and development of the child. Long-term influences can even affect chronic diseases of adulthood. Here we describe the major psychosocial and physical environmental factors that should be measured in longitudinal birth cohort studies.

Allergy in day care children: prevalence and environmental risk factors

AIM

To investigate the prevalence of atopic disease among Finnish day care children and the relationship between atopy and environmental factors.

METHODS

A cross-sectional study of 594 day care children aged 1-6 years from Helsinki, Finland. Each child's history of atopic diseases and environmental exposure was collected in a questionnaire completed by the parents.

RESULTS

The prevalence of diagnosed asthma was 0.9% for the 1-3-year olds and 5.5% for the 4-6-year olds, atopic eczema/dermatis was 16% in both groups, and allergic rhinitis 5% in the younger group, 9% in the older group. According to multivariable logistic regression models, breastfeeding (exclusive > or =4 months or partial > or =6 months) reduced the risk of atopic diseases (OR = 0.60; CI(95) 0.39-0.93, p = 0.021). Atopic diseases were more common in the oldest age group, 5-6-year olds, compared to the youngest, 1-2-year olds (OR = 2.18; CI(95) 1.14-4.15, p = 0.018). One parent with atopic disease increased the child's risk (OR = 1.89; CI(95) 1.20-2.97, p = 0.006), more so if both parents had a history (OR = 3.17; CI(95) 1.48-6.78, p = 0.003).

CONCLUSION

Our results support the hypothesis that breastfeeding for at least six months may protect against atopic diseases. The child's greater age (5-6 years) and parental history of atopic diseases increased the risk of atopy.

Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi-urban setting

BACKGROUND

The success of breastfeeding promotion is influenced by maternal factors. Therefore, it is vital to examine the influence of basic maternal demographic factors on breastfeeding practices.

OBJECTIVE

To determine the influence of maternal socio-demographic factors on the initiation and exclusivity of breastfeeding.

METHOD

A cross-sectional survey of mothers of children aged from 1 to 24 months attending a Nigerian Infant Welfare Clinic was conducted. Respondents were grouped according to age, parity, education, occupation, sites of antenatal care and delivery. These groups were compared for breastfeeding indices using bivariate and multivariate analysis.

RESULTS

All the 262 respondents breastfed their children. The exclusive breastfeeding rate was 33.3% for children aged 0-3 months, 22.2% for children aged 4-6 months and 19.4% for children aged 7-24 months at the time of the study. Significantly higher proportions of mothers with at least secondary education, clinic-based antenatal care and delivery in health facilities initiated breastfeeding within 1 h of birth, avoided pre-lacteal feeding and practiced exclusive breastfeeding for the first 6 months of life. Maternal age and parity did not confer any advantage on breastfeeding practices. Delivery of children outside health facilities strongly contributed to delayed initiation of breastfeeding (P < 0.001), pre-lacteal feeding (P = 0.003) and failure to breastfeed exclusively (P = 0.049). Maternal education below secondary level strongly contributed to pre-lacteal feeding (P = 0.004) and failure to practice exclusive breastfeeding (P = 0.008).

CONCLUSION

Low maternal education and non-utilization of orthodox obstetric facilities impairs early initiation and exclusivity of breastfeeding.

Breastfeeding rates and duration in Germany: a Bavarian cohort study

Breastfeeding is the recommended feeding for all healthy infants. The aim of our study was to assess the current state of breastfeeding prevalence, duration and behaviour in Bavaria, Germany as a basis for targeting breastfeeding promotion measures. The Bavarian Breastfeeding Study is a prospective cohort study of 3822 mothers who delivered in April 2005 in Bavaria, Germany. Breastfeeding duration and determinants such as socioeconomic status, attitudes towards breastfeeding, birth mode and breastfeeding problems were assessed by questionnaires 2–6 d after birth and 2, 4, 6, and 9 months after birth. The initial breastfeeding rate was 90 %. After 4 months 61 % still breastfed (any breastfeeding). In the multivariate analyses the main influencing factor reducing breastfeeding initiation was the partner's negative attitude towards breastfeeding (OR 21·79; 95 % CI 13·46, 35·27). No initial breastfeeding was also associated with lower education, maternal grandmother's negative attitude and pre-term birth. Protective factors were primary breastfeeding experience and information on breastfeeding before birth. Breastfeeding duration < 4 months was strongly associated with breastfeeding problems (OR 7·56; 95 % CI 6·21, 9·19), smoking, lower education, partner's negative attitude and Caesarean section. Since the attitude of family members is an important influencing factor on breastfeeding rates, breastfeeding promotion should also target the partners of pregnant women and the families of newborn infants. Public health interventions such as more effective support for the management of breastfeeding problems, especially in lower social status families, should be implemented and their effectiveness should be critically evaluated.

Ethnic/racial diversity, maternal stress, lactation and very low birthweight infants

OBJECTIVE

(1) To compare maternal characteristics and psychological stress profile among African-American, Caucasian and Hispanic mothers who delivered very low birthweight infants. (2) To investigate associations between psychosocial factors, frequency of milk expression, skin-to-skin holding (STS), and lactation performance, defined as maternal drive to express milk and milk volume.

STUDY DESIGN

Self-reported psychological questionnaires were given every 2 weeks after delivery over 10 weeks. Milk expression frequency, STS, and socioeconomic variables were collected.

RESULT

Infant birthweight, education, and milk expression frequency differed between groups. Trait anxiety, depression and parental stress in a neonatal intensive care unit (PSS:NICU) were similar. African-American and Caucasian mothers reported the lowest scores in state anxiety and social desirability, respectively. Maternal drive to express milk, measured by maintenance of milk expression, correlated negatively with parental role alteration (subset of PSS:NICU) and positively with infant birthweight and STS. Milk volume correlated negatively with depression and positively with milk expression frequency and STS.

CONCLUSION

Differences between groups were observed for certain psychosocial factors. The response bias to self-reported questionnaires between groups may not provide an accurate profile of maternal psychosocial profile. With different factors correlating with maintenance of milk expression and milk volume, lactation performance can be best enhanced with a multi-faceted intervention program, incorporating parental involvement in infant care, close awareness and management of maternal mental health, and encouragement for frequent milk expression and STS.

Maternal cigarette smoking and breastfeeding duration

AIM

To examine the relationship between cigarette smoking and breastfeeding duration at 2 wk, 6 mo, and longer.

METHODS

Design. A 12-mo longitudinal study. Setting. Two public maternity hospitals in the Perth metropolitan area (Western Australia). Subjects. Eligible mothers of healthy newborn infants. Interventions. Participants completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women regardless of their chosen infant feeding method were followed up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 wk postpartum. Main outcome measures. Prevalence of breastfeeding at 2 wk, 2 wk to 6 mo and >6 mo in women who smoked during pregnancy, and breastfeeding duration.

RESULTS

Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 vs 11 wk, 95% CI 8.3-13.7). This effect remained even after adjustment for age, education, income, father's smoking status, mother's country of birth, intended duration of breastfeeding >6 mo and birthweight (risk ratio 1.59, 95% CI 1.22-2.08).

CONCLUSION

Women who smoke during pregnancy are at greater risk of not achieving national and international targets for breastfeeding. Encouraging smoking cessation in the antenatal setting is an area for considerable public health gain.

Breast-feeding in Athens, Greece: factors associated with its initiation and duration

OBJECTIVES

To determine the prevalence, examine the influence of hospital practices and investigate potential determinants of breast-feeding in Athens.

PATIENTS AND METHODS

Three hundred twelve mothers provided information regarding feeding practices at certain maternity hospitals in Athens, at 40 days and 6 months postpartum. Multiple logistic regression analysis was performed to evaluate the association between the initiation and maintenance of breast-feeding and potential risk factors.

RESULTS

Although almost 90% of newborn infants were given a breast milk substitute one or more times during the first 2 days at the maternity hospital, the exclusive breast-feeding percentage on the last day of hospital stay reached 85%. Breast-feeding and exclusive breast-feeding percentages dropped to 55% and 35%, respectively, at 40 days postpartum and to 16% and 12%, respectively, at 6 months postpartum. While in the hospital, 3% of mothers initiated breast-feeding within 1 hour of labor, only 34% were informed about the advantages of breast-feeding by health professionals and 42% were trained to breast-feed by the midwives. "Rooming-in" was not practiced in the private hospitals. The educational level was positively associated with the initiation of breast-feeding [odds ratio (OR): 1.36, confidence interval (CI): 1.02-1.81], the mother's body mass index was negatively associated with the maintenance of breast-feeding for 40 days (OR: 0.56, CI: 0.32-0.98) and 6 months (OR: 0.28, CI: 0.06-1.26) and a caesarean section was negatively associated with the initiation (OR: 0.24, CI: 0.11-0.49) and maintenance of breast-feeding (OR: 0.42, CI: 0.20-0.89).

CONCLUSIONS

Breast-feeding is not appropriately supported in certain maternity hospitals in Athens, and this is probably the cause of observed low breast-feeding prevalence.

Maternal and child characteristics associated with infant and toddler feeding practices

OBJECTIVE

To describe maternal/child characteristics associated with important practices of feeding US infants and toddlers aged 4 to 24 months.

DESIGN

Cross-sectional analysis of data collected in the 2002 Feeding Infants and Toddlers Study. Maternal/child characteristics associated with compliance to American Academy of Pediatrics feeding guidelines, and maternal/child characteristics associated with specific feeding patterns were assessed.

SUBJECTS

A national random sample of mothers (n=2,515) whose infants and toddlers aged 4 to 24 months made up the Feeding Infants and Toddlers Study cohort.

STATISTICAL ANALYSIS

Student t tests were used to compare the means and standard errors and were considered significant if P<.05. To predict if the mother/child met a particular recommendation, logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals.

RESULTS

Having a college education was the maternal characteristic associated with the largest number of positive child feeding behaviors. Mothers with a college education were significantly more likely than mothers without a college education to initiate breastfeeding and breastfeed the child to age 6 and 12 months (OR 2.8, 3.2, and 3.9, respectively). College-educated mothers were significantly more likely to comply with the American Academy of Pediatrics juice and complementary feeding recommendations (OR 1.4 and 2.0). In addition, infants and toddlers whose mother had a college education were more likely to consume fruit and less likely to consume sweetened beverages and desserts or candy. Ever breastfeeding the sample child, living in the western region of the United States, and being married and older were also associated with multiple positive practices. The child being in day care was associated with decreased duration of breastfeeding at age 6 and 12 months as well as with consumption of salty snacks.

CONCLUSIONS

Initiatives to improve infant and toddler feeding practices should focus on assisting mothers who have less than a college education, who are unmarried, whose child is in day care, or who are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children.

Breastfeeding duration and perinatal cigarette smoking in a population-based cohort

OBJECTIVES

We examined the association between breastfeeding duration and maternal smoking before, during, and after pregnancy.

METHODS

Data from the 2000-2001 Oregon Pregnancy Risk Assessment Monitoring System were used. Early weaning was defined as not breastfeeding at 10 weeks postpartum.

RESULTS

At 10 weeks after pregnancy, 25.7% of mothers who initiated breastfeeding no longer breastfed. After controlling for confounders, quitters (mothers who quit smoking during pregnancy and maintained quit status after pregnancy) and postpartum relapsers (mothers who quit smoking during pregnancy and resumed smoking after delivery) did not have significantly higher risk for early weaning than nonsmokers. However, persistent smokers (mothers who smoked before, during, and after pregnancy) were 2.18 times more likely not to breastfeed at 10 weeks (95% confidence interval=1.52, 2.97). Women who smoked 10 or more cigarettes per day postpartum (i.e., heavy postpartum relapsers and heavy persistent smokers) were 2.3-2.4 times more likely to wean their infants before 10 weeks than were nonsmokers.

CONCLUSIONS

Maternal smoking is associated with early weaning. Stopping smoking during pregnancy and decreasing the number of cigarettes smoked postpartum may increase breastfeeding duration.