Breastfeeding and maternal health outcomes: a systematic review and meta-analysis

The Menstrual Cycle as a Vital Sign: a comprehensive review

Some medical professional organizations have advocated for including the menstrual cycle as a vital sign in adolescence, but not in adulthood. However, documenting menstrual cycle patterns is not routine clinical or research practice. Vital signs are used to predict health outcomes, indicate needed treatment, and monitor a clinical course. They can help identify pathologies, affirm wellness, and are responsive to exposures. Here we review the scientific evidence showing how the menstrual cycle meets these criteria and should therefore be treated as a vital sign. Using key words and controlled vocabulary terms, we carried out multiple literature searches, prioritizing the inclusion of systematic reviews, meta-analyses, and clinical practice guidelines. This review describes how the menstrual cycle is a health indicator, can cyclically impact health conditions, and its associations with long-term post-menopausal health outcomes. We review exposures influencing the menstrual cycle, evidence underlying its use to optimize wellness, and available tools for documenting cycles. Supplementary materials include patient handouts on menstrual cycle tracking, and an index of related clinical practice guidelines and reviews by subject. The menstrual cycle is a vital sign from menarche through menopause, an underutilized but powerful tool for understanding gynecological and general health.

Primary Care Behavioral Counseling Interventions to Support Breastfeeding: US Preventive Services Task Force Recommendation Statement

Importance

The association between breastfeeding and health benefits in children has been previously well established; health benefits have also been found for women who breastfeed. However, breastfeeding rates in the US are relatively modest; as of 2021, 59.8% of infants at age 6 months are breastfed and 27.2% of infants at that age are exclusively breastfed.

Objective

The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the evidence on the benefits and harms of primary care behavioral counseling interventions to support breastfeeding.

Population

Adolescents and adults who are pregnant or postpartum, and their infants and children.

Evidence Assessment

The USPSTF concludes with moderate certainty that primary care behavioral counseling interventions to support breastfeeding have a moderate net benefit.

Recommendation

The USPSTF recommends providing interventions or referrals, during pregnancy and after birth, to support breastfeeding. (B recommendation).

Exposure to ethinyl estradiol during lactation reduces maternal mammary gland complexity and restricts pup growth in mice

The mammary gland undergoes dramatic changes during pregnancy and lactation, remodeling a relatively simple ductal structure into an extensive network of milk secreting alveoli. Estradiol, through activation of estrogen receptor (ER), plays an essential role in the early expansion of the mammary epithelium during pregnancy, but has little role during lactation when circulating levels are low. Yet, ER is present in the epithelium during lactation and exposure to estrogenic endocrine disrupting chemicals (EDCs) could disrupt the lactational capability of the mammary gland. To understand the effects of ER agonists during lactation, we exposed CD-1 mice to ethinyl estradiol [20μg/kg] from lactation day 1 (LD1) until weaning at LD21. To assess changes in lactational output, pup weight gain was assessed throughout the lactation period. Both maternal weight gain and maternal behavior were observed as well. Maternal mammary glands were collected and assessed for changes in histomorphology and molecular indicators of differentiation and cell death. We observed that EE2 exposure restricted weight growth in dams, increased time nursing on the nest and reduced other maternal activities. EE2 exposed pups had restricted growth and development. At weaning, EE2 exposed dams had less epithelial complexity than VEH controls despite no changes in alveolar structure. Molecular analysis of the mammary gland at weaning indicated that EE2 reduced epithelial pSTAT3 expression, an early indicator of cell degradation, without altering differentiation markers or apoptosis. These findings indicate that EE2 exposure reduces epithelial expansion in lactation prior to weaning, resulting in restricted growth and development in pups.

Breastfeeding in metabolic and bariatric patients: a comprehensive guide for surgeons, patients, and the multidisciplinary team

Since nearly 40% of metabolic and bariatric surgery (MBS) patients are individuals with the ability to bear children, many may seek to become pregnant or may be currently lactating when seeking surgery. While many patients plan to breastfeed, MBS patients are at high risk for premature cessation of breastfeeding. Limited literature exists on the impact of MBS on lactation and there are no established guidelines to help clinicians support and educate MBS patients about breastfeeding. Herein, we aim to fill that gap by providing a comprehensive guide for bariatric surgeons, obstetricians, women's health providers, lactation consultants, registered dietitians, bariatric nurse coordinators, and advanced practice providers to support breastfeeding in patients with a history of MBS or who are considering MBS. We review physician-patient discussion points on how MBS impacts lactation, the micronutrient and caloric needs for this unique population, and data to support successful breastfeeding in post-MBS patients who are lactating regarding practical, anesthetic, and imaging considerations.

Longitudinal association of cumulative risk factors in early life, genetic risk, and healthy lifestyles during adulthood with the risk of type 2 diabetes

BACKGROUND

The combined influence of early life risk factors on the type 2 diabetes (T2D) development is not well-studied, and it is unclear whether these associations can by modified by genetic risk and healthy lifestyles in later life.

METHODS

We studied 148,621 participants in the UK Biobank. We calculated early-life risk scores (ERS) by summing the cumulative number of three early-life risk factors: low birth weight, maternal smoking during pregnancy, and non-breastfed as a baby. We estimated polygenic risk scores (PRS) for T2D and calculated participants' modifiable healthy lifestyle score (MHS) during adulthood.

RESULTS

A total of 7,408 incident T2D were identified. ERS showed a positive dose-response association with T2D risk. Compared with participants with 0 ERS, those with 3 ERS had the highest risk of developing T2D (hazard ratio [HR]: 1.93; 95% confidence interval [CI]: 1.65, 2.26). This association was not modified by T2D-PRS or MHS. In the joint exposure analyses, compared with participants with the lowest risk exposure (i.e., lowest ERS combined with lowest T2D-PRS/healthy lifestyle in later life), we observed highest risk of T2D among individuals with the highest ERS combined with the highest tertile of T2D-PRS (HR = 6.67, 95% CI: 5.43, 8.20) or an unhealthy lifestyle in later life (HR = 4.99, 95% CI: 3.54, 7.02), respectively.

CONCLUSIONS

Early-life risk factors are associated with a higher risk of T2D in a dose-response manner, regardless of genetic risk or later-life healthy lifestyle. Therefore, identifying early-life modifiable risk factors is helpful to develop strategies of T2D prevention.

Variation of continued breastfeeding by age of the child among children aged 12-23 months: evidence from 21 sub-Saharan African countries

BACKGROUND

Appropriate breastfeeding practices are recommended to decrease the burden of under-five mortality and its related costs in sub-Saharan Africa. Continued breastfeeding is associated with a reduced risk of child morbidity and mortality. There is no evidence on the pooled prevalence and determinants of continued breastfeeding conducted using the most recent indicators for assessing infant and young child feeding practices in 2021. Therefore, the findings of this study could help nutrition policymakers prioritize and implement specific interventions for breastfeeding continuation.

METHODS

Data from the most recent demographic and health surveys, which were carried out between 2015 and 2022 in 21 sub-Saharan African countries, were used. The study comprised a weighted sample of 44,423 children between the ages of 12 and 23 months. Software for statistical analysis, STATA/SE version 14.0, was used to clean, recode, and analyze data. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Statistical significance was attained by variables having an adjusted odds ratio with a 95% confidence interval and a p-value < 0.05.

RESULTS

The pooled prevalence of continued breastfeeding among children aged 12 to 23 months was 64.59% (95% CI: 64.15%, 65.04%). Factors like maternal age [AOR = 1.22; 95% CI (1.09, 1.38)], maternal educational level [AOR = 0.51; 95% CI (0.47, 0.55)], and paternal educational level [AOR = 0.79; 95% CI (0.73, 0.85)], marital status of the mother [AOR = 1.13; 95% CI (1.05, 1.22)], maternal working status [AOR = 1.32; 95% CI (1.25, 1.39)], wealth index [AOR = 0.82; 95% CI (0.77, 0.88)], parity [AOR = 1.09; 95% CI (1.00, 1.19)], place of delivery [AOR = 0.92; 95% CI (0.87, 0.98)], ANC visits [AOR = 1.27; 95% CI (1.15, 1.39)], mode of delivery [AOR = 0.81; 95% CI (0.73, 0.89)], twin status [AOR = 4.65; 95% CI (4.07, 5.31), age of the child [AOR = 9.59; 95% CI (9.03, 10.2)], sex of the child [AOR = 0.95; 95% CI (0.91, 0.99)], preceding birth interval [AOR = 1.28; 95% CI (1.20, 1.37)], residence [AOR = 0.74; 95% CI (0.70, 0.79)], and community level education [AOR = 0.90; 95% CI (0.85, 0.96)] were significantly associated with continued breastfeeding.

CONCLUSION

In the present study, nearly two-thirds of children aged 12 to 23 months in sub-Saharan African countries continued breastfeeding. Higher odds of continued breastfeeding were reported among older, educated, and married women; working mothers; wealthier households; grand multiparous women; home delivery; attending ANC visits; vaginal delivery; single birth; younger children; male children; long preceding birth interval; urban residence; and mothers from eastern Africa. Therefore, women's empowerment, improving maternal healthcare services, and giving special attention to unmarried and younger women, primiparous women, women with multiple births, mothers with female children, and mothers from rural areas are recommended.

Breastfeeding Counseling Practices Among Plastic Surgeons: Results From a National Survey

Background

Breastfeeding has well-established benefits for maternal and infant health. Difficulty with breastfeeding is a possible complication after breast surgery and can have detrimental maternal psychological consequences. Although lactation outcomes after breast surgery have been reported, plastic surgeons' preoperative counseling practices regarding breastfeeding after surgery have not yet been studied.

Methods

From November 2021 to January 2022, a 25-question anonymous survey on breastfeeding counseling practices, personal breastfeeding experiences, demographics, surgical training, and length of practice was administered to 6000 members of the American Society of Plastic Surgeons.

Results

A total of 146 respondents were included, and 90.7% of respondents believe that breast surgery can affect breastfeeding. Although 96.6% of respondents routinely discuss possible postoperative challenges with breastfeeding, 39.3% differentiate between inclusive and exclusive breastfeeding, 22.2% discuss potential emotional consequences, and only 12.8% discuss the need for galactagogues or labor-intensive ancillary activities. Significantly more respondents who had been in practice for less than 15 years believed that breast surgery can affect breastfeeding and reported counseling on breastfeeding impairment risk before transgender top surgery, compared with those who had been out of training for more than 15 years (96% versus 84%, P = 0.05; 72% versus 54%, P = 0.05).

Conclusions

Most plastic surgeons believe breast surgery can affect lactation and counsel patients as such. However, the potential deleterious mental health consequences of challenged breastfeeding after breast surgery seem undercounseled. Our findings highlight a potential need for increased education and improved preoperative breastfeeding counseling protocols for plastic surgeons.

'I'm glad my baby has weaned so I don't need to make that decision.' Understanding breastfeeding-related COVID-19 vaccine narratives on social media

ISSUE ADDRESSED

During the coronavirus disease 2019 (COVID-19) pandemic, the infodemic has been highly visible. Vaccine-related advice and evidence-based guidelines for breastfeeding women have lagged, and, at times have been contradictory and confusing. Breastfeeding is an important public health issue with long-lasting health benefits for infants and mothers. This online social listening study aimed to understand breastfeeding-related narratives on social media during the early stages of the Australian COVID-19 vaccine roll-out.

METHODS

Public content about breastfeeding and COVID-19 vaccines from Facebook pages with Australian-based administrators were accessed via the CrowdTangle platform. All related content posted between 1 December 2020-31 December 2021 was included. Content (n = 29 567) was coded to an adapted vaccine narrative typology, and emergent themes were inductively identified.

RESULTS

Most posts were promoting, sharing or discussing reliable information. However, the comments responding to these posts varied more widely. Several consistent questions, concerns, and information voids were evident, and misinformation and conflicting information contributed to confusion and challenges with decision-making.

CONCLUSIONS

These findings highlight the complexities associated with decision-making. Pregnant and breastfeeding women continue to be a priority group for vaccination, yet there were gaps in data, evidence and information. Incorporating social listening and infodemic management into public health work is important. SO WHAT?: Information voids, when identified early, can help inform public health messaging. Increasing social listening and infodemic training and skills in the health promotion workforce can help build future capacity and give insight into optimising public health communication and addressing misinformation.

Perinatal Intimate Partner Violence and Maternal-Infant Bonding in Women With Anxiety Symptoms in Pakistan: The Moderating Role of Breastfeeding

Intimate partner violence (IPV) during the perinatal period can negatively affect both a woman's health and the bonding with her infant. Research on IPV among pregnant women experiencing psychological distress in South Asia is limited. We examined associations between perinatal exposure to IPV and postnatal maternal-infant bonding in Pakistani women with symptoms of anxiety and assessed if breastfeeding practices moderated these associations. Postnatal data were collected from 720 Pakistani women who reported at least mild levels of anxiety symptoms in pregnancy. We performed Poisson regression with robust variance analyses to examine the associations between IPV during pregnancy or within 6 weeks after delivery (i.e., the perinatal period) and maternal-infant bonding. Interaction terms between IPV and breastfeeding practices were included in the analytic models to examine the moderating effects. About 27% of women were exposed to at least one type of perinatal IPV. Women who were exposed to IPV were more likely to have moderate to severe postpartum anxiety (n = 57, 28.9% of IPV-exposed women), compared to those without IPV (n = 65, 12.4% of unexposed women; p value < .001). Compared to women not reporting IPV, women exposed to any IPV showed a 38% increase in Postpartum Bonding Questionnaire scores, suggesting higher likelihood of impaired bonding (risk ratio [RR] = 1.38, 95% confidence interval [CI] [1.21, 1.56]). Among women who initiated breastfeeding later than 1 hr post-delivery, IPV was associated with impaired bonding (RR = 1.09, 95% CI [1.06, 1.20]), whereas no association was present for women who initiated breastfeeding within 1 hr (RR = 1.03, 95% CI [0.98, 1.08]). In addition to the efforts to reduce IPV, encouraging IPV-exposed women to adhere to the breastfeeding guidelines (e.g., early breastfeeding) may enhance maternal-infant bonding.

Association Between Breastfeeding Intensity and Mammary Gland Involution Markers in Early Postpartum Among Women from Low-Income Households

Background: The aim was to examine the associations between breastfeeding intensity and changes in concentrations of mammary gland involution markers (protein and lactose) among mothers participating in federal food assistance programs. Methods: Pregnant women in their third trimester who planned to breastfeed were recruited from local prenatal clinics (n = 25). After delivery, six weekly home visits were conducted to collect human milk samples and 24-hour infant feeding recalls. Milk protein and lactose concentrations were measured utilizing Bicinchoninic Acid and Megazyme assays, respectively. Bivariate tests were carried out using a statistical significance of p < 0.05. Results: Majority (84%) of our participants were either African American or of Latino origin. About one-fourth of our participants were primiparous and the average monthly household income was $3,150 with an average household size of 4. In week 2 postpartum, 18 mothers had a 100% breastfeeding intensity, while in week 6 it decreased to 16 mothers. A significant difference in milk protein concentration was seen between exclusive and mixed-feeding mothers from weeks 2 to 6; meanwhile, for lactose concentrations, the significant differences were seen only in weeks 3 and 4 (p < 0.005). Protein changes were negatively associated with breastfeeding intensity (as breastfeeding intensity went up, protein decreased), while lactose changes were positively associated with breastfeeding intensity (protein r = -0.5578; lactose r = 0.6571). Conclusions: Significant associations between intensity of breast milk feeding and mammary gland involution markers highlight the sensitivity of the mammary gland to mixed feedings in the early postpartum period.

Impact of the baby friendly community initiative on breastfeeding outcomes: A systematic review and meta-analysis

OBJECTIVE

To examine the impact of the Baby Friendly Community Initiative (BFCI) on breastfeeding outcomes worldwide, specifically the duration of any and exclusive breastfeeding, compared to standard maternal care.

METHODS

A systematic review and meta-analysis were conducted. Seven electronic databases were searched from November 1998 to July 2024. Quantitative studies examining the effects of BFCI on breastfeeding outcomes were included. The quality of included studies was assessed using the Cochrane risk of bias tools and NHLBI study quality assessment tools. Narrative synthesis was performed for studies not suitable for meta-analysis.

RESULTS

Out of 14,495 identified records, 13 were included after the removal of duplicates and ineligible articles. The majority of included studies found that BFCI, whether implemented partially, fully or in combination with other initiatives, is an effective intervention for improving breastfeeding outcomes. The meta-analysis showed an increase prevalence of exclusive breastfeeding at 6 months postpartum in BFCI group (OR=4.00; 95 % CI 1.29-12.38, P = 0.02). Further studies are needed to investigate the statistical significance of BFCI on any breastfeeding from 6 months to 2 years postpartum.

DISCUSSION

BFCI has the potential to significantly enhance long-term exclusive breastfeeding rates and may also improve any breastfeeding rates from 6 months onward. However, the nature of BFCI implementation posed limitations to study design, which reduced the overall methodological quality of the included studies.

REGISTRATION

The protocol for this review was registered on PROSPERO (registration number CRD42023460801) on 17th September 2023.

Feeding attitudes of fathers in the United States are associated with breastfeeding success: A cross-sectional study

Background/Aims: Fathers are increasingly recognized as a source of breastfeeding support. This online cross-sectional study examined the relationship between fathers' feeding attitudes and breastfeeding outcomes (initiation, duration, exclusivity) and factors influencing breastfeeding. Methods: Demographic characteristics, anthropometric measurements, and infant feeding methods were self-reported. The Iowa Infant Feeding Attitude Scale (IIFAS) assessed the feeding attitudes of 509 fathers in the USA (34.4 ± 5.2 years). Significance was determined using chi-square tests and analysis of variance (p < .05). Results: The IIFAS categorized participants into feeding attitude groups (positive to formula feeding (PFF), n = 142; neutral feeding (NF), n = 270; positive to breastfeeding (PBF), n = 97). The mean IIFAS score (55.7 ± 16.0) suggested fathers have a neutral attitude toward breastfeeding. The PBF group reported a longer duration of breastfeeding (17.1 ± 7.1 months) compared to the PFF (6.1 ± 3.0 months) or NF (12.7 ± 7.3 months) groups (p < .001). The PFF group reported that their child initiated complementary liquids earlier (18.0 ± 5.8 weeks) compared to the NF or PBF groups (NF = 21.5 ± 13.8; PBF = 24.5 ± 9.2 weeks; p < .001). Initiation of complementary solids was statistically different between the PFF group (21.3 ± 5.4 weeks) and the NF and PBF groups (NF = 26.4 ± 12.0; PBF = 26.4 ± 6.1 weeks; p < .001). Breastfeeding initiation was associated with the feeding attitude group (p < .001). Among those that reported their partner initiated breastfeeding, the feeding source (breastmilk, breastmilk + formula) was associated with the feeding attitude group (p < .001). Reasons for not breastfeeding exclusively or breastfeeding cessation were related to concerns about maternal/child health, convenience, and processes associated with breastfeeding. Conclusions: Fathers' feeding attitudes are related to breastfeeding success. Research should explore education and interventions for fathers to improve breastfeeding rates.

Associations between maternal diet quality in pregnancy and infant feeding practices

Postpartum maternal diet quality has been linked with optimal infant feeding practices. However, whether maternal diet quality during pregnancy influences infant feeding practices remains unclear. The present study explored the relationship between maternal diet quality in pregnancy and infant feeding practices in Australian women. A brief 15-item FFQ was used to collect maternal dietary data (n 469). Diet quality was calculated using a modified 2013 Dietary Guideline Index (DGI). Multivariable linear and logistic regressions with adjustment for covariates were used to examine associations between maternal diet quality in pregnancy and infant feeding practices: infant feeding mode, breast-feeding duration and timing of solids introduction. Higher DGI score during pregnancy was associated with higher odds of breast-feeding than formula/mixed feeding (adjusted OR (AOR) 1·03, 95 % CI 1·00, 1·07), longer breast-feeding duration (adjusted β 0·09, 95 % CI 0·03, 0·15) and higher odds of breast-feeding for ≥ 6 months (AOR 1·04, 95 % CI 1·02, 1·07) than for < 6 months. Associations between maternal DGI score and breast-feeding variables were moderated by maternal country of birth, with significant associations observed in Australian-born mothers only. No association was found between maternal DGI score and timing of solids introduction. Higher maternal diet quality was associated with better infant feeding practices, and the association was moderated by country of birth. Our findings provide evidence to support the initiation of dietary interventions to promote diet quality during pregnancy, particularly among Australian-born women. Further research could explore underlying mechanisms linking maternal diet quality and infant feeding practices.

Mode of delivery among preterm twins and offspring health, a retrospective cohort study

Although cesarean delivery (CD) has been linked to long-term health risks in singleton infants, the impact of delivery mode on long-term health outcomes in preterm twins remains underexplored. A retrospective cohort study was conducted at a tertiary medical center in Israel from 1991 to 2021, comparing preterm twins vaginally delivered (VD) versus cesarean section, excluding cases with congenital malformations or perinatal deaths. Kaplan-Meier survival curves were used to compare the cumulative incidence, and Cox proportional hazards models were applied to adjust for potential confounders. Four thousand twenty-eight preterm twin offspring were included, with 1703 (42%) VD and 2325 (58%) by CD. Preterm twins delivered by CD had a higher incidence of respiratory morbidities (42% vs. 35% in the VD group, p < 0.001), with an adjusted Hazard Ratio (aHR) of 1.15 (95%CI 1.02-1.30). CD was associated with an increased incidence of neurologic morbidities (22% vs. 17% in the VD group, p < 0.001), with an aHR of 1.16 (95%CI 1.02-1.36). CD was associated with a higher incidence of infectious morbidities (69% vs. 62%, p < 0.001), with an aHR of 1.10 (95%CI 1.01-1.21). Gastrointestinal morbidities were more pronounced in the CD group (29% vs. 25%, p < 0.001), but the multivariable analysis did not reach significance (aHR = 1.10, 95%CI 0.95-1.27). Sub-analyses of elective-uncomplicated deliveries showed consistent results for most morbidities.

CONCLUSIONS

Cesarean delivery in preterm twins is associated with long-term respiratory, neurologic, infectious and gastrointestinal morbidities of the offspring. The findings suggest the potential benefits of vaginal over cesarean deliveries regarding offspring long-term health complications.

WHAT IS KNOWN

• Studies on singleton births show that cesarean delivery may increase respiratory, infectious, neurological and gastrointestinal outcomes remains inconsistent across term and preterm deliveries. • Cesarean delivery rates remain high despite recommendations to reduce their frequency, yet data on the association between cesarean delivery and morbidity among twins, particularly in small for gestational age twins, is limited.

WHAT IS NEW

• This is the first large-scale study demonstrating that cesarean delivery in preterm twins increases the odds of respiratory, neurologic, infectious and gastrointestinal long-term morbidities up to age 18. • The higher rates of respiratory, neurologic, infectious, and gastrointestinal complications persist even in uncomplicated cesarean deliveries.

Convergence of Two Fields-Breastfeeding and Lifestyle Medicine: Integrating Early Nutrition and Wellness for Lifelong Outcomes: A Tribute to Dr. Ruth Lawrence, A Pioneer in Both Fields

Breastfeeding medicine and lifestyle medicine are grounded in preventive health and holistic care, emphasizing early interventions that foster long-term wellness. Dr. Ruth Lawrence, a pioneer in breastfeeding medicine, recognized breastfeeding as a cornerstone of preventive care, advocating for its profound impact on maternal and infant health. Her seminal work, Breastfeeding: A Guide for the Medical Profession, and her role in founding the journal Breastfeeding Medicine have been instrumental in shaping the field, emphasizing both the nutritional and psychosocial benefits of breastfeeding. Breastfeeding provides optimal nutrition, immune protection, and metabolic programming, reducing the risk of acute infections, chronic diseases, and maternal conditions such as postpartum depression and cancer. Similarly, lifestyle medicine focuses on modifiable factors-nutrition, physical activity, stress management, and sleep hygiene-to improve lifelong health outcomes. These fields converge in their shared emphasis, for example, on the gut microbiome, a critical determinant of immune and metabolic health. Breastfed infants have more diverse and beneficial gut microbiota, which reduce the risk of obesity and metabolic disorders, a focus paralleled by lifestyle medicine's advocacy for plant-based, fiber-rich diets. This review explores the parallels between breastfeeding and lifestyle medicine, advocating for research that moves beyond isolated nutrient analysis to examining whole dietary patterns in breastfeeding mothers. Maternal diet during lactation enhances the bioactive components of breast milk, including prebiotics, probiotics, and immune factors, amplifying its preventive effects. By integrating Dr. Lawrence's forward-thinking principles with insights from lifestyle medicine, breastfeeding medicine can advance its understanding of how maternal nutrition and modifiable lifestyle factors optimize health outcomes for both mother and infant, underscoring the transformative potential of early interventions in shaping lifelong health.

Racial Disparities in Mother's Own Milk Feedings Persist after Discharge from the Neonatal Intensive Care Unit

Objective: To investigate mother's own milk (MOM) feeding rates in the first year of life after neonatal intensive care unit (NICU) discharge for infants born <37 weeks gestational age and compare rates by race and ethnicity. Study Design: This was a retrospective study of preterm infants discharged from the NICU who sought care at a primary care clinic within our academic health system. Infant demographic characteristics and feeding at NICU discharge were extracted from the medical record. Post-discharge feeding history was extracted from health care maintenance (HCM) visit records at 2, 4, 6, 9, and 12 months for infants born between January 2018 and December 2019. Exclusion criteria included having a contraindication to MOM feeding or insufficient feeding documentation. Results: Of the 314 infants meeting inclusion criteria, 57% received any MOM and 24% received exclusive MOM at NICU discharge. At the 6-month HCM visit, MOM feeding rates decreased to 25% for any MOM and 12% for exclusive MOM. Statistically significant racial and ethnic differences in MOM feeding rates were observed at all HCM visits, with White infants having the highest and Black infants having the lowest MOM feeding rates. Conclusions: MOM feeding rates decreased from NICU discharge to the 12-month HCM visit. Disparities observed during the birth hospitalization persisted after discharge, with Black infants having consistently lower MOM feeding rates compared with Hispanic and White infants. These disparities highlight research opportunities to pinpoint factors contributing to the decline in MOM feedings and develop targeted interventions to address these disparities.

Human Milk Feeding in Inherited Metabolic Disorders: A Systematic Review of Growth, Metabolic Control, and Neurodevelopment Outcomes

Human milk (HM) is the optimal source of nutrition for infants. Yet the suitability of HM macronutrient composition, paired with the challenge of regulating HM intake, may deserve some consideration for infants with inherited metabolic disorders (IMDs) requiring restrictive and controlled dietary management. Except for classic galactosemia, HM feeding is expected to be feasible, allowing infants to maintain metabolic stability, while growing and developing optimally. However, information about HM feeding in nonphenylketonuria (PKU) literature is scarce. In this systematic review, 52 studies were included, representing 861 infants (86% PKU) receiving HM after IMD diagnosis (mean duration 4-10 months depending on the IMD). For non-PKU IMDs (e.g., other amino acidopathies, urea cycle disorders, organic acidemias, fatty acid oxidation disorders), outcomes of HM feeding were available for few infants, except for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency (n = 48). In PKU, HM feeding combined with phenylalanine-free formula, led to adequate metabolic control (25 studies), growth (15 studies), and neurodevelopment (10 studies). For other IMDs, more evidence is required, but the limited data suggest that HM feeding is possible, with attentive monitoring and disease-specific formula supplementation where applicable. In MCAD deficiency, ensuring adequate HM intake is essential, as symptoms were more frequently reported in exclusively breastfed infants. No IMD-specific articles were found on the relationship between HM feeding and many other outcomes of interest (e.g., immune status or comorbidity risk later in life). With the exception of galactosemia, HM feeding is expected to benefit infants with IMD. More data should be published for IMDs other than PKU.

Multidisciplinary Management of Pregnancy-Associated Breast Cancer

Breast cancer during pregnancy is uncommon; however, it is one of the most common malignancies affecting pregnant women. Pregnancy-associated breast cancer (PABC) is a complex entity characterized by unique risk factors, presentation, and pathology. Furthermore, although management generally aims to mirror that for nonpregnant patients, there are distinct aspects of oncologic care delivery specific to PABC. The focus is on optimizing maternal outcomes while maximizing maternal and fetal safety. A multidisciplinary approach is key, and the timing of various treatment modalities is critical. Postdelivery care and counseling are also imperative to address issues such as contraception, breastfeeding, and future fertility. In the present review, we discuss the current knowledge base and the diagnostic and treatment landscape for PABC, including recent literature and practice pattern updates.

Potential cost-savings of breastfeeding promotion to prevent breast cancer: a Monte Carlo simulation

BACKGROUND

Breastfeeding protects mothers against breast cancer. Our study aimed to estimate the healthcare cost-savings resulting from a reduction in breast cancer attributed to an increase in the breastfeeding rate in Hong Kong.

METHODS

This is an economic evaluation. We constructed an individual-based Monte Carlo method to simulate with probabilistic sensitivity analysis the development of breast cancer over a woman's lifetime in a hypothetical birth cohort aged 20 years in 2018 (n = 33500) using best available data mainly from government statistics. We predicted the cases of, and deaths due to breast cancer in the base case (with the actual breastfeeding rate in 2018) and two hypothetical optimal scenarios (90% exclusive breastfeeding for six months or cumulative exclusive/partial breastfeeding for at least 12 months). The healthcare cost-savings, the number of deaths averted and the increase in disability-adjusted life years (DALYs) due to the prevention of breast cancer attributed to a higher breastfeeding rate were then deduced, assuming an annual discount rate of 3%.

RESULTS

Increasing the proportion of parous women breastfeeding exclusively for six months from 26 to 90% averted 266 (95% CI 259, 273) or ~ 10% of all-stage breast cancer cases, 18 deaths (95% CI 17, 19) and 399 DALYs (95% CI 381, 416), over the lifetime of each annual cohort of women in Hong Kong. The lifetime medical costs that could be saved would be ~ USD3 million using 2018 prices. However cost-savings were 5-times less in another scenario where the cumulative partial/exclusive breastfeeding for 12 months in parous women is increased to 90% due to its weaker protection against breast cancer compared to exclusive breastfeeding.

CONCLUSIONS

Promoting and protecting breastfeeding could lead to cost-savings for treating breast cancer in Hong Kong. Our analysis can inform the annual healthcare budget that could be allocated to promote exclusive breastfeeding for six months.

Optimizing breastfeeding for hospitalized newborns: A narrative review of midwifery-led interventions

Breastmilk is the best source of nutrition for newborns. The World Health Organization recommends exclusive breastfeeding for the first six months of life as it has benefits to mother and child. However, breastfeeding can be challenging. Especially when the newborn is hospitalized, the physical separation of mother and child can make breastfeeding difficult. Hence pre- and post-natal midwife care supporting breastfeeding become more important. The aim of this narrative review is to identify measures taken by midwives in the labor ward, on the postpartum unit and at home that can influence breastfeeding success positively in hospitalized newborns. A literature review was conducted in PubMed and CINAHL and on the website of the European Institute for Breastfeeding and Lactation from April to September 2023. Studies from 2013 to 2023 written in German or English comparing two different measures/groups were considered. Twenty studies were included and five measures, taken by midwives, were identified. Skin-to-skin contact leads to higher (exclusive) breastmilk feeding rates, better sucking behavior and a shorter time to full enteral feeding. Regular breastmilk expression and supervised breastfeeding attempts result in higher breast milk feeding rates. Breastfeeding counselling enables the mothers to access lactation education. Uninterrupted visiting hours lead to higher exclusive breastmilk feeding rates. Midwives play a key role in promoting breastfeeding among hospitalized newborns involving initiating lactation, strengthening the mother-child bond and providing appropriate breastfeeding advice. There is a further need for research, as midwives are rarely involved in studies.

MELK study: an observational study on human milk composition and infant health determinants during the first year of life in a Dutch cohort

INTRODUCTION

Human milk plays a crucial role in infants' nutrition and immunity, with its composition being influenced by different factors. The role of maternal diet on human milk fatty acid composition, especially eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is well studied. Higher fish intake is associated with higher DHA levels in human milk, while fewer associations have been reported for EPA. Yet, maternal diet's impact on human milk composition for other nutrients is understudied, and variations in sampling protocols and study quality hinder definitive conclusions on its overall impact. Ethnicity may also impact milk composition, with different dietary habits intertwined with different genetic backgrounds, but also here research lacks standardised protocols. Our study aims to investigate maternal diet, ethnicity, and their association with human milk composition, along with their potential short-term associations with infant health and development, through detailed dietary assessment and by recruiting participants from diverse backgrounds. Understanding these associations could inform the development of tailored nutritional guidelines for mothers and infants, ultimately promoting optimal health and well-being for both. The study design, with its strict sampling procedure, can guide and inspire future studies.

METHODS AND ANALYSIS

We will conduct an observational study involving 120 healthy mothers from three ethnic backgrounds (Chinese, Caucasian and Turkish), exclusively breastfeeding their 2-month-old infants. We will collect human milk samples at two time points and assess maternal dietary intake over 4 days. Additionally, we will collect data on various maternal and child characteristics, including maternal stress, socioeconomic status and health, and infant feeding, sleeping, crying, gastrointestinal health and developmental status.

ETHICS AND DISSEMINATION

The study has been approved by the Medical Ethical Committee Oost-Nederland (NL79447.091.21), and all participants provided written informed consent before entering the study. Findings will be widely disseminated at international conferences and meetings including the annual Nutrition & Growth conference, ESPGHAN, and through publication in scientific peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN registry (ISRCTN35735283).

Perinatal intimate partner violence and breastfeeding practices: A systematic review and meta-analysis protocol

BACKGROUND

Intimate partner violence increases the risk of detrimental health, behaviors and psychological issues in mothers, affecting infant nutrition and development. However, the potential effects of maternal exposure to intimate partner violence on breastfeeding practices are understudied, and the results of individual studies are inconsistent and conflicting. The aims of this systematic review and meta-analysis are therefore to 1) estimate the prevalence of perinatal intimate partner violence and, 2) examine the relationship between perinatal intimate partner violence and breastfeeding outcomes.

METHODS AND ANALYSIS

This systematic review and meta-analysis will investigate the association between perinatal intimate partner violence and breastfeeding outcomes, including early initiation within 1 hour after giving birth, exclusive breastfeeding under six months, and continued breastfeeding at two years or beyond. Comprehensive searches will be conducted in PsycInfo, Scopus, Web of Science, Medline, Cochrane, JBI EBP, CINAHL, Informit, and PubMed electronic databases. Data extraction will be performed independently by two reviewers, with discrepancies resolved by a third reviewer. Statistical analysis will be conducted using STATA/SE version 17, employing random-effects models to calculate pooled effect sizes and assess heterogeneity with I2 and Chi-square tests. Subgroup analyses and meta-regression will explore potential sources of heterogeneity.

DISCUSSION AND CONCLUSION

Evidence suggests that intimate partner violence is linked to poor breastfeeding outcomes. This systematic review and meta-analysis will update, compile, and critically review the evidence of the role of intimate partner violence on breastfeeding outcomes. This systematic review and meta-analysis will also inform effective strategies and interventions to support breastfeeding among IPV-affected women, thereby enhancing maternal and child health.

ETHICS AND DISSEMINATION

As this review and meta-analysis involves secondary analysis of existing data, ethical approval is not required. Findings will be disseminated through peer-reviewed publications and scientific conferences, aiming to inform strategies to support breastfeeding among women affected by intimate partner violence.

STUDY REGISTRATION

This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42024555048.

Untold Narratives: Perceptions of Human Milk Banking and Donor Human Milk Among Ghanaian Immigrant Women Living in the United States

BACKGROUND

Donor human milk (DHM) though primarily administered in the NICU setting is increasingly being offered in well baby nurseries to promote exclusive breastfeeding. Despite the evidence supporting the use of DHM as a preferred supplement when mother's own milk (MOM) is unavailable or insufficient, foreign-born non-Hispanic black women are less likely to use DHM. Recognizing the cultural diversity and uniqueness among foreign-born non-Hispanic black communities in the USA, this exploratory study sought to understand perceptions of DHM and human milk banking (HMB) as well as factors influencing decision-making toward DHM among Ghanaian immigrant women living in the USA.

METHODS

Semi-structured interviews were conducted with 16 Ghanaian women living in the USA. Using a narrative thematic approach, interview transcripts were coded, analyzed, and organized into categories and themes.

RESULTS

Findings indicate mixed sentiments toward DHM/HMB among Ghanaian immigrant women. Regarding decision-making toward DHM utilization and donation, four themes were identified: (1) women's decision-making which is informed by external influences, (2) health provider's role in promoting human milk utilization, (3) the importance of addressing barriers to human milk utilization and donation, and (4) superstition and spirituality.

CONCLUSIONS

Maternal perceptions of DHM/HMB are influenced by individual-, interpersonal-, and community-level factors. It is imperative that health promotion efforts adopt multi-level approaches to addressing the disparities in DHM access and utilization as well as factors that impact milk donation in order to ensure optimum health outcomes for neonates of foreign-born non-Hispanic black populations.

A Call to Action: Healthcare Professionals to Become Independent of the Commercial Milk Formula Industry

Health-care professionals (HCP) have a responsibility to protect and promote maternal and infant health and breastfeeding is one of the most effective measures to support this. Increasing breastfeeding rates in Australia is crucial to improving population health, but the absence of robust policies, programmes and education for HCP undermines this effort. The pervasive marketing of commercial milk formulas (CMF), including sponsorship of HCP and their organisations, has introduced significant conflicts of interest that distort clinical practice, education, research and guidelines developed in the infant feeding domain. This paper calls on all HCP to seek independence from the CMF industry and to actively support breastfeeding in their practice.

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.

Conditional and Unconditional Social Transfers, Early-Life Nutrition, and Child Growth: A Randomized Clinical Trial

Importance

Rates of exclusive breastfeeding are declining despite the numerous benefits to mothers and their children.

Objective

To assess the effectiveness of conditional and unconditional social transfers on exclusive breastfeeding rates and child growth.

Design, Setting, and Participants

This is a prospective, parallel, 3-armed randomized clinical trial conducted between August 2022 and October 2023. The trial was conducted in 4 districts of Vientiane, Lao People's Democratic Republic. Mothers identified from a large birth cohort were randomized into 2 intervention groups (conditional social transfer or unconditional social transfer) or a control group at a ratio of 1:1:1. Data analysis was conducted from December 2023 to January 2024.

Interventions

Two interventions were tested: (1) conditional social transfer, in which the mother received the social transfer only if still exclusively breastfeeding at 6 months, and (2) unconditional social transfer, in which the mother received the social transfer at 6 months regardless of breastfeeding status. Mothers in the control group received educational material only.

Main Outcomes and Measures

The primary outcome was the proportion of women exclusively breastfeeding at 6 months post partum. Secondary outcomes included exclusive breastfeeding duration (in months) and child growth (height, weight, and head circumference).

Results

A total of 298 mothers (mean [SD] age, 27.2 [6.5] years) were identified from a large birth cohort and randomized into a conditional social transfer group (n = 100), an unconditional social transfer group (n = 97), or a control group (n = 101). The adjusted odds ratio of exclusive breastfeeding at 6 months post partum was 4.60 (95% CI, 2.10-10.07; P < .001) for the conditional social transfer group and 2.51 (95% CI, 1.11-5.66; P = .03) for the unconditional social transfer group compared with the control group. The risk of early exclusive breastfeeding cessation was lower for participants who received the unconditional social transfer (adjusted hazard ratio [aHR], 0.68; 95% CI, 0.49-0.92; P = .02) or conditional social transfer (aHR, 0.60; 95% CI, 0.44-0.83; P = .002) compared with participants in the control group. There were no significant differences between groups for child growth at 6 months post partum.

Conclusions and Relevance

The findings suggest that social transfers can substantially improve exclusive breastfeeding rates at 6 months post partum, with particularly large benefits for conditional transfers. Continued evaluation at 1, 2, and 3 years post partum will be conducted to assess the long-term outcomes of social transfers on complementary breastfeeding and child health and development over time.

Trial Registration

ClinicalTrials.gov Identifier: NCT05665049.

Personality traits of women with hereditary risk for breast/ovarian cancer versus obstetric history and cancer preventive behaviors

The aim of the study is to analyze the relationship between personality traits of women with hereditary predisposition to breast/ovarian cancer and their obstetric history and cancer-preventive behaviors. A total of 357 women, participants of 'The National Program for Families With Genetic/Familial High Risk for Cancer', were included in the study. The Neo Five-Factor Inventory (NEO-FFI) and a standardized original questionnaire designed for the purpose of the study were used. Breast ultrasound examination at a younger age was associated with Extraversion. Openness to Experience was linked with lower number of children, more frequent use of hormonal contraceptives, and younger age at first breast ultrasound examination. Women with higher Agreeableness scores were less likely to use contraceptives and underwent their first breast ultrasound later in life. Conscientiousness was associated with more frequent use of hormonal contraceptives and younger age at first breast ultrasound examination. Women at increased risk for developing breast/ovarian cancer who used hormonal contraceptives underwent breast ultrasound examinations earlier in life, while those who had breastfed their children chose to have their first mammogram earlier in life. Personality traits affect health-related behaviors and should be taken into account when designing theoretical models as well as interventions regarding health habits.

Admitted when Breastfeeding: Impact and Experiences of Hospital Care

Objective: This study analyzes the impact and experiences of hospitalization for any reason on breastfeeding women. Methods: Cross-sectional online survey (November 2019-March 2020). Adults admitted to a Spanish hospital for at least one night, when actively breastfeeding, were included. The questionnaire aimed at assessing breastfeeding, breast complications, and support and perceived health care workers' attitudes to breastfeeding. Results: Of the 266 included participants, 70 (26%) stopped breastfeeding during hospitalization, and 13 (5%) interrupted it permanently. A total of 24 (10%) participants reported that hospitalization meant problems for later breastfeeding, and 67 (25%) reported experiencing breast complications. The most common negative comment was that the child was too old to be breastfed (median age, 15 months [interquartile range (IQR) 11-25]). Problems for later breastfeeding due to the hospitalization were more likely if breastfeeding was interrupted (odds ratio [OR] 3.68, 95% confidence interval [CI] 1.32-10.5) or breast problems were experienced (OR 4.11, 95% CI 1.51-11.7). Problems were less likely when patients felt encouraged (OR 0.38, 95% CI 0.21-0.69) and hospitalized in a surgical inpatient area (OR 0.15, 95% CI 0.03-0.65). Conclusions: Hospitalizations can cause breastfeeding and breast problems. Hospital services must update protocols to integrate breastfeeding into usual care.

Empowering Global Health Systems to Protect, Promote and Support Optimal Breastfeeding

Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability-adjusted life years (DALYs) attributed to suboptimal breastfeeding practices-namely, non-exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years-low- and middle-income countries (LMICs) continue to bear a staggering 50-fold higher burden compared to high-income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby-Friendly Hospital Initiative (BFHI) reach through community-driven efforts such as the Baby-Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence-driven policies-such as strict monitoring and regulation of product labelling and digital media marketing-to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.

Breastfeeding Trends Following the US Infant Formula Shortage

OBJECTIVE

Breastfeeding enhances maternal and child health, yet US breastfeeding rates remain below optimal levels and substantial disparities persist. The 2022 infant formula crisis had the potential to influence infant feeding practices due to formula shortages and fears about the safety of formula feeding in the wake of recalls. This report studies the evolution of breastfeeding-initiation trends during the infant formula crisis and compares the effects across subpopulations.

METHODS

This study analyzed 2016-2022 national birth certificate data from 47 states and the District of Columbia based on Bayesian structural time-series analysis to measure average changes in breastfeeding-initiation trends and a linear probability model to test for heterogeneous effects.

RESULTS

During the 2022 infant formula crisis, average breastfeeding-initiation rates increased by 1.96 percentage points (pp) (95% credible interval, 1.68 pp to 2.23 pp) and remained elevated above historical levels at the end of the formula crisis. The increase was particularly pronounced among mothers with lower education levels, those receiving Special Supplemental Nutrition Program for Women, Infants, and Children assistance, residents of less populated counties, Medicaid recipients, and Black mothers, possibly due to their higher reliance on formula feeding. Populations meeting all of these sociodemographic criteria experienced the largest increase in breastfeeding initiation at 6.06 pp (95% confidence interval, 5.26 pp to 6.87 pp). Preexisting disparities in breastfeeding initiation declined in 2022.

CONCLUSION

The infant formula crisis highlights the potential for addressing breastfeeding disparities and reducing associated child and maternal health risks through targeted interventions to promote breastfeeding.

Evidence-based cesarean delivery: postoperative care (part 10)

The following review focuses on routine postoperative care after cesarean delivery (CD), including specific Enhanced Recovery After Cesarean recommendations as well as important postpartum counseling points. Following CD, there is insufficient evidence to support administration of prophylactic multi-dose antibiotics to all patients. Additional antibiotic doses are indicated for the following scenarios: patients with obesity who did not receive preoperative azithromycin, CD lasting ≥4 hours since prophylactic dose, blood loss >1500 mL, or those with an intra-amniotic infection. An oxytocin infusion for prevention of postpartum hemorrhage should be continued post-CD. While initial measures to prevent postoperative pain occur in the intraoperative period, with the consideration of 1 g intravenous (IV) acetaminophen and IV or intramuscular nonsteroidal anti-inflammatory medications (eg, 30 mg IV ketorolac), the focus postoperatively continues with this multimodal approach with scheduled acetaminophen per os (PO, 650 mg every 6 hours) and nonsteroidal agents (ketorolac 30 mg IV every 6 hours for 4 doses followed by ibuprofen 600 mg PO every 6 hours) being recommended. Short-acting opioids should be reserved for breakthrough pain. Low-risk patients should receive mechanical thromboprophylaxis until ambulation with chemoprophylaxis being reserved for patients with additional risk factors. When an indwelling bladder catheter was placed intraoperatively for scheduled CD, it should be removed immediately postoperatively. Chewing gum to aid in return of bowel function and early oral intake of solid food can occur immediately after CD and within 2 hours, respectively. For prevention of postoperative nausea and vomiting, administration of 5HT3 antagonists with the addition of either a dopamine antagonist or a corticosteroid is recommended based on noncesarean data. Early ambulation after CD starting 4 hours postoperatively is encouraged and should be incentivized by pedometer. For patients that receive a dressing over the CD skin incision, limited evidence supports leaving it in place for 48 hours. Adjunct nonpharmacologic interventions for postoperative recovery discussed in this review are acupressure, acupuncture, aromatherapy, coffee, ginger, massage, reiki, and transcutaneous electrical nerve stimulation. In the low-risk patient, hospital discharge may occur as early as 24 to 28 hours if close (ie, 1-2 days) outpatient neonatal follow-up is available due to the potential for neonatal jaundice; otherwise, patients should be discharged at 48 to 72 hours postoperatively. Upon discharge, the multimodal pain control recommendations of acetaminophen and ibuprofen should be continued. If short-acting opioids are necessary, the prescribing practices should be individualized based upon the inpatient opioid requirements. Other portions of postoperative/postpartum counseling during the inpatient stay include the optimal interpregnancy interval of 18 to 23 months, encouraging exclusive breastfeeding for at least 6 months, quick resumption of physical activity, and vaginal intercourse guidance as tolerated. Patients should also be counseled pre-CD on the option of immediate postpartum intrauterine devices insertion, intraoperative salpingectomy, or placement of long-acting reversible contraception in the postpartum period. Implementation of such evidence-based postoperative care protocols decrease length of stay, surgical site infection rates, and improve patient satisfaction and breastfeeding rates. El resumen está disponible en Español al final del artículo.

A qualitative exploration of mothers' perspectives on infant formula use in Uruguay

The transformation of the first-food systems and the widespread availability and marketing of breastmilk substitutes undermine efforts to promote adequate breastfeeding practices. The objective of the present research was to explore mothers' perspectives on infant formula use in Montevideo, the capital of Uruguay. A generic qualitative design was used to explore mothers' perspectives on the factors that act as enablers or barriers for infant formula use. Semi-structured interviews with thirty-four mothers of 0-23 months old children, aged between 25- and 40-years old, were conducted. The interview transcripts were analyzed using content analysis based on inductive-deductive coding considering the framework of the Capability, Opportunity, Motivation, and Behavior (COM-B) model. The discourse of the interviewees enabled the identification of a wide range of barriers and enablers for the use of infant formula, which were related to the three components of the model: capabilities, opportunity, and motivation. The health system emerged as the key determinant of infant formula use. Most of the participants who used infant formula referred to medical indication when explaining the reasons underlying their infant feeding decisions. The working status of the mother and emotional aspects of the child feeding experience were also identified as key enablers of infant formula use, whereas knowledge about health benefits and breastfeeding techniques, support from families and health-professionals, and motivation to breastfeed were key barriers. Taken together, these results suggest that strategies to reduce the use of infant formula in Uruguay should mainly focus on providing opportunities to breastfeed by improving the quality of the support and guidance provided to families in the health system and facilitating greater balance between breastfeeding and work.

Maternal Lifestyle Factors Affecting Breast Milk Composition and Infant Health: A Systematic Review

BACKGROUND/OBJECTIVES

Breast milk is a dynamic, personalized nutrition source, influenced by maternal diet, lifestyle, and environmental factors, which shape its composition and impact infant health. This review synthesizes evidence on the associations between maternal lifestyles (e.g., diet, physical activity, smoking), breast milk composition, and child health, offering insights for interventions to optimize breastfeeding benefits.

METHODS

We searched Web of Science, Medline, Embase, and PubMed for studies published up to March 2024 using predefined terms.

RESULTS

Out of 5244 articles, 20 studies met the inclusion criteria. Maternal Body Mass Index and macronutrient intake significantly affected breast milk fatty acid composition, influencing infant growth, cognitive development, and metabolic health. Micronutrient intake, particularly iodine, omega-3 fatty acids, and vitamins, was linked to better neurodevelopment and reduced atopic risks. Maternal diet and supplementation improved breast milk nutrient profiles and infant outcomes, though exposure to toxins like ochratoxin A raised concerns. Smoking was associated with altered milk composition, including lower osteopontin levels, potentially affecting infant immunity and growth.

CONCLUSIONS

This review emphasizes that adequate intake of key nutrients is essential for infant development, highlighting the need for policies that address nutritional deficiencies, promote healthy lifestyles, and reduce socio-economic barriers. These efforts can improve outcomes for both mothers and children, enhancing public health and reducing disparities.

Does caesarean section have an impact on exclusive breastfeeding? Evidence from four Southeast Asian countries

BACKGROUND

The effect of caesarean section (CS) on breastfeeding initiation has been extensively studied, but its influence on exclusive breastfeeding practices remains inconclusive. Therefore, this study aims to investigate the impact of CS on exclusive breastfeeding using evidence from four countries in the Southeast Asian region.

METHODS

This cross-sectional study used secondary data obtained from the Demographic and Health Surveys (DHS) conducted between 2016 and 2022 in four countries within the Southeast Asian Region. We included information on the youngest children aged 0-5 months living with their mothers within the DHS datasets. The association between CS and exclusive breastfeeding was determined using a simple and multiple logistic regression models. Weight factors were taken into account in all analyses for the two-stage stratified cluster sampling design.

RESULTS

Among 3420 children, nearly half (49.1%, 95%CI: 47.0, 51.2) were exclusively breastfed. Children born by CS had lower odds of being exclusively breastfed, compared to children born vaginally (aOR = 0.68, 95%CI: 0.53, 0.88). Women who were married or living with a partner (aOR = 2.19, 95%CI: 1.33, 3.60), children born at a health facility (aOR = 1.31, 95%CI: 1.00, 1.71), and girl babies (aOR = 1.24, 95%CI: 1.05, 1.48) had higher odds of exclusive breastfeeding. Furthermore, residing in rural areas was associated with an increased likelihood of exclusive breastfeeding (aOR = 1.47, 95%CI: 1.20, 1.80). Maternal age, mother's education, parity, antenatal and postnatal care taken, and mass media exposure were not associated with exclusive breastfeeding.

CONCLUSION

This study highlights a significant association between CS and reduced exclusive breastfeeding practices. The findings underscore the importance of providing adequate support and interventions to mothers who deliver by CS and their family members to ensure they can successfully achieve exclusive breastfeeding, particularly in a global context where CS rates are rising.

Efficacy and safety of domperidone and metoclopramide on human milk production in postpartum mothers: a bayesian network meta-analysis of randomized controlled trials

BACKGROUND

Breastfeeding is the most advantageous nutrition for infants because of its many health benefits. However, lactation insufficiency is a prevalent issue among women, particularly those who give birth prematurely. Galactagogues, such as domperidone and metoclopramide, have been reported and may be beneficial for lactation insufficiency. However, the optimal pharmacological galactagogue remains unclear.

METHODS

The PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library databases were searched from their inception to April 23, 2023. The primary aim of this research was to assess the efficacy and safety of domperidone and metoclopramide using Bayesian network meta-analysis. The efficacy outcome was the increased breast milk volume (in mL/day). The safety outcome was the frequency of maternal drug-related adverse events during the study period.

RESULTS

Seventeen randomized controlled trials were included in the final analyses. Preterm mothers who took domperidone had a greater increase in breast milk volume than those who took metoclopramide or placebo (domperidone vs. metoclopramide: MD = 82.84, 95% CI: 37.04-118.95; domperidone vs. placebo: MD = 88.30, 95% CI: 59.48-118.62). However, in the term mothers, domperidone did not show the above benefit compared with metoclopramide or placebo (domperidone vs. metoclopramide: MD = 93.67, 95% CI: -186.11-375.59; domperidone vs. placebo: MD = 126.25, 95% CI: -49.91-304.55). Both in preterm and term mothers, metoclopramide was no better than the placebo. There was no difference in the frequency of maternal drug-related adverse outcomes among domperidone, metoclopramide, and placebo.

CONCLUSION

Domperidone increased the daily breast milk volume in mothers of preterm infants, without serious adverse events. However, this conclusion is limited due to the small sample sizes in the studies analyzed.

A qualitative study on the perspectives of prenatal breastfeeding educational classes in Ireland: Implications for maternal breastfeeding decisions

BACKGROUND

Breastfeeding, acknowledged for its critical health benefits for both infants and mothers, remains markedly underutilized in Ireland, which reports the lowest breastfeeding rates in Europe. Recent data indicate that fewer than 60% of Irish mothers initiate breastfeeding at birth, with this rate precipitously declining in the subsequent weeks postpartum. Various sociocultural, psychological, and educational elements, such as prenatal breastfeeding education, influence this persistently low prevalence. This descriptive qualitative study explores the perspectives of mothers and healthcare professionals, specifically midwives and lactation consultants, on prenatal breastfeeding education classes in Ireland and how they influence mothers' breastfeeding decisions.

METHODS

A qualitative descriptive methodology was employed, utilizing online semi-structured interviews with midwives, lactation consultants (n = 10), and postnatal mothers (n = 20) from four tertiary hospitals in the Republic of Ireland. The data were subjected to reflexive thematic analysis, adhering to the six-step process of thematic analysis, to extrapolate and analyse the interview transcriptions. NVivo software was used to facilitate this analysis, given its robust capabilities in organizing, coding, and retrieving qualitative data efficiently. Four criteria for qualitative research were also used to enhance analytical rigor.

RESULTS

Prenatal breastfeeding education in Ireland often presents breastfeeding in an idealized way, resulting in a gap between mothers' expectations and their actual experiences. Participants needed practical content that included realistic scenarios and breastfeeding benefits. Additionally, findings indicate a desire for a more interactive and personalized educational model to address expectant mothers' unique needs better. Limitations of the virtual class format were also highlighted, with participants noting the potential for technology to improve engagement and personalization. The data further underscore the need for consistency and accuracy in breastfeeding education, with participants identifying standardized approaches and awareness of socio-cultural dynamics, including partner involvement, as essential elements in effective prenatal breastfeeding education.

CONCLUSION

This study underscores the necessity for a more realistic, interactive, and standardized approach to prenatal breastfeeding education in Ireland. Current classes often set idealized expectations that may leave mothers feeling unprepared for breastfeeding's real-life challenges. Addressing these gaps by integrating practical scenarios, enhancing technological tools for virtual classes, and incorporating socio-cultural considerations could improve breastfeeding education and maternal outcomes. This qualitative descriptive study highlights a disconnect between educational objectives and mothers' actual experiences, advocating for a holistic approach that includes personalized, culturally sensitive support and comprehensive training for healthcare providers.

Nutritional requirements in pregnancy and lactation

Optimal nutrition during pregnancy and lactation is vital for the health of the mother and fetus. Nutritional needs should begin in the preconception period, as the fetus depends on the placenta for essential nutrients required for growth and development. A balanced diet rich in nutrient-dense foods-such as whole grains, vegetables, fruits, dairy, legumes, fish, and lean meats-is essential to meet caloric needs during pregnancy. Assessment of maternal health, including dietary history and micronutrient status, is critical to identify potential risks and ensure adequate nutrition. The increased need for micronutrients must be met to prevent complications and fetal growth. Exclusive breastfeeding is recommended for the first six months, and continued breastfeeding is recommended throughout the first year and beyond. During pregnancy and lactation, calorie intake should be increased by focusing on protein and healthy fats. The composition of breast milk is adapted during the breastfeeding period, so that it can provide the necessary nutrients for the growth of the infant. Personalized nutrition plans, developed in consultation with health care professionals, are critical to optimizing maternal and infant health outcomes. This manuscript supports the importance of comprehensive nutritional strategies during pregnancy and lactation to reduce risks and support healthy growth and development of mother and child.

When Black and White Turns Gray: Navigating the Ethical Challenges of Implementing Shared Infant Feeding Decisions for Persons Living with Human Immunodeficiency Virus in the United States

In 2023, US guidelines for feeding perinatally human immunodeficiency virus (HIV)-exposed infants were revised to encourage collaborative decision-making in lieu of categorical proscription of breastfeeding. This change advances autonomy and health equity for persons living with HIV in the United States, for the first time supporting those who prioritize the maternal and infant benefits of breastfeeding in the setting of effective, well-established HIV risk mitigation. The authors review key moral dilemmas facing clinicians and patients who must navigate the reversal of longstanding dogma against breastfeeding and provide recommendations for implementation of a new ethical paradigm.

Exclusive Breastfeeding Rates Upon Hospital Discharge at a Tertiary Centre Prior to and During the COVID-19 Pandemic

This study aimed to describe exclusive breastfeeding (EBF) rates at discharge at Sunnybrook Health Sciences Centre and explore factors that contributed to changes in breastfeeding rates during the COVID-19 pandemic. Overall, 4762 patient charts were reviewed, 2000 from the pre-pandemic period, and 2762 from the lockdown period. Data was collected on EBF status at discharge, on maternal health history, and on infant characteristics. EBF rates fell from 75.8% to 73.85% from the pre-COVID-19 to COVID-19 period. During the pandemic, EBF was positively associated with BMI <30, spontaneous conception, and infants at risk of low blood sugar. Non-spontaneous conception was associated with lower EBF.

Postpartum Hemorrhage after Vaginal Delivery Is Associated with a Decrease in Immediate Breastfeeding Success

OBJECTIVE

 This study aimed to identify the impact of postpartum hemorrhage (PPH) after vaginal delivery on immediate breastfeeding success.

STUDY DESIGN

 This is a retrospective cohort study examining the impact of PPH on breastfeeding for nulliparous patients after term, singleton, vaginal deliveries at a large academic institution from 2017 to 2018. Indicators of successful breastfeeding in the immediate postpartum period were measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life.

RESULTS

 A total of 1,904 women met inclusion criteria during the study period, 262 (13.8%) of whom experienced PPH, defined as an estimated blood loss of 500 mL or greater after vaginal delivery. Women who had a PPH had significantly fewer breastfeeding sessions on average (β = -0.06, p-value 0.01) and required more time at each breastfeeding session (β = 0.08, p-value <0.002). Neonates of women with PPH had a larger percentage in weight loss over the first 2 to 3 days of life compared with those without PPH (β = 0.06, p = 0.008).

CONCLUSION

 Women who experience PPH after vaginal delivery have a decreased number of breastfeeding sessions despite spending more time trying to breastfeed, and an increased percentage in neonatal weight loss over the first 2 to 3 days of life. Further work is needed to elicit the mechanism behind this association; however, it is possible that PPH results in decreased secretion of endogenous oxytocin from the hypothalamic-pituitary axis as a result of hypovolemia. These women may therefore require additional breastfeeding support for successful breastfeeding initiation in the immediate postpartum period.

KEY POINTS

· Women who experience PPH after vaginal delivery have decreased breastfeeding success.. · Further work is needed to elicit the mechanism behind this association.. · These women may require additional support for successful breastfeeding initiation postpartum..

Maternal Big Five personality traits and breastfeeding outcomes: what we know and what we don't know

Introduction

Exclusive breastfeeding-feeding an infant only breast milk for the first 6 months of life-is recognized as the preventive intervention with the greatest potential to reduce child mortality. However, the World Health Organization (WHO) estimates that only 44% of all infants globally are exclusively breastfed for the first 6 months of life. Research into the barriers to meeting this goal of exclusive breastfeeding suggests an important role for sociodemographic factors. Maternal personality traits, another possible factor affecting infant feeding outcomes, have received relatively sparse attention from researchers and are the focus of this mini-review.

Methods

Three databases and one peer-reviewed journal in lactation that was not included in either were systematically searched. Studies that analyzed the relationship between maternal Big Five personality traits and breastfeeding or lactation outcomes were included in this mini-review. In addition, the reference sections of all included studies were searched for other possible matches, resulting in one more study being included.

Results

Eleven studies dating from 2006 to 2022 met the criteria for inclusion in this mini-review. In total, they included n = 19,425 participants. Due to the differences in methodology, statistical analysis, and breastfeeding outcomes analyzed, they were summarized using a narrative synthesis.

Conclusion

There were no emerging patterns regarding associations between Big Five personality traits and breastfeeding outcomes. While personality traits may play a role, their influence might be moderated by other factors, including other psychological, social, and demographic variables. More studies employing state-of-the-art research design and analysis methods are needed to see whether patterns will emerge.

Association between cigarette and heated tobacco use and breastfeeding cessation within 6 months postpartum in Japan: an internet-based cross-sectional study

This study examined the association between cigarette and heated tobacco product (HTP) use before and during pregnancy and after six months postpartum and premature breastfeeding cessation (within 6 months postpartum). An internet-based cross-sectional survey was conducted from July to August 2021 in Japan, and the data of 4,005 women who gave birth between January 2019 and February 2021 were analyzed. The Poisson regression model with robust error variance showed that pre-pregnancy cigarette-only (adjusted prevalence ratio [aPR], 1.34; 95% confidence interval, [CI] 1.06 - 1.70) and combination users (i.e., cigarettes and HTPs) (aPR, 1.34; 95% CI, 1.02 - 1.77) and quitters during pregnancy (aPR, 1.37; 95% CI, 1.15 - 1.64) were more likely to cease breastfeeding prematurely than non-users. HTP-only users before (aPR, 1.32; 95% CI, 0.99 - 1.76) and during pregnancy (aPR, 1.08; 95% CI, 0.61 - 1.92) had no association with premature breastfeeding cessation. The multinomial logistic regression model showed that premature breastfeeding cessation was associated with cigarette-only (adjusted relative risk ratios [aRRR], 2.17; 95% CI, 1.22 - 3.85) and combination-use (aRRR, 2.62; 95% CI, 1.17 - 5.87) after 6 months postpartum. Women with cigarette or combination-use histories, despite quitting during pregnancy, tended to terminate breastfeeding prematurely, but this was not the case for HTP-only users.

The Breastfeeding Experiences of Mother-Infant Dyads and the Effects of an FMR1 Mutation

This study examined the early breastfeeding experiences of mothers with an FMR1 premutation (FXPM) and their infants with and without fragile X syndrome (FXS) to identify early feeding needs and potential opportunities for intervention. Data collection occurred through a retrospective national survey that captured data on breastfeeding experiences and co-occurring conditions of mother and child. Participants were 246 mothers with an FXPM. Of their 384 infants, 287 had FXS and 97 were unaffected (i.e., they did not have FXS or an FXPM). Unaffected infants had a longer breastfeeding duration relative to infants with FXS, and infants of mothers who had postpartum depression (PPD). Additionally, infants who were reported to display aggressiveness towards others later in childhood had a shorter breastfeeding duration than those who did not go on to display aggression. Approximately 42% percent of mothers reported difficulties with breastfeeding infants with FXS compared to only 17% of unaffected infants. The most common reason for breastfeeding cessation for mothers of children with FXS was perceived difficulties in breastfeeding for the child (37%), whereas the most common reason for mothers of unaffected infants was a personal choice to stop (37%). This study provides preliminary evidence that infants with FXS show early phenotypes that make breastfeeding more difficult. Future research should investigate whether interventions for infants with FXS could improve breastfeeding outcomes.

Influence of Perceived Maternal Self-Efficacy on Exclusive Breastfeeding Initiation and Consolidation: A Systematic Review

BACKGROUND/OBJECTIVES

Different international organizations recommend exclusive breastfeeding during the neonate's first six months of life; however, figures of around 38% are reported at the global level. One of the reasons for early abandonment is the mothers' perception of supplying insufficient milk to their newborns. The objective of this research is to assess how mothers' perceived level of self-efficacy during breastfeeding affects their ability to breastfeed and the rates of exclusive breastfeeding up to six months postpartum.

METHODS

A systematic review for the 2000-2023 period was conducted in the following databases: Cochrane, Web of Science, Scopus, PubMed, Science Direct, and CINAHL. Original articles, clinical trials, and observational studies in English and Spanish were included.

RESULTS

The results comprised 18 articles in the review (2006-2023), with an overall sample of 2004 participants. All studies were conducted with women who wanted to breastfeed, used the Breastfeeding Self-Efficacy Scale or its short version to measure postpartum self-efficacy levels, and breastfeeding rates were assessed up to 6 months postpartum.

CONCLUSIONS

The present review draws on evidence suggesting that mothers' perceived level of self-efficacy about their ability to breastfeed affects rates of exclusive breastfeeding up to 6 months postpartum. High levels of self-efficacy are positively related to the establishment and maintenance of exclusive breastfeeding; however, these rates decline markedly at 6 months postpartum.

Breastfeeding Beyond Six Months: Evidence of Child Health Benefits

Breastfeeding is globally recognized as the optimal method of infant nutrition, offering health benefits for both the child and the mother, making it a public health priority. However, the potential advantages of breastfeeding extend well beyond initial months. Breast milk adapts to the evolving needs of the growing infant, and its immunological, microbiological, and biochemical properties have been associated with enhanced protection against infections and chronic diseases, improved growth and development, and lower rates of hospitalization and mortality. This review explores the evidence supporting the continuation of breastfeeding beyond six months. More meticulous studies employing consistent methodologies and addressing confounders are essential. This will enable a more accurate determination of the extent and mechanisms of the positive impact of prolonged breastfeeding and allow for the implementation of effective public health strategies.

Antipsychotic Use and Risk of Breast Cancer in Women With Severe Mental Illness: Replication of a Nationwide Nested Case-Control Database Study

BACKGROUND AND HYPOTHESIS

Breast cancer is more prevalent in women with severe mental illness than in the general population, and use of prolactin-increasing antipsychotics may be a contributing factor.

STUDY DESIGN

A nested case-control study was conducted using the Swedish nationwide registers (inpatient/outpatient care, sickness absence, disability pension, prescribed drugs, cancers). All women aged 18-85 years with schizophrenia/schizoaffective/other nonaffective psychotic disorder/bipolar disorder and breast cancer (cases) were matched for age, primary psychiatric diagnosis, and disease duration with five women without cancer (controls). The association between cumulative exposure to prolactin-increasing/prolactin-sparing antipsychotics and breast cancer was analyzed using conditional logistic regression, adjusted for comorbidities and co-medications.

STUDY RESULTS

Among 132 061 women, 1642 (1.24%) developed breast cancer between 2010 and 2021, at a mean age of 63.3 ± 11.8 years. Compared with 8173 matched controls, the odds of breast cancer increased in women with prior exposure to prolactin-increasing antipsychotics for 1-4 years (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI] = 1.03-1.41), and for ≥ 5 years (aOR = 1.47, 95%CI = 1.26-1.71). There were no increased or decreased odds of breast cancer with exposure to prolactin-sparing antipsychotics of either 1-4 years (aOR = 1.17, 95%CI = 0.98-1.40) or ≥5 years (aOR = 0.99, 95%CI = 0.78-1.26). The results were consistent across all sensitivity analyses (ie, according to different age groups, cancer types, and primary psychiatric diagnosis).

CONCLUSIONS

Although causality remains uncertain, exposure to prolactin-elevating antipsychotics for ≥ 1 year was associated with increased odds of breast cancer in women with severe mental illness. When prescribing antipsychotics, a shared decision-making process should consider individual risk factors for breast cancer.

Relation Between Initiation of Breastfeeding Success and Postpartum Depression

OBJECTIVES

This study was designed to assess the effect of initiation of breastfeeding success on postpartum depression (PPD) among women who gave birth in Quebec.

METHODS

Secondary analysis of the "Quality of Care, Obstetrics Risk Management, and Mode of Delivery" trial (QUARISMA trial), conducted in Quebec from 1 April 2008 to 31 October 2011 to reduce rates of cesarean delivery in Quebec.

INCLUSION CRITERIA

all women ≥18 years old who gave birth at the hospital of a single baby ≥370 weeks of gestation. Logistic regression was performed to investigate the impact of initiation of breastfeeding success on PPD rates. Outcome was reported using adjusted ORs with 95% CIs.

RESULTS

A total of 151 708 women (21 525 women with unsuccessful initiation of breastfeeding and 130 183 women with successful initiation of breastfeeding) were selected to participate in this study. We observed a significant association between initiation of breastfeeding success and a lower rate of PPD (0.16% vs. 0.29%) (OR 0.57; 95% CI 0.41-0.79, P < 0.001).

CONCLUSIONS

Initiation of breastfeeding success is significantly associated with a lower risk of PPD.

Metabolomics Approach to Identify Biomarkers of Acute and Subacute Mastitis in Milk Samples: A Pilot Case-Control Study

Background and aims: Mastitis is one of the main complications during breastfeeding and contributes to the cessation of breastfeeding. However, the etiopathogenesis and diagnosis of mastitis are complex and not yet well defined. We aimed to identify metabolic and lipidic changes in human milk during acute and subacute mastitis in order to detect potential biomarkers of mastitis. Methods: We conducted a pilot case-control study including 14 breastfeeding women with acute mastitis, 32 with subacute mastitis symptoms, and 19 without any mastitis symptoms (control). Milk samples were collected and analyzed by proton nuclear magnetic resonance (H-NMR) for metabolomics analysis. To assess the association between the significant metabolites and lipids and the development of acute and subacute mastitis, multi-adjusted logistic regression models were developed. Results: The NMR-based metabolomics approach was able to identify and quantify a total of 40 metabolites in breast milk samples. After adjusting for confounding variables, acute mastitis was significantly associated with acetate (OR 3.9 IC 1.4-10.8), total cholesterol (OR 14 CI 3.2-62), esterified cholesterol (OR 3.3 CI 1.9-5.8), and sphingomyelin (OR 2.6 CI 1.2-5.8). The other metabolites presented weak association (OR < 2.5). Subacute mastitis was significantly associated with glutamine, lysophosphatidylcholine, phosphatidylcholine, plasmalogen, and total polyunsaturated fatty acids, but only cholesterol showed a strong association (OR > 2.5) with an OR of 2.6 (IC 1.1-6.6). Conclusions: Metabolic alteration in breast milk occurs during a process of both acute and subacute mastitis. Acetate, esterified cholesterol, lysophostidylcholine, and polyunsaturated fatty acids increased in both acute and subacute mastitis. However, according to the multi-adjusted regression logistic models, the candidate biomarkers for acute and subacute mastitis are cholesterol, lysophosphatidylcoholine, phosphatidylcholine, plasmalogen, and polyunsaturated fatty acids.

Human Breast Milk Exosomes: Affecting Factors, Their Possible Health Outcomes, and Future Directions in Dietetics

Background: Human breast milk is a complex biological fluid containing multifaceted biological compounds that boost immune and metabolic system development that support the short- and long-term health of newborns. Recent literature suggests that human breast milk is a substantial source of nutrients, bioactive molecules, and exosomes. Objectives: This review examines the factors influencing exosomes noted in human milk and the impacts of exosomes on infant health. Furthermore, it discusses potential future prospects for exosome research in dietetics. Methods: Through a narrative review of the existing literature, we focused on exosomes in breast milk, exosome components and their potential impact on exosome health. Results: Exosomes are single-membrane extracellular vesicles of endosomal origin, with an approximate radius of 20-200 nm. They are natural messengers that cells secrete to transport a wide range of diverse cargoes, including deoxyribonucleic acid, ribonucleic acid, proteins, and lipids between various cells. Some studies have reported that the components noted in exosomes in human breast milk could be transferred to the infant and cause epigenetic changes. Thus, it can affect gene expression and cellular event regulation in several tissues. Conclusions: In this manner, exosomes are associated with several pathways, including the immune system, oxidative stress, and cell cycle, and they can affect the short- and long-term health of infants. However, there is still much to learn about the functions, effectiveness, and certain impacts on the health of human breast milk exosomes.

Association between in-hospital exclusive breastfeeding and subsequent exclusive breastfeeding until 6 months postpartum in Japan: A cross-sectional study

Breastfeeding practices during hospitalisation may influence subsequent breastfeeding practices; however, this association has not been well studied in Japan. Therefore, we aimed to examine the association between exclusive breastfeeding (EBF) during hospitalisation and that under 6 months and describe the change in breastfeeding patterns from the first to the sixth month based on the breastfeeding status during hospitalisation. This nationwide cross-sectional internet survey conducted in Japan included 1,433 postpartum women of < 6 months who underwent live singleton deliveries between January 2021 and August 2021. Multivariate Poisson regression was used to analyse the association of first day EBF (24 h after birth) and the first 7 d of EBF, a proxy for the hospitalisation period, with a 24-h recall of EBF before the survey. We described the proportion of breastfeeding practices per age group under 6 months. The rates of EBF during the first day and the first 7 d were 29.7% and 10.0%, respectively. The EBF during the first-day group and the first 7-d group showed significantly higher prevalence ratios of 24-h recall EBF under 6 months of age than the non-EBF groups. The area graphs showed that the rate of EBF was the lowest in the first month of age and gradually increased over time until weaning was initiated. This rate was higher among infants exclusively breastfed during the first 7 d than among those exclusively breastfed on the first day. In conclusion, EBF during hospitalisation was significantly associated with subsequent EBF practice for < 6 months. However, 90% of the infants were supplemented with milk rather than breast milk during hospitalisation. Strengthening breastfeeding support during hospitalisation and after discharge may increase the rate of EBF in children under 6 months, and more mothers and their infants will benefit from breastfeeding.