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Kronborg H, Vaeth M. The influence of psychosocial factors on the duration of breastfeeding. Scand J Public Health 2016; 32:210-6. [PMID: 15204182 DOI: 10.1080/14034940310019218] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: A study was undertaken to examine to what extent psychosocial factors are related to the length of breastfeeding. Methods: A cohort of Danish mothers giving birth to a single child was followed up for four months. Information on mother and baby including psychosocial variables was obtained from a self-report questionnaire. Breastfeeding status was subsequently monitored by a health visitor. Results: A total of 471 (88%) mothers participated, 98.7 % initiated breastfeeding and after four months 277 (59%) were still exclusive breastfeeding; 99 mothers, 51% of those who stopped, stopped within the first five weeks. In Cox regression analyses the duration of breastfeeding showed a positive association with mother's schooling ( p=0.002), her intention to breastfeed ( p=0.001), previous experience with breastfeeding ( p<0.001), self-efficacy with respect to breastfeeding ( p<0.001), her confidence in breastfeeding ( p=0.012) and knowledge about breastfeeding ( p=0.001). The effect of the mother's knowledge depended on the parity of the child. Among primiparous mothers high knowledge was associated with long duration of breastfeeding, but this association was not found among the multiparous. Conclusions: To help the mothers who would like to breastfeed their baby, we must improve our ability to identify mothers at risk of early cessation. Mother's schooling, her intention, self-efficacy and earlier breastfeeding experience can be used as early predictors. An intervention should aim at improving the self-efficacy and resources of these mothers, with a focus on practical knowledge. The first five weeks, when the largest proportion of the cessations occurred, require special attention.
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Affiliation(s)
- Hanne Kronborg
- School of Nursing and Medical Research Unit, Deaprtment of Nursing Science, University of Aarhus, Denmark.
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Zachariassen G, Faerk J, Grytter C, Esberg B, Juvonen P, Halken S. Factors associated with successful establishment of breastfeeding in very preterm infants. Acta Paediatr 2010; 99:1000-4. [PMID: 20151950 DOI: 10.1111/j.1651-2227.2010.01721.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To describe feeding practices at hospital discharge in relation to characteristics of the very preterm infants (VPI) and their mothers. METHODS Design. Prospective hospital-based registration of very preterm infants born with a gestational age < or =32 weeks in Denmark during 2004-2008. Subjects. Healthy mothers and VPI without diseases causing eating disabilities at discharge. RESULTS A total of 478 VPI were registered. At discharge, 60% were exclusively breastfed, 35% were exclusively bottlefed, and 5% were both breast- and bottle-fed. Mothers of high social class (p = 0.000) and 'not smoking' (p = 0.003) were significantly more often breastfeeding their preterm infant(s) at discharge. Single births infants tended more often to be breastfed (p = 0.09). Infant age at discharge and duration of hospitalization did not influence breastfeeding at discharge. Increase in weight z-score from birth to discharge was largest in the bottlefeeding-group compared with the breastfeeding-group (p = 0.000) probably as a result of feeding practice the last week(s) of hospitalization. CONCLUSION Breastfeeding can successfully be established in very preterm infants. Mothers of low social classes, smokers, multiple birth and very preterm infants with low weight for age may need extra attention in breastfeeding establishing policies.
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Affiliation(s)
- G Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
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Liu J, Rosenberg KD, Sandoval AP. Breastfeeding duration and perinatal cigarette smoking in a population-based cohort. Am J Public Health 2005; 96:309-14. [PMID: 16380564 PMCID: PMC1470493 DOI: 10.2105/ajph.2004.060798] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between breastfeeding duration and maternal smoking before, during, and after pregnancy. METHODS Data from the 2000-2001 Oregon Pregnancy Risk Assessment Monitoring System were used. Early weaning was defined as not breastfeeding at 10 weeks postpartum. RESULTS At 10 weeks after pregnancy, 25.7% of mothers who initiated breastfeeding no longer breastfed. After controlling for confounders, quitters (mothers who quit smoking during pregnancy and maintained quit status after pregnancy) and postpartum relapsers (mothers who quit smoking during pregnancy and resumed smoking after delivery) did not have significantly higher risk for early weaning than nonsmokers. However, persistent smokers (mothers who smoked before, during, and after pregnancy) were 2.18 times more likely not to breastfeed at 10 weeks (95% confidence interval=1.52, 2.97). Women who smoked 10 or more cigarettes per day postpartum (i.e., heavy postpartum relapsers and heavy persistent smokers) were 2.3-2.4 times more likely to wean their infants before 10 weeks than were nonsmokers. CONCLUSIONS Maternal smoking is associated with early weaning. Stopping smoking during pregnancy and decreasing the number of cigarettes smoked postpartum may increase breastfeeding duration.
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Affiliation(s)
- Jihong Liu
- Div. of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Cernadas JMC, Noceda G, Barrera L, Martinez AM, Garsd A. Maternal and perinatal factors influencing the duration of exclusive breastfeeding during the first 6 months of life. J Hum Lact 2003; 19:136-44. [PMID: 12744530 DOI: 10.1177/0890334403253292] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the influence of certain factors on the duration of exclusive breastfeeding during the first 6 months of life. In 597 mothers, 26 variables were assessed during the postpartum period. The mothers were interviewed monthly by telephone about how they were feeding their babies. In 539 mothers (92.2%), complete data were obtained until the sixth month. At discharge, 1 month, 4 months, and 6 months, the frequency of exclusive breastfeeding was 97%, 83%, 56%, and 19%, respectively. The median duration was 4 months. A longer duration of exclusive breastfeeding was significantly associated with positive maternal attitudes toward breastfeeding, adequate family support, good mother-infant bonding, appropriate suckling technique, and no nipple problems. These associations persisted after controlling for maternal education and other confounding variables. Certain maternal factors related to a longer duration of exclusive breastfeeding can be identified in the maternity ward and might contribute to the development of more effective breastfeeding policies.
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Abstract
The effects of environmental tobacco smoke (ETS) on breast-feeding patterns are poorly understood, while those of parental smoking on breast-feeding initiation vs. duration have not been clearly delineated. We conducted a prospective, population-based birth cohort study to examine the independent effects of maternal, paternal and ETS on breast-feeding initiation and duration. A total of 6747 Hong Kong Chinese infants were recruited and followed up in 1997-8. We obtained detailed household smoking history and recorded breast-feeding patterns in three follow-up interviews over 9 months. We found that both maternal and paternal smoking were associated with not initiating breast feeding (odds ratio [OR] for ever maternal smoking = 2.51, 95% confidence interval [CI] = 1.63, 3.86; OR for ever paternal smoking = 1.22, 95% CI = 1.08, 1.39). Exposure to ETS in utero and post partum were also related to not starting breast feeding (OR(ETS in utero) = 1.10, 95% CI = 0.99,1.24; OR(ETS post partum) = 1.21, 95% CI = 1.08, 1.36). These effects, however, did not persist for breast-feeding duration of < or = 4 months. Cox proportional hazards modelling confirmed the lack of association between any form of smoking and breast-feeding duration. Our findings suggest that smoking of any kind, during or after pregnancy, is a strong risk indicator for not initiating breast feeding. Smoking as a risk indicator for underlying socio-economic, demographic and psychosocial factors is probably responsible for most of the observed adverse effects, although we cannot rule out direct contributions from pathophysiological mechanisms. Public health strategies directed at these underlying factors should be vigorously pursued to reduce the adverse effects of tobacco on breast feeding and infant health in general.
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Affiliation(s)
- Gabriel M Leung
- Department of Community Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China.
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Abstract
AIM To systematically review the possible mechanisms by which maternal smoking affects lactation. METHODS Databases (Medline, CINAHL, Current Contents, Psychinfo, Sociological Abstracts and the Cochrane Library) were searched for smoking and breastfeeding or infant feeding. The Journal of Human Lactation and Birth were hand-searched, searches were also conducted at NMAA's Lactation Resource Centre and references cited were located where appropriate. Articles were divided into the various ways that smoking could affect breastfeeding and were tabulated. RESULTS Most studies were conducted on small samples of animals or humans; the majority were prior to 1985. Most animal studies exposed the animals to much greater levels of nicotine than those to which humans are exposed. Most studies did not examine if breastfeeding behaviour was similar in smokers and non-smokers, and did not consider that any physiological difference found could be the result of poor lactation practices, rather than the cause of poor lactation in smokers. The definition of breastfeeding infants was also problematic in many studies. The effect of smoking on oxytocin in women was only examined in one study, and no effect was found, yet a negative effect of smoking on oxytocin release is reported in the breastfeeding literature. CONCLUSION Although there is consistent evidence that women who smoke breastfeed their infants for a shorter duration than non-smokers, the evidence for a physiological mechanism is not strong.
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Affiliation(s)
- L H Amir
- Centre for the Study of Mothers' and Children's Health, LaTrobe University, 251 Faraday St., 3053, Carlton, Australia.
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Horta BL, Kramer MS, Platt RW. Maternal smoking and the risk of early weaning: a meta-analysis. Am J Public Health 2001; 91:304-7. [PMID: 11211645 PMCID: PMC1446540 DOI: 10.2105/ajph.91.2.304] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study reviewed evidence on the effect of maternal smoking on early weaning. METHODS The following databases and journals were searched: Medline, Scientific Citation Index, Pediatrics, Journal of Pediatrics, New England Journal of Medicine, and Lancet. Analysis was restricted to studies in which infants who had never been breastfed were excluded or the prevalence of breastfeeding initiation was more than 90%. RESULTS In smoking vs nonsmoking mothers, the random effects odds ratio for weaning before 3 months was 1.93 (95% confidence interval [CI] = 1.55, 2.40). An adjusted odds ratio of 1.50 (95% CI = 1.34, 1.68) was shown in studies that had lost-to-follow-up rates below 15% and included adequate adjustment for confounding. CONCLUSIONS Maternal smoking increases the risk of early weaning.
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Affiliation(s)
- B L Horta
- Department of Social Medicine, School of Medicine and Psychology, Universidade Católica de Pelotas, Pelotas, Brazil.
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Killersreiter B, Grimmer I, Bührer C, Dudenhausen JW, Obladen M. Early cessation of breast milk feeding in very low birthweight infants. Early Hum Dev 2001; 60:193-205. [PMID: 11146238 DOI: 10.1016/s0378-3782(00)00116-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This investigation was carried out to comparatively assess the duration of breast milk feeding and to analyze risk factors for early cessation of breast milk feeding in term and very preterm infants. A cohort study was performed in 89 consecutive very low birthweight (VLBW) infants (<1500 g) who survived for at least for one week, and 177 term infants with birthweights >2500 g born in the same hospital matched for gender and multiplicity. Median duration of breast milk feeding, as determined from charts and questionnaires mailed to the mothers at 6 and 12 months corrected age, was 36 days in VLBW infants, compared to 112 days in control infants (P<0.0001). In both VLBW and control infants, smoking during pregnancy, low maternal and low paternal school education were each significantly associated with short duration of breast milk feeding. In VLBW infants, multiple pregnancy and gestational age <29 weeks were each associated with prolonged breast milk feeding, as were maternal age >35 years and spontaneous pregnancy (as opposed to pregnancy following infertility treatment) in term infants. Multivariate analysis revealed that VLBW, smoking and low parental school education were independent negative predictors of breast milk feeding. While these results emphasize the need for special support of VLBW infant mothers promoting lactation, the relationships between smoking, school education and breast milk feeding in both strata show that efforts to increase breast milk feeding require a public health perspective.
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Affiliation(s)
- B Killersreiter
- Department of Neonatology, Charité Virchow Hospital, Humboldt University, Berlin, Germany
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Abstract
This study of 230 Brazilian mothers examined the associations of several sociodemographic variables, maternal attitudes and perceptions with intended breast feeding duration. The usual relationships of sociodemographic variables such as mother's age, education, smoking, parity and infant birth weight with intended breast feeding duration were not found. However, mother's intentions were related to gender role attitudes with both the least and the most traditional women intending to breast feed longer than women with moderately traditional gender role attitudes. Mother's attitude toward breast feeding, help with household tasks, and the attitudes of friends and relatives toward breast feeding were also very significantly related to intended breast feeding duration. Women who did not work outside the home intended to breast feed significantly longer than those who were employed.
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Affiliation(s)
- P Paine
- Department of Nutrition, University of Brasilia, Brasilia, Brazil.
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Abstract
BACKGROUND Smoking in the postpartum period may contribute to early weaning, although the nature and temporal aspect of the relationship are poorly understood. The objective of this study was to examine the association between early weaning and smoking relapse among women who stopped smoking during pregnancy. METHODS A secondary analysis of data from a randomized controlled trial was conducted. The participants were 228 women who had stopped smoking for pregnancy, who participated in a smoking relapse prevention trial, and who breastfed. Women who relapsed to daily smoking postpartum were compared with those who remained abstinent or smoked occasionally. The dependent variable was breastfeeding for less than 26 weeks (early weaning). Potential covariates included intended duration of breastfeeding, parity, partner's smoking, nicotine dependence, emotional health, return to paid employment, and various sociodemographic variables. RESULTS Approximately two-thirds (65.1%) of the women who relapsed to daily smoking weaned before 26 weeks compared with 33.8 percent of the women who remained abstinent or smoked occasionally. Controlling for intended duration of breastfeeding, education, and return to paid employment, women who resumed daily smoking were almost four times more likely to wean early than those who abstained or smoked occasionally. CONCLUSIONS Early weaning may result from psychological or physiological changes associated with tobacco use. Smoking relapse prevention in the postpartum period may be one of the most effective interventions in ensuring that women who stop smoking for pregnancy remain stopped and breastfeed their babies for the recommended duration.
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Affiliation(s)
- P A Ratner
- School of Nursing, University of British Columbia, Vancouver, Canada
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Abstract
To explore the association between smoking and breastfeeding, we obtained data from a retrospective questionnaire-based national survey comprising a random sample (n = 34799) of all mothers giving birth in Norway 1970-91. Variables studied were postpartum smoking habits for both parents, duration of breastfeeding, infant's year of birth and parental age. The response rate was 70% (n = 24438). During the study period, the maternal postpartum smoking prevalence decreased from 38% to 26%. The proportion breastfeeding at 6 months increased from 15% to 44% among smokers, and from 30% to 72% among non-smokers. In spite of a considerable increase in breastfeeding both among smokers and non-smokers, the proportion of breastfeeding, non-smoking women at 6 months was twice that of smoking women during the whole period. Furthermore, the duration of breastfeeding was shorter among young mothers and when the fathers were smoking. There was epidemiological evidence that the effect on breastfeeding of smoking might represent both biological and social mechanisms.
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l'Hoir MP, Engelberts AC, van Well GT, Westers P, Mellenbergh GJ, Wolters WH, Huber J. Case-control study of current validity of previously described risk factors for SIDS in The Netherlands. Arch Dis Child 1998; 79:386-93. [PMID: 10193249 PMCID: PMC1717734 DOI: 10.1136/adc.79.5.386] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study aimed to assess whether previously established risk factors for sudden infant death syndrome (SIDS) are still valid now that the incidence in the Netherlands has dropped to 0.26 per 1000 liveborn infants. A distinction was made between immutable and mutable risk factors. This case-control study (part of the European Concerted Action on SIDS) comprised 73 SIDS cases and 146 controls and lasted from March 1995 to September 1996. Adjustments were made for sleeping position and bedding factors by treating them as covariables. Apart from these factors, well known risk factors that remain of importance in the Netherlands are: male sex, young maternal age, twins, and low socioeconomic status. These factors are largely immutable. Other well known risk factors which might reflect attitudes to child care and could possibly be mutable are: smoking, alcohol consumption by the mother, bottle feeding, and change of babycare routine. Intervention strategies should focus on early signalling, thereby assisting parents in changing these unfavourable parenting attitudes. Information on optimal child care and extra support by public health nurses specifically aimed at families at risk could help to decrease further the incidence of SIDS in the Netherlands.
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Affiliation(s)
- M P l'Hoir
- Psychosocial Department, University Hospital Utrecht/Wilhelmina Children's Hospital, University Hospital for Children and Youth, Utrecht, Netherlands
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