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Diaz LE, Yee LM, Feinglass J. Rates of breastfeeding initiation and duration in the United States: data insights from the 2016-2019 Pregnancy Risk Assessment Monitoring System. Front Public Health 2023; 11:1256432. [PMID: 38192551 PMCID: PMC10773697 DOI: 10.3389/fpubh.2023.1256432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction While breastfeeding rates in the United States have been increasing, they remain low by international standards with substantial racial, income and education disparities. This study uses recent population-based data to analyze sociodemographic differences in breastfeeding initiation, duration, and exposure to information and education. Methods We used the 2016-2019 Pregnancy Risk Assessment Monitoring System (PRAMS) to compare breastfeeding duration among a representative population from 43 states and the District of Columbia. We modeled the likelihood of never initiating breastfeeding by respondent's age, race and ethnicity, language, marital status, household income, educational attainment, parity and insurance status. We also compared sources of information and education for respondents who never breastfed to those who breastfed up to 6 months. Results Among 142,643 new mother respondents, representing an estimated population of 7,426,725 birthing individuals, 12.6% never breastfed, 60.4% reported breastfeeding at 3 months and 54.7% at 6 months. While 75.8% of college graduates reported breastfeeding at 3 months, this was only 37.8% of respondents with high school or less. Among those with the lowest six-month rates were non-Hispanic Black participants (36.3%) and those age < 20 (25.5%). Respondents with Medicaid coverage for their delivery were 25% more likely to have never breastfed than the privately insured. Respondents reporting household income <$20,000 were 57% more likely to have never breastfed as compared to those with household income>$85,000. While 64.1% of those breastfeeding at 6 months reported receiving information from "my" doctor', this was only 13.0% of those who never breastfeed. Discussion Improved breastfeeding rates could have significant effects on reducing health disparities in the United States. Clinical and public health policy initiatives need to include culturally sensitive breastfeeding education before and after childbirth, with psychological and direct support from obstetrics and primary care providers. Health plans should support home and community-based in-person and telelactation consulting services. Public policies such as paid family and medical leave and workplace accommodations will also be critical. Given the huge implications of breastfeeding rates on the development of infant immune defenses and a healthy microbiome, improving breastfeeding rates should be a much more important public health priority in the United States.
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Affiliation(s)
- Laura E. Diaz
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joe Feinglass
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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2
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Gallagher L, Brady V, Kuliukas L, Dykes C, Rubertsson C, Hauck YL. Australian, Irish, and Swedish women's comfort levels when breastfeeding in public. BMC Public Health 2023; 23:2535. [PMID: 38110935 PMCID: PMC10729571 DOI: 10.1186/s12889-023-17472-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Despite a flux of global initiatives to increase and sustain breastfeeding rates, challenges persist. The decision to commence and sustain breastfeeding is influenced by multiple, complex factors. Feelings of social embarrassment, shame, fear of judgement, and lack of confidence when breastfeeding in public, compound women's decisions to breastfeed and may result in formula feeding or early cessation of breastfeeding. A greater understanding of where and how women feel most comfortable when breastfeeding in public can assist in designing interventions to support the initiation and continuation of breastfeeding. METHODS A cross-sectional survey was conducted with women living in Australia (n = 10,910), Sweden (n = 1,520), and Ireland (n = 1,835), who were currently breastfeeding or who had breastfed within the previous two years. Our aim was to explore where, and how often women breastfeed in public and to compare their levels of comfort when breastfeeding in public. Data were collected in 2018 using an anonymous online survey over a four-week period in Ireland, Australia, and Sweden, and were analyzed using SPSS Version 25. RESULTS Most respondents were highly educated, with over 70% in each country reporting having a university or college degree. Observing women breastfeeding in public was more commonly reported to be a weekly or daily occurrence in Sweden (24.5%) and Australia (28%), than in Ireland (13.3%). Women in the participating countries reported breastfeeding in public most commonly whenever their babies needed feeding. Very few women never or rarely breastfed publicly. Coffee shops/cafes, restaurants, and parks were the most popular locations. In all three countries, partners were reported to be very supportive of breastfeeding in public, which enhanced breastfeeding women's comfort levels. When asked to score out of a maximum comfort level of 10, women reported higher mean levels of comfort when breastfeeding in front of strangers (Ireland M = 7.33, Australia M = 6.58, Sweden M = 6.75) than with those known to them, particularly in front of their father-in-law (Ireland M = 5.44, Australia M = 5.76, Sweden M = 6.66 out of 10), who scored lowest in terms of women's comfort levels. CONCLUSION This study offers important insights into the experiences and comfort levels of women breastfeeding in public. Limitations include the anonymous nature of the surveys, thus preventing follow-up, and variances in terminology used to describe locations across the three settings. Recommendations are made for research to determine the relationships between the frequency of breastfeeding in public and breastfeeding women's perceived comfort levels, the influence of family members' perceptions of breastfeeding in public and women's experiences, and the experience of women who feel uncomfortable while breastfeeding in public, with a view to developing support measures.
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Affiliation(s)
- Louise Gallagher
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02 T283, Ireland.
| | - Vivienne Brady
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, D02 T283, Ireland
| | - Lesley Kuliukas
- School of Nursing, Curtin University Perth, Perth, WA, Australia
| | | | - Christine Rubertsson
- Perinatal and Sexual Health, Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Yvonne L Hauck
- School of Nursing, Curtin University Perth, Perth, WA, Australia
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3
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Kremer JC, Späth B. Breastfeeding and the role of the commercial milk formula industry. Lancet 2023; 402:448-449. [PMID: 37543420 DOI: 10.1016/s0140-6736(23)01196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 08/07/2023]
Affiliation(s)
| | - Beat Späth
- Specialised Nutrition Europe, 1040 Brussels, Belgium.
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4
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Saunders CM, Rehbinder EM, Carlsen KCL, Jonassen CM, LeBlanc M, Nordlund B, Skjerven HO, Söderhäll C, Vettukattil R, Carlsen MH. Feeding Practices and Dietary Diversity in the First Year of Life: PreventADALL, a Scandinavian Randomized Controlled Trial and Birth Cohort Study. J Nutr 2023; 153:2463-2471. [PMID: 37336319 PMCID: PMC10447610 DOI: 10.1016/j.tjnut.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Breastmik is considered the optimal source of nutrition in early infancy. However, recommendations and practices for when and how complementary food should be introduced in the first year of life vary worldwide. Early introduction of allergenic foods may prevent food allergies, but if early food introduction influences infant feeding practices is less known. OBJECTIVES We sought to assess infant feeding practices in the first year of life and to determine if early interventional food introduction influences breastfeeding and dietary diversity. METHODS Dietary intake was assessed in infants from the population-based clinical trial Preventing Atopic Dermatitis and ALLergies (PreventADALL) in children study. A total of 2397 infants were cluster-randomized at birth into 4 different groups: 1) control, 2) skin intervention, 3) introduction to 4 allergenic foods between 3 and 4 mo of age: peanut, cow milk, wheat, and egg, as small tastings until 6 mo, and 4) combined skin and food interventions. Dietary data were available from at least one of the 3-, 6-, 9-, and 12-mo questionnaires in 2059 infants. In the present analysis, groups 1 and 2 constitute the No Food Intervention group, whereas groups 3 and 4 constitute the Food Intervention group. We used the log-rank test and Cox regression to assess the impact of food intervention on age of breastfeeding cessation. Mixed effects logistic regression was used to compare dietary diversity, defined as the number of food categories consumed, between intervention groups. RESULTS At 3, 6, 9, and 12 mo, 95%, 88%, 67%, and 51% were breastfed, respectively, and breastfeeding duration was not affected by the food intervention. In the No Food Intervention group, mean age of complementary food introduction was 18.3 wk (confidence interval [CI]: 18.1, 18.5). In the Food Intervention group, the dietary diversity score was 1.39 units (CI: 1.16, 1.62) higher at 9 mo (P < 0.001) and 0.7 units (CI: 0.5, 0.9) higher at 12 mo (P < 0.001) compared to the No Food Intervention group. CONCLUSIONS Early food intervention did not affect breastfeeding rates and increased dietary diversity at 9 and 12 mo.
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Affiliation(s)
- Carina Madelen Saunders
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
| | - Eva Maria Rehbinder
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Karin C Lødrup Carlsen
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Christine Monceyron Jonassen
- Genetic Unit, Centre for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway; Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of LifeSciences, Ås, Norway
| | - Marissa LeBlanc
- Oslo University Hospital and University of Oslo, Oslo, Norway, Oslo Centre for Biostatistics and Epidemiology
| | - Björn Nordlund
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Håvard Ove Skjerven
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Cilla Söderhäll
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Riyas Vettukattil
- University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway; Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Monica Hauger Carlsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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5
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Crawford KA, Gallagher LG, Baker ER, Karagas MR, Romano ME. Predictors of Breastfeeding Duration in the New Hampshire Birth Cohort Study. Matern Child Health J 2023; 27:1434-1443. [PMID: 37269393 DOI: 10.1007/s10995-023-03714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Breastfeeding has significant health benefits for infants and birthing persons, including reduced risk of chronic disease. The American Academy of Pediatrics recommends exclusively breastfeeding infants for 6 months and recently extended its recommendation for continuing to breastfeed with supplementation of solid foods from one to two years. Studies consistently identify lower breastfeeding rates among US infants, with regional and demographic variability. We examined breastfeeding in birthing person-infant pairs among healthy, term pregnancies enrolled in the New Hampshire Birth Cohort Study between 2010 and 2017 (n = 1176). METHODS Birthing persons 18-45 years old were enrolled during prenatal care visits at ~ 24-28 weeks gestation and have been followed since enrollment. Breastfeeding status was obtained from postpartum questionnaires. Birthing person and infant health and sociodemographic information was abstracted from medical records and prenatal and postpartum questionnaires. We evaluated the effects of birthing person age, education, relationship status, pre-pregnancy body mass index, gestational weight gain (GWG), smoking and parity, and infant sex, ponderal index, gestational age and delivery mode on breastfeeding initiation and duration using modified Poisson and multivariable linear regression. RESULTS Among healthy, term pregnancies, 96% of infants were breastfed at least once. Only 29% and 28% were exclusively breastfed at 6-months or received any breastmilk at 12-months, respectively. Higher birthing person age, education, and parity, being married, excessive GWG, and older gestational age at delivery were associated with better breastfeeding outcomes. Smoking, obesity, and cesarean delivery were negatively associated with breastfeeding outcomes. CONCLUSIONS Given the public health importance of breastfeeding for infants and birthing persons, interventions are needed to support birthing persons to extend their breastfeeding duration.
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Affiliation(s)
- Kathryn A Crawford
- Environmental Studies Program, Middlebury College, 276 Bicentennial Way, Middlebury, VT, 05753, USA.
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Lisa G Gallagher
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Emily R Baker
- Maternal Fetal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Megan E Romano
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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O'Reilly D, Conway R, Murphy CA, Munblit D, Fitzpatrick P. Trends in specialized low-allergy infant formula dispensing in Ireland: 2016-2021. Clin Exp Allergy 2023; 53:367-371. [PMID: 36695212 PMCID: PMC10946711 DOI: 10.1111/cea.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Daniel O'Reilly
- Department of PaediatricsRotunda HospitalDublinIreland
- University College of Dublin School of Biomolecular and Biomedical ScienceUCDDublinIreland
| | - Robert Conway
- Health Service ExecutiveOffice of the National Clinical Director for Health ProtectionDublinIreland
| | - Claire A. Murphy
- Department of PaediatricsRotunda HospitalDublinIreland
- Department of PaediatricsRCSIDublinIreland
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of MedicineImperial College LondonLondonUK
- Department of Paediatrics and Paediatric Infectious DiseasesInstitute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Patrick Fitzpatrick
- Department of Paediatric Emergency MedicineChildrens Health IrelandDublinIreland
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Stordal B. Breastfeeding reduces the risk of breast cancer: A call for action in high-income countries with low rates of breastfeeding. Cancer Med 2023; 12:4616-4625. [PMID: 36164270 PMCID: PMC9972148 DOI: 10.1002/cam4.5288] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/12/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
Women in the UK have a 15% lifetime risk of developing breast cancer. Like other high-income countries, women in the UK are having children later in life which increases their risk. The risk of breast cancer is reduced by 4.3% for every 12 months of breastfeeding, this is in addition to the 7.0% decrease in risk observed for each birth. Breastfeeding reduces the risk of Triple-Negative Breast Cancer (20%) and in carriers of BRCA1 mutations (22-55%). The mechanisms of reduced risk as a result of pregnancy are related to changes in RNA processing and cellular differentiation. The UK has a low rate of breastfeeding (81%) and this is contrasted to countries with higher (Sweden, Australia) and lower rates (Ireland). The low UK rate is in part due to a lack of experience in the population, todays grandmothers have less experience with breastfeeding (62%) than their daughters. An estimated 4.7% of breast cancer cases in the UK are caused by not breastfeeding. The UK only has 43% of maternity services with full Baby-Friendly accreditation which promotes compliance with the WHO 'Ten Steps to Successful Breast Feeding'. Legislation in the UK and Europe is far short of the WHO Guidance on restricting the advertising of formula milk. Expansion of the Baby-Friendly Hospital Initiative, stricter laws on the advertising of formula milk and legislation to support nursing mothers in the workplace have the potential to increase breastfeeding in the UK. Women with a family history of breast cancer should particularly be supported to breastfeed as a way of reducing their risk.
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Affiliation(s)
- Britta Stordal
- Department of Natural Sciences, Middlesex University London, London, UK
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8
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McGovern L, Geraghty A, McAuliffe F, O'Reilly S. An exploration of prenatal breastfeeding self-efficacy: a scoping review protocol. OPEN RESEARCH EUROPE 2023; 2:91. [PMID: 37645344 PMCID: PMC10445816 DOI: 10.12688/openreseurope.14938.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 08/31/2023]
Abstract
Objective: To synthesise the evidence on prenatal breastfeeding self-efficacy, including identifying concepts and theoretical frameworks that underpin its development, the evidence on its measurement, interventions used to improve it, and association with breastfeeding outcomes. Background: Breastfeeding self-efficacy is described as a woman's self-belief and confidence in her perceived ability to breastfeed. It is a modifiable measure that is strongly associated with breastfeeding outcomes such as initiation, exclusivity, and duration. Interventions aimed at increasing self-efficacy are often in the postnatal period and have been shown to be effective at improving breastfeeding outcomes. The prenatal period appears to be underexplored in the literature and yet focusing on enhancing it may have the potential for further improvements in self-efficacy and on subsequent breastfeeding outcomes. A comprehensive knowledge synthesis on prenatal breastfeeding self-efficacy is lacking. Methods: The search will include databases across health, psychology, sociology, and the grey literature on breastfeeding guidance. Once the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period) is met, sources of evidence from any contextual setting will be eligible for inclusion. Limits will not be applied on geographic location or year of publication. The PRISMA-ScR flow diagram of search and study selection will be used to report final figures. Two independent reviewers will perform title and abstract screening and full text review. Data will be charted to provide a logical and descriptive summary of the results that align with the objectives. Conclusion: The results will provide an understanding of what has been done in the space and what gaps exist, informing recommendations for the timing of measurement and the design of prenatal interventions.
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Affiliation(s)
- Liz McGovern
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland
| | - Aisling Geraghty
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland
| | - Fionnuala McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland
| | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, D04 V1W8, Ireland
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, D02 YH21, Ireland
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9
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Philip RK, Worobetz A, Byrt H, Beirne I, Zutshi R, Cassidy T, Dunne CP. A repeated cross-sectional analysis of breastfeeding initiation rates in Ireland for two decades and 10 recommended priorities for improvement. MATERNAL & CHILD NUTRITION 2022; 19:e13424. [PMID: 36147028 PMCID: PMC9749595 DOI: 10.1111/mcn.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
Despite a number of public health and policy-based initiatives, Ireland's national breastfeeding rates are among the lowest globally. Regionally, the Mid-West of Ireland has historically had low breastfeeding initiation rates, and parts of its major urban area such as Limerick City suffer the highest levels of economic deprivation in the country. In that context, this repeated cross-sectional study analysed breastfeeding initiation trends in the Mid-West of Ireland for two decades, from 2001 to 2020 inclusively. Statistical analysis revealed persistently low percentages of women initiating breastfeeding in the region. Time series analyses of the data demonstrated that overall breastfeeding rates are increasing, but continue to be lower than Irish national averages. From these findings and a narrative review of published research, we determined 10 plausible reasons for these consistently low breastfeeding rates. Arising from these, we propose '10 Priorities' to increase the breastfeeding initiation rates in Ireland.
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Affiliation(s)
- Roy K. Philip
- Division of Neonatology, Department of PaediatricsUniversity Maternity Hospital LimerickLimerickIreland,School of MedicineUniversity of LimerickLimerickIreland
| | | | - Helen Byrt
- Lactation Division, Department of Nursing MidwiferyUniversity Maternity Hospital LimerickLimerickIreland
| | - Irene Beirne
- Neonatal Nursing, Department of MidwiferyUniversity Maternity Hospital LimerickLimerickIreland
| | | | - Tanya Cassidy
- Sociology and Anthropology, School of Nursing, Psychotherapy and Community HealthDublin City UniversityDublinIreland
| | - Colum P. Dunne
- School of MedicineUniversity of LimerickLimerickIreland,Centre for Interventions in Infection, Inflammation and Immunity (4i)University of Limerick School of MedicineLimerickIreland
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10
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Zimmerman DR, Kaplan M, Shoob H, Freisthler M, Toledano M, Stein-Zamir C. Breastfeeding challenges and support in a high initiation population. Isr J Health Policy Res 2022; 11:31. [PMID: 36071536 PMCID: PMC9449948 DOI: 10.1186/s13584-022-00538-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The breastfeeding initiation rate in Israel is approximately 90%, yet exclusive breastfeeding drops sharply in the early postnatal period. The study objective was to assess early postpartum professional breastfeeding support, its association with breastfeeding success and identification of risk factors for early breastfeeding discontinuation. METHODS As part of a post-discharge newborn follow-up study, a convenience sample of 868 mothers attending Maternal and Child Health Centers (MCHCs) up to three months post-partum were interviewed using a 26-item questionnaire. Breastfeeding-related questions covered demographic variables, pregnancy and birth details; breastfeeding duration, lactation support in hospital and post-discharge; and problems experienced. RESULTS Most mothers, 797 (91.8%), initiated breastfeeding in hospital. All women who initiated breastfeeding in the hospital reported exclusive breastfeeding; by two weeks postpartum, 70 women (13.2%) were supplementing with formula (partial breastfeeding). Kaplan-Meier Survival Analysis revealed an estimated mean duration of exclusive breastfeeding in the sample population of 66.8 ± 1.5 days. This duration was shorter for women with preterm births, low birthweight infants (LBW), cesarean births, and hospitalizations in neonatal intensive care units (NICU). A total of 472 (59.3%) breastfeeding mothers reported receiving in-hospital guidance. Of these, 290 (61.3%) were observed breastfeeding. Of all women who initiated breastfeeding, 280 (35.1%) attended MCHC follow-up within 72 h of hospital discharge. A higher proportion of women experiencing breastfeeding difficulties attended an MCHC within 72 h (131/297, 44.1%) compared to women not experiencing difficulties (148/499, 29.7%). The most frequently reported problems were mechanical (55.2%) or milk supply concerns (18.5%). First-time mothers were more likely to report problems, as were Jewish (vs Arab) mothers. CONCLUSIONS Even in a population with high initiation rates of breastfeeding, breastfeeding duration, both exclusive and partial, is less than recommended. As much of this drop-off occurs during maternity leave, it is likely related to breastfeeding challenges other than employment. Breastfeeding support needs of women are currently not adequately met; staffing and time for both in-hospital and community-based counseling needs to be funded as well as mandated. Counseling hours should be tailored to assure adequate coverage of high-risk groups such as women after cesarean delivery and newborns requiring intensive care.
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Affiliation(s)
- Deena R Zimmerman
- Department of Maternal and Child Health, Public Health Services, Ministry of Health, 39 Yirmyahu St, P.O.B. 1176, 9446724, Jerusalem, Israel.
| | - Michael Kaplan
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Hanna Shoob
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Marlaina Freisthler
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Monique Toledano
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, 86 Jaffa Road, Jerusalem, Israel.,Faculty of Medicine, The Hebrew University and Hadassah Braun School of Public and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Larsson B, Elfving M, Vesterlund E, Karlström A, Hildingsson I. Fulfilment of expectations on birth and the postpartum period - A Swedish cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100748. [PMID: 35728347 DOI: 10.1016/j.srhc.2022.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The fulfilment of birth expectations is important to women and strongly related to birth satisfaction. OBJECTIVE The aim of this study was to investigate women's expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled. METHODS A longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences. RESULTS The majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women's expectations and experiences. Most likely to be fulfilled were women's expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled. CONCLUSIONS Pregnant women's expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.
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Affiliation(s)
- Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Elin Vesterlund
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
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12
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Niu Z, Naya CH, Reynaga L, Toledo-Corral CM, Johnson M, Yang T, Grubbs B, Lurvey N, Lerner D, Dunton GF, Habre R, Breton CV, Bastain TM, Farzan SF. Association of Breastfeeding Duration with 12-Month Postpartum Blood Lipids in a Predominately Lower-Income Hispanic Pregnancy Cohort in Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3008. [PMID: 35270701 PMCID: PMC8910591 DOI: 10.3390/ijerph19053008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
Breastfeeding may protect women’s long-term cardiovascular health; however, breastfeeding-related postpartum lipid changes remain unclear. We aim to examine associations of breastfeeding duration with maternal lipids at 12 months postpartum. In a subsample (n = 79) of the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort, breastfeeding status and duration at 3, 6, and 12 months postpartum were self-reported. Serum levels of lipids, including total cholesterol, triglycerides (TG), high-, low-, and very low-density lipoprotein cholesterol (HDL-C, LDL-C, VLDL-C), were measured from blood samples collected at 12 months postpartum. We used linear regression models to compare lipids by breastfeeding duration, adjusting for potential confounders. Women who were breastfeeding at 12 months had higher HDL-C (mean: 41.74 mg/dL, 95% CI: 37.27−46.74 vs. 35.11 mg/dL, 95% CI: 31.42−39.24), lower TG (80.45 mg/dL, 95% CI: 66.20−97.77 vs. 119.11 mg/dL, 95% CI: 98.36−144.25), and lower VLDL-C (16.31 mg/dL, 95% CI: 13.23, 20.12 vs. 23.09 mg/dL, 95% CI: 18.61−28.65) compared to women who breastfed for <6 months. No lipids were significantly different between women who breastfed for 6−11 months and for <6 months. Each month’s increase in breastfeeding duration was significantly, inversely associated with TG and VLDL-C and positively with HDL-C. Adjusting for fasting status, demographics, pre-pregnancy body mass index, breastfeeding frequency, and pregnancy complications did not appreciably change effect estimates. Breastfeeding at 12 months postpartum and a longer duration of breastfeeding in the first year postpartum were both associated with increased HDL-C and decreased TG and VLDL-C at 12 months postpartum.
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Affiliation(s)
- Zhongzheng Niu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Christine H. Naya
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Lorena Reynaga
- Department of Health Sciences, College of Health and Human Development, California State University Northridge, Northridge, CA 91330, USA;
| | - Claudia M. Toledo-Corral
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
- Department of Health Sciences, College of Health and Human Development, California State University Northridge, Northridge, CA 91330, USA;
| | - Mark Johnson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Tingyu Yang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Brendan Grubbs
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
- Department of Obstetrics & Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA
| | - Nathana Lurvey
- Eisner Health, Los Angeles, CA 90015, USA; (N.L.); (D.L.)
| | - Deborah Lerner
- Eisner Health, Los Angeles, CA 90015, USA; (N.L.); (D.L.)
| | - Genevieve F. Dunton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Rima Habre
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, USA; (Z.N.); (C.H.N.); (C.M.T.-C.); (M.J.); (T.Y.); (B.G.); (G.F.D.); (R.H.); (C.V.B.); (T.M.B.)
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13
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Wilde VK. Neonatal Jaundice and Autism: Precautionary Principle Invocation Overdue. Cureus 2022; 14:e22512. [PMID: 35228983 PMCID: PMC8873319 DOI: 10.7759/cureus.22512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
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14
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Renjith V, Yesodharan R, Noronha JA, Ladd E, George A. Qualitative Methods in Health Care Research. Int J Prev Med 2021; 12:20. [PMID: 34084317 PMCID: PMC8106287 DOI: 10.4103/ijpvm.ijpvm_321_19] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.
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Affiliation(s)
- Vishnu Renjith
- School of Nursing and Midwifery, Royal College of Surgeons Ireland - Bahrain (RCSI Bahrain), Al Sayh Muharraq Governorate, Bahrain
| | - Renjulal Yesodharan
- Department of Mental Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Judith A Noronha
- Department of OBG Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Elissa Ladd
- School of Nursing, MGH Institute of Health Professions, Boston, USA
| | - Anice George
- Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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15
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Ongun H, Demir M. Family-centered lactation counseling and breastfeeding in preterm infants upon neonatal intensive care discharge. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_167_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Chleilat F, Klancic T, Ma K, Schick A, Nettleton JE, Reimer RA. Human Milk Oligosaccharide Supplementation Affects Intestinal Barrier Function and Microbial Composition in the Gastrointestinal Tract of Young Sprague Dawley Rats. Nutrients 2020; 12:nu12051532. [PMID: 32466125 PMCID: PMC7284880 DOI: 10.3390/nu12051532] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022] Open
Abstract
Human milk oligosaccharides (HMOs) are chief maternal milk constituents that feed the intestinal microbiota and drive maturation of the infant gut. Our objective was to determine whether supplementing individual HMOs to a weanling diet alters growth and gut health in rats. Healthy three-week-old Sprague Dawley rat pups were randomized to control, 2'-O-fucosyllactose (2'FL)- and 3'sialyllactose (3'SL)-fortified diets alone or in combination at physiological doses for eight weeks. Body composition, intestinal permeability, serum cytokines, fecal microbiota composition, and messenger RNA (mRNA) expression in the gastrointestinal tract were assessed. Males fed a control diet were 10% heavier and displayed elevated interleukin (IL-18) (p = 0.01) in serum compared to all HMO-fortified groups at week 11. No differences in body composition were detected between groups. In females, HMOs did not affect body weight but 2'FL + 3'SL significantly increased cecum weight. All female HMO-fortified groups displayed significant reductions in intestinal permeability compared to controls (p = 0.02). All HMO-fortified diets altered gut microbiota composition and mRNA expression in the gastrointestinal tract, albeit differently according to sex. Supplementation with a fraction of the HMOs found in breast milk has a complex sex-dependent risk/benefit profile. Further long-term investigation of gut microbial profiles and supplementation with other HMOs during early development is warranted.
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Affiliation(s)
- Faye Chleilat
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (F.C.); (T.K.); (K.M.); (J.E.N.)
| | - Teja Klancic
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (F.C.); (T.K.); (K.M.); (J.E.N.)
| | - Kyle Ma
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (F.C.); (T.K.); (K.M.); (J.E.N.)
| | - Alana Schick
- International Microbiome Centre, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada;
| | - Jodi E. Nettleton
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (F.C.); (T.K.); (K.M.); (J.E.N.)
| | - Raylene A. Reimer
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada; (F.C.); (T.K.); (K.M.); (J.E.N.)
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Correspondence:
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