Breastfeeding in times of COVID-19: a scoping review

Association between infant feeding practices, COVID-19 related cognitive factors, and postpartum depression during the COVID-19 pandemic: a cross-sectional online study in Thailand

BACKGROUND

Maternal beliefs towards COVID-19 vaccine safety may be associated with infant feeding practice and postpartum depression (PPD). Since there is a paucity of studies, this study aims to identify associations of COVID-19-related cognitive factors (e.g., COVID-19-vaccination-related belief and COVID-19-related knowledge and attitude) with infant feeding practices and their associations with PPD during the COVID-19 pandemic in Thai postpartum mothers.

METHODS

A cross-sectional online survey was conducted among 840 postpartum mothers whose infants were less than or equal to 6 months old. Mothers with a score ≥ 13 using the Edinburgh Postnatal Depression Scale (EPDS) were considered to have PPD. Student t-tests were used to measure the association between infant feeding practices and COVID-19-related cognitive factors, and Chi-square tests were used to assess their associations with PPD. Significant variables (p < 0.05) from the chi-square test were included in the logistic regression analysis. Multivariable logistic regression analyses were performed to identify factors associated with PPD. The associations were reported in adjusted odds ratio at 95% confidence interval.

RESULTS

This study showed one-third of the participants (32.4%) were at risk of having PPD. Mothers who fed expressed breastmilk had positive beliefs towards COVID-19 vaccination and higher scores on COVID-19 knowledge and attitude, while mothers who fed infant formula or solid, semi-solid, or soft food had negative beliefs towards the vaccination compared to their counterparts. Multivariable logistic regression showed women who fed their infant with solid, semi-solid, and soft foods (AOR = 3.28; 95% CI = 1.35-10.92) had significantly higher odds of PPD. Among COVID-19-related cognitive factors, negative or moderate COVID-19-related attitudes were associated with higher odds of PPD (1.91; 1.19-3.07 and 1.85; 1.20-2.86, respectively). Socio-demographic factors associated with PPD included living in urban areas, residing outside the Southern region, having food insecurity during the pandemic, having unintended pregnancy, and having health problems during the perinatal period.

CONCLUSIONS

The association of COVID-19-related cognitive factors and feeding practices with PPD may suggest that proper education on prevention, control, and vaccination of emerging infectious diseases such as COVID-19, as well as support for appropriate infant feeding practices, should be provided to postpartum mothers, which ultimately contributes to improving their mental health.

Breastfeeding success and perceived social support in lactating women with a history of COVID 19 infection: a prospective cohort study

BACKGROUND

Given the limited availability of research on the association between COVID-19 infection and breastfeeding success, the primary objective of this study is to conduct a comprehensive evaluation of this relationship.

METHODS

This prospective cohort study included 260 women who were on the postnatal ward of an academic hospital affiliated with Tehran University of Medical Sciences during the COVID-19 pandemic (between March and August 2021). Among these women, 130 had tested positive for COVID-19 in pregnancy, while the remaining 130 were considered healthy. The study aimed to assess various factors, including sociodemographic characteristics and the results of four validated questionnaires: The Bristol Breastfeeding Questionnaire, The Multidimensional of Perceived Social Support (MPSS), The Breastfeeding Self-Efficacy Scale (BSES), and The Postpartum Partner Support Scale (PPSS). These questionnaires were administered to each participant to gather relevant data. After eight weeks, a telephone follow-up was carried out to assess the success of breastfeeding. The evaluation focused on determining if exclusive breastfeeding was maintained or not. Data was collected by questioning mothers about their infants' feeding habits in the past 24 h. Exclusive breastfeeding refers to the exclusive use of breast milk without the introduction of other liquids or solid foods.

RESULTS

Women with a previous COVID-19 infection (case group) had a lower mean infant gestational age (P < 0.001) and a higher prevalence of cesarean section (P = 0.001) compared to the control group. The proportion of women who exclusively breastfed was higher in the control group (98.5%) than in women with a history of COVID-19 infection (89.2%) (P = 0.011). Furthermore, the case group reported lower scores in perceived social support and the Breastfeeding Self-Efficacy Scale, in contrast to the control group. Notably, there was a significant correlation between breastfeeding success and women's breastfeeding self-efficacy score.

CONCLUSIONS

The findings of this study offer valuable insights for healthcare professionals, enabling them to promote early initiation of breastfeeding in mothers with a history of COVID-19 infection, while ensuring necessary precautions are taken.

Association of the presence of a COVID-19 infection at the time of birth and the rates of exclusive breastfeeding upon discharge in BFHI hospitals: a multicenter, prospective cohort study

BACKGROUND

Very few studies have assessed the association between COVID-19 infection and the rates of exclusive breastfeeding (EBF) upon discharge following the first waves of the pandemic and after initiation of vaccination. The primary objective of this study is to compare the rates of EBF since birth upon discharge in mothers diagnosed with COVID-19 infection at the time of the delivery versus a group of non-infected mothers in maternity hospitals with Baby Friendly Hospital Initiative (BFHI) accreditation. The secondary objectives include determining the rates of any breastfeeding at three and six months of life in both groups, as well as determining the possible factors associated with EBF rates observed upon discharge.

METHODS

An observational, Spanish multi-center hospital, prospective cohort study conducted from 1 to 2021 to 31 March 2022 and with follow-up during the first six months of life. Follow-up was performed via telephone contact with calls performed at three and six months. A multivariate logistic regression analysis model was used to identify the factors related to a lower probability of EBF upon discharge.

RESULTS

308 mother-infant pairs participated in the study, 111 in the cohort of women with COVID infection and 197 in the comparison group. EBF upon discharge was 62.7% in the COVID group vs. 81.2% in the comparison group (p = 0.002); at three months; 52.4% vs. 57.0% (p = 0.33) were performing EBF, with the rates of EBF at six months being 43.0% vs. 39.3% (p = 0.45), respectively. Exposure to COVID-19 at delivery (AOR 5.28; 95% CI 2.01, 13.86), not practicing BF previously (AOR 36.3; 95% CI 7.02, 187.74), birth via Cesarean section (AOR 5.06; 95% CI 1.62, 15.79) and low birth weight of the newborn (AOR 1.01; 95% CI 1.01, 1.01) were associated with a greater risk of not performing EBF upon discharge.

CONCLUSIONS

Mothers with a mild or asymptomatic COVID-19 infection at the time of the delivery were less likely to have exclusively breastfed during their hospital stay than other mothers in these BFHI-accredited hospitals. However, there were no differences in breastfeeding rates between the groups at three and six months postpartum.

Changes in Breastfeeding and Lactation Support Experiences During COVID

Background: We surveyed parents who gave birth from 2019 to 2021 to examine changes in breastfeeding experiences and professional and lay breastfeeding support services due to the coronavirus disease 2019 (COVID-19) pandemic. We also examined racial and ethnic disparities in breastfeeding support. Materials and Methods: A cross-sectional opt-in survey of 1,617 parents was administered on Ovia's parenting app in January 2022. Respondents were 18-45 years of age and delivered in one of three birth cohorts: August-December 2019, March-May 2020, or June-August 2021. We fit linear and logistic regression models wherein the outcomes were six breastfeeding support and experience measures, adjusting for birth cohort and respondent demographics. Results: Parents who gave birth in the early pandemic versus those in the prepandemic had reduced odds of interacting with lactation consultants (odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.44-0.90), attending breastfeeding classes (OR: 0.71; 95% CI: 0.54-0.94), meeting breastfeeding goals (OR: 0.65; 95% CI: 0.46-0.92), and reporting it was easy to get breastfeeding help (estimate: -0.36; 95% CI: -0.55 to -0.17). Birth cohort was not associated with use of donor milk or receipt of in-hospital help. The later pandemic cohort differed from the prepandemic cohort for one outcome: they were less likely to meet their breastfeeding goals (OR: 0.67; 95% CI: 0.48-0.95). There were racial and ethnic disparities in the use of multiple types of breastfeeding support. Although one-third of respondents felt that the pandemic facilitated breastfeeding because of more time at home, 18% felt the pandemic posed additional challenges including disruptions to lactation support. Conclusions: Parents who gave birth in the later pandemic did not report significant disruptions to professional breastfeeding support, likely as a result of the growth of virtual services. However, disparities in receipt of support require policy attention and action.