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

Trend and Burden of Suboptimal Breastfeeding in Children Under Five Years of Age in 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021

Background/Objectives: Breastfeeding is a cost-effective early child health intervention that has been identified as a protective factor against adverse child health outcomes. However, as estimated by previous epidemiological studies, the prevalence of breastfeeding in most countries around the world is below the recommended levels established by the World Health Organization. This study aims to assess the changes in suboptimal breastfeeding mortality, disability-adjusted life years (DALYs), and years lost to disabilities (YLDs) on a global, regional, and national level from 1990 to 2021. Methods: Data regarding suboptimal breastfeeding in children under 5 years of age from 1990 to 2021 were extracted from the Global Health Data Exchange query tool. Data from 204 countries and territories countries were classified into 5 regions based on the sociodemographic index (SDI) and 21 Global Burden of Disease (GBD) regions according to geographical contiguity. The average annual percentage change (AAPC) was calculated to assess changes in the trends of suboptimal breastfeeding DALYs, YLDs, and mortality in the past 30 years. Results: Countries with high-middle (AAPC = -0.94, 95% CI = -0.95 to -0.93) SDI scores had the greatest degree of improvement in both suboptimal breastfeeding mortality from 28,043.47 to 1128.24 and disease burden from 43,202.94 to 4428.47, while countries with high (AAPC = -0.83, 95% CI = -0.86 to -0.81) and low SDI (AAPC = -0.63, 95% CI = -0.71 to -0.55) scores showed the least improvement from 16,775.75 to 5930.56 and 49,522.23 to 32,881.08, respectively. Conclusions: Significant global improvements in suboptimal breastfeeding mortality and morbidity have occurred in the last 30 years. However, the extent of improvement differs significantly across nations, while some countries also showed no improvements or increased suboptimal breastfeeding mortality and disease burden. Nation-specific policies that account for cultural practices and economic conditions are required to target vulnerable mothers that are unable to achieve optimal breastfeeding.

Spatial patterns and temporal trends in stillbirth, neonatal, and infant mortality: an exploration of country-level data from 2000 to 2021

Background

Despite significant progress in improving child survival and health, substantial disparities persist and are being increasingly threatened by a complex and dynamic global environment. In this ecological study, we investigated spatial patterns, temporal trends, and key determinants of disparities in stillbirth, neonatal, and infant mortality rates across 195 countries from 2000 to 2021.

Methods

We sourced our data from two publicly available databases: the United Nations Children's Fund Data Warehouse for mortality indicators and the World Bank for World Development Indicators. We conducted spatial analysis to assess spatial autocorrelation and identify geographical clusters of countries and applied joinpoint regression to evaluate temporal trends in mortality indicators, reported as annual percentage change. We also used forward regression analysis to determine the primary indicators influencing stillbirth, neonatal, and infant mortality rates.

Results

The average stillbirth rate in 2021 was 10.9 per 1000 total births, a significant decrease from 16.3 per 1000 in 2000. Neonatal mortality also declined from 23.6 to 13.5 per 1000 live births during the same period, while infant mortality dropped from 45.0 to 22.5 per 1000 live births. Despite these improvements, spatial analysis showed notable positive spatial autocorrelations for stillbirth, neonatal, and infant mortality rates, indicating that high mortality rates were geographically clustered, particularly in African countries forming hot-spot clusters. Conversely, developed countries in Europe and Asia formed cold-spot clusters characterised by low mortality indicators. Some countries, identified as low-high or high-low clusters, stood out due to dissimilar mortality rates compared to their neighbours, warranting further investigation. Key determinants of mortality rates included the young-age dependency ratio, prevalence of undernourishment, the percentage of women aged 15 and older living with HIV, the incidence of tuberculosis, and the adolescent fertility rate - all of which showed a positive association with higher mortality rates. In contrast, factors such as the use of at least basic sanitation services, mean years of schooling, and government effectiveness had an inverse relationship, contributing to lower mortality rates.

Conclusions

By identifying hotspots and outliers, this study highlights the need for targeted health interventions and efficient resource allocation. This approach ensures that efforts are strategic and impactful, focussing on areas with the greatest need.

Effects of Breastfeeding Knowledge and Health Beliefs Regarding Gestational Diabetes Mellitus on the Breastfeeding Intention of Pregnant Women

PURPOSE

This study aims to explore the relationships between gestational diabetes mellitus (GDM)-related breastfeeding knowledge, GDM-related breastfeeding health beliefs, and breastfeeding intention. It investigates the factors influencing breastfeeding intention among pregnant women in Nepal.

METHODS

A total of 229 healthy pregnant women visiting an antenatal clinic in Nepal participated in this study between January and March, 2023. They completed a questionnaire that assessed their GDM-related breastfeeding knowledge, GDM-related breastfeeding health beliefs, and breastfeeding intention. The data were analyzed using descriptive statistics, an independent t-test, one-way analysis of variance including Scheffé's post hoc test, and logistic regression analysis.

RESULTS

Of the participants, 86.9% (n = 199) indicated positive breastfeeding intention, even with a relatively low level of GDM-related breastfeeding knowledge. Logistic regression analysis of the factors influencing breastfeeding intention yielded a significant model (χ2 = 38.80, p < .001) with significant variables; GDM-related breastfeeding knowledge [odds ratio (OR): 1.0, 95% confidence interval (CI): 1.02-1.40], GDM-related breastfeeding health beliefs (OR: 1.09, 95% CI: 1.04-1.15), and immediate family experience with diabetes mellitus (OR: 5.38, 95% CI: 1.98-14.62).

CONCLUSION

Nurses should lead interventions to educate pregnant women about the benefits of breastfeeding that can help in mitigating the long-term effects of GDM and reinforce health beliefs through positive experiences. This study provides information demonstrating the need for nurse-led improvements in Nepal's GDM management system, from screening to comprehensive care.

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.

A Potential Link Between Outcome of Periodic Fever, Aphthous Stomatitis, Pharyngitis, Cervical Adenitis (PFAPA) Syndrome in Children and Breastfeeding: A Retrospective Single-Center Cohort Snapshot

Background/Objectives: Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome, often referred to as PFAPA syndrome, may enigmatically recur for an undetermined time in affected children: a potential reason to explain its recurring pattern for an unpredictable period or its self-limitation is currently unknown. We explored the relationship between different general, demographic, clinical, and laboratory features of PFAPA children and disease evolution over the course of a decade. Methods: We have retrospectively screened 150 Italian children with a history of PFAPA syndrome attending the Outpatients Clinic of Pediatric Rheumatology in our Institution during the period 2014-2024, all without any recognized chronic diseases: 88 males, 62 females, mean age at onset of 2.5 ± 1.7 years, age range of 0.3-9.4 years, and mean age at diagnosis of 4.5 ± 2.0 years. The whole cohort of PFAPA patients had been followed up for a median period of 5 years (IQR: 4-7). Results and Conclusions: After dividing patients into two groups based on either the disappearance or persistence of PFAPA symptoms during follow-up, we found that positive family history of recurring fevers, cervical lymphadenopathy, arthralgia, myalgia, and breastfeeding for more than 6 months were associated with the disappearance of febrile attacks for at least six months. Performing a multivariate analysis adjusted for sex and age, we found that only breastfeeding duration longer than 6 months and higher education level of PFAPA patients' mothers were independently associated with the resolution of PFAPA symptoms.

Social and Nutritional Profiles of Pregnant Women: A Cluster Analysis on the "MAMI-MED" Cohort

BACKGROUND/OBJECTIVES

During the pre-conceptional period, addressing social determinants of health (SDOH) is essential for reducing maternal health disparities, particularly among disadvantaged groups. Key SDOH factors such as income, education, and healthcare access significantly influence maternal and infant outcomes, increasing risks like miscarriage, preterm birth, and pregnancy complications. Here, we aimed to explore maternal and neonatal characteristics according to socio-economic status. Thus, we identified clusters of pregnant women with similar social and behavioral characteristics and explored their variability in terms of neonatal outcomes.

METHODS

Data from 1512 pregnant women in the "MAMI-MED" cohort at ARNAS Garibaldi Nesima in Catania were analyzed. A two-step cluster analysis grouped the women based on education level, employment status, pre-pregnancy nutritional status, and Mediterranean diet score (MDS).

RESULTS

Two clusters of pregnant women were identified. Cluster 1 (n = 739) consisted of women with lower educational attainment who were unemployed, overweight and/or obese, and had a lower mean MDS. Instead, cluster 2 (n = 773) was mostly characterized by women with a medium-high level of education who were employed, had normal weight, and had a higher average MDS. Women in cluster 1 had significantly higher proportions of preterm births (p = 0.004), low-birth weight newborns (p = 0.002), and large-for-gestational-age newborns. Differences in gestational week (p < 0.001), birth weight (p < 0.001), and newborn length (p = 0.004) were also noted between the two clusters.

CONCLUSIONS

Cluster analysis can help identify high-risk groups who may benefit from personalized public health interventions. Our results highlight the need to examine the complex interactions between socio-demographic, behavioral, and genetic factors that contribute to maternal-infant health.

Breastfeeding practices among immigrants living in Finland: Results from the FinChildren survey

Background

Breastfeeding is a cornerstone of child health and survival as it provides crucial, non-replaceable nourishment necessary for infant's growth and development. Immigration has been shown to influence breastfeeding particularly among immigrants from low- and middle-income countries. Our aim was to examine breastfeeding practices and sociodemographic characteristics of Somali-, Arabic-, and Russian-speaking in comparison with Finnish-speaking mothers.

Methods

We analyzed data from 5348 mothers with infants who participated in FinChildren survey conducted in 2020. Univariate and multivariate analysis were used to estimate the association between maternal origin and breastfeeding practices by comparing immigrant mothers with native-born mothers.

Results

Somali-/Arabic-speaking mothers were younger, less educated and had higher BMI than Russian- and native Finnish-speaking mothers. Proportions of exclusive breastfeeding at 4-5 months of age were lowest among Somali-/Arabic-speaking mothers (21 %) compared to native-born (49 %) and to Russian-speaking mothers (52 %). Again, Somali-/Arabic-speaking mothers had the highest proportions of mixed feeding (66 %) compared to native Finnish-speaking (38 %) and Russian-speaking mothers (32 %). Being a Somali-/Arabic-speaking mother decreased the odds of exclusive breastfeeding five times (OR 0.20, 95 % CI 0.10-0.45) and quadrupled (OR 4.0, 95 % CI 2.18-7.37) the odds of mixed feeding at 4-5 months of age.

Conclusion

Even though the number of immigrant mothers was low, this study suggests that maternal origin is a significant predictor of suboptimal breastfeeding independent of sociodemographic and antenatal characteristics. There is a need for culturally sensitive interventions to promote breastfeeding among these groups.

Maternal employment characteristics as a structural social determinant of breastfeeding after return to work in the European Region: a scoping review

BACKGROUND

The European Region has the lowest rate of exclusive breastfeeding at 6 months worldwide. Improving work-related breastfeeding issues is important given that women may have difficulties combining work and breastfeeding, especially those in precarious working situations, which adds to their adversity. This scoping review overviews research on the maternal employment characteristics that support breastfeeding continuation after return to work in the European Region.

METHODS

Studies published from 2013 to 2023 were collected from Scopus, PubMed, and PsycInfo. Quantitative and qualitative studies published in English or French that explored the association between maternal employment characteristics and any breastfeeding status, duration, or experience were included. Participants included were mothers of healthy children who continued breastfeeding after resuming work. The main determinants were work-related factors that can lead to socially differentiated working conditions, including type of employment (e.g., occupation, employed/self-employed status, type of contract, working time, occupational prestige), working conditions (e.g., work schedule, decision latitude, latitude to organize worktime), and work environment (e.g., occupational exposure, family-friendly workplace policy, social support). The geographic area encompassed countries included in the World Health Organization European Region.

RESULTS

Of the 693 single studies retrieved and screened, 13 were included in the review. Eight studies focused on combining work and breastfeeding, while the others had a broader spectrum by investigating breastfeeding determinants. The represented countries were Spain (n = 4), France (n = 4), UK (n = 2), Ireland (n = 2), and the Netherlands (n = 1). Results highlighted the heterogeneity of measures, time frames, and fields of inquiry, thus revealing a lack of conceptual framework regarding the links between work, breastfeeding, and social health inequalities. Nonetheless, being self-employed, working in a non-manual profession with time flexibility, having lactation rooms at work, being supported by co-workers, and having a breastfeeding workplace policy were salient factors that supported breastfeeding in working mothers.

CONCLUSIONS

Supporting working mothers who choose to breastfeed is important given the myriad of adverse factors faced by mothers and their children. These results advocate for targeted actions at the workplace such as time flexibility, breastfeeding facilities, and the promotion of breastfeeding-friendly policies.

The Effect of Maternal Dietary Patterns on Birth Weight for Gestational Age: Findings from the MAMI-MED Cohort

Limited evidence exists on the effects of maternal dietary patterns on birth weight, and most studies conducted so far did not adjust their findings for gestational age and sex, leading to potentially biased conclusions. In the present study, we applied a novel method, namely the clustering on principal components, to derive dietary patterns among 667 pregnant women from Catania (Italy) and to evaluate the associations with birth weight for gestational age. We identified two clusters reflecting distinct dietary patterns: the first one was mainly characterized by plant-based foods (e.g., potatoes, cooked and raw vegetables, legumes, soup, fruits, nuts, rice, wholemeal bread), fish and white meat, eggs, butter and margarine, coffee and tea; the second one consisted mainly of junk foods (sweets, dips, salty snacks, and fries), pasta, white bread, milk, vegetable and olive oils. Regarding small gestational age births, the main predictors were employment status and primiparity, but not the adherence to dietary patterns. By contrast, women belonging to cluster 2 had higher odds of large for gestational age (LGA) births than those belonging to cluster 1 (OR = 2.213; 95%CI = 1.047-4.679; p = 0.038). Moreover, the odds of LGA increased by nearly 11% for each one-unit increase in pregestational BMI (OR = 1.107; 95%CI = 1.053-1.163; p < 0.001). To our knowledge, the present study is the first to highlight a relationship between adherence to an unhealthy dietary pattern and the likelihood of giving birth to a LGA newborn. This evidence adds to the current knowledge about the effects of diet on birth weight, which, however, remains limited and controversial.

How Wearable Sensors Can Support the Research on Foetal and Pregnancy Outcomes: A Scoping Review

The application of innovative technologies, and in particular of wearable devices, can potentially transform the field of antenatal care with the aim of improving maternal and new-born health through a personalized approach. The present study undertakes a scoping review to systematically map the literature about the use wearable sensors in the research of foetal and pregnancy outcomes. Online databases were used to identify papers published between 2000-2022, from which we selected 30 studies: 9 on foetal outcomes and 21 on maternal outcomes. Included studies focused primarily on the use of wearable devices for monitoring foetal vital signs (e.g., foetal heart rate and movements) and maternal activity during pregnancy (e.g., sleep patterns and physical activity levels). There were many studies that focused on development and/or validation of wearable devices, even if often they included a limited number of pregnant women without pregnancy complications. Although their findings support the potential adoption of wearable devices for both antenatal care and research, there is still insufficient evidence to design effective interventions. Therefore, high quality research is needed to determine which and how wearable devices could support antenatal care.

Main Biopsychosocial Factors Influencing Breastfeeding: a Systematic Review

Background: Background: Breastfeeding is important for an infant's development as well as the mother's recovery after birth. Breastfeeding is influenced by a variety of biopsychosocial variables. The purpose of this study was to conduct a comprehensive literature search and explore the relationship between any biopsychological component and breastfeeding duration and intensity. Methods:The databases of PubMed and ScienceDirect were searched. The official website of World Health Organization (WHO) was also explored. Results:The search identified 19 studies, reporting the main biopsychosocial factors affecting breastfeeding intention and duration, including maternal age, occupation, smoking, obesity, the feeding type that the women received, social support, birth complications, cesarean delivery, anxiety and self-efficacy. Conclusion:This systematic review has confirmed that there are specific biopsychosocial factors influencing the breastfeeding process. It is proposed that current care and support should encourage mothers to breastfeed their newborns by providing corrective information and aid.

The Impact of the COVID-19 Pandemic on Dietary Patterns of Pregnant Women: A Comparison between Two Mother-Child Cohorts in Sicily, Italy

A maternal diet, before and during pregnancy, plays a key role in ensuring maternal and newborn health. The COVID-19 pandemic, however, may have compromised dietary habits in the general population and in specific subgroups of individuals. Here, we evaluated the impact of COVID-19 on the diet of pregnant women, using data from two mother-child cohorts in Sicily (Italy). Dietary data were collected using a food frequency questionnaire and analyzed through the Mediterranean diet (MD) score and principal component analysis (PCA). The comparison of maternal dietary consumption before and during the COVID-19 pandemic showed differences in terms of vegetables (p < 0.001), fruit (p < 0.001), dairy products (p < 0.001), fish (p < 0.001), and legumes (p = 0.001). Accordingly, after adjusting for covariates, mothers enrolled during the pandemic were more likely to report low adherence to MD than those enrolled before (OR = 1.65; 95%CI = 1.12−2.42; p = 0.011). A similar result was obtained by analyzing the adherence to a prudent dietary pattern, derived through PCA and characterized by high intake of cooked and row vegetables, legumes, fruit, fish, and soup. Overall, these findings suggested that the COVID-19 pandemic may have influenced maternal diet during pregnancy. However, further efforts are needed to investigate the main causes and consequences of this change.

Postnatal women's breastfeeding beliefs, practices, and support during the COVID-19 pandemic: a cross-sectional comparative study across five countries

Background

Women with COVID-19 experienced numerous concerns and doubts about the safety of breastfeeding their babies, and lack of support may have impacted breastfeeding practices. This study aims to compare breastfeeding beliefs, practices, and contact with healthcare professionals regarding the level of postnatal feeding support provided during the COVID-19 pandemic in Brazil, South Korea, Taiwan, Thailand, and the United Kingdom.

Methods

A multi-country cross-sectional study was conducted with postnatal women in five countries. Women up to six months postpartum were invited to complete an online survey concerning the transmission of preventative measures, beliefs toward breastfeeding, infant feeding practices in the last 24 hours and experiences of postnatal infant feeding support between July to November 2021. Bivariate and multivariate analyses were performed to identify the association.

Results

Of the 3,253 eligible responses received, 39.5% of children were aged between one and two months, but in Taiwan (36%) and South Korea (42.8%) they were between three and four months. The mean of the belief score was significantly different among countries (p < 0.0001). Women in Brazil and the UK had a higher rate of breastfeeding at the breast (90.7% and 85.4%, respectively) compared to the three Asian countries (p < 0.0001) while feeding with expressed breastmilk in Thailand (59.9%), Taiwan (52.6%), and South Korea (50.4%) was higher than the others (p < 0.0001). Brazil and UK mothers (mean = 16.0 and 14.5 respectively) had a higher mean score for belief toward breastfeeding during the COVID-19 than the others. These results are inversely associated with breastfeeding but positively related to formula feeding practice. Postnatal feeding support during the COVID-19 pandemic was mainly provided by healthcare professionals (67.1%) and peers / family through face-to-face personal contact (51.6%) in all countries.

Conclusion

Some differences were found in breastfeeding beliefs during the COVID-19 pandemic in Asian countries. A positive breastfeeding belief was associated with the practice of breastfeeding at the breast. Women from all countries received postpartum infant feeding support from health professionals and peers / family through personal contacts. Governments need to emphasize and disseminate the importance of breastfeeding safety, especially in Asian countries.

Nutrient intakes and telomere length of cell-free circulating DNA from amniotic fluid: findings from the Mamma & Bambino cohort

Pregnancy represents a crucial period in which several exposures—and especially maternal diet—might shape children’s health. Thus, identifying how maternal dietary intakes early affect biological aging in children represents a public health mission. We aimed to assess the relationship between maternal intake of nutrients in early pregnancy and telomere length of cell-free circulating DNA (cfDNA) from amniotic fluid. We used data and samples from the ongoing prospective “Mamma & Bambino” study, which recruits mother–child pairs from Catania at the first prenatal visit. Maternal nutrient intakes were assessed using a Food Frequency Questionnaire, while relative telomere length of cfDNA was assessed by real-time polymerase chain reaction. Our analysis included 174 mother–child pairs. The intakes of iron, vitamin B1, and magnesium were positively correlated with relative telomere length (p-values < 0.05). However, only the intake of magnesium was positively associated with relative telomere length, after applying a linear regression model (β = 0.002; SE = 0.001; p = 0.024). Magnesium deficiency was negatively associated with relative telomere length after adjusting for the same covariates (β = −0.467; SE = 0.176; p = 0.009). To our knowledge, this is the first evidence of a positive relationship between maternal nutrient intake and telomere length of cfDNA. Further efforts are needed for deeply investigating the effect of maternal dietary intakes on telomere length, in order to develop effective public health strategies.

The Relationship between Telomere Length and Gestational Weight Gain: Findings from the Mamma & Bambino Cohort

Inadequate gestational weight gain (GWG) affects a growing number of pregnancies, influencing intrauterine environment and long-term health. Uncovering molecular mechanisms associated with GWG could be helpful to develop public health strategies for tackling this issue. Here, our study aimed to understand the relationship of DNA telomere length with weigh gain during pregnancy, using data and samples from the ongoing prospective “Mamma & Bambino” study (Catania, Italy). GWG was calculated according to the Institute of Medicine (IOM) guidelines. Relative telomere length was assessed by real-time quantitative polymerase chain reaction in 252 samples of maternal leucocyte DNA (mlDNA) and 150 samples of cell-free DNA (cfDNA) from amniotic fluid. We observed that relative telomere length of mlDNA seemed to weakly increase with GWG. In contrast, telomere length of cfDNA exhibited a U-shaped relationship with GWG. Women with adequate GWG showed longer telomere length than those who gained weight inadequately. Accordingly, the logistic regression model confirmed the association between telomere length of cfDNA and adequate GWG, after adjusting for potential confounders. Our findings suggest an early effect of GWG on telomere length of cfDNA, which could represent a molecular mechanism underpinning the effects of maternal behaviours on foetal well-being.

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

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

The Effect of Alcohol on Telomere Length: A Systematic Review of Epidemiological Evidence and a Pilot Study during Pregnancy

Several studies—albeit with still inconclusive and limited findings—began to focus on the effect of drinking alcohol on telomere length (TL). Here, we present results from a systematic review of these epidemiological studies to investigate the potential association between alcohol consumption, alcohol-related disorders, and TL. The analysis of fourteen studies—selected from PubMed, Medline, and Web of Science databases—showed that people with alcohol-related disorders exhibited shorter TL, but also that alcohol consumption per se did not appear to affect TL in the absence of alcohol abuse or dependence. Our work also revealed a lack of studies in the periconceptional period, raising the need for evaluating this potential relationship during pregnancy. To fill this gap, we conducted a pilot study using data and samples form the Mamma & Bambino cohort. We compared five non-smoking but drinking women with ten non-smoking and non-drinking women, matched for maternal age, gestational age at recruitment, pregestational body mass index, and fetal sex. Interestingly, we detected a significant difference when analyzing relative TL of leukocyte DNA of cord blood samples from newborns. In particular, newborns from drinking women exhibited shorter relative TL than those born from non-drinking women (p = 0.024). Although these findings appeared promising, further research should be encouraged to test any dose–response relationship, to adjust for the effect of other exposures, and to understand the molecular mechanisms involved.

Knowledge, Intention, and Self-Efficacy Associated with Breastfeeding: Impact of These Factors on Breastfeeding during Postpartum Hospital Stays in Taiwanese Women

Breastfeeding knowledge, intention, and self-efficacy affect breastfeeding rates during the postpartum period. Insufficient knowledge, lack of intention, and poor breastfeeding self-efficacy reduce the likelihood of breastfeeding postpartum. The purposes of this study were to (1) assess women’s intention to breastfeed and knowledge and self-efficacy regarding breastfeeding following childbirth, and to (2) identify the factors associated with postpartum breastfeeding during women’s hospital stays. This longitudinal study with a pretest and posttest design study recruited pregnant women from the gynecology and obstetrics outpatient departments and inpatient wards at a medical center in northern Taiwan. Demographic and obstetric characteristics were recorded, and participants were assessed using the Numeric Rating Scale, the Breastfeeding Knowledge Questionnaire, the Breastfeeding Self-Efficacy Scale—Short Form, and breastfeeding status postpartum. Of the 120 participants, 25% reported breastfeeding during the postpartum hospital stay. Postpartum breastfeeding was associated with lower levels of education and higher prenatal levels of breastfeeding intention. Establishing a breastfeeding-friendly environment in the family and workplace may effectively increase continued breastfeeding.