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Arora I, Juneja H, Bhandekar H, Chandankhede M. Neonatal hypernatremic dehydration in breastfed neonates: a prospective study unmasking the influences of breastfeeding practices and early weight monitoring. J Matern Fetal Neonatal Med 2024; 37:2299568. [PMID: 38151267 DOI: 10.1080/14767058.2023.2299568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby's admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD.
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Affiliation(s)
- Ishani Arora
- Department of Pediatrics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
| | - Hemant Juneja
- Department of Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
| | - Heena Bhandekar
- Department of Pediatrics, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
| | - Manju Chandankhede
- Department of Biochemistry, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, India
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Call CC, Hawkins MS, Shah VK, Frank D, Niemi S, Jouppi RJ, Ferguson E, Conlon RPK, Levine MD. A longitudinal investigation of breastfeeding planning, initiation, and duration among individuals with pre-pregnancy overweight or obesity. Appetite 2024; 197:107333. [PMID: 38570117 DOI: 10.1016/j.appet.2024.107333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Individuals with a body mass index (BMI)≥25 kg/m2 are less likely to initiate and continue breastfeeding than are those with BMIs<25. Given the intergenerational health benefits of breastfeeding, it is important to understand breastfeeding behaviors and their correlates among individuals with BMIs≥25. Thus, in an observational cohort with BMI≥25 (N = 237), we aimed to characterize longitudinal relationships among breastfeeding planning, initiation, and duration and their sociodemographic/clinical correlates and determine if pre-pregnancy BMI predicts breastfeeding planning, initiation, and duration. Breastfeeding behaviors, weight/BMI, and sociodemographic/clinical characteristics were assessed in early, mid, and late pregnancy, and at six-months postpartum. Most participants planned to (84%) and initiated (81%) breastfeeding, of which 37% breastfed for ≥6 months. Participants who were married, first-time parents, higher in education/income, and had never smoked tobacco were more likely to plan, initiate, and achieve ≥6 months of breastfeeding. Higher pre-pregnancy BMI was not associated with breastfeeding planning or initiation but was associated with lower adjusted odds of breastfeeding for ≥6 months relative to <6 months. Findings suggest that support aimed at extending breastfeeding among those with elevated pre-pregnancy BMI may be warranted. Future interventions should also address sociodemographic and clinical inequities in breastfeeding.
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Affiliation(s)
- Christine C Call
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Marquis S Hawkins
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Vrusha K Shah
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - David Frank
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Sarah Niemi
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Riley J Jouppi
- University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Emma Ferguson
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Rachel P K Conlon
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Michele D Levine
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA; University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
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Fung AK, Li Y, Wang J, Leahy TP, Shetye SS, Liu XS, Soslowsky LJ. Long-Term Effects of Reproduction and Lactation on the Rat Supraspinatus Tendon and Proximal Humerus. J Biomech Eng 2024; 146:060905. [PMID: 37792487 PMCID: PMC11005856 DOI: 10.1115/1.4063628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
During pregnancy and breastfeeding, women undergo hormonal fluctuations required for fetal development, parturition, and infant growth. These changes have secondary consequences on the maternal musculoskeletal system, increasing the risk for joint pain and osteoporosis. Though hormone levels return to prepregnancy levels postpartum, women may experience lasting musculoskeletal pain. Sex disparities exist in the prevalence of musculoskeletal disorders, but it remains unclear how reproductive history may impact sex differences. Specifically, the effects of both reproductive history and sex on the rotator cuff have not been studied. Pregnancy and lactation affect bone microstructure, suggesting possible impairments at the enthesis of rotator cuff tendons, where tears commonly occur. Therefore, our objective was to evaluate how reproductive history affects sex differences of the supraspinatus tendon and proximal humerus using male, virgin female, and female rats with a history of reproduction (referred to as reproductive females). We hypothesized tendon mechanical properties and humeral bone microstructure would be inferior in reproductive females compared to virgin females. Results showed sex differences independent of reproductive history, including greater tendon midsubstance modulus but lower subchondral bone mineral density (BMD) in females. When considering reproductive history, reproductive rats exhibited reduced tendon insertion site modulus and trabecular bone micro-architecture compared to virgin females with no differences from males. Overall, our study identified long-term changes in supraspinatus tendon mechanical and humeral trabecular bone properties that result following pregnancy and lactation, highlighting the importance of considering reproductive history in investigations of sex differences in the physiology and pathology of rotator cuff injuries.
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Affiliation(s)
- Ashley K. Fung
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania,Philadelphia, PA 19104; Department of Bioengineering, University of Pennsylvania,Philadelphia, PA 19104
| | - Yihan Li
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania,Philadelphia, PA 19104; Department of Bioengineering, University of Pennsylvania,Philadelphia, PA 19104
- University of Pennsylvania
| | - Jasmine Wang
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania,Philadelphia, PA 19104; Department of Bioengineering, University of Pennsylvania,Philadelphia, PA 19104
- University of Pennsylvania
| | - Thomas P. Leahy
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania,Philadelphia, PA 19104; Department of Bioengineering, University of Pennsylvania,Philadelphia, PA 19104
- University of Pennsylvania
| | - Snehal S. Shetye
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104
| | - X. Sherry Liu
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania,332A Stemmler Hall, Philadelphia, PA 19104-6081; Department of Bioengineering, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA 19104-6081
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania,307A Stemmler Hall, Philadelphia, PA 19104-6081; Department of Bioengineering, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA 19104-6081
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Hochman VGA, Nascimento RCFDA, da Silva CBM, Quinderé PNA, Melo RX, Velarde LGC, Bueno AC, Vieira AA. Relationship Between Maternal Age and Macronutrient Content of Colostrum. J Hum Lact 2024; 40:286-295. [PMID: 38411139 DOI: 10.1177/08903344241233500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Little is known about the relationship between maternal age and the macronutrient content of colostrum. RESEARCH AIMS This study aimed to evaluate the relationship between maternal age and human milk macronutrient content by comparing the concentrations of lactose, proteins, and lipids in the colostrum of women with younger, moderate, and advanced maternal age. METHODS An observational, cross-sectional study was designed to compare the macronutrient concentrations in the colostrum of women aged < 20 years, 20 to 34 years, and > 34 years (younger, moderate, and advanced maternal age, respectively; n = 33 per group). For each participant, 3 ml of colostrum was collected by manual extraction from the right breast at 10 am, 39-48 hr after delivery, and analyzed using a Miris Human Milk Analyzer. Macronutrient concentrations were compared between the groups using analysis of variance. P < 0.05 was considered significant. RESULTS Mothers with moderate maternal age had a higher colostrum lipid concentration than those with younger or advanced maternal age (2.3 mg, SD = 1.4 mg vs. 1.5 mg, SD = 1.0 mg vs. 1.6 mg, SD = 0.9 mg, respectively; p = 0.007). Lactose and protein contents in the analyzed samples did not differ among the three study groups. CONCLUSION This study lends support to the potential variation of lipids in colostrum by maternal age and suggests individual adaptation to the nutritional components of milk to the needs of the infant may be beneficial.
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Affiliation(s)
| | | | | | | | - Raquel Ximenes Melo
- National Institute for Women's, Children's and Adolescent's Health Fernandes Figueira/ FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Arnaldo Costa Bueno
- Faculty of Medicine, Maternal and Child Department, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Alan Araújo Vieira
- Faculty of Medicine, Maternal and Child Department, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Guerra J. Meet International Lactation Consultant Association's ® (ILCA ®) New Board Members. J Hum Lact 2024; 40:328. [PMID: 38407135 DOI: 10.1177/08903344241233582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
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Kozai S, Kato I, Mizuno N, Nakamura N, Okada H, Mizuno K, Kusaka T. Caffeine Concentrations in Human Milk Donated to a Human Milk Bank in Japan. J Hum Lact 2024; 40:307-313. [PMID: 38407091 DOI: 10.1177/08903344241231954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Human milk banks have been established to provide human milk to preterm infants who are unable to obtain milk from their mothers. Donor screening methods vary, and prospective donors are commonly screened for drug and recreational substance use through behavioral screening. Although the risk of illegal drug consumption in Japan is extremely low, caffeine may be consumed unknowingly and can be found in human milk. To date, only a few reports have been conducted on the concentration of caffeine in donor milk. RESEARCH AIM This study aimed to examine the pre-pasteurization levels of caffeine in human milk donated to a milk bank in Japan. METHODS This was a cross-sectional, observational study of caffeine concentrations in human milk donated to a human milk bank in Japan. Caffeine concentration in the donor milk was measured using high-performance liquid chromatography. RESULTS Caffeine was detected in 70% of the donor milk samples (N = 350). The median (range) of caffeine concentration was 0.46 [< 0.10, 7.54] mg/L, and 64.0% of the samples had less than 1 mg/L of caffeine. The caffeine concentration varied widely among as well as within individuals. CONCLUSION The average caffeine concentration in Japanese donor milk samples was higher than that previously reported in samples from Spain, but the range was similar. Donors should be informed that caffeine intake should be within a moderate range, to further increase the safety of donor milk.
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Affiliation(s)
- Shoko Kozai
- Department of Obstetrics and Gynecology, Yashima General Hospital, Kagawa, Japan
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Ikuko Kato
- Department of Health Sciences, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | | | | | - Hitoshi Okada
- Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Kagawa, Japan
| | - Katsumi Mizuno
- Japanese Human Milk Bank Association, Tokyo, Japan
- Department of Pediatrics, Showa University School of Medicine, Tokyo, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Marmet C, Dodgson JE. The Birth and Development of the Lactation Consultant Profession (1980-2007): An Interview With Chele Marmet (Part II). J Hum Lact 2024; 40:200-209. [PMID: 38509795 DOI: 10.1177/08903344241235169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The remarkable world-changing growth of International Board Certified Lactation Consultants (globally over 35,000 IBCLCs in 2023), as the internationally recognized lactation professional since Chele Marmet conceptualized the field in 1977, demonstrates its importance for society and breastfeeding dyads. The early 1980s was a seminal time in the development of lactation care as a allied health field with specialized knowledge, study, and certification. Chele Marmet played a significant role as an innovator and activist during all these major changes. In this interview, she details these historic events, which she is elaborating further in her upcoming memoir.Although the terms LC and lactation professional have commonly been used to refer to those working clinically with breastfeeding families, in this article both terms refer only to the International Board Certified Lactation Consultant (IBCLC). JHL has a policy not to use the term LC (Dodgson, 2016, 2020); our rationale is that this term is currently too vague and is often misused by those with less education and experience than IBCLCs. However, we have used LC in this article at times when referring to lactation professionals prior to the development of the international board examination. This article is the second part of the interview; Part I was published in the previous JHL issue (February 2014). This interview has been transcribed with minor editing for ease of reading. (CM = Chele Marmet, JD = Joan Dodgson).
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Affiliation(s)
- Chele Marmet
- Lactation Institute and Breastfeeding Clinic, Los Angeles, CA, USA
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Chetwynd E, Demirci J. The Gap Between Breastfeeding Research and the Clinical Needs of Lactation Support Providers. J Hum Lact 2024; 40:195-196. [PMID: 38606762 DOI: 10.1177/08903344241235166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Ellen Chetwynd
- School of Medicine, Department of Family Medicine University of North Carolina, Chapel Hill, NC, USA
| | - Jill Demirci
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Kiliçli Id A, Zeyneloglu Id S. Effect of Reflexology on Pain, Fatigue, Sleep Quality, and Lactation in Postpartum Primiparous Women After Cesarean Delivery: A Randomized Controlled Trial. J Hum Lact 2024; 40:221-236. [PMID: 38426483 DOI: 10.1177/08903344241232982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Mothers commonly experience pain, fatigue, sleep disruption, and breastfeeding problems after cesarean delivery. To date, no follow-up study has examined all of these variables to evaluate the utility of reflexology in reducing these problems and supporting breastfeeding. RESEARCH AIM This study aimed to determine the effect of foot reflexology performed in the postpartum period on pain, fatigue, sleep quality, and lactation in primiparous women who underwent cesarean delivery. METHODS This is a two-arm, parallel-group randomized controlled trial. Data were collected between January 1, 2020, and January 31, 2021, with a sample of 80 women who were randomly assigned to the reflexology (n = 40) and control (n = 40) groups. The reflexology group received 40 minutes of foot reflexology once a week for 8 weeks. The primary outcomes of the study were pain, fatigue, sleep quality, and breastfeeding efficacy. RESULTS Pain scores in the reflexology group decreased by 90.9% in week 1, 90.2% in week 2, and 59.8% in week 3 compared to the control group. Pain resolved at week 4 in the reflexology group and week 7 in the control group. The reflexology group showed a 36.9% decrease in fatigue level, a 48.0% increase in energy level, a 70.7% increase in sleep quality, and a 20.2% increase in breastfeeding efficacy compared to the control group (p < 0.05). CONCLUSIONS Foot reflexology reduces postpartum symptoms and positively affects breastfeeding and can be used safely in postnatal care practices.
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Affiliation(s)
- Ayşegül Kiliçli Id
- Nursing Department, Faculty of Health Sciences, Mus Alparslan University, Mus City, Turkey
| | - Simge Zeyneloglu Id
- Nursing Department, Faculty of Health Sciences, Gaziantep University, Gaziantep City, Turkey
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Hernández-Aguilar MT. BFHI Network News Brief: The BFHI in Slovenia and Croatia. J Hum Lact 2024; 40:331. [PMID: 38357891 DOI: 10.1177/08903344241232389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
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Zielinska-Pukos MA, Michalska-Kacymirow M, Kurek E, Bulska E, Grabowicz-Chądrzyńska I, Wesołowska A, Hamulka J. Breastmilk mineral composition among well-educated mothers from Central Poland - Associations with maternal dietary intake, dietary patterns and infant psychomotor development. J Trace Elem Med Biol 2024; 83:127393. [PMID: 38271826 DOI: 10.1016/j.jtemb.2024.127393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Maternal dietary habits could affect breastmilk mineral composition, which may influence infant development. Mineral dietary intake or supplementation slightly affects its breastmilk concentration. However, the intake of selected food groups or dietary patterns that reflect diet complexity could have a greater impact. Hence, the aim of the study was to assess breastmilk mineral composition at one, three, and six months of lactation among mothers living in urban area of Central Poland, as well as the evaluate maternal dietary determinants and associations with infant anthropometric and psychomotor development. METHODS The study was conducted among 43 healthy and exclusively breastfeeding mothers. In the first, third, and sixth months of lactation, we collected breastmilk samples and assessed the concentration of Ca, P, Zn, Fe, Se, Ni, As, Pb, and Cd using the ICP-MS method. Maternal dietary habits were evaluated by a food frequency questionnaire in the first month of lactation, whereas in the third and sixth by the three-day food record. Based on the collected data adherence to the Polish-adapted Mediterranean (Pl-aMED; 1 month) and the DASH diet (Mellen's Index; 3 and 6 months) was assessed. In the third and sixth months of lactation infant anthropometric parameters and the sixth month of lactation psychomotor development were evaluated. RESULTS Breastmilk Se, Ni, As, Pb, and Cd levels were under the LOQ in all the breastmilk samples at all study visits. Median breastmilk mineral concentrations of Ca, P, Zn, and Fe in the first, third, and sixth months of lactation varied from 381.9 to 332.7 mg/L, 161.6 to 139.1 mg/L, 2.2 to 0.8 mg/L, and 0.26 to 0.17 mg/L, respectively. Maternal dietary intake and supplementation did not affect breastmilk Ca, P, Zn, and Fe. Pl-aMED scores were associated with breastmilk Ca (β = 0.489, 95% CI 0.180 - 0.799, p = 0.003) and Zn (β = 0.499, 95% CI 0.199 - 0.798, p = 0.002) in the first month of lactation, whereas no association with the DASH diet were observed in the third and sixth month of lactation. Breastmilk Fe in the third month was associated with infant motor development (β = 0.420, 95% CI 0.113 - 0.727, p = 0.009) in the sixth month of life, but no other associations with anthropometric or psychomotor development were observed. Moreover, we estimated that few infants meet their adequate intake (AI) requirements for P, Zn, and Fe. CONCLUSION Our study showed that maternal adherence to Pl-aMED is a significant predictor of breastmilk Ca and Zn in the first month of lactation, which may be especially important considering that more than 75% of infants had inadequate Zn intake. Moreover, we found that breastmilk Fe positively influenced infant motor development, despite the majority of infants having inadequate intake. On the other hand, no infant had deficiency symptoms, which emphasizes the necessity to evaluate of AI norms for infants.
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Affiliation(s)
- Monika A Zielinska-Pukos
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska St. 159c, 02-776 Warsaw, Poland.
| | - Magdalena Michalska-Kacymirow
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Żwirki i Wigury St. 101, 02-089 Warsaw, Poland
| | - Eliza Kurek
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Żwirki i Wigury St. 101, 02-089 Warsaw, Poland
| | - Ewa Bulska
- Faculty of Chemistry, Biological and Chemical Research Centre, University of Warsaw, Żwirki i Wigury St. 101, 02-089 Warsaw, Poland
| | | | - Aleksandra Wesołowska
- Department of Medical Biology, Laboratory of Human Milk and Lactation Research at Regional Human Milk Bank in Holy Family Hospital, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland
| | - Jadwiga Hamulka
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), Nowoursynowska St. 159c, 02-776 Warsaw, Poland
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Blauvelt CA, Turcios S, Wen T, Boscardin J, Seidman D. Breastfeeding Initiation in People With Hepatitis C Virus Infection in the United States. Obstet Gynecol 2024; 143:683-689. [PMID: 38513240 DOI: 10.1097/aog.0000000000005555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To evaluate breastfeeding initiation rates among people living with and without hepatitis C virus (HCV) infection during pregnancy and to identify characteristics associated with breastfeeding initiation. METHODS We conducted a cross-sectional analysis of individuals who had a live birth in the United States from 2016 to 2021 using the National Center for Health Statistics birth certificate data. We grouped participants by whether they had HCV infection during pregnancy. Using propensity-score matching, we assessed the association between breastfeeding initiation before hospital discharge , defined as neonates receiving any parental breast milk or colostrum, and HCV infection during pregnancy in a logistic regression model. We also assessed factors associated with breastfeeding initiation among those with HCV infection. RESULTS There were 96,896 reported cases (0.5%) of HCV infection among 19.0 million births that met inclusion criteria during the study period. Using propensity-score matching, we matched 87,761 individuals with HCV infection during pregnancy with 87,761 individuals without HCV infection. People with HCV infection during pregnancy were less likely to initiate breastfeeding compared with those without HCV infection (51.5% vs 64.2%, respectively; odds ratio 0.59, 95% CI, 0.58-0.60, P <.001). Characteristics associated with higher rates of breastfeeding initiation among individuals with HCV infection included a college degree (adjusted odds ratio [aOR] 1.22, 95% CI, 1.21-1.24); self-identified race or ethnicity as Native Hawaiian or Pacific Islander (aOR 1.22, 95% CI, 1.06-1.40), Asian (aOR 1.09, 95% CI, 1.06-1.13), or Hispanic (aOR 1.09, 95% CI, 1.08-1.11); private insurance (aOR 1.07, 95% CI, 1.06-1.08); nulliparity (aOR 1.09, 95% CI, 1.08-1.10), and being married (aOR 1.08, 95% CI, 1.07-1.09). Characteristics associated with not breastfeeding before hospital discharge included receiving no prenatal care (aOR 0.81, 95% CI, 0.79-0.82), smoking during pregnancy (aOR 0.88, 95% CI, 0.88-0.89), and neonatal intensive care unit admission (aOR 0.92, 95% CI, 0.91-0.93). CONCLUSION Despite leading health organizations' support for people living with HCV infection to breastfeed, our study demonstrates low breastfeeding initiation rates in this population. Our findings highlight the need for tailored breastfeeding support for people with HCV infection and for understanding the additional effects of human immunodeficiency virus (HIV) co-infection, HCV treatment, and concurrent substance use disorders on breastfeeding initiation.
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Affiliation(s)
- Christine A Blauvelt
- Department of Obstetrics, Gynecology and Reproductive Sciences and the School of Medicine, University of California, San Francisco, San Francisco, California
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Silva RS, Vasconcelos CM, Pessoa IS, Santos TCD, Scherer R, Endringer DC, Fronza M. Influence of Maternal Dietary Pattern on the Pro-Oxidant and Antioxidant Status of Mother's Own Milk. J Hum Lact 2024; 40:296-306. [PMID: 38407258 DOI: 10.1177/08903344241233571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Human milk is essential for a child's best development. However, what a mother eats while breastfeeding can directly influence the composition of mother's milk. RESEARCH AIM This study aimed to assess the antioxidant-oxidant profile of human milk and establish a connection between this profile and the dietary habits of the mothers. METHODS A cross-sectional study was conducted at the Hospital Infantil e Maternidade Alzir Bernardino Alves (HIMABA), located in the municipality of Vila Velha-ES, Brazil. The sample included 98 participants. All volunteers completed a structured interview and a Food Frequency Questionnaire. Approximately 5-10 ml of colostrum, transitional milk, and mature milk were manually collected. The antioxidant activity of human milk was assessed using the colorimetric method for free radical scavenging with 2,2'-azinobis-3-ethylbenzothiazoline-6-sulfonic acid. Oxidative stress was determined by measuring lipid peroxidation through malondialdehyde concentration, evaluating advanced oxidation protein products, and assessing total protein content using the Bradford method. RESULTS The antioxidant profile of colostrum was higher than that observed in later phases of milk, whereas pro-oxidants increased in later phases. Maternal dietary patterns influenced the pro-oxidant status of human milk. Participants with a higher daily intake of milk, dairy products, vegetable oils, olive oils, and legumes exhibited lower levels of lipid peroxidation in colostrum, transition milk, and mature milk, respectively. CONCLUSIONS Our study highlights the vital role of a balanced maternal diet in shaping the pro-oxidant status of human milk, with implications for infant health.
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Affiliation(s)
- Racire Sampaio Silva
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | | | - Iana Soares Pessoa
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | | | - Rodrigo Scherer
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | - Denise Coutinho Endringer
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
- Instituto Capixaba de Ciências e Administração (ICCA), Vila Velha, Brazil
| | - Marcio Fronza
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
- Instituto Capixaba de Ciências e Administração (ICCA), Vila Velha, Brazil
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14
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Abstract
Cow's milk allergy refers to an immunological reaction to milk protein. It is one of the commonest food protein allergies with an estimated prevalence of 0.5% to 3% at 1 y of life. The disease may be IgE or non-IgE mediated or mixed with a wide range of symptoms often involving multiple organ systems. Gastrointestinal manifestations are common in non-IgE disease and may consist of enteropathy, proctocolitis, colic, reflux-like symptoms, constipation, enterocolitis syndrome and eosinophilic esophagitis. The gold standard for diagnosis remains a double-blind placebo-controlled oral challenge. Specific IgE and skin prick tests may predict severe and persistent disease, and aid in deciding on reintroduction or oral immunotherapy; however, they do not contribute to a definitive diagnosis as they indicate only sensitization. In practice, an elimination diet followed by open challenge under medical supervision is often used for diagnosis except when symptoms are severe such as anaphylaxis. Management consists of the elimination of the allergen with resolution of symptoms between 1-4 wk later depending on the type of allergy. Extensively hydrolyzed and Amino acid formulas are used to substitute milk in infants. Soy-based formulas are often utilized in resource-limited settings. Tolerance to the protein develops over time and periodic reintroduction should be attempted every six months after the initial one year of elimination diet. Oral immunotherapy is a newer treatment technique for IgE-mediated disease. There is no firm evidence on prevention apart from recommending breast feeding in early life along with initiating complementary feeding between 4-6 mo age.
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Affiliation(s)
- Rohan Malik
- Division of Pediatric Gastroenterology, Hepatology and Clinical Nutrition, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Sanjeevani Kaul
- Division of Pediatric Gastroenterology, Hepatology and Clinical Nutrition, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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15
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Kassir R, Ghani R. Comments on "Association Between Bariatric Surgery and Breastfeeding Outcomes in Women: A Retrospective Case-Control Study". Obes Surg 2024; 34:1954-1955. [PMID: 38438669 DOI: 10.1007/s11695-024-07149-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Radwan Kassir
- Department of Digestive and Bariatric Surgery, The View Hospital, Legtaifiya, Doha, Qatar.
| | - Rauf Ghani
- Department of Obstetrics and Gynecology, The View Hospital, Legtaifiya, Doha, Qatar
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16
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Chetwynd E. Ethical Use of Artificial Intelligence for Scientific Writing: Current Trends. J Hum Lact 2024; 40:211-215. [PMID: 38482810 PMCID: PMC11015711 DOI: 10.1177/08903344241235160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Ellen Chetwynd
- Department of Family Medicine, University of North Carolina, School of Medicine, Chapel Hill, NC, USA
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17
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18
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Strobl F, Theurich MA. Prolonged Jaundice in a Premature Breastfed Infant With Gilbert's Syndrome. J Hum Lact 2024; 40:270-275. [PMID: 38334089 PMCID: PMC11015704 DOI: 10.1177/08903344241227226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Neonatal jaundice and prematurity pose significant barriers to breastfeeding in the first days of life. There is limited literature exploring the relationship between prolonged jaundice in breastfed infants and Gilbert's (Meulengraght) syndrome. This case study describes the diagnostic and therapeutic challenges associated with Gilbert's syndrome in a late preterm breastfed infant born in Germany. MAIN ISSUE In this case report, an infant born to a primipara woman presented at 3 weeks postpartum to an International Board Certified Lactation Consultant. The initial assessment revealed a late preterm infant with inadequate weight gain and jaundice. The dyad received breastfeeding support and eventually achieved adequate weight gain; however, the infant's jaundice persisted. MANAGEMENT The consulting midwife suggested that the persistent jaundice was "breastmilk jaundice" and recommended temporarily interrupting breastfeeding. Due to a suspected family history of Gilbert's Syndrome, the dyad was referred, instead, to a pediatric gastroenterologist. Pathologic liver disease was excluded, and genetic testing confirmed Gilbert's Syndrome. At 6 months of age, the dyad was successfully breastfeeding and beginning complementary feeding. CONCLUSION Genetic testing for Gilbert's Syndrome should be considered for infants with prolonged jaundice and positive family history. Interruption or cessation of breastfeeding are not evidence-based recommendations, and current guidelines do not support these practices. Lactation professionals play a critical role in the management of breastfeeding for preterm infants with prolonged jaundice and should refer to specialists to rule out pathologic etiologies.
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Affiliation(s)
- Frances Strobl
- School of Life Sciences, Technical University of Munich, Munich, Germany
| | - Melissa Ann Theurich
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkoffer School of Public Health, Faculty of Medicine, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
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19
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Mokhlesi SS, Vasilevski V, Sweet L. Breastfeeding and pre-pregnancy bariatric surgery: A scoping review. Women Birth 2024; 37:101600. [PMID: 38513305 DOI: 10.1016/j.wombi.2024.101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Bariatric surgery is a procedure for people with class II and III obesity who are unable to lose weight using traditional methods. The incidence rate of bariatric surgery in reproductive-age women is increasing rapidly, so the number of women who become pregnant after bariatric surgery is rising. AIM To collate and synthesise available literature regarding breastfeeding following bariatric surgery. METHODS This review was reported by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-Scr). The review included peer-reviewed research studies and research-based conference abstracts on breastfeeding outcomes in mothers who have undergone bariatric surgery before pregnancy. Health databases were searched from 1990 to December 2023. Included studies were analysed using a narrative synthesis. FINDINGS From 1506 abstracts, 16 papers were identified. Three themes emerged from the analysis: challenges in exclusive breastfeeding, nutritional composition in breast milk, and breastfeeding experience. There was a tendency for lower breastfeeding rates and shorter durations in mothers who had bariatric surgery. Most studies focussed on the nutritional composition of breast milk however these results were mixed. Only three articles were qualitative, and their findings showed that women wanted more information and support about breastfeeding following bariatric surgery. DISCUSSION Our review indicates breastfeeding challenges in post-bariatric surgery mothers and reduced breastfeeding rates. It is unclear whether bariatric surgery impacts the nutritional quality of breast milk due to inconsistent study outcomes. CONCLUSION Future research is essential, specifically on understanding the breastfeeding concerns and experiences of women who have undergone bariatric surgery.
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Affiliation(s)
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Center for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Center for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
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20
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Long-Goding JL. LEAARC NEWS BRIEF: Lactation Education and Approval Review Committee News. J Hum Lact 2024; 40:332. [PMID: 38389288 DOI: 10.1177/08903344241232390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
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21
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Radwan H, Naja F, Abbas N, Kharma JA, Obaid RS, Al Ghazal H, Abdelrahim DN, Saqan R, Alameddine M, Al Hilali M, Hasan H, Hashim M. Influence of maternal characteristics and infant feeding patterns on infant growth from birth till 18 months: The MISC study. Pediatr Obes 2024; 19:e13106. [PMID: 38383983 DOI: 10.1111/ijpo.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND The growth and development of infants during the first 1000 days of life are crucial for their health. OBJECTIVES This study aims to assess the impact of maternal characteristics and infant feeding patterns on infant growth from birth to 18 months. METHODS Data were derived from the 2-year perspective Mother Infant Study Cohort (MISC) study which included six visits from the third trimester of pregnancy until 18 months postpartum. A convenient sample of 256 pregnant women aged 19-40 years was recruited from Sharjah, Dubai and Ajman in the United Arab Emirates. RESULTS Amongst mothers' characteristics, Arab nationality, pre-pregnancy overweight/obesity, higher gestational weight gain and lower physical activity were found to increase the likelihood of infants being overweight at 6, 12 and 18 months. Exclusive breastfeeding was positively correlated with reduced odds of the infant being overweight at 18 months (aOR = 0.31, 95% CI: 0.12-0.81). Breastfeeding for up to 6 months and the introduction of solid foods after 6 months was associated with reduced odds of the infant being overweight at 12 months old (aOR = 4, 95% CI: 1.1-14.6; aOR = 2.97, 95% CI: 1.09-8.08, respectively). CONCLUSION The findings spotlight the influence of maternal characteristics and infant feeding on infant growth. This asserts the need for evidence-based programmes targeting mothers to promote optimal feeding practices and foster healthy child growth.
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Affiliation(s)
- Hadia Radwan
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Farah Naja
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nada Abbas
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Joelle Abi Kharma
- Nutrition Program, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Reyad Shaker Obaid
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Hessa Al Ghazal
- Sharjah Child-Friendly Office-Sharjah Health Authority, Sharjah, United Arab Emirates
| | - Dana N Abdelrahim
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Roba Saqan
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Marwa Al Hilali
- Clinical Nutrition Department, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Hayder Hasan
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Mona Hashim
- College of Health Sciences, Department of Clinical Nutrition and Dietetics, Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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22
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Lojander J, Axelin A, Niela-Vilén H. 'Breastfeeding exclusivity, difficulties, and support in the first days after hospital discharge: A correlational study'. Eur J Obstet Gynecol Reprod Biol 2024; 296:76-82. [PMID: 38412800 DOI: 10.1016/j.ejogrb.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/12/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Global breastfeeding rates are not optimal, and the early postpartum period represents a critical time for breastfeeding initiation. The Baby-Friendly Hospital Initiative endeavours to provide mothers with evidence-based breastfeeding support in birth hospitals. This study examined factors associated with breastfeeding exclusivity and breastfeeding difficulties in the first days after being discharged from Baby-Friendly designated hospital. The adequacy of breastfeeding support and maternal preferences for optimal support were also reported. STUDY DESIGN A non-experimental correlational study was conducted between May 2021 and October 2022. A total of n = 80 breastfeeding mothers completed a semi-structured questionnaire within two weeks of discharge from Baby-Friendly hospital in Finland. The questionnaire included demographic and obstetric background information and six questions on breastfeeding exclusivity, breastfeeding difficulties, and breastfeeding support. Descriptive statistical analysis and multivariate binary logistic regression analysis were performed. RESULTS The mean age of the mothers was 30.6 years (SD 5.4), and half of the mothers were primiparas (49 %). Most mothers gave birth vaginally (85 %) to a full-term infant (84 %). Most (85 %) had made some prenatal plans for breastfeeding, and the median planned duration of breastfeeding was 12 months. Half of the infants (53 %) received supplemental milk while in the hospital. Most mothers (81 %) were exclusively breastfeeding after hospital discharge. Mothers whose infants received supplemental milk in the hospital had an increased odds of non-exclusive breastfeeding (aOR 16.5 [CI 95 % 1.7-156.7], p 0.015). Approximately one-third of the mothers (39 %) experienced breastfeeding difficulties. Primiparous mothers had increased odds of experiencing breastfeeding difficulties (aOR 3.41 [CI 95 % 1.2-9.8], p 0.023). Mothers who received adequate postnatal breastfeeding support in birth hospital had decreased odds of experiencing breastfeeding difficulties (aOR 0.16 [CI 95 % 0.03-0.8], p 0.026). Mothers were mainly satisfied with breastfeeding support, although timelier access to support was preferred after hospital discharge. CONCLUSION Adequate in-hospital postnatal breastfeeding support, including avoidance of non-medical supplementation, contributes to successful breastfeeding after hospital discharge in terms of more exclusive breastfeeding and fewer breastfeeding difficulties. Primiparous mothers need emphasized support to mitigate breastfeeding difficulties. Timelier access to breastfeeding support after discharge is needed.
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Affiliation(s)
- Jaana Lojander
- Department of Nursing Science, 20014 University of Turku, Finland.
| | - Anna Axelin
- Department of Nursing Science, 20014 University of Turku, Finland
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23
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Abstract
Culture competence is a concept that can be traced back to health care considerations in the 1960s and 1970s, and in particular to nursing education. Critics of the concept have argued that this was not simple a listing of cultural facts, behaviors, and practices, but instead follow a more ethnographic understanding of culture. In this article, I recognize that culture is not simply about the other, but something we all possess, and is also always changing throughout our lives. Understanding and respecting diversity and culture is key to improving services, including lactation support.
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Affiliation(s)
- Tanya M Cassidy
- Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Ireland
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24
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Westerkam L, Masson R, Hsiao J, Sayed CJ. A survey-based study evaluating breastfeeding decisions and their impact on management in patients with hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:1023-1025. [PMID: 38185255 DOI: 10.1016/j.jaad.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/17/2023] [Accepted: 12/31/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Linnea Westerkam
- University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Rahul Masson
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jennifer Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, California
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina
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25
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Lima HK, Licata A, Mattos S. Assessing the Landscape of Lactation Education: Results of a Pilot Survey. J Hum Lact 2024; 40:276-285. [PMID: 38419567 DOI: 10.1177/08903344241232402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The field of lactation currently uses breastfeeding rates to measure effectiveness. While monitoring breastfeeding outcomes can provide insight into the successes of lactation consulting as a profession, the improvement of breastfeeding outcomes is a multifactorial issue. In order to facilitate the growth of lactation education processes, understanding experiences during training and perceptions of readiness of current International Board Certified Lactation Consultants (IBCLC) for clinical practice is necessary. RESEARCH AIM The aim of this survey was to provide a baseline assessment of the current landscape of the lactation profession through data related to certification, job market, practice confidence after passing the International Board of Lactation Consultant Examiners (IBLCE) certifying examination, and perceptions of specializations. METHODS A cross-sectional study design was used to assess the experiences of practicing IBCLCs. Non-probability convenience sampling was implemented from December 2021 through January 2022. A total of 281 unique responses were recorded with complete data on variables of interest. RESULTS The majority of respondents were white females under age 50 located in the United States. The majority of respondents were certified through a Pathway 1. The largest barrier to certification was reported to be a lack of clinical/mentorship opportunities. Respondents were significantly more confident in providing entry-level support to dyads when mentored by four or more preceptors. CONCLUSION Diversification of the field of lactation is necessary to provide appropriate support to lactating families in the United States. Additionally, addressing the barrier of accessing clinical/mentorship opportunities is essential for continued growth of the field of lactation.
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Affiliation(s)
| | - Ashley Licata
- Department of Human Nutrition, Winthrop University, Rock Hill, SC, USA
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26
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Muniz MCR, Lima RV, Maia VQCC, Bezerra AM, Freire IF, Lima MCC, Matos YMT, Pontes LP, Cavalcante ANM. The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis. Eur J Pediatr 2024; 183:2049-2058. [PMID: 38456990 DOI: 10.1007/s00431-024-05501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
Several potential risk factors have been identified in the etiopathogenesis of febrile seizures (FS), including the type and extent of breastfeeding (BF). Given the lack of conclusive data, this study aims to systematically evaluate the evidence on the association between BF and FS. We conducted a systematic review and meta-analysis according to PRISMA guidelines. The search was conducted using descriptors for FS, BF, and formula feeding in MEDLINE, Embase, and Web of Science databases. We included observational studies that compared the incidence of FS between those who had ever breastfed and those who were formula fed. The study protocol was registered on the PROSPERO platform under the number CRD42023474906. A total of 1,893,079 participants from 8 datasets were included. Our main analysis showed no significant association of any type of BF on the incidence of FS compared with formula-fed children (OR: 0.84; CI: 0.67-1.04; I2 = 78%; Cochran's Q = 0.0001), although meta-regression showed that BF was associated with a lower incidence of FS in preterm infants. Our secondary outcome showed a significantly reduced incidence of FS in children who received BF exclusively (OR: 0.80; CI: 0.65-0.99; I2 = 70%; Cochran's Q = 0.02). Conclusion: There was no significant reduction in the incidence of FS in those who were breastfed compared to formula feeding. However, our meta-regression analysis indicated an association between BF and a lower incidence of FS in preterm infants. Additionally, children who exclusively received BF had a significantly reduced incidence of FS. These findings should be further investigated in prospective cohorts. What is Known: • Breastfeeding can modify risk factors for febrile seizures, such as susceptibility to viral and bacterial infections, micronutrient deficiencies, and low birth weight. • However, studies have shown conflicting results regarding the impact of breastfeeding on febrile seizures. What is New: • When comparing any breastfeeding pattern with no breastfeeding, there is no significant difference in the incidence of febrile seizures. • When comparing exclusive breastfeeding with no breastfeeding, there may be a decrease in the occurrence of febrile seizures.
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Affiliation(s)
- Maria Carolina Rocha Muniz
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Rian Vilar Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil.
| | | | - Arthur Meneses Bezerra
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Isabela Franco Freire
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Manuela Cavalcante Coling Lima
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Yuri Marques Teixeira Matos
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Letícia Pinheiro Pontes
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
| | - Ana Nery Melo Cavalcante
- Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil
- PhD in Collective Health By the University of Fortaleza, Neonatologist Pediatrician at Dr. César Cals de Oliveira General Hospital, Fortaleza, Ceara, Brazil
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Das D, Trikha A, Kaur M, Muthiah T, Pandey RK, Ankalji B, Madhusudhan KS, Srivastava DN, Singh PM. Comparison of gastric emptying time between breast-fed and formula milk-fed infants less than 6 months old, using gastric ultrasound-An observational study. Paediatr Anaesth 2024; 34:430-437. [PMID: 38323713 DOI: 10.1111/pan.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Fasting before elective anesthesia care is a standardized practice worldwide. The aim is to decrease the risk of aspiration leading to pulmonary complications such as aspiration pneumonitis during anesthesia care. There are different guidelines for elective preoperative fasting in children. However, there is insufficient literature measuring gastric emptying time after breast milk or formula milk feeding in infants. OBJECTIVE This study used gastric ultrasound to determine the gastric emptying time for breast milk and formula milk in children below 6 months of age. We also compared the calculated gastric volumes among breast-fed and formula milk-fed based on Schmitz's and Spencer's formula. MATERIALS AND METHODS This prospective observational study was conducted at a tertiary care center in India between November (2017-2019). A total of 52 infants less than 6 months of age were recruited. The study population was divided into two groups (breast-fed and formula milk-fed) of 26 patients each. Ultrasound was used to measure the antral cross-sectional area of the stomach and to calculate the gastric volume using the two classical formulas (Schmitz and Spencer's). Gastric emptying was reported when the bull's eye appearance of the gastric antrum was seen or when the antral cross-sectional area was less than 3.07 cm2. RESULTS The number of breast-fed children whose antral cross-sectional was greater than 3.07 cm2 (cut-off value for aspiration risk) beyond 1 h was 14/26 (53.84%) while none (0) children went beyond 3 h. The number of formula-fed children whose antral cross-sectional was greater than 3.07 cm2 beyond 1 h was 17/26 (65.38%) while one child (3.84%) went beyond 3 h. Using Schmitz's formula, mean (SD) gastric emptying times were 0.35 ± 0.68 h (95% CI 0.35 ± 0.185, range 0.165-0.535) for breast-fed patients and 0.35 ± 0.69 h (95% CI 0.35 ± 0.188, range 0.162-0.538) for formula-fed patients, and were thus neither clinically nor statistically different (p = .73) Using Spencer's formula, the mean gastric emptying times were 0.12 ± 0.33 h (95% CI 0.12 ± 0.09, range 0.03-0.21) for breast-fed patients and 0.04 ± 0.20 h (95% CI 0.04 ± 0.05, range -0.01 to 0.09) for formula-fed patients, and were also neither clinically nor statistically different p = .13. CONCLUSION In our series, the gastric emptying times in breast-fed and formula-fed infants less than 6 months old were similar. Our results support the fasting guidelines of the European Society of Anaesthesiology and Intensive Care 2022, that is, 3 h for breastfeeding and 4 h for formula milk feeding. In addition, this shows that the Schmitz's and Spencer's formulae used to calculate the gastric volume based on ultrasound measurement of the antral cross-sectional area are not comparable in infants less than 6 months.
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Affiliation(s)
- Debashis Das
- Department of Anesthesia, Indira Gandhi Memorial Hospital, Male, Maldives
| | - Anjan Trikha
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Manpreet Kaur
- Department of Anesthesiology and Peri operative Medicine, Penn State Milton S, Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Ravinder Kumar Pandey
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Basavraj Ankalji
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Romano ME, Gallagher LG, Price G, Crawford KA, Criswell R, Baker E, Botelho JC, Calafat AM, Karagas MR. Plasma per- and polyfluoroalkyl substance mixtures during pregnancy and duration of breastfeeding in the New Hampshire birth cohort study. Int J Hyg Environ Health 2024; 258:114359. [PMID: 38521049 DOI: 10.1016/j.ijheh.2024.114359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Prior studies suggest that prenatal per- and polyfluoroalkyl substances (PFAS) exposures are associated with shorter breastfeeding duration. Studies assessing PFAS mixtures and populations in North America are sparse. METHODS We quantified PFAS concentrations in maternal plasma collected during pregnancy in the New Hampshire Birth Cohort Study (2010-2017). Participants completed standardized breastfeeding surveys at regular intervals until weaning (n = 813). We estimated associations between mixtures of 5 PFAS and risk of stopping exclusive breastfeeding before 6 months or any breastfeeding before 12 months using probit Bayesian kernel machine regression. For individual PFAS, we calculated the relative risk and hazard ratio (HR) of stopping breastfeeding using modified Poisson regression and accelerated failure time models respectively. RESULTS PFAS mixtures were associated with stopping exclusive breastfeeding before 6 months, primarily driven by perfluorooctanoate (PFOA). We observed statistically significant trends in the association of perfluorohexane sulfonate (PFHxS), PFOA, and perfluorononanoate (PFNA) (p-trends≤0.02) with stopping exclusive breastfeeding. Participants in the highest PFOA quartile had a 28% higher risk of stopping exclusive breastfeeding before 6 months compared to those in the lowest quartile (95% Confidence Interval: 1.04, 1.56). Similar trends were observed for PFHxS and PFNA with exclusive breastfeeding (p-trends≤0.05). PFAS were not associated with stopping any breastfeeding before 12 months. CONCLUSIONS In this cohort, we observed that participants with greater overall plasma PFAS concentrations had greater risk of stopping exclusive breastfeeding before 6 months and associations were driven largely by PFOA. These findings further support the growing literature indicating that PFAS may be associated with shorter duration of breastfeeding.
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Affiliation(s)
- Megan E Romano
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA.
| | - Lisa G Gallagher
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | - George Price
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
| | | | - Rachel Criswell
- Skowhegan Family Medicine, Redington-Fairview General Hospital, Skowhegan, ME, USA
| | - Emily Baker
- Department of Obstetrics and Gynecology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Julianne Cook Botelho
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret R Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH, USA
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Koenig T, Robins C, Darby Lipman P, Dinatale M, Johnson T, Sahin L, Roca C, Limpert J, Baisden K, Mulugeta Y, Yao L, Jennings KA, Alimchandani M, Everett D, Gassman A, Chang C, Ellis C, Pfuma Fletcher E, Samuels S. Healthcare providers' use of a concise summary to prescribe for lactating patients. Res Social Adm Pharm 2024; 20:531-538. [PMID: 38413289 DOI: 10.1016/j.sapharm.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Most breastfeeding individuals take at least one prescription drug, yet limited data from lactation studies are available to inform the safety of these drugs during breastfeeding. As a result, healthcare providers (HCPs) rely on available information about safety of drugs used during pregnancy or on personal experiences to inform prescribing/counseling decisions for breastfeeding individuals. To improve risk communication regarding drugs used during lactation, the U.S. Food and Drug Administration published the Pregnancy and Lactation Labeling Rule (PLLR) in 2015, which added a narrative summary of available risk information to the lactation section of Prescribing Information (PI). Prior studies on labeling in PLLR format revealed that although HCPs found these details valuable, they regarded the narrative as too long to support decision-making during patient encounters. OBJECTIVE This qualitative study's objective was to assess the utility of adding a concise summary to the Lactation subsection of PI to complement the narrative and succinctly communicate to busy HCPs a drug's risks when used during lactation. The concise summary consisted of a bolded headline, bulleted descriptions of available study findings and potential adverse reactions, and recommendations for risk mitigation. METHODS Twenty-five online focus groups were conducted with five segments of HCPs to obtain their feedback on the concise summary and discuss their prescribing/counseling decisions for four fictitious prescription drugs including one vaccine. RESULTS HCPs utilized the concise summary to make initial prescribing/counseling decisions. Many also used the labeling narrative for a comprehensive benefit-risk assessment. CONCLUSION The findings indicate a need to continue to improve communication about safety of drugs used during lactation, and that the concise summary may help facilitate this communication. The study also highlights the need to educate HCPs about PI limitations when clinical data are lacking and the need to encourage clinical studies to be conducted to support actionable recommendations about use of prescription drugs during lactation.
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Affiliation(s)
| | | | | | | | - Tamara Johnson
- United States Food and Drug Administration, United States
| | - Leyla Sahin
- United States Food and Drug Administration, United States
| | - Catherine Roca
- United States Food and Drug Administration, United States
| | | | | | - Yeruk Mulugeta
- United States Food and Drug Administration, United States
| | - Lynne Yao
- United States Food and Drug Administration, United States
| | | | | | - Darcie Everett
- United States Food and Drug Administration, United States
| | - Audrey Gassman
- United States Food and Drug Administration, United States
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30
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Beltran-Silva F, McInnis N. Relationship Between Sex-Specific Labor Market Performance and Breastfeeding Prevalence. J Hum Lact 2024; 40:318-327. [PMID: 38454611 DOI: 10.1177/08903344241230547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Prior research has explored the association between women's employment status and breastfeeding at the individual level, however; a notable gap in scholarly inquiry exists regarding the relationship between labor market performance and breastfeeding at the population level. RESEARCH AIM The aim of this paper is to investigate the association between labor market performance and breastfeeding prevalence in the United States. METHODS This study is a cross-sectional analysis of the association between labor market performance and the prevalence of breastfeeding. Our analysis is conducted at the state level using data published up to late 2021 from the Current Population Survey and the National Immunization Survey. The first dataset was used to construct aggregate and sex-specific state level indicators of labor market performance for both males and females. The second dataset supplied the proportion of mothers breastfeeding for the corresponding birth cohort from each state. RESULTS Higher average weekly hours worked by females in the year before giving birth was associated with a lower prevalence of breastfeeding, but employment rates among females did not significantly affect breastfeeding prevalence. Among males, current employment rates were positively associated with breastfeeding prevalence; however, no significant relationship was observed between breastfeeding prevalence and average weekly work hours worked. CONCLUSION Sex-specific labor market performance may play a role in breastfeeding decisions and the timing of labor market performance relative to childbirth is important. Furthermore, these results highlight that employment rates and hours worked might be associated with child health through breastfeeding prevalence.
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Affiliation(s)
- Francisco Beltran-Silva
- Bookstein Hall David Nazarian College of Business and Economics, California State University Northridge, Northridge, CA, USA
| | - Nicardo McInnis
- Bookstein Hall David Nazarian College of Business and Economics, California State University Northridge, Northridge, CA, USA
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Garrido F, González-Caballero JL, García P, Gianni ML, Garrido S, González L, Atance V, Raffaeli G, Cavallaro G. Association between co-sleeping in the first year of life and preschoolers´ sleep patterns. Eur J Pediatr 2024; 183:2111-2119. [PMID: 38351212 DOI: 10.1007/s00431-024-05429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 03/27/2024]
Abstract
This study aimed to investigate the association between co-sleeping practiced during the first year of life and preschoolers' sleep patterns. A cross-sectional study including toddlers was designed to analyze their sleep patterns. The Brief Infant Sleep Questionnaire, validated in Spanish, was used to measure sleep quality. A latent class analysis was performed to identify qualitative subgroups in the sample and explore the effects of co-sleeping. The sleep patterns of 276 children were analyzed. A total of 181 (65%) parents reported having practiced co-sleeping with their children. The latent class analysis identified a two-class solution with two different sleep patterns. One of them showed a worse quality sleep pattern, which had a significant association with having practiced co-sleeping during the first year of life, and with the fact that they were still sleeping in the parents' room, among other characteristics related to co-sleeping and parental concerns. Breastfeeding also showed association with a worse quality sleep pattern. Conclusion: Based on the present findings, co-sleeping during the first year of life appears to be associated with poor sleep patterns in young preschoolers. What is Known: • Co-sleeping shows benefits for infants and parents, mainly facilitating successful breastfeeding. • Literature on the effect of co-sleeping in lately sleep quality in children and their parents is very limited. What is New: • Co-sleeping practiced during the first year of life could be associated with a worse sleep pattern measured with BISQ-E tool. • A balance between the correct practice of co-sleeping and the achievement of a healthy sleep routine in preschool should probably be part of parents' health education.
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Affiliation(s)
- Felipe Garrido
- Department of Pediatrics, Clínica Universidad de Navarra. Calle Marquesado de Santa Marta, 1, Madrid (28227), Spain.
| | | | | | - Maria-Lorella Gianni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
- Neonatal Intensive Care Unit. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. 20122, Milan, Italy
| | - Silvia Garrido
- Department of Pediatrics, Clínica Universidad de Navarra, Madrid (28227), Spain
| | - Lucía González
- Department of Pediatrics, Clínica Universidad de Navarra, Madrid (28227), Spain
| | - Verónica Atance
- Department of Pediatrics, Clínica Universidad de Navarra, Madrid (28227), Spain
| | - Genny Raffaeli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
- Neonatal Intensive Care Unit. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. 20122, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. 20122, Milan, Italy
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Sterken E. Conflict of Interest and the Protection of Breastfeeding. J Hum Lact 2024; 40:329-330. [PMID: 38389295 DOI: 10.1177/08903344241232384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
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Han S, Kim B, Park H. Auricular Acupressure on Breast Pain Among Breastfeeding Mothers Receiving Gentle Hand Techniques: A Randomized, Single-Blind, Sham-Controlled Trial. J Hum Lact 2024; 40:248-258. [PMID: 38379313 DOI: 10.1177/08903344241228545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Auricular acupressure influences pain reduction in patients with diseases. However, study results on its influence on breast pain, common among breastfeeding mothers, are insufficient. RESEARCH AIM This study aimed to explore the effectiveness of auricular acupressure on breast pain among breastfeeding mothers who also received a standard gentle hand technique. METHODS This was a placebo-controlled study wherein auricular acupressure was provided for 4 weeks to 52 breastfeeding mothers consulting a local breastfeeding clinic. In the intervention group, auricular acupressure was applied to specific acupoints, including Shenmen, central rim, breast, and endocrine, which are related to breast pain and postpartum lactation. For the placebo control group, auricular acupressure was applied to acupoints not related to breast pain. The degree of breast pain was assessed using a numeric rating scale and a pressure algometer. RESULTS After 4 weeks of auricular acupressure, numeric rating scale pain scores did not show a significant change. However, the pressure pain threshold for the upper left (Z = -2.202, p = .028) and upper right (t = 2.613, p = .012) areas of the right breast increased significantly in the intervention group. CONCLUSION This study employed subjective and objective measurements to evaluate the efficacy of auricular acupressure in alleviating breast pain. The intervention shows potential as a nursing measure. Further research is required to determine the optimal intervention duration and frequency, particularly for breastfeeding parents with severe pain, and to evaluate long-term outcomes.
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Affiliation(s)
- Shinae Han
- The Graduate School of Clinical and Public Health Convergence, Ewha Womans University, Seoul, South Korea
| | - Bomi Kim
- College of Nursing, Ewha Womans University, Seoul, South Korea
| | - Hyojung Park
- College of Nursing, Ewha Womans University, Seoul, South Korea
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Ikiisik H, Ozkaptan B, Cakir M, Maral I. Assessment of the general health status of children in Turkey: A community-based cross-sectional study. Child Care Health Dev 2024; 50:e13260. [PMID: 38600783 DOI: 10.1111/cch.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024]
Abstract
AIM This study aims to assess the general health status and factors affecting the general health status in the 0-14 age group in Turkey. METHODS This cross-sectional study was conducted using the Turkish Statistical Institute Turkey Health Survey 2022 micro data set. RESULTS This study included 7019 participants. Household heads described the general health status of 91.3% of children and the dental and gum status of 82.4% of children as very good or good, and 9.2% of children had any chronic disease. Although the median breastfeeding duration was 15 months, there is statistical significant association between sex and general health status (p = 0.014) and sex and duration of breastfeeding (p = 0.006). A statistical difference was found between duration of breastfeeding and general health status (p = 0.009) and dental and gum status (p = 0.001). CONCLUSION In 2022, the majority of children in Turkey had very good or good general health and dental and gum status. More than a third of children were breastfed for less than 12 months. Considering the possibility of neglecting oral and dental health problems, it is recommended to prioritize oral and dental health literacy trainings and to continue breastfeeding promotion programmes.
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Affiliation(s)
- Hatice Ikiisik
- Department of Public Health, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Beyzanur Ozkaptan
- Department of Public Health, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mustafa Cakir
- Department of Public Health, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Isil Maral
- Department of Public Health, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Steele C, Alessi S. Evaluation of the Use of Dedicated Technicians and Bar Code Scanning Technology for Fortified Human Milk Feeding Preparation in a Single Neonatal Intensive Care Unit to Reduce Risk of Adverse Events. J Acad Nutr Diet 2024; 124:559-563. [PMID: 38135271 DOI: 10.1016/j.jand.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Affiliation(s)
| | - Samantha Alessi
- Hassenfeld Children's Hospital at NYU Langone, New York, New York.
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Poposka L, Risteski D, Cvetkovski D, Pocesta B, Janusevski F, Zimbakov Z, Trajkov I, Stefanovski D, Logar M, Ksela J. Stepwise transvenous lead extraction due to pacemaker pocket infection following lactational mastitis complicated with breast abscess. Int Breastfeed J 2024; 19:27. [PMID: 38641819 PMCID: PMC11027399 DOI: 10.1186/s13006-024-00633-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/04/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lactational mastitis is a common painful and debilitating inflammation of breast tissue, generally treated conservatively or with pus puncture in case of breast abscess. However, treating mastitis in patients with implantable surgical material located in the affected breast region can be extremely challenging. We present an unusual case of lactational mastitis complicated by pacemaker pocket infection in a breastfeeding mother. CASE PRESENTATION A 35-year-old pacemaker-dependent female developed lactational mastitis seven weeks postpartum. Initially, the condition was treated conservatively with analgesics and antibiotics. After abscess formation, pus was aspirated using fine-needle aspiration technique. Four weeks after mastitis resolution, pacemaker pocket infection developed. According to current cardiovascular implantable electronic device infection treatment guidelines a complete surgical extraction of the entire electronic system, followed by targeted antibiotic treatment and reimplantation of a new device after infection resolution, was recommended. However, after thorough discussion with the young woman and her family and after detailed review of surgery-related risks, she declined a potentially high-risk surgical procedure. Thus, only the pulse generator was explanted; pacing leads positioned in the sub-pectoral pocket; new pacemaker implanted on the contralateral side and broad-spectrum antibiotic therapy continued for six weeks. After breastfeeding cessation, and with chronic fistula development at the primary pacemaker implantation site, the possibility of delayed surgical intervention including complete extraction of retained pacemaker leads was again thoroughly discussed with her. After thoughtful consideration the woman consented to the proposed treatment strategy. A surgical procedure including transvenous lead extraction through the primary implantation venous entry site, using hand-powered bidirectional rotational sheaths, was successfully performed, removing all retained leads through the left subclavian venous entry site, and leaving the fully functional and clinically uninfected pacemaker on the contralateral site intact. CONCLUSION Although patients' decisions for delayed extraction in a case of cardiovascular implantable electronic device infection should be discouraged by attending physicians and members of interdisciplinary teams, our case shows that a stepwise treatment strategy may be successful as a bailout clinical scenario in patients with specific requests, demands and / or clinical needs.
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Affiliation(s)
- Lidija Poposka
- University Clinic for Cardiology, Skopje, North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
| | - Dejan Risteski
- University Clinic for Cardiology, Skopje, North Macedonia
| | | | - Bekim Pocesta
- University Clinic for Cardiology, Skopje, North Macedonia
| | | | - Zhan Zimbakov
- University Clinic for Cardiology, Skopje, North Macedonia
| | - Ivan Trajkov
- Clinical hospital "Acibadem Sistina" Skopje, Skopje, North Macedonia
| | - Dime Stefanovski
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Logar
- Clinic of Infectious Diseases and Febrile Illnesses, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jus Ksela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Kovacs CS. Complex clinical encounter series: osteoporosis presenting during pregnancy and lactation: wait and reassess. J Bone Miner Res 2024; 39:197-201. [PMID: 38477812 DOI: 10.1093/jbmr/zjae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/15/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
Two months after her first pregnancy, a 35-yr-old exclusively breastfeeding woman bent to move her baby in the car seat and experienced sudden, severe pain from 5 spontaneous vertebral compression fractures. Genomic screen was negative but she had mild ankylosing spondylitis previously well controlled on etanercept. She was vegetarian with a high phytate intake. A lactation consultant had advised her to pump and discard milk between feeds, leading her to believe she produced twice as much milk as her baby ingested. She presented with a LS Z score of -3.6 and a TH Z score of -1.6. After 6 mo postweaning, she was treated with teriparatide (14 mo intermittently over 18 mo) and ultimately achieved a 50% increase in LS bone density and an 8% increase in TH bone density. Her fragility is explained by normal lactational bone loss amplified by excessive milk production and phytate-induced impairment of intestinal calcium absorption, ankylosing spondylitis, and the bend-and-lift maneuver. The marked increase in bone density resulted from the combined effects of spontaneous recovery and pharmacotherapy. Spontaneous recovery of bone mass and strength should occur during 12 mo after weaning in all women, including those who have fractured.
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Affiliation(s)
- Christopher S Kovacs
- Faculty of Medicine - Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland A1B 3V6, Canada
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Schwab I, Wullenkord R, Eyssel F, Dresbach T, Scholten N. Lactation support in neonatal intensive care units in Germany from the mothers' perspective - a mixed-method study of the current status and needs. BMC Pregnancy Childbirth 2024; 24:282. [PMID: 38627697 PMCID: PMC11022450 DOI: 10.1186/s12884-024-06339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Establishing successful lactation in mothers of very low birth weight (VLBW, <1500g) infants requires structured lactation support. Little is known about mothers' perspectives on lactation support in German neonatal intensive care units (NICUs). METHODS This paper features a convergent mixed-method approach that includes a retrospective, cross-sectional questionnaire and interview data to showcase mothers' perceptions of lactation support in NICUs. Content analysis of the interviews (n = 12) and a descriptive analysis of quantitative data (n = 533) were performed to illustrate the current status and need for lactation support in German NICUs. RESULTS The results show that lactation support in German NICUs is often inadequate and does not comply with recommendations based on the existing literature to encourage pumping and breastfeeding in mothers. The data imply that even if lactation is successfully initiated in most cases, it is often not maintained over time, which may be due to a lack of personal support and consistent information. CONCLUSION The overall structures and institutional guidelines for lactation support should be encouraged to promote nutrition with mother´s own milk in German NICUs.
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Affiliation(s)
- Isabella Schwab
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, 50933, Cologne, Germany
| | - Ricarda Wullenkord
- CITEC Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, Germany.
| | - Friederike Eyssel
- CITEC Center for Cognitive Interaction Technology, Bielefeld University, Inspiration 1, Bielefeld, 33619, Germany
| | - Till Dresbach
- Department of Neonatology and Pediatric Intensive Care, Children's Hospital, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair for Health Services Research University of Cologne, Faculty of Medicine and University Hospital Cologne, Eupener Straße 129, 50933, Cologne, Germany
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Yadollahi P, Padashian F, Doostfatemeh M. Five-factor model personality traits, exclusive breastfeeding, and self-efficacy: a mediational analysis. BMC Pregnancy Childbirth 2024; 24:279. [PMID: 38627657 PMCID: PMC11022404 DOI: 10.1186/s12884-024-06494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Despite the World Health Organization's (WHO) emphasis on exclusive breastfeeding, the documents show a declining trend worldwide. Studies assert that the mother's personality traits appear to have an impact on this issue. This study aimed to investigate the potential influence of personality traits on exclusive breastfeeding, which might be channeled by self-efficacy as a mediator variable. METHODS Data were analyzed from the cross-sectional study. The exclusive breastfeeding scale, the breastfeeding self-efficacy questionnaire, and the Five-Factor Model questionnaire (as follows: neuroticism, extraversion, openness experience, agreeableness, and conscientiousness) were completed by120 Iranian volunteer mothers with an infant aged 6-12 months referred to health centers in Shiraz (a major city in southern Iran) between May to December 2019. The structural equation modeling (SEM) approach was used to obtain the direct and indirect effects of personality traits and self-efficacy on exclusive breastfeeding. RESULTS The study showed the significant direct effect of some personality traits (agreeableness, extraversion, and consciousness) and self-efficacy on exclusive breastfeeding. The indirect effect of extraversion on exclusive breastfeeding through self-efficacy was also obtained from the result of SEM analysis. The model fit the data satisfactorily, according to the fit indices criteria extracted from the mediational analysis. CONCLUSIONS Self-efficacy appears to be a significant predictor of exclusive breastfeeding. Therefore, exclusive breastfeeding could be enhanced by safe education in pregnancy, reinforcing the self-efficacy of pregnant women and considering their personality traits.
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Affiliation(s)
- Parvin Yadollahi
- Maternal-fetal Medicine Research Center, Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Padashian
- Department of Midwifery, Behbahan Branch, Islamic Azad University, Behbahan, Iran
| | - Marziyeh Doostfatemeh
- Department of Biostatistics, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Hirsch-Moverman Y, Hsu A, Abrams EJ, Killam WP, Moore B, Howard AA. Guidelines for tuberculosis screening and preventive treatment among pregnant and breastfeeding women living with HIV in PEPFAR-supported countries. PLoS One 2024; 19:e0296993. [PMID: 38625930 PMCID: PMC11021021 DOI: 10.1371/journal.pone.0296993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/21/2023] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) preventive treatment (TPT) is recommended by the World Health Organization (WHO) for persons living with HIV, including pregnant and breastfeeding women. Given the President's Emergency Plan for AIDS Relief (PEPFAR)'s investment in TPT services for persons living with HIV as a strategy to prevent TB as well as uncertainty in guidelines and policy regarding use of TPT during pregnancy and the postpartum period, we conducted a review of current relevant national guidelines among PEPFAR-supported countries. METHODS Our review included 44/49 PEPFAR-supported countries to determine if TB screening and TPT are recommended specifically for pregnant and breastfeeding women living with HIV (WLHIV). National guidelines reviewed and abstracted included TB, HIV, prevention of vertical HIV transmission, TPT, and any other relevant guidelines. We abstracted information regarding TB screening, including screening tools and frequency; and TPT, including timing, regimen, frequency, and laboratory monitoring. RESULTS Of 44 PEPFAR-supported countries for which guidelines were reviewed, 66% were high TB incidence countries; 41% were classified by WHO as high TB burden countries, and 43% as high HIV-associated TB burden countries. We found that 64% (n = 28) of countries included TB screening recommendations for pregnant WLHIV in their national guidelines, and most (n = 35, 80%) countries recommend TPT for pregnant WLHIV. Fewer countries included recommendations for breastfeeding as compared to pregnant WLHIV, with only 32% (n = 14) mentioning TB screening and 45% (n = 20) specifically recommending TPT for this population; most of these recommend isoniazid-based TPT regimens for pregnant and breastfeeding WLHIV. However, several countries also recommend isoniazid combined with rifampicin (3RH) or rifapentine (3HP). CONCLUSIONS Despite progress in the number of PEPFAR-supported countries that specifically include TB screening and TPT recommendations for pregnant and breastfeeding WLHIV in their national guidelines, many PEPFAR-supported countries still do not include specific screening and TPT recommendations for pregnant and breastfeeding WLHIV.
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Affiliation(s)
- Yael Hirsch-Moverman
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, United States of America
| | - Allison Hsu
- ICAP at Columbia University, New York, New York, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, United States of America
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York, United States of America
| | - William P. Killam
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brittany Moore
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrea A. Howard
- ICAP at Columbia University, New York, New York, United States of America
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, United States of America
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Donislecel (Lantidra) for type 1 diabetes. Med Lett Drugs Ther 2024; 66:63-64. [PMID: 38576150 DOI: 10.58347/tml.2024.1700d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The FDA has approved donislecel-jujn (Lantidra – CellTrans), an allogeneic pancreatic islet cellular therapy, for use in conjunction with immunosuppression for treatment of adults with type 1 diabetes who are unable to approach target HbA1c because of current repeated episodes of severe hypoglycemia despite intensive diabetes management and education. Donislecel is the first cell-based treatment to be approved in the US for type 1 diabetes.
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Wallenborn JT, Hyland C, Sagiv SK, Kogut KR, Bradman A, Eskenazi B. Prenatal exposure to polybrominated diphenyl ether (PBDE) and child neurodevelopment: The role of breastfeeding duration. Sci Total Environ 2024; 921:171202. [PMID: 38408669 DOI: 10.1016/j.scitotenv.2024.171202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Prenatal and early-life exposure to polybrominated diphenyl ethers (PBDEs) is associated with detrimental and irreversible neurodevelopmental health outcomes during childhood. Breastfeeding may be a child's largest sustained exposure to PBDE- potentially exacerbating their risk for adverse neurodevelopment outcomes. However, breastfeeding has also been associated with positive neurodevelopment. Our study investigates if breastfeeding mitigates or exacerbates the known adverse effects of prenatal exposure to PBDEs and child neurodevelopment. METHODS Participants included 321 mother-infant dyads from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), a longitudinal birth cohort in California. PBDE concentrations were measured in maternal serum blood samples collected during pregnancy or at delivery. Using generalized estimated equations (GEE), we estimated associations of PBDE concentrations with children's attention, executive function, and cognitive scores assessed longitudinally between 7 and 12 years of age, stratified by duration of exclusive and complementary breastfeeding. RESULTS We observed that higher maternal prenatal PBDE concentrations were associated with poorer executive function among children who were complementary breastfed for a shorter duration compared to children breastfed for a longer duration; preservative errors (β for 10-fold increase in complementary breastfeeding <7 months = -6.6; 95 % Confidence Interval (CI): -11.4, -1.8; β ≥ 7 months = -5.1; 95 % CI: -10.2, 0.1) and global executive composition (β for 10-fold increase <7 months = 4.3; 95 % CI: 0.4, 8.2; β for 10-fold increase ≥7 months = 0.6; 95 % CI: -2.8, 3.9). CONCLUSIONS Prolonged breastfeeding does not exacerbate but may mitigate some previously observed negative associations of prenatal PBDE exposure and child neurodevelopment.
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Affiliation(s)
- Jordyn T Wallenborn
- Center of Excellence for Maternal and Child Health, School of Public Health, University of California, Berkeley, CA, USA; Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Carly Hyland
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA; Division of Agriculture and Natural Resources, University of California, Berkeley, CA, USA; Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
| | - Sharon K Sagiv
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
| | - Katherine R Kogut
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
| | - Asa Bradman
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
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Corkery-Hayward M, Talaei M. Teleintervention's effects on breastfeeding in low-income women in high income countries: a systematic review and meta-analysis. Int Breastfeed J 2024; 19:26. [PMID: 38615079 PMCID: PMC11015560 DOI: 10.1186/s13006-024-00631-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/22/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Many mothers in high-income countries (HIC) do not breastfeed to the World Health Organisation's recommendation of two years. This is particularly true for low-income women (LIW). They often face additional socio-structural barriers that encourage early discontinuation and are inadequately supported by current healthcare interventions. Teleinterventions are flexible and widely used following the global pandemic and increase maternal autonomy over intervention delivery. They show promise in improving other maternal conditions in LIW, including postpartum depression. Teleinterventions can increase breastfeeding rates in the wider maternal population, however their efficacy for this underserved population has not yet been systematically assessed. This meta-analysis aimed to identify if teleinterventions increase 'exclusive' or 'any' breastfeeding by LIW in HIC at 1-, 3-4, and 6-months postpartum. METHODS We searched five online databases for randomised controlled trials assessing breastfeeding teleinterventions for LIW in HIC. Risk ratios (RR) were used to calculate the average effect of teleinterventions on 'any' and 'exclusive' breastfeeding at at 1-, 3-4, and 6-months postpartum using random effects meta-analysis. Study bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB2), and outcome quality was evaluated against GRADE criteria. RESULTS Nine studies met inclusion criteria: six providing telephone calls, two text messages and one an online support group. All the studies were conducted in the United States, with small sample sizes and a high risk of bias. Pooled results indicate teleinterventions modestly increase 'any' and 'exclusive' breastfeeding at all time points, with a statistically significant increase in 'exclusive' breastfeeding after 3-4 months (RR 1.12, 95% CI [1.00,1.25]). At 3-4 months teleinterventions providing peer support were more effective than educational teleinterventions at promoting any and exclusive breastfeeding. Evidence for all outcomes were rated 'low' or 'very low' quality using the GRADE tool, mainly due to high attrition and low power. CONCLUSIONS Despite insufficient high-quality research into breastfeeding teleinterventions for LIW, our results suggest teleinterventions may improve exclusive and any breastfeeding. Given breastfeeding is particularly low in LIW population from HIC, our findings are promising and require further exploration by larger, methodologically sound trials in other HIC.
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Affiliation(s)
- Madeleine Corkery-Hayward
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
- Barts and The London Medical School, Queen Mary University of London, London, E1 2AD, UK.
| | - Mohammad Talaei
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Suthasmalee S, Phaloprakarn C. Lactation duration and development of type 2 diabetes and metabolic syndrome in postpartum women with recent gestational diabetes mellitus. Int Breastfeed J 2024; 19:25. [PMID: 38610024 PMCID: PMC11015662 DOI: 10.1186/s13006-024-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The World Health Organization and United Nations Children's Fund recommend exclusive breastfeeding (EBF) for the first six months of an infant's life. Although evidence suggests that maintaining breastfeeding has positive impacts on glucose and lipid metabolism in postpartum women with a history of gestational diabetes mellitus (GDM), no study has investigated whether such effects differ between breastfeeding intensities. This study aimed to evaluate the impact of maintaining breastfeeding on prediabetes, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) six months postpartum in women with GDM. This study also examined the potential variations in glucometabolic outcomes between EBF at six months and partial breastfeeding at six months. METHODS This prospective cohort study included 130 women with recent GDM who experienced live births between 7 September 2020 and 31 January 2023 at a university hospital in Bangkok, Thailand. All the women were free of T2DM and MetS at baseline (six weeks postpartum). We followed up these women six months postpartum to assess their breastfeeding practices (EBF at six months, partial breastfeeding at six months, or not maintaining breastfeeding) and evaluate their progression to prediabetes, T2DM, and MetS. Maintaining breastfeeding was defined as breastfeeding for six months. EBF was determined using the "recall since birth" method. RESULTS Of the 130 participants included, the rates of prediabetes, T2DM, and MetS six months postpartum were 33% (n = 43), 2% (n = 3), and 17% (n = 22), respectively. In the unadjusted model, maintaining breastfeeding was associated with a reduction in the risks of prediabetes and MetS but not T2DM. After adjusting for potential confounders, maintaining breastfeeding was a significant protective factor only for prediabetes. The adjusted risk ratios and 95% confidence intervals were 0.54 (0.29, 0.99) for prediabetes and 0.47 (0.19, 1.06) for MetS. When EBF at six months and partial breastfeeding at six months were separately analyzed, the risks of prediabetes and MetS differed between the two groups. In the EBF at six months-to-partial breastfeeding at six months comparison, the adjusted risk ratios (95% confidence intervals) of prediabetes and MetS were 0.46 (0.22, 0.97) vs. 0.79 (0.25, 2.49) and 0.34 (0.11, 0.99) vs. 0.69 (0.22, 2.07), respectively. CONCLUSIONS Maintaining breastfeeding reduced the risk of prediabetes and MetS, but not of T2DM, six months postpartum; these effects were significant only with EBF. These findings indicate that supporting maternal efforts to practice EBF for six months may improve women's health after GDM. TRIAL REGISTRATION Thai Clinical Trials Registry Registration No. TCTR20200902003. Date of registration: September 2, 2020. Date of initial participant enrollment: September 7, 2020.
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Affiliation(s)
- Sasiwan Suthasmalee
- Women's Health Center, MedPark Hospital, Bangkok, Thailand
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| | - Chadakarn Phaloprakarn
- Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand.
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Ahmadinezhad GS, Karimi FZ, Abdollahi M, NaviPour E. Association between postpartum depression and breastfeeding self-efficacy in mothers: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:273. [PMID: 38609849 PMCID: PMC11015580 DOI: 10.1186/s12884-024-06465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Depression is one of the most common mental disorders in the postpartum period. Depression can decrease self-efficacy in breastfeeding by reducing the mother's self-confidence. Considering the conflicting results regarding the relationship between postpartum depression and breastfeeding self-efficacy, this systematic review was conducted to investigate the relationship between breastfeeding self-efficacy and postpartum depression. METHOD In this systematic review, published articles in PubMed, Scopus, Web of Sciences, Cochrane Library, and Google Scholar databases were searched using English keywords "Self-efficacy, breastfeeding, breastfeeding Self-efficacy, depression, postpartum depression" without publication date limit. Data analysis was done with employing STATA14 software. Heterogeneity was assessed using I2 index which was 0%. Therefore, the fixed effects method was used to combine the data and perform meta-analysis. RESULT The results of the meta-analysis showed that based on the fixed effect method, depression was associated with decreased breastfeeding self-efficacy on the first day (SMD = 0.62, 95%CI: -0.830, -0.41, p = 0.0001) and on the third day (SMD = 0.84, 95% CI: -0.55,1.14, p = 0.0001). The Begg and Manzumdar test revealed no publication bias, with p = 0.317. CONCLUSION Postpartum depression may be associated with a decrease in the mother's breastfeeding self-efficacy and placing mother in a condition to pay low attention to her maternal role. Therefore, healthcare providers should provide adequate support according to the needs of mothers and develop diagnostic and treatment protocols to improve the level of maternal health.
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Affiliation(s)
| | - Fatemeh Zahra Karimi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mahboobeh Abdollahi
- Department of Public Health, Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh, Iran
| | - Elham NaviPour
- Department of Social Medicine, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Department of Medical Education, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Obeagu EI, Obeagu GU. Exploring the profound link: Breastfeeding's impact on alleviating the burden of breast cancer - A review. Medicine (Baltimore) 2024; 103:e37695. [PMID: 38608095 PMCID: PMC11018178 DOI: 10.1097/md.0000000000037695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/01/2024] [Indexed: 04/14/2024] Open
Abstract
Breastfeeding has emerged as a critical factor in understanding and potentially mitigating the risk of breast cancer among women. This review delves into the intricate relationship between breastfeeding and breast cancer, elucidating the biological mechanisms, protective effects, and broader implications for public health. Epidemiological evidence consistently demonstrates a correlation between breastfeeding and a reduced risk of breast cancer, with longer durations of lactation showing a dose-dependent decrease in risk. The biological nexus between breastfeeding and breast cancer involves hormonal changes and the elimination of potentially damaged cells, influencing breast tissue and potentially mitigating carcinogenesis. Moreover, breastfeeding appears to impact tumor subtypes and aggressiveness, particularly demonstrating associations with lower risks of hormone receptor-negative and certain aggressive breast cancer subtypes. Recognizing the significance of breastfeeding in reducing breast cancer risk has profound public health implications, necessitating comprehensive support, education, and policies to encourage and facilitate breastfeeding.
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Heppner N, Reitmeier S, Heddes M, Merino MV, Schwartz L, Dietrich A, List M, Gigl M, Meng C, van der Veen DR, Schirmer M, Kleigrewe K, Omer H, Kiessling S, Haller D. Diurnal rhythmicity of infant fecal microbiota and metabolites: A randomized controlled interventional trial with infant formula. Cell Host Microbe 2024; 32:573-587.e5. [PMID: 38569545 DOI: 10.1016/j.chom.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/13/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
Microbiota assembly in the infant gut is influenced by diet. Breastfeeding and human breastmilk oligosaccharides promote the colonization of beneficial bifidobacteria. Infant formulas are supplemented with bifidobacteria or complex oligosaccharides, notably galacto-oligosaccharides (GOS), to mimic breast milk. To compare microbiota development across feeding modes, this randomized controlled intervention study (German Clinical Trial DRKS00012313) longitudinally sampled infant stool during the first year of life, revealing similar fecal bacterial communities between formula- and breast-fed infants (N = 210) but differences across age. Infant formula containing GOS sustained high levels of bifidobacteria compared with formula containing B. longum and B. breve or placebo. Metabolite and bacterial profiling revealed 24-h oscillations and circadian networks. Rhythmicity in bacterial diversity, specific taxa, and functional pathways increased with age and was strongest following breastfeeding and GOS supplementation. Circadian rhythms in dominant taxa were further maintained ex vivo in a chemostat model. Hence, microbiota rhythmicity develops early in life and is impacted by diet.
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Affiliation(s)
- Nina Heppner
- Chair of Nutrition and Immunology, Technical University of Munich, Gregor-Mendel-Strasse 2, 85354 Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany
| | - Sandra Reitmeier
- Chair of Nutrition and Immunology, Technical University of Munich, Gregor-Mendel-Strasse 2, 85354 Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany
| | - Marjolein Heddes
- Chair of Nutrition and Immunology, Technical University of Munich, Gregor-Mendel-Strasse 2, 85354 Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany
| | - Michael Vig Merino
- Chair of Nutrition and Immunology, Technical University of Munich, Gregor-Mendel-Strasse 2, 85354 Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany
| | - Leon Schwartz
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, 85354 Freising, Germany
| | - Alexander Dietrich
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, 85354 Freising, Germany
| | - Markus List
- Data Science in Systems Biology, School of Life Sciences, Technical University of Munich, 85354 Freising, Germany
| | - Michael Gigl
- Bavarian Center for Biomolecular Mass Spectrometry, Technical University of Munich, Gregor-Mendel-Strasse 4, 85354 Freising, Germany
| | - Chen Meng
- Bavarian Center for Biomolecular Mass Spectrometry, Technical University of Munich, Gregor-Mendel-Strasse 4, 85354 Freising, Germany
| | - Daan R van der Veen
- Faculty of Health and Biomedical Science, University of Surrey, 388 Stag Hill Campus, Guildford 17 GU27XH, UK
| | - Melanie Schirmer
- ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany
| | - Karin Kleigrewe
- Bavarian Center for Biomolecular Mass Spectrometry, Technical University of Munich, Gregor-Mendel-Strasse 4, 85354 Freising, Germany
| | - Hélène Omer
- Chair of Nutrition and Immunology, Technical University of Munich, Gregor-Mendel-Strasse 2, 85354 Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany
| | - Silke Kiessling
- Chair of Nutrition and Immunology, Technical University of Munich, Gregor-Mendel-Strasse 2, 85354 Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany; Faculty of Health and Biomedical Science, University of Surrey, 388 Stag Hill Campus, Guildford 17 GU27XH, UK
| | - Dirk Haller
- Chair of Nutrition and Immunology, Technical University of Munich, Gregor-Mendel-Strasse 2, 85354 Freising, Germany; ZIEL - Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany.
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Haile RN, Abate BB, Kitaw TA. Predictors of late initiation of breastfeeding practice in Ethiopia: a multilevel mixed-effects analysis of recent evidence from EDHS 2019. BMJ Open 2024; 14:e081069. [PMID: 38604642 PMCID: PMC11015321 DOI: 10.1136/bmjopen-2023-081069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES To identify the predictors of late initiation of breastfeeding practice in Ethiopia. DESIGN Cross-sectional study design. SETTING Ethiopia. PARTICIPANTS A total of 1982 weighted samples of mothers with children aged under 24 months were included. OUTCOME MEASURE Late initiation of breastfeeding practice. RESULTS The prevalence of late breastfeeding initiation practice is 26.4% (95 CI 24.4 to 28.3). Being a young mother (15-24 years) (adjusted odds ratio (AOR) =1.66; 95 CI 1.06 to 2.62), no antenatal care (ANC) visit (AOR=1.45; 95 CI 1.04 to 2.02), caesarean section (AOR=4.79; 95 CI 3.19 to 7.21) and home delivery (AOR=1.53; 95 CI 1.14 to 2.06) were found to be the determinants of late initiation of breast feeding. CONCLUSION More than one-fourth of newborn children do not start breast feeding within the WHO-recommended time (first hour). Programmes should focus on promoting the health facility birth and increasing the ANC visits. Further emphasis should be placed on young mothers and those who deliver via caesarean section to improve the timely initiation of breast feeding.
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Affiliation(s)
- Ribka Nigatu Haile
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Tegene Atamenta Kitaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Van Neste M, Nauwelaerts N, Ceulemans M, Van Calsteren K, Eerdekens A, Annaert P, Allegaert K, Smits A. Determining the exposure of maternal medicines through breastfeeding: the UmbrelLACT study protocol-a contribution from the ConcePTION project. BMJ Paediatr Open 2024; 8:e002385. [PMID: 38599799 PMCID: PMC11015172 DOI: 10.1136/bmjpo-2023-002385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Breastfeeding is beneficial for the health of the mother and child. However, at least 50% of postpartum women need pharmacotherapy, and this number is rising due to the increasing prevalence of chronic diseases and pregnancies at a later age. Making informed decisions on medicine use while breastfeeding is often challenging, considering the extensive information gap on medicine exposure and safety during lactation. This can result in the unnecessary cessation of breastfeeding, the avoidance of pharmacotherapy or the off-label use of medicines. The UmbrelLACT study aims to collect data on human milk transfer of maternal medicines, child exposure and general health outcomes. Additionally, the predictive performance of lactation and paediatric physiologically based pharmacokinetic (PBPK) models, a promising tool to predict medicine exposure in special populations, will be evaluated. METHODS AND ANALYSIS Each year, we expect to recruit 5-15 breastfeeding mothers using pharmacotherapy via the University Hospitals Leuven, the BELpREG project (pregnancy registry in Belgium) or external health facilities. Each request and compound will be evaluated on relevance (ie, added value to available scientific evidence) and feasibility (including access to analytical assays). Participants will be requested to complete at least one questionnaire on maternal and child's general health and collect human milk samples over 24 hours. Optionally, two maternal and one child's blood samples can be collected. The maternal medicine concentration in human milk will be determined along with the estimation of the medicine intake (eg, daily infant dose and relative infant dose) and systemic exposure of the breastfed child. The predictive performance of PBPK models will be assessed by comparing the observed concentrations in human milk and plasma to the PBPK predictions. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee Research UZ/KU Leuven (internal study number S67204). Results will be published in peer-reviewed journals and presented at (inter)national scientific meetings. TRIAL REGISTRATION NUMBER NCT06042803.
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Affiliation(s)
- Martje Van Neste
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- L-C&Y, KU Leuven Child & Youth Institute, Leuven, Belgium
| | - Nina Nauwelaerts
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Michael Ceulemans
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- L-C&Y, KU Leuven Child & Youth Institute, Leuven, Belgium
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kristel Van Calsteren
- Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - An Eerdekens
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Annaert
- Drug Delivery and Disposition, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- BioNotus GCV, Niel, Belgium
| | - Karel Allegaert
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- L-C&Y, KU Leuven Child & Youth Institute, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Anne Smits
- L-C&Y, KU Leuven Child & Youth Institute, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
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Soliman Y, Yakandawala U, Leong C, Garlock ES, Brinkman FSL, Winsor GL, Kozyrskyj AL, Mandhane PJ, Turvey SE, Moraes TJ, Subbarao P, Nickel NC, Thiessen K, Azad MB, Kelly LE. The use of prescription medications and non-prescription medications during lactation in a prospective Canadian cohort study. Int Breastfeed J 2024; 19:23. [PMID: 38589955 PMCID: PMC11000278 DOI: 10.1186/s13006-024-00628-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 03/17/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. METHODS Data were collected from the CHILD Cohort Study which enrolled pregnant women across Canada between 2008 and 2012. Participants completed questionnaires regarding medications and non-prescription medications used and breastfeeding status at 3, 6 and 12 months postpartum. Medications, along with self-reported reasons for medication use, were categorized by ontologies [hierarchical controlled vocabulary] as part of a large-scale curation effort to enable more robust investigations of reasons for medication use. RESULTS A total of 3542 mother-infant dyads were recruited to the CHILD study. Breastfeeding rates were 87.4%, 75.3%, 45.5% at 3, 6 and 12 months respectively. About 40% of women who were breastfeeding at 3 months used at least one prescription medication during the first three months postpartum; this proportion decreased over time to 29.5% % at 6 months and 32.8% at 12 months. The most commonly used prescription medication by breastfeeding women was domperidone at 3 months (9.0%, n = 229/2540) and 6 months (5.6%, n = 109/1948), and norethisterone at 12 months (4.1%, n = 48/1180). The vast majority of domperidone use by breastfeeding women (97.3%) was for lactation purposes which is off-label (signifying unapproved use of an approved medication). Non-prescription medications were more often used among breastfeeding than non-breastfeeding women (67.6% versus 48.9% at 3 months, p < 0.0001), The most commonly used non-prescription medications were multivitamins and Vitamin D at 3, 6 and 12 months postpartum. CONCLUSIONS In Canada, medication use is common postpartum; 40% of breastfeeding women use prescription medications in the first 3 months postpartum. A diverse range of medications were used, with many women taking more than one prescription and non-prescription medicines. The most commonly used prescription medication by breastfeeding women were domperidone for off-label lactation support, signalling a need for more data on the efficacy of domperidone for this indication. This data should inform research priorities and communication strategies developed to optimize care during lactation.
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Affiliation(s)
- Youstina Soliman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Uma Yakandawala
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada
| | - Christine Leong
- College of Pharmacy, Rady Faculty of Health Science, University of Manitoba, Winnipeg, MB, Canada
| | - Emma S Garlock
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Fiona S L Brinkman
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Geoffrey L Winsor
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Piushkumar J Mandhane
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Winnipeg, MB, Canada
| | - Kellie Thiessen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Lauren E Kelly
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
- , 417-753 McDermot Ave, R3E 0T6, Winnipeg, MB, Canada.
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