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Wagner CL, Hulsey TC, Ebeling M, Shary JR, Asghari G, Howard CR, Baatz JE, Newton DA, Wahlquist AE, Reed SG, Taylor SN, Lawrence RA, Hollis BW. Safety Aspects of a Randomized Clinical Trial of Maternal and Infant Vitamin D Supplementation by Feeding Type Through 7 Months Postpartum. Breastfeed Med 2020; 15:765-775. [PMID: 32915638 PMCID: PMC7757584 DOI: 10.1089/bfm.2020.0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The safety of higher dose vitamin D (vitD) supplementation in women who change from exclusive or full breastfeeding to combination feeding or who continue supplementation after cessation of breastfeeding is unknown. Objective: Compare vitD supplementation safety of 6,400 to 400 IU/day and 2,400 IU/day using specific laboratory parameters in postpartum women and their infants through 7 months postpartum by feeding type. Design: In this randomized controlled trial, mothers (exclusively breastfeeding or formula-feeding) were randomized at 4-6 weeks' postpartum to 400, 2,400, or 6,400 IU vitD3 (cholecalciferol)/day for 6 months. Breastfeeding infants in 400 IU group received oral 400 IU vitD3/day; infants in 2,400 and 6,400 IU groups received placebo. Maternal safety parameters (serum vitD, 25-hydroxy-vitamin D [25(OH)D; calcidiol], calcium, phosphorus, intact PTH; urinary calcium/creatinine ratios; and feeding type/changes) were measured monthly; infant parameters were measured at months 1, 4, and 7. Sufficiency was defined as 25(OH)D >50 nmol/L. Feeding type was defined as exclusive/full, combination, or formula-feeding. Data were analyzed using SAS 9.4. Results: Four hundred nineteen mother-infant pairs were randomized into the three treatment groups and followed: 346 breastfeeding and 73 formula-feeding pairs. A dose of 6400 IU/day safely and significantly increased maternal vitD and 25(OH)D from baseline in all mothers regardless of feeding type (p < 0.0001) and was superior to the 400 and 2,400 IU groups in achieving vitD sufficiency with no other differences in safety parameters by treatment or feeding type. Infants in the 2,400 IU group were more likely vitD-deficient than the other groups; otherwise, there were no infant safety parameter differences. Conclusions: While 6,400 IU/day was more effective than 400 or 2,400 IU/day in achieving maternal vitD sufficiency in all feeding groups, the groups did not differ on other safety parameters. Similarly, infant safety parameters did not differ by treatment group or feeding status. Clinical Trial Registration: FDA IND Number: 66,346; ClinicalTrials.gov Number: NCT00412074.
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Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas C Hulsey
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia, USA
| | - Myla Ebeling
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Judy R Shary
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Golaleh Asghari
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA.,Nutrition and Endocrine Research Center, Research Institute of Endocrine Sciences and Metabolism, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cynthia R Howard
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - John E Baatz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Danforth A Newton
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amy E Wahlquist
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Susan G Reed
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sarah N Taylor
- Divison of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ruth A Lawrence
- Department of Pediatrics, University of Rochester, Rochester, New York, USA
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Shawn Jenkins Children's Hospital, Medical University of South Carolina, Charleston, South Carolina, USA
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Rosen-Carole C, Allen K, Thompson J, Martin H, Goldstein N, Lawrence RA. Prenatal Provider Support for Breastfeeding: Changes in Attitudes, Practices and Recommendations Over 22 Years. J Hum Lact 2020; 36:109-118. [PMID: 30840540 DOI: 10.1177/0890334419830996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prenatal care providers play a central role in breastfeeding outcomes. A survey on obstetricians' support of breastfeeding was conducted in 1993 in Monroe County, NY. Since the landscape of prenatal care and breastfeeding support has changed significantly in the past 2 decades, we repeated and extended this survey in 2015. RESEARCH AIM To determine changes in breastfeeding support by prenatal care providers over a 20 year period. METHODS We sent a 46-item on-line or paper questionnaire to all categories of prenatal care providers identified by an online search. A breastfeeding support score was created based on the prior survey, with a maximum score of 3. One point was awarded for: (1) personally discussing breastfeeding; (2) generally suggesting breastfeeding; and (3) commonly receiving questions from patients. Data were analyzed using Chi-square. RESULTS We had 164 participants (response rate 80%). More current participants, compared to 1993, reported discussing (97% vs. 86%, p < .001) and recommending (93% vs. 80%, p = .001) breastfeeding. Only 10% of 2015 participants gave infant formula samples, compared with 34% in 1993 (p < .0001). Improvement in the support score was seen, with 98% of current participants having high scores compared to 87% in 1993 (p < .001). Similar numbers reported receiving breastfeeding education, though more reported that the education was inadequate (54% vs. 19%, p < .0001). CONCLUSION Breastfeeding support improved significantly over time, even though breastfeeding education has not improved in quality or quantity. Improving education of prenatal care providers may help future providers be more prepared to support breastfeeding.
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Affiliation(s)
- Casey Rosen-Carole
- Assistant Professor of Pediatrics and Obstetrics and Gynecology, Medical Director of Lactation Services and Programs, University of Rochester School of Medicine and Dentistry
| | - Katherine Allen
- Pediatric Resident, University of Minnesota at Minneapolis, MN, USA
| | | | - Hayley Martin
- MD, University of Rochester School of Medicine and Dentistry
| | | | - Ruth A Lawrence
- MD, Professor of Pediatrics and Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Medical Director of the Ruth A. Lawrence Poison and Drug Information Center and of the Breastfeeding and Human Lactation Study Center
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Blair PS, Ball HL, McKenna JJ, Feldman-Winter L, Marinelli KA, Bartick MC, Noble L, Calhoun S, Elliott-Rudder M, Kair LR, Lappin S, Larson I, Lawrence RA, Lefort Y, Marshall N, Mitchell K, Murak C, Myers E, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Wight N, Wonodi A. Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019. Breastfeed Med 2020; 15:5-16. [PMID: 31898916 DOI: 10.1089/bfm.2019.29144.psb] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Peter S Blair
- Centre for Academic Child Health, University of Bristol, Bristol, United Kingdom
| | - Helen L Ball
- Infancy and Sleep Centre, Department of Anthropology, Durham University, Durham, United Kingdom
| | - James J McKenna
- Department of Anthropology, Santa Clara University, Santa Clara, California.,Mother-Baby Sleep Lab, Department of Anthropology, University of Notre Dame, South Bend, Indiana
| | - Lori Feldman-Winter
- Department of Pediatrics, Division of Adolescent Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
| | - Kathleen A Marinelli
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut.,Connecticut Children's Medical Center, Division of Neonatology, Hartford, Connecticut
| | - Melissa C Bartick
- Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge Massachusetts
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Mitchell KB, Fleming MM, Anderson PO, Giesbrandt JG, Noble L, Reece-Stremtan S, Bartick M, Calhoun S, Dodd S, Elliott-Rudder M, Kair LR, Lappin S, Lawrence RA, LeFort Y, Marinelli KA, Marshall N, Murak C, Myers E, Okogbule-Wonodi A, Roberts A, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Fleur RS, Wight N, Winter L. ABM Clinical Protocol #30: Radiology and Nuclear Medicine Studies in Lactating Women. Breastfeed Med 2019; 14:290-294. [PMID: 31107104 DOI: 10.1089/bfm.2019.29128.kbm] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Katrina B Mitchell
- 1 Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico
| | | | - Philip O Anderson
- 3 Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California
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5
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Mitchell KB, Johnson HM, Eglash A, Noble L, Reece-Stremtan S, Bartick M, Calhoun S, Dodd S, Elliott-Rudder M, Kair LR, Lappin S, Larson I, Lawrence RA, LeFort Y, Marinelli KA, Marshall N, Murak C, Myers E, Okogbule-Wonodi A, Roberts A, Rosen-Carole C, Rothenberg S, Schmidt T, Seo T, Sriraman N, Stehel EK, Fleur RS, Winter L, Weissman G, Wight N. ABM Clinical Protocol #30: Breast Masses, Breast Complaints, and Diagnostic Breast Imaging in the Lactating Woman. Breastfeed Med 2019; 14:208-214. [PMID: 30892931 DOI: 10.1089/bfm.2019.29124.kjm] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or influence, for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Katrina B Mitchell
- 1 Breast Surgical Oncology, Presbyterian Healthcare Services-MD Anderson Cancer Network, Albuquerque, New Mexico
| | - Helen M Johnson
- 2 Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Anne Eglash
- 3 Department of Family and Community Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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6
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Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
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Reece-Stremtan S, Campos M, Kokajko L, Noble L, Brent N, Bunik M, Harrel C, Lawrence RA, LeFort Y, Marinelli KA, Rosen-Carole C, Rothenberg S, Seo T, St. Fleur R, Young M. ABM Clinical Protocol #15: Analgesia and Anesthesia for the Breastfeeding Mother, Revised 2017. Breastfeed Med 2017; 12:500-506. [PMID: 29624435 DOI: 10.1089/bfm.2017.29054.srt] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Sarah Reece-Stremtan
- 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System , Washington, District of Columbia
| | - Matilde Campos
- 2 Division of Anesthesiology, Centro Hospitalar do Porto , Porto, Portugal
| | - Lauren Kokajko
- 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System , Washington, District of Columbia
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Lawrence RA. Academy of Breastfeeding Medicine 2017 Summit Summary. Breastfeed Med 2017; 12:493. [PMID: 28846449 DOI: 10.1089/bfm.2017.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ruth A Lawrence
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester , Rochester, New York
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Flaherman VJ, Maisels MJ, Noble L, Brent N, Bunik M, Harrel C, Lawrence RA, Marinelli KA, Reece-Stremtan S, Rosen-Carole C, Seo T, St. Fleur R, Young M. ABM Clinical Protocol #22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 Weeks or More of Gestation-Revised 2017. Breastfeed Med 2017; 12:250-257. [PMID: 29624434 DOI: 10.1089/bfm.2017.29042.vjf] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Valerie J Flaherman
- 1 Department of Pediatrics, School of Medicine, University of California , San Francisco, California
| | - M Jeffrey Maisels
- 2 Department of Pediatrics, William Beaumont School of Medicine, Oakland University , Royal Oak, Michigan
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Lawrence RA, Howard CR. The Challenge of the Eighth Summit. Breastfeed Med 2016; 11:395. [PMID: 27533471 DOI: 10.1089/bfm.2016.29021.ral] [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: 11/12/2022]
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Affiliation(s)
- Ruth A Lawrence
- Chair Summit, Distinguished Alumna Professor of Pediatrics and Obstetrics/Gynecology, University of Rochester School of Medicine, Rochester, New York
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Abstract
BACKGROUND Sodium oxybate is used in the treatment of narcolepsy. Currently no published literature supports its safety during breastfeeding, although it has a favorable pharmacokinetic profile for minimizing exposure. MATERIALS AND METHODS We report a case of a 27-year-old primigravida with narcolepsy who was taking sodium oxybate for symptom control and contacted our Lactation Study Center for advice. Based on our current pharmacokinetic knowledge, she was advised to avoid breastfeeding 4 hours after a dose. RESULTS Follow-up phone interviews were done and the patient reported that the feeding schedule was manageable, and she was able to exclusively breastfeed for 6 months of her infant's life. Based on pediatric records, her infant's growth and development were excellent. There were no noted side effects of the medication for the infant. CONCLUSIONS This is the first report to our knowledge of breastfeeding during maternal therapy with sodium oxybate, which appears to be compatible with safe, exclusive breastfeeding when managed appropriately.
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Affiliation(s)
- Lauren Z Gashlin
- 1 Department of Pharmacy, University of Rochester Medical Center , Rochester, New York
| | - David Sullo
- 2 Department of Pediatrics School of Medicine and Dentistry, University of Rochester Medical Center , Rochester, New York
| | - Ruth A Lawrence
- 2 Department of Pediatrics School of Medicine and Dentistry, University of Rochester Medical Center , Rochester, New York
| | - Casey Rosen-Carole
- 2 Department of Pediatrics School of Medicine and Dentistry, University of Rochester Medical Center , Rochester, New York
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Kantorowska A, Wei JC, Cohen RS, Lawrence RA, Gould JB, Lee HC. Impact of Donor Milk Availability on Breast Milk Use and Necrotizing Enterocolitis Rates. Pediatrics 2016; 137:e20153123. [PMID: 26908696 PMCID: PMC4771129 DOI: 10.1542/peds.2015-3123] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To examine the availability of donor human milk (DHM) in a population-based cohort and assess whether the availability of DHM was associated with rates of breast milk feeding at NICU discharge and rates of necrotizing enterocolitis (NEC). METHODS Individual patient clinical data for very low birth weight infants from the California Perinatal Quality Care Collaborative were linked to hospital-level data on DHM availability from the Mothers' Milk Bank of San José for 2007 to 2013. Trends of DHM availability were examined by level of NICU care. Hospitals that transitioned from not having DHM to having DHM availability during the study period were examined to assess changes in rates of breast milk feeding at NICU discharge and NEC. RESULTS The availability of DHM increased from 27 to 55 hospitals during the study period. The availability increased for all levels of care including regional, community, and intermediate NICUs, with the highest increase occurring in regional NICUs. By 2013, 81.3% of premature infants cared for in regional NICUs had access to DHM. Of the 22 hospitals that had a clear transition to having availability of DHM, there was a 10% increase in breast milk feeding at NICU discharge and a concomitant 2.6% decrease in NEC rates. CONCLUSIONS The availability of DHM has increased over time and has been associated with positive changes including increased breast milk feeding at NICU discharge and decrease in NEC rates.
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Affiliation(s)
- Agata Kantorowska
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Julia C. Wei
- Berkeley School of Public Health, University of California, Berkeley, California
| | - Ronald S. Cohen
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and
| | | | - Jeffrey B. Gould
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and,California Perinatal Quality Care Collaborative, Stanford, California
| | - Henry C. Lee
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; and,California Perinatal Quality Care Collaborative, Stanford, California
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Lawrence RA. Introduction to the ISRHML 2016 Abstracts. Breastfeed Med 2016; 11:97. [PMID: 26894515 DOI: 10.1089/bfm.2016.29004.ral] [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: 10/22/2022]
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Affiliation(s)
- Ruth A Lawrence
- 1 Department of Pediatrics, University of Rochester School of Medicine and Dentistry , Golisano Children's Hospital at Strong, Rochester, New York
| | - Cynthia R Howard
- 2 Department of Pediatrics, University of Rochester School of Medicine and Dentistry , Rochester General Hospital, Rochester, New York
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Hollis BW, Wagner CL, Howard CR, Ebeling M, Shary JR, Smith PG, Taylor SN, Morella K, Lawrence RA, Hulsey TC. Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial. Pediatrics 2015; 136:625-34. [PMID: 26416936 PMCID: PMC4586731 DOI: 10.1542/peds.2015-1669] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Compare effectiveness of maternal vitamin D3 supplementation with 6400 IU per day alone to maternal and infant supplementation with 400 IU per day. METHODS Exclusively lactating women living in Charleston, SC, or Rochester, NY, at 4 to 6 weeks postpartum were randomized to either 400, 2400, or 6400 IU vitamin D3/day for 6 months. Breastfeeding infants in 400 IU group received oral 400 IU vitamin D3/day; infants in 2400 and 6400 IU groups received 0 IU/day (placebo). Vitamin D deficiency was defined as 25-hydroxy-vitamin D (25(OH)D) <50 nmol/L. 2400 IU group ended in 2009 as greater infant deficiency occurred. Maternal serum vitamin D, 25(OH)D, calcium, and phosphorus concentrations and urinary calcium/creatinine ratios were measured at baseline then monthly, and infant blood parameters were measured at baseline and months 4 and 7. RESULTS Of the 334 mother-infant pairs in 400 IU and 6400 IU groups at enrollment, 216 (64.7%) were still breastfeeding at visit 1; 148 (44.3%) continued full breastfeeding to 4 months and 95 (28.4%) to 7 months. Vitamin D deficiency in breastfeeding infants was greatly affected by race. Compared with 400 IU vitamin D3 per day, 6400 IU/day safely and significantly increased maternal vitamin D and 25(OH)D from baseline (P < .0001). Compared with breastfeeding infant 25(OH)D in the 400 IU group receiving supplement, infants in the 6400 IU group whose mothers only received supplement did not differ. CONCLUSIONS Maternal vitamin D supplementation with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy her nursing infant's requirement and offers an alternate strategy to direct infant supplementation.
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Affiliation(s)
- Bruce W. Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, South Carolina
| | - Carol L. Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, South Carolina
| | - Cynthia R. Howard
- Department of Pediatrics, University of Rochester, Rochester, New York; and
| | - Myla Ebeling
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia
| | - Judy R. Shary
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, South Carolina
| | - Pamela G. Smith
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, South Carolina
| | - Sarah N. Taylor
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, South Carolina
| | - Kristen Morella
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia
| | - Ruth A. Lawrence
- Department of Pediatrics, University of Rochester, Rochester, New York; and
| | - Thomas C. Hulsey
- Department of Epidemiology, West Virginia University, Morgantown, West Virginia
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Lawrence RA. Urgent issues of breastfeeding management. Breastfeed Med 2014; 9:415-6. [PMID: 25361471 PMCID: PMC4216485 DOI: 10.1089/bfm.2014.9972] [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: 11/13/2022]
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Lawrence RA. Choosing to breastfeed: finding the answers. Breastfeed Med 2014; 9:373-4. [PMID: 25313835 DOI: 10.1089/bfm.2014.9977] [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: 11/12/2022]
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Affiliation(s)
- Ruth A Lawrence
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital at Strong , Rochester, New York
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Brownell EA, Lussier MM, Dozier AM, Howard CR, Fisher SG, Duckett JW, Lawrence RA, Fernandez ID. The discordance between planned use and actual receipt of immediate postpartum depot medroxyprogesterone among low-income women. Breastfeed Med 2014; 9:290-3. [PMID: 24893264 DOI: 10.1089/bfm.2013.0112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study describes the patterns of planned use and actual receipt of immediate postpartum depot medroxyprogesterone (DMPA) prior to hospital discharge among low-income breastfeeding initiators. MATERIALS AND METHODS Bivariate analyses among DMPA recipients by prenatal planned/unplanned use and the sensitivity of DMPA self-report relative to pharmacologic record were calculated. RESULTS Among immediate postpartum DMPA recipients (n=58), 72.4% (n=42) did not plan to use DMPA. The sensitivity of self-reported DMPA use was 89.7% (95% confidence interval, 85.2, 94.2). CONCLUSIONS Clinically, it is unclear if the immediate postpartum period is the appropriate time to obtain consent and administer a long-acting contraceptive method. In our sample, women accurately recalled receiving DMPA in the immediate postpartum period. However, the majority did not plan to use this contraceptive method. Further high-quality qualitative and quantitative research regarding women's contraceptive plans and perception of the postpartum DMPA consent process and the healthcare provider's attitudes regarding consent and prescription of immediate postpartum DMPA are warranted.
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Affiliation(s)
- Elizabeth A Brownell
- 1 Connecticut Human Milk Research Center, Division of Neonatology, Connecticut Children's Medical Center , Hartford, Connecticut
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Lawrence RA. A perfect plan or a perfect storm. Breastfeed Med 2014; 9:171-2. [PMID: 24823917 DOI: 10.1089/bfm.2014.9988] [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: 11/12/2022]
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Lawrence RA. Resolving disparity, one more step. Breastfeed Med 2014; 9:111-2. [PMID: 24725103 DOI: 10.1089/bfm.2014.9992] [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: 11/13/2022]
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Dozier AM, Nelson A, Brownell EA, Howard CR, Lawrence RA. Patterns of postpartum depot medroxyprogesterone administration among low-income mothers. J Womens Health (Larchmt) 2014; 23:224-30. [PMID: 24443831 PMCID: PMC3996992 DOI: 10.1089/jwh.2012.4016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Depot medroxyprogesterone acetate (DMPA) is often administered immediately postpartum to reduce the risk of short-interval repeat or unintended pregnancies, but little is known about the actual patterns of postpartum DMPA use. This article examines the patterns of DMPA administered among low-income new mothers in an upstate New York State community. METHODS Mothers attending urban pediatric practices (births 2009-2011) completed a mailed survey approximately 5 months after delivery. Among 83 survey items were questions about breastfeeding and timing of DMPA receipt. RESULTS Unintended pregnancy was reported by 48.8% of the subjects. Their deliveries occurred across four local hospitals. Among the 31.3% of subjects who received postpartum DMPA, 62.6% received it prior to hospital discharge. Those receiving in-hospital DMPA (n=127) were significantly more likely than other mothers to be black, older, urban dwelling, non-high school graduates, multiparous, and planning to formula feed. Administration patterns differed by hospital. CONCLUSIONS This study of postpartum DMPA administration among a convenience sample of low-income mothers demonstrated rates of 26% overall, but there was between-hospital variability. Additional study may identify approaches to ensure timely administration to appropriate candidates.
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Affiliation(s)
- Ann M. Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Alice Nelson
- Department of Public Health Sciences, University of Rochester, Rochester, New York
| | - Elizabeth A. Brownell
- Departments of Research and Neonatology, Connecticut Children's Medical Center; Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Cynthia R. Howard
- Department of Pediatrics, University of Rochester, Rochester, New York; Rochester General Hospital
| | - Ruth A. Lawrence
- Departments of Pediatrics and Obstetrics and Gynecology, University of Rochester, Rochester, New York
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Dozier AM, Howard CR, Brownell EA, Wissler RN, Glantz JC, Ternullo SR, Thevenet-Morrison KN, Childs CK, Lawrence RA. Labor epidural anesthesia, obstetric factors and breastfeeding cessation. Matern Child Health J 2013; 17:689-98. [PMID: 22696104 DOI: 10.1007/s10995-012-1045-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia's association with breastfeeding outcomes show mixed results; many have methodological flaws. We analyzed potential associations between epidural anesthesia and overall breast-feeding cessation within 30 days postpartum while adjusting for standard and novel covariates and uniquely accounting for labor induction. A pooled analysis using Kaplan-Meier curves and modified Cox Proportional Hazard models included 772 breastfeeding mothers from upstate New York who had vaginal term births of healthy singleton infants. Subjects were drawn from two cohort studies (recruited postpartum between 2005 and 2008) and included maternal self-report and maternal and infant medical record data. Analyses of potential associations between epidural anesthesia and overall breastfeeding cessation within 1 month included additional covariates and uniquely accounted for labor induction. After adjusting for standard demographics and intrapartum factors, epidural anesthesia significantly predicted breastfeeding cessation (hazard ratio 1.26 [95% confidence interval 1.10, 1.44], p < 0.01) as did hospital type, maternal age, income, education, planned breastfeeding goal, and breastfeeding confidence. In post hoc analyses stratified by Baby Friendly Hospital (BFH) status, epidural anesthesia significantly predicted breastfeeding cessation (BFH: 1.19 [1.01, 1.41], p < 0.04; non-BFH: 1.65 [1.31, 2.08], p < 0.01). A relationship between epidural anesthesia and breastfeeding was found but is complex and involves institutional, clinical, maternal and infant factors. These findings have implications for clinical care and hospital policies and point to the need for prospective studies.
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Affiliation(s)
- Ann M Dozier
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA.
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Lawrence RA, Howard CR. Five years of progress: a road map for the future. Breastfeed Med 2013; 8:429-30. [PMID: 24112056 DOI: 10.1089/bfm.2013.9985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ruth A Lawrence
- 1 Department of Pediatrics, University of Rochester School of Medicine and Dentistry; and Director , Breastfeeding and Human Lactation Study Center, Golisano Children's Hospital at Strong, Rochester, New York
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Affiliation(s)
- Ruth A Lawrence
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry; and Director , Breastfeeding and Human Lactation Study Center, Golisano Children's Hospital at Strong, Rochester, New York
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Brownell EA, Fernandez ID, Fisher SG, Howard CR, Ternullo SR, Lawrence RA, Duckett JW, Dozier AM. The effect of immediate postpartum depot medroxyprogesterone on early breastfeeding cessation. Contraception 2013; 87:836-43. [PMID: 23153897 PMCID: PMC4038903 DOI: 10.1016/j.contraception.2012.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 07/09/2012] [Revised: 08/23/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study evaluated the effect of immediate postpartum depot medroxyprogesterone (DMPA) on breastfeeding cessation within 6 weeks postpartum. STUDY DESIGN At low-income-serving obstetric and pediatric clinics, eligible mothers within 1 year postpartum were recruited to participate in a retrospective cohort study. The 183 participants completed a self-administered survey. Surveys were merged with birth certificate data and perinatal maternal/infant medical records. Kaplan-Meier distributions assessed the relationship between DMPA use and breastfeeding cessation. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and included five known risk factors (age, education, race, parity and parental cohabitation) and identified potential confounders. RESULTS Consistent with the biologic model, the Kaplan-Meier results raised the possibility of a detrimental effect of DMPA on duration of any breastfeeding, but differences in these distributions did not achieve statistical significance (p=.24); after adjustment for potential confounders, this nonstatistically significant association remained (HR: 1.22; confidence interval: 0.75-1.98). CONCLUSION Given the state of the evidence, it is unclear whether a causal effect does or does not exist. However, if there is a causal effect of DMPA on breastfeeding duration, it is minimal. Additional well-designed research is warranted.
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Affiliation(s)
- Elizabeth A Brownell
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
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Lawrence RA. A tribute: Honorary Academy Of Breastfeeding Medicine founder C. Everett Koop, MD. Breastfeed Med 2013; 8:149-50. [PMID: 23573798 DOI: 10.1089/bfm.2013.9991] [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: 11/12/2022]
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Wagner CL, Howard CR, Hulsey TC, Lawrence RA, Ebeling M, Shary J, Smith PG, Morella K, Taylor SN, Hollis BW. Maternal and infant vitamin D status during lactation: Is latitude important? Health (London) 2013. [DOI: 10.4236/health.2013.512271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lawrence RA. Challenging the truth of some breastfeeding dogma. Breastfeed Med 2012; 7:391-2. [PMID: 23215906 DOI: 10.1089/bfm.2012.9976] [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: 11/13/2022]
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Abstract
The Renaissance of breastfeeding is at hand. With the energy of an epidemic and the passion of a crusade, breastfeeding has become the norm for infant feeding. The World Health Organization (WHO) and the Centers for Disease Control and Prevention have affirmed breastfeeding's value to public health. Strong organizations such as the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Association of Family Practice, and the Academy of Breastfeeding Medicine have confirmed the value of human milk. The discussion is over. Leading the charge is an eclectic group of health professionals and women, but the cause cannot rest. Efforts to change hospital behavior are key, but the support for mother-baby couples at home for the weeks and months that follow has just begun. Duration is the challenge. Employment and employers comprise one arm of the campaign. The other arms of the effort are under construction. Now is a time to move ahead, not rest on past achievement.
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Affiliation(s)
- Ruth A Lawrence
- Pediatrics and Obstetrics/Gynecology, Lactation Study Center in the Department of Pediatrics, Division of Neonatology, University of Rochester School of Medicine & Dentistry, Rochester, NY 14642, USA
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Affiliation(s)
- Ruth A. Lawrence
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital at Strong, Rochester, New York
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Lawrence RA, Howard CR. Final thoughts and ponderings from the chairs. Breastfeed Med 2012; 7:380-1. [PMID: 23016659 DOI: 10.1089/bfm.2012.9981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Ruth A. Lawrence
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Golisano Children's Hospital at Strong, Rochester, New York
| | - Cynthia R. Howard
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester General Hospital, Rochester, New York
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Brownell E, Howard CR, Lawrence RA, Dozier AM. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr 2012; 161:608-14. [PMID: 22575242 PMCID: PMC3670592 DOI: 10.1016/j.jpeds.2012.03.035] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 03/05/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between delayed lactogenesis II (>3 days postpartum; delayed onset lactogenesis II [DLII]) and the cessation of any and exclusive breastfeeding at 4-weeks postpartum. STUDY DESIGN We constructed multivariable logistic regression models using data from 2491 mothers enrolled in the prospective Infant Feeding Practice Study II cohort. Models included DLII, known risk factors for breastfeeding cessation (age, education, race, parity/previous breastfeeding, and exclusive breastfeeding plan), and potential confounders identified in bivariate analyses (P ≤ .1). Backward selection processes (P ≤ .1) determined risk factor retention in the final model. RESULTS DLII was associated with cessation of any and exclusive breastfeeding at 4-weeks postpartum (OR 1.62; CI 1.14-2.31; OR 1.62; CI 1.18-2.22, respectively); numerous independent risk factors qualified for inclusion in the multivariable model(s) and were associated with the outcome(s) of interest (eg, supplemental nutrition program for women, infants, and children enrollment, onset of prenatal care, feeding on-demand, time initiated first breastfeed, hospital rooming-in, obstetric provider preference for exclusive breastfeeding, and maternal tobacco use). CONCLUSIONS Women experiencing DLII may be less able to sustain any and/or exclusive breastfeeding in the early postpartum period. Routine assessment of DLII in postpartum breastfeeding follow-up is warranted. Women with DLII may benefit from additional early postpartum interventions to support favorable breastfeeding outcomes.
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Affiliation(s)
- Elizabeth Brownell
- Department of Research, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
| | - Cynthia R. Howard
- Rochester General Hospital, and Departments of Pediatrics and Community and Preventive Medicine, University of Rochester
| | - Ruth A. Lawrence
- Departments of Pediatrics and Obstetrics and Gynecology, University of Rochester
| | - Ann M. Dozier
- Department of Community and Preventive Medicine, University of Rochester
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Lawrence RA. The evolution of the mammary gland and the milk it produces. Breastfeed Med 2012; 7:131. [PMID: 22803927 DOI: 10.1089/bfm.2012.9987] [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: 11/13/2022]
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Lawrence RA. Challenges to successful breastfeeding. Breastfeed Med 2012; 7:1-2. [PMID: 22309298 DOI: 10.1089/bfm.2012.9994] [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: 11/13/2022]
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