Patterns for the initiation of breastfeeding in humans

Local environmental quality positively predicts breastfeeding in the UK's Millennium Cohort Study

Background and Objectives: Breastfeeding is an important form of parental investment with clear health benefits. Despite this, rates remain low in the UK; understanding variation can therefore help improve interventions. Life history theory suggests that environmental quality may pattern maternal investment, including breastfeeding. We analyse a nationally representative dataset to test two predictions: (i) higher local environmental quality predicts higher likelihood of breastfeeding initiation and longer duration; (ii) higher socioeconomic status (SES) provides a buffer against the adverse influences of low local environmental quality. Methodology: We ran factor analysis on a wide range of local-level environmental variables. Two summary measures of local environmental quality were generated by this analysis-one 'objective' (based on an independent assessor's neighbourhood scores) and one 'subjective' (based on respondent's scores). We used mixed-effects regression techniques to test our hypotheses. Results: Higher objective, but not subjective, local environmental quality predicts higher likelihood of starting and maintaining breastfeeding over and above individual SES and area-level measures of environmental quality. Higher individual SES is protective, with women from high-income households having relatively high breastfeeding initiation rates and those with high status jobs being more likely to maintain breastfeeding, even in poor environmental conditions. Conclusions and Implications: Environmental quality is often vaguely measured; here we present a thorough investigation of environmental quality at the local level, controlling for individual- and area-level measures. Our findings support a shift in focus away from individual factors and towards altering the landscape of women's decision making contexts when considering behaviours relevant to public health.

Correlates of early neonatal feeding practice in Dabat HDSS site, northwest Ethiopia

Background

Delaying the start of breastfeeding and giving prelacteal feeding leads to a significant increase in neonatal and infant deaths, particularly in a resource limited countries, like Ethiopia. Therefore, this study aimed to assess early neonatal feeding practice and its determinants in Dabat HDSS site, northwest Ethiopia.

Methods

The census for the reconciliation of the surveillance of the Dabat Health and Demographic Surveillance System (HDSS) site was conducted from October to December 2014. Data were entered into the Household Registration System (HRS) version 2.1 and analyzed using Stata version 14. A total of 6,761 mother-child pairs were included in the study. Sociodemographic factors, maternal health care and early neonatal feeding practices (early initiation of breastfeeding and prelacteal feeding) were collected by interviewing the mothers. The prevalence of early/timely initiation of breastfeeding was computed as the ratio of children put to the breast within one hour of delivery to the total number of children. Prelacteal feeding was defined as giving anything to drink other than breast milk in the first three days following birth. Binary logistic regression models were used to identify variables which were associated with the dependent variable. A multivariable logistic regression analysis was carried out to identify factors associated with early initiation of breastfeeding.

Results

The prevalence of early initiation of breastfeeding was 43.9% (95% CI, 41.6, 46.2). More than half (56%) of the mothers gave prelacteal feeds. An urban residence (Adjusted Odds Ratio [AOR] 1.47, 95% Confidence Interval [CI] 1.25. 1.73) and antenatal care (AOR 1.41, 95% CI 1.24, 1.59) were correlated with early initiation of breastfeeding. Similarly, increased odds of timely initiation of breastfeeding were observed among mothers who didn’t give prelacteal feeds (AOR 5.72; 95% CI, 5.12, 6.40).

Conclusion

Delayed initiation of breastfeeding and prelacteal feeding still remain public health concerns in this community. The promotion of improved infant and young child feeding (IYCF) practices and the utilization of antenatal care services should be intensified.

A twin study of breastfeeding with a preliminary genome-wide association scan

Breastfeeding has been an important survival trait during human history, though it has long been recognized that individuals differ in their exact breastfeeding behavior. Here our aims were, first, to explore to what extent genetic and environmental influences contributed to the individual differences in breastfeeding behavior; second, to detect possible genetic variants related to breastfeeding; and lastly, to test if the genetic variants associated with breastfeeding have been previously found to be related with breast size. Data were collected from a large community-based cohort of Australian twins, with 3,364 women participating in the twin modelling analyses and 1,521 of them included in the genome-wide association study (GWAS). Monozygotic (MZ) twin correlations (r MZ = 0.52, 95% CI 0.46-0.57) were larger than dizygotic (DZ) twin correlations (r DZ = 0.35, 95% CI 0.25-0.43) and the best-fitting model was the one composed by additive genetics and unique environmental factors, explaining 53% and 47% of the variance in breastfeeding behavior, respectively. No breastfeeding-related genetic variants reached genome-wide significance. The polygenic risk score analyses showed no significant results, suggesting breast size does not influence breastfeeding. This study confers a replication of a previous one exploring the sources of variance of breastfeeding and, to our knowledge, is the first one to conduct a GWAS on breastfeeding and look at the overlap with variants for breast size.

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

BACKGROUND

Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that mothers are provided with high-quality evidence to inform their feeding decisions.

OBJECTIVES

To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2013), CINAHL (1981 to 13 November 2013), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (6 November 2013).

SELECTION CRITERIA

Randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form were eligible for inclusion if sufficient data were available. Studies using a cross-over design were not eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We independently assessed for inclusion all the potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.

MAIN RESULTS

No studies were identified that were eligible for inclusion in this review.

AUTHORS' CONCLUSIONS

This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns, therefore no conclusions could be taken at this point. It is recommended that no changes are made to current practice guidelines without undertaking further robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Further research is needed to also evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding on successful breastfeeding, for healthy newborns. However, conducting such a study, particularly a randomised controlled trial is unlikely to receive ethical approval, as the issue of obtaining informed consent from new mothers or mothers-to-be for randomisation between baby-led and scheduled breastfeeding is a difficult one and it is likely that the Baby Friendly Hospital Initiative practices would prohibit such a study.

The genetic and environmental structure of reproduction-related variables: the case of fertility and breastfeeding

Life history theory studies the evolution of traits related to reproductive fitness. Fertility and parental investment are key life history traits which, from an evolutionary standpoint, appear strongly interrelated. The aim of this work was to analyze the genetic and environmental structure and relationship of two behaviors associated with reproductive fitness: total number of offspring and mean duration of breastfeeding. A total of 1,347 women distributed in 239 monozygotic pairs, 236 dizygotic pairs, and 393 individual twins from opposite sex pairs provided information about their reproductive history. We conducted separate univariate analyses to study the sources of variance of both variables; and a bivariate analysis, with threshold liability models. The sources of variance for number of children and breastfeeding were best explained by a model including familial and unique environmental factors, being E = 0.54 (CI 95%: 0.44, 0.66) and E = 0.46 (CI 95%: 0.34, 0.61), respectively. The phenotypic correlation between number of children and breastfeeding was low but significant (r = 0.16, CI 95%: 0.07, 0.25). Familial correlation between these variables did not reach significance, but unique environmental correlation did (re = 0.20, CI 95%: 0.02, 0.37). In conclusion, results do not support the existence of a clear common structure for the number of children a woman has and the time she spends breastfeeding them, at least in modern societies. The relationship found was mainly due to unique environmental factors. More research on these and related phenotypes is needed to better understand women's reproductive decisions and how natural selection acts on the life history traits.

Breastfeeding: an emotional instinct

OBJECTIVE

The proposed objective of this research is twofold: (1) it examines the significance of emotions to the breastfeeding experience in relation to cognition, and (2) it analyzes the extent to which emotions and cognition are connected to breastfeeding.

MATERIALS AND METHODS

An empirical research work has been carried out based on a questionnaire that was administered in a maternity hospital in the autumn of 2008, in order to gather information regarding cognitive and emotional aspects of breastfeeding behavior. The final sample comprised 311 breastfeeding mothers, and the sampling error was 5.55%.

RESULTS

The research shows that breastfeeding is not only more of an emotional reaction than a rational decision, but also demonstrates that the emotional development of breastfeeding is independent from the cognitive process.

CONCLUSIONS

A new approach in the literature of breastfeeding is put forward in which the predominant cognitive techniques and theories are complemented by highlighting the importance of understanding the target group and implementing suitable and affective actions. Specific practical implications are provided for social marketing campaigns as well as future lines of research.

Infant nutrition in the first seven days of life in rural northern Ghana

BACKGROUND

Good nutrition is essential for increasing survival rates of infants. This study explored infant feeding practices in a resource-poor setting and assessed implications for future interventions focused on improving newborn health.

METHODS

The study took place in the Kassena-Nankana District of the Upper East Region of northern Ghana. In-depth interviews were conducted with 35 women with newborn infants, 8 traditional birth attendants and local healers, and 16 community leaders. An additional 18 focus group discussions were conducted with household heads, compound heads and grandmothers. All interviews and discussions were audio taped, transcribed verbatim and analyzed using NVivo 9.0.

RESULTS

Community members are knowledgeable about the importance of breastfeeding, and most women with newborn infants do attempt to breastfeed. However, data suggest that traditional practices related to breastfeeding and infant nutrition continue, despite knowledge of clinical guidelines. Such traditional practices include feeding newborn infants water, gripe water, local herbs, or traditionally meaningful foods such as water mixed with the flour of guinea corn (yara'na). In this region in Ghana, there are significant cultural traditions associated with breastfeeding. For example, colostrum from first-time mothers is often tested for bitterness by putting ants in it - a process that leads to a delay in initiating breastfeeding. Our data also indicate that grandmothers - typically the mother-in-laws - wield enormous power in these communities, and their desires significantly influence breastfeeding initiation, exclusivity, and maintenance.

CONCLUSION

Prelacteal feeding is still common in rural Ghana despite demonstrating high knowledge of appropriate feeding practices. Future interventions that focus on grandmothers and religious leaders are likely to prove valuable in changing community attitudes, beliefs, and practices with regard to infant nutrition.

Early initiation of breast-feeding in Ghana: barriers and facilitators

To explore why women in Ghana initiate breast-feeding early or late, who gives advice about initiation and what foods or fluids are given to babies when breast-feeding initiation is late. Qualitative data were collected through 52 semistructured interviews with recent mothers, 8 focus group discussions with women of child-bearing age and 13 semistructured interviews with health workers, policy makers and implementers. The major reasons for delaying initiation of breast-feeding were the perception of a lack of breast milk, performing postbirth activities such as bathing, perception that the mother and the baby need rest after birth and the baby not crying for milk. Facilitating factors for early initiation included delivery in a health facility, where the staff encouraged early breast-feeding, and the belief in some ethnic groups that putting the baby to the breast encourages the milk. Policy makers tended to focus on exclusive breast-feeding rather than early initiation. Most activities for the promotion of early initiation of breast-feeding were focused on health facilities with very few community activities. It is important to raise awareness about early initiation of breast-feeding in communities and in the policy arena. Interventions should focus on addressing barriers to early initiation and should include a community component.

Endocrinology of lactation

The endocrine control of lactation is one of the most complex physiologic mechanisms of human parturition. Mammogenesis, lactogenesis, galactopoiesis, and galactokinesis are all essential to assure proper lactation. Prolactin is the key hormone of lactation and seems to be the single most important galactopoietic hormone. Oxytocin, serotonin, opioids, histamine, substance P, and arginine-leucine modulate prolactin release by means of an autocrine/paracrine mechanism, whereas estrogen and progesterone hormones can act at the hypothalamic and adenohypophysial levels. Human placental lactogen and growth factors play an essential role to assure successful lactation during pregnancy. Oxytocin is the most powerful galactokinetic hormone.

Hormonal correlates for the initiation of breast-feeding in Bangladeshi women

Hormonal changes that occur before or during parturition are known to trigger early postpartum maternal behaviors in many mammals. In humans, little evidence has been found for hormonal mediation of early postpartum maternal behavior. In this paper, we investigate associations between fetoplacental hormone concentrations in late pregnancy on the time from parturition to initiation of breast-feeding. A sample of 91 pregnant rural Bangladeshi women, enrolled in a 9-month prospective study, provided twice-weekly urine specimens and structured interviews. The subjects provided self-reports of time from parturition to initiation of breast-feeding. Specimens were assayed for urinary concentrations of human chorionic gonadotropin (hCG), pregnanediol-3alpha-glucuronide (PdG, a metabolite of progesterone), and urinary estrone conjugates (E1C). Parametric hazards analysis was used to investigate the effects of hCG, PdG, and E1C concentrations and other covariates (mother's age, parity, and child's sex) on the duration from parturition to breast-feeding. Mother's age, parity, the child's sex, hCG, and PdG showed no association with the onset of breast-feeding. Urinary E1C was significantly associated with time to initiation of breast-feeding, explaining about 4% of the variation in the behavior. The relationship was positive so that higher prepartum concentrations of EIC were associated with later times to initiation of breast-feeding. The direction of this relationship is opposite that found for many other species of mammals but is consistent with some recent findings in primates.