Risk factors for cessation of breastfeeding prior to six months postpartum among a community sample of women in Calgary, Alberta

A perinatal social nutrition approach to improve breastfeeding in a culturally diverse group of low-income women

Alima, Perinatal Social Nutrition Centre, is an established community organization that adopts a perinatal social nutrition approach to provide multidimensional support to women living in vulnerable conditions, particularly those with a precarious migratory status. This study aims to (i) determine which maternal characteristics, pregnancy-related variables, and structural features of the Alima intervention are associated with breastfeeding; and (ii) examine whether the association between attending breastfeeding workshops and breastfeeding characteristics differ according to maternal factors. The Alima digital database was used to analyze data from women who received the perinatal intervention between 2013 and 2020. Infant feeding data were retrieved at 2 weeks postpartum (T0, n = 2925), 2 months postpartum (T2, n = 1475), and 4 months postpartum (T4, n = 890). Logistic regressions were used to estimate the odds of overall and exclusive breastfeeding depending on sociodemographic characteristics, pregnancy-related variables, and features of the intervention. The prevalence of overall and exclusive breastfeeding was, respectively, 96.1% and 60.7% at T0; 93.0% and 58.5% at T2; 83.0% and 48.4% at T4. Higher education, previous breastfeeding experience, and recent immigration were associated with a higher likelihood of breastfeeding at each time point. Breastfeeding workshop attendance was associated with a greater likelihood of overall and exclusive breastfeeding at T2 and T4, with a stronger effect among women aged 35 or less, those with lower education, and those with excessive gestational weight gain. In conclusion, the Alima intervention is associated with positive breastfeeding outcomes, especially among vulnerable women living with precarious migratory status in Canada.

The Role of Maternal Depression Symptoms and Maternal Attachment in Predicting Exclusive Breastfeeding: A Multisite Prospective Study

Background: Previous research shows that 61% of children younger than 6 months in low- and middle-income countries (LMICs) are not exclusively breastfed. Although data on the role of pre- and postnatal depression on breastfeeding exclusivity is mixed, fetomaternal attachment might foster breastfeeding exclusivity. Thus, we tested the potential mediating role of fetomaternal attachment and postnatal depression in the relationship between maternal prenatal depression and exclusive breastfeeding. Materials and Methods: Data were collected as part of a prospective, cross-cultural project, Evidence for Better Lives Study, which enrolled 1208 expectant mothers, in their third trimester of pregnancy across eight sites, from LMICs. Of the whole sample, 1185 women (mean age = 28.32, standard deviation [SD] = 5.77) completed Computer-Aided Personal Interviews on prenatal depressive symptoms, fetomaternal attachment, and socioeconomic status. A total of 1054 women provided follow-up data at 3-6 months after birth, about postnatal depressive symptoms, exclusive breastfeeding, and infant health indicators. Path analysis was used to assess parallel mediation. Results: In the whole sample, the effect of prenatal depression on breastfeeding exclusivity was completely mediated by postnatal depression, whereas fetomaternal attachment did not mediate the relationship. The full mediation effect was replicated individually in Pakistan and Sri Lanka. Conclusions: The study results indicate that prenatal depression symptoms contributed to the development of depressive symptoms after birth, negatively affecting the probability of exclusive breastfeeding. Future research should explore this in early prevention interventions, increasing the chances of healthy child development in LMICs. Considering the mixed results around the sites, it is important to better understand the relationship between maternal depression, fetomaternal attachment and breastfeeding behavior in each site's socio-cultural context.

Predictors of Breastfeeding Duration in the New Hampshire Birth Cohort Study

INTRODUCTION

Breastfeeding has significant health benefits for infants and birthing persons, including reduced risk of chronic disease. The American Academy of Pediatrics recommends exclusively breastfeeding infants for 6 months and recently extended its recommendation for continuing to breastfeed with supplementation of solid foods from one to two years. Studies consistently identify lower breastfeeding rates among US infants, with regional and demographic variability. We examined breastfeeding in birthing person-infant pairs among healthy, term pregnancies enrolled in the New Hampshire Birth Cohort Study between 2010 and 2017 (n = 1176).

METHODS

Birthing persons 18-45 years old were enrolled during prenatal care visits at ~ 24-28 weeks gestation and have been followed since enrollment. Breastfeeding status was obtained from postpartum questionnaires. Birthing person and infant health and sociodemographic information was abstracted from medical records and prenatal and postpartum questionnaires. We evaluated the effects of birthing person age, education, relationship status, pre-pregnancy body mass index, gestational weight gain (GWG), smoking and parity, and infant sex, ponderal index, gestational age and delivery mode on breastfeeding initiation and duration using modified Poisson and multivariable linear regression.

RESULTS

Among healthy, term pregnancies, 96% of infants were breastfed at least once. Only 29% and 28% were exclusively breastfed at 6-months or received any breastmilk at 12-months, respectively. Higher birthing person age, education, and parity, being married, excessive GWG, and older gestational age at delivery were associated with better breastfeeding outcomes. Smoking, obesity, and cesarean delivery were negatively associated with breastfeeding outcomes.

CONCLUSIONS

Given the public health importance of breastfeeding for infants and birthing persons, interventions are needed to support birthing persons to extend their breastfeeding duration.

Effect of positive emotion intervention during late pregnancy on improving colostrum secretion: a randomised control trial protocol

INTRODUCTION

Though evidence has revealed the beneficial effects of cognitive improvement interventions on breastfeeding, the effect of psychological interventions has rarely been studied. This study aims to test whether promoting a positive emotion intervention, 'Three Good Things' intervention, during the last trimester of pregnancy can enhance early colostrum secretion and breastfeeding behaviours by modulating the hormones associated with lactation (prolactin and insulin-like growth factor I). We will attempt to promote exclusive breastfeeding by using physiological behavioural measures.

METHODS AND ANALYSIS

This study is designed as a randomised controlled trial conducted in the Women's Hospital School of Medicine at Zhejiang University and the Wuyi First People's Hospital. The participants will be randomly divided into two groups using stratified random grouping: the intervention group will receive 'Three Good Things' intervention, while the control group will write about three things that come to mind first. These interventions will be continued from enrolment until the day of delivery. Maternal blood hormone levels will be tested approaching delivery and the following day after birth. Behavioural information about breastfeeding will be collected 1 week afterwards.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Committees of the Women's Hospital School of Medicine at Zhejiang University and the Wuyi First People's Hospital. Results will be disseminated through peer-reviewed journals or international academic conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2000038849.

The Relationship between Psychological Suffering, Value of Maternal Cortisol during Third Trimester of Pregnancy and Breastfeeding Initiation

Background and Objectives: Cortisol, the stress hormone, is an important factor in initiating and maintaining lactation. Maternal suffering during pregnancy is predictive for the initiation and shorter duration of breastfeeding and can also lead to its termination. The aim of this study is to evaluate the relationship between the level of salivary cortisol in the third trimester of pregnancy and the initiation of breastfeeding in the postpartum period in a cohort of young pregnant women who wanted to exclusively breastfeed their newborns during hospitalization. Materials and Methods: For the study, full-term pregnant women were recruited between January and May 2022 in the Obstetrics and Gynecology Clinic of the Mureș County Clinical Hospital. Socio-demographic, clinical obstetric and neonatal variables were collected. Breastfeeding efficiency was assessed using the LATCH Breastfeeding Assessment Tool at 24 and 48 h after birth. The mean value of the LATCH score assessed at 24 and 48 h of age was higher among mothers who had a higher mean value of salivary cortisol measured in the third trimester of pregnancy (p < 0.05). A multivariate logistic regression model was used to detect risk factors for the success of early breastfeeding initiation. Results: A quarter of pregnant women had a salivary cortisol level above normal limits during the third trimester of pregnancy. There is a statistically significant association between maternal smoking, alcohol consumption during pregnancy and the level of anxiety or depression. Conclusions: The most important finding of this study was that increased salivary cortisol in the last trimester of pregnancy was not associated with delayed initiation/absence of breastfeeding.

Impact of lifetime lactation on the risk and duration of frequent vasomotor symptoms: A longitudinal dose-response analysis

OBJECTIVE

To examine the association between lifetime lactation and risk and duration of frequent vasomotor symptoms (VMS).

DESIGN

Prospective cohort.

SETTING

USA, 1995-2008.

SAMPLE

2356 parous midlife women in the Study of Women's Health Across the Nation.

METHODS

Lifetime lactation was defined as the duration of breastfeeding across all births in months. We used generalised estimating equations to analyse risk of frequent VMS and Cox regression to analyse duration of frequent VMS in years.

MAIN OUTCOME MEASURES

Frequent VMS (hot flashes and night sweats) were measured annually for 10 years, defined as occurring ≥6 days in the past 2 weeks.

RESULTS

Overall, 57.1% of women reported hot flashes and 43.0% reported night sweats during follow-up. Lifetime lactation was inversely associated with hot flashes plateauing at 12 months of breastfeeding (6 months: adjusted odds ratio [AOR] 0.85, 95% confidence interval (CI) 0.75-0.96; 12 months: AOR 0.78, 95% CI 0.65-0.93) and was inversely associated with night sweats in a downward linear fashion (6 months: AOR 0.93, 95% CI 0.81-1.08; 18 months: AOR 0.82, 95% CI 0.67-1.02; 30 months: AOR 0.73, 95% CI 0.56-0.97). Lifetime lactation was associated with shorter duration of hot flashes and night sweats in a quadratic (bell-shaped) fashion. The association was strongest at 12-18 months of breastfeeding and significant for hot flashes (6 months: adjusted hazard ratio [AHR] 1.35, 95% CI 1.11-1.65; 18 months: AHR 1.54, 95% CI 1.16-2.03; 30 months: AHR 1.18, 95% CI 0.83-1.68).

CONCLUSIONS

Longer lifetime lactation is associated with decreased risk and duration of frequent VMS.

Association of lifetime lactation and age at natural menopause: a prospective cohort study

OBJECTIVE

The aim of this study was to examine the association between duration of lifetime lactation and age at natural menopause.

METHODS

In this prospective cohort study, we analyzed parous premenopausal women in the multiethnic Study of Women's Health Across the Nation who were followed approximately annually for 10 years (1995-2008). Lifetime lactation was defined as the duration of breastfeeding across all births in months. Age at natural menopause was defined as age in years after 12 consecutive months of amenorrhea after the final menstrual period for no other reported cause. We used Cox proportional hazard models to analyze time to natural menopause with age as the underlying time scale. Multivariable models controlled for education, race/ethnicity, parity, smoking, body mass index, and oral contraceptive use.

RESULTS

Among 2,377 women, 52.6% experienced natural menopause during follow-up and reported a valid final menstrual period date. The small, crude association between lifetime lactation up to 24 months and later age at natural menopause attenuated to nonsignificance in adjusted models (6 months: adjusted hazard ratio [AHR], 0.96; 95% confidence interval (CI), 0.87-1.06; 12 months: AHR, 0.95; 95% CI, 0.82-1.11; 18 months: AHR, 0.96; 95% CI, 0.82-1.13; 24 months: AHR, 0.99; 95% CI, 0.84-1.16).

CONCLUSIONS

Duration of lifetime lactation was not associated with age at natural menopause after controlling for sociodemographic characteristics.

The relationship between skin-to-skin contact and rates of exclusive breastfeeding at four months among a group of mothers in Nova Scotia: a retrospective cohort study

OBJECTIVES

Exclusive breastfeeding is the ideal source of nutrition for the first 6 months of life. Although skin-to-skin contact (SSC) has been shown to be associated with greater rates of exclusive breastfeeding, the results are heterogeneous. SSC involves placing a naked infant on its mother's bare chest immediately after birth. We examined the association between SSC immediately after birth and exclusive breastfeeding at 4 months.

METHODS

A retrospective cohort of healthy, term, singleton infants who were liveborn from 2008 to 2019 was constructed from the Nova Scotia Atlee Perinatal Database. Our main outcome was exclusive breastfeeding at 4 months, available for a subset of the cohort through linkage to a primary care database (n=256). Our secondary outcome was exclusive breastfeeding at hospital discharge, available for the broader cohort (n=56,459). Odds ratios (OR) for the association between SSC and exclusive breastfeeding at 4 months were estimated from logistic regression models.

RESULTS

The odds of breastfeeding exclusively at 4 months were 4.14 (95% confidence interval (CI) 1.89-9.25) times greater among those who had SSC than among those who did not. The odds of breastfeeding exclusively at hospital discharge were 3.81 (95% CI 3.64-3.99) times greater among those who had SSC than among those who did not. The association between SSC and exclusive breastfeeding at hospital discharge was heterogeneous by birth year (OR 4.35, CI 4.07-4.65 in 2008-2011; OR 2.81, CI 2.57-3.07 in 2012-2015; OR 1.89, CI 1.63-2.10 in 2016-2019).

CONCLUSION

Skin-to-skin contact appears to be associated with greater odds of exclusive breastfeeding at discharge and 4 months postpartum. Early SSC should continue to be supported for breastfeeding promotion.

Ocupação materna e duração do aleitamento materno exclusivo: resultados de uma coorte de nascimento em São Luís, Maranhão, Brasil

Nas investigações dos determinantes da duração do aleitamento materno exclusivo (AME), a variável trabalho materno remunerado é quase sempre dicotomizada em não e sim. Este estudo analisa possíveis associações entre características da ocupação materna e menor duração do AME. Foi realizado um estudo de coorte em uma amostra sistemática de nascimentos do Município de São Luís (Maranhão, Brasil) em 2010. As exposições tipo de ocupação materna, números de dias trabalhados/semana e de horas trabalhadas/dia, trabalha em pé a maior parte do tempo e levanta objetos pesados nesse trabalho foram coletadas com 5.166 mães de nascidos vivos. A amostra final desse estudo teve 3.268 observações. Foi utilizada análise de sobrevida para testar associações entre as exposições e os desfechos AME até 4 meses (AME4) e AME até 6 meses (AME6). Não ter trabalho remunerado foi a categoria de referência. Regressões ajustadas de Cox mostraram que mães com ocupações manuais semiespecializadas (intervalo de 95% de confiança, IC95%: 1,02-1,58 para AME4 e IC95%: 1,11-1,56 para AME6) e mães que trabalhavam 8 ou mais horas diárias (IC95%: 1,01-1,36 para AME4 e IC95%: 1,11-1,41 para AME6) mais frequentemente interromperam AME. Mães com ocupações em funções de escritório (IC95%: 1,07-1,46), que trabalhavam 4-5 dias (IC95%: 1,01-1,36) ou 6-7 dias/semana (IC95%: 1,09-1,40) e por 5-7 horas (IC95%: 1,03-1,43) também praticaram menos AME6. Trabalhar (IC95%: 1,08-1,40) ou não (IC95%: 1,03-1,34) em pé a maior parte do tempo e levantar (IC95%: 1,07-1,56) ou não (IC95%: 1,06-1,33) objetos pesados no trabalho diminuíram a duração de AME6. Tipos de ocupação e de jornada de trabalho interferiram mais frequentemente na duração de AME6.

The Impact of Antepartum Depression and Postpartum Depression on Exclusive Breastfeeding: A Systematic Review and Meta-Analysis

The aim of this study was to systematically review the impact of antepartum depression on exclusive breastfeeding. A total of 15 studies were included in the review and 12 studies were used for the meta-analysis. The mean values of antepartum depression indicated that women who breastfed exclusively between 3 and 6 months had less antepartum depression symptoms (Mean Difference = -0.55, 95% CI = -0.76 to -0.35). The analysis also showed that the existence of antepartum depression was negatively related to continuing exclusive breastfeeding for longer than 3 months postpartum as well as for 8 weeks postpartum (OR = 0.48, 95% CI = 0.26-0.88 and OR = 0.83, 95% CI = 0.75-0.91, respectively). The cumulative evidence is conclusive that antepartum depressive symptoms are negatively associated with exclusive breastfeeding, particularly between 3 and 6 months postpartum. This review supports the necessity of screening and follow-up for depression throughout the perinatal period to promote exclusive breastfeeding for 6 months.

The significance of breastfeeding practices on postpartum depression risk

OBJECTIVE

Examine the relationship between breastfeeding practices (breastfeeding status and breastfeeding length) and postpartum depression (PPD) risk, after controlling for significant risk factors for PPD.

DESIGN

A cross-sectional, correlational study design was used. Data was used from a national dataset using a subsample of women (n = 29,682) residing in 26 states in the United States that answered the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. A secondary analysis was conducted using descriptive and bivariate analyses, and a multiple logistic regression model.

RESULTS

Women currently breastfeeding (AOR = 0.87 CI: 0.79-0.95, p = .001), and women who breastfed for longer periods of time (p = < .002) had a statistically significantly lower PPD risk compared to their counterparts, even after accounting for significant covariates.

CONCLUSIONS

Study findings suggest breastfeeding as a cost efficient and healthy behavior that can decrease a woman's risk for PPD. Nurses should educate and promote the maternal mental health benefits of breastfeeding in addition to the health benefits for the infant.

Breastfeeding patterns and effects of minimal supplementation on breastfeeding exclusivity and duration in term infants: A prospective sub-study of a randomised controlled trial

AIM

Despite international recommendations, less than one-third of Australian women exclusively breastfeed for 6 months. The aims of this study were to prospectively determine rates and factors associated with the type and duration of breastfeeding in the first year and examine the effect of minimal supplementation.

METHODS

We conducted a sub-study of a randomised controlled trial in Sydney, Australia, which included 635 women with uncomplicated term births who intended to breastfeed. Data were collected daily for 56 days, and then at 2, 6 and 12 months post-partum.

RESULTS

Breastfeeding outcomes were evaluated for 553 (87%), 480 (76%) and 392 (62%) women at 2, 6 and 12 months. Exclusive breastfeeding was 81% at 2 months and 8% at 6 months. Partial breastfeeding was 75% at 6 months and 54% at 12 months. Factors associated with breastfeeding cessation included caesarean birth, low milk supply, problems latching, increased time to breastfeed, use of formula >7 days in the first 2 months, return to work and early introduction of solids. Breast pain in the first week was associated with a 10% decrease in exclusive breastfeeding. Cracked nipples and no previous breastfeeding experience were associated with supplementation of ≤7 days but had no effect on long-term breastfeeding duration.

CONCLUSIONS

Exclusive breastfeeding declined significantly between 2 and 6 months post-partum. Early intervention and education to prolong breastfeeding duration should include strategies to manage breast pain and nipple damage to minimise prolonged supplementation. Consistent guidelines about introduction of complementary foods, improved maternity leave and workplace incentives could be effective in prolonging breastfeeding.

Association between Breastfeeding Duration and Long-Term Midwifery-Led Support and Psychosocial Support: Outcomes from a Greek Non-Randomized Controlled Perinatal Health Intervention

Background: This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding. Methods: A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014–January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted. Results: The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively). Conclusions: Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.

Kellner's Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties

INTRODUCTION

Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment.

OBJECTIVE

The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being).

METHODS

The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included.

RESULTS

A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo.

CONCLUSIONS

The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.

Women's Mental Health as a Factor Associated with Exclusive Breastfeeding and Breastfeeding Duration: Data from a Longitudinal Study in Greece

Background: This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. Methods: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave birth during the 5-year period between January 2014 and January 2019 in Athens, Greece, was designed. Women’s history and two psychometric tools—the Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) administered at 5-time points—were used for data collection. Logistic regression analysis and a series of multiple analysis of variance (MANOVA) tests were performed. Results: The chance for exclusive breastfeeding (giving only breast milk) appeared to decrease (a) with an increase of the scores for psychometric tools antenatally (PHQ-9, p = 0.030) or at the 6th week postpartum (EPDS, p < 0.001 and PHQ-9, p < 0.001), (b) with an increase in the number of psychotherapeutic sessions needed antenatally (p = 0.030), and (c) when the initiation of psychotherapy was necessary postpartum (p = 0.002). Additionally, a shorter duration of any breastfeeding (with or without formula or other types of food/drink) seems to be associated with (a) the occurrence of pathological mental health symptoms (p = 0.029), (b) increased PHQ-9 scores antenatally (p = 0.018), (c) increased EPDS scores at the 6th week (p = 0.004) and the 12th month postpartum (p = 0.031), (d) the initiation of psychotherapy postpartum (p = 0.040), and e) the need for more than 13 psychotherapeutic sessions (p = 0.020). Conclusions: This study demonstrates a negative relationship between exclusive breastfeeding and breastfeeding duration, and poor maternal mental health in the perinatal period.

Maternal Body Mass Index and Breastfeeding Non-Initiation and Cessation: A Quantitative Review of the Literature

This study aims to investigate which maternal body mass index (BMI) categories are associated with the non-initiation or cessation of breastfeeding (BF) based on a quantitative review of the literature. We searched Ovid MEDLINE and EBSCO CINAHL for peer-reviewed articles published between 1946 (MEDLINE) or 1981 (CINAHL), and 2019. Selected studies were either cross-sectional or cohort studies, of healthy mothers and infants, that reported nutrition method (exclusive/full or any) and period (initiation/duration/cessation) of breastfeeding according to maternal BMI levels. Pairwise meta-analyses of 57 studies demonstrated that the pooled odds risks (OR) of not initiating BF among overweight and obese mothers compared to normal weight mothers were significant across 29 (OR 1.33, 95% confidence interval (CI), 1.15–1.54, I² = 98%) and 26 studies (OR 1.61, 95% CI, 1.33–1.95, I² = 99%), respectively; the pooled risks for BF cessation were inconsistent in overweight and obese mothers with substantial heterogeneity. However, we found that overweight mothers (n = 10, hazard ratio (HR) 1.16, 95% CI, 1.07–1.25; I² = 23%) and obese mothers (n = 7, HR 1.45, 95% CI: 1.27–1.65; I² = 44%) were both associated with an increased risk of not continuing any BF and exclusive BF, respectively. Overweight and obese mothers may be at increased risk of not initiating or the cessation of breastfeeding.

Maternal obesity adversely affects early breastfeeding in a multicultural, multi-socioeconomic Melbourne community

BACKGROUND

Maternal breastfeeding support and maternal obesity are concerns effectively addressed at the community level. International, national and regional surveys have established that elevated maternal body mass index (BMI) is a risk factor for early cessation of breastfeeding. However, the extent of these concerns in the local community is often an unknown and related to variables such as socioeconomic status, education, culture and ethnicity.

AIMS

We believed that a survey of post-natal breastfeeding and BMI status would provide a valuable insight into developing targeted local health initiatives.

MATERIALS AND METHODS

In 2014, we teamed up with the Whittlesea Maternal and Child Health Service to complete a questionnaire of mothers and babies attending the eight-week infant review. Data included: infant and maternal weight, medical conditions, breastfeeding experience and satisfaction, prime language, education level, support.

RESULTS

Maternal obesity at eight weeks postpartum was high at 28.9%, with 63.6% of mothers being overweight or obese. Obesity was associated with a lack of higher education (P < 0.05) and with English as the prime language (P < 0.05). Breastfeeding initiation was high across all BMI categories at 98.3%. By eight weeks, 32.2% of mothers had ceased breastfeeding. Breastfeeding continuation at eight weeks was negatively correlated with elevated BMI (P < 0.01). Breastfeeding cessation in mothers with elevated BMI correlated with psycho-social concerns (P < 0.05) and lack of previous breastfeeding experience (P < 0.01).

CONCLUSION

Elevated maternal BMI is prevalent in our community and significantly impacts the success of breastfeeding in the early post-natal period. The survey data have allowed targeted health responses to be developed.

Maternal mood symptoms in pregnancy and postpartum depression: association with exclusive breastfeeding in a population-based birth cohort

PURPOSE

This study aimed to evaluate the association between mood symptoms during pregnancy and exclusive breastfeeding at 3 months, as well as the association between exclusive breastfeeding at 3 months and maternal depression at 12 months postpartum.

METHODS

Data from the Pelotas 2004 Birth Cohort with 4231 live births were used. Maternal mood symptoms during pregnancy were assessed through the question "During pregnancy, did you have depression or nervous problems?" and depression symptomatology at 12 months postpartum was assessed with the Edinburg Postnatal Depression Scale (EPDS). Information on exclusive breastfeeding at 3 months was collected through a dietary recall questionnaire. Crude and adjusted relative risks (RR) with 95% confidence intervals (95% CI) were estimated by Poisson regression.

RESULTS

Prevalence of mood symptoms during pregnancy was 25.1% (95% CI 23.8; 26.4%) and prevalence of EPDS ≥ 10 at 12 months after birth was 27.6% (95% CI 26.2; 29.0%). Prevalence of exclusive breastfeeding at 3 months was 26.5% (95% CI 25.2; 27.9%). In crude analyses, maternal mood symptoms during pregnancy were associated with non-exclusive breastfeeding at 3 months and non-exclusive breastfeeding at 3 months was associated with postpartum maternal depression at 12 months. In the adjusted analyses, both associations were lost after the inclusion of maternal education (RR 0.92; 95% CI 0.81-1.04 and RR 0.92; 95% CI 0.81-1.03, respectively).

CONCLUSION

In our study, the crude association between mood symptoms in pregnancy, exclusive breastfeeding at 3 months, and postpartum depression was due more to the low maternal education than to a true relationship between them.

Early Term Delivery and Breastfeeding Outcomes

OBJECTIVE

Higher rates of adverse outcomes have been reported for early term (37 0 to 38 6 weeks) versus full term (≥ 39 0 weeks) infants, but differences in breastfeeding outcomes have not been systematically evaluated. This study examined breastfeeding initiation and exclusivity in early and full term infants in a large US based sample.

METHODS

This secondary analysis included 743 geographically- and racially-diverse women from the Measurement of Maternal Stress Study cohort, and 295 women from a quality assessment at a hospital-based clinic in Evanston, IL. Only subjects delivering ≥ 37 weeks were included. Initiation of breastfeeding (IBF) and exclusive breastfeeding (EBF) were assessed via electronic medical record review after discharge. Associations of IBF and EBF with early and full term delivery were assessed via univariate and multivariate logistic regression.

RESULTS

Among 872 women eligible for inclusion, 85.7% IBF and 44.0% EBF. Early term delivery was not associated with any difference in frequency of IBF (p = 0.43), but was associated with significantly lower odds of EBF (unadjusted OR 0.61, 95% CI 0.466, 0.803, p < 0.001). This association remained significant (adjusted OR 0.694, 95% CI 0.515, 0.935, p = 0.016) after adjusting for maternal diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal age, race/ethnicity, parity, Medicaid status, NICU admission, current smoking, and delivery hospital.

CONCLUSIONS FOR PRACTICE

Despite comparable breastfeeding initiation frequencies, early term infants were significantly less likely to be exclusively breastfed compared to full term infants. These data suggest that women with early term infants may benefit from counseling regarding the potential for breastfeeding difficulties as well as additional breastfeeding support after delivery.

Cessation of Exclusive Breastfeeding and Determining Factors at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Exclusive breastfeeding (EBF) is the gold standard of infant feeding practice which lasts up to 6 months postpartum. Not all infants are exclusively breastfed in developing countries, including Ethiopia. This study, therefore, assessed the magnitude and determining factors of EBF cessation practice among mothers at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Method

Institutional-based cross-sectional study design using a systematic random sampling technique was applied to select 344 mothers of infants aged 9 months came for measles vaccination. Pretested structured questionnaire was used to collect the data. Data were entered, cleaned, and analyzed by using SPSS version 21. Independent variables with a P value of <0.05 indicated association.

Result

The magnitude of cessation of EBF was 21.5% with 95% CI (17.24-25.76). Maternal age ≤ 19 years [AOR = 5.53; 95% CI (1.07-28.57)], civil servants [AOR = 4.73; 95% CI (2.20-10.19)], illiterate husbands [AOR = 3.76; 95% CI (1.13-12.49)], primi-para [AOR = 2.42; 95% CI (1.22-4.79)], no postnatal follow up [AOR = 2.62; 95% CI (1.44-4.80)], and having poor knowledge on breastfeeding benefits and composition of breastmilk [AOR = 3.15; 95% CI (1.56-6.35)] were independent factors significantly associated with cessation of EBF. Conclusion and recommendation. The magnitude of cessation of EBF was high. Maternal age, parity, employment status, postnatal follow-up, and breastfeeding knowledge as well as spouse literacy level were independent factors significantly associated with cessation of EBF. Our study provides further impetus for empowering young and primi-para with breastfeeding knowledge, an extension of maternity leave time, and support for breastfeeding at the workplace.

A Moderated Mediation Model of Maternal Perinatal Stress, Anxiety, Infant Perceptions and Breastfeeding

This study examined a moderated mediation model of relations among maternal perinatal stress/anxiety, breastfeeding difficulties (mediator), misperceptions of infant crying (moderator), and maternal breastfeeding duration to understand risk factors for early breastfeeding termination. It was hypothesized that more breastfeeding difficulties would mediate the relation between greater prenatal stress/anxiety and shorter breastfeeding duration, and that perceptions of response to infant crying as spoiling would moderate the relation between more breastfeeding difficulties and reduced breastfeeding duration. Additionally, it was hypothesized that participants who breastfed through 6 months would demonstrate less postnatal stress/anxiety and there would be a positive relation between fewer breastfeeding difficulties and less postnatal stress/anxiety through 6 months. Participants included 94 expectant mothers at 33-37 weeks gestation and 6 months (±2 weeks) postpartum. Greater prenatal anxiety was associated with shorter breastfeeding duration. Results presented are the first to document negative relations between prenatal (as opposed to postnatal) anxiety and breastfeeding duration (as opposed to frequency or other indicators) in a U.S. sample. Future studies should seek to replicate findings in a more diverse sample and compare findings from clinical and non-clinical samples. Studies may also wish to explore the effects of anxiety prevention/intervention on breastfeeding duration.

A prospective study of maternal postnatal depressive symptoms with infant-feeding practices in a Chinese birth cohort

BACKGROUND

The first few weeks after childbirth are critical, as women may encounter lactation problems and postpartum depression during this period. However, it is still unclear whether early breastfeeding behaviours are related to the symptoms of postnatal depression (PND) in Chinese populations. Therefore, the current study aimed to investigate the association between symptoms of PND and infant feeding practices based on a large-scale Chinese cohort.

METHODS

A prospective study of the community-based cohort was conducted from January 2015 to December 2016. Infant feeding outcomes, including exclusive/partial breastfeeding and formula feeding, were assessed according to the WHO guidelines. Symptoms of PND were assessed by the Edinburgh Postnatal Depression Scale at 4 weeks postpartum. Multivariate generalized estimating equation models were applied to investigate the associations between depressive symptoms and infant feeding behaviours.

RESULTS

A total of 956 mother-infant pairs were included. Fifty-six mothers presented screen-positive symptoms of PND with a cut-off ≥10. The percentage of early breastfeeding initiation was 75.8%, while the average duration of exclusive breastfeeding was 3.90 ± 2.33 months. Postnatal depressive symptoms were associated with a shorter breastfeeding duration (8.02 vs. 6.32 months, P < 0.05) and earlier formula introduction (4.98 vs. 3.60 months, P < 0.05). After adjustments were made for covariates, postnatal depressive symptoms were associated with an increased risk of the discontinuation of exclusive and partial breastfeeding (β = - 0.049, P = 0.047 and β = - 0.082, P = 0.006, respectively). Compared to mothers without symptoms of PND, mothers with depressive symptoms were more likely to supplement formula for their infants in the first year of life (β =0.074, P = 0.016). These associations were still significant in the sensitivity analyses, using an EPDS cut-off of ≥13.

CONCLUSIONS

Our findings indicate that depressive symptoms at 4 weeks postpartum are associated with the cessation of exclusive and partial breastfeeding duration and the introduction of formula in the 12 months of delivery. Early psychosocial assessment and social support should be offered to mothers in the early postpartum period to indirectly prevent adverse breastfeeding outcomes.

The Mood, Mother, and Infant Study: Associations Between Maternal Mood in Pregnancy and Breastfeeding Outcome

Purpose: We sought to determine the role of depression and anxiety in breastfeeding cessation. Materials and Methods: Participants underwent a baseline visit with a structured clinical interview in the third trimester of pregnancy. Monthly phone interviews assessed current mood symptoms and infant feeding status. We assessed the association between baseline mood and infant feeding outcomes using Cox proportional hazards regression, adjusting for infant feeding intention and sociodemographic confounders. Results: We enrolled 222 mother-infant dyads in late pregnancy, of whom 206 completed assessments through 12 months postpartum. We enriched our study with symptomatic women by enrolling 87 women with current depression or anxiety (Current), 64 women with a history of depression or anxiety (Past), and 71 women with no psychiatric history (Never). In multivariable-adjusted analyses, baseline diagnosis was not associated with breastfeeding outcome, but baseline symptoms of depression (Beck Depression Inventory ≥11) or anxiety (Spielberger State Anxiety ≥40) were associated with earlier introduction of formula (depression: adj hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.01-2.30; anxiety: 1.70, 95% CI 1.01-2.87); and any cessation of breastfeeding (depression: adj HR 2.02, 95% CI 1.23-3.31; anxiety: 1.83, 95% CI 1.00-3.33), as were depression symptoms among women who were being treated with antidepressants, compared with untreated asymptomatic women (formula: adj HR 2.27, 95% CI 1.29-4.02; cessation: 2.32, 95% CI 1.17-4.61). History of childhood trauma (adj HR 1.34, 95% CI 1.12-1.61), disordered eating symptoms (adj HR 1.22, 95% CI 1.02-1.46), and poor sleep quality in pregnancy (adj HR 1.32, 95% CI 1.09-1.60) were independently associated with earlier introduction of formula. Conclusions: Baseline mood symptoms were independently associated with earlier formula introduction and cessation of breastfeeding. History of childhood trauma, disordered eating symptoms and poor sleep quality were associated with earlier formula introduction. Targeted support may enable women with these symptoms to achieve their feeding goals.

Impact of Maternal Anxiety on Breastfeeding Outcomes: A Systematic Review

Prenatal and postpartum anxiety may impair maternal functioning and disrupt mother-infant behaviors including breastfeeding. The objective of this narrative review is to examine the association between maternal anxiety from pregnancy to 12 mo postpartum and breastfeeding initiation, duration, and exclusivity. Using a combination of Medical Subject Headings terms and text words, relevant studies were identified through PubMed and PsycINFO. Studies that were conducted in high-income countries, assessed anxiety during gestation and/or postpartum through a standardized measure, and evaluated the impact of anxiety on any of the primary outcomes were included. Sixteen studies met the eligibility criteria although they varied greatly in methodological rigor. A negative association between postpartum anxiety and breastfeeding initiation, duration, and exclusivity was suggested. No associations were found between prenatal anxiety and breastfeeding initiation or exclusivity. Evidence is mixed regarding the association between prenatal anxiety and breastfeeding duration. All studies included in the review were of low or very low quality. Although there was consistency in the association between maternal anxiety and breastfeeding outcomes in the included studies, future studies with greater methodological rigor are needed to determine the extent of the relation between prenatal and/or postpartum anxiety and breastfeeding outcomes.

National Analysis of Risk Assessment Content in Prenatal Records Across Canada

Each Canadian province/territory has a distinct prenatal record form to guide maternity health care. Because there is no national oversight of these forms, little is known about how they compare regarding content on risk assessment for adverse perinatal outcomes. We cataloged and compared the risk factors that are captured on prenatal record forms across Canada. Nine out of 12 records included risk sections, with an average of 35 risk items. We identified 100 prenatal risk factors and categorized them as medical (73%), lifestyle (11%), psychosocial (11%), or personal (5%). Where present, clinical definitions for risk factors often varied. The substantial differences in risk assessment content in the prenatal record forms may contribute to differences in health care quality among provinces. The development of standardized national guidelines for prenatal risk assessment may be a valuable goal.

Prevalence and predictors of exclusive breastfeeding among immigrant and Canadian-born Chinese women

Breastfeeding is the optimal method for infant feeding, yet migrant women may be at risk for suboptimal exclusivity rates. In a cohort of immigrant and Canadian-born Chinese women, our objectives were to (a) describe patterns and prevalence of exclusive breastfeeding at 1, 3, and 6 months postpartum; (b) identify risk and protective factors associated with exclusivity; and (c) examine potentially differential importance of these factors across this 6-month period. This was a prospective study of 565 immigrants and Canadian-born Chinese women (Toronto, Canada). Exclusive breastfeeding was measured at 1, 3, and 6 months postpartum. Predictors comprised fixed (demographics, history of depression, immigrant status, prenatal breastfeeding classes, in-hospital formula supplementation, baseline social support, and baseline acculturative stress) and time-dependent (depression, anxiety, fatigue, and breastfeeding problems) variables. Descriptive statistics, logistic regression, and generalized linear mixed models, respectively, were undertaken to address the objectives. Patterns of breastfeeding practices included exclusive breastfeeding in all time points (26.8%) or none (32.9%) and moving from exclusive to nonexclusive (20.3%) or nonexclusive to exclusive breastfeeding (15.2%). Women less likely to breastfeed exclusively at 1, 3, or 6 months were those whose infants received in-hospital formula supplementation. Exclusivity attrition was higher between 3 and 6 months than 1-3 months. Immigrant status and in-hospital formula supplementation had a significant impact on exclusivity earlier in the postpartum period while breastfeeding problems were associated with decreased exclusivity across time. Proactive preventive efforts are need to maintain breastfeeding exclusivity especially between 3 and 6 months if women are to meet international breastfeeding recommendations.

Postdischarge Feeding of Very-low-birth-weight Infants: Adherence to Nutrition Guidelines

OBJECTIVES

Infant feeding guidelines are important public health strategies to promote optimal growth, development, and chronic disease prevention, but their effectiveness is contingent upon families' ability to adhere to them. Little is known of adherence to guidelines among nutritionally vulnerable infants, specifically those born very-low-birth-weight (VLBW) (<1500 g). This study investigated whether postdischarge feeding practices for VLBW infants align with current recommendations and explored parental and infant baseline sociodemographics related to these practices.

METHODS

Prospectively collected data from families of 300 VLBW infants participating in a randomized clinical trial (ISRCTN35317141) were used. Baseline demographics were obtained at enrollment and postdischarge feeding practices via monthly telephone questionnaires to 6 months corrected age (CA).

RESULTS

At discharge, 4 and 6 months CA, 72%, 39%, and 29% of infants received any amount of mother's milk, respectively; exclusive breast-feeding rates were 49%, 20%, and 6%, respectively. Among infants receiving mother's milk, rates of vitamin D supplementation were ≥83%. Recommendations for introducing solids between 4 and 6 months CA were followed by 71% of the cohort and for iron supplementation by 58%. Overall, 12% of infants adhered to all aforementioned recommendations. Mothers with university degrees were more likely to provide mother's milk, whereas mothers of Middle Eastern/South Asian ethnicity were less likely to provide mother's milk.

CONCLUSIONS

Low rates of partial and exclusive breast-feeding of VLBW infants to 6 months CA were reported. Overall adherence to iron supplementation was low. Strategies to provide increased support for mothers identified as at-risk should be developed.

A population-based study of the relationship between perinatal depressive symptoms and breastfeeding: a cross-lagged panel study

Studies suggest that perinatal depression and breastfeeding co-vary, but determining the relationship between breastfeeding and perinatal depression has proved challenging. A bidirectional association has been suggested, implying that depression may impact on breastfeeding and that breastfeeding might influence depressive symptoms. The present study aimed to contribute to the understanding of the relationship between perinatal depression and breastfeeding in a population-based sample where we used structural equation modeling (SEM) techniques to investigate cross-lagged and autoregressive effects as well as concurrent associations. The present study was part of a large-scale Norwegian prospective study. Nurses and midwives at nine well-baby clinics recruited participants. All the well-baby clinics had implemented the Edinburgh method, which combines the use of the Edinburgh Postnatal Depression Scale (EPDS) with an immediate follow-up conversation. Completed EPDS forms were recorded, as well as the mothers' reports of breastfeeding behaviors. Depressive symptoms measured prenatally during the last trimester, at 4 and 6 months postpartum did not predict breastfeeding behavior at 4, 6, or 12 months postpartum, respectively. Furthermore, breastfeeding at 4 and 6 months postpartum did not predict depressive symptomatology at 6 or 12 months postpartum. There were no significant concurrent associations between breastfeeding and depressive symptoms at 4, 6, or 12 months postpartum. Depressive symptoms predicted subsequent depressive symptoms and breastfeeding predicted subsequent breastfeeding. There was no evidence of a relationship between depressive symptoms and breastfeeding. Potential explanations and implications are discussed.

[Telephone support for breastfeeding by primary care: a randomised multicentre trial]

OBJECTIVE

To evaluate a telephone support programme for mothers who breastfeed for the first 6 months.

METHODS

A randomised unmasked clinical trial was conducted in 5 urban Primary Care centres that included mothers with healthy newborns who were breastfeeding exclusively (EBF) or partially (PBF). The control group received the usual care. The intervention group also received telephone support for breastfeeding on a weekly basis for the first 2months and then every 2weeks until the sixth month. The type of breastfeeding was recorded in the usual check-up visit (1, 2, 4 and 6 months).

RESULTS

The study included 193 patients in the intervention group, and 187 in a control group. The greatest increase in the percentage of EBF was observed at 6 months: 21.4% in the control group compared to 30.1% in the intervention group. However, in the adjusted odds ratios analysis, confidence intervals did not show statistical significance. The odds ratio at 1 month, 2 months, 4 months, and 6 months for EBF were 1.45 (0.91-2.31), 1.35 (0.87-2.08), 1.21 (0.80-1.81), and 1.58 (0.99-2.53), respectively. The odds ratio in the same age groups for any type of breastfeeding (EBF + PBF) were 1.65 (0.39-7.00), 2.08 (0.94-4.61), 1.37 (0.79-2.38), and 1.60 (0.98-2.61), respectively.

CONCLUSIONS

Telephone intervention was not effective enough to generalise it.

Low-Level Prenatal Toxin Exposures and Breastfeeding Duration: A Prospective Cohort Study

Introduction Maternal exposure to tobacco smoke is associated with shortened breastfeeding duration, but few studies have examined the effects on breastfeeding outcomes of low level exposures to other toxic chemicals. Moreover, it is unclear if passive smoking is associated with duration of breastfeeding. Our objective was therefore to examine the effect of low-level prenatal exposures to common environmental toxins (tobacco smoke, lead, and phthalates) on breastfeeding exclusivity and duration. Methods We conducted an analysis of data from the Health Outcomes and Measures of the Environment (HOME) Study. Serum and urine samples were collected at approximately 16 and 26 weeks gestation and at delivery from 373 women; 302 breastfed their infants. Maternal infant feeding interviews were conducted a maximum of eight times through 30 months postpartum. The main predictor variables for this study were gestational exposures to tobacco smoke (measured by serum cotinine), lead, and phthalates. Passive smoke exposure was defined as cotinine levels of 0.015-3.0 μg/mL. Primary outcomes were duration of any and exclusive breastfeeding. Results Serum cotinine concentrations were negatively associated with the duration of any breastfeeding (29.9 weeks unexposed vs. 24.9 weeks with passive exposure, p = 0.04; and 22.4 weeks with active exposure, p = 0.12; p = 0.03 for linear trend), but not duration of exclusive breastfeeding. Prenatal levels of blood lead and urinary phthalate metabolites were not significantly associated with duration of any or exclusive breastfeeding. Conclusions Passive exposure to tobacco smoke during pregnancy was associated with shortened duration of any breastfeeding.

Exploring the influence of psychosocial factors on exclusive breastfeeding in Bangladesh

Exclusive breastfeeding is a proven benefit for both mothers and infants and is, therefore, an important public health priority. Intimate partner violence (IPV) is regarded as one of the potential psychosocial risk factors that may negatively affect exclusive breastfeeding (EBF). This study aimed to explore the influence of psychosocial factors including IPV on EBF. Cross-sectional survey data was collected from October 2015 to January 2016 in Chandpur District of Bangladesh from 426 married women, aged 15-49 years, who had at least one child 6 months of age or younger. Multivariate logistic regression models were used in order to investigate whether women who experienced IPV after childbirth, as well as other risk factors such as postpartum depression (PPD) and childhood sexual abuse, were more likely to face difficulties with EBF compared with women who had not experienced these same risk factors. Whilst the initiation rate of breastfeeding was 99.3%, at the time of the woman's interview, the overall EBF rate had fallen to 43.7%. Based on the adjusted model, women who experienced physical IPV (AOR 0.17, 95% CI [0.07, 0.40]) and psychological IPV (AOR 0.51, 95% CI [0.26, 1.00]) after childbirth and women who reported childhood sexual abuse (AOR 0.32, 95% CI [0.13, 0.80]) and PPD (AOR 0.20, 95% CI [0.09, 0.44]) were significantly less likely to exclusively breastfeed their infants than those who had not reported these experiences. Moreover, women with an intended pregnancy and high social support exhibited a higher likelihood of EBF. Our results suggest that preventing or reducing the occurrence of physical IPV, PPD and childhood sexual abuse may improve the EBF duration. Support from family members can assist in this process.

A well-baby peer counseling program is not associated with human milk receipt in the NICU

OBJECTIVE

Evaluate the impact of a non-neonatal intensive care unit (NICU)-specific peer counseling (PC) program on the cessation of human milk receipt at and post-NICU discharge.

STUDY DESIGN

A multivariable logistic regression model used data from 400 mother-infant dyads from a level IV NICU to compare cessation of human milk receipt at NICU discharge by PC program status. Kaplan-Meier distributions and a multivariable Cox proportional hazards model assessed the relationship between participants/non-participants and cessation of human milk post-NICU discharge.

RESULTS

No statistically significant differences between groups in cessation of human milk either by or post-discharge were observed. Identified variables associated with the outcome(s) of interest included maternal and infant age, length of stay, presence of a breastfeeding duration goal and frequency of NICU lactation consultant contact.

CONCLUSION

Exposure to a non NICU-specific PC program was not associated with human milk receipt either by or post-NICU discharge.

Social Support and Exclusive Breast feeding among Canadian Women

BACKGROUND

The World Health Organization recommendation for exclusive breast feeding for 6 months has been endorsed by Health Canada, the Canadian Pediatric Society, Dietitians of Canada, and the Breastfeeding Committee for Canada as of 2012. This study examines whether social support is associated with exclusive breast feeding up to 6 months among Canadian mothers.

METHODS

We utilised data from the Canadian Community Health Survey and limited our sample to mothers who gave birth in the 5 years prior to the 2009-2010 survey (n = 2133). Multivariable logistic regression was used to examine the relationship between exclusive breast feeding and four dimensions of social support: (i) tangible, (ii) affectionate, (iii) positive social interaction, and (iv) emotional and informational, based on the Medical Outcomes Study Social Support Scale. Absolute and relative differences in the probability of breast feeding exclusively and their 95% confidence intervals were calculated.

RESULTS

In adjusted models, differences in the probability of exclusive breast feeding for 6 months were not different among women with high vs. low social support. The association between social support and breastfeeding exclusively was modified by education level, with significantly higher probability of breast feeding exclusively among women with lower education and high vs. low levels of tangible and affectionate support.

CONCLUSIONS

Among women with education below a high school level, high tangible and affectionate support significantly increased probability of exclusive breast feeding for 6 months in this study. Efforts to encourage exclusive breast feeding need to address social support for mothers, especially those with lower education.

Inadequate prenatal care use and breastfeeding practices in Canada: a national survey of women

Background

Previous studies have demonstrated that prenatal care (PNC) has an effect on women’s breastfeeding practices. This study aims to examine the influence of adequacy of PNC initiation and services use on breastfeeding practices in Canada.

Methods

Data for this secondary analysis was drawn from the Maternity Experiences Survey (MES), a cross sectional, nationally representative study that investigated the peri-and post-natal experiences of mothers, aged 15 and above, with singleton live births between 2005 and 2006 in the Canadian provinces and territories. Adequacy of PNC initiation and services use were measured by the Adequacy of Prenatal Care Utilization Index. The main outcomes were mother’s intent to breastfeed, initiate breastfeeding, exclusively breastfeed, and terminate breastfeeding at 6 months. Multivariate logistic regression analysis assessed the adequacy of PNC initiation and service use on breastfeeding practices, while adjusting for socioeconomic, demographic, maternal, pregnancy and delivery related variables. Bootstrapping was performed to account for the complex sampling design.

Results

Around 75.0 % of women intended to only breastfeed their child, with 90.0 % initiating breastfeeding, while 6 month termination and exclusive breastfeeding rates were at 52.0 % and 14.3 %, respectively. Regression analysis showed no association between adequate PNC initiation or services use, and any breastfeeding practice. Mothers with either a family doctor or a midwife as PNC provider were significantly more likely to have better breastfeeding practices compared to an obstetrician.

Conclusions

In Canada, provider type impacts a mother’s breastfeeding decision and behavior rather than quantity and timing of PNC.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-0889-9) contains supplementary material, which is available to authorized users.

Breastfeeding difficulties and supports and risk of postpartum depression in a cohort of womenwho have given birth in Calgary: a prospective cohort study

BACKGROUND

A link exists between breastfeeding difficulties and postpartum depression, and evidence shows that some breastfeeding promotion initiatives may increase maternal stress and contribute to risk of the condition. We conducted a prospective cohort study to determine whether breastfeeding difficulties affect the risk of postpartum depression and whether breastfeeding support modifies the relationship between breastfeeding difficulties and postpartum depression.

METHODS

Between June and October 2010, we recruited 442 women who intended to breastfeed from all maternity hospitals in Calgary within 72 hours of giving birth to full-term, singleton infants. We administered questionnaires at birth and 6 weeks and 6 months postpartum, measuring breastfeeding difficulties, exposure to breastfeeding supports and postpartum depression. We used qualitative inquiry to measure breastfeeding support experiences. Postpartum depression was defined as a score of 10 or greater on the Edinburgh Postnatal Depression Scale or a self-reported diagnosis of depression in the first 6 months postpartum.

RESULTS

A total of 386 women (87.3%) reported moderate to severe breastfeeding difficulties and 437 (98.9%) received some form of breastfeeding advice, help or support. Among women with breastfeeding difficulties, those who did not report a negative breastfeeding support experience were at decreased risk of postpartum depression (risk ratio 0.36). In the final regression model a negative breastfeeding support experience was a significant effect modifier of the relationship between breastfeeding difficulties and postpartum depression.

INTERPRETATION

The quality of breastfeeding support is important not only for breastfeeding promotion but also for maternal mental health. Educating front-line caregivers to ensure that support experiences of breastfeeding women are positive can reduce the risk of postpartum depression.

Combined effects of maternal age and parity on successful initiation of exclusive breastfeeding

Maternal age at first childbirth has increased in most developed countries in the past 20 years. The purpose of this study is to investigate effects of maternal age at delivery and parity on successful initiation of exclusive breastfeeding (EBF). This retrospective study investigated 1193 singleton dyads with vaginal-delivered at 37-42 gestational weeks during January and December in 2011 at one large "Baby-Friendly" certified hospital in Japan. A multivariate logistic regression model was used to evaluate individual and combined effects of maternal age and parity on successful initiation of EBF after adjusted for pre-pregnancy body mass index, gestational weight gain, pregnancy complications, mothers' underlying illness, smoking and alcohol drinking habits, gestational week at delivery, child's sex and nurturing support from grandparents. Success rates of EBF at one month after child delivery was 69.4% in primiparous aged ≥ 35 (group A: n = 284), 73.5% in multiparous aged ≥ 35 (group B: n = 268), 74.3% in primiparous aged < 35 (group C: n = 432), and 82.3% in multiparous aged < 35 (group D: n = 209). Older maternal age and primiparous became independently associated with EBF initiation. The combined effect for successful initiation of EBF was the lowest in group A referent to group D both at discharge and at one month (odds ratio (OR) 5.9, 95% confidence interval (CI): 3.0-11.9, and OR 2.2, 95% CI: 1.4-3.4, respectively). Primiparous mothers in late child-bearing aged 35 years or older are at the greatest risk of EBF initiation.

Predictors of impaired breastfeeding initiation and maintenance in a diverse sample: what is important?

PURPOSE

This study aimed to investigate socio-demographic, medical and psychological factors that have an impact on breastfeeding.

METHODS

Questionnaires were administered to 330 women prenatally (TI third trimester) and postpartum (TII 3-4 days, TIII 4 months). Medical data were collected from the hospital records. Self-reported data on initiation and maintenance of breastfeeding was collected simultaneously. Primary endpoint was breastfeeding initiation and maintenance. Data analyses were performed using Spearman's ρ correlations between breastfeeding and other study variables and generalized multiple ordinal logistic regression analysis.

RESULTS

Neonatal admission to the NICU, high BMI, cesarean section, difficulties with breastfeeding initiation and high maternal state anxiety were the strongest predictors of impaired breastfeeding initiation, explaining together 50 % of variance. After 4 months, the strongest predictors of impaired maintenance of breastfeeding were maternal smoking, a high BMI and a history of postpartum anxiety disorder, explaining 30 % of variance.

CONCLUSIONS

Successful initiation and maintenance of breast feeding is a multifactorial process. Our results underline the need of interdisciplinary approaches to optimise breastfeeding outcomes by demonstrating the equality of medical and psychological variables. Whereas practices on maternity wards are crucial for optimal initiation, continuous lifestyle modifying and supporting approaches are essential for breastfeeding maintenance. Healthcare providers can also significantly influence breastfeeding initiation and maintenance by counselling on the importance of maternal BMI.

Temporal trends in social disparities in maternal smoking and breastfeeding in Canada, 1992-2008

A steady decrease in maternal smoking during pregnancy and a steady increase in breastfeeding rates have been observed in Canada in the past two decades. However, the extent to which all socioeconomic classes have benefited from this progress is unknown. Therefore, this study was undertaken to determine: (1) whether progress achieved benefited the entire population or was limited to specific strata; and (2) whether disparities among strata decreased, stayed the same, or increased over time. We used data from the National Longitudinal Survey of Children and Youth, which enrolled children aged 0-3 years between 1994 and 2008. Data collected at entry was analyzed in a cross-sectional manner. Between birth years 1992-1996 and 2005-2008, smoking during pregnancy decreased from 11.5 % (95 % CI 10.0-13.0 %) to 5.2 % (95 % CI 4.1-6.3 %) among mothers with a college or university degree and from 43.0 % (95 % CI 38.8-47.2 %) to 38.6 % (95 % CI 32.9-44.2 %) among those with less than secondary education. During the same period, the rate of breastfeeding initiation increased from 83.8 % (95 % CI 81.9-85.6 %) to 91.5 % (95 % CI 90.2-92.8 %) among mothers with a college or university degree and from 63.1 % (95 % CI 58.9-67.4 %) to 74.7 % (95 % CI 69.8-79.7 %) among those with less than secondary education. The risks of smoking and of not breastfeeding remained significantly higher in the least educated category than in the most educated throughout the study period, and these associations remained statistically significant after controlling for maternal age. Gaps between the least and the most educated mothers narrowed for breastfeeding but widened for smoking during pregnancy.

Still nursing at 6 months: a survey of breastfeeding mothers

PURPOSE

To learn about the duration of breastfeeding and to describe the variables influencing breastfeeding practices of mothers who gave birth at a suburban community hospital.

STUDY AND DESIGN

An Institutional Review Board approved this descriptive anonymous survey with 20 questions concerning patients' characteristics and experiences with breastfeeding, which was developed based on current literature. The survey was distributed to mothers through Survey Monkey via email 6 months after birth.

RESULTS

The survey link was sent to 806 mothers, with a response rate of 50%. Over 59% were still breastfeeding at 6 months. Mothers who initiated skin-to-skin contact in the first hour had a higher rate of breastfeeding during this time frame compared to mothers who did not perform skin-to-skin contact. Women who had cesarean births and women who were primiparas reported a higher use of formula while in the hospital, and breastfed for a shorter duration. The primary reasons for stopping breastfeeding were low milk supply, returned to work, and baby did not latch and nurse well.

CLINICAL IMPLICATIONS

This study adds to the knowledge base of what practices influence rates and duration of breastfeeding in the first 6 months of a baby's life. The information could enhance the care provided to mothers and babies through improving lactation programs and thereby increasing breastfeeding success rates.

Breast-feeding and postpartum maternal weight trajectories

Objective

We examined whether breast-feeding, and in particular exclusive breast-feeding, was associated with maternal weight and body composition changes at 4 months postpartum independently of other maternal variables.

Design

Prospective longitudinal study. Women were recruited in the first trimester after an ultrasound examination confirmed an ongoing singleton pregnancy. Weight and body composition were measured using advanced bio-electrical impedance analysis at the first antenatal visit and 4 months postpartum. Detailed questionnaires were completed on breast-feeding, socio-economic status, diet and exercise in addition to routine clinical and sociodemographic details.

Setting

Large Irish university maternity hospital.

Subjects

Women who delivered a baby weighing ≥500 g between November 2012 and March 2014.

Results

At the postpartum visit, the mean weight was 70·9 (sd14·2) kg (n470) and the mean BMI was 25·9 (sd5·0) kg/m2. ‘Any breast-feeding’ was reported by 65·1 % of women (n306). Irish nativity (OR=0·085,P<0·001), current smoking (OR=0·385,P=0·01), relative income poverty (OR=0·421,P=0·04) and deprivation (OR=0·458,P=0·02) were negatively associated with exclusive breast-feeding. At 4 months postpartum there was no difference in maternal weight change between women who exclusively breast-fed and those who formula-fed (+2·0v. +1·1 kg,P=0·13). Women who exclusively breast-fed had a greater increase in percentage body fat at 4 months postpartum compared with women who formula-fed (+1·0v. −0·03 %,P=0·02), even though their dietary quality was better. Exclusive breast-feeding was not associated with postpartum maternal weight or body fat percentage change after adjusting for other maternal variables.

Conclusions

There are many reasons why breast-feeding should be strongly promoted but we found no evidence to support postpartum weight management as an advantage of breast-feeding.

Cumulative risks and cessation of exclusive breast feeding: Australian cross-sectional survey

OBJECTIVES

To estimate the prevalence of cessation of exclusive breast feeding at each month up to 6 months and document key factors and cumulative risks associated with exclusive breastfeeding cessation for children aged from 0 to 6 months.

METHODS

Secondary analysis using a national representative sample of 22 202 mother and infant pairs derived from the 2010 Australian Institute of Health and Welfare cross-sectional survey, the Australian Infant Feeding Survey.

RESULTS

Among breastfed infants, 49% had ceased exclusive breast feeding before they had reached 2 months of age. In the final Cox proportional hazards model, cessation of exclusive breast feeding was most strongly associated with partners preferring bottle feeding (HR 1.86, 95% CI 1.69 to 20.6) or having no preference (HR 1.37, 95% CI 1.33 to 1.42), regular dummy use (HR 1.35, 95% CI 1.31 to 1.39) and maternal obesity (HR 1.29, 95% CI 1.24 to 1.35). Living within the most disadvantaged areas of Australia (quintile 1) was not strongly associated with cessation (HR 1.08, 95% CI 1.02 to 1.14) compared with least disadvantaged areas. Having three risk factors significantly increased the risk of cessation by 31% (HR 1.31, 95% CI 1.07 to 1.6).

CONCLUSIONS

The prevalence of early cessation of exclusive breast feeding is alarmingly high with 50% of infants no longer exclusively breast fed by age 2 months. Given that not one factor is associated with cessation of exclusive breast feeding, the greatest public health impact is likely to be achieved when multiple risk factors are modified or prevented.

Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions

Maternal obesity is associated with significantly lower rates of breastfeeding initiation, duration and exclusivity. Increasing rates of obesity among reproductive-age women has prompted the need to carefully examine factors contributing to lower breastfeeding rates in this population. Recent research has demonstrated a significant impact of breastfeeding to reduce the risk of obesity in both mothers and their children. This article presents a review of research literature from three databases covering the years 1995 to 2014 using the search terms of breastfeeding and maternal obesity. We reviewed the existing research on contributing factors to lower breastfeeding rates among obese women, and our findings can guide the development of promising avenues to increase breastfeeding among a vulnerable population. The key findings concerned factors impacting initiation and early breastfeeding, factors impacting later breastfeeding and exclusivity, interventions to increase breastfeeding in obese women, and clinical considerations. The factors impacting early breastfeeding include mechanical factors and delayed onset of lactogenesis II and we have critically analyzed the potential contributors to these factors. The factors impacting later breastfeeding and exclusivity include hormonal imbalances, psychosocial factors, and mammary hypoplasia. Several recent interventions have sought to increase breastfeeding duration in obese women with varying levels of success and we have presented the strengths and weaknesses of these clinical trials. Clinical considerations include specific techniques that have been found to improve breastfeeding incidence and duration in obese women. Many obese women do not obtain the health benefits of exclusive breastfeeding and their children are more likely to also be overweight or obese if they are not breastfed. Further research is needed into the physiological basis for decreased breastfeeding among obese women along with effective interventions supported by rigorous clinical research to advance the care of obese reproductive age women and their children.

Breastfeeding Initiation and Continuation by Employment Status among Korean Women

PURPOSE

The objective of this study was to examine the factors associated with initiation and continuation of breastfeeding among Korean women in relation to their employment status.

METHODS

Data were collected using a web-based self-administered questionnaire from 1,031 Korean mothers living in Seoul with babies younger than 24 months. Demographic characteristics, education on breastfeeding, rooming in, breastfeeding during hospital stay, and breastfeeding knowledge were examined. Multivariate logistic regression analyses were performed to identify factors associated with initiation and continuation at 1, 6 and 12 months according to mothers' employment status.

RESULTS

Breastfeeding initiation rates were similar regardless of mothers' employment status. Continuation rates decreased for both groups of mothers, but were significantly lower among employed mothers at all duration points. Unemployed mothers who were able to keep their babies in the same room during the hospital stay were more likely to initiate breastfeeding. The factor that was consistently associated with breastfeeding continuation for all duration points among unemployed mothers was whether the mother breastfed during the hospital stay. Higher knowledge scores and having an infant with atopic dermatitis were also associated with breastfeeding continuation at 6 months and 12 months, respectively for unemployed mothers, and receiving education on breastfeeding was associated with 12-month continuation for employed mothers.

CONCLUSION

These results emphasize the significant roles of hospitals for breastfeeding initiation and continuation, with rooming-in, initial breastfeeding practice and education during hospital stay as important practices. In addition, for working mothers to continue their breastfeeding, significant support from the workplace is crucial.

Breastfeeding initiation: impact of obesity in a large Canadian perinatal cohort study

OBJECTIVE

To evaluate incidence of breastfeeding initiation according to maternal pre-pregnancy body mass index (BMI) in "Grossesse en Santé", a large prospective birth cohort in Quebec City.

METHODS

Breastfeeding initiation in the post-partum period, pre-pregnancy BMI, sociodemographic determinants and obstetrical and neonatal factors were collected from years 2005 to 2010 in 6592 women with single pregnancies. Prenatal non-intention to breastfeed was documented in a subgroup of the cohort (years 2009-2010). Log-binomial regression analyses were performed to assess relative risk (RR) of non-initiation of breastfeeding between maternal BMI categories in models including pre- and post-natal determinants, after exclusion of variables with a mediating effect.

RESULTS

Twenty percent (20%) of obese women did not initiate breastfeeding in the post-natal period at hospital compared to 12% for normal weight women. Compared with those having a normal pre-pregnancy BMI, obese women had a higher risk of non-initiation of breastfeeding (RRunadj 1.69, 95% CI 1.44-1.98), even after adjustment for prenatal and sociodemographic factors (RRadj 1.26, 95% CI 1.08-1.46). Furthermore, the risk of non-initiation of breastfeeding in obese women still remained higher after introduction of per- and post-natal factors (RR 1.22, 95% CI 1.04-1.42). The prenatal non-intention to breastfeed was strongly associated with the non-initiation of breastfeeding for all categories of BMI.

CONCLUSION

Maternal obesity is associated with a two-fold rate of non-initiation of breastfeeding. Considering the benefits of breastfeeding and the increasing obesity rate, adapted interventions and specialized support should target both pre- and immediate post-natal periods in this population.

Breastfeeding and depression: a systematic review of the literature

BACKGROUND

Research has separately indicated associations between pregnancy depression and breastfeeding, breastfeeding and postpartum depression, and pregnancy and postpartum depression. This paper aimed to provide a systematic literature review on breastfeeding and depression, considering both pregnancy and postpartum depression.

METHODS

An electronic search in three databases was performed using the keywords: "breast feeding", "bottle feeding", "depression", "pregnancy", and "postpartum". Two investigators independently evaluated the titles and abstracts in a first stage and the full-text in a second stage review. Papers not addressing the association among breastfeeding and pregnancy or postpartum depression, non-original research and research focused on the effect of anti-depressants were excluded. 48 studies were selected and included. Data were independently extracted.

RESULTS

Pregnancy depression predicts a shorter breastfeeding duration, but not breastfeeding intention or initiation. Breastfeeding duration is associated with postpartum depression in almost all studies. Postpartum depression predicts and is predicted by breastfeeding cessation in several studies. Pregnancy and postpartum depression are associated with shorter breastfeeding duration. Breastfeeding may mediate the association between pregnancy and postpartum depression. Pregnancy depression predicts shorter breastfeeding duration and that may increase depressive symptoms during postpartum.

LIMITATIONS

The selected keywords may have led to the exclusion of relevant references.

CONCLUSIONS

Although strong empirical evidence regarding the associations among breastfeeding and pregnancy or postpartum depression was separately provided, further research, such as prospective studies, is needed to clarify the association among these three variables. Help for depressed pregnant women should be delivered to enhance both breastfeeding and postpartum psychological adjustment.