Facteurs associés à l’allaitement maternel du nourrisson jusqu’à 6 mois à la maternité de l’hôpital Antoine-Béclère, Clamart

The impact of historical breastfeeding practices on the incidence of cancer in France in 2015

PURPOSE

The purpose of the study was to estimate the number of new breast cancer cases in France in 2015 attributable to breastfeeding for durations below recommendations (at least 6 months per child), and cases prevented through historical breastfeeding. As a secondary analysis, the corresponding numbers for ovarian cancer were estimated.

METHODS

Historical breastfeeding data were obtained from population surveys. Duration of breastfeeding data were obtained from the French Épifane cohort study. Relative risks were obtained from meta-analyses, cohort, and case-control studies. Cancer incidence data were obtained from the French Network of Cancer Registries. A 10-year latency period was assumed.

RESULTS

Among parous women 25 years of age and older, 14.1% breastfed for at least 6 months per child born before 2006. As a result, 1,712 new breast cancer cases (3.2% of all new breast cancer cases) were attributable to breastfeeding for < 6 months per child, while actual breastfeeding practices prevented 765 breast cancer cases. Furthermore, 411 new ovarian cancer cases (8.6% of all new ovarian cancer cases) may be attributable to breastfeeding for < 6 months per child, with breastfeeding preventing 163 ovarian cancer cases.

CONCLUSIONS

The historically low breastfeeding prevalence and duration in France led to numerous avoidable cancer cases.

Use of water turnover method to measure mother's milk flow in a rat model: Application to dams receiving a low protein diet during gestation and lactation

Assessment of milk production is of utmost relevance for pediatricians and scientists interested in early life nutrition. The weight-suckle-weight (WSW) method, which consists of weighing babies before and after they suckle their mother, uses the difference in body weight as an estimate of milk intake. However, this is prone to many sources of error. In the current study, we used for the first time the water turnover method and compartmental analysis with deuterated water (D₂O) as a non-toxic tracer to quantify in vivo milk production in a rat model. We assessed the effect of a nutritional intervention presumed to affect milk production, a maternal dietary protein restriction during gestation and lactation, which results in the birth of pups with intrauterine growth restriction. The specific aim of this study was to determine milk production with the body water turnover method in rat dams receiving during gestation and lactation, either a control diet (NP) or an iso-caloric low-protein diet (LP). In NP dams, mass of dam’s total body water, output flow constant from dam to litter (K21) and median milk flow, calculated between days 11 to 14 after pup birth, were 282.1 g, 0.0122 h^-1 and 3.30 g/h for NP dams, respectively. Maternal dietary protein restriction (-59%) during perinatal period led to a 34% reduction in milk flow (NP versus LP). With the WSW method, milk flow varied from 1.96 g/h to 2.37 g/h between days 11 to 14 for NP dams. The main advantage of the D₂0 method compared to the WSW method stems from its higher precision, as attested by the narrowest range of measured values of milk flow ([2.90; 3.75] and [0.98; 6.85] g/h, respectively) for NP group. This method could be suitable for testing the effectiveness of candidate galactologue molecules presumed to enhance milk production in the lactating rat model.

[Hospital practices and breastfeeding cessation risk within 6 months of delivery]

BACKGROUND

The impact of maternity ward practices on breastfeeding duration remains uncertain in France.

OBJECTIVE

This study aimed to determine whether compliance with an increasing number of Baby-Friendly Hospital Initiative recommended practices was associated with a decreasing risk for breastfeeding cessation within 6 months of delivery.

METHODS

We analyzed the original data from a prospective cohort study carried out in eight maternity centers in France in 2005-2006. A pediatrician or a midwife prospectively collected data on breastfeeding initiation within 1h of birth, rooming-in 24h a day, pacifier non-use, and giving breast milk only for 908 mothers who were breastfeeding at discharge.

RESULTS

Overall, 315 (34.7%), 309 (34.0%), 186 (20.5%), and 98 (10.8%) mothers experienced 4, 3, 2, or 0-1 maternity ward practices. The median breastfeeding duration was 18 weeks (25th-75th percentiles, 9 to >26), with 87.6% and 31.5% of mothers who were still breastfeeding by 4 and 26 weeks after delivery, respectively. After adjusting for study center and baseline characteristics, the hazard ratios of breastfeeding cessation associated with 3, 2, and 0-1 practices were 1.32 (95% confidence interval [CI], 1.06-1.64), 1.54 (95% CI, 1.20-1.98), and 1.59 (95% CI, 1.13-2.25) as compared with compliance with four practices (p for trend <0.001).

CONCLUSION

Although the causal interpretation for this relationship remains speculative, these findings support interventions aimed to implement or reinforce Baby-Friendly Hospital Initiative recommended practices in order to establish prolonged breastfeeding and decrease the risk for early cessation after discharge to home.

[Breastfeeding in the French-speaking community of Belgium (2009)]

PURPOSE

The objectives of this paper were to study the prevalence of breastfeeding in the French-speaking community of Belgium, to assess whether the targets of the Maternal and Child Health program (MCH) were met (prevalence of breastfeeding of 85, 70, 50, and 25% at the maternity hospital and at 3, 6, and 12 months of age, respectively), and to identify factors associated with breastfeeding at the maternity hospital and at 6 months of age.

MATERIALS AND METHODS

A sample (two-stage cluster sampling) was drawn from the population of children aged 18-24 months living in the area. A face-to-face questionnaire was administered by trained investigators. Anamnestic data on breastfeeding at the maternity hospital and at 3, 6, and 12 months as well sociodemographic information were collected from 522 mothers. The survey took place in 2009.

RESULTS

At the maternity hospital, 75.7% (95%CI [72.7-79.5]) of the mothers were breastfeeding: 72.4% among the Belgians (and French) and 89.0% among foreign mothers. At 3 months of age, the breastfeeding prevalence was 48.3% (CI, 44.0-52.6): 42.5% among the Belgians (and French) and 72.0% among foreign mothers (p<0.001). At 6 months of age, 26.0% of the mothers were breastfeeding (CI, 22.3-29.8): 19.3% among the Belgians (and French) and 53.0% among foreign mothers (p<0.001). At 12 months of age, 10.0% (CI, 7.4-12.5) of the mothers were breastfeeding: 4.8% among the Belgians (and French) and 31.0% among the foreign mothers (p<0.001). When fitting a logistic model, the predictors associated with breastfeeding at the maternity hospital were educational level, nationality of birth, and parity. At 6 months, logistic models were fitted separately in the two strata. Among the Belgians, the level of education and attending a MCH consultation were significantly associated with breastfeeding. In the stratum of foreign mothers, the only factor associated with breastfeeding was working time. No association was observed between breastfeeding and the mother's age at the maternity hospital or at 6 months.

DISCUSSION

The targets of the MCH were not reached in Belgian and French mothers, while they were in mothers of other nationalities. Until now, transversal surveys have been the only way of knowing the prevalence and the factors associated with breastfeeding in the French-speaking community of Belgium. These first representative data on breastfeeding came from the 2009 vaccine coverage survey.

[Weaning before the age of 6 months in Marrakech: associated factors and prevalence]

BACKGROUND

In Morocco breastfeeding has become a declining practice. The objectives of this study were to estimate the prevalence of weaning before the age of 6 months and to identify associated factors.

METHODS

A cross-sectional survey was conducted among 400 mothers of infants aged 0 to 24 months. Participants were recruited from patients attending 40 randomly selected general practices in Marrakech. A trained interviewer administered a questionnaire to collect data on breastfeeding practice and factors associated with it. Early weaning was defined as a cessation of breastfeeding before the age of 6 months and was studied in mother-child couples whose infants were aged 6 months and older. Three binary logistic regression models were used to model the probability that an infant aged 6 months or more is weaned early.

RESULTS

Breastfeeding was initiated by the majority of respondents (97.5%). Early weaning was observed in 75 infants (28% of registered weaning). Factors associated with early weaning were: mother having an occupational activity (Odds Ratio [OR]=2.09; 95% confidence interval [CI]: [1.07-4.06]), caesarean delivery (OR=4.15; 95% CI: [1.74-9.88]) and the fact that the pregnancy was desired (OR=0.19; 95% CI: [0.05-0.68]).

CONCLUSION

Weaning before 6 months of age is a common practice in our context. Identifying factors associated with early weaning is critical to promote breastfeeding.

Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi-urban setting

BACKGROUND

The success of breastfeeding promotion is influenced by maternal factors. Therefore, it is vital to examine the influence of basic maternal demographic factors on breastfeeding practices.

OBJECTIVE

To determine the influence of maternal socio-demographic factors on the initiation and exclusivity of breastfeeding.

METHOD

A cross-sectional survey of mothers of children aged from 1 to 24 months attending a Nigerian Infant Welfare Clinic was conducted. Respondents were grouped according to age, parity, education, occupation, sites of antenatal care and delivery. These groups were compared for breastfeeding indices using bivariate and multivariate analysis.

RESULTS

All the 262 respondents breastfed their children. The exclusive breastfeeding rate was 33.3% for children aged 0-3 months, 22.2% for children aged 4-6 months and 19.4% for children aged 7-24 months at the time of the study. Significantly higher proportions of mothers with at least secondary education, clinic-based antenatal care and delivery in health facilities initiated breastfeeding within 1 h of birth, avoided pre-lacteal feeding and practiced exclusive breastfeeding for the first 6 months of life. Maternal age and parity did not confer any advantage on breastfeeding practices. Delivery of children outside health facilities strongly contributed to delayed initiation of breastfeeding (P < 0.001), pre-lacteal feeding (P = 0.003) and failure to breastfeed exclusively (P = 0.049). Maternal education below secondary level strongly contributed to pre-lacteal feeding (P = 0.004) and failure to practice exclusive breastfeeding (P = 0.008).

CONCLUSION

Low maternal education and non-utilization of orthodox obstetric facilities impairs early initiation and exclusivity of breastfeeding.