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Ballesta-Castillejos A, Rodríguez-Almagro J, Gómez-Salgado J, Martínez-Galiano JM, Romero-Blanco C, Hernández-Martínez A. Preparation and validation of a predictive model of breastfeeding initiation in the first hour of life. Midwifery 2024; 134:104019. [PMID: 38718431 DOI: 10.1016/j.midw.2024.104019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE The objective was to develop and validate a predictive model of initiation of breastfeeding in the first hour after delivery. METHODS Retrospective cohort study on women who gave birth between 2013 and 2018 in Spain. For data collection, an ad hoc questionnaire was designed to be filled in by the mothers, which was distributed to the different Spanish breastfeeding associations which, in turn, shared it with their associate partners. The development of the predictive model was made on a cohort of 3218 women (2/3) and was validated on a cohort of 1609 women (1/3). Mothers whose children were admitted to hospital at the time of birth were excluded. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). RESULTS 81.0 % (2608) women started breastfeeding in the first hour in the derivation cohort, and 80.1 % (1289) in the validation cohort. The predictive factors in the final model were: the highest number of children and skin-to-skin contact at birth as flattering factors, while dystocic delivery reduced the likelihood of the onset of breastfeeding. The predictive ability (ROC AUC) in the derivation cohort was 0.89 (CI 95 %: 0.87-0.90), while in the validation cohort it was 0.89 (CI 95 %: 0.87-0.92). CONCLUSIONS This three-variable predictive model has excellent predictive ability in both the derivation cohort and the validation cohort. This model can identify women who are at high risk of non-initiating breastfeeding within the first hour after delivery.
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Affiliation(s)
| | - Julián Rodríguez-Almagro
- Department of Nursing. Ciudad Real School of Nursing. University of Castilla La-Mancha, Ciudad Real, Spain.
| | - Juan Gómez-Salgado
- Deparment of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva 21071, Spain; Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaén, Spain. Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Cristina Romero-Blanco
- Department of Nursing. Ciudad Real School of Nursing. University of Castilla La-Mancha, Ciudad Real, Spain
| | - Antonio Hernández-Martínez
- Department of Nursing. Ciudad Real School of Nursing. University of Castilla La-Mancha, Ciudad Real, Spain
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Suglo M, Kpekura S, Yiryuo L. Breastfeeding challenges among adolescent mothers: a phenomenological study at the Korle Bu Teaching Hospital in Ghana. BMJ Open 2024; 14:e077504. [PMID: 38950996 PMCID: PMC11218013 DOI: 10.1136/bmjopen-2023-077504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The natural and best approach to give newborns the nutrients they need for healthy growth and development is through breast feeding. Breastfeeding rates fall more sharply with time for mothers under the age of 20 years. AIM This study sought to explore the challenges experienced by adolescent mothers who visit the department of obstetrics and gynaecology of Korle Bu Teaching Hospital in Ghana. METHOD This study employed a qualitative phenomenology design and collected data from adolescent mothers. Data were gathered with the aid of a semistructured in-depth interview guide from 13 breastfeeding adolescent mothers. Data for the study were analysed using content analysis. The study was conducted at the obstetrics and gynaecology department of Korle Bu Teaching Hospital, Ghana. FINDINGS Two major themes were generated from the study to be the challenges that confront adolescent breastfeeding mothers, and they are maternal factors of breastfeeding barriers and societal factors of breastfeeding barriers. Subcategories were generated for both themes during the process. CONCLUSION AND RECOMMENDATION Training of pregnant adolescents during antenatal care visits on how to manage the inability to lactate, breastfeeding stress, painful and sore nipple, engorged breast, stigma from society will lessen their burden. Furthermore, training close family members and friends on how to be kind and support adolescent mothers during breast feeding is important. In-service training should be organised for health workers to enhance their knowledge and practice of approaching and guiding adolescent mothers on effective breast feeding and the provision of cubicles in public places where adolescent mothers can comfortably breastfeed.
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Affiliation(s)
- Mavis Suglo
- Neonatal Intensive Care. P. O. Box 16, Tamale Teaching Hospital, Tamale, Ghana
| | - Stephen Kpekura
- Department of Nursing and Preventive, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Lilian Yiryuo
- Department of Pediatrics, St. Joseph's Hospital, P. O. Box 3, Ghana Health Service, Jirapa, Ghana
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3
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Takahata K, Horiuchi S, Miyauchi A, Tadokoro Y, Shuo T. A breast milk production model for achieving exclusive breastfeeding in low-risk primiparas who had vaginal births at 4 months postpartum: A prospective cohort study. Jpn J Nurs Sci 2024; 21:e12588. [PMID: 38343351 DOI: 10.1111/jjns.12588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/01/2023] [Accepted: 01/07/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND This study aimed to investigate the thresholds of milk production for predicting the achievement of exclusive breastfeeding (EBF) at 4 months postpartum. METHODS The inclusion criteria were singleton, low-risk primiparas, non-cesarean section, and healthy mothers and infants. Temporary feeding of artificial milk in the past was included. Women who could be judged to have intentionally used artificial milk were excluded from the analysis. Measurements of the 24-h milk production by test weights were obtained at early postpartum (days 3-4) and at 1 month postpartum. To predict the achievement of EBF at 4 months postpartum, the area under the receiver operating characteristic (ROC) curve was calculated for early postpartum and 1 month milk production. RESULTS There were 80 eligible participants analyzed. ROC analysis of milk production for achieving EBF at 4 months revealed an area under the curve (AUC) of 0.736 (95% CI: [0.625, 0.848]) for early postpartum and an AUC of 0.854 (95% CI: [0.772, 0.936]) for 1 month postpartum. The proposed thresholds are 102 g/day (higher sensitivity) and 161 g/day (higher specificity) at early postpartum, and 527 g/day (higher sensitivity) at 1 month postpartum. CONCLUSIONS In low-risk primiparas, the milk production models at early postpartum and 1 month postpartum showed a high accuracy for predicting the achievement of EBF at 4 months postpartum. The present study indicates that even when formula milk is temporarily used, it is still possible to reach the goal of achieving EBF.
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Affiliation(s)
- Kaori Takahata
- Department of Nursing, Shonan Kamakura University of Medical Sciences, Kamakura, Japan
| | - Shigeko Horiuchi
- Department of Midwifery, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Ai Miyauchi
- Department of Maternal Health, Japanese Red Cross College of Nursing, Shibuya, Japan
| | - Yuriko Tadokoro
- Chiba Faculty of Nursing, Tokyo Healthcare University, Chiba, Japan
| | - Takuya Shuo
- Faculty of Health and Medical Sciences, Hokuriku University, Ishikawa, Japan
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Dijokienė I, Žemaitienė R, Stonienė D. Late Preterm Newborns: Breastfeeding and Complementary Feeding Practices. CHILDREN (BASEL, SWITZERLAND) 2024; 11:401. [PMID: 38671618 PMCID: PMC11049072 DOI: 10.3390/children11040401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The aim of this study is to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of complementary feeding; Methods: Prospective cohort study was conducted of infants born at 34+0 to 36+6 weeks gestational age in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics during 2020-2021. Families were followed up until the infants reached 12 months of age. Average breastfeeding initial time, average breastfeeding duration time, prevalence of exclusive breastfeeding and average solid-food feeding initiation time were examined. The correlations among factors that might affect breastfeeding rates were calculated using the chi-square test (p < 0.05); Results: In our study with 222 eligible participants, we observed a statistically significant delay in breastfeeding initiation only in the 34+0+6 gestational age group (p < 0.001). At discharge, the 36+0+6 group exhibited a significantly higher exclusive breastfeeding rate (p < 0.001). Over the first year, breastfeeding rates varied, with no correlation found between duration of exclusive breastfeeding and gestational age. Initial solid-food feeding times were similar across groups, and all infants were introduced to vegetables first; Conclusions: Vaginal delivery, skin-to-skin contact after birth, early rooming-in, and breastfeeding within 2 h after birth statistically significantly causes earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid-food feeding at an average age of 5 months, with vegetables being the primary food choice.
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Affiliation(s)
| | | | - Dalia Stonienė
- Department of Neonatology, Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (I.D.); (R.Ž.)
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Nixarlidou E, Margioula-Siarkou C, Almperis A, Vavoulidis E, Laganà AS, Dinas K, Petousis S. Clinical significance and main parameters promoting the breast‑feeding strategy (Review). MEDICINE INTERNATIONAL 2024; 4:14. [PMID: 38410759 PMCID: PMC10895466 DOI: 10.3892/mi.2024.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024]
Abstract
Breastfeeding provides numerous nutritional and immunological benefits, promotes neurological and cognitive development, and protects against chronic and infectious diseases, rendering it beneficial to the survival and well-being of infants. According to international recommendations, infants should be exclusively breastfed for the first 6 months. However, despite global health recommendations and funding initiatives, exclusive breastfeeding rates remain low worldwide. A number of studies attribute the low rates to factors that can be grouped into demographic, psychosocial, economic and midwifery factors, and outline the profile of each mother who opts to exclusively breastfeed her infant. In addition, the number of previous pregnancies, induced labor, the use of epidurals at birth or the possibility of the newborn being delivered prematurely, and the need for admission to an intensive care unit are the factors that reduce the likelihood of exclusive breastfeeding. Further research is required to understand the factors influencing the initiation and maintenance of exclusive breastfeeding, as international interventions have been ineffective. The aim of the present review was to provide an up-to-date summary of these various factors in an aim to assist health care professionals and policy makers in developing effective interventions with which to promote and support exclusive breastfeeding.
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Affiliation(s)
- Eleni Nixarlidou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Aristarchos Almperis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS 'Civico-Di Cristina-Benfratelli', Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, I-90127 Palermo, Italy
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
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Grano C, Fernandes M, Conner M. Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women. Psychol Health 2023; 38:1536-1552. [PMID: 35007452 DOI: 10.1080/08870446.2021.2025374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/12/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Breastfeeding up to 2-years has been associated with short and long-term health benefits for both newborns and mothers. However, few women breastfeed up to 2-years after birth. This study extends previous research on the theory of planned behaviour (TPB) examining the predictors of intention and maintenance of breastfeeding up to 2-years in both primiparous and multiparous women. DESIGN 155 pregnant women participated in this longitudinal study. METHODS Expectant mothers completed a questionnaire and then 2-years after the child's birth were asked to report breastfeeding behaviour. Interactions among parity and TPB constructs were examined. RESULTS Attitudes, descriptive and injunctive norms, and perceived behavioural control (PBC) explained 58% of the variance in mothers' intention to breastfeed. Attitudes were the strongest predictor, followed by PBC, descriptive norms and parity. A significant interaction was found between parity and PBC, showing that PBC was only a significant predictor of intention to breastfeed at 2-years in multiparous women. Intentions predicted breastfeeding behaviour at 2-years. CONCLUSION Promoting intentions may be a useful way to increase breastfeeding duration to 2-years and targeting attitudes and norms may be one way to increase intentions. Further, targeting PBC may also be useful to increase intentions, but only in multiparous women.
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Affiliation(s)
- Caterina Grano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
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Rojas-García A, Lingeman S, Kassianos AP. Attitudes of mothers and health care providers towards behavioural interventions promoting breastfeeding uptake: A systematic review of qualitative and mixed-method studies. Br J Health Psychol 2023; 28:952-971. [PMID: 37060265 DOI: 10.1111/bjhp.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Recommendations for exclusive breastfeeding are not often adhered to despite the robust evidence of its benefits. This systematic review aims to collate evidence on the attitudes mothers and health care providers have towards breastfeeding interventions to understand what aspects best contribute to acceptability and feasibility. METHODS This review further investigates the value of identifiable behaviour change techniques (BCTs) to uncover which components of an intervention are perceived to be most useful and acceptable. The main biomedical databases were searched, and 17 (n = 17) studies met the inclusion criteria. RESULTS A total of nine BCTs were identified within the interventions. The thematic analysis produced four main domains: usefulness, accessibility, value and sustainability. Women discussed the importance of the support they received in these interventions and demonstrated a positive view towards three BCTs: 'social support (unspecified)', 'instruction on how to perform behaviour' and 'demonstration of behaviour'. Additionally, women highlighted the benefit of personal, non-clinical and flexible emotional and practical support from peers, lactation consultants and support groups. Health care providers echoed these opinions and specifically highlighted the usefulness of interventions that allowed for continuity of care and more personal breastfeeding support. CONCLUSIONS These findings suggest that ongoing practical as well as emotional support is crucial for standard in-hospital support to succeed at increasing breastfeeding rates. Future research would need to better understand the nuances of the interventions among women and providers to enhance their implementation.
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Affiliation(s)
- Antonio Rojas-García
- Mental Health Policy Research Unit, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK
- Department of Psychiatry, Faculty of Medicine, University of Granada, Granada, Spain
- Institute of Neurosciences, Biomedical Research Centre (CIBM), University of Granada, Granada, Spain
| | - Sabrina Lingeman
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
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Oberfichtner K, Oppelt P, Fritz D, Hrauda K, Fritz C, Schildberger B, Lastinger J, Stelzl P, Enengl S. Breastfeeding in primiparous women - expectations and reality: a prospective questionnaire survey. BMC Pregnancy Childbirth 2023; 23:654. [PMID: 37689660 PMCID: PMC10493027 DOI: 10.1186/s12884-023-05971-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Breastfeeding provides the optimal nutrition for infants and offers numerous benefits for both mother and child. The World Health Organisation recommends exclusive breastfeeding during the first 6 months of life and the introduction of complementary feeding between the fifth and seventh months of life. There is a discrepancy between breastfeeding recommendations and the actual duration of breastfeeding. The aim of this study was to analyse breastfeeding behaviour in primiparous women in order to be able to provide support for mothers. METHODS In this prospective, questionnaire-based study conducted between 2020 and 2022, primiparous women were asked to complete three questionnaires at three defined survey time points (routine prepartum presentation, postpartum hospitalization, completed sixth month of life). RESULTS A total of 140 women were included and returned all three questionnaires. Fifty-eight percent performed breastfeeding exclusively at least until their baby had reached the age of 6 months, whereas 20% already stopped within the first 6 months. The main reasons given for early cessation were insufficient milk supply and inadequate infant weight gain. A comprehensive level of prepartum knowledge had a significant positive effect on participants' sense of confidence with breastfeeding. Sociodemographic factors such as age and educational level were also associated with breastfeeding behaviour, but significant corresponding differences in the duration of breastfeeding were not observed. Women with postpartum midwifery care breastfed significantly longer (p < 0.05). CONCLUSIONS Breastfeeding behaviour and duration are influenced by multiple factors. Although certain sociodemographic factors are unalterable, comprehensive prepartum knowledge transfer and postpartum midwifery care have a positive impact on breastfeeding behaviour. TRIAL REGISTRATION The study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) on 6 December 2022 (DRKS00030763).
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Affiliation(s)
- Katrin Oberfichtner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University, Altenbergerstrasse 69, 4040, Linz, Austria.
| | - Peter Oppelt
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University, Altenbergerstrasse 69, 4040, Linz, Austria
| | - Daniela Fritz
- University of Applied Sciences for the Health Professions, Linz, Austria
| | - Katharina Hrauda
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University, Altenbergerstrasse 69, 4040, Linz, Austria
| | - Christian Fritz
- Institute for Statistical Analysis Jaksch & Partner GmbH, Linz, Austria
| | | | - Julia Lastinger
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University, Altenbergerstrasse 69, 4040, Linz, Austria
| | - Patrick Stelzl
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University, Altenbergerstrasse 69, 4040, Linz, Austria
| | - Sabine Enengl
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University, Altenbergerstrasse 69, 4040, Linz, Austria
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Crawford KA, Gallagher LG, Baker ER, Karagas MR, Romano ME. Predictors of Breastfeeding Duration in the New Hampshire Birth Cohort Study. Matern Child Health J 2023; 27:1434-1443. [PMID: 37269393 DOI: 10.1007/s10995-023-03714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Kathryn A Crawford
- Environmental Studies Program, Middlebury College, 276 Bicentennial Way, Middlebury, VT, 05753, USA.
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Lisa G Gallagher
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Emily R Baker
- Maternal Fetal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Megan E Romano
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Bhattacharya S, Ali W, Ghildiyal A. Correlation Between Maternal Age and Cytokine (IL-6 and TGF-Beta) Levels in Colostrum. Cureus 2023; 15:e39146. [PMID: 37384101 PMCID: PMC10294278 DOI: 10.7759/cureus.39146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Cytokines are small proteins that play an important role in cell signaling, particularly in inflammatory pathways. There are both pro- as well as anti-inflammatory cytokines that regulate this pathway and modulate the immune responses. Advancing maternal age is associated with systemic inflammation. The present study intends to evaluate the effect of advancing maternal age on cytokine (IL-6 and TGF-β) levels in colostrum, the first breast milk secreted by mothers. METHODOLOGY A total of 77 term deliveries were enrolled in the study. Colostrum specimens were collected and evaluated for cytokine IL-6 and TGF-β levels. Colostrum IL-6 and TGF-β levels were correlated with maternal age and were assessed using the Spearman rank correlation coefficient. Multivariate analysis was done using a linear regression model comprising age, parity, and mode of delivery. RESULTS Mean colostrum IL-6 and TGF-β levels were 113.3±73.1 pg/ml and 20.9±23.6 pg/ml, respectively. No significant correlation between maternal age and colostrum IL-6 levels was observed (r=0.137; p=0.314). However, there was a significant positive correlation between maternal age and colostrum TGF-β levels (r=0.452; p<0.001). CONCLUSIONS The findings of the study show a significant association between maternal age and colostrum TGF-β levels. The impact of colostrum cytokine levels on neonatal growth and development in context with advancing maternal age needs to be evaluated.
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Affiliation(s)
| | - Wahid Ali
- Pathology, King George's Medical University, Lucknow, IND
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The Effect of Parenting Peer Education Interventions for Young Mothers on the Growth and Development of Children under Five. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020338. [PMID: 36832465 PMCID: PMC9954868 DOI: 10.3390/children10020338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
One of the contributing factors in the growth and development of children under five is the mother's ability to provide childcare, but young mothers do not have enough parenting skills. The goal of the current study was to examine the effect of the parenting peer education (PPE) programme on young mothers' parenting self-efficacy and behaviour, and the growth and development of children under five. There were two groups, which were a control group (without intervention) and an intervention group, in which there were 15 participants in each group. Analysis covariance with the pre-test scores as covariates was used in this study. The results showed that, compared with the control group, the intervention group reported significantly better parenting self-efficacy, parenting behaviour, children's growth, and children's development, including cognitive, language, and motoric aspects. The PPE programme can exchange the young mothers' experiences on how their children grow and develop, and the mothers will also receive psychological support. In conclusion, the PPE programme affected the young mothers' parenting self-efficacy and parenting behaviour and the children's growth and development.
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12
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Bove R, Hellwig K, Pasquarelli N, Borriello F, Dobson R, Oreja-Guevara C, Lin CJ, Zecevic D, Craveiro L, McElrath T, Vukusic S. Ocrelizumab during pregnancy and lactation: Rationale and design of the MINORE and SOPRANINO studies in women with MS and their infants. Mult Scler Relat Disord 2022; 64:103963. [PMID: 35753176 DOI: 10.1016/j.msard.2022.103963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/26/2022] [Accepted: 06/10/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Most disease-modifying therapies (DMTs) approved for the treatment of multiple sclerosis (MS) are not recommended during pregnancy, and discouraged while breastfeeding. However, discontinuation of some DMTs before pregnancy can leave women vulnerable to MS relapses. Although available data on ocrelizumab suggest no increased risk in terms of pregnancy or neonatal outcomes, it is unknown whether ocrelizumab transfers across the placenta or is absorbed through breastmilk; and if so, whether infant B cell development, immune responses or growth and development are affected. This manuscript describes two studies designed to address these uncertainties. METHODS/DESIGN MINORE and SOPRANINO are multicentre open-label studies. MINORE, which addresses placental transfer, will recruit 44 women with MS or clinically isolated syndrome (CIS) exposed to ocrelizumab between 6 months before the last menstrual period (LMP) to the end of the first trimester. It will evaluate pharmacodynamic effects of potential in utero exposure through the proportion of infants with B cell numbers below lower limit of normal (LLN) at week 6 of life (primary endpoint); as well as through vaccine-induced antibody responses (reflecting B cell function) during the first year of life. Placental transfer will be assessed through measurement of ocrelizumab concentrations in paired samples at delivery (maternal blood as well as umbilical cord blood), and infant serum at week 6 of life. SOPRANINO, which evaluates breastmilk transfer, will recruit 20 women with MS or CIS who resume or initiate ocrelizumab treatment while breastfeeding. The effect of potential exposure through breastmilk will be assessed through the proportion of infants with B cell levels below LLN at 30 days after the mother's first post-partum ocrelizumab infusion (co-primary endpoint). Infant exposure via breastmilk will be assessed through ocrelizumab average daily infant dose in breastmilk over 60 days after the same infusion (co-primary endpoint). Vaccine-induced responses will be measured as in MINORE. Both studies will also measure infant growth and development over the first year of life and safety outcomes in both mothers and infants. All analyses will be descriptive, under an estimand framework. DISCUSSION Both studies are designed to mimic real-world clinical practice. Treatment decisions for ocrelizumab are independent from study participation; as such, these studies will recruit women who decide, along with their physicians, to continue their pregnancies despite potential in utero exposure (for MINORE); or to breastfeed while under ocrelizumab treatment (for SOPRANINO). MINORE is the first prospective study to measure placental transfer of any DMT in MS, and to perform comprehensive assessments in infants and mothers. Results may inform the optimal contraception period for women treated with ocrelizumab who are planning a pregnancy. Similarly, SOPRANINO is the first prospective study to measure pharmacodynamic effects of ocrelizumab in breastfed infants in addition to pharmacokinetic parameters in breastmilk. SOPRANINO may establish whether breastfeeding is safe for infants whose mothers received treatment with ocrelizumab. CONCLUSION By collecting detailed pharmacokinetic, pharmacodynamic and safety information, MINORE and SOPRANINO will contribute to understanding the risk/benefit of ocrelizumab in pregnant and lactating women with MS.
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Affiliation(s)
- Riley Bove
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
| | - Kerstin Hellwig
- Katholisches Klinikum Bochum, St. Josef Hospital, Universitätsklinikum der Ruhr-Universität, Bochum, Germany
| | | | | | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | | | | | - Thomas McElrath
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Sandra Vukusic
- Service de Neurologie et Sclérose en Plaques, Fondation Eugène Devic EDMUS contre la Sclérose en Plaques, Hôpital Neurologique Pierre Wertheimer, Lyon, France
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Vollstedt A, Hougen HY, Gupta P, Johans C, Baldea KG. Gender-Based Pay Gap in Urology: A Review of the Literature and Potential Solutions. Urology 2022; 168:21-26. [DOI: 10.1016/j.urology.2022.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/07/2022] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
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Lojander J, Axelin A, Bergman P, Niela-Vilén H. Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby-Friendly Hospital Initiative: A quasi-experimental study. Midwifery 2022; 110:103350. [DOI: 10.1016/j.midw.2022.103350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/24/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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Suzuki T, Nojiri K, Higurashi S, Tsujimori Y, Toba Y, Nomura K. Relationship between Child Care Exhaustion and Breastfeeding Type at Two and Six Months in a Cohort of 1210 Japanese Mothers. Nutrients 2022; 14:nu14061138. [PMID: 35334795 PMCID: PMC8955404 DOI: 10.3390/nu14061138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 02/05/2023] Open
Abstract
This study investigated whether parenting stress is associated with breastfeeding type (exclusive or partial). Between 2014 and 2019, we recruited 1210 healthy mothers (mean age, 31.2 years; 65%, multiparity) from 73 obstetric institutions across all prefectures of Japan. Among these, 1120 mothers at two months and 1035 mothers at six months were investigated for parenting stress and breastfeeding type: exclusive versus otherwise (partial). Parenting stress was measured by a validated Japanese scale consisting of childcare exhaustion, worry about child’s development, and no partner support. Exclusive breastfeeding prevalence was 75% at two and 78% at six months. The total scores for childcare exhaustion and worry about child development were statistically higher in the partial breastfeeding group than in the exclusive breastfeeding group at two months but not at six months. A logistic regression model demonstrated that childcare exhaustion was significantly associated with an increased risk of having partial breastfeeding at two months after adjusting for the maternal Body Mass Index, parity, and baby’s current weight. However, the association was no longer significant at six months. The present study suggests that intervention for parenting stress at two months postpartum may promote prolonged exclusive breastfeeding.
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Affiliation(s)
- Tomoya Suzuki
- School of Medicine, Akita University, 1-1-1 Hondo, Akita 010-8543, Japan;
| | - Keisuke Nojiri
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Satoshi Higurashi
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Yuta Tsujimori
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Yasuhiro Toba
- Research and Development Department, Bean Stalk Snow Co., Ltd., Saitama 350-1165, Japan; (K.N.); (S.H.); (Y.T.); (Y.T.)
| | - Kyoko Nomura
- Department of Environment Health Science and Public Health, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
- Correspondence: ; Tel.: +81-18-884-6087
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Naja F, Chatila A, Ayoub JJ, Abbas N, Mahmoud A, Abdulmalik MA, Nasreddine L. Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar. Int Breastfeed J 2022; 17:15. [PMID: 35209913 PMCID: PMC8867651 DOI: 10.1186/s13006-022-00456-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention. Methods Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy (n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months (n = 185) and six months (n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk. Results Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68). Conclusions Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00456-x.
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Affiliation(s)
- Farah Naja
- Clinical Nutrition and Dietetics Department, College of Health Sciences, University of Sharjah, Sharjah, UAE.,Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, UAE.,Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Aya Chatila
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jennifer J Ayoub
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Nada Abbas
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Amira Mahmoud
- Public Health Department, Ministry of Public Health, Doha, Qatar
| | | | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Yu J, Gao M, Wei Z, Wells JCK, Fewtrell M. The impact of the Covid-19 pandemic on maternal delivery experiences and breastfeeding practices in China: data from a cross-sectional study. BMC Pediatr 2022; 22:104. [PMID: 35209865 PMCID: PMC8866109 DOI: 10.1186/s12887-022-03155-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/08/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The COVID-2019 pandemic has placed extensive pressure on health systems and posed a severe public health challenge worldwide. Lockdown measures implemented in many countries have delayed virus spread. However, a considerable number of people have faced unprecedented pressure, especially pregnant and breast-feeding women, because face-to-face professional support has been reduced during the lockdown in many countries. OBJECTIVES To compare the delivery and infant feeding experiences of women who delivered before (BL) versus during (DL) the Covid-19 pandemic in Beijing, China and to investigate predictors of breastfeeding at 6-months. METHODS Women aged ≥18 years with an infant ≤18 months of age completed an anonymous survey. Information/links were shared online and via local clinics in Beijing. Logistic regression was performed to assess predictors of breastfeeding during the first 6-months. RESULTS One thousand eight hundred seven women provided data; BL 1231 (68.1%), DL 576 (31.9%). Significantly more mothers in DL group reported the lockdown had moderate to high impact to their household income (p = 0.013) and the convenience of purchasing daily necessities(p = 0.014). Compared to BL mothers, significantly more mothers in the DL groups thought their birth location and breastfeeding intention had been effected by the COVID-19 (p < 0.001, p = 0.036 respectively). Mostly breastfeeding (MBF, mainly breastfeeding with few non-formula fluids added) at 6 months was predicted by delivery during the lockdown period (OR1.43, 95% confidence interval (CI) 1.08, 1.90), younger maternal age (OR 0.96, 95%CI 0.93, 0.99), getting support from friends or relatives (OR 1.95, 95%CI 1.06, 3.59), and discussing health issues in online groups > four times a week (OR 1.66, 95%CI 1.09, 2.53). CONCLUSION The COVID-19 pandemic and lockdown measures influenced mothers' planned birth location and breastfeeding intention. However, breastfeeding practice was maintained during the pandemic. Our results highlight the importance of feeding support as well as potential beneficial effects of increased mother-infant contact during the lockdown period which is relevant even under normal circumstances.
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Affiliation(s)
- Jinyue Yu
- Population, Policy & Practice Research & Teaching Department, UCL Institute of Child Health, University College London, London, UK.
| | - Mingyue Gao
- Population, Policy & Practice Research & Teaching Department, UCL Institute of Child Health, University College London, London, UK
| | - Zhuang Wei
- Department of Child Health, Capital Medical University Beijing Children's Hospital, Beijing, China
| | - Jonathan C K Wells
- Population, Policy & Practice Research & Teaching Department, UCL Institute of Child Health, University College London, London, UK
| | - Mary Fewtrell
- Population, Policy & Practice Research & Teaching Department, UCL Institute of Child Health, University College London, London, UK
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Consales A, Colombo L, Zanotta L, Morniroli D, Sannino P, Rampini S, Piccoli G, Donghi M, Marchisio P, Mosca F, Plevani L, Giannì ML. Pilot Feasibility Study of a Hospital-Based Post-Natal Educational Intervention on New Mothers in a BFHI-Compliant Tertiary Referral Center for Neonatal Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042020. [PMID: 35206209 PMCID: PMC8871806 DOI: 10.3390/ijerph19042020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022]
Abstract
The immediate post-partum period offers a valuable opportunity for parental education on various health topics. The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019. The Diary was given to mothers enrolled in Phase 2, together with the Nurse-Parent Support Tool (NPST). The Diary-NPST couples analyzed were 269. The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as "clear and comprehensive". Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high. In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers' knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.
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Affiliation(s)
- Alessandra Consales
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Lorenzo Colombo
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Lidia Zanotta
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Daniela Morniroli
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
- Correspondence: ; Tel.: +39-0255032907
| | - Patrizio Sannino
- Direzione Professioni Sanitarie, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (P.S.); (S.R.)
| | - Serena Rampini
- Direzione Professioni Sanitarie, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy; (P.S.); (S.R.)
| | - Giulia Piccoli
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Michaela Donghi
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
| | - Paola Marchisio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Pediatric Unit, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Laura Plevani
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
| | - Maria Lorella Giannì
- Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122 Milan, Italy; (A.C.); (G.P.); (M.D.); (F.M.); (M.L.G.)
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, NICU, Via della Commenda 12, 20122 Milan, Italy; (L.C.); (L.Z.); (L.P.)
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The impact of breast augmentation on breast feeding in primigravida women - A cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 268:116-120. [PMID: 34902748 DOI: 10.1016/j.ejogrb.2021.11.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/07/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Breast augmentations are among the most common interventional cosmetic procedures performed nowadays, but scarcity of data exists on its effects on breastfeeding. Our aim was to evaluate whether breast augmentation adversely affects breastfeeding. STUDY DESIGN A retrospective cohort study using database of a 2.3-million-member state mandate health maintenance organization (HMO). We identified primigravida women with a singleton pregnancy who delivered between the years 1998-2016, at gestational age of >34 weeks of gestation. Study group included women with breast augmentation surgery, which compared to control group of women who did not undergo breast augmentation. The primary outcome was documentation of any breastfeeding during the first three months postpartum. RESULTS Overall, 14,919 women were included, of them, 3913 and 11,006 women with and without breast augmentation, respectively. Women with breasts augmentation were younger (29.8 ± 3.6 years vs. 30.9 ± 4.0 years, p < 0.001), had lower pre-pregnancy BMI (25.2 ± 5.0 vs. 26.36 ± 5.0 Kg/m2, p < 0.001), belong to higher socioeconomic status level and less religious communities. Breastfeeding rates in the study group were lower as compared to controls (70.7% VS 85.1%; p < 0.0001), with an adjusted odds ratio of 0.42(95% CI: 0.38-0.461). Maternal diabetes mellitus and advanced maternal age were associated with a lower likelihood of breastfeeding (95% CI:0.45-0.78, p-value < 0.0001), while belonging to religious communities were associated with higher breastfeeding rates (95% CI: 1.34-1.99, p-value < 0.0001). CONCLUSION Women with breast augmentation tend to breastfeed less than women without breast augmentation, during the first three month of postpartum.
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Tracz J, Gajewska D, Myszkowska-Ryciak J. The Association between the Type of Delivery and Factors Associated with Exclusive Breastfeeding Practice among Polish Women-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010987. [PMID: 34682733 PMCID: PMC8535354 DOI: 10.3390/ijerph182010987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
The type of delivery influences breastfeeding, both in terms of initiation and duration. The aim of the study was to determine the association between the type of delivery and factors associated with exclusive breastfeeding (EBF) practice among Polish women. Data on sociodemographic variables, pre-pregnancy weight, height, course of pregnancy, type of delivery and duration of breastfeeding were collected using a Computer-Assisted Web Interview. Of the 1024 breastfeeding women who participated in the study, 59.9% gave birth vaginally and 40.1% gave birth by caesarean section. The chance of starting EBF [OR: 0.478; 95% Cl: 0.274, 0.832] and continuing it for four months [OR: 0.836; 95% Cl: 0.569, 0.949] was lower in the case of caesarean delivery. Starting EBF was negatively affected by pre-pregnancy overweight status and obesity in the case of caesarean delivery. EBF practice for four months was negatively affected by age [18–24 years and 25–34 years], elementary education and average income [2001–4000 PLN] in the case of caesarean delivery. A negative impact on the chance of EBF for six months was also observed for younger age [18–24 years], elementary and secondary education and average income [2001–4000 PLN] in the case of caesarean delivery. There was no association between starting EBF and age, net income, place of living, pregnancy complications or the child′s birth weight category in the case of both subgroups, as well as between education and previous pregnancies in the case of vaginal delivery. These results suggest that women who deliver by caesarean section need additional breastfeeding support.
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Bansal SC, Odedra R, Talati K, Morgaonkar VA, Shinde M, Nimbalkar SM. Infant and young child feeding (IYCF) practices and their determinants in two Urban districts of India. J Family Med Prim Care 2021; 10:3137-3143. [PMID: 34660459 PMCID: PMC8483104 DOI: 10.4103/jfmpc.jfmpc_184_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: It is essential to maintain optimal nutrition during the early years of life when the growth rate is maximum. Aims and Objectives: Our study investigated the prevalence of various feeding practices. We also explored their association with different sociodemographic, biomedical variables, and childhood morbidity. Methodology: This was a cross-sectional community-based study. Data were collected through a questionnaire-based survey of mothers of school-going children aged 2–6 years in the districts of Anand and Vadodara, Gujarat. Results: A total of 367 mothers participated in the study. About 78% of the mothers did early initiation of breastfeeding within 1 h of birth, and 68% gave colostrum to the newborn. Around 30% of the mothers practiced bottle feeding, and 25% gave prelacteal feeds. Most mothers received good family support for breastfeeding (93.73%). On univariate analysis, we found the following associations of feeding practices—breastfeeding initiation with the gender of the baby (P value—0.006) and type of delivery (P value < 0.001); the duration of exclusive breastfeeding with the time difference between two deliveries (P value—0.027) and maternal age (P value—0.004); prelacteal feeds with the type of delivery (P value—0.034); feeding difficulty with the time difference between two deliveries (P value < 0.001) and breastfeeding at night with maternal education (P value—0.002). The time of the initiation of breastfeeding was associated with cough and cold episodes. No other association was found between breastfeeding variables and health indicators. Conclusion: Maternal age, maternal education, the time difference between two deliveries, the type of delivery, and gender of the baby were significantly associated with different Infant and Young Child Feeding (IYCF) practices. Identifying these factors might help in the development of strategies for optimizing feeding practices.
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Affiliation(s)
- Satvik C Bansal
- Department of Pediatrics, Gajra Raja Medical College, Gwalior, Madhay Pradesh, India
| | - Rahul Odedra
- Medical Officer, Department of Paediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
| | - Kandarp Talati
- Department of Interdisciplinary Research, Foundation for Diffusion of Innovations, Vadodara, Gujarat, India
| | | | - Mayur Shinde
- Central Research Services, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | - Somashekhar M Nimbalkar
- Professor and Head, Department of Paediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, India
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Adam M, Johnston J, Job N, Dronavalli M, Le Roux I, Mbewu N, Mkunqwana N, Tomlinson M, McMahon SA, LeFevre AE, Vandormael A, Kuhnert KL, Suri P, Gates J, Mabaso B, Porwal A, Prober C, Bärnighausen T. Evaluation of a community-based mobile video breastfeeding intervention in Khayelitsha, South Africa: The Philani MOVIE cluster-randomized controlled trial. PLoS Med 2021; 18:e1003744. [PMID: 34582438 PMCID: PMC8478218 DOI: 10.1371/journal.pmed.1003744] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs ("mentor mothers"). METHODS AND FINDINGS We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants' median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers' time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations. CONCLUSIONS This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs' direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services. TRIAL REGISTRATION The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018.
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Affiliation(s)
- Maya Adam
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Jamie Johnston
- Stanford Center for Health Education, Stanford, California, United States of America
| | - Nophiwe Job
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | | | - Ingrid Le Roux
- The Philani Maternal Child Health and Nutrition Trust, Khayelitsha, South Africa
| | - Nokwanele Mbewu
- The Philani Maternal Child Health and Nutrition Trust, Khayelitsha, South Africa
| | - Neliswa Mkunqwana
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, United Kingdom
| | - Shannon A. McMahon
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amnesty E. LeFevre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- University of Cape Town, School of Public Health and Family Medicine, Cape Town, South Africa
| | - Alain Vandormael
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Kira-Leigh Kuhnert
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Pooja Suri
- Stanford Center for Health Education, Stanford, California, United States of America
- Berkeley School of Public Health, Berkeley, California, United States of America
| | - Jennifer Gates
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Bongekile Mabaso
- School of Management Studies, University of Cape Town, Cape Town, South Africa
| | - Aarti Porwal
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Charles Prober
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States of America
- Stanford Center for Health Education, Stanford, California, United States of America
- Digital Medic, Stanford Center for Health Education, Cape Town, South Africa
| | - Till Bärnighausen
- Heidelberg University Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, United States of America
- Wellcome Trust’s Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
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Benova L, Siddiqi M, Abejirinde IOO, Badejo O. Time trends and determinants of breastfeeding practices among adolescents and young women in Nigeria, 2003-2018. BMJ Glob Health 2021; 5:bmjgh-2020-002516. [PMID: 32764127 PMCID: PMC7412589 DOI: 10.1136/bmjgh-2020-002516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/27/2020] [Accepted: 06/19/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Optimal breastfeeding practices have far-reaching health and economic benefits. Evidence suggests disparities in breastfeeding practices by maternal age-groups, with younger mothers often having lower rates of breastfeeding initiation, continuation and exclusivity compared with older mothers. There is limited knowledge of trends and factors associated with breastfeeding practices, particularly among adolescent and younger mothers in Nigeria. We examine key breastfeeding practices in Nigeria over a 15-year period, comparing adolescent mothers to young women. Methods We used four Nigeria Demographic and Health Surveys collected between 2003 and 2018. We constructed six key breastfeeding indicators to cover the time period of breastfeeding from initiation to child age 24 months in women of three maternal age groups at the time of birth: young adolescents (<18 years), older adolescents (18–19.9 years) and young women (20–24.9 years). We used logistic regression to examine the association between maternal age group and select breastfeeding behaviours on the 2018 survey. Results Analysis showed an increase in optimal breastfeeding practices across the four surveys and among all maternal age groups examined. Adolescent mothers had consistently lower prevalence for three of the six key breastfeeding indicators: early initiation of breastfeeding, exclusive breastfeeding <6 months and no prelacteal feed. Compared with young women, adolescent mothers had a higher prevalence of continued breastfeeding at 1 and 2 years. In multivariate analysis, we found that maternal age group was not associated with early breastfeeding initiation or with exclusive breastfeeding <6 months. However, several sociodemographic (ethnicity, region of residence) and healthcare-related (mode of delivery, antenatal care, postnatal breastfeeding counselling) factors were strongly associated with these two practices. Conclusions In Nigeria, there is need to better support breastfeeding and nutritional practices in adolescents and young women focusing on ethnic groups (Hausa, Fulani, Kanuri/Beriberi) and geographic regions (South East) that are lagging behind.
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Affiliation(s)
- Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Manahil Siddiqi
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | | | - Okikiolu Badejo
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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The Association between a Novel Baby-Friendly Hospital Program and Equitable Support for Breastfeeding in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136706. [PMID: 34206374 PMCID: PMC8296950 DOI: 10.3390/ijerph18136706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
Background: Rates of early initiation of breastfeeding are low in Southeast Asia, despite evidence that increased initiation of early breastfeeding would lead to better long-term infant and child health and decrease inequities in long-term health and well-being. In response, a novel performance-based, baby-friendly hospital program designates hospitals that adhere to evidence-based early essential newborn care (EENC) and breastfeeding interventions as Centers of Excellence for Breastfeeding (COE). This study examined whether hospital participation in the program was associated with better breastfeeding outcomes. Methods: Hospitals (n = 28) were invited into the program in December 2018. Hospitals developed an improvement plan for promoting a breastfeeding-friendly environment and meeting the standards of the COE accreditation process and were enrolled on a rolling basis over the course of a year. Post-partum surveys were conducted with parents (n = 9585) from January 2019 through April 2020 to assess their breastfeeding and post-partum experience. Segmented regression models were used to assess how breastfeeding outcomes evolved before and after hospital enrollment in the COE program. Results: Enrollment was associated with a 6 percentage-point (95% CI: 3, 9) increase in the level of early initiation of breastfeeding, which continued to increase in the post-enrollment period, and a 5 percentage-point (95% CI: 2, 9) increase in the level of exclusive breastfeeding during hospital stay. We did not observe evidence that enrollment was immediately associated with receipt of lactation counseling or exclusive breastfeeding at survey time. Conclusion: The prevalence of early and exclusive breastfeeding increased after enrollment in the COE program, suggesting that the program has the potential to improve breastfeeding initiation rates and longer-term child health and well-being. Further research should be conducted to examine whether the program has an impact on the overall duration of breastfeeding.
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Uchoa JL, Barbosa LP, Mendonça LBDA, Lima FET, Almeida PCD, Rocha SSD. Influence of social determinants of health on skin to skin contact between mother and newborn. Rev Bras Enferm 2021; 74:e20200138. [PMID: 34133704 DOI: 10.1590/0034-7167-2020-0138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/24/2020] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE to analyze the association of skin-to-skin contact and social determinants of health. METHODS this is a cross-sectional study with 187 medical records of newborns from a reference rooming in in northeastern Brazil. An instrument with maternal and neonatal data was used. Analysis was descriptive and inferential statistics. For the associations, a chi-square test was used to measure strength, an Odds Ratio was calculated, with a 95% confidence interval. RESULTS 62% of newborns who made skin-to-skin contact at birth were eutrophic, full-term, Apgar > 7, mothers with prenatal care and without abortion. The determinants associated with non-skin-to-skin contact were preterm (CR=3.2;95%CI: 2.72-18.98); 1st minute Apgar < 7 (CR:2.9;95%CI: 2.38-3.06), cesarean section (CR:8.4;95%CI: 4.29-16.57), and unhealthy NB (CR 12.7;95%CI: 4.9-32.67). We used STROBE guidelines. CONCLUSION skin-to-skin contact was influenced by gestational age, Apgar, delivery, and newborn health.
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Affiliation(s)
- Janaiana Lemos Uchoa
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídio. Fortaleza, Ceará, Brazil
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Enggar, Pont AV, Alam G, Madeppungeng M. The effect of parity, nutritional status, age of baby and smoking status to antioxidant of breast milk. ENFERMERIA CLINICA 2021. [PMID: 33040928 DOI: 10.1016/j.enfcli.2020.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was aimed to know the effect of parity, nutritional mother, age of the baby, and smoking status to antioxidant of breast milk. METHOD This study was an experimental laboratory study aimed at obtaining total antioxidants in breast milk. A sample of 24 people was taken using purposive sampling that met the inclusion criteria, namely postpartum mothers over ten days who were breastfeeding, mothers who gave birth normally enough months (37-40 weeks), babies born alive, and were willing to participate in this study by signing informed consent. Samples taken were breastfeeding mothers who have babies less than or equal to 6 months old. A sample of 10ccs of breast milk was taken from the respondent using a breast milk pump, and then it was tested for its antioxidant levels by testing the antioxidant activity of the DPPH method (1,1-diphenyl-2-picrylhydrazyl) in the Biopharmaca Laboratory. RESULTS The results showed that there was no influence of the parity (p=0.464), the age of the baby (p=0.649), the nutritional status of the mother (p=0.960) on the antioxidant breast milk but smoking status had significant influence with antioxidants breast milk (p=0.026). CONCLUSION Parity, nutritional status of the mother, and age of baby are not influenced antioxidants of breast milk, but smoking status has significant influence.
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Affiliation(s)
- Enggar
- Politeknik Cendrawasih Palu, Indonesia; Department of Midwifery, Graduate School, Hasanuddin University, Indonesia; Politeknik Kesehatan Kementerian Kesehatan Palu, Indonesia
| | - Anna Veronica Pont
- Department of Midwifery, Graduate School, Hasanuddin University, Indonesia; Politeknik Kesehatan Kementerian Kesehatan Palu, Indonesia
| | - Gemini Alam
- Faculty of Pharmacy, Hasanuddin University, Indonesia.
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Afolabi RF, Palamuleni ME. Multilevel analysis of unhealthy bodyweight among women in Malawi: Does urbanisation matter? PLoS One 2021; 16:e0249289. [PMID: 33780505 PMCID: PMC8006991 DOI: 10.1371/journal.pone.0249289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Underweight and overweight constitute unhealthy bodyweight and their coexistence is symptomatic of the dual burden of malnutrition (DBM) of high public health concern in many sub-Saharan Africa countries. Little is known about DBM and its correlates in Malawi, a country undergoing urbanisation. The study examined net effects of urban residence on unhealthy weights amidst individual- and community-level factors among women in Malawi. METHODS Data on 7231 women aged 15-49 years nested within 850 communities extracted from 2015-16 Malawi Demographic and Health Survey were analysed. Women's weight status measured by body mass index, operationally categorised as underweight, normal and overweight, was the outcome variable while urban-rural residence was the main explanatory variable. Multilevel multinomial logistic regression analysis was employed at 5% significant level; the relative-risk ratio (RR) and its 95% confidence interval (CI) were presented. RESULTS Urban residents had a significantly higher prevalence of overweight than rural (36.4% vs. 17.2%; p< 0.001) but a -non-significant lower prevalence of underweight (6.2% vs. 7.4%; p = 0.423). Having adjusted for both individual- and community-level covariates, compared to rural, living in urban (aRR = 1.25; CI: 1.02-1.53) accounted for about 25% higher risk of being overweight relative to normal weight. Higher education attainment, being married and belonging to Chewa, Lomwe or Mang'anja ethnic group significantly reduced the risk of being underweight but heightened the risk of being overweight. Being older and living in wealthier households respectively accounted for about 3- and 2-times higher likelihood of being overweight, while breastfeeding (aRR = 0.65; CI: 0.55-0.76) was protective against overweight. Living in communities with higher poverty and higher education levels reduced and increased the risk of being overweight, respectively. Evidence of community's variability in unhealthy weights was observed in that 11.1% and 3.0% respectively of the variance in the likelihood of being overweight and underweight occurred across communities. CONCLUSIONS The study demonstrated association between urban residence and women overweight. Other important associated factors of overweight included breastfeeding, community education- and poverty-level, while education attainment, marital status and ethnicity were associated with the dual unhealthy weight. Thus, both individual- and community-level characteristics are important considerations for policy makers in designing interventions to address DBM in Malawi.
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Affiliation(s)
- Rotimi Felix Afolabi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Population Studies and Demography Programme & Population and Health Research Entity, Faculty of Humanities, North-West University, Mmabatho, South Africa
| | - Martin Enock Palamuleni
- Population Studies and Demography Programme & Population and Health Research Entity, Faculty of Humanities, North-West University, Mmabatho, South Africa
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Martinelli KG, Gama SGND, Santos Neto ETD. The role of parity in the mode of delivery in advanced maternal age women. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2021. [DOI: 10.1590/1806-93042021000100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the profile of Brazilian Advanced Maternal Age (AMA) women (> 35 years) according to parity, as well as to analyze the role of parity in the relationship between AMA and mode of delivery. Methods: this is a cross-sectional study, based on the “Nascer no Brasil” (Born in Brazil) survey. The data were collected in 2011/2012. The chi-square test was performed to verify the association between parity and maternal, prenatal and delivery characteristics, maternal habits, pre-pregnancy diseases, maternal complications and obstetric history. Results: of the 2,510 puerperal AMA women, 20.2% were nulliparous, 54.4% had one or two previous births and 25.4% had three or more previous births. The nulliparous women had higher schooling, higher economic class and adequate BMI, were white; and had better maternal habits when compared to multiparous. However, they were also more submitted to cesarean section, although without reported complications. Conclusions: one cannot speak of AMA pregnant women as a homogeneous group in Brazil. There are inequalities that can be revealed via parity, since nulliparous women have maternal characteristics, habits and access to prenatal care and childbirth that are more advantageous than multiparous women.
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Edwards R, Cragg B, Dunn S, Peterson WE. The breastfeeding and early motherhood experiences of older first-time mothers: A constructivist grounded theory study. Midwifery 2021; 96:102945. [PMID: 33601127 DOI: 10.1016/j.midw.2021.102945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/21/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of this paper is to present the results of a qualitative study that explored the factors surrounding decision-making related to breastfeeding and the experiences of early motherhood for 23 first-time mothers over the age of 35 in Canada. Previous studies on breastfeeding have not examined older first-time mothers as a group that is unique due to their experience of coming to motherhood in the context of the growing phenomenon of delayed childbearing in the 21st century. Many older women come to motherhood with both well- established life and professional experiences, and as such their needs may differ from their younger or multiparous counterparts. The research question was: "What factors affect how first-time mothers >35 years of age make decisions about breastfeeding, and how do these factors affect the decisions they make related to breastfeeding and their transition to motherhood in the first six months postpartum?" DESIGN Constructivist grounded theory FINDINGS: The theory of From Ideology to Independence: Older First-time Mothers, Breastfeeding, and Becoming a Mother provides a lens to view the underlying processes influencing the decisions the mothers made related to breastfeeding and early motherhood. The mothers worked through the processes of learning breastfeeding, redefining self, and defining motherhood. The mothers' belief that breastfeeding defines motherhood, coupled with lack of knowledge and control, had a negative effect on both early breastfeeding and their transition to motherhood. As the idea of breastfeeding equating successful mothering waned the mothers became active agents in decision-making related to infant feeding and mothering.
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Affiliation(s)
- Rosann Edwards
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, 100 Tucker Park Drive, Saint John, New Brunswick, E2L 4L5, Canada.
| | - Betty Cragg
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sandra Dunn
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, 100 Tucker Park Drive, Saint John, New Brunswick, E2L 4L5, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Wendy E Peterson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Ballesta-Castillejos A, Gómez-Salgado J, Rodríguez-Almagro J, Hernández-Martínez A. Development and validation of a predictive model of exclusive breastfeeding at hospital discharge: Retrospective cohort study. Int J Nurs Stud 2021; 117:103898. [PMID: 33636452 DOI: 10.1016/j.ijnurstu.2021.103898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The benefits of breastfeeding for both mother and newborn have been widely demonstrated. However, breastfeeding rates at discharge are lower than recommended, so being able to identify women at risk of not breastfeeding at discharge could allow professionals to prioritise care. OBJECTIVE To develop and validate a predictive model of exclusive breastfeeding at hospital discharge. DESIGN Retrospective cohort study on women who gave birth between 2014 and 2019 in Spain. DATA SOURCES The data source was a questionnaire distributed through the Spanish breastfeeding associations. The development of the predictive model was made on a cohort of 3387 women and was validated on a cohort of 1694 women. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). RESULTS 80.2% (2717) women exclusively breastfed at discharge in the derivation cohort, and 82.1% (1390) in the validation cohort. The predictive factors in the final model were: maternal age at birth; BMI; number of children; previous breastfeeding; birth plan; induced birth; epidural analgesia; type of birth; prematurity; multiple pregnancy; macrosomia; onset of breastfeeding within the first hour; and skin-to-skin contact. The predictive ability (ROC AUC) in the derivation cohort was 0.76 (CI 95%: 0.74-0.78), while in the validation cohort it was 0.74 (CI 95%: 0.71-0.77). CONCLUSIONS A predictive model of exclusive maternal breastfeeding at hospital discharge has been developed, based on thirteen variables, with satisfactory predictive ability in both the derivation cohort and the validation cohort according to the Swets' criteria. This model can identify women who are at high risk of not breastfeeding at hospital discharge.
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Affiliation(s)
| | - Juan Gómez-Salgado
- PhD.Department of Sociology, Social Work and Public Health, University of Huelva, 21071 Huelva, Spain; Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
| | - Julián Rodríguez-Almagro
- PhD. Department of Nursing. Ciudad Real School of Nursing, University of Castilla La-Mancha, Ciudad Real, Spain.
| | - Antonio Hernández-Martínez
- Msc. Department of Obstetrics & Gynaecology, Alcázar de San Juan, Ciudad Real, Spain; Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
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Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey. PLoS One 2020; 15:e0244229. [PMID: 33338080 PMCID: PMC7748140 DOI: 10.1371/journal.pone.0244229] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/05/2020] [Indexed: 11/19/2022] Open
Abstract
Background Early initiation of breast feeding has great importance for both mothers and newborns. Despite, recommendations for exclusive and early initiation of breast feeding within one hour of birth, Ethiopia reports that 58% of infants under six months of age are exclusively breastfed. Cesarean deliveries may affect timing of breastfeeding initiation, establishment of milk supply and infant breastfeeding interest compared to vaginal deliveries. The aim of this study was to assess the impact of cesarean delivery on breastfeeding initiation. Methods A cross-sectional study was conducted with a total of 7115 study participants from the 2016 Ethiopian Demographic Health Survey (EDHS). Both descriptive and analytical statistical analysis was employed. Univariable and multivariable logistic regression analyses were used to identify anyassociations between variables. Odds ratios with its corresponding 95% confidence intervals (CI) were reported. During multivariable analysis, variables with p-value < 0.05 were considered as statistically significant. Results The prevalence of late initiation of breast feeding among women with their last live birth was 25.03% (95%CI; 20.5–32.2). Significant factors associated with late initiation of breastfeeding were cesarean delivery [AOR = 4.06 (95%CI, 2.66–6.2)], primipara mother [AOR = 1.45(95%CI, 1.13–1.7)], and having an unplanned pregnancy [AOR = 1.35(95%CI, 1.1–1.65)]. Positively associated with early initiation of breastfeeding was the mother’s age, for women between 20–34 years-old. This association, reported as a negative association of late initiation of breast feeding was [AOR = 0.77(95%CI, 0.61–0.98)]. Conclusion Cesarean delivery adversely affects the initiation of breast feeding. Cesarean delivery, unplanned pregnancy, and being primiparous, were associated with late initiation of breastfeeding. Women between the ages of 20–34 years of age had a reduced chance of late initiation of breastfeeding. Providing counseling regarding the strategy and importance of early initiation of breast feeding, could have crucial importance for the mother and her newborn.
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Demir G, Yardimcı H, Özçelik AÖ, Çakıroğlu FP. Compliance of mothers' breastfeeding and complementary feeding practices with WHO recommendations in Turkey. Nutr Res Pract 2020; 14:654-666. [PMID: 33282126 PMCID: PMC7683210 DOI: 10.4162/nrp.2020.14.6.654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/25/2019] [Accepted: 05/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to evaluate how breastfeeding and complementary nutrition practices of mothers of 0-24-month-old children comply with the World Health Organization (WHO) recommendations for infant and young child feeding and to compare the results with selected demographic parameters related to the mother and child. SUBJECTS/METHODS The research sample comprised mothers (n = 250) with children less than 2 years old. Data were obtained via questionnaire and were analyzed using SPSS 20.0 package program. The Pearson χ2 or Fisher's exact tests were used for assessing relationships between categorical variables. The one-sample t-test was used for comparisons with reference values. RESULTS Most mothers (97.2%) breastfed their babies immediately after birth. The mean time to breastfeeding after delivery was 47.8 ± 14.8 minutes, and 40.8% of the mothers complied with the WHO recommendation. Furthermore, 59.8% of the mothers exclusively breastfed their children for 6 months (mean 5.2 ± 1.5 months). The mean duration to the start of providing complementary food was 5.8 ± 0.6 months, and 76.1% of mothers who complied with the WHO recommendation. Only 12.3% of mothers breastfed their children for at least 12 months (mean 7.7 ± 3.3 months). On average, mothers gave cow milk to their children for the first time at 10.1 ± 1.7 months and honey at 11.8 ± 2.3 months. The mothers' rates of compliance with the WHO recommendations on cow milk and honey feeding were 32.0% and 71.6%, respectively. The rate of mothers who complied with the WHO minimum meal frequency recommendation was 88.3%. CONCLUSIONS We suggest that the WHO recommendations on this subject will be realized more fully by emphasizing the importance of the positive effects of breastfeeding until the age of 2 years and of a timely start of complementary food provision. Such changes will affect child health over the long term.
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Affiliation(s)
- Gülperi Demir
- Department of Nutrition and Dietetics, Selçuk University, Alaaddin Keykubat Kampüsü, Konya 42250, Turkey
| | - Hülya Yardimcı
- Department of Nutrition and Dietetics, Ankara University, Keçiören, Ankara 06290, Turkey
| | - Ayşe Özfer Özçelik
- Department of Nutrition and Dietetics, Ankara University, Keçiören, Ankara 06290, Turkey
| | - Funda Pınar Çakıroğlu
- Department of Nutrition and Dietetics, Ankara University, Keçiören, Ankara 06290, Turkey
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Ciccone MF, Trousdell MC, Dos Santos CO. Characterization of Organoid Cultures to Study the Effects of Pregnancy Hormones on the Epigenome and Transcriptional Output of Mammary Epithelial Cells. J Mammary Gland Biol Neoplasia 2020; 25:351-366. [PMID: 33131024 PMCID: PMC7960614 DOI: 10.1007/s10911-020-09465-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
The use of mouse derived mammary organoids can provide a unique strategy to study mammary gland development across a normal life cycle, as well as offering insights into how malignancies form and progress. Substantial cellular and epigenomic changes are triggered in response to pregnancy hormones, a reaction that engages molecular and cellular changes that transform the mammary epithelial cells into "milk producing machines". Such epigenomic alterations remain stable in post-involution mammary epithelial cells and control the reactivation of gene transcription in response to re-exposure to pregnancy hormones. Thus, a system that tightly controls exposure to pregnancy hormones, epigenomic alterations, and activation of transcription will allow for a better understanding of such molecular switches. Here, we describe the characterization of ex vivo cultures to mimic the response of mammary organoid cultures to pregnancy hormones and to understand gene regulation and epigenomic reprogramming on consecutive hormone exposure. Our findings suggest that this system yields similar epigenetic modifications to those reported in vivo, thus representing a suitable model to closely track epigenomic rearrangement and define unknown players of pregnancy-induced development.
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Fadiloglu E, Karatas E, Tez R, Cagan M, Unal C, Nar M, Tanacan A, Beksac MS. Assessment of Factors Affecting Breastfeeding Performance and Latch Score: A Prospective Cohort Study. Z Geburtshilfe Neonatol 2020; 225:353-360. [PMID: 33022737 DOI: 10.1055/a-1255-3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the risk factors that may affect LATCH scores. MATERIALS AND METHODS We prospectively evaluated the LATCH scores and any relevant risk factors of patients who delivered at our institution during April and May 2020. All examinations were performed by the same physicians during the study period. LATCH scores were determined at initial breastfeeding session, and postnatal days 1 and 2. RESULTS We analyzed 338 patients in this prospective study. Patients with high-risk pregnancies were found to have lower LATCH scores at each measurement (p: 0.002, 0.001, and 0.09, respectively). Skin-to-skin contact immediately after delivery and breastfeeding longer than 20 min in the first session did not improve LATCH scores (p>0.05). Breastfeeding within 30 min after delivery significantly improved LATCH scores at each session (p<0.01 for all). Odds ratios of having a LATCH score lower than 8 was 10.9 (95% CI: 4.22-28.37) for the patients breastfed after more than 30 min, while this ratio was 2.17 (95% CI: 1.34-3.50) and 6.5 (95% CI: 3.46-12.58) for the patients having a high-risk pregnancy and cesarean section, respectively. Furthermore, we also determined a positive statistically significant association between parity and all LATCH scores according to regression analyses (p: 0.005, 0.028, and 0.035 for LATCH scores at initial breastfeeding, postnatal day 1 and 2, respectively) CONCLUSION: High-risk pregnancies, patients who delivered by cesarean section, and patients not attempting to breastfeed within 30 min tend to have lower LATCH scores.
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Affiliation(s)
- Erdem Fadiloglu
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Esra Karatas
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Ruya Tez
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Murat Cagan
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Canan Unal
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Makbule Nar
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Mehmet Sinan Beksac
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Hacettepe University Medical Faculty, Ankara, Turkey
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Gayatri M, Dasvarma GL. Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey. PLoS One 2020; 15:e0239446. [PMID: 32970729 PMCID: PMC7514028 DOI: 10.1371/journal.pone.0239446] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Commencing breastfeeding within one hour of birth is defined as early initiation of breastfeeding (EIBF). Both the mother and child benefit from EIBF. This study aims to identify the predictors of EIBF among Indonesian women. Methods This paper analyses data from a weighted sample of 6,616 women collected at the Indonesia Demographic and Health Survey (IDHS) 2017.The frequency of EIBF is measured by the proportion of children born in the two years preceding the survey who received breastmilk within one hour of birth. The analysis uses bivariate and multivariate logistic regression for complex sample designs, adjusted for confounders to examine the relationship of EIBF with women’s individual, household and community level characteristics. Results Overall, 57% (95% CI: 54.9%-58.2%) of the children born in the two years preceding the survey had EIBF. Statistically significant (p<0.05) predictors of EIBF are women’s non-working status, second or higher order of the birth of the most recent child, average or large size of the most recent child at birth, poor status of the household and non-agricultural work of the woman’s husband; while statistically highly significant (p<0.01) predictors are skin-to-skin contact with the new-born (OR: 2.62; 95% CI: 2.28–3.00), Caesarean deliveries (OR: 0.47; 95% CI: 0.40–0.56), and skilled birth attendants (OR: 1.83; 95% CI: 1.65–2.08). Caesarean deliveries reduce the likelihood of EIBF by half compared to vaginal deliveries. Women’s age, education or rural-urban residence display no statistically significant relationship with EIBF. Conclusion Skin-to-skin contact, mode of delivery and type of birth attendance exert the strongest influence on EIBF in Indonesia in 2017. EIBF should be continuously promoted and supported particularly among mothers who do not have early skin-to-skin contact with their new-born, who have Caesarean deliveries and who have no skilled birth attendant.
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Affiliation(s)
- Maria Gayatri
- National Population and Family Planning Board—Family Planning and Family Welfare Research and Development Unit, East Jakarta, Indonesia
- * E-mail:
| | - Gouranga Lal Dasvarma
- Flinders University—College of Humanities, Arts and Social Sciences, Adelaide, South Australia, Australia
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Pregnancy and Lactation in a 67-Year-Old Elderly Gravida following Donor Oocyte In Vitro Fertilization. Case Rep Obstet Gynecol 2020; 2020:9801565. [PMID: 33005465 PMCID: PMC7509548 DOI: 10.1155/2020/9801565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022] Open
Abstract
There is limited data on the anticipated perinatal course among gravidae in their sixth and seventh decades. Our objective was to describe the relatively uncomplicated prenatal, intrapartum, and postpartum course of a 67-year-old essential primigravida. Briefly, our patient conceived a singleton pregnancy via IVF with donor oocytes, then presented at 13 6/7 weeks of gestation to initiate prenatal care. Her medical history was significant for chronic hypertension, hyperlipidemia, and obesity. Her cardiac function was monitored throughout pregnancy, and she delivered at 36 1/7 weeks by cesarean for a decline in left ventricular function with mitral regurgitation. Her intrapartum and postpartum course was uncomplicated, and she was able to successfully breastfeed for six months and resume prepregnancy activity. For comparison, we analyzed deliveries among gravidae > 45 years of age from our institutional obstetrical database (2011-2018). This case represents the eldest gravidae identified in the literature and illustrates the potential for a relatively uncomplicated perinatal course with successful lactation. This case may enable other providers to counsel elderly patients on anticipated outcomes inclusive of ability to breastfeed.
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Burianova I, Cerny M, Borsky J, Zilinska K, Dornakova J, Martin A, Janota J. Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair. Cleft Palate Craniofac J 2020; 58:146-152. [PMID: 32799648 DOI: 10.1177/1055665620949114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. DESIGN This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. SETTING Tertiary neonatal and pediatric surgery center. PATIENTS Hospital A: 61 newborns, Hospital B: 157 newborns. INTERVENTIONS Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. MAIN OUTCOME MEASURES Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. RESULTS Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. CONCLUSIONS The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.
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Affiliation(s)
- Iva Burianova
- Department of Neonatology, 48208Thomayer Hospital, Prague, Czech Republic and Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Milos Cerny
- Department of Obstetrics and Gynecology/Neonatology, 48359University Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Borsky
- Department of Otorhinolaryngology, 2nd Faculty of Medicine, Charles University, Prague, Faculty Hospital Motol, Czech Republic
| | - Kristyna Zilinska
- Department of Neonatology, 48209Thomayer Hospital, Prague, Czech Republic
| | - Jana Dornakova
- Department of Obstetrics and Gynecology/Neonatology, 48359University Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Aisling Martin
- Department of Obstetrics and Gynecology, 8830Coombe Women and Infants University Hospital, University College Dublin, Ireland
| | - Jan Janota
- Department of Neonatology, 48209Thomayer Hospital, Prague and Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Abstract
OBJECTIVE To test whether perception of insufficient milk (PIM) supply in the breast-feeding relationship of one child predicts how long mothers breast-feed subsequent children, and whether this association differs for first-time mothers v. mothers with previous children. DESIGN Secondary analysis of Infant Feeding Practices Study II (ordinary least squares regression) and Year 6 follow-up. SETTING Mailed, self-report survey of US mother-infant dyads, 2005-2012. PARTICIPANTS Women pregnant with a singleton were recruited from a consumer opinion panel. Exclusion criteria included: mother age <18; infant born <5 lbs, born before 35 weeks or with extended NICU stay, and mother or infant diagnosed with condition that impacts feeding. A subsample with PIM data (n 1460) was analysed. RESULTS We found that women who weaned because of PIM with the index child stopped breast-feeding 5·7 weeks earlier than those who weaned due to other reasons (4·9 weeks earlier for multiparas, P < 0·001; 7·1 weeks earlier for primiparas, P < 0·001). Using Year 6 follow-up data (n 350), we found subsequent child 1 weaned 9·2 weeks earlier if the mother experiences PIM as a multipara (P = 0·020) and 10·6 weeks earlier if the mother experiences PIM as a primipara (P = 0·019). For subsequent child 2 (n 78), the magnitude of association was even larger, although insignificant due to low power. CONCLUSIONS These findings indicate that PIM may carry forward in the reproductive life course, especially for first-time mothers. Perceptions of breast milk insufficiency and contributors to actual inadequate milk supply with the first child should be targeted, rather than intervening later in the reproductive life course.
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Fang Z, Liu Y, Wang H, Tang K. The Patterns and Social Determinants of Breastfeeding in 12 Selected Regions in China: A Population-Based Cross-Sectional Study. J Hum Lact 2020; 36:436-447. [PMID: 31513461 DOI: 10.1177/0890334419868156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking. RESEARCH AIM We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China. METHODS The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model. RESULTS The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0-5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]). CONCLUSIONS The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.
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Affiliation(s)
- Zhe Fang
- 33133 School of Public Health, Peking University Health Science Centre, Beijing, China.,12442 Research Center for Public Health, Tsinghua University, Beijing, China
| | - Yuning Liu
- 234189 Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hanyu Wang
- Institute for Medical Humanities, Peking University Health Science Centre, Beijing, China
| | - Kun Tang
- 12442 Research Center for Public Health, Tsinghua University, Beijing, China
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Little SH, Motohara S, Plegue M, Medaugh C, Sen A, Ruffin MT. Japanese Women's Concerns and Satisfaction With Pregnancy Care in the United States. J Perinat Educ 2020; 29:152-160. [PMID: 32760184 DOI: 10.1891/j-pe-d-19-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Immigrant women report a high level of stress during pregnancy due to language barriers, cultural differences, and differences in the standard of prenatal care. In this study, we evaluated the level of concern Japanese women in the United States feel during pregnancy and their level of satisfaction with their care. This data can be used to modify prenatal care programs and education to address these concerns. Data collected from 96 women showed there was a high level of prenatal concern regarding their baby's health, pain control, the short length of hospitalization after birth, and the lack of breastfeeding support. Despite these concerns, postpartum women ended up being satisfied with all items except the short duration of their hospital stay.
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Grubesic TH, Durbin KM. A Spatial Analysis of Breastfeeding and Breastfeeding Support in the United States: The Leaders and Laggards Landscape. J Hum Lact 2019; 35:790-800. [PMID: 31206311 DOI: 10.1177/0890334419856615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To better track progress in achieving the Healthy People 2020 goals, the Centers for Disease Control and Prevention (CDC) publishes an annual Breastfeeding Report Card (BRC) that represents a compilation of data on breastfeeding practices in all states. With data drawn from the CDC National Immunization Survey, the BRC provides an especially valuable source of information about geographic trends in breastfeeding and related support activities. RESEARCH AIM This study aimed to identify important geographic trends in both breastfeeding practices and support structures in the United States, highlighting their spatial disparities. METHODS Exploratory spatial data analysis, including local indicators of spatial association, is combined with spatial regression models to highlight geographic variations in breastfeeding practices and support. RESULTS Geographic variation in both breastfeeding practices and allied support exists within the United States. Geographic hot spots of breastfeeding are found in the western and northeastern sections of the United States, and cool spots are located primarily in the Southeast. Regression results suggested that unemployment and demographic diversity are negatively associated with breastfeeding rates, whereas higher education and the presence of International Board Certified Lactation Consultants® (IBCLCs®) are positively connected to persistent breastfeeding practices. Further, although the availability of professional support (IBCLC) strengthened nationwide between 2011 and 2016, the availability of mother-to-mother support (La Leche League) softened. CONCLUSION Although breastfeeding initiation rates continue to increase in the United States, rates of exclusive breastfeeding at 3 and 6 months remain low, displaying significant geographic variation. The ability to pinpoint lagging regions can help to efficiently allocate additional breastfeeding support resources and interventions.
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Affiliation(s)
- Tony H Grubesic
- Center for Spatial Reasoning & Policy Analytics, Watts College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USA
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Ruan Y, Zhang Q, Li J, Wan R, Bai J, Wang W, Zhou Y, Wan Q, Zhao J, Yu S, Peng M, Liu Z. Factors associated with exclusive breast-feeding: A cross-sectional survey in Kaiyuan, Yunnan, Southwest China. PLoS One 2019; 14:e0223251. [PMID: 31596897 PMCID: PMC6785077 DOI: 10.1371/journal.pone.0223251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/17/2019] [Indexed: 02/02/2023] Open
Abstract
Breastfeeding has a wide range of benefits for both infants and mothers. The identification of factors associated with exclusive breastfeeding (EBF) are important to increase the prevalence of EBF. The study aimed to determine the prevalence of EBF within the first six months and its associated factors in Kaiyuan, Yunnan Province, Southwest China. This cross-sectional study was conducted in Kaiyuan, a middle-sized city of Yunnan Province, Southwest China. Mothers of infants under twelve months were randomly selected for a face to face interview in four towns (two in urban areas and two in rural areas) in Kaiyuan. A structured questionnaire was applied for collection of sociodemographic information, mothers’ and infants’ health, and breastfeeding information. A 24-hour food recall survey was used to collect infant feeding information. A logistic regression analysis was performed to identify the factors independently associated with exclusive breastfeeding for infants up to six months of age. The number of 417 mothers with infants under six months was interviewed. The prevalence of EBF at six months was 27.34%. Logistic regression indicated that EBF within six months was more likely to be practiced by mothers who had higher average household income per year (OR = 2.09, 95% CI: 1.05–4.17 p = 0.037; OR = 1.85, 95% CI: 1.04–3.28 p = 0.037), and mothers who received breastfeeding information (OR = 2.46, (95%CI: 1.45–4.18, p = 0.0009). The prevalence of EBF in Kaiyuan, Southwest China is considerably lower than national and international recommendations. Yearly household income, and mothers who received breastfeeding information are associated with higher EBF prevalence. Breastfeeding information should be given to mothers in order to increase the prevalence of EBF.
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Affiliation(s)
- Yuan Ruan
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Qiang Zhang
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Juanjuan Li
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Rong Wan
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Jun Bai
- Department of Public Health, Kaiyuan Centre for Disease Control and Prevention (CDC), Honghe, Yunnan, China
| | - Wenzhong Wang
- Department of Public Health, Kaiyuan Centre for Disease Control and Prevention (CDC), Honghe, Yunnan, China
| | - Yutong Zhou
- Department of Public Health, Kaiyuan Centre for Disease Control and Prevention (CDC), Honghe, Yunnan, China
| | - Qingqing Wan
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Jiang Zhao
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Siyang Yu
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Min Peng
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
| | - Zhitao Liu
- Department of Nutrition and Food Hygiene, Yunnan Centre for Disease Control and Prevention (CDC), Kunming, Yunnan, China
- * E-mail:
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Burianova I, Bronsky J, Pavlikova M, Janota J, Maly J. Maternal body mass index, parity and smoking are associated with human milk macronutrient content after preterm delivery. Early Hum Dev 2019; 137:104832. [PMID: 31422343 DOI: 10.1016/j.earlhumdev.2019.104832] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Maternal characteristics may be associated with human milk macronutrients but no definite conclusions have been made to date. AIM This study aimed to determine the relationship of maternal-associated factors on the content of macronutrients in human milk for the first six weeks after preterm delivery. STUDY DESIGN Prospective observational cohort study. SUBJECTS Milk samples were collected from mothers after premature birth between 24 + 0-35 + 6 weeks. OUTCOME MEASURES Macronutrients and energy content were analyzed by mid-infrared transmission spectroscopy. Demographic and anthropometric data from mothers were systematically recorded. RESULTS A total 1.558 human milk samples from 192 mothers were analyzed. Colostrum: higher protein (p = 0.001) and lower carbohydrate content (p = 0.003) were present in primiparous compared to multiparous milk. Vaginal birth was associated with increased carbohydrate content (p = 0.021). Fat and energy content in colostrum was not related to any maternal characteristics. Mature human milk: similarly to colostrum, higher protein content (p = 0.001) and lower carbohydrates content (p = 0.022) were observed in primiparous compared to multiparous milk. The mode of delivery was found to be another factor possibly influencing protein and carbohydrate levels (p = 0.036, p = 0.003, respectively). Pre-pregnancy obesity was associated with increased fat (p = 0.030) and energy content (p = 0.020) in human milk. On the contrary, smoking had a negative relationship to fat and energy content (p = 0.026, p = 0.007, respectively). CONCLUSION Human milk macronutrient concentration after preterm delivery is associated with pre-pregnancy obesity, parity, mode of delivery and smoking. The impact of maternal factors on human milk composition should be taken into account in a strategy of feeding in premature infants.
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Affiliation(s)
- Iva Burianova
- Department of Neonatology, Thomayer Hospital, Prague, Czech Republic; Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Jiri Bronsky
- Department of Paediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marketa Pavlikova
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, Prague, Czech Republic
| | - Jan Janota
- Department of Neonatology, Thomayer Hospital, Prague, Czech Republic; Institute of Pathological Physiology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Maly
- Department of Paediatrics, Division of Neonatology, Faculty of Medicine, Charles University and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Sherwood WB, Bion V, Lockett GA, Ziyab AH, Soto-Ramírez N, Mukherjee N, Kurukulaaratchy RJ, Ewart S, Zhang H, Arshad SH, Karmaus W, Holloway JW, Rezwan FI. Duration of breastfeeding is associated with leptin (LEP) DNA methylation profiles and BMI in 10-year-old children. Clin Epigenetics 2019; 11:128. [PMID: 31464656 PMCID: PMC6716837 DOI: 10.1186/s13148-019-0727-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Breastfeeding is protective against many long-term diseases, yet the mechanisms involved are unknown. Leptin gene (LEP) is reported to be associated with body mass index (BMI). On the other hand, breastfeeding duration has been found to be associated with DNA methylation (DNAm) of the LEP gene. Therefore, epigenetic regulation of LEP may represent the mechanism underlying the protective effect of breastfeeding duration against obesity. METHODS In the Isle of Wight Birth Cohort, peripheral blood DNAm at 23 cytosine-phosphate-guanine sites (CpGs) in the LEP locus in 10-year-old (n = 297) samples and 16 CpGs in 18-year-old (n = 305) samples, were generated using the Illumina Infinium MethylationEPIC and HumanMethylation450 Beadchips respectively and tested for association with breastfeeding duration (total and exclusive) using linear regression. To explore the association between breastfeeding durations and genome-wide DNAm, epigenome-wide association studies (EWASs) and differential methylation region (DMR) analyses were performed. BMI trajectories spanning the first 18 years of life were used as the outcome to test the association with breastfeeding duration (exposure) using multi-nominal logistic regression. Mediation analysis was performed for significant CpG sites. RESULTS Both total and exclusive breastfeeding duration were associated with DNAm at four LEP CpG sites at 10 years (P value < 0.05), and not at 18 years. Though no association was observed between breastfeeding duration and genome-wide DNAm, DMR analyses identified five significant differentially methylated regions (Sidak adjusted P value < 0.05). Breastfeeding duration was also associated with the early transient overweight trajectory. Furthermore, DNAm of LEP was associated with this trajectory at one CpG site and early persistent obesity at another, though mediation analysis was not significant. CONCLUSIONS Breastfeeding duration is associated with LEP methylation at age 10 years and BMI trajectory. LEP DNAm is also significantly associated with BMI trajectories throughout childhood, though sample sizes were small. However, mediation analysis did not demonstrate that DNAm of LEP explained the protective effect of breastfeeding against childhood obesity.
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Affiliation(s)
- William B Sherwood
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, University of Southampton, Duthie Building, MP808, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Victoria Bion
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, University of Southampton, Duthie Building, MP808, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Gabrielle A Lockett
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, University of Southampton, Duthie Building, MP808, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Nandini Mukherjee
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN, 38152, USA
| | - Ramesh J Kurukulaaratchy
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Susan Ewart
- College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN, 38152, USA
| | - S Hasan Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN, 38152, USA
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, University of Southampton, Duthie Building, MP808, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Faisal I Rezwan
- Human Development and Health, Faculty of Medicine, University Hospital Southampton, University of Southampton, Duthie Building, MP808, Tremona Road, Southampton, Hampshire, SO16 6YD, UK.
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Huang Y, Ouyang YQ, Redding SR. Previous breastfeeding experience and its influence on breastfeeding outcomes in subsequent births: A systematic review. Women Birth 2019; 32:303-309. [DOI: 10.1016/j.wombi.2018.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Xiang AH, Chow T, Mora-Marquez J, Martinez MP, Wang X, Yu W, Panganiban MB, Richter PM, Schneider DI. Breastfeeding Persistence at 6 Months: Trends and Disparities from 2008 to 2015. J Pediatr 2019; 208:169-175.e2. [PMID: 30876751 DOI: 10.1016/j.jpeds.2018.12.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/20/2018] [Accepted: 12/28/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess trends and disparities in breastfeeding by maternal characteristics (race and ethnicity, age at delivery, obesity, parity, and level of education) and the relative importance among these for breastfeeding at 6 months. STUDY DESIGN This retrospective birth cohort study included 195 861 live singleton children born at 32-42 weeks of gestation from 2008 to 2015 within a single integrated healthcare system. All children had healthcare coverage during the first year of life. Maternal characteristics and breastfeeding status at 6 months of age were extracted from electronic medical records. Trends over time of any breastfeeding ≥6 months were evaluated for the 5 maternal characteristics. Robust Poisson regression models were used to estimate breastfeeding rate differences associated with each of the 5 characteristics. The relative importance among them associated with breastfeeding ≥6 months was assessed by comparing model quasi-likelihood information criteria. RESULTS Rates of breastfeeding ≥6 months significantly increased overall and among groups defined by the maternal characteristics. However, there was little improvement over time in closing disparities associated with maternal race and ethnicity, age at delivery, prepregnancy obesity status, and level of education. Education level contributed to the greatest disparity in breastfeeding ≥6 months. Maternal age was the second factor, followed by prepregnancy obesity and maternal race and ethnicity. CONCLUSIONS Breastfeeding outreach programs focusing on women with less than a college education, women <25 years old, and women from non-Hispanic black or Hispanic race and ethnicity may help to reduce disparities and improve breastfeeding persistence rates within integrated healthcare systems.
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Affiliation(s)
- Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Janet Mora-Marquez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Mayra P Martinez
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Xinhui Wang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Wei Yu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Paula M Richter
- Department of Obstetrics and Gynecology, Kaiser Permanente Southern California, Pasadena, CA
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Adam M, Tomlinson M, Le Roux I, LeFevre AE, McMahon SA, Johnston J, Kirton A, Mbewu N, Strydom SL, Prober C, Bärnighausen T. The Philani MOVIE study: a cluster-randomized controlled trial of a mobile video entertainment-education intervention to promote exclusive breastfeeding in South Africa. BMC Health Serv Res 2019; 19:211. [PMID: 30940132 PMCID: PMC6444854 DOI: 10.1186/s12913-019-4000-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/07/2019] [Indexed: 01/21/2023] Open
Abstract
Background In South Africa, rates of exclusive breastfeeding remain low and breastfeeding promotion is a national health priority. Mobile health and narrative entertainment-education are recognized strategies for health promotion. In-home counseling by community health workers (CHWs) is a proven breastfeeding promotion strategy. This protocol outlines a cluster-randomized controlled trial with a nested mixed-methods evaluation of the MObile Video Intervention for Exclusive breastfeeding (MOVIE) program. The evaluation will quantify the causal effect of the MOVIE program and generate a detailed understanding of the context in which the intervention took place and the mechanisms through which it enacted change. Findings from the study will inform the anticipated scale-up of mobile video health interventions in South Africa and the wider sub-Saharan region. Methods We will conduct a stratified cluster-randomized controlled trial in urban communities of the Western Cape, to measure the effect of the MOVIE intervention on exclusive breastfeeding and other infant feeding practices. Eighty-four mentor-mothers (CHWs employed by the Philani Maternal Child Health and Nutrition Trust) will be randomized 1:1 into intervention and control arms, stratified by neighborhood type. Mentor-mothers in the control arm will provide standard of care (SoC) perinatal in-home counseling. Mentor-mothers in the intervention arm will provide SoC plus the MOVIE intervention. At least 1008 pregnant participants will be enrolled in the study and mother-child pairs will be followed until 5 months post-delivery. The primary outcomes of the study are exclusive breastfeeding at 1 and 5 months of age. Secondary outcomes are other infant feeding practices and maternal knowledge. In order to capture human-centered underpinnings of the intervention, we will conduct interviews with stakeholders engaged in the intervention design. To contextualize quantitative findings and understand the mechanisms through which the intervention enacted change, end-line focus groups with mentor-mothers will be conducted. Discussion This trial will be among the first to explore a video-based, entertainment-education intervention delivered by CHWs and created using a community-based, human-centered design approach. As such, it could inform health policy, with regards to both the routine adoption of this intervention and, more broadly, the development of other entertainment-education interventions for health promotion in under-resourced settings. Trial Registration The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27th, 2018.
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Affiliation(s)
- Maya Adam
- The Department of Pediatrics, Stanford University, Stanford, CA, USA. .,Stanford University's Digital Medical Education International Collaborative (Digital MEdIC), Cape Town, South Africa. .,Stanford Center for Health Education, Stanford, CA, USA.
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ingrid Le Roux
- Philani Maternal Child Health and Nutrition Trust, Cape Town, South Africa
| | - Amnesty E LeFevre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health, Cape Town, South Africa
| | - Shannon A McMahon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Angela Kirton
- Stanford University's Digital Medical Education International Collaborative (Digital MEdIC), Cape Town, South Africa.,Stanford Center for Health Education, Stanford, CA, USA
| | - Nokwanele Mbewu
- Philani Maternal Child Health and Nutrition Trust, Cape Town, South Africa
| | | | - Charles Prober
- The Department of Pediatrics, Stanford University, Stanford, CA, USA.,Stanford University's Digital Medical Education International Collaborative (Digital MEdIC), Cape Town, South Africa.,Stanford Center for Health Education, Stanford, CA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Boston, USA.,Africa Health Research Institute (AHRI), Somkhele, KwaZulu-Natal, South Africa
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Govoni L, Ricchi A, Molinazzi MT, Galli MC, Putignano A, Artioli G, Foà C, Palmieri E, Neri I. Breastfeeding pathologies: analysis of prevalence, risk and protective factors. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:56-62. [PMID: 30977749 PMCID: PMC6625556 DOI: 10.23750/abm.v90i4-s.8240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Breastfeeding is essential for the health of mothers and newborns, and it is recommended by WHO-UNICEF as the sole source of nutrition and protection for the first 6 months of life and beyond. In order to fully promote this practice, it is important to recognize early conditions that can lead to pathological breastfeeding. AIM The study aims to analyze the prevalence and the possible risk or protective factors concerning the pathology of breastfeeding. METHODS For this observational study were consulted the medical records and the files of the Breastfeeding clinic of 1065 puerperal women, of the University Hospital of Modena, from January to August 2016. The data were processed with the SPSS Software. RESULTS In our study population, 532 (50%) puerperal women presented a breastfeeding-related disease, of which 330 (31%) had a disease affecting the mother (breast engorgement, fissures, a-/hypo-galactia, discontinuation of breastfeeding, galactocele, mastitis and candidiasis), 105 (9.9%) of the newborn (inadequate suction, neonatal jaundice, pathological weight loss, need for admission to NICU) and 97 (9.1%) of both the mother and the newborn. DISCUSSIONS It is evident from the results that the predicting factors of pathology in breastfeeding are present in pregnant women who give birth in an early gestational age and with high age, birth rate and nationality. CONCLUSIONS staff training courses are essential to respond to WHO-UNICEF recommendations and to improve the continuity of care for the mother-child dyad.
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Association of age and colostrum discarding with breast-feeding practice in Ethiopia: systematic review and meta-analyses. Public Health Nutr 2019; 22:2063-2082. [PMID: 30846022 DOI: 10.1017/s1368980019000314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate whether maternal/caregiver's age, infant age (0-6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia. DESIGN A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle-Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done. SETTING All observational studies conducted in Ethiopia.ParticipantsMothers of children aged less than 2 years.ResultA total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver's age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver's age (OR=1·09; 95 % CI 0·84, 1·41). CONCLUSIONS There was no association between maternal/caregiver's age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum.
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Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues. Nutrients 2019; 11:nu11020312. [PMID: 30717261 PMCID: PMC6413139 DOI: 10.3390/nu11020312] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/27/2019] [Accepted: 01/29/2019] [Indexed: 12/17/2022] Open
Abstract
The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that could interfere with breastfeeding initiation and duration in this population. We conducted a prospective observational study, in which we administered questionnaires on breastfeeding variables and habits to mothers of late preterm infants who were delivered in the well-baby nursery of our hospital and followed up for three months after delivery. We enrolled 149 mothers and 189 neonates, including 40 pairs of twins. Our findings showed that late preterm infants had a low rate of breastfeeding initiation and early breastfeeding discontinuation at 15, 40 and 90 days of life. The mothers with higher educational levels and previous positive breastfeeding experience had a longer breastfeeding duration. The negative factors for breastfeeding were the following: Advanced maternal age, Italian ethnicity, the feeling of reduced milk supply and having twins. This study underlines the importance of considering these variables in the promotion and protection of breastfeeding in this vulnerable population, thus offering mothers tailored support.
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