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Brani P, Mrvoljak-Theodoropoulou I, Pechlivani F, Iliadou M, Antoniou E, Daskalakis G, Drakakis P, Dagla M. Breastfeeding Intention and Breastfeeding Postpartum Outcomes between High-Risk and Low-Risk Pregnant Women: A Greek Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:755. [PMID: 38929000 PMCID: PMC11204224 DOI: 10.3390/ijerph21060755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/26/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This prospective cohort study, conducted from pregnancy to six months postpartum and grounded in STROBE methodology, quantitatively explores the relationship between antenatal breastfeeding intentions and subsequent breastfeeding outcomes among high-risk pregnant women, compared to a low-risk pregnancy group. METHODS The study was conducted in one of the largest public hospitals in Attica that provides care to pregnant women, enrolling 380 participants divided into high-risk (n = 200) and low-risk (n = 180) cohorts. Data were collected over 20 months (starting from the end of May 2020 until January 2022), spanning from pregnancy to six months postpartum, via comprehensive questionnaires. RESULTS Statistical analysis revealed a pronounced correlation between prenatal breastfeeding intentions and actual breastfeeding behaviors across both groups. Specifically, 81.1% of women in the high-risk group and 82.5% in the low-risk group expressed intentions of exclusively breastfeeding during pregnancy. By six months postpartum, 54.9% of the high-risk and 64.3% of the low-risk pregnancy group managed to sustain breastfeeding. Extended antenatal hospitalization emerged as a statistically significant factor (p = 0.045) negatively impacting exclusive breastfeeding intentions among high-risk pregnancies. CONCLUSION The findings illuminate the critical influence of antenatal intentions on breastfeeding outcomes, particularly among high-risk pregnancies. Moreover, the study identifies the detrimental effect of prolonged hospital stays on breastfeeding aspirations. These insights underscore the necessity for nuanced, supportive interventions aimed at bolstering breastfeeding rates, thereby advancing maternal and neonatal health objectives aligned with World Health Organization recommendations.
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Affiliation(s)
- Panagiota Brani
- Department of Midwifery, School of Health & Care Sciences, University of West Attica, 12243 Athens, Greece; (P.B.); (F.P.); (M.I.); (E.A.)
| | | | - Fani Pechlivani
- Department of Midwifery, School of Health & Care Sciences, University of West Attica, 12243 Athens, Greece; (P.B.); (F.P.); (M.I.); (E.A.)
| | - Maria Iliadou
- Department of Midwifery, School of Health & Care Sciences, University of West Attica, 12243 Athens, Greece; (P.B.); (F.P.); (M.I.); (E.A.)
| | - Evangelia Antoniou
- Department of Midwifery, School of Health & Care Sciences, University of West Attica, 12243 Athens, Greece; (P.B.); (F.P.); (M.I.); (E.A.)
| | - Georgios Daskalakis
- First Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Peter Drakakis
- Third Department of Obstetrics and Gynecology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Maria Dagla
- Department of Midwifery, School of Health & Care Sciences, University of West Attica, 12243 Athens, Greece; (P.B.); (F.P.); (M.I.); (E.A.)
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Pavlidou E, Papadopoulou SK, Alexatou O, Tsourouflis G, Antasouras G, Louka A, Chatziprodromidou IP, Mentzelou M, Sampani A, Chrysafi M, Apostolou T, Dakanalis A, Papadopoulou VG, Giaginis C. Association of Gestational Hypertension with Sociodemographic and Anthropometric Factors, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2103. [PMID: 38138206 PMCID: PMC10744616 DOI: 10.3390/medicina59122103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Gestational hypertension has been associated with several pregnancy short-term and long-term complications, affecting both the mother and her infant's health. The present study aims to assess the potential association of gestational hypertension with sociodemographic and anthropometry factors, perinatal outcomes, breastfeeding habits, and Mediterranean diet (MD) compliance. Materials and Methods: This is a cross-sectional study conducted on 5271 mothers that was carried out after delivery. The anthropometry characteristics and perinatal outcomes were retrieved from the mothers' medical records. Sociodemographic characteristics, MD adherence, and breastfeeding habits were assessed via one-to-one interviews of the assigned women with qualified staff. Results: Maternal older age, being employed, family history of gestational hypertension, overweight/obesity before gestation, and abnormal gestational weight gain (GWG) independently increased the risk of developing gestational hypertension. Moreover, gestational hypertension was independently related with a greater incidence of abnormal childbirth body weight and preterm birth, not exclusively breastfeeding, and lower levels of MD adherence. Conclusions: This study highlights the importance of informing future mothers about the risk factors of gestational hypertension, underlining also that a healthy lifestyle, which simultaneously includes a healthy nutritional pattern such as MD, may decrease the risk of developing gestational hypertension and the subsequent pregnancy complications.
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Affiliation(s)
- Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (O.A.); (G.A.); (A.L.); (M.M.); (M.C.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (V.G.P.)
| | - Olga Alexatou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (O.A.); (G.A.); (A.L.); (M.M.); (M.C.)
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece;
| | - Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (O.A.); (G.A.); (A.L.); (M.M.); (M.C.)
| | - Aikaterini Louka
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (O.A.); (G.A.); (A.L.); (M.M.); (M.C.)
| | | | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (O.A.); (G.A.); (A.L.); (M.M.); (M.C.)
| | - Anastasia Sampani
- First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece;
| | - Maria Chrysafi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (O.A.); (G.A.); (A.L.); (M.M.); (M.C.)
| | - Thomas Apostolou
- Department of Physiotherapy, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece;
| | - Antonios Dakanalis
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy;
- Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Vasiliki G. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (V.G.P.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Myrina, Lemnos, Greece; (E.P.); (O.A.); (G.A.); (A.L.); (M.M.); (M.C.)
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Bookhart LH, Anstey EH, Jamieson DJ, Kramer MR, Perrine CG, Ramakrishnan U, Worrell N, Young MF. Factors Associated with In-Hospital Exclusive Breastfeeding Among a Racially and Ethnically Diverse Patient Population. Breastfeed Med 2023; 18:751-758. [PMID: 37856663 PMCID: PMC11019771 DOI: 10.1089/bfm.2023.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Objective: The aim of this study is to examine in-hospital exclusive breastfeeding (EBF) and its association with sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support. Materials and Methods: We conducted a retrospective cross-sectional study using medical records from 2015 to 2019 of healthy term infants without breastfeeding contraindications at a public teaching hospital serving a racially and ethnically diverse patient population. Using multivariable regression analysis, we examined the associations between in-hospital EBF and sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support (in-hospital breastfeeding education and lactation support). Results: The prevalence of in-hospital EBF was 29.0%. The statistically significant findings from our fully adjusted regression analysis include that there was a higher prevalence of in-hospital EBF among adult mothers (prevalence ratio [PR]: range 1.78-1.96), married mothers (PR: 1.35, 95% confidence interval [CI]: 1.23-1.44), and mothers who were White (PR: 1.41, 95% CI: 1.20-1.66, compared with Black). Factors associated with a lower prevalence of in-hospital EBF were maternal diabetes (PR: 0.82, 95% CI: 0.70-0.95), pre-eclampsia/eclampsia (PR: 0.82, 95% CI: 0.71-0.95), cesarean delivery (PR: 0.84, 95% CI: 0.77-0.92), neonatal hypoglycemia (PR: 0.46, 95% CI: 0.36-0.59), and intention in the prenatal period to formula feed only (PR: 0.15, 95% CI: 0.10-0.22). In-hospital lactation support was associated with higher prevalence of in-hospital EBF (PR: 1.24, 95% CI: 1.16-1.33). Conclusions: Prioritizing lactation support for Black mothers, adolescent mothers, those intending in the prenatal period to formula feed only, and mother-infant dyads with certain medical factors could improve in-hospital EBF.
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Affiliation(s)
| | - Erica H. Anstey
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Denise J. Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Cria G. Perrine
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Usha Ramakrishnan
- Laney Graduate School, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
| | | | - Melissa F. Young
- Laney Graduate School, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA
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Goulding AN, Antoniewicz L, Leach JM, Boggess K, Dugoff L, Sibai B, Lawrence K, Hughes BL, Bell J, Edwards RK, Gibson K, Haas DM, Plante L, Metz TD, Casey B, Esplin S, Longo S, Hoffman M, Saade GR, Hoppe KK, Foroutan J, Tuuli M, Owens MY, Simhan HN, Frey H, Rosen T, Palatnik A, Baker S, Reddy UM, Kinzler W, Su E, Krishna I, Nguyen N, Norton ME, Skupski D, El-Sayed YY, Ogunyemi D, Harper LM, Ambalavanan N, Oparil S, Szychowski JM, Tita AT. Breastfeeding initiation and duration among people with mild chronic hypertension: a secondary analysis of the Chronic Hypertension and Pregnancy trial. Am J Obstet Gynecol MFM 2023; 5:101086. [PMID: 37437694 PMCID: PMC10528420 DOI: 10.1016/j.ajogmf.2023.101086] [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] [Received: 06/02/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Increased duration of breastfeeding improves maternal cardiovascular health and may be especially beneficial in high-risk populations, such as those with chronic hypertension. Others have shown that individuals with hypertension are less likely to breastfeed, and there has been limited research aimed at supporting breastfeeding goals in this population. The impact of perinatal blood pressure control on breastfeeding outcomes among people with chronic hypertension is unknown. OBJECTIVE This study aimed to evaluate whether breastfeeding initiation and short-term duration assessed at the postpartum clinic visit differed according to perinatal blood pressure treatment strategy (targeting blood pressure <140/90 mm Hg vs reserving antihypertensive treatment for blood pressure ≥160/105 mm Hg). STUDY DESIGN We performed a secondary analysis of the Chronic Hypertension and Pregnancy trial. This was an open-label, multicenter, randomized trial where pregnant participants with mild chronic hypertension were randomized to receive antihypertensive medications with goal blood pressure <140/90 mm Hg (active treatment) or deferred treatment until blood pressure ≥160/105 mm Hg (control). The primary outcome was initiation and duration of breastfeeding, assessed at the postpartum clinic visit. We performed bivariate analyses and log-binomial and cumulative logit regression models, adjusting models for variables that were unbalanced in bivariate analyses. We performed additional analyses to explore the relationship between breastfeeding duration and blood pressure measurements at the postpartum visit. RESULTS Of the 2408 participants from the Chronic Hypertension and Pregnancy trial, 1444 (60%) attended the postpartum study visit and provided breastfeeding information. Participants in the active treatment group had different body mass index class distribution and earlier gestational age at enrollment, and (by design) were more often discharged on antihypertensives. Breastfeeding outcomes did not differ significantly by treatment group. In the active and control treatment groups, 563 (77.5%) and 561 (78.1%) initiated breastfeeding, and mean durations of breastfeeding were 6.5±2.3 and 6.3±2.1 weeks, respectively. The probability of ever breastfeeding (adjusted relative risk, 0.99; 95% confidence interval, 0.93-1.05), current breastfeeding at postpartum visit (adjusted relative risk, 1.01; 95% confidence interval, 0.94-1.10), and weeks of breastfeeding (adjusted odds ratio, 0.87; 95% confidence interval, 0.68-1.12) did not differ by treatment group. Increased duration (≥2 vs <2 weeks) of breastfeeding was associated with slightly lower blood pressure measurements at the postpartum visit, but these differences were not significant in adjusted models. CONCLUSION In a secondary analysis of the cohort of Chronic Hypertension and Pregnancy trial participants who attended the postpartum study visit and provided breastfeeding information (60% of original trial participants), breastfeeding outcomes did not differ significantly by treatment group. This suggests that maintaining goal blood pressure <140/90 mm Hg throughout the perinatal period is associated with neither harm nor benefit for short-term breastfeeding goals. Further study is needed to understand long-term breastfeeding outcomes among individuals with chronic hypertension and how to support this population in achieving their breastfeeding goals.
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Affiliation(s)
- Alison N Goulding
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Goulding and Antoniewicz).
| | - Leah Antoniewicz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Goulding and Antoniewicz)
| | - Justin M Leach
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL (Drs Leach and Szychowski)
| | - Kim Boggess
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Boggess)
| | - Lorraine Dugoff
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA (Dr Dugoff)
| | - Baha Sibai
- Department of Maternal-Fetal Medicine, The University of Texas Health Science Center at Houston, Houston, TX (Dr Sibai)
| | - Kirsten Lawrence
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT (Dr Lawrence)
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC (Dr Hughes)
| | - Joseph Bell
- Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA (Dr Bell)
| | - Rodney K Edwards
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (Dr Edwards)
| | - Kelly Gibson
- Department of Obstetrics and Gynecology, MetroHealth, Case Western Reserve University, Cleveland, OH (Dr Gibson)
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN (Dr Haas)
| | - Lauren Plante
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA (Dr Plante)
| | - Torri D Metz
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT (Dr Metz)
| | - Brian Casey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey and Tita)
| | - Sean Esplin
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, UT (Dr Esplin)
| | - Sherri Longo
- Ochsner Baptist Medical Center, New Orleans, LA (Dr Longo)
| | | | - George R Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX (Dr Saade)
| | - Kara K Hoppe
- Department of Obstetrics and Gynecology, UnityPoint Health-Meriter Hospital/Marshfield Clinic, Madison, WI (Dr Hoppe)
| | - Janelle Foroutan
- Saint Peter's University Hospital, New Brunswick, NJ (Dr Foroutan)
| | - Methodius Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI (Dr Tuuli)
| | - Michelle Y Owens
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS (Dr Owens)
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, UPMC Magee-Women's Hospital, University of Pittsburgh, Pittsburgh, PA (Dr Simhan)
| | - Heather Frey
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH (Dr Frey)
| | - Todd Rosen
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ (Dr Rosen)
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI (Dr Palatnik)
| | - Susan Baker
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile, AL (Dr Baker)
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Dr Reddy)
| | - Wendy Kinzler
- Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY (Dr Kinzler)
| | - Emily Su
- Department of Obstetrics and Gynecology, University of Colorado, Boulder, CO (Dr Su)
| | - Iris Krishna
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA (Dr Krishna)
| | - Nicki Nguyen
- Department of Obstetrics and Gynecology, Denver Health, Denver, CO (Dr Nguyen)
| | - Mary E Norton
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, and Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA (Dr Norton)
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Queens Hospital, New York, NY (Dr Skupski)
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Dr El-Sayed)
| | - Dotun Ogunyemi
- Department of Obstetrics and Gynecology, Arrowhead Regional Medical Center, Colton, CA (Dr Ogunyemi); Beaumont Internal Medicine, Southfield, MI (Dr Ogunyemi)
| | - Lorie M Harper
- Department of Women's Health, The University of Texas at Austin, Austin, TX (Dr Harper)
| | - Namasivayam Ambalavanan
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Division of Neonatology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL (Dr Ambalavanan)
| | - Suzanne Oparil
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Dr Oparil)
| | - Jeff M Szychowski
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL (Drs Leach and Szychowski); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita)
| | - Alan T Tita
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey and Tita)
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Pithia N, Grogan T, Garg M, Kesavan K, Calkins K. A Pilot Single-Site Randomized Control Trial: Investigating the Use of Donor Milk in the Late Preterm and Term Infant in the Neonatal Intensive Care Unit. RESEARCH SQUARE 2023:rs.3.rs-2540272. [PMID: 36798190 PMCID: PMC9934751 DOI: 10.21203/rs.3.rs-2540272/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Objective : We aimed to study the use of donor milk (DM) in term and late preterm infants (LPIs) when mother’s own milk (MOM) was unavailable. We hypothesized this study would be feasible and breastfeeding attempts and the percentage of MOM (MOM%) would increase with DM without adversely affecting growth. Study Design : This was a pilot study (n=32). Infants with gestational age >34 weeks admitted to the neonatal intensive care unit were included. Infants were randomized to: the human milk (MOM+DM) or formula (MOM+F) groups. Result : Consent rate was 52%. Breastfeeding attempts increased significantly over time in the MOM+DM group compared to the MOM+F group (group p=0.41, time p =0.02, group*time p=0.01) . Growth at multiple time points was similar when the two groups were compared. Conclusion : A study randomizing term infants and LPIs to DM or formula when MOM is unavailable is feasible. DM may increase breastfeeding attempts without compromising growth.
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Study protocol for the sheMATTERS study (iMproving cArdiovascular healTh in new moThERS): a randomized behavioral trial assessing the effect of a self-efficacy enhancing breastfeeding intervention on postpartum blood pressure and breastfeeding continuation in women with hypertensive disorders of pregnancy. BMC Pregnancy Childbirth 2023; 23:68. [PMID: 36703104 PMCID: PMC9878496 DOI: 10.1186/s12884-022-05325-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/14/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Individuals with hypertensive disorders of pregnancy (HDP) have an elevated lifetime risk of chronic hypertension, metabolic syndrome, and premature cardiovascular disease. Because breastfeeding duration and exclusivity have been associated in observational studies with improved cardiovascular health, optimizing breastfeeding in those with HDP might be an unrealized cardio-prevention approach, in particular because individuals with HDP have more breastfeeding challenges. Breastfeeding supportive interventions targeting one's breastfeeding self-efficacy have been shown to improve breastfeeding rates. METHODS We designed an open-label, multi-center 1:1 randomized behavioral trial to test whether a previously validated self-efficacy enhancing breastfeeding intervention can improve breastfeeding duration and/or exclusivity, and lower postpartum blood pressure at 12 months. Randomization is computer-generated and stratified by site (four hospitals in Montreal, Quebec and one hospital in Kingston, Ontario; all in Canada). Included are breastfeeding participants with HDP (chronic/gestational hypertension or preeclampsia) who delivered a live singleton infant at > 34 weeks, speak English or French, and have no contraindications to breastfeeding. Informed and written consent is obtained at hospitalization for delivery or a re-admission with hypertension within 1 week of discharge. Participants assigned to the intervention group receive a breastfeeding self-efficacy-based intervention delivered by a trained lactation consultant in hospital, with continued reactive/proactive support by phone or text message for up to 6 months postpartum. Regardless of group assignment, participants are followed for self-reported outcomes, automated office blood pressure, and home blood pressure at several time points with end of follow-up at 12 months. DISCUSSION This study will assess whether an intensive nurse-led behavioral intervention can improve breastfeeding rates and, in turn, postpartum blood pressure - an early marker for atherosclerotic cardiovascular disease. If effective, this form of enhanced breastfeeding support, along with closer BP and metabolic surveillance, can be implemented broadly in individuals lactating after HDP. TRIAL REGISTRATION ClinicalTrials.gov, # NCT04580927 , registered on Oct 9, 2020.
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Özkardeş T, Egelioğlu Cetişli N. The Effects of Preeclampsia on Breastfeeding Self-Efficacy and Postpartum Depression. CYPRUS JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4274/cjms.2021.2609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Horsley K, Chaput K, Da Costa D, Nguyen TV, Dayan N, Tomfohr-Madsen L, Tough S. Hypertensive disorders of pregnancy and breastfeeding practices: A secondary analysis of data from the All Our Families Cohort. Acta Obstet Gynecol Scand 2022; 101:871-879. [PMID: 35610941 DOI: 10.1111/aogs.14378] [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: 05/27/2021] [Revised: 03/18/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy occur in approximately 7%-10% of pregnancies and are associated with adverse maternal cardiovascular health outcomes across the lifespan. In contrast, breastfeeding has been associated with a reduction in cardiovascular risk factors in a dose-dependent manner. Despite the potential protective effects of lactation on cardiovascular risk, how hypertensive disorders of pregnancy relate to breastfeeding practices and experiences is not well understood. The aim of this study was to investigate the association between hypertensive disorders of pregnancy and breastfeeding outcomes in the first year postpartum. MATERIAL AND METHODS We conducted a secondary analysis of prospective data from the All Our Families Cohort, a population-based study conducted in Calgary, Alberta, Canada. Women with a singleton pregnancy (n = 1418) who completed self-report questionnaires at <25 weeks and 34-36 weeks of gestation, and 4 months and 12 months postpartum, and provided consent to link to electronic medical records that identified diagnoses of hypertensive disorders of pregnancy (n = 122). Logistic and multiple linear regression analyses were used to model associations between hypertensive disorders of pregnancy and breastfeeding outcomes. Outcomes included breastfeeding intention, intended duration, exclusive breastfeeding at 4 months, breastfeeding duration at 12 months and breastfeeding difficulties. RESULTS Hypertensive disorders of pregnancy were not associated with breastfeeding intention (odds ration [OR] 1.30, 95% confidence interval [CI] 0.47-3.03, P = 0.57), intended breastfeeding duration (b = -3.28, 95% CI -7.04 to 0.48, P = 0.09), or initiation (OR = 0.64, 95% CI 0.29- 1.65, P = 0.32), but were associated with an increase in the odds of non-exclusive breastfeeding at 4 months postpartum (OR = 2.11, 95% CI 1.39-3.22, P < 0.001). Women with hypertensive disorders breastfed for 6.26 (95% CI -10.00 to -2.51, P < 0.001) weeks less over 12 months postpartum, had significantly higher odds of reporting insufficient milk supply (OR = 1.75, 95% CI 1.19-2.46, P < 0.05) and had lower odds of breast and/or nipple pain (OR = 0.66, 95% CI 0.44-0.92, P < 0.05) compared with those without hypertensive disorders of pregnancy. CONCLUSIONS Hypertensive disorders of pregnancy are associated with altered breastfeeding practices and experiences during the first year postpartum. Further research is needed to examine biopsychosocial mechanisms through which hypertensive disorders associate with shorter breastfeeding duration, and to examine whether greater breastfeeding duration, intensity or exclusivity reduces short- or long-term maternal cardiovascular risk.
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Affiliation(s)
- Kristin Horsley
- Department of Psychology, Faculty of Science, McGill University, Montreal, Quebec, Canada
| | - Kathleen Chaput
- Department of Obstetrics and Gynecology, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah Da Costa
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Tuong-Vi Nguyen
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Natalie Dayan
- Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lianne Tomfohr-Madsen
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Pediatrics and Community Health Sciences, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
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9
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Neves RO, Guimarães LSP, Bosa VL, Nunes LM, da Silva CH, Goldani MZ, Bernardi JR. Infant processed food consumption and their interaction to breastfeeding and growth in children up to six months old. BMC Public Health 2021; 21:1512. [PMID: 34353303 PMCID: PMC8340519 DOI: 10.1186/s12889-021-11539-5] [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: 08/20/2020] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Evidences suggest that early processed food (PF) consumption may cause harm to infant health. During the first 6 months of life, it is not known whether the timing and quantity of this food group can impact breastfeeding and growth. The aim of the study was to analyze the associations between time of introduction and quantity of infant PF consumption with duration of breastfeeding and infant growth at 6 months of age. Methods Data were longitudinally collected in six interviews, from birth to 6 months, in a sample of Brazilian newborns with adverse intrauterine environments. PF consumption was calculated by gravity score of processed foods (GSPF) in relation to feeding supply quality and time. For the analysis, the scores were divided into tertiles, making scores severities: Null, Mild, Moderate, and Severe. The interaction between GSPF and breastfeeding (exclusive and non-exclusive) and growth parameters (analyzed in Z-scores, by weight for height, weight for age, and body mass index for age) was tested. Results A total of 236 infants were included in the study. Greater GSPF were associated with better rates of breastfeeding practices and higher growth indicators scores in the sixth month of infants. These findings were confirmed after adjustment for family income, maternal age, pre-gestational body mass index, and growth z scores at birth. Conclusion The harms of eating PF in relation to breastfeeding and infant growth are more evident the greater and earlier they are consumed. Future studies should explore interventions to reduce and delay the consumption of these foods to prevent adverse health outcomes in later life. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11539-5.
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Affiliation(s)
- Renata Oliveira Neves
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | - Vera Lúcia Bosa
- Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Clécio Homrich da Silva
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo Zubaran Goldani
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Rombaldi Bernardi
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Graduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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10
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Morrow AL, McClain J, Conrey SC, Niu L, Kinzer A, Cline AR, Piasecki AM, DeFranco E, Ward L, Ware J, Payne DC, Staat MA, Nommsen-Rivers LA. Breastfeeding Disparities and Their Mediators in an Urban Birth Cohort of Black and White Mothers. Breastfeed Med 2021; 16:452-462. [PMID: 33733869 PMCID: PMC8418439 DOI: 10.1089/bfm.2020.0327] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Black mothers in the United States have shorter breastfeeding (BF) durations and less exclusive breastfeeding (EBF) than others. The factors underlying these disparities require investigation. Methods: Using longitudinal data from a CDC-sponsored birth cohort in Cincinnati, Ohio, we analyzed the factors mediating racial disparity in BF outcomes. Study mothers were enrolled in prenatal clinics associated with two large birth hospitals. Analysis was restricted to racial groups with sufficient numbers in the cohort, non-Hispanic Black (n = 92) and White (n = 113) mothers, followed to at least 6 months postpartum. Results: Black mothers were 25 times more likely to reside in socioeconomically deprived neighborhoods and 20 times more likely to have an annual household income <$50,000/year than White mothers (p < 0.001). The gap in EBF for 6 weeks was 45 percentage points by racial group (13%-Black mothers versus 58%-White mothers, p < 0.001); in any BF at 6 months was 37 percentage points (28%-Black mothers versus 65%-White mothers, p < 0.001); and in mothers meeting their own intention to BF at least 6 months was 51 percentage points (29%-Black mothers versus 80%-White mothers, p < 0.001). Racial disparity in EBF at 6 weeks was mediated in logistic regression models by inequities in socioeconomic position, maternal hypertension, and BF intention. Racial disparities in BF at 6 months or meeting 6-month BF intention were mediated by inequities in socioeconomic position, maternal obesity, and EBF at 6 weeks. Not all BF disparities could be explained by models used in these analyses. Conclusions: Efforts to lessen BF disparities should address the underlying structural inequities that disproportionately affect Black mothers and children, should incorporate maternal health, and focus on breastfeeding exclusivity and duration. Few Black mothers achieved EBF at 6 weeks, which contributed to disparity in BF duration. Greater attention to Black mother-infant pairs is a public health priority.
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Affiliation(s)
- Ardythe L. Morrow
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Janelle McClain
- Breastfeeding Outreach for Our Beautiful Sisters, Cincinnati, Ohio, USA
| | - Shannon C. Conrey
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Liang Niu
- Division of Epidemiology, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexandra Kinzer
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Allison R. Cline
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Alexandra M. Piasecki
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily DeFranco
- Department of Obstetrics & Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laura Ward
- Division of Neonatology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Julie Ware
- Division of Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel C. Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary A. Staat
- Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Laurie A. Nommsen-Rivers
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, Cincinnati, Ohio, USA
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11
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Burgess A, Eichelman E, Rhodes B. Lactation Patterns in Women with Hypertensive Disorders of Pregnancy: An Analysis of Illinois 2012-2015 Pregnancy Risk Assessment Monitoring System (PRAMS) Data. Matern Child Health J 2020; 25:666-675. [PMID: 33200325 DOI: 10.1007/s10995-020-03069-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy have lifelong implications on maternal cardiovascular health. Breastfeeding has a variety of maternal benefits, including improved lifelong maternal cardiovascular outcomes, with longer periods of lactation resulting in further improvement. Women with hypertensive disorders of pregnancy encounter many barriers to breastfeeding. Little is known about lactation initiation and duration rates in women with hypertensive disorders of pregnancy. The purpose of this study is to describe lactation patterns in women with HDP, hypertensive disorders of pregnancy, compared to normotensive controls using data from the phase 7 Illinois Pregnancy Risk Assessment Monitoring System (PRAMS). SUBJECTS AND METHODS Illinois PRAMS 2012-2015 (Phase 7) data was used to assess lactation patterns as well as rationale for not initiating breastfeeding or earlier cessation. Women who delivered during this time period were eligible to participate in the PRAMS survey, 5285 were included the analysis. RESULTS Overall, 17.6% of all women in the study reported their healthcare provider did not speak with them prenatally about breastfeeding. Women who reported they had HDP, were significantly less likely (p ≤ 0.001) to ever breastfeed or pump breast milk to feed their baby, even for a short period, than those women without an HDP. At the time the PRAMS survey was completed, more women without an HDP were still breastfeeding or providing their baby with pumped milk (54.9 v. 48%; p = 0.002). More women with HDP reported stopping breastfeeding because they got sick or had to stop for medical reasons (p = 0.002) and/or because their baby was jaundiced (p = 0.007). CONCLUSION Cardiovascular disease remains the leading cause of death among women and women with a history of HDP are at increased risk for cardiovascular related morbidity and mortality. Obstetrical providers and nurses caring for this high-risk population should ensure they educate women about the increased cardiovascular risk associated with HDP and the maternal cardiovascular benefits associated with lactation in order to promote and support lactation in this population of women.
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Affiliation(s)
- Adriane Burgess
- WellSpan Health, Women and Children Service Line, 1001 S. George St, York, PA, 17405, USA.
| | - Emily Eichelman
- Neonatal Intensive Care Unit, Studer Family Children's Hospital, 1 Bubba Watson Drive, Pensacola, FL, 32504, USA
| | - Brittney Rhodes
- MedStar Franklin Square Medical Center, 9000 Franklin Square Dr, Baltimore, MD, 21237, USA
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