Factors that positively influence in-hospital exclusive breastfeeding among women with gestational diabetes: An integrative review

Publicly available Australian hospital data on infant feeding: A review and comparative analysis of outcomes

BACKGROUND

Breastfeeding is the optimal method of providing infant nutrition. The Baby Friendly Health Initiative (BFHI) is a global strategy to promote breastfeeding. This study aimed to explore infant feeding data in Australian hospitals and compare outcomes between BFHI and non-BFHI accredited hospitals, and between public and private hospitals.

METHODS

We targeted publicly available Australian public and private hospital data on breastfeeding outcomes at discharge from 2018 to 2019. We linked the data to the BFHI accredited hospitals and used t tests to compare mean breastfeeding rates and Chi square or Fisher's exact test for categorical variables.

FINDINGS

Across all Australian states and territories, only New South Wales (NSW) and Victoria (VIC) provided the publicly available target data. Breastfeeding indicators were defined differently between these states. In NSW, breastfeeding at discharge was reported as a full breastfeeding rate among live born infants (71 %) whereas in VIC, it was reported as exclusive breastfeeding rates among term babies only (79 %). Comparing public with private hospitals, the rates of full breastfeeding at discharge in NSW and exclusive breastfeeding in VIC were significantly lower among private non-BFHI accredited hospitals compared to public non-BFHI accredited hospitals.

CONCLUSION

BFHI accreditation can be beneficial in decreasing the rates of commercial milk formula use. Consistent reinforcement of BFHI principles and implementation in both private and public hospitals is required. Regular state monitoring and national dissemination of aggregated data collected using standardised breastfeeding indicators is also essential.

Evaluating a woman-centred web-based breastfeeding educational intervention in Saudi Arabia: A before-and-after quasi-experimental study

BACKGROUND

Although digital educational resources are used worldwide to educate new parents, the impact of digital resources tailored specifically to women's needs on breastfeeding practices is not well explored.

AIM

The study aimed to evaluate the effectiveness of using a women-centred Web-Based Breastfeeding Educational Resource (WEBBER) in increasing the rate of exclusive breastfeeding at one month after birth.

METHODS

A quasi-experimental study with before and after intervention was conducted in one metropolitan hospital in Saudi Arabia. Participants were primiparous women (n=290) aged 18 or above who intended to breastfeed. The intervention involved introducing the WEBBER to pregnant women and reinforcing its uses as a routine breastfeeding educational resource. Women's characteristics and infant feeding data were collected at one month after birth via an online survey.

FINDINGS

The rate of exclusive breastfeeding at one month postpartum among the women who received the WEBBER intervention was nearly three times higher compared to the women prior to the introduction of the intervention (66 % vs. 26 %, p-value <.001). Furthermore, other predictors of exclusive breastfeeding at one month were the mother being unemployed, the baby not receiving infant formula in the hospital, and the mother having postnatal intention to continue breastfeeding for 6 months or more.

DISCUSSION AND CONCLUSION

Using WEBBER as a routine breastfeeding educational resource increased the rate of exclusive breastfeeding one month after birth. Embedding woman-centred digital resources into routine breastfeeding education is an effective intervention for women in Saudi Arabia.

Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review

BACKGROUND

Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy.

METHODS

A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework.

RESULTS

From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis - the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group.

CONCLUSION

Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.

The Association of Nutrition and Exercise Behaviors of Women with Diabetes in Pregnancy with Infant Breastfeeding Practices

Background: Although breastfeeding confers significant benefits to infants, women with diabetes in pregnancy experience unique nutrition and health challenges, which may influence infant feeding practice. This study aimed to determine the association between nutrition and exercise behaviors of women with diabetes in pregnancy and breastfeeding at birth and 6 months. Methods: A secondary data analysis of a longitudinal study on maternal pregestational diabetes mellitus (DM) and gestational diabetes (GDM) and infant development was conducted. Women self-reported engaging in nutrition behaviors, such as using meal plans, and exercise health behaviors. Primary outcomes were exclusive breastfeeding at birth and any breastfeeding at 6 months. Logistic regression models adjusted for significant maternal-infant covariates. Results: Of n = 48 women with diabetes in pregnancy, 94% had GDM and 6% had pregestational type 1 or type 2 DM. Forty percent of women exclusively breastfed at birth and 68% partially or exclusively breastfed at 6 months (of n = 34 with complete 6-month data). Women who cooked their own meals had two times greater adjusted odds of exclusive breastfeeding at birth (adjusted odds ratio [AOR] = 1.94, 95% confidence interval [CI] = 1.12-5.11), and women who exercised during pregnancy had seven times greater adjusted odds of any breastfeeding at 6 months (AOR = 7.2, 95% CI = 1.10-42.8). Conclusion: Nutrition and exercise behaviors were associated with exclusive breastfeeding at birth and any breastfeeding at 6 months. Health behaviors to effectively manage diabetes during pregnancy may inform efforts to improve breastfeeding initiation and duration, and future studies in a larger sample are needed.

Self-Efficacy and Outcomes in Women with Diabetes: A Prospective Comparative Study

Background: Breastfeeding is especially beneficial to women with diabetes and their infants, yet diabetic mothers frequently experience less favorable breastfeeding outcomes. Objectives: To identify facilitators and barriers to breastfeeding for women with diabetes by comparing cognitive and social factors, health and hospital-related factors, and breastfeeding outcomes between women with and without diabetes. Design/Methods: Women with any type of diabetes (n = 28) and without diabetes (n = 29) were recruited during pregnancy. Data were collected from the electronic medical record and maternal surveys at 24-37 weeks' gestation, birth hospitalization, and 4 weeks' postbirth. We compared differences in mother's regard for breastfeeding, breastfeeding intention, and birth hospital experience by diabetes status, and estimated odds ratios for exclusive breastfeeding (EBF) and unmet intention to breastfeed. Results: Women with and without diabetes had similar breastfeeding intentions, attitudes, and self-efficacy. Women with diabetes were less likely to EBF, and more likely to have unmet intentions to EBF at hospital discharge, compared to women without diabetes. At 4 weeks' postpartum, there was no difference in breastfeeding by diabetes status, although EBF at hospital discharge was strongly associated with EBF at 4 weeks. Infant neonatal intensive care unit (NICU) admission and hypoglycemia were significantly associated with diabetes status, reduced EBF rates, and unmet breastfeeding intentions. Conclusions: Despite having a strong intent to breastfeed, women with diabetes experienced less favorable early breastfeeding outcomes and were less likely to meet their own breastfeeding goals. These differences may be driven by neonatal complications, such as infant hypoglycemia and NICU admissions, rather than maternal cognitive and social factors.

Dendrobium mixture improves gestational diabetes mellitus through regulating Nrf2/HO1 signaling pathway

BACKGROUND

Gestational diabetes mellitus (GDM) is characterized by insulin resistance during pregnancy, and it is always combined with serious complications. Dendrobium mixture (DMix) is a kind of traditional Chinese medicine, and it has been proved to be an effective treatment for diabetes. However, the regulatory role of DMix in GDM remains elusive.

METHODS

High fat feed combined with streptozotocin injection and high glucose medium were used to establish GDM animal and cell models, respectively. The levels of blood glucose, blood lipid, and insulin were measured with commercial kits. Western blotting was used to detect protein expression.

RESULTS

DMix improved pancreas and placenta injury in GDM rats. DMix reversed the influence of GDM on the levels of SOD, MDA, and glutathione in the serum. Hyperglycemia and hyperlipidemia in GDM rats were suppressed by DMix. The activation of MAPK and inhibition of Nrf2/HO1 in GDM animal and cell models were reversed by DMix. The increase of ROS intensity, apoptosis, and inflammation factors in HG treated cells were reversed by DMix.

CONCLUSION

This research proved that DMix improved GDM through inhibiting oxidative condition, inflammation factors, hyperglycemia and hyperlipidemia. This study might provide a novel thought for the prevention and treatment of GDM.

Study on the Effect of Early Comprehensive Intervention of Skin Contact Combined with Breastfeeding on Improving Blood Glucose in Early Birth of Newborns with Gestational Diabetes Mellitus

Objective

To explore the value of early comprehensive intervention of skin contact combined with breastfeeding on improving early blood glucose in newborns with gestational diabetes mellitus (GDM).

Methods

A total of 300 newborns from pregnant women with gestational diabetes who were hospitalized in Wuxi People's Hospital from January 2021 to December 2021 were randomly assigned into the observation group (n = 150) and the control group (n = 150). The former group received early comprehensive intervention of skin contact combined with breastfeeding, and the latter group received postnatal naked contact, physical examination after late navel severing, and routine nursing intervention such as early contact and early sucking in 30 min. The peripheral blood microglucose value at 1 and 2 hours after birth, neonatal hospitalization rate, ear temperature of 30 min, 60 min, 90 min, and 120 min after birth, neonatal crying, incidence of postpartum hemorrhage, uterine contraction/wound pain index, lactation before delivery, immediately after delivery, early sucking 15 min, and 2 hours postpartum were observed.

Results

Compared to the control group, the values of trace blood glucose at 1 hour and 2 hours after birth in the observation group were higher, and the difference between groups was statistically significant (P < 0.05), the neonatal hospitalization rate in the observation group was lower, and the difference between groups was statistically significant (P < 0.05); the ear temperature of 30 min, 60 min, 90 min and 120 min after birth in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). The crying frequency of newborns in the observation group was lower, and the difference between groups was statistically significant (P < 0.05). The incidence of postpartum hemorrhage in the observation group was lower, and the difference between groups was statistically significant (P < 0.05). The rate of uterine contraction/wound pain index grade 1 in the observation group was higher, and the difference between groups was statistically significant (P < 0.05). The rates of uterine contraction/wound pain index grade 2 and grade 3 in the observation group were lower, and the difference between groups was statistically significant (P < 0.05). The rate of lactation at 2 hours postpartum in the observation group was higher, and the difference between groups was statistically significant (P < 0.05).

Conclusion

Early comprehensive intervention of skin contact combined with breastfeeding can significantly increase the early blood glucose of newborns with GDM, effectively promote the occurrence of early hypoglycemia of GDM newborns, avoid a series of serious complications caused by excessive fluctuation of blood sugar, promote the stability of vital signs of newborns, reduce the hospitalization rate of newborns, improve the success rate of breastfeeding, reduce uterine contraction/wound pain, and reduce the incidence of postpartum hemorrhage. My clinical registration number is chictr220059454.

Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico

INTRODUCTION

In this study we describe breastfeeding practices among women from semi-rural communities in southeast Mexico, and explore which factors, modifiable or not, are associated with such practices.

MATERIALS AND METHODS

This was a formative cross-sectional study that included 143 mothers with infants 4-6 months old, from semi-rural communities in Tabasco, Mexico. We collected data on two categories of factors: (1) women's sociodemographic characteristics, and (2) maternal / infant factors. We first analyzed the frequency of various breastfeeding practices. Then, we classified participants into the up to 1 month of exclusive breastfeeding group ( ≤ 1 m-EBF) and the beyond 1 month EBF group (>1 m-EBF), if they practiced EBF for less or more than 1 month, respectively. We compared the two categories of factors between groups and then, using logistic regression models, explored which factors were associated with practicing >1 m-EBF.

RESULTS

By the end of the 1st month postpartum, 51.7% of participants had abandoned EBF, introduced milk formula (35%), other food (9.1%), non-nutritive liquids (7.7%), or had stopped breastfeeding completely. In the next months, EBF practice fell sharply and mixed feeding grew importantly.Logistic regression models showed that women were more likely to be in the >1 m-EBF group if they lived with the baby's father, had complications during pregnancy, delivered vaginally and attended a health center at least three times postpartum. To the contrary, women were less likely to be practice >1 m-EBF if they gave infants other liquids during their hospital stay; experienced pain or discomfort in breasts/nipples, or used a pacifier after hospitalization; had larger bodies (i.e., higher BMI); and believed that you should give the infant powdered milk or some other food when the baby is not full.

CONCLUSION

Many factors associated with abandoning EBF, particularly in the early postpartum period, are modifiable and can be altered through timely interventions that include giving correct information and ensuring its comprehension; assertive personal counseling and accompaniment must be provided to mothers; and reinforcement during the early postpartum at health facilities and other settings.