Parity and the Association Between Maternal Sociodemographic Characteristics and Breastfeeding

Predicting mothers' exclusive breastfeeding for the first 6 months: Interface creation study using machine learning technique

BACKGROUND

Machine learning techniques (MLT) build models to detect complex patterns and solve new problems using big data.

AIM

The present study aims to create a prediction interface for mothers breastfeeding exclusively for the first 6 months using MLT.

METHOD

All mothers who had babies aged 6-24 months between 15.09.2021 and 15.12.2021 and to whom the surveys could be delivered were included. 'Personal Information Form' created by the researchers was used as a data collection tool. Data from 514 mothers participating in the study were used for MLT. Data from 70% of mothers were used for educational purposes, and a prediction model was created. The data obtained from the remaining 30% of the mothers were used for testing.

RESULTS

The best MLT algorithm for predicting exclusive breastfeeding for the first 6 months was determined to be the Random Forest Classifier. The top five variables affecting the possibility of mothers breastfeeding exclusively for the first 6 months were as follows: "the mother not having any health problems during pregnancy," "there were no people who negatively affected the mother's morale about breastfeeding," "the amount of water the mother drinks in a day," "thinking that her milk supply is insufficient," "having no problems breastfeeding the baby".

CONCLUSIONS

Using created prediction model may allow early identification of mothers with a risk of not breastfeeding their babies exclusively for the first 6 months. In this way, mothers in the risk group can be closely monitored in the early period.

Predictors of planned home birth before and during the COVID-19 pandemic

OBJECTIVES

To determine how demographic and clinical predictors of home birth have changed since the onset of the COVID-19 pandemic in the US.

METHODS

Using National Vital Statistics birth certificate data, a retrospective population-based cohort study was performed with planned home births and hospital births among women age ≥18 years during calendar years 2019 (pre-pandemic) and 2021 (pandemic-era). Birth location (planned home birth vs. hospital birth) was analyzed using univariate and multivariable logistic regression, systematically examining the interaction of each demographic and clinical covariate with study year.

RESULTS

After exclusions, a total of 6,087,768 birth records were retained for analysis, with the proportion of home births increasing from 0.82 % in 2019 to 1.24 % in 2021 (p<0.001). In the final multivariable logistic regression model of planned home birth, five demographic variables retained a statistically significant interaction with year: race and ethnicity, age, educational attainment, parity, and WIC participation. In each case, demographic differences between those having planned home births and hospital births became smaller (odds ratios closer to 1) in 2021 compared to 2019.

CONCLUSIONS

Planned home births increased by more than 50 % during the pandemic, with greater socioeconomic diversity in the pandemic-era home birth cohort. The presence of clinical risk factors remained a strong predictor of hospital birth, with no evidence that pandemic-era home births had a higher clinical risk profile as compared to the pre-pandemic period.

Breastfeeding and less healthy beverage intake during the first year of life

BACKGROUND AND OBJECTIVES

Breastfeeding during infancy is associated with healthier beverage consumption later in childhood, but little is known about this relation during infancy. This was a longitudinal study of breastfeeding and less healthy beverage consumption during the first year of life, in a birth cohort study conducted 2013-2018 in the Southeastern United States (n = 666).

METHODS

We estimated monthly rates of 100% juice and sugar-sweetened beverage (SSB) consumption comparing infants who were exclusively or partially breastfed, versus those who were not, in multivariable adjusted models.

RESULTS

Mothers had a median age of 26.5 years, 71% identified as Black/African-American, and 61% reported household incomes <$20 000/year. The prevalence of any breastfeeding during the first month was 78.2% and 18.7% at month 12. By age 12 months, infants consumed juice a mean (SD) 9.1 (10.1) times per week and SSBs 3.6 (9.5) times per week. Breastfed infants had a 38% lower incidence rate of weekly juice consumption (95% CI 52%, 15%, p = 0.003) and a 57% lower incidence rate of weekly SSB consumption (95% CI 76%, 22%, p = 0.006), compared with infants who were not breastfed.

CONCLUSIONS

Research on early-life correlates of dietary health should focus on the earliest beverages, given evidence that consumption of obesogenic beverages may begin prior to age 1 year.

Facility Size and Risk Factors for Mortality in Pediatric Trauma

BACKGROUND

Pediatric trauma outcomes can vary across facilities, yet evidence on the relationship between facility bed size and pediatric trauma outcomes has been mixed. We aimed to identify how facility bed size might modify the impact of patient-level risk factors on mortality in pediatric trauma. We hypothesized that patient-level risk factors would have a stronger association with mortality at smaller trauma centers, and a weaker association with mortality at larger centers.

METHODS

We used deidentified data obtained from the 2017-2018 Trauma Quality Programs registry, including patients ages 0-18 years of age who were admitted to the hospital. The primary outcome was in-hospital mortality. Facility bed size was dichotomized as large (>600 beds) vs small/medium (≤600 beds). Sensitivity analyses used 200 and 400 beds as alternative cutoffs. Interaction between facility bed size and patient characteristics was assessed using unadjusted logistic regression, with statistically significant interactions entered in a final, fully adjusted model.

RESULTS

The analysis included 171 810 patients (mean age 10 ± 5 years; 65%/35% male/female), including 28% treated in a large hospital and 1.2% who died during the hospitalization. Controlling for trauma center level (or subsetting to pediatric trauma centers only), larger bed size did not reduce mortality risk associated with patient characteristics such as injury mechanism, injury severity, or patient demographics.

CONCLUSIONS

Contrary to our hypothesis, greater facility bed size was not associated with reduced mortality risk associated with patient characteristics. Future studies are needed to identify hospital practices or characteristics that can attenuate the excess risk of known patient-level risk factors.

Breastfeeding in women with systemic lupus erythematosus: results from a Norwegian quality register

BACKGROUND

Knowledge on breastfeeding among women with systemic lupus erythematosus (SLE) is sparse. We wanted to identify the frequency of breastfeeding in SLE, and to compare breastfeeding women with SLE to non-breastfeeding women to examine possible differences in disease characteristics and self-reported health data between the groups.

METHODS

Prospective data on women with SLE from RevNatus, a consent-based Norwegian nationwide quality register was used for this study. Data were collected during January 2016 to September 2021. We used data registered at inclusion when planning pregnancy or in 1^st trimester, and 6 weeks, 6 and 12 months after delivery. Breastfeeding and non-breastfeeding patients were compared according to demographic, serological and obstetric data as well as disease activity, medication, self-reported pain, and fatigue.

RESULTS

A total of 114 pregnancies in 101 SLE women were included in the analysis. A majority of the women (78%) breastfed six weeks postpartum. Six and 12 months after delivery, breastfeeding rates were 54% and 30% respectively. Six weeks postpartum, non-breastfeeding women showed higher prevalence of emergency caesarean delivery (p = 0.038), preeclampsia (p = 0.056) and lower educational level (p = 0.046) compared to breastfeeding women. 12 months after delivery, we observed a higher frequency of multiparity among breastfeeding women (p = 0.017) compared to non-breastfeeding. Overall, we found low disease activity in both groups at all registrations in the follow-up, and disease activity did not differ between the groups. More than 70% of both breastfeeding and non-breastfeeding women used hydroxychloroquine (HCQ).

CONCLUSIONS

Breastfeeding rate in women with SLE was high six weeks postpartum. Multiparous women breastfed longer than primiparas. Disease activity, use of HCQ, and self-reported health data were comparable between the groups. Our data indicate that health professionals should encourage women with SLE to breastfeed.

The Association of Maternal Smoking and Drinking Changes During Pregnancy and Postpartum Breastfeeding Pattern and Duration

Objectives: To conduct a secondary data analysis of how changes in smoking and drinking during pregnancy impact status of any breastfeeding and breastfeeding duration in a national cohort. Materials and Methods: A cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System (PRAMS) data between 2009 and 2017 (n = 334,203). Univariate and multivariate analyses were conducted on the status of any breastfeeding and breastfeeding duration. Results: A dose-dependent inverse relationship was found in which women who smoked the same or more or resumed smoking during pregnancy showed the lowest likelihood and shortest duration of breastfeeding, followed by reduced smokers, quitters, and nonsmokers. Women with a history of alcohol use were significantly more likely to breastfeed compared with women without a history of alcohol use. Conclusions: The profile of smoking change during pregnancy impacts the likelihood and duration of breastfeeding in a dose-dependent and inverse manner. No such relationship was found with drinking change during pregnancy. Public Health Implications: Significant public health efforts should focus on implementing and sustaining evidence-based interventions for prenatal smoking cessation and educating providers and maternal populations on the adverse effect of postpartum alcohol exposure.

Effectiveness of Lactation Cookies on Human Milk Production Rates: A Randomized Controlled Trial

BACKGROUND

Expensive lactation cookies (LC) are marketed as milk-boosters; however, their effectiveness remains unknown.

OBJECTIVE

To evaluate the effectiveness of 1-month daily intake of LC on changes in objective and subjective milk production and breastfeeding self-efficacy.

METHODS

A 1-month, randomized controlled trial among 18-45-year-old exclusively lactating parents of healthy, term, 2-month-old infants living in the United States from March to December 2021. Participants (n=176) were randomly assigned to eat daily 56.5g of either LC with "galactagogues" (oatmeal, brewer's yeast, flax seeds, and fenugreek), or conventional cookies containing similar weight, calories, and presentation, but lacking galactagogues. The primary outcome was baseline-to-1-month changes in human milk production rate (HMPR), measured with a validated milk expression protocol. Secondary outcomes included changes in perceived insufficient milk (PIM) and lactation self-efficacy scores.

RESULTS

Among 176 randomized participants (age 31.3 ±5.8 years, 71.0% self-identified as White, 15.3% Hispanic/Latine, 6.3% Black, 4.0% Asian), 90 participants (51.1%) completed endline HMPR measures and 129 (73.3%) completed secondary outcomes. Imputed models showed a mean increase in HMPR of 5.8mL/h ±15.7 in control participants and 5.5mL/h ±17.6 in the LC participants after 1 month of daily cookie intake. No significant differences were observed with adjusted linear mixed models on the multiply imputed data comparing baseline-to-endline changes in HMPR, PIM, or breastfeeding self-efficacy: mean (standard error) difference-in-differences for HMPR, -0.33 (4.97), p=0.948; PIM scores (range 5-50), -0.52 (1.83), p=0.775; and self-efficacy scores (range 14-70), 0.31 (2.23), p=0.888, respectively.

CONCLUSIONS

AND RELEVANCE: This study found no evidence for an effect of consuming LC on HMPR, PIM, or breastfeeding self-efficacy in exclusively breastfeeding parents with overall adequate perceived milk supply. Recommendations to consume LC for increasing objective or subjective milk supply may deliver false hope and unnecessary financial costs at a vulnerable time.

TRIAL REGISTRATION NUMBER

Clinical Trials NCT04805008.

Real-Time Breastfeeding Documentation: Timing of Breastfeeding Initiation and Outpatient Duration

BACKGROUND

Current breastfeeding guidelines promote initiating breastfeeding ≤1 h after birth to establish long-term breastfeeding. Previous studies dichotomized initiation to ≤1 h versus subsequent hours combined. There are limited data evaluating the effect of initiation in each subsequent hour on breastfeeding duration. Our objective was to evaluate the association between breastfeeding initiated at ≤1 h versus the subsequent 23 hours after birth and outpatient breastfeeding duration.

METHODS

In this retrospective cohort study, we analyzed real-time, discretely documented electronic health record (EHR) breastfeeding data for 3315 infants born at a university center and followed to age ≥12 mo at 27 university primary care clinics. The primary outcome was breastfeeding duration. The exposure variable was hour of breastfeeding initiation within 24 h postnatally. Data were analyzed by univariable and multivariable linear regression separately for infants born by vaginal versus cesarean delivery.

RESULTS

In adjusted models, initiating breastfeeding during each hour from age >1 to ≤6 h and during ages >6 to ≤24 h was not associated with decreased breastfeeding duration versus initiating breastfeeding at ≤1 h after birth for infants born via vaginal or cesarean delivery.

CONCLUSIONS

Delaying breastfeeding initiation to >1 to ≤24 h after birth is not associated with decreased breastfeeding duration compared with initiating breastfeeding at ≤1 h after birth. Integration of breastfeeding measures into inpatient and outpatient EHR discrete data fields may clarify best practices that support long-term breastfeeding as a public health imperative.

Development of Mothers' Health Literacy: Findings From the KUNO-Kids Study

BACKGROUND AND OBJECTIVE

The aim of this study was to analyze the longitudinal development of health literacy (HL) in a large cohort of new mothers in Germany and to investigate which determinants are associated with the initial HL level and with change over time.

METHODS

Longitudinal data from 1,363 mothers participating with their child in the KUNO-Kids Health Study was used; data were collected at birth of the child (baseline), after 6 and 12 months, using interviews and self-report questionnaires. The HL of mothers was assessed with the health care scale of the European Health Literacy Survey Questionnaire, which has 16 items on accessing, understanding, appraising, and applying health information in the health care setting. Latent growth curve models were used to analyze average trajectories and predictors of HL in the total sample and in the subgroup of first-time mothers.

KEY RESULTS

HL values increased from baseline (M = 35.46, standard deviation [SD] = 7.34) over 6 months (M = 37.31, SD = 7.31) to 12 months (M = 38.01, SD = 7.41). The increase was statistically significant in the total sample (1.188, standard error [SE] = 0.087, p < .001) and in the subgroup of first-time mothers (1.357, SE = 0.113, p <. 001), with a steeper trajectory for mothers with lower HL at baseline. Several personal and situational variables were associated with HL at baseline (e.g., education, child health) and with its development (e.g., number of children).

CONCLUSION

Overall, new mothers became slightly more health literate during their child's first year of life. However, some groups of mothers could benefit from support in developing HL skills even before childbirth. [HLRP: Health Literacy Research and Practice. 2023;7(1):e39-e51.] Plain Language Summary: We investigated how health literacy (that is the ability to find, understand, and apply health information) develops in new mothers in Germany. Mothers told us that this ability slightly improved during the child's first year of life. Some mothers still have difficulties in dealing with health information; these mothers should be supported even before childbirth.

Factors Associated with Breastfeeding Initiation and Duration in Greece: Data from the Hellenic National Nutrition and Health Survey

Despite its well-documented benefits, breastfeeding rates and duration worldwide do not meet the recommended goals set by the World Health Organization. Data on infant feeding, socio-demographic, lifestyle and perinatal factors were used from 490 mothers (and 958 children), participants at the Hellenic National Nutrition and Health Survey between 2013−2015. Clustered multiple logistic regression and multilevel mixed-model regression analyses were performed to identify factors associated with breastfeeding initiation and duration, respectively. Maternal lower education [Odds Ratio (OR): 2.29, 95% Confidence intervals (95% CI): 1.30−4.04; p = 0.004], smoking during pregnancy (OR: 3.08, 95% CI: 1.64−5.77; p < 0.001), caesarean section (OR = 3.26, 95% CI: 1.83−5.83; p < 0.001), prematurity (OR = 2.74, 95% CI: 1.40−5.37; p = 0.003) and higher birth order (OR = 1.30, 95% CI: 1.04−1.62; p = 0.020) were associated with increased odds of not initiating breastfeeding. Living in rural areas [beta coefficient b = −27.93, p = 0.043], smoking during pregnancy (b = −64.47, p < 0.001), caesarean section (b = −28.76, p = 0.046) and prematurity (b = −46.67, p = 0.048) were significantly associated with shorter breastfeeding duration. Children born chronologically closer to the survey were more likely to breastfeed and for longer periods. Educational promotion and enhancement of breastfeeding awareness that account for maternal exposures are required. Prevention of prematurity and avoidance of unnecessary caesarean section is crucial, while additional breastfeeding support is needed when preterm birth occurs, or caesarean section cannot be avoided.

Changes in Breastfeeding Exclusivity and Satisfaction During the COVID-19 Pandemic

BACKGROUND

Because of its many benefits, exclusive breastfeeding for 6 months is a common public health goal. However, only 44% of infants aged 0-6 months are exclusively breastfed worldwide and, in the United States, only 26% of infants are exclusively breastfed for 6 months. The restrictions imposed during the COVID-19 pandemic may have reduced these rates even further.

RESEARCH AIM

To examine the differences in breastfeeding exclusivity and satisfaction before and during the COVID-19 pandemic.

METHODS

A cross-sectional, two-group survey design was used. Parents (N = 110) of infants born April 1 to December 31, 2019 (pre-pandemic; n = 69), or April 1 to December 31, 2020 (during the pandemic; n = 41), who received lactation support services from an urban academic breastfeeding clinic were surveyed.

RESULTS

Respondents who gave birth in 2020 (pandemic year) were no less likely to exclusively breastfeed for the first 6 months of their infant's life compared to respondents who gave birth in 2019 (pre-pandemic year). After multivariable logistic regression, the odds of high breastfeeding satisfaction were 73% lower in respondents with infants born in 2020 than in respondents with infants born in 2019 (OR = 0.27, 95% CI [0.08, 0.89]). The strongest contributor to high breastfeeding satisfaction was a prenatal breastfeeding visit with an International Board Certified Lactation Consultant.

CONCLUSIONS

Future research is needed to identify the specific pandemic-related factors that led to the difference in breastfeeding satisfaction between the two groups and to confirm the impact of prenatal International Board Certified Lactation Consultant visits on breastfeeding satisfaction.

Association Between a History of Hookah Use and Breastfeeding Duration

Background: There is limited evidence on the relationship between hookah use and breastfeeding. This study examines the association between a history of hookah use and breastfeeding duration among women in the United States. Materials and Methods: This cross-sectional study examined 96,392 women from the Pregnancy Risk Assessment and Monitoring System (PRAMS) 2016-2019 data. The main outcome of interest was any breastfeeding for at least 3 months. Descriptive statistics, chi-square test, and multivariable regression analyses were performed. Results: Overall, 68.3% of women breastfed for at least 3 months and 4.6% reported using hookah in the last 2 years. Women who reported using hookah in the last 2 years were significantly less likely to breastfeed for at least 3 months compared with women who did not report using hookah in the last 2 years (56.0% versus 68.9%; p < 0.001). In the multivariable model, the odds of breastfeeding for at least 3 months were significantly lower in women who used hookah in the last 2 years compared with those who did not use hookah; odds ratio (95% confidence interval) 0.82 (0.74-0.92; p < 0.001). Additionally, the odds of breastfeeding for at least 3 months were significantly lower for dual users of hookah and cigarettes 0.48 (0.33-0.68; p < 0.001). Conclusion: A history of hookah use is associated with early weaning, independent of potential confounders. This finding suggests the need for educating women about the negative consequences of hookah use on breastfeeding during preconception, prenatal, and postpartum care encounters.

Social Determinants of Emergency Department Visits in Mild Compared to Moderate and Severe Asthma

BACKGROUND

Social determinants of health (SDH) influence emergency department (ED) use among children with asthma. We aimed to examine if SDH were more strongly associated with ED use among children with moderate/severe compared to mild asthma.

METHODS

This study utilized the 2016-2019 data from the National Survey of Children's Health. Children with asthma ages 0-17 years (N = 9937) were included in the analysis. Asthma severity and all-cause ED use in the past year were reported by caregivers. The association between patient factors and ED visits was evaluated using ordinal logistic regression.

RESULTS

Based on the study sample, 29% of children with asthma had moderate/severe asthma. In the mild group, 30% visited the ED at least once in the past 12 months, compared to 49% in the moderate/severe group. SDH associated with ED visits included race/ethnicity, insurance coverage, and parental educational attainment, but the strength of these associations did not vary according to asthma severity.

CONCLUSIONS

In a nationally representative data set, SDH were equally predictive of ED use regardless of children's asthma severity. Interventions to reduce ED use among children with asthma should be considered for children with any severity of asthma, especially children in socially disadvantaged groups at higher risk of ED utilization.

Primiparous women differ from multiparous women after early discharge regarding breastfeeding, anxiety, and insecurity - A prospective cohort study

INTRODUCTION

Breastfeeding and factors influencing breastfeeding are essential when considering the association between parity and neonatal and maternal morbidity risks when mothers are discharged within 24 hours after birth. However, there is a lack of studies examining the effect of parity and breastfeeding in a setting where all healthy mothers are recommended discharge four hours after birth. Therefore, this study examined the association between parity and the time for discharge, breastfeeding, and factors influencing breastfeeding.

METHODS

The study was designed as a prospective cohort study. Data were obtained from questionnaires at one and at six weeks after birth, and combined with registered data. All 147 included mothers were healthy, with an uncomplicated birth and a healthy newborn, discharged within 24 hours after birth.

RESULTS

This study documented that primiparous women had a higher relative risk (RR=2.62; 95% CI: 1.35–5.10) of having doubts about infant feeding after discharge than multiparous women. Furthermore, 54% of primiparous women contacted the maternity ward after discharge compared to 27% of multiparous women. Twice as many primiparous than multiparous women felt anxious or depressed at one and at six weeks after birth. Finally, the study documented that 13% of primiparous women and 5% of multiparous women discharged within six hours after birth perceived the time before discharge to be too short.

CONCLUSIONS

Primiparous women differ from multiparous women regarding breastfeeding, insecurity, and anxiety. Special attention towards primiparous women and a follow-up strategy that allows the mothers to contact the maternity ward after early discharge is recommended.

Breast milk components and factors that may affect lactation success

Introduction. Breastfeeding is the most important way to feed a newborn, infant and a young child. Lactogenesis is the ability of secreting milk from the mammary gland and includes secretory initiation and activation. The birth of the placenta and decrease in progesterone levels stimulate an increase in prolactin levels and the secretion of milk from the breast. Human milk contains carbohydrates, lipids, proteins, vitamins, minerals, fatty acids, amino acids and trace elements. In addition, numerous cells, macrophages, bacteria, chemokines, cytokines, immunoglobulins, hormones, growth factors, and mucin are present. The composition of milk differs depending on the phase of secretion. Colostrum is secreted for the first five days after birth, then comes transitional milk, and mature milk two weeks after birth. During the very act of breastfeeding, there is a difference between pre-milk and last milk. In pre-milk, the fat content is low and increases with the duration of lactation, and in breast milk it is relatively high. Aim: To point out the importance of milk composition and factors that are influential for breastfeeding. Conclusion: Maternal parity, age or socioeconomic status and education can affect the concentration of certain components of breast milk. Adequate social policy and support, along with education related to early breastfeeding experiences, can be the key factors in initiating and maintaining breastfeeding. Besides the mother and the child, the entire social community would benefit from that.

Association Between Electronic Nicotine Delivery Systems Use and Breastfeeding Duration

Background: Breastfeeding is beneficial for both mothers and infants. Unfortunately, some infants are not breastfed for the recommended duration of time. Previous studies have identified several demographic, socioeconomic, biological, and behavioral factors that impact breastfeeding practices. Studies examining the influence of electronic nicotine delivery systems (ENDS) on breastfeeding practices are currently lacking. Materials and Methods: This population-based, cross-sectional study used data from the 2016-2018 Pregnancy Risk Assessment and Monitoring System (n = 42,827). Chi-squared tests and multivariable logistic regression analyses were performed. Results: The prevalence of prenatal ENDS use was 0.9%. Only 40.8% of women who used ENDS during pregnancy breastfed for at least 3 months compared with 68.5% of women who did not use ENDS during pregnancy. In the multivariable model, the odds of breastfeeding for at least 3 months were significantly lower in women who used ENDS during pregnancy compared with those who did not use ENDS; odds ratio (95% confidence interval) 0.63 (0.44-0.89; p = 0.010). Conclusion: Prenatal exposure to ENDS is negatively associated with breastfeeding duration, independent of potential confounders. This finding suggests that screening for ENDS use during pregnancy can play a vital role in identifying women at-risk for suboptimal breastfeeding and offering ongoing support to improve breastfeeding practices.