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O'Reilly SL, McNestry C, McGuinness D, Killeen SL, Mehegan J, Coughlan B, O'Brien EC, O'Brien D, Szafranska M, Brosnan M, Sheehy L, Murtagh R, O'Hagan L, Corbett M, Walsh M, Keogh R, Power P, Woodcock M, Phelan M, Carroll A, Murray S, Scallan C, Dunn E, McAuliffe FM. Multicomponent perinatal breastfeeding support in women with BMI >25: The Latch On multi-centre randomised trial. BJOG 2024; 131:1197-1206. [PMID: 38344894 DOI: 10.1111/1471-0528.17782] [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: 03/10/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To investigate the effectiveness of a multicomponent breastfeeding support intervention on breastfeeding prevalence at 3 months among women with a body mass index (BMI) >25 kg/m2. DESIGN Multicentre multicomponent randomised controlled trial. SETTING Four maternity centres in Ireland. POPULATION A total of 225 primiparous women and their nominated support partners. Participants were aged 18 years and over, with BMI ≥25 kg/m2, carrying a singleton pregnancy and without contraindication for breastfeeding. METHODS The intervention included an antenatal group breastfeeding education session for participants and their support partners, followed by a planned postnatal breastfeeding assessment and telephone support for up to 6 weeks by a lactation consultant. MAIN OUTCOME MEASURES Any breastfeeding at 3 months postpartum. RESULTS Any breastfeeding prevalence was 68.7% (n = 68) in the intervention group and 62.1% (n = 59) in the control group at 3 months postpartum (odds ratio 1.33, 95% confidence interval 0.72-2.46, p = 0.36). Any and exclusive breastfeeding rates did not significantly differ at any other time point. More women in the control group accessed support from private lactation consultants (intervention 23.5% [n = 12], control 45.3% [n = 24], p = 0.02). CONCLUSIONS The control group had higher than expected breastfeeding rates, and the study found no evidence of effect on the primary outcome. Providing comprehensive education and support for women intending to breastfeed remains of paramount importance.
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Affiliation(s)
- Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Catherine McNestry
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Denise McGuinness
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - John Mehegan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Barbara Coughlan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eileen C O'Brien
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Denise O'Brien
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marcelina Szafranska
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | | | | - Paula Power
- St Luke's General Hospital, Mullingar, Ireland
| | | | - Mary Phelan
- St Luke's General Hospital, Mullingar, Ireland
| | - Amy Carroll
- St Luke's General Hospital, Mullingar, Ireland
| | | | | | | | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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López-Gimeno E, Falguera-Puig G, García-Sierra R, Vicente-Hernández MM, Cubero LB, Seguranyes G. Impact of shared decision-making on women's childbirth preferences: A cluster randomised controlled trial. Midwifery 2024; 133:103999. [PMID: 38643600 DOI: 10.1016/j.midw.2024.103999] [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: 05/14/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Midwives provide counselling for birth plans (BPs) to women during prenatal care; however, the impact of individualised BP counselling interventions based on shared decision-making (SDM) regarding women's preferences is unknown. METHODS This randomised cluster trial included four primary healthcare units. Midwives provided BP counselling based on SDM to women in the intervention group (IG) during prenatal care along with a handout about evidence-based recommendations. Women in the control group (CG) received standard BP counselling from midwives. The main outcome was preference changes concerning BPs. RESULTS A total of 461 (95.5 %) pregnant women received BP counselling (IG, n = 247; CG, n = 214). Women in the IG changed their BP preferences for 13 items compared with those in the CG. These items were: using an unique space during birth (81.1 % vs 51.6 %; p < 0.001), option for light graduation (63 % vs 44.7 %; p < 0.001), listening to music (57.3 % vs 43.6 %; p = 0.006), drinking fluids during labour (84.6 % vs 93.6 %; p = 0.005), continuous monitoring (59 % vs 37.8 %; p < 0.001); desire for natural childbirth (36.6 % vs 25 %; p = 0.014), epidural analgesia (55.1 % vs 43.6 %; p = 0.023); breathing techniques (65.2 % vs 50.5 %; p = 0.003), massage (74.9 % vs 55.3 %; p < 0.001); birthing ball use (81.9 % vs 56.9 %; p < 0.001), spontaneous pushing (49.3 % vs 28.7 %; p < 0.001), choosing birth position (69.6 % vs 41.5 %) and delayed umbilical cord clamping (67.8 % vs 44.1 %; p = 0.001). CONCLUSION SDM counselling, together with a handout about evidence-based recommendations on childbirth and newborn care, produced more changes in women's preferences expressed in the BP than standard counselling.
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Affiliation(s)
- Encarnación López-Gimeno
- Sexual and Reproductive Healthcare Services (ASSIR), Barcelona, Catalan Health Institute (ICS), Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain; Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona, Hospitalet LL, Spain; Sexual and Reproductive Healthcare Services (ASSIR), Nord Metropolitan Area, Catalan Health Institut (ICS), Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain.
| | - Gemma Falguera-Puig
- Sexual and Reproductive Healthcare Services (ASSIR), Nord Metropolitan Area, Catalan Health Institut (ICS), Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain
| | - Rosa García-Sierra
- Research Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Spain; Nursing Department, Faculty of Medicine, Campus Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain; Primary Care Group, Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain; Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-01484), Barcelona, Spain
| | - Mª Mercedes Vicente-Hernández
- Sexual and Reproductive Healthcare Services (ASSIR), Nord Metropolitan Area, Catalan Health Institut (ICS), Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain; Sexual and Reproductive Healthcare Services (ASSIR), Badalona, Catalan Health Institute (ICS), Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain
| | - Lucia Burgos Cubero
- Sexual and Reproductive Healthcare Services (ASSIR), Catalan Health Institute (ICS), Mollet del Vallés, Spain
| | - Gloria Seguranyes
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona, Hospitalet LL, Spain; Sexual and Reproductive Healthcare Services (ASSIR), Nord Metropolitan Area, Catalan Health Institut (ICS), Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), 08007 Barcelona, Spain
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Chaudry ZA, Naz T, Arshad I, Zahoor A, Javaid M, Sikander S. Innovative continuum of care to promote exclusive breast feeding in Pakistan: protocol of a pilot randomised controlled trial. BMJ Paediatr Open 2024; 8:e002562. [PMID: 38769049 PMCID: PMC11110549 DOI: 10.1136/bmjpo-2024-002562] [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: 02/08/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Breastmilk being the ideal nutrition from birth to 2 years and beyond has many health benefits for both newborn and mothers. This study will assess the feasibility and acceptability of a continuum of care programme, which is a health facility and community based till 6 months post partum to encourage ideal breastfeeding practices. METHODS AND ANALYSIS A pilot randomised control trial having two-parallel arms of intervention and control groups was conducted in gynaecology and obstetrics department of Aziz Bhatti Shaheed Teaching Hospital with a community outreach component of 6 months. 50 women between 28 and 32 weeks of gestation fulfilling inclusion criteria will be allocated in 1:1 randomly into intervention and control groups through computer-generated random number generator software. 25 participants in intervention group will receive counselling and training on breast feeding during antenatal visits along with a family member of support by a trained female doctor within the hospital, at birth by a trained nurse and at home for 6 months by a trained lady health worker. It will be supported by reading materials and videos through a mobile phone WhatsApp application. The 25 participants in control group will receive the support already provided within the hospital and at home. The primary outcomes feasibility and acceptability will be determined at 6 months post partum from participants and providers by a semistructured questionnaire. The secondary outcomes are rates of infant early initiation and exclusive breast feeding at 2 weeks, 1, 3 and 6 months, Infant Feeding Attitude at 1 month and Breastfeeding Self-Efficacy at 3 months. Quantitative and qualitative data will be analysed via SPSS software V.20 and thematic analysis, respectively. CONCLUSION This pilot randomised controlled trial (RCT) will guide the interventions for the definite RCT. ETHICS AND DISSEMINATION Approved by institutional ethical committee, informed consent from all participants and results will be disseminated in peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05951868.
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Affiliation(s)
- Zahid Azam Chaudry
- Department of Community Medicine & Public Health, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Tehmina Naz
- Department of Gynecology & Obstetrics Aziz Bhatti Shaheed Teaching Hospital, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Iqra Arshad
- Department of Gynecology & Obstetrics Aziz Bhatti Shaheed Teaching Hospital, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Aisha Zahoor
- Department of Gynecology & Obstetrics Aziz Bhatti Shaheed Teaching Hospital, UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Mahum Javaid
- UOG Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Siham Sikander
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
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Iwuagwu C, Chen MJ, Hoyt-Austin AE, Kair L, Fix M, Schwarz EB. Awareness of the Maternal Health Benefits of Lactation Among U.S. Pregnant Individuals. Womens Health Issues 2024; 34:283-290. [PMID: 38302344 DOI: 10.1016/j.whi.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION We assessed awareness of the maternal health benefits of lactation among a sample of nulliparous pregnant individuals in the United States, identified variables associated with awareness of these benefits, and examined whether awareness of these benefits impacts breastfeeding attitudes or intentions. METHODS We administered a web-based survey to nulliparous U.S.-born individuals carrying a singleton gestation of at least 28 weeks. We assessed awareness of the maternal health benefits of lactation using 10 items to create a summative score. We examined variation in awareness of these benefits by demographic characteristics, health insurance, and personal or family health history and used multivariable models to estimate associations between awareness of the maternal health benefits of lactation and breastfeeding intentions. RESULTS Of the 675 individuals invited to complete surveys, 451 (67%) responded. Only 50% were aware that breastfeeding lowers maternal risk of breast cancer; fewer were aware that breastfeeding lowers the risk of ovarian cancer (35%), diabetes (27%), and hypertension and heart disease (26%). Awareness of the maternal benefits of lactation did not vary by age or race/ethnicity. However, significant regional variation was noted. In multivariable models, scores of awareness of the maternal health benefits of breastfeeding were significantly associated with intentions to breastfeed for at least 12 months (adjusted odds ratio, 1.23; 95% confidence interval, 1.11, 1.37). CONCLUSIONS Efforts to increase awareness of the maternal health benefits of lactation are still needed. Increasing awareness of the maternal health benefits of lactation may strengthen intentions to breastfeed as recommended.
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Affiliation(s)
- Caidon Iwuagwu
- Center for Healthcare Research and Policy, University of California, Davis, Sacramento, California
| | - Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California
| | | | - Laura Kair
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Margaret Fix
- Center for Healthcare Research and Policy, University of California, Davis, Sacramento, California
| | - Eleanor Bimla Schwarz
- Department of Medicine, University of California, San Francisco, San Francisco, California.
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Acar Z, Şahin N. Development of a mobile application -based breastfeeding program and evaluation of its effectiveness. J Pediatr Nurs 2024; 74:51-60. [PMID: 37995477 DOI: 10.1016/j.pedn.2023.11.011] [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: 08/21/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Breastfeeding has many benefits for maternal and infant health. Mobile health interventions are increasingly used to increase breastfeeding initiation and support breastfeeding continuation. PURPOSE This study aimed to develop a mobile application-based breastfeeding program (MABBP) and to evaluate effectiveness. DESIGN AND METHODS This randomized controlled trial study was conducted with 73 mothers on the first postpartum day hospitalized in the postpartum service of a university hospital in Turkey. Mothers in the MABBP group (experimental group) were included in the mobile application-based breastfeeding training program on the first postpartum day. The Participant Information Form, the Infant Breastfeeding Assessment Tool (IBFAT), and the Breastfeeding Experience Scale (BES), Breastfeeding Follow-up Form, and Baby Physical Development Follow-up Form were administered. In the second follow-up, the Mobile Application Evaluation Form was used additionally to collect data from the MABBP group. RESULTS There was no significant difference between the postpartum first-day MABBP and control groups in the mean IBFAT scores. In the first and second follow-up, the rate of breastfeeding exclusively was higher and the rate of experiencing breastfeeding problems was lower in the MABBP group compared to the control group. While the mean BES score on the first postpartum day was significantly higher in the MABBP group compared to the control group, it was found to be significantly lower in the second follow-up. CONCLUSION It was determined that the MABBP contributed to the mothers' experiencing fewer breastfeeding problems and feeding the babies exclusively with breast milk at a higher rate. PRACTICE IMPLICATIONS This study suggests that pediatric nurses can support mothers during breastfeeding with the breastfeeding mobile application.
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Affiliation(s)
- Zehra Acar
- University of Health Sciences Hamidiye Faculty of Nursing, Istanbul, Turkey.
| | - Nevin Şahin
- Istanbul University- Cerrahpaşa Florence Nightingale Nursing Faculty, Istanbul, Turkey
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Schwarz EB, Hoyt-Austin A, Fix M, Kair LR, Iwuagwu C, Chen MJ. Prenatal Counseling on the Maternal Health Benefits of Lactation: A Randomized Trial. Breastfeed Med 2024; 19:52-58. [PMID: 38190278 PMCID: PMC11071093 DOI: 10.1089/bfm.2023.0219] [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: 01/10/2024]
Abstract
Objective: To assess the effects of prenatal counseling about the maternal health benefits of lactation on postpartum knowledge, breastfeeding intentions, and infant feeding behaviors. Materials and Methods: We conducted a randomized trial with 411 nulliparous U.S.-born women carrying a singleton gestation. Participants were recruited online; after completing a baseline survey that assessed breastfeeding knowledge and intentions, participants were randomized to receive a 10-minute virtual counseling session about the benefits of breastfeeding or attention-control counseling about smoke-free homes. We collected data on breastfeeding knowledge, intentions, and infant feeding behaviors through 12 months postpartum and conducted an intention-to-treat analysis. Results: On enrollment, awareness of the maternal health benefits of lactation was similarly low in both study groups. Postpartum, participants who received this prenatal counseling intervention had significantly greater awareness that breastfeeding decreases maternal risk of breast cancer, ovarian cancer, diabetes, heart disease, and rheumatoid arthritis (p < 0.001 for all). On enrollment, intended duration of breastfeeding was similar between groups (10.1 months versus 9.7 months, p = 0.41). At 1-month postpartum, intended duration of breastfeeding had increased from baseline among those who received this counseling (+0.7 months versus -0.7 months among controls, p = 0.004); among intervention participants intended duration of breastfeeding decreased less at 3 (-0.8 versus -1.6, p = 0.18), 6 (-2.0 versus -3.0, p = 0.06), 9 (-2.8 versus -4.2, p = 0.03), and 12 months postpartum (-4.8 versus -6.2, p = 0.09). Rates of exclusive breastfeeding and any breastfeeding were similar between groups. Conclusion: Prenatal counseling on the maternal health benefits of lactation increases awareness of these maternal health benefits and extends intended duration of breastfeeding. ClinicalTrials.gov Identifier: NCT04601987.
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Affiliation(s)
- Eleanor B. Schwarz
- Division of General Internal Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Adrienne Hoyt-Austin
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
| | - Margaret Fix
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California, USA
| | - Laura R. Kair
- Department of Pediatrics, University of California at Davis, Sacramento, California, USA
| | - Caidon Iwuagwu
- Center for Healthcare Policy and Research, University of California at Davis, Sacramento, California, USA
| | - Melissa J. Chen
- Department of Obstetrics and Gynecology, University of California at Davis, Sacramento, California, USA
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Augustyn M, Haskins D, Gross S, Resnik AK, Ducharme-Smith K, Orta-Aleman D, Silbert-Flagg J, Rosenblum N, Caulfield LE. Maternity care experiences and breastfeeding at discharge among Maryland WIC participants: A qualitative analysis. Birth 2023; 50:1009-1017. [PMID: 37533361 DOI: 10.1111/birt.12758] [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] [Received: 09/16/2021] [Revised: 04/18/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Breastfeeding imparts numerous health and social benefits for families. Barriers deter some individuals from breastfeeding. Rates are lower among certain populations, including participants of the federally funded Women, Infants, and Children's Program (WIC). Women, Infants, and Children's Program provides low-income pregnant and postpartum women and children under 5 with nutrition education, supplemental foods, breastfeeding education and support, and resource linkages. Investigation of WIC participants' hospital experiences and breastfeeding decisions is limited. We explore qualitative themes associated with breastfeeding-related hospital maternity care practices experienced by WIC participants. METHODS Thirty pregnant individuals intending to breastfeed were recruited at WIC clinics to complete in-depth interviews at 2 weeks, 3 months, and 6 months of postpartum. Using the Thematic Framework methodology, we analyzed data from the two-week interviews of 29 participants with respect to hospital breastfeeding experiences. RESULTS Fourteen participants were exclusively breastfeeding at discharge (EBFD). Fifteen were partially breastfeeding at discharge (PBFD). Differences between groups were found in hospital breastfeeding experiences, particularly in staff support. All participants EBFD reported positive breastfeeding-related staff experiences. Most participants PBFD reported limited and ineffective staff interaction, leading to formula introduction. CONCLUSIONS Individuals EBFD and those PBFD reported about the same rate of hospital breastfeeding difficulties, yet half introduced formula within the first few days postpartum. Results reiterate the importance of hospital staff support to breastfeeding exclusivity at 2-3 days postpartum. The challenges that these individuals faced may have been resolved through available, responsive, and effective intervention. Data-driven breastfeeding education programs for hospital health professionals are critical to affect patient breastfeeding outcomes.
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Affiliation(s)
- Marycatherine Augustyn
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health (JHUBSPH), Baltimore, Maryland, USA
| | - Danielle Haskins
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health (JHUBSPH), Baltimore, Maryland, USA
| | - Susan Gross
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health (JHUBSPH), Baltimore, Maryland, USA
| | - Amy Kovar Resnik
- Maryland WIC Program, Maryland Department of Health, Baltimore, Maryland, USA
| | - Kirstie Ducharme-Smith
- Center for Human Nutrition, Johns Hopkins University Bloomberg School of Public Health (JHUBSPH), Baltimore, Maryland, USA
| | - Dania Orta-Aleman
- Center for Human Nutrition, Johns Hopkins University Bloomberg School of Public Health (JHUBSPH), Baltimore, Maryland, USA
| | - JoAnne Silbert-Flagg
- Pediatric Nurse Practitioner Track, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Nadine Rosenblum
- Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Adjunct Faculty, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Laura E Caulfield
- Center for Human Nutrition, Johns Hopkins University Bloomberg School of Public Health (JHUBSPH), Baltimore, Maryland, USA
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Dario H, Spatz DL. An Integrative Review of Breastfeeding and Homelessness. Nurs Womens Health 2023; 27:416-426. [PMID: 37806318 DOI: 10.1016/j.nwh.2023.06.002] [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: 01/21/2023] [Revised: 06/14/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To synthesize the current literature surrounding breastfeeding and homelessness, and to determine the impact of disparities in this population. DATA SOURCES An integrative search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and using the search terms "breastfeeding" and "homelessness" throughout electronic databases PubMed, CINAHL, and Scopus. STUDY SELECTION Inclusion criteria were articles published in English from January 2007 to September 2022. Exclusion criteria were studies published more than 15 years ago, studies published in a language other than English, opinion articles, and irrelevance to breastfeeding and homelessness. The initial search yielded 100 results. After removing duplicates and articles because of irrelevance, the final number of articles for this synthesis was seven. DATA EXTRACTION Data were extracted from each article, critically appraised using Joanna Briggs Institute criteria, and summarized in a table of evidence. DATA SYNTHESIS Three common themes were identified: Decreased Breastfeeding Initiation Rates and Duration in the Homeless Population, Impact of Community and Clinical Support, and Breastfeeding Practices Influenced by Individual Factors. CONCLUSION Providers and nurses should refer patients to the Special Supplemental Nutrition Program for Women, Infants, and Children; use techniques to instill a parent's intent to breastfeed; provide early breastfeeding education; promote breastfeeding initiation within 1 hour of birth; and encourage peer support groups. Although current researchers provide insight into potential barriers and interventions, more research is needed to gain additional data on how to overcome identified barriers to breastfeeding.
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Fewtrell M, Bandsma RHJ, Baur L, Duggan CP, Dumrongwongsiri O, Hojsak I, Khatami K, Koletzko B, Kovalskys I, Li Z, Mouane N, Nel E, Sachdev HS, Spolidoro JV. Role of Pediatricians in Promoting and Supporting Breastfeeding: A Position Paper of the International Pediatric Association Strategic Advisory Group on Infant, Child, and Adolescent Nutrition. ANNALS OF NUTRITION & METABOLISM 2023; 79:469-475. [PMID: 37673040 DOI: 10.1159/000534004] [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: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Promoting and supporting breastfeeding is an important public health intervention with multiple benefits for both infants and mothers. Even modest increases in the prevalence and duration of breastfeeding could significantly reduce healthcare costs and improve maternal and child health outcomes. However, widespread adoption of breastfeeding recommendations remains poor in most settings, which contributes to widening health and social inequalities. Pediatricians have a duty to advocate for improving child health, including promoting and supporting breastfeeding. SUMMARY This paper, from the International Pediatric Association Special Advisory Group on Nutrition, considers common barriers to breastfeeding and addresses how pediatricians can better promote and support breastfeeding, both at an individual level and by influencing practice and policy. All pediatricians need to understand the basics of breastfeeding, including lactation physiology, recognize common breastfeeding problems, and advise mothers or refer them for appropriate support; training curricula for general pediatricians and all pediatric subspecialties should reflect this. Even in the situation where their day-to-day work does not involve direct contact with mothers and infants, pediatricians can have an important influence on policy and practice. They should support colleagues who work directly with mothers and infants, ensuring that systems and environments are conducive to breastfeeding and, where appropriate, milk expression. Pediatricians and pediatric organizations should also promote policies aimed at promoting and supporting breastfeeding at local, regional, national, and international levels. KEY MESSAGES Pediatricians have a duty to promote and support breastfeeding, regardless of their day-to-day role and responsibilities. Pediatric training curricula should ensure that all trainees acquire a good understanding of breastfeeding so they are able to effectively support mothers in their personal practice but also influence breastfeeding practice and policy at a local, regional, national, and international level.
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Affiliation(s)
- Mary Fewtrell
- Childhood Nutrition Research Group, Population, Practice and Policy Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert H J Bandsma
- Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, Toronto, Ontario, Canada
| | - Louise Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher P Duggan
- Division of Gastroenterology, Hepatology and Nutrition, Division of Nutrition, Harvard Medical School, Department of Nutrition, Harvard TH Chan School of Public Health, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Oraporn Dumrongwongsiri
- Division of Nutrition, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Iva Hojsak
- Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia
| | - Katayoun Khatami
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, LMU - Ludwig Maximillians Universität Munich, Munich, Germany
| | - Irina Kovalskys
- Faculty of Medical Sciences, Argentine Pontifical Catholic University, Buenos Aires, Argentina
- Maestría en Nutrición Humana, IDIP Instituto de Desarrollo e Investigaciones Pediátricas del Hospital de Niños de La Plata, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Zhenghong Li
- Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Nezha Mouane
- Academic Children's Hospital Ibn Sina, Mohammed V University, Rabat, Morocco
| | - Etienne Nel
- FMHS, Stellenbosch University, Stellenbosch, South Africa
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AlQurashi A, Wani T, Alateeq N, Heena H. Effect of Counseling Service on Breastfeeding Practice among Saudi Mothers. Healthcare (Basel) 2023; 11:healthcare11060878. [PMID: 36981537 PMCID: PMC10048408 DOI: 10.3390/healthcare11060878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
Objective: To assess the knowledge and practice of breastfeeding and the effects of lactation counseling, as a health promotion intervention, on breastfeeding duration and exclusive breastfeeding (EBF) among Saudi women. Methods: In this quasi-experimental design study, 664 mothers attending a women’s hospital from January 2017 to December 2018 were interviewed. Women were allocated into two groups, control and intervention groups, based on received lactation counseling. Interviews were performed using a structured questionnaire collecting data on the sociodemographic characteristics, knowledge, attitude and practice of breastfeeding mothers. A chi-squared test was used to determine the level of significance on breastfeeding practices among two groups. Propensity score matching was presented to control confounders, as women cannot be randomly assigned to lactation counseling. Results: Of 664 women, 592 were Saudi nationals, and the majority of mothers were literate (96.2%). A significantly higher number of mothers in the consultation group were employed as compared with the non-consultation group (p = 0.015). One third (33.3%) of the women practiced EBF, while 39.8% preferred mixed feeding for the first six months of the infant’s life. The consultation group demonstrated a significantly higher response rate in their knowledge on the benefits of breastfeeding in babies (increased intelligence; p < 0.05) and mothers (breast engorgement; p = 0.004), colostrum and its importance (p = 0.027) and effective breastfeeding practices (initiate breastfeeding within 30 min after birth (p = 0.01), baby needs 10–20 min between each feed (p = 0.009), breastfeeding should last for 6 months (p = 0.01)) compared with the non-consultation group. The age of weaning (5.3 ± 2.8 vs. 5.9 ± 3.2 months) was similar across both the groups. However, “the intended duration of BF” was higher in the non-consultation group, and the difference was statistically significant (p = 0.002). The mean weight and length of the baby at follow-up were similar in both groups, with no statistical significance. The duration of exclusive breastfeeding among two groups was not statistically significantly different (8.7 ± 6.9 vs. 8.1 ± 7.1 weeks). Mothers in the two groups were satisfied with their breastfeeding experience. The mean scores lie within the range of 4.2 to 5.0. Baby age (month), mother LoE, mother job and type of BF were controlled for, and the propensity-score-matched 62.5% sample from both the groups yielded the same results. Conclusions: Breastfeeding women in our study showed a fair knowledge of EBF. However, the duration of actual EBF was very short, and the counseling intervention showed no impact on EBF in our study population. We recommend interventions that are tailored to the needs of this population, while identifying factors that improve breastfeeding practice among mothers.
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11
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Sağlik M, Karaçam Z. Effectiveness of structured education and follow-up in the management of perceived breastmilk insufficiency: A randomized control trial. Health Care Women Int 2023; 44:276-294. [PMID: 34919025 DOI: 10.1080/07399332.2021.2007249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this study, we examine the effectiveness of structured education and follow-up in the management of perceived milk insufficiency and in increasing the baby's amount of milk intake in breastfeeding mothers. We conducted a randomized controlled trial over the period December 2018-June 2019 at Family Health Centers in Turkey with 64 mothers (intervention group: 33 and control group: 31). We provided the intervention group with education using structured educational material. A Descriptive Information Form, a Breastfeeding Follow-up Form, and the Scoring System for Measuring a Baby's Intake of Breast Milk were the instruments we used in the data collection. Mothers in the intervention group started breastfeeding their babies in the first one hour after birth. We observed at each monitoring that a significantly greater percentage of the mothers in the intervention group believed their milk to be sufficient and that they fed their babies exclusively with breast milk in the three follow-ups. We found from the data we obtained that all three tracking times indicated that the baby's amount of milk intake in the intervention group was better than in the control group; the differences were statistically significant. We concluded that structured education and follow-ups increased the exclusive breastfeeding of 0-2-month-old babies, improved perceptions of sufficient milk intake, diminishing the perception of breast milk deficiency.Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.2007249.
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Affiliation(s)
| | - Zekiye Karaçam
- Faculty of Health Sciences, Division of Midwifery, Aydın Adnan Menderes University, Aydın, Turkey
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12
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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13
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Arocha-Zuluaga GP, Caicedo-Velasquez B, Forero-Ballesteros LC. [Economic, social, and health determinants that influence exclusive breastfeeding in Colombia]. CAD SAUDE PUBLICA 2022; 38:e00186621. [PMID: 36169511 DOI: 10.1590/0102-311xes186621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 07/25/2022] [Indexed: 11/22/2022] Open
Abstract
Exclusive breastfeeding (EBF) is an important practice that offers many benefits, such as nutritional support, prevention of infectious and chronic diseases, and assistance in psychosocial and cognitive development. This study aims to identify the determinants associated with EBF abandonment in 1,527 children under six months of age, based on information collected by the Colombian National Survey of Nutritional Status and the Colombian National Demographic and Health Survey, 2010. This is an observational cross-sectional cohort study, in which a hierarchical Poisson regression model with robust variance was applied; considering in the first level the factors associated with the mother and child and, in the second level, the information of 32 departments and Bogotá. We noticed a high rate abandonment of EBF (57.6%) and its variation between departments. The factors associated with a longer time of EBF were higher maternal schooling level, having a partner, knowledge in breastfeeding, belonging to a lower level of income, living in the eastern region, having delivery assisted by qualified team, and low birth weight. According to the variance partition coefficient (VPC), 3.2% of the probability of abandonment of EBF may be related to factors within the departmental scope. The median odds ratio (MOR) indicates that the individual risk of abandoning EBF of a child would increase by 47% if the child moved from a department with a low prevalence of abandonment to a department with high prevalence. This study allows a better understanding of the abandonment of EBF from its determinants, providing evidence to implement more effective interventions for child nutrition.
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14
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Hamer DH, Solomon H, Das G, Knabe T, Beard J, Simon J, Nisar YB, MacLeod WB. Importance of breastfeeding and complementary feeding for management and prevention of childhood diarrhoea in low- and middle-income countries. J Glob Health 2022; 12:10011. [PMID: 35916658 PMCID: PMC9344980 DOI: 10.7189/jogh.12.10011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Early and exclusive breastfeeding have been shown to protect young infants from all-cause and diarrhoea-related mortality. Ideally breastfeeding should be initiated within the first hour of birth. Despite efforts to increase rates of early and exclusive breastfeeding in low- and middle-income countries (LMICs), challenges with uptake remain. This analysis reviews trends in early and exclusive breastfeeding, and the impact of infant feeding interventions in reducing childhood diarrhoea. Methods We conducted a detailed review of articles written in English between 1990 and 2020 on the impact and efficacy of breastfeeding and complementary feeding on diarrhoea in children aged 0-2 years in LMICs. Using data from 86 countries and all WHO global regions collected from the mid-1980s through 2018 obtained from publicly available Demographic Health Surveys, we assessed trends in five-year intervals of timing of breastfeeding initiation, exclusive breastfeeding, median and mean duration of exclusive breastfeeding, and complementary feeding. Results The literature search identified ten articles that described variable rates of early initiation of breastfeeding from 20% in Pakistan to 76% in Egypt. An analysis of 288 DHS studies found that the proportion of women who reported initiating breastfeeding within an hour of birth increased from 32% in the early 1990s to 55% between 2016 and 2020. Exclusive breastfeeding increased from 20% in the late 1980s to 48% between 2016 and 2020 and the mean duration of exclusive breastfeeding of 2-to-4-month-old infants doubled. Early initiation of breastfeeding and exclusive breastfeeding was associated with reductions in diarrhoea prevalence in the South East Asian, Western Pacific, Eastern Mediterranean, and African regions. Eight studies evaluating the effectiveness of different maternal education interventions, health care worker training, and media campaigns demonstrated improvements in exclusive breastfeeding, and most resulted in reductions in the incidence or duration of diarrhoea. Conclusions During the last two decades, early and exclusive breastfeeding have increased. Nevertheless, the uptake of this basic, low-cost intervention remains suboptimal across all global regions. Given the potential benefits the in reduction of diarrhoea and diarrhoea-associated mortality, interventions for improving the uptake of early and exclusive breastfeeding in different sociological contexts need to be designed, implemented, and evaluated.
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Affiliation(s)
- Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Hiwote Solomon
- Doctor of Public Health Program, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Gopika Das
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Tanner Knabe
- College of Engineering, Boston University, Massachusetts, USA
| | - Jennifer Beard
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jon Simon
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Yasir B Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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15
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Shorey S, Loh DNL, Chan V, Chua C, Choolani MA. Parents' perceptions of antenatal educational programs: A meta-synthesis. Midwifery 2022; 113:103432. [PMID: 35907268 DOI: 10.1016/j.midw.2022.103432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 06/17/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Contents and mode of delivery of antenatal educational programs differed considerably. Yet there is a lack of high-level evidence about the delivery of these programs. OBJECTIVE We aimed to understand the experiences and needs of parents who have attended antenatal educational programs. DESIGN Six databases were searched from each database. Included studies were appraised using the Critical Appraisal Skills Program tool. Qualitative data were meta-summarized and meta-synthesized. FINDINGS Seventeen studies were included, and three themes were developed: (1) Contradicting views on antenatal educational programs, (2) Feeling 'well prepared' after attending the antenatal educational programs, and (3) Parents' expectations and way forward for the antenatal educational programs. DISCUSSION Findings revealed that the description of contents of antenatal educational programs needed to be more specific. Mindfulness strategies were well-received by parents in the included studies. Educators should take into account inclusivity and increase educational resources related to individual, cultural and community needs. Learning needs can be assessed before and after classes. Parents with specific needs that were not addressed should be identified and referred to the relevant professionals for continued support. More deliberate actions were needed during the programs to foster social and professional networks for attendees to support them throughout antenatal and postnatal periods. CONCLUSION We consolidated the experiences and needs of parents who have attended antenatal educational programs. Findings can help refine policies related to antenatal care to improve pregnancy, birth and parenthood experiences for both mothers and fathers.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Doris Ngiuk Lan Loh
- Obstetrics and Gynecology Department, National University of Singapore, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Valerie Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Crystal Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Mahesh A Choolani
- Obstetrics and Gynecology Department, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
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16
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Amoo TB, Popoola T, Lucas R. Promoting the practice of exclusive breastfeeding: a philosophic scoping review. BMC Pregnancy Childbirth 2022; 22:380. [PMID: 35501834 PMCID: PMC9063230 DOI: 10.1186/s12884-022-04689-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life and continued breastfeeding for 2 years. The global rate of exclusive breastfeeding is low at 33%. Thus, it is important to identify philosophical and theory-based strategies that can promote exclusive breastfeeding. The aim of the study was to identify philosophical schools of thought and theories used in research on promoting the practice of exclusive breastfeeding. Methods A scoping review using Arksey and O'Malley's framework explored the phenomenon of exclusive breastfeeding practice promotion. Searches were conducted using CINAHL Plus full-text, PubMed, APA PsycInfo, and Academic Search Premier. Search terms included theory, philosophy, framework, model, exclusive breastfeeding, promotion, support, English, and publication between 2001—2022. Results The online search yielded 1,682 articles, however, only 44 met the inclusion criteria for the scoping review. The articles promoting exclusive breastfeeding used pragmatism (n = 1) or phenomenology (n = 2) philosophies and theories of self-efficacy (n = 10), theory of planned behaviour (n = 13), social cognitive theories (n = 18) and represented 16 countries. Theories of self-efficacy and planned behaviour were the most used theories. Conclusions This review suggests that theories and models are increasingly being used to promote exclusive breastfeeding. Orienting exclusive breastfeeding programmes within theoretical frameworks is a step in the right direction because theories can sensitize researchers and practitioners to contextually relevant factors and processes appropriate for effective exclusive breastfeeding strategies. Future research should examine the efficacy and effectiveness of theory-informed exclusive breastfeeding programmes over time. Such information is important for designing cost-effective EBF programmes. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04689-w.
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Affiliation(s)
| | - Tosin Popoola
- School of Nursing, Victoria University of Wellington, Wellington, New Zealand
| | - Ruth Lucas
- School of Nursing, University of Connecticut, Storrs, CT, USA
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17
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Simsek A, Balkan E, Caliskan E. Determination of mothers' thoughts and adaptation behaviors regarding the infant: A descriptive study. Pediatr Neonatol 2022; 63:276-282. [PMID: 35277367 DOI: 10.1016/j.pedneo.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/16/2021] [Accepted: 12/26/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With motherhood, women focus on their new baby. They begin to develop new adaptation behaviors to provide the best care for the infant. The study aims to describe the adaptive behaviors and concerned thoughts of first-time and repeat mothers. METHODS The study was designed in descriptive and cross-sectional type. Data were collected from mothers using a questionnaire and "The scale of being the mother of a baby." The study was completed with 112 mothers who were reached by snowball sampling method and agreed to participate. The data were analyzed at the 95% confidence interval at the p˂.05 significance level. RESULTS 66.1% of the mothers had a baby for the first time, and 73.2% of the mothers received information/education about baby care. It was determined that they wanted to receive information on topics such as maternal and infant nutrition, diseases, and immunization. A statistically significant difference was found between the age of pacifier use (p = .032). It was determined that mothers got 130.7 points in total from the scale, 88.3 points from the evaluation of motherhood sub-dimension, and 42.3 points from the life change sub-dimension. A statistically significant difference was found between the baby care knowledge/training status and the scale scores. CONCLUSION The importance and continuity of education during and after pregnancy has emerged. Nurses are competent people with a key role in this regard, and it is recommended to use individualized care protocols for the training provided.
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Affiliation(s)
- Aysegul Simsek
- Department of Midwifery, Faculty of Health Sciences, Istinye University, 34010, Istanbul, Turkey.
| | - Elif Balkan
- Department of Midwifery, Faculty of Health Sciences, Istinye University, 34010, Istanbul, Turkey
| | - Esra Caliskan
- Department of Nursing, Faculty of Health Sciences, Istinye University, 34010, Istanbul, Turkey
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18
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Agyekum MW, Codjoe SNA, Dake FAA, Abu M. Enablers and inhibitors of exclusive breastfeeding: perspectives from mothers and health workers in Accra, Ghana. Int Breastfeed J 2022; 17:21. [PMID: 35313914 PMCID: PMC8935745 DOI: 10.1186/s13006-022-00462-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 02/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Despite the health and economic benefits of exclusive breastfeeding, there is evidence of a decline globally and in Ghana. Previous studies addressing this problem are mostly quantitative with only a few of such studies using qualitative or mixed methods to examine the predictors, benefits, ways of improving and managing exclusive breastfeeding, and the challenges associated with exclusive breastfeeding from the perspective of exclusive and nonexclusive breastfeeding mothers, and health workers. This study employs the health belief model to examine the experiences of mothers and health workers regarding exclusive breastfeeding to fill this gap in the literature. Methods A cross-sectional qualitative study involving in-depth interviews was conducted among health workers and mothers attending child welfare clinic at two polyclinics in Madina, Accra-Ghana in 2019. Purposive sampling was used to select health facilities and participants for the study. Twenty participants comprising ten exclusive breastfeeding mothers, six non-exclusive breastfeeding mothers and four health workers were interviewed for the study. The data were analyzed based on emerging themes from inductive and deductive coding. Results The decision to practice exclusive breastfeeding was based on mothers’ work, advertisement on exclusive breastfeeding and education on breastfeeding provided by health workers. Insufficient flow of breast milk, pressure from family and friends, and insufficient breast milk for infants were among the reasons for discontinuing exclusive breastfeeding. The factors that help improve exclusive breastfeeding include eating healthy food and breastfeeding on demand, while counselling and monitoring, restricting advertisement on infant formula and granting maternity leave for breastfeeding mothers were identified as factors that can facilitate the practice of exclusive breastfeeding. Conclusion Different levels of experience affect and shape exclusive breastfeeding practice in Ghana. The decision to practice exclusive breastfeeding, as well as the challenges and strategies employed in managing exclusive breastfeeding, emanates from mothers’ personal experiences and interactions with institutional factors. In view of this, there should be counselling on the management of challenges associated with exclusive breastfeeding and provision of accurate information on exclusive breastfeeding to enable mothers practice exclusive breastfeeding. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00462-z.
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Affiliation(s)
- Martin Wiredu Agyekum
- Institute for Educational Research and Innovation Studies, University of Education, Winneba, P. O. Box 25, Winneba, Ghana. .,Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon-Accra, Ghana.
| | - Samuel N A Codjoe
- Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon-Accra, Ghana
| | - Fidelia A A Dake
- Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon-Accra, Ghana
| | - Mumuni Abu
- Regional Institute for Population Studies, University of Ghana, P. O. Box LG 96, Legon-Accra, Ghana
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19
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Griffin S, Watt J, Wedekind S, Bramer S, Hazemi-Jebelli Y, Boyle R, Weaver G, Shenker NS. Establishing a novel community-focussed lactation support service: a descriptive case series. Int Breastfeed J 2022; 17:7. [PMID: 35033128 PMCID: PMC8760776 DOI: 10.1186/s13006-021-00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Although breastfeeding is widely acknowledged as protecting both infant and maternal health postnatally, a partial or complete shortfall of maternal milk can occur for a range of reasons. In this eventuality, the currently available options for feeding infants are screened donor human milk (DHM), infant formula or unscreened shared human milk. In the UK, DHM has only been widely available in specific clinical contexts for the last 40 years, mainly to reduce the risk of necrotising enterocolitis in extremely preterm infants alongside optimal support for maternal lactation and breastfeeding. The Hearts Milk Bank (HMB) was established in 2017 as an independent, non-profit human milk bank that aimed to ensure equitable, assured access to screened DHM for neonatal units. As a result of the generosity of mothers, a surplus of DHM rapidly became available and together with lactation support, has since been provided to families with a healthcare referral. This programme has now been formalised for families facing lactational challenges, and DHM stocks are permanently maintained to meet their needs. Case series This case series describes the clinical paths of four families who accessed lactation support and DHM from the HMB, along with a description of the process for community provision. To date, the HMB has supported over 300 families. Working collaboratively with key stakeholders, the HMB team has developed a prioritisation strategy based on utilitarian ethical models, protocols that ensure safe handling and appropriateness of use, broader donor recruitment parameters that maintain safety with a pragmatic approach for full term healthy infants, and a process to ensure parents or carers have access to the knowledge needed to give informed consent and use DHM appropriately. Conclusions Stakeholders, including parents, healthcare professionals, and milk banks, will need to discuss priorities for both DHM use and research gaps that can underpin the equitable expansion of services, in partnership with National Health Service (NHS) teams and third-sector organisations that support breastfeeding and maternal mental health.
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Affiliation(s)
- Samantha Griffin
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK
| | - Jo Watt
- The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK
| | - Sophie Wedekind
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK
| | - Solange Bramer
- Imperial College London Medical School, St Mary's Hospital, London, W2 1NY, UK
| | | | - Robert Boyle
- Department of Paediatrics, Imperial College London, St Mary's Hospital, London, W2 1NY, UK
| | - Gillian Weaver
- The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK
| | - Natalie S Shenker
- Department of Surgery and Cancer, Imperial College London, England, W12 0HS, UK. .,The Human Milk Foundation, Rothamsted Institute, Hertfordshire, AL5 2JQ, UK.
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20
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Hadi H, Fatimatasari F, Irwanti W, Kusuma C, Alfiana RD, Asshiddiqi MIN, Nugroho S, Lewis EC, Gittelsohn J. Exclusive Breastfeeding Protects Young Children from Stunting in a Low-Income Population: A Study from Eastern Indonesia. Nutrients 2021; 13:4264. [PMID: 34959815 PMCID: PMC8706015 DOI: 10.3390/nu13124264] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022] Open
Abstract
The prevalence of stunting in young Indonesian children is the highest among countries belonging to the Association of Southeast Asian Nations (ASEAN). Breastfed children are reported to grow better than non-breastfed. The present study examined the protective effect of exclusive breastfeeding against stunting in children under two years old (CU2) and its interaction with monthly household expenditure. Secondary analyses were conducted based on a 2012 cross-sectional study including 408 children aged 6-24 months and their caregivers from 14 villages in rural Eastern Indonesia. Data on breastfeeding history, childcare, and household expenditures were collected using structured questionnaires. Focus Group Discussions (FGDs) were conducted in each village (n = 14). Nearly two-thirds (61%) of caregivers who identified as the biological mother exclusively breastfed their child at 6 months. Exclusively-breastfed CU2 from poorer households were 20% less likely to be stunted than their non-exclusively-breastfed peers. Further, exclusively-breastfed CU2 from wealthier households were 50% less likely to be stunted than non-exclusively-breastfed CU2 from poorer households. FGDs revealed that some mothers were unaware of the importance of recommended breastfeeding practices. Exclusive breastfeeding may protect low-income children against stunting. Health promotion to improve caregiver motivation to exclusively breastfeed is critical in the present setting and beyond.
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Affiliation(s)
- Hamam Hadi
- Alma Ata Graduate School of Public Health, the University of Alma Ata, Yogyakarta 55183, Indonesia; (C.K.); (S.N.)
- Alma Ata Center for Healthy Life and Foods (ACHEAF), the University of Alma Ata, Yogyakarta 55183, Indonesia
| | - Fatimatasari Fatimatasari
- Department of Midwifery, Faculty of Health Sciences, the University of Alma Ata, Yogyakarta 55183, Indonesia; (F.F.); (R.D.A.)
| | - Winda Irwanti
- Department of Nutrition, Faculty of Health Sciences, The University of Alma Ata, Yogyakarta 55183, Indonesia;
| | - Chahya Kusuma
- Alma Ata Graduate School of Public Health, the University of Alma Ata, Yogyakarta 55183, Indonesia; (C.K.); (S.N.)
| | - Ratih Devi Alfiana
- Department of Midwifery, Faculty of Health Sciences, the University of Alma Ata, Yogyakarta 55183, Indonesia; (F.F.); (R.D.A.)
| | - M. Ischaq Nabil Asshiddiqi
- Department of Nursing, Faculty of Health Sciences, the University of Alma Ata, Yogyakarta 55183, Indonesia;
| | - Sigit Nugroho
- Alma Ata Graduate School of Public Health, the University of Alma Ata, Yogyakarta 55183, Indonesia; (C.K.); (S.N.)
| | - Emma Clare Lewis
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (E.C.L.); (J.G.)
| | - Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (E.C.L.); (J.G.)
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21
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Truva T, Valasoulis G, Pouliakis A, Gkorezi-Ntavela I, Pappa D, Bargiota A, Garas A, Grivea I, Daponte A. The Effect of a Structured Individualized Educational Intervention on Breastfeeding Rates in Greek Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11359. [PMID: 34769876 PMCID: PMC8582789 DOI: 10.3390/ijerph182111359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/06/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Breastfeeding rates remain extremely low in Greece and women with gestational diabetes mellitus and hypothyroidism may experience additional difficulties. The aim of the study was to investigate the effect of a structured individualized lactation educational intervention by a midwife on increasing breastfeeding rates in women with endocrine disorders and low-risk women compared to women receiving standard care, 24 months after delivery. Two-hundred women made up the study population. Half of them were experiencing endocrine pregnancy disorders and 100 women constituted the low-risk pregnancy standard care control group. Women who were breastfeeding exclusively were significantly higher in the midwifery intervention group with endocrine disorders, namely breastfeeding continued at four months (breastfeeding: 20% vs. 12%, exclusive breastfeeding: 50% vs. 26%, p = 0.0228), and at six months after childbirth (breastfeeding: 54% vs. 28%, exclusive breastfeeding: 32% vs. 12%, p = 0.0011), compared to the standard care control group with endocrine disorder. The low-risk midwifery intervention group breastfed at four months (22% vs. 14%, p = 0.0428) and at six months (52% vs. 26%, p = 0.0018) at higher rates compared to the standard care control group. In addition, exclusive breastfeeding was significantly higher in the low-risk midwifery intervention group at four months (46% vs. 20%, p = 0.0102) and six months (38% vs. 4%, p < 0.0001) compared to the standard care control group. This study was the first attempt of a structured midwifery breastfeeding education in Greece and its major contribution reflects a significant positive impact on breastfeeding rates in terms of duration and exclusivity in women with gestational endocrine disorders as well as in low-risk women, and could possibly be applied and instituted in everyday clinical practice to increase the low breastfeeding rates in Greece.
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Affiliation(s)
- Theoni Truva
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
| | - George Valasoulis
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
- Hellenic National Public Health Organization—ECDC, 15123 Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, 12464 Athens, Greece;
| | - Irontianta Gkorezi-Ntavela
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
| | - Dimitra Pappa
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece; (D.P.); (A.B.)
| | - Alexandra Bargiota
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece; (D.P.); (A.B.)
| | - Antonios Garas
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
| | - Ioanna Grivea
- Department of Pediatrics, University of Thessaly, University Hospital of Larissa, 41334 Larissa, Greece;
| | - Alexandros Daponte
- Department of Obstetrics & Gynaecology, University Hospital of Larisa, 41334 Larisa, Greece; (G.V.); (I.G.-N.); (A.G.)
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22
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Associations between Prenatal Education, Breastfeeding and Autistic-Like Behaviors in Pre-Schoolers. CHILDREN-BASEL 2021; 8:children8020124. [PMID: 33572414 PMCID: PMC7916179 DOI: 10.3390/children8020124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022]
Abstract
This study aimed to investigate the association between prenatal education and autistic-like behaviors of preschoolers as well as the mediating role of breastfeeding in their associations. A cross-sectional study via a structured questionnaire was conducted with 67,578 preschool children and parents from Longhua District of Shenzhen, China. Hierarchical logistic regression models were performed to explore the associations between maternal participation in prenatal education and autistic-like behaviors in preschoolers, as well as the mediating effect of breastfeeding in the associations. After controlling for potential confounders, logistic regression analysis indicated that maternal participation in prenatal education could significantly increase the prevalence of breastfeeding, and the strength of the association was enhanced with the increase frequency of prenatal education visits (ORs ranging from 1.191 to 1.899). While both maternal participation in prenatal education (ORs ranging from 0.732 to 0.798) and breastfeeding (OR = 0.773) were significantly associated with the lower presence of autistic-like behaviors in preschoolers. The crossover analysis indicated that children with both maternal prenatal education and breastfeeding had the lower risk of presence of autistics-like behaviors (OR = 0.569). Furthermore, mediation analysis illustrated that breastfeeding mediated the association between maternal participation in prenatal education and the presence of autistic-like behaviors in preschoolers, with a mediating effect of approximately 14.3%. Our findings suggest that maternal participation in prenatal education is significantly associated with a decreased risk of autistic-like behaviors in preschool children through increased breastfeeding in the mothers who attended prenatal education.
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23
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Wang Y, You HX, Luo BR. Exploring the breastfeeding knowledge level and its influencing factors of pregnant women with gestational diabetes mellitus. BMC Pregnancy Childbirth 2020; 20:723. [PMID: 33228638 PMCID: PMC7685611 DOI: 10.1186/s12884-020-03430-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background Studies reveal that promoting the breastfeeding knowledge level help to improve breastfeeding behaviors. Promoting breastfeeding knowledge is a simple and economical way to increase breastfeeding rates. However, there are no studies focus on the level of breastfeeding knowledge and factors influencing the knowledge in women with gestational diabetes mellitus (GDM), which is defined as any degree of glucose tolerance impairment first diagnosed during pregnancy. Thus, the objectives of this study were to investigate the breastfeeding knowledge level of GDM pregnant women and explore factors influencing the knowledge level. Methods Cross-sectional survey and convenience sampling were conducted in this study. The sociodemographic characteristics, caregivers in pregnancy, knowledge source, breastfeeding status and breast status information of participants were collected. Breastfeeding Knowledge Scale was used to assess the breastfeeding knowledge level of pregnant women with GDM. Multiple linear regression was used to analyze the influence factors of breastfeeding knowledge level in this study. Results A total of 226 questionnaires were issued and finally 212 valid questionnaires were collected. Some misconceptions still existed (e.g. ‘breastfeeding cannot prevent your baby from being overweight’ and ‘it is advisable to breastfeed 3-4 times per day within 2-3 days after delivery’), although women with GDM had a good score of breastfeeding knowledge (mean score: 103.5 ± 10.4). Multiple linear regression analysis found that gestational age, family per capita monthly income, educational level, knowledge source were the independent protective factors for breastfeeding knowledge and minority nationality was the independent risk factor. The educational level had the greatest influence on the breastfeeding knowledge level of GDM pregnant women (β = 0.210, t = 2.978, P = 0.003). Conclusion GDM pregnant women with insufficient gestational age, low educational level, low family per capita monthly income and single access to knowledge should be included in the focus of health education on breastfeeding. In-depth and systematic health education should be conducted for pregnant women with GDM to improve their breastfeeding rate.
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Affiliation(s)
- Yan Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital /West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Hua-Xuan You
- Department of Reproductive Endocrinology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
| | - Bi-Ru Luo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China. .,Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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24
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Jacobson LT, Zackula RE, Lu K. Effectiveness of a Pilot Breastfeeding Educational Intervention Targeting High BMI Pregnant Women. Kans J Med 2020; 13:219-227. [PMID: 32952865 PMCID: PMC7497864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/12/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Overweight and obesity during pregnancy are associated with adverse health outcomes leading to increased maternal and neonatal morbidity and mortality. Women with a high body mass index (BMI) also experience low breastfeeding rates. There is limited evidence of effective educational programs that aim to improve length of breastfeeding among this population. The main objective of this pilot educational intervention was to determine knowledge and skills retention at six weeks after completion of a breastfeeding class. METHODS A two-hour breastfeeding class was offered during the second and third trimester of pregnancy targeting high BMI women. A longitudinal, survey study design was conducted using two data collection points. No comparator group was employed. RESULTS Baseline mean age of respondents was 26.6 years (SD = 5.7). Respondents who completed post-intervention surveys were largely white (69.2%) followed by Hispanic (15.4%) and non-Hispanic black (15.4%), some college (57.1%), earned less than $50,000/year (64.3%), had employer-provided insurance (53.8%), and did not receive WIC benefits (78.6%). Most respondents had a pre-pregnancy BMI category of overweight (28.6%) or obese (57.1%). The intervention appeared to have some impact on responses. The following were observed: an increased understanding that baby may be fussy in the evening hours and wants to nurse more often (p < 0.002), how to bring baby to the breast (p = 0.004), knowing what to do if breastfeeding hurts (p = 0.031), and knowing what to do when baby has trouble breastfeeding (p = 0.021). CONCLUSION Consistent with previous findings, all participants in our study reported increased knowledge to breastfeed. Thus, women's confidence to breastfeed their infant is enhanced through knowledge obtained from breastfeeding education. Additional studies are underway to assess breastfeeding behaviors.
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Affiliation(s)
- Lisette T. Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Rosalee E. Zackula
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Kelsey Lu
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
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25
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Hu L, Ding T, Hu J, Luo B. Promoting breastfeeding in Chinese women undergoing cesarean section based on the health belief model: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e20815. [PMID: 32664074 PMCID: PMC7360307 DOI: 10.1097/md.0000000000020815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The high rate of cesarean section is an important factor affecting breastfeeding in China. To improve the nation's current situation of breastfeeding, promoting breastfeeding in women undergoing cesarean section is essential. OBJECTIVE To explore the effects of health belief model-based interventions on breastfeeding knowledge, breastfeeding behaviors, and breastfeeding satisfaction of Chinese cesarean women. METHODS A total of 346 cesarean section women were enrolled in the randomized controlled trial conducted at a center in Chengdu, China, between July 1, 2018 and August 31, 2018. While the control group (n = 173) received conventional breastfeeding guidance only, the intervention group (n = 173) received additional interventions based on the health belief model. Questionnaires were distributed to assess breastfeeding knowledge, breastfeeding behavior, and breastfeeding satisfaction at discharge, 42 days postpartum, and 4 months postpartum, respectively. RESULTS At discharge from hospital, the breastfeeding knowledge score of the intervention group was higher than that of the control group (Z = -11.753, P < .001). The exclusive breastfeeding rates in the intervention group at the time of discharge, 42 days postpartum, and 4 months postpartum were 67.3%, 60.7%, and 52.9%, respectively, while those of the control group were 41.2%, 41.6%, and 40.4%, respectively. The differences were statistically significant (χ = 23.353, P < .001; χ = 11.853, P < .001; χ = 4.805, P = .03). The breastfeeding satisfaction of the intervention group was also higher than the control group at the time of discharge, 42 days postpartum and 4 months postpartum (t = 4.955, P < .001; t = 3.051, P = .002; Z = -3.801, P < .001). CONCLUSION The health belief model-based interventions can effectively increase breastfeeding knowledge for Chinese cesarean women and improve their breastfeeding behaviors and breastfeeding satisfaction within 4 months after delivery. CLINICAL TRIAL REGISTRATION ChiCTR1900026006 <http://www.chictr.org.cn/usercenter.aspx>.
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Affiliation(s)
- Lei Hu
- Department of Nursing, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
- West China Nursing College, Sichuan University, Chengdu, Sichuan
| | - Tingting Ding
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Juan Hu
- Department of Nursing, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
| | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education
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