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Namuddu MG, Mukunya D, Nakibuuka V, Amulen E, Nantale R, Kiguli J. "It's just like a blood transfusion": perceptions on the use of donated breast milk in selected hospitals in central Uganda: a qualitative study. BMC Public Health 2023; 23:901. [PMID: 37193959 DOI: 10.1186/s12889-023-15648-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/10/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Breast milk is crucial for the nutritional and developmental milestones in the first two years of life. Uganda has recognized the need for a human milk bank as an opportunity that offers reliable and healthy milk to babies who lack access to their mothers. However, there is little information on the perceptions towards donated breast milk in Uganda. This study aimed to explore the perceptions of mothers, fathers, and health workers on the use of donated breast milk at Nsambya and Naguru hospitals in Kampala district, central Uganda. METHODS A qualitative descriptive study was conducted at Nsambya and Naguru hospitals in central Uganda. The study consisted of 8 focus group discussions (FGDs) of 6 participants each and 19 key informant interviews (KIIs) among mothers, fathers, and health workers. Participants were purposively selected. Data collected were transcribed, translated from Luganda to English, and analyzed using thematic analysis. All data were organized and managed in Nvivo version 12.0. RESULTS A total of 67 participants were involved in the study. Two main themes were identified: positive perceptions and negative perceptions. Participants linked donated breast milk to blood transfusion, believed it had nutrients comparable to the biological mother's milk, and thought it was an opportunity to avoid formula or cow milk and help babies that cannot access breast milk. However, the notable negative perceptions were; the feeling that donated breast milk is disgusting, could result in acquiring non-parental genes and traits, and that it was unsafe. Participants also feared that donated breast milk could be expensive and affect the bond between mother and child. CONCLUSION In summary, participants had positive perceptions about donated breast milk but were concerned about the potential side effects. Health workers should take extra precautions to ensure that donated breast milk is safe. The development of appropriate information and communication programs to sensitize the public about the benefits of donated breast milk will improve the uptake. Further research should focus on understanding the social-cultural beliefs regarding donated breast milk.
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Affiliation(s)
- Mary Gorreth Namuddu
- School of Public Health, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Faculty of Health Sciences, P.O. Box 1460, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Victoria Nakibuuka
- Department of Paediatrics, Nsambya Hospital, P.O. Box 7146, Kampala, Uganda
| | - Esther Amulen
- School of Public Health, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University, Faculty of Health Sciences, P.O. Box 1460, Mbale, Uganda
| | - Juliet Kiguli
- School of Public Health, Makerere University, College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Lian W, Ding J, Xiong T, Liuding J, Nie L. Determinants of delayed onset of lactogenesis II among women who delivered via Cesarean section at a tertiary hospital in China: a prospective cohort study. Int Breastfeed J 2022; 17:81. [PMID: 36451171 PMCID: PMC9714018 DOI: 10.1186/s13006-022-00523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cesarean birth is associated with a higher prevalence of delayed onset of lactogenesis II (DOLII) than vaginal birth. DOLII refers to the delayed initiation of copious milk production beyond 72 h after birth. This study aimed to determine the prevalence of, and factors associated with, DOLII among women who delivered via Cesarean section in China. METHODS This prospective longitudinal cohort study recruited 468 women who delivered via Cesarean section at a tertiary hospital in China from 9 October 2021 to 17 May 2022. Face-to-face interviews were conducted during their delivery hospital stay to obtain information about demographic, medical, and breastfeeding factors. We assessed the onset of lactogenesis on postpartum day four, based on the maternal perception of changes in breast fullness. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postpartum depression. Women with DOLII were interviewed via telephone or WeChat daily for one week postpartum to determine the timing of the onset of lactogenesis II. Univariate and multivariable logistic regression analyses were used to identify the determinants of DOLII. RESULTS DOLII was experienced by 156 of 468 participants (33.3%). After adjusting for potential confounders, the odds of DOLII were 95% higher in primiparous women than multiparous women (adjusted odds ratio [aOR] 1.95; 95% confidence interval [CI] 1.29, 2.98), 75% higher in women with a serum albumin concentration < 35 g / L than women with normal serum albumin concentrations (aOR 1.78; 95% CI 1.09, 2.99), increased by 2.03-fold in women with an EPDS score ≥ 10 than women with an EPDS score < 10 (aOR 2.03; 95% CI 1.35, 3.07), and decreased in women with a higher number of breastfeeding sessions in the first 48 h postpartum (aOR 0.88; 95% CI 0.83, 0.93). CONCLUSIONS One-third of women with Cesarean section delivery experienced DOLII. DOLII was more likely in women who were primiparous, had a serum albumin concentration < 35 g / L, had a lower frequency of breastfeeding sessions, and had an EPDS score ≥ 10. Women with these risk factors who deliver via Cesarean section may need early breastfeeding support to ensure successful lactation.
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Affiliation(s)
- Weining Lian
- grid.412633.10000 0004 1799 0733Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
| | - Juan Ding
- grid.412633.10000 0004 1799 0733Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
| | - Tiantian Xiong
- grid.207374.50000 0001 2189 3846Medical College of Zhengzhou University, 40 Daxue Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
| | - Jiandi Liuding
- grid.41156.370000 0001 2314 964XSchool of Traditional Chinese Medicine of Nanjing University, 282 Hanzhong Road, Nanjing City, 210029 Jiangsu Province China
| | - LinTao Nie
- grid.412633.10000 0004 1799 0733Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
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Segura‐Pérez S, Richter L, Rhodes EC, Hromi‐Fiedler A, Vilar‐Compte M, Adnew M, Nyhan K, Pérez‐Escamilla R. Risk factors for self‐reported insufficient milk during the first 6 months of life: A systematic review. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13353. [PMID: 35343065 PMCID: PMC9113468 DOI: 10.1111/mcn.13353] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/22/2022]
Abstract
The objective of this systematic review was to identify multifactorial risk factors for self‐reported insufficient milk (SRIM) and delayed onset of lactation (DOL). The review protocol was registered a priori in PROSPERO (ID# CDR42021240413). Of the 120 studies included (98 on SRIM, 18 on DOL, and 4 both), 37 (31%) studies were conducted in North America, followed by 26 (21.6%) in Europe, 25 (21%) in East Asia, and Pacific, 15 (12.5%) in Latin America and the Caribbean, 7 (6%) in the Middle East and North Africa, 5 (4%) in South Asia, 3 (2.5%) in Sub‐Saharan Africa, and 2 (1.7%) included multiple countries. A total of 79 studies were from high‐income countries, 30 from upper‐middle‐income, 10 from low‐middle‐income countries, and one study was conducted in a high‐income and an upper‐middle‐income country. Findings indicated that DOL increased the risk of SRIM. Protective factors identified for DOL and SRIM were hospital practices, such as timely breastfeeding (BF) initiation, avoiding in‐hospital commercial milk formula supplementation, and BF counselling/support. By contrast, maternal overweight/obesity, caesarean section, and poor maternal physical and mental health were risk factors for DOL and SRIM. SRIM was associated with primiparity, the mother's interpretation of the baby's fussiness or crying, and low maternal BF self‐efficacy. Biomedical factors including epidural anaesthesia and prolonged stage II labour were associated with DOL. Thus, to protect against SRIM and DOL it is key to prevent unnecessary caesarean sections, implement the Baby‐Friendly Ten Steps at maternity facilities, and provide BF counselling that includes baby behaviours. Socioeconomic and demographic factors indicative of lower economic status increased the risk of self‐reported insufficient milk (SRIM) and delayed onset of lactation (DOL). Timely breastfeeding (BF) initiation and avoidance of in‐hospital commercial milk formula (CMF) supplementation are likely to reduce the prevalence of SRIM and DOL. BF counselling designed to prevent SRIM and DOL needs to strengthen maternal BF self‐efficacy, maternal understanding of baby behaviours such as fussiness and maternal wellbeing. Research is needed to better understand how the risk of DOL and SRIM increases with primiparity, caesarean sections, maternal overweight/obesity, and poor overall maternal health. Intervention studies specifically designed to reduce the risk of SRIM and DOL are urgently needed in low‐ and middle‐income countries.
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Affiliation(s)
- Sofia Segura‐Pérez
- Community Nutrition Unit Hispanic Health Council Hartford Connecticut USA
| | - Linda Richter
- DSI‐NRF Centre of Excellence in Human Development University of the Witwatersrand, Office 154 School of Public Health Johannesburg South Africa
| | - Elizabeth C. Rhodes
- Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
| | - Amber Hromi‐Fiedler
- Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
| | - Mireya Vilar‐Compte
- Department of Public Health Montclair State University Montclair New Jersey USA
| | - Misikir Adnew
- Department of Health Policy and Management Yale School of Public Health New Haven Connecticut USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library Yale University New Haven Connecticut USA
| | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral Sciences Yale School of Public Health New Haven Connecticut USA
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Martin M, Keith M, Olmedo S, Edwards D, Barrientes A, Pan A, Valeggia C. Cesarean section and breastfeeding outcomes in an Indigenous Qom community with high breastfeeding support. Evol Med Public Health 2022; 10:36-46. [PMID: 35154778 PMCID: PMC8830290 DOI: 10.1093/emph/eoab045] [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: 05/07/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cesarean section may lead to suboptimal breastfeeding outcomes, though evidence has been mixed. Factors, such as premature birth, birth weight and maternal age may independently increase risk of cesarean and hinder breastfeeding initiation, while maternal preferences, support and sociostructural barriers may influence breastfeeding practices beyond the immediate postpartum period. METHODOLOGY We assessed impacts of cesarean section and gestational factors on breastfeeding duration among Indigenous Qom mothers in Argentina who have strong traditional breastfeeding support. We modeled transitions from exclusive breastfeeding to complementary feeding and from complementary feeding to full weaning in a Bayesian time-to-event framework with birth mode and gestational covariates (n = 89 infants). RESULTS Estimated median time to full weaning was 30 months. Cesarean-delivered babies were weaned an average of 5 months later adjusting for gestational age, maternal parity and infant sex. No factors were associated with time-to-complementary feeding, and time-to-complementary feeding was not associated with time-to-full weaning. CONCLUSIONS AND IMPLICATIONS Among Indigenous Qom mothers in Argentina, cesarean section was not associated with suboptimal breastfeeding outcomes. Although some Qom mothers do experience early breastfeeding problems, particularly following first birth, problems are not more frequent following cesarean delivery. Traditional postpartum kin and community support during prolonged postpartum periods may be instrumental in helping mothers to overcome early breastfeeding problems due to cesarean or other risk factors.
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Affiliation(s)
- Melanie Martin
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100, USA,Corresponding author. Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100, USA. Tel: +1 206-616-7701; E-mail:
| | - Monica Keith
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100, USA
| | - Sofía Olmedo
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad (CIECS-CONICET), Universidad Nacional de Cordoba, AV. Valparaiso S/N. Ciudad Universitaria, Cordoba, Argentina
| | - Deja Edwards
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100, USA
| | - Alicia Barrientes
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100, USA
| | - Anwesha Pan
- Department of Anthropology, University of Washington, 314 Denny Hall, Box 353100, Seattle, WA 98195-3100, USA
| | - Claudia Valeggia
- Department of Anthropology, Yale University, P.O. Box 208277, New Haven, CT 06520-8277, USA
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Mohebati LM, Hilpert P, Bath S, Rayman MP, Raats MM, Martinez H, Caulfield LE. Perceived insufficient milk among primiparous, fully breastfeeding women: Is infant crying important? MATERNAL AND CHILD NUTRITION 2021; 17:e13133. [PMID: 33399268 PMCID: PMC8189230 DOI: 10.1111/mcn.13133] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/03/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
Breastfeeding mothers often report perceived insufficient milk (PIM) believing their infant is crying too much, which leads to introducing formula and the early abandonment of breastfeeding. We sought to determine if infant crying was associated with reported PIM (yes/no) and number of problems associated with lactation (lactation problem score [LPS] 6-point Likert scale) before formula introduction. Primiparous breastfeeding mothers were recruited at birth and visited at 1, 2 and 4 weeks. Among those fully breastfeeding at 1 week (N = 230), infant crying variables based on maternal reports were not associated with PIM at 1 week, but LPS was. However, a mother's expectation that her infant would cry more than other infants was associated with increased odds of reporting PIM at 2 and 4 weeks, as were delayed onset of lactation and previous LPS. At 1 week, crying variables (frequency, difficulty in soothing) were associated with LPS along with percent weight change. Delayed onset of lactation, infant care style, number of breastfeeds and previous LPS were longitudinally associated with change in LPS from 1 to 2 weeks and 2 to 4 weeks. Our data suggest that reported infant crying is associated with PIM and LPS in the first 4 weeks of life. Guidance on what to expect in crying behaviour and the impact of infant care style may be beneficial in reducing PIM and LPS in the first month.
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Affiliation(s)
- Lisa M Mohebati
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Nutrition, Food and Exercise Sciences Department, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, UK.,Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, Surrey, UK
| | - Peter Hilpert
- School of Psychology, University of Surrey, Guildford, Surrey, UK
| | - Sarah Bath
- Nutrition, Food and Exercise Sciences Department, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, UK
| | - Margaret P Rayman
- Nutrition, Food and Exercise Sciences Department, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, UK
| | - Monique M Raats
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, Surrey, UK
| | - Homero Martinez
- NTEAM, Nutrition International, Ottawa, Ontario, Canada.,Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Laura E Caulfield
- Center for Human Nutrition, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Casey T, Sun H, Burgess HJ, Crodian J, Dowden S, Cummings S, Plaut K, Haas D, Zhang L, Ahmed A. Delayed Lactogenesis II is Associated With Lower Sleep Efficiency and Greater Variation in Nightly Sleep Duration in the Third Trimester. J Hum Lact 2019; 35:713-724. [PMID: 30920856 DOI: 10.1177/0890334419830991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Metabolic and hormonal disturbances are associated with sleep disturbances and delayed onset of lactogenesis II. RESEARCH AIMS The aim of this study was to measure sleep using wrist actigraphy during gestation weeks 22 and 32 to determine if sleep characteristics were associated with blood glucose, body mass index, gestational related disease, delayed onset of lactogenesis II, or work schedule. METHODS Demographic data were collected at study intake from primiparous women who wore a wrist actigraph during gestation weeks 22 (n = 50) and 32 (n = 44). Start and end sleep time, total nighttime sleep, sleep efficiency, wake after sleep onset, and sleep fragmentation were measured. Night to night variability was assessed with the root mean square of successive difference. Blood glucose levels, body mass index, and gestational disease data were abstracted from medical charts. Timing of lactogenesis II was determined by survey. RESULTS Between gestation week 22 and 32, sleep efficiency decreased and fragmentation increased (p < .05). During gestation week 32, blood glucose was negatively correlated with sleep duration, and positively related to fragmentation (p < .05). Women who experienced delayed lactogenesis II had lower sleep efficiency and greater fragmentation (p < .05), and greater night-to-night variability in sleep start and end time, efficiency, and duration during gestation week 32 (p < .05). CONCLUSION Women with better sleep efficiency and more stable nightly sleep time are less likely to experience delayed onset of lactogenesis II. Interventions to improve sleep may improve maternal health and breastfeeding adequacy.
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Affiliation(s)
- Theresa Casey
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - Hui Sun
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Helen J Burgess
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jennifer Crodian
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - Shelley Dowden
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Shelby Cummings
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - Karen Plaut
- Department of Animal Sciences, Purdue University, West Lafayette, IN, USA
| | - David Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN, USA
| | - Lingsong Zhang
- Department of Statistics, Purdue University, West Lafayette, IN, USA.,Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
| | - Azza Ahmed
- School of Nursing, Purdue University, West Lafayette, IN, USA
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Pérez-Escamilla R, Buccini GS, Segura-Pérez S, Piwoz E. Perspective: Should Exclusive Breastfeeding Still Be Recommended for 6 Months? Adv Nutr 2019; 10:931-943. [PMID: 31147672 PMCID: PMC6855974 DOI: 10.1093/advances/nmz039] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The WHO recommends exclusive breastfeeding of infants for the first 6 mo of life (EBF-6). We reviewed the evidence behind concerns related to this recommendation. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. At the moment there is no population-level evidence indicating that exclusive breastfeeding for 6 mo compared with <6 mo increases the risk of developing food allergies. Mild to moderate maternal undernutrition may reduce amounts of some nutrients in breast milk but does not directly diminish milk volume. Persistent reports of insufficient milk by women globally are likely to be the result of lack of access to timely lactation counseling and social support rather than primary biological reasons. All newborns should have their growth, hydration status, and development carefully monitored. In instances where formula supplementation is required, it should be done under the guidance of a qualified provider taking into account that early introduction of breast-milk supplements is a risk factor for early termination of exclusive breastfeeding and any breastfeeding. We found no evidence to support changes to the EBF-6 public health recommendation, although variability in inter-infant developmental readiness is recognized. We suggest that infant and young feeding guidelines make clear that complementary foods should be introduced at around 6 mo of age, taking infant developmental readiness into account.
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Affiliation(s)
| | | | | | - Ellen Piwoz
- Bill & Melinda Gates Foundation, Seattle, WA
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Lau Y, Tha PH, Ho-Lim SST, Wong LY, Lim PI, Citra Nurfarah BZM, Shorey S. An analysis of the effects of intrapartum factors, neonatal characteristics, and skin-to-skin contact on early breastfeeding initiation. MATERNAL AND CHILD NUTRITION 2017; 14. [PMID: 28799193 DOI: 10.1111/mcn.12492] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022]
Abstract
This study aims to determine relationships between intrapartum factors, neonatal characteristics, skin-to-skin contact (SSC), and early breastfeeding initiation after spontaneous vaginal and Caesarean section or operative vaginal birth. A total of 915 mother-newborn dyads were considered in a hypothetical model based on integrated concepts of breastfeeding initiation model, infant learning framework, and attachment theory. Multiple-group path analysis was used to determine whether differences exist between effects of immediate SSC (≤30 min) on early breastfeeding initiation in different modes of birth. SSC, mode of birth, labour duration, and neonatal intensive care unit admission were significantly associated with early breastfeeding initiation, as indicated by the path analysis model, which included all samples. Women with immediate SSC were more likely to initiate early breastfeeding in different modes of birth. In the spontaneous vaginal birth group, women showed a lower likelihood of initiating early breastfeeding when their neonates were admitted to the neonatal intensive care unit and presented an Apgar score of <7 at 1 min. Multiple-group analysis showed no significant difference between effects of immediate SSC on early breastfeeding initiation in different modes of birth (critical ratio = -0.309). Results showed that models satisfactorily fitted the data (minimum discrepancy divided by degrees of freedom = 1.466-1.943, goodness of fit index = 0.981-0.986, comparative fit index = 0.947-0.955, and root mean square error of approximation = 0.023-0.032). Our findings emphasize the crucial importance of prioritizing promotion of immediate SSC under different modes of birth.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pyai Htun Tha
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Lai Ying Wong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Peng Im Lim
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Nommsen-Rivers LA. Does Insulin Explain the Relation between Maternal Obesity and Poor Lactation Outcomes? An Overview of the Literature. Adv Nutr 2016; 7:407-14. [PMID: 26980825 PMCID: PMC4785481 DOI: 10.3945/an.115.011007] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
It is well established that obese women are at increased risk of delayed lactogenesis and short breastfeeding duration, but the underlying causal contributors remain unclear. This review summarizes the literature examining the role of insulin in lactation outcomes. Maternal obesity is a strong risk factor for insulin resistance and prediabetes, but until recently a direct role for insulin in milk production had not been elucidated. Over the past 6 y, studies in both animal models and humans have shown insulin-sensitive gene expression to be dramatically upregulated specifically during the lactation cycle. Insulin is now considered to play a direct role in lactation, including essential roles in secretory differentiation, secretory activation, and mature milk production. At the same time, emerging clinical research suggests an important association between suboptimal glucose tolerance and lactation difficulty. To develop effective interventions to support lactation success in obese women further research is needed to identify how, when, and for whom maternal insulin secretion and sensitivity affect lactation ability.
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Affiliation(s)
- Laurie A Nommsen-Rivers
- Division of Neonatology/Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Saidi L, Godbout P. Étude de deux indicateurs de difficulté de mise en place de l’allaitement maternel : la fatigue maternelle et le comportement non optimal du bébé au sein. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.125.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Matias SL, Dewey KG, Quesenberry CP, Gunderson EP. Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Am J Clin Nutr 2014; 99:115-21. [PMID: 24196401 PMCID: PMC3862450 DOI: 10.3945/ajcn.113.073049] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The timely onset of stage II lactogenesis (OL) is important for successful breastfeeding and newborn health. Several risk factors for delayed OL are common in women with a history of gestational diabetes mellitus (GDM), which may affect their chances for successful breastfeeding outcomes. OBJECTIVE We investigated the prevalence and risk factors associated with delayed OL in a racially and ethnically diverse cohort of postpartum women with recent GDM. DESIGN We analyzed data collected in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT), which is a prospective cohort of women diagnosed with GDM who delivered at Kaiser Permanente Northern California hospitals from 2008 to 2011. At 6-9 wk postpartum, delayed OL was assessed by maternal report of breast fullness and defined as occurring after 72 h postpartum. We obtained data on prenatal course and postdelivery infant feeding practices from electronic medical records and in-person surveys. We used multivariable logistic regression models to estimate associations of delayed OL with prenatal, delivery, and postnatal characteristics. RESULTS The analysis included 883 SWIFT participants who initiated breastfeeding and did not have diabetes at 6-9 wk postpartum. Delayed OL was reported by 33% of women and was associated with prepregnancy obesity (OR: 1.56; 95% CI: 1.07, 2.29), older maternal age (OR: 1.05; 95% CI: 1.01, 1.08), insulin GDM treatment (OR: 3.11; 95% CI: 1.37, 7.05), and suboptimal in-hospital breastfeeding (OR: 1.65; 95% CI: 1.20, 2.26). A higher gestational age was associated with decreased odds of delayed OL but only in multiparous mothers (OR: 0.79; 95% CI: 0.67, 0.94). CONCLUSIONS One-third of women with recent GDM experienced delayed OL. Maternal obesity, insulin treatment, and suboptimal in-hospital breastfeeding were key risk factors for delayed OL. Early breastfeeding support for GDM women with these risk factors may be needed to ensure successful lactation. This trial was registered at clinicaltrials.gov as NCT01967030.
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Affiliation(s)
- Susana L Matias
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (SLM, CPQ, and EPG), and the Department of Nutrition, University of California, Davis, Davis, CA (SLM and KGD)
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12
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Brownell E, Howard CR, Lawrence RA, Dozier AM. Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding. J Pediatr 2012; 161:608-14. [PMID: 22575242 PMCID: PMC3670592 DOI: 10.1016/j.jpeds.2012.03.035] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 03/05/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between delayed lactogenesis II (>3 days postpartum; delayed onset lactogenesis II [DLII]) and the cessation of any and exclusive breastfeeding at 4-weeks postpartum. STUDY DESIGN We constructed multivariable logistic regression models using data from 2491 mothers enrolled in the prospective Infant Feeding Practice Study II cohort. Models included DLII, known risk factors for breastfeeding cessation (age, education, race, parity/previous breastfeeding, and exclusive breastfeeding plan), and potential confounders identified in bivariate analyses (P ≤ .1). Backward selection processes (P ≤ .1) determined risk factor retention in the final model. RESULTS DLII was associated with cessation of any and exclusive breastfeeding at 4-weeks postpartum (OR 1.62; CI 1.14-2.31; OR 1.62; CI 1.18-2.22, respectively); numerous independent risk factors qualified for inclusion in the multivariable model(s) and were associated with the outcome(s) of interest (eg, supplemental nutrition program for women, infants, and children enrollment, onset of prenatal care, feeding on-demand, time initiated first breastfeed, hospital rooming-in, obstetric provider preference for exclusive breastfeeding, and maternal tobacco use). CONCLUSIONS Women experiencing DLII may be less able to sustain any and/or exclusive breastfeeding in the early postpartum period. Routine assessment of DLII in postpartum breastfeeding follow-up is warranted. Women with DLII may benefit from additional early postpartum interventions to support favorable breastfeeding outcomes.
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Affiliation(s)
- Elizabeth Brownell
- Department of Research, Connecticut Children's Medical Center, Hartford, CT 06106, USA.
| | - Cynthia R. Howard
- Rochester General Hospital, and Departments of Pediatrics and Community and Preventive Medicine, University of Rochester
| | - Ruth A. Lawrence
- Departments of Pediatrics and Obstetrics and Gynecology, University of Rochester
| | - Ann M. Dozier
- Department of Community and Preventive Medicine, University of Rochester
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Galipeau R, Goulet C, Chagnon M. Infant and maternal factors influencing breastmilk sodium among primiparous mothers. Breastfeed Med 2012; 7:290-4. [PMID: 22612625 PMCID: PMC3411346 DOI: 10.1089/bfm.2011.0022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study identified birth events and infant/maternal factors related to breastmilk sodium (Na+) among primiparous mothers. SUBJECTS AND METHODS Data were collected in a larger study on perceived insufficient milk among 252 breastfeeding mothers at a Canadian, French-speaking university maternal care center. Birth events and infant and maternal factors were collected at 48 hours, 2 weeks, and 6 weeks after birth and were analyzed with bivariate and regression analysis. RESULTS Presence of gestational diabetes increases the risk of an elevated breastmilk Na+ level at 48 hours, and increased number of breastfeeds (mean=8.91, SD=3.77) lowers it, indicating lactogenesis II was initiated. CONCLUSIONS Breastfeeding frequency impacts initiation of lactogenesis II, which in turn influences duration of breastfeeding exclusivity. Therefore feedings should be promoted as soon as possible after birth and as frequently as eight to 12 times a day.
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Affiliation(s)
- Roseline Galipeau
- Nursing Department, University of Quebec in Outaouais, Gatineau, Québec, Canada.
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14
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Nommsen-Rivers LA, Dolan LM, Huang B. Timing of stage II lactogenesis is predicted by antenatal metabolic health in a cohort of primiparas. Breastfeed Med 2012; 7:43-9. [PMID: 21524193 PMCID: PMC3546359 DOI: 10.1089/bfm.2011.0007] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Time to onset of stage II lactogenesis varies widely, and delayed onset of lactogenesis (OL) is common among first-time mothers in the United States. Higher body mass index, older age, and larger infant birth weight are identified risk factors for delayed OL; all are known correlates with glucose metabolism. Our objective was to prenatally assess maternal biomarkers related to metabolic health and determine the extent to which these biomarkers predict timing of OL. METHODS We enrolled a population-based sample of expectant primiparas attending a single prenatal clinic. We obtained a blood sample 1-hour post-glucose load from an antenatal oral glucose challenge test and assayed for the following biomarkers: serum insulin, glucose, adiponectin, leptin, C-reactive protein, interleukin-6, resistin, and tumor necrosis factor-α. Our outcome measure was timing of OL, based on maternal report at 3-5 days postpartum. We used linear regression to model OL hour. RESULTS Twenty-six of 29 (90%) agreed to screening, 18 delivered at term and initiated breastfeeding, and 16 have complete data. Median (minimum-maximum) postpartum body mass index was 27.4 (21.8-34.7) kg/m(2), and median time to OL was 64 (10-121) hours. The model, OL = 232 - 34.9(ln[ratio insulin/glucose]) - 1.4(adiponectin), explained 56% of the variation in OL hour (p = 0.005) and was not weakened by potential confounders. CONCLUSIONS Higher serum insulin secretion relative to serum glucose after a glucose challenge and higher serum adiponectin are associated with earlier onset of OL. These findings suggest that factors associated with better glucose tolerance predict earlier OL.
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Affiliation(s)
- Laurie A Nommsen-Rivers
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA
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