1
|
Elliott HR, Bennett CL, Caramaschi D, English S. Negative association between higher maternal pre-pregnancy body mass index and breastfeeding outcomes is not mediated by DNA methylation. Sci Rep 2024; 14:14675. [PMID: 38918574 PMCID: PMC11199553 DOI: 10.1038/s41598-024-65605-0] [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: 11/03/2023] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
The benefits of breastfeeding for the health and wellbeing of both infants and mothers are well documented, yet global breastfeeding rates are low. One factor associated with low breast feeding is maternal body mass index (BMI), which is used as a measure of obesity. The negative relationship between maternal obesity and breastfeeding is likely caused by a variety of social, psychological, and physiological factors. Maternal obesity may also have a direct biological association with breastfeeding through changes in maternal DNA methylation. Here, we investigate this potential biological association using data from a UK-based cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). We find that pre-pregnancy body mass index (BMI) is associated with lower initiation to breastfeed and shorter breastfeeding duration. We conduct epigenome-wide association studies (EWAS) of pre-pregnancy BMI and breastfeeding outcomes, and run candidate-gene analysis of methylation sites associated with BMI identified via previous meta-EWAS. We find that DNA methylation at cg11453712, annotated to PHTP1, is associated with pre-pregnancy BMI. From our results, neither this association nor those at candidate-gene sites are likely to mediate the link between pre-pregnancy BMI and breastfeeding.
Collapse
Affiliation(s)
- Hannah R Elliott
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Chloe L Bennett
- School of Biological Sciences, University of Bristol, Bristol, UK
| | - Doretta Caramaschi
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Faculty of Health and Life Sciences, Department of Psychology, University of Exeter, Exeter, UK
| | - Sinead English
- School of Biological Sciences, University of Bristol, Bristol, UK.
| |
Collapse
|
2
|
Call CC, Hawkins MS, Shah VK, Frank D, Niemi S, Jouppi RJ, Ferguson E, Conlon RPK, Levine MD. A longitudinal investigation of breastfeeding planning, initiation, and duration among individuals with pre-pregnancy overweight or obesity. Appetite 2024; 197:107333. [PMID: 38570117 PMCID: PMC11104448 DOI: 10.1016/j.appet.2024.107333] [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: 11/22/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Individuals with a body mass index (BMI)≥25 kg/m2 are less likely to initiate and continue breastfeeding than are those with BMIs<25. Given the intergenerational health benefits of breastfeeding, it is important to understand breastfeeding behaviors and their correlates among individuals with BMIs≥25. Thus, in an observational cohort with BMI≥25 (N = 237), we aimed to characterize longitudinal relationships among breastfeeding planning, initiation, and duration and their sociodemographic/clinical correlates and determine if pre-pregnancy BMI predicts breastfeeding planning, initiation, and duration. Breastfeeding behaviors, weight/BMI, and sociodemographic/clinical characteristics were assessed in early, mid, and late pregnancy, and at six-months postpartum. Most participants planned to (84%) and initiated (81%) breastfeeding, of which 37% breastfed for ≥6 months. Participants who were married, first-time parents, higher in education/income, and had never smoked tobacco were more likely to plan, initiate, and achieve ≥6 months of breastfeeding. Higher pre-pregnancy BMI was not associated with breastfeeding planning or initiation but was associated with lower adjusted odds of breastfeeding for ≥6 months relative to <6 months. Findings suggest that support aimed at extending breastfeeding among those with elevated pre-pregnancy BMI may be warranted. Future interventions should also address sociodemographic and clinical inequities in breastfeeding.
Collapse
Affiliation(s)
- Christine C Call
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Marquis S Hawkins
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Vrusha K Shah
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - David Frank
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Sarah Niemi
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Riley J Jouppi
- University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Emma Ferguson
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Rachel P K Conlon
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Michele D Levine
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA; University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| |
Collapse
|
3
|
Carbonneau E, Dumas A, Lepage S, Dumas AA, Fontaine-Bisson B. A perinatal social nutrition approach to improve breastfeeding in a culturally diverse group of low-income women. Appl Physiol Nutr Metab 2024; 49:824-837. [PMID: 38387015 DOI: 10.1139/apnm-2023-0408] [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] [Indexed: 02/24/2024]
Abstract
Alima, Perinatal Social Nutrition Centre, is an established community organization that adopts a perinatal social nutrition approach to provide multidimensional support to women living in vulnerable conditions, particularly those with a precarious migratory status. This study aims to (i) determine which maternal characteristics, pregnancy-related variables, and structural features of the Alima intervention are associated with breastfeeding; and (ii) examine whether the association between attending breastfeeding workshops and breastfeeding characteristics differ according to maternal factors. The Alima digital database was used to analyze data from women who received the perinatal intervention between 2013 and 2020. Infant feeding data were retrieved at 2 weeks postpartum (T0, n = 2925), 2 months postpartum (T2, n = 1475), and 4 months postpartum (T4, n = 890). Logistic regressions were used to estimate the odds of overall and exclusive breastfeeding depending on sociodemographic characteristics, pregnancy-related variables, and features of the intervention. The prevalence of overall and exclusive breastfeeding was, respectively, 96.1% and 60.7% at T0; 93.0% and 58.5% at T2; 83.0% and 48.4% at T4. Higher education, previous breastfeeding experience, and recent immigration were associated with a higher likelihood of breastfeeding at each time point. Breastfeeding workshop attendance was associated with a greater likelihood of overall and exclusive breastfeeding at T2 and T4, with a stronger effect among women aged 35 or less, those with lower education, and those with excessive gestational weight gain. In conclusion, the Alima intervention is associated with positive breastfeeding outcomes, especially among vulnerable women living with precarious migratory status in Canada.
Collapse
Affiliation(s)
- Elise Carbonneau
- Centre de recherche Nutrition Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada
- School of Nutrition, Faculty of Agriculture and Food Science, Université Laval, Québec, QC G1V 0A6, Canada
| | - Alex Dumas
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
| | - Suzanne Lepage
- Alima, Perinatal Social Nutrition Centre, Montreal, QC H3H 1J3, Canada
| | - Audrée-Anne Dumas
- Centre de recherche Nutrition Santé et Société (NUTRISS), Institute of Nutrition and Functional Foods, Université Laval, Québec, QC G1V 0A6, Canada
- School of Nutrition, Faculty of Agriculture and Food Science, Université Laval, Québec, QC G1V 0A6, Canada
| | - Bénédicte Fontaine-Bisson
- Alima, Perinatal Social Nutrition Centre, Montreal, QC H3H 1J3, Canada
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| |
Collapse
|
4
|
Blair RA, Neves JS, Nicklas JM, Horn CE, Skurnik G, Seely EW. Breastfeeding Associated with Lower Prevalence of Metabolic Syndrome in Women with Gestational Diabetes in the Very Early Postpartum Period. Am J Perinatol 2024; 41:72-81. [PMID: 34670318 DOI: 10.1055/a-1674-5724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study is to examine the association of breastfeeding with metabolic syndrome (MetS) in women with recent gestational diabetes mellitus (GDM) in the very early postpartum (PP) period. STUDY DESIGN We performed a secondary analysis of the Balance After Baby Intervention (BABI) study which enrolled women with recent GDM. Data collected during an early (~8 weeks) PP visit were used in this analysis. At this visit, weight, height, waist circumference (WC), blood pressure (BP), fasting plasma glucose (FPG), and lipids were obtained. MetS was classified per National Cholesterol Education Program Adult Treatment Program III (NCEP-ATP III) criteria. We defined breastfeeding as currently breastfeeding or not currently breastfeeding for the main analysis. RESULTS Of 181 women enrolled in BABI, 178 were included in this analysis (3 excluded for missing lipids). Thirty-four percent were Hispanic. Of non-Hispanics, 31.5% were White, 18.5% Asian, and 12.9% Black/African American. The prevalence of MetS was 42.9% in women not breastfeeding versus 17.1% in women breastfeeding (p < 0.001; adjusted odds ratio [aOR] = 0.16 [95% confidence interval (CI): 0.06-0.41]). Breastfeeding women had significantly lower odds of FPG ≥100 mg/dL (aOR = 0.36 [95% CI: 0.14-0.95], p = 0.039), HDL < 50 mg/dL (aOR = 0.19 [95% CI: 0.08-0.46], p < 0.001), and triglycerides (TG) ≥ 150 mg/dL (aOR = 0.26 [95% CI: 0.10-0.66], p = 0.005). When evaluated as continuous variables, WC, FPG, and TG were significantly lower and HDL significantly higher in women breastfeeding in the very early PP period (vs. not breastfeeding). CONCLUSION In a diverse population of women with recent GDM, there was lower prevalence of MetS in women breastfeeding compared with those not breastfeeding in the very early PP period. This study extends the findings of an association of breastfeeding with MetS previously reported at time points more remote from pregnancy to the very early PP period and to an ethnically and racially diverse population. KEY POINTS · MetS prevalence in women with recent GDM was lower in breastfeeding than not breastfeeding women.. · FPG, HDL, WC, and TG were improved in the breastfeeding group.. · This study extends prior findings to the very early PP period and to a diverse population..
Collapse
Affiliation(s)
- Rachel A Blair
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, São João University Hospital Center, Porto, Portugal
- Department of Surgery and Physiology, Cardiovascular Research and Development Center, Faculty of Medicine University of Porto, Porto, Portugal
| | - Jacinda M Nicklas
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Christine E Horn
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Geraldine Skurnik
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Ellen W Seely
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| |
Collapse
|
5
|
Jin X, Perrella SL, Lai CT, Taylor NL, Geddes DT. Causes of Low Milk Supply: The Roles of Estrogens, Progesterone, and Related External Factors. Adv Nutr 2024; 15:100129. [PMID: 37832920 PMCID: PMC10831895 DOI: 10.1016/j.advnut.2023.10.002] [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: 08/07/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Low milk supply (LMS) poses a significant challenge to exclusive and continued breastfeeding, affecting ∼10% to 15% of mothers. Milk production is intricately regulated by both endocrine and autocrine control mechanisms, with estrogens and progesterone playing pivotal roles in this process. In addition to endogenously produced hormones, external substances capable of interfering with normal hormonal actions, including phytoestrogens, mycoestrogens, synthetic estrogens, and hormonal contraceptives, can influence milk production. The effects of these extrinsic hormones on milk production may vary based on maternal body mass index. This comprehensive review examines the multifaceted causes of LMS, focusing on the involvement of estrogens, progesterone, and related external factors in milk production. Furthermore, it investigates the interplay between hormonal factors and obesity, aiming to elucidate the endocrine mechanisms underlying obesity-associated LMS. Insights from this review provide valuable perspectives for developing interventions to improve milk production and address the challenges associated with LMS.
Collapse
Affiliation(s)
- Xuehua Jin
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sharon L Perrella
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ching Tat Lai
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Nicolas L Taylor
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia; ARC Training Centre in Biomedical Analysis, The University of Western Australia, Crawley, Western Australia, Australia
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, Crawley, Western Australia, Australia; ARC Training Centre in Biomedical Analysis, The University of Western Australia, Crawley, Western Australia, Australia. donna@
| |
Collapse
|
6
|
Baker N, Bick D, Bamber L, Wilson CA, Howard LM, Bakolis I, Soukup T, Chang Y. A mixed methods systematic review exploring infant feeding experiences and support in women with severe mental illness. MATERNAL & CHILD NUTRITION 2023; 19:e13538. [PMID: 37276241 PMCID: PMC10483956 DOI: 10.1111/mcn.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
There are many benefits of breastfeeding to women and their infants but meeting the recommended 6 months of exclusive breastfeeding is likely to be more challenging for women with severe mental illness (SMI). This is the first systematic review that aims to examine evidence of (a) infant feeding outcomes in women with SMI and the factors associated with this, (b) the experiences of infant feeding and infant feeding support for women with SMI, (c) interventions for supporting infant feeding among these women and (d) health care professionals' attitudes toward supporting infant feeding in women with SMI. Mixed methods systematic review was carried out using the principles of Joanna Briggs Institute's (JBI) 'convergent integrated' methodology. CINAHL, PsycINFO, Medline and MIDIRS were used to search literature between 1994 and 2022. The quality of selected articles was assessed using JBI critical appraisal tools and thematic synthesis was undertaken to obtain findings. Eighteen papers were included in the final review. Women with SMI were less likely to initiate and continue breastfeeding than women without SMI. Several challenges with breastfeeding were highlighted, and while these were often linked to women's mental health difficulties, inconsistent advice from health care professionals and poor support with breastfeeding further compounded these challenges. This review highlights that policy and practice need to take into account the individual challenges women with SMI face when planning, initiating and maintaining breastfeeding. Education and training for health care professionals are needed to enable them to provide tailored infant feeding support to women with SMI, which reflects their individual needs.
Collapse
Affiliation(s)
- Natasha Baker
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Louise Bamber
- Child and Maternal Mental Health Team, South London and Maudsley NHS Foundation TrustLondonUK
| | - Claire A. Wilson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Child and Maternal Mental Health Team, South London and Maudsley NHS Foundation TrustLondonUK
| | - Louise M. Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics & Health Service and Population Research Department, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Tayana Soukup
- Department of Surgery and CancerImperial College LondonLondonUK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Yan‐Shing Chang
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College LondonLondonUK
| |
Collapse
|
7
|
Ren Z, Zhang A, Fan X, Feng J, Xia H. Utility of the capability, opportunity, and motivation behaviour (COM-B) model in explaining the negative association between pre-pregnancy body mass index and exclusive breastfeeding at six weeks postpartum. Appetite 2023; 188:106631. [PMID: 37302414 DOI: 10.1016/j.appet.2023.106631] [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: 12/06/2022] [Revised: 05/21/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
The mechanisms underlying the negative associations between pre-pregnancy body mass index (BMI) and exclusive breastfeeding remain poorly understood. Thus, the study aimed to determine whether the negative associations between high pre-pregnancy BMI and exclusive breastfeeding at six weeks postpartum are mediated by components of the capability, opportunity, and motivation behaviour (COM-B) model. In this prospective observational study, we assigned 360 primiparous women to a pre-pregnancy overweight/obese group (n = 180) and a normal-BMI group (n = 180). A structural equation model was designed to study how capabilities (onset of lactogenesis II, perceived milk supply, breastfeeding knowledge, and postpartum depression), opportunities (pro-breastfeeding hospital practices, social influence, social support), and motivations (breastfeeding intention, breastfeeding self-efficacy, and attitudes towards breastfeeding) affected exclusive breastfeeding at six weeks postpartum in groups of women with different pre-pregnancy BMIs. In all, 342 participants (95.0%) possessed complete data. Women with high pre-pregnancy BMI were less likely to exclusively breastfeed at six weeks postpartum than women with a normal BMI were. We observed a significant negative direct effect of high pre-pregnancy BMI on exclusive breastfeeding at six weeks postpartum and a significantly negative indirect effect of high pre-pregnancy BMI via the explanatory mediating variables of capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy) on exclusive breastfeeding at six weeks postpartum. Our findings support certain capabilities (onset of lactogenesis II, perceived milk supply, and breastfeeding knowledge) and motivations (breastfeeding self-efficacy), partially explaining the negative association between high pre-pregnancy BMI and exclusive breastfeeding outcome. We suggest that interventions aimed at promoting exclusive breastfeeding among women with high pre-pregnancy BMI should address the capacity and motivation factors specific to this population.
Collapse
Affiliation(s)
- Ziqi Ren
- School of Nursing, Fudan University, 305 Fenglin Road, Xuhui District, 200032, Shanghai, China.
| | - Aixia Zhang
- Department of Nursing, The Women's Hospital of Nanjing Medical University, 123 Tianfei Lane, Mochou Road, Qinhuai District, 210004, Nanjing, China.
| | - Xuemei Fan
- Department of Nursing, The Women's Hospital of Nanjing Medical University, 123 Tianfei Lane, Mochou Road, Qinhuai District, 210004, Nanjing, China.
| | - Jingyi Feng
- Faculty of Science, The Hong Kong Polytechnic University, 11 Yuk Chai Road, Hung Hom, 999077, Hong Kong, China.
| | - Haiou Xia
- School of Nursing, Fudan University, 305 Fenglin Road, Xuhui District, 200032, Shanghai, China.
| |
Collapse
|
8
|
Pérez-Escamilla R. Breastfeeding and the Obesity Pandemic. Am J Clin Nutr 2023:S0002-9165(23)48893-4. [PMID: 37210290 DOI: 10.1016/j.ajcnut.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023] Open
Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT.
| |
Collapse
|
9
|
Nagpal TS, Nippert KE, Velletri M, Tomiyama AJ, Incollingo Rodriguez AC. Close Relationships as Sources of Pregnancy-Related Weight Stigma for Expecting and New Mothers. Int J Behav Med 2023; 30:297-303. [PMID: 35486351 DOI: 10.1007/s12529-022-10083-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Experiencing weight stigma during pregnancy is detrimental to psychosocial health outcomes, including increasing maternal stress and undermining engagement in health behaviors. Guided by a recent socioecological framework, close interpersonal relationships are integral in pregnancy to facilitate healthy behaviors and protect maternal mental health, but they may also be sources that project weight stigma. The purpose of this study was to characterize weight stigma experienced during pregnancy and postpartum from close relationships including partners, immediate family, extended family, and friends. METHOD Women who were pregnant or up to 1 year postpartum completed a survey that assessed sources of weight stigma since becoming pregnant. A thematic analysis was performed to code open-ended responses to understand the lived experiences of pregnancy-related weight stigma experienced from close relations. RESULTS Of the 501 women who completed the online survey, 157 indicated experiencing weight stigma from close relations. Average frequency of weight stigma from close relations was 1.83 ("less than once a month" to "a few times a month"). Weight-stigmatizing examples from close relations during pregnancy included negative assumptions about maternal or fetal health and maternal lifestyle behaviors based on weight gain; comparing women to pregnant body ideals; and making comments that resulted in women judging themselves poorly as a pregnant individual or mother. CONCLUSIONS Close relationships can be sources of pregnancy-related weight stigma. This may not only increase risk for adverse stigma-related consequences, but also could cut off the important benefits of maternal social support resulting in poor mental health outcomes and health behaviors.
Collapse
Affiliation(s)
- Taniya S Nagpal
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
| | - Kathryn E Nippert
- Psychological & Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Mia Velletri
- Psychological & Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA, USA.
- Salisbury Labs 317B, 100 Institute Road, Worcester, MA, 01609, USA.
| |
Collapse
|
10
|
Nommsen-Rivers L, Black MM, Christian P, Groh-Wargo S, Heinig MJ, Israel-Ballard K, Obbagy J, Palmquist AEL, Stuebe A, Barr SM, Proaño GV, Moloney L, Steiber A, Raiten DJ. An equitable, community-engaged translational framework for science in human lactation and infant feeding-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 5. Am J Clin Nutr 2023; 117 Suppl 1:S87-S105. [PMID: 37173062 DOI: 10.1016/j.ajcnut.2023.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 05/15/2023] Open
Abstract
Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all.
Collapse
Affiliation(s)
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA; RTI International, Research Triangle Park, NC, USA
| | - Parul Christian
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sharon Groh-Wargo
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - M Jane Heinig
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | | | - Julie Obbagy
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Washington, DC, USA
| | - Aunchalee E L Palmquist
- Department of Maternal & Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison Stuebe
- Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
11
|
Demirci JR, Glasser M, Bogen DL, Sereika SM, Ren D, Ray K, Bodnar LM, O'Sullivan TA, Himes K. Effect of antenatal milk expression education on lactation outcomes in birthing people with pre-pregnancy body mass index ≥25: protocol for a randomized, controlled trial. Int Breastfeed J 2023; 18:16. [PMID: 36927811 PMCID: PMC10019405 DOI: 10.1186/s13006-023-00552-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Birthing people with pre-pregnancy body mass indices (BMIs) ≥ 25 kg/m2, particularly those without prior breastfeeding experience, are at increased risk for suboptimal lactation outcomes. Antenatal milk expression (AME) may be one way to counteract the negative effects of early infant formula supplementation common in this population. METHODS This ongoing, randomized controlled trial in the United States evaluates the efficacy of a telelactation-delivered AME education intervention versus an attention control condition on lactation outcomes to 1 year postpartum among 280 nulliparous-to-primiparous, non-diabetic birthing people with pre-pregnancy BMI ≥ 25 kg/m2. The assigned study treatment is delivered via four weekly online video consultations between gestational weeks 37-40. Participants assigned to AME meet with study personnel and a lactation consultant to learn and practice AME. Instructions are provided for home practice of AME between study visits. Control group participants view videos on infant care/development at study visits. Participants complete emailed surveys at enrollment (340/7-366/7 gestational weeks) and 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postpartum. Surveys assess lactation and infant feeding practices; breastfeeding self-efficacy, attitudes, and satisfaction; perception of insufficient milk; onset of lactogenesis-II; lactation support and problems; and reasons for breastfeeding cessation. Surveys also assess factors associated with lactation outcomes, including demographic characteristics, health problems, birth trauma, racial discrimination, and weight stigma. Health information and infant feeding data are abstracted from the pregnancy and birth center electronic health record. Milk samples are collected from the intervention group at each study visit and from both groups at each postpartum follow-up for future analyses. Qualitative interviews are conducted at 6 weeks postpartum to understand AME experiences. Primary outcomes of interest are breastfeeding exclusivity and breastfeeding self-efficacy scores at 2 weeks postpartum. Outcomes will be examined longitudinally with generalized linear mixed-effects modeling. DISCUSSION This is the first adequately powered trial evaluating the effectiveness of AME among U.S. birthing people and within a non-diabetic population with pre-pregnancy BMI ≥ 25 kg/m2. This study will also provide the first evidence of acceptability and effectiveness of telelactation-delivered AME. TRIAL REGISTRATION ClinicalTrials.gov: NCT04258709.
Collapse
Affiliation(s)
- Jill R Demirci
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
| | - Melissa Glasser
- Department of Health Promotion & Development, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Debra L Bogen
- Allegheny County Health Department, Pittsburgh, PA, USA
| | - Susan M Sereika
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Dianxu Ren
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Kristin Ray
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Children's Community Pediatrics, Pittsburgh, PA, USA
| | - Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Therese A O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Katherine Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| |
Collapse
|
12
|
O'Reilly SL, Conway MC, O'Brien EC, Molloy E, Walker H, O'Carroll E, McAuliffe FM. Exploring Successful Breastfeeding Behaviors Among Women Who Have High Body Mass Indices. J Hum Lact 2023; 39:82-92. [PMID: 35708019 PMCID: PMC9929695 DOI: 10.1177/08903344221102839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with high body mass indices are at risk of lower breastfeeding rates but the drivers of successful breastfeeding in this population are unclear. RESEARCH AIM We aimed to (a) explore the barriers and enablers to breastfeeding among women with high body mass indices and (b) map specific behaviors suitable for intervention across the antenatal to postpartum periods. METHODS This was a prospective, cross-sectional qualitative study. We conducted semi-structured interviews with women with high body mass indices who successfully breastfed for 6 months or more (n =20), partners (n = 22), and healthcare professionals (n =19) in Ireland during 2018. Interviews were audio recorded, and transcribed verbatim. Data were inductively coded using reflexive thematic analysis and deductively mapped within the Capability, Opportunity, Motivation-Behavior model. RESULTS The three themes developed were knowledge, support, and self-efficacy. Knowledge supported a participant's psychological and physical capability to engage in breastfeeding. Support was related to the social and physical opportunity to enable performance of breastfeeding behaviors. Self-efficacy influenced reflective and automatic motivation to perform breastfeeding behaviors. A multifactorial intervention design is needed to support successful breastfeeding. CONCLUSION The barriers and enablers identified for participants with high body mass indices were similar to those for the broader population; however, the physicality and associated social bias of high body mass indices mean that additional support is warranted. Antenatal and postpartum breastfeeding services need a multifaceted, inclusive, and high-quality program to provide the necessary support to women with higher body mass indices.
Collapse
Affiliation(s)
- Sharleen L O'Reilly
- University College Dublin 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
| | - Marie C Conway
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eileen C O'Brien
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Eva Molloy
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Hannah Walker
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Eimear O'Carroll
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Fionnuala M McAuliffe
- University College Dublin Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| |
Collapse
|
13
|
Relationships between maternal body mass index and child cognitive outcomes at 3 years of age are buffered by specific early environments in a prospective Canadian birth cohort. J Dev Orig Health Dis 2023; 14:42-52. [PMID: 35481433 DOI: 10.1017/s2040174422000228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Fetal and child development are shaped by early life exposures, including maternal health states, nutrition and educational and home environments. We aimed to determine if suboptimal pre-pregnancy maternal body mass index (BMI; underweight, overweight, obese) would associate with poorer cognitive outcomes in children, and whether early life nutritional, educational and home environments modify these relationships. Self-reported data were obtained from mother-infant dyads from the pan-Canadian prospective Maternal-Infant Research on Environmental Chemicals cohort. Relationships between potential risk factors (pre-pregnancy maternal BMI, breastfeeding practices and Home Observation Measurement of the Environment [HOME] score) and child cognitive development at age three (Weschler's Preschool and Primary Scale of Intelligence, Third Edition scale and its subcategories) were each evaluated using analysis of variance, multivariable regression models and moderating analyses. Amongst the 528 mother-child dyads, increasing maternal pre-pregnancy BMI was negatively associated with scores for child full-scale IQ (β [95% CI]; -2.01 [-3.43, -0.59], p = 0.006), verbal composite (-1.93 [-3.33, -0.53], p = 0.007), and information scale (-0.41 [-0.70, -0.14], p = 0.003) scores. Higher maternal education level or HOME score attenuated the negative association between maternal pre-pregnancy BMI and child cognitive outcome by 30%-41% and 7%-22%, respectively, and accounted for approximately 5%-10% greater variation in male children's cognitive scores compared to females. Maternal education and higher quality home environment buffer the negative effect of elevated maternal pre-pregnancy BMI on child cognitive outcomes. Findings suggest that relationships between maternal, social and environmental factors must be considered to reveal pathways that shape risk for, and resiliency against, suboptimal cognitive outcomes in early life.
Collapse
|
14
|
Amorim M, Hobby E, Zamora-Kapoor A, Perham-Hester KA, Cowan SK. The heterogeneous associations of universal cash-payouts with breastfeeding initiation and continuation. SSM Popul Health 2023; 22:101362. [DOI: 10.1016/j.ssmph.2023.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/30/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
|
15
|
Intrasexual Competition in Women’s Likelihood of Self-Enhancement and Perceptions of Breast Morphology: A Hispanic Sample. SEXES 2023. [DOI: 10.3390/sexes4010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Women’s breasts are considered sexually attractive because they may infer a woman’s residual reproductive value. Given that men find women’s breasts attractive, women may compete with other women to enhance their physical attractiveness when primed with an intrasexual competitive cue. The current study investigated women’s intrasexual competition when viewing variations in breast morphology. Women (N = 189) were randomly assigned to a partner threat condition and shown images of women’s breasts that included variations in breast size, ptosis (i.e., sagginess), and intermammary distance (i.e., cleavage). Women were more likely to report an increase in enhancing their appearance, wearing revealing clothing, dieting and exercising, and perceiving the breasts as a sexual threat as a function of larger breast sizes with low ptosis and intermediate distances. The partner threat prime did not play a role in ratings. Interestingly, there was a moderating role for women’s dispositional levels in intrasexual competition. Women with higher levels of intrasexual competition were more likely to enhance their appearance when viewing large breast sizes. The study points to the role that breast morphology indicative of residual reproductive value has on increasing enhancement strategies.
Collapse
|
16
|
Luzardo-Ocampo I, Dena-Beltrán JL, Ruiz-Herrera X, Ocampo-Ruiz AL, Martínez de la Escalera G, Clapp C, Macotela Y. Obesity-derived alterations in the lactating mammary gland: Focus on prolactin. Mol Cell Endocrinol 2023; 559:111810. [PMID: 36374835 DOI: 10.1016/j.mce.2022.111810] [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: 05/10/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
Obesity is a modern pandemic with negative consequences in women's reproductive health. Women with overweight and obesity can develop mammary gland alterations that unable exclusive breastfeeding. Obesity associates with a disturbed lactating mammary gland endocrine environment including a decreased action of the hormone prolactin (PRL), the master regulator of lactation. The PRL receptor and the action of PRL are reduced in the mammary gland of lactating rodents fed an obesogenic diet and are contributing factors to impaired lactation in obesity. Also, treatment with PRL improves milk yield in women with lactation insufficiency. This review focuses on the impact of diet-induced obesity in the lactating mammary gland and how obesity impairs the lactogenic action of PRL. Although obesity alters lactation performance in humans and rodents, the responsible mechanisms have been mainly addressed in rodents.
Collapse
Affiliation(s)
- Ivan Luzardo-Ocampo
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, 76230, Querétaro, Mexico
| | - José L Dena-Beltrán
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, 76230, Querétaro, Mexico
| | - Xarubet Ruiz-Herrera
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, 76230, Querétaro, Mexico
| | - Ana Luisa Ocampo-Ruiz
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, 76230, Querétaro, Mexico
| | - Gonzalo Martínez de la Escalera
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, 76230, Querétaro, Mexico
| | - Carmen Clapp
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, 76230, Querétaro, Mexico
| | - Yazmín Macotela
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, 76230, Querétaro, Mexico.
| |
Collapse
|
17
|
Cross-lagged models of health-related quality of life and breastfeeding across different body mass index groups: A three-wave prospective longitudinal study. Midwifery 2022; 112:103413. [DOI: 10.1016/j.midw.2022.103413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 05/15/2022] [Accepted: 06/25/2022] [Indexed: 11/21/2022]
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Dieterich RR, Sereika S, Demirci J. Early Postpartum Patterns of Breastfeeding Exclusivity and Perceived Insufficient Milk by Prepregnancy Body Mass Index. J Obstet Gynecol Neonatal Nurs 2022; 51:205-217. [PMID: 34793724 PMCID: PMC8901544 DOI: 10.1016/j.jogn.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore trajectories of breastfeeding exclusivity and perceived insufficient milk (PIM) over the first 8 weeks postpartum among primiparous women and the association of these trajectories with prepregnancy body mass index (BMI). DESIGN Secondary analysis of data from a randomized controlled trial. SETTING Recruitment for the primary study was conducted in Pittsburgh, Pennsylvania. PARTICIPANTS One hundred twenty-two primiparous women with intention to exclusively breastfeed. METHODS We used group-based trajectory modeling to classify participants into breastfeeding exclusivity and PIM trajectory groups. We used logistic regression to explore the predictive relationship between prepregnancy BMI and breastfeeding exclusivity and PIM trajectory group memberships. RESULTS We identified two trajectories each for breastfeeding exclusivity and PIM over the first 8 weeks postpartum. For breastfeeding exclusivity, one group (n = 60, 49%) had low initial probability of exclusive breastfeeding with linear decline in likelihood of exclusivity over time. The other group (n = 62, 51%) had greater initial probability of exclusive breastfeeding, which remained constant over time. For PIM, one group (n = 41, 34%) had consistently greater probability of endorsing PIM at each time point, whereas the other group (n = 81, 66%) had consistently low probability of endorsing PIM over time. Prepregnancy BMI did not predict group membership in breastfeeding exclusivity, χ2(1) = 2.8, p = .094, or PIM, χ2(1) = 0.72, p = .397. CONCLUSION Breastfeeding exclusivity and PIM appeared to be relatively stable phenomena in the postpartum period among a sample of predominately White primiparous women who intended to breastfeed. We did not find a clear association with prepregnancy BMI.
Collapse
Affiliation(s)
| | - Susan Sereika
- Associate Dean for Research and Education Support Services, Health & Community Systems, University of Pittsburgh, Pittsburgh, PA
| | - Jill Demirci
- Health Promotion and Development, University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
20
|
Medina Poeliniz C, Hoban R, Schoeny ME, Engstrom JL, Patel AL, Meier P. Prepregnancy Body Mass Index Is Associated with Time-Dependent Changes in Secretory Activation Measures During the First 7 Days Postpartum in Breast Pump-dependent Mothers of Premature Infants. Breastfeed Med 2022; 17:173-181. [PMID: 34919412 DOI: 10.1089/bfm.2021.0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Little is known about the biology of secretory activation (SA) in overweight and obese (OW/OB) mothers who are breast pump dependent with a premature infant in the neonatal intensive care unit. Objective: To compare time-dependent changes in daily pumped milk volume, maternal milk sodium (Na) concentration, and Na-to-potassium (K) ratios (Na:K) in the first 14 days postpartum in breast pump-dependent mothers with prepregnancy body mass index (BMI) <27 and BMI ≥27 kg/m2. Design/Methods: This secondary analysis for 39 subjects, 44% (n = 17) with prepregnancy BMI <27 and 56% (n = 22) with BMI ≥27, included transformed data of outcome measures, chi-square, t-tests, and growth curve models. Results: For days 1-7, daily pumped milk volume increased significantly more rapidly for mothers with BMI <27 (65.82 mL/d) versus BMI ≥27 (33.08 mL/d), but the daily rate of change in pumped milk volume during days 8-14 was not statistically different. Daily milk Na concentration decreased significantly faster in BMI <27 (-3.93 mM/d) versus BMI ≥27 (-2.00 mM/day) during days 1-7, but was not significantly different for days 8-14. No statistical differences were noted for Na:K ratio for either time period. Conclusion: These data add biologic evidence to previous research, suggesting delayed or impaired SA in OW/OB mothers, and suggest that the window of opportunity for research and clinical interventions is days 1-7 postpartum in this population.
Collapse
Affiliation(s)
| | - Rebecca Hoban
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA.,Division of Neonatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Michael E Schoeny
- College of Nursing, Rush University Medical Center, Chicago, Illinois, USA
| | - Janet L Engstrom
- Department of Women and Children's Nursing, Rush University Medical Center, Chicago, Illinois, USA
| | - Aloka L Patel
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - Paula Meier
- Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
21
|
Misita D, Yamamoto JM, Yuan Y, Donovan LE, Bell RC, Jarman M. An exploration of differences in infant feeding practices among women with and without diabetes in pregnancy: A mixed-methods study. Diabet Med 2021; 38:e14635. [PMID: 34265117 DOI: 10.1111/dme.14635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
AIMS (1) To determine the likelihood of full breastfeeding at 3 months postpartum in women with and without diabetes in pregnancy (DiP); (2) to explore the associations between diabetes management practices and infant feeding practices in those who had DiP and (3) to examine women's experiences of feeding their infants after having DiP. METHODS The quantitative study used data from Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study. Participants who had DiP (n = 62) were matched 1:3 to participants without DiP for pre-pregnancy BMI, parity, mode of delivery and pre-term birth. Infant feeding questionnaires, prospective breastfeeding diaries and medical chart data were analysed to determine likelihood of fully breastfeeding at 3 months postpartum. For the qualitative study, interviews were conducted with postpartum women who had DiP to explore the experiences of infant feeding. Interviews were thematically analysed, and the results were compared between women who were categorized as 'full breast feeders' or 'mixed feeders'. RESULTS The odds of fully breastfeeding were 50% lower in women with DiP than women without DiP (OR: 0.50, 95% CI 0.25-0.99, p = 0.04). Qualitative interviews identified that although all women showed resilience in the face of infant feeding challenges, those who were fully breastfeeding reported seeking out external infant feeding supports, for example, classes or Doula's. Mixed Feeders perceived there was a lack of infant feeding information and support given to them prior to giving birth. CONCLUSION Women with DiP may require additional prenatal and postnatal infant feeding support to be better prepared to overcome feeding challenges they may face.
Collapse
Affiliation(s)
- Dragana Misita
- Department of Agricultural, Food and Nutritional Sciences, Division of Human Nutrition, University of Alberta, Edmonton, AB, Canada
| | - Jennifer M Yamamoto
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Medicine, Division of Endocrinology and Metabolism, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Lois E Donovan
- Department of Medicine, Division of Endocrinology and Metabolism, Department of Obstetrics and Gynecology, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Sciences, Division of Human Nutrition, University of Alberta, Edmonton, AB, Canada
| | - Megan Jarman
- Department of Agricultural, Food and Nutritional Sciences, Division of Human Nutrition, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
22
|
Marshall J, Ross S, Buchanan P, Gavine A. Providing effective evidence based support for breastfeeding women in primary care. BMJ 2021; 375:e065927. [PMID: 34725097 DOI: 10.1136/bmj-2021-065927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Joyce Marshall
- Division of Maternal Health, University of Huddersfield, UK
| | - Sam Ross
- School of Medicine, Dentistry and Nursing, University of Glasgow and NHS Greater Glasgow and Clyde, UK
| | | | - Anna Gavine
- School of Health Sciences, University of Dundee, UK
| |
Collapse
|
23
|
Mahdizadeh-Shahri M, Nourian M, Varzeshnejad M, Nasiri M. The Effect of Oketani Breast Massage on Successful Breastfeeding, Mothers' Need for Breastfeeding Support, and Breastfeeding Self-Efficacy: an Experimental Study. Int J Ther Massage Bodywork 2021; 14:4-14. [PMID: 34484490 PMCID: PMC8362827 DOI: 10.3822/ijtmb.v14i3.625] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The negative effects of cesarean section on breastfeeding are a major global concern. PURPOSE This study aimed to determine the effect of Oketani breast massage on the maternal need for support during breastfeeding, breastfeeding success, and breastfeeding self-efficacy. SETTING Three hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran, from April to July 2019. STUDY DESIGN The participants in this experimental study were 113 pregnant women who were candidates for cesarean section. The mothers were selected using convenience sampling and randomly assigned. In addition to routine care, the mothers in the intervention group received Oketani breast massages twice. However, the mothers in the control group received routine care. The data were collected using the Infant Breastfeeding Assessment Tool (IBFAT), LATCH Assessment Score, and the Breastfeeding Self-Efficacy Scale (BSES). The data were analyzed with SPSS 20 software via the independent samples t test, the Mann-Whitney U test, and the chi-square test. RESULTS The results of the study suggested that the breastfeeding success rate, which was evaluated with IBFAT in both the first two breastfeeding stages and the last pre-discharge breastfeeding, was significantly higher for the mothers in the intervention group (p < .001). In addition, the mother's need for support, which was evaluated with LATCH in the first two breastfeeding stages (p = .044) and the last pre-discharge breastfeeding (p < .001) in the intervention group, was less. The total number of breastfeeding sessions from birth to discharge was higher in the intervention group (p = .002). Furthermore, the mothers in the intervention group breastfed their infants in a significantly shorter time interval (p = .002). Breastfeeding self-efficacy, according to the BSES, was significantly higher in the mothers of the intervention group (p < .001). CONCLUSION Oketani massage can be used as a care intervention by nurses to improve breastfeeding in mothers who undergo cesarean sections.
Collapse
Affiliation(s)
- Maryam Mahdizadeh-Shahri
- Student of Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Manijeh Nourian
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Varzeshnejad
- Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maliheh Nasiri
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
24
|
Rassie K, Mousa A, Joham A, Teede HJ. Metabolic Conditions Including Obesity, Diabetes, and Polycystic Ovary Syndrome: Implications for Breastfeeding and Breastmilk Composition. Semin Reprod Med 2021; 39:111-132. [PMID: 34433215 DOI: 10.1055/s-0041-1732365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Breastfeeding is internationally recognized as the recommended standard for infant nutrition, informed by evidence of its multiple benefits for both mother and baby. In the context of common metabolic conditions such as polycystic ovary syndrome, diabetes (type 1, type 2, and gestational), and obesity, breastfeeding may be particularly beneficial for both mother and infant. However, there is evidence of delayed lactogenesis and reduced breastfeeding rates and duration in women with these conditions, and the effects of altered maternal metabolic environments on breastmilk composition (and potentially infant outcomes) are incompletely understood. In this review, we explore the relationships between maternal metabolic conditions, lactogenesis, breastfeeding, and breastmilk composition. We examine relevant potential mechanisms, including the central role of insulin both in lactogenesis and as a milk-borne hormone. We also describe the bioactive and hormonal components of breastmilk and how these may link maternal and infant health.
Collapse
Affiliation(s)
- Kate Rassie
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes, Monash Health, Melbourne, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes, Monash Health, Melbourne, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Diabetes, Monash Health, Melbourne, Australia
| |
Collapse
|
25
|
Cramer RL, McLachlan HL, Shafiei T, Amir LH, Cullinane M, Small R, Forster DA. Women's experiences of infant feeding support: Findings from a cross-sectional survey in Victoria, Australia. Women Birth 2021; 34:e505-e513. [PMID: 34420765 DOI: 10.1016/j.wombi.2020.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/16/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate new mothers' experiences of infant feeding support. DESIGN A postal survey developed for this study was sent to all new mothers in ten local government areas in Victoria, Australia when their baby was six months of age. Questions explored infant feeding methods, feeding support services, and experiences of infant feeding support. This survey made up one component of the Supporting breastfeeding In Local Communities (SILC) cluster randomised controlled trial. FINDINGS 997/4127 women (24%) completed the survey between 15 April 2013 and 31 July 2013. Women received infant feeding support from multiple sources, including professionals, family members, and peers. Overall, 88% reported receiving adequate infant feeding support. Women who reported not receiving adequate infant feeding support were less likely to be giving any breast milk at six months compared to those reporting adequate support (OR = 0.59; 95% CI 0.40, 0.88). Adjusting for breastfeeding intention and parity did not alter the association (Adj. OR = 0.60; 95% CI 0.40, 0.90). Women were most satisfied when they received accessible, available, consistent professional infant feeding support provided in a non-judgemental and reassuring way. Women were dissatisfied when there were barriers restricting access to support, or when they received conflicting advice or support that made them feel guilty, pressured or judged. KEY CONCLUSIONS Regardless of infant feeding method, women wanted accessible, non-judgemental support. Given that receiving adequate support was associated with more breast milk feeding at six months, care providers should ensure accessible infant feeding support is available to all new mothers.
Collapse
Affiliation(s)
- Rhian L Cramer
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Health, Federation University Australia, Mount Helen, VIC 3350, Australia.
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; School of Nursing & Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/touransh
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/Lisa_H_Amir
| | - Meabh Cullinane
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/mbcullinane
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia. https://www.twitter.com/small_rhonda
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, Bundoora, VIC 3086, Australia; The Royal Women's Hospital, Locked Bag 300, Cnr Grattan St and Flemington Rd, Parkville, VIC 3052, Australia
| |
Collapse
|
26
|
Perez MR, de Castro LS, Chang YS, Sañudo A, Marcacine KO, Amir LH, Ross MG, Coca KP. Breastfeeding Practices and Problems Among Obese Women Compared with Nonobese Women in a Brazilian Hospital. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2021; 2:219-226. [PMID: 34235509 PMCID: PMC8243705 DOI: 10.1089/whr.2021.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
Background: Women who are obese have lower rates of breastfeeding initiation and duration and are less likely to breastfeed exclusively compared with women who are not obese. To develop programs to improve breastfeeding practices among this group of women, we investigated the association between maternal obesity and breastfeeding practices and problems in the first days postpartum. Methods: We analyzed medical records from postpartum women at a rooming-in maternity ward in State of São Paulo, Brazil, between 2016 and 2018. We included those who had intended to exclusively breastfeed, had given birth to a singleton and were admitted to rooming-in. We analyzed exclusive breastfeeding and nonexclusive breastfeeding each day of hospitalization and the presence of breastfeeding problems, comparing women in the obese category (body mass index [BMI] ≥30 kg/m2) to normal and overweight women (≥18.6 to ≤29.9 kg/m2). Results: Two hundred and twenty-four postpartum women participated, including 86 women in the obese category. More than 50% of women with obesity reported a breastfeeding problem in the first and second postpartum days (p = 0.026 and p = 0.017, respectively) compared with the 41% and 38% nonobese group. Children of obese women were 2.8 times more likely to have poor latch during breastfeeding (95% confidence interval [CI]: 1.29-6.10) compared with the nonobese group on the third day. Conclusion: Maternal obesity increased the probability of breastfeeding difficulties and nonexclusive breastfeeding at discharge. Professionals need to support breastfeeding techniques in the days immediate after delivery to improve breastfeeding outcomes for mothers with obesity.
Collapse
Affiliation(s)
- Marina Rico Perez
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucíola Sant'Anna de Castro
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Adriana Sañudo
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, Victoria, Australia
- Breastfeeding Service, Royal Women's Hospital, Victoria, Australia
| | - Michael G. Ross
- Obstetrics and Gynecology, Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kelly Pereira Coca
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| |
Collapse
|
27
|
Abstract
Mother's own milk (MOM) feeding is a cost-effective strategy to reduce risks of comorbidities associated with prematurity and improve long-term health of infants hospitalized in the Neonatal Intensive Care Unit (NICU). Significant racial and socioeconomic disparities exist in MOM provision in the NICU, highlighting the importance of developing strategies to reduce these disparities. Mothers of infants in the NICU experience many health concerns which may negatively impact lactation physiology. Objective measures of lactation physiology are limited but may assist in identifying mothers at particular risk. Several strategies to assist mothers of hospitalized infants are essential, including maternal education, qualified lactation professionals, early and frequent milk expression with a hospital-grade double electric breast pump, and providing support for transitioning to direct breastfeeding prior to discharge from the NICU.
Collapse
|
28
|
Larsen JK, Bode L. Obesogenic Programming Effects during Lactation: A Narrative Review and Conceptual Model Focusing on Underlying Mechanisms and Promising Future Research Avenues. Nutrients 2021; 13:nu13020299. [PMID: 33494303 PMCID: PMC7911998 DOI: 10.3390/nu13020299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 12/18/2022] Open
Abstract
Animal studies have consistently demonstrated that maternal obesity and a high-fat diet during lactation enhances obesity risk in the offspring. However, less is known about these potential obesogenic programming effects in obese humans. We propose three important pathways that may explain obesogenic programming effects of human breastmilk. First, human milk components and hormones may directly affect child eating and satiety characteristics. Second, human milk constituents can affect child microbiota that, in turn, may influence child eating and weight outcomes. Third, human milk composition may affect child eating and weight outcomes through flavor exposure. We reviewed a few very recent findings from well-powered longitudinal or experimental human research with regard to these three pathways. Moreover, we provide a research agenda for future intervention research with the overarching aim to prevent excessive pediatric weight gain during lactation and beyond. The ideas presented in this paper may represent important “black box” constructs that explain obesogenic programming effects during lactation. It should be noted, however, that given the scarcity of studies, findings should be seen as working hypotheses to further test in future research.
Collapse
Affiliation(s)
- Junilla K. Larsen
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands
- Correspondence:
| | - Lars Bode
- Department of Pediatrics and Larsson-Rosenquist-Foundation Mother-Milk-Infant Center of Research Excellence, University of California, San Diego, CA 92101, USA;
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Chang Y, Glaria AA, Davie P, Beake S, Bick D. Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review. MATERNAL & CHILD NUTRITION 2020; 16:e12865. [PMID: 31240826 PMCID: PMC7038894 DOI: 10.1111/mcn.12865] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022]
Abstract
Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence-based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.
Collapse
Affiliation(s)
- Yan‐Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | | | - Philippa Davie
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Sarah Beake
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Debra Bick
- Warwick Clinical Trials UnitUniversity of WarwickCoventryUK
| |
Collapse
|
31
|
Determinants of Continued Breastfeeding at 12 and 24 Months: Results of an Australian Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203980. [PMID: 31635280 PMCID: PMC6843256 DOI: 10.3390/ijerph16203980] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022]
Abstract
Breastfeeding to 12 months and beyond offers considerable health benefits to both infants and mothers. Despite these recognized benefits, relatively few women in high income countries breastfeed for 12 months, and rarely breastfeed to 24 months. The aim of this study was to identify the prevalence and determinants of continued breastfeeding to 12 and 24 months amongst a cohort of Australian women participating in the Adelaide-based Study of Mothers' and Infants' Life Events affecting oral health (SMILE). Duration of breastfeeding was known for 1450 participants and was derived from feeding related data collected at birth, 3, 6, 12 and 24 months. Multivariable logistic regression analysis was used to investigate the relationship between explanatory variables and continued breastfeeding to 12 and 24 months. In total, 31.8% of women breastfed to 12 months and 7.5% to 24 months. Women who were multiparous, university educated, had not returned to work by 12 months and whose partners preferred breastfeeding over bottle feeding were more likely to be breastfeeding at 12 months. While women who had introduced complementary foods before 17 weeks and formula at any age were less likely to be breastfeeding at 12 months. Mothers who were born in Asian countries other than India and China, had not returned to work by 12 months and had not introduced formula were more likely to be breastfeeding at 24 months. The majority of the determinants of continued breastfeeding are either modifiable or could be used to identify women who would benefit from additional breastfeeding support and encouragement.
Collapse
|