Does exclusive breastfeeding increase after hospital discharge? A Greek study

Frequency and Determinants of Breastfeeding in Greece: A Prospective Cohort Study during the COVID-19 Pandemic

Breastfeeding is considered to be the cornerstone of child health. In Europe however, overall breastfeeding rates remain low. The present study aimed at estimating the frequency of breastfeeding in Greece during the COVID-19 pandemic period and comparing findings with the latest national study in order to identify a potential impact of the pandemic. Additionally, possible correlations of socio-cultural and demographic characteristics with breastfeeding indicators were investigated. This prospective cohort study included 847 women from five tertiary maternity hospitals, between January and December 2020. Data were collected by a structured questionnaire via interview during hospitalization and via telephone in the first, third and sixth month postpartum. Results showed that all breastfeeding indicators improved over the last three years. Full breastfeeding reached 7.2%, contrary to 0.78% of the latest national study at six months postpartum. Employment, marital status, educational level, mode of delivery, type of maternity hospital, body mass index before pregnancy, previous breastfeeding experience of the mother and infant’s birth weight correlated significantly with breastfeeding indicators at different time periods. The COVID-19 pandemic seems to have favorably influenced breastfeeding initiation and duration in Greece due to lockdowns, home confinement and teleworking.

Maternal Depressive Symptoms and Infant Feeding Practices at Hospital Discharge: Findings from the Born in Queensland Study

INTRODUCTION

This study aims to explore association between maternal depressive symptoms and infant feeding practice at hospital discharge.

METHODS

Data were obtained from a birth cohort study based in Australia that linked to health administrative records. Maternal demographic data, mental health status derived from the Edinburgh Postnatal Depression Scale (EPDS), feeding practices of livebirths of at least 400 g or gestation periods of at least 20 weeks recorded during July-December 2015 were included (n = 14,658). Logistic regression models were performed to test association between presence of depressive symptoms and exclusive breast or formula feeding within 24 h prior to hospital discharge while adjusting for covariates known to be associated with breastfeeding.

RESULTS

About 12% of women self-reported having depressive symptoms (EPDS score ≥ 10). Although only 7% of women (n = 1012) exclusively formula fed their babies, having depressive symptoms was associated with a 51% higher likelihood of exclusive formula feeding at hospital discharge. The association remains significant after adjustment for maternal age, gestational weeks, number of previous pregnancies, socioeconomic and partner status (p < 0.001) and all other covariates (p = 0.009).

CONCLUSIONS FOR PRACTICE

Having depressive symptoms was associated with increased likelihood of exclusive formula feeding. Routine measurement post-delivery and early management of maternal depressive symptoms may influence infant feeding practice and reduce prevalence of exclusive formula feeding at hospital discharge.

Increase of breast-feeding in the past decade in Greece, but still low uptake: cross-sectional studies in 2007 and 2017

OBJECTIVE

To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants.

DESIGN

Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology.

SETTING

Telephone interview with babies' mothers or fathers.

PARTICIPANTS

Representative sample of infants who participated in the national neonatal screening programme (n 549 in 2017, n 586 in 2007).

RESULTS

We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and <1 % of babies, respectively, were exclusively breast-feeding. We also found early introduction of solid foods (after the 4th month of age). Maternity hospital practices favouring breast-feeding were more prevalent in 2017, but still suboptimal (63 % experienced rooming-in; 51 % experienced skin-to-skin contact in the first hour after birth; 19 % received free sample of infant formula on discharge).

CONCLUSIONS

We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates - particularly rates of exclusive breast-feeding - remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding 'culture' and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

Measuring the Effectiveness of a Midwife-led Education Programme in Terms of Breastfeeding Knowledge and Self-efficacy, Attitudes Towards Breastfeeding, and Perceived Barriers of Breastfeeding Among Pregnant Women

Introduction:

Exclusive breastfeeding is the optimal mode of feeding for the first six months of a child’s life. Modifiable factors associated with increased breastfeeding, may be addressed through antenatal breastfeeding education. In Greece, the rates of exclusive breastfeeding remain rather low.

Aim:

The aim of the current study was to evaluate the effectiveness of a structured in-hospital midwife-led antenatal breastfeeding educational programme on breastfeeding knowledge and self-efficacy, attitudes towards breastfeeding and perceived-barriers of breastfeeding.

Patients and Methods:

This was a quasi-experimental study with two study groups: an intervention group (following a four-hour midwife-led antenatal breastfeeding programme) and a control group. All nulliparous women attending antenatal care at the tertiary hospital in Athens, Greece during May 2016–January 2017 were invited to participate, of which 203 nulliparous pregnant women took part. Demographic data forms, the Breastfeeding Self-efficacy Scale, the Iowa Infant Feeding Attitude Scale, the Breast Feeding Knowledge Questionnaire and the Perceived Breast Feeding Barriers Questionnaire were used for data collection.

Results:

Post-intervention, women in the intervention group had a more positive attitude towards breastfeeding (73.5% versus 66.1%, p<0.001), greater knowledge (14.6% versus 13.1%, p<0.001) and more breastfeeding self-efficacy (51.4% versus 45.6%, p<0.001) compared to the control group. Furthermore, they had significantly less perceived barriers regarding breastfeeding (27.4% versus 31.0%, p<0.001).

Conclusion:

The four-hour antenatal breastfeeding education intervention which occurred and was evaluated for the first time in the Greek female population was effective in increasing breastfeeding knowledge, self-efficacy and a positive attitude towards breastfeeding. The intervention was furthermore effective in lowering perceived breastfeeding barriers. This midwife-led antenatal breastfeeding education programme could be suitable for integration to routine antenatal care in health care services in Greece.

Factors affecting breastfeeding duration in Greece: What is important?

AIM: To investigate factors associated with breastfeeding duration (BD) in a sample of mothers living in Greece.

METHODS: Four hundred and twenty-eight mothers (438 infants) were initially recruited in a tertiary University Hospital. Monthly telephone interviews (1665 in total) using a structured questionnaire (one for each infant) were conducted until the sixth postpartum month. Cox regression analysis was used to assess factors influencing any BD.

RESULTS: Any breastfeeding rates in the first, third, and sixth month of the infant’s life reached 87.5%, 57.0% and 38.75%, respectively. In the multivariate analysis, maternal smoking in the lactation period [hazard-ratio (HR) = 4.20] and psychological status (HR = 1.72), and the introduction of a pacifier (HR = 2.08), were inversely associated, while higher maternal education (HR_{university/collegevsprimary/high school} = 0.53, HR_{master’svsprimary/high school} = 0.20), and being an immigrant (HR = 0.35) were positively associated with BD.

CONCLUSION: Public health interventions should focus on campaigns against smoking during lactation, target women of lower educational status, and endorse the delayed introduction of pacifiers.

Factors affecting breast-feeding initiation in Greece: What is important?

OBJECTIVE

to investigate the association between breast-feeding initiation and socio-demographic, lifestyle-related, clinical and lactation-related factors in a sample of mothers living in Greece.

DESIGN

cross-sectional study.

SETTING

Tertiary University Hospital, maternity ward.

PARTICIPANTS

428 mothers were interviewed (43.2% response rate) from February until December 2009, using a structured face-to-face questionnaire after at least 24 hours from childbirth.

MEASUREMENTS AND FINDINGS

71.0% of mothers were Greeks and 29.0% immigrants; the mean age was 32.0 years. 44.4% initiated exclusive breast feeding, 7.9% artificial milk -feeding and 47.7% partial feeding. In the multivariate analysis, exclusive breast feeding was inversely related to maternal body mass index (BMI) at the beginning of gestation (odds ratio (OR)=0.93, 95% confidence intervals (95%CI)=0.89-0.98) and caesarean section (OR=0.54, 95% CI=0.35-0.84). Lactation-related factors which favourably affected exclusive breast-feeding initiation included previous breast-feeding experience (OR=2.29, 95% CI=1.39-3.78), information about breast feeding (OR=2.38, 95% CI=1.41-4.01) and rooming-in (OR=1.62 95% CI=1.03-2.54), whilst any breast feeding was favourably affected by encouraging women to breast feed (OR=5.42, 95% CI=1.90-15.50), providing information about breast feeding (OR=6.92, 95% CI=2.53-18.89), and rooming-in (OR=6.93 95% CI=2.01-23.88), and negatively associated with caesarean section (OR=0.11, 95% CI=0.03-0.39). Being an immigrant mother was also positively associated with any breast-feeding initiation (OR=7.97, 95% CI=1.02-62.19). Maternal age, education and income, as well as, smoking status, were not associated with any breast-feeding initiation.

KEY CONCLUSIONS

maternal BMI and immigrant status, information provided by midwives and encouragement, rooming-in and mode of childbirth (caesarean section), were found to be important for breast-feeding initiation in this study population. No other indicator of socio-demographic status was found to be associated with breast-feeding initiation.

IMPLICATIONS FOR PRACTICE

focus should be given to pregnant women with higher BMI at the beginning of pregnancy, and women who had undergone caesarean section. Breast-feeding information and encouragement should be provided to all women in the maternity ward, along with the dedicated practice of rooming-in, in order to promote and increase breast-feeding initiation rates.

Smoking and caesarean deliveries: major negative predictors for breastfeeding in the mother-child cohort in Crete, Greece (Rhea study)

Although benefits of breastfeeding have been widely promoted and accepted, exclusive breastfeeding for the first 6 months of life is far from the norm in many countries. In a prospective mother-child cohort study in Crete, Greece ('Rhea' study), we assessed the frequency of breastfeeding and its socio-demographic predictors. Information on breastfeeding was available for a period of 18 months post-partum for a cohort of 1181 mothers and their 1208 infants. The frequency of exclusive and predominant breastfeeding in the first month post-partum was 17.8% and 3.4%, respectively, with almost three-quarters of women (73.6%) ceasing any breastfeeding after 4 months post-partum. Women were less likely to initiate breastfeeding if they had a caesarean delivery (CD), whereas they were more likely to initiate breastfeeding if they had a higher education or gave birth to a private clinic. Among women breastfeeding, those who had a CD, were ex-smokers or smokers during pregnancy had a statistically significant shorter duration of breastfeeding, whereas higher education and being on leave from work were associated with a longer duration of breastfeeding. Study findings suggest suboptimal levels of exclusive and any breastfeeding and difficulty maintaining longer breastfeeding duration. CD and smoking are common in Greece and are strong negative predictors for breastfeeding initiation and/or duration, necessitating targeting women at risk early in the prenatal period so as to have a meaningful increase of breastfeeding practices in future cohorts of mothers.

Influência de estratégia de educação em saúde mediada por álbum seriado sobre a autoeficácia materna para amamentar

Objetivou-se verificar a autoeficácia da puérpera em amamentar, antes e após a intervenção educativa. Optou-se por um estudo quantitativo, desenvolvido com 100 puérperas de uma maternidade pública de Fortaleza-CE. Antes e após aplicação do álbum seriado "Eu posso amamentar o meu filho", foram realizadas entrevistas utilizando dois formulários abordando dados de identificação da puérpera e a Breastfeeding Self-Efficacy Scale Short Form. Constatou-se um aumento dos escores da escala após a utilização da intervenção educativa, sobretudo em puérperas com características específicas, já que se observou associação estatisticamente significante entre as seguintes variáveis: idade entre 20-29 anos; estado civil casado/união consensual; número de cinco a sete moradores na casa; puérperas que exerciam atividades remuneradas fora do lar e rendas familiares de dois a oito salários mínimos. Conclui-se que a tecnologia educativa implementada às puérperas foi eficaz no aumento da autoeficácia materna em amamentar, podendo resultar, consequentemente, no alcance de boas taxas de aleitamento materno.

Understanding the evidence for and against the role of breastfeeding in allergy prevention

The relationship between breastfeeding and allergic disease risk has been controversial. This article reviews the current evidence for the role of breastfeeding in the prevention of allergic disease. We found considerable methodological limitations inherent in most studies evaluating the effect of breastfeeding in allergic disease. Nevertheless, since randomized control trials in breast feeding research would be considered unethical, the evidence remains limited to poorer quality observational studies where participation and recall bias can severely affect the objectivity of the data collected. Furthermore, reporting of type of breastfeeding (exclusive, full or partial) may be biased by a participant's inherent belief system of what they think they should be doing. Current evidence is inconclusive regarding the effect of breastfeeding on the development of eczema, with the most recent systemic review reporting no protective effect. There is insufficient data regarding the effects of breastfeeding on objective measures of food allergy at any age. Studies show a paradoxical effect of breastfeeding on the prevention of asthma, with an apparent protective effect against early wheezing illness in the first years of life yet an increased risk of asthma in later life; however, these findings must be interpreted with caution. Existing studies fail to adequately adjust for confounders, including the critical issues of protection against early life respiratory illnesses and reverse causation. Therefore, it is possible that the effect of breastfeeding on early wheezing illness reflects protection against respiratory infection, the predominant trigger of wheezing in early childhood, rather than a true reduction in risk of asthma. In summary, future research that takes into account the potential contribution of confounding factors and effect modifiers is needed to clarify the role of breastfeeding in development of allergic disease and to inform current clinical guidelines on the prevention of allergic disease.

Complexities and subtleties in the measurement and reporting of breastfeeding practices

BACKGROUND

Monitoring of breastfeeding is vital. However, infant feeding practices are difficult to assess at the population level. Although significant efforts have been made towards the consistent measurement and reporting of breastfeeding, few countries have successfully implemented a system to do so. Many inaccuracies, inconsistencies and issues remain. This paper highlights the main issues relating to the methods and indicators used to monitor breastfeeding, particularly exclusive breastfeeding, at the population level. In doing so, it aims to support progress in this area.

DISCUSSION

Indicators are used primarily for comparative purposes and should be broadly consistent with recommended practice; regarding exclusive breastfeeding this is 'to six months'. There are limitations to both main methods used to measure and report on breastfeeding: current status (often 24-hour recall), and longer-term recall. Issues relate to how age is considered within the analysis and interpretation of data, including boundary points or cut offs, as well as how breastfeeding practices are reported against different ages, especially regarding whether to use the preposition 'to' or 'at'. Other issues include the conversion from weeks to months, as well as the 'regular' versus 'first' introduction of something other than breast milk, to signify the deviation from exclusive breastfeeding. Differences in how data are collected, and uncertainties around how data are interpreted, have led to the mixed and often inaccurate reporting of breastfeeding practices, particularly exclusive breastfeeding. Assuming a particular definition of exclusive breastfeeding, such as that of the World Health Organization, the period over which exclusive breastfeeding is measured and how it is determined in the survey are important in relation to indicator phrasing. Often compromises are made in data collected to report against exclusive breastfeeding, despite subsequent reporting of exclusivity.

SUMMARY

Indicators to report on breastfeeding must be carefully phrased. The commonly reported indicator exclusive breastfeeding at six months is redundant and should never be reported, while the more appropriate indicator exclusive breastfeeding to six months may not be sufficiently sensitive to change, and cannot be measured by current status methods alone. Importantly, indicators must accurately reflect the data collected to ensure valid comparisons between surveys.

Influência da disfunção oral do neonato a termo sobre o início da lactação

OBJETIVO: verificar a associação entre a disfunção oral e os fatores socioeconômicos, variáveis relacionadas à mãe e ao recém-nascido com o desempenho da mamada, durante as primeiras 48 horas de vida. MÉTODOS: estudo transversal, analítico, realizado em uma maternidade pública do Recife-PE. Foram entrevistadas todas as mães de crianças nascidas a termo entre abril e julho de 2008, perfazendo 588 binômios mãe/recém-nascido. A avaliação do sistema sensório motor oral do neonato e avaliação da mamada foram elaboradas, codificando-se como zero quando o item era "esperado/normal" e um quando "não esperado/de risco". A soma total dos itens "não esperados/de risco" resultou em um Índice de Disfunção Oral e um Índice de Avaliação da Mamada. RESULTADOS: verificou-se que 57,3% dos binômios mães/recém-nascidos apresentavam alteração da mamada, 43,9% apresentavam 1 e/ou 2 alterações e 13,4% maior número de alterações. A frequência de disfunção oral foi de aproximadamente 30%. Na análise de regressão logística entre as variáveis incluídas, apenas a disfunção oral manteve-se associada significativamente com o insucesso da mamada. Crianças com maior número alterações da função oral apresentaram chance 4 vezes maior de ter alteração da mamada. CONCLUSÕES: sendo as disfunções orais uma das causas para o não estabelecimento da lactação, estas devem ser identificadas precocemente, visto que podem ser corrigidas, evitando o desmame. As maternidades devem possuir equipe capacitada no manejo do aleitamento, com um profissional que dê atenção especial às alterações do sistema sensório motor oral.

Assignment to a hospital-based breastfeeding clinic and exclusive breastfeeding among immigrant Hispanic mothers: a randomized, controlled trial

A randomized controlled trial is used to determine whether assigning mixed feeders to a breastfeeding clinic within 1 week postpartum will increase exclusive breastfeeding at 1 month among Hispanic immigrants. Subjects are eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and 85% are monolingual Hispanic. Mothers (n = 522) of infants at low risk for hyperbilirubinemia are approached at bedside 20 to 48 hours after delivery and randomly assigned to treatment or control groups. Intent-to-treat analysis of feeding behavior at 4 weeks postpartum indicates that the intervention group is more likely to be exclusively breastfeeding (16.4% vs 10% in the control group, P = .03; adjusted odds ratio 1.87; 95% confidence interval, 1.07-3.26); that the incidence of formula supplementation does not differ between groups; and that the intervention group is less likely to supplement with water and tea (P < .002).

Effect of hospital practices on breastfeeding: a survey in the Italian Region of Lazio

To investigate hospital practices associated with infant feeding during hospital stay and at 1 month of age, all women who were in 17 maternity hospitals on a given day and had delivered a singleton newborn were contacted. Of the 165 eligible women, 153 participated in the survey. Data were collected from the mothers' clinical records and through interview. Odds ratios were calculated to estimate the effect of hospital practices on breastfeeding rates. The main findings are that cesarean section (adjusted odds ratio [OR(adj)] = 3.69; 95% confidence interval [CI], 1.19-11.47), lack of information about the advantages of breastfeeding (OR(adj) = 4.78; 95% CI, 1.50-15.26), and absence or partial absence of rooming-in (OR(adj) = 14.64; 95% CI, 2.24-95.75) increase the risk of complementary breastfeeding during hospital stay. In turn, complementary breastfeeding during hospital stay was the major factor associated with not breastfeeding at 1 month of age (OR(adj) = 6.35; 95% CI, 2.52-16.01). These findings suggest that some hospital practices might have a negative effect on the initiation and continuation of breastfeeding.