Infant Feeding Practices In a Diverse Group of Women: The Healthy Start Study

Obesity and Prenatal Intention as Predictors of Meeting Breastfeeding Recommendations in an Urban Birth Cohort

Background and Objectives: Few U.S. women meet the public health recommendations to exclusively breastfeed for 6 months and continue breastfeeding for at least 1-2 years. We compared prenatally collected demographic, health, and breastfeeding support/intention variables to examine how these factors intersect to predict meeting breastfeeding recommendations. Methods: PREVAIL, a CDC-funded birth cohort in Cincinnati, OH, was approved by the IRB at CDC, Cincinnati Children's Hospital, and the hospitals where enrollment (third trimester, 2017-2018) occurred. The prenatal questionnaire captured sociodemographics, pre-pregnancy weight and height, breastfeeding environment, and breastfeeding intention, while health factors were obtained from obstetrical records. Body mass index (BMI) (kg/m2) was categorized as healthy (18.5-24.9), overweight (25-29.9), obesity 1 (30-34.9), and obesity 2+ (≥35). Mothers self-reported date of exclusive and any breastfeeding cessation through quarterly postnatal questionnaires. Random forest was used for variable selection, cross-validated in multivariable logistic models. Results: Analysis included n = 237 mothers with BMI ≥18.5. Random forest identified BMI category, prenatal intention, and insurance type as the most important predictors of meeting breastfeeding recommendations. The resulting logistic models explained >40% of the variance with an area under the curve of ≥0.89 for both recommendations. More than 73% of the risk of not meeting breastfeeding recommendations was attributable to having an elevated BMI or lacking strong breastfeeding intention. Conclusions: In PREVAIL, maternal BMI and prenatal intention explained most risks of not meeting breastfeeding exclusivity and duration recommendations. Our findings suggest efforts to improve breastfeeding exclusivity and duration should focus on strengthening prenatal breastfeeding intention and identifying effective interventions for supporting breastfeeding among mothers with higher BMI.

Associations of infant feeding practices with abdominal and hepatic fat measures in childhood in the longitudinal Healthy Start Study

BACKGROUND

Infant feeding patterns have been linked with obesity risk in childhood, but associations with precise measures of body fat distribution are unclear.

OBJECTIVE

We examined associations of infant feeding practices with abdominal fat and hepatic fat trajectories in childhood.

METHODS

This study included 356 children in the Healthy Start Study, a prospective prebirth cohort in Colorado. Infant feeding practices were assessed by postnatal interviews and categorized as any human milk <6 mo compared with ≥6 mo; complementary foods introduced ≤4 mo compared with >4 mo; soda introduced ≤18 mo compared with >18 mo. Abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) areas and hepatic fat (%) were assessed by magnetic resonance imaging in early and middle childhood (median 5 and 9 y old, respectively). We examined associations of infant feeding with adiposity trajectories across childhood using linear mixed models.

RESULTS

In the sample of children, 67% consumed human milk ≥6 mo, 75% were introduced to complementary foods at >4 mo, and 81% were introduced to soda at >18 mo. We did not find any associations between duration of any human milk consumption and childhood adiposity trajectories. Early introduction to complementary foods (≤4 mo) was associated with faster rates of change for SAT and VAT during childhood (Slope [95% CI]: 15.1 [10.7,19.4] cm2/y for SAT; 2.5 [1.9,2.9] cm2/y for VAT), compared with introduction at >4 mo (5.5 [3.0,8.0] cm2/y and 1.6 [1.3,1.9] cm2/y, respectively). Similarly, early introduction to soda (≤18 mo) was associated with faster rates of change for all 3 outcomes during childhood (Slope [95% CI]: 20.6 [15.0,26.1] cm2/y for SAT, 2.7 [2.0,3.3] cm2/y for VAT, 0.3 [0.1,0.5] %/year for hepatic fat) compared with delayed introduction (5.4 [2.8,8.0] cm2/y, 1.7 [1.3, 2.0] cm2/y, -0.1 [-0.2,0.0] %/y, respectively).

CONCLUSIONS

The timing of introduction and quality of complementary foods in infancy was associated with rates of abdominal and hepatic fat accrual during childhood. Experimental studies are needed to assess underlying mechanisms.

Incidence and timing of offspring asthma, wheeze, allergic rhinitis, atopic dermatitis, and food allergy and association with maternal history of asthma and allergic rhinitis

Background

Studying the developmental precursors of allergy may help explain the mechanisms (or etiology) of allergic disease. We studied childhood respiratory and allergic diseases in a pre-birth cohort from the United States.

Objective

We assessed the associations between maternal history of asthma and the development of respiratory and allergic diseases in offspring. We also assessed associations with maternal history of allergic rhinitis.

Methods

Maternal history of asthma and allergic rhinitis was self-reported during early pregnancy. Offspring respiratory and allergy information was obtained from electronic medical records. Adjusted Cox proportional hazard models assessed the associations between maternal history of asthma and development of respiratory and allergic diseases in the offspring up to 8 years. A similar approach was used for maternal history of allergic rhinitis.

Results

Children born to women with a history of asthma had a 77% greater risk of developing asthma, a 45% greater risk of atopic dermatitis/eczema, and a 65% greater risk of wheeze (all p < 0.01), but no significantly increased risk of allergic rhinitis or food allergies, compared to children born to women with no history of asthma. Maternal history of allergic rhinitis was not associated with any child allergy outcome, and maternal history of both asthma and allergic rhinitis was associated with child atopic dermatitis/eczema only.

Conclusions

Maternal history of asthma was significantly associated with offspring respiratory and allergic diagnoses. The association between maternal history of asthma and offspring asthma and atopic dermatitis is a novel finding. Our findings may guide physicians who counsel families with a history of maternal asthma and allergic rhinitis about their child's risk of developing respiratory and allergic diseases.

Formula Feeding and Associated Factors among a Group of Egyptian Mothers

BACKGROUND

Breastfeeding provides an unequalled way of infant nutrition, despite that, the rate of exclusive breastfeeding for the first 6 months in Egypt is only 13%, and the rates of artificial feeding are rising.

AIM

The current study aimed to explore the reasons for the use of artificial feeding among mothers receiving subsidised milk from formula dispensing centres in Egypt, and to detect the reasons behind the use of a formula only for infant feeding rather than mixed breastfeeding and artificial feeding.

METHODS

This exploratory cross-sectional study involved 197 mothers; who attended centres for dispensing subsidised artificial formula at primary health care facilities (PHC) in El-Fayom and Ismailia governorates via a purposive sampling technique. The study spanned over 6-months duration from June till December 2018.

RESULTS

A statistically significant higher percentage of artificial feeding only was noticed in male infants (47.5% in the AF group only versus 28.7% in the mixed feeding group (p = 0.018), and infants aged 6-12 months (47.5% in the AF group only versus 28.7% in the mixed feeding group, p = 0.032). A statistically significant higher percentage of artificial feeding only was noticed among infants born to mothers who have general anaesthesia during labour (67.2% in the AF group only versus 41.9% in the mixed feeding group, p = 0.004), and among infants born to mothers who think that formula feeding is better (13.1% in the AF group only versus 0.7% in the mixed feeding group, or that formula has a similar quality to breast milk (6.6%% in the AF group only versus 4.4% in the mixed feeding group, p = 0.0004. The most common reasons for formula feeding reported by both groups were perceived breast milk insufficiency (60.9%), weak babies (50.3%), and doctors' advice (37%). Previous negative breastfeeding experience and the need for own body privacy were the two reasons which differed statistically in both groups p = 0.004 and 0.008, respectively.

CONCLUSION

Antenatal care education is essential to improve mothers' knowledge and practice of breastfeeding. Baby-friendly hospital initiative implementation is essential to ensure early initiation and continuation of breastfeeding.