1
|
Slater CN, Juntereal NA, Kral TVE, Spatz DL, Chao AM. Comparison of the Effect of Direct Breastfeeding, Expressed Human Milk, and Infant Formula Feeding on Infant Weight Trajectories: A Systematic Review. Breastfeed Med 2024; 19:235-247. [PMID: 38497755 DOI: 10.1089/bfm.2023.0149] [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] [Indexed: 03/19/2024]
Abstract
Background: Formula and breastfeeding are known factors associated with infant weight trajectories. Evidence exploring the effect of expressed human milk feeding on infant weight in the community setting has not been well synthesized. Objectives: This systematic review examined (1) weight changes among infants fed expressed human milk and (2) differences in weight change between infants fed expressed human milk and infants fed at the breast or infant formula via bottle. Methods: A comprehensive search of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of each study was appraised using the Joanna Briggs Critical Appraisal Tools. Results: A total of six studies met the eligibility criteria and included a total of 5,152 infants. The within-subject analysis identified only 31 infants strictly or predominantly fed expressed human milk. The between-subject analysis comparing expressed human milk feeding to the available comparison groups (formula-fed or direct at the breastfed) revealed that higher weight gains were observed in the weight trajectories among infants in the bottle or formula-fed conditions in four of the six included studies. Conclusions: Findings from the few studies included in this review found a difference in the infant weight gain patterns among expressed human milk-fed infants when compared with their respective feeding groups (directly breastfed or formula-fed). Further research is needed to corroborate these findings and elucidate the clinical significance of the differences in weight gain patterns observed across infant feeding groups.
Collapse
Affiliation(s)
- Courtney N Slater
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Nina A Juntereal
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Tanja V E Kral
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Diane L Spatz
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Pediatric Nursing Research & Evidence-Based Practice, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ariana M Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Du Y, Onyango-Makumbi C, Walia B, Owor M, Musoke P, Owora AH. Correlates of early breastfeeding cessation and breastmilk expression in Uganda: a case-control study. J Int Med Res 2024; 52:3000605231223041. [PMID: 38443751 PMCID: PMC10916486 DOI: 10.1177/03000605231223041] [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: 08/04/2023] [Accepted: 12/11/2023] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To identify the correlates of early breastfeeding (BF) cessation and breastmilk expression (BE) among mothers 12 months after childbirth. METHODS We used a case-control study design to compare characteristics between mothers who stopped BF and expressed breastmilk 12 months after childbirth in Uganda. BF practices were determined in 12-month follow-up interviews using an adapted World Health Organization infant feeding questionnaire. Univariate and bivariate logistic regression models identified correlates of early BF cessation and BE as distinct but related outcomes. RESULTS The odds of early BF cessation were higher among mothers who expressed breastmilk irrespective of maternal age (adjusted odds ratio: 2.82; 95% confidence interval: 1.39, 5.68). Mothers who stopped BF and did not express breastmilk were more likely to be older than those who continued BF and did not express breastmilk during the first 12 postpartum months. CONCLUSION Mothers living with human immunodeficiency virus infection have disproportionately high odds of early BF cessation that may contribute to disparities in child health outcomes. Promotion of safe BF practices coupled with family and social support could be a viable preventive strategy for attenuating such disparities, especially among young mothers at risk of early BF cessation.
Collapse
Affiliation(s)
- Yu Du
- Department of Epidemiology Biostatistics, Indiana University School of Public Health Bloomington, IN, USA
| | - Carolyn Onyango-Makumbi
- Makerere University, Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Bhavneet Walia
- Department of Public Health, Syracuse University, Syracuse, New York, USA
| | - Maxie Owor
- Makerere University, Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Phillipa Musoke
- Makerere University, Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Arthur H. Owora
- Department of Epidemiology Biostatistics, Indiana University School of Public Health Bloomington, IN, USA
- Department of Pediatrics, Indiana University School of Medicine, IN, USA
| |
Collapse
|
3
|
Pérez-Hernández M, García-Hernández JP, Hidalgo-Aguirre RM, Guevara MA, Robles-Aguirre FA, Hernández-González M. Electroencephalographic activity during direct breastfeeding and breast milk expression in primiparous mothers. Early Hum Dev 2024; 189:105945. [PMID: 38271767 DOI: 10.1016/j.earlhumdev.2024.105945] [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: 10/06/2023] [Revised: 12/06/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
Breastfeeding is recognized worldwide as the best option for infant feeding. Expressing breast milk is an alternative for mothers to provide their infants all the benefits of maternal milk. During breast milk expression, mothers receive a distinct kind of sensory stimulation, because there is no direct bodily or affective interaction with their infants, many women report feeling isolated, generating a love-hate relation with pumping, and even low levels of satisfaction while expressing breast milk. While it is well known that the prefrontal, parietal, and temporal cortices play important roles in the emotional and cognitive processing of maternal stimuli, knowledge about how these cortical areas function during breastfeeding is lacking. This study was designed to characterize EEG activity in the prefrontal and parietal cortices and the affective scores of primiparous breastfeeding mothers during two conditions of milk expression: breast milk expression and direct breastfeeding. Participants reported higher valence and arousal and a pleasant state during direct breastfeeding. In the direct breastfeeding condition, both prefrontal areas showed a higher absolute power (AP) of the slow bands, with a lower AP of the alpha band in the parietal cortex. A lower correlation between frontopolar and dorsolateral areas with a higher correlation between prefrontal and parietal cortices was obtained mainly in the right hemisphere. This EEG activity could be linked to an internal state of focused attention and, simultaneously, open monitoring of the environment that suggests an integration of the motive-emotional and cognitive processes necessary for adequate mother-baby interaction during direct breastfeeding.
Collapse
Affiliation(s)
- M Pérez-Hernández
- Centro Universitario del Norte, Universidad de Guadalajara, Carr. Federal No. 23, Km. 191, C.P. 46200 Colotlán, Jalisco, Mexico
| | - J P García-Hernández
- Universidad Tecnológica de México - UNITEC MÉXICO - Campus Guadalajara, Mexico; Centro Universitario de los Valles, Universidad de Guadalajara, Carretera Guadalajara - Ameca Km. 45.5, C.P. 46600 Ameca, Jalisco, Mexico
| | - R M Hidalgo-Aguirre
- Centro Universitario de los Valles, Universidad de Guadalajara, Carretera Guadalajara - Ameca Km. 45.5, C.P. 46600 Ameca, Jalisco, Mexico
| | - M A Guevara
- Instituto de Neurociencias, Universidad de Guadalajara, Francisco de Quevedo 180, Colonia Arcos-Vallarta, C.P. 44130 Guadalajara, Jalisco, Mexico
| | - F A Robles-Aguirre
- Centro Universitario del Norte, Universidad de Guadalajara, Carr. Federal No. 23, Km. 191, C.P. 46200 Colotlán, Jalisco, Mexico
| | - M Hernández-González
- Instituto de Neurociencias, Universidad de Guadalajara, Francisco de Quevedo 180, Colonia Arcos-Vallarta, C.P. 44130 Guadalajara, Jalisco, Mexico.
| |
Collapse
|
4
|
Kholina K, Brady J, Snelgrove-Clarke E, Rossiter MD, Whitfield KC. Dual modality feeders: a group of human milk feeders with unique practices and needs. Public Health Nutr 2023; 26:2882-2890. [PMID: 37927150 PMCID: PMC10755423 DOI: 10.1017/s1368980023002367] [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: 03/22/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Dual modality feeding (DMF) - feeding human milk interchangeably from the breast and from a bottle - comes with unique practical, emotional and relational challenges, as well as support needs. Yet, there is little research that explores the experiences of individuals who use DMF in the Canadian context. The aim of this study is to explore the practices, challenges, reasons and enablers of DMF. DESIGN Repeat, semi-structured one-on-one interviews were conducted at 8 weeks and 22 weeks postpartum. Interview transcripts were thematically analysed using a critical feminist lens. SETTING Nova Scotia, Canada. PARTICIPANTS Ten DMF mothers. RESULTS DMF practices were influenced by a mix of social and material circumstances, including breast-feeding challenges, the involvement of support persons, finances and access to lactation support. Individuals who predominantly fed at the breast expressed milk strategically to mitigate transitory breast-feeding challenges, for convenience under specific circumstances, and to share feeding responsibilities with other caregivers for personal and practical reasons. Individuals who mainly bottle-fed did so due to long-term breast-feeding challenges or a need to return to employment. Enablers of successful DMF were consistent between the two groups and included practical, personal and relational aspects. CONCLUSIONS DMF is a unique practice compared to feeding human milk solely from the breast or bottle. Despite the potential growing prevalence of DMF, it is currently understudied and inadequately addressed in existing support programmes in Nova Scotia. Tailored programming and public messaging are needed to support DMF families.
Collapse
Affiliation(s)
- Ksenia Kholina
- Department of Applied Human Nutrition, Mount Saint Vincent University, 166 Bedford Hwy, Halifax, Nova Scotia, B3M 2J6Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia, Canada
| | - Jennifer Brady
- School of Nutrition and Dietetics, Acadia University, 15 University Ave, Wolfville, Nova Scotia, Canada
| | - Erna Snelgrove-Clarke
- School of Nursing, Faculty of Health Sciences, Queen’s University, 92 Barrie Street, Kingston, ON, Canada
| | - Melissa D Rossiter
- Department of Applied Human Sciences, University of Prince Edward Island, 550 University Ave, Charlottetown, Prince Edward Island, Canada
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, 166 Bedford Hwy, Halifax, Nova Scotia, B3M 2J6Canada
| |
Collapse
|
5
|
Douglas P. Does the Academy of Breastfeeding Medicine's Clinical Protocol #36 'The Mastitis Spectrum' promote overtreatment and risk worsened outcomes for breastfeeding families? Commentary. Int Breastfeed J 2023; 18:51. [PMID: 37670315 PMCID: PMC10481477 DOI: 10.1186/s13006-023-00588-8] [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: 12/05/2022] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND In 2022 the Academy of Breastfeeding Medicine (ABM) published Clinical Protocol #36: The Mastitis Spectrum, which aims to update clinical approaches to management of benign lactation-related breast inflammation. The protocol has been timely because of the exponential increase in knowledge about the human milk microbiome over the past decade. This Commentary aims to continue respectful debate amongst clinicians and researchers within the Academy of Breastfeeding Medicine and more broadly, confident that we share a fundamental commitment to promote breastfeeding and support the well-being of lactating women, their infants and their families. ANALYSIS Although Clinical Protocol #36 offers advances, it does not fulfil the principles of best practice implementation science for translation of evidence into clinical guidelines. Clinical Protocol #36 inaccurately represents studies; misrepresents theoretical models as proven aetiologies; does not consistently attribute sources; does not reliably apply the SORT taxonomy; and relies upon single case reports. As a result, various recommendations in Clinical Protocol #36 lack an evidence-base or credible underlying theoretical model. This includes recommendations to use 'lymphatic drainage' massage, therapeutic ultrasound, and oral lecithin. Similarly, based on a contestable theoretical model which is presented as fact, Clinical Protocol #36 makes the recommendation to either reduce frequency of milk removal or to maintain current frequency of milk removal during an episode of breast inflammation. Although Clinical Protocol #36 limits this advice to cases of 'hyperlactation', the diagnosis 'hyperlactation' itself is undefinable. As a result, this recommendation may put breastfeeding women who present with breast inflammation at risk of worsened inflammation and decreased breast milk production. CONCLUSION Clinical Protocol #36 offers some advances in the management of breast inflammation. However, Clinical Protocol #36 also exposes clinicians to two international trends in healthcare which undermine health system sustainability: overdiagnosis, including by over-definition, which increases risk of overtreatment; and antibiotic over-use, which worsens the crisis of global antimicrobial resistance. Clinical Protocol #36 also recommends unnecessary or ineffective interventions which may be accessed by affluent patients within advanced economies but are difficult to access for the global majority. The Academy of Breastfeeding Medicine may benefit from a review of processes for development of Clinical Protocols.
Collapse
Affiliation(s)
- Pamela Douglas
- The School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
- General Practice Clinical Unit, The University of Queensland, Brisbane, Australia.
- Medical Director, The NDC Institute, ndcinstitute.com.au, Brisbane, Australia.
| |
Collapse
|
6
|
Liu Y, Chang C. The relationship between early childhood development and feeding practices during the dietary transitional period in rural China: a cross-sectional study. Front Public Health 2023; 11:1202712. [PMID: 37637814 PMCID: PMC10450922 DOI: 10.3389/fpubh.2023.1202712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Early childhood feeding environments and practices not only affect children's nutritional status but also provide children with a variety of external stimulations to affect the development of the child's brain, especially for the first 1,000 days of children. The relationship between early childhood development (ECD) and feeding practices during the dietary transitional period has not previously been described. Method This study used quantitative survey data from the Integrated Early Childhood Development Project to investigate this association between ECD and feeding practices during the dietary transitional period in poor rural areas of China. Data concerning the child and family characteristics and feeding practices were collected through the questionnaire completed by caregivers. Developmental delays were explored through a five-pronged, structured, parent-completed Age and Stage Questionnaire. The chi-squared test and multivariate logistic regression analyses were used to explore the associated factors in ECD. Results The results showed that 33.6% of children had at least one area of developmental delay during the dietary transitional period. Of all five regions evaluated, the prevalence of fine motor developmental delays was highest (17.7%), followed by communication (14.9%), problem-solving (13.8%), personal-social skills (11.9%), and gross motor (11.8%), respectively. Significant predictors of increased odds of developmental delay included types of complementary foods (OR = 0.70, 95% CI = 0.53-0.94), adequate feeding frequency (OR = 0.69, 95% CI = 0.52-0.90), and breastfeeding time and bottle feeding (OR = 0.66, 95% CI = 0.50-0.88). Discussion According to the results, a high prevalence of developmental delay was observed in children during the dietary transitional period in the rural areas of China. The feeding practices of children were associated with their developmental status, including factors such as inadequate feeding frequency, types of complementary foods, breastfeeding duration, and low family income. These findings highlight the focus and potential direction for early identification and intervention.
Collapse
Affiliation(s)
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
7
|
Nakayama JY, Marks KJ, McGowan A, Li R, Hamner HC. Human milk expression in the first year postpartum among persons with low incomes. J Hum Nutr Diet 2023; 36:1261-1269. [PMID: 36624691 PMCID: PMC10329723 DOI: 10.1111/jhn.13136] [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: 10/20/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Expressing milk (i.e., human milk) is common in the USA, but practices are unknown among families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study of a WIC population explores the practice of and reasons for expressing milk in the first year postpartum. METHODS We analysed data from a longitudinal study to examine milk expression at 1, 3, 5, 7, 9, 11, and 13 months postpartum among breastfeeding persons enrolled in WIC with term singletons. We cross-sectionally analysed the weighted prevalence of milk expression at each survey month and report reasons for milk expression in the first 7 months. RESULTS Among the study participants who reported feeding human milk at Month 1, 70.4% expressed milk in the first 13 months postpartum. The prevalence of milk expression was 56.8% at Month 1 and decreased to 13.9% at Month 13 among those feeding any human milk that month. Reasons for expressing milk changed over time; in the first month, increasing milk supply, relieving engorgement, and having an emergency supply of milk were common. In later months, having a supply of milk available so that someone else could feed their infant was common. CONCLUSIONS Clinicians, health educators, WIC staff, and others working with WIC families can promote optimal expressed milk feeding and storage practices. Extra attention and support may be especially important in the first months postpartum when milk expression is common. Support for persons who are expressing milk can be tailored for reasons of milk expression.
Collapse
Affiliation(s)
- Jasmine Y. Nakayama
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristin J. Marks
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service Commissioned Corps, Rockville, MD, USA
| | - Andrea McGowan
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Ruowei Li
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Heather C. Hamner
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
8
|
Ondrušová S. Breastfeeding and Bonding: A Surprising Role of Breastfeeding Difficulties. Breastfeed Med 2023. [PMID: 37219989 DOI: 10.1089/bfm.2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Aims: To explore the role of breastfeeding difficulties in bonding. Background: Studies published to date yielded varying results regarding the relationship between breastfeeding and bonding. In qualitative studies, mothers often describe breastfeeding as a bonding experience and regard breastfeeding difficulties as challenging. Only one quantitative study explored the impact of breastfeeding difficulties on bonding. Methods: A cross-sectional method was used and a self-report questionnaire was administered to a convenience sample of mothers with infants aged 0-6 months. Results: We found that having problem-free breastfeeding versus breastfeeding associated with breastfeeding difficulties led to a difference in bonding quality. Experiencing any breastfeeding difficulties was associated with bonding impairment (p = 0.000, r = 0.174), especially in cases of breast engorgement (p = 0.016, r = 0.094), a nonlatching baby (p = 0.000, r = 0.179), perceived low milk supply (p = 0.004, r = 0.112), and fussing at the breast (p = 0.000, r = 0.215). We also found a difference in bonding impairment between exclusively breastfeeding and exclusively bottle-feeding mothers (p = 0.001), but only when taking into account breastfeeding difficulties. Conclusions: Breastfeeding is a complex interaction that can be associated with mother-infant bonding in various ways. We found that breastfeeding difficulties were linked to bonding impairment, whereas exclusive breastfeeding without the presence of breastfeeding difficulties was not. Strategies to help achieve exclusive breastfeeding and prevent and resolve breastfeeding difficulties may help mothers fulfill the bonding potential with their infant.
Collapse
Affiliation(s)
- Soňa Ondrušová
- Department of Psychology, Palacky University in Olomouc, Olomouc, Czech Republic
| |
Collapse
|
9
|
Maxwell C, Fleming V, Porcellato L. Why have a bottle when you can have draught? Exploring bottle refusal by breastfed babies. MATERNAL & CHILD NUTRITION 2023; 19:e13481. [PMID: 36737247 PMCID: PMC10019064 DOI: 10.1111/mcn.13481] [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: 09/05/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/05/2023]
Abstract
Bottle refusal by breastfed babies is a scenario that has received surprisingly little attention in the literature, given the number of mothers who appear to be experiencing it globally and the subsequent negative impact it can have. In line with this, we undertook a study to explore mothers' views on why their breastfed baby refuses to bottle feed. A parallel, two-stage, exploratory qualitative design was employed using 30 semi-structured interviews and 597 online forum posts. Data were analysed using a thematic analysis, and a biopsychosocial model was applied resulting in four overarching themes being identified: 'Breastfeeding is the answer to everything….' 'Bottle feeding: an alien concept… 'Babies are individuals' and 'Find the right bottle and don't delay'. The psychological benefits of breastfeeding, not inherent in bottle feeding, appeared to underpin some mothers' views on their baby's refusal. Other mothers explained refusal as being down to a baby's biological expectation to be fed by the breast; therefore, bottle feeding was not a normal concept to them. A baby's individual personality and temperament were also suggested as contributing to the scenario and refusal was linked to babies disliking a certain brand of bottle and being introduced to it 'too late'. This study's findings point to a complex, multifactorial picture underpinning bottle refusal by breastfed babies, which transcends physical, psychological and biological concepts, and is influenced by socio-cultural norms surrounding infant feeding. Recognition of these contributing factors is needed to aid those supporting mothers experiencing the scenario and, importantly, to underpin mothers' decision-making around managing it.
Collapse
Affiliation(s)
- Clare Maxwell
- Department of Midwifery, Faculty of Health, School of Public and Allied HealthLiverpool John Moores UniversityLiverpoolUK
| | - Valerie Fleming
- Department of Midwifery, Faculty of Health, School of Public and Allied HealthLiverpool John Moores UniversityLiverpoolUK
| | - Lorna Porcellato
- Department of Midwifery, Faculty of Health, School of Public and Allied HealthLiverpool John Moores UniversityLiverpoolUK
| |
Collapse
|
10
|
Hookway L, Brown A, Grant A. Breastfeeding sick children in hospital: Exploring the experiences of mothers in UK paediatric wards. MATERNAL & CHILD NUTRITION 2023; 19:e13489. [PMID: 36808886 PMCID: PMC10019061 DOI: 10.1111/mcn.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
There is a paucity of literature exploring the challenges of breastfeeding sick children in hospital. Previous research has focused on single conditions and hospitals which limits understanding of the challenges in this population. Although evidence suggests that current lactation training in paediatrics is often inadequate, it is unclear where the specific training gaps are. This qualitative interview study of UK mothers aimed to explore the challenges of breastfeeding sick infants and children on a paediatric ward or paediatric intensive care unit. From 504 eligible respondents, a sample of 30 mothers of children aged 2-36 months with various conditions and demographic backgrounds was purposively chosen, and a reflexive thematic analysis undertaken. The study identified previously unreported impacts such as complex fluid needs, iatrogenic withdrawal, neurological irritability and changes to breastfeeding behaviour. Mothers described breastfeeding as emotionally and immunologically meaningful. There were many complex psychological challenges such as guilt, disempowerment, and trauma. Wider struggles such as staff resistance to bedsharing, inaccurate breastfeeding information, lack of food and inadequate breast pump provision made breastfeeding more challenging. There are numerous challenges related to breastfeeding and responsively parenting sick children in paediatrics, and these also impacted maternal mental health. Staff skill and knowledge gaps were widespread, and the clinical environment was not always conducive to supporting breastfeeding. This study highlights strengths in clinical care and provides insight into what measures are perceived as supportive by mothers. It also highlights areas for improvement, which may inform more nuanced paediatric breastfeeding standards and training.
Collapse
Affiliation(s)
- Lyndsey Hookway
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| | - Aimee Grant
- Centre for Lactation, Infant Feeding and Translation (LIFT), School of Health and Social CareSwansea UniversitySwanseaUK
| |
Collapse
|
11
|
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
|
12
|
Chan K, Labonté JM, Francis J, Zora H, Sawchuk S, Whitfield KC. Breastfeeding in Canada: predictors of initiation, exclusivity, and continuation from the 2017-2018 Canadian Community Health Survey. Appl Physiol Nutr Metab 2023; 48:256-269. [PMID: 36596236 DOI: 10.1139/apnm-2022-0333] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Human milk is the ideal source of nutrition for infants; however, adherence to breastfeeding recommendations is suboptimal and availability of Canadian breastfeeding data are limited. Using the 2017-2018 Canadian Community Health Survey Public Use Microdata File (Maternal Experiences Module, n = 5558, weighted n = 1 669 462) we computed breastfeeding indicators and explored sociodemographic, health, and geographical predictors of breastfeeding with univariate logistic regression models. Nationally, of all participants who gave birth in the preceding 5 years, 91% initiated breastfeeding, 43% exclusively breastfed to ≥5 months and 35% to ≥6 months, 56% reported any breastfeeding at ≥6 months, and 31% reported breastfeeding at ≥12 months. Breastfeeding cessation was most commonly attributed to insufficient milk supply (25%), but reasons differed significantly by breastfeeding duration. Breastfeeding initiation, exclusivity for ≥5 months, and extended breastfeeding ≥12 months all differed by geographic region, and by most sociodemographic and health characteristics. Positive breastfeeding outcomes were highest in British Columbia, and lowest in Quebec and the Atlantic region, and generally higher if caregivers had recently immigrated to Canada, were married, were >30 years of age, were not White, were nonsmoking, had completed postsecondary education, and had an annual household income >$40 000. These disparities indicate the need for tailored, equitable approaches to breastfeeding support, and continued regional monitoring of breastfeeding outcomes.
Collapse
Affiliation(s)
- Kathleen Chan
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Jocelyne M Labonté
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Jane Francis
- Department of Sociology, Acadia University, Wolfville, NS, Canada
| | - Haley Zora
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| | - Sandra Sawchuk
- Library, Mount Saint Vincent University, Halifax, NS, Canada
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada
| |
Collapse
|
13
|
Quinn EA, Sobonya S, Palmquist AE. Maternal perceptions of human milk expression output: An experimental design using photographs of milk. Soc Sci Med 2023; 324:115871. [PMID: 37023658 DOI: 10.1016/j.socscimed.2023.115871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/20/2023] [Accepted: 03/26/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The widespread use of breast pumps in the United States is a recent phenomenon that is reshaping how individuals understand and perceive lactation. In the 1990s, adequacy of milk supply was primarily measured indirectly by infant weight gain and/or diapers; now >95% of all lactating persons in the United States use breast pumps and are seeing their milk regularly. How seeing milk impacts the perception of lactation sufficiency is an important area of research. Research aim/question: To understand personal and intersubjective influences of seeing expressed human milk on perceptions of milk supply among participants who express milk for their infants. METHODS We surveyed 805 lactating participants from the United States about their pumping practices using an online survey. Participants described pumping practices, milk output, and beliefs. They were then randomized to view one of three photographs of expressed milk (<2 oz, 4 oz, >6oz) and asked to imagine they had just pumped that amount and provide a written response; this created 4 exposure groups (2 increase and 2 decrease) and a control group (no difference). RESULTS Participants randomized to a higher volume reported more positive feelings and used the terms "good", "great", and "accomplished" to describe emotional responses to output. Participants randomized to lower milk volumes reported more feelings of "bad" or "depressed." A subset of participants reported feeling "annoyed" about small volumes of milk. CONCLUSIONS Participants in this study were very conscious of the volume of milk pumped each session; both increases and decreases were associated with emotional responses that could contribute to decisions about pumping practices, perceived milk supply, and lactation duration.
Collapse
|
14
|
Obaid YY, Toubasi AA, Albustanji FH, Al-Qawasmeh AR. Perinatal risk factors for infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis. J Pediatr Surg 2023; 58:458-466. [PMID: 36137827 DOI: 10.1016/j.jpedsurg.2022.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/15/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is one of the most common diseases that require surgical intervention amongst the paediatric population. Although the treatment and the diagnosis of pyloric stenosis are well established, the perinatal risk factors associated with it still need further investigation. METHODS We searched the following databases: Cochrane, Google Scholar, PubMed, and Scopus. Studies were included if they were case-control or cohort in design and studied the perinatal risk factors associated with IHPS. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). RESULTS Twenty-one articles were included in this meta-analysis, including 18,104,753 participants. Our analysis showed a significant association between IHPS and male sex (RR=2.71, 95% CI:1.93-3.78), maternal smoking (RR=1.75, 95% CI: 1.54 - 2.00), bottle-feeding (RR=1.68, 95% CI: 1.42 - 1.98), being first born (RR=1.23, 95% CI:1.07-1.40), African ethnicity (RR=0.51, 95% CI: 0.35-0.75), and cesarean section (RR=1.57, 95% CI: 1.49-1.66). On the contrary, there was no significant association between IHPS and multiple gestations, preterm labour, being born in summer, and small for gestational age (SGA). CONCLUSION In conclusion, our analysis showed that male sex, bottle feeding, maternal smoking and African ethnicity were significantly associated with the risk of IHPS. However, most of the included articles were retrospective in design which necessitates conducting future prospective well-designed studies to further investigate the risk factors of IHPS.
Collapse
Affiliation(s)
- Yazan Y Obaid
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962.
| | - Ahmad A Toubasi
- Faculty of Medicine, University of Jordan, Amman, Jordan, 11962
| | | | | |
Collapse
|
15
|
Jarman M, Shen Y, Yuan Y, Madsen M, Robson PJ, Bell RC. Applying suggested new terminology and definitions for human milk feeding in the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal pregnancy cohort. Appl Physiol Nutr Metab 2023; 48:17-26. [PMID: 36137297 DOI: 10.1139/apnm-2021-0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The complexity of human milk-feeding behaviours may not be captured using simpler definitions of "exclusive" and "non-exclusive" breastfeeding. New definitions have been suggested to describe variation in these behaviours more fully but have not been widely applied. We applied the new definitions to data derived from 3-day human milk-feeding diaries. Participants (n = 1091) recorded the number, beginning/end time, and modes of feeding of infants aged 3 months. Data were used to create six exclusive groups according to feeding mode(s): (1) human milk at-breast only; (2) human milk at-breast and human milk in a bottle; (3) human milk at-breast and infant formula in a bottle; (4) human milk at-breast and human milk and infant formula mixed in the same bottle; (5) human milk at-breast, human milk in a bottle, and infant formula in a bottle (not mixed); and (6) a bottle that sometimes contained human milk and sometimes infant formula (not mixed), never at-breast. Differences in maternal and infant characteristics were examined among groups. Fifty-seven percent fed at-breast only (Group 1). Those in Group 1 spent a similar amount of time feeding directly at-breast (median 132 (IQR 98-172) min/day) as those in Groups 2 (124 (95-158)), 3 (143 (100-190)), and 5 (114 (84-142)) (p > 0.05), indicating that adding bottle feeding did not always reduce the time infants were fed at-breast. Applying new suggested definitions to describe human milk-feeding behaviours from the mothers' perspective highlights the complexity of patterns used and warrants further application and research to explore impacts on health outcomes.
Collapse
Affiliation(s)
- Megan Jarman
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Psychology, College of Health and Life Science, Aston University, Birmingham, UK
| | - Ye Shen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton AB, Canada
| | - Mette Madsen
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Paula J Robson
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton AB, Canada.,Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3H1, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
16
|
Mildon A, Francis J, Stewart S, Underhill B, Ng YM, Rousseau C, Di Ruggiero E, Dennis CL, Kiss A, O'Connor DL, Sellen DW. Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada. BMJ Open 2022; 12:e055830. [PMID: 35676013 PMCID: PMC9185489 DOI: 10.1136/bmjopen-2021-055830] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months. DESIGN Pooled data from two prospective cohort studies SETTING: Three Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada. PARTICIPANTS 337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum. EXCLUSIONS pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum. PRIMARY AND SECONDARY OUTCOME MEASURES Main exposure variable: any use of expressed human milk at 2 weeks postpartum. OUTCOMES cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum. RESULTS All participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84). TRIAL REGISTRATION NUMBERS NCT03400605, NCT03589963.
Collapse
Affiliation(s)
- Alison Mildon
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane Francis
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stacia Stewart
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Bronwyn Underhill
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | - Yi Man Ng
- Health Promotion and Community Engagement, Parkdale Queen West Community Health Centre, Toronto, Ontario, Canada
| | | | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Alex Kiss
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Deborah L O'Connor
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Pediatrics, Sinai Health, Toronto, Ontario, Canada
| | - Daniel W Sellen
- Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
- Anthropology, Faculty of Arts and Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Kotowski J, Fowler C, Orr F. Bottle-feeding, a neglected area of learning and support for nurses working in child health: An exploratory qualitative study. J Child Health Care 2022; 26:199-214. [PMID: 33829871 DOI: 10.1177/13674935211007321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breastfeeding is the ideal infant feeding modality; however, the reality is some parents need or choose to use bottles to feed their infants. Parents who bottle-feed have been identified as not receiving adequate levels of bottle-feeding information and advice from health professionals. This study's aim was to explore nurses' knowledge of the components in the bottle-feeding act. Twenty-one nurses working in early parenting residential units participated in three focus groups. Three themes were identified relating to nurses' bottle-feeding knowledge: experience not evidence-based, it is hard to know what to advise, we will support whatever choice they make. The nurses identified a deficit in their knowledge, education and training related to the components of bottle-feeding. The nurses struggled with their interpretation of infant feeding policies and the provision of bottle-feeding information to parents. Nurses working in child and family health were motivated to inform, educate and enable parents to confidently make decisions concerning infant feeding. The healthcare system and the infant feeding policy drivers appear to have a mixed and at times negative impact on nurses' practice. Further research is required across a larger population of nurses.
Collapse
Affiliation(s)
- Judith Kotowski
- School of Nursing & Midwifery, Faculty of Health, 1994University of Technology, Sydney, Australia
| | - Cathrine Fowler
- School of Nursing & Midwifery, Faculty of Health, 1994University of Technology, Sydney, Australia
| | - Fiona Orr
- School of Nursing & Midwifery, Faculty of Health, 1994University of Technology, Sydney, Australia
| |
Collapse
|
18
|
Moorhead AM, Amir LH, Forster DA, Crawford SB. 'Is there any point in me doing this?' Views and experiences of women in the Diabetes and Antenatal Milk Expressing (DAME) trial. MATERNAL & CHILD NUTRITION 2022; 18:e13307. [PMID: 34939318 PMCID: PMC8932693 DOI: 10.1111/mcn.13307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/20/2022]
Abstract
The Diabetes and Antenatal Milk Expressing (DAME) randomised controlled trial (RCT) was conducted in 2011–2015, at six sites in Melbourne, Australia to explore the effect of advising women with diabetes in pregnancy to express breast milk from 36 weeks gestation. Infants whose mothers were randomised to express in pregnancy were more likely to be exclusively breast milk fed during their hospital stay, and there was no evidence of harm. This paper explores women's views and experiences of antenatal expressing. In this two‐arm RCT, 635 women with diabetes in pregnancy who were otherwise of low medical risk were randomised at 36–37 weeks gestation to usual care (not expressing, n = 316), or the intervention, where women were advised to hand express for 10 min twice daily until birth (n = 319). Semistructured face‐to‐face interviews were conducted with 10 women who expressed antenatally. They were asked about their experiences of antenatal expressing, including how they felt about the overall experience, the amount of breast milk they expressed, making time to express, and their experience of breastfeeding. Thematic analysis of the in‐depth interviews identified six themes: (1) learning and adapting expressing, (2) feelings and sensations associated with expressing, (3) support, (4) dis/empowerment, (5) health, and (6) the value of breast milk. Women had both positive and negative experiences of antenatal expressing. If health professionals are advising antenatal expressing to women, it is important they understand the range of outcomes and experiences. Women's experiences of antenatal expressing were both positive and negative; it is important to understand the range of experiences. Women should be advised that some women express little or no breast milk antenatally and therefore be reassured if they are concerned. For women with diabetes in pregnancy, their diabetes management is a significant time burden, and should be considered when discussing antenatal expressing with women. Maternity care providers need to follow‐up with pregnant women advised to express, to provide education, reassurance, and reassess expressing techniques. Maternity care providers need to manage and prioritise the use of expressed breast milk.
Collapse
Affiliation(s)
- Anita M Moorhead
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Della A Forster
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.,Midwifery and Maternity Services Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Sharinne B Crawford
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
19
|
Gribble KD, Bewley S, Bartick MC, Mathisen R, Walker S, Gamble J, Bergman NJ, Gupta A, Hocking JJ, Dahlen HG. Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding and Newborn Care: The Importance of Sexed Language. Front Glob Womens Health 2022; 3:818856. [PMID: 35224545 PMCID: PMC8864964 DOI: 10.3389/fgwh.2022.818856] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 01/10/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Karleen D. Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
- *Correspondence: Karleen D. Gribble
| | - Susan Bewley
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Melissa C. Bartick
- Mount Auburn Hospital, Cambridge, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI Solutions, Hanoi, Vietnam
| | - Shawn Walker
- Department of Women and Children's Health, King's College London, London, United Kingdom
- Chelsea and Westminster Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Centre for Health Care Research, Coventry University, Coventry, United Kingdom
| | - Nils J. Bergman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arun Gupta
- Breastfeeding Promotion Network of India, New Delhi, India
| | - Jennifer J. Hocking
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, VIC, Australia
| | - Hannah G. Dahlen
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| |
Collapse
|
20
|
Duale A, Singh P, Al Khodor S. Breast Milk: A Meal Worth Having. Front Nutr 2022; 8:800927. [PMID: 35155521 PMCID: PMC8826470 DOI: 10.3389/fnut.2021.800927] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022] Open
Abstract
A mother is gifted with breast milk, the natural source of nutrition for her infant. In addition to the wealth of macro and micro-nutrients, human milk also contains many microorganisms, few of which originate from the mother, while others are acquired from the mouth of the infant and the surroundings. Among these microbes, the most commonly residing bacteria are Staphylococci, Streptococci, Lactobacilli and Bifidobacteria. These microorganisms initiate and help the development of the milk microbiota as well as the microbiota of the gastrointestinal tract in infants, and contribute to developing immune regulatory factors such as cytokines, growth factors, lactoferrin among others. These factors play an important role in reducing the risk of developing chronic diseases like type 2 diabetes, asthma and others later in life. In this review, we will summarize the known benefits of breastfeeding and highlight the role of the breast milk microbiota and its cross-talk with the immune system in breastfed babies during the early years of life.
Collapse
Affiliation(s)
- Anoud Duale
- Division of Maternal and Child Health, Department of Translational Medicine, Research Branch, Sidra Medicine, Doha, Qatar
| | - Parul Singh
- Division of Maternal and Child Health, Department of Translational Medicine, Research Branch, Sidra Medicine, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Ar-Rayyan, Qatar
| | - Souhaila Al Khodor
- Division of Maternal and Child Health, Department of Translational Medicine, Research Branch, Sidra Medicine, Doha, Qatar
- *Correspondence: Souhaila Al Khodor
| |
Collapse
|
21
|
Bigalky J, Dietrich Leurer M, McCabe J, Mackey A, Laczko D, Deobald V. Advice from Canadian Mothers Who Express Human Milk: An Interpretive Description Qualitative Study. Matern Child Health J 2021; 26:342-350. [PMID: 34609705 DOI: 10.1007/s10995-021-03237-w] [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: 09/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Human milk expression has become an increasingly common means for providing milk to an infant, with women expressing to address breastfeeding problems or to allow for flexible feeding options. This study explored the experiences and recommendations of mothers who expressed human milk, with this paper reporting on the advice mothers would offer to other mothers to address common challenges. METHODS Interpretive description was used in this qualitative project. Using purposive sampling, mothers of infants aged 0-24 months who expressed human milk were recruited to participate from two health regions in western Canada. Individual, audio-taped interviews were completed with 35 women. NVIVO™ software was used for data analysis. RESULTS Mothers reported the desire to offer experiential advice to other mothers navigating milk expression and encouraged other mothers to seek guidance from health care professionals such as lactation consultants, peer support online, and from family and friends. Experiential knowledge shared included: (a) product recommendations, (b) expression tips, (c) support for workplace expression, (d) encouragement to seek help, and (e) moral support. CONCLUSIONS Healthcare professionals should include evidence-based expression information as part of routine lactation support, while recognizing the importance of mother-to-mother knowledge transfer and emotional support. Services that assist mothers to determine and access pumps appropriate to their unique breastfeeding needs and goals should be offered, and the opportunity for peer support through creation of, or referral to, appropriate in-person or online support groups should be made available.
Collapse
Affiliation(s)
- Jodie Bigalky
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada.
| | - Marie Dietrich Leurer
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
| | - Janet McCabe
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - April Mackey
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
| | | | - Virginia Deobald
- College of Nursing, University of Saskatchewan, Regina Campus, #100 4400-4th Avenue, Regina, SK, S4T 0H8, Canada
| |
Collapse
|
22
|
Fan HSL, Fong DYT, Lok KYW, Tarrant M. Association between expressed breast milk feeding and breastfeeding duration in Hong Kong mothers. Women Birth 2021; 35:e286-e293. [PMID: 34238703 DOI: 10.1016/j.wombi.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Expressed breast milk feeding has increased substantially in the past two decades. Once used primarily for preterm infants, feeding expressed breast milk is now more common in mothers giving birth to healthy term infants. However, the effect of expressed breast milk feeding on breastfeeding duration is unclear. OBJECTIVES To assess the association between breast milk expression practices and breastfeeding duration in women giving birth to healthy infants. METHODS From 2017 to 2018, we recruited 821 new mothers from two public hospitals in Hong Kong. Participants were followed up at 1.5, 3, and 6 months postpartum or until they stopped breastfeeding. The proportion, type, and mode of all milk feeding were assessed at each follow-up. RESULTS At 1.5 months postpartum, 47.9%, 37.7%, and 14.4% of participants were feeding by direct breastfeeding only, mixed-mode feeding, and expressed breast milk only, respectively. Participants feeding expressed breast milk only were more likely to be supplementing with infant formula. When compared with participants who provided only direct breastfeeding, participants who gave only expressed breast milk at 1.5 months had 57% lower odds of breastfeeding continuation at three months postpartum. After stratification by infant formula supplementation, expressed breast milk feeding only at 1.5 months was associated with an increased risk of breastfeeding cessation in participants supplementing with infant formula (adjusted hazard ratio [aHR] = 1.86, 95% CI = 1.17-2.95). CONCLUSION In the first six months postpartum, giving only expressed breast milk is associated with early breastfeeding cessation, especially in participants who are also supplementing with infant formula.
Collapse
Affiliation(s)
- Heidi Sze Lok Fan
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Kris Yuet Wan Lok
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong.
| | - Marie Tarrant
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada
| |
Collapse
|
23
|
Fry HL, Levin O, Kholina K, Bianco JL, Gallant J, Chan K, Whitfield KC. Infant feeding experiences and concerns among caregivers early in the COVID-19 State of Emergency in Nova Scotia, Canada. MATERNAL & CHILD NUTRITION 2021; 17:e13154. [PMID: 33619906 PMCID: PMC7995067 DOI: 10.1111/mcn.13154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/24/2020] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
The global emergency caused by the novel coronavirus (COVID-19) pandemic has impacted access to goods and services such as health care and social supports, but the impact on infant feeding remains unclear. Thus, the objective of this study was to explore how caregivers of infants under 6 months of age perceived changes to infant feeding and other food and health-related matters during the COVID-19 State of Emergency in Nova Scotia, Canada. Four weeks after the State of Emergency began, between 17 April and 15 May 2020, caregivers completed this online survey, including the Perceived Stress Scale. Participants (n = 335) were 99% female and mostly White (87%). Over half (60%) were breastfeeding, and 71% had a household income over CAD$60,000. Most participants (77%) received governmental parental benefits before the emergency, and 59% experienced no COVID-19-related economic changes. Over three quarters of participants (77%) scored moderate levels of perceived stress. Common themes of concern included social isolation, COVID-19 infection (both caregiver and infant), and a lack of access to goods, namely, human milk substitutes ('infant formula'), and services, including health care, lactation support, and social supports. Most COVID-19-related information was sought from the internet and social media, so for broad reach, future evidence-based information should be shared via online platforms. Although participants were experiencing moderate self-perceived stress and shared numerous concerns, very few COVID-19-related changes to infant feeding were reported, and there were few differences by socio-economic status, likely due to a strong economic safety net in this Canadian setting.
Collapse
Affiliation(s)
- Hillary L. Fry
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Olga Levin
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Ksenia Kholina
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Jolene L. Bianco
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Jelisa Gallant
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Kathleen Chan
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Kyly C. Whitfield
- Department of Applied Human NutritionMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| |
Collapse
|
24
|
Foong SC, Tan ML, Foong WC, Ho JJ, Rahim FF. Comparing breastfeeding experiences between mothers spending the traditional Chinese confinement period in a confinement centre and those staying at home: a cohort study. Int Breastfeed J 2021; 16:4. [PMID: 33407645 PMCID: PMC7789407 DOI: 10.1186/s13006-020-00353-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/10/2020] [Indexed: 12/05/2022] Open
Abstract
Background Ethnic Chinese mothers in Malaysia adhere to 30 days of traditional postpartum practices (the “confinement period”) aimed at recuperation after delivery. Recently there has been an emergence of confinement centres (CCs) where mothers stay and receive traditional confinement care. Ethnic Chinese mothers have low breastfeeding rates. There are concerns that practices in CCs could contribute to this but no data exists. We described mothers’ breastfeeding experiences at CCs and identified areas for potential improvement in breastfeeding support. Methods Ethnic Chinese mothers intending to breastfeed their healthy infants were recruited post-delivery between August and October 2017 then, at 1 and 6 months, they were telephone interviewed about their experience. For every participant going to a CC after the birth, another mother going home (“home”) for her confinement was recruited. Chi-square test was used to compare groups and multiple logistic regression was used to assess the effect of confinement place on exclusive breastfeeding. Results Of 187 mothers, 88 (47%) went to CCs. Significantly more were primipara and fewer had previous breastfeeding experience. Response rates for the 1- and 6- month interviews were 88% (CC) versus 97% (home); and 77% (CC) versus 87% (home) respectively. Exclusive breastfeeding rates were similar between the groups: 62% (CC) versus 56% (home) at 1 month (p = 0.4); and 37% (CC) versus 42% (home) at 6 months (p = 0.5). Multiple logistic regression did not show that CCs were a factor affecting exclusive breastfeeding rates at 1 month, (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 0.9, 3.3), or 6 months (aOR 0.9, 95% CI 0.4, 1.7). However, significantly more CC participants only fed expressed breast milk. Despite 66% of CC participants reporting that their centre supported breastfeeding, only 6 (8%) CC participants compared to 66 (69%) of home participants roomed-in with their baby (p < 0.001). The proportion encountering breastfeeding difficulties were similar between groups. CC participants sought help for breastfeeding problems mainly from CC staff and support groups while home participants obtained help from friends and healthcare professionals. Conclusions Breastfeeding rates appeared to be similar at CCs and at home during the confinement period, but there were gaps in how CCs supported breastfeeding. Targeted training to CC staff to support breastfeeding may result in better outcomes for mothers staying in CCs.
Collapse
Affiliation(s)
- Siew Cheng Foong
- RCSI & UCD Malaysia Campus, 4 Jalan Sepoy Lines, George Town, Penang, Malaysia.
| | - May Loong Tan
- RCSI & UCD Malaysia Campus, 4 Jalan Sepoy Lines, George Town, Penang, Malaysia
| | - Wai Cheng Foong
- RCSI & UCD Malaysia Campus, 4 Jalan Sepoy Lines, George Town, Penang, Malaysia
| | - Jacqueline J Ho
- RCSI & UCD Malaysia Campus, 4 Jalan Sepoy Lines, George Town, Penang, Malaysia
| | | |
Collapse
|
25
|
Abstract
Human milk contains a diverse community of bacteria. The growing appreciation of commensal microbes and increasing availability of high-throughput technology has set the stage for a theory-driven approach to the study of milk microbiota, and translation of this knowledge to improve maternal and child health. We recently profiled the milk microbiota of healthy Canadian mothers and applied theory-driven causal modeling, finding that mode of breast milk feeding (nursing directly at the breast vs. pumping and feeding breast milk from a bottle) was significantly associated with milk microbiota composition. This observation could reflect an increased exposure to pumps and/or a decreased exposure to the infant mouth. Either way, it provides evidence for the retrograde mechanism of milk inoculation. Here, we discuss the implications of this research and related controversies, and raise new questions about the origins and function of milk bacteria.
Collapse
Affiliation(s)
- Shirin Moossavi
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada,Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada,Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Winnipeg, MB, Canada,Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Meghan B. Azad
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada,Developmental Origins of Chronic Diseases in Children Network (DEVOTION), Winnipeg, MB, Canada,Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada,CONTACT Meghan B. Azad 501G John Buhler Research Centre,715 McDermot Ave., Winnipeg, MBR3E 3P4, Canada
| |
Collapse
|
26
|
Bartels RL, DiTomasso D, Macht GA. A mother-centered evaluation of breast pumps. APPLIED ERGONOMICS 2020; 88:103123. [PMID: 32421634 DOI: 10.1016/j.apergo.2020.103123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
Existing literature outlines mothers' negative experiences with breast pumps, yet a gap exists of which breast pump characteristics are important to mothers. Identifying which breast pump characteristics are important to breast pumping mothers, and any variation between mothers who do or do not work outside of the home, will help identify user needs. A survey collected information on mothers' experiences with breast pumps and impressions of their characteristics. Latent Class Analysis (LCA) was used to determine whether there were possible groupings of impressions of these characteristics. The LCA identified a two-class model with mothers' age as a significant covariate. Portability, ease of use, low-weight, fast milk extraction, comfortability, low-noise, and discreet were all found to be important to one group of mothers, while only portability, ease of use, fast milk extraction, and comfortability were found to be important to another group of mothers. Mothers' work status was not a significant covariate but did predict class membership when considered as a grouping variable in conjunction with age. Breast pumping mothers' needs were found to differ based on their work status and age together, and collecting and considering these different needs is vital to creating redesigns that improve mothers' breast pumping experience.
Collapse
Affiliation(s)
- Rachel L Bartels
- Mechanical, Industrial & Systems Engineering, University of Rhode Island, Kingston, RI, USA
| | - Diane DiTomasso
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Gretchen A Macht
- Mechanical, Industrial & Systems Engineering, University of Rhode Island, Kingston, RI, USA.
| |
Collapse
|
27
|
Kumar S, Rathore P, Shweta, Krishnapriya V, Haokip N, Thankachan A, Bhatnagar S, Kumar B. Why I Can't Breastfeed My New-born Baby? Psychosocial Dilemma of a COVID-Positive Post-LSCS Mother. Indian J Palliat Care 2020; 26:S150-S152. [PMID: 33088107 PMCID: PMC7534992 DOI: 10.4103/ijpc.ijpc_157_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 12/23/2022] Open
Abstract
A 26-year-old postpartum COVID-positive mother admitted in COVID isolation facility at a tertiary care center in India. Her primary physical concern was suture site pain and concerns related to expressed breast milk discarding. Her psychological concerns include distrust on COVID report, belief of unjust isolation, lack of family support, loneliness, feeling of not breast feeding her baby, fear, anxiety, anger, stress, and depression. She was concerned about the stigma anticipated for herself and her baby. Spiritually, she was concerned as she was not able to make harmony between herself and environment.
Collapse
Affiliation(s)
- Sanjeev Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Rathore
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - V Krishnapriya
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nengneivah Haokip
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alice Thankachan
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Balbir Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
28
|
Benítez-Páez A, Olivares M, Szajewska H, Pieścik-Lech M, Polanco I, Castillejo G, Nuñez M, Ribes-Koninckx C, Korponay-Szabó IR, Koletzko S, Meijer CR, Mearin ML, Sanz Y. Breast-Milk Microbiota Linked to Celiac Disease Development in Children: A Pilot Study From the PreventCD Cohort. Front Microbiol 2020; 11:1335. [PMID: 32655529 PMCID: PMC7324710 DOI: 10.3389/fmicb.2020.01335] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/25/2020] [Indexed: 12/23/2022] Open
Abstract
Celiac disease (CeD) is an immune-mediated disorder triggered by exposure to dietary gluten proteins in genetically predisposed individuals. In addition to the host genome, the microbiome has recently been linked to CeD risk and pathogenesis. To progress in our understanding of the role of breast milk microbiota profiles in CeD, we have analyzed samples from a sub-set of mothers (n = 49) included in the PreventCD project, whose children did or did not develop CeD. The results of the microbiota data analysis indicated that neither the BMI, HLA-DQ genotype, the CeD condition nor the gluten-free diet of the mothers could explain the human milk microbiota profiles. Nevertheless, we found that origin country, the offspring’s birth date and, consequently, the milk sampling date influenced the abundance and prevalence of microbes in human milk, undergoing a transition from an anaerobic to a more aerobic microbiota, including potential pathogenic species. Furthermore, certain microbial species were more abundant in milk samples from mothers whose children went on to develop CeD compared to those that remained healthy. These included increases in facultative methylotrophs such as Methylobacterium komagatae and Methylocapsa palsarum as well as in species such as Bacteroides vulgatus, that consumes fucosylated-oligosaccharides present in human milk, and other breast-abscess associated species. Theoretically, these microbiota components could be vertically transmitted from mothers-to-infants during breastfeeding, thereby influencing CeD risk.
Collapse
Affiliation(s)
- Alfonso Benítez-Páez
- Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, Spanish National Research Council, Valencia, Spain
| | - Marta Olivares
- Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, Spanish National Research Council, Valencia, Spain
| | - Hania Szajewska
- Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
| | | | - Isabel Polanco
- Department of Pediatric Gastroenterology and Nutrition, La Paz University Hospital, Madrid, Spain
| | - Gemma Castillejo
- Gluten-Associated Disorder Unit, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | - Merce Nuñez
- Gluten-Associated Disorder Unit, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | | | | | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital of Munich, Munich, Germany.,Department of Paediatrics, School of Medicine Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Caroline R Meijer
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - M Luisa Mearin
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Yolanda Sanz
- Microbial Ecology, Nutrition and Health Research Unit, Institute of Agrochemistry and Food Technology, Spanish National Research Council, Valencia, Spain
| |
Collapse
|
29
|
Maxwell C, Fleming KM, Fleming V, Porcellato L. UK mothers' experiences of bottle refusal by their breastfed baby. MATERNAL AND CHILD NUTRITION 2020; 16:e13047. [PMID: 32558209 PMCID: PMC7503095 DOI: 10.1111/mcn.13047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/17/2020] [Accepted: 06/02/2020] [Indexed: 01/17/2023]
Abstract
Little is known about bottle refusal by breastfed babies; however, an informal review of global online forums and social media suggested large numbers of mothers experiencing the scenario. This study aimed to explore UK mothers' experiences of bottle refusal by their breastfed baby in order to provide understanding of the scenario and enhance support for mothers experiencing it. A 22‐point online questionnaire was developed and completed by 841 UK mothers. Findings suggest that mothers introduced a bottle to their breastfed baby due to physical, psychological and socio‐cultural factors. Advice and support for mothers experiencing bottle refusal was not always helpful, and 27% of mothers reported bottle refusal as having a negative impact on their breastfeeding experience. When compared with eventual bottle acceptance, bottle refusal was significantly associated with previous experience of bottle refusal (p < .001), how frequently mothers intended to feed their baby by bottle and babies being younger at the first attempt to introduce a bottle (p < .001). This study provides a unique insight into the complexities of bottle refusal by breastfed babies and the impact it can have upon mothers' breastfeeding experiences. It generates knowledge and understanding that can help to inform practice and policies. In addition, a ‘normalising’ of the scenario could enable mothers, and those supporting them, to view and manage it more positively.
Collapse
Affiliation(s)
- Clare Maxwell
- Faculty of Health, School of Nursing and Allied Health, Henry Cotton Building, Liverpool John Moores University, Liverpool, UK
| | - Kate M Fleming
- Institute of Population Health Sciences, Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, UK
| | - Valerie Fleming
- Faculty of Health, School of Nursing and Allied Health, Henry Cotton Building, Liverpool John Moores University, Liverpool, UK
| | - Lorna Porcellato
- Public Health Institute, Exchange Station, Liverpool John Moores University, Liverpool, UK
| |
Collapse
|
30
|
Dietrich Leurer M, McCabe J, Bigalky J, Mackey A, Laczko D, Deobald V. "We Just Kind of Had to Figure It Out": A Qualitative Exploration of the Information Needs of Mothers Who Express Human Milk. J Hum Lact 2020; 36:273-282. [PMID: 31710816 DOI: 10.1177/0890334419883203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Human milk expression, primarily by pump, is practiced by the majority of breastfeeding mothers in affluent countries. Existing literature is focused on determining prevalence and duration rates and the factors behind this trend. There is less research exploring mothers' perspectives and experiences related to expression. RESEARCH AIM To gather the experiential wisdom of mothers with a focus on their information needs and sources related to human milk expression. METHODS Audiotaped interviews were conducted with 35 mothers of infants, aged birth to 24 months, who had expressed milk at least once in western Canada. This study was guided by interpretive description, an applied qualitative research approach. RESULTS Registered nurses and international board-certified lactation consultants were the most common sources of information, with Internet, friends/family, and other mothers also important. Inconsistent expression advice was confusing for participants, and many reported health care providers did not address all their expression learning needs. Desired topic areas included practical advice on how to express, determining expression frequency/timing/duration, milk storage guidelines, the influence of expression on milk supply, product information, and general support/encouragement. CONCLUSIONS Assessment of expression learning needs should be part of routine lactation support at each encounter. Nonjudgmental, factual guidance will assist mothers in making evidence-informed decisions related to expression practices that are consistent with their unique breastfeeding goals. This should be supplemented by reputable online resources that provide timely and accurate information as well as efforts to connect mothers with peer support groups.
Collapse
Affiliation(s)
| | - Janet McCabe
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
- University of Ontario Institute of Technology
| | - Jodie Bigalky
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
| | - April Mackey
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
| | - Dana Laczko
- 70397 7235 University of Saskatchewan, Regina, SK, Canada
- Saskatchewan Polytechnic
| | | |
Collapse
|
31
|
Human Milk Storage for Term Infants: Why We Still Don't Know What to Tell Parents in 2020. J Perinat Neonatal Nurs 2020; 34:110-112. [PMID: 32332439 DOI: 10.1097/jpn.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Strauch L, Sweet L, Scott H, Müller A. Mechanisms of support for exclusive breastmilk expressers in the community: a scoping review. BMC Pregnancy Childbirth 2019; 19:511. [PMID: 31856734 PMCID: PMC6923915 DOI: 10.1186/s12884-019-2667-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/08/2019] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization recommends that infants be exclusively breastfed until the age of six months. Breastfeeding is generally understood to mean the provision of human breastmilk to the infant by direct feeding at the breast, and interventions aimed at supporting exclusive breastfeeding are therefore targeted at this activity. However, breastfeeding is actually an umbrella term covering the provision of breastmilk to an infant by any means. Our population of interest is mothers who exclusively feed their infants indirectly using expressed breastmilk. Some research suggests that any expressing, and exclusively expressing in particular, can be a risk factor for early cessation of exclusive breastmilk provision, so we were interested to identify whether any specific support existed for exclusively expressing mothers outside of the context of premature infants and the Neonatal Intensive Care Unit setting. Methods A scoping review following the Joanna Briggs Institute approach was used to explore the phenomenon of formal and informal supports in the community for exclusively expressing mothers. Searches were run across academic databases and of government websites and infant feeding support organisations. Finally, an informal internet search was run using a simple search string. Results On analysis of results, there were no studies or articles that met the search criteria. An informal internet search linked us directly with websites and blogs that could be considered a form of support intervention. These informal results suggest that support material or programs could possibly exist in other modalities but we cannot find them in the context of this type of scoping review. Conclusions The results of the search corroborated what we had suspected – that exclusively expressing mothers are not specifically supported by usual channels for new parents and that it is also difficult to find acknowledgement that exclusive expression exists. The absence of results demonstrates the relevance of this study: exclusively expressing mothers are an under-served population. If we wish to strive towards achievement of World Health Organization breastfeeding goals, exclusively expressing mothers require targeted support to assist in their infant feeding experience, and there is little formal evidence of it currently being provided.
Collapse
Affiliation(s)
- Leah Strauch
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University and Western Health Partnership, 221 Burwood Hwy, Burwood, VIC, 3125, Australia. .,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Hayley Scott
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amanda Müller
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| |
Collapse
|
33
|
Moukarzel S, Wiedeman AM, Soberanes LS, Dyer RA, Innis SM, Lamers Y. Variability of Water-Soluble Forms of Choline Concentrations in Human Milk during Storage, after Pasteurization, and among Women. Nutrients 2019; 11:nu11123024. [PMID: 31835736 PMCID: PMC6949891 DOI: 10.3390/nu11123024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/28/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
Choline is critical for infant development and mother’s milk is the sole source of choline for fully breastfed infants until six months of age. Human milk choline consists to 85% of water-soluble forms of choline including free choline (FC), phosphocholine (PhosC), and glycerophosphocholine (GPC). Donor milk requires safe handling procedures such as cold storage and pasteurization. However, the stability of water-soluble forms of choline during these processes is not known. The objectives of this research were to determine the effect of storage and pasteurization on milk choline concentration, and the diurnal intra- and inter-individual variability of water-soluble choline forms. Milk samples were collected from healthy women who were fully breastfeeding a full-term, singleton infant <6 months. Milk total water-soluble forms of choline, PhosC, and GPC concentrations did not change during storage at room temperature for up to 4 h. Individual and total water-soluble forms of choline concentrations did not change after storage for 24 h in the refrigerator or for up to one week in the household freezer. Holder pasteurization decreased PhosC and GPC, and thereby total water-soluble choline form concentrations by <5%. We did not observe diurnal variations in PhosC and total water-soluble forms of choline concentrations, but significant differences in FC and GPC concentrations across five sampling time points throughout one day. In conclusion, these outcomes contribute new knowledge for the derivation of evidence-informed guidelines for the handling and storage of expressed human milk as well as the development of optimized milk collection and storage protocols for research studies.
Collapse
Affiliation(s)
- Sara Moukarzel
- Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California, San Diego, CA 92093, USA;
| | - Alejandra M. Wiedeman
- British Columbia Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.W.); (L.S.S.); (R.A.D.); (S.M.I.)
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Lynda S. Soberanes
- British Columbia Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.W.); (L.S.S.); (R.A.D.); (S.M.I.)
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Roger A. Dyer
- British Columbia Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.W.); (L.S.S.); (R.A.D.); (S.M.I.)
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Sheila M. Innis
- British Columbia Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.W.); (L.S.S.); (R.A.D.); (S.M.I.)
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - Yvonne Lamers
- British Columbia Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada; (A.M.W.); (L.S.S.); (R.A.D.); (S.M.I.)
- Food, Nutrition, and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Correspondence: ; Tel.: +1-604-827-1776
| |
Collapse
|
34
|
Francis J, Dickton D. Physical Analysis of the Breast After Direct Breastfeeding Compared with Hand or Pump Expression: A Randomized Clinical Trial. Breastfeed Med 2019; 14:705-711. [PMID: 31483146 DOI: 10.1089/bfm.2019.0008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Expressing human milk using commercially available pumps has increased. Most women use mechanical means to transfer their milk at some point during lactation. Yet, there is very little quantification of any breast tissue changes that occur when using mechanical devices to facilitate milk transfer. Objective: Women comfortable with breastfeeding were recruited to participate in a study to measure physical changes of the breast with a variety of human milk transfer modalities under close observation. Materials and Methods: Direct breastfeeding with their infant, hand expression, and mechanical milk transfer using two commonly available breast pumps were utilized over four milk transfer sessions with each participant. Each participant directly breastfed on the first milk transfer session and the remaining modalities were randomized. Measurements were taken before and after each modality using digital calipers. Participants completed a modified pain scale after each observation. Measurements taken after breastfeeding were used as the control for data interpretation for each participant. After a 20-minute rest period, breast tissue was again examined, and tissue appearance was recorded. Within-subject modality differences were calculated, and paired analysis mean difference and standard error of the mean are presented. Results: Fifty eligible women were approached with 92% participating. The "before" measurements were not significant for all the modalities. The "after" measurements were significantly different at p < 0.003 for breast pumps but not for breastfeeding or hand expressing. Many participants indicated pain with pumping. Conclusion: Mechanical pump use correlated with significantly increased length and diameter of the nipple compared with the post-breastfeeding and hand expressing dimensions. Pump use correlated with significant pain scores and resulted in localized inflammatory changes. Understanding how pumps affect breast tissue is helpful in improving experiences with breast pumps and may improve breastfeeding outcomes. Additional research is needed to better understand ramifications of long-term use of breast pumps.
Collapse
Affiliation(s)
- Jimi Francis
- Department of Health & Kinesiology, University of Texas at Tyler, Tyler, Texas
| | - Darby Dickton
- CAPT, USAF 60 AMC SGCS, University of California, Davis - Health System, Sacramento, California
| |
Collapse
|
35
|
Ghaffari M, Rakhshanderou S, Harooni J, Mehrabi Y, Ebrahimi A. Prenatal Interventional Program about Mothers' Behavior Related to Exclusive Breast Feeding: Findings of Planned Behavior Theory-Based Research. J Lifestyle Med 2019; 9:143-149. [PMID: 31828034 PMCID: PMC6894448 DOI: 10.15280/jlm.2019.9.2.143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Background Promotion of exclusive breast feeding is known as a savior strategy, to reduce infantile mortality. The theory of planned behavior is an appropriate theory to explain the effect of psychosocial factors on infant feeding behavior. This study aimed to evaluate impact of planned behavior theory-based education on the behavior of pregnant women related to exclusive breast feeding in Arak city, 2016–17. Methods This study is an interventional study that was done on 101 pregnant women with gestational age of 32–28 weeks in health centers of Arak city. All individuals were divided into experimental and control groups randomly. Valid and reliable questionnaires were completed before, on and 3 months after intervention. Experimental group received educational intervention in 3 sessions. Date was analyzed using SPSS 16 software (Chi-square, T, R.M.ANOVA Tests). Results The results showed that, after implementation of the intervention, mean of scores for attitudes, subjective norms, Perceived behavioral control, intention and exclusive breast feeding behavior has increased significantly in the experimental group compared with the control group. Conclusion The findings of this study, showed the efficiency and effectiveness of educational intervention based on the theory of planned behavior on exclusive breast feeding behavior. Designing and implementing educational programs based on the theory of planned behavior is proposed to encourage women to breast-feed exclusively to encourage women to breast-feed exclusively.
Collapse
Affiliation(s)
- Mohtasham Ghaffari
- Health Education and Health Promotion, Environmental & Occupational Hazards Control Research Center, School of Public Health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sakineh Rakhshanderou
- Health Education and Health Promotion, Environmental & Occupational Hazards Control Research Center, School of Public Health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javad Harooni
- Health Education & Health Promotion, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Yadollah Mehrabi
- Biostatistics, Environmental & Occupational Hazards Control Research Center, Tehran, Iran
| | - Azar Ebrahimi
- Health Education, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
36
|
Paynter MJ. Clinical Opinion Letters Regarding Breastfeeding and Neonatal Abstinence Syndrome for Child Apprehension Family Court Proceedings. J Hum Lact 2019; 35:349-353. [PMID: 30543758 DOI: 10.1177/0890334418818421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The accelerating reach of opioid use disorder in North America includes increasing prevalence among pregnant people. In Canada, the rate of Neonatal Abstinence Syndrome (NAS) rose 27% between 2012-2013 and 2016-2017, and it is estimated that 0.51% of all infants now experience NAS after delivery. Pregnant people are a priority population for access to opioid replacement therapy programs. Participation in such programs demonstrates significant commitment to self-care among pregnant people and concern for fetal and infant wellbeing. Participation in opioid replacement therapy often results in family surveillance by Child Protection Services and infant apprehension. Children of Indigenous descent are held in foster care at high and disproportionate rates.The Convention on the Rights of the Child principle of Best Interests of the Child governs family law and child access decisions. The value of breastfeeding for all children and in particular for children recovering from NAS can be a consideration in the Best Interest of the Child. Clinicians with expertise in lactation may support the breastfeeding dyad to remain together by preparing Clinical Opinion Letters for the court. This Insights into Policy presents a how-to description of the content of clinical opinion letters in such cases, including context and process considerations, client background, breastfeeding science, and factors specific to neonatal abstinence syndrome.
Collapse
|
37
|
Abstract
Breastfeeding is a reproductive right for mothers, including women in the workforce. Limited postpartum leave, reliance on expressing milk at work, and lack of access to lactation rooms pose challenges for working mothers. Specific to mothers in academia, the heavy demands of teaching, sustaining research, and attending meetings and conferences pose additional challenges. Many female academicians delay childbearing due to pressures to attain tenure as early as possible. Women who leave academic careers often do so in the early career period, which coincides with the childbearing years. Lack of support for these mothers is a social-justice issue that warrants close examination and a realignment of priorities to facilitate and ensure breastfeeding success. The following are recommendations for developing a network of support for breastfeeding mothers: (a) Improved and standardized family leave policies, (b) inclusive workplace infrastructure, (c) flexibility in work schedule and structure, (d) equal opportunity to advance on the tenure track, (e) establishment of onsite daycares, (f) supportive policies clearly communicated and enforced, and (g) change in attitude and culture.
Collapse
|
38
|
Yonke N, Maston R, Weitzen S, Leeman L. Breastfeeding Intention Compared With Breastfeeding Postpartum Among Women Receiving Medication-Assisted Treatment. J Hum Lact 2019; 35:71-79. [PMID: 29723483 DOI: 10.1177/0890334418769637] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Women taking methadone or buprenorphine are encouraged to breastfeed if stable without polysubstance use. RESEARCH AIM: We aimed to determine the difference between stated intention to breastfeed prenatally in women taking methadone or buprenorphine compared with breastfeeding at discharge and 2 months postpartum. Secondary outcomes were determining whether breastfeeding was more common in women taking buprenorphine, in women without hepatitis C infection, and in women without a history of heroin use, and whether breastfeeding reduced the need for pharmacological treatment of neonatal opioid withdrawal syndrome. METHODS: This was a retrospective cohort study of 228 women enrolled in a perinatal substance abuse treatment program. Electronic medical records were reviewed to abstract data on mother-infant dyads. Chi-square tests were used to analyze our outcomes. RESULTS: Women taking buprenorphine had a higher prevalence of breastfeeding compared with women taking methadone (83% [ n = 100] vs. 71% [ n = 76]; χ2 = 4.35, p = .03), despite no difference in their prenatal intention to breastfeed (87% vs. 81%; χ2 = 1.28, p = .25). Only 31% ( n = 38) of women taking buprenorphine and 19.6% ( n = 21) of women taking methadone exclusively breastfed at discharge (χ2 = 5.43, p = .06). Exclusively breastfed infants required less pharmacological treatment for neonatal opioid withdrawal syndrome compared with formula-fed infants (15.8% [ n = 21] vs. 47.4% [ n = 38]; χ2 = 19.72, p < .05). CONCLUSION: Despite most women reporting a high prenatal intention to breastfeed, exclusive breastfeeding at hospital discharge postpartum was low. Breastfeeding was associated with a decreased likelihood of pharmacological treatment for neonatal opioid withdrawal syndrome.
Collapse
Affiliation(s)
- Nicole Yonke
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Rebekah Maston
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Sherry Weitzen
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Lawrence Leeman
- 1 Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA.,2 Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
39
|
Twenty-five-year trends in breastfeeding initiation: The effects of sociodemographic changes in Great Britain, 1985-2010. PLoS One 2019; 14:e0210838. [PMID: 30653579 PMCID: PMC6336342 DOI: 10.1371/journal.pone.0210838] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 01/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background Data from the UK Infant Feeding Surveys indicate that breastfeeding initiation increased between 1985 and 2010. During this period, societal changes in GB also influenced the sociodemographic characteristics of women in the childbearing population. As breastfeeding behaviour is highly socially patterned in GB, the increasing trend in breastfeeding initiation may have hidden inequalities in breastfeeding practices. This study examines the sociodemographic inequalities in breastfeeding initiation in GB between 1985 and 2010, exploring whether and how this may have been influenced by social and policy changes. Methods Data drawn from the nationally representative 1985, 1990, 1995, 2000, 2005 and 2010 Infant Feeding Surveys were used to estimate changes in the proportion of mothers in selected sociodemographic groups over time. Logistic regression models estimated the independent associations between breastfeeding initiation in each survey year and maternal sociodemographic characteristics. Associations were adjusted for maternal sociodemographic, pregnancy-related and support factors. Evidence of a change in the association between breastfeeding initiation and each sociodemographic characteristic over time was assessed using a test for statistical heterogeneity. Results The sociodemographic characteristics of mothers in GB changed substantially between 1985 and 2010. Mothers were increasingly more likely to be 30 or over; have higher education and socioeconomic status; and be single or cohabiting. An increasing proportion of mothers in GB identified as being of black or minority ethnic origin. Reported smoking in pregnancy declined. These same characteristics independently predicted higher odds of breastfeeding initiation; the associations between these characteristics and breastfeeding initiation did not vary significantly over time. Conclusions Marked inequalities in breastfeeding initiation persisted over the study period, hidden among the increasing initiation rate at the population level. The increasing overall rate of initiation was most likely driven by the rising prevalence of those groups of mothers who were, and remain, characteristically most likely to breastfeed.
Collapse
|
40
|
|
41
|
Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Collapse
Affiliation(s)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Kent JC, Gardner H, Lai CT, Hartmann PE, Murray K, Rea A, Geddes DT. Hourly Breast Expression to Estimate the Rate of Synthesis of Milk and Fat. Nutrients 2018; 10:E1144. [PMID: 30135368 PMCID: PMC6165356 DOI: 10.3390/nu10091144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 11/28/2022] Open
Abstract
Objective measurement of the rate of synthesis of breast milk and fat in breastfeeding mothers requires test-weighing of each breastfeed and the measurement of each expression from each breast over 24 h, with the collection of milk samples before and after each breastfeed and expression. We sought an abbreviated technique for measuring these rates of synthesis. Participants completed a 24-h breastfeeding milk profile, and expressed their breasts on arrival at the research room and each hour thereafter for 3 h (4 expressions). The hourly rate of milk synthesis, as measured by the yield of milk from the fourth expression, was closely related to the hourly rate of milk synthesis calculated from the 24-h milk profile. The hourly rate of fat synthesis, calculated from the fat content of small samples of the first and last milk expressed during the fourth expression, was different from the rate of fat synthesis calculated from the fat content and volumes of all the breastfeeds and expressions during the 24-h milk profile. The study confirms the use of an abbreviated technique to measure the rate of breast milk synthesis, but is not reliable as a measure of the rate of fat synthesis for an individual.
Collapse
Affiliation(s)
- Jacqueline C Kent
- School of Molecular Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Hazel Gardner
- School of Molecular Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Ching-Tat Lai
- School of Molecular Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Peter E Hartmann
- School of Molecular Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Alethea Rea
- Centre of Applied Statistics, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Donna T Geddes
- School of Molecular Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| |
Collapse
|
43
|
Advantages of Breastfeeding During Acute Infections: What The Evidence Says. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0157-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
44
|
Yourkavitch J, Rasmussen KM, Pence BW, Aiello A, Ennett S, Bengtson AM, Chetwynd E, Robinson W. Early, regular breast-milk pumping may lead to early breast-milk feeding cessation. Public Health Nutr 2018; 21:1726-1736. [PMID: 29433598 PMCID: PMC6657516 DOI: 10.1017/s1368980017004281] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/07/2017] [Accepted: 12/13/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To estimate the effect of early, regular breast-milk pumping on time to breast-milk feeding (BMF) and exclusive BMF cessation, for working and non-working women. DESIGN Using the Infant Feeding Practices Survey II (IFPS II), we estimated weighted hazard ratios (HR) for the effect of regular pumping (participant defined) compared with non-regular/not pumping, reported at month 2, on both time to BMF cessation (to 12 months) and time to exclusive BMF cessation (to 6 months), using inverse probability weights to control confounding. SETTING USA, 2005-2007. SUBJECTS BMF (n 1624) and exclusively BMF (n 971) IFPS II participants at month 2. RESULTS The weighted HR for time to BMF cessation was 1·62 (95 % CI 1·47, 1·78) and for time to exclusive BMF cessation was 1·14 (95 % CI 1·03, 1·25). Among non-working women, the weighted HR for time to BMF cessation was 2·05 (95 % CI 1·84, 2·28) and for time to exclusive BMF cessation was 1·10 (95 % CI 0·98, 1·22). Among working women, the weighted HR for time to BMF cessation was 0·90 (95 % CI 0·75, 1·07) and for time to exclusive BMF cessation was 1·14 (95 % CI 0·96, 1·36). CONCLUSIONS Overall, regular pumpers were more likely to stop BMF and exclusive BMF than non-regular/non-pumpers. Non-working regular pumpers were more likely than non-regular/non-pumpers to stop BMF. There was no effect among working women. Early, regular pumpers may need specialized support to maintain BMF.
Collapse
Affiliation(s)
- Jennifer Yourkavitch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | | | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | - Allison Aiello
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | - Susan Ennett
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Angela M Bengtson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| | - Ellen Chetwynd
- Department of Food, Bioprocessing and Nutrition Science, North Carolina State University, Raleigh, NC, USA
| | - Whitney Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA
| |
Collapse
|
45
|
Casey L, Fucile S, Dow KE. Determinants of Successful Direct Breastfeeding at Hospital Discharge in High-Risk Premature Infants. Breastfeed Med 2018; 13:346-351. [PMID: 29746151 DOI: 10.1089/bfm.2017.0209] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Despite a mother's intention to breastfeed, there are many barriers to feeding preterm infants that decrease breastfeeding rates. OBJECTIVE The objective of this research was to determine factors associated with successful direct breastfeeding (DBF) of the preterm infant at hospital discharge. MATERIALS AND METHODS A retrospective chart review of 69 preterm (<34 weeks' gestational age) infants in the neonatal intensive care unit, whose mothers intended to breastfeed, was conducted. Infant-, mother-, and feeding-related factors were examined by chi-square or t test for their relationship with breastfeeding success, and by multiple logistic regression to identify predictive factors. RESULTS Successful DBF at discharge occurred in 64%. Mothers of infants who were breastfed were older (p < 0.0001); had less psychiatric illness (p = 0.03); and were less likely to smoke (p < 0.0001) and use recreational drugs (p = 0.04). The infants had higher birth weights (p = 0.03) and lower incidence of bronchopulmonary dysplasia (p = 0.04). A higher proportion of infants received DBF at their first oral feed (p < 0.001), and were discharged earlier (p = 0.03). Reduced milk supply was cited for breastfeeding failure in 36%. Older maternal age (odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.02-1.51) and DBF at the first oral feed (OR = 7.72, 95% CI 1.37-43.6) were associated with successful DBF at discharge. CONCLUSION Maternal age and method of first oral feed are critical predictors of breastfeeding success in preterm infants. Mothers should be encouraged to breastfeed at the infant's first oral attempt and strategic breastfeeding support should be provided before initiation of oral feeding.
Collapse
Affiliation(s)
- Lara Casey
- Department of Pediatrics, Kingston Health Sciences Centre, Queen's University , Kingston, Ontario, Canada
| | - Sandra Fucile
- Department of Pediatrics, Kingston Health Sciences Centre, Queen's University , Kingston, Ontario, Canada
| | - Kimberly E Dow
- Department of Pediatrics, Kingston Health Sciences Centre, Queen's University , Kingston, Ontario, Canada
| |
Collapse
|
46
|
Fogleman AD, Meng T, Osborne J, Perrin MT, Jones F, Allen JC. Storage of Unfed and Leftover Mothers' Own Milk. Breastfeed Med 2018; 13:42-49. [PMID: 29235902 DOI: 10.1089/bfm.2016.0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective was to examine the bacteriological and immunological properties of freshly expressed, previously frozen, and leftover mothers' own milk during storage. MATERIALS AND METHODS In the first of two pilot studies, 12 mother-infant dyads participated. The milk studied included freshly expressed unfed and freshly expressed leftover milk. Milk samples were stored at 24°C, 4°C, or -20°C. In the second pilot study, 11 mother-infant dyads participated. The milk studied included milk that had been previously frozen, including previously frozen leftover milk. Milk samples were stored at 24°C and 4°C. After storage in both studies, the milk was analyzed for bacteriological and immunological properties. RESULTS Bacteriological and immunological characteristics of freshly expressed unfed and freshly expressed leftover milk and previously frozen unfed and previously frozen leftover milk remained stable during storage at 4°C for at least 6 days. The quality of all groups of mothers' milk declined when stored at 24°C for longer than 3 hours. CONCLUSIONS While this study provides evidence that human milk might be safe at longer storage times, storage guidelines should not be revised until more research is performed. This study serves as a call to action for more research on the topic of human milk storage, specifically leftover human milk. The study provides information to inform future study designs on the topic of unpasteurized human milk storage. More research is needed regarding leftover human milk storage with a greater number of participants, determination of the quality of human milk, and the storage of human milk in a real-life setting.
Collapse
Affiliation(s)
- April D Fogleman
- 1 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University , Raleigh, North Carolina
| | - Ting Meng
- 1 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University , Raleigh, North Carolina
| | - Jason Osborne
- 2 Department of Statistics, North Carolina State University , Raleigh, North Carolina
| | - Maryanne T Perrin
- 1 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University , Raleigh, North Carolina.,3 Department of Nutrition, University of North Carolina at Greensboro , Greensboro, North Carolina
| | - Frances Jones
- 4 Lactation Service & Provincial Milk Bank, BC Women's Hospital , Vancouver, British Columbia, Canada
| | - Jonathan C Allen
- 1 Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University , Raleigh, North Carolina
| |
Collapse
|
47
|
Behairy OG, Fadl AMA, Arafa OS, Fadl AA, Attia MA. Influence of early feeding practices on biomarkers of cardiovascular disease risk in later life. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2017. [DOI: 10.1016/j.epag.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
48
|
Klopp A, Vehling L, Becker AB, Subbarao P, Mandhane PJ, Turvey SE, Lefebvre DL, Sears MR, Azad MB. Modes of Infant Feeding and the Risk of Childhood Asthma: A Prospective Birth Cohort Study. J Pediatr 2017; 190:192-199.e2. [PMID: 29144244 DOI: 10.1016/j.jpeds.2017.07.012] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/13/2017] [Accepted: 07/06/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether different modes of infant feeding are associated with childhood asthma, including differentiating between direct breastfeeding and expressed breast milk. STUDY DESIGN We studied 3296 children in the Canadian Healthy Infant Longitudinal Development birth cohort. The primary exposure was infant feeding mode at 3 months, reported by mothers and categorized as direct breastfeeding only, breastfeeding with some expressed breast milk, breast milk and formula, or formula only. The primary outcome was asthma at 3 years of age, diagnosed by trained healthcare professionals. RESULTS At 3 months of age, the distribution of feeding modes was 27% direct breastfeeding, 32% breastfeeding with some expressed breast milk, 26% breast milk and formula, and 15% formula only. At 3 years of age, 12% of children were diagnosed with possible or probable asthma. Compared with direct breastfeeding, any other mode of infant feeding was associated with an increased risk of asthma. These associations persisted after adjusting for maternal asthma, ethnicity, method of birth, infant sex, gestational age, and daycare attendance (some expressed breast milk: aOR, 1.64, 95% CI, 1.12-2.39; breast milk and formula, aOR, 1.73, 95% CI, 1.17-2.57; formula only: aOR, 2.14, 95% CI, 1.37-3.35). Results were similar after further adjustment for total breastfeeding duration and respiratory infections. CONCLUSIONS Modes of infant feeding are associated with asthma development. Direct breastfeeding is most protective compared with formula feeding; indirect breast milk confers intermediate protection. Policies that facilitate and promote direct breastfeeding could have impact on the primary prevention of asthma.
Collapse
Affiliation(s)
- Annika Klopp
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lorena Vehling
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Stuart E Turvey
- Department of Pediatrics Child and Family Research Institute, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
49
|
Felice JP, Geraghty SR, Quaglieri CW, Yamada R, Wong AJ, Rasmussen KM. "Breastfeeding" without baby: A longitudinal, qualitative investigation of how mothers perceive, feel about, and practice human milk expression. MATERNAL & CHILD NUTRITION 2017; 13:e12426. [PMID: 28078789 PMCID: PMC5491350 DOI: 10.1111/mcn.12426] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/27/2022]
Abstract
Most American mothers who produce human milk (HM) now pump in place of some or all feeding at the breast, and most American infants are now fed pumped HM. We aimed to investigate mothers' perceptions of, attitudes toward, and practices for pumping and providing pumped HM. Results related to pumping are reported here. We conducted in-depth, semi-structured interviews among a diverse sample of 20 mothers who pumped, following each from pregnancy through infant HM-feeding cessation up to 1 year postpartum. Data were analyzed using thematic analysis with Atlas.ti. Mothers' reasons for pumping changed over time and reflected their needs and desires (e.g., latch difficulty, return to work, and increasing their milk supply). Mothers reported that pump type and quality were important to pumping success and that pumping was time-consuming, costly, and unpleasant compared to feeding at the breast. Regardless of how often mothers pumped, most felt pumping was necessary to meet their infant HM-feeding goals and was a welcome means of sharing with other caregivers the bonding opportunity and tasks they associated with feeding infants. Mothers interpreted output from pumping sessions to understand their ability to provide enough milk to meet their infants' needs. Mothers' reasons for pumping may signal constraints to infant HM feeding that may be addressed with policy changes. Mothers' attitudes and perceptions toward pumping indicate that, although pumping fills important and welcome roles for many mothers, the reality of its practice may make it an unacceptable or infeasible substitute for some.
Collapse
Affiliation(s)
- Julia P. Felice
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | | | | | - Rei Yamada
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Adriana J. Wong
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | | |
Collapse
|
50
|
Pang WW, Bernard JY, Thavamani G, Chan YH, Fok D, Soh SE, Chua MC, Lim SB, Shek LP, Yap F, Tan KH, Gluckman PD, Godfrey KM, van Dam RM, Kramer MS, Chong YS. Direct vs. Expressed Breast Milk Feeding: Relation to Duration of Breastfeeding. Nutrients 2017; 9:nu9060547. [PMID: 28554997 PMCID: PMC5490526 DOI: 10.3390/nu9060547] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 11/24/2022] Open
Abstract
Background: Studies examining direct vs. expressed breast milk feeding are scarce. We explored the predictors of mode of breastfeeding and its association with breastfeeding duration in a multi-ethnic Asian population. Methods: We included 541 breastfeeding mother—infant pairs from the Growing Up in Singapore Toward healthy Outcomes cohort. Mode of breastfeeding (feeding directly at the breast, expressed breast milk (EBM) feeding only, or mixed feeding (a combination of the former 2 modes)) was ascertained at three months postpartum. Ordinal logistic regression analyses identified predictors of breast milk expression. Cox regression models examined the association between mode of breastfeeding and duration of any and of full breastfeeding. Results: Maternal factors independently associated with a greater likelihood of breast milk expression instead of direct breastfeeding were Chinese (vs. Indian) ethnicity, (adjusted odds ratio, 95% CI; 3.41, 1.97–5.91), tertiary education (vs. secondary education or lower) (2.22, 1.22–4.04), primiparity (1.54, 1.04–2.26) and employment during pregnancy (2.53, 1.60–4.02). Relative to those who fed their infants directly at the breast, mothers who fed their infants EBM only had a higher likelihood of early weaning among all mothers who were breastfeeding (adjusted hazard ratio, 95% CI; 2.20, 1.61–3.02), and among those who were fully breastfeeding (2.39, 1.05–5.41). Mothers who practiced mixed feeding, however, were not at higher risk of earlier termination of any or of full breastfeeding. Conclusions: Mothers who fed their infants EBM exclusively, but not those who practiced mixed feeding, were at a higher risk of terminating breastfeeding earlier than those who fed their infants directly at the breast. More education and support are required for women who feed their infants EBM only.
Collapse
Affiliation(s)
- Wei Wei Pang
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
| | - Geetha Thavamani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
| | - Yiong Huak Chan
- Department of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
| | - Doris Fok
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
| | - Shu-E Soh
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
| | - Mei Chien Chua
- Department of Neonatology, KK Women's and Children's Hospital, Singapore 229899, Singapore.
| | - Sok Bee Lim
- Department of Child Development, KK Women's & Children's Hospital, Singapore 229899, Singapore.
| | - Lynette P Shek
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore 119228, Singapore.
| | - Fabian Yap
- Department of Paediatric Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore.
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
- Duke-NUS Medical School, Singapore 169857, Singapore.
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand.
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, Southampton SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
| | - Michael S Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University Faculty of Medicine, Montreal, QC H3A 1A2, Canada.
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore 117609, Singapore.
| |
Collapse
|