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Hsu S, Balan A, Bove R. Topical review: Lactation and use of DMTs in women with MS. Mult Scler 2024; 30:1578-1591. [PMID: 39348090 PMCID: PMC11568642 DOI: 10.1177/13524585241257843] [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: 08/14/2023] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 10/01/2024]
Abstract
One in three females with multiple sclerosis (MS) becomes pregnant after diagnosis. In the postpartum period, there is a risk of rebound inflammatory activity. This risk can likely be reduced with breastfeeding, as well as with early initiation of effective therapies that have low therapeutic lag. To guide patients in their choices surrounding breastfeeding and MS therapies, clinicians must be familiar with how best to protect against relapses, to ensure infant safety, and to support breastfeeding choices. This topical review provides a broad framework on lactation in women with MS. It seeks to reframe guidelines around caring for the maternal-infant dyad, and for diverse populations living with MS. It also provides updated data on the effects of lactation in women with MS and the limited data on transfer of disease-modifying therapies (DMTs) into breastmilk. The ultimate goal is to support informed shared decision-making between clinicians and patients regarding breastfeeding during the high-risk postpartum period.
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Affiliation(s)
- Stephanie Hsu
- University of California San Francisco, San Francisco, CA, USA
| | - Ayushi Balan
- University of California San Francisco, San Francisco, CA, USA
| | - Riley Bove
- University of California San Francisco, San Francisco, CA, USA
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McGuinness D, Ni Mhurchu S, Frazer K, Bhardwaj N, Cornally P, Cantwell M, Cullen M, McNamara E, McDonald R, Carroll L, Cullen W, Kincaid R, Vickers N. A co-designed evaluation study to identify Breastfeeding Knowledge of General Practitioners' and Practice Nurses'. Health Promot Int 2024; 39:daae021. [PMID: 38452240 PMCID: PMC10919884 DOI: 10.1093/heapro/daae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
The World Health Organization and American Academy of Paediatrics recommend exclusive breastfeeding until 6 months of age, with continued breastfeeding along with complementary solid foods for up to 2 years and beyond. Despite the well-established importance of breastfeeding, Irish rates remain the lowest in Europe. Healthcare professionals' breastfeeding knowledge and skills have a positive impact on increasing breastfeeding rates. There is limited evidence of the knowledge, attitudes or practices of general practitioners (GPs) and general practice nurses (GPNs), which is essential to breastfeeding in Ireland. The aim of this study was to evaluate the breastfeeding knowledge, attitudes and practices of GPs and GPNs in one community healthcare organisation (CHO) in Ireland. A co-designed evaluation study was used following low-risk ethical exemption (LS-LR-22-161). A modified version of a validated breastfeeding questionnaire was developed. A Project Steering Committee was established that included patient, and public involvement stakeholders. The anonymised survey was distributed via online Qualtrics platform (November 2022-February 2023). STROBE Guidelines were utilised. The overall response rate was 25.9% (n = 121) and valid responses were reported in the article. The total population size was n = 468 (GPs n = 290 and GPNs n = 178). Our pilot study identified that 42.7% (n = 47/110) of respondents never attended a breastfeeding education programme, and 53.9% (n = 55/102) identified that their knowledge could be improved. The majority of respondents, 92.9% (n = 92/99) wish to complete further education in breastfeeding. The results of this pilot study in one CHO in Ireland indicate a gap in knowledge and a need for specific breastfeeding and lactation theoretical and skills training for GPs and GPNs working in primary care to support, promote and protect breastfeeding.
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Affiliation(s)
- Denise McGuinness
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Siobhan Ni Mhurchu
- Child Health Programme Development Officer, HSE Community Healthcare Organisation, Dublin North City & County, Tonlegee Health Centre, Dublin 5, D05 K2E6, Ireland
| | - Kate Frazer
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Nancy Bhardwaj
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Paula Cornally
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Marie Cantwell
- HSE Community Healthcare Organisation, Dublin North City and County, HSE Unit 1,2,3, Nexus Building, Block 6A, Blanchardstown Corporate Park, Ballycoolin, Eircode D15 CF9K, Ireland
| | - Marina Cullen
- Rotunda Hospital Parnell Square East, Rotunda, Dublin 1, D01 P5W9, Ireland
| | - Edel McNamara
- Department of Health Promotion and Improvement, Health and Wellbeing Division, HSE Dublin North City and County Community Healthcare, 1st Floor, Unit 4 Nexus Building, Block 6A Blanchardstown Corporate Park, Dublin 15, D15 CF 9K, Ireland
| | - Rita McDonald
- Regional Centre for Nurse & Midwifery Education, Academic Centre, Connolly Hospital, Blanchardstown, Dublin 15, D15 X40D, Ireland
| | - Lisa Carroll
- Rotunda Hospital Parnell Square East, Rotunda, Dublin 1, D01 P5W9, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | | | - Niamh Vickers
- School of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
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Scime NV, Brockway ML, Metcalfe A, Nettel-Aguirre A, Tough SC, Chaput KH. Association of illness perceptions and exclusive breastfeeding intentions among pregnant women with chronic conditions: A community-based pregnancy cohort study. J Psychosom Res 2023; 172:111418. [PMID: 37429127 DOI: 10.1016/j.jpsychores.2023.111418] [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: 07/08/2022] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE We examined whether changes in illness perceptions from preconception to pregnancy were associated with intentions to exclusively breastfeed to 6 months postpartum among women with chronic physical health conditions. METHODS We analyzed self-reported cross-sectional questionnaire data collected in the third trimester from 361 women with chronic conditions enrolled in a community-based cohort study (Alberta, Canada). For individual and total illness perceptions, measured with the Brief Illness Perception Questionnaire, women were classified using change scores (preconception minus pregnancy) into one of the following groups: "worsening," "improving," or "stable" in pregnancy. Intention to exclusively breastfeed was defined as plans to provide only breast milk for the recommended first 6 months after birth. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariable logistic regression modelling, with the "stable" group as the reference and controlling for demographic factors, chronic condition duration and medication, prenatal class attendance, and social support. RESULTS Overall, 61.8% of women planned to exclusively breastfeed to 6 months. Worsened total illness perceptions (adjusted OR 0.50, 95% CI 0.30-0.82) as well as perceptions of worsened identity (i.e., degree of symptoms; adjusted OR 0.49, 95% CI 0.28-0.85) or consequences (i.e., impact on functioning; adjusted OR 0.60, 95% CI 0.34-1.06) were associated with lower odds of intending to exclusively breastfeed to 6 months. CONCLUSIONS Women who perceive their illness experience to worsen during pregnancy are less likely to plan to exclusively breastfeed to 6 months in accordance with public health recommendations.
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Affiliation(s)
- Natalie V Scime
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Meredith L Brockway
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Centre For Health and Social Analytics, National Institute for Applied Statistical Research, School of Mathematics and Statistics, University of Wollongong, NSW, Australia.; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen H Chaput
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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