Association between breastfeeding and new mothers' sleep: a unique Australian time use study

Perinatal maternal factors influencing postpartum feeding practices at six weeks

OBJECTIVE

Despite the World Health Organization's recommendation of exclusive breastfeeding for the initial 6 months, breastfeeding rates decline within the first 6 weeks after delivery. This study aimed to (1) investigate the breastfeeding rate at 6 weeks postpartum and (2) explore the influence of perinatal factors on feeding patterns at 6 weeks postpartum.

METHOD

A total of 635 participants were enrolled from February to August 2023 at outpatient clinics in three tertiary hospitals in Nantong City. Variables were collected through questionnaires during the third trimester of pregnancy, including demographic information, pregnancy stress, anxiety, depression, sleep, and resilience. At 6 weeks postpartum, information regarding feeding patterns, delivery and postpartum situations, postpartum stress, anxiety, depression, sleep, and resilience was gathered. Initial single-factor analyses were conducted using feeding pattern as the dependent variable, and variables with significance were chosen as independent variables. The disordered multi-classification logistic regression model was then established using the stepwise forward method.

RESULTS

Within the first 6 weeks, 35.28% (224/635) of postpartum women exclusively breastfed their infants. Factors influencing exclusive breastfeeding and formula feeding at 6 weeks postpartum included breast pain, sleep quality, mental resilience, difference between postpartum and late pregnancy anxiety, insufficient milk supply, and maternal herself caring for the infant (P < 0.05). Factors influencing the transition from exclusive to partial breastfeeding were insufficient milk supply and maternal herself caring for the infant (P < 0.05).

CONCLUSION

The study reveals a relative low rate of exclusive breastfeeding in China's first 6 weeks postpartum, along with a comparison of perinatal factors affecting three different feeding patterns. Our findings may contribute additional evidence to the association between perinatal factors and feeding patterns. This study guides healthcare professionals in developing strategies to promote exclusive breastfeeding and improve personalized counseling for exclusive breastfeeding and mental health.

From Breastfeeding to Support in Mothers' Feeding Choices: A Key Role in the Prevention of Postpartum Depression?

The postpartum period represents a critical phase of profound transition for women. This timeframe encompasses the physical recuperation associated with childbirth, the intricate psychosocial adjustments inherent in assuming the role of motherhood and also important alterations in steroid and peptide hormones. Hence, as women navigate the reconfiguration of relationships and strive to address the diverse needs of their infants and family members, they concurrently grapple with dramatic transformations which are characteristic of the postpartum phase. In fact, relevant prevalence ranges are reported for maternity blues, a mild condition characterized by self-limited and transient depressive symptoms, but also a well-established risk factor for more serious postpartum mood disorders, such as depression (PPD), with an incidence of 10-15%. Unlike in the US, at the European level, there are no concrete recommendations for the routine integration of the assessment of the mother's emotional state by healthcare professionals, with a considerable risk of underdiagnosing or undertreating these conditions. In this regard, there is a growing body of scientific evidence on the important role of breastfeeding in reducing the risk of PPD and also of the importance of mothers' compliance with this practice. Indeed, sucking the baby regulates the circadian rhythm of the HPA axis and, together with the action of prolactin, the stress response is decreased. In addition, other positive consequences of breastfeeding, which are inversely correlated with the onset of PPD, include the regulation of sleep and waking patterns for mother and baby, the improvement of the mother's self-efficacy and her emotional involvement. It should also be considered that the request for support for breastfeeding can often conceal a request for support for motherhood itself and for the mother's emotional well-being. It therefore emerges that the personnel involved in primary pediatric care to provide adequate support in the transition to motherhood must support mothers in their breastfeeding choices, whether breastfeeding or formula feeding, so that each choice is made conscientiously and serenely. Therefore, neonatal feeding assumes a decisive role, since if, on the one hand, it regulates specific neurohormonal pathways that are protective for maternal emotional well-being (breastfeeding), on the other hand, support in mothers' breastfeeding choices, even in the case of formula feeding, means validating their being mothers in the absence of judgement and counteracting any feelings of inadequacy, conditions that are inversely correlated to DPP.

The influence of factors associated with past reproductive histories on migraines in middle-aged premenopausal women: a nationwide population-based study in Republic of Korea

Introduction

Women can experience various reproductive events, such as pregnancy, childbirth, lactation, and contraception, which cause long-term changes in female hormones. In middle-aged women, the prevalence of migraine is high, and a clear gender difference is evident. This study investigated the effects of factors associated with past reproductive events on the risk of new migraine in middle-aged premenopausal women.

Methods

The influence of reproductive factors on migraine in middle-aged women was investigated using the Korean National Health Insurance Service (KNHIS) and Korean Health Examination (KHE) databases. The reproductive factors of interest were parity, breastfeeding, and oral contraceptive (OC) use. The study included 949,704 middle-aged premenopausal women 40-60 years of age. The study population was divided into two groups based on new diagnosis of migraine during the follow-up period (2009-2018).

Results

The risk of new migraine tended to increase in the primiparous (hazard ratio, HR: 1.179; 95% confidence interval, CI: 1.137-1.221) and multiparous groups (HR: 1.181; 95% CI: 1.142-1.221) compared with the nulliparous group. The breastfeeding ≥12 months group (HR: 1.071; 95% CI: 1.052-1.091) showed a significantly increased risk of new migraine compared with the non-breastfeeding group. All women in the OC groups (< 1 year, HR: 1.048; 95% CI: 1.028-1.069 and ≥ 1 year, HR: 1.100; 95% CI: 1.067-1.134) showed a higher risk of new migraine than those in the non-OC group.

Conclusion

The results of the current study indicate that childbirth, longer breastfeeding, and OC use may be associated with a higher risk of new migraine in middle-aged premenopausal women.

Correlation Between Maternal Anxiety During Mid-Pregnancy and Subsequent Infant Sleep Issues: A Cross-Sectional Study from 2015 to 2016

Purpose

To explore the correlation between maternal anxiety during mid-pregnancy and infant sleep issues based on the anxiety status of mothers in mid-pregnancy.

Patients and Methods

A cohort of 2122 primigravida women from Ma'anshan City, Anhui Province, was followed from pregnancy until 6 months postpartum. The study analyzed the impact of maternal anxiety on infant sleep patterns, including primary caregivers, encompassing insufficient sleep duration, frequent nocturnal awakenings, prolonged nocturnal awakening durations, and elongated sleep latency.

Results

A total of 1891 mother-infant pairs were included in this analysis. After adjusting for confounding factors, a positive correlation was found between maternal anxiety during mid-pregnancy and insufficient sleep duration (OR=1.69, 95% CI:1.13-2.52), and elongated sleep latency (OR=2.26, 95% CI:1.61-3.18).

Conclusion

Maternal anxiety during mid-pregnancy is associated with sleep issues in infants. Addressing maternal mental health during pregnancy may enhance sleep quality for mothers and infants, promoting overall maternal-infant health.

The Impact of Maternity and Working Demands in Women's Sleep Pattern

This literature review seeks to understand how motherhood and profession affect women's sleep. After the birth of a child, there is an increase in dissatisfaction with the quantity and quality of sleep. Awakenings and sleep disturbances are more frequent and can lead to increased fatigue and stress to reconcile household activities and work demands. These changes in sleep can lead to physical and/or psychological health problems. Sleep hygiene and social support become fundamental for the performance of the maternal tasks, reducing risks and increasing prevention of future problems, both for women and children.

How do infant feeding method, sleeping location, and postpartum depression interact with maternal sleep quality?

New mothers generally experience poor and/or disrupted sleep. A range of infant care and mental health factors may impact new mothers' sleep quality. A cross-sectional online survey was completed by a sample of 101 Australian new mothers with children under 12 months (M = 5.52 months, SD = 3.29 months) to examine the relationship between infant feeding method, infant sleeping location, and postpartum depression with maternal sleep quality. Subjective maternal sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and postpartum depression was measured using the Edinburgh Postpartum Depression Scale (EPDS). Overall, new mothers experienced poor subjective sleep quality, with high average PSQI scores, above the cut-off of 5 (M = 9.63, SD = 4.07). The majority of new mothers did not experience postpartum depression, with an average EPDS score below the cut-off of 11 (8.66, SD = 5.20). Mothers who breastfed their infants experienced significantly better subjective sleep quality than mothers who bottle-fed, with a medium effect size (ηp2 = 0.458). Subjective maternal sleep quality did not differ based on infant sleeping location. Poor subjective maternal sleep quality was a significant predictor of postpartum depression. While poor sleep was common in this sample of Australian new mothers, this study demonstrated that new mothers who breastfeed may experience slightly better subjective sleep quality than other feeding methods. Further research into, and better services for the education and advocation of, new mothers' sleep quality will be beneficial to both new mothers and clinicians.

Association of illness perceptions and exclusive breastfeeding intentions among pregnant women with chronic conditions: A community-based pregnancy cohort study

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.

Associations between Perinatal Sleepiness and Breastfeeding Intentions and Attitudes and Infant Feeding Behaviors and Beliefs

Breastfeeding rates fall short of public health goals, but barriers are poorly understood. We examined whether excessive sleepiness during pregnancy and the postpartum period was associated with breastfeeding intentions, attitudes, initiation, and continuation in a tobacco-exposed sample participating in a randomized controlled trial to reduce smoke exposure (n = 399). We used the Epworth Sleepiness Scale (ESS) to examine associations between excessive sleepiness in early (12-16 weeks gestation) and late (32 weeks gestation) pregnancy and at 6 months postpartum, with breastfeeding attitudes using the Mitra index, intentions, initiation, and continuation, as well as other infant feeding practices using the Infant Feeding Questionnaire. Logistic regression models adjusted for age, racial/ethnic identity, parity, marital status, and maternal education showed that excessive sleepiness in late pregnancy was associated with less favorable attitudes toward breastfeeding. In addition, in unadjusted models, excessive sleepiness at 6 months postpartum was associated with less of a tendency to use feeding to calm a fussy infant. Excessive sleepiness was not associated with intent, initiation, or continuation of breastfeeding. Assessing excessive sleepiness in late pregnancy may assist in identifying individuals with negative attitudes to breastfeeding and lead to novel approaches to promoting breastfeeding in populations with lower breastfeeding rates.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

Sleep duration of lactating mothers and its relationship with feeding pattern, milk macronutrients and related serum factors: A combined longitudinal cohort and cross-sectional study

Objective

Insufficient sleep is common in postpartum mothers. The main objectives of this study are to explore the sleep duration among Chinese lactating mothers and preliminarily investigate the relationship between sleep duration and feeding pattern. The secondary objectives are to investigate the relationships between sleep duration and milk macronutrients and between maternal-related indicators, including melatonin (MT), growth hormone (GH), ghrelin (GHRL), glucagon-like peptide-1 (GLP-1), prolactin (PRL), and cholecystokinin (CCK).

Methods

The present study comprises a longitudinal and a cross-sectional cohort from December 2019 to December 2021. Postpartum lactating women living in Shanghai were recruited through online and offline recruitment. The subjects were included in the longitudinal cohort or cross-sectional study based on their lactation period at the time of recruitment. The longitudinal cohort included a total of 115 mothers. Human milk and feeding pattern were measured and collected at 2–4 months and 5–7 months postpartum. At four predetermined follow-up time points, data on sleep duration was collected (at the time of recruitment, 2–4 months postpartum, 5–7 months postpartum, and 12–17 months postpartum). The cross-sectional study included 35 lactating mothers (2–12 months postpartum) who reported their sleep duration and provided blood samples. Mid-infrared spectroscopy (MIRS) method was used to analyze the macronutrients of breast milk, while MT, GH, GHRL, GLP-1, PRL, and CCK in maternal blood were determined by ELISA.

Results

The maternal sleep duration before pregnancy was 8.14 ± 1.18 h/d (n = 115), 7.27 ± 1.31 h/d (n = 113) for 2–4 months postpartum, 7.02 ± 1.05 h/d (n = 105) for 5–7 months postpartum, and 7.45 ± 1.05 h/d (n = 115) for 12–17 months postpartum. The incidence of insufficient sleep (<7 h/d) before pregnancy (12.17%) was significantly less than at any follow-up time after delivery (vs. 2–4 months postpartum, χ² = 10.101, p = 0.001; vs. 5–7 months postpartum, χ² = 15.281, p < 0.0001; vs. 12–17 months postpartum, χ² = 6.426, p = 0.011). The percentage of insufficient maternal sleep was highest at 5–7 months postpartum (34.29%). No significant difference was found between the incidence of insufficient sleep at 5–7 months postpartum, 2–4 months postpartum (29.20%, χ² = 0.650, p = 0.420), and 12–17 months postpartum (25.22%, χ² = 2.168, p = 0.141). At 2–4 months postpartum, the frequency of formula feeding per day is related to reduced maternal sleep duration (Standardization coefficient β = −0.265, p = 0.005, Adjusted R² = 0.061). At 2–4 months and 5–7 months postpartum, the relationship between macronutrients in breast milk and the mother's sleep duration was insignificant (all p > 0.05). Other than the positive correlation found between maternal GHRL and sleep duration (r = 0.3661, p = 0.0305), no significant relationship was observed between sleep duration and other indexes (all p > 0.05).

Conclusions

Postpartum mothers generally sleep less, but there is no correlation between insufficient sleep and the macronutrient content of breast milk. Formula feeding may be related to the mother's sleep loss, while breastfeeding (especially direct breastfeeding) may be related to increased maternal sleep duration. The findings suggest that sleep duration is related to maternal serum GHRL. More high-quality studies are needed to clarify the mechanism of these findings and provide a solid theoretical basis and support references for breastfeeding.

Perceived Sleep Quality and Fatigue in a Population of New Mothers: A Cross-Sectional Study Comparing Relationships with Breastfeeding and Bottle Feeding

Introduction: This study, which used a cross-sectional design, was carried out to examine the factors associated with the way mothers fed their infants such as breastfeeding or bottle feeding, and to compare perceived sleep quality and fatigue levels. Method: The study sample consisted of a total of 100 women in the 4th to 16th week postpartum, including 50 women breastfeeding and 50 women bottle feeding their infants. The data of the study were collected in Family Health Centers (FHC) through the face-to-face interview technique using "a Personal Information Form," "the Pittsburgh Sleep Quality Index-PSQI," and "the Checklist Individual Strength-CIS." Results: The mothers' total sleep quality (PSQI) score was found to not differ significantly according to the type of infant feeding. Similarly, total scores for fatigue assessment obtained from the CIS did not differ according to the infant feeding type variable. A significant positive correlation was found between total sleep quality and total fatigue level, and subjective fatigue level. Discussion: The sleep quality and fatigue levels of mothers are independent of the method of feeding their infants. Midwives should plan initiatives with parents to improve maternal sleep quality and reduce fatigue levels and inform parents that breastfeeding is not a factor that reduces sleep quality or increases fatigue. Clinical Trials.gov ID: 1129/5463.

Re-thinking benign inflammation of the lactating breast: Classification, prevention, and management

Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as benign inflammation of the lactating breast remain a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for benign inflammatory conditions of the lactating breast which lack agreed or evidence-based aetiology, definitions, and treatment. This article is the second in a three-part series. This second review analyses the heterogeneous research literature concerning benign lactation-related breast inflammation from the perspectives of the mechanobiological model and complexity science, to re-think classification, prevention, and management of lactation-related breast inflammation. Benign lactation-related breast inflammation is a spectrum condition, either localized or generalized. Acute benign lactation-related breast inflammation includes engorgement and the commonly used but poorly defined diagnoses of blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, and mastitis. End-stage (non-malignant) lactation-related breast inflammation presents as the active inflammations of abscess, fistula, and septicaemia, and the inactive condition of a galactocoele. The first preventive or management principle of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents strain and rupture of a critical mass of lactocyte tight junctions. This is achieved by frequent and flexible milk removal. The second preventive or management principle is elimination of the mechanical forces which result in high intra-alveolar pressures. This requires elimination of conflicting vectors of force upon the nipple and breast tissue during milk removal; avoidance of focussed external pressure applied to the breast, including avoidance of lump massage or vibration; and avoidance of other prolonged external pressures upon the breast. Three other key preventive or management principles are discussed. Conservative management is expected to be effective for most, once recommendations to massage or vibrate out lumps, which worsen micro-vascular trauma and inflammation, are ceased.