Intenção materna de amamentar: revisão sistemática

Breastfeeding is associated with the intelligence of school-age children in Mexico

Breastfeeding has been consistently associated with higher intelligence since childhood. However, this relation could be confounded due to maternal selection bias. We estimated the association between predominant breastfeeding and intelligence in school-age children considering potential selection bias and we simulated the intelligence gap reduction between low versus higher socioeconomic status children by increasing breastfeeding. We analysed predominant breastfeeding practices (breastmilk and water-based liquids) of children 0-3 years included in the Mexican Family Life Survey (MxFLS-1). Intelligence was estimated as the z-score of the abbreviated Raven score, measured at 6-12 years in the MxFLS-2 or MxFLS-3. We predicted breastfeeding duration among children with censored data with a Poisson model. We used the Heckman selection model to assess the association between breastfeeding and intelligence, correcting for selection bias and stratified by socioeconomic status. Results show after controlling for selection bias, a 1-month increase in predominant breastfeeding duration was associated with a 0.02 SD increase in the Raven z-score (p < 0.05). The children who were predominantly breastfed for 4-6 months versus <1 month had 0.16 SD higher Raven z-score (p < 0.05). No associations were found using multiple linear regression models. Among low socioeconomic status children, increasing predominantly breastfeeding duration to 6 months would increase their mean Raven z-score from -0.14 to -0.07 SD and reduce by 12.5% the intelligence gap with high socioeconomic status children. In conclusion, predominant breastfeeding duration was significantly associated with childhood intelligence after controlling for maternal selection bias. Increased breastfeeding duration may reduce poverty-driven intelligence inequities.

Breastfeeding initiation and duration through the COVID-19 pandemic, a linked population-level routine data study: the Born in Wales Cohort 2018-2021

OBJECTIVES

The WHO recommends exclusive breastfeeding for the first 6 months of life. This study aimed to examine the impact the pandemic had on breastfeeding uptake and duration, and whether intention to breastfeed is associated with longer duration of exclusive breastfeeding.

METHODS

A cohort study using routinely collected, linked healthcare data from the Secure Anonymised Information Linkage databank. All women who gave birth in Wales between 2018 and 2021 recorded in the Maternal Indicators dataset were asked about intention to breastfeed. These data were linked with the National Community Child Health Births and Breastfeeding dataset to examine breastfeeding rates.

RESULTS

Intention to breastfeed was associated with being 27.6 times more likely to continue to exclusively breastfeed for 6 months compared with those who did not intend to breastfeed (OR 27.6, 95% CI 24.9 to 30.7). Breastfeeding rates at 6 months were 16.6% prepandemic and 20.5% in 2020. When compared with a survey population, the initial intention to breastfeed/not breastfeed only changes for about 10% of women.

CONCLUSION

Women were more likely to exclusively breastfeed for 6 months during the pandemic compared with before or after the pandemic. Arguably, interventions which enable families to spend more time with their baby such as maternal and paternal leave may help improve breastfeeding duration. The biggest predictor of breastfeeding at 6 months was intention to breastfeed. Therefore, targeted interventions during pregnancy to encourage motivation to breastfeed could improve duration of breastfeeding.

The influence of breastfeeding attitudes on breastfeeding behavior of postpartum women and their spouses

Purpose

This study aimed to explore: (1) the influence of maternal sociodemographic factors on breastfeeding attitudes, (2) the relationship between breastfeeding attitudes of postpartum women and their spouses, (3) the predictors of breastfeeding behavior (mixed breastfeeding) at two months postpartum, and (4) to establish the reliability of the Chinese version of the paternal Iowa Infant Feeding Attitude Scale (IIFAS) in Taiwan.

Methods

A correlational and follow-up study design was used on a convenience sample of 215 women and 215 fathers recruited from a regional teaching hospital in central Taiwan from July 2020 to December 2020. The participants completed the IIFAS during postpartum hospitalization and a follow-up via telephone at 8 weeks postpartum for information on feeding methods and duration. The Cox proportional hazards model was used to analyze the predictors of breastfeeding duration.

Results

Maternal breastfeeding attitude scores ranged from 42 to 79, with a mean score of 59.78 (SD ± 6.68). Spouses' breastfeeding attitude scores ranged from 46 to 81, with a mean score of 59.60 (SD ± 6.93). Mother and spouse's IIFAS scores were highly correlated (r = 0.50, p < 0.001), and the scores of both parents were significantly associated with the duration of breastfeeding. With each increased point on maternal and paternal IIFAS scores, the odds of breastfeeding during the first 8 weeks increased 6% and 10%, respectively.

Conclusion

This is the first study to validate the IIFAS (Chinese version) with paternal participants in Taiwan. Identifying and understanding the infant feeding attitudes of mothers and their spouses should be an early step in designing and implementing breastfeeding interventions.

Mothers' breastfeeding six weeks postpartum and factors influencing exclusive breastfeeding during the first six months

We aimed to assess the feeding pattern and influencing factors within six weeks postpartum on exclusive breastfeeding duration among Chinese mothers. This study was conducted using 2:1 matched case-control study. Cases and controls were matched for maternal age, parity and mode of birth. A total of 210 women were included. Approximately 67.9% of women stopped exclusive breastfeeding within the first six weeks postpartum. Maternal non-exclusive breastfeeding intention, lower maternal educational level, mother-infant skin to skin contact over one hour, unsatisfied breastfeeding self-evaluation and maternal unhealthy condition within the first six weeks were risk factors for ceasing exclusive breastfeeding early.

Intention to Breastfeed and Paternal Influence on Pregnant Mothers Exclusively Using Marijuana Compared with Other Substances

Objective: To determine intention to breastfeed (ITBF) rates among mothers exclusively using marijuana (eMJ) compared with electronic cigarettes (eEcig), tobacco products (eTob), or multisubstances (MS), nonusers (NU), and the influence of paternal presence and paternal substance use. Study Design: Cross-sectional study of parental survey responses merged with electronic birth certificates. Accounting for clinical and social determinants of health, analyses of ITBF included (1) all mothers, (2) single mothers, and (3) mothers with fathers. Results: Among all mothers (n = 1,073), eMJ, eTob, and MS users had lower odds of ITBF compared with NU. Only eMJ users had lower odds of ITBF for those without paternal presence. However, in those mothers with a paternal presence, odds of ITBF were similar to NU for eMJ, eTob, and MS users when accounting for paternal factors, including paternal substance use. Conclusion: Women exclusively using MJ have lower ITBF compared with NU. However, paternal presence mitigated this effect, independent of parental MJ use. The presence of fathers may represent a unique predictor for increased ITBF in MJ using mothers.

[A quantitative and qualitative study of exclusive breastfeeding intention by high-risk pregnant women]

The scope of this research was to assess the breastfeeding intention among high-risk pregnant women and related factors. It is a cross-sectional, qualitative and quantitative study, with 1,118 high-risk pregnant women who attended the prenatal care unit at a specialized center of the Unified Health System. The dependent variables were exclusive breastfeeding intention, intended duration and conditions that might interfere with breastfeeding. The Epi Info 7.4.1, Bioestat 5.3 and IRAMUTEQ 0.7.2.0 programs were used for data processing. The results showed that 8.76% of the pregnant women had conditions that could affect lactation. Among the women, 93.83% affirmed having exclusive breastfeeding intention, of which 69.86% intended to breastfeed until the child was six months old, revealing an association with sociodemographic variables (p<0.05). The intended breastfeeding duration was related to the age (p=0.0041), marital status (p=0.0053) and level of education (p=0.0116). The main reasons reported for not providing exclusive breastfeeding were the following: HIV, use of medications, work and lack of information. This research concluded that a small cohort of high-risk pregnant women presented conditions that could interfere with breastfeeding. Most of them intended to breastfeed exclusively for six months.

Cultural adaptation of Infant Feeding Intentions Scale (IFI) for pregnant women in Brazil

OBJECTIVES

to translate and culturally adapt the Infant Feeding Intentions Scale for pregnant women in Brazil.

METHODS

methodological study that included stages of translation, synthesis, face and content validation, back translation and semantic assessment. In the face and content and semantic validation stages, we used the Content Validity Index for individual items and for the overall scale for clarity and representativeness.

RESULTS

nine (100.0%) experts participated in face and content validation, and the average index obtained was 85.0% for representativeness. In the semantic assessment, performed with 31 (100.0%) pregnant women, the tool was considered clear, obtaining an average index of 91.0%.

CONCLUSIONS

the Brazilian version of the scale was considered representative and clear. After assessing psychometric properties, the scale is expected to be valid and reliable to assess maternal intention to breastfeed exclusively until the infant's six months of life in different Brazilian settings.

Intenção de amamentar entre gestantes: associação com trabalho, fumo e experiência prévia de amamentação

Resumo O objetivo do presente estudo foi estimar a prevalência de intenção de amamentar (IA) por tempo insuficiente (inferior a 6 meses) ou prolongado (24 meses ou mais) e investigar sua associação com variáveis demográficas, socioeconômicas, comportamentais relacionadas à saúde, antecedentes obstétricos e experiência prévia com amamentação entre gestantes. Estudo transversal com gestantes em acompanhamento pré-natal em 17 unidades da Estratégia Saúde da Família, em Colombo (PR). Análises de regressão logística multinomial brutas e ajustadas foram empregadas para identificar associações entre IA e variáveis de exposição. Dentre as gestantes participantes da pesquisa (n = 316), 99,1% relataram IA. O tempo médio de IA foi de 13,5 meses. A IA por tempo insuficiente e prolongado foi referida por 9,8% e 22,0% das gestantes, respectivamente. Apresentaram maiores chances de IA por tempo insuficiente aquelas que não possuíam companheiro (OR 3,23, IC95% 1,31; 7,94), que exerciam trabalho remunerado (OR 5,56, IC95% 2,10; 14,71) e que eram fumantes (OR 7,79, IC95% 2,35; 25,81). A IA prolongada foi mais frequente entre as gestantes com experiência prévia em amamentação prolongada (OR 3,05, IC95% de 1,02; 9,03). Por fim, identifica-se que os fatores associados à IA subsidiam ações voltadas para os grupos vulneráveis com vistas à promoção da prática do aleitamento materno.

Factors Associated With Breastfeeding Among Women With Gestational Diabetes

BACKGROUND

Breastfeeding offers benefits to mother and child but is frequently not practiced among women whose pregnancy is complicated by gestational diabetes mellitus. Factors associated with not initiating or not maintaining breastfeeding among these women have been little investigated.

RESEARCH AIMS

(1) To evaluate the frequency of breastfeeding for 30 days among women with a recent pregnancy complicated by gestational diabetes and (2) to determine factors associated with not initiating or not maintaining breastfeeding.

METHODS

Between January 2014 and July 2017 we enrolled women with gestational diabetes at high-risk prenatal services in three Brazilian cities. We collected baseline sociodemographic and health data and followed up with participants by telephone. Using Kaplan-Meier curves, we calculated the proportions of participants not initiating breastfeeding or not maintaining it for at least 30 days. We used Poisson regression with robust variance to identify factors related to this outcome.

RESULTS

Of the 2328 participants with complete information, 2236 (96.1%) initiated breastfeeding, and 2166 (93.1%) maintained breastfeeding for 30 days. Not having breastfed the previous infant (relative risk [RR] = 5.02, 95% CI [3.39, 7.45]), smoking during pregnancy (RR = 2.37, 95% CI [1.48, 3.80]), infant with health problems (RR = 2.25, 95% CI [1.27, 3.99]), early preterm birth (RR = 2.49, 95% CI [1.07, 5.77]), and not intending to breastfeed (RR = 3.73, 95% CI [1.89, 7.33]) were related to not maintaining breastfeeding for at least 30 days.

CONCLUSIONS

Breastfeeding initiation was nearly universal among participants, and most maintained breastfeeding for 30 days. Factors relating to not breastfeeding at 30 days were easily identifiable.

Prenatal Exposure to Stressful Life Events and Infant Breastfeeding

BACKGROUND

Of the various barriers to breastfeeding, limited information is available on the relationship between prenatal stress and breastfeeding. This study investigates the association between prenatal stressful life event (SLE) exposure and breastfeeding initiation postpartum.

MATERIALS AND METHODS

Using Rhode Island Pregnancy Risk Assessment Monitoring System data from 2012 to 2014, SLE was defined as self-report of prenatal exposure to 14 predefined life events such as job loss or illness. Exposure to SLE was categorized by number and type of events. Multivariable logistic regression was performed to assess the relationship between SLE and breastfeeding initiation. Results accounted for complex survey design and were adjusted for maternal and infant characteristics (age, race, ethnicity, insurance, delivery type, parity, gestational age, birth weight for gestational age, and neonatal intensive care unit admission).

RESULTS

Among 3,353 respondents, 86% reported breastfeeding initiation, 74% reported exposure to ≥1 SLE, and 17% reported exposure to ≥4 SLE. Decreased odds of breastfeeding initiation were associated with prenatal exposure to ≥4 SLE (adjusted odds ratio [aOR] 0.67; 95% confidence interval [CI]: 0.48-0.95), emotional stressors (aOR 0.77; 95% CI: 0.61-0.98), and traumatic stressors (aOR 0.68; 95% CI: 0.50-0.91).

CONCLUSION

This study underscores the impact of exposure to prenatal SLE on breastfeeding initiation among postpartum women. Findings may assist providers in identifying at-risk women for anticipatory guidance to improve breastfeeding rates.

Factors associated to nipple trauma in lactation period: a systematic review

Abstract Objectives: To identify the characteristics associated to nipple trauma in nursing mothers and propose a theoretical model explaining in hierarchical levels its determining factors. Methods: a systematic review of the literature based on the search of epidemiological studies of factors associated to nipple trauma in the databases of Medical Literature Analysis and Retrieval System Online/Pubmed, Literatura Latino-Americana and Caribe em Ciências da Saúde (Latin American Literature and Caribbean Health Sciences) and ScienceDirect. The conduct on searching articles occurred until June 2016. Results: 17 articles were selected which investigated 27 variables and found a significant association between 16 of these variables and nipple trauma. The factors associated to nipple trauma reported in two or more studies were: mother of race/color white or yellow, primiparity, inadequate position between mother and child during breastfeeding and handling the infant incorrectly to the mother's breast. Guidance received on handling and positioning the infant during prenatal care was a protective factor against nipple trauma. Conclusions: in the theoretical model explaining the factors associated to nipple trauma in hierarchical levels, the variables classified at the proximal level were the most investigated and were identified as risk factors in selected studies, indicating that in the postpartum care period is an important protective factor against nipple trauma.