Effect of a prenatal nutritional intervention program on initiation and duration of breastfeeding

The Effect of Home Visit Program Based on the Continued Kangaroo Mother Care on Maternal Resiliency and Development of Premature Infant: A Randomized Clinical Trial

BACKGROUND

Premature birth is a crisis for mothers and affects resilience. Premature babies are at risk for developmental disorders. The Kangaroo Mother Care (KMC) can reduce maternal stress and improve the growth of the baby. This study aimed at assessing the effect of home visit based on the continued KMC on maternal resiliency and development of premature infant.

METHODS

This randomized controlled trial conducted on 50 pairs of mothers and premature babies with gestational age of 26-32 weeks who were admitted to Neonatal Intensive Care Unit of Om-al-Banin Hospital, Mashhad, Iran in 2019. The KMC is practiced routinely for all eligible newborns in this hospital. The experimental group continued the KMC one month after discharge at home and received two home visits. Resiliency of the mothers was assessed in admission, discharge, and one month after discharge with the Connor and Davison questionnaire and the development of the newborns was assessed in two months of adjusted age with Ages and Stages Questionnaire (ASQ). Data analysis was performed using SPSS software version 16 and t-test, Mann-Whitney, ANOVA, Friedman, Chi-square, Fishers exact. The significance level was set at P<0.05.

RESULTS

The resiliency score of the mothers one month after discharge was112.50±5.50 and 76.40±5.60 in the experimental and control groups, which was significantly different (P<0.001). The ASQ development score of the newborns in two months of adjusted age was also significantly higher in the experimental than the control group (280.40±15.60vs223.80±22.00) (P<0.001).

CONCLUSION

The results showed that the home visit program based on the continued KMC was effective in increasing maternal resilience and the development of premature infants. Trial Registration Number IRCT20181121041718N1.

Invested in Success: A Qualitative Study of the Experience of CenteringPregnancy Group Prenatal Care for Perinatal Educators

The objective of this study was to understand the central meaning of the experience of providing CenteringPregnancy for perinatal educators who were facilitators for the group sessions. Four perinatal educators participated in one-on-one interviews and/or a validation focus group. Six themes emerged: (a) "stepping back and taking on a different role," (b) "supporting transformation," (c) "getting to knowing," (d) "working together to bridge the gap," (e) "creating the environment," and (f) "fostering community." These themes contributed to the core phenomenon of being "invested in success." Through bridging gaps and inconsistencies in information received from educators and physicians, this model of CenteringPregnancy provides an opportunity for women to act on relevant information more fully than more traditional didactic approaches to perinatal education.

Relationship between maternal DHA and iron status and infants' cognitive performance

PURPOSE

The dietary nutrients iron and long-chain polyunsaturated fatty acids are believed to play an important role in early brain development. We investigated the relationship between pregnant women's iron and docosahexaenoic acid (DHA) status and their infants' cognitive performance at age six months.

METHODS

Blood iron and DHA status were analyzed in pregnant women at 28 to 32 weeks of gestation. The women's dietary habits, sociodemographic background, and cognitive performance were assessed using questionnaires. At age six months, infants' blood hemoglobin was analyzed, feeding practices assessed, and weight, length, and head circumference recorded. Each infant's cognitive performance was assessed using the Brunet-Lézine Scale of Psychomotor Development of Early Childhood and the Bayley Scales of Infant Development. Sixty-three mother-infant dyads completed the study.

RESULTS

During pregnancy, 9.5% of pregnant women were anemic, 34.9% had low iron stores, and 3.2% suffered from iron deficiency anemia. The DHA represented 4.36% and 2.15% in erythrocyte and plasma total fatty acids, respectively. These levels were considered adequate. No significant relationship was observed between gestational iron or DHA status and infants' cognitive performance.

CONCLUSIONS

In this small group of infants born to mothers with relatively good feeding practices and a privileged socioeconomic background, cognitive testing with the instruments above was not associated with maternal iron and DHA levels at age six months.

Complexities and subtleties in the measurement and reporting of breastfeeding practices

BACKGROUND

Monitoring of breastfeeding is vital. However, infant feeding practices are difficult to assess at the population level. Although significant efforts have been made towards the consistent measurement and reporting of breastfeeding, few countries have successfully implemented a system to do so. Many inaccuracies, inconsistencies and issues remain. This paper highlights the main issues relating to the methods and indicators used to monitor breastfeeding, particularly exclusive breastfeeding, at the population level. In doing so, it aims to support progress in this area.

DISCUSSION

Indicators are used primarily for comparative purposes and should be broadly consistent with recommended practice; regarding exclusive breastfeeding this is 'to six months'. There are limitations to both main methods used to measure and report on breastfeeding: current status (often 24-hour recall), and longer-term recall. Issues relate to how age is considered within the analysis and interpretation of data, including boundary points or cut offs, as well as how breastfeeding practices are reported against different ages, especially regarding whether to use the preposition 'to' or 'at'. Other issues include the conversion from weeks to months, as well as the 'regular' versus 'first' introduction of something other than breast milk, to signify the deviation from exclusive breastfeeding. Differences in how data are collected, and uncertainties around how data are interpreted, have led to the mixed and often inaccurate reporting of breastfeeding practices, particularly exclusive breastfeeding. Assuming a particular definition of exclusive breastfeeding, such as that of the World Health Organization, the period over which exclusive breastfeeding is measured and how it is determined in the survey are important in relation to indicator phrasing. Often compromises are made in data collected to report against exclusive breastfeeding, despite subsequent reporting of exclusivity.

SUMMARY

Indicators to report on breastfeeding must be carefully phrased. The commonly reported indicator exclusive breastfeeding at six months is redundant and should never be reported, while the more appropriate indicator exclusive breastfeeding to six months may not be sufficiently sensitive to change, and cannot be measured by current status methods alone. Importantly, indicators must accurately reflect the data collected to ensure valid comparisons between surveys.

Maternal obesity, health status during pregnancy, and breastfeeding initiation and duration

OBJECTIVE

The purpose of this study was to determine whether maternal prepregnancy overweight/obesity has independent effects on breastfeeding initiation and duration and whether these effects are different for women who experience medical problems during pregnancy or labor/delivery complications in comparison with those who have no medical or labor/delivery complications.

METHODS

We used the early childhood longitudinal study-birth cohort data. Kaplan-Meier survival functions, logistic, and Cox regression modeling were used in the analyses.

RESULTS

Findings indicate that overweight/obese women with medical or labor/delivery complications were less likely to initiate breastfeeding in comparison with their counterparts of normal weight. We did not find an independent effect of prepregnancy overweight/obesity on breastfeeding initiation among women with no medical problems. This group of women, however, had an 11% increased risk of stopping breastfeeding with each additional month of breastfeeding duration in comparison to those of normal weight.

CONCLUSIONS

It is important to evaluate the health history and pregnancy complications among overweight/obese mothers in developing interventions for successful initiation and duration of breastfeeding.

Maternal socio-demographic factors influencing the initiation and exclusivity of breastfeeding in a Nigerian semi-urban setting

BACKGROUND

The success of breastfeeding promotion is influenced by maternal factors. Therefore, it is vital to examine the influence of basic maternal demographic factors on breastfeeding practices.

OBJECTIVE

To determine the influence of maternal socio-demographic factors on the initiation and exclusivity of breastfeeding.

METHOD

A cross-sectional survey of mothers of children aged from 1 to 24 months attending a Nigerian Infant Welfare Clinic was conducted. Respondents were grouped according to age, parity, education, occupation, sites of antenatal care and delivery. These groups were compared for breastfeeding indices using bivariate and multivariate analysis.

RESULTS

All the 262 respondents breastfed their children. The exclusive breastfeeding rate was 33.3% for children aged 0-3 months, 22.2% for children aged 4-6 months and 19.4% for children aged 7-24 months at the time of the study. Significantly higher proportions of mothers with at least secondary education, clinic-based antenatal care and delivery in health facilities initiated breastfeeding within 1 h of birth, avoided pre-lacteal feeding and practiced exclusive breastfeeding for the first 6 months of life. Maternal age and parity did not confer any advantage on breastfeeding practices. Delivery of children outside health facilities strongly contributed to delayed initiation of breastfeeding (P < 0.001), pre-lacteal feeding (P = 0.003) and failure to breastfeed exclusively (P = 0.049). Maternal education below secondary level strongly contributed to pre-lacteal feeding (P = 0.004) and failure to practice exclusive breastfeeding (P = 0.008).

CONCLUSION

Low maternal education and non-utilization of orthodox obstetric facilities impairs early initiation and exclusivity of breastfeeding.