Health Care Costs Associated to Type of Feeding in the First Year of Life

The economic cost consequences of suboptimal infant and young child feeding practices: a scoping review

Breastfeeding is important for women and children's health, but less than half of infants worldwide begin life with optimal breastfeeding. A growing literature shows consistently large economic costs of not breastfeeding, with global studies showing economic losses of around US$300 billion globally. However, existing studies are highly diverse in approaches, methods, data sources and country results. Building on a landmark 2012 UNICEF UK review focused on high-income countries, we conducted a scoping review to map and characterize the expanding literature and identify future research directions in this research area. We included studies (n = 36) in diverse country settings and outcomes for women and children. We used PubMed, Web of Science, EMBASE, MEDLINE, ProQuest and manual searches of cost of not breastfeeding studies published between 1996 and 2023. Articles were excluded if they were macroeconomic evaluations, did not assign monetary values or only evaluated breastfeeding or formula feeding costs and not outcomes or were cost of programs studies. We found considerable diversity in disciplinary approaches and differences in methodologies. Though there were different cost measurement perspectives (societal, institutional/payer and individual), all but two excluded the costs of unpaid care. Studies typically measured costs of medical treatment, with more recent studies using dynamic simulation models. The largest economic costs were derived from lifetime estimates of human capital losses, namely cost of premature death and loss of intelligence quotient points. Medical and death costs varied widely depending on method of calculation, but total costs consistently exceeded $US100 billion annually for the USA, and around $US300 billion in global studies. Our findings suggest that greater interdisciplinary collaboration is needed particularly to better define infant feeding exposures, and advance comprehensive measurement of costs and outcomes across lifetimes, in order to prioritize breastfeeding as a public health strategy of economic importance.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study

OBJECTIVE

To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals.

METHOD

Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach.

RESULTS

In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula.

CONCLUSIONS

Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

Influence of Health Literacy on Maintenance of Exclusive Breastfeeding at 6 Months Postpartum: A Multicentre Study

Background: International organizations recommend initiating breastfeeding within the first hour of life and maintaining exclusive breastfeeding for the first 6 months. However, worldwide rates of exclusive breastfeeding for 6-month-old infants is far from meeting the goal proposed by the World Health Organization, which is to reach a minimum of 50% of infants. Education is one of the factors affecting the initiation and continuation of breastfeeding, and incidentally, it is also related to lower health literacy. This study explored the influence of health literacy on maintenance of exclusive breastfeeding at 6 months postpartum. Methods: A longitudinal multicenter study with 343 women were recruited between January 2019 and January 2020. The first questionnaire was held during the puerperium (24−48 h) with mothers practicing exclusive breastfeeding, with whom 6-month postpartum breastfeeding follow-up was performed. Socio-demographic, clinical and obstetric variables were collected. Breastfeeding efficiency was assessed using the LATCH breastfeeding assessment tool. The health literacy level was evaluated by the Newest Vital Sign screening tool. A multivariate logistic regression model was used to detect protective factors for early exclusive breastfeeding cessation. Results: One third of the women continued exclusive breastfeeding at 6 months postpartum. Approximately half the participants had a low or inadequate health literacy level. An adequate health literacy level, a high LATCH breastfeeding assessment tool score (>9 points) and being married were the protective factors against exclusive breastfeeding cessation at 6 months postpartum. Conclusion: Health literacy levels are closely related to maintaining exclusive breastfeeding and act as a protective factor against early cessation. A specific instrument is needed to measure the lack of “literacy in breastfeeding”, in order to verify the relationship between health literacy and maintenance of exclusive breastfeeding.

Induction of SARS-CoV-2-Specific IgG and IgA in Serum and Milk with Different SARS-CoV-2 Vaccines in Breastfeeding Women: A Cross-Sectional Study in Northern Spain

Breastfeeding mothers were excluded from the clinical trials conducted for vaccines against SARS-CoV-2. Since the start of the vaccination, some doubts have arisen regarding its compatibility with breastfeeding. The aim of this study was to analyse the presence of anti-SARS-CoV-2 antibodies in breast milk and serum (IgG and IgA) of vaccinated breastfeeding women. The main variables of the observational study were: adverse related events after vaccination and determination of the presence of IgG and IgA isotypes antibodies in serum and in breast milk of vaccinated women against the SARS-CoV-2 antigens. Results: 110 breastfeeding mothers were included; 70 women (63.6%) were vaccinated with two doses of BNT162b2, 20 women (18.2%) with two doses of mRNA-1273, and 20 women (18.2%) with a single dose of ChAdOx1-S. Regarding adverse reactions and vaccine safety, 38 women had no adverse reactions; 20 (18.2%) had general malaise or adenopathies; 10 (9.1%) had a headache; and 7 (6.4%) had fever. When analysing IgG antibodies, significantly higher levels of antibodies were found in serum and breast milk from mothers vaccinated with BNT162b2 or mRNA-1273 vs. ChAdOx1-S (p < 0.001 and p = 0.001, respectively). Analysing IgA antibodies, significant differences were found when comparing mean values in serum from mothers vaccinated with BNT162b2 or mRNA-1273 vs. ChAdOx1-S (0.12, 0.16, and 0.02, respectively; p < 0.001) and breast milk of mothers vaccinated when comparing BNT16b2 vs. ChAdOx1-S. All vaccinated breastfeeding mothers had serum anti-S1 IgG antibodies in response to vaccination against SARS-CoV-2, regardless of the commercial vaccine administered. Conclusions: the anti-SARS-CoV-2 vaccines were well tolerated by the mothers and the breastfed infant. In addition, breastfeeding mothers offer their infants IgA and IgG isotype antibodies directed against SARS-CoV-2 protein S in breast milk.

Results of Pregnancy Control before and during the COVID-19 Pandemic: A Comparison of Two Cohorts

The COVID-19 pandemic placed pregnant women at high risk, but behavioural changes have also led to lower rates of preterm births in high-income countries. The main goal of this article is to study the ongoing impact of the COVID-19 pandemic on pregnancy control and outcomes; this is a joint analysis of two cohorts. The pre-pandemic cohort includes 969 pregnant women recruited in 2018. The pandemic cohort comprises 1168 pregnant women recruited in 2020. Information on demographic and socioeconomic characteristics, reproductive history, characteristics of the current pregnancy and its outcome were obtained from medical records. Birth by Caesarean section was more frequent in the pre-pandemic cohort (adjusted odds ratio (OR) = 0.71, 95% confidence interval (CI): 0.55-0.92). A birth weight lower than 2500 g and higher than 4000 g occurred more frequently in the pre-pandemic cohort (adjusted OR = 0.62, 95% CI: 0.41-0.93 for lower than 2500 g and adjusted OR = 0.30, 95% CI: 0.20-0.46 for higher than 4000 g). Exclusive breastfeeding upon hospital discharge was more frequent in the pandemic cohort than in the pre-pandemic cohort (60% vs. 54%, p = 0.005), with adjusted OR = 0.67, 95% CI: 0.52-0.86 for mixed breastfeeding and infant formula. In conclusion, we report reductions in Caesarean sections and reduced numbers of low birth weight babies during the pandemic in a hospital located in northern Spain. Further analysis will clarify if these reductions are related to changes in health-related behaviour or healthcare operation.

COVID-19 in a cohort of pregnant women and their descendants, the MOACC-19 study

PURPOSE

The Mother and Child COVID-19 study is a cohort recruiting pregnant women and their children in Cantabria, North of Spain, during COVID-19 pandemic in order to ascertain consequences of SARS-CoV-2 infection on pregnant women and their descendants. This article reports the cohort profile and preliminary results as recruitment is still open.

PARTICIPANTS

Three subcohorts can be identified at recruitment. Subcohort 1 includes women giving birth between 23 March and 25 May 2020; they have been retrospectively recruited and could have been exposed to COVID-19 only in their third trimester of pregnancy. Subcohort 2 includes women giving birth from 26 May 2020 on; they are being prospectively recruited and could have been exposed to COVID-19 in both their second and third trimesters of pregnancy. Subcohort 3 includes women in their 12 week of pregnancy prospectively recruited from 26 May 2020 on; they could have been exposed to COVID-19 anytime in their pregnancy. All women are being tested for SARS-CoV-2 infection using both RT-PCR for RNA detection and ELISA for anti-SARS-CoV-2 antibodies. All neonates are being tested for antibodies using immunochemoluminiscency tests; if the mother is tested positive for SARS-CoV-2 RNA, a nasopharyngeal swab is also obtained from the child for RT-PCR analysis.

FINDINGS TO DATE

As of 22 October, 1167 women have been recruited (266, 354 and 547 for subcohorts 1, 2 and 3, respectively). Fourteen women tested positive to SARS-CoV-2 RNA by the day of delivery. All 14 children born from these women tested negative for SARS-CoV-2 RNA.

FUTURE PLANS

Children from women included in subcohort 3 are expected to be recruited by the end of 2020. Children will be followed-up for 1 year in order to ascertain the effect that COVID-19 on their development.