Choice of feeding method of adolescent mothers: does ego development play a role?

STUDY OBJECTIVES

The purpose of this study was to determine whether, among childbearing adolescents, ego development was associated with intention to breast-feed and with actual breast-feeding behavior at birth and at 2 weeks postpartum. In addition, we sought to determine whether positive attitudes toward breast-feeding influenced pregnant adolescents' intentions to breast-feed and actual breast-feeding at the hospital and at 2 weeks postpartum. We hypothesized that adolescents with higher levels of ego development and positive attitudes toward breast-feeding would be more likely to intend to breast-feed and to actually breast-feed.

DESIGN

Prospective cohort study of pregnant adolescents who completed questionnaires, Loevinger's Sentence Completion Tests, and attitudes toward breast-feeding scales before delivery and a follow-up questionnaire at 2 weeks postpartum assessing feeding practice in the hospital and at 2 weeks postpartum.

SETTING

Two adolescents' clinics and two "teen-and-tot" clinics in urban teaching hospitals.

PARTICIPANTS

Fourteen- to 22-year-old pregnant adolescents who had never given birth and who planned to carry their pregnancy to term and parent their children.

MAIN OUTCOME MEASURES

1) Intended feeding practice during pregnancy, 2) feeding method in the hospital, and 3) feeding method at 2 weeks postpartum.

RESULTS

Of the 125 subjects enrolled in the study, 106 were at 2 weeks postpartum or more. Of these 106 participants, 75% (n = 78) completed more than 75% of the attitudes toward breast-feeding scale and Loevinger's Sentence Completion Test and are included in these analyses. Mean age at entry was 17.8 +/- 1.5 years (range, 14.3 to 21.8 years). Mean gestational age at enrollment was 21.2 +/- 11.6 weeks (range, 4 to 41 weeks). Of the 78 participants, 12% (n = 9) were at the preconformist, 85% (n = 66) at the conformist, and 4% (n = 3) at the postconformist level of ego development as determined by the Sentence Completion Test. Attitudes toward breast-feeding, intention to breast-feed, breast-feeding in the hospital, and breast-feeding at 2 weeks postpartum were not significantly associated with adolescents' stages of ego development. Almost three fourths of the adolescents intended to breast-feed, and 85% tried breast-feeding in the hospital. A total of 97% (56 of 58) of those who intended to breast-feed tried breast-feeding in the hospital compared with 40% (4 of 10) of those who did not intend to breast-feed (P < .0001). At 2 weeks postpartum, 58% of the participants were still breast-feeding. Of those participants who intended to breast-feed, 67% (39 of 58) were breast-feeding at 2 weeks postpartum compared with 10% (1 of 10) who did not intend to breast-feed (P = .001). The mean breast-feeding attitude score was 53.7 +/- 11.6 (range, 25 to 72). The mean breast-feeding attitude score was higher for those who intended to breast-feed than for those who intended to formula-feed (P = .009), but the score was not associated with breast-feeding in the hospital or at 2 weeks postpartum.

CONCLUSION

Adolescent mothers were predominantly in ego stages 4 and 5, the conformist level. Because ego development was not associated with outcome measures in this study, ego development may not be a crucial factor when designing interventions to facilitate breast-feeding among adolescents. Attitudes toward breast-feeding were associated with the intention to breast-feed but not behaviors; the intention to breast-feed was significantly associated with breast-feeding behaviors.

A tyrosine kinase regulates alpha-adrenoceptor-stimulated contraction and phospholipase D activation in the rat aorta

Since previous studies had indicated a role for tyrosine kinases in alpha 2-adrenoceptor-induced contractile responses in other blood vessels, as well as in the activation of phospholipase D, we examined the sensitivity of these responses in rat aorta to the tyrosine kinase inhibitor genistein. Contractions induced by both noradrenaline and the alpha 2-adrenoceptor-selective agonist UK14304 (5-bromo-6-[2-imidazolin-2-yl-amino]-quinoxaline) were fully inhibited by genistein, with the latter responses being more sensitive. Contractions induced by high K+ buffer were also inhibited, but to a lesser extent. Both agonists caused a stimulation of phospholipase D activity, which could be blocked by pretreatment with pertussis toxin, indicating involvement of either Gi or Go. Genistein completely inhibited the agonist-induced phospholipase D activity and also substantially reduced the basal level of phospholipase D activity. Pretreatment with either the alpha 1-adrenoceptor antagonist prazosin or the alpha 2-adrenoceptor antagonist rauwolscine was also effective in eliminating the agonist-induced increase of phospholipase D. These results indicate that a tyrosine kinase-regulated phospholipase D plays a critical role in alpha-adrenoceptor-induced contractions of the rat aorta and that stimulation of both alpha 1- and alpha 2-adrenoceptors is essential to allow phospholipase activation.

Atypical lymphocytosis in children

A complete blood count performed during the evaluation of a febrile or traumatized child may show the presence of atypical lymphocytosis. Although atypical lymphocytes occur in several conditions, they are most closely associated with infectious mononucleosis (IM). We initiated a study to determine if the presence in children of atypical lymphocytosis without the triad of splenomegaly, pharyngitis, and adenopathy is a manifestation of IM. Heterophil antibody (HA) and Epstein-Barr virus (EBV) titers were performed on 45 children with greater than or equal to 5% atypical lymphocytes. None had a significant HA titer. Thirty-three were seronegative for EBV, and 11 had titers indicative of past infection. One child had an antibody pattern suggesting a recent EBV infection; none had a titer consistent with acute IM. We conclude that isolated atypical lymphocytes does not point to infectious mononucleosis.