Anxiety about food supply in cree women with infants in Quebec

OBJECTIVES

The objectives were to document the prevalence of maternal anxiety about food supply in Cree women who had 9-month-old infants, and to understand maternal and infant characteristics associated with anxiety.

STUDY DESIGN

The design was descriptive and combined both cross-sectional and retrospective analyses.

METHODS

The study took place in nine Cree communities in northern Quebec. Data on maternal characteristics in pregnancy (age, parity, anemia, smoking status) and infant characteristics (gestational age, birth weight, weight and hemoglobin concentration at 9 months old) were obtained from medical records. At 9 months postpartum, mothers were asked about infant feeding practices, the health of their infant, and the question, "Do you ever worry you don't have enough money to buy your children food to eat?" Affirmative responses were considered evidence for anxiety about food supply. Pricing data was collected for commercial baby food, formula, milk and water in the communities and, for comparison, in the large urban city of Montreal.

RESULTS

245 woman-infant pairs participated. One-fifth (20.8%) of mothers were anxious about food supply. The prevalences of anxiety in women who had anemia, or smoked, during pregnancy, or who bottle-fed their 9-month-old infants, were 44.4%, 27.5% and 24.0%, respectively. The corresponding prevalences of anxiety in women who did not have anemia, who did not smoke, or who breastfed without bottle-feeding at 9-months postpartum, were 19.0%, 13.6% and 6.7%. The adjusted ORs for anxiety were 3.10 (95% CI, 1.11-8.65), 2.12 (95% CI, 1.05-4.29) and 3.87 (95% CI, 1.12-13.36) for anemia, smoking and bottle-feeding, respectively. Prevalences of anemia and infection were comparable between infants of mothers who did and did not express anxiety. However, infants whose mothers had anemia during pregnancy had higher prevalences of anemia (44.0% vs. 24.6%, p = 0.04) and infection (77.8% vs. 50.2%, p = 0.03) at 9 months old.

CONCLUSION

Women who had anxiety about food supply for their children had characteristics that distinguished them from women who did not have anxiety. Anxiety was associated with anemia and smoking during pregnancy, and with bottle-feeding at 9 months postpartum.

Breastfeeding trends in Cambodia, and the increased use of breast-milk substitute-why is it a danger?

A cross-sectional analysis of the Cambodia Demographic Health Surveys from 2000, 2005 and 2010 was conducted to observe the national trends in infant and young child feeding practices. The results showed that rates of exclusive breastfeeding among infants aged 0–5.9 months have increased substantially since 2000, concurrent with an increase in the rates of early initiation of breastfeeding and a reduction in the giving of pre-lacteal feeds. However, the proportion of infants being fed with breast-milk substitutes (BMS) during 0–5.9 months doubled in 5 years (3.4% to 7.0%) from 2000 to 2005, but then did not increase from 2005, likely due to extensive public health campaigns on exclusive breastfeeding. BMS use increased among children aged 6–23.9 months from 2000 to 2010 (4.8% to 9.3%). 26.1% of women delivering in a private clinic provided their child with breast-milk substitute at 0–5.9 months, which is five times more than women delivering in the public sector (5.1%), and the greatest increase in bottle use happened among the urban poor (5.8% to 21.7%). These findings are discussed with reference to the increased supply and marketing of BMS that is occurring in Cambodia.

Marketing breast milk substitutes: problems and perils throughout the world

On 21 May 1981 the WHO International Code of Marketing Breast Milk Substitutes (hereafter referred to as the Code) was passed by 118 votes to 1, the US casting the sole negative vote. The Code arose out of concern that the dramatic increase in mortality, malnutrition and diarrhoea in very young infants in the developing world was associated with aggressive marketing of formula. The Code prohibited any advertising of baby formula, bottles or teats and gifts to mothers or 'bribery' of health workers. Despite successes, it has been weakened over the years by the seemingly inexhaustible resources of the global pharmaceutical industry. This article reviews the long and tortuous history of the Code through the Convention on the Rights of the Child, the HIV pandemic and the rare instances when substitute feeding is clearly essential. Currently, suboptimal breastfeeding is associated with over a million deaths each year and 10% of the global disease burden in children. All health workers need to recognise inappropriate advertising of formula, to report violations of the Code and to support efforts to promote breastfeeding: the most effective way of preventing child mortality throughout the world.

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

OBJECTIVE

Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes, and identifies women at risk of future type 2 diabetes mellitus (T2DM). Breast-feeding may improve post partum maternal glucose tolerance. Our objective was to identify the prevalence of post partum dysglycemia after GDM, to delineate associated factors and to examine the effect of lactation on post partum glucose tolerance.

DESIGN

We compared post partum 75 g oral glucose tolerance test (OGTT) results from 300 women with GDM and 220 controls with normal gestational glucose tolerance (NGT) in five regional centers. Breast-feeding data was collected at time of OGTT. Methods Post partum OGTT results were classified as normal (fasting plasma glucose (FPG) <5.6 mmol/l, 2 h <7.8 mmol/l) and abnormal (impaired fasting glucose (IFG), FPG 5.6-6.9 mmol/l; impaired glucose tolerance (IGT), 2 h glucose 7.8-11 mmol/l; IFG+IGT; T2DM, FPG ≥7 mmol/l±2 h glucose ≥11.1 mmol/l). Binary logistic regression was used to identify factors predictive of persistent hyperglycemia.

RESULTS

Five hundred and twenty women were tested; six (2.7%) with NGT in pregnancy had post partum dysglycemia compared with 57 (19%) with GDM in index pregnancy (P<0.001). Non-European ethnicity (odds ratio (OR) 3.40; 95% confidence interval (CI) 1.45-8.02, P=0.005), family history of T2DM (OR 2.14; 95% CI 1.06-4.32, P=0.034), and gestational insulin use (OR 2.62; 95% CI 1.17-5.87, P=0.019) were associated with persistent dysglycemia. The prevalence of persistent hyperglycemia was significantly lower in women who breast-fed vs bottle-fed post partum (8.2 vs 18.4%, P<0.001).

CONCLUSIONS

Non-European ethnicity, gestational insulin use, family history of T2DM, and elevated body mass index were associated with persistent dysglycemia after GDM. Breast-feeding may confer beneficial metabolic effects after GDM and should be encouraged.

Use of an intensity ratio to describe breastfeeding exclusivity in a national sample

Breastfeeding behavior in a sample of 1863 mother-infant pairs was examined using data from the 1988 National Maternal-Infant Health Survey. Breastfeeding behavior was operationalized as an intensity ratio, calculated as the number of breast milk feeds (on average in 24 hours) divided by the total number of all liquid feeds (on average in 24 hours), with a range from 0 to 1.0. During the first month postpartum, 61% of the sample reported exclusive breastfeeding, declining to 31% during months 2-3 postpartum and to 13% during months 4-6 postpartum. This decline was consistent with the linear decline in the mean intensity ratio, .82, .55, and .31, respectively, during the same three time periods. A higher breastfeeding intensity ratio was significantly associated with longer duration of breastfeeding, up to 1 year of life. Intensity ratio, as a measure of exclusivity, is a useful outcome measure for monitoring breastfeeding behavior.

Infant feeding in the 20th century: formula and beikost

The early years of the 20th century were notable for improvements in general sanitation, dairying practices and milk handling. Most infants were breast-fed, often with some formula feeding as well. Availability of the home icebox permitted safe storage of milk and infant formula, and by the 1920s, feeding of orange juice and cod liver oil greatly decreased the incidence of scurvy and rickets. Use of evaporated milk for formula preparation decreased bacterial contamination and curd tension of infant formulas. From 1930 through the 1960s, breast-feeding declined and cow's milk and beikost were introduced into the diet at earlier and earlier ages. Although commercially prepared formulas, including iron-fortified formulas replaced home-prepared formulas, few infants were breast-fed or formula fed after 4-6 mo of age. Iron deficiency was prevalent. From 1970 through 1999, a resurgence of breast-feeding was associated with a prolongation of formula feeding and an increase in usage of iron-fortified formulas. By the end of the century, formula feeding of older infants had largely replaced feeding of fresh cow's milk and the prevalence of iron deficiency had greatly decreased.

Cow's milk versus formula in older infants: consequences for human nutrition

Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions. However, modern technology has produced alternative, "humanized formulae", which closely mimic the composition of human milk. The ingestion of human milk, "humanized formulae" or whole cow's milk has consequences for human nutrition. Gastroesophageal reflux, iron deficiency, calcium and sodium excesses or deficiencies may be influenced by the type and amount of milk fed to the infant. Likewise, neurological development and the likelihood of developing diabetes or cancer may also be influenced by early dietary practices. Until new information is available, we should continue to pattern formulae for older infants after breast milk, but with sufficient protein, calories, lipid and minerals to support optimal growth.

[Past and present status in the design of infant formulas]

This paper describes briefly the history of infant foods, from the alternate ways of feeding developed during the late 19th century to the present-day infant formulas, and enumerates the different available types (milk-based, soy-based, hypoallergenic, lactose-free, etc,). Among the nutritional aspects the main characteristics of formulation are emphasized, especially within the nitrogen, fat and mineral fractions. Considering the nitrogen fraction, it must be taken into account that the amino acid profiles in milk-based formulas differ according to the casein/whey proteins ratio (either 80:20 or 40:60 in the so-called "adapted" or "humanized"). On the other hand, it has been recognized recently that some non-protein components of human milk, such as taurine, carnitine and nucleotides, are relevant to infant nutrition and therefore, they are being included in some formulas. Regarding fat, essential fatty acids supply is very important; present recommendations stress the importance of providing n-6 to n-3 series ratios close to that found in human milk and also a preformed supply of long-chain polyunsaturated fatty acids. Among minerals, bioavailability and relative proportions of trace elements are important issues in formulation. Other concepts of relevance are the renal solute load and the osmolarity because of their effect on neonate's metabolism.

Infant feeding in Queensland, Australia: long-term trends

Infant feeding practices were retrospectively ascertained in a random cohort of parous women (mean age 54.8 years) from Brisbane, Australia. Reported proportions of infants who were ever breast-fed fell from around 90% before 1960 to around 70% in the early 1970s, with some subsequent increase. Similar but stronger trends were reported in proportions of infants breast- but not bottle-fed. Few maternal characteristics were associated with feeding practices, but women with more education appear to have led both the early retreat from and the later return to breast-feeding.

Influences on the extent of breast-feeding: a prospective study in the Philippines

There has been much controversy about the impact of the health sector and the infant food industry on breast-feeding behavior. This study links causal factors to breast-feeding decisions, using a longitudinal survey of more than 3,000 Filipino mother-infant pairs. Most factors decreasing the likelihood that mothers will breast-feed seem to be related to family economics. Delivery in a private hospital, urban residence, high income, absence of spouse, and having worked for wages affect adversely the initiation of breast-feeding. Formula advertising and distribution of samples appear to have relatively little impact on feeding decisions.

Determinants for breast feeding and bottle feeding in Botswana

In the Botswana Primary Health Care Survey 1983-84 data on breast and bottle feeding were collected as well as characteristics of households, mothers, and children. The country-wide median breast-feeding duration was 1 year and 7 months, with a tendency towards shorter duration in the urban areas. Better hygienic conditions, higher education of the mother, and wage employment of the mothers were associated with shorter breast-feeding duration. Similarly, the risk of starting bottle feeding was higher in households with better hygienic conditions. However, a substantial proportion of the bottle feeding took place in households lacking piped water indoors. These data may indicate a current shift from traditional feeding patterns towards shorter breast feeding and introduction of bottle feeding, starting among well-off families, but also threatening the health of children in less privileged conditions. The association with maternal factors such as type of occupation calls for breast feeding promotion including improved conditions for the salary employed mothers.

Trends in infant feeding in Port Moresby

A survey of infant feeding practices was conducted among children aged less than 1 year attending an urban health clinic and the main Children's Outpatients Department (COPD) in Port Moresby in 1986. A further survey was conducted in 1987 to assess the short-term trends. The use of artificial milk increased by 60%, from 9.4% in the first to 15.2% in the second survey. This increase was particularly marked in the COPD sample. Bottle feeding accounted for 95% of artificial feeding methods. In 67% of cases the reason given for using artificial feeding was that the mother was working. Legislation and an explicit government policy to foster the establishment of creches in the work place may be necessary to counter the worrying increase in artificial feeding.

Infantile hypertrophic pyloric stenosis: a study of feeding practices and other possible causes

We carried out a case-control study of the hospital charts of 91 infants with infantile hypertrophic pyloric stenosis (IHPS) to determine the feeding practices at the time of discharge from the neonatal nursery. We excluded infants whose feeding might have been influenced by confounding factors. The infants were matched with controls for gestational age. The mean birth weight of the IHPS group was 3501 g and of the control group 3543 g. The male:female ratio for the IHPS group was 5.5. The odds ratio of male predominance was 4. We found that bottle-feeding was 2.9 times more prevalent among the infants with IHPS than among the control subjects. We speculate that the recently observed decrease in the incidence of IHPS is due to the decline in bottle-feeding.

Breast-feeding, bottle-feeding and related factors. The Leiden Pre-School Children Study

Infant feeding practices and related factors were studied in a survey of 189 mothers of 4-month-old infants in 1980 and of 151 mothers of 6-month-old infants in 1982. In both groups about 70% of the mothers commenced with breast-feeding. In 1980, 21% of the infants were still being breast-fed at the age of 4 months, compared with 32% in 1982. 26% of the infants were still being breast-fed at the age of 6 months. The most frequently mentioned reason for not commencing with or discontinuing breast-feeding was 'insufficient milk'. Univariate analyses showed that the educational level of the mother and her smoking habits were significantly related to both the commencement and the duration of breast-feeding in 1980 and 1982. These results were confirmed by multivariate analyses which suggest that well educated, non-smoking mothers are the most successful in breast-feeding their infants.

'These are modern times': infant feeding practice in Peninsular Malaysia

Traditionally, Malaysian women (Malay, Indian and Chinese) breastfed their infants as a matter of course and for an extended period of time; only elite Chinese women might have resorted to a wet-nurse. But the introduction of condensed and dehydrated milk in colonial Malaya from the late nineteenth century, and the later marketing also of commercially manufactured baby foods, led to some variation in traditional practice. Structural changes, industrialiZation and urbanisation affected social as well as economic life, and again these broad changes had an impact on infant feeding. Today, few women remain unfamiliar with the wide range of infant food products sold in the most isolated provision shops. This paper focuses on key sociological factors that might predict the frequency and duration of breastfeeding and weaning patterns. The data analysed below, collected during semi-structured interviews with 278 women presenting at Maternal and Child Health Clinics in Peninsular Malaysia, are in part confusing. They suggest that the women most likely to bottle feed only or to breast feed for a short period, and to use commercial baby foods, are young, with one child only, who reside in urban or peri-urban areas and have a reasonable household income. Higher educated women, and women whose husbands are in non-traditional occupations, are also less likely to breast feed or to do so for an extended period. But the profile of infant feeding practices is by no means clear. One of the shortcomings of the study relates to the method of collection of data, and highlights the need for detailed ethnographic studies to better explore the variability and complexity of the patterns of infant feeding.

[A method of modernized milk formula preparation in children's hospitals]

Nurses on the ward prepare the milk formula just before feeding by the nurse on the ward. Bottles and nipples are cleaned mechanically by dishwashers using alkaline cleaner for bottles, or a mild-alkaline cleaner (WA 725 S) and an antiseptic (Septo DA) for nipples. The nipples are sealed into plastic bags immediately after cleaning using sterile equipment. No further sterilisation is necessary as frequent bacterial culturing has shown. This procedure is safe, easy, and saves cost and time.

Food for the suckling: revolution and development

The 1970's saw a renaissance in child nutrition, a major revision of infant feeding practice and substantial changes in food for the suckling. Many more babies are breast fed, those who are not receive an infant formula specifically designed for this period of life, and solid foods are no longer introduced in the early weeks. These changes have contributed to the improvement in the suckling's health, particularly the reduction in neonatal tetany, and in deaths from gastroenteritis. Developments in the 1980's should improve our knowledge of breast milk and its properties, advisable intakes of specific nutrients and their interrelationships, and the immunology of infant feeding. Meanwhile, practice will be directed towards the enhancement of successful lactation, the processing of donor human milk, the establishment of standards for infant formulas and the special problems of the low birth weight baby.

The Pima infant feeding study: the role of sociodemographic factors in the trend in breast- and bottle-feeding

In 1978, a retrospective study of the influence of sociodemographic factors on the trend in breast- and bottle-feeding was conducted among a sample of Pima Indian women 15 to 44 yr old residing on the Gila River Reservation. Based on interviews with 257 Pima Indian women about their infant feeding experiences, the proportion of women who breast-fed dropped significantly between 1949 and 1977. The decline in breast-feeding was evident among women aged 35 to 44 in 1978 across three socioeconomic strata, while women aged 30 to 34 experienced an increase in breast-feeding across two socioeconomic strata. Between 1949 and 1963, women of 50 to 100 and 100% Pima Indian descent breast-fed significantly less than those with other tribal affiliations; however, the influence of tribal descent was reduced thereafter. Bottle-feeding was more prevalent in the high birth orders over time. Among women with first births before 1963, those with small families bottle-fed more than those with large families across birth order. Conversely, among women with first births during or after 1963, those with large families bottle-fed more than those with small families across birth order.