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Nutrients Sep 2019Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by... (Observational Study)
Observational Study
Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt well-supported by health professionals. Maternal perception of not having a sufficient amount of milk, infant's failure to thrive, mastitis, and the return to work were associated with a higher risk of non-exclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support.
Topics: Adult; Breast Feeding; Female; Humans; Infant; Infant, Newborn; Logistic Models; Mothers; Postpartum Period; Prospective Studies; Risk Factors; Time Factors; Young Adult
PubMed: 31547061
DOI: 10.3390/nu11102266 -
American Family Physician Oct 2019The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient...
The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient postpartum care should be initiated within three weeks after delivery in person or by phone, and may require multiple contacts with the patient to fully address needs and concerns. A full assessment is recommended within 12 weeks. Care should initially focus on acute needs and risks for morbidity and mortality and then transition to care for chronic conditions and health maintenance. Complications of pregnancy, such as hypertensive disorders and gestational diabetes mellitus, affect a woman's long-term health and require specific attention. Women diagnosed with gestational diabetes should receive a 75-g two-hour fasting oral glucose tolerance test between four and 12 weeks postpartum. Patients with hypertensive disorders of pregnancy should have a blood pressure check performed within seven days of delivery. All women should have a biopsychosocial assessment (e.g., depression, intimate partner violence) screening in the postpartum period, and preventive counseling should be offered to women at high risk. Additional patient concerns may include urinary incontinence, constipation, breastfeeding, sexuality, and contraception. Treating these issues during the postpartum period is important to the new mother's immediate and long-term health.
Topics: Breast Feeding; Curriculum; Education, Medical, Continuing; Female; Humans; Mothers; Postnatal Care; Postpartum Period; Practice Guidelines as Topic
PubMed: 31613576
DOI: No ID Found -
Clinical Therapeutics Feb 2022Despite recommendations from the World Health Organization and the American Academy of Pediatrics to exclusively breastfeed infants for their first 6 months of life, 75%... (Review)
Review
PURPOSE
Despite recommendations from the World Health Organization and the American Academy of Pediatrics to exclusively breastfeed infants for their first 6 months of life, 75% of women do not meet exclusive breastfeeding guidelines, and 60% do not meet their own breastfeeding goals. Numerous observational studies have linked maternal psychological distress (eg, perceived stress, anxiety, and depression) with nonoptimal breastfeeding outcomes, such as decreased proportion and duration of exclusive breastfeeding. The physiological mechanisms underlying these associations, however, remain unclear.
METHODS
For this narrative review, we evaluated the evidence of relationships between maternal psychological distress and lactation and breastfeeding outcomes in pregnancy and post partum and the possible physiological mechanisms that facilitate these relationships. We searched PubMed using the following terms: stress, anxiety, depression, breastfeeding, and lactation. Additional search by hand was conducted to ensure a thorough review of the literature.
FINDINGS
Among the studies examined, methods used to assess maternal psychological distress were not uniform, with some studies examining perceived distress via a variety of validated tools and others measuring biological measures of distress, such as cortisol. Evidence supports a role for psychological distress in multiple breastfeeding outcomes, including delayed secretory activation and decreased duration of exclusive breastfeeding. One physiological mechanism proposed to explain these relationships is that psychological distress may impair the release of oxytocin, a hormone that plays a critical role in milk ejection during lactation. Continued impairment of milk ejection may lead to decreased milk production because of incomplete emptying of the breast during each feed. Maternal distress may also yield elevated levels of serum cortisol and decreased insulin sensitivity, which are associated with decreased milk production. The relationship between psychological distress and breastfeeding is likely to be bidirectional, however, in that breastfeeding appears to reduce maternal distress, again possibly via effects on the pleasure or reward pathway and calming effects of oxytocin on the mother. This finding suggests that interventions to support lactation and breastfeeding goals in women who score high on measures of psychological distress would be beneficial for both maternal and infant well-being.
IMPLICATIONS
Evidence to date suggests that maternal psychological distress may impair lactation and breastfeeding outcomes, but stronger study designs and rigorous assessment methods are needed. A better understanding of the physiological mechanisms leading to impaired lactation may assist in the development of early interventions for mothers experiencing distress. In addition, stress-reducing programs and policies should be investigated for their potential to improve breastfeeding outcomes.
Topics: Breast Feeding; Child; Female; Humans; Hydrocortisone; Infant; Lactation; Milk, Human; Oxytocin; Pregnancy; Psychological Distress
PubMed: 34937662
DOI: 10.1016/j.clinthera.2021.11.007 -
Journal of Obstetric, Gynecologic, and... Jul 2022To determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices... (Review)
Review
OBJECTIVE
To determine what is known about postpartum education provided by nurses to women before discharge from the hospital after birth and whether current nursing practices are effective to prepare women to identify warning signs of complications, perform self-care (physical and emotional), prepare for parenting a newborn, and establish infant feeding.
DATA SOURCES
We conducted a systematic search of CINAHL Plus and MEDLINE for relevant sources, including peer-reviewed articles, conference presentations, and guidelines from professional organizations, that were published in English from January 2010 through November 30, 2020.
STUDY SELECTION
We included sources if participants were women who had given birth to a healthy, liveborn, term infant and were receiving education in whole or in part by a nurse during the maternity hospitalization. We excluded sources with samples of high-risk women or those who gave birth to high-risk infants (preterm, congenital anomalies, neonatal abstinence syndrome). Forty-six of the sources met the inclusion criteria.
DATA EXTRACTION
We extracted citation, type of document, country of origin, context (prenatal/postpartum or both and inpatient/outpatient or both), aim, participants (mother/father or both, sample characteristics), content of education and who provided it, outcomes or key themes, and main results.
DATA SYNTHESIS
Infant topics included breastfeeding and safe sleep, and maternal topics included breastfeeding, postpartum mood, and self-care after birth. Nurses prioritized safety, including safe sleep; preventing infant falls; decreasing infection; screening for postpartum depression; and avoiding adverse outcomes after discharge. Women focused on self-care, pain management, infant care, and parenting. Women and nurses prioritized breastfeeding. Authors of the included sources measured effectiveness by patient satisfaction, chart audit, pre- and posttests of nurses' knowledge, and breastfeeding duration. Women reported barriers to postpartum education such as limited nursing time or conflicting information.
CONCLUSION
Postpartum education is a priority, but its effectiveness is not well studied. Few maternal or infant health-centered outcomes have been measured beyond breastfeeding duration. Nursing care and nurse expertise are not easily quantified or measured. Research is needed to inform best practices for postpartum education.
Topics: Breast Feeding; Clinical Competence; Female; Humans; Infant; Infant, Newborn; Male; Mothers; Nurses; Patient Discharge; Postpartum Period; Pregnancy
PubMed: 35483423
DOI: 10.1016/j.jogn.2022.03.002 -
BMC Women's Health May 2020Breastfeeding is one of the most important interfering factors in infants' health. Monitoring mothers' performance and providing them with the feedback helps to increase... (Randomized Controlled Trial)
Randomized Controlled Trial
The effect of prenatal counseling on breastfeeding self-efficacy and frequency of breastfeeding problems in mothers with previous unsuccessful breastfeeding: a randomized controlled clinical trial.
BACKGROUND
Breastfeeding is one of the most important interfering factors in infants' health. Monitoring mothers' performance and providing them with the feedback helps to increase their self-efficacy, interest in learning, and level of performance. The present research evaluates the effect of prenatal counseling on the breastfeeding self-efficacy and frequency of breastfeeding problems in mothers with previous unsuccessful breastfeeding.
METHODS
This randomized controlled clinical trial was conducted on 108 pregnant women with unsuccessful breastfeeding in Tabriz health centers during 2017-2018. The participants were randomly assigned to intervention and control groups. The intervention group had four prenatal counseling sessions and the controls only received routine care. Then, the mothers who gave birth to their children received a counseling session up to 4 months after the delivery. The Breastfeeding Self-Efficacy (BSES) questionnaire and the frequency of breast feeding problems checklist on the 15th day, and 2nd and 4th month were completed both by the intervention and control groups.
RESULTS
The mean (SD) of breastfeeding self-efficacy was 119.3 (10.5), 128.3 (8.3) and 133.8 (10.3) in the intervention group and 105.3 (16.1), 105.7 (19.7) and 109.4 (24.7) in the control group on the 15th day, 2nd and 4th month after the delivery, respectively. There was a significant difference in terms of breastfeeding self-efficacy between intervention and control group on the 15th day (p < 0.001), and 2nd (p < 0.001) and 4th (p < 0.001) month after the delivery. The frequency of breastfeeding problems on the 15th (p = 0.008), 2nd (p < 0.001) and 4th (p < 0.001) after the delivery was significantly different in most cases of the intervention group when compared to the controls.
CONCLUSION
The results indicated that prenatal counseling can increase mothers' breastfeeding self-efficacy and solves most breastfeeding problems during postpartum period.
TRIAL REGISTRATION
IRCT20100109003027N19.
Topics: Adult; Breast Feeding; Child; Counseling; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Mothers; Outcome Assessment, Health Care; Patient Education as Topic; Postpartum Period; Pregnancy; Pregnant Women; Prenatal Care; Self Efficacy
PubMed: 32370804
DOI: 10.1186/s12905-020-00947-1 -
Nutrients Aug 2021Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in... (Review)
Review
Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.
Topics: Ankyloglossia; Body Composition; Breast; Breast Feeding; Child Development; Female; Gastrointestinal Microbiome; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Lactation; Male; Milk, Human
PubMed: 34578947
DOI: 10.3390/nu13093071 -
Journal of Pediatric Gastroenterology... Aug 2019Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm...
Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities.Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction.The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources.In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.
Topics: Breast Feeding; Europe; Gestational Age; Humans; Infant Formula; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Nutritional Requirements; Practice Guidelines as Topic; Societies, Medical
PubMed: 31095091
DOI: 10.1097/MPG.0000000000002397 -
Pediatrics Jun 2019Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity emerge. Understanding obesity-promoting infant-feeding beliefs, styles, and practices in the context of food insecurity could better inform both food insecurity and child obesity prevention interventions and policy guidelines.
METHODS
We performed purposive sampling of low-income Hispanic mothers ( = 100) with infants in the first 2 years of life, all of whom were participants in a randomized controlled trial of an early child obesity prevention intervention called the Starting Early Program. Bilingual English-Spanish interviewers conducted semistructured qualitative interviews, which were audio recorded, transcribed, and translated. By using the constant comparative method, transcripts were coded through an iterative process of textual analysis until thematic saturation was reached.
RESULTS
Three key themes emerged: (1) contributors to financial strain included difficulty meeting basic needs, job instability, and high vulnerability specific to pregnancy, infancy, and immigration status; (2) effects on infant feeding included decreased breastfeeding due to perceived poor maternal diet, high stress, and limiting of healthy foods; and (3) coping strategies included both home- and community-level strategies.
CONCLUSIONS
Stakeholders in programs and policies to prevent poverty-related disparities in child obesity should consider and address the broader context by which food insecurity is associated with contributing beliefs, styles, and practices. Potential strategies include addressing misconceptions about maternal diet and breast milk adequacy, stress management, building social support networks, and connecting to supplemental nutrition assistance programs.
Topics: Adult; Breast Feeding; Child, Preschool; Female; Food Supply; Hispanic or Latino; Hospitals, Public; Humans; Infant; Male; Mothers; Pediatric Obesity; Poverty; Pregnancy
PubMed: 31088893
DOI: 10.1542/peds.2018-4113 -
Health Policy and Planning Jul 2019Evidence shows that breastfeeding has many health, human capital and future economic benefits for young children, their mothers and countries. The new Cost of Not...
Evidence shows that breastfeeding has many health, human capital and future economic benefits for young children, their mothers and countries. The new Cost of Not Breastfeeding tool, based on open access data, was developed to help policy-makers and advocates have information on the estimated human and economic costs of not breastfeeding at the country, regional and global levels. The results of the analysis using the tool show that 595 379 childhood deaths (6 to 59 months) from diarrhoea and pneumonia each year can be attributed to not breastfeeding according to global recommendations from WHO and UNICEF. It also estimates that 974 956 cases of childhood obesity can be attributed to not breastfeeding according to recommendations each year. For women, breastfeeding is estimated to have the potential to prevent 98 243 deaths from breast and ovarian cancers as well as type II diabetes each year. This level of avoidable morbidity and mortality translates into global health system treatment costs of US$1.1 billion annually. The economic losses of premature child and women's mortality are estimated to equal US$53.7 billion in future lost earnings each year. The largest component of economic losses, however, is the cognitive losses, which are estimated to equal US$285.4 billion annually. Aggregating these costs, the total global economic losses are estimated to be US$341.3 billion, or 0.70% of global gross national income. While the aim of the tool is to capture the majority of the costs, the estimates are likely to be conservative since economic costs of increased household caregiving time (mainly borne by women), and treatment costs related to other diseases attributable to not breastfeeding according to recommendations are not included in the analysis. This study illustrates the substantial costs of not breastfeeding, and potential economic benefits that could be generated by government and development partners' investments in scaling up effective breastfeeding promotion and support strategies.
Topics: Breast Feeding; Cost-Benefit Analysis; Female; Global Health; Humans; Infant; Infant Mortality; Maternal-Child Health Services; Surveys and Questionnaires
PubMed: 31236559
DOI: 10.1093/heapol/czz050 -
Maternal & Child Nutrition Jul 2020This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross-sectional study of 4,740 children aged 9-11 years was...
This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross-sectional study of 4,740 children aged 9-11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate-to-vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable-adjusted ORs based on different breastfeeding durations (none, 1-6, 6-12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (P = .020) and 1.00, 0.64, 047, and 0.64 for high body fat (P = .012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9- to 11-year-old children from 12 countries.
Topics: Breast Feeding; Child; Cross-Sectional Studies; Female; Humans; Internationality; Male; Pediatric Obesity
PubMed: 32141229
DOI: 10.1111/mcn.12984