8th ABM/EABM European Regional Conference May 11–13, 2023 Split, Croatia

Abstract

Breastfeeding MedicineAhead of Print AbstractsFree Access8th ABM/EABM European Regional Conference May 11–13, 2023 Split, CroatiaPublished Online:14 Apr 2023https://doi.org/10.1089/bfm.2023.29239.abstractsAboutSectionsPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Oral Presentations1. Systematic Review and Meta‐analysis of the effect of relaxation interventions on breastmilk quantity and maternal mental healthIlana Levene1, Nurul Husna Mohd‐Shukri2, Frances O'Brien3, Maria Quigley1, Mary Fewtrell41National Perinatal Epidemiology Unit, University of Oxford, United Kingdom2Universiti Putra Malaysia, Malaysia3John Radcliffe Hospital, United Kingdom4Institute for Child Health, University College London, United KingdomBackground: Breastfeeding is an important public health goal. Rates of breastfeeding are low and geographically variable. Maternal stress could impair lactation, through hormonal, neuronal or behavioural pathways.Objectives: This study aims to analyse the effect of relaxation interventions on lactation outcomes.Methods: Systematic review and meta‐analysis were performed to address the question: “in lactating mothers, does relaxation therapy, compared to standard care, improve milk quantity and maternal mental health?” Randomised studies with interventions designed to achieve relaxation through reduction in mind‐stress were included. Fixed‐effects meta‐analysis was used. A standardised mean difference (SMD) was calculated if the units of measurement varied between studies.Results: The search took place in August 2022. Twelve studies are included, with data from 1533 lactating parents. Interventions included guided relaxation, music and mindfulness. Seven studies measured milk quantity with summary SMD of 0.75. This is equivalent to an increase in daily breastmilk yield of 225ml, which is clinically significant. Five studies measured maternal anxiety and four measured maternal stress. The summary SMDs were −0.52 and −0.7 respectively, which are medium effect sizes. There was significant statistical heterogeneity in all outcomes.Conclusion: There is evidence for a clinically significant increase in breastmilk quantity and a moderate reduction in maternal stress and anxiety when a relaxation intervention is provided. Given the low potential harm and high availability of relaxation interventions, they can be recommended to lactating parents, particularly to those with concerns over milk quantity and/or stress.2. Knowledge, Attitudes and Practices on Breastfeeding and the first one thousand days of life among social and healthcare professionalsGabriella Tambascia1,2, Francesca Zambri1, Francesca Marchetti1,2, Annachiara Di Nolfi1,2, Jessica Preziosi1,2, Elise M. Chapin3 Stefania Solare3, Angela Giusti11National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy2Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy3Italian National Committee for UNICEF, ItalyBackground: Healthcare professionals' (HCP) support and training on breastfeeding and the first one thousand days of life is an essential factor for successful breastfeeding.Objective: To describe the Knowledge, Attitudes and Practices (KAP) of social and healthcare professionals on breastfeeding and the first thousand days of life.Methods: During 2022, an e‐learning module was developed by the Italian National Institute of Health, in collaboration with UNICEF Italy and Local Health Authority of Rome (ASL Roma 5). A KAP pre‐assessment was carried out at course entrance, using a 37‐item questionnaire.Results: Data from 19315 professionals (Jan–Nov 2022) show a mean age of 42,6 and the most represented professions were general and pediatric nurses (37,38%), midwives (19,2%) and psychologists (11,7%). The median knowledge score was 81,8%. The most frequent incorrect answer (39,1%) was about breastfeeding duration. Likewise, 30,5% disagreed that breastfeeding can be continued beyond the second year of life. As for opinions, 65,2% of participants considered collecting donations of Breast‐milk Substitutes (BMS) in emergencies important, despite its not being recommended. Moreover, 44,3% disagreed that most medications can be used during breastfeeding. As for practices, 54,1% of respondents declared they often inform parents on the important role of fathers in managing household labor and childcare. Eighty‐nine percent thought that fathers do not lose their masculinity taking care for children.Conclusion: These results show a good level of knowledge at course entrance. Some common misconceptions, e.g. duration of breastfeeding, managing BMS donations in emergencies and the father's role in childcare, are still widespread.3. Maternal physical health and breastfeeding problems in Croatia: national online survey of new mothersLisa Amir1, Daniela Drandić2, Anita Pavicic Bosnjak3, Ana Vidović Roguljić4, Gill Thomson5, Irena Zakarija‐Grković61La Trobe University and Royal Women's Hospital, Australia2RODA‐ Parents in Action, Croatia3University Hospital Centre Zagreb, Croatia4Community Health Centre, Split‐Dalmatia County, Croatia5University of Central Lancashire, United Kingdom6University of Split School of Medicine, CroatiaBackground: Maternal physical symptoms are common in the postpartum period, yet these “hidden morbidities” receive little attention from health care providers. In addition, many mothers experience breastfeeding problems, including nipple pain and mastitis. While studies in several countries have provided prevalence estimates, there have been no studies in Croatia looking at maternal postpartum physical health.Objectives: To document maternal physical health and breastfeeding problems in the first six months after giving birth in Croatia.Methods: We conducted a cross‐sectional study using an online questionnaire between February and April 2022 among resident Croatian women who had enrolled in the RODA (‘Parents in Action’) online antenatal course. Women aged 18+ years, who had given birth in a Croatian maternity facility between February 2020 and December 2021 were eligible. The questionnaire contained 75 items, covering sociodemographic characteristics, hospital practices, community support, maternal mental and physical health.Results: Postpartum health and breastfeeding items were completed by 1760 participants. Major physical health issues were fatigue (28%; n = 487), back pain (14%; n = 252), and hemorrhoids (10%; n = 171). Urinary incontinence was a minor problem for 23% (n = 397), somewhat of a problem for 8% (n = 139) and a major problem for 4% (n = 67).The most common breastfeeding problems were nipple pain/damage 50% (n = 885), difficulty attaching 43%, (n = 761), low milk supply 28% (n = 490), mastitis 22% (n = 391), engorgement 22% (n = 393), breast refusal 22% (n = 381), and too much milk 22% (n = 380).Conclusion: Postpartum women in Croatia experienced many physical health challenges. The frequency of pain associated with breastfeeding is concerning.4. Questioning the usefulness of 24‐hour recall of exclusive breastfeedingKeiko Nanishi, Joseph Green, Akira Shibanuma, Hiroko HongoGraduate School of Medicine, the University of Tokyo, JapanBackground: The WHO recommends exclusive breastfeeding for the first six months, and it promotes the Ten Steps to Successful Breastfeeding (Ten Steps). It also recommends monitoring the proportion of infants under six months old fed exclusively with breastmilk during the previous 24 hours. Whether that 24‐hour recall usefully reflects the Ten Steps is unknown.Objective: To compare two indicators of infant feeding, exclusive breastfeeding since birth and 24‐hour recall, by quantifying each indicator's association with provision of the Ten Steps.Methods: Mothers in Japan who had had a healthy singleton delivery in the previous two years were surveyed online in August 2021. Because of Japan's recommendation to start complementary feeding five months after birth, 3,753 mothers with infants older than five months reported on their breastfeeding from birth to five months, and 1,029 mothers with infants under five months reported on their breastfeeding over the previous 24 hours. The strength of each indicator's association with provision of the Ten Steps was quantified as the area under the receiver operating characteristic curve (AUC).Results: Exclusive breastfeeding since birth (prevalence = 4.4%) was moderately‐well associated with provision of the Ten Steps: AUC = 0.72. In contrast, 24‐hour recall of exclusive breastfeeding under five months (prevalence = 31.6%) was only very weakly associated with provision of the Ten Steps: AUC = 0.59.Conclusion: The WHO's recommended indicator of exclusive breastfeeding (24‐hour recall) concealed the effectiveness of providing the WHO's Ten Steps. Using 24‐hour recall to evaluate breastfeeding‐promotion interventions may be inappropriate.5. Finding a path in a maze. Identification of an adverse reaction during lactation based on a case study of ergotamineKarolina MorzePrivate Clinic, Departament of Pharmacovigilance, PolandIntroduction: The article presents a lactating patient who contacted the pharmacy office to inquire about the alarming reaction to ergotamine. She was given ergotamine due to retention of lochia and during the treatment she experienced a severe nipple pain.Main Issue: The patient was unable to feed directly from the breast and bottle fed the baby with her own expressed milk. She was worried that the nipple pain would worsen and persist for a long time and was concerned that the situation would affect further lactation.Management: The pharmacist conducted an interview, prepared and analyzed the treatment timeline based on the reported symptoms [figure 1], provided information and possible solutions to the problem. A follow‐up was performed one, two, and 20 days after the consultation. Using Adverse Drug Reaction Probability Scale, the pharmacist identified a definite adverse event related to ergotamine intake – Raynaud syndrome in the nipple. As a result of the consultation, the patient decided to continue taking the drug, and wait for the symptom to resolve to resume direct feeding from the breast. She felt more confident and less worried with the medical supportive care.Conclusion: Ergotamine treatment caused a vasospasm in the nipple of the patient and resulted in a change in the way the infant was being fed. The situation affected the maternal ability to breastfeed, caused direct and indirect costs and negatively impacted the patient's quality of life. It had no apparent adverse effect on the baby and the situation did not impact the milk supply.6. Identifying indicators of a breastfeeding‐friendly city: A Delphi surveyMay Loong Tan1,5, Siew Cheng Foong1, Wai Cheng Foong1, Grace YW Tay2, Jacqueline J Ho1, Amal Omer‐Salim3, Elizabeth J O'Sullivan4, Fionnuala M McAuliffe51Department of Paediatrics, RCSI & UCD Malaysia Campus, Penang, Malaysia2IBCLC, Gloria Group Sdn Bhd, Penang, Malaysia3World Alliance for Breastfeeding Action, Malaysia4School of Biological, Health and Sports Science, Technological University Dublin, Ireland5UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, IrelandBackground: A breastfeeding‐friendly city is one with a synchronous and enabling environment for breastfeeding. There is currently no specific set of indicators of a breastfeeding‐friendly city. A scoping review and interviews with breastfeeding mothers identified numerous potential indicators of a breastfeeding‐friendly city.Objective: To determine a set of indicators of a breastfeeding‐friendly city through consensusMethods: A Delphi‐method survey in two rounds was used. In Round 1, participants from 3 stakeholder groups (experts, policy‐makers and families) rated a list of 52 potential indicator identified from a scoping review and interviews with breastfeeding mothers. Participants could also suggest additional indicators. In Round 2, participants were shown the ratings of the other participants and were asked to rate the items again with the choice of changing their original ratings. Consensus was defined as more than 70% participants rating an item as critical (score 7–9) or not important (1–3). Any item that did not reach consensus was discussed at a consensus meeting.Results: There were 107 participants from 14 countries. After both rounds, 50 (out of 56) items reached consensus. A consensus meeting with selected participants from the 3 stakeholder groups discussed items that did not reach consensus. The final list had 52 items that was summarized into 5 sectors – administration, community, healthcare, workplace and collaboration.Conclusion: Using a systematic approach, we identified a list of indicators in 5 sectors of a breastfeeding‐friendly city. The next step is to determine how each of these indicators can be measured and applied.7. What is known about cow's milk protein allergy in preterm infants?Mona Florquin1, An Eerdekens21Department of Pediatrics, University Hospital Leuven, KU Leuven, Belgium2Department of Neonatology, University Hospital Leuven, KU Leuven, BelgiumBackground: Cow's milk protein allergy (CMPA) is well described in term infants, as opposed to preterm infants. In preterm infants, CMPA shares many gastro‐intestinal symptoms with necrotizing enterocolitis (NEC).Objectives: To evaluate the presentation of CMPA in preterm infants and to investigate the different diagnostic and therapeutic options.Methods: We searched for relevant literature using the medical databases PubMed, Web of Science, and the Cochrane Library. We performed a post hoc analysis on the 25 case‐reports included in this study.Results: Literature was scarce and heterogeneous. The majority of preterm infants with CMPA were exposed to bovine‐based milk proteins prior to the development of symptoms. The most common clinical manifestations were bloody stools, vomiting and abdominal distension. Of the 25 cases, only seven (28%) retained human milk in their diet after diagnosis. In the larger studies, no study has human milk as primary feeding choice after diagnosis.Conclusions: Preterm infants exposed to a type of cow's milk‐based formula in their first days of life, have a higher risk of developing CMPA. Most of the preterm infants are no longer fed with human milk after the diagnosis of CMPA is made, which is in contrast with current feeding guidelines. We strongly advocate that human milk with mothers on a cow's milk free diet is the first choice of feed after the diagnosis of CMPA. Prospective studies are necessary to obtain more information regarding clinical presentation, diagnostic tools and therapeutic approaches.8. Facility‐based maternal and newborn care during the COVID‐19 pandemic: IMAgiNE EURO Study findings on breastfeeding practices in 12 countriesMarzia Lazzerini,1 Benedetta Covi,1 Ilaria Mariani,1 Zalka Drglin,2 Maryse Arendt,3 Ingvild Hersoug Nedberg,4 Helen Elden,5,6 Raquel Costa,7,8,9 Daniela Drandić,10 Jelena Radetić,11 Marina Ruxandra Otelea,12,13 Céline Miani,14 Serena Brigidi,15 Virginie Rozée,16 Barbara Mihevc Ponikvar,2 Barbara Tasch,3,17 Sigrun Kongslien,18 Karolina Linden,5 Catarina Barata,19 Magdalena Kurbanović,20 Jovana Ružičić,11 Stephanie Batram‐Zantvoort,14 Lara Martín Castañeda,21 Elise de La Rochebrochard,16 Anja Bohinec,2 Eline Skirnisdottir Vik,22 Mehreen Zaigham,23 Teresa Santos,24,25 Lisa Wandschneider,14 Ana Canales Viver,26 Amira Ćerimagić,27 Emma Sacks,28 Emanuelle Pessa Valente11WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy2National Institute of Public Health, Ljubljana, Slovenia3Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg4Department of community medicine, UiT The Arctic University of Norway5Institute of Health and Care sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden6Region Västra Götaland, Sahlgrenska university hospital, Dept of Obstetrics & Gynecology, Gothenburg, Sweden7EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal8Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal9Human‐Environment Interaction Laboratory, Universidade Lusófona, Portugal10Roda – Parents in Action, Zagreb, Croatia11Centar za mame, Belgrade, Serbia12University of Medicine and Pharmacy Carol Davila, Bucharest, Romania13SAMAS Association, Bucharest, Romania14Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany15Department of Anthropology, Philosophy and Social Work. Medical Anthropology Research Center (MARC). Rovira i Virgili University (URV), Tarragona, Spain16Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Paris, France17Neonatal intensive care unit, KannerKlinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg18Department of health and care sciences, UiT The Arctic University of Norway19Institute of Social Sciences of the University of Lisbon, Lisbon, Portugal20Faculty of Health Studies, University of Rijeka, Rijeka, Croatia21Institut Català de la Salut, Generalitat de Catalunya, Spain22Department of health and caring sciences, Western Norway University of Applied Sciences, Norway23Obstetrics and Gynaecology, Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund and Skåne University Hospital, Malmö, Sweden24Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica Portuguesa, Lisbon, Portugal25Universidade Europeia, Lisboa, Portugal26Institut Català d'Antropologia (ICA), Barcelona, Spain27NGO Baby Steps, Sarajevo, Bosnia‐HerzegovinaBackground: Evidence suggests poor quality of maternal and newborn care (QMNC) during the COVID‐19 pandemic. Few studies have investigated quality of breastfeeding practices utilising the WHO Standards as a reference, and using the same set of indicators across several countries.Objectives: Investigate the WHO Quality Measures related to breastfeeding practices during the COVID‐19 pandemic, in 12 countries of the WHO European Region.Methods: Data were collected via IMAgiNE EURO, a multi‐country, cross‐sectional study using an anonymous, online questionnaire including 40 WHO Standard‐based Quality Measures. Women who gave birth in health facilities in the WHO European Region from March 2020 to March 2021 were eligible.Results: Overall, 21027 mothers were included, of whom 85.9% (18063) underwent labour. Major heterogeneity was found across countries in breastfeeding practices: lack of skin‐to‐skin ranged from 0.5% in Luxemburg to 64.4% in Romania; lack of early breastfeeding, inadequate breastfeeding support, lack of rooming‐in were consistently higher in Serbia (69.9%, 56.9%, 55.6% respectively) and lower in Luxemburg (4.7%, 16.5%, 5.5% respectively) compared to other countries. Lack of exclusive breastfeeding at discharge ranged from 17.5% in Spain to 44.1% in Romania. Women who had a prelabour caesarean section reported gaps in breastfeeding practices more frequently than women who had experienced labour (p < 0.02).Conclusion: Large inequities exist across countries in the WHO European Region in the quality of breastfeeding‐related practices. Multi‐level actions are urgently needed to promote breastfeeding and enhance support to women during and beyond the COVID‐19 pandemic.9. Breastfeeding experiences during hospitalization for childbirth among migrant versus non‐migrant women: preliminary results of the IMAgiNE study in ItalyEmanuelle Pessa Valente1, Ilaria Mariani1, Karen Loisotto2, Gina Cervi2, Marzia Lazzerini11Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy2Trieste University, Department of Medicine, Surgery and Health Sciences, Trieste, ItalyBackground: Evidence suggests gaps in the quality of maternal and newborn care during childbirth in Italy. Migrant population is particularly vulnerable. Few studies have investigated migrant women’ perspectives, in particular when related to breastfeeding experiences, using the WHO Standards as reference.Objectives: The study aimed at investigating breastfeeding experience during hospitalization for childbirth, in migrant versus non‐migrant women, in Friuli Venezia‐Giulia (FVG) region, North‐East Italy.Methods: Cross‐sectional study using validated, anonymous, telephone interview based on WHO Standards. Women given birth in one of the nine maternity hospitals of FVG region, in the period from September 2019 – April 2022 were eligible to participate. We compared indicators related to breastfeeding experience among migrant versus non‐migrant women using a Chi‐square test. Values p < 0.05 indicate statistical significance.Results: A total of 4882 women were included, of whom 883 (18.1%) migrants (Table 1). We found no statistically significant differences between migrant and non‐migrant women reports of skin to skin (86.2% migrants vs 86.6%, p = 0.757), breastfeeding support from health workers in the first hour after birth (76.3% migrants vs 75.0% non‐migrant, p = 0.404) and rooming‐in (87.1% migrants vs 86.5% non‐migrant, p = 0.654). Overall, exclusive breastfeeding rate at discharge had a large heterogeneity across maternity hospitals, with higher rates reported by migrant women (86.1% migrants vs 78.4% non‐migrant, p < 0.001).Conclusion: Actions are needed to ensure breastfeeding promotion across facilities and high‐quality care to all women and newborns.10. A neural window on a primitive relationship: the cerebral synchronization between mothers and their newborns during breastfeedingStefano Bembich, Elena Castelpietra, Jenny Bua, Enrica Causin, Chiara Pavan, Laura TravanInstitute for Maternal and Child Health IRCCS “Burlo Garofolo” – Trieste, Italy for all authorsBackground: Early co‐regulation processes between mothers and newborns involved in the primary relationship have been described and breastfeeding is part of it. A reciprocal co‐regulation involving their brain may be hypothesized too.Objectives: This research aimed to identify a possible synchronization between mother and newborn's cerebral cortex functional activation during breastfeeding.Methods: Twenty mother‐full term newborn dyads were enrolled. Cortical activation during breastfeeding was identified by multichannel near‐infrared spectroscopy, which detects changes in haemoglobins concentration from multiple regions of the cortex. Functional activity was simultaneously detected (hyperscanning) in mothers and their newborns' frontal cortex. The first five minutes of breastfeeding were monitored and oxygenated haemoglobin increase was identified as a cortical activation estimate. Wavelet Transform Coherence (WTC) analysis was used to identify a possible synchronization between functional activations in mother and newborn's frontal cortex.Results: Newborns showed a functional activation in right somatosensory/primary motor cortex and mothers in central somatosensory/primary motor cortex. WTC analysis revealed a cyclic functional synchronization between the cortical regions found activated in mothers and newborns.Conclusion: During breastfeeding, newborns show an activation of the right somatosensory/primary motor cortex and mothers of the central somatosensory/primary motor cortex. Breastfeeding seems to be associated with an intense experience for both newborns and mothers. Moreover, the frontal cortex of both partners shows to be cyclically synchronized throughout the first five minutes of breastfeeding, revealing a common sharing of experiences associated with somatosensation, reciprocal dynamic motor adjustment and attachment related feelings, which permeates the primary dyad during such a primitive experience.11. Considering the Environmental Impact of Powdered Baby Formula in Planetary and Population Health PolicyKarin Cadwell, Anna Blair, Cindy Turner‐MaffeiHealthy Children Project, United StatesBackground: Breastfeeding is situated in the nexus between the health of the earth's environment and the health of its population. Although human milk feeding has negligible cost to the environment and is the undisputed foundation of optimal population health, around two‐thirds of humans are fed processed foods, such as powdered baby formula, as a substitute for human milk in the first 2 years after birth.Objective: Describe the environmental cost of powdered standard infant, special, follow‐on and growing‐up formula data as has been calculated for more than a dozen countries including those in the Asia Pacific region, North America, South America and Europe.Method: Compare the differences in computations of the minimal estimate of greenhouse gas (GHG) “farm to gate” emissions for powdered baby formula products sold in different parts of the world.Results: Powdered infant formula is a highly processed food that contributes GHG emission for a kilogram of milk formula (including standard infant formula, follow on formula, and toddler milk), from a low of around 4 kg CO2 eq. in Asia Pacific countries to a high of more than 10 kg CO2 eq. for “growing up” powdered formula in North America.Conclusion: Along with the acknowledged health and social benefits of breastfeeding, the cost to the environment should be considered in developing and funding infant feeding policies and supportive practices.12. Breastfeeding mothers undergoing a (surgical) procedure: health care providers' advice and experienced practices by mothersJoke Muyldermans1, Santina Gorsen2, Kristien De Paepe2, Eline Tommelein11Faculty of Medicine and Pharmacy, Department of Pharmacy, Vrije Universiteit Brussel, Jette, Belgium2Faculty of Medicine and Pharmacy, Department of Pharmacy, In Vitro Toxicology and Dermato‐Cosmetology, Vrije Universiteit Brussel, Jette, BelgiumBackground: Multiple recommendations are published considering breastfeeding mothers who need to undergo a (surgical) procedure to support and protect the continuation of breastfeeding.Objectives: To map advice of health care providers (HCPs) and experiences of breastfeeding women concerning undergoing a (surgical) procedure during breastfeeding.Methods: This cross‐sectional study ran from February 2021 to April 2022 assessing advice of HCPs and experiences of mothers through online questionnaires. HCPs could participate when they came into contact with breastfeeding mothers at least once a year. A mother could participate when she was living in Belgium, older than 18 year and underwent a (minor or major) (surgical) procedure during breastfeeding in the 2 preceding years. Participants were reached through social media channels, HCP professional organization and HCPs (for mothers).Results: Questionnaires were completed by 291 HCPs and 183 mothers. HCPs believed their knowledge about breastfeeding to be good and almost all acknowledged the superiority of breastfeeding and the importance of its continuation after surgery. However, very few HCPs are familiar with published protocols. Each recommended practice is routinely advised by less than half of HCPs. The parallel research in breastfeeding mothers confirmed that each recommended practice was given to less than 40% of mothers. For a quarter of the respondents, the use of medication during surgery was never discussed and more than 70% of mothers received no or incorrect advice about breast milk storage or use.Conclusion: There is a knowledge gap leading to inappropriate care for breastfeeding mothers undergoing a (surgical) procedure.Poster Session13. How accepted is public breastfeeding in Germany? Experiences and Attitudes of the Population and Breastfeeding Mothers 2016 and 2020Stephanie Luecke1, Severine Koch2, Gaby‐Fleur Boel2, Maria Flothkoetter11Healthy Start ‐ Young Family Network, Federal Centre for Nutrition, Bonn, Germany2Department Risk Communication, German Federal Institute for Risk Assessment, Berlin, GermanyBackground: Germany is only moderately breastfeeding‐friendly. Based on a reference study, a survey on the acceptance of breastfeeding in public was conducted.Objectives: The aim of the work is to capture perceptions and attitudes towards public breastfeeding in comparison between 2016 and 2020. In addition, differences between the general population and mothers of young children as well as between mothers with different levels of education are considered.Methods: 1,007 people aged 16 and older and 307 mothers with children up to 24 months were surveyed online about public breastfeeding in 2020.Results: In 2020, a larger percentage of mothers breastfeed in public than in 2016. Mothers with lower levels of education are less likely to breastfeed, also in public, and more likely to report mixed reactions. Among the general population, acceptance of public breastfeeding has declined. The potential for conflict noted in 2016, e.g., in restaurants, has intensified. About one in six (17%) explicitly rejects breastfeeding in public. Knowledge about the health effects of breastfeeding is lower among the general public than among mothers. As in 2016, knowledge about the positive effects of breastfeeding is associated with greater acceptance of public breastfeeding.Conclusion: The results underline the importance of measures that increase the acceptance of breastfeeding, for example, to communicate knowledge to the population, to show breastfeeding more frequently in mass media and through positive role models, and to make the settings in which families live more breastfeeding‐friendly. Measures should pay special attention