Breastfeeding Women Research Articles

Women’s lived experience of intimate partner violence manifestations during the breastfeeding period: a lifeworld hermeneutic study

BackgroundOne in three women will experience Intimate Partner Violence (IPV). Exposure during breastfeeding endangers women’s and children’s health and wellbeing, negatively affects breastfeeding, and violates human rights and global sustainability goals. Previous qualitative studies have demonstrated that existential aspects are crucial in the separate experience of both IPV and breastfeeding. However, there is a lack of studies examining the meaning of the concurrent experience of these phenomena. An enhanced understanding of the experience of IPV manifestations during the breastfeeding period may inform the provision of care and support for women exposed to IPV. Accordingly, the study aims to explain and understand women’s lived experience of IPV manifestations during the breastfeeding period.MethodsThe study adopts a lifeworld hermeneutic approach based on Reflective Lifeworld Research. Data collection was conducted between June 2022 and August 2023. Swedish women with experience of the phenomenon IPV manifestations during the breastfeeding period participated either through written lifeworld stories (forty-nine women) or lifeworld interviews (nine women). Data were analysed interpretatively. The main interpretation was inspired by Liz Kelly’s theory ‘The continuum of violence’.ResultsThe results show that women experience IPV manifestations during breastfeeding in terms of being accused, devalued, neglected, controlled, opposed, forced to adapt, and/or punished. The main interpretation suggests that the manifestations are intertwined within a multidimensional continuum where the most frequent IPV manifestations are less commonly recognised as violence. The main interpretation further illustrates that the continuum is dependent on both the subjective lifeworld of the woman and the patriarchal context in which it exists. In relation to the patriarchal context, the breastfeeding intimacy within the mother–child dyad is pivotal to explaining and understanding the phenomenon.ConclusionsThe breastfeeding intimacy within the mother–child dyad seems to change the intersubjective power balance in the partner relationship and provoke partners, making breastfeeding women especially vulnerable to IPV. Knowledge of breastfeeding women’s lived experience of exposure to IPV is central for carers to strengthen their ability to support women’s health and wellbeing.

Phytonutrients in Breast Milk and Their Association with Maternal Dietary Intake: A Longitudinal Study in Adjamé

Carotenoids and flavonoids are essential nutrients for infant development. As for today, there is limited data on their availability in breast milk and the associated dietary factors, particularly in Côte d’Ivoire, where the diet of breastfeeding women is largely composed of cooked meals. The primary objective of this study was to determine the levels of carotenoids and flavonoids in breast milk using high-performance liquid chromatography (HPLC) during two lactation periods in Ivorian women who consumed two different diets. Mature breast milk samples were collected from healthy breastfeeding women on the 45th and 105th postpartum days. The mothers’ dietary frequencies were obtained using a questionnaire. A final sample of 60 breastfeeding women was selected. Two predominant basic diets were identified: cooked rice with palm nut sauce (R-SG) and attiéké with fried fish in refined palm oil accompanied by a paste of cooked vegetables (onion-red chili-fresh tomato) (A-PF). An overall increase in flavonoid levels was observed in all women’s milk on the 105th postpartum day, in contrast to carotenoid levels, where only the β-carotene content increased on the 105th day in the milk of women who consumed the R-SG diet (from 1.82 ± 0.30 µg/L to 2.13 ± 0.6 µg/L). The quercetin content in the milk of women on the A-PF diet (from 10.8 ± 1.6 µg/L to 19.98 ± 3.6 µg/L) significantly increased (p<0.05) compared to other flavonoids. Based on our results, consumption of cooked rice with palm nut sauce and attiéké with fried fish in refined palm oil accompanied by cooked vegetable sauce (onion-red chili-fresh tomato) increases the concentrations of quercetin, kaempferol, and epicatechin in milk. These findings can serve as dietary guidelines for breastfeeding mothers to improve β-carotene and flavonoid levels in breast milk, thus promoting infant growth and development.

Breastfeeding and contrast agents-A critical review and presentation of new aspects.

There are discrepancies between guidelines of scientific societies and information of the package inserts of contrast media concerning breastfeeding following the application of a contrast agent to the mother. The contents of different review articles reflect the opinion of scientific societies. Consequently, in clinical routine settings it is difficult to find the optimal advice for a breastfeeding woman and her baby. Therefore, the paper carefully summarized important information dealing with the topic 'breastfeeding and contrast media' from the literature. Among other things, the paper focuses on topics that are not yet taken into account in other reviews (e.g. approval for breastfeeding women, contrast agents that have been analysed in human breast milk). In this way, the review shows new aspects. It has been revealed that data concerning the amount of contrast agents in human breast milk as well as contrast medium absorption by the infants' intestine are sparse. Instead of them, a lot of speculations and incorrect conclusions do exist in the literature. Because studies are rare or missing, contrast media are not approved for breastfeeding women (off-label-use). Although breastfeeding women 100% prefers a break from breastfeeding, in current decision-making processes, their preference plays a minor role. However, this should change in the future. In addition, it would be very important to inform breastfeeding women in the future about the missing data concerning 'breastfeeding and contrast media'.

Factors Associated with the Prevalence of Breastfeeding Periods in a Cohort of Spanish Primiparous Pregnant Women.

To assess factors associated with the prevalence of breastfeeding in a cohort of Spanish primiparous pregnant women to whom a health education program was applied. Prospective, descriptive, and inferential cohort analysis with data obtained from the beginning of pregnancy to the child's year. Prevalence of breastfeeding was classified into periods or categories: (1) "non-breastfeeding"; (2) "breastfeeding until 6 months"; (3) "breastfeeding up to 12 months". The sample was 288 primiparous pregnant women divided into two groups of equal size using as a matching strategy whether they attended the health education sessions with or without an informal caregiver (mother, partner, sister): group A (primiparous women who attended the sessions without an informal caregiver; n = 144) and group B (primiparous women who attended the sessions with an informal caregiver; n = 144). The best-associated variables with the prevalence of breastfeeding were age, vitamin B12 variation (postintervention-preintervention), and informal caregiver intervention. This association was statistically significant for breastfeeding up to 12 months of age compared to non-breastfeeding (age (p = 0.007); vitamin B12 variation (p = 0.010); caregiver intervention (p = 0.008)). The younger the breastfeeding woman, the greater the probability of breastfeeding up to 12 months (β: -0.246 (0.91); OR: 0.782 (0.654-0.935)). The greater the increase in vitamin B12 after the educational intervention program, the greater the probability of breastfeeding up to 12 months (β: 0.007 (0.003); OR: 1.007 (1.002-1.012)). The absence of an informal caregiver decreased the likelihood that breastfeeding would be maintained until the child's 12 months (β: -0.734 (1.024); OR: 0.065 (0.009-0.483)). The prevalence of breastfeeding up to 12 months, in a cohort of Spanish primiparous women, increased the higher increase in vitamin B12 levels after applying an educational intervention program to promote breastfeeding. The prevalence of breastfeeding up to 12 months also increased with the presence of the informal caregiver and in young women.

Tenofovir Disoproxil Fumarate/Emtricitabine Prophylaxis Has No Effect on Bone Mineral Density and Bone Mineral Content in African Breastfeeding Women Receiving Pre-Exposure Prophylaxis for HIV.

Tenofovir disoproxil fumarate (TDF) when used as preexposure prophylaxis (PrEP) in pregnancy is considered safe overall however there is insufficient evidence of its effect on maternal bone. We compared bone mineral density (BMD) and content (BMC) at the lumbar spine (LS) and hip of African breastfeeding women exposed and not exposed to TDF-containing PrEP in a randomized control trial (RCT). This is a secondary data analysis of an RCT where pregnant women were randomized to initiating PrEP in pregnancy or delayed initiation of PrEP until breastfeeding cessation. BMD and BMC at the LS and hip were measured using dual-energy x-ray absorptiometry (DXA) at 6, 26, 50, and 74 weeks postpartum. In an exploratory analysis, BMD at the hip and LS were evaluated against varying Tenofovir (TFV) levels during pregnancy. Of 300 women in the RCT who had a DXA at 6 weeks postpartum, 102 (66%) women in the Immediate PrEP arm and 105 (72%) in the Delayed PrEP arm had a 74-week DXA scan. Adjusting for breastfeeding duration and body mass index (BMI), there were no significant differences in BMD or BMC at the hip and LS between treatment arms. There was no consistent dose-effect of TFV-DP detected during pregnancy on BMD at the hip (p=0.231) or the LS (p=0.277). After adjusting for breastfeeding and BMI, TDF when given as oral preexposure prophylaxis during pregnancy had no deleterious effect on BMD and BMC at the hip and LS of African breastfeeding women.

Factors Associated with COVID-19 Vaccination Among Breastfeeding Women in Abidjan, in 2023

<i>Background</i>. In 2022, the WHO recommended the vaccination of breastfeeding women against COVID-19. In the same year, the Minister of Health sent a referral to the National Committee of Independent Experts for Vaccination and Vaccines of Côte d'Ivoire (CNEIV-CI) for its opinion on the vaccination of breastfeeding women against COVID-19 in the country. The CNEIV-CI recommended the vaccination of breastfeeding women against COVID-19. <i>Objective</i>. To identify factors associated with COVID-19 vaccination among breastfeeding women. <i>Method.</i> We conducted a cross-sectional survey. The study population consisted of breastfeeding women. Data were collected, using a questionnaire, in health centers during a direct interview with breastfeeding women who came for their child's vaccination. The dependent variables were COVID-19 vaccination status and vaccination intention after weaning, and the independent variables were age, education level, religion, living with a partner, and district of residence. A multivariate analysis, by logistic regression, was performed to search for factors associated with COVID-19 vaccination status, on the one hand, and with vaccination intention after weaning, on the other hand. The measure of association was the adjusted Odds Ratio (ajOR) with a 95% confidence interval (95% CI) and a degree of significance p < 0.05. The data were analyzed using SPSS. <i>Results</i>. A total of 1009 breastfeeding women were surveyed. The respondents median age was 29 years; the minimum age was 16 years and the maximum age was 44 years. 49 % of respondents were vaccinated. Factors associated with COVID-19 vaccination status among breastfeeding women were education level (ajOR = 8.57; 95 % CI: 4.92 – 14.94), living with a partner (ajOR = 4.75; 95 % CI: 3.34 – 6.76), and age group (ajOR = 1.63; 95 % CI: 1.02 – 2.6). <i>Conclusion.</i> Awareness-raising among women on the acceptance of COVID-19 vaccination must continue. Factors associated with COVID-19 vaccination status were living with a partner, education level, and age group. Qualitative studies could be carried out to understand the underlying reasons behind non-vaccination among breastfeeding women.

Advancing Glaucoma Treatment During Pregnancy and Breastfeeding: Contemporary Management Strategies and Prospective Therapeutic Developments

The management of glaucoma in pregnancy and breastfeeding requires a careful evaluation of treatment choices to guarantee the well-being of both the mother and the developing fetus. This review explores the intricacies of controlling glaucoma in pregnant and breastfeeding women, including a comprehensive overview of existing glaucoma treatment methods, clinical guidelines, and future therapeutic approaches. The efficacy and safety profiles of traditional treatment approaches, such as topical and systemic medicines and surgical treatments, are evaluated specifically about their use during pregnancy and breastfeeding. The significance of personalized treatment programs to achieve a balance between controlling intraocular pressure and ensuring the safety of the fetus and the newborn and the importance of a multidisciplinary approach that includes ophthalmologists, obstetricians, and other healthcare experts are underlined. Non-pharmacological therapies, lifestyle adjustments, and the importance of patient education in the management of glaucoma during pregnancy and the post-partum period are also examined. Advancing our comprehension of and strategy toward glaucoma can reduce the effects of glaucoma on maternal, fetal, and newborn well-being.

Health System Factors Influencing the Integration of Pre-Exposure Prophylaxis into Antenatal and Postnatal Clinic Services in Cape Town, South Africa.

Oral pre-exposure prophylaxis (PrEP) is an effective and safe option to prevent HIV acquisition and vertical HIV transmission in pregnant and breastfeeding women. Understanding health system factors influencing the integration of PrEP into care for pregnant and breastfeeding women is key to increasing access. We explored managers' and health care workers' (HCWs) experiences with integrating PrEP into antenatal care and postnatal care services in primary health care clinics in Cape Town, South Africa. This exploratory qualitative study used codebook thematic analysis, where HCWs were purposively, heterogeneously sampled from an implementation science study. Semistructured individual interviews were conducted with 9 managerial-level staff, and 3 focus group discussions were conducted with HCWs (nurses, midwives, and HIV counselors) providing PrEP (6-7 HCWs per group) between November 2022 and January 2023 (N=28). Interview guides covered health system facilitators, barriers, and recommendations. The Health Systems Dynamics framework guided data analysis and presentation of results. PrEP integration into antenatal care services was described as acceptable and feasible; however, changes to HIV testing policy and indicators in breastfeeding women are needed to integrate PrEP into postnatal clinics, together with identification of mother and baby as a dyad in visits. Results showed that supportive policies facilitated wider, simplified PrEP provision. The availability and accessibility of prescribing nurses and lay HIV counselors, PrEP (both within facilities and in communities), and information about PrEP for implementers and pregnant and breastfeeding women will be pivotal to facilitating integration. Facilitators for PrEP integration include task-shifting PrEP education and identification of women for PrEP initiation to HIV counselors, changes to national guidelines defining who can prescribe PrEP, revision and integration of PrEP training for HCWs, community-level interventions for PrEP demand creation and stigma reduction, and provision of differentiated PrEP delivery options.

Lipid signature changes of women with gestational diabetes mellitus in response to puerperal exclusive breastfeeding.

We here investigated whether lactation during puerperium could help to reverse the diabetogenic effect of gestation and further explored the lipid profiling changes upon breastfeeding. Thirty-five women diagnosed with GDM were recruited, and fasting plasma samples were collected at ~6 weeks postpartum. Maternal metabolic parameters were determined, and an untargeted lipidomic analysis was performed. The relationship between underlying lipidomic responses and lactation was explored. Improved glucose homeostasis and insulin sensitivity were observed in GDM women who adopted breastfeeding during the puerperium. Further lipidomics analysis revealed prominent correlations between lipid constitution changes and breastfeeding in women with GDM. A total of 766 lipid species were identified, 33 of which were found to be significantly altered in response to lactation. Significant associations between dysregulated lipids and maternal metabolic parameters were also shown. Subsequently, we identified a panel of three lipids that were strongly associated with breastfeeding, from which we constructed a predictive model with higher discriminating power. We generally revealed that lactation during puerperium appears to have favorable effects on diabetogenic risk factors for GDM women. We also discovered that lipidomic changes related to lactation could elucidate the mother's recovery from GDM pregnancy.

Investigation of a fully mechanistic physiologically based pharmacokinetics model of absorption to support predictions of milk concentrations in breastfeeding women and the exposure of infants: A case study for albendazole.

Due to limited non-clinical and clinical data, European guidance recommends to discontinue breastfeeding when taking albendazole. The aim of this study was to consider the use of PBPK modeling to support the expected exposure in breastfed infants. A fully mechanistic PBPK approach was used to provide quantitative predictions of albendazole and its main active metabolite, albendazole sulfoxide, concentrations in plasma and breast milk of lactating women. The model predicted the exposure in adults and the large food effect, however, it does not predict all the clinical data for the exposure in children. Milk/plasma ratio predictions were also largely over-predicted for this lipophilic compound, but not for the less lipophilic metabolite. Predictions using the observed ratio and a worse-case exposure based on Cmax predictions, suggest doses to children through milk will be low. However, more clinical data are required before full exposure predictions can be made to breastfed infants.

Evaluation of Vaccination Coverage Against COVID-19 Among Postpartum Women at the Gaspard Kamara Health Center in Senegal in 2020

The COVID-19 pandemic has shaken the world and the rapid delivery of vaccines against the virus has raised many questions. Doubts have been raised about the effectiveness and safety of the vaccine in pregnant and breastfeeding women, hence the need to assess vaccination coverage of postpartum women at the Gaspard Kamara health center. We therefore carried out a cross-sectional analytical study from May 31 to June 28, 2022 on all women who gave birth at the Gaspard Kamara health center. Exhaustive recruitment was carried out and the data were analyzed using the SSP software version 2022. In total, 235 women participated in the study, with a mean age of 28.22 ± 5.96 years and extremes 16 and 44 years old. More than half of the patients (68.94%) had given birth vaginally. Those with secondary education accounted for 72.34%. Less than a quarter of women (7.23%) tested positive for COVID19 and 96.60% of them received information on the fight against COVID19, with the media being their main source of information. Less than half (40.43%) knew the vaccines available in Senegal, Johnson & Johnson being the best known. The majority of women (82.55%) believe in the effectiveness of vaccination to eradicate the disease. Age (30 years), lack of information on the fight against COVID19, lack of knowledge of the risks of serious forms in FE, knowledge of the availability of the vaccine in Senegal and vaccination of the spouse were statistically associated with vaccination against COVID19 among women in this country. study. Conclusion: The results of this study show the need to strengthen awareness and communication on the effectiveness and safety of vaccines among pregnant women, particularly those under 30 years of age. Let women know that they can be vaccinated at any age and during any trimester of pregnancy and breastfeeding.

Effects of Nurse-Led Intervention for Mother-Infant Dyads on Breastfeeding, Infant Health Outcomes.

This study aimed to investigate the efficacy of nurse-led interventions in enhancing breastfeeding women's knowledge and practices and in preventing diarrhea among their infants. The study was conducted in rural areas of Haryana, India, and used the survey design and pre-experimental research design in Phase I and Phase II, respectively. Mothers who had recently delivered a baby were identified using the birth register at the panchayat office, and 200 mothers who met the inclusion criteria were chosen using purposive sampling technique. The data were collected by interview approach using the knowledge questionnaire on breastfeeding, observational checklist on practice of breastfeeding, diarrhea assessment tool, and the duration of data collection was between May to August 2022. In Phase I, exclusive and non-exclusive breastfeeding mothers were surveyed regarding the occurrence of diarrhea among infants. In Phase II, non-exclusive breastfeeding mothers' knowledge and practice were assessed, and then nurseled intervention on breastfeeding was administrated and on 30th, 60th, and 90th days, post-test was done. The study's findings demonstrate that the knowledge and practice scores varied significantly across different tests, from pre-test 1 (6.73 ± 1.94) to post-test 3 (16.19 ± 3.04), (F=294.11, p < .000) for knowledge, and for practice pre-test 1 (23.41 ± 8.90) to post-test 3 (101.81 ± 22.4), (F=535.98, p < .000) in the intervention group. Further, in the intervention group, there was decrease in diarrhea occurrence among various observations (Q=60.609, p < .000). The nurse-led intervention of breastfeeding is an effective teaching technique to improve the knowledge and practice of mothers, as well as it helps to reduce the occurrence of diarrhea among infants, there by it can contribute to reducing the infant mortality rate.

“I desire to have an HIV-free baby”: pregnant and breastfeeding mothers’ perceptions of Viral load testing and suppression in HIV care in southwestern Uganda

IntroductionViral suppression is a critical component for preventing mother-to-child transmission of HIV(MTCT). Mothers’ perceptions of viral load suppression is crucial in the attainment of successful outcomes in preventing mother to child transmission of HIV. We therefore aimed to explore the experiences and perceptions of women on viral suppression.MethodsThis was a qualitative sub-study embedded in a cluster-randomized trial (NCT04122144) designed to improve viral load outcomes among pregnant and breastfeeding mothers living with HIV in four level III/IV health facilities in South-western Uganda. Thirty-two in-depth interviews were conducted with pregnant and breastfeeding women with HIV from 1st March 2020 to 30th September 2020 to explore their understanding and interpretation of viral suppression. Interviews were audio-recorded, transcribed, and coded in Dedoose software for analysis.ResultsA total of 32 Women living with HIV were enrolled in this qualitative study. WLHIV explained viral suppression in the context of attaining good health and having HIV-free babies. Adherence to ART was presented as a key avenue to viral suppression. The level of engagement with providers was presented as a key attribute of attaining viral suppression. The participants narrated their experiences with viral load testing within the routine services. However, they revealed experiencing some proximate barriers to suppression including anticipated stigma, challenges with non-disclosure of HIV status, pregnancy distress, and distance to the health facility.ConclusionThe understanding and interpretation of viral suppression among pregnant and breastfeeding mothers living with HIV provides a basis for adopting behaviors leading to prevention of vertical transmission of HIV. Health care workers can support women by providing clear and culturally appropriate education about viral suppression, adherence strategies and creating a supportive and non-judgmental environment.

Level of knowledge about exclusive breastfeeding in postpartum women attending the pediatric service of a public health center in the city of Fray Luis Beltrán

The present study assesses the level of knowledge about exclusive breastfeeding (EBF) in 40 postpartum mothers. EML, recommended by international organizations for up to six months, provides benefits for the child, such as protection against disease and cognitive development, and for the mother, by reducing the risk of certain cancers and postpartum depression. However, only 42.5% of the participants knew that EML should be maintained until six months, and knowledge about benefits for the mother and breastfeeding techniques was low. The survey showed that 43% had a fair level, 38% a poor level and 20% a good level of knowledge. These results indicate the need to strengthen EML education, especially in sectors with less access to information and medical resources.

Logistic Regression Model on Nutritional Status Based on Body Mass Index (BMI) in Women of Reproductive Age (WRA) in Indonesia

The aggregate analysis of Riskesdas data in Indonesia revealed that nearly all provinces face a serious double burden of malnutrition. Both undernutrition and overnutrition negatively affect the quality of human resources, especially when they occur in adolescent girls, Women of Reproductive Age (WRA), and pregnant and breastfeeding women, as this can lead to intergenerational nutritional problems. Body Mass Index (BMI) is a nutritional status measurement technique recommended by WHO. Nutritional problems occur when BMI is abnormal or not ideal, categorized as underweight (&lt;18.5 kg/m²), pre-obesity (25-29.9 kg/m²), obesity class I (30-34.9 kg/m²), obesity class II (35-39.9 kg/m²), and obesity class III (&gt;40 kg/m²). Data from laboratory results completed up to 2017, based on selected samples from the 2013 Basic Health Research (Riskesdas), were used to assess the nutritional status of the Indonesian population. This study used 9,418 respondent data samples from 33 provinces in Indonesia. Logistic regression analysis was applied because the response variable in this study is binary, representing ideal BMI (1) and non-ideal BMI (0). The independent variables used in this study include Hemoglobin level, Ferritin level, CRP level, age group, physical activity, living location, marital status, education, and risky food consumption patterns. All independent variables are categorical. The study found that the factors influencing nutritional status based on BMI in WRA are Hemoglobin level, Ferritin level, CRP level, age, and location. The resulting logit model is logit (π)=0.27695-0.1491 (Non-anemic Hemoglobin level)-0.1721 (Normal Ferritin level)+0.741 (Non-infectious CRP level)-0.2933 (Adult age group)-0.0976 (rural location). logit (π)=0.27695-0.1491 (Non-anemic Hemoglobin level)-0.1721 (Normal Ferritin level)+0.741 (Non-infectious CRP level)-0.2933 (Adult age group)-0.0976 (rural location). The largest odds ratio The largest odds ratio was produced by the CRP level variable, indicating that CRP level is the most influential factor affecting nutritional status based on BMI in WRA, where non infectious CRP compared to infectious CRP increases the likelihood of WRA having an ideal BMI.

Comparative effects of tea and coffee drinking on body weight in adults: a systematic review and network meta-analysis of randomised trials.

We aimed at quantifying the effects of different tea and coffee on weight loss in adults. We searched PubMed, Scopus, CENTRAL and grey literature sources to July 2024. The study excluded cross-over trials without washout period, those in critically ill patients, pregnant or breast-feeding women, multicomponent interventions and active control groups with tea or coffee. A random-effects network meta-analysis with a Bayesian framework was performed to calculate the mean difference (MD) and 95 % credible intervals (CrIs). The certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach, and risk of bias was assessed using Cochrane tool. Twenty-two randomised controlled trials with 1710 participants (average intervention duration = 10 weeks) were included. Green tea was effective for weight loss compared with placebo (MD: −1·23 kg, 95 % CrI: −2·45, −0·02; low certainty evidence) or water (MD: −1·61 kg, 95 % CrI: −2·90, −0·35; very low certainty evidence), while other beverages (coffee, decaffeinated coffee, green coffee, black tea and sour tea) were not. Green tea was effective for weight loss compared with water in sensitivity analysis of healthy individuals (MD: −3·31 kg, 95 % CrI: −5·83, −1·04). Based on very low to low certainty evidence, green tea drinking may result in a small weight loss in adults. This study mainly focused on weight loss effects of green tea and coffee, with limited data on other teas. Only five trials had longer intervention durations, suggesting future research on long-term effects. Most trials had high bias risk and low certainty, requiring more high-quality trials.

An update on the pharmacotherapy of postpartum depression.

Extensive research has been conducted on postpartum depression (PPD) over the past century, and yet no definitive answer regarding its etiopathogenesis, risk factors, genetic predilection, and treatment has been found. The few preclinical and clinical studies propose that maternal brain adaptations to the endocrinological, immunological, and behavioral changes and external sociodemographic risk factors in the perinatal period make women more vulnerable to anxiety and depression. Irrespective of the cause, a dilemma exists regarding the type of help to provide postpartum mothers. With very few treatment options at our disposal, deciding between psychotherapy, pharmacological, and non-pharmacological therapy on a case-by-case basis is unproductive because in developing countries infrastructure is limited and the availability of medications, especially for psychiatric illnesses, is still evolving. Hence, regardless of psychotherapy, antidepressants remain the first line of treatment with selective serotonin reuptake inhibitors (SSRIs); sertraline has the best efficacy and safety profile in breastfeeding women. As endocrine factors play a significant role in etiopathogenesis, hormonal therapy with oxytocin has been shown to be efficacious, and studies investigating the role of testosterone in treating PPD are also under way. In 2019, the US Food and Drug Administration (FDA) approved the first and only drug for the sole purpose of treating PPD, brexanolone. Zuranolone, a drug recently approved by the FDA, has a similar mechanism of action to brexanolone. For breastfeeding mothers reluctant to use pharmacotherapy, somatic therapy has been studied, including bright light therapy, vagal nerve stimulation, and newer noninvasive interventions. This article encompasses a short note on PPD, including its etiopathogenesis and clinical characteristics, and recapitulates the various available and evolving pharmacological and nonpharmacological therapies.

Supporting breastfeeding for women with low education levels, psychosocial problems, and/or socioeconomic constraints: a scoping review protocol

Objective: This scoping review aims to identify and map interventions and/or strategies used to support the initiation and continuation of breastfeeding for women at risk of delaying initiation, early cessation, or not breastfeeding due to low levels of education, psychosocial problems, and/or socioeconomic challenges in high-income countries. Introduction: While breastfeeding has lifelong beneficial health effects for women and infants, there is a risk of delaying initiation, early cessation, or not initiating breastfeeding at all due to factors related to health inequalities, such as low levels of education, psychosocial problems, and/or socioeconomic constraints. Inclusion criteria: This review will include eligible quantitative, qualitative, and mixed methods studies, as well as systematic reviews and gray literature. We will include studies conducted in high-income countries, focusing on interventions and/or strategies to support women with low levels of education, psychosocial problems, and/or socioeconomic constraints in the initiation and continuation of breastfeeding for up to 6 months postpartum. Methods: This review will follow the JBI methodology for scoping reviews, using the Participants, Concept, and Context framework. The primary search will be performed in MEDLINE (Ovid), PsycINFO (EBSCOhost), Embase (Ovid), and CINAHL (EBSCOhost). We will include publications in English, Swedish, Norwegian, Danish, German, Bulgarian, Arabic, and Spanish, published from 1991 until the present. A data charting form will be developed and used for all the included articles. Review registration: Open Science Framework https://osf.io/tmp4v/

Spousal Postpartum Social Support and Association with Sexual Function and Sexual Quality of Life among Breastfeeding Women

Background: The present study investigated the relationship between spousal support during postpartum period and the sexual function and sexual quality of life among lactating women. Methods: A cross-sectional study was carried out from October to March 2021 comprising 301 breastfeeding women referred to comprehensive health centers in Qazvin, Iran. The sampling method was performed in two stages. First, via cluster sampling, ten comprehensive health centers were randomly selected. Then based on the list of lactating mothers, 31 mothers in each center were randomly selected and invited to complete the survey. The survey included three psychometric instruments (i.e., Postpartum Partner Support Scale [PPSS], Female Sexual Function Index [FSFI] and Sexual Quality of Life-Female version [SQOL-F]) as well as a reproductive and demographic information questionnaire. The findings were analyzed using univariable and multivariable regression models at a significance level of p&lt;0.05. Results: The participants had a mean age of 30.33 years and a mean length of marriage of 7.99 years. A total of 219 women were exclusively breastfeeding (72.8%), and 82 used a combination of breastfeeding and formula milk to feed their infants (27.2%). The mean (standard deviation) scores in the postpartum period were 61.34 out of 80 (SD=11.41) on the PPSS, 86.52 out of 108 (SD=19.68) on the SQOL-F, and 22.78 out of 36 (SD=6.20) on the FSFI. Based on adjusted multivariable regression models, spousal support in the postpartum period was a significant predictor of sexual quality of life (β=0.39, p&lt;0.001) but not a significant predictor of sexual function. Sexual quality of life was a significant predictor of sexual function (β=0.44, p&lt;0.001). Conclusion: Given the importance of spousal support during the postpartum period in relation to sexual quality of life and sexual function, designing and implementing counseling programs based on the role of spousal support during postpartum sexual life would be helpful.

Reduction of tumor necrosis factor (TNF) in milk of women receiving anti-TNF antibody.

Tumor Necrosis Factor (TNF) are expressed in milk. Experimental data indicate enhanced brain growth and cognitive development in the mouse offspring given milk deficient in TNF and TNF-dependent chemokines. Although monoclonal antibodies against TNF (TNFmAb) are used during breastfeeding due to minimal milk excretion, whether it affects endogenous TNF levels in human milk is unclear. A prospective cohort study was conducted in 26 breastfeeding women with inflammatory bowel disease (IBD) and 31 non-IBD women. Milk TNF and related chemokines were measured at 5-6 weeks postpartum (early-lactation point) as a primary endpoint and further determined at 13-14 weeks postpartum. In a subset of their infants, neurocognitive development was assessed at 12 and 18 months of age using Bayley-III tool. While milk TNF levels were not significantly different between the control and those with IBD, women with IBD receiving TNFmAb showed 70% lower median milk TNF than those without TNFmAb (P = 0.019) at early lactation period. TNF-dependent chemokines (MIP-1β and IP-10) also showed similar patterns. Neurocognitive development of the infants was not significantly different among the groups. Women with IBD receiving TNFmAb show significantly lower milk TNF/chemokines at 5-6 weeks postpartum than those without TNFmAb. gov NCT03397108. We found that milk concentrations of Tumor Necrosis Factor (TNF) and TNF-dependent chemokines (MIP-1β and IP-10) are low in women with inflammatory bowel disease who are receiving anti-TNF monoclonal antibody (TNFmAb), compared to those without concurrent anti TNF therapy. While maternal use of TNFmAb during breastfeeding is considered inconsequential to infant health due to their low levels of milk excretion, it affects profiles of endogenous cytokines in milk. Our findings provide a rationale to investigate human implications of the animal data in the literature that suggest enhancement of neurocognitive development of the offspring fed with milk deficient in TNF-dependent chemokines.