Continued Breastfeeding Research Articles

Adverse Drug Reactions in Breastfed Infants: A Cross-Sectional Study of Lactating Mothers.

Background: Breastfeeding-related adverse drug reactions (ADRs) are thought to be uncommon as reported cases are globally low. The nonspecific nature of these reactions and a lack of awareness and difficulty in identification of ADRs by mothers and clinicians may result in these ADRs being underreported. Aims: This study hypothesized that breastfeeding-related infant ADRs are more frequent than reported. As a first-hand account of breastfeeding mothers, this study aimed to evaluate the impact of the perceived ADRs on the continuation of breastfeeding and maternal treatment. Methods: Women currently breastfeeding or having breastfed in the last 12 months were invited to complete an online survey. The survey comprised 42 questions in 5 sections to obtain data from breastfeeding mothers, including their use of medicines during lactation, perceptions of infant adverse reactions attributable to maternal medication use and its potential impact on breastfeeding. Results: This online survey was completed by 339 women, 42% of whom reported taking at least one medication during breastfeeding. ADRs were reported in 23 infants where a possible or probable causal relationship indicated by a Naranjo score of 1-8 was established in 16 (11.3%). Antibiotics (n = 12) and opioids (n = 2), including tramadol and oxycodone were identified as the most common adverse reaction-causing drugs. The average age of infants at the time of the perceived ADR was 25.6 days (95% confidence interval; 4-85 days; median age 17.5 days). Conclusion: Suspected ADR reporting in this study was significantly greater than those reported to the regulatory body, the Australian Therapeutics Goods Administration, which shows that common breastfeeding-related infant ADRs are underreported.

Protecting both infant and mother: perceptions of infant feeding practices in rural Haiti

Background Global recommendations for optimal breastfeeding include early initiation, exclusivity for six months, and continued breastfeeding for two years and beyond. Although breastfeeding is near universal in Haiti, gaps in optimal practices persist. Determinants of breastfeeding practices are complex, and a contextualized understanding is needed to strengthen breastfeeding support interventions. We conducted a qualitative study to explore mothers’ perceptions of factors influencing breastfeeding practices in rural Haiti. Methods Focus group discussions were held in eight rural communes participating in a nutrition project. Study participants (n=86) were recruited from mothers’ support groups. A moderator facilitated the focus groups in Haitian Creole using a question guide to elicit observations about community breastfeeding practices related to early initiation, colostrum feeding, complementary foods and beverages, and breastfeeding cessation. Focus groups were recorded, and three observers took notes which were compiled into a single report of key points and validated by participants following each session. Quotes representing the key points were selected from the audio recordings, translated into English and analyzed to identify explanatory themes. Results Participants described breastfeeding for 12-18 months as the norm in study areas, with early and frequent use of additional foods and beverages. Three explanatory themes were identified, related to concerns for (i) infant well-being, including digestive health, nutritional needs and contentment; (ii) transmission of negative maternal emotional and physical states through breast milk; and (iii) maternal well-being, including effects on breastfeeding practices of maternal illness, hunger, stress, and competing time pressures. Underlying all these concerns is the context of rural poverty and the cultural meanings of breastfeeding. Conclusions Findings suggest that practices which compromise global breastfeeding recommendations may persist because of their perceived value in addressing concerns for infant and maternal well-being in the challenging context of rural poverty, food insecurity and poor health. Multi-sectoral interventions are needed to mitigate these underlying contributors and create an enabling environment for early, exclusive and continued breastfeeding.

Association of Infant Feeding Indicators and Infant Feeding Practices with Coexisting Forms of Malnutrition in Children under Six Months of Age.

Breastmilk is the only recommended source of nutrition for infants below six months of age. However, a significant proportion of children are either on supplemental breastfeeding (SBF) or weaned due to the early introduction of solid/semi-solid/soft food and liquids (SSF) before six months of age. There is good evidence that exclusive breastfeeding (EBF) in infants below six months of age protects them from preventable illnesses, including malnutrition. The relationship between infant feeding practices and coexisting forms of malnutrition (CFMs) has not yet been explored. This study examined the association of different feeding indicators (continuation of breastfeeding, predominant feeding, and SSF) and feeding practices (EBF, SBF, and complete weaning) with CFM in infants aged below six months in Pakistan. National and regional datasets for Pakistan from the last ten years were retrieved from the Demographic Health Surveys (DHS) and UNICEF data repositories. In Pakistan, 34.5% of infants have some form of malnutrition. Among malnourished infants, 44.7% (~15.4% of the total sample) had a CFM. Continuation of breastfeeding was observed in more than 85% of infants, but less than a quarter were on EBF, and the rest were either SBF (65.4%) or weaned infants (13.7%). Compared to EBF, complete weaning increased the odds of coexistence of underweight with wasting, and underweight with both wasting and stunting by 1.96 (1.12–3.47) and 2.25 (1.16–4.36), respectively. Overall, breastfed children had lower odds of various forms of CFM (compared to non-breastfed), except for the coexistence of stunting with overweight/obesity. Continuation of any breastfeeding protected infants in Pakistan from various types of CFM during the first six months of life.

Impact of the COVID-19 Pandemic on Breastfeeding Support Services and Women's Experiences of Breastfeeding: A Review.

ObjectiveThe aim of this systematic review was to explore the impact of the COVID-19 pandemic on breastfeeding support services and continuation rates.MethodsElectronic searches were undertaken in seven databases: Academic Search Complete, Springer Nature Journals, CINAHL Medline, Health Source: Nursing/Academic Edition, Masterfile premier, and SocINDEX. Publications following the COVID-19 pandemic between January 2020 and March 2022 were searched for using the following keywords: impact or effect or influence and breastfeeding support and breastfeeding continuation and COVID-19 or coronavirus. Fifteen studies were included for investigation and extracted to identify seven themes related to breastfeeding support during COVID-19.ResultsFactors which impacted breastfeeding support during the COVID-19 pandemic included separation, lack of skin-to-skin contact, insufficient support, online breastfeeding support, the impact of the pandemic on breastfeeding rates and experiences, fears of the pandemic, and the need for additional support. The pandemic mostly influenced breastfeeding support negatively, with a small exception occurring where some mothers experienced lockdown as positive since it protected the mother-infant dyad from unwanted visitors. Virtual breastfeeding support was introduced in many contexts; however, practitioners and mothers reported that this could not replace the need for face-to-face support.ConclusionBreastfeeding is a lifesaving intervention, especially in the face of a disruption such as a pandemic. This work highlights the need for clear, consistent, and evidence-based information about risks, and for key practices to be maintained including not separating mothers and infants, promoting skin-to-skin contact, and ensuring availability of high-quality breastfeeding support.

Protocol for a multicentre prospective observational study of families with full-term infants on postnatal wards and in the community to capture feeding practices across the first year of life: the Mother Infant Lactation Questionnaire (MILQ) study

IntroductionBreastmilk is considered the gold standard for infant nutrition. Breast feeding is recommended as the sole source of nutrition between birth until around 6 months of age and should be...

Prevalence and determinants of exclusive breastfeeding; a cross sectional study in Najaf city, Iraq.

To determine the prevalence of exclusive and continued breastfeeding in an urban setting, and the factors influencing the choice. The cross-sectional study was conducted from February 1 to August 30, 2018, in Najaf, Iraq, and comprised children aged up to 2 years from 12 randomly selected primary healthcare centres. Data were collected using a predesigned questionnaire that had three parts covering the mother, the child and the demographic variables. Data was analysed using SPSS 20. Of the 373 subjects, 209(56.0%) were males. The overall mean age was 8.8± 6.2 months (range: 1-23 months), while the mean age of the mothers was 26.5±5.8 years (range: 15-46 years). Children aged <6 months were 169(45.3%), and, among them, exclusive breastfeeding was found in 66(39.1%) cases. There was significant relationship between exclusive breastfeeding and feeding of other siblings (p=0.001), admission to hospital (p=0.02), family support (p=0.009), husband's support (p=0.007). Child sickness in early life also had significant association with exclusive breastfeeding (p<0.05). The prevalence of exclusive breastfeeding was found within the reported estimate for low- and middle-income countries, but much lower than the World Health Organisation recommendation.

The Manifold Bioactivity and Immunoreactivity of Microbial Proteins of Cow and Human Mature Milk in Late Lactation.

Simple SummaryThe debate over the validity and benefits of breastfeeding children after the age of 1 and the superiority of human over cow’s milk is still ongoing. The recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as a complementary food source for 1 year or longer, seems justified under many circumstances. The microbiological parameters of the milk play a vital role in this respect. So far, the focus has been on the qualitative profile of the microbiota, bacterial interactions with milk compounds, and the metabolites produced by bacteria. However, the role of bacterial proteins in milk, according to the authors’ knowledge, has been analyzed. It is reported that due to the disruption of the regulatory axis of the immune system in the course of hypersensitivity, organisms may give rise to decreased IgA-mediated (physiological) and increased IgE-mediated (hypersensitive) responses even to host gut microbiota proteins. In this publication, the aim was to compare whether the bacterial proteins in the mature human milk of late lactation and cow’s milk of different breeds can determine the different immunoreactive and bioactive properties of milk.(1) Human milk (HM) is a source of many microorganisms, whose structure contains microbial protein (MP). In addition to the known health-promoting properties of HM, many activities, including immunoreactivity, may result from the presence of MP. Cow’s milk (CM)-derived MP may be 10 times more abundant than MP derived from HM. (2) Raw cow’s milk samples of Holstein and Jersey breeds, commercially available pasteurized milk, and milk from three human donors in the late lactation phase were subjected to chemical and microbiological analyzes. Microorganisms from the milk material were recovered, cultured, and their activities were tested. MPs were extracted and their immunoreactivity was tested with human high IgE pooled sera. The milk types were subjected to simulated digestion. Milk and microbial proteins were identified with LCMS and subjected to an in silico analysis of their activities. Their antioxidant potential was analysed with the DPPH method. (3) The MP of HM shows a stronger IgE and IgG immunoreactivity in the tests with human sera compared to the MP of CM (p = 0.001; p = 0.02, respectively). There were no significant differences between the microbes in the MP of different cattle breeds. The MS-identification and in silico tests of milk and microbial proteins confirmed the presence of MP with immunoreactivity and antioxidant potential. (4) MPs possess a broad bioactive effect, which was determined by an in silico tools. The balance between an MP’s individual properties probably determines the raw material’s safety, which undoubtedly requires further research.

The Academy of Breastfeeding Medicine27th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

The Academy of Breastfeeding Medicine27^th Annual International MeetingBaltimore, MarylandSeptember 15–18, 2022

Studi Literatur: Pengalaman Menyusui pada Ibu Usia Remaja

Breastfeeding in one of the best ways to reduce infant mortality. However, UNICEF data in 2019 recorded that only 43% of newborns started breastfeeding in the first hour and 41% received exclusively breastfed. The causes of initiation and continuation of breastfeeding are closely related to the age of the mother. Adolescent mothers were found to not continue exclusive breastfeeding. This article aims to explore the experience of exclusive breastfeeding for adolescent mothers. The method used is a literature study. Research questions were identified using the PEOS (Population, Exposure, Outcome, Study Design) framework. The journals used in the literature review were obtained through the Pubmed, Science Direct and Google Scholar databases from 2010-2020. The keywords used according to MESH (Medical Subject Heading) are "experience", "exclusive breastfeeding", and "adolescent mothers", and selected full text. The results of the review of 6 articles include: mother’ decisions to breastfeed such as, breastfeeding is a natural, easy, and fun way, a supportive environment, breastfeeding can improve baby’s health, provide benefits for mothers, save costs. The obstacles faced by adolescent mother include, lack of knowledge and skills, uncontrollable and unplesant physical experiences, inadequate response to health services, lack of support for breastfeeding at work/school, and difficulty breastfeeding in public places. So, adolescent mothers need breastfeeding support such as information support, instrumental support, emotional support, and apraisal support.

Determinants of Childhood Overweight and Obesity among Children 2 – 6 Years of Age Attending Anganwadi Centres in a Block of North Bengal

BACKGROUND&#x0D; Childhood obesity, a precursor of obesity in adulthood, is an important risk factor for adverse health outcomes and is showing a rising trend in India. Duration of exclusive breastfeeding, early introduction of complementary feeding, overweight or obesity in the mother, and maternal diabetes are important risk factors. The study was conducted to determine the proportion of overweight and obesity and its determinants among children in a block of North Bengal.&#x0D; METHODS&#x0D; A cross-sectional study was conducted among children aged 2 – 6 years attending Anganwadi Centres in Tufanganj I Block, District Cooch Behar, West Bengal. 221 children aged between 2 and 6 years, were selected by 2 stage sampling technique, from 5 AWCs by simple random sampling, after taking informed consent from their mothers. Proportions, 95% CI for prevalence, and adjusted odds ratio for risk factors were calculated.&#x0D; RESULTS&#x0D; Proportions of overweight and obesity were 22.2% and 11.3% respectively. The proportion of combined overweight and obesity was significantly higher when the duration of exclusive breastfeeding was for less than 6 months compared to more than 6 months [AOR=8.069, 95% CI = 1.778-36.624, P=0.007] and the duration of continued breastfeeding was for less than 6 months compared to more than 6 months [AOR=12.586, 95% CI = 5.196-30.486, P=&lt;0.001].&#x0D; CONCLUSIONS&#x0D; The proportion of overweight and obesity was observed to be higher compared to other studies. Increased duration of breastfeeding appears to be a protective factor for the prevention of childhood overweight and obesity.

Breastfeeding Social Support Among African American Women in the United States: A Meta-Ethnography.

In the United States, there are racial disparities in 6 months of exclusive breastfeeding. Only, 25.8% of American infants were breastfed for the first 180 days of life, with African American infants least (19.8%) exclusively breastfed in 2018. The meta-ethnography explored the breastfeeding support for African American women in the United States. The online databases of American Psychological Association, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Scopus were searched with key words, and the search was not limited by the year of publication. The inclusion criteria for the study selection entailed all qualitative studies conducted on breastfeeding support among self-identified African American women in the United States, written in English language, peer reviewed, or dissertation. The initial search produced 905 articles of which 8 met the eligibility criteria. Data extraction and analysis were guided by Noblit and Hare's (1988) meta-ethnography approach. The analysis process was completed by a team of researchers, inclusive of breastfeeding experts. Five overarching themes emerged including trustworthy information; early postpartum support by key influencers; maternal culture; tangible resources, and Black mothers' empowerment. Social support is a major determinant for the initiation and continuation of breastfeeding among African American women in the United States. Future longitudinal studies are warranted to explore the social support of breastfeeding among African American women in the United States.

The Effect of Counseling on Breastfeeding Self-Efficacy (BSFE) in Women with Gestational Diabetes

Background: Different strategies have been suggested to increase successful breastfeeding, including establishing child-friendly hospitals, prenatal training courses, and various counseling models in breastfeeding self-efficacy enhancement in women with gestational diabetes. Objectives: This study aimed to determine the effect of counseling on breastfeeding self-efficacy in women with gestational diabetes. Methods: The present study was a quasi-experimental intervention conducted on 100 pregnant women with gestational diabetes after obtaining informed consent. The intervention group received breastfeeding counseling based on the GATHER approach in the third trimester of pregnancy between 32 and 33 weeks and between 35 and 36 weeks of pregnancy, respectively. The follow-up process was performed in 4 sessions after delivery: 14 to 16 days after delivery and 28 to 30 days after delivery for 60 to 90 minutes. The control group, on the other hand, only received routine care. After counseling, self-efficacy was examined at the end of the study and after the third month. The data were analyzed using statistical independent t-tests and chi-square. Results : The mean score of self-efficacy of breastfeeding at the end of the study was 55.12 in the experimental group, which was higher than that of the control group (46.16) (P =0.0001). The frequency percentage of exclusive breastfeeding was 58% in the experimental group and 22% in the control group (P =0.0001). Conclusion: Considering the effectiveness of breastfeeding counseling on increasing self-efficacy and continuity of breastfeeding in diabetic breastfeeding mothers, it is suggested to use prenatal and continued in postnatal for diabetic mothers.

Time to early cessation of exclusive breast feeding and associated factors among 6-12 months old children: Survival analysis.

WHO and UNICEF (1990) have recommended EBF for six months, followed by an introduction of complementary foods at the age of six months with continued breastfeeding for the first 24 months or more. Exclusive breastfeeding (EBF) during the first 6 months of life reduces infant morbidity and mortality. According to Ethiopia Demographic Health Survey (DHS), only 58% of children were exclusively breastfed during the first 6 months of age. The study aimed to identify time to early cessation of EBF and associated factors among 6-12 months old children in Lanfuro Woreda, Silte Zone. A community-based cross-sectional study was conducted in Lanfuro Woreda, Silte Zone, from March to April 2017. A total of 636 mothers with 6-12 months old infants from ten randomly selected kebeles were included. Both quantitative and subjective information assortment techniques were utilized. The Kaplan-Meier curve with log-rank test was used to compare the survival difference by the selected covariates. Both bivariate (P<0.25) and multivariable (P<0.05) Cox Proportional Hazards model were fitted to identify factors predicting time to early cessation of EBF. The median duration of exclusive breastfeeding was 6.22 months. The highest proportion of cessation of exclusive breastfeeding occurred during the first four to five months. Early cessation of exclusive breastfeeding was observed in 295 (48%). Place of residence (AHR: 1.6; 95% CI=1.14-2.20), knowledge on EBF (AHR=1.31; 95% CI=1.02-1.68), type of delivery (AHR: 2.41; 95% CI=2.24-3.68), pre-lacteal feeding (AHR=1.8; 95% CI=1.32-2.36) and household food insecurity (AHR=5.02; 95% CI=3.89-6.50) were significant independent factors which were associated with time to early cessation of exclusive breastfeeding. There are still sizable proportions of children not enjoying exclusive breastfeeding for the first full six months. Being an urban resident and coming from food-insecure households, giving birth by CS, having low knowledge on EBF, and giving pre-lacteal feeding were factors associated with time to early cessation of EBF. Multi-sectoral action should be taken for respective predictors of time to early cessation of EBF.

Impact of COVID-19 on the Care of Pre-term Babies

The impact of the pandemic on maternal and newborn health-care services is problematic given the target of sustainable developmental goals. The present review was undertaken to assess the status of pre-term care during the COVID-19 pandemic. The literature search was done using various databases. Standard guidelines were followed to extract, synthesise and report the findings. A total of 20 articles that met the selection criteria were included in the review. The recent research threw light on the decrease in antenatal care services and the increase in pre-term birth during the pandemic lockdown period. Pre-term babies are more vulnerable to infections and development-associated morbidities. During the beginning of the pandemic, there were no clear guidelines regarding the dos and don'ts of pre-term care and policies that were evidence-based that resulted in the disruption of routine care within a chaotic environment. Currently, child welfare agencies and governmental and non-governmental health-care organisations are undertaking vigorous research and providing updates on the care of pre-term babies. As updates on newborn care policies based on research emerged, the continuation of breastfeeding, promotion of rooming-in, hygienic practices, digital-based health care, counseling and follow-up care were advocated for promoting pre-term babies' health and reducing morbidity and mortality. Capacity-building of the health workforce in managing pre-term babies during the pandemic period is crucial. More research is warranted to face such kind of situations in the future also. Above all, there is an urgent need for multi-sectorial and multi-disciplinary coordination in rendering essential services to the most vulnerable population i.e. pre-term babies.

Technical Report: Breastfeeding and the Use of Human Milk.

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding or the provision of human milk a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention and The Joint Commission monitor breastfeeding practices in United States hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding. Efforts to improve breastfeeding rates must acknowledge existing disparities and the impact of racism in promoting equity in breastfeeding education, support, and services.

Policy Statement: Breastfeeding and the Use of Human Milk.

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. The short- and long-term medical and neurodevelopmental advantages of breastfeeding make breastfeeding, or the provision of human milk, a public health imperative. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately 6 months after birth. Furthermore, the AAP supports continued breastfeeding, along with appropriate complementary foods introduced at about 6 months, as long as mutually desired by mother and child for 2 years or beyond. These recommendations are consistent with those of the World Health Organization (WHO). Medical contraindications to breastfeeding are rare. The AAP recommends that birth hospitals or centers implement maternity care practices shown to improve breastfeeding initiation, duration, and exclusivity. The Centers for Disease Control and Prevention (CDC) and The Joint Commission monitor breastfeeding practices in US hospitals. Pediatricians play a critical role in hospitals, their practices, and communities as advocates of breastfeeding and, thus, need to be trained about the benefits of breastfeeding for mothers and children and in managing breastfeeding.

Complimentary feeding practices in rural areas of Telangana

Infant feeding practices are critical determinants of survival, growth and development during infancy. Breast feeding is required for child survival, birth spacing and prevention of childhood infections.Complementary feeding is essential from six months of age while continuing breast feeding to meet the needs of the growing baby.To study the existing practices of complementary feeding and assess the knowledge and practice gap. Study design: Hospital based, cross-sectional, descriptive study. Setting: In a tertiary care teaching hospital of rural Telangana. Total 140 mothers with children in the age group of 6-23 months of age. Participants were randomly selected after informed consent. Data regarding currently following complementary feeding practices was collected in the predesigned, semi-structured questionnaire and analyzed. Only 56.4% of mothers in the current study initiated feeds at recommended time. Demand feeding was practiced by only 53%. A detailed analysis on the practice of clean feeding methods showed only 37.1% followed cleaning of hands before feeding. Only 28.6% have gained knowledge on infant feeding practices from a qualified person. A majoirty of them followed cultural practices (23.6%) and advices from friends and relatives (40%). Thus, Information, Health education and Communication activities are required to improve breast feeding and weaning practices especially among the low-socio-economic and rural groups. A detailed analysis on the practice of clean feeding methods showed only 37.1% followed cleaning of hands before feeding. Since good complimentary feeding practices helps in the overall growth and development of child, there should be renewed focus on public health education regarding this in the form of advisory to new parents while discharge from the hospital, regular advisories from community health care workers in the rural areas to the parents.

Experiences of young Australian mothers with infant feeding

BackgroundDespite the overwhelming evidence of health and other benefits of breastfeeding and recommendations to breastfeed by peak health bodies, breastfeeding rates are significantly lower than recommended in Australia and globally. Young mothers are identified as being at high risk of not breastfeeding their infants according to infant feeding recommendations. This study aimed to gain an in-depth understanding of young Australian mothers’ experiences of infant feeding, and to explore the factors which facilitated or hindered adherence to recommended breastfeeding practices.MethodsPurposive and snowball sampling were used to recruit young mothers in Australia (n = 17) aged 18–25 years who had given birth to their first child within the last two years. Data were collected through semi-structured interviews via online videoconferencing. Interviews were audio-recorded, transcribed verbatim, coded, and subsequently analysed. Thematic analysis was conducted using Quirkos, a qualitative data management and analysis software.ResultsFour major themes were identified: Breastfeeding is challenging; Feeling judged about infant feeding choices; Experiences with breastfeeding support; and Experiences and views on breastfeeding education. Most mothers reported experiencing breastfeeding challenges, particularly those arising from lactation difficulties, yet many were able to overcome these challenges through their determination to breastfeed. Many mothers expressed perceiving judgement from others for breastfeeding in public. Some mothers who were bottle feeding their infants, whether with expressed breast milk or infant formula, felt that they were being judged for using a bottle. Many mothers reported professional, partner, family, and peer support as critical facilitators to the continuation of breastfeeding. Most mothers shared positive experiences of attending breastfeeding education sessions, but indicated the need for community education to reduce judgement toward mothers’ infant feeding decisions.ConclusionsThe barriers and enablers to infant feeding experienced by young mothers are similar to those experienced by mothers of all ages. Young mothers experience significant breastfeeding challenges and need support from partner, family, peers, and professionals to continue breastfeeding in line with recommendations. Breastfeeding campaigns to support young mothers should be aimed at the wider community to increase awareness of breastfeeding challenges, reduce stigma associated with breastfeeding in public, and to support mothers in their infant feeding decisions.

Pre-pregnancy Obesity Associated With Lower Odds of Meeting Breastfeeding Recommendations When Controlling for Prenatal Intentions

ObjectivesThe American Academy of Pediatrics (AAP) recommends exclusive breastfeeding (EBF) to 6 months of age, with continued breastfeeding (any BF) for at least 1 year. Maternal obesity has been associated with reduced duration of any and exclusive BF. However, few studies have incorporated degree of obesity or controlled for prenatal BF intentions when comparing BF outcomes. We calculated odds of meeting AAP BF recommendations by pre-pregnancy BMI category while controlling for prenatal BF intentions and demographics in PREVAIL, a CDC-funded birth cohort in Cincinnati, OH.MethodsPrenatally, enrolled subjects completed a 3rd trimester questionnaire including demographics, pre-pregnancy weight and height, and EBF intention to 6 months. BMI (kg/m2) was categorized as healthy (18.5–24.9), overweight (25–29.9), obesity 1 (30–34.9), or obesity 2+ (≥35). Postnatally, mothers self-reported BF initiation, exclusivity, and duration via quarterly study questionnaires. Logistic regression compared EBF to 6 months and ABF to 1 year across BMI categories among those who initiated BF. All models were adjusted for maternal race, education, income and intention to EBF to 6 months.ResultsOf N = 245 enrolled subjects, the pre-pregnancy maternal obesity prevalence was 41% (n = 100), with 23% (n = 57) meeting Obesity 2 + criteria. There were no significant differences between BMI categories in intention to EBF to 6 months or BF initiation, with high (84–87%) initiation rates. Healthy BMI mothers reported the highest (40%) and mothers with obesity 2 + the lowest (4%), rates of EBF to 6 months (aOR 0.13 (CI 0.02–0.57)). Although only 26% of mothers provided any BF at the 1 year mark, healthy BMI mothers (49%) were more likely to achieve this recommendation than mothers with overweight (13%, aOR 0.11 (CI: 0.04, 0.34)), obesity 1 (16%, aOR 0.11 (CI 0.03, 0.33) and obesity 2+ (10%, aOR 0.15 (CI 0.04, 0.46)).ConclusionsDespite high BF initiation rates, increasing BMI category was associated with decreasing odds of meeting AAP BF recommendations after adjustment for demographics and prenatal EBF intention in the PREVAIL Cohort. Whether these findings can be explained by physiologic barriers associated with higher BMI merits further attention.Funding SourcesCenters for Disease Control and Prevention.

Characteristics and Related Factors to Breast Milk Production of Postpartum: Preliminary Study at Public Health Center of Semarang City

Approximately 38-63% of primiparous postpartum mothers experience lactation insufficiency, which has an impact on not breastfeeding their babies. The purpose of this study was to determine the characteristics and factors associated with postpartum mothers' milk production at the Public Health Center of Semarang City. This type of research is observational and cross-sectional design. The population of all postpartum women in Semarang City in October 2021, was taken by cluster random sampling at 8 selected health centers and a sample of 124 postpartum women. Methods of collecting data were questionnaires and data analysis with chi-square. The results of the research are the characteristics of mothers with an average age of 28 years, 56.5% of secondary education, 40% of primiparous parity, 59% of normal BMI, 92.7% of normal LILA, average age of the baby was 7 days, 82.3% of moderate anxiety level, 99.2% off good staff support, 58.9% of good surveillance worker support, 91.1% of good family support, 82.3% of more calorie intake of 2200 kcal, 62.1% of 1600 ml more fluid intake. There was a relationship between anxiety, family support, health volunteer support, calorie and fluid intake with breast milk production (p-value &lt;0.05). There was no relationship between the support of health workers with postpartum mothers' milk production (p = 0.166). Mother’s psychological condition while breastfeeding, support from family, and health insurance are important things in increasing breast milk production as a continuation of breastfeeding and exclusive breastfeeding. In addition, calorie and fluid intake need to be considered to maintain the adequacy of mother's milk.