Decrease In Breastfeeding Research Articles

Explaining the experience of breastfeeding in women with gestational diabetes and designing and implementing an educational program based on planned behavior theory: a combined exploratory study protocol.

Gestational diabetes is a type of carbohydrate intolerance that is diagnosed for the first time during pregnancy. Researches have shown that gestational diabetes is associated with many negative prenatal and birth outcomes. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. Research findings indicate a decrease in breastfeeding in mothers with gestational diabetes/ or contradictory tissues regarding the factors affecting the breastfeeding behavior of mothers with gestational diabetes and a special program to promote breastfeeding for these mothers based on the social and cultural conditions of Iranian society. The present study aims to design an interventional program with a mixed qualitative study based on the theory of planned behavior (PBT) to prevent the decrease of breastfeeding in diabetic mothers. A mixed methods exploratory design will be used to conduct this study in 3 phases. The first phase (qualitative): The purpose of the first phase is to understand the experience of breastfeeding mothers who had gestational diabetes, which will be done using the directed content analysis method. The purposive sampling will be used on pregnant mothers with gestational diabetes 30-34weeks and mothers with infants (up to 6months) with a history of gestational diabetes. The second phase include designing and implementing an educational program based on the PBT: Education will be conducted based on the needs assessment of the qualitative phase, the opinions of the focus group, and the literature review, then the breastfeeding behavior will be measured using the survey tool of "breastfeeding drop". The third phase: Interventional quantitative phase: The sample size will be carried out by a pilot study, then a designed program as an educational intervention for teaching breastfeeding behavior based on the PBT for 30-34weeks pregnant mothers with gestational diabetes will be implemented during 3-4 sessions and breastfeeding behavior will be evaluated after delivery. This is the first mixed-method study in Iran that led to implement an interventional program based on the theory of planned behavior. Because of the complications such as infant death, several diabetics' mothers plan to stop breastfeeding. We hope that the result of this research will be a step in solving breastfeeding problems in mothers with gestational diabetes.

Evolution of infant feeding practices in children from 9 to 24 months, considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL-ED study.

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods.

Factors Affecting Breastfeeding Practices under Lockdown during the COVID-19 Pandemic in Thailand: A Cross-Sectional Survey.

A COVID-19 lockdown and restrictive order has had a large impact on the lives of people. This cross-sectional study was conducted to identify factors affecting breastfeeding among mothers living in Thailand during the lockdown. Data were collected from 903 mothers with infants ages 0–12 months from 17 July 2020 to 17 October 2020 after the first nationwide COVID-19 lockdown period by an online platform and interview questionnaire survey. Multivariable logistic regression analysis was used to investigate the association between the effect of lockdown and breastfeeding practices with potential confounder adjustment including maternal age, ethnicity, newborn age <6 months, family income below $16,130 per annum, education below undergraduate level, and working status. Mothers changed breastfeeding practices in this period (n = 39, 4.32%) including having changed from exclusive breastfeeding to combined breastfeeding with formula milk (n = 22, 2.44%), and having reduced the frequency when compared to before the pandemic (n = 13, 1.44%). The associated factors of changing breastfeeding practices were “contact with healthcare services” (aOR = 0.46, 95% CI 0.22 to 0.96, p = 0.04), “infant feeding support from health personnel” (aOR = 0.39, 95% CI 0.16 to 1.94, p = 0.035), and “lack family support and help with feeding your baby after lockdown” (aOR = 7.04, 95% CI 1.92 to 25.84, p = 0.003). In conclusion, this study showed a slight decrease in breastfeeding in the sampled mothers during the COVID-19 lockdown in Thailand. A long-term national surveillance system for maintenance of breastfeeding should be established. Health care service interventions and additional information are needed to support mothers and families for breastfeeding during pandemics.

Rolling back the gains: Maternal stress undermines pregnancy health after Flint's water switch.

Environmental disasters impact disadvantaged communities disproportionately both through the epidemiological challenge of exposure, but also by undermining the progress of public health efforts. This paper studies changes to smoking cessation, breastfeeding, and weight gain during pregnancy in the period following the switch in water supply in Flint, Michigan, in April 2014. As the switch resulted in immediate and significant deterioration in water quality, eventually leading to its contamination with lead, we estimate a 10.5 percentage point increase in smoking and a 2.1 percentage point decrease in breastfeeding. We show evidence that these changes in maternal behavior are linked to increased stress due to changing water quality. We estimate that the increase in smoking alone is responsible for most of the increase in incidence of low birthweight among infants in Flint, resulting in $700 additional costs per birth. Increased smoking during pregnancy and lower breastfeeding rates in Flint roll back years of public health efforts, resulting in lifetime higher rates of cardiovascular disease, diabetes, and cancer for mothers in the community.

Does bottle feeding in the newborn period in addition to breastfeeding decrease breastfeeding success?

Does bottle feeding in the newborn period in addition to breastfeeding decrease breastfeeding success?

Breastfeeding preterm born infant: Chance and challenge.

Background and ObjectivesFor preterm infants, breastmilk plays an important role in their development, but mothers encounter a number of barriers to breastfeeding. The aim of this study was to investigate breastfeeding prevalence in preterm infants and to examine factors that may face mothers when starting to feed at-breast and their impact on the result.MethodsWomen (N = 79) with preterm infants (N = 84) were interviewed within the follow-up program in Latvia during a six-month period in 2018 using the original study protocol.Results61.9% infants were breastfed and 38.1% were not. The median infant birth weight in breastfed group was 1730 g, the median duration of tube feeding 21 days. The median age when started to feed at-breast 33 days. Later only 40.4% infants were still feeding at-breast. A relationship was found between breastfeeding and the mother’s confidence during pregnancy that she would breastfeed (P < .05). 98% mothers who began to feed at-breast, during pregnancy were confident that they would breastfeed. 54.2% women who started to breastfeed as success mentioned medical staff training, 29.2% family support.The median birth weight in the non-breastfed group was 1494 g, the median duration of tube feeding 21 days. 50% women who did not begin to breastfeed had not received enough information about breastfeeding; 17.2% during pregnancy were not confident that they would breastfeed. 38.7% women stated infants’ inability to suckle as failure, 22.6% thought they had no milk. Mothers under 32 years were more likely not to breastfeed their infant (OR = 0.8, 95% CI 0.33–1.96).ConclusionMost mothers began to breastfeed immediately, less than half continued later. Women did not receive enough family support. Young maternal age was associated with decrease in breastfeeding. Mothers with higher education were more likely to breastfeed. Being born extremely preterm and very preterm were associated with the least chance of being breastfed.

Strategically Positioned: Breastfeeding, Advocacy, and the Hands-On Nurse.

Breastfeeding, a health behavior that provides well-known benefits for mothers, infants, and children, is an essential strategy to improve public health. Breastfeeding can reduce the incidence of infant illness and death and provides both short- and longterm physiological benefits to mothers. National and international government agencies and grassroots organizations supporting breastfeeding include the World Health Organization, the United Nations International Children's Emergency Fund, the World Alliance for Breastfeeding Action, the Centers for Disease Control and Prevention, and the La Leche League. In the United States, breastfeeding of infants was the norm until the late 1890s when the Progressive Era's emphasis on science and modernity led to the transition of childbirth from residential in-home births to community-based hospital births and the aggressive rise of the baby formula industry. By 1966, only 18% of mothers were exclusively breastfeeding their infants at hospital discharge. This drastic decrease in breastfeeding reduced the percentage of mothers and grandmothers who could share their breastfeeding knowledge and experience. Nurses who provide care for women and infants are essential stakeholders in bridging the breastfeeding knowledge gap by offering education on the short- and long-term health benefits of breastfeeding to both mother and baby and timely encouragement to mothers during the most significant time for establishing lactation.

Perinatal factors associated with the development of cow's milk protein allergy

The prevalence of cow's milk protein allergy (CMPA) has increased in recent years, and is associated with antimicrobial use during the perinatal period, prematurity, the type of childbirth, and the decrease in breastfeeding. The aim of this study was to analyze whether there is any association between these factors and the development of CMPA. Material and methodsA retrospective, comparative, cross-sectional, observational study was conducted by reviewing the case records of 101 children diagnosed with CMPA and seen at the Department of Gastroenterology and Nutrition of the Instituto Nacional de Pediatría within the time frame of January 2012 and August 2013. The following variables were included: age, sex, weeks of gestation, history of maternal infection and antimicrobial use during the pregnancy, type of delivery, and feeding with human milk, and its duration. Likewise, the case records of 90 children were reviewed as a control group on not having CMPA or any other allergy. The chi-square test was used for proportions, and the Mann-Whitney U test was used for comparing means in the statistical analysis. ResultsThe factors associated with CMPA were the use of antimicrobials during gestation and breastfeeding duration in months. Both factors were statistically significant (P<.001). No association was found between CMPA and gestational age or type of delivery. ConclusionsThe statistically significant associated factors were breastfeeding duration and the use of antimicrobials during the gestational stage. These results underline the necessity for prospective studies.

Adherence to recommendations to reduce the risk of Sudden infant Death Syndrome

Recommendations for Sudden Infant Death Syndrome (SIDS) are available, although it is uncertain the degree of adherence to these measures. The aim of the study is to assess the adherence to recommendations to reduce the risk of SIDS, seeking factors associated to the noncompliance with these recommendations. 468 infants were enrolled in two maternity hospitals, one public and one private. Postpartum and 4-month assessments were performed. A questionnaire was used adapting a model validated by the International Child Care Practices Study. Adherence to obstetric recommendations was higher (75.4%) than to pediatric recommendations (53.3%). Regarding pediatric recommendations, a compliance decrease was detected after 4 months. Follow-ups showed decrease in breastfeeding (p < 0.001 84.9% vs 48.6%) and supine position (61.2% vs 21.2%, p < 0.001). The decreased adherence to recommendations for SIDS prevention was mainly observed in younger and less educated women, who were not in a relationship and living in poor housing quality and crowded environments.

Infant Feeding and Contraceptive Practices Among Adolescents with a High Teen Pregnancy Rate: A 3-Year Retrospective Study

Adolescents consistently demonstrate the lowest rates of breastfeeding among women of reproductive age despite well-documented benefits of breastfeeding. In Amarillo, Texas, a medium-sized community with a perennially high teen pregnancy rate, we sought (1) to determine breastfeedings practices among adolescent females immediately after delivery and again at 6 weeks and (2) to identify contraceptive choices among the same teen population. This was a retrospective chart review focused on adolescents between the ages of 13 and 18 coming to a university-based obstetrical service between January 1, 2006, and December 31, 2008. Data on breastfeeding and contraceptive practices were analyzed. Five hundred forty-three cases were analyzed. At hospital discharge, 59.3% initiated breastfeeding, but this dropped to 22.2% at the 6-week postpartum appointment. Over 27% of all study subjects failed to appear for postpartum evaluation. Multiparity was the only outcome variable associated with failure to initiate breastfeeding. Depot-medroxyprogesterone acetate, the levonorgestrel intrauterine device (IUD), and combination oral contraceptives were the most popular contraceptive choices, but 16% elected to forego any form of contraception at the postpartum visit. Adolescent women living in an area of Texas with a high teen pregnancy rate reported relatively low breastfeeding rates immediately postpartum, with a >50% decrease in breastfeeding in any form by 6 weeks postpartum. A substantial number failed to initiate any form of contraception at the postpartum visit. These findings support the critical need for additional breastfeeding support and contraceptive education in this at-risk adolescent population.

Breast-feeding protects against otitis media.

Although exclusive breast-feeding decreases infant mortality and morbidity in developing countries, its protective effects in infants living in industrialized nations have been more difficult to quantitate. A recent study provides strong evidence that exclusive breast-feeding for at least four months decreases the incidence of otitis media in the first year of life.

Reply: Breast-feeding and allergy

We would once again like to comment the paper by Kull et al. (1), in which the authors suggest that breast-feeding decreases the risk for development of eczema and discuss in general terms that breastfeeding protects against the development of allergy. Our criticism was based on the fact that exclusive breast-feeding for 4 months or more did not reduce the risk for eczema at the age of 4 years [odds ratio (OR) 0.88, not significant) [2]. In order to avoid all possible disease-related modification of exposure, the authors excluded all children who developed eczema or asthma during the period of breastfeeding. By excluding those children who developed symptoms while they were breast-fed and by creating an arbitrary group with ‘‘severe allergic disease’’, the authors found support for a protective role of breast-feeding yielding a slightly lower OR of 0.78. The authors have now replied to our comments (3) by referring to two meta-analyses, one about breastfeeding and asthma (4) and another about breastfeeding and eczema (5). It is well known from several studies that breast-feeding protects against wheezing, at least during infancy. However, the problem is that recurrent wheezing has different phenotypes. The evidence quoted by Kull et al. refers to the non-allergic phenotype. This has also been shown in studies in Sweden by Ronmark et al. (6). In her reply (3) to our initial critical remarks, Kull exemplifies the previous results by pooling asthma and eczema together and makes a point of the fact that there is no statistically significant difference between the association of breast-feeding and eczema whether children with an overlap and exposure are excluded or not. Such secondary analyses are open to critique, particularly in the absence of any power calculations. Non-allergic asthma is particularly common in very small children. By including non-allergic asthmatics, the results become biased when discussing protection against allergy. The fact is that there is little or no support for any major impact of breast-feeding on allergy development. The study by Kull et al. (1) has not contributed novel data on that point. There is a problem with the meta-analysis related to eczema (5) quoted by Kull in that five of the papers providing low odds ratios for childhood eczema to be associated with breast-feeding were conducted by Chandra, whose work has been revealed to be fraudulent (7). Obviously Kull could not possibly have known this at the time of writing her paper, but the fact nevertheless provides further reason for our argument that there is little support for any significant allergy-preventive effect of breast-feeding. We would like to reaffirm our initial statement that preventive measures and information should be based on solid scientific ground, just as other medical therapies and interventions.

The Rise of Breastfeeding in the United States

What factors influenced the resurgence of breastfeeding in the last decades of the twentieth century? This article has considered several explanations. Demographic trends, particularly the increased birth rate among black and Hispanic women, coupled with the resurgence of breastfeeding in these groups, may have contributed to the increase in the breastfeeding rate during the 1990s but likely played a minimal role in the earlier, more dramatic increase. The decrease in breastfeeding in the earlier part of the twentieth century may be partly attributable to increased maternal employment, but the resurgence of breastfeeding occurred during the late twentieth century--a period of unprecedented influx of new mothers into the workforce. There is no evidence that health care practitioners are providing more support for breastfeeding, and most international and US policies postdated the resurgence of breastfeeding, although they may have influenced the increase in the 1990s. A more plausible explanation of the resurgence of breastfeeding in all major segments of society is the pervasive influence of the natural-childbirth movement of the 1960s and 1970s, with its effects on the standard management of childbirth. Also, the increase in breastfeeding among low-income women may be attributable partly to programmatic changes in the provision of supplemental food through the WIC program and the targeting of breastfeeding-promotion efforts to the specific concerns of these women. Although breastfeeding increased at the end of the twentieth century relative to earlier decades, the disparity between the recommended rates and those achieved by US women is great. Thus, efforts to increase breastfeeding initiation and duration should continue, particularly for the groups that are at greatest risk for illness, such as minority and low-income infants. This article suggests that the strategies likely to have a lasting effect on future breastfeeding rates will be social pressures that affect existing barriers to breastfeeding. Such pressures may come from health maintenance organizations, insurance companies, and the US government, which are likely to increasingly recognize the costs of not breastfeeding to their institutions. The provision of flexible work hours and paid maternity leave, either by the US government or family-friendly workplaces, could increase the ability of employed women to optimally feed their infants. As Retsinas noted in an article on the cultural context of breastfeeding, "While it is 'known' that breastfeeding is better, our society is not structured to facilitate that choice." Efforts to improve breastfeeding rates need to make visible the wider cultural context in which infant-feeding choices are made and alter components that make it difficult for US women to feed their infants optimally.

NIDDM and breastfeeding

The study by David Pettitt and co-workers in today's Lancet shows an association between breastfeeding and reduced risk of non-insulin-dependent diabetes mellitus (NIDDM). The relation was consistent by age cohort, by degree of breastfeeding, and by degree of obesity. Prospective randomised controlled studies investigating the relation between breastfeeding and NIDDM could theoretically be piggy-backed onto those underway for insulin-dependent diabetes. However, such studies would need to be extended for several decades since they are being conducted among ethnic groups with much lower prevalences of NIDDM and a higher age at diagnosis than Pimas. In view of the lack of markers with a high positive-predictive value for NIDDM and the length of time needed to complete randomised trials, it is essential that the findings of this new study are put into perspective. Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima IndiansExclusive breastfeeding for the first 2 months of life is associated with a significantly lower rate of NIDDM in Pima Indians. The increase in prevalence of diabetes in some populations may be due to the concomitant decrease in breastfeeding. Full-Text PDF

Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians

Early exposure to cow's milk has been implicated in the occurrence of insulin-dependent diabetes mellitus but there is little information about infant-feeding practices and subsequent non-insulin-dependent diabetes mellitus (NIDDM). We examined the association between breastfeeding and NIDDM in a population with a high prevalence of this disorder, the Pima Indians. Glucose-tolerance status was obtained from a 75 g oral glucose-tolerance test. A standard questionnaire given to mothers was used to classify infant-feeding practices for the first 2 months of life into three groups; exclusively breastfed, some breastfeeding, or exclusively bottlefed. The association between the three infant-feeding groups and NIDDM was analysed by multiple logistic regression. Data were available for 720 Pima Indians aged between 10 and 39 years. 325 people who were exclusively bottlefed had significantly higher age-adjusted and sex-adjusted mean relative weights (146%) than 144 people who were exclusively breastfed (140%) or 251 people who had some breastfeeding (139%) (p = 0.019). People who were exclusively breastfed had significantly lower rates of NIDDM than those who were exclusively bottlefed in all age-groups (age 10-19, 0 of 56 vs 6 [3.6%] of 165; age 20-29, 5 [8.6%] of 58 vs 17 [14.7%] of 116]; age 30-39, 6 [20.0%] of 30 vs 13 [29.6%] of 44). The odds ratio for NIDDM in exclusively breastfed people, compared with those exclusively bottlefed, was 0.41 (95% CI 0.18-0.93) adjusted for age, sex, birthdate, parental diabetes, and birthweight. Exclusive breastfeeding for the first 2 months of life is associated with a significantly lower rate of NIDDM in Pima indians. The increase in prevalence of diabetes in some populations may be due to the concomitant decrease in breastfeeding.

Breast-feeding: time to teach what we preach

To the Editor. —I thank Freed1for his review of our dismal support of breast-feeding. Although I agree with his call for improved education of physicians to solve problems with breast-feeding, I do not feel that physicians will ever "provide effective counseling and support to increase the incidence and duration of breast-feeding." Our involvement in this area should be limited to supporting lactation consultants, lay groups such as the La Leche League, and other community-based programs, especially prenatally, and decreasing interventions that lead to iatrogenic decrease in breast-feeding. Primary care physicians cannot be all things to all people— this is one area we'd be better off leaving to others. The study by Kistin et al2that Freed refers to demonstrated the effect of a 15-minute to 30-minute prenatal visit, concerning breast-feeding issues only, by one of the authors with women prior to the 30th week of gestation. There

The Relationship of Siblings to the Size of Rural Nigerian Preschoolers

Staff from a health education project in Eket village in Cross River State, Nigeria collected 1985-1986 height and weight data from at least 286 preschool children. Results from the 1 way analysis of variance tests revealed that age significantly affected mean weights for age and for height (p.01). For example, between 1 and 2 years of age the weights for age and for height fell substantially due to a decrease in breast feeding and introduction of solid foods. Similarly, birth rank significantly accounted for mean height for age (p=.01) and mean weight for age (p.01). For instance, the mean height for age and mean weight for age fell for 2nd born children. After the 2nd child, they climbed to the point where at the 6th child and greater the means were greater than for the 1st born. Number of children in the household only significantly affected mean weight for age (p=.01). A single child ranked significantly better in weight for age and weight for height than households with 2-6 children. After the 3rd child, however, a steady increase in mean percentile rank occurred with each additional child. In fact, mean percentile weight for age values of all the children in households of 7 or more children were higher than for any other household size. Observations of field staff supported the hypothesis that, in large families, the older children care and nurture the younger siblings and do not have high demands to work in the fields and maintain the households thereby accounting for the superior nutritional status for children in families of 7 or more children. Nevertheless overall nutritional status of 28% of the children were severely malnourished. Further, current nutritional status of 14% were severely malnourished. Moreover 36% ranked as chronically malnourished.

Trends in Infant Feeding in Developing Countries

In recent years, interest in breast-feeding and infant-supplementation practices in the developing world has been growing. Numerous community, regional, and national studies have described the patterns of breast-feeding and, to a lesser extent, of supplementation in a wide range of low-income countries. Nevertheless, adequate documentation of national trends in breast-feeding is available for only a small number of developing countries, and trends in supplementation remain to be described. The apparent decline in breast-feeding in the developing world has been the subject of numerous articles describing the impact of this trend on infant morbidity and mortality, fertility levels, and family finances. Frequently, the examples used to illustrate the decrease in breast-feeding are methedologically flawed; they use nonrepresentative or noncomparable samples, for example, or make implicit assumptions about past breast-feeding practices. In spite of such shortcomings, the consistent reports of important declines appear to indicate that some basic changes are taking place in breast-feeding practices in certain areas of the developing world. The fact that these changes seem to be following the general pattern of breast-feeding decline that occurred at earlier times in developed countries adds to their plausibility. Although a general awareness of changes in lactation in the developing world now prevails, the documentation of this trend is far from complete. Even for those countries in which trends have been appropriately measured, the amount and pattern of change may vary widely from country to country. In most of the countries with information on breast-feeding trends, recent declines have occurred, although the decreases range from sharp to moderate.

Breast-feeding, birth spacing and pregnancy care: prevalence and outcome.

The Maternity Care Monitoring project in Indonesia analyzes the protective triad of: 1) breastfeeding; 2) family planning; and 3) antenatal care. The same data set and the same technique of 3 dimensional display of findings is used as in previous analysis. The 11-university center pool comprises 36802 mothers with singleton birth admitted from autumn 1978 to summer 1980. 7 items were selected from the maternity record: 1) maternal education; 2) maternal age; 3) breastfeeding of the previous live birth; 4) contraceptive method used before the current conception; 5) number of antenatal visits; 6) number of months since last pregnancy ended; and 7) death of fetus/newborn. 33.2% of the mothers had breast fed 12+ months as compared with 54.9% for women for very little education in their early 30s; against only 18.2% for women with a high educational level in their early 20s. At all ages long breastfeeding (12+ months) decreases markedly with formal education and for all educational levels long breastfeeding decreases for younger age cohorts. 15.9% of the mothers had practiced family planning. Practice increases with formal education but a more marked increase in practice is documented with increasing maternal age within the educational categories. The decision to practice is more dependent on age (parity) than on formal education. The mean duration of birth interval was 31.8 months as compared with 23.5 months for women with short breastfeeding (1-5 months) and no contraception against 44.8 months for women with 6-11 months of breastfeeding and use of the IUD--a difference in length of birth interval of 21/3 months: 49.7% of the mothers showed a total lack of pregnancy care. The rate of hospital perinatal death is 76.2/1000 singleton infants. An important threshold of antenatal visits appears to be 4.

1393 THE EFFECTS OF MATERNAL COUNSELLING ON BREASTFEEDING PATTERNS OF HIGH RISK NEONATES

Breast milk has been recommended for feeding high risk neonates due to the psychological, nutritional and immunological advantages of breastfeeding (BF). In order to assess the influence of maternal counselling, we studied the BF pattern of 503 mothers of infants admitted to the neonatal ICU for 2 periods of 6 months prior to and following initiation of counselling. A special group of certified counsellors, who successfully breastfed their own sick neonates, were available by phone to all mothers. With counselling there was a significant increase in the number of mothers who engaged in BF (32/242=13.2% to 92/261=34.8%, p<0.001) and significant decrease in the number of mothers who stopped BF during infant's hospitalization (9/23=39.3% to 8/94=8.5%) (p < 0.001). Duration of BF after hospital discharge was similar pre and post counselling (mean ± SEM 9.8 ± 5.4 vs. 10.1 ± 6.5 months) (NS), and higher than national rates of BF reported for full term infants. Demographic data were comparable for both study groups and showed that BF mothers were predominantly white (95 and 93%), privately insured (87.5 and 78%) and in the age range of 20 to 30 years (98 and 92.5%). The results of this study demonstrate that special counselling can effectively increase the rate of BF among mothers of high risk neonates and that special efforts in counselling mothers of younger ages and lower social economic groups is presently needed.