Differences In Breastfeeding Duration Research Articles

Breastfeeding Experiences in Women from Ten States Reporting Opioid Use Before or During Pregnancy: PRAMS, Phase 8.

Evidence of opioid use at hospital delivery has increased over the past two decades, increasing risk of neonatal withdrawal. Breastfeeding may improve infant outcomes, but little is known about breastfeeding experiences of women who have a history of opioid use prior to or during pregnancy. This study aimed to determine if self-reported opioid use prior to or during pregnancy impacted breastfeeding, specifically attempt to breastfeed, duration of breastfeeding, assessment of prenatal breastfeeding intention, source of breastfeeding information, and early hospital experiences. Data from ten states (n = 10,550) that evaluated opioid use in the 2016 Pregnancy Risk Assessment Monitoring System survey were included. Weighted univariate and multivariate linear and logistic regression were calculated. The multivariate regression also included adjustment for covariates. Among the overall sample, 939 participants reported opioid exposure before or during pregnancy. We found no significant difference in breastfeeding attempt. Breastfeeding for at least 6, 10, or 20 weeks was significantly less likely in participants reporting opioid exposure. Exposure correlated with lower odds of skin-to-skin contact, infant being fed in the first hour, exclusive breastfeeding in the hospital, and feeding on demand. Hospital pacifier use was associated with opioid exposure. While we found no difference in breastfeeding attempt, we did observe significant differences in breastfeeding duration and early hospital experiences which may represent modifiable gaps in clinical practice. Future work should focus on optimizing early hospital experiences and support when breastfeeding is clinically indicated.

Factors Affecting Complementary Feeding of Infants. A Pilot Study Conducted after the Introduction of New Infant Feeding Guidelines in Poland.

Adequate nutrition in the first year of life is the key prerequisite for a child’s healthy growth and development. The success of complementary feeding is influenced by various factors, including the family’s socioeconomic status, maternal age, place of residence and educational level, older children and duration of breastfeeding. Modified infant feeding guidelines were introduced in Poland in 2016. The aim of this study was to identify the factors that exert the greatest influence on infant feeding practices in the Polish population. A thorough understanding of maternal factors that are responsible for undesirable feeding practices is required to improve the mothers’ knowledge and to promote healthy feeding practices. This study was carried out in March–June 2018 and between November 2018 and March 2019 in the Region of Lublin in southeastern Poland. The mothers of children aged 9–14 months, who had introduced complementary foods, were invited to the study. A total of 441 mothers agreed to participate, and 289 of them fully and correctly completed the questionnaires. Logistic regression models were developed to assess the association between maternal factors, such as age, educational level and the nutrition knowledge score, and introduction of solid foods. The infant’s sex and birth weight and the mother’s place of residence had no significant influence on the duration of breastfeeding. The mother’s age and educational level, the number of children in the family and maternal nutrition knowledge scores contributed to significant differences in breastfeeding duration. Older mothers (30–34 years vs. 25–29 years, p = 0.001), better educated mothers (university vs. secondary school education p = 0.002) and mothers with one or two children exclusively breastfed their children for longer (17 weeks vs. 11 weeks, p = 0.002) than younger mothers with secondary school education and more than three children. Exclusive formula feeding was significantly correlated with untimely introduction of solid foods compared to exclusive breastfeeding (13 weeks vs. 19.7 weeks, p = 0.001). Mothers with nutrition knowledge scores in the upper tertile were more likely to adapt food consistency to the skills manifested by the child (88%) (OR = 1.88; Cl: 1.53–2.26, p < 0.05) and were less likely to delay the introduction of new foods that required chewing and biting (84%) (OR = 0.22; Cl: 0.09–0.34, p < 0.05) than mothers with nutrition knowledge scores in the bottom tertile. Maternal age, educational level and nutrition knowledge significantly increased the age at which infants were introduced to solid foods and the correct identification of the signs indicative of the child’s readiness to explore new tastes and foods with a new consistency. The above factors contributed to delayed, but not untimely, introduction of complementary foods (6 months of age or later), including gluten.

Feasibility and Effectiveness of Telelactation Among Rural Breastfeeding Women.

To evaluate the feasibility and impact of telelactation via personal electronic devices on breastfeeding duration and exclusivity among rural women. The Tele-MILC trial, a pragmatic, parallel design trial, recruited 203 women during their postpartum hospitalization in a critical access hospital in Pennsylvania and randomized them to receive telelactation (n = 102) or usual care (n = 101). We used intent-to-treat (ITT) and instrumental variable (IV) approaches to analyze study data for the 187 participants who completed follow-up. The primary outcomes were any breastfeeding and exclusive breastfeeding at 12 weeks postpartum. Among participants in the telelactation arm, 50% (47/94) reported participating in video calls. At 12 weeks, 71% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the ITT model (3% difference, P = .73), whereas 73% of participants in the telelactation arm versus 68% of control participants were breastfeeding in the IV model (5% difference, P = .74). Among participants who were still breastfeeding at 12 weeks, 51% participants in the telelactation arm were breastfeeding exclusively versus 46% of control participants in the ITT model (5% difference, P = .47), whereas 56% of participants in the telelactation arm were breastfeeding exclusively versus 45% of control participants in the IV model (11% difference, P = .48). In all models, participants in the telelactation arm were breastfeeding at higher rates; however, differences were not statistically significant. This trial demonstrated that telelactation can be implemented with a rural underserved population. Though this trial was not powered to detect differences in breastfeeding duration and exclusivity, and none were observed, telelactation remains a promising approach for further investigation. ClinicalTrials.gov Identifier: NCT02870413.

Impact of an Infant Friendly Business Designation

In response to suboptimal breastfeeding rates, North Dakota added a provision to SB 2344 (public indecency legislation) creating an Infant Friendly business designation for employers providing specified lactation accommodations to employees. However, there has been no evaluation of this designation to determine effectiveness. The purpose of this article is to examine the impact of the Infant Friendly business designation in North Dakota on breastfeeding continuation rates within the context of the social ecological model (SEM). Between November 2016 and March 2017, an 85-item online questionnaire, designed using the SEM, was distributed to working women across the state using various sampling methods. T tests, analysis of variance, and regression were used to analyze results. Designated (intervention) and nondesignated (control) businesses were targeted. There was no statistically significant difference in breastfeeding duration between designated and nondesignated businesses. There was a 2-month difference in duration between continually designated businesses and those with lapsing designations. Twenty-eight percent of the women working for Infant Friendly businesses were aware that their businesses were designated, indicating a lack of awareness regarding the designation. The designation is a starting point for worksite breastfeeding support. A policy promotion plan based on the SEM targeting individual awareness and employee education may improve the designation's effectiveness.

The Role of Complementary Feeding Methods on Early Eating Behaviors and Food Neophobia in Toddlers

ABSTRACTBackground: Feeding methods used during infancy may impact upon eating behaviors in toddlers and influence the likelihood of developing weight issues. The aim of this study was to compare eating behaviors and food neophobia (defined as the reluctance to eat, or the avoidance of, new foods) in toddlers between three different complementary feeding (CF) groups; spoon-feeding (SF), baby-led weaning (BLW), and mixed method (MM). The study also aimed to investigate changes in early feeding practices and sociodemographic factors in relation to eating behaviors.Methods: One hundred and sixty-two parents with a child aged 12–48 months completed a questionnaire through online parenting forums and via Children's Centers. Parents reported their CF method at the point of introduction to complementary foods, the child's age when this occurred and the feeding method at one year along with breastfeeding duration. Toddler eating behaviors were measured using the Child Eating Behavior Questionnaire and the Child Food Neophobia Scale. The questionnaire also examined sociodemographic measures.Results: No significant differences were found in any measured eating behaviors or neophobia between CF groups. There were significant differences in breastfeeding duration, exclusive breastfeeding for 6 months, timing of CF, gestational age and weight at birth between CF groups. CF method changed at one year such that more people moved to a MM approach of feeding.Conclusions: CF method does not appear to influence toddler neophobia, and relationships between breastfeeding and BLW and later introduction of CF are further confirmed. Furthermore, it appears that individuals that do not undertake BLW at the onset of CF are rarely undertaking it at one year. This research implies that early CF methods do not influence eating habits during toddlerhood. Further work is required to educate parents on the benefits of progressing infants to complementary food by one year.

The effectiveness of a sustained nurse home visiting intervention for Aboriginal infants compared with non-Aboriginal infants and with Aboriginal infants receiving usual child health care: a quasi-experimental trial - the Bulundidi Gudaga study

BackgroundIn Australia there is commitment to developing interventions that will ‘Close the Gap’ between the health and welfare of Indigenous and non-Indigenous Australians and recognition that early childhood interventions offer the greatest potential for long term change. Nurse led sustained home visiting programs are considered an effective way to deliver a health and parenting service, however there is little international or Australian evidence that demonstrates the effectiveness of these programs for Aboriginal infants. This protocol describes the Bulundidi Gudaga Study, a quasi-experimental design, comparing three cohorts of families from the Macarthur region in south western Sydney to explore the effectiveness of the Maternal Early Childhood Sustained Home-visiting (MECSH) program for Aboriginal families.MethodsMothers were recruited when booking into the local hospital for perinatal care and families are followed up until child is age 4 years. Participants are from three distinct cohorts: Aboriginal MECSH intervention cohort (Group A), Non-Aboriginal MECSH intervention cohort (Group B) and Aboriginal non-intervention cohort (Group C). Eligible mothers were those identified as at risk during the Safe Start assessment conducted by antenatal clinic midwives. Mothers in Group A were eligible if they were pregnant with an Aboriginal infant. Mothers in Group B were eligible if they were pregnant with a non-Aboriginal infant. Mothers in Group C are part of the Gudaga descriptive cohort study and were recruited between October 2005 and May 2007. The difference in duration of breastfeeding, child body mass index, and child development outcomes at 18 months and 4 years of age will be measured as primary outcomes. We will also evaluate the intervention effect on secondary measures including: child dental health; the way the program is received; patterns of child health and illness; patterns of maternal health, health knowledge and behaviours; family and environmental conditions; and service usage for mothers and families.DiscussionInvolving local Aboriginal research and intervention staff and investing in established relationships between the research team and the local Aboriginal community is enabling this study to generate evidence regarding the effectiveness of interventions that are feasible to implement and sustainable in the context of Aboriginal communities and local service systems.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12616001721493 Registered 14 Dec 2016. Retrospectively registered.

What promotes and hinders success in breastfeeding in hospital care? – the role of social support and anxiety

BackgroundHospital stay is associated with difficult circumstances, which may be accompanied by anxiety. Difficulty with initiation and continuation of breastfeeding may be commonly experienced in the hospital. Observed difficulties can be modified by sharing knowledge and involvement of midwives in the care of mothers and newborns. Breastfeeding is considered to be the ideal choice of nutrition and infant’s feeding, providing many benefits both for infants and their mothers. The aim of the study is to explore the role of the quality of breastfeeding assistance during delivery hospitalization and maternal anxiety for overall breastfeeding duration.Participants and procedureThe study included 858 women after labor from intentionally selected hospitals of Pomerania, discharged from hospital up to 15 days after birth. We used a questionnaire to collect data on the nursing assistance and the process of breastfeeding during patients’ stay in a hospital. In addition, we applied the State-Trait Anxiety Inventory (STAI) to measure the levels of state and trait anxiety.ResultsThe results showed a significant relationship between the level of maternal postpartum anxiety and duration of breastfeeding. Mothers (mostly after physiological labor) reported a significantly lower level of state anxiety in hospitals titled Baby Friendly. Additionally, a significant difference in breastfeeding duration depending on the hospital and mothers’ perception of receiving support from midwives was found.ConclusionsIt is reasonable to continue the activities increasing standards of medical personnel support and raising the midwives’ and mothers’ awareness of the importance of anxiety for breastfeeding duration.

Efficacy of Six-Week Extended-Dose Nevirapine Varies by Infant Birth Weight with Greatest Relative Efficacy in Low Birth Weight Infants.

Latest World Health Organization guidelines recommend weight-based nevirapine prophylaxis for all HIV-exposed infants in resource-limited settings, yet low birth weight (LBW) infants (< 2500 g) have been understudied. Using data from the NIH-funded India six-week extended-dose nevirapine (SWEN) study, a randomized clinical trial of SWEN versus single-dose nevirapine (SD) for prevention of breast-milk HIV-1 transmission, we examined the relative impact of SWEN among 737 mother-infant pairs stratified by infant birth weight. Birth weight groups were defined as very LBW (VLBW) ≤ 2000 g, moderate LBW (MLBW) >2000 g and ≤ 2500 g, and normal birth weight (NBW) > 2500 g. Outcomes were HIV-1 infection, HIV-1 infection or death by 12 months, and severe adverse events (SAEs). The Kaplan-Meier method was used to estimate probability of efficacy outcomes in birth weight groups, and differential effects of SWEN by birth weight group were examined using Cox proportional hazards models adjusting for independent risk factors for HIV maternal-to-child transmission and significant covariates. Among 50 VLBW, 249 MLBW, and 433 NBW infants, 50% were randomized to SWEN; median gestational age was 36, 38 and 38 weeks, respectively; and there was no difference in breastfeeding duration (p = 0.99). Compared to SD: SWEN-treated VLBW had lower estimates of HIV-1 infection (13% vs. 38%, p = 0.004) and HIV-1 infection or death (13% vs. 41%, p = 0.002); SWEN-treated MLBW had lower estimated HIV-1 infection (13% vs. 17%, p = 0.042); and efficacy endpoints were similar by treatment arm in NBW. In multivariate analysis, SWEN was associated with reduced risk of HIV-1 infection or death by 83% (p = 0.03) in VLBW versus 45% (p = 0.05) in MLBW. SAE frequency was similar by treatment arm in VLBW (68% vs. 76%, p = 0.53) and MLBW (37% vs. 36%, p = 0.93). SWEN may safely increase HIV-free survival among HIV-exposed LBW infants with greatest protective advantage among infants ≤ 2000 g.

Association between levels of persistent organic pollutants in adipose tissue and cryptorchidism in early childhood: a case-control study.

BackgroundCongenital cryptorchidism, i.e. failure of the testicular descent to the bottom of the scrotum, is a common birth defect. The evidence from epidemiological, wildlife, and animal studies suggests that exposure to mixtures of endocrine disrupting chemicals during fetal development may play a role in its pathogenesis. We aimed to assess the association between cryptorchidism and prenatal exposure to polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), and polybrominated diphenyl ethers (PBDEs).MethodsWe conducted a case–control study consisting of 44 cryptorchid cases, and 38 controls operated for inguinal hernia, umbilical hernia, or hydrocele at the Turku University Hospital or Rigshospitalet, Copenhagen in 2002–2006. During the operation a subcutaneous adipose tissue biopsy was taken. Samples were analysed for 37 PCBs, 17 PCDD/Fs and 14 PBDEs by gas chromatography-high-resolution mass spectrometry. Chemical concentrations were adjusted for postnatal variation introduced by differences in duration of breastfeeding, age at the operation, and country of origin with a multiple linear regression. Association between adjusted and unadjusted chemical concentrations and the risk of cryptorchidism were analysed with logistic regression to get an estimate for odds ratio (OR) of cryptorchidism per multiplication of chemical concentrations with ca. 2.71 (Napier’s constant).ResultsTotal-TEq i.e. the WHO-recommended 2,3,7,8-TCDD equivalent quantity of 17 dioxins and 12 dioxin-like PCBs and sum of PCDD/Fs were positively associated with cryptorchidism [OR 3.21 (95 % CI 1.29–9.09), OR 3.69 (95 % CI 1.45–10.9), respectively], when adjusting for country of origin, the duration the child was breastfed, and age at operation. The association between the sum of PCBs and cryptorchidism was close to significant [OR 1.92 (95 % CI 0.98–4.01)], whereas the association between the sum of PBDEs and cryptorchidism was not [OR 0.86 (95 % CI 0.47–1.54)]. There were no associations between unadjusted chemical concentrations and the risk of cryptorchidism.ConclusionsPrenatal exposure to PCDD/Fs and PCDD/F-like PCBs may be associated with increased risk for cryptorchidism. Our finding does not exclude the possibility of an association between the exposure to PBDEs and cryptorchidism.Electronic supplementary materialThe online version of this article (doi:10.1186/s12940-015-0065-0) contains supplementary material, which is available to authorized users.

Does Maternal Mental Health Affect Initiation, Exclusivity, and Duration of Breastfeeding? [140

INTRODUCTION: Up to 30% of women experience postpartum depression, anxiety, or both. The effect of such maternal mental health issues on breastfeeding is poorly understood. Our objective was to examine relationships between maternal mental health and breastfeeding initiation, exclusivity, and duration. METHODS: This was a cross-sectional study of families with children aged 12 months and younger using the 2011 National Survey of Children's Health (10,024 children). We used logistic and linear regression models to measure associations between self-reported maternal mental health (poor or fair, good, very good, excellent) and ever breastfeeding, exclusive breastfeeding for 6 months, and duration of any breastfeeding. We controlled for maternal (physical health, age, household, smoker, primary language, single mother, parental stress), child (prematurity, race, sex), and socioeconomic (child insured, poverty level, Women, Infants, and Children [WIC]) factors that may affect breastfeeding. RESULTS: Eighty-three percent (95% confidence interval [CI] 81.3–84.5) of children were ever breastfeed of whom 17.4% (95% CI 15.2–19.5) were exclusively breastfed for 6 months. Average duration was 5.6 months (95% CI 5.4–5.8). After adjusting for covariates, the odds of ever breastfeeding were 0.31 lower among mothers reporting poor or fair mental health compared with mothers reporting excellent mental health (95% CI 0.00–0.74, P=.003). The odds of exclusive breastfeeding were not significantly different (OR 0.47, 95% confidence interval 0.00–1.50, P=.28). There was no significant difference in duration of breastfeeding by maternal mental health (P=.78). CONCLUSION AND IMPLICATION: Breastfeeding initiation was strongly associated with maternal mental health, whereas exclusive breastfeeding and duration were not. These findings suggest that breastfeeding may be of good duration if initiation could be improved, indicating a potential role for targeted breastfeeding support for women with mental health concerns.

Determination of The Primary Reasons For Overweight and Obesity Among First Grade Elementary School Students in Shiraz During The Academic Year 2010-2011

Background: The epidemic peak of obesity and overweight began in 1980. Obesity during childhood and adolescence, particularly in the second decade of life, is a strong predictor of obesity in adulthood. The significant risk factors for obesity and overweight in childhood include breastfeeding, obese parents, socioeconomic status, birth weight, physical activities and diet. Breastfeeding is one of the most important strategies for weight loss and reduction in childhood obesity. Objectives: The purpose of this study is to investigate the relationship between overweight, obesity, breastfeeding patterns and birth weight among first grade elementary school students in Shiraz, Iran. Patients and Methods: This case-control study included 200 obese (case group) and 200 normal weight (control group) children. A sample size of 400 children was determined. Study participants were selected from among elementary schools in Shiraz by multistage sampling. First, schools were chosen according to a stratified random sampling method. Then, we chose all overweight or obese first grade students. For each case, we chose a control student matched in terms of age, sex, grade and elementary school. The General Information Questionnaire, Socioeconomic Questionnaire, Questionnaire of Breastfeeding during Infancy, Physical Activity Questionnaire and 24-Hour Dietary Recall Questionnaire were completed. Mothers’ height and weight were also measured. Data analysis was carried out by SPSSversion 15. Conclusion : Obesity and overweight in first grade elementary school students is related to breastfeeding pattern; however, this may not be an independent relationship. Results: There was a significant difference in breastfeeding duration between the case and control groups. No relationship was found among birth weight, overweight and obesity in the case group. Mother’s body mass index (BMI) and obesity in immediate family members showed a significant difference between case and control groups. There was no significant difference in the socioeconomic status of the two groups. Conclusion: Obesity and overweight in first grade elementary school students is related to breastfeeding pattern; however, this may not be an independant relationship.

The Effect of Early Postpartum Home Visits by Health Visitors: A Natural Experiment

The purpose of this study was to assess if the absence of early home visits influenced the mothers' breastfeeding duration and use of medical services. Data from mothers who had given birth during a strike period were compared with data from a reference period with usual work practice. The study included 3,834 newborn and 375 health visitors, 75 of whom worked during the strike period. All families were offered nonstandardized home visits after discharge in the reference period. During the strike, the service was based on individual risk assessment. Overall, no difference in breastfeeding duration between the two periods was seen, but unvisited mothers in the strike period had shorter durations of full breastfeeding than a comparable group of mothers in the reference period (p<.005). Moreover, mothers in the strike period reported a significantly higher use of medical services. The mothers' needs for postnatal visits differed depending on parity: primiparae underlined uncertainty, multiparae underlined previous breastfeeding experience. Mothers had missed out on guidance on all areas of the health visitors' service. Nonstandardized home visits by health visitors were associated with a longer breastfeeding duration. The postnatal visits depended on parity and unmet needs increased the use of medical services.

Body image concerns and reduced breastfeeding duration in primiparous overweight and obese women

To test differences in breastfeeding duration by prepregnant maternal weight status, and determine whether body image concerns mediate any differences. A prospective longitudinal cohort of primiparous women was followed from pregnancy to, at minimum, 6 months postpartum. Questionnaire responses on body concerns were obtained during pregnancy and at 4 months postpartum. Kaplan-Meier curves compared breastfeeding duration in overweight/obese and normal weight groups. Cox proportional hazard regression was used to determine whether body image variables mediated the relationship between maternal weight and duration. Although intended duration was similar between groups, overweight/obese women had a shorter median duration of any breastfeeding (38.6 weeks) compared to normal weight women (48.9 weeks) (P < 0.01) and they experienced higher risk of breastfeeding cessation over the entire first year postpartum [hazard risk (HR) = 1.43; confidence interval (CI) = 1.02-2.01; P < 0.05]. Overweight/obese women reported lack of body comfort/confidence postpartum more frequently than normal BMI women (P < 0.01). Lack of body comfort/confidence postpartum was negatively associated with duration after adjusting for maternal BMI (P = 0.01). Thus, the effect of BMI on duration was reduced by this variable (HR = 1.31; CI = 0.93, 1.86; P = 0.13), suggesting mediation. Women with high prepregnant BMI have reduced lactation duration that is mediated by lack of comfort/confidence with one's body. Further research into the interplay between body image, weight status, and breastfeeding outcomes may point to behavioral targets amenable to intervention and modification that may in turn improve breastfeeding outcomes for overweight/obese women and their infants.

Commentary: breastfeeding and obesity--the 2011 Scorecard

Commentary: breastfeeding and obesity--the 2011 Scorecard

Racial/Ethnic Differences in Breastfeeding Duration among WIC-Eligible Families

Purpose This research documented racial/ethnic differences in breastfeeding duration among mothers from seven diverse racial/ethnic groups in rural and urban areas of the United States that initiated breastfeeding among income and categorically eligible WIC participants. Methods Using data from the Longitudinal 9-Month–Preschool Restricted-Use data file of the Early Childhood Longitudinal Study–Birth Cohort, this research first assessed racial/ethnic differences in breastfeeding initiation and duration, maternal and child health characteristics, social service usage, and sociodemographic characteristics. Next, breastfeeding survivorship and Cox proportional hazards models were estimated to assess potential racial/ethnic disparities in breastfeeding duration once these control variables were accounted for in multiple variable models. Findings Breastfeeding initiation rates and breastfeeding durations of 6 months were lower among WIC-eligible mothers compared with all mothers. WIC-eligible, foreign-born Mexican-Origin Hispanic (FBMOH) mothers were most likely to breastfeed for 6 months. Breastfeeding duration rates dropped quickly after 4 months of duration among WIC-eligible mothers that initiated. Two crossover patterns in breastfeeding durations were noted among 1) FBMOH and non-Hispanic Black mothers and 2) Asian and Native American mothers. A FBMOH breastfeeding duration advantage was noted compared with non-Hispanic White mothers once all control variables were included in the Cox proportional hazard models. No other racial/ethnic disparities in breastfeeding duration were noted. Conclusion More attention to educational programs and broad forms of support as part of WIC are needed to help reach the breastfeeding duration goals of Healthy People 2010 and continued support of the Loving Support Peer Counseling Program may serve as an ideal policy for local WIC offices.

The effect of maternal obesity on initiation and duration of breast-feeding in Greece: the GENESIS study

The current paper aims to describe the characteristics of mothers failing to initiate breast-feeding, provide information on the factors contributing to longer duration of breast-feeding and identify the association of maternal obesity with both initiation and duration of breast-feeding in the Greek population. Data from the cross-sectional GENESIS (Growth, Exercise and Nutrition Epidemiological Study In preSchoolers) study were used. Mothers were categorized by their pre-pregnancy BMI and their gestational weight gain according to guidelines from the Institute of Medicine. Preschool children aged 1-5 years in five counties in Greece. Preschoolers (n 2374) with full maternal anthropometric data before and during pregnancy and breast-feeding data. A higher percentage of mothers with increased pre-pregnancy BMI or high gestational weight gain failed to initiate breast-feeding compared with their normal-weight counterparts. Obese mothers were 2.86 times more likely to fail in initiating breast-feeding in a multiple logistic regression model. Multiple linear regression analysis showed that among women initiating breast-feeding, those who were either underweight before pregnancy or smoked at the third trimester of pregnancy breast-fed their children for about 1.5 weeks less than their normal-weight or non-smoking counterparts, respectively. Similarly, multiparous women breast-fed their children for about 7 weeks less than uniparous women. In women who initiated breast-feeding, no significant differences in breast-feeding duration were found between women of different gestational weight gains. Mothers with high pre-pregnancy BMI are less likely to initiate breast-feeding while high gestational weight gain has no effect on either the initiation or duration of breast-feeding in Greece.

Fat intake and metabolism in Swedish and Italian infants

The purpose of the study was to compare fat intake and metabolism between two infant populations from Sweden and Italy given breast milk or similar infant formulas, but different weaning foods. Nutrient intake and fat metabolism were studied prospectively from 3–12 mo in 68 Swedish and 46 Italian healthy infants, breastfed or given similar infant formulas in combination with Swedish or Mediterranean weaning foods. Although nutrient intake and fat metabolism were similar at 6 mo, fat intake was lower at 12 mo in the Italian than in the Swedish formula group (p < 0.001). At 6 and 12 mo, higher dietary ratios of monounsaturated to saturated fatty acids (p < 0.01 and p < 0.001, respectively), and monounsaturated to polyunsaturated fatty acids (p < 0.05, p < 0.001) were found in the Italian than in the Swedish formula group. Total cholesterol and apolipoprotein B were lower at 6 mo (p < 0.01) in Italian breastfed infants than in Swedish ones. Lower concentrations at 6 and 12 mo of total cholesterol (p < 0.05, p < 0.05, respectively), apolipoprotein B (p < 0.05, p<0.01) and triglycerides (p< 0.001, p<0.01), and of apolipoprotein A1 (p < 0.01) at 12 mo, were found in the Italian formula group than in the Swedish one. In conclusion, plasma total cholesterol, apolipoprotein B and triglycerides were found to be lower in Italian infants than in Swedish infants during the second half of infancy. These findings may partly result from differences in fat compositions between Swedish and Mediterranean weaning diets and in total fat intake in late infancy. Differences in duration of breastfeeding and possibly in breast milk composition may also have influenced our results.

Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level?

Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National Level?

22 Breastfeeding Across Geographical Areas in Italy

Objective. To evaluate and compare the rates of initiation and duration of breastfeeding across geographical areas of Italy. Methods. A total of 2450 mothers, who delivered a healthy full term infant in Italy, were interviewed through the first 12 months after delivery about feeding practices. Breastfeeding was classified in accordance with the World Health Organization (WHO). Adherence to the WHO ten steps to successful breastfeeding was further assessed. Chi-square and log-rank tests, logistic and Cox regressions were used for the statistical analysis. Results. Breastfeeding started in 91% of mothers, ranging from 85% (Sicilia) to 93% (North-east, South). At discharge the rate of exclusive breastfeeding was 77%, ranging from 57% (Sicilia) to 81% (North-east, Sardinia). Mean duration of breastfeeding ranged from 3.1 (Sicilia) to 6.0 months (Sardinia). Mean duration of exclusive breastfeeding ranged from 1.8 (Sicilia) to 2.6 months (North-east and Sardinia). Lower adherence to the WHO steps and less favorable socio-demographic characteristics, especially maternal lower education level, smoking habits and overweight, influenced negatively both breastfeeding and exclusive breastfeeding. Conclusion. Differences in duration of breastfeeding and exclusive breastfeeding across geographical areas of Italy require planning of strategies for improvement, possibly taking into account for the WHO steps and socio-demographic characteristics.

Avaliação da Ação de Vigilância à Morbi-mortalidade Infantil na periferia de Belo Horizonte, Minas Gerais

OBJETIVOS: avaliar a Ação de Vigilância à Morbi-mortalidade Infantil no Centro de Saúde (CS) São Marcos e verificar a associação entre critérios de risco - baixo peso ao nascer (RNBP), mães não escolarizadas e/ou adolescentes - e variáveis como crescimento e aleitamento materno. MÉTODOS: estudo analítico tipo coorte prospectivo. Os recém-nascidos (RN) de risco, nascidos entre janeiro de 1996 a dezembro de 1998, foram observados quanto à utilização do CS após busca ativa, comparando-os com controles. Após 12 meses, verificou-se a sua evolução em relação ao crescimento e duração da amamentação. RESULTADOS: foram identificados 199 RN de risco, os quais apresentaram maior procura do CS. Foram acompanhados 131 riscos e 88 controles. Não houve diferença da duração da amamentação entre os grupos. Ao final do acompanhamento, os RNBP apresentavam menores pesos e comprimentos.(p &lt;0,01). Registraram-se 17 óbitos, a maioria neonatal. O risco relativo de óbito para os RNBP no primeiro ano foi 69,81. CONCLUSÕES: a Ação de Vigilância à Morbi-Mortalidade Infantil representou avanço ao implementar estratégias de identificação, captação e acompanhamento de crianças de risco. Todavia, os esforços devem buscar atuação mais precoce e ampla, principalmente para os RNBP.