Duration Of Breastfeeding Research Articles

Effect of Mobile-Based Counselling on Breastfeeding in Spain: A Randomized Controlled Trial Protocol (COMLACT Study).

The primary aim of this study is to determine the influence of an intervention in women based on a free mobile application (LactApp®, Barcelona, Spain) in maintaining breastfeeding (BF) up to 6 months postpartum. The secondary aim is to assess the effect of health literacy (HL) on breastfeeding duration. A multicenter, randomized controlled clinical trial of parallel groups will be carried out. Women will be randomly assigned to each of the parallel groups. In the control group, usual clinical practice will be followed from the third trimester of pregnancy to promote BF. In the intervention group, and in addition to usual clinical practice, the women will use a free mobile application (LactApp®) from the third trimester to 6 months postpartum. The type of BF at birth, at 15 days and at 3 and 6 months postpartum and the causes of cessation of BF in both groups will be monitored. The hypothesis will be tested using inferential analysis, considering an alpha of 5%. The study protocol was approved by the Clinical Research Ethics Committee of Hospital de la Ribera (Alzira, Valencia, Spain) in February 2021. A per protocol analysis and an intention-to-treat analysis will be performed. This study will identify the influence of a mobile application on improving BF rates. If the application proves effective, we will have a tool with free information available to any user at any time of day, which may be complemented by normal clinical practice and be integrated into our health care system. ClinicalTrials.gov ID: NCT05432700.

Evaluation of the Relationship Between Duration of Breast Feeding, Use of Pacifier, Bottle-feeding and Early Childhood Caries

Amaç: Bu çalışmada amaç 3-5 yaş arası çocukların, anne sütü alma süresi, emzik ve biberon kullanım süresi, doğum şekli, çocuğun diş fırçalama alışkanlığı ve ailenin sosyoekonomik durumu ile erken çocukluk çağı çürüğü (EÇÇ) arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem: Kliniğimize başvuran 3-5 yaş aralığında süt dentisyon dönemindeki çocukların doğum şekli, anne sütü alma süresi ve dönemi, emzik ve biberon kullanımı, diş hekimi ziyareti ve çocuğun diş fırçalama sıklığı ebeveynlere yapılan anketler ile kaydedilmiş; ağız muayenesi ile de dmft değerleri belirlenmiştir. EÇÇ görülme riskine etki eden bağımsız değişkenlerin incelenmesinde Binary Lojistik Regresyon analizi kullanılmıştır. Bulgular: Modeller çok değişkenli olarak incelendiğinde, 18- 36 ay biberon kullananlarda EÇÇ görülme riski daha yüksektir (p=0.027). Diş fırçalama sayısı arttıkça EÇÇ görülme riski azalmaktadır (p<0.05). Anne sütü alım süresi ve emzik kullanımı ile EÇÇ riskinin artması arasında anlamlı farklılık gözlenmemiştir (p>0.05). Sezaryen ve vajinal doğum yapanlar arasında EÇÇ değerleri arasında anlamlı farklılık izlenmemiştir (p>0.05). Sonuç: Uzun süreli anne sütü ve emzik kullanımının erken çocukluk çağı çürüğü riskini artırmadığı söylenebilir; ancak biberonun uzun süreli kullanımına dikkat edilmelidir. Bununla birlikte annelerin emzirme dönemlerinde çocukların düzenli diş fırçalama ve ağız hijyeni konularına özen göstermeleri EÇÇ oluşma riskini azaltacaktır.

Practices and Policies That Support Breastfeeding Among Military Women: A Systematic Review.

Previous and limited assessments of breastfeeding in women serving on active duty in the U.S. military demonstrate varied and conflicting data regarding breastfeeding outcomes. Disparities exist within the military where enlisted service members have consistently lower rates of breastfeeding duration compared to officers. Yet, little is known about successful care practices and military policies that promote breastfeeding in military women. The aim of this systematic review is to examine care practices and military policies associated with increased breastfeeding initiation and duration among women serving in the U.S. military. We searched Cochrane Database, Cumulative Index of Nursing and Allied Health Literature, PubMed, and PsycInfo for studies published from 2000 to 2022 that included U.S. military personnel and that focused on care practices and military policies that support breastfeeding. Our search terms included (breastfeeding OR breastfeed AND military) and (lactation OR lactating AND military). We included randomized controlled trials, quasi-experimental, cohort, cross-sectional, and other observational designs. We evaluated potential bias in studies using the Evidence Project Risk of Bias Tool and synthesized the overall evidence using the Johns Hopkins Nursing Evidence-Based Practice Synthesis and Recommendations Tool. We included 14 studies that were independently reviewed by two authors. Breastfeeding initiation rates among military women were between 66% and 98%, and breastfeeding duration rates at 6 months ranged from 13% to 62%. In these studies, researchers examined various inpatient care practices (skin-to-skin care, timing of circumcision, and infant baths) (n = 3), care delivered by different types of providers (n = 3), group versus individual prenatal care (n = 2), breastfeeding education (n = 2), length of maternity leave (n = 2), and workplace support (n = 2). Skin-to-skin contact following delivery was positively associated with breastfeeding outcomes. There is insufficient evidence to determine if care by different types of medical providers, different types of prenatal care and education, timing of circumcision or baths, length of maternity leave, and workplace support influence breastfeeding outcomes. Certain perinatal practices designed to encourage early skin-to-skin contact appear to improve breastfeeding initiation and duration among women serving in the U.S. military. However, there is an overall lack of quality evidence supporting effective practices and policies associated with increased breastfeeding initiation and duration in this population. Given the recent movement toward policy changes that support pregnant and postpartum service members across services, more research is needed to determine the impact of these and other practices and policies on breastfeeding rates, specifically among enlisted service members who have demonstrated lower breastfeeding rates than officers.

The Association of Maternal Smoking and Drinking Changes During Pregnancy and Postpartum Breastfeeding Pattern and Duration.

Objectives: To conduct a secondary data analysis of how changes in smoking and drinking during pregnancy impact status of any breastfeeding and breastfeeding duration in a national cohort. Materials and Methods: A cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System (PRAMS) data between 2009 and 2017 (n = 334,203). Univariate and multivariate analyses were conducted on the status of any breastfeeding and breastfeeding duration. Results: A dose-dependent inverse relationship was found in which women who smoked the same or more or resumed smoking during pregnancy showed the lowest likelihood and shortest duration of breastfeeding, followed by reduced smokers, quitters, and nonsmokers. Women with a history of alcohol use were significantly more likely to breastfeed compared with women without a history of alcohol use. Conclusions: The profile of smoking change during pregnancy impacts the likelihood and duration of breastfeeding in a dose-dependent and inverse manner. No such relationship was found with drinking change during pregnancy. Public Health Implications: Significant public health efforts should focus on implementing and sustaining evidence-based interventions for prenatal smoking cessation and educating providers and maternal populations on the adverse effect of postpartum alcohol exposure.

Factors associated with syndemic anemia and stunting among children in Myanmar: A cross-sectional study from a positive deviance approach

BackgroundAnemia and stunting in children are detrimental to the prospects of a normal, healthy upbringing. Having similar risk factors and serious consequences, the syndemic aspect of these two ailments is mostly underrated, and positive deviant (PD) factors that ensure non-anemic status in stunted children have not been studied to date. MethodsThis study aimed to identify PD factors that have potential to prevent syndemic anemia among stunted children aged 6–59 months in Myanmar. This was a cross-sectional secondary analysis of the Myanmar Demographic and Health Survey (DHS) data conducted in 2016, applying the PD concept, where children who were stunted without anemia were considered as PDs. ResultsAmong 1248 stunted children, those who had the syndemic condition were compared with their PD peers in terms of maternal characteristics as well as socioeconomic and health-related factors. Multivariable logistic regression analyses were used to identify the determinants of syndemic state. The results showed that three out of every five stunted children were anemic. The syndemic risk was decreased among children of maternal age groups 20–34 years and 35–44 years: [aOR] = 0.19, 95% CI = 0.05–0.69; p = 0.012, and aOR = 0.19, 95% CI = 0.05–0.75; p = 0.018, respectively. Moderately stunted children (aOR = 0.53, 95% CI = 0.34–0.81; p = 0.004) and children who were not currently breastfed (aOR = 1.56, 95% CI = 1.01–2.41; p = 0.044) were less likely to develop the syndemic condition. ConclusionMaternal age, stunting severity, breastfeeding duration, and maternal anemic status are strong predictors in determining hemoglobin concentrations among stunted children. This study suggests that nutritional interventions targeting PD factors could represent syndemic action in improving child health.

The effect of paid parental leave on breastfeeding, parental health and behavior

Little is known about the effects of paid parental leave (in particular fathers’ quotas) on parental health and involvement. In this paper, we exploit a reform that took place in the Canadian province of Quebec to address that important topic. In 2006, Quebec opted out of the federal plan and established its own parental insurance plan, named the Quebec Parental Insurance Plan (QPIP). This program has lowered the eligibility criteria, increased income replacement and introduced fathers’ quotas. Using three data sets, we investigate the impact of the QPIP on breastfeeding and parental health and behavior. Our results show that the reform increased breastfeeding duration. The results also suggest that the policy had limited positive effects on parental health and parenting practices.

Formula feeding and associated factors among mothers with infants 0-6 months old in Mettu Town, Southwest Ethiopia.

Adequate nutrition during infancy is essential for children's normal development and well-being. However, the duration of breastfeeding has been declining and is being replaced by formula feeding, particularly in the urban communities of developing countries, including Ethiopia. Hence, this study aimed to assess formula feeding and its associated factors, as relatively little information is available regarding this problem in Ethiopia, particularly in Mettu Town. A community-based cross-sectional study was conducted in Mettu Town from May 17 to July 1, 2021, among 366 mothers with infants 0-6 months old. A simple random sampling technique was used in this study. Pre-tested semi-structured questionnaires were used to collect the data. Descriptive statistics and multivariable logistic regression were performed, and variables with a p-value <0.05 in the final model were declared statistically significant with formula feeding found to be 28.4% [95% CI: (24.0-33.0)]. Primiparity [AOR = 3.27, 95% CI: (1.71-6.27)], cesarean delivery [AOR = 2.62, 95% CI: (1.28-5.35)], initiation of breastfeeding after 24 h [AOR = 3.5, 95% CI: (1.74-10.0)], employed mothers [AOR = 2.4, 95% CI: (1.29-4.19)], positive attitude toward formula feeding [AOR = 2.4, 95% CI: (1.29-4.19)], and poor knowledge of formula feeding [AOR = 2.6, 95% CI (1.49-4.74)] were factors significantly associated with formula feeding. Almost one-third of the mothers were formula feeding their infants. Primiparity, maternal employment, initiation of breast milk after 24 h, cesarean delivery, poor maternal knowledge, and positive attitude toward formula feeding were among the contributing factors to this high formula-feeding practice. Hence, much effort should be invested in educating pregnant and lactating mothers to improve their knowledge of formula feeding while working on activities that change their attitude toward formula feeding.

Pregnancy Intention and Breastfeeding Behaviors in Virginia: A Secondary Analysis of PRAMS Data

Background:Unintended pregnancy has been linked to adverse outcomes for the mother–baby dyad. The literature on the association between pregnancy intention and breastfeeding is inconsistent. This project aims to use pregnancy intention as a proxy for breastfeeding intention to determine the relationship between pregnancy intention and breastfeeding behaviors among postpartum women in Virginia.Methods:Participants were drawn from the Virginia Pregnancy Risk Assessment Monitoring System Phase 8 (2018–2019) dataset (N= 1,765). The population of interest was women who had recently given birth to a live infant during the surveillance year. Descriptive analyses were carried out, followed by bivariate analyses, to assess the correlation between pregnancy and breastfeeding initiation and duration. Multivariate logistic regressions were run to evaluate the probability of initiating breastfeeding and breastfeeding duration using pregnancy intention status.Results:Factors significantly associated with breastfeeding initiation were having a normal body mass index (BMI; OR 2.02; 95% CI: 1.08–3.77), being a nonsmoker (OR 4.17; 95% CI: 2.09–8.30), and being 30–34 years old (OR 6.22; 95% CI: 1.37–28.28). Pregnancy intention revealed a statistically significant correlation with breastfeeding initiation in the bivariate analysis (p&lt; .001). Factors associated with breastfeeding longer than 12 weeks were having a low level of income (OR 1.65; 95% CI: 1.05–2.58), having a normal or overweight BMI (OR 1.84; 95% CI: 1.35–2.52; OR 1.56; 95% CI: 1.10–2.23), and being a nonsmoker (OR 2.91; 95% CI: 1.64–5.16). Although Chi-Square tests reported a statistically significant correlation with pregnancy intention and breastfeeding duration (p&lt; .001), the relationship was no longer significant in the adjusted analysis (p&gt; .2).Conclusion:Interventions to promote breastfeeding, especially among women with unintended pregnancies, are necessary to improve maternal and child health outcomes.

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

Lung function and cognitive ability in children: a UK birth cohort study

BackgroundDecreased adult lung function is associated with subsequent impairment in cognition. A similar relationship in early life could be of great policy importance, since childhood cognitive ability determines key adult...

Eight Hours Versus twenty four hours Postpartum Magnesium Sulphate for Prophylaxis in Women with Pre-Eclampsia

Aim: To compare the outcome of 8 hours versus 24 hours postpartum magnesium sulphate for eclampsia prophylaxis in women with moderate to severe pre-eclampsia. Study design: Randomized control trial Place and duration of study: The study was conducted in Gynecology and Obstetrics Department, MCH -1, PIMS Hospital, Islamabad from August 2020- Jan 2021 Methodology: After getting approval from hospital ethical committee and informed consent from patients the randomized controlled trial was conducted. The sample size was calculated by using WHO sample size calculator and total sample size was 108 patients that were selected after fulfilling of selection criteria. Complete history, physical examination, laboratory investigations and sonographical evaluation was performed for the selected women. The selected women were randomly assigned to either group A or B using a random list developed by lottery method. Group A received MgSO4 for 8 hour (8micro drops/min) and Group B received MgSO4 for 24 hours only (8micro drops/min). The primary outcome was occurrence of eclamptic fits and secondary outcomes were ambulation time, initiation of breast feeding, patient’s hospital stay and patient satisfaction in both groups. Data was analyzed by using SPSS version 21.0. P-value &lt;0.05 was considered significant Results: Women in both groups had similar demographic profile. Baseline patients’ characteristics (systolic BP, diastolic BP, Hb, ALT and uric acid, urinary protein) were also similar in both groups. Main symptoms were headache, blurred vision and epigastric pain in both groups Eclamptic fits in the first 72 hours were not observed in both groups. In group A patients, mean ambulation time was 10.6±1.1 hours and in group B it was 18.8±7.5 hours (P=0.001). In group A patients, mean time to initiate breast feeding was 14.6 ± 1.9 hours and in group B it was 24.3±8.3 hours (P=0.001). In group A patients, mean duration of hospital stay was 2.8±0.43 days and in group B it was 3.4±0.49 days (P=0.001). In group A patients, mean patient satisfaction score was 8.9±1.1 and in group B it was 4.5±1.8 (P=0.001). Clinical implication:Less risk of side effects observed and less monitoring required. Conclusion:Both the dosing regimens were equally effective and eclamptic fits in the first 72 hours were not observed in both groups. Mean ambulation time, mean time to initiate breastfeeding and mean duration of hospital stay was significantly shorter in patient treated with MgSO4 for 8 hours compared to those treated with MgSO4 for 24 hours. Patients treated with MgSO4 for 8 hours demonstrated better satisfaction when compared to those treated with MgSO4 for 24 hours. Keywords: Postpartum magnesium sulphate, eclampsia, prophylaxis, pre-eclampsia. Ambulation time, Breastfeeding

Association between prenatal and early postnatal exposure to perfluoroalkyl substances (PFAS) and IQ score in 7-year-old children from the Odense Child Cohort.

Perfluoroalkyl substances (PFAS) are persistent chemicals capable of crossing the placenta and passing into breastmilk. Evidence suggests that PFAS exposure may affect brain development. We investigated whether prenatal or early postnatal PFAS exposure was associated with IQ-scores in schoolchildren from the Odense Child Cohort, Denmark 2010 to 2020. We assessed perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA) concentrations in maternal serum collected in the 1st trimester of pregnancy and in child serum at age 18 months. At 7 years of age children completed an abbreviated version of Wechsler Intelligence Scale for Children version-V (WISC-V) from which Full Scale Intelligence Quotient (FSIQ) and Verbal Comprehension Index (VCI) were estimated. In multiple linear regressions among 967 mother-child pairs a doubling in maternal PFOS and PFNA concentrations was associated with lower FSIQ, while no significant associations were observed for PFOA, PFHxS or PFDA. PFAS concentrations at 18 months and duration of breastfeeding were strongly correlated and even in structural equation models it was not possible to differentiate the opposite effects of PFAS exposure and duration of breastfeeding on FSIQ. As PFAS exposure is ubiquitous association with even a small reduction in IQ is of public health concern.

Breastfeeding Self-Efficacy, a Predictor of Early Cessation of Exclusive Breastfeeding Among Mothers Giving Birth Preterm.

The aim was to describe the prevalence of exclusive breastfeeding among mothers of premature infants and investigate the extent to which breastfeeding self-efficacy is associated with early cessation of exclusive breastfeeding. The study population consisted of 136 mother-infant dyads with information on the outcome of exclusive breastfeeding and exposure of self-efficacy, recruited between September 2016 and February 2018. Data were collected via questionnaires with follow-up at 6 months. The statistical analysis included descriptive analysis with survival curves and logistic regression analysis. At 2 months, 101 (74%) premature infants were exclusively breastfed; at 4 and 6 months, 82 (60%) and 41 (30%), respectively. Higher levels of self-efficacy were significantly associated with breastfeeding exclusively for 2 months ( P = .03). In multivariate analysis, mothers who had a low level of early self-efficacy toward breastfeeding had 2½ times higher odds of breastfeeding cessation before 2 months (odds ratio = 2.63, 95% confidence interval: 1.16-5.96). The risk did not change when adjusted for potential confounders. Breastfeeding self-efficacy is an early predictor of exclusive breastfeeding for 2 months of the premature infant. Health professionals should use self-efficacy as a prognostic factor to identify mothers at risk of early cessation of breastfeeding and support those with low self-efficacy to increase duration of exclusive breastfeeding.

Breastfeeding in adolescent mothers-premature infant dyads

Background: Studies have shown that the duration of exclusive breastfeeding is shorter in adolescent mothers and preterm infants. The objective was to identify the prevalence of exclusive breastfeeding, its survival curve and associated factors, in adolescent mother-premature infant dyads and to compare two hospitals aligned or not with the Baby-Friendly Hospital Initiative up to 6 months.Methods: Follow-up and comparative study. Carried out in two reference hospitals (certified as Baby-Friendly Hospital Initiative and Non-certified). The participants were 67 adolescent mothers and 69 premature infants hospitalized in Neonatal Unit where the follow-up began in all the dyads with the informed consent. Data collection was carried out in clinical files and interview of adolescent mothers in the hospitals and by telephone in the follow-up. (February 2016 to March 2017). The variables were Exclusive breastfeeding, sociodemographic, perinatal and clinical status of the premature infants. The statistical analysis was descriptive and we applied Kaplan-Meier and Pearson's r Test (significance p ≤ .05).Results: The exclusive breastfeeding was 27.1%, 63.8%, 66.7%, 48.1% and 26.3% in internment, discharge, 15 days post-discharge, third and sixth month of life, respectively. The exclusive breastfeeding survival: at Baby-Friendly Hospital Initiative (40%, 30 days post discharge) and Non-Baby-Friendly Hospital Initiative (30%, 15 days post discharge) (p ≤ .05). Cessation of breastfeeding due to the perception of low milk production (15 days post-discharge, r = .556, p ≤ .05).Conclusions: The prevalence and the survival curve of exclusive breastfeeding are low, especially in Non-Baby-Friendly Hospital Initiative, and the perception of low milk production. The health system efforts are required to initiate and continue exclusive breastfeeding according with WHO recommendations.

What is tongue-tie and does it interfere with breast-feeding? - a brief review.

The most common symptom attributed to ankyloglossia is difficulty breast feeding due to poor latch, inefficient milk extraction and/or maternal nipple pain. During the past two decades, despite a declining birth rate, there has been a dramatic increase in the number of infants diagnosed with and treated for ankyloglossia in the United States, Canada and Australia. Despite a dramatic increase in the diagnosis and treatment of ankyloglossia in these countries, there remains no universally agreed upon definition of ankyloglossia and none of the published scoring systems have been rigorously validated. However ankyloglossia is defined, the majority of infants with ankyloglossia are asymptomatic. Perhaps, infants with ankyloglossia have a greater incidence of difficulty breast feeding. Lingual frenulotomy may decrease maternal pain and at least transiently improve the quality of breast feeding in some infants however no published studies take into account the fact that sucking and feeding are soothing to infants and the observed improvements immediately following frenulotomy may be a response to the pain associated with the procedure rather than a result of the procedure itself. While there are almost certainly some infants in whom tongue-tie interferes with breast-feeding, there is currently no good evidence lingual frenulotomy leads to longer duration of breast-feeding. Frenulotomy appears to be a generally safe procedure however there are reports of serious complications. Finally, there are no studies of long-term outcomes following frenulotomy during infancy and given traditional thinking that the lingual frenulum is a cord of connective tissue tethering the tongue to the floor of the mouth may be incorrect and the frenulum contains motor and sensory branches of the lingual nerve, the procedure may be less benign than previously thought.

Fetal Alcohol-Related Postnatal Growth Restriction Is Independent of Infant Feeding Practices and Postnatal Alcohol Exposure in a Prospective South African Birth Cohort

Prenatal alcohol exposure (PAE) causes growth restriction that worsens in the first year of life. However, the roles of postnatal nutrition in fetal alcohol growth restriction and the impact of postnatal alcohol exposure via breastmilk on growth remain unknown. We aimed to compare infant feeding practices during the first 6.5 months of life between heavy drinkers and abstainers/light drinkers, to examine whether these practices play confounding roles in fetal alcohol growth restriction, and to determine the impact of postnatal alcohol exposure via breastmilk on growth. Eighty-seven heavy-drinking pregnant women and 71 abstainers/light drinkers (controls) were recruited prenatally from antenatal clinics in Cape Town, South Africa. Demographic background and alcohol, cigarette, marijuana, and methamphetamine use during pregnancy were assessed pre- and postnatally. Infant feeding practices were assessed at 6.5 months postpartum using the USDA Infant Feeding Questionnaire. Infant weight, length, and head circumference were measured at 2 weeks, 6.5 and 12 months, and 5 years. Neither prenatal nor postnatal alcohol consumption was related to the duration of breastfeeding, exclusive breastfeeding, exclusive formula, or mixed feeding. Complementary feeding practices were remarkably similar between exposure groups. PAE was related to all postnatal anthropometry measures at all age points, independent of infant feeding practices. Postnatal alcohol exposure via breastmilk was unrelated to any anthropometry outcome after control for PAE. In conclusion, fetal alcohol-related postnatal growth restriction was not attributable to differences in postnatal infant feeding practices or postnatal alcohol exposure and is thus likely a direct teratogenic effect of PAE.

Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study.

In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices.

Exclusive breastfeeding at 6 months after assisted and spontaneous conceiving: a prospective study in Northern Italy

Conceiving by assisted infertility treatments may influence breastfeeding duration. In one-year time, to evaluate the goal of 6 months breastfeeding, we recruited 55 consecutive mothers who conceived using assisted treatment compared to 45 mothers conceiving naturally, all giving birth to healthy, full-term, singleton infants, sharing the double-occupancy room. At birth, maternal/neonatal characteristics were obtained by medical records and interviews. Six months after, a telephonic interview was done about the exclusivity of breastfeeding, mood instability, and breastfeeding complications. All the women were supported by the same neonatal-pediatrician team, during the study period. The number of mothers who were exclusively breastfeeding at six months was not statistically different between the two groups, as well as, breastfeeding initiation, BMI, smoking habit, mood instability, co-morbidities. In the assisted group, the women were older, had fewer previous children, upper degree of education, higher rate of cesarean sections, their neonate’s birthweight was lower; they reported more breastfeeding complications, but the distribution was not different between groups. The control women had higher number of previously breastfed siblings. Our experience highlights that the mode of conception may not be the defining factor influencing the goal of 6 months lactation. The support of healthcare professional team has a crucial role in maintaining breastfeeding.

Effects of breastfeeding training programmes for midwives on breastfeeding outcomes: a systematic review and meta-analysis

BackgroundAppropriate breastfeeding training for midwives is necessary to enhance their knowledge, attitude, and practice (KAP). However, evidence surrounding the effects of midwife breastfeeding training programmes is insufficient to draw a conclusion of its effectiveness on breastfeeding initiation, duration, and rates.ObjectiveThe aim of this systematic review was to identify, summarise, and critically analyse the available literature to evaluate the effects of midwife breastfeeding training programmes on the midwives’ KAP towards breastfeeding and breastfeeding initiation, duration and rates among postnatal mothers.MethodsNine English and six Chinese databases were searched with relevant key words. The methodological quality of the included studies were assessed by two reviewers independently using the Joanna Briggs Institute critical appraisal checklists.ResultsNine English and one Chinese articles were included in this review. Five articles investigating midwives’ KAP towards breastfeeding reported positive results (p < 0.05). The meta-analysis revealed that breastfeeding training programmes significantly improved midwives’ breastfeeding-related knowledge and skills (standardised mean difference = 1.33; 95% confidence interval, 0.98 to 1.68; p < 0.01; I2 = 36%), as well as their attitude towards breastfeeding (p < 0.05). An additional five articles measured the effects of breastfeeding training programmes on the initiation, duration, and rates of breastfeeding among postnatal mothers. Following the implementation of a breastfeeding training programme for midwives, mothers had significantly longer durations of exclusive breastfeeding (p < 0.05), fewer breastfeeding challenges (p < 0.05) (e.g. breast milk insufficiency), and higher satisfaction with breastfeeding counselling (p < 0.01), and fewer infants received breast milk substitutes in their first week of life without medical reasons (p < 0.05) in the intervention group compared with the control group. However, no significant effects were seen on the initiation and rates of breastfeeding after implementation of the programmes.ConclusionsThis systematic review has demonstrated that midwife breastfeeding training programmes could improve midwives’ KAP towards breastfeeding. However, the breastfeeding training programmes had limited effects on breastfeeding initiation and rates. We suggest that future breastfeeding training programme should incorporate counselling skills alongside breastfeeding knowledge and skills training.Review registrationThis systematic review has been registered in the International prospective register of systematic reviews (PROSPERO) (ID: CRD42022260216).

The median time to stopover exclusive breastfeeding among employed and unemployed mothers of infants aged 6–12 months in Ethiopia, 2019

Early discontinuation of breastfeeding is known to be associated with avoidable childhood morbidity and mortality. The effect of maternal employment on the duration of exclusive breastfeeding and its determinants has not been addressed adequately in in Ethiopia in general and in the stud area in particular. Hence, this study was aimed to compare the time to stop exclusive breastfeeding and its determinants among employed and unemployed mothers of infants 6–12 months of age. A community-based comparative cross-sectional study was conducted from March 1 to 30, 2019. A total of 426 mothers were recruited using a simple random sampling technique. The Kaplan–Meier curve with log-rank test was used to compare the difference in cessation of exclusive breastfeeding before 6 months. Bivariate and Cox proportional hazards model were computed. Hazard ratios and their 95% confidence intervals were computed to determine the level of significance. Four hundred twenty-six (213 employed and 213 un-employed) mothers were included in the final analysis. The median duration of exclusive breastfeeding was 4 months and 6 months for infants of employed and unemployed mothers, respectively. The likelihood of ceasing of exclusive breastfeeding before 6 months of age was significantly associated with family support of exclusive breastfeeding [AHR = 3.99, 95% CI (1.9, 8.3)], and lack of exclusive breastfeeding counseling during postnatal care [AHR = 7.76, 95% CI (2.99, 20.1)], primipara mothers [AHR = 1.5, 95% CI (1.14, 2.04)], maternity leave of 4 months [AHR = 7, 95% CI 2.2, 22.2)] and employed mothers [AHR = 3.77, 95% CI (2.4, 5.9)]. The median duration of exclusive breastfeeding was shorter among employed mothers than un-employed mothers. It is clear from this study that cessation of exclusive breastfeeding was associated with the duration of paid maternity leave for employed mothers. Family support and perceived adequacy of breast milk were associated with cessation of exclusive breastfeeding before 6 months among unemployed mothers.