Early Cessation Of Breastfeeding Research Articles

Non-alcoholic fatty liver disease and its associations among adolescents in an urban, Sri Lankan community

BackgroundNonalcoholic fatty liver disease (NAFLD) is a common problem across the world. We aimed to determine the prevalence of NAFLD and its associations in Sri Lankan adolescents living in an urban Sri Lankan community.MethodThe study population consisted of the birth cohort of the year 2000, residing in the Ragama Medical Officer of Health area. Socio-demographic and anthropometric data [anthropometric measurements, blood pressure and total body fat distribution] of these adolescents were collected by trained data collectors. Fasting blood sugar, serum insulin, fasting serum lipids and serum alanine aminotransferase (ALT) levels were measured and an abdominal ultrasound was performed. NAFLD was diagnosed on established ultrasound criteria for fatty liver and absent alcohol consumption.ResultsThe study sample consisted of 499 adolescents [263 (51.8%) girls]. Forty two (8.4%) had NAFLD. NAFLD was significantly associated with being breast fed for less than 4 months (33.3% vs. 17.1 in controls, p = 0.02), higher waist circumference (prevalence risk ratio 83.3/20.3, 4.1, p < 0.0001), higher body mass index (prevalence risk ratio 40.5/4.8, 8.4, p < 0/0001),higher HOMA-IR (3.7 vs. 1.9, p < 0.0001) and high triglycerides (prevalence risk ratio 14.3/5.8, 2.5, p = 0.033). Adolescents with NAFLD also had a higher amount of total body fat (p < 0.001) and subcutaneous fat (p < 0.001) than those without NAFLD. The number of children with metabolic derangements was higher among adolescents with NAFLD than those without (85.8 vs 26.3 in controls, p < 0.0001), but a family history of hypertension, diabetes, myocardial infarction or dyslipidaemia were not.ConclusionPrevalence of NAFLD was high in Sri Lankan adolescents, and was associated with metabolic derangements, especially obesity, insulin resistance and early cessation of breast feeding.

ENFERMEIROS ESPECIALISTAS EM ENFERMAGEM DE SAÚDE INFANTIL E PEDIATRIA E PROMOÇÃO DA AMAMENTAÇÃO APÓS O REGRESSO AO TRABALHO

Abstract.NURSES SPECIALIST IN CHILD HEALTH AND PEDIATRICS AND PROMOTION OF BREASTFEEDING AFTER THE RETURN TO WORKBackground: In Portugal, breastfeeding rates are still below those recommended by the World Health Organization, despite the initiatives for its promotion. Most women choose and are favourable to breastfeeding. Working outside the home has become a reality for most women, and reconciling breastfeeding with the professional activity is often difficult. Thus, the return to work is one of the reasons mentioned by mothers for early breastfeeding cessation. The promotion of breastfeeding is a public health priority. Nurses’ attitudes and interventions influence the success of breastfeeding and help overcome some of the difficulties encountered. Objectives: To identify measures developed by primary care nurses specialized in Child Health and Pediatrics to promote breastfeeding and encourage working mothers to continue breastfeeding, as well as identify these nurses’ interventions toward the promotion of breastfeeding in the community, family, workplace, and day-care centers. Participants and Methods: Descriptive, cross-sectional study with a quantitative methodology using a sample of 13 nurses specialized in Child Health and Pediatrics working in Health Care Centers of a Cluster of Health Centers. Data were collected through semi-structured interviews between June and July 2015. Dara were analyzed using Bardin’s content analysis technique. Results: Aware of the need to promote breastfeeding after the mother’s return to work, nurses implement multiple interventions targeted at mothers, fathers, and grandparents (“breastfeeding corners”, phone support services, home visits, training sessions, celebration of the World Breastfeeding Week) in nursing consultations. Conclusions: Nurses only intervene in nursing consultations. However, there are other places where nurses should intervene, namely day-care centers, the workplace, and the community in general, with the purpose of reducing early breastfeeding cessation due to the mothers’ return to workKeywords: Breastfeeding; Women, Working; Pediatric Nursing; Primary Health Care.Resumo. Antecedentes: Em Portugal, apesar das iniciativas desenvolvidas para promover o aleitamento materno, as taxas e suas práticas continuam abaixo do recomendado pela OMS. A generalidade das mulheres decide e é favorável à amamentação. Trabalhar fora de casa tornou-se uma realidade para a maioria das mulheres. Por vezes torna-se difícil conciliar o aleitamento materno com a atividade laboral e o regresso ao trabalho encontra- se entre um dos motivos apontados pelas mães para o abandono precoce da amamentação. Promover a amamentação é uma prioridade de saúde pública. As atitudes e intervenções dos enfermeiros exercem influência no processo/sucesso da amamentação e no ultrapassar de dificuldades que surgem. Objetivos: Conhecer as medidas promotoras da amamentação que os enfermeiros dos cuidados de saúde primários, especialistas em Enfermagem de Saúde Infantil e Pediatria, desenvolvem no sentido de apoiar as mães que trabalham a continuar a amamentar e identificar as intervenções promotoras da amamentação desenvolvidas por estes enfermeiros junto das mães, a nível da comunidade, na família, nos locais de trabalho, nas creches e nos seus próprios locais de trabalho. Participantes e Métodos: Estudo descritivo, transversal, segundo a metodologia qualitativa, junto de 13 enfermeiros Especialistas em Enfermagem de Saúde Infantil e Pediatria que trabalham em Centros de Saúde de um Agrupamento de Centros de Saúde. Colheram-se dados por entrevista semiestruturada entre Junho e Julho de 2015. No tratamento da informação recorreu-se à análise de conteúdo de Laurence Bardin. Resultados: Os Enfermeiros embora despertos para a necessidade de promover a manutenção da amamentação após o regresso das mães ao trabalho desenvolvem, predominantemente no contexto das consultas de enfermagem, várias intervenções (cantinhos da amamentação, apoio telefónico, visita domiciliária, ensinos, comemoração da semana mundial do aleitamento materno) junto das mães, pais e avós. Conclusões: A atuação dos Enfermeiros resume-se ao contexto das consultas de enfermagem. Há contudo, outros locais onde as intervenções de enfermagem devem chegar, nomeadamente, creches, entidades patronais e sociedade em geral, com vista a reduzir o desmame precoce motivado pelo regresso das mães ao trabalho.Palavras-chave: Aleitamento Materno; Mulheres Trabalhadoras; Enfermagem Pediátrica; Cuidados de Saúde Primários.

Cesarean Section, Formula Feeding, and Infant Antibiotic Exposure: Separate and Combined Impacts on Gut Microbial Changes in Later Infancy.

Established during infancy, our complex gut microbial community is shaped by medical interventions and societal preferences, such as cesarean section, formula feeding, and antibiotic use. We undertook this study to apply the significance analysis of microarrays (SAM) method to quantify changes in gut microbial composition during later infancy following the most common birth and postnatal exposures affecting infant gut microbial composition. Gut microbiota of 166 full-term infants in the Canadian Healthy Infant Longitudinal Development birth cohort were profiled using 16S high-throughput gene sequencing. Infants were placed into groups according to mutually exclusive combinations of birth mode (vaginal/cesarean birth), breastfeeding status (yes/no), and antibiotic use (yes/no) by 3 months of age. Based on repeated permutations of data and adjustment for the false discovery rate, the SAM statistic identified statistically significant changes in gut microbial abundance between 3 months and 1 year of age within each infant group. We observed well-known patterns of microbial phyla succession in later infancy (declining Proteobacteria; increasing Firmicutes and Bacteroidetes) following vaginal birth, breastfeeding, and no antibiotic exposure. Genus Lactobacillus, Roseburia, and Faecalibacterium species appeared in the top 10 increases to microbial abundance in these infants. Deviations from this pattern were evident among infants with other perinatal co-exposures; notably, the largest number of microbial species with unchanged abundance was seen in gut microbiota following early cessation of breastfeeding in infants. With and without antibiotic exposure, the absence of a breast milk diet by 3 months of age following vaginal birth yielded a higher proportion of unchanged abundance of Bacteroidaceae and Enterobacteriaceae in later infancy, and a higher ratio of unchanged Enterobacteriaceae to Alcaligenaceae microbiota. Gut microbiota of infants born vaginally and exclusively formula fed became less enriched with family Veillonellaceae and Clostridiaceae, showed unchanging levels of Ruminococcaceae, and exhibited a greater decline in the Rikenellaceae/Bacteroidaceae ratio compared to their breastfed, vaginally delivered counterparts. These changes were also evident in cesarean-delivered infants to a lesser extent. The clinical relevance of these trajectories of microbial change is that they culminate in taxon-specific abundances in the gut microbiota of later infancy, which we and others have observed to be associated with food sensitization.

Obesity as a Predictor of Delayed Lactogenesis II.

Lactogenesis II is the onset of copious milk production. A delay in this has been associated with an increased risk of formula supplementation and early cessation of breastfeeding. Prepregnancy obesity has also been associated with decreased breastfeeding rates and early cessation. Research aim: This study aimed to evaluate the effect of prepregnancy obesity on self-reported delayed lactogenesis II. We conducted a prospective observational cohort study of 216 women with a singleton pregnancy and who planned to breastfeed. We compared the onset of lactogenesis II between women with a body mass index (BMI) < 30 kg/m2 and women with a BMI ≥ 30 kg/m2. Using multivariate logistic regression analyses, we assessed the relationship between maternal BMI and delay of lactogenesis II. The prevalence of delayed lactogenesis II among women with prepregnancy BMI < 30 kg/m2 and BMI ≥ 30 kg/m2 was 46.4% and 57.9%, respectively. Delayed lactogenesis II occurred more frequently among women who were obese at the time of delivery ( p < .05). After controlling for the covariates, age, prepregnancy BMI, and gestational weight gain were positively associated with delayed lactogenesis II. Prepregnancy obesity and excessive gestational weight gain are associated with an increased risk of delayed lactogenesis II. Women who are at risk for delay in lactogenesis II and early breastfeeding cessation will need targeted interventions and support for them to achieve their personal breastfeeding goals.

Associations Between Postpartum Depression, Breastfeeding, and Oxytocin Levels in Latina Mothers.

Postpartum depression (PPD), often comorbid with anxiety, is the leading medical complication among new mothers. Latinas have elevated risk of PPD, which has been associated with early breastfeeding cessation. Lower plasma oxytocin (OT) levels have also been associated with PPD in non-Latinas. This pilot study explores associations between PPD, anxiety, breastfeeding, and OT in Latinas. Thirty-four Latinas were enrolled during their third trimester of pregnancy and followed through 8 weeks postpartum. Demographic data were collected at enrollment. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) at each time point (third trimester of pregnancy, 4 and 8 weeks postpartum). The Spielberger State-Trait Anxiety Inventory (STAI) was administered postpartum and EPDS anxiety subscale was used to assess anxiety at each time point. Breastfeeding status was assessed at 4 and 8 weeks postpartum. At 8 weeks, OT was collected before, during, and after a 10-minute breast/bottle feeding session from 28 women who completed the procedures. Descriptive statistics are provided and comparisons by mood and breastfeeding status were conducted. Analyses of variance were used to explore associations between PPD, anxiety, breastfeeding status, and OT. Just under one-third of women were depressed at enrollment. Prenatal depression, PPD, and anxiety were significantly associated with early breastfeeding cessation (i.e., stopped breastfeeding before 2 months) (p < 0.05). There was a significant interaction between early breastfeeding cessation and depression status on OT at 8 weeks postpartum (p < 0.05). Lower levels of OT were observed in women who had PPD at 8 weeks and who had stopped breastfeeding their infant by 8 weeks postpartum. Future studies should investigate the short- and long-term effects of lower OT levels and early breastfeeding cessation on maternal and child well-being.

What influences women to bottle-feed from birth and to discontinue breastfeeding early?

Background Internationally, breast milk is recognised as the best form of infant feeding, yet in the UK, bottle feeding rates are among the highest in the world. Aims The aim of this research study was to investigate the relationship between socioeconomic, demographic, family-related, pregnancy and birth factors, and bottle feeding in the UK. Methods A secondary analysis of the Infant Feeding Survey 2010 was conducted and two time points differentiated: bottle feeding from birth and early breastfeeding cessation. Findings Results demonstrated that bottle feeding from birth was predicted by a range of independent social disadvantage factors, namely being young, single, unemployed, white British and poorly educated. Other influencing factors were the increased number of children, having a caesarean section, no underlying health problems post birth and having friends who bottle-fed. Early breastfeeding cessation was predicted by the same independent determinants except for working in intermediate or routine/manual occupations, having friends that mix-fed, and developing health problems post birth. Conclusions The context in which mothers live is a key determinant of how they feed their babies and that, for many women, feeding method is a consequence of their social context and not a choice.

Early Life Protein Intake: Food Sources, Correlates, and Tracking across the First 5 Years of Life

BackgroundHigh consumption of protein has been associated with accelerated growth and adiposity in early childhood. ObjectiveTo describe intake, food sources, correlates, and tracking of protein in young children. DesignSecondary analysis of Melbourne Infant Feeding Activity and Nutrition Trial (InFANT). Dietary data were collected using three 24-hour dietary recalls at ages 9 and 18 months as well as 3.5 and 5 years. Participants/settingFirst-time mothers and their child (n=542) participated in an 18-month intervention to prevent childhood obesity and the cohort was followed-up with no intervention when children were aged 3.5 and 5 years. Main outcome measuresProtein intake, food sources, correlates, and tracking of protein. Statistical analyses performedChild and maternal correlates of protein intake were identified using linear regression and tracking of protein intake was examined using Pearson correlations of residualized protein scores between time points. ResultsMean protein (grams per day) intake was 29.7±11.0, 46.3±11.5, 54.2±13.8, and 60.0±14.8 at 9 and 18 months and 3.5 and 5 years, respectively. Protein intakes at all ages were two to three times greater than age-appropriate Australian recommendations. The primary source of protein at 9 months was breast/formula milk. At later ages, the principal sources were milk/milk products, breads/cereals, and meat/meat products. Earlier breastfeeding cessation, earlier introduction of solids, high dairy milk consumption (≥500 mL), and high maternal education were significant predictors of high protein intake at various times (P<0.05). Slight tracking was found for protein intakes at 9 months, 18 months, and 5 years (r=0.16 to 0.21; P<0.01). ConclusionsThis study provides unique insights into food sources and correlates of young children’s high protein intakes, and confirms that early protein intakes track slightly up to age 5 years. These finding have potential to inform nutrition interventions and strategies to address high protein intakes and protein-related obesity risk.

The Relationship Between Infant Feeding Outcomes and Maternal Emotional Well-being Among Mothers of Late Preterm and Term Infants: A Secondary, Exploratory Analysis.

Late preterm birth is associated with lower rates of breastfeeding and earlier breastfeeding cessation than term birth. The objectives of this secondary analysis were to compare the incidence of exclusive breastfeeding after late preterm and term childbirth and to examine the association between infant feeding outcomes and maternal emotional well-being. Participants were 105 mother-infant dyads (54 late preterm and 51 term) at a southeastern US medical center. Face-to-face data collection and telephone follow-up occurred during 2009-2012. Late preterm mothers were less likely to exclusively provide their milk than were term mothers during hospitalization. Feeding at 1 month did not differ between late preterm and term infants. Among late preterm mothers, (1) formula supplementation during hospitalization was associated with greater severity of anxiety than among those exclusively providing formula and (2) exclusive provision of human milk at 1 month was associated with less severe depressive symptoms than among those supplementing or exclusively formula feeding. Among term mothers, feeding outcome was not related to emotional well-being measures at either time point. Mothers of late preterm infants may particularly benefit from anticipatory guidance and early mental health screening, with integrated, multidisciplinary lactation teams to support these interrelated healthcare needs. Prospective research is critical to document women's intentions for infant feeding and how experiences with childbirth and the early postpartum period impact achievement of their breastfeeding goals.

Infant Formula Feeding at Birth Is Common and Inversely Associated with Subsequent Breastfeeding Behavior in Vietnam

Background: The association between infant formula feeding at birth and subsequent feeding patterns in a low- or middle-income context is not clear.Objective: We examined the association of infant formula feeding during the first 3 d after birth with subsequent infant formula feeding and early breastfeeding cessation in Vietnam.Methods: In a cross-sectional survey, we interviewed 10,681 mothers with children aged 0−23 mo (mean age: 8.2 mo; 52% boys) about their feeding practices during the first 3 d after birth and on the previous day. We used stratified analysis, multiple logistic regression, propensity score-matching analysis, and structural equation modeling to minimize the limitation of the cross-sectional design and to ensure the consistency of the findings.Results: Infant formula feeding during the first 3 d after birth (50%) was associated with a higher prevalence of subsequent infant formula feeding [stratified analysis: 7−28% higher (nonoverlapping 95% CIs for most comparisons); propensity score-matching analysis: 13% higher (P < 0.001); multiple logistic regression: OR: 1.47 (95% CI: 1.30, 1.67)]. This practice was also associated with a higher prevalence of early breastfeeding cessation (e.g., <24 mo) [propensity score-matching analysis: 2% (P = 0.08); OR: 1.33 (95% CI: 1.12, 1.59)]. Structural equation modeling showed that infant formula feeding during the first 3 d after birth was associated with a higher prevalence of subsequent infant formula feeding (β: 0.244; P < 0.001), which in turn was linked to early breastfeeding cessation (β: 0.285; P < 0.001).Conclusions: Infant formula feeding during the first 3 d after birth was associated with increased subsequent infant formula feeding and the early cessation of breastfeeding, which underscores the need to make early, exclusive breastfeeding normative and to create environments that support it.

Predictors of early breastfeeding cessation among HIV-infected women in Botswana.

Infants born to HIV-infected women receiving antiretroviral treatment (ART) can be breastfed through at least 6 months with very low risk of HIV acquisition. We aimed to identify demographic and cultural factors that may influence mothers' willingness to breastfeed for the recommended duration. We evaluated factors associated with early cessation of breastfeeding (i.e. before 5 months post-partum) in a randomized clinical trial evaluating different ART regimens used for prevention of mother-to-child transmission during breastfeeding in Botswana. Univariate and multivariable Cox regressions were used to describe predictors of early exclusive BF cessation. Among 677 women who started breastfeeding, the median time to breastfeeding cessation was 178 days (IQR 150-181) and 25.1% weaned early. In multivariable analysis, urban location (aHR = 1.86 95%CI 1.27-2.73; P = 0.002), salaried employment or being a student (aHR = 2.78 95% CI 1.63-4.75; P < 0.001) and infant hospitalisation before weaning (aHR = 2.04 95% CI 1.21-3.45; P = 0.008) were independently and significantly associated with early BF cessation. Improved support for breastfeeding among employed mothers, especially in urban settings, may allow HIV-infected women who are receiving ART prophylaxis to breastfeed longer.

The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum.

BackgroundThe caesarean section (c-section) rate in Canada is 27.1 %, well above the 5–15 % of deliveries suggested by the World Health Organization in 2009. Emergency and planned c-sections may adversely affect breastfeeding initiation, milk supply and infant breastfeeding receptivity compared to vaginal deliveries. Our study examined mode of delivery and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum.MethodsThe All Our Babies study is a prospective pregnancy cohort in Calgary, Alberta, that began in 2008. Participants completed questionnaires at <25 and 34–36 weeks gestation and approximately 4 months postpartum. Demographic, mental health, lifestyle, and health services data were obtained. Women giving birth to singleton infants were included (n = 3021). Breastfeeding rates and difficulties according to mode of birth (vaginal, planned c-section and emergency c-section) were compared using cross-tabulations and chi-square tests. A multivariable logistic regression model was created to examine the association between mode of birth on breastfeeding duration to 12 weeks postpartum.ResultsMore women who delivered by planned c-section had no intention to breastfeed or did not initiate breastfeeding (7.4 % and 4.3 % respectively), when compared to women with vaginal births (3.4 % and 1.8 %, respectively) and emergency c-section (2.7 % and 2.5 %, respectively). Women who delivered by emergency c-section were found to have a higher proportion of breastfeeding difficulties (41 %), and used more resources before (67 %) and after (58 %) leaving the hospital, when compared to vaginal delivery (29 %, 40 %, and 52 %, respectively) or planned c-sections (33 %, 49 %, and 41 %, respectively). Women who delivered with a planned c-section were more likely (OR = 1.61; 95 % CI: 1.14, 2.26; p = 0.014) to discontinue breastfeeding before 12 weeks postpartum compared to those who delivered vaginally, controlling for income, education, parity, preterm birth, maternal physical and mental health, ethnicity and breastfeeding difficulties.ConclusionsWe found that when controlling for socio-demographic and labor and delivery characteristics, planned c-section is associated with early breastfeeding cessation. Anticipatory guidance around breastfeeding could be provided to women considering a planned c-section. As well, additional supportive care could be made available to lactating women with emergency c-sections, within the first 24 hours post birth and throughout the early postpartum period.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0876-1) contains supplementary material, which is available to authorized users.

Effect of two different nursing care approaches on reduction of breast engorgement among postnatal women

Background : Breast engorgement is a painful and unpleasant condition that affects huge numbers of women in the early postpartum period. It is associated with unsuccessful breastfeeding, early breastfeeding cessation, mastitis and inflammation of the breast. So, there is a need to increase awareness regarding efficiency of different nursing interventions as; warm compresses and cold cabbage leaves to treat breast engorgement. Aim: was to reduce the level of breast engorgement among postnatal mothers and to compare the effect of warm compresses versus cold cabbage leaves on breast engorgement. Subjects and methods : A Quasi-experimental (equivalent pre-posttest group) research design was adopted. Setting : this study was conducted at postnatal ward and outpatient clinic at El-Manial Maternity hospital, Cairo, Egypt. Subjects: A purposive sample of 90 postnatal women randomly assigned into two groups . Tools: Four tools were used:1)Structured interviewing questionnaire, 2) Six- points engorgement scale, 3)Visual Analog Scale and 4) LATCH breastfeeding scale. Results: The mean age of the sample was 26.6 ± 4.3 years old. More than twenty percent of each group was suffered from firm and tender breasts (22.2%& 28.9%). Also there was a statistical significant differences between the pre and post symptoms of breast engorgement, levels of breast engorgement, pain score and engorgement score for both groups ( p < .05*).Hence both the interventions were effective in relieving pain and reducing breast engorgement. Conclusion : an application of cold cabbage leaves and warm compresses are effective for relieving breast engorgement but the cold cabbage group was improved regarding symptoms and levels of engorgement better than the warm compresses group. In addition, there was a statistical significant difference between the pretest and posttest of pain score and engorgement score for both groups ( p < .001*). Recommendations: Nurses should be trained to include different nursing approaches for managing breast engorgement in their discharge plan. Also early detection and nursing care to prevent breast complications should be done for all postnatal women.

Determinants of suboptimal breastfeeding practice in Debre Berhan town, Ethiopia: a cross sectional study.

BackgroundOptimal breastfeeding is inextricably linked to the achievement of Millennium Development Goals (MDGs) of eradicating extreme poverty and hunger, reducing child mortality and improving maternal health. Breastfeeding is safe, promotes sensory and cognitive development and contains antibodies that protect infants from common childhood illnesses. The objective of this study was to assess suboptimal breastfeeding and its determinants factors among mothers who have children below 23 months old in Debre Berhan, Ethiopia.MethodsA community based cross sectional study was conducted from 1 March 2015 until 30 March 2015. Five hundred forty eight mothers were included in the study using a two stage sampling technique. The data was collected by trained data collectors through pretested semi structured questionnaire. The collected data were cleaned, coded, entered and then analyzed using SPSS version 20 windows program. Descriptive statistics, binary and multivariable regression analysis with 95 % confidence interval was carried out and p value less than 0.05 used to determine the significant association. Late initiation of breastfeeding was defined as initiation of breastfeeding after one hour of delivery while early cessation of breastfeeding was to stop breastfeeding before 24 months of age. According to World Health Organization exclusive breastfeeding was defined as the practice of feeding breast milk only, including expressed breast milk, to infants and excluding water, other liquids, breast milk substitutes, and solid foods. Vitamin drops, minerals, oral rehydrating solution (ORS) and medicines may be given.ResultsThe prevalence of late initiation of breastfeeding, not exclusively breastfeeding and early cessation of breastfeeding were 17.5 % (95 % Confidence Interval [CI] 15.2 %, 19.4), 49.8 % (95 % CI 46.3, 50.5) and 12.8 % (95 % CI 11.7, 14.1) respectively. Birth at home was significantly associated with late initiation of breastfeeding (Adjusted Odds Ratio [AOR] 3.0; 95 % CI 1.5, 6.0). No advice during antenatal care was a predictor of not exclusively breastfeeding (AOR1.7; 95 % CI 1.2, 2.5). Being illiterate (AOR 3.2; 95 % CI 1.2, 8.3) and no advice during antenatal care about breastfeeding (AOR 1.9; 95 % CI 1.0. 3.4) were significantly associated with early cessation of breastfeeding.ConclusionEducational status, age, antenatal and postnatal follow up, resident and place of delivery were predictors of suboptimal breastfeeding. Integrated and targeted interventions were recommended to achieve a better outcome in minimizing the late initiation, non-exclusive and early cessation of breastfeeding.

Ethics of Care and Urban Aboriginal and Torres Strait Islander Breastfeeding beyond Three Months

Background: Although early cessation of breastfeeding is common in Australia, as in other industrialised nations, higher proportions of Indigenous mothers cease breastfeeding in the first three months in comparison with other Australian mothers.Methods: Twenty urban Aboriginal and Torres Strait Islander mothers of infants aged 3 to12 months participated in in-depth, semistructured interviews which explored the mothers' experiences of infant feeding, and the advice and support they received from health professionals. Data were analysed thematically, using an ethics of care lens.Results: Three themes arising from the data are presented here: the impact of care on breastfeeding trajectories, relational support, and mother-centred care. Professional care was found to have a strong influence on breastfeeding initiation and duration. Caring relationships with health professionals which prioritise continuity of care and attention to mothers' and infants' specific needs build mothers' trust in their health carers and their own capacities to breastfeed and in turn facilitate positive breastfeeding outcomes. Mother-centred care in hospital, during clinic follow-up, home visits or phone calls facilitates timely identification of mothers' feeding doubts or problems and initiation of solutions to breastfeeding problems. Empathic mother-centred infant feeding care is especially important for mothers with limited support at home.Conclusion: In this research we saw that when health professionals working with urban Aboriginal and Torres Strait Islander mothers demonstrate an ethic of care, which is characterised by culturally safe, mother-centred, relational support, they can positively influence breastfeeding initiation and duration beyond three months. To support urban Indigenous mothers to breastfeed, policy and services need to embrace relational, mother-centred care.

Obstetric and gynecologic problems associated with eating disorders.

This article summarizes the literature on obstetric and gynecologic complications associated with eating disorders. We performed a comprehensive search of the current literature on obstetric and gynecologic complications associated with eating disorders using PubMed. More recent randomized-controlled trials and larger data sets received priority. We also chose those that we felt would be the most relevant to providers. Common obstetric and gynecologic complications for women with eating disorders include infertility, unplanned pregnancy, miscarriage, poor nutrition during pregnancy, having a baby with small head circumference, postpartum depression and anxiety, sexual dysfunction and complications in the treatment for gynecologic cancers. There are also unique associations by eating disorder diagnosis, such as earlier cessation of breastfeeding in anorexia nervosa; increased polycystic ovarian syndrome in bulimia nervosa; and complications of obesity as a result of binge eating disorder. We focus on possible biological and psychosocial factors underpinning risk for poor obstetric and gynecological outcomes in eating disorders. Understanding these factors may improve both our understanding of the reproductive needs of women with eating disorders and their medical outcomes. We also highlight the importance of building multidisciplinary teams to provide comprehensive care to women with eating disorders during the reproductive years.

Clinically overweight and obese mothers and low rates of breastfeeding: Exploring women's perspectives

Background: It is universally recognised that breastmilk is the best food for babies and that breastfeeding provides significant health benefits for both mothers and babies. Women who are overweight or obese have lower rates of initiation and duration of breastfeeding. There is a need to understand the woman's perspective, and any additional factors that may contribute to breastfeeding difficulties for overweight or obese women. Objective: The aims of this research were to explore the breastfeeding experiences and perspectives of a specifically recruited group of clinically overweight and obese women and to gain an understanding of what influenced their infant feeding decisions. Method: This study used a qualitative methodology. In-depth interviews were conducted with six mothers who were overweight or obese and initiated breastfeeding, but then did not continue to exclusively or fully breastfeed their babies. Using a thematic analysis the researcher identified seven themes which captured the breastfeeding experiences of these women. Findings: The women believed in the importance of breastfeeding for their babies' health, but experienced challenges with latching and perceived their breast milk supply to be insufficient. The physical challenges of large breasts and body image issues when feeding in public also contributed to early cessation of exclusive breastfeeding. This study adds to the body of knowledge on this subject and to our understanding of the association between maternal overweight and obesity and early cessation of breastfeeding. Conclusion: It is important to recognise the unique needs of overweight and obese women and provide support antenatally and postnatally. This support is crucial if we are to achieve the public health aim of reaching World Health Organization (WHO) and national targets for exclusive and full breastfeeding. ABStRACt:

Past and recent abuse is associated with early cessation of breast feeding: results from a large prospective cohort in Norway

ObjectiveBreast feeding provides a wide range of health benefits for both infants and mothers. Few studies have examined the impact of past and recent abuse of women on breastfeeding behaviour....

Can we identify women who initiate and then prematurely cease breastfeeding? An Australian multicentre cohort study.

BackgroundHealth authorities recommend 6 months of fully breastfeeding and continuation of breastfeeding for at least a year. Many women initiate breastfeeding in hospital but discontinue before the six-month period, and therefore do not optimise the public health benefits. The aim of this study was to determine whether these women could be identified at hospital discharge, to enable targeted interventions.MethodsA secondary analysis of women who intended to breastfeed and were enrolled in a large randomised trial was undertaken. Women were enrolled in the antenatal period and antenatal, delivery and six month postnatal questionnaires were completed. Univariate and multivariate analyses were undertaken to determine the variables associated with early cessation of breastfeeding within six months, compared to women who continued to breastfeed.ResultsOf 2148 women who initiated breastfeeding in hospital, 877 continued to breastfed either partially (N = 262) or fully (N = 615) until six months postpartum and 1271 ceased breastfeeding early. Median breastfeeding duration in women who ceased early was 3+6 weeks (IQR 1+1 to 11+2 weeks). In multivariate analysis, factors that were significantly associated with early cessation of breastfeeding were maternal factors of lower education (less than 12 years of schooling, no completion of further education), smoking (pre-pregnancy or during pregnancy), and newborn factors of preterm birth and low birthweight (all p < 0.01). These variables correctly identify 83% of women.ConclusionWe can identify women who initiate and then prematurely discontinue breastfeeding prior to hospital discharge. Evaluation of additional interventions to support longer duration of breastfeeding in women at risk of ceasing prematurely is needed.

Ghanaian Mothers' Complementary Feeding Practices and Perception on Children's Health

Objectives: To understand factors that influence Ghanaian mothers' introduction and variety of complementary foods, and capture their perception of the implications of complementary foods on children's health, growth, and development.Methods: Ghanaian mothers (n=99) with children 4‐24 months of age from the Central Region of Ghana were recruited to participate. Eleven focus groups interviews were conducted and a participant demographic questionnaire was administered. A focus group guide was developed to ask mothers' opinions about their complementary feeding practices. Sessions were audio recorded, and transcribed. The transcriptions were coded and analyzed to identify themes, meta‐themes, and to generate theories.Results: Participants reported inappropriate complementary feeding practices: early introduction of solids, early cessation of breastfeeding, inappropriate cues of introducing solids, and inadequate frequency of offering complementary foods. Mothers stated factors that influenced complementary feeding: finances, time, moms' food preference, convenience, and beliefs. Finance was the major determinant to the food offered to their children, irrespective of the implication. Mothers' knowledge about food, child health, and growth outcomes motivated their feeding practices. However, motivation was affected by the lack of support from spouse, picky eating habits of children, and finances. While over 80% (85) of the moms reported some knowledge about the effects of complementary feeding, 45% (45) of the children were undernourished. Some mothers held misconceptions about the effect of food on children's health.Implications: Ghanaian mothers identified challenges and misconceptions in complementary feeding, indicating the need for nutrition education and support.

Feeding of infant formula at birth links with feeding of infant formula and discontinuation of breastfeeding in Vietnam

Few studies have examined the association between feeding infant formula at birth and future feeding patterns. This study was conducted to examine the association between feeding infant formula in the first 3 days after birth (IF3d) and current feeding infant formula (IFcur), as well as discontinuation of breastfeeding (noBF). In a cross‐sectional survey, we interviewed 10,681 mothers with children aged 0−23.9 mo in Vietnam about current breastfeeding practices and feeding practices during 3 days after birth. The prevalence of feeding IF3d was 52%, higher in those with cesarean delivery (78%) than vaginal delivery (45%, P &lt; 0.01). The prevalence of IFcur in children 0−0.9, 3−3.9, 4−8.9, and 9−23.9 mo fed with IF3d was 31%, 40%, 50% and 50%, which was statistically higher than those who were not fed IF3d (5%, 15%, 30%, and 40%, respectively). The stratified analysis by delivery mode showed a similar trend. At 12 to 14.9 mo, the noBF prevalence was higher in infants fed IF3d than who were not. IF3d was associated with increased prevalence of IFcur (OR: 1.76; 95% CI: 1.58, 1.95) and noBF (OR: 1.32; 95% CI: 1.14, 1.53), which was stronger in the younger infants. Structural equation modeling shows that a) IF3d was associated with higher IFcur (std β: 0.244), which in turn linked with noBF (std β: 0.285) and b) IF3d was associated with cesarean delivery (std β: 0.627), intention of feeding formula at birth (std β: 0.556), and lack of professional breastfeeding support at birth (std β: 0.213; P &lt; 0.01 for all). Support for exclusive breastfeeding in the first 3 days of life can reduce early introduction of infant formula and early cessation of breastfeeding.Funding: Bill &amp; Melinda Gates Foundation, through Alive &amp; Thrive, managed by FHI 360