Early Discontinuation Of Breastfeeding Research Articles

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.

Perinatal Factors Associated With Breastfeeding Trends After Preterm Birth

ObjectiveTo determine the rates and perinatal factors associated with initiation and early discontinuation of breastfeeding among very preterm neonates. MethodsThis was a retrospective cohort study of very preterm infants (<29 weeks gestation) admitted to 2 regional Level III neonatal intensive care units (NICUs) from January 1, 2015, to December 31, 2019. A national neonatal database was used to evaluate initiation and continuation rates of breastfeeding and associated perinatal factors. Stored nutrition profiles and delivery record books were used to determine feeding volumes associated with continuation of breastfeeding to hospital discharge for a subgroup of infants at a single site. Descriptive and inferential statistics were used to present the results between groups, and logistic regression modeling was used to calculate crude and adjusted odds ratios (OR) and 95% CI. ResultsOf 391 eligible neonates, 84% initiated breastfeeding but only 38% continued to discharge. Interestingly, frequency of breastfeeding initiation (P < 0.001) and continuation (P < 0.001) declined over the study period. After adjustment for confounders, younger maternal age, earlier gestational age, cigarette smoking, and multiparity were significantly associated with early discontinuation of breastfeeding prior to hospital discharge. Early discontinuation of breastfeeding was also related to lower volumes of breastmilk by day 7 of life (P = 0.004). ConclusionVery preterm neonates are at high risk for non-initiation and early discontinuation of breastfeeding. The early postnatal period represents a critical time to establish breastmilk volumes, and the identification of key perinatal risk factors allows for early and targeted breastfeeding support.

The association between intrapartum interventions and immediate and ongoing breastfeeding outcomes: an Australian retrospective population-based cohort study

BackgroundThe use of intrapartum interventions is becoming increasingly common globally. Interventions during birth, including caesarean section (CS), epidural analgesia and synthetic oxytocin infusion, can be important in optimizing obstetric care, but have the potential to impact breastfeeding. This study aimed to identify whether women who have certain intrapartum interventions have greater odds of unfavourable breastfeeding outcomes, both the immediate post-partum period and in the months after birth.MethodsThis was a population-based cohort study of singleton livebirths at ≥37 weeks’ gestation between 2010 and 2018 in Victoria, Australia using routinely-collected state-wide data from the Victorian Perinatal Data Collection (VPDC) and the Child Development Information System (CDIS). The interventions included were pre-labour CS, in-labour CS, epidural analgesia, and synthetic oxytocin infusion (augmentation and/or induction of labour). Outcomes were formula supplementation in hospital, method of last feed before hospital discharge and breastfeeding status at 3-months and 6-months. Descriptive statistics and multivariable logistic regression models adjusting for potential confounders were employed.ResultsIn total, 599,191 women initiated breastfeeding. In-labour CS (aOR 1.96, 95%CI 1.93,1.99), pre-labour CS (aOR 1.75, 95%CI 1.72,1.77), epidural analgesia (aOR 1.45, 95%CI 1.43,1.47) and synthetic oxytocin infusion (aOR 1.24, 95%CI 1.22,1.26) increased the odds of formula supplementation in hospital. Long-term breastfeeding data was available for 105,599 infants. In-labour CS (aOR 0.79, 95%CI 0.76,0.83), pre-labour CS (aOR 0.73, 95%CI 0.71,0.76), epidural analgesia (aOR 0.77, 95%CI 0.75,0.80) and synthetic oxytocin infusion (aOR 0.89, 95%CI 0.86–0.92) decreased the odds of exclusive breastfeeding at 3-months post-partum, which was similar at 6-months. There was a dose-response effect between number of interventions received and odds of each unfavourable breastfeeding outcome.ConclusionCommon intrapartum interventions are associated with less favourable breastfeeding outcomes, both in hospital and in the months after birth. This confirms the importance of only undertaking interventions when necessary. When interventions are used intrapartum, an assessment and identification of women at increased risk of early discontinuation of breastfeeding has to be performed. Targeted breastfeeding support for women who have intrapartum interventions, when they wish to breastfeed, is important.

Perinatal Depression

Key Points Perinatal mood and anxiety disorders affect 15% to 20% of mothers from conception to 1 year postpartum and 4% to 25% of fathers.Infants of affected mothers are at risk for impaired social interaction, delays in language and cognitive development, failure to thrive, reactive attachment disorder of infancy, early discontinuation of breastfeeding, and neglect and abuse; longer-term adverse effects can be seen in the child’s learning, memory, behavioral, and emotional adaptation.Formal screening for perinatal depression at infant preventive visits, consistent with the peaks of occurrence, is recommended by Bright Futures, 4th Edition; US Preventive Services Taskforce (2016); and Centers for Medicare &amp; Medicaid Services (2016).Caregivers with a positive screen result and/or symptoms of depression should be triaged for a psychiatric or social emergency and their infants should be screened and followed for potential social-emotional problems.Management is 2-generational.For the parents, demystification, brief interventions to promote the mother-infant relationship and encourage social connections, and referral for evidence-based therapy (individual or couple), emergency medical services, or hospitalizationFor the child, regular monitoring of social-emotional development and Early Intervention Part C servicesFor the mother-infant dyad, evidence-based therapy by a pediatric mental health specialist with expertise in treating infants and young children (0–5 years of age).

Risk factors for discontinuation of exclusive breast feeding within 1month: a retrospective cohort study in Japan

BackgroundWhile breastfeeding provides benefits for infants and the mother, many women either do not breastfeed or terminate breastfeeding earlier than recommended. The aim of this analysis was to identify factors associated with early discontinuation of breastfeeding in Japanese women.MethodsThis study used data from medical records of women delivering a singleton live birth between March 2017 and August 2019 in Iwase General Hospital, Fukushima Prefecture, Japan to assess cessation of breastfeeding by the 1-month postpartum appointment. Demographic (age at birth, and employment status), medical (parity, and physical and mental condition of the mother; and infant medical factors, such as sex, Apgar score, and jaundice, among other), and family factors (husband/partner, family members living at the same house, among others) in 734 women who had initiated breastfeeding during their delivery hospital stay were examined, and multiple logistic regression was used to determine significant predictors of early cessation of exclusive breastfeeding.ResultsBivariate analysis revealed that women who were primipara, unmarried, exposed to secondhand smoke, and employed; those who smoked before pregnancy; and those who had asthma were more likely to discontinue exclusive breastfeeding than other women. Infant factors associated with discontinuation were lower birthweight, earlier gestational age, neonatal intensive care unit admission, treatment for jaundice, or lower weight gain. Multivariable analysis revealed that primiparity, passive smoking before pregnancy, maternal employment, and neonatal jaundice therapy were associated with discontinuation of breastfeeding.ConclusionsIn particular, women whose partners smoked before pregnancy may need to be targeted for additional support for breastfeeding.

The association between engagement in a perinatal collaborative care program and breastfeeding among people with identified mental health conditions

Untreated antenatal mental health conditions are associated with noninitiation and early discontinuation of breastfeeding. Whether interventions designed to optimize perinatal mental health can mitigate this association is unknown. This study aimed to examine whether engagement of pregnant people with mental health conditions in a perinatal mental health collaborative care program was associated with differences in breastfeeding initiation and continuation and whether any observed association was mediated by changes in depressive symptoms. This retrospective cohort study included all pregnant people who were referred antenatally by their obstetrical clinician to a perinatal collaborative care program and who delivered viable neonates between January 2017 and June 2018. Pregnant people were dichotomized by whether they engaged in collaborative care services. Breastfeeding initiation (endorsed at delivery) and continuation at the postpartum visit were compared between individuals who did and did not engage in collaborative care using bivariable and multivariable analyses. Mediation analyses were performed to determine if any observed associations were mediated by improvements or remission in depressive symptoms. During the study period, 350 eligible pregnant people were referred to the perinatal collaborative care program because of an identified mental health condition. Of these people, 264 (75.4%) engaged in collaborative care. Compared with those who did not engage in collaborative care, people who engaged in collaborative care were more likely to initiate breastfeeding (168 [95%] vs 47 [87%]; P=.046) and continue breastfeeding at the postpartum visit (92 [74%] vs 20 [53%]; P=.012). These associations persisted after controlling for potential confounders (adjusted odds ratio for initiation, 3.30; 95% confidence interval, 1.09-9.98; adjusted odds ratio for continuation, 3.08; 95% confidence interval, 1.29-7.36). Neither association was mediated by improvements or remission in depressive symptoms. Although antenatal mental health conditions are a risk factor for lack of initiation or early cessation of breastfeeding, engagement in a collaborative care program was associated with improvements in both breastfeeding initiation and continuation. This association was independent of improvement in depressive symptoms, suggesting that the benefits of perinatal collaborative care may extend beyond its psychological impact.

Relationship Between the Rates of Breast Milk Production of Preterm Mothers in the First Week Post-Delivery and Continuation of Breastfeeding Through Discharge

BackgroundMothers of preterm infants born between 26- and 35-weeks’ gestation often report challenges with maintaining a pumping schedule and experience perceptions of low milk supply, both of which may contribute to early termination of breastfeeding within the first few weeks.PurposeThe purpose of this study was to assess the relationship between the amount of expressed milk volumes in the first 2 weeks after delivery and infant’s continuing to receive mother’s milk at hospital discharge. These results were part of a larger study that examined multiple maternal variables that may impact the amount of milk volumes and continuation of breastfeeding in the preterm infant admitted to the NICU.MethodsMothers of infants (N = 37) in the NICU were recruited for this correlational, longitudinal study. Data was collected at 24–48 hours post-delivery, at 2 weeks, at 4 weeks from mothers participating in the study and from infant chart reviews.Results/OutcomesMothers who reported higher expressed milk volumes at 3 days post-delivery had consistently higher volumes of expressed breast milk and a higher percentage of continued breastfeeding at hospital discharge. There was no statistically significant relationship between breastfeeding self-efficacy scores, socio-demographic variables, or pumping frequency and the percentage of infants receiving breast milk at hospital discharge. Overall, 76.4% of the infants enrolled in the study were receiving 100% of their intake with fortified mother’s milk at hospital discharge.Discussion/Implications for PracticeThe use of a breast pump log in the first 2 weeks to monitor milk volumes may assist in predicting mothers who are at risk of lower milk supply and early discontinuation of breastfeeding.

Knowledge, Attitudes and Behaviours Towards Exclusive Breastfeeding Amongst Mothers in Sarawak, Malaysia: A Qualitative Study

Introduction: Exclusive breastfeeding is recommended as the optimal method of infant feeding for the first six months, but the rate remains low in many countries, including Malaysia. It is important to understand barriers preventing exclusive breastfeeding, to enable tackling these issues and thereby improving maternal and child health. This study aims to do this by exploring the knowledge, attitudes and behaviours of mothers towards breastfeeding in Sarawak, Malaysia. Material and Methods: Qualitative methods were employed, using semi-structured interviews with an interpreter, conducted in Sarawak General Hospital between 16th April and 11th May 2012. Convenience sampling was used to recruit participants from the maternity wards. Interviews were conducted using a topic guide, were audio-recorded and transcribed verbatim. Analysis was based on conventional content analysis, with codes and themes developing from the interviews. Results: Analysis of the 17 interviews identified five major themes; (1) positive attitudes towards breastfeeding, (2) lack of knowledge relating to exclusive breastfeeding, (3) fear of insufficient milk, (4) methods to improve awareness and knowledge of breastfeeding, (5) improvements in the workplace. There is a lack of knowledge amongst mothers in Malaysia regarding breastfeeding, causing anxiety and early discontinuation of breastfeeding. Methods to improve education of mothers and healthcare staff have been suggested, as well as improvements to encourage breastfeeding in the workplace. Conclusion: Focused education for new mothers and widespread community education may help improve breastfeeding continuation rates. The provision of workplace facilities and flexible working hours for new mothers may help overcome physical barriers preventing breastfeeding continuation once back at work.

Causes of perception of insufficient milk supply in Western Australian mothers.

A perception of insufficient milk supply (PIMS) is associated with early discontinuation of breastfeeding. Ideally, an objective measure of milk supply would either dispel or confirm this perception and provide reassurance or guide professional advice. Clinical signs of sufficient milk intake (steady growth, sufficient elimination, infant alertness and breasts feeling full before breastfeeds and soft after breastfeeds) should provide confidence in milk supply. We surveyed 423 mothers in early lactation who had breastfeeding problems to determine the proportion that had PIMS and to determine if the mothers with PIMS relied on these clinical signs or other perceptions of their infants' behaviour as indications of insufficient milk supply. By 3 weeks after birth, we found that the rate of PIMS among mothers with breastfeeding problems was 44%. Supplementary infant formula was being given to 66% of the infants, so the clinical indications were that milk intake was sufficient, but 74% of the mothers with PIMS cited concerns that their infants did not appear satisfied after breastfeeds. After targeted advice from lactation consultants, mothers with PIMS showed positive changes in their perceptions of their milk supply, underlining the value of professional guidance soon after birth. We conclude that an appearance of infant dissatisfaction is the major cause of PIMS in Western Australia.

Breastfeeding Difficulties and Risk for Early Breastfeeding Cessation.

Although breast milk is the normative feeding for infants, breastfeeding rates are lower than recommended. We investigated breastfeeding difficulties experienced by mothers in the first months after delivery and their association with early breastfeeding discontinuation. We conducted a prospective observational study. Mothers breastfeeding singleton healthy term newborns at hospital discharge were enrolled and, at three months post-delivery, were administered a questionnaire on their breastfeeding experience. Association among neonatal/maternal characteristics, breastfeeding difficulties and support after hospital discharge, and type of feeding at three months was assessed using multivariate binary logistic regression analysis. We enrolled 792 mothers, 552 completed the study. Around 70.3% of mothers experienced breastfeeding difficulties, reporting cracked nipples, perception of insufficient amount of milk, pain, and fatigue. Difficulties occurred mostly within the first month. Half of mothers with breastfeeding issues felt well-supported by health professionals. Maternal perception of not having a sufficient amount of milk, infant’s failure to thrive, mastitis, and the return to work were associated with a higher risk of non-exclusive breastfeeding at three months whereas vaginal delivery and breastfeeding support after hospital discharge were associated with a decreased risk. These results underline the importance of continued, tailored professional breastfeeding support.

Do a Few Weeks Matter? Late Preterm Infants and Breastfeeding Issues.

The late preterm infant population is increasing globally. Many studies show that late preterm infants are at risk of experiencing challenges common to premature babies, with breastfeeding issues being one of the most common. In this study, we investigated factors and variables that could interfere with breastfeeding initiation and duration in this population. We conducted a prospective observational study, in which we administered questionnaires on breastfeeding variables and habits to mothers of late preterm infants who were delivered in the well-baby nursery of our hospital and followed up for three months after delivery. We enrolled 149 mothers and 189 neonates, including 40 pairs of twins. Our findings showed that late preterm infants had a low rate of breastfeeding initiation and early breastfeeding discontinuation at 15, 40 and 90 days of life. The mothers with higher educational levels and previous positive breastfeeding experience had a longer breastfeeding duration. The negative factors for breastfeeding were the following: Advanced maternal age, Italian ethnicity, the feeling of reduced milk supply and having twins. This study underlines the importance of considering these variables in the promotion and protection of breastfeeding in this vulnerable population, thus offering mothers tailored support.

Investigation of the relationship between social support and breastfeeding self-efficacy in primiparous breastfeeding mothers

Background: Breastfeeding is one of the public health priorities in the world. Reduction and early discontinuation of breastfeeding have many harmful effects on maternal, child, and community health. Various factors affect breastfeeding and its sustainability including breastfeeding self-efficacy (BSE) and social support. Since breastfeeding is a behavior that needs knowledge, skills, support, and self-confidence for the mother. Objective: to investigate the relationship between social support and self-efficacy in primiparous breastfeeding women referring to Mashhad health centers. This cross-sectional study was conducted on 300 primiparous breastfeeding mothers with less than 6 months infants referring to healthcare centers of Mashhad, Iran. Materials and methods: The study population was selected through a multistage random sampling method. Data gathering was done by demographic form, Breastfeeding Self-efficacy Scale and perceived social support questionnaire. Data were analyzed using descriptive and inferential statistics, through SPSS version 16 (SPSS Inc., Chicago, IL). Results: Mean score of BSE and social support was 130.89 ± 13.60 and 67.36 ± 5.52, respectively. Stepwise linear regression analysis was used to examine the relationship between social support and BSE precisely. The results showed that social support had a significant effect on BSE (p < .001, β = 0.35, t = 6.44). Conclusions: According to the present study, social support was significantly related to the BSE. Therefore, those with more social support had higher rates of BSE. Therefore, receiving support from the woman’s social network members in form of participation and encouragement, during the breastfeeding is necessary.

849: The association between engagement in a perinatal collaborative care program and breastfeeding

Perinatal collaborative care is a health systems approach to deliver mental health care within the obstetric setting. While perinatal collaborative care has been associated with improvements in mental health outcomes in randomized trials, not all referred women engage in the care provided. Untreated antenatal mental health disorders are associated with lack of initiation and early discontinuation of breastfeeding. Our objective was to examine whether engagement of women with a mental illness referred antenatally to a perinatal collaborative care program was associated with differences in breastfeeding intention and continuation, and whether any observed association was mediated by changes in depressive symptoms. This retrospective cohort study included all women who were referred antenatally by their obstetrician to a perinatal collaborative care program and who delivered viable infants between January 2017 and June 2018. Women were dichotomized by whether they engaged in collaborative care services, defined as participation in either therapy and/or medication management services. Breastfeeding intention (endorsed at delivery) and continuation at the postpartum visit were compared between women who did and did not engage in collaborative care by using bivariable and multivariable analyses. Mediation analyses were performed to determine if any observed associations were mediated by improvements or remission in depressive symptoms. Of the 340 eligible women referred to the perinatal collaborative care program, 264 (75.4%) engaged in the program. Compared to women who did not engage, women who engaged were more likely to intend breastfeeding [168 (95%) vs 47 (87%), p=0.046] and to continue breastfeeding at the postpartum visit [92 (74%) vs 20 (53%), p=0.012]. These associations persisted after controlling for potential confounders (Table) and were not mediated by improvements or remission in depressive symptoms. While antenatal mental health disorders are a risk factor for lack of intention or early cessation of breastfeeding, engagement in a collaborative care program is associated with improvement in both breastfeeding intention and continuation, independent of the mental health benefits.

Development of a novel motivational interviewing (MI) informed peer-support intervention to support mothers to breastfeed for longer

BackgroundMany women in the UK stop breastfeeding before they would like to, and earlier than is recommended by the World Health Organization (WHO). Given the potential health benefits for mother and baby, new ways of supporting women to breastfeed for longer are required. The purpose of this study was to develop and characterise a novel Motivational Interviewing (MI) informed breastfeeding peer-support intervention.MethodsQualitative interviews with health professionals and service providers (n = 14), and focus groups with mothers (n = 14), fathers (n = 3), and breastfeeding peer-supporters (n = 15) were carried out to understand experiences of breastfeeding peer-support and identify intervention options. Data were audio-recorded, transcribed, and analysed thematically. Consultation took place with a combined professional and lay Stakeholder Group (n = 23). The Behaviour Change Wheel (BCW) guided intervention development process used the findings of the qualitative research and stakeholder consultation, alongside evidence from existing literature, to identify: the target behaviour to be changed; sources of this behaviour based on the Capability, Opportunity and Motivation (COM-B) model; intervention functions that could alter this behaviour; and; mode of delivery for the intervention. Behaviour change techniques included in the intervention were categorised using the Behaviour Change Technique Taxonomy Version 1 (BCTTv1).ResultsBuilding knowledge, skills, confidence, and providing social support were perceived to be key functions of breastfeeding peer-support interventions that aim to decrease early discontinuation of breastfeeding. These features of breastfeeding peer-support mapped onto the BCW education, training, modelling and environmental restructuring intervention functions. Behaviour change techniques (BCTTv1) included social support, problem solving, and goal setting. The intervention included important inter-personal relational features (e.g. trust, honesty, kindness), and the BCTTv1 needed adaptation to incorporate this.ConclusionsThe MI-informed breastfeeding peer-support intervention developed using this systematic and user-informed approach has a clear theoretical basis and well-described behaviour change techniques. The process described could be useful in developing other complex interventions that incorporate peer-support and/or MI.

Intrapartum synthetic oxytocin and breastfeeding: a retrospective cohort study

Non-pulsatile oxytocin given during labour can negatively affect breastfeeding. The aim of this study was to assess whether intrapartum oxytocin administration has any effect on breastfeeding. Secondly, to assess whether some maternal or neonatal variables influence breastfeeding. A retrospective cohort study was done, comparing two groups: women exposed (n = 101) and not exposed to oxytocin (n = 100) during labour. Women with caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation, premature neonates and with an Apgar score <7 at 5 minutes were excluded. Duration of breastfeeding was evaluated by a phone call interview. A regression analysis was done, evaluating possible confounding factors. The use of oxytocin during labour was demonstrated to be a predictor of impaired first hour breastfeeding (OR =2.493, CI: 1.05–5.92; p = .038). At three months’ postpartum, 26.7% women in the exposed group versus 14% in the non-exposed group were not breastfeeding (p = .035). This result was not statistically significant when adjusting for possible confounders. High pregestational body mass index was the best predictor of an impaired third month’s postpartum breastfeeding (OR =0.901, CI: 0.835–0.972; p = .007). Intrapartum oxytocin administration could inhibit first hour breastfeeding. A novel association was detected, pregestational body mass index was a predictor of impaired breastfeeding at three months, possibly confounding the oxytocin effect. Additional prospective studies are needed to investigate potential associations between intrapartum oxytocin and breastfeeding.Impact statementWhat is already known on this subject? Oxytocin is a common medical intervention during labour. Some studies suggest a negative association between intrapartum oxytocin dose, newborn sucking and an increased risk of early breastfeeding discontinuation. However, some maternal variables were not considered in these studies and the impact synthetic oxytocin may have on breastfeeding has not been thoroughly researched.What do the results of this study add? In this study, intrapartum oxytocin administration seems to inhibit the first hour breastfeeding. However, a novel association was detected, high pregestational body mass index was a predictor of impaired breastfeeding at three months, possibly confounding oxytocin effects.What are the implications of these findings for clinical practice and/or further research? Additional prospective studies are needed to investigate potential associations between intrapartum oxytocin and breastfeeding. Therefore, health care professionals should help obese women, starting from conception, to maximise breastfeeding outcomes as much as possible.

Risk Factors for Early Discontinuation of Breastfeeding in Iranian Mothers

Objective: The present study was conducted to evaluate the risk factors that reduce the rate of breastfeeding among Iranian women in the first six months after delivery. Materials and Methods: This cross sectional study was performed on 542 mothers with infants less than six months old who came to Taleghani Hospital, Tehran, Iran, for vaccination follow up, from 2012 to 2014. Trained examiners filled a predesigned questionnaire including information about breastfeeding and factors that may affect the mode of infant feeding. The results were analyzed using SPSS software. Results: Out of 542 breastfeeding infants 53.2% were female; the average birth weight was 3217 ± 40 gr and 57.7% were first born. The age of mothers was from 17 to 43 years with the average of 27.7 ± 4.9. Among mothers 58.1% had a high school diploma or less education and 41.9% had higher education. The rate of cesarean section was 62.2%. The rate of breastfeeding showed a reducing trend from the first month after birth to the sixth month: 91.7% of mothers reported breastfeeding in the first month which was reduced to 70.1% in the sixth month. Multivariate analysis using logistic regression analysis showed the risk factors reducing the rate of breastfeeding as follow: use of pacifier (P < 0.000, OR = 3.695, CI95% = 2.460 - 5.553), cesarean section delivery (p < 0.000, OR = 2.717, CI95% = 1.690 - 4.369), lack of breastfeeding training (P = 0.004, OR = 2.347, CI95% = 1.354 - 4.063), and mothers’ higher education (P = 0.029, OR = 1.614, CI95% = 1.014 - 2.569). Conclusion: Use of pacifiers, cesarean section, lack of breastfeeding training, and mothers’ higher education were the risk factors for reduced breastfeeding among Iranian mothers.

Traditional Unani perspective of perceived insufficient milk (Qillatul Laban) and Galactogogues: A literary research with recent studies

The most important reason mentioned for the early discontinuation of breast feeding and introduction of supplementary bottles is Perceived Insufficient Milk (PIM), which is relatively common in women. This is of public health concern because the use of breast milk substitutes increases the risk of morbidity and mortality among infants in developing countries and shortens birth intervals. Thus, a literary search in classical text for aetiopathogenesis, symptoms and treatment of PIM were appraised to implement in contemporary era. The classical Unani texts viz., Al Qanon fit Tib (Canon of Medicine), Al Hawi (Continens Liber), Zakheera Kharzam Shahi, Tarjuma Kamilus Sana, Tibbe Akbar, Akseer Azam, and Kitabul Kulliyat were reviewed. Further certain galactogogue herbs which are in use since antiquity such as fenugreek, cotton seeds, cumin, asparagus, black cumin etc were explored in different search engines on website for proven galactogogue activity. The causes of PIM are abnormal temperament of body or breast, anaemia, anxiety, depression, malnutrition etc. The principle treatment is treating the cause viz., the temperament is corrected by diet and drugs in abnormal temperament, elimination of humour is required in dominance of humour etc. The aforementioned drugs are proven scientifically for their galactogogue activity. The classical texts are having valuable information regarding PIM, which can be implemented in present era. Aforementioned Unani drugs are proven scientifically for with their galactogogue effect, however, clinical trials are scarce. Therefore, further randomized controlled clinical trials are recommended.

Establishment of Intestinal Microbiota during Early Life: a Longitudinal, Explorative Study of a Large Cohort of Danish Infants

Fecal samples were obtained from a cohort of 330 healthy Danish infants at 9, 18, and 36 months after birth, enabling characterization of interbacterial relationships by use of quantitative PCR targeting 31 selected bacterial 16S rRNA gene targets representing different phylogenetic levels. Nutritional parameters and measures of growth and body composition were determined and investigated in relation to the observed development in microbiota composition. We found that significant changes in the gut microbiota occurred, particularly from age 9 to 18 months, when cessation of breastfeeding and introduction of a complementary feeding induce replacement of a microbiota characterized by lactobacilli, bifidobacteria, and Enterobacteriaceae with a microbiota dominated by Clostridium spp. and Bacteroides spp. Classification of samples by a proxy enterotype based on the relative levels of Bacteroides spp. and Prevotella spp. showed that enterotype establishment occurs between 9 and 36 months. Thirty percent of the individuals shifted enterotype between 18 and 36 months. The composition of the microbiota was most pronouncedly influenced by the time of cessation of breastfeeding. From 9 to 18 months, a positive correlation was observed between the increase in body mass index and the increase of the short-chain-fatty-acid-producing clostridia, the Clostridum leptum group, and Eubacterium hallii. Considering previously established positive associations between rapid infant weight gain, early breastfeeding discontinuation, and later-life obesity, the corresponding microbial findings seen here warrant attention.

Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum

Although breastfeeding is known to be beneficial to both mother and infant, many women encounter barriers to breastfeeding, even after successful breastfeeding initiation, which may put them at greater risk for early cessation of breastfeeding. The objectives of this study were to conduct a secondary analysis of data from a longitudinal study of postpartum depression to (a) examine factors related to very early discontinuation of breastfeeding (at 2 weeks postpartum) following hospital discharge and (b) identify women's reasons for very early cessation of breastfeeding. The results of this study support findings from previous research. Having a perceived support system, whether it is personal or professional, may have an effect on both the initiation and duration of breastfeeding. Educating expectant and new mothers, especially women who encounter multiple barriers and are at risk for very early cessation of breastfeeding, of the benefits of breastfeeding and supporting them in developing efficient techniques and problem-solving skills can help increase the duration of breastfeeding.

Outcome of Infants Exposed to Olanzapine During Breastfeeding

This study evaluated the outcome of infants exposed to olanzapine during lactation. A prospective, controlled observational study design was used. Mothers who contacted Beilinson Teratology Information Service regarding use of olanzapine while breastfeeding were followed by phone interview. Data on lactation, neonatal symptoms, and outcome at the age of 1-2 years were obtained. Mother-infant groups were compared. Mothers breastfeeding while taking olanzapine (n = 22) were compared to two control groups of mothers who continued to take olanzapine but did not breastfeed (n = 15) and to breastfeeding mothers using a drug known to be safe during lactation (n = 51). Follow-up was obtained for 37 of 70 women. Comparison of olanzapine-exposed breastfed versus control breastfed infants showed a similar duration of breastfeeding; however, early discontinuation of breastfeeding was more common in the olanzapine-exposed breastfed group (five of 22 vs. none of 51, p = 0.02). The rate of adverse outcomes in olanzapine-exposed breastfed infants did not differ from those of the control groups. Among the 30 newborns exposed in utero to olanzapine, no congenital birth defects were found. Neonatal symptoms were seen in six of 30 of olanzapine-exposed infants versus two of 51 of nonexposed infants (p < 0.05). A withdrawal syndrome was seen in three of 30 (10%) infants. No increase in adverse long-term outcomes in olanzapine-exposed breastfed infants were found. Our data in conjunction with previous estimates of very low drug exposure support continuation of breastfeeding in women treated with olanzapine. However, until additional long-term studies are available, infants exposed to olanzapine through breastmilk should be followed up.