Health Risk For Infants Research Articles

Public Opinions About Infant Feeding in the United States.

Exclusive breastfeeding is recommended for the first 6 months of life. However, many barriers to breastfeeding exist. We examine public opinions about the benefits of breastfeeding and the infant health risks associated with formula feeding. A national public opinion survey was conducted in 2013. Participants indicated their level of agreement with four breastfeeding-related statements. Except for the last one, all statements were positively worded with agreement representing positive opinions toward breastfeeding. To focus on the prevalence of positive opinions, we estimated percentage agreement with the first three statements, but disagreement with the fourth. Multiple logistic regression was used to examine how odds of these positive opinions varied by socio-demographic factors. Seventy-eight percent of participants agreed that breastmilk is nutritionally designed for infants, but few believed breastfeeding protects against overweight (12%). Approximately one-quarter agreed that formula feeding increases the chance of illness, whereas 45 percent disagreed that infant formula is equivalent to breastmilk. Older, less-educated, unmarried, and non-Hispanic black participants were less likely to agree that formula feeding increases the risk of infant illness. Races other than non-Hispanic white, participants aged 30-44 years and 45-59 years, unmarried, and less-educated participants were less likely to disagree with the equivalence of infant formula to breastmilk. The nutritional value of breastmilk is well known. Fewer adults believe that breastfeeding protects against childhood overweight or that formula feeding increases the chance of infant illness. Communication efforts may increase public awareness of the health benefits of breastfeeding.

Assessment of Aflatoxin M1 and Heavy Metal Levels in Mothers Breast Milk in Famagusta, Cyprus.

Breast milk contributes towards optimal nutrition for infants. However, studies showed that it can also contain different toxins and heavy metals, which reduce its health benefits. The aim of this study is to determine the level of contaminants such as aflatoxin M1 (AFM1), Pb, Cd, As, and Hg in breast milk samples from Famagusta, Cyprus. Correlations between moldy food consumption, smoking habits of the mothers, and contaminant levels in breast milk were also investigated. Breast milk samples from 50 lactating mothers in rural and urban areas of Famagusta District were analyzed for AFM1 by ELISA. Eighty percent of them were found to be contaminated with AFM1 with the mean measurement of 7.84 ± 1.72ng/l. Socio-demographic status, moldy food consumption habits, and smoking status do not have any effect on the AFM1 levels observed in breast milk. Heavy metal levels in breast milk were examined by inductively coupled plasma mass spectrometry, and the mean measurements were1.19 ± 1.53ppm for Pb, 0.73 ± 0.58ppm for As, 0 ± 0.20ppm for Hg, and 0.45 ± 0.23ppm for Cd. This study indicates that the levels of these contaminants in breast milk samples obtained in Famagusta District are well within the acceptable levels. However, the presence of AFM1 and heavy metals still may pose risks for infant health.

Pre-pregnancy body mass index, height and physical activity are associated with rate of gestational weight gain among Malaysian mothers.

Both inadequate and excessive weight gain during pregnancy can have immediate and long-term health risks for women and infants. This study investigated rate of gestational weight gain (GWG) and its associated factors in Malaysian pregnant women. This cross-sectional study was conducted at maternal and child health clinics in Selangor and Negeri Sembilan between November 2010 and April 2012. A pre-tested questionnaire was used to obtain sociodemographic, obstetric, dietary intake and physical activity information. Current weight and height were measured using standard procedures. GWG rate was calculated as the average weekly weight gain in that particular trimester of pregnancy and further categorized according to the Institute of Medicine (IOM) recommendations. Mean GWG rate for all pre-pregnancy BMI categories in the second and third trimesters was higher than the IOM recommendations. Overweight women (adjusted OR, 4.26; 95%CI: 1.92-9.44) and women <153 cm tall (adjusted OR, 1.96; 95%CI: 1.21-3.18) tend to have inadequate GWG rate. Women with high pre-pregnancy body mass index (BMI; ≥25.0 kg/m(2) ; overweight: adjusted OR, 3.88; 95%CI: 2.12-7.09; obese: adjusted OR, 2.34; 95%CI: 1.28-4.29) and low physical activity (adjusted OR, 1.74; 95%CI: 0.77-3.97) were two-threefold more likely to have excessive GWG. Both inadequate and excessive GWG can have detrimental effects on the health of mothers and infants. Pre-pregnancy BMI, height and physical activity should be emphasized in prenatal care to ensure that women have adequate GWG rate.

Assisted Reproductive Technology Surveillance - United States, 2013.

Assisted Reproductive Technology Surveillance - United States, 2013.

Synthetic musk compounds and benzotriazole ultraviolet stabilizers in breast milk: Occurrence, time–course variation and infant health risk

Synthetic musk compounds (SMCs) and benzotriazole ultraviolet stabilizers (BUVSs) are used as additives in many consumer products. Limited data are available on the accumulation of SMCs in human fluids, and no data are available on BUVSs. In this study, 208 human breast milk samples were collected from 87 participants during the lactation period at <7, 15, 30, and 90 days after delivery in Korea. The total concentrations of SMCs and BUVSs ranged from <LOQ to 1593 (median: 286)ng/g lipid weight and from <LOQ to 2172 (median: 64.7)ng/g lipid weight, respectively. The residue levels of HHCB and AHTN in our samples were the highest, compared to those reported in the US, Europe, and China. The predominant compounds were HHCB and AHTN for SMCs and UV-328 for BUVSs, consistent with consumption patterns of these contaminants. Over the lactation period, no significant changes were found in concentrations of SMCs and BUVSs for both parity groups. Maternal age, body mass index, and parity were not associated with the concentrations of SMCs and BUVSs, while gestational age and delivery mode were associated with these contaminants. The estimated daily intakes of HHCB and AHTN were lower than the provisional tolerable daily intake values, suggesting a limited health risk to Korean infants. This study is the first to comprehensively investigate the current levels, accumulation features, contributing factors of BUVSs associated with breast milk consumption in Korea.

Embryo transfer practices and multiple births resulting from assisted reproductive technology: an opportunity for prevention

To evaluate assisted reproductive technology (ART) ET practices in the United States and assess the impact of these practices on multiple births, which pose health risks for both mothers and infants. Retrospective cohort analysis using the National ART Surveillance System data. US fertility centers reporting to the National ART Surveillance System. Noncanceled ART cycles conducted in the United States in 2012. None. Multiple birth (birth of two or more infants, at least one of whom was live-born). Of 134,381 ART transfer cycles performed in 2012, 51,262 resulted in live births, of which 13,563 (26.5%) were multiple births: 13,123 twin and 440 triplet and higher order births. Almost half (46.1%) of these multiple births resulted from the following four cycle types: two fresh blastocyst transfers among favorable or average prognosis patients less than 35 years (1,931 and 1,341 multiple births, respectively), two fresh blastocyst transfers among donor-oocyte recipients (1,532 multiple births), and two frozen/thawed ETs among patients less than 35 years (1,452 multiple births). More than half of triplet or higher order births resulted from the transfer of two embryos (52.5% of births among fresh autologous transfers, 67.2% of births among donor-oocyte recipient transfers, and 42.9% among frozen/thawed autologous transfers). A substantial reduction of ART-related multiple (both twin and triplet or higher order) births in the United States could be achieved by single blastocyst transfers among favorable and average prognosis patients less than 35 years of age and donor-oocyte recipients.

Inorganic arsenic in rice-based products for infants and young children

Inorganic arsenic (Asi) is a chronic, non-threshold carcinogen. Rice and rice-based products can be the major source of Asi for many subpopulations. Baby rice, rice cereals and rice crackers are widely used to feed infants and young children. The Asi concentration in rice-based products may pose a health risk for infants and young children. Asi concentration was determined in rice-based products produced in the European Union and risk assessment associated with the consumption of these products by infants and young children, and compared to an identical US FDA survey. There are currently no European Union or United States of America regulations applicable to Asi in food. However, this study suggests that the samples evaluated may introduce significant concentration of Asi into infants’ and young children’s diets. Thus, there is an urgent need for regulatory limits on Asi in food, especially for baby rice-based products.

Bisphenol A and nonylphenol in foodstuffs: Chinese dietary exposure from the 2007 total diet study and infant health risk from formulas

Concentrations of bisphenol A (BPA) and nonylphenol (NP) were measured in food samples from the 2007 Chinese total diet study (TDS). BPA and NP were detected in 72 and 143 of 144 TDS samples, respectively, with concentrations ranging from 20ng/kg to 267μg/kg and 30ng/kg to 1268μg/kg, respectively. BPA was highest in Hebei (HB) province for most food groups. NP was much higher in milk than in other foods across all the provinces. Mean exposures to BPA and NP were estimated to be 43ng/kgbw/day and 520ng/kgbw/day for a Chinese adult, respectively, well below the tolerable daily intake (TDI). Mean exposure to NP from formula for infants aged 0–6years ranged from 300ng/kgbw/day to 17μg/kgbw/day. For infants aged 0–1year, intakes ranged from 5 to 17μg/kgbw/day, which is above the TDI.

Family risk as a predictor of initial engagement and follow-through in a universal nurse home visiting program to prevent child maltreatment

ObjectiveAs nurse home visiting to prevent child maltreatment grows in popularity with both program administrators and legislators, it is important to understand engagement in such programs in order to improve their community-wide effects. This report examines family demographic and infant health risk factors that predict engagement and follow-through in a universal home-based maltreatment prevention program for new mothers in Durham County, North Carolina. MethodsTrained staff members attempted to schedule home visits for all new mothers during the birthing hospital stay, and then nurses completed scheduled visits three to five weeks later. Medical record data was used to identify family demographic and infant health risk factors for maltreatment. These variables were used to predict program engagement (scheduling a visit) and follow-through (completing a scheduled visit). ResultsProgram staff members were successful in scheduling 78% of eligible families for a visit and completing 85% of scheduled visits. Overall, 66% of eligible families completed at least one visit. Structural equation modeling (SEM) analyses indicated that high demographic risk and low infant health risk were predictive of scheduling a visit. Both low demographic and infant health risk were predictive of visit completion. ConclusionsFindings suggest that while higher demographic risk increases families’ initial engagement, it might also inhibit their follow-through. Additionally, parents of medically at-risk infants may be particularly difficult to engage in universal home visiting interventions. Implications for recruitment strategies of home visiting programs are discussed.

Improving Infant Exposure and Health Risk Estimates: Using Serum Data to Predict Polybrominated Diphenyl Ether Concentrations in Breast Milk

Women in the United States have breast milk concentrations of polybrominated diphenyl ethers (PBDEs) that are among the highest in the world, leading to concerns over the potential health implications to breastfeeding infants during critical stages of growth and development. Developing cost-effective and sustainable methods for assessing chemical exposures in infants is a high priority to federal agencies and local communities. PBDE data are available in nationally representative serum samples but not in breast milk. As a method to predict PBDE concentrations in U.S. breast milk, we present the development of congener-specific linear regression partitioning models and their application to U.S. serum data. Models were developed from existing paired milk and serum data and applied to 2003-2004 NHANES serum data for U.S. women. Highest estimated median U.S. breast milk concentrations were for BDE-47 (30.6 ng/g lipid) and BDE-99 (6.1 ng/g lipid) with the median concentration of Σ7PBDEs estimated at 54.2 ng/g lipid. Predictions of breast milk PBDE concentration were consistent with reported concentrations from 11 similarly timed U.S. studies. When applied to NHANES data, these models provide a sustainable method for estimating population-level concentrations of PBDEs in U.S. breast milk and should improve exposure estimates in breastfeeding infants.

Occurence of potentially enterotoxigenic Bacillus cereus in infant milk powder

Considering that powdered infant milk formula effectively supports the growth of numerous pathogens, this study investigates the prevalence of potentially pathogenic Bacillus cereus in dried milk products by evaluating the occurrence of B. cereus and the presence of virulence-associated genes. The approach consisted of enriching, isolating and biochemical identifying isolates, followed by PCR assays aimed at the hbl (C, D, A, B), nhe (A, B, C) and cytK enterotoxin genes coding HBL complex, NHE complex and cytotoxin K, respectively. Among cytK-positive strains, the discrimination of two different forms for cytotoxin K, cytK-1 and cytK-2 was performed. Bacillus cereus was detected in powdered infant milk formula samples. All the strains harbored at least one gene of the cytK, HBL and NHE enterotoxins. Because of an increasing trend in invasive infections by B. cereus in infants and immunocompromised children, our PCR findings highlight the need to implement an adequate control plan in order to guarantee the health of potentially fragile consumers. From a hygiene point of view, intensive and continuous monitoring of potentially pathogenic B. cereus may be crucial for powdered infant milk formula safety and even recommended in order to assess the infant health risk, as proposed by Commission Regulation (EC) no. 1441/2007 on microbiological criteria for foodstuffs. Furthermore, the detection in this study of B. licheniformis, B. subtilis and B. mycoides strains raises significant health issues regarding Bacillus spp. in powdered infant milk formula.

Prevalence of viruses in stool of premature neonates at a neonatal intensive care unit

Premature neonates represent a population highly vulnerable to infection. This study aims to profile viral colonisation of gut and the associated clinical manifestations among premature neonates admitted to a neonatal intensive care unit (NICU) in Australia. In a cohort of 75 premature neonates born at less than 32 weeks gestation, who were followed for 4 weeks following admission to a NICU in Sydney, Australia, multiplex polymerase chain reaction assays were used to determine viral presence in stool, and clinical data were examined. Overall, viral RNA or DNA was detected in 24/419 (5.7%) of specimens, including norovirus genogroup 2 (1.9%), enterovirus (1.2%), herpes simplex virus-2 (1.2%), cytomegalovirus (0.7%), Epstein-Barr virus (0.5%) and rotavirus (0.2%). Viral infection was detected in 13/75 (17%) of premature neonates at some time point, including five (7%) neonates shedding more than one type of virus in stool. A higher rate of infection was observed among premature neonates with intrauterine growth restriction (56%) compared with those infants born appropriate for gestational age (12%. P = 0.006). The overall viral detection rate in stool of 5.7% (affecting 17% of neonates) indicates viral infections are an important health risk for premature infants in NICU.

Aflatoxin M1 contamination of human breast milk in Isfahan, Iran.

Background:During the last decades there has been great attention paid to aflatoxins. They are highly toxic, immunosuppressive, mutagenic, teratogenic, and carcinogenic compounds. Aflatoxin M1 (AFM1), a hydroxylated metabolite of aflatoxin B1 (AFB1), is formed in the liver and excreted into the breast milk. It is considered to cause certain hygienic risks for infant health. The aim of this study was to evaluate the presence of the AFM1 in the breast milk using AFM1 in milk as a biomarker for exposure to aflatoxin B1 and determine the level of AFM1 contamination in the lactating mothers in Isfahan, Iran.Materials and Methods:This study was carried out on 80 lactating women randomly selected from two urban health centers. Mother's milk samples and information on food intake were collected from the participants using structured food-frequency questionnaire. Breast milk samples were tested for AFM1 by a competitive ELISA technique.Results:Our findings showed that only one sample was contaminated with AFM1 with concentrations of 6.8 ng/L. However, the AFM1 level in this sample was lower than the maximum tolerable limit (25 ng/L) accepted by the European Communities and Codex Alimentarius.Conclusion:Although the concentration of AFM1 in none of the samples was higher than the acceptable level, the presence of AFM1 in only one of them confirms the need for developing strategies to reduce exposure to aflatoxin in foods and to carry out biological monitoring of aflatoxins as a food quality control measure routinely.

Fusarium verticillioides from finger millet in Uganda

Finger millet (Eleusine coracana) is a subsistence crop grown in Sub-Saharan Africa and the Indian Sub-continent. Fusarium species occurring on this crop have not been reported. Approximately 13% of the Fusarium isolates recovered from finger millet growing at three different locations in eastern Uganda belong to Fusarium verticillioides, and could produce up to 18,600 µg/g of total fumonisins when cultured under laboratory conditions. These strains are all genetically unique, based on AFLP analyses, and form fertile perithecia when crossed with the standard mating type tester strains for this species. All but one of the strains is female-fertile and mating-type segregates 13:20 Mat-1:Mat-2. Three new sequences of the gene encoding translation elongation factor 1− α were found within the population. These results indicate a potential health risk for infants who consume finger millet gruel as a weaning food, and are consistent with the hypothesis that F. verticillioides originated in Africa and not in the Americas, despite its widespread association with maize grown almost anywhere worldwide.

Polybrominated diphenyl ethers exposure in breast milk in Shanghai, China: Levels, influencing factors and potential health risk for infants

The use of polybrominated diphenyl ethers (PBDEs) is increasing annually in China. Although several studies have reported significant contamination by these compounds in biological samples in China, little is known about the factors that may influence the levels of exposure and the potential health risk for infants. We investigated PBDE exposure levels in breast milk, its influencing factors and the potential health risk for infants in Shanghai, China by enrolling 48 healthy women between September 2006 and April 2007. PBDE exposure was assessed by analyses of seven PBDE congeners in breast milk. The estimated daily intake of PBDEs by infants via breastfeeding was determined for evaluating the potential health risk for infants. The median (range) of total PBDE content in breast milk was 8.81 (1.92–41.55)ng/g lipid. 34 (71%) of the 48 samples tested positive for all seven congeners. Maternal education level and household monthly salary were positively associated with PBDE concentration in breast milk (r=0.337, p=0.019 and r=0.436, p=0.004, respectively). The median of estimated daily intake of BDE-99 (6.67ng/kg/day) by infants via breastfeeding was below the human no adverse effect level (NAEL) set for BDE-99 for neurodevelopmental toxicity (18.8ng/kg/day). However, 3 (6%) of the samples exceeded the human NAEL. Taking the high detection rate of PBDEs in breast milk together with 6% of their EDI higher than NAEL in Shanghai, more studies on the effects of maternal PBDE exposure on fetal growth and child neurodevelopment are warranted.

Support for healthy breastfeeding mothers with healthy term babies.

There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended infants be exclusively breastfed until six months of age, with breastfeeding continuing as an important part of the infant's diet till at least two years of age. However, breastfeeding rates in many countries currently do not reflect this recommendation. To assess the effectiveness of support for breastfeeding mothers. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (3 October 2011). Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Two review authors independently assessed trial quality and extracted data. Of the 67 studies that we assessed as eligible for inclusion, 52 contributed outcome data to the review (56,451 mother-infant pairs) from 21 countries. All forms of extra support analysed together showed an increase in duration of 'any breastfeeding' (includes partial and exclusive breastfeeding) (risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.96). All forms of extra support together also had a positive effect on duration of exclusive breastfeeding (RR at six months 0.86, 95% CI 0.82 to 0.91; RR at four to six weeks 0.74, 95% CI 0.61 to 0.89). Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Maternal satisfaction was poorly reported. All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place.Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available.Support should be tailored to the needs of the setting and the population group.

Brominated flame retardants and polychlorinated biphenyls in human breast milk from several locations in India: Potential contaminant sources in a municipal dumping site

This study investigated the status of contamination of organohalogen compounds (OCs) such as polychlorinated biphenyls (PCBs) and brominated flame retardant (BFRs), including polybrominated diphenyl ethers (PBDEs) and hexabromocyclododecanes (HBCDs) in human milk samples from several locations in India. The levels of OCs were significantly higher in the milk of mothers living in and near municipal dumping site than other locations indicating that the open dumping sites for municipal wastes act as potential sources of these contaminants in India. The PCB concentrations observed in this study tended to decrease compared to those in the matched locations reported previously, probably due to the restriction of technical PCB usage in India. PBDE levels in human milk were two to three folds lower than those of PCBs in all the sampling locations investigated. Congener profiles of PCBs and PBDEs were different between samples from the dumping site mothers and general populations in other areas suggesting the presence of region-specific sources and pathways. HBCDs were detected in human milk from only two sites, with much lower concentrations and detection frequencies compared to PCBs and PBDEs. When hazard quotients (HQs) of PCBs and PBDEs were estimated for infant health risk, the HQs in some milk samples from the dumping site exceeded the threshold value (HQ > 1) of PCBs, indicating the potential risk for infants in the specific site.

Accuracy of physical activity assessment during pregnancy: an observational study

BackgroundPrenatal physical activity may improve maternal and infant health and lower future disease risk for both mother and baby; however, very few physical activity assessment methods have been validated for use during pregnancy. The purpose of this study was to evaluate the accuracy of a subjective physical activity record (PAR) and an objective activity monitor, against a reference standard to quantify moderate and vigorous physical activity (MVPA) in pregnant women. The reference standard was based on participant interviews to determine if a woman was an exerciser and confirmed with information obtained from the PAR and a heart rate monitor.MethodsFifty-two pregnant women completed a physical activity record (PAR) and wore a SenseWear® Mini Armband (SWA) activity monitor over a 7-day period at 18 weeks gestation. Total minutes spent in MVPA were totaled from both modalities and evaluated against the reference standard using contingency analysis and Pearson's chi-square test to evaluate the number of women meeting minimum prenatal physical activity recommendations (at least 3, 30 minute sessions of exercise per week). Both modalities were also tested individually and collectively to assess their ability as indicators of activity using empirically determined cut-offs as indicated by receiver-operator characteristic curves. These experimentally-derived criteria were also tested with Pearson's chi-square test.ResultsAccording to the reference standard, 13 of 52 participants (25%) met the criterion of 3, 30 minute sessions of volitional, moderate-intensity activity. When compared to the reference standard, both the PAR and SWA overestimated exercise status; 42 (81%) and 52 (100%) participants, respectively, achieved 90 minutes of MVPA (P < 0.0001 for both comparisons). Single-modality predictors of MVPA did not show a significant correlation. A composite predictor of MVPA offered the most favorable option for sensitivity and specificity (true positives, n = 8 and true negatives, n = 36) using cut-offs of 280 and 385 minutes/week for the PAR and SWA, respectively.ConclusionCompared to the reference standard, time spent in MVPA obtained from the PAR or SWA overestimated the prevalence of women meeting prenatal exercise recommendations. The most accurate predictor of women meeting current prenatal exercise guidelines was identified by using the PAR and SWA collectively.

Emotional availability and attachment across generations: variations in patterns associated with infant health risk status

The presence of limits or distortions in the children's communicative behaviours (due to a chronic illness) may interfere with the possibility to build secure attachment relationships. Moreover, the distress that the atypical chronic illness condition brings to family life may interfere the intergenerational transmission of attachment. This study evaluated the associations between maternal attachment representations, emotional availability and mother-child attachment in a clinical and in a comparison group. Forty infants (23 female) in their 14th month of life and their mothers participated in this study, 20 dyads with clinical infants (10 premature infants and 10 infants affected by atopic dermatitis) and 20 full-term and healthy comparison infants. The Adult Attachment Interview, the Emotional Availability Scales (EAS) and the Strange Situation Procedure were used to assess, respectively, the security of mothers' attachment representations, the emotional availability and the quality of mother-child attachment. We found that the two groups (clinical vs. comparison) did not differ with respect to the Adult Attachment Interview and the Emotional Availability Scales measures. A significant difference was found in the distribution of the infant-mother attachment patterns, with a higher incidence of insecure infants in the clinical group. In the typically developing group, more secure maternal attachment representations predicted more emotional availability in mother-infant interactions, which predicted more secure infant-mother attachments. However, we did not find similar support for intergenerational transmission of attachment in the clinical group. We speculate that constant concerns about the child's health condition and communicative difficulties of clinical infants may hamper or even mitigate the intergenerational transmission of attachment.

Out-of-hospital births and the supply of maternity units in France

Maternity unit closures in France have increased distances that women travel to deliver in hospital. We studied how the supply of maternity units influences the rate of out-of-hospital births using birth certificate data. In 2005–6, 4.3 per 1000 births were out-of-hospital. Rates were more than double for women living 30km or more from their nearest unit and were even higher for women of high parity. These associations persisted in multilevel analyses adjusting for other maternal characteristics. Long distances to maternity units should be a concern to health planners because of the maternal and infant health risks.