Improve Breastfeeding Outcomes Research Articles

Enhancing oxytocin and prolactin levels to address oligogalactia through emotional management and massage in working mothers.

Emotional management, combined with oxytocin massage and breast care, offers a comprehensive approach to boost prolactin release, enhance milk production, and improve breastfeeding outcomes. The aim of this study was to evaluate the effectiveness of combining emotional management with oxytocin massage and breast care in increasing oxytocin and prolactin hormone levels to address oligogalactia in working postpartum mothers. A quasi-experimental study was conducted at Kudus Community Health Center, Kudus Regency, Central Java, Indonesia, from January to March 2024. A total of 93 postpartum mothers were randomly assigned to three groups: (1) emotional management with oxytocin massage; (2) emotional management with breast care; and (3) lactation education only. Blood samples were collected before and after the interventions to measure oxytocin and prolactin levels. The present study found that emotional management combined with oxytocin massage significantly increased oxytocin levels from 505.0±264.0 pg/mL to 600.0±231.3 pg/mL (mean difference: 103 pg/mL; p=0.002) and prolactin levels from 191.0±67.3 ng/mL to 233.0±86.8 ng/mL (mean difference: 27 ng/mL; p=0.001). The emotional management and breast care group showed a smaller increase in oxytocin (362.0±175.1 pg/mL to 418.0±185.1 pg/mL; mean difference: 23 pg/mL; p=0.048) and a significant increase in prolactin (195.0±48.8 ng/mL to 255.0±82.3 ng/mL; mean difference: 38 ng/mL; p=0.049). In contrast, the lactation education group showed no significant changes in oxytocin (p=0.756) or prolactin levels (p=0.341). In conclusion, emotional management combined with oxytocin massage significantly increased both oxytocin and prolactin levels, suggesting that integrating emotional management and oxytocin massage may be an effective strategy for postpartum lactation support.

Enhancing oxytocin and prolactin levels to address oligogalactia through emotional management and massage in working mothers

Emotional management, combined with oxytocin massage and breast care, offers a comprehensive approach to boost prolactin release, enhance milk production, and improve breastfeeding outcomes. The aim of this study was to evaluate the effectiveness of combining emotional management with oxytocin massage and breast care in increasing oxytocin and prolactin hormone levels to address oligogalactia in working postpartum mothers. A quasi-experimental study was conducted at Kudus Community Health Center, Kudus Regency, Central Java, Indonesia, from January to March 2024. A total of 93 postpartum mothers were randomly assigned to three groups: (1) emotional management with oxytocin massage; (2) emotional management with breast care; and (3) lactation education only. Blood samples were collected before and after the interventions to measure oxytocin and prolactin levels. The present study found that emotional management combined with oxytocin massage significantly increased oxytocin levels from 505.0±264.0 pg/mL to 600.0±231.3 pg/mL (mean difference: 103 pg/mL; p=0.002) and prolactin levels from 191.0±67.3 ng/mL to 233.0±86.8 ng/mL (mean difference: 27 ng/mL; p=0.001). The emotional management and breast care group showed a smaller increase in oxytocin (362.0±175.1 pg/mL to 418.0±185.1 pg/mL; mean difference: 23 pg/mL; p=0.048) and a significant increase in prolactin (195.0±48.8 ng/mL to 255.0±82.3 ng/mL; mean difference: 38 ng/mL; p=0.049). In contrast, the lactation education group showed no significant changes in oxytocin (p=0.756) or prolactin levels (p=0.341). In conclusion, emotional management combined with oxytocin massage significantly increased both oxytocin and prolactin levels, suggesting that integrating emotional management and oxytocin massage may be an effective strategy for postpartum lactation support.

Return-on-Investment Analysis of an Enhanced Community Doula Program: Pre- and Post-COVID-19 Considerations.

Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real-world data and a return-on-investment (ROI) analysis approach. We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post-COVID-19 program costing estimates were also performed. Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per-person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not. The BBB-enhanced community doula program was cost-saving to payers and increased access to doula support for low-income people. Even with post-COVID-19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget-conscious Medicaid payers that doula services are affordable.

The impact of the Baby-Friendly Hospital Initiative on breastfeeding rates at maternity units in France.

The Baby-Friendly Hospital Initiative (BFHI) is associated with improved breastfeeding outcomes in many high-income countries including the UK and the USA, but its effectiveness has never been evaluated in France. We investigated the impact of the BFHI on breastfeeding rates in French maternity units in 2010, 2016 and 2021 to assess if the BFHI aids to reduce inequalities in breastfeeding. We examined breastfeeding in maternity units (exclusive, mixed and any breastfeeding) in mothers of singleton full-term newborns using the 2010 (n = 13 075), 2016 (n = 10 919) and 2021 (n = 10 209) French National Perinatal Surveys. We used mixed-effect hierarchical multinomial regression models adjusting for neonatal, maternal, maternity unit and French administrative department characteristics, and tested certain interactions. The adjusted rate of exclusive breastfeeding was higher by +5.8 (3.4-8.1) points among mothers delivering in BFHI-accredited maternity units compared with those delivering in non-accredited units. When compared with average-weight newborns, this difference was sharper for infants with low birthweight: +14.9 (10.0-19.9) points when their birthweight was 2500 g. Mixed breastfeeding was lower by -1.7 points (-3.2-0) in BFHI-accredited hospitals, with no notable difference according to the neonatal or maternal characteristics. Mothers delivering in BFHI-accredited maternity units had higher exclusive breastfeeding rates and lower mixed breastfeeding rates than those delivering in non-accredited maternity units. The positive impact of the BFHI was stronger among low-birthweight neonates, who are less often breastfed, helping reduce the gap for this vulnerable group while favouring mothers with higher education levels.

The Impact of Excessive Weight on Breastfeeding Intention, Initiation, and Duration.

Background: Breastfeeding is widely recognized as the optimal feeding method for infants. However, breastfeeding goals are often unmet, especially in mothers with excessive weight. Potential factors associated with unmet goals could be disparities in care for women with higher body mass index (BMI) or mental health symptomology. Methods: Women enrolled in a longitudinal study were stratified by BMI into three groups: mothers with normal weight (18.5-24.9 kg/m2, n = 101), with overweight (25-29.9 kg/m2, n = 78), and with obesity (OB; 30-35 kg/m2, n = 48). Breastfeeding intention and standardized mental health questionnaires were administered at gestational weeks 12 and 36. The prevalence of initiation and duration of breastfeeding were determined based on self-reported breastfeeding start and end dates. Wilcoxon tests, pairwise proportion test, Cox proportional hazards regression, and linear regression were used. Results: Higher maternal weight status (OB) was significantly associated with lower breastfeeding intention and duration. As expected, higher breastfeeding intention scores were associated with significantly longer breastfeeding duration. Higher scores on the Beck Depression Inventory (BDI), associated with a greater number of depression symptoms, mediated the negative impact of weight status on breastfeeding intention. Conclusions: breastfeeding outcomes are negatively associated with maternal weight status and prenatal mental health with the relationship between the two being interconnected, despite subclinical scores on the BDI. Further research is needed to explore the role of mental health on breastfeeding outcomes. From these findings, targeted prenatal interventions for women with excessive weight and depressive symptoms would likely promote and improve breastfeeding outcomes. ClinicalTrials.gov: www.clinicaltrials.gov, ID #NCT01131117.

What works to protect, promote and support breastfeeding on a large scale: A review of reviews.

Globally women continue to face substantial barriers to breastfeeding. The 2016 Lancet Breastfeeding Series identified key barriers and reviewed effective interventions that address them. The present study updates the evidence base since 2016 using a review of reviews approach. Searches were implemented using the Epistomenikos database. One hundred and fifteen reviews of interventions were identified and assessed for quality and risk of bias. Over half of reviews (53%) were high‐ or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias. A large portion of studies addressed high‐income and upper‐middle income settings, (41%), and a majority (63%) addressed health systems, followed by community and family settings (39%). Findings from reviews continue to strengthen the evidence base for effective interventions that improve breastfeeding outcomes across all levels of the social‐ecological model, including supportive workplace policies; implementation of the Baby‐Friendly Hospital Initiative, skin to skin care, kangaroo mother care, and cup feeding in health settings; and the importance of continuity of care and support in community and family settings, via home visits delivered by CHWs, supported by fathers', grandmothers' and community involvement. Studies disproportionately focus on health systems in high income and upper‐middle income settings. There is insufficient attention to policy and structural interventions, the workplace and there is a need for rigorous assessment of multilevel interventions. Evidence from the past 5 years demonstrates the need to build on well‐established knowledge to scale up breastfeeding protection, promotion and support programmes.

The Use of an Incentive to Improve Breastfeeding Outcomes: The Effectiveness of Offering a Free Family YMCA Membership to Increase Support Group Participation.

Suboptimal breastfeeding can result in negative health consequences for mother and infant and economic consequences for families and communities. Breastfeeding outcomes improve when multifaceted interventions spanning the perinatal period are implemented. Incentives to increase participation in effective, existing community-based breastfeeding support programs have the potential to create behavioral change and improve breastfeeding outcomes but results to date are inconclusive. The aim of this pilot study was to investigate the effectiveness of offering a Young Men's Christian Association membership as an incentive to increase attendance at an existing breastfeeding support program to improve breastfeeding duration and exclusivity. This was a two-group, quasi-experimental study using demographic information and pre- and post-intervention participant surveys. Attendance at a breastfeeding support program was incentivized with an offer of a free family Young Men's Christian Association membership. Surveys and demographic information were used to compare attendance, maternal interest, and perceived significant other and family support for attendance with a non-incentivized control group in an adjacent city. The groups differed demographically and socioeconomically. Significantly more at-risk participants both attended the incentivized group and perceived support from their families to attend. There was a significant increase in the incentivized group's attendance: 62% (n = 26) of participants in the incentivized group attended three or more times compared to 36% (n = 50) of participants in the control group (p = .03). Both groups exceeded national breastfeeding averages for exclusive breastfeeding at six months. Offering an incentive increased breastfeeding support group attendance by participants at risk for suboptimal breastfeeding and improved their breastfeeding outcomes, thus closing the breastfeeding disparity gap in this population.

Mothers in Need of Lactation Support May Benefit from Early Postnatal Galactagogue Administration: Experience from a Single Center.

Background: Galactagogues are substances that promote lactation, although data on their effects on humans remain limited. We investigated the efficacy of Silitidil to increase milk supply and duration of breastfeeding of a specific subgroup of mothers in need of lactation support. Methods: 161 mothers from November 2018 until January 2021 were the study subjects in this retrospective study; during their hospitalization, due to neonatal or maternal factors that inhibited lactation, they were prescribed galactagogues. Mothers were surveyed by telephone interview via a 13-item questionnaire. Results: 73.91%, were primigravidas, 78.26% gave birth by cesarean section (CS) and 72.05% continued to take galactagogues after hospital discharge. Of the neonates, 24.22% were preterm ≤37 weeks of gestation, and 55.9% had birth weight (BW) between 2500 and 3500 g. With respect to breastfeeding rates, 100% were breastfed during their first week, 98.8% breastfed during the first month, 87% during the first 4 months, dropping to 56.5% at 6 months, 41% at 1 year and 19.3% over 1 year of age. Conclusions: This study demonstrates that administration of a galactagogue containing Silitidil (Piulatte-Humana) improves breastfeeding rates at from 1 until 12 months of life in mothers with low milk supply during their hospital stay. Further studies are needed to generate evidence-based strategies to improve breastfeeding outcomes.

Parental Cohabitation and Breastfeeding Outcomes Among United States Adolescent Mothers.

AbstractBackground: Adolescent mothers in the United States experience disproportionately lower rates of breastfeeding compared to older mothers. Evidence suggests that paternal support helps improve breastfeeding outcomes; however, support is difficult to quantify. Parental cohabitation is easy to identify and could be used to quantify paternal support. Research Aim: Our study is to investigate the association between parental cohabitation and breastfeeding initiation and duration among US adolescent mothers. Materials and Methods: Data from the 2011-2017 National Survey of Family Growth were used. Our study sample included primipara, adolescent mothers (aged 15-19 years) who gave birth to a singleton (n = 1,867). Multivariate logistic regression and Cox Proportional Hazards models were used to analyze the relationship between cohabitation and breastfeeding initiation and duration, respectively. All models were subsequently stratified by race/ethnicity due to evidence of effect modification. Results: After adjusting for all a priori confounders, cohabiting with the infant's father at birth was associated with increased odds of breastfeeding initiation compared to noncohabiting adolescent mothers (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.08-2.16). After stratifying by race/ethnicity, both Hispanic and non-Hispanic white adolescent mothers were more likely to initiate breastfeeding if cohabiting with the infant's father (ORHispanic: 1.9, 95% CI: 1.10-3.35; ORNon-Hispanic white: 1.7, 95% CI: 1.05-2.87). We found no evidence of an association between parental cohabitation and breastfeeding duration. Conclusions: Our study found evidence that cohabitation status at birth increases the odds of breastfeeding initiation in adolescent mothers. Practitioners should consider cohabitation status when working with adolescent mothers.

Economic Coaching: Addressing Poverty as a Means of Improving Early Child Development.

Economic Coaching: Addressing Poverty as a Means of Improving Early Child Development.

Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study

BackgroundDespite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors.MethodsUsing a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes.ResultsAlmost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum.ConclusionThis study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.

The Value of Mobile Health in Improving Breastfeeding Outcomes Among Perinatal or Postpartum Women: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BackgroundBreastfeeding is essential for maintaining the health of mothers and babies. Breastfeeding can reduce the infection rate and mortality in newborns, and can reduce the chances of overweight and obesity in children and adolescents. For mothers, a longer duration of breastfeeding can reduce the risk of breast cancer, ovarian cancer, and type 2 diabetes. Although breastfeeding has many benefits, the global breastfeeding rate is low. With the progress of time, the popularity of mobile devices has increased rapidly, and interventions based on mobile health (mHealth) may have the potential to facilitate the improvement of the breastfeeding status.ObjectiveThe main objective of this study was to analyze the existing evidence to determine whether mHealth-based interventions can improve the status of breastfeeding.MethodsWe systematically searched multiple electronic databases (PubMed, Web of Science, The Cochrane Library, Embase, CNKI, WanFang, and Vip ) to identify eligible studies published from 1966 to October 29, 2020. Included studies were randomized controlled trials (RCTs) studying the influence of mHealth on breastfeeding. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RevMan 5.3 was used to analyze the data.ResultsA total of 15 RCTs with a total sample size of 4366 participates met the inclusion criteria. Compared with usual care, interventions based on mHealth significantly increased the postpartum exclusive breastfeeding rate (odds ratio [OR] 3.18, 95% CI 2.20-4.59; P<.001), enhanced breastfeeding self-efficacy (mean difference [MD] 8.15, 95% CI 3.79-12.51; P=.002; I2=88%), reduced health problems in infants (OR 0.62, 95% CI 0.43-0.90; P=.01; I2=0%), and improved participants’ attitudes toward breastfeeding compared with usual care (MD 3.94, 95% CI 1.95-5.92; P<.001; I2=0%). There was no significant difference in the initiation of breastfeeding within an hour of birth between the intervention group and the usual care group (OR 1.26, 95% CI 0.55-2.90; P=.59). In addition, subgroup analysis was carried out according to different subjects and publication times. The results showed that the breastfeeding rate was not limited by the types of subjects. The breastfeeding rate based on mHealth at 1 month and 2 months after delivery did not change over the time of publication (2009 to 2020), and the breastfeeding rate based on mHealth at 3 months and 6 months after delivery gradually increased with time (2009 to 2020).ConclusionsInterventions based on mHealth can significantly improve the rate of postpartum exclusive breastfeeding, breastfeeding efficacy, and participants’ attitudes toward breastfeeding, and reduce health problems in infants. Therefore, encouraging women to join the mHealth team is feasible, and breastfeeding-related information can be provided through simple measures, such as text messages, phone calls, and the internet, to improve the health of postpartum women and their babies.

Use and experiences of galactagogues while breastfeeding among Australian women.

Galactagogues are substances thought to increase breast milk production, however evidence to support their efficacy and safety remain limited. We undertook a survey among Australian women to examine patterns of use of galactagogues and perceptions regarding their safety and effectiveness. An online, cross-sectional survey was distributed between September and December 2019 via national breastfeeding and preterm birth support organisations, and networks of several research institutions in Australia. Women were eligible to participate if they lived in Australia and were currently/previously breastfeeding. The survey included questions about galactagogue use (including duration and timing), side effects and perceived effectiveness (on a scale of 1 [Not at all effective] to 5 [Extremely effective]). Among 1876 respondents, 1120 (60%) reported using one or more galactagogues. Women were 31.5 ± 4.8 years (mean ± standard deviation) at their most recent birth. Sixty-five percent of women were currently breastfeeding at the time of the survey. The most commonly reported galactagogues included lactation cookies (47%), brewer's yeast (32%), fenugreek (22%) and domperidone (19%). The mean duration of use for each galactagogue ranged from 2 to 20 weeks. Approximately 1 in 6 women reported commencing galactagogues within the first week postpartum. Most women reported receiving recommendations to use herbal/dietary galactagogues from the internet (38%) or friends (25%), whereas pharmaceutical galactagogues were most commonly prescribed by General Practitioners (72%). The perceived effectiveness varied greatly across galactagogues. Perceived effectiveness was highest for domperidone (mean rating of 3.3 compared with 2.0 to 3.0 among other galactagogues). Over 23% of domperidone users reported experiencing multiple side effects, compared to an average of 3% of women taking herbal galactagogues. This survey demonstrates that galactagogues use is common in Australia. Further research is needed to generate robust evidence about galactagogues' efficacy and safety to support evidence-based strategies and improve breastfeeding outcomes.

Interventions to Improve Breastfeeding Outcomes from Six Weeks to Six Months: A Systematic Review.

In the United States, breastfeeding duration and exclusivity rates are not at ideal levels. The purpose of this systematic review was to examine the effects of education and support interventions during the third trimester, immediate postpartum, and the first six months of life on breastfeeding duration and exclusivity from six weeks to six months. Inclusion criteria were (a) randomized controlled trials or controlled clinical trials, (b) pregnant and/or postpartum women, (c) lactation education and support interventions, (d) measurement of breastfeeding outcomes during the first six months, and (e) published between 2008 and 2020. Twenty articles (21 studies) were reviewed. Fourteen studies employed interventions that resulted in significant differences in breastfeeding outcomes between groups. Common study weaknesses included limited use of a theoretical model, incomplete description of the intervention, and inconsistent outcome definitions and measurements. Based on these results recommendations for future breastfeeding interventions were derived.

Breastfeeding Data by the Numbers: Using Data from Different Stakeholders to Create a Complete Data Picture for a Statewide Breastfeeding QI Collaborative

Background: The Gift is a designation and quality improvement program for Louisiana birthing facilities designed to provide resources and framework to improve breastfeeding outcomes through the incremental adoption of the Ten Steps to Successful Breastfeeding. Using the theories of Continuous Quality Improvement (CQI), Gift supports progress toward the pursuit of Baby-Friendly designation. Forty-nine of fifty-two facilities are engaged, with sixteen facilities now Baby-Friendly accredited. The Gift conducts curated surveys of different stakeholders, which are used to determine accreditation and quality improvement progress. The Gift uses this unique set of coordinated surveys to create a complete data story for …

Effectiveness of theory-based educational interventions on breastfeeding self-efficacy and exclusive breastfeeding: A systematic review and meta-analysis

BackgroundEnhancing breastfeeding self-efficacy and intention is crucial for successful breastfeeding. Educational interventions highlighting breastfeeding self-efficacy and breastfeeding plans have been developed to help mothers initiate and sustain breastfeeding practices. Research aimThis study aimed to determine whether the use of theory-based educational interventions, i.e., the theory of breastfeeding self-efficacy or theory of planned behavior, is associated with improved breastfeeding outcomes and to identify key factors of effective breastfeeding educational programs. MethodsWe used electronic databases and reference lists of articles to identify published randomized controlled trials of educational programs that adopted the breastfeeding self-efficacy theory or theory of planned behavior. ResultsIn total, 24 randomized controlled trials were identified, and 5678 mothers were included in those studies, with 4178 mothers in the breastfeeding self-efficacy group and 1500 mothers in the theory of planned behavior group. Mothers who received theory-based interventions had better breastfeeding outcomes for up to 6 months postpartum (standardized mean difference =0.63, 95% confidence interval: 0.34~0.92 for self-efficacy scores at 1~2 months; odds ratio =1.82, 95% confidence interval: 1.27~2.61 for the exclusive breastfeeding rate at 1~2 months; and odds ratio =2.19, 95% confidence interval: 1.24~3.89 for the exclusive breastfeeding rate at 3~6 months). Mothers who were from non-Organization for Economic Co-operation and Development countries, were of older age, had participated in an educational program in a hospital setting, or had used an integrative class format had higher levels of self-efficacy and longer breastfeeding durations to 6 months. ConclusionsTheory-based educational interventions are effective in improving breastfeeding self-efficacy and exclusive breastfeeding rates at 6 months. Future breastfeeding educational programs incorporating the theories of breastfeeding self-efficacy and planned behavior would be helpful in promoting sustained breastfeeding practices among mothers.

Does observation or surgery for newborn ankyloglossia result in improved breastfeeding outcomes?

Does observation or surgery for newborn ankyloglossia result in improved breastfeeding outcomes?

Timing of Circumcision and Breastfeeding Frequency: A Multi-Center, Prospective, Randomized Clinical Trial

Purpose: Many newborn providers believe that early circumcision (before 24 hours of life) interferes with breastfeeding. Limited observational studies do not support an association between circumcision and breastfeeding initiation or duration. Our specific research aim is to determine if the timing of newborn circumcision affects breastfeeding exclusivity in the first 6 months of life. Methods: We conducted a multicenter, prospective, clinical trial wherein mother-infant dyads across three clinical sites were randomized to one of three circumcision timing groups, defined as: 1) early, age 6-24hrs, 2) standard, age 24-72hrs, or 3) late, age 1-3 weeks. Exclusion criteria included gestational age <38 weeks, multiple delivery, NICU admission or observation, no maternal intention to breastfeed at time of delivery, and parents declining circumcision for their newborn. We collected data on feeding method at time of nursery discharge, and at 2-weeks, 2 months, 4 months and 6 months of age. One-way ANOVA and Fisher’s exact tests were used to determine any statistical differences among characteristics of our three study groups. Fisher’s exact test was then used to determine if there was a significant relationship between circumcision timing and breastfeeding frequency at each of our measured time points. Results: One hundred and three mother-infant dyads have been enrolled to date. Thirty-seven infants have been randomized to have early circumcision performed at <24hrs, and thirty-six have been randomized to the standard (24-72hr) group. The remaining 30 infants have had late circumcisions performed in the outpatient setting at 1-3 weeks of age. There are no statistically significant differences among our three study groups. The frequency of exclusive breastfeeding in the early circumcised group is significantly higher from 2 weeks through 6 months. There is a statistically significant decrease in breastfeeding frequency from hospital discharge through six months of age in the stardard and late circumcision groups. Conclusion: Early circumcision of otherwise healthy, term males has no deleterious effects on breastfeeding initiation and maintenance. In fact, early circumcision (<24hrs) is associated with significantly higher breastfeeding frequency at all measured time points in our study. Hospital policies need not place limitations on circumcision prior to 24 hours of life due to concerns regarding breastfeeding. Deferment of circumcision to the outpatient setting after breastfeeding establishment may not improve breastfeeding outcomes.

Application and evaluation of mobile device-based continuous breastfeeding intervention program

Objective To investigate the effects of a mobile application-based continuous breastfeeding intervention program for gravidas. Methods Pregnant women who received prenatal care and delivered at First Maternity and Infant Hospital Affiliated to Tongji University were enrolled in this quasi-experiment from April 1 to May 31, 2017. Those women who met the inclusion criteria in the Eastern and Southern campuses of the hospital were recruited as intervention group (n=100) and control (n=100) group, respectively. In addition to the routine breastfeeding support which the control group was offered only, the intervention group also received mobile application-based continuous breastfeeding intervention, namely a questionnaire was sent through WeChat official account where the pregnant women had free access to continuous breastfeeding support based on their survey results, such as understanding the benefits of breastfeeding at the first trimester, relationships between breastfeeding and immunity at the second trimester, breast care at the third trimester, treatment of milk spillage/spit during labor, and iron and vitamin supplementation at puerperium. Basic information about the participants, results of Breastfeeding Knowledge Questionnaires administered at the first, second and third trimesters and during labor and the puerperium, responses to Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium, and exclusive breastfeeding rates at discharge and 42 d postpartum were compared between the two groups using two independent sample t-test and Chi-square test. Results There were 83 and 80 pregnant women in the intervention group and control group finally analyzed, respectively. No statistical difference in the scores of the Breastfeeding Knowledge Questionnaire at the first trimester was observed between the intervention group and control group (13.4±1.9 vs 13.3±1.9, t=0.133, P=0.895). However, the scores at the second and third trimesters and during labor and the puerperium in the intervention group were higher than those in the control group (14.1±1.3 vs 13.5±2.0, 14.7±1.1 vs 14.2±1.3, 15.3±1.7 vs 14.4±1.2 and 15.7±1.5 vs 14.9±1.0; t=2.160, 2.435, 4.104 and 3.946; all P<0.05), respectively. The scores of Self-efficacy of Breastfeeding Questionnaires during labor and the puerperium were also higher in the intervention group (123.5±4.7 vs 118.5±5.7 and 128.4±4.2 vs 119.0±6.5, t=6.170 and 10.959, both P<0.01). Compared to the control group, the intervention group had higher exclusive breastfeeding rate at discharge and on 42 d after delivery [78.3% (65/83) vs 61.2% (49/80), χ2=5.641; 57.8% (48/83) vs 38.8% (31/80), χ2=5.938; both P<0.05]. Conclusions The mobile application-based continuous breastfeeding intervention program may effectively improve breastfeeding outcomes. Key words: Breast feeding; Telemedicine; Clinical protocols; Validation studies

Physical Activity During Pregnancy is Associated with Improved Breastfeeding Outcomes: A Prospective Cohort Study.

Physical activity is important for health, but little is known about associations between physical activity during pregnancy and breastfeeding. The aim of this study was to investigate any association between antenatal physical activity and breastfeeding duration. A prospective cohort of 2030 Vietnamese women, recruited between 24 and 28 week-gestation was followed up to twelve months postpartum. Physical activity was determined using the pregnancy physical activity questionnaire at baseline interview. Data was available for 1715 participants at 12 months, a 15.5% attrition rate. At 12 months 71.8% of mothers were still breastfeeding. A total of 20.9% women met physical activity targets and those mothers undertaking higher levels of physical activity had a lower risk of breastfeeding cessation by twelve months [hazard ratios HR = 0.59 (95% CI 0.47–0.74), p < 0.001, and HR = 0.74 (0.60–0.92), p = 0.006; respectively] when compared to the lowest tertile. Similarly, women with increased levels of physical activity have higher rates of breastfeeding at twelve months, compared to the lowest level [odds ratio OR = 1.71 (95% CI 1.29–2.25) and 1.38 (1.06–1.79)]. Higher levels of physical activity by pregnant women are associated with improved breastfeeding outcomes.