Increased Breastfeeding Rates Research Articles

Gestational Diabetes Mellitus-Induced Milk Fat Globule Membrane Protein Changes of Human Mature Milk Based on TMT Proteomic Analysis

Breastfeeding by mothers with gestational diabetes mellitus (GDM) has been shown to reduce maternal insulin demands and diminish the risks of diabetes in infants, leading to improved long-term health outcomes. Milk fat globule membrane (MFGM) proteins play a crucial role in influencing the immunity and cognitive development of infants. Understanding the alterations in MFGM proteins in breastmilk from mothers with GDM is essential for enhancing their self-efficacy and increase breastfeeding rates. The objective of this study is to investigate and compare MFGM proteins in milk from mothers with GDM and without based on tandem mass tag (TMT) labeling and liquid chromatography tandem mass spectrometry (LC-MS) techniques. A total of 5402 proteins were identified, including 4 upregulated proteins and 24 downregulated proteins. These significantly altered proteins were found to be associated with human diseases, cellular processes, and metabolism pathways. Additionally, the oxidative phosphorylation pathway emerged as the predominant pathway through Gene Set Enrichment Analysis (GSEA) involving all genes.

Mothers’ experiences of breast milk expression during separation from their hospitalized infants: a systematic review of qualitative evidence

BackgroundMother-infant separation, which is occurring with an increasing incidence, is a barrier to direct breastfeeding. Owing to the importance of breast milk to hospitalized infants, mothers are actively encouraged to express milk during their infants’ neonatal intensive care unit (NICU) stay. However, mothers are often faced with a number of challenges in this process. There is a need to understand such mothers’ real-life experiences of breast milk expression to develop supportive strategies to reduce the burden on mothers and increase breastfeeding rates.MethodsA comprehensive search of 12 databases was conducted for relevant studies published from database construction to December 2022. All qualitative and mixed-method studies published in English and Chinese that reported on mothers’ experiences of human milk expression during separation from their hospitalized infants were included. Two reviewers independently conducted screening, data extraction, and quality appraisal, with disagreements resolved by a third reviewer. The process of searching followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The JBI Qualitative Assessment and Review Instrument was used to assess study quality and the credibility of study findings. Meta-aggregation was performed to integrate the results.ResultsThis systematic review aggregated mothers’ experiences of milk expression during separation from their hospitalized infants. Database search yielded 600 records, of which 19 full-text documents were screened. Finally, 13 studies of good quality were included with data from 332 mothers across seven countries. A total of 61 primary findings with illustrations were extracted from the 13 eligible studies, the findings were generalized into 16 categories, and further were concluded as four synthesized findings: purpose and motivation, physical and emotional experiences, barrier factors, and coping styles.ConclusionMothers were driven by extrinsic motivation in their decision to express breast milk. They experienced physical exhaustion and many negative emotional feelings while expressing. This process was affected by numerous barriers. Social support was essential to the initiation and maintenance of milk expression. Medical staff and families should pay more attention to the mental health of mothers with infants in the NICU. Future research should incorporate strategies to cope with emotional responses and offer practical strategies for managing milk expression.Systematic review registration[www.crd.york.ac.uk], identifier [PROSPERO 2022 CRD42022383080].

Group Prenatal Care Models, Experiences, and Outcomes: An Integrative R

Background:The United States (US) has the highest maternal and infant mortality rates among developed countries. Indiana has the third highest maternal mortality rate in the US. Group Prenatal Care (GPC) was piloted in the early 1990s to improve perinatal experiences and outcomes through enhanced social support and education. Further research is needed as GPC is increasingly implemented in diverse contexts. This study critically synthesized current evidence on GPC models, experiences, and perinatal outcomes in the US to inform a Community Based Participatory Research Partnership between Indiana University School of Medicine-Northwest and Community HealthNet.
 Methods:This integrative review utilized PRISMA guidelines to conduct a systematic search in Embase, CINAHL, and PubMed. Two researchers screened articles for inclusion criteria and quality. Studies were included if they were empirical research or meta-analyses conducted in the US and published in English between January 2013 and June 2023. Data synthesis utilized a qualitative analytical approach that sorted findings thematically.
 Results:We retained 98 articles, including 8 meta-analyses, 4 randomized trials, 3 cluster randomized trials, 3 quasi-experimental studies, 4 prospective cohort studies, 12 observational studies, 19 qualitative studies, and 46 retrospective cohort studies. There were several GPC models adapted to high-risk groups such as persons living with HIV, gestational diabetes, pre-existing or pregnancy-induced hypertension, and substance use disorders. GPC was associated with decreased preterm births among low-income and minority women, with more significant reductions when attending 5 or more GPC sessions. GPC improved psychosocial outcomes including satisfaction with care, empowerment, and social connectedness. It was also associated with increased breastfeeding rates in adolescents and African Americans, and increased contraception use among adolescents.
 Conclusions:Engaging in GPC may have benefits for high-risk pregnancies, adolescents, low-income, and minority populations. More studies are needed to evaluate GPC’s impacts on perinatal experiences and outcomes among high-risk women.

Long-term cost savings with Centering-based group antenatal care

IntroductionGroup antenatal care (gANC) is a group-based care-model combining routine antenatal care, with health assessment, education, and community building. GANC has shown positive results on perinatal outcomes. However, midwives in Dutch primary care have reported higher costs when providing gANC. The purpose of this study was to assess the effect of replacing individual prenatal care (IC) by gANC on (expected future) health care costs and health outcomes. MethodsWe performed an exploratory cost-benefit analysis comparing costs and consequences of gANC with those of IC, using a hypothetical cohort of 12,894 women in gANC. Primary input data were derived from a stepped wedge cluster randomized controlled trial carried out in the Netherlands, assessing both health and psychosocial effects of gANC comparing them with IC. Other data was retrieved from available literature and an online questionnaire among midwifery practices. The main outcome measure was differential cost of gANC and lifetime direct healthcare costs related to the effects of gANC compared to IC (price level 2019). ResultsResults showed that gANC comes at a differential cost of €45 extra per person when compared to IC. However, projected healthcare cost-savings related to increased breastfeeding rates, reduced prevalence of pregnancy induced hypertension and less postpartum smoking, lead to an average net cost-savings of €67 per gANC participant. DiscussionAlthough gANC shows better health- and psychosocial outcomes when compared to IC, it is more costly to provide. However, findings indicate that the differential costs of gANC are off-set by long-term healthcare cost-savings.

Examining Barriers and Strengthening Community Collaboration as a Means to Increase Exclusive Breastfeeding Rates in Sarasota County, Florida.

Background Maternal and infant benefits of breastfeeding have been established and widely recommended by the American Academy of Pediatrics. However, there is a discrepancy between the number of mothers initiating breastfeeding and those continuing to breastfeed for six months and beyond. In this project, we investigated current breastfeeding practices and barriers to feeding for mothers in Sarasota County, Florida to develop an intervention aimed at increasing the rate of exclusive breastfeeding at six months and beyond. Methodology The PDSA framework was used to develop interventions aimed at increasing breastfeeding rates in Sarasota County. Initially, breastfeeding mothers were administered a survey to understand breastfeeding practices and barriers. Community agencies that supported breastfeeding practices were identified. Based on survey data and feedback, a community breastfeeding conference was organized to improve collaboration and increase breastfeeding rates. Attendees' knowledge and confidence were assessed through a conference pre-test and post-test. Additionally, attendees developed Smart, Measurable, Achievable, Relevant, and Timely goals that were recorded for data collection. Results Of the 28 completed community breastfeeding surveys, the respondents were of Caucasian or Hispanic ethnicity with an average age of 31. The majority of respondents had a goal of breastfeeding for 12 months, but only two participants reported that they continued to exclusively breastfeed to the 12-month mark. A total of 38 individuals from different agencies pre-registered for the conference; of these pre-registrants, 19 individuals checked in for conference attendance, 17 completed the conference pre-test, and 15 completed the conference post-test. Each domain surveyed demonstrated an increase in the values. Conclusions Following our intervention, there is an evident need for improvement in the pipeline of expanding collaboration among breastfeeding community agencies in Sarasota County. Upon completing our community breastfeeding conference, it was shown that this intervention provided both an educational improvement (demonstrated by increased mean domain scores) and a novel platform for providers to network. Our project highlights that strengthening the existing breastfeeding service infrastructure may directly increase exclusive breastfeeding rates at six months and beyond. Future interventions will aim to solidify recurrent infrastructural processes and policies.

Safety and Effect of the Use of Hydrotherapy during Labour: A Retrospective Observational Study.

Hydrotherapy is a technique used for pain management during labour, but its safety for both the mother and foetus remains uncertain. The main aim of this study is to determine whether the use of hydrotherapy in the first stage of labour is safe for both the mother and newborn. A retrospective observational study was conducted to collect data from the partogram, maternal and neonatal history. A total of 377 women who gave birth at the Costa del Sol Hospital in Malaga between January 2010 and December 2020 were randomly selected. They were divided into a control group (253 women) and an intervention group (124 women) that used hydrotherapy in the first stage of labour. There were no significant differences between the groups in terms of age, history of previous miscarriages, type of delivery, or newborn weight. The results showed that most women who opted for hydrotherapy were nulliparous, and the use of hydrotherapy during labour was safe for both the mother and foetus. There were no significant differences in the variables of maternal arterial hypotension, postpartum haemorrhage, postpartum maternal fever, foetal complications, neonatal admission, 1 and 5 min Apgar scores, umbilical arterial or venous pH, or foetal cardiotocographic recording. However, there was a significant difference (p = 0.005) in the rate of breastfeeding among mothers who opted for hydrotherapy (96% vs. 85.7%). The use of hydrotherapy during the first stage of labour is safe and is associated with increased breastfeeding rates compared to conventional delivery.

Donor Milk Leads to Increased Breastfeeding Rates in the Well-Newborn Population

Donor Milk Leads to Increased Breastfeeding Rates in the Well-Newborn Population

Promotion, protection, and support of breastfeeding at work, and achieving sustainable development: a scoping review.

This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women's empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study's search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.

Promoção, proteção e apoio à amamentação no trabalho e o alcance do desenvolvimento sustentável: uma revisão de escopo

Abstract This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women’s empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study’s search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.

A multidisciplinary approach to increase breastfeeding rates among gestational diabetes prospective randomized controlled trial

Breastfeeding (BF), the normative form of nutrition for newborns, may be challanging. While many factors contribute to maintaining BF among parturients, gestational diabetes mellitus (GDM), as diagnosed during pregnancy, is associated with low rates of BF. One hypothesis for the general low rates is the lack of available evidence-based data regarding BF. Our primary outcome was to assess whether an educational videoclip could increase the rates of breastfeeding among parturients, among those with GDM A prospective double-blind randomized controlled trial, of pregnant individuals with GDM. Participants were randomized by 1:1 ratio to study group; receiving a link to an online educational videoclip presented by a multidisciplinary team including an obstetrician, pediatrician, dietitian, and a nurse certified as BF-consultant. Controls received none. The intervention took place at Carmel Medical Center at any time point before delivery while visiting the hospital for unrelated causes (for example- admission to ER, during hospitalization, prior to delivery). After delivery, participants were contacted by telephone and were inquired about the newborn’s feeding habits 146 participants with GDM were randomized to the study group (n=70) and control group (n=75). While 96.5% of all participants reported they were intending to BF prior to intervention, only 63.8% reported any BF form (exclusive or formula-combined) upon questioning postpartum. BF rates among the study group (36/54) were similar to the control group (31/50) p-value >0.05. The discrepancy between the intention to breastfeed and BF prevalence, could not be met by mere online videoclip. More research is needed in order to reveal what are the unmet needs of both the mother and infant, so they can be addressed and potentially increase BF rates.

Examining students’ knowledge of infant feeding: A non-experimental descriptive study

Introduction: Breastfeeding rates in Canada are suboptimal, putting mothers and their infants’ health at risk. Understanding breastfeeding knowledge and attitudes in the university student population is important as many are likely to become parents in the future. University students’ knowledge and attitudes regarding infant feeding has been studied internationally; however, no studies including both female and male students have been conducted in Canada. The purpose of this study was to determine breastfeeding experiences, education, knowledge, infant feeding attitude and perceptions of the difference in mode of infant feeding among university students which can be used to inform future health promotion campaigns and school curriculum. Methods: A non-experimental, descriptive cross-sectional study was conducted in which data from university students was collected to to identify knowledge and attitude toward breastfeeding identify differences in knowledge of breast and bottle feeding. Results: Findings suggest 65% (n=117) of university students had no previous knowledge of breastfeeding practices. Conclusion: Breastfeeding information within the high school curriculum is needed to support evidence-informed preconception infant feeding choices and increase future parents' understanding of how breastfeeding works to assist them in meeting their future infant feeding goals and increase breastfeeding rates.

Fathers’ emotional challenges and barriers to supporting breastfeeding initiation and duration

Exclusive breastfeeding has significant health benefits for mother and child. Research highlights the important role of fathers in helping increase breastfeeding rates, but little is known about their emotional needs and how these affect breastfeeding decisions. This article aims to explore and identify the emotional challenges fathers experience, and how they affect initiation and duration rates. Eleven studies were included in the literature review and four themes were identified: Information/education; Decision making; Role/attachment; and Wellbeing. The findings suggest that fathers should be proactively involved in breastfeeding interventions and should recognise their own emotional needs to positively influence breastfeeding rates.

Factors Attributed to Breastfeeding Success in a Tertiary Obstetric Hospital.

Introduction:Increasing breastfeeding rates is a national health objective, however substantial barriers and disparities continue to exist in breastfeeding initiation and continuation. Our study aim is to identify factors associated with birthing persons' breastfeeding “success” (patients admitted to Labor & Delivery desiring to breastfeed and discharged breastfeeding) and breastfeeding “failure” (patients admitted to Labor & Delivery desiring to breastfeed and discharged exclusively formula feeding).Materials and Methods:We conducted a retrospective cohort study between July 2015 and June 2016. Patients were asked infant feeding plan intentions (breast, formula, combination) upon admission for delivery. Feeding plan was reassessed at discharge from delivery stay and validated to serve as proxy for feeding status at discharge. Logistic regression was used to identify the population(s) most likely to voice intent to breastfeed and to identify predictors of altered breastfeeding intent at discharge.Results:Between July 2015 and June 2016, 6690 patients met criteria for analysis. Patients reporting intent to breastfeed before delivery were more likely Caucasian (p < 0.0001), married (p < 0.001), nulliparous (p < 0.01), privately insured (p < 0.0001), educated (p < 0.0001), and older (p < 0.01) compared with patients not intending to breastfeed. These characteristics were similar in those who were “successful breastfeeders,” that is, breastfeeding at discharge. The strongest predictor of breastfeeding at discharge was intent to breastfeed before delivery (p < 0.0001). African American race was the strongest predictor of nonbreastfeeding intent at admission (p < 0.0001) and conversion to formula feeding by hospital discharge (p < 0.001).Conclusion:Intent to breastfeed before delivery was the strongest predictor of breastfeeding at discharge; thus, prenatal breastfeeding education within the at-risk population is crucial to increasing breastfeeding rates.

New Predictive Tool That Could Increase Breastfeeding Rates

New Predictive Tool That Could Increase Breastfeeding Rates

The Effect of a Father's Support on Breastfeeding: A Systematic Review.

Aim: Including fathers in breastfeeding education programs may raise infant breastfeeding rates and durations. The aim of the study was to assess the effect on breastfeeding of breastfeeding education and/or psychosocial interventions in which fathers are included. Method: The study is based on the PRISMA method, the technique that is used in systematic reviews. A search was conducted in the literature over the period November 1, 2021-December 1, 2021 using keywords and without imposing any time restrictions. The databases "PubMed," "Web of Science," Scopus," "Medline," and "CINAHL" were scanned. Results: A total of 462 publications were reached. However, only 7 studies were considered for review on the basis of the inclusion criteria. Six of these 7 studies indicated that the support of the father increased the breastfeeding rate. Conclusions: This review shows that a father's support of breastfeeding improves breastfeeding outcomes. Including fathers in the breastfeeding process and ensuring their active participation increase breastfeeding rates.

Generating change through collective impact and systems science for childhood obesity prevention: The GenR8 Change case study.

BackgroundCommunity-based interventions have shown promise in reducing childhood overweight and obesity. However, they have been critiqued for using linear logic models. Participatory community-based systems approaches are posited as addressing the complexity of non-linear relationships in a local context. Community members are empowered to understand and describe obesity causation, identify and prioritise possible solutions. The application of such approaches to childhood obesity is in its infancy.AimTo describe the first 12 months of a participatory whole-of-community systems approach to creating collective action to tackle childhood obesity, called GenR8 Change, in a local government area of Victoria, Australia.MethodsThree group model building (GMB) sessions focused on the development of a causal loop diagram (CLD), prioritised evidence-informed actions, and developed implementation strategies. The collective impact framework underpinned the approach, with a local backbone group supporting community members to implement prioritised actions.ResultsThe first two GMB sessions included 20 key community leaders where a CLD examining the factors contributing to childhood obesity in the community was constructed and refined (22 variables GMB1, 53 variables GMB2). In the third session, 171 members of the wider community further refined the CLD, identified priorities for childhood obesity prevention (72 variables in final CLD). One-hundred and thirteen individuals signed up across 13 working groups to plan and implement 53 prioritised actions. Agreed community actions included creating sugar free zones; developing healthy policies; increasing breastfeeding rates; improving drinking water access; and increasing physical activity options. Twelve months post-GMB3, 115 actions had been implemented.ConclusionGenR8 Change is one of the first communities to apply systems thinking to childhood obesity prevention. Knowledge on how to collectively identify relevant leverage points to tackle childhood obesity can now be shared with other communities.

The cost-effectiveness of antenatal and postnatal education and support interventions for women aimed at promoting breastfeeding in the UK

BackgroundBreastfeeding is associated with health benefits to mothers and babies and cost-savings to the health service. Breastfeeding rates in the UK are low for various reasons including cultural barriers, inadequate support to initiate and sustain breastfeeding, lack of information, or choice not to breastfeed. Education and support interventions have been developed aiming at promoting breastfeeding rates. The objective of this study was to assess the cost-effectiveness of such interventions for women, initiated antenatally or in the first 8 weeks postnatally, aiming at improving breastfeeding rates, in the UK.MethodsA decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of a breastfeeding intervention from the perspective of health and personal social services in England. Data on intervention effectiveness and the benefits of breastfeeding were derived from systematic reviews. Other model input parameters were obtained from published sources, supplemented by expert opinion.ResultsThe incremental cost-effectiveness ratio (ICER) of the modelled intervention added on standard care versus standard care was £51,946/QALY, suggesting that the intervention is not cost-effective under National Institute for Health and Care Excellence (NICE) criteria in England. Sensitivity analysis suggested that the cost-effectiveness of the intervention improved as its effectiveness increased and intervention cost decreased. At the base-case effect (increase in breastfeeding rates 16–26 weeks after birth by 19%), the intervention was cost-effective (<£20,000/QALY) if its cost per woman receiving the intervention became ≈£40–£45. At the base-case cost (£84), the intervention was cost-effective if it increased breastfeeding rates by at least 35–40%.ConclusionsAvailable breastfeeding interventions do not appear to be cost-effective under NICE criteria in England. Future breastfeeding interventions need to have higher effectiveness or lower cost compared with currently available interventions in order to become cost-effective. Public health and other societal interventions that protect, promote and support breastfeeding may be key in improving breastfeeding rates in the UK.

Breasts and the city: an urban ethnography of infant feeding in public spaces within Cardiff, United Kingdom

BackgroundInternationally, women report challenges breastfeeding in public spaces. This study aimed to investigate the social-spatial aspects of public spaces in one UK city, Cardiff, in order to suggest possible barriers and facilitators to breastfeeding in public spaces.MethodsThe study observation location guide prioritised places that had been reported as hostile to breastfeeding or breastfeeding friendly in the existing literature. Data were collected between April and September 2018 at various times of day, in several areas of the city, and included transport (n = 4), transport hubs (n = 3), high streets (n = 4), cafes (n = 2), a large city centre shopping complex, comprising of three joined shopping malls and a large city centre department store containing a third café. Low inference field notes were written on an encrypted smart phone and expanded soon after. Data were analysed thematically using deductive codes based on the observation schedule. Additional inductive codes relating to places were added.ResultsOverall, public transport and the city centre were inhospitable environments for those who might need to breastfeed, and even more so for those who need to express breastmilk. The core barriers and facilitators across locations were the availability of appropriate seating coupled with either high privacy or politely unimposing strangers (civil inattention). The one variation to this model arose from the department store café, where civil inattention was not performed and there was low privacy, but breastfeeding occurred anyway.ConclusionsThis research highlights the physical and social barriers to breastfeeding within one urban city centre in the UK and its associated transport links. It is clear that there is an urgent need for change in urban city centres and public transport if countries are to meet their aims in relation to increasing breastfeeding rates. Interventions will need to be multifaceted, accounting for social norms relating to infant feeding as well as changes to the physical environment, policy and potentially legal change. Further research should be undertaken in other countries to examine the extent to which hostile environments exist, and if correcting these could facilitate breastfeeding and reduce gender-based violence.

809 Pregnancy latency among patients with preterm prelabor rupture of membranes attending inpatient centering groups

Outpatient CenteringPregnancy© groups have been shown to reduce rates of preterm birth, specifically in Black mothers, and increase breastfeeding rates, the inpatient use is limited and understudied. We sought to determine the impact of inpatient centering(IC) on latency among women admitted with preterm prelabor rupture of membranes(PPROM). Single institution, retrospective cohort study of women with PPROM participating in at least 1 IC group from 2019-2020 compared to historic controls from 2013-2019. Patients admitted after 33 weeks, age<18, higher order multiples or a latency <24hrs excluded. Primary outcome was pregnancy latency. Secondary outcomes included maternal morbidity, and 6wk post-partum(PP) breastmilk feeding. Analysis stratifying by race performed. Bivariate statistics compared IC cohort to controls. Regression models used to control for confounders. 11 women with PPROM participated in IC compared to 278 controls. IC women had higher rates of HTN, twins and anxiety(Table 1). IC women had longer median latency compared to controls(26 days[IQR:13, 29] vs8 days[3,14] p<0.01), as well as, increased rates of PP breastmilk feeding(91% vs 59% p<0.01)(Table 2). In regression models controlling for confounders, IC was associated with 10.2 day longer latency and 9.4-fold increased odds of PP breastmilk feeding(Table 2). When stratifying by race, Black women who participated in IC had longer median latency than Black controls (27.5vs20 days, p<0.01). This difference did not extend to White women(18vs10 days, p=0.13) or Latinx women(14.5vs7 days, p=0.88). In regression models, IC participation predicted 20.0 days longer latency for Black women, but was not a significant predictor of latency for White or Latinx women (Table 2). No significant differences in PP breastmilk feeding rates seen when stratified by race. This pilot Inpatient Centering study demonstrated longer latency and improved breastfeeding among participants, with more benefit seen among Black women. The adaptation of the CenteringPregnancy model to the antepartum service should be further explored.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Climate Change, Food Supply, and Dietary Guidelines.

Food production is affected by climate change, and, in turn, food production is responsible for 20-30% of greenhouse gases. The food system must increase output as the population increases and must meet nutrition and health needs while simultaneously assisting in achieving the Sustainable Development Goals. Good nutrition is important for combatting infection, reducing child mortality, and controlling obesity and chronic disease throughout the life course. Dietary guidelines provide advice for a healthy diet, and the main principles are now well established and compatible with sustainable development. Climate change will have a significant effect on food supply; however, with political commitment and substantial investment, projected improvements will be sufficient to provide food for the healthy diets needed to achieve the Sustainable Development Goals. Some changes will need to be made to food production, nutrient content will need monitoring, and more equitable distribution is required to meet the dietary guidelines. Increased breastfeeding rates will improve infant and adult health while helping to reduce greenhouse gases.