Median Breastfeeding Research Articles

Abstract A036: Hair relaxers use and breast cancer risk by tumor estrogen receptor status: Results from the Ghana Breast Health study

Abstract Background: Hair relaxer use is highly prevalent among women of African descent world-wide and in previous analyses within the Ghana Breast Health Study (GBHS) ever use was associated with a 60% elevated risk of breast cancer. Subsequent studies in the GBHS showed selected alterations in estrogen metabolites with hair relaxer use among controls, suggesting a possible hormonal mechanism may underlie the relation of hair relaxers to breast cancer risk. We investigated if the association between relaxer use and breast cancer risk differed by tumor estrogen-receptor (ER) status and hypothesized ever-users would be at a higher risk of ER+ tumors. Methods: The GBHS is a population-based case-control study conducted between 2013– 2015 in Accra and Kumasi of 1,071 cases with pathologically confirmed invasive breast cancer and 2,106 controls, aged 18-74 years. A standardized interview-based questionnaire collected information on currency and duration of use of hair relaxers and whether products used were lye or non-lye formulations. ER status was available for 915 cases, determined using either mRNA expression data from nCounter® Breast Cancer 360™ Panel (65% of 915 cases) or immunohistochemistry. We used multivariable multinomial logistic regression models to estimate odds ratios (OR) with 95% confidence intervals (CI) for ER+ vs. ER- breast cancers. Models were adjusted for age, hospital site, education, body size, age at menarche, parity, age at first birth, median breastfeeding months/child, menopausal status. To determine if risk related to exposure to relaxers differed by ER status, we used logistic regression analyses with ER+ tumors as the reference and calculated heterogeneity p-values (p-het). Results: The majority of women reported ever use of relaxers (96% of cases and 94% of controls). Of the 1,071 cases included in analyses, 422 (44%) were ER+, 438 (41%) ER-, and 156 (15%) unknown for ER. Elevated risk did not differ by ER status for ever compared to never use (OR ER+ =1.67, 95% CI [0.95–2.93]; OR ER - =1.59, 95% CI [0.92–2.76], p-het=0.90). Risks were highest among former users (OR ER+ =2.19, 95% CI [1.21–3.95]; OR ER- =2.21, 95% CI [1.24–3.93], p-het=0.98. Additional analyses showed elevated risk for those with long durations of use, and those who predominantly used non-lye products, but associations did not differ according to ER tumor status. Conclusion: Our analysis of relaxer use in Ghanaian women showed elevated breast cancer risk, particularly for former, long-term users of non-lye formulations, irrespective of tumor ER status. Additional analyses by tumor and other characteristics related to biologically aggressive tumor types needed to determine if associations differ beyond ER consistent with disparities seen in African ancestry women. Further, future research is warranted regarding specific products used that may provide insights into hormonal and non-hormonal mechanisms underlying observed associations. Citation Format: Kaitlin E. White, Quiera Booker, Nicholas Titiloye, Lawrence Edusei, Louise Brinton, Beatrice Wiafe, Ernest Adjei, Jonine Figueroa, On behalf of the Ghana Breast Health Study Team. Hair relaxers use and breast cancer risk by tumor estrogen receptor status: Results from the Ghana Breast Health study [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A036.

Breastfeeding Duration and Cardiometabolic Health during Adolescence: A Longitudinal Analysis

ObjectiveTo investigate the longitudinal association between breastfeeding duration and cardiometabolic health, using repeated measures study design among children and adolescents. Study designThis study included 635 offspring aged 10 to 21 years (52% female) from the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) birth cohort followed up to four time points during adolescence. Breastfeeding duration was prospectively quantified using questionnaires during early childhood. Cardiometabolic risk factors, body composition, and weight-related biomarkers were assessed as outcomes during adolescent follow-up visits. Sex-stratified linear mixed-effects models were used to model the association between quartiles of breastfeeding duration and outcomes, adjusting for age and additional covariates. ResultsMedian breastfeeding duration was 7 months (mo) (min=0, max=36). Boys in the 2nd quartile (median breastfeeding= 5 mo) had lower total fat mass % (β (SE) -3.2 (1.5) p= 0.037), and higher lean mass % (3.1 (1.6) p= 0.049) and skeletal muscle mass % (1.8 (0.8) p= 0.031) compared with the reference group (median breastfeeding= 2 mo). A positive linear trend between breastfeeding duration and trunk lean mass % (0.1 (0.04) p= 0.035) was found among girls. No association was found with other cardiometabolic indicators. ConclusionDespite sex-specific associations of breastfeeding duration with body composition, there was a lack of substantial evidence for the protective effects of breastfeeding against impaired cardiometabolic health during adolescence among Mexican youth. Further longitudinal studies with a robust assessment of breastfeeding are recommended.

Knowledge gaps related to breastfeeding and immunization in the mothers of infants with congenital heart diseases: An urgent concern

BackgroundInfants born with congenital heart diseases are extremely vulnerable to infections. ObjectivesWe explored the knowledge and practices of the mothers of infants with congenital heart disease (CHD) related to breastfeeding and immunization and also assessed the breastfeeding rate and immunization coverage of infants with CHD. MethodIn a cross-sectional study, mothers (N = 100) of infants with congenital heart disease attending the outdoor patient department (OPD) were enrolled using convenience sampling. A structured self-developed pretested and validated knowledge questionnaire was used to collect data. Data were analyzed using SPSS version 26.0 for windows. ResultThe mean age of the mothers was 26.57 years (SD ± 4.1), with most (59) mothers having one child and mothers educated up to secondary level (44). The median age of the infants was 4.35 months (IQR, 2–12). The median breastfeeding and immunization knowledge scores of the mothers were 9 (6.5–10.0) and 4.5 (2–6) respectively. A significant number of mothers had poor knowledge related to immunization (83) and breastfeeding (33). The majority of infants were either partially breastfed or not breastfed (69) and partially vaccinated (66) at the time of the survey. ConclusionA significant remediable gap was observed in the knowledge of the mothers of infants with CHD, requiring a regular educational session on breastfeeding and immunization in the follow-up OPD by the health care providers.

P033 Impact of breastfeeding on Juvenile Idiopathic Arthritis outcomes

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common, chronic rheumatic disease of childhood. The aetiology is still unclear. Over the past few years, several studies have investigated the association between JIA and environmental exposures such as infections and parental smoking. However, data concerning the influence of past breastfeeding on the presentation and the severity of JIA remain scarce and still a matter of debate (1, 2).The aim of this study was to determine the influence of breastfeeding history on the pattern and severity of JIA. Methods A cross-sectional monocentric study was carried out on JIA patients according to International League of Associations for Rheumatology (ILAR). Demographic, clinical and biological data were collected from medical records. Breastfeeding data were obtained by interviewing mothers. Patients were divided into two groups: group 1 (G1) stands for JIA patients breastfed over 6 months and group 2 (G2) stands for JIA non-breastfed patients or patients breastfed <6 months. Data were analyzed using the SPSS statistical package. A p-value < 0.05 was considered significant. Results Twenty-nine patients (10 male and 19 female) were enrolled. Mean age at disease onset was 9.1 ± 3.4 years [2–15]. Median diagnosis delay from symptoms onset was 3.5 ± 21. 1 SD months [1–72]. Median disease duration was 36 ± 79 SD months [7–336]. JIA subtypes were in decreasing order of frequency: enthesitisenthesitis-related arthritis (n = 13), oligoarticular (n = 8), Polyarticular RF- (n = 4), Polyarticular RF + (n = 2), systemic (n = 1) and psoriatic arthritis (n = 1). Inflammatory markers were raised in 48.3% (n = 14) of cases. Median ESR (raised in 41.3% of the cases) and CRP (raised in 34.4% of the cases) were 17 ± 25.1 SD mm/h [3–98] and 3 ± 18 SD mg/l [0–56]. Among patients with enthesitis-related arthritis, median BASDAI and BASFI scores were 1.8 ± 1.6 SD [0.3–6.3] and 2.5 ± 1.7 SD [0–6] respectively. Only 16 (55.2%) patients had bone densitometry. Osteoporosis and osteopenia were found in 10.3% and 13.8% of cases, respectively. Coxitis was found in 65.5% of patients (n = 19). Overall, 82.8% of children (n = 24) were breastfed. Breastfeeding was exclusive in 55.2% of cases (n = 16). Median breastfeeding duration was 12 ± 10.3 SD months [1.5–48]. Over two-thirds (n = 19) of patients were breastfed for >6 months. The statistical study revealed that G1 had significantly lesser occurrence of coxitis than G2 (57.9% vs 80%; P = 0.032). Age at disease onset (P = 0.26), diagnosis delay (P = 0.9), raised inflammatory markers (P = 0.76) and the frequency of osteoporosis (P = 0.87) were comparable between the two groups. No correlation was noted between breastfeeding duration and the following parameters: age at disease onset, ESR rate, CRP rate, BASDAI and BASFI. Conclusions In this study, JIA patients breastfed over 6 months had fewer coxitis occurrence. Further investigations with larger sample sizes are still required to assess the benefits of breastfeeding on JIA outcomes.

Risk factors for and protective factors against breastfeeding interruption before 2\u2009years: a birth cohort study

BackgroundLittle is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years. The objective of this study was to identify risk factors for and protective factors against breastfeeding interruption before 2 years of age.MethodsIn this live birth cohort, mother and infant dyads were followed for 2 years. Data collection was performed at the maternity ward and subsequently at the children’s homes, monthly during the first 6 months of life and then at 9, 12, 18, and 24 months. The outcome of interest was breastfeeding interruption before 2 years of age. Median duration of breastfeeding was estimated using Kaplan-Meier’s survival analysis, and the associations were tested using Cox’s hierarchical multivariate model. Significance was set at 5%.ResultsData from a total of 1344 dyads were assessed. Median breastfeeding duration was 385 days. The following risk factors for breastfeeding interruption were identified: white skin color (adjusted hazard ratio [HRa]: 1.31; 95% confidence interval [95%CI]: 1.10–1.56), primiparity (HRa: 1.21; 95%CI: 1.05–1.40), working outside the home (HRa: 1.52; 95%CI: 1.30–1.77), child sex male (HRa: 1.18; 95%CI: 1.03–1.35) and use of a pacifier (HRa: 3.46; 95%CI: 2.98–4.01). Conversely, the following protective factors were identified: lower family income (HRa: 0.81; 95%CI: 0.71–0.94), mother-infant bed-sharing (HRa:0.61, 95%CI: 0.52–0.73), on-demand breastfeeding in the first month (HRa: 0.64; 95%CI: 0.47–0.89) and exclusive breastfeeding at 4 months (HRa: 0.58, 95%CI: 0.48–0.70).ConclusionsThe findings allowed to identify both risk factors for and protective factors against breastfeeding interruption before 2 years of age. Knowledge of these factors may help prevent this event and aid in the development of programs that help women maintain breastfeeding for at least 2 years, as recommended by the WHO.

Factors Associated with Age at Breastfeeding Cessation in Amazonian Infants: Applying a Proximal-Distal Framework.

Introduction Breastfeeding is an important determinant of child survival and normal growth and development, but breastfeeding prevalence is generally low in Brazil. Factors associated with infant feeding practices there are not well understood. This paper examines factors associated with breastfeeding cessation in a township in the western Brazilian Amazon. Methods A cross-sectional, population-based study was conducted among children younger than 25months and collected information on maternal and child characteristics. Survival analysis based on a proximal-distal framework examined the association between breastfeeding duration and socioeconomic and maternal/child biological factors. Results The median breastfeeding duration among 101 children who were no longer breastfeeding was 120days. Almost two-thirds (63%) of these children stopped breastfeeding before 6months of age. In the larger sample of 209 children, 74.6% had previously been bottle-fed. Considering the full proximal-distal model, a child who had ever been bottle-fed was expected to cease breastfeeding about 88% sooner than one who was never bottle-fed (p<0.001). Children in the second-poorest wealth quartile stopped breastfeeding sooner than children in the poorest quartile (p<0.05). Discussion Breastfeeding cessation in the study area occurred much earlier than the recommended 2years of age. Factors associated with ending breastfeeding early included ever-use of a bottle, having a single mother, and belonging to the second-poorest wealth quartile. Further research is needed to better understand these factors and other barriers women face to continuing breastfeeding.

Military milk: breastfeeding rates among Australian Defence Force women who return to military service following maternity leave.

The breastfeeding behaviors among Australian Defence Force women have not previously been examined. Studies have shown that breastfeeding prevalence and duration are affected by maternity leave entitlements and returning to work. This study aimed to benchmark breastfeeding initiation, prevalence, and duration among a cohort of Australian Defence Force women and to compare these findings against Australian population norms. A cross-sectional survey was conducted via email in 2008 for Australian Defence Force women who had taken maternity leave in the Australian financial year of 2006/2007. Analysis of breastfeeding indicators was undertaken. Ninety-eight percent of Australian Defence Force women in this cohort initiated breastfeeding and breastfed for a median duration of 8 months, returning to work when the mean age of the child was 8.4 months. Breastfeeding prevalence did not meet 2003 Australian National Health and Medical Research Council targets by 6 months postpartum but compared favorably to the Australian population norms. Sixty-six percent of the respondents returned to work full-time, with a median breastfeeding duration of 7 months. Women who returned to work part-time had a longer median duration of 10 months. Breastfeeding rates among this cohort of Australian Defence Force women compare favorably with the general Australian population until 9 months, coinciding with returning to work after a period of maternity leave. The results support recent Australian population studies on breastfeeding and employment.

Determinants of 6-Month Maternal Satisfaction with Breastfeeding Experience in a Multicenter Prospective Cohort Study

Although a personally defined experience, successful breastfeeding is usually measured with regard to duration. This study investigated the determinants of maternal satisfaction with breastfeeding experience for 907 mothers enrolled in a prospective cohort study. Despite a median breastfeeding duration (18 weeks) that fell short of recommendations, 822 mothers (90.6%) rated their breastfeeding experience as very or fairly satisfactory. Anticipated breastfeeding duration was a determinant of satisfaction only for women who actually breastfeed < 2 months; in this subgroup of mothers, satisfaction rates ranged from 84.6% for those who anticipated breastfeeding < 2 months to 69.8% for those who anticipated breastfeeding > 4 months (P = .01). Smoking during pregnancy and experiencing breastfeeding difficulties after discharge were independently associated with decreased satisfaction. Eliciting the mother's expectations regarding breastfeeding duration may help the lactation consultant in providing appropriate guidance. Future studies should assess maternal satisfaction using validated instruments.

Prevalência de aleitamento materno e introdução precoce de suplementos alimentares em área urbana do Sudeste do Brasil, Embu, SP

OBJETIVOS: estimar a prevalência do aleitamento materno em Embu, utilizando indicadores da Organização Mundial de Saúde; investigar a associação dos eventos "não início do aleitamento materno" e "introdução precoce de suplementos alimentares" com fatores sociodemográficos e relacionados à assistência à saúde. MÉTODOS: estudo transversal analítico, domiciliar, com amostragem por conglomerados em dois estágios (sorteio sistemático) - parte do projeto "Morbidade e Utilização de Serviços de Saúde". População: 798 menores de três anos, residentes no Embu em 1996. RESULTADOS: aleitamento materno - 95,7% (IC95%: 93,2-98,2) dos menores de um ano; aleitamento exclusivo - 10,3% (IC95%: 2,9-17,6); predominante - 32,3% (IC95%: 23,5-41,2); duração mediana do aleitamento: seis meses. Fatores associados à introdução precoce de suplementos (uso de outros alimentos, exceto água ou chás, antes de 120 dias): residir em favela - OR = 3,70 (IC95%; 2,01-6,81); alta hospitalar do recém-nascido após cinco dias de vida - OR = 6,12 (IC95%: 1,64-22,80); mãe com 30 anos ou mais - OR = 1,70 (IC95%: 1,01-2,86). CONCLUSÕES: foram caracterizados grupos priori-tários para intervenção em aleitamento materno, apontando para a necessidade de novos estudos, além de ações dirigidas à população favelada e à melhora da assistência pré e perinatal.

The onset of lactation: implications for breast-feeding promotion programs.

This paper discusses the implications of the onset of lactation (OL) for breast-feeding (BF) promotion programs. It is noted that a delay in OL may lead to an early introduction of infant formula and an early termination of BF even after controlling for maternal original BF intentions. This is evinced by multivariate analyses performed on samples from different countries which consistently indicate that a delayed OL is a risk factor for poor BF outcomes. A longitudinal study conducted in urban Mexico found that OL was inversely associated with the likelihood of BF at 2 months post-partum (pp). In Honduras a cross-sectional survey among women with children 2 years old or younger indicated that OL > 72 hours pp was positively associated with the use of milk-based prelacteal feeds which was in turn associated with a lower likelihood of BF. A longitudinal study conducted in Hartford Connecticut USA found that the median BF duration among women with OL or = 72 hours pp. These data suggest that the longer it takes for women to perceive OL the more likely it is that they will become stressed and begin using breast milk substitutes. This may further delay OL leading to an early termination of BF. Future studies should emphasize the relationship between biological and psychosocial stress with OL and subsequent infant feeding outcomes.