Non-exclusive Breastfeeding Research Articles

Factors associated with growth faltering in Sri Lankan infants: A case-control study in selected child welfare clinics in Sri Lanka

Background Growth faltering during later infancy is common in Sri Lanka. While retarding the physical and mental development of the infant, its burden on the social and economic aspects of the family, society and country is immense. Methods A case-control study, involving 150 controls and 75 cases (Total 225), was conducted in two randomly selected Child Welfare Clinics. Infants with failure to thrive were identified from Child Health Development Records and a pre-tested, interviewer administered questionnaire was used for data collection. Data was analyzed using SPSS 17.0. Results Sex distribution was almost equal (Males=52.4%, Females=47.6%). The mean age of mothers was 26 years (SD=4.7) and only 26.2% (n=59) were employed although over 90% had secondary education. Lower segment caesarean section, low birth weight, intra-uterine growth restriction and presence of acute illnesses had a significant association with growth faltering with odds ratios (OR) of 3.3 (95% CI=1.8-5.8), 3.0 (95% CI=1.6-5.6), 3.5 (95% CI=1.3-9.5) and 2.3 (95% CI=1.3-4.1) respectively. Significant factors pertaining to feeding were, non-exclusive breast feeding (OR=2.8 and 95% CI=1.5-5.3), inadequate duration of breast feeding per feed (OR=3.8 and 95% CI= 2.1-6.9), formula feeding (OR=2.1 and 95% CI=1.2-3.7) and inadequate diet (OR=2.7 and 95% CI=1.5-5.0). Parental and household factors such as young maternal age, inadequate maternal education, increased number of children and non-availability of domestic help were not statistically significant. However, low monthly income was a significant factor associated with growth faltering (OR=3.3 and 95% CI=1.8-6.2). Conclusion: Infant and dietary factors were of paramount importance while parental and household factors played a minor role in growth faltering.

Maternal, Infant Characteristics, Breastfeeding Techniques, and Initiation: Structural Equation Modeling Approaches.

ObjectivesThe aim of this study was to examine the relationships among maternal and infant characteristics, breastfeeding techniques, and exclusive breastfeeding initiation in different modes of birth using structural equation modeling approaches.MethodsWe examined a hypothetical model based on integrating concepts of a breastfeeding decision-making model, a breastfeeding initiation model, and a social cognitive theory among 952 mother-infant dyads. The LATCH breastfeeding assessment tool was used to evaluate breastfeeding techniques and two infant feeding categories were used (exclusive and non-exclusive breastfeeding).ResultsStructural equation models (SEM) showed that multiparity was significantly positively associated with breastfeeding techniques and the jaundice of an infant was significantly negatively related to exclusive breastfeeding initiation. A multigroup analysis in the SEM showed no difference between the caesarean section and vaginal delivery groups estimates of breastfeeding techniques on exclusive breastfeeding initiation. Breastfeeding techniques were significantly positively associated with exclusive breastfeeding initiation in the entire sample and in the vaginal deliveries group. However, breastfeeding techniques were not significantly associated with exclusive breastfeeding initiation in the cesarean section group. Maternal age, maternal race, gestations, birth weight of infant, and postnatal complications had no significant impacts on breastfeeding techniques or exclusive breastfeeding initiation in our study. Overall, the models fitted the data satisfactorily (GFI = 0.979–0.987; AGFI = 0.951–0.962; IFI = 0.958–0.962; CFI = 0.955–0.960, and RMSEA = 0.029–0.034).ConclusionsMultiparity and jaundice of an infant were found to affect breastfeeding technique and exclusive breastfeeding initiation respectively. Breastfeeding technique was related to exclusive breastfeeding initiation according to the mode of birth. This relationship implies the importance of early effective interventions among first-time mothers with jaundice infants in improving breastfeeding techniques and promoting exclusive breastfeeding initiation.

Prevalence and Risk Factors of Iron Deficiency Anaemia in Children admitted in a Tertiary Care Hospital of Bangladesh

Introduction: Anaemia is a common problem in childhood. In Bangladesh, overall 68% of children aged 6-59 months are anaemic. Anaemia impairs normal growth and development, decreases physical exercise tolerance and intellectual performance in children. The objective of this study was to find out the prevalence and risk factors for iron deficiency anaemia in hospitalized children aged 6 to 36 months.Materials and Methods: Eligible children admitted in Dhaka Shishu (Children’s) Hospital due to any acute illness, were enrolled from 1st June 2010 to 30th August 2010. Anaemia (Hb <11gm/dl) was classified as microcytic, normocytic or macrocytic. Peripheral blood film, serum ferritin, haemoglobin electrophoresis, serum C-reactive protein and stool microscopy were done. Risk factors were looked for in cases of iron deficiency anaemia.Results: Among 331 enrolled children, 201 (61%) had anaemia, among them 63 (31%) had iron deficiency anaemia. Lower the socioeconomic status, higher was the rate of anaemia. Prematurity and low birth weight was significantly associated with anaemia. Poor feeding practices including colostrum rejection, non-exclusive breastfeeding, early/late weaning and inappropriate weaning diet were important risk factors. Gender was not found as a risk factor.Conclusion: A large proportion of hospitalized children under three years of age were found anaemic, among them iron deficiency anaemia was most common. The study result emphasizes the importance of identifying the risk factors of anaemia in this age group. Raising awareness of the problem and providing health and nutrition education will be the key interventions to prevent and control this huge public health problem in Bangladesh.J Nepal Paediatr Soc 2015;35(1):38-43

Exclusive Breastfeeding and the Effect on Postpartum Multiple Sclerosis Relapses.

Women with multiple sclerosis (MS) experience an elevated risk of relapse after giving birth. The effect of exclusive breastfeeding on postpartum risk of MS relapse is unclear. To determine the effect of exclusive breastfeeding on postpartum risk of MS relapse and to investigate the effect of introducing supplemental feedings on that risk. Data on 201 pregnant women with relapsing-remitting MS were collected prospectively from January 1, 2008, to June 30, 2012, with 1 year follow-up post partum in the nationwide German MS and pregnancy registry. The effect of the intention to breastfeed exclusively (no regular replacement of breastfeeding meals with supplemental feedings) for at least 2 months compared with nonexclusive breastfeeding (partial or no breastfeeding) on the first postpartum MS relapse, using Cox proportional hazards regression model adjusted for age and disease activity, before and during pregnancy was analyzed. Data analysis was performed from August 30, 2013, to May 25, 2015. Exclusive breastfeeding defined as at least 2 months of breastfeeding without regular replacement of any meal by supplemental feeding. First postpartum MS relapse. Of 201 women, 120 (59.7%) intended to breastfeed exclusively for at least 2 months and 81 (40.3%) breastfed and included supplemental feeding (42 [20.9%]) or did not breastfeed (39 [19.4%]). Thirty-one women (38.3%) who did not breastfeed exclusively had a relapse within the first 6 months post partum compared with 29 women (24.2%) who intended to breastfeed exclusively for at least 2 months (unadjusted hazard ratio, 1.80; 95% CI, 1.09-2.99; P = .02; adjusted hazard ratio, 1.70; 95% CI, 1.02-2.85; P = .04). The time to first postpartum relapse after the introduction of supplemental feedings did not differ significantly between women who previously breastfed exclusively and those who did not (P = .60). The findings of this study suggest that exclusive breastfeeding is a modestly effective MS treatment with a natural end date. Our study provides further evidence that women with MS who breastfeed exclusively should be supported to do so since it does not increase the risk of postpartum relapse.

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Tempo de aleitamento materno entre indígenas Xakriabá aldeados em Minas Gerais, Sudeste do Brasil

OBJETIVO: Estimar a duração mediana do aleitamento materno na Terra Indígena Xakriabá e identificar fatores que se relacionaram ao tempo de amamentação nessa população. MÉTODOS: Neste estudo transversal, coletaram-se dados por meio de questionário que abrange características sociodemográficas, saúde e amamentação de 342 binômios mãe/criança, residentes na Terra Indígena Xakriabá, Minas Gerais, em 2007. Dados descritivos foram obtidos de 317 crianças que mamaram por pelo menos um dia, mas, para alcance dos objetivos, analisaram-se somente questionários que foram integralmente respondidos e que se referiam a crianças que mamaram por pelo menos um dia, ou seja, 82,2% (287) do universo das 349 crianças indígenas menores de 3 anos, pelo método de Kaplan Meier e modelo de Regressão de Cox. RESULTADOS: A maioria das crianças era do sexo masculino (52,0%), 1º, 2º ou 3º filho (53,6%) e teve o leite materno como primeiro alimento (94,6%). A duração mediana do aleitamento materno exclusivo e do aleitamento materno foi de 11,73 meses e 7,27 dias, respectivamente, sendo os meninos e as crianças nascidas na 4ª ordem ou adiante os mais vulneráveis ao desmame. CONCLUSÃO: Na Terra Indígena Xakriabá, a duração mediana do aleitamento materno exclusivo foi curta, e metade das crianças deixou de ter os benefícios nutricionais, imunológicos e funcionais do leite materno em idade próxima a 12 meses, quando foram desmamadas. O sexo e a ordem de nascimento se relacionaram a essa duração, mas pesquisas poderiam ser realizadas para maior entendimento dos fatores socioculturais que se relacionaram ao tempo de amamentação nesta Terra Indígena.

Prevalence and Associated Factors of Nonexclusive Breastfeeding to Infants within the First 6 Months in Gondar Town, Northwest Ethiopia, 2014

Introduction. Nonexclusive breastfeeding (NEBF) is giving infants other foods or fluids in addition to the breast milk within the first six months of age. According to Ethiopian Demographic and Health Survey 2011, prevalence of NEBF was found to be 48%; this has a great impact on the health and development of the child.Objectives. To assess the prevalence and associated factors of NEBF to infants within the first six months.Methods. Community based cross-sectional study design was employed from March 1 to 31, 2014, among 828 mothers with infants 6 to 12 months old. Systematic random sampling technique was used to select study subjects. Logistic regression analysis with 95% CI was computed to identify predictor variables.Result. A total of 828 mothers with infants aged between 6 and 12 months were interviewed with 100% response rate. Prevalence of NEBF was 47.5%. Mothers who completed primary school (AOR=0.46[95% CI: 0.30, 0.71]) were less likely practicing NEBF compared to mothers with no formal education. Governmental employees (AOR=2.55[95% CI: 1.45, 4.46]) were more likely practicing NEBF.Conclusion. NEBF was practiced by 47% of mothers. Maternal educational status, occupation, and knowledge of initiation of complementary feeding were factors significantly associated with NEBF.

Infant Breastfeeding and Kidney Function in School-Aged Children

Early life factors may influence kidney growth and function throughout the life course. We examined the associations of breastfeeding duration and exclusivity and age at introduction of solid foods with kidney outcomes at school age. Prospective cohort study from fetal life onward. 5,043 children in the Netherlands. Infant feeding was assessed prospectively using questionnaires. In children at a median age of 6.0 years, we measured kidney volume with ultrasound, estimated glomerular filtration rate (eGFR) from serum creatinine level, and microalbuminuria from urinary albumin and creatinine levels. 92% of all children were ever breastfed, of whom 27% were breastfed for more than 6 months and 21% were breastfed exclusively for at least 4 months. Compared with ever-breastfed children, never-breastfed children had smaller combined kidney volumes (-2.69 [95% CI, -4.83 to -0.56] cm(3)) and lower eGFRs (-2.42 [95% CI, -4.56 to -0.28] mL/min/1.73 m(2)) at school age. Among breastfed children, shorter duration of breastfeeding was associated with smaller combined kidney volume and lower microalbuminuria risk (P<0.05). Compared to exclusive breastfeeding for 4 months, nonexclusive breastfeeding in the first 4 months was associated with smaller combined kidney volume and lower eGFR (both P<0.05). Associations with eGFR were explained largely by kidney volume. Age at introduction of solid foods was not associated with any kidney outcome. Observational study, so causality cannot be established. Follow-up measurements were available for 76% of children. These results suggest that breastfeeding is associated with subclinical changes in kidney outcomes in childhood. Further studies are needed to explore whether early life nutrition also affects the risk of kidney disease in adulthood.

Profiling the Determinants of Baby Weights in Bolgatanga Municipality of Ghana

Introduction:Birth weights and subsequent weights (weight-for-age of babies) have been found to play a vital role in early childhood development and have profound effect on later lives of children. The weight-for-age of babies, as a measure of child’s growth, was found in several literatures as one of the key determinants of under-five mortality. This paper therefore deemed it crucial to explore how prognostic factors are influencing infants’ growth in the weights of babies in Ghana using Bolgatanga municipality in the Upper East region of Ghana as case study.Method:The post-natal records of three hundred (300) nursing mothers were retrospectively followed from January to December 2013 in the seven health facilities of the municipality for the study. Inclusion criterion was used to recruit two hundred and thirty five (235) qualified subjects. The weight-for-age of babies and socio-demographics of the babies and the mothers were recorded. The determinants of infant growth in the weights of the babies were profiled.Results:The study disclosed that the mean birth weight in both sexes, 2.71kg for males and 2.74kg for females, were higher than the standard normal birth weights of 2.50kg by WHO. The multivariate analysis of variance showed a nonlinear infants growth profile in the weights of babies during their first developmental year. The profile of the determinants showed that factors such as educational status and age of mother, breastfeeding type and sex of baby did not differ in the infants’ weights by these groups even-though higher education and nonexclusive breastfeeding had positive effects. However, maternal factors such as: religious affiliations (socio-cultural practices), occupation, parity, injection as at last type of family planning practiced by nursing mothers were significant, highlighting the effect of these maternal socio-demographics and biological factors on infant growth and child survival.Conclusion:The profiles of the effects of the maternal determinants on the weights of babies considered in this study established that infant growth is non-linear. It could also be stated on the basis of the profile analysis that, the weights of babies in this municipality could be modeled for predictions using the maternal determinants such as occupation, parity group, injectable family planning method, breastfeeding type, educational level and socio-cultural practices (religion). The profile analysis of the effects of the maternal socio-demographics and biological factors on infant weights established that the infant’s growth can be improved significantly by the nursing mothers, health service providers and the government if efforts are made to improve and/or modify the significant health indicators.

Impact of Early Life Shocks on Human Capital Formation: El NiiiO Floods in Ecuador

A growing body of research argues that early adverse experiences have lasting effects not only on later health outcomes, but also on human capital accumulation. This paper investigates the persistent effect of negative shocks early in life on children's health and cognitive outcomes, and explores whether shocks at certain periods matter more than others. The paper exploits the geographic intensity of extreme floods during the 1997-1998 El Nino phenomenon in Ecuador as a source of exogenous variation in children's exposure to a negative shock at different periods early in life. It is shown that children exposed to severe floods in utero, especially during the third trimester, are shorter in stature five and seven years later. Also, children affected by the floods in the first trimester of pregnancy score lower on cognitive tests. Potential mechanisms are explored by studying how exposure to the El Nino shock affected key inputs to the production of children's human capital: birth weight and family inputs (income, consumption, and breastfeeding). Children exposed to El Nino floods, especially during the third trimester in utero, were more likely to be born with low birth weight. Furthermore, households affected by El Nino 1997-98 suffered a decline in income, total consumption, and food consumption in the aftermath of the shock. Moreover, exposure to El Nino floods decreased the duration of exclusive breastfeeding and increased the duration of non-exclusive breastfeeding. Falsification exercises suggest that selection concerns such as selective fertility, mobility, and infant mortality do not drive these results.

Severe acute malnutrition in a population of hospitalized under-five Nigerian children

This study was to determine the prevalence and socio- clinical factors associated with severe acute malnutrition (SAM) among hospitalized under-five children. A cross-sectional survey of children aged less than 59 months was carried out at the Children's Ward of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria using the 2006 WHO criteria for SAM. A total of 208 children were studied. Overall, 64.9% had normal nutrition while 18.3% had SAM. Of the 38 children with SAM, 68.4% were hospitalised primarily for severe protein-energy malnutrition using the Wellcome classification. Low maternal education (84.2% vs 65.2%; p = 0.025), non-exclusive breastfeeding (84.2% vs 61.5%; p = 0.009), untimely commencement of weaning (77.8% vs 47.1%; p = 0.006), cessation of breastfeeding before the age of 12 months (45.5% vs 0.0%; p < 0.0001) and presence of infections (84.2% vs 58.5%; p = 0.004) were associated with SAM. Multivariate analysis identified presence of infections (OR = 4.9; p = 0.002), non- exclusive breastfeeding (OR = 1.1; p = 0.048) and low maternal education (OR = 2.1; p = 0.02) as strong determinants of SAM. The prevalence of SAM among hospitalized Under-Fives was high. This justifies the routine use of the WHO diagnostic criteria at the community level for early detection of at-risk children.

Constraints to the optimal breastfeeding practices of breastfeeding mothers in the rural communities of Arba Minch Zuria Woreda, Ethiopia: a community-based, cross-sectional study

Objective: The aim of this study was to identify the constraints and factors associated with breastfeeding practices.Design: This was a community-based, cross-sectional study.Subjects and setting: Three hundred and eighty-four breastfeeding mothers of infants aged two years and younger were randomly selected from rural communities in Arba Minch Zuria Woreda.Outcome measures: Data were collected using structured questionnaires, and from using an observation checklist and in-depth interviews. Quantitative data from binary logistic regression were used to determine the strength of association between the independent and dependent variables using odds ratios and 95% confidence intervals. Multivariate logistic regression analysis was employed to identify predictors of the delayed initiation of breastfeeding and non-exclusive breastfeeding practices.Results: Breastfeeding is considered to be a natural gift from God in Arba Minch Zuria Woreda. The delayed initiation therefof was common in this study. Only 57% of the mothers initiated breastfeeding within an hour of delivery. Some women rejected their colostrum as they considered it to be an expired substance capable of causing abdominal pain to their infants. The delayed initiation of breasfeeding was positively associated with a lack of education and failure to attend health education sessions. Thirty-one per cent of the mothers did not exclusively breastfeed their infant up to six months of age months. Non-exclusive breastfeeding was significantly associated with having a radio, attending antenatal care and attending health education.Conclusion: The promotion of strong community-based networks tp ensure optimal infant and young child feeding is recommended through both governmental and non-governmental organisations.

Maternal smoking during pregnancy and growth in infancy: a covariance structure analysis.

BackgroundSmoking during pregnancy is related to fetal constraint and accelerated postnatal growth. However, the pathways between these factors have not been clarified. Pathway analyses that link these factors can help us better understand the mechanisms involved in this association. Therefore, this study aimed to examine pathways between maternal smoking during pregnancy and growth in infancy.MethodsParticipants were singletons born between 1993 and 2006 in rural Japan. The outcome was the change in weight z-score between birth and 3 years of age. Pathways from maternal smoking and other maternal factors (such as maternal body mass index and work status) to growth in infancy via birth factors (such as birth weight and gestational age) and breastfeeding were examined using structural equation modeling.ResultsComplete data were available for 1524 children (775 boys and 749 girls). The model fit appeared adequate. Lower birth weight and non-exclusive breastfeeding mediated the association between maternal smoking during pregnancy and rapid growth in infancy. Maternal smoking was also directly linked to rapid growth in infancy (standardized direct effects 0.06, P = 0.002). Taking all pathways into account, the standardized total effect of maternal smoking on growth in infancy was 0.11.ConclusionsMaternal smoking during pregnancy may both indirectly, through birth weight and breastfeeding status, and directly influence growth during infancy; however, there may be other pathways that have not yet been identified.

Reasons Behind Non-Exclusive Breastfeeding by Working Women in Mataram City West Nusa Tenggara

Reasons Behind Non-Exclusive Breastfeeding by Working Women in Mataram City West Nusa Tenggara

Effects of breastfeeding on postpartum weight loss among U.S. women

ObjectiveThe aim of this study is to evaluate the effects of breastfeeding on maternal weight loss in the 12months postpartum among U.S. women. MethodsUsing data from a national cohort of U.S. women conducted in 2005–2007 (N=2102), we employed propensity scores to match women who breastfed exclusively and non-exclusive for at least three months to comparison women who had not breastfed or breastfed for less than three months. Outcomes included postpartum weight loss at 3, 6, 9, and 12months postpartum; and the probability of returning to pre-pregnancy body mass index (BMI) category and the probability of returning to pre-pregnancy weight. ResultsCompared to women who did not breastfeed or breastfed non-exclusively, exclusive breastfeeding for at least 3months resulted in 3.2 pound (95% CI: 1.4,4.7) greater weight loss at 12months postpartum, a 6.0-percentage-point increase (95% CI: 2.3,9.7) in the probability of returning to the same or lower BMI category postpartum; and a 6.1-percentage-point increase (95% CI: 1.0,11.3) in the probability of returning to pre-pregnancy weight or lower postpartum. Non-exclusive breastfeeding did not significantly affect any outcomes. ConclusionOur study provides evidence that exclusive breastfeeding for at least three months has a small effect on postpartum weight loss among U.S. women.

Breastfeeding self-efficacy: a cohort study

Objective Evaluate the clinical use of the Breastfeeding Self-Efficacy Scale as predictive of early weaning and verify if women who had higher self-efficacy scores breastfed for longer periods. Methods Cohort study developed with 100 postpartum mothers. Research instrument used: Breastfeeding Self-Efficacy Scale-Short Form. The feeding was monitored on the 7th, 15th, 30th, 45th and 60th day, by phone. Results The mean duration of exclusive breastfeeding was 53.2 days (SD 14.2). Most mothers (82.3%) had scores compatible with high self-efficacy for breastfeeding, none had low efficacy. There was no statistically significant difference in the comparison of mean duration of exclusive and non-exclusive breastfeeding, with the scores of medium and high efficacy. Conclusion Findings did not enable the confirmation of the use of the scale as a predictor of risk of early weaning. No relation was observed between higher scores of high efficacy and longer periods of exclusive breastfeeding.

Evaluation of the Relationship between Unwanted Pregnancy and Infant Feeding

Introduction: Unwanted pregnancy is one of the most important problems, facing married couples. This type of pregnancy has a negative impact on maternal, fetal, and neonatal outcomes. In this study, we aimed to evaluate the relationship between unwanted pregnancy (based on the couples’ opinions) and infants’ nutrition in patients admitted to medical centers of Mashhad in years 2009-2010. Methods: In this cross-sectional study, 300 women with infants under the age of 1 year, who were referred to medical centers of Mashhad, were asked whether or not their pregnancy was planned. Then, they were questioned about their infants’ nutritional status (at the age of 4 months). Data were collected using questionnaires and interviews. Validity and reliability of the methods were confirmed using content analysis and test-retest. Data were analyzed using SPSS version 11.5 and statistical tests. In statistical tests, P-value of 0.05 was considered statistically significant. Results: The findings of statistical analysis showed a significant association between unwanted pregnancy and infant’s nutritional status (P=0.03). Also, the prevalence of unwanted pregnancy in couples with lower education level (high-school education or less) was noticeably higher than other couples. Conclusion: Since unwanted pregnancy often leads to non-exclusive breastfeeding and adverse health outcomes, we highly recommend avoiding unprotected intercourse. Educational programs and marital consultation are also useful for raising couples’ awareness.

Environment as a risk factor in delayed development in premature, low‐birthweight and mild asphyxia children

Premature infants with low birthweight (LBW) and asphyxia are at high risk of delay of language and visual-motor development. Environmental risk factors contributing to the delay include parents' education, family income, number of children in the family, exclusive breast-feeding, and the mother's parenting time. Lack of research in Indonesia on premature, LBW and mild asphyxia children minimizes information to parents on the importance of an optimal environment. The aim of this study was to observe the role of the environment as a risk factor for delay in language and visual-motor development. A cross-sectional study was carried out from June to December 2011 of 12-24-month-old children born premature, with LBW and mild asphyxia at the Hasan Sadikin, Bandung City, and Muhammadiyah Hospitals. Language and visual-motor development were measured by Capute scales. Risk factors were analyzed using chi-squared test and multivariate logistic regression analysis. Of the 70 subjects, 49% had language and visual-motor delay. Environmental factors related to the delay were low parental education, low family income, non-exclusive breast-feeding (P < 0.001) and full-time maternal parenting (P < 0.05). On multivariate analysis non-exclusive breast-feeding was associated with a 175-fold risk (prevalence rate [PR], 174.756; 95% confidence interval [CI]: 10.407-2934.516, P < 0.001), and low family income, a 0.042-fold risk (PR 0.042; 95%CI: 0.005-0.321, P < 0.05). Low family income and non-exclusive breast-feeding are risk factors for delay in language and visual-motor development in 12-24-month-old children born premature, with LBW and mild asphyxia.

Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial

The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity. We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts. We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10-1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10-1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68-0.89). A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.

Breast feeding, infant growth, and body mass index at 30 and 35 years.

This study examined the associations between duration of breast feeding, early infant growth, and body mass index (BMI) at 30 and 35 years, in a birth cohort studied to age 35. Data were gathered on duration of exclusive and non-exclusive breast feeding (months), early growth (kg; 0-9 months), and BMI at ages 30 and 35 from the Christchurch Health and Development Study. The Christchurch Health and Development Study is a study of a birth cohort of 1265 children, born in Christchurch in 1977. Population-averaged generalised estimating regression models showed statistically significant associations between: duration of breast feeding and mean BMI; and early growth and mean BMI. After adjustment for perinatal, family, and social background factors, statistically significant associations were found between: longer duration of breast feeding and lower adult BMI (B = -0.424 [95% confidence interval (CI) -0.708, -0.140]); and increasing early growth and higher adult BMI (B = 0.393 [95% CI 0.080, 0.707]). When breast feeding and infant growth were entered into the regression model and adjusted for covariates, breast feeding was no longer statistically significantly associated with BMI (B = -0.250 [95% CI -0.553, 0.054]), while early growth remained statistically significantly associated with BMI (B = 0.355 [95% CI 0.039, 0.671]). A test for mediation showed that the association between breast feeding and BMI was mediated by early growth (P = 0.01). The association between longer duration of breast feeding and later lower BMI scores in adulthood was mediated by lower early growth. Breast feeding may be included as one component of multicompartment programmes targeted at early growth and later obesity.