Shorter Breastfeeding Research Articles

Colostrum TGF-β-1 associates with the duration of breast-feeding

Several stressful environmental factors are associated with short-term breast-feeding. A high concentration of sodium in colostrum has predicted early failure. We studied the association of growth factors in colostrum and the length of breast-feeding (BF). We measured concentrations of TGF-beta1 and -beta2; epidermal growth factor, total protein, and sodium and compared their concentrations in colostral samples from mothers who either breast-fed their infants exclusively less than 0.5 months (n = 109) or longer than 3.5 months (n = 119). In the short BF group more mothers smoked and were primiparous more frequently and had less often a university education. They also provided the colostral samples significantly later than did those with long BF. Geometric mean concentration for TGF-beta1 was 1.9 times as high in the samples from short BF mothers as in those with long BF; significant difference remained in comparisons of samples taken equally long postpartum. Samples from the short BF group showed higher levels for sodium, TGF-beta2 and total protein, whereas concentrations of epidermal growth factor were similar between groups. We thus infer that concentrations of factors in breast milk with an effect on the development and involution of the mammary gland, like TGF-beta1 in milk, may be one of many biological factors having an impact on the successful initiation of breast-feeding.

Low Prepregnant Body Mass Index and Breastfeeding Practices

The relationship of low prepregnant body mass index with breastfeeding was investigated in 1272 women who delivered a term infant with birthweight > or = 2500 g at the San Paolo Hospital in Milan, Northern Italy. Underweight was defined using the Institute of Medicine's cutoff of 19.8 kg/m(2). Women were interviewed via telephone through 12 months postdelivery about breastfeeding practices. Education level (high versus low, odds ratio [OR], 1.41), primiparity (OR, 1.35), vaginal delivery (OR, 0.74), and birthweight of the infant (normal versus high, OR, 1.89) were associated with low, as opposed to normal, pre-pregnant body mass index. After adjustment for these confounders, no difference was found between underweight and normal weight women for initiation or duration of breastfeeding (mean adjusted difference, 0.4; 95% confidence interval [95% CI], -0.1 to 0.9 months) or exclusive breastfeeding (0.1 [95% CI, -0.1 to 0.3] months). Underweight mothers of healthy term infants may not be at increased risk for not initiating or shorter breastfeeding.

Association between breastfeeding duration and mandibular retrusion: A cross-sectional study of children in the mixed dentition

In this study, we examined the relationships among breastfeeding duration, nonnutritive infantile sucking habits, Class II facial patterns with mandibular retrusion, and Class II dental relationships. A sample of 249 children in the mixed dentition was examined by 2 orthodontists. Data about the duration of breastfeeding and nonnutritive sucking habits were obtained by written questionnaires answered by the parents. The chi-square test did not indicate a statistically significant association between breastfeeding duration and mandibular deficiency or Class II malocclusion. However, statistically significant associations were found between short breastfeeding duration (<6 months) and nonnutritive sucking habits, and between nonnutritive sucking habits and Class II malocclusions. These findings point to the hypothesis that nonnutritive sucking habits may work as a dominant variable in the relationship between breastfeeding duration and the occurrence of Class II malocclusion. However, the prevention of mandibular deficiency should not be listed as one of the advantages of breastfeeding.

Airway hyperresponsiveness and body mass index: The child health and environment cohort study in Hesse, Germany

Increased body mass index has been linked to wheezing, a diagnosis of asthma, and morbidity. We investigated the association between body mass index (BMI), breastfeeding, and airway hyperresponsiveness (AHR) in 536 German schoolchildren. We analyzed consecutive surveys in 1994-1995 and 1997, conducted as part of the Child Health and Environment Cohort Study in Hesse, Germany. The questionnaire included questions adapted from the German version of the International Study of Asthma and Allergy in Childhood (ISAAC). A bronchial challenge test using 4.5% hypertonic saline was conducted during the 1997 survey. AHR was defined as a fall in forced expiratory volume in 1 sec (FEV(1)) of > or = 15%. Of 536 children who participated in the 1997 survey (median age, 10.3 years), 82 (15%) tested positive for AHR. In a multivariate analysis, there was no association between AHR determined at age 10 years and the highest quintile of BMI compared to the lowest quintile at age 4 years (odds ratio (OR), 1.4; 95% confidence interval (CI), 0.5-3.6), 7-8 years (OR, 0.6; 95% CI, 0.1-2.5), or 10 years (OR, 1.1; 95% CI, 0.2-4.3). Breastfeeding for 12 weeks or longer protected against AHR (OR, 0.4; 95% CI, 0.2-0.9). However, when children in the highest quintile of BMI at age 4 years had been breastfed for 8 weeks or less, the prevalence of AHR at age 10 years was significantly increased (27.7%, P = 0.01). In conclusion, our results demonstrate a protective effect of breastfeeding against AHR, and reinforce the need to encourage breastfeeding. Although there was no association between BMI and AHR, our finding of an interactive effect of high BMI and short breastfeeding on AHR suggests a complex etiological pathway that needs to be further explored.

Reduction of mother-to-child transmission of HIV at Saint Camille Medical Centre in Burkina Faso

One thousand three hundred and twenty-eight pregnant women with less than 32 weeks of amenorrhea received voluntary counseling and testing at Saint Camille Medical Center from May 1, 2002 to December 30, 2004. Following informed consent and pre-test counseling, HIV screening was performed in 1,202 women. According to the prevention protocol, HIV-positive women received a single dose of Nevirapine (200 mg) during their labor, while their newborn received a single dose of Nevirapine (2 mg/kg) within 72 hr from birth. HIV seroprevalence (11.2%) was higher than in the overall population. One hundred and ninety-three children were born at the end of December 2004; 53 children (27.5%) followed a short breastfeeding protocol for 4 months, while 140 (72.5%) were fed artificially. All the children underwent RT-PCR test for HIV 5-6 months after their birth: 173 (89.6%) were HIV negative whilst 20 children (10.4%) were HIV positive. Out of the 20 positive children 5/53 (9.4%) had received breast milk for 4 months, while the remaining 15/140 (10.7%) had been fed artificially (P = 0.814). Artificially fed babies (3/140 (2.1%)) and 1/53 (1.9%) of those breast fed for 4 months deceased according to mortality rate of HIV-positive children. This shows that there is no statistically significant difference (P = 0.648) between the mortality of artificially fed (3/140 or 2.1%) and breast-fed (1/53 or 1.9%) children. Artificially fed children (20/140 (14.3%)) and 5/53 (9.4%) of breast-fed children died within 6-10 months. This figure indicates that there is no significant difference between the mortality rate of artificially and that of breast-fed children (P = 0.427). Although the HIV prevention program reduced significantly the vertical transmission of HIV at Saint Camille Medical Center, the mortality of artificially fed children was still high due to gastrointestinal diseases. The HIV diagnosis by RT-PCR technique was of great help in the early identification of HIV-infected children.

Gastrointestinal complaints and diagnosis in children: a population‐based study

To find out the extent to which children at 10-11 y of age suffer from various gastrointestinal complaints and how often a food-induced or other diagnostic disorder might be assessed behind them, we carried out a population-based survey of 404 children in a rural Finnish town. A questionnaire filled in retrospectively by their parents was used to describe the frequency of various abdominal symptoms during the previous 2 y and to select the symptomatic subjects for closer clinical examination. In the clinical investigation of the children, an elimination challenge with milk protein and lactose intolerance tests, as well as endoscopic examinations in selected cases and blood tests, were performed. In all, 110 (27%) subjects reported some gastrointestinal (GI) complaints during the last 2 y; 64 (16%) meeting the Apley criteria for recurrent abdominal pain. A specific organic or functional disorder was found in 26 subjects (6%), two having no GI symptoms. Milk protein intolerance was the most common specific disorder diagnosed in nine subjects (2.2%), followed by lactose intolerance in eight (2%), coeliac disease in five (1.2%) and Helicobacter pylori infection in three (0.7%). An endoscopic examination performed on 17 subjects (4.2%) and a colonoscopy on three revealed significant findings in 11; lymphonodular changes being most common, occurring in five subjects. Subjects with milk protein-induced disorders showed significantly lower IgA-class antibodies to milk and its fractions than the non-symptomatic controls. Chronic diseases, short breastfeeding, GI problems and food intolerance during the first year of life were observed as significant risk factors in determining whether a subject belonged to the group experiencing any GI complaints. We conclude that in one in five of those with any, even mild, GI complaints we were able to assess a specific organic disease; milk-induced disorders being most common. A milk protein and/or lactose load test, completed in some cases with an endoscopic examination, would help in assessing a proper individual diagnosis.

Long-Term Duration of Breastfeeding in Swedish Low Birth Weight Infants

The aim of this study was to describe the long-term incidence of breastfeeding in a geographically defined cohort of low birth weight (LBW) (<2500 g) Swedish infants (N = 70) at discharge from a neonatal unit and at the postnatal ages of 2, 4, 6, and 8 months. The infants' breastfeeding data were examined retrospectively and compared to annual breastfeeding data for all infants born in the same year and county (N = 2751). Ninety-three percent of the LBW infants were fed breast milk at discharge and 36% at 6 months, compared to 97% and 75%, respectively, of the county population. Cox regression analysis showed that multiparity was a significant predictor associated with shorter breastfeeding in LBW infants (odds ratio = 2.51, 95% confidence interval, 1.35-4.69). LBW infants had a high breastfeeding incidence but a significantly shorter duration than controls. This result indicates the need for intensified support throughout the breastfeeding period. J Hum Lact. 19(2):157-165.

Long-term duration of breastfeeding in Swedish low birth weight infants.

The aim of this study was to describe the long-term incidence of breastfeeding in a geographically defined cohort of low birth weight (LBW) (< 2500 g) Swedish infants (N = 70) at discharge from a neonatal unit and at the postnatal ages of 2, 4, 6, and 8 months. The infants' breastfeeding data were examined retrospectively and compared to annual breastfeeding data for all infants born in the same year and county (N = 2,751). Ninety-three percent of the LBW infants were fed breast milk at discharge and 36% at 6 months, compared to 97% and 75%, respectively, of the county population. Cox regression analysis showed that multiparity was a significant predictor associated with shorter breastfeeding in LBW infants (odds ratio = 2.51. 95% confidence interval, 1.35-4.69). LBW infants had a high breastfeeding incidence but a significantly shorter duration than controls. This result indicates the need for intensified support throughout the breastfeeding period.

Changes in breast feeding behavior in Styria 1994 and 2000

Aim of this study was to examine breast feeding behaviour in Styria, Austria in the years 1994 and 2000. Differences were documented and possibilities for better support were outlined. 1994 106 and 2000 60 mothers were questioned about breast feeding behaviour of the last child after delivery of a newborn in our hospital. The social status of the parents, breast feeding duration and frequency, problems while breast feeding and contraception were documented. The mothers were also asked about the breast feeding behaviour they planed for the newborn. 1994 83% and 2000 88% of the mothers breast fed their babies for at least 1 month. The average breast feeding duration increased from 4.8 months in 1994 to 5.3 months in 2000. The frequency of breast feeding also increased. Low social status was correlated with shorter breast feeding duration. Support for breast feeding was used by 53% of the mothers in 1994 and by only 28% of the mothers in 2000. 27% of the mothers wish to breast-feed the newborn longer than the last child in 2000. Breast feeding duration has increased in Styria, Austria from 1994 to 2000. Since mothers want to breast feed even longer, support to breast feeding mothers should be offered as often as possible.

Short hospital discharge and breastfeeding duration: California, 1999

Short hospital discharge and breastfeeding duration: California, 1999

Short hospital discharge and breastfeeding duration: California, 1999

Short hospital discharge and breastfeeding duration: California, 1999

Pacifier Use is Associated With Shorter Breastfeeding Duration Among Low-Income Women

Pacifier Use is Associated With Shorter Breastfeeding Duration Among Low-Income Women

Pacifier Use is Associated With Shorter Breastfeeding Duration Among Low-Income Women

To the Editor. Increasing breastfeeding rates has long been advocated as a method of improving maternal and child health in both developed and developing countries. In the United States, breastfeeding duration rates remain low, particularly among low-income and minority women.1 Better understanding factors related to breastfeeding duration can help improved breastfeeding education, support, and, ultimately, rates among target populations. Many factors related to breastfeeding duration have been cited in the literature.2 However, limited information exists concerning modifiable factors such as pacifier use.3–6Recent studies suggest that pacifier use is associated with shorter breastfeeding duration and with lactation difficulties,3 …

Breastfeeding duration among low income women

Breastfeeding has been identified as a possible deterrent to the development of osteoporosis and breast cancer in women. In addition, infants who are breastfed exclusively for at least 4 months reportedly have fewer incidence of SIDS, ear infection, diarrhea, and allergies. Further, low income women who breastfeed may be empowered by the experience. Increasing the frequency and duration of breastfeeding is recognized as a national priority, particularly for low income, minority women. Yet, recent national data indicate that in 1997, only 16.5% of low income mothers breastfed for at least 6 months. Short breastfeeding duration in low income women may be due to problems unique to them; thus, consistent and comprehensive breastfeeding support should be provided by midwives, nurses, lactation consultants, and peer counselors who are skilled in culturally sensitive management of lactation within the context of limited financial and social resources. This article focuses on the benefits of breastfeeding, and factors that may influence its duration. It also explores culturally relevant strategies as well as suggested interventions to increase breastfeeding duration among low-income women.

Cross-cultural dimensions of breastfeeding practices and abstinence: Evidence from Uttar Pradesh and Tamilnadu, India

The analysis contained in this paper brings out very clearly that the practice of breastfeeding and abstinence in the two major states of India: Uttar Pradesh and Tamilnadu are highly related to socio-cultural factors and changes in generational gaps. The findings reveal that literate, non-Hindu, and rich (high SLI) women have shorter breastfeeding durations than illiterates, Hindus, and poor (low SLI) women of Uttar Pradesh and Tamilnadu. In addition, the breastfeeding practice in Uttar Pradesh is influenced by residence background and generational age-gaps. The role of socio-cultural factors in influencing post-partum sexual abstinence period has been found to be significantly important through the variables; residence background, generational age-gaps, religion and working status of women. The results reveal that urban women, of younger cohorts (below 30 years), non-Hindu, and non-working women have shorter abstinence periods compared to rural women, of older cohorts (above 30 years), Hindus, and working women in both the states.

Pacifier use and short breastfeeding duration: cause, consequence, or coincidence?

Pacifiers are related to a shorter duration of breastfeeding. However, it is unclear whether this association is causal, because confounding, reverse causality, and self-selection of mothers may play a role. These issues were investigated through a combination of epidemiologic and ethnographic research in southern Brazil. A population-based cohort of 650 mothers and infants were visited shortly after delivery and at 1, 3, and 6 months. The rate of complete follow-up was 96.8%. A subsample of 80 mothers and infants was selected for the ethnographic study, which included in-depth interviews and participant observations in the age range of 2 to 6 months with a mean of 4.5 visits. The epidemiologic study showed that pacifier use was common with 85% of users at 1 month. However, this was a dynamic process, with many infants starting or abandoning the pacifiers in any age range. Children who stopped breastfeeding in a given period were likely to take up the pacifier during that period. Further analyses excluded all infants not breastfed at 1 month of age and those who reportedly had breastfeeding problems, leaving 450 infants with full data. Intense pacifier users at 1 month (children who used the pacifiers during most of the day and at least until falling asleep) were four times more likely to stop breastfeeding by 6 months of age than nonusers. Users also had fewer daily breastfeedings than nonusers. After adjustment for several confounding variables, logistic regression showed that pacifier use was still associated with an odds ratio of 2.5 (95% confidence interval, 1.40 to 4.01) for stopping breastfeeding. The ethnographic analysis showed that pacifier use was widely regarded as a positive behavior and that mothers often strongly stimulated the infants to accept it. Although few mothers openly admitted that pacifiers might shorten breastfeeding, a considerable group effectively used pacifiers to get their infants off the breast or to increase the interval between feedings. The latter also had rigid breastfeeding styles that increased maternal-infant distance, had important concerns about objective aspects of infant growth and development, and were highly sensitive to infant crying. These behaviors were linked to intense comparison between themselves and other mothers and to a lack of self-confidence. Nonwhite mothers, those who delivered vaginally, and mothers of infant girls seemed to be more confident and less affected by these difficulties. The epidemiologic analysis confirmed that pacifier use was more closely associated with breastfeeding duration among nonwhite mothers and for normally delivered infants. Pacifiers may be an effective weaning mechanism used by mothers who have explicit or implicit difficulties in breastfeeding, but they are much less likely to affect infants whose mothers are confident about nursing. Breastfeeding promotion campaigns aimed specifically at reducing pacifier use will fail unless they also help women face the challenges of nursing and address their anxieties. The combination of epidemiologic and ethnographic methods was essential for understanding the complex relations between pacifier use and breastfeeding.

Factors associated with the duration of breastfeeding: analysis of the primary and secondary responders to a self-completed questionnaire.

A cohort of 1192 consecutive newborn infants was followed prospectively for factors possibly affecting the length of time they were breastfed. Following the procedure of a double-blind test, one-third of the cohort received Credé prophylaxis at age 2 h. The duration of breastfeeding (sole or partial) was recorded up to age 6 months and there was a 100% follow-up. Multivariate proportional hazards regression analysis (Cox) of the whole cohort showed that babies being delivered between 21.00 and 24.00 h were associated with a shorter duration of breastfeeding (rate ratio = 1.37, 99% confidence interval = 1.05-1.78). Mother's age (under 21 years), marital status (unmarried) and birthweight (inversely) were factors also independently associated with shorter breastfeeding duration. Boys were breastfed for a shorter time than girls (p < 0.05). In univariate analyses only, the first-born babies had a significantly shorter breastfeeding time, and purulent eyes in the first 24 h was a factor of borderline significance (p < 0.05). Educational level, socioeconomic status and smoking habits of the mothers were not investigated in this study. Owing to the lack of regulations in place at the time of the study (1981-82), it was possible to differentiate between the mothers who responded spontaneously to the self-completion questionnaire (primary responders, 68.5%) and those who required one or two reminders. Short breastfeeding time was the strongest predictor of being a secondary responder, followed by being very young or unmarried. Approaching the secondary responders reduced the prevalence of breastfeeding at 6 months by 5% (from 53.8% to 48.8%).

Identification of risk factors for short breastfeeding duration in Mexico city through survival analysis1 2

The objectives of these analyses are to identify in Mexico City recent: a) infant feeding policies in maternity wards, b) infant feeding patterns, and c) socio‐economic, cultural, behavioral and biomedical determinants of breastfeeding. Subjects (n = 518) were recruited in two large public hospitals and followed‐up in their homes at one and four months post‐partum (pp). Breastfeeding rates at four months ranged from 49% to 60%. The main reason given for stopping breastfeeding was insufficient milk. Multivariate survival analyses showed that delivery in a nursery (vs. rooming‐in) ward, maternal employment, having a refrigerator in the household, being a teenaged mother and low maternal motivation for breastfeeding were risk factors for shorter breastfeeding duration. These results may be useful for improving breastfeeding promotion policies in Mexico.

Impact of Breast Feeding on the Number of Diarrheal Episodes and Nutritional Status in Children Less Than Six Months Old

OBJECTIVE: To evaluate the impact of breast feeding on the number of episodes of diarrhea and nutritional status in infants. MATERIALS AND METHODS: From January to April 1993, we enrolled in a case-control study 102 children with acute diarrheal disease (ADD) and 37 healthy children who were <6 months of age, at the Oral Rehydration Unit (ORU) of Children's Health Institute (CHI) in Lima, Peru. We assessed duration of breast feeding, number of episodes of diarrhea, nutritional status, socio-economic status, hygienic behaviour, and maternal age. We used linear regression analysis to determine whether duration of breastfeeding correlated with episodes of diarrhea. RESULTS: 44% of patients with ADD, were breastfed until 1 month of age, 29% until 3 months, and only 27% until 6 months. In contrast, 95% of the healthy controls were breastfed for 6 months. Among infants with ADD, 20% showed mild, 19% moderate, and 40% showed severe malnutrition. Children with shorter breastfeeding had more episodes of diarrhea and were more likely to be malnourished (p=0.01). There was an inverse correlation between the number of episodes of diarrhea and duration of breast-feeding (r=0.46). CONCLUSION: Exclusive breast-feeding for a minimum of four months significantly reduces the number of episodes of diarrhea and malnutrition in children less than 6 months of age.

Infection and Disease: The Impact of Early Weaning

Although the protective effect of breastfeeding against infectious diseases has been long suspected, it has only recently been adequately quantified This article reviews the available epidemiologic evidence. Breastfeeding provides marked protection against diarrhoeal morbidity and severity (as measured by its duration, level of dehydration, or case-fatality rate), and mortality. This is true for acute watery diarrhoea as well as for dysentery and persistent diarrhoea. A dose-response pattern is observed: the risk level for children receiving both breastmilk and artificial milk is between that of exclusively breasfed children and that of completely weaned children. Even the introduction of water or herbal teas to a previously exclusively breasfed infant increases the risk of morbidity and mortality. The protection is greatest for young infants, and the period immediately after weaning seems to carry the highest risk. Although breastfeeding does not seem to have an appreciable effect on the incidence of acute respiratory infections as a whole, there is evidence of an effect on the incidence of pneumonia, on the incidence of hospitalization for pneumonia, and on mortality from respiratory infections. The level of protection against pneumonia, however, is lower than that against diarrhoea. Breastfeeding also protects against onus media and other infections, including neonatal sepsis, meningitis, and bacteraemia, although the number of relevant studies is small. A simulation exercise shows that a 40% reduction in the prevalence of nonbreastfeeding would prevent up to 15% of diarrhoea deaths and 7% of pneumonia deaths occurring in regions with a short breastfeeding duration, such as urban Latin America. In regions where breastfeeding durations are longer, the emphasis should be on maintaining these high rates and increasing the proportion of young infants who are exclusively breastfed. The present review confirms that breastfeeding promotion is an essential child survival strategy.