Journal of Human Lactation最新文献

The term "weaning" is used heterogeneously in scientific and gray literature, with no commonly agreed-upon definition. Weaning can describe the gradual transition in the infant diet, usually from milk feedings to complementary foods, but it is also commonly used to describe any gradual transition between milks, foods, or feeding modalities. In an epidemiological context, it may also refer to changing breastfeeding rates within a cohort. The meaning of weaning has changed over time and may vary by the scientific assumptions applied to this period of human development. For these reasons, we propose that investigators avoid using the term weaning, and substitute it with more precise terminology. We present a series of proposed standard terms with corresponding definitions to guide more precise and accurate reporting of the various potential meanings of the term in the scientific literature. The objective is to improve reporting and reproducibility of research in the field of breastfeeding and human lactation.

The importance of a child receiving their mother's own milk (MOM) in the care and treatment of preterm infants is undisputed in the literature. Despite this, lactation support in the Neonatal Intensive Care Unit is often fragmented. Gaps in adequate lactation care for infants receiving MOM, and barriers to that lactation care, can contribute to healthcare disparities and outcome inequalities. Here, I outline a comprehensive lactation care manager model based on the concepts of continuity of care and care management. This is a starting point for discussion that may be helpful in informing future research and adequate lactation care options.

Exclusive breastfeeding, as recommended by the World Health Organization (WHO) for the first 6 months of life, is a critical metric for evaluating maternal and infant feeding practices and health outcomes. Despite its importance, inconsistencies in defining and measuring breastfeeding exclusivity present challenges for research comparability and interpretation. Equally, research design, outcomes of interest, and study resources are necessary considerations when collecting and analyzing exclusive breastfeeding data, and may require the adaption of standardized questions and techniques to individual situations. This paper explores key considerations for researchers when operationalizing and measuring exclusive breastfeeding. We address the nuances of point prevalence and since-birth measures, highlighting their influence on study outcomes and data interpretation. Statistical approaches for analyzing exclusivity data, including logistic regression, survival analysis, and Kaplan-Meier methods, are also discussed. By outlining best practices for precise definitions, tailored data collection, and transparent reporting, this paper aims to provide an overview for precise definition, effective data collection, and clear interpretation.

Secondary data analysis has emerged as an important approach for researchers seeking to explore new research questions using existing datasets. These datasets often comprise large and diverse, as well as longitudinal data, enabling comprehensive analyses that might be impractical through primary data collection alone. This paper discusses the importance of secondary data analysis in breastfeeding research, provides examples of publicly available and restricted datasets containing breastfeeding variables, outlines the methodological steps in conducting secondary data analysis, and discusses common limitations associated with this approach. By emphasizing both the utility and challenges of secondary data analysis, the paper aims to encourage informed use of secondary data analysis to advance knowledge and address important research questions in breastfeeding.

Background: Shifts in women's maternal roles may contribute to the global low prevalence of exclusive breastfeeding.

Research aim: To investigate the association between maternal gender-role ideologies and exclusive breastfeeding in rural China.

Methods: Cross-sectional studies were conducted in 10 counties in Shaanxi Province using random sampling in 2021 and 2023. Data on breastfeeding practices, maternal gender-role ideology, and expected educational attainment from 586 rural participants were collected through structured questionnaires. Multivariable regression analysis was employed to explore the association between maternal gender-role ideology and exclusive breastfeeding.

Results: The prevalence of exclusive breastfeeding within 6 months in rural western China was 18.8%. Women with more egalitarian gender-role ideologies were more likely to engage in exclusive breastfeeding (OR = 1.34, 95% CI [1.04, 1.72]), particularly for female infants (OR = 1.63, 95% CI [1.09, 2.43]). Furthermore, women with stronger egalitarian gender-role ideologies were found to exhibit a greater propensity for financial investment in their children (Beta = 0.20, 95% CI [0.01, 0.40]) and hold higher educational expectations for their daughters (OR = 1.50, 95% CI [1.00, 2.25]).

Conclusion: Maternal gender-role ideology positively correlates with exclusive breastfeeding. More policies should be implemented on gender equality in rural China, and cultural perspectives should be incorporated into the analysis of breastfeeding practice.

Background: Globally, rising trends in gestational diabetes and body mass index contribute to maternal and neonatal morbidity and mortality. Lifestyle modifications and breastfeeding may reverse this effect, although few studies combine these into one intervention.

Research aims: To measure postpartum weight retention, breastfeeding duration, hemoglobin A1C, and mean arterial blood pressure at 6 months postpartum among women with elevated pre-pregnancy body mass index.

Methods: The electronic Monitoring of Mom's Schedule study (eMOMS™) was a feasibility, three-arm, randomized controlled trial modeled after a Diabetes Prevention Program and breastfeeding support. A health coach delivered a 12-month virtual intervention. Study arm results were compared using Wilcoxon signed-ranks exact test reporting from a two-sided test and bootstrapped samples with 95% confidence intervals.

Results: Between September 2019 and May 2021, 100 individuals were screened, and 35 were randomized: nine to Group 1, 14 to Group 2, and 12 to Group 3. At baseline, participants averaged 13.0 (SD = 2.5) weeks gestation, with a mean pre-pregnancy body mass index of 29.7 (SD = 3.0). With 5,000 bootstrapped samples, mean weight retention from baseline to 6 months postpartum was: 4.0 kg, 95% CI [1.6, 6.2] for Group 1; 3.7 kg, CI [-1.8, 9.8] for Group 2; and 7.5 kg, CI [4.1, 11.6] for Group 3. Mean (exclusive) breastfeeding duration was 9.3 weeks, 95% CI [0.43, 26.1]; 9.6 weeks, CI [4.4, 15.7]; and 15.1 weeks, CI [6.5, 23.3] for each group, respectively.

Conclusion: Our intervention was positively associated with postpartum weight retention and breastfeeding duration. Future research is needed to assess intervention components.

Background: Web-based prenatal education is increasingly employed, but its association with increased breastfeeding and predictors of breastfeeding success is uncertain.

Research aims: Our primary aim was to evaluate our live, online intervention's association with exclusive breastfeeding at hospital discharge. Secondarily, we aimed to describe participants' reports of the intervention on predictors of breastfeeding success.

Method: We used a retrospective quasi-experimental cohort design to assess the association between our intervention and exclusive breastfeeding at discharge. The intervention consisted of an evidence-based live, online, 2-hour class open to all prenatal patients and supporters at our urban community medical center from June 2020 through April 2022. Patient characteristics and breastfeeding rates were extracted from the electronic medical record. Samples were drawn using stratified random sampling. Three logistic regression models were conducted to assess the associations between the intervention and exclusive breastfeeding. Two surveys assessed the participant reports of the intervention.

Results: Samples of the first model, comprised of 160 participants and 160 non-participants, were similar in important characteristics. Participants were 2.12 times (95% CI [1.12, 3.69]) more likely to exclusively breastfeed. Participants reported positively on the impacts of the intervention on breastfeeding predictors.

Conclusions: Our live, online intervention was significantly associated with an increased likelihood of exclusive breastfeeding at hospital discharge. A randomized, prospective examination of the intervention's association with breastfeeding duration would further define its impact.

Background: Subclinical mastitis is an asymptomatic inflammatory condition of the lactating mammary glands possibly associated with premature interruption of breastfeeding and poor weight gain in infants. However, data on human milk composition in mothers with subclinical mastitis are limited and inconsistent. Although human milk from donors with subclinical mastitis may be used after pasteurization if it meets the criteria, whether the composition is suitable for donor human milk remains unknown.

Research aims: This study assessed the human milk composition of participants with subclinical mastitis and verified the safety of donor human milk, including that from mothers with subclinical mastitis.

Methods: This cross-sectional survey included 106 milk samples collected between March 2022 and January 2023. Subclinical mastitis status was assessed using the sodium-potassium ratio, which was measured using an ion-selective electrode. The concentrations of lactoferrin and secretory Immunoglobulin A were analyzed using an enzyme-linked immunosorbent assay. True protein, fat, carbohydrate, and energy levels were analyzed using a mid-infrared transmission spectroscopy.

Results: In human milk from the subclinical mastitis group, lactoferrin and true protein concentrations were significantly increased compared to those without subclinical mastitis. A positive correlation was observed between lactoferrin and secretory Immunoglobulin A levels.

Conclusions: Increased immunological substances and protein concentrations in human milk are similar to those observed in clinical mastitis, indicating an inflammatory response in the body, even in asymptomatic individuals. Immunological substances and proteins are beneficial for preterm infants. Therefore, human milk from mothers with subclinical mastitis is suitable for use by milk banks.

Background: Peer support programs may be effective for supporting breastfeeding among diverse groups, and in reducing disparities. This study provides insight regarding the implementation and outcomes of a peer breastfeeding support program.

Research aims: (1) to examine how participation affected the outcomes of breastfeeding motivation, confidence, and coping strategies; and (2) to evaluate satisfaction with the program.

Method: This was a cross-sectional, retrospective study. Seven pilot sites in the United States uniquely implemented a federally-funded peer support program for low-income women. Data were collected using a survey and focus groups/interviews. Over 12 months, 1,296 women participated, comprising 615 peer support pairs. A total of 401 women responded to the survey. Twenty-three focus groups and 63 interviews were conducted across the seven sites.

Results: Participants who enrolled in the program during pregnancy: t (189) = -6.55, p < 0.001, and after the baby was born: t (170) = -2.59, p = 0.001, gained confidence in breastfeeding. More satisfied participants were more likely to breastfeed longer: F (7,352) = 12.75, p < 0.001, and cope with breastfeeding challenges: F (7,352) = 7.83, p < 0.001.

Conclusion: Effective operation strategies of the peer breastfeeding support program have significantly influenced participant satisfaction. Introducing peer support for low-income women to share their breastfeeding experiences would be beneficial in enhancing breastfeeding rates. However, the generalizability of these findings may be limited to this U.S. federally-funded peer support program.

National staffing guidelines for hospital lactation services do not account for the lactation acuity of breastfeeding patients. Higher acuity breastfeeding couplets require a higher level of knowledge and skill from lactation care providers. In these cases, a referral to an International Board Certified Lactation Consultant (IBCLC) is recommended for appropriate management. Use of a lactation acuity classification system as a clinical practice innovation was implemented at Oklahoma University Medical Center to improve the distribution of staff resources for optimal care of breastfeeding patients. Lactation service reports from this facility, a tertiary care teaching hospital, were reviewed to evaluate staffing, number of lactation consults, reason for and acuity of consults, and time spent. The review included over 10,000 lactation consults completed over a 1-year period. Once the lactation acuity system for IBCLC staff was in place, there was an increased mean direct consult time and acuity level with 85% of IBCLC time allocated to high acuity consults. Trained bedside nurses handled most low-acuity patients. The percentage of patients needing a lactation consult who received one increased along with the number of consults per patient. Data on time spent per consult were stratified by acuity, location, and reason for consult, including details on priority consults for neonatal intensive care unit patients. The productivity of the lactation team was higher with the use of a lactation acuity system compared to without it. The data reported support the use of lactation acuity in making recommendations for staffing of hospital lactation services.