Journal of Human Lactation最新文献

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.

Background: Nipple trauma and pain pose a challenge, leading to premature discontinuation of breastfeeding. Moisturizing therapies, including lanolin and hydrogel dressings, have been proposed for nipple trauma and pain management. Despite the availability of multiple approaches, evidence for moisturizing therapy is lacking.

Research aim: This review aimed to determine the efficacy of moisturizing therapy in treating nipple trauma and nipple pain in lactating women.

Methods: A systematic review based on the PRISMA-P guidelines was conducted. Seven databases were systematically searched and screened, and 24 studies were analyzed. The interventions were categorized as high, moderate, or low, based on their moisturization levels. Sample characteristics, interventions, and outcomes were examined.

Results: A total of 21 interventions were identified: high moisturization (two types), moderate moisturization (12 types), and low moisturization (seven types). Hydrogel dressings, lanolin, and breast milk are commonly used interventions. Although intervention and effectiveness evaluation methods differed between studies and could not be compared, results in 10 (41%) of the studies demonstrated that one intervention with more moistening was more effective. Of the three studies categorized as including high moistening interventions, two (66%) supported their effectiveness compared to low moistening interventions; however, two of the three studies were judged to be at high risk of bias, and some reported adverse events.

Conclusions: Moisturization interventions show promise for treating nipple trauma and pain more than drying nipples or using breast milk, but high moisturization needs cautious use due to few rigorous trials and the presence of reported risks. Methodological challenges and the lack of robust trials hinder evidence synthesis and robust conclusions.

Abstract in japanese: ： やはにをするである。そのとして、ラノリンやハイドロジェルドレッシングによるがされている。しかし、やにするのにするはしている。： システマティックレビューは、のとのにおけるのをすることをとした。： PRISMA-Pガイドラインにづくレビューをした。7つのデータベースをいて、にとスクリーニングをい、に24のをとした。をレベルにづいて、、にし、サンプルや、、およびについてした。： （2）、（12）、（7）の21のがされた。ハイドロジェルドレッシング、ラノリン、のがなとしてされていた。およびのはでなり、のはであったが、10（41％）でよりいのがであるとされていた。にされた3のうち2（66％）がのとしてであるとされたが、2（66％）はバイアスリスクがいとされたであり、のもあった。： はやのとしてやのとしてであるが、のにはなのとのがあり、ながである。なのとなが、のとエビデンスののげとなっている。Back translated by Katsumi Mizuno, PhD, MD, IBCLC.

Anwar Fazal has been a driving force in the founding of several civil society organizations in the areas of health, human rights, environment, and peace, that have been at the forefront of activism locally, nationally, and globally. In this interview, he shares his journey of 6 decades, involving a multiverse of public interest issues, which led him into the breastfeeding movement. It began with the setting up of the International Baby Food Action Network (IBFAN), a pioneering action that triggered the formation of Health Action International (HAI), Pesticide Action Network (PAN), and the World Alliance for Breastfeeding Action (WABA). Each of these resulted in several unique frameworks and codes relating to the marketing of infant foods, pharmaceuticals, and pesticides. They also led to the formation of World Breastfeeding Week, now being celebrated globally. Anwar studied Economics at the University of Malaya and did his postgraduate studies in Education. Anwar has served as a visiting professor at the University of Science Malaysia and the International Islamic University Malaysia (IIUM). He is the recipient of the Right Livelihood Award, popularly known as the "Alternative Nobel Prize," for his work on breastfeeding and infant nutrition and other health, environmental, and consumer issues. La Leche League International (LLLI) and the United Nations Development Programme (UNDP) have honored him with the International Health Award and the Millennium Development Goals Award. He has written extensively on breastfeeding. He is currently Chairperson Emeritus of the World Alliance for Breastfeeding Action (WABA) and continues to speak out actively on protecting, promoting, and supporting breastfeeding.

Introduction: Favipiravir is a known anti-influenza agent that has been used globally, especially during the coronavirus disease 2019 (COVID-19) pandemic. This drug has been important for treating influenza and other emerging infectious diseases, although it was ultimately proven to be ineffective for COVID-19. Currently, no studies have reported the human-milk transfer of favipiravir at doses of 1,600-3,600 mg/day in the treatment of diseases, including COVID-19.

Main issue: A 38-year-old mother gave birth at 38 gestational weeks because of severe respiratory distress caused by COVID-19. Considering her illness and the inadequate information available on the safety of favipiravir in breastfeeding, she chose formula feeding for her infant. However, she still provided human milk and blood samples for the analysis of drug concentrations.

Management: Five concentrations of favipiravir in the mother's milk and four in maternal blood were measured (3.0-80.9 and 3.5-78.4 μg/ml, respectively). Metabolites of favipiravir were not measured. The relative infant dose was 15.2%. The favipiravir concentration in human milk was as high as 80.9 μg/ml at 1.3 hours after the medication was given, when maternal blood levels are considered to be at their highest; however, favipiravir concentration was low in human milk immediately before medication administration (5.9-9.7 μg/ml).

Conclusion: Breastfeeding is not contraindicated in mothers undergoing favipiravir therapy and would be safer immediately before medication. Avoiding feeding at the peak time (1.3 hours after medication) minimizes infant exposure.