International Breastfeeding Journal最新文献

Background: Most women can produce enough milk to exclusively breastfeed. However, a small cohort are prevented from doing so due to a condition known as primary low milk supply. The aim of the study was to provide new insights into how mothers with this condition experience help and support from professionals, volunteer support groups, and partners.

Methods: Interpretative phenomenological analysis was used to explore the lived experiences of nine first-time breastfeeding mothers in Ireland who had primary low milk supply. One-hour interviews were conducted over Zoom between April and October 2021.

Results: Being with Others, one of four superordinate themes identified in this study, concerns the participants' experiences of receiving professional, voluntary, and partner breastfeeding support. Four sub-themes were identified: Disconnected Encounters, Perceiving Judgement from Others, Being in a Safe Space and Having a Saviour. The encounters of participants with healthcare professionals revealed a lack of rapport, intrusive hands-on support, poor perceived quality of breastfeeding support and a heightened sensitivity to language and tone. Participants expressed that they valued empathy and emotional support from lactation professionals as much as they valued skilled lactation support. Furthermore, participants appeared to experience an enhanced motherhood self-identity and self-acceptance through seeing their experiences mirrored in the experiences of other mothers with primary low milk supply in specialist low milk supply-specific support groups.

Conclusion: The interactions that mothers with primary low milk supply have with various others in their world (healthcare professionals, lactation consultants, volunteer breastfeeding supporters, and partners) can shape how they view themselves and can have a profound impact on their breastfeeding journey. There is a need for greater knowledge and understanding among healthcare professionals of the phenomenon of primary low milk supply so that women suspected of having the condition may receive appropriate support. Where possible, mothers with primary low milk supply should be directed to specialist breastfeeding support groups.

Background: To evaluate breastfeeding and complementary feeding practices and their determinants among infants and young children in the United Arab Emirates using the 2021 WHO/UNICEF IYCF guidelines.

Methods: The Mother and Infant Study Cohort (MISC), is a prospective study of mothers recruited in their third gestational trimester and followed with their infants up to 18 months of age (n = 167). Data were collected at 3rd trimester, delivery, 2, 6, 12, and 18 months postpartum via questionnaires, review of medical records, anthropometric measurements, and 24-hour dietary recalls of the child's intake at 6, 12, and 18 months. Descriptive statistics and multiple logistic regressions were used to report on feeding practices and their determinants.

Results: Ever breastfeeding, Early initiation of breastfeeding, and exclusive breastfeeding under 6 months were reported by 84.3%, 99.4%, and 32.9% of participants, respectively. Of children, 96.4% consumed solid foods at 6-8 months; 68.7% and 44.7% continued to be breastfed at 12 and 18 months, respectively. Despite improvement with age; several complementary feeding indicators remained suboptimal at 18 months: Minimum Dietary Diversity: 40.4%, Minimum Meal Frequency: 56.7%, Minimum Acceptable Diet: 23.1%, Sugar-Sweetened Beverages, 26.9%, Zero Vegetables and Fruits: 28.8%, Unhealthy Food Consumption: 65.4%. After adjustment, multiparous mothers had higher odds of exclusive breastfeeding, whereas pregnancy complications were associated with lower odds of exclusive breastfeeding. Continued breastfeeding at 18 months was associated with older age among mothers and lower income. Among the factors associated with complementary feeding indicators were higher physical activity and Minimum Dietary Diversity. While Gestational Diabetes Mellitus, Sugar-Sweetened Beverages, and higher education were associated with lower odds of Zero Vegetables and Fruits, and a higher income was associated with lower Unhealthy Food Consumption.

Conclusions: This study reported good rates of Early initiation of breastfeeding and ever-breastfeeding, yet suboptimal exclusive breastfeeding and complementary feeding. The identified risk factors for inappropriate practices could be used to guide nutrition interventions and public health programs in the United Arab Emirates.

Background: The WHO/UNICEF global nutrition target for exclusive breastfeeding for six months is at least 70% of infants by 2030. However, global prevalence rates are 48% with variations between countries and within regions. Kyrgyzstan has consistently high early breastfeeding initiation rates, yet exclusive breastfeeding for six months is 46%. This qualitative study addressed two research questions: (1) What are the barriers and drivers for mothers to exclusive breastfeeding in the first six months? (2) What are the barriers and drivers for health workers in primary care facilities to supporting exclusive breastfeeding in the first six months?

Methods: The study took place from April to June 2023 in five sites (mix of urban and rural). Ten focus group discussions with 40 primary care health workers and 20 in-depth interviews with mothers of a child currently aged 6-12 months who initiated breastfeeding with this child were conducted. Mothers were purposively selected to represent four groups of infant feeding practices in the first six months: (1) exclusive breastfeeding, (2) breastfeeding alongside other fluids/solids, (3) breastfeeding alongside infant formula, (4) breastfeeding followed by switching to formula only. The Capability-Opportunity-Motivation-Behaviour (COM-B) model was the underpinning theoretical framework. Data were analysed using the Framework approach.

Results: The study uncovered important misperceptions amongst mothers who were not exclusively breastfeeding (groups 2-4). These existed alongside a perceived inability to resolve physical challenges of breastfeeding and social pressure to supplement breastmilk with fluids/solids or formula. Half of all mothers felt uncomfortable breastfeeding in public. Health workers were recommending and supporting women with exclusive breastfeeding during multiple antenatal and postnatal interactions during the initial six months. They were knowledgeable and motivated to do this. Moreover, they felt well supported with training, resources, and legislation with just a few mentioning workplace time or space challenges. Very few doctors appeared to currently be meeting with formula industry representatives.

Conclusions: This theory-informed qualitative study focusing on mother and health worker perspectives provided important insights into the individual and contextual barriers and drivers to exclusive breastfeeding for the first six months in Kyrgyzstan. These insights have informed recommendations for tailored interventions for both groups.

Background: Despite efforts to promote optimal breastfeeding practices, the practice of exclusive breastfeeding is low in South Africa. We conducted a trial to determine whether text messaging plus motivational interviewing prolonged exclusive breastfeeding during the first six months of life and improved child health outcomes.

Methods: We conducted a randomized parallel group-controlled trial between July 2022 and May 2024, at a secondary-level healthcare facility. Mothers living with HIV, 18 years or older, initiating breastfeeding, on combination antiretroviral therapy (cART) and their infants were enrolled. The primary endpoint was exclusive breastfeeding from birth through week 24, based on the consecutive 24-hour food recall interviews. We compared differences in exclusive breastfeeding rates using a proportion test. Mothers who completely stopped breastfeeding were asked an open-ended question on reasons for stopping breastfeeding.

Results: Using block randomization mother-child pairs (n = 276) were randomly allocated to receive intervention (n = 138) or standard infant feeding counselling (n = 138), of whom 105 and 101 mother-child pairs in the intervention group and standard care group, respectively, completed all four study visits. Exclusive breastfeeding rate at 24 weeks in the intervention group was 6% (6/105) and 7% (7/101) in the standard care group, rate difference - 1% (95% CI -6-4%). Sixty-two of 276 mothers completely stopped breastfeeding, of whom 25% (34/138) and 20% (28) were in the intervention group and standard care group, respectively. The most common reasons for stopping breastfeeding were the mother needing to return to work or look for work, 66% (n = 41). We also found that early breastfeeding cessation increased risk of child hospitalization or death compared to any form of breastfeeding to week 24, 10% (5/48) versus 3% (5/158), p = 0.055.

Conclusions: We found no effect of the intervention on exclusive breastfeeding rates. Early cessation of breastfeeding was prevalent and maternal employment characteristics are important social determinants of breastfeeding behaviour. There is need for further research evaluating the effect of interventions that include financial incentives on breastfeeding practices among socioeconomically disadvantaged mothers. HIV services should reliably offer cART, consistently monitor viral load, and support mothers cART adherence, in settings where mixed feeding is common.

Trial registration: The trial was registered on ClinicalTrials.gov (NCT05063240) and Pan African Clinical Trial Registries (PACTR202110870407786) before recruitment of the first subject.

Background: The use of Complementary Medicine Products (CMPs) has been increasing worldwide, including among breastfeeding mothers. This study aims to investigate the reasons and associated factors of CMP use among breastfeeding mothers in Turkey, alongside their attitudes and experiences.

Methods: A descriptive cross-sectional study was conducted using a self-administered, anonymous online survey between 17 December 2023 and 17 March 2024. Women from diverse regions across Türkiye, aged 18 years or older, with a child aged 36 months or younger, who were currently breastfeeding or had breastfed, were invited to participate in the survey.

Results: Among 445 mothers who completed the survey, 334 (75.1%) reported using at least one CMP during breastfeeding, with vitamin D, iron supplements, and fennel being the most frequently used. Educational level, employment status, and being a health worker were found to be factors associated with CMP use during breastfeeding, with those having university or higher education, being employed, or working in healthcare showing higher usage rates. The most common reasons for CMP use were "staying healthy" (60.2%) and "supporting immunity" (59.3%). While 91.9% of mothers perceived at least one CMP they used as beneficial, 14.4% of mothers using CMPs experienced adverse effects with at least one product. Safety perceptions of mothers who used CMP varied, with 45.8% believing CMPs were generally safe during breastfeeding. Among CMP users, doctors were chosen as the most trusted (n = 310, 92.8%) information source. A majority of mothers (85.6%) reported that they would like to receive more information about the safety and effectiveness of CMPs.

Conclusions: Breastfeeding mothers often use CMPs to stay healthy and support immunity. While healthcare providers are the most trusted source of information, many women get advice from family, friends, or herbalists, and some use CMPs without any recommendations. This underscores the importance of healthcare providers' role in guiding mothers on the safe and informed use of both prescribed and self-prescribed CMPs.

Background: Marriage promotes breastfeeding duration through economic and social supports. The COVID-19 pandemic disproportionately affected marginalized communities and impacted women's employment and interpersonal dynamics. This study examined how marriage affects breastfeeding duration across socioeconomic and racially minoritized groups during COVID-19, aiming to inform social support strategies for vulnerable families in public health crises.

Methods: For this cross-sectional study, data were drawn from the 2017-2021 North Dakota Pregnancy Risk Assessment Monitoring System (weighted n = 41433). Breastfeeding duration was self-reported, and 2-, 4-, and 6-month duration variables were calculated. Marital status(married, not married) and education (< high school education, ≥high school education) were drawn from birth certificates. Income (≤ US$48,000, > US$48,000) and race/ethnicity (White, American Indian, Other) were self-reported. Infant birth date was used to identify pre-COVID (2017-2019) and COVID (2020-2021) births. Logistic regression estimated odds ratios and 95% confidence intervals for the association between marital status and breastfeeding duration outcomes. Models were fit overall, by COVID-19 era and by demographic factors. Lastly, demographic-specific models were further stratified by COVID era. Models were adjusted for maternal health and sociodemographic factors.

Results: Overall, married women consistently had 2-fold higher odds of breastfeeding across all durations during both pre-COVID and COVID eras. Pre-COVID, marriage was a stronger predictor for all breastfeeding durations in low-income women (4-month duration OR 4.07, 95%CI 2.52, 6.58) than for high-income women (4-month duration OR 1.76, 95%CI 1.06, 2.91). Conversely, during COVID, marriage was a stronger predictor of breastfeeding duration for high-income women (4-month duration OR 2.89, 95%CI 1.47, 5.68) than low-income women (4-month duration OR 1.59, 95%CI 0.80, 3.15). Findings were similar among American Indian women and those with less than high school education, in that both groups lost the benefit of marriage on breastfeeding duration during the COVID-19 pandemic.

Conclusion: Marriage promotes breastfeeding duration, yet the observed benefit was reduced for low-socioeconomic and racially minoritized populations during the COVID-19 pandemic. These observations highlight the disproportionate impacts low-socioeconomic and racially minoritized populations face during public health crises. Continued research examining how major societal disruptions intersect with social determinants to shape breastfeeding outcomes can inform more equitable systems of care.

Background: Emerging knowledge about supportive neurodevelopmental neonatal care shows the need for an individual approach to establish breastfeeding. However, evidence on how cue-based breastfeeding is supported in neonatal intensive care units (NICUs) is scarce. Therefore, the aim was to describe supporting practices for cue-based breastfeeding.

Method: Through Delphi rounds, a questionnaire was developed comprising questions on the usage and occurrence of supportive practices for cue-based breastfeeding. A multinational online survey was distributed September to October in 2023 to NICUs in Europe using snowball sampling. Practices such as the practice of skin-to-skin contact (SSC), restrictions for breastfeeding, providing information to parents, observing and responding to infants' cues were explored.

Results: The survey was completed by 105 neonatal units across 15 European countries. Less than half (46%) of the NICUs had no restrictions upon placing the infant in SSC with the parents. Approximately half (49%) of the NICUs stated that infants had SSC within the first hour after birth. Many units (68%) had some restriction for breastfeeding. One week after birth, 48% of the NICUs encouraged breastfeeding for infants at 33 postmenstrual age whenever the infant showed cues, regardless of scheduled tube feeding time. This percentage increased to 59% at 33-35 gestational age. Less than half of the units (47%) stated that they had the necessary tools/instruments to support the transition from tube feeding to breastfeeding. There were variations in how milk intake was assessed, such as weighing before and after breastfeeding or estimating milk intake by time spent sucking. Infants in 50% of the units had to be fed exclusively orally before discharge. Many units (65%) provided specific support to or enabled discharge before the infant was exclusively orally fed.

Conclusion: European NICUs employ supportive practices, SSC, early initiation of breastfeeding, and provide information to parents. Staff plays a significant role in fostering cue-based feeding in preterm infant-mother dyads. There still exist restrictions for SSC and breastfeeding. To understand the impact of different strategies and practices, there is need for evaluations by parents and testing of the implementation of cue-based feeding practices in neonatal care.

Background: The advantages of breastfeeding for maternal and child health have been widely acknowledged on an international scale. However, there is a paucity of research regarding the effectiveness of paternal support in breastfeeding. This study aimed to systematically review the impact of paternal support interventions on breastfeeding and to contribute additional evidence to inform current breastfeeding practices.

Methods: A systematic search was conducted across multiple databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data, the VIP Database, the Chinese Biomedical Literature Service System (SinoMed), PubMed, EMBASE, the Cochrane Library, and Web of Science, for randomized controlled trials (RCTs) related to breastfeeding and paternal support interventions, covering the period from the inception of the databases to June 2024. In accordance with the predefined inclusion and exclusion criteria, two researchers independently screened the literature and performed a meta-analysis via RevMan 5.4.1 software. The choice between fixed or random effects models was determined by the outcomes of the heterogeneity test, and relative risks (RR) along with 95% confidence intervals (CI) were computed.

Results: A comprehensive search yielded 3065 studies, of which eight were included in the meta-analysis. These studies involved a total of 2531 participants, with 1306 in the intervention group and 1225 in the control group. The studies conducted across the United Kingdom, Australia, Canada, and China encompassed a variety of interventions, including breastfeeding education, consultations led by specialists, distribution of informational materials, utilization of educational media, facilitation of interactive discussions, provision of online support through phone or WeChat, dissemination of public account messages, training in breastfeeding techniques, postpartum social support, and guidance on maternal and newborn care. The meta-analysis results indicated that the rate of exclusive breastfeeding was significantly higher in the intervention group compared to the control group at various time points: within one week postpartum (RR 1.28; 95% CI 1.16, 1.42); at 30-42 days postpartum (RR 1.12; 95% CI 1.02, 1.23); and at three months postpartum (RR 1.35; 95% CI 1.21, 1.50). These findings suggest that paternal support interventions effectively enhance breastfeeding practices.

Conclusions: The findings suggest that current evidence supports the efficacy of paternal support interventions in both the initiation and maintenance of breastfeeding.

Background: Exclusive breastfeeding (EBF) is defined as feeding infants only breast milk of the mother or a wet nurse for the first six months, without additional food or liquids except the oral rehydration solution or drops/syrups of vitamins, minerals or medicines. The working status of women in developed countries adversely affects the EBF rates, which calls for an assessment in rapidly developing countries like India. Therefore, the primary aim of the present study is to determine the prevalence of EBF using the data from the National Family Health Surveys (NFHS 3, 4, 5) conducted between 2005 and 06, 2015-16 and 2019-21 to estimate the likelihood EBF according to mothers' employment status.

Methods: We did a secondary data analysis of the cross-sectional surveys. Exclusive breastfeeding was the primary dependent variable and defined as the percentage of youngest children under six months exclusively breastfed per last 24 h. The employment status of the mother was the primary independent variable and was coded dichotomously (yes/no). Chi-square analysis assessed the association of EBF with the outcome variable of interest. A multi-level modelling approach has been used for portioning variation in the prevalence of exclusive breastfeeding at different geographical levels.

Results: From NFHS rounds 3 to 5, the overall prevalence of exclusive breastfeeding was 47.45%, 54.85%, and 64.01% respectively. On segregating the women as per their employment status, the prevalence among employed women was 51.1%, 51.1%, and 60.3%, while in unemployed women the prevalence was 45.9%, 54.8%, and 67.3% respectively. The odds of practising EBF in NFHS-5 doubled since NFHS-3 (Adjusted Odds Ratio: 2; 95% Confidence Interval: 1.08, 3.67). Employed mothers had a significantly lower odds ratio (0.94, 0.91, 0.98) of practising exclusive breastfeeding. The likelihood increased when mothers were exposed to media, had normal BMI, and visited health centres > 4 times during pregnancy. The likelihood decreased in older mothers, birth of infant in a health facility, female gender of the child, and late initiation of breastfeeding.

Conclusions: The lower prevalence of exclusive breastfeeding among working mothers calls for an urgent need to improve policies around maternity benefits at workplaces.