International Breastfeeding Journal最新文献

Background: Autism spectrum condition (ASC) is a neurodevelopmental disorder characterized by persistent difficulties in social communication and repetitive behaviors. Emerging evidence suggests that early nutrition, particularly reduced breastfeeding exposure, may be associated with an increased risk of ASC. However, this evidence is limited, especially in non-Western populations.

Methods: We conducted an unmatched case-control study in Saudi Arabia to investigate the association between breastfeeding practices and ASC. Data were collected through an online questionnaire from mothers of children with and without ASC. Cases were children with a confirmed ASC diagnosis, and controls were neurotypical children without a diagnosis of ASC. Breastfeeding exposure was categorized according to the World Health Organization definitions (from highest to lowest exposure) as follows: exclusive, predominant, partial, or no breastfeeding. Logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI).

Results: Between 1 October 2024 and 25 January 2025, a total of 283 participants (126 cases and 157 controls) were recruited. A dose-response relationship was observed, where decreased breastfeeding exposure was associated with progressively higher odds of ASC (OR for trend: 1.58; 95% CI 1.24, 2.01). In univariable analyses, using exclusive breastfeeding as the reference category, partial breastfeeding was associated with increased odds of ASC (OR: 2.49; 95% CI 1.40, 4.42). Similarly, children who were not breastfed had significantly higher chance of ASC than the reference category (OR: 3.46; 95% CI 1.47, 8.13). The strength of these associations was attenuated after multivariable adjustment but remained statistically significant (OR: 2.28; 95% CI 1.22, 4.25 for partial versus exclusive breastfeeding and OR: 2.86; 95% CI 1.12, 7.26 for no breastfeeding versus exclusive breastfeeding).

Conclusions: Our findings suggest that reduced breastfeeding exposure is associated with increased odds of ASC. However, these results should be interpreted cautiously, considering the inherent limitation of case-control studies and the potential of reverse causality.

Background: Breastfeeding supports infant health, yet medicine use during this period is often influenced by limited safety data, cultural beliefs, and weak regulatory guidance. This study highlights how these factors, along with partner influence, contribute to uncertainty and reliance on informal advice, emphasizing the need for clear guidelines and better communication to support safe medicine use.

Methods: This exploratory qualitative study was conducted between January and April 2024, involving twelve breastfeeding women, seven of their partners, ten healthcare providers, and five representatives from the National Drug Authority in Uganda. Data were collected through in-depth interviews with breastfeeding women and their partners, while key informant interviews were conducted with healthcare providers and regulatory officials. Thematic analysis was employed to analyze the data, identifying recurring codes that were systematically organized into subthemes and overarching themes.

Results: Four key themes were identified concerning perspectives on medicine use during breastfeeding. First, healthcare providers and regulatory personnel showed varying levels of knowledge of medicine use during breastfeeding, relying on external resources due to uncertainty, while women identified healthcare providers as their primary and most trusted source of information regarding medicine use. Facilitators included trust in healthcare providers, support from partners and family, access to reliable safety information, strengthening pharmacovigilance systems, and conducting drug safety studies. The role of partners in offering financial and emotional support and encouraging medicine adherence was acknowledged. Barriers to medication use during breastfeeding included poor communication and inadequate guidance from healthcare providers, stigma, and concerns about risks from the medicines to the infant. Additionally, unclear drug labeling, inaccessibility of information, and ethical concerns about including breastfeeding women in studies hindered informed decision-making. Recommendations emphasized improving health education, using reliable resources, prescribing safer drugs, timing breastfeeding to minimize medicine risks, and considering non-hormonal contraceptive options to prevent reduced breast milk supply.

Conclusion: The study highlights the critical need for improved communication, guidance, and access to reliable information regarding medicine use during breastfeeding. It emphasizes the importance of healthcare provider education, partner involvement, and evidence-based guidelines to support informed decision-making.

Background: The intersection of exclusive breastfeeding (EBF) and Human Immunodeficiency Virus (HIV) presents unique challenges for maternal and infant health, particularly in settings where safe feeding alternatives are limited. For HIV-exposed infants, EBF alongside maternal viral suppression significantly reduces the risk of HIV transmission and supports infant survival. However, infant feeding practices vary globally, and HIV introduces added social, medical, and cultural challenges. In Kenya, EBF rates are sub-optimal among HIV-positive mothers, with national rates estimated at around 61%. This study aimed to explore the breastfeeding experiences of HIV-positive mothers with HIV-exposed infants younger than six months at a hospital in Eldoret, Kenya.

Methods: This qualitative study was conducted at a mother-baby-friendly accredited hospital in Eldoret, Kenya in November 2023. In-depth interviews were conducted with 27 purposively selected HIV-positive mothers to explore their breastfeeding experiences. All interviews were conducted in Kiswahili, audio-recorded, transcribed, and translated into English. MAXQDA was used to manage the data, and thematic analysis guided the interpretation.

Results: Mothers acknowledged the importance of practising EBF. However, breastfeeding initiation was influenced by factors such as mode of delivery and parity. Mixed maternal attitudes toward EBF while living with HIV, conflicting information on EBF from biomedical, social, and personal sources, as well as social support, all influenced which feeding practices were considered normative. Tough economic realities and stigma associated with breastfeeding HIV-exposed infants complicated feeding decisions. Structurally, the clinic set-up played a crucial role in providing support to mothers, yet in some cases led to unintentional HIV disclosure.

Conclusion: Creating an empathetic and supportive community for HIV-positive mothers opting to breastfeed is necessary to improve EBF uptake. Although progress has been made to implement EBF guidelines, building individual confidence and a supportive environment, both within health facilities and in communities, is paramount for these mothers. This includes dispelling community misconceptions about the risks of breastfeeding with HIV. This study serves as a call to action, highlighting structural barriers and urging collective efforts to foster a transformative environment for HIV-positive mothers and their infants.

Background: Human milk dynamically adapts its composition of immunoglobulins (Igs), cytokines, and other proteins as lactation progresses, influencing the infant's immune development and protection. Understanding how maternal factors, such as parity, influence the composition of human milk can provide strategies aimed at enhancing infant immune protection and reducing early-life infections. This study aims to investigate whether the immune composition of human milk differs based on parity, and if so, how these changes are related to infections in early life.

Methods: The study included 75 healthy mother-infant pairs from the MAMI cohort (Clinical Trial Registry NCT03552939), with milk samples collected from the same mothers at days 7 and 15 postpartum, during transitional lactation stage. Igs, cytokines, and adipokines were quantified using multiplex immunoassays and ELISA. A comparison was conducted between primiparous and multiparous mothers regarding both the overall and individual composition of immune components in human milk at each time point, as well as their evolution throughout the transitional phase.

Results: Infants from multiparous mothers recorded higher infection rates in early life than those of primiparous mothers. Some human milk immune components also differed by parity, with multiparous mothers exhibiting higher levels of IgA, total IgG, IgG1, IgG2, IgG3, IgE, and IL-23 at the beginning of the transitional phase (day 7), as well as higher IL-18 and IL-21 levels toward its end (day 15), compared to primiparous mothers. Additionally, the evolutionary pattern in levels of Igs, cytokines, and adipokines throughout the transitional milk stage also differed. Moreover, in multiparous mothers, higher levels of IgG, particularly IgG1 and IgG2 (day 7), as well as IL-18 and IL-22 (day 15), were associated with reduced infant infections, highlighting their potential protective role.

Conclusions: Parity is a maternal factor that influences some immune components of human milk during the transitional stage and may be linked to the susceptibility of infants to infections during the first 6 months of life. Future studies aimed at analyzing the impact of the parity factor, among others, on the progression of immune components in human milk may contribute to a better understanding and improved strategies for newborn health.

Background: Breastfeeding is essential for ensuring the health and survival of children, particularly in regions where diarrhoea, pneumonia and malnutrition are common causes of child mortality. In sub-Saharan Africa, over one million HIV-positive women become pregnant each year and face significant challenges in infant feeding due to limited access to treatment and safe water. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months and continuous breastfeeding up to 24 months in conjunction with antiretroviral treatment. The aim of this study was to assess the knowledge, attitudes, and practices (KAP) of HIV-positive mothers in Africa during the last 10 years, to provide evidence for public health strategies.

Methods: A systematic review was conducted on studies that explored the KAP surrounding recommended infant feeding practices among HIV-exposed children in African countries. The review followed the PRISMA guidelines and searched major databases for articles published between 2013 and 2024.

Results: Of the 586 articles identified, 22 met the inclusion criteria. 70% of the studies were conducted in Ethiopia, South Africa, and Kenya and 95% of the studies were carried out in healthcare facilities. Mothers demonstrated good knowledge, attitudes, and practices regarding EBF for HIV-exposed children, but exhibited limited knowledge and negative attitudes towards continuous breastfeeding practice. Healthcare workers were reported as their primary source of information. Stigma associated with practicing EBF and returning to work were identified as major reasons for early cessation of breastfeeding.

Conclusion: The knowledge, attitudes, and practices related to the infant feeding practices currently recommended by WHO for HIV-positive mothers were found to be limited. There is little evidence regarding the situation in other countries, particularly among vulnerable women with limited access to the health system. Public health policies must be strengthened to ensure that health workers are adequately trained in the current guidelines in order to improve adherence to infant feeding practices among HIV-positive mothers.

Background: Despite extensive global research on mothers' intentions regarding human milk banking (HMB), its acceptability remains underexplored in non-Western contexts, particularly in Muslim-majority countries. This study investigates barriers to HMB acceptability among nursing mothers in Iran through the lens of Social Cognitive Theory (SCT), emphasizing how cultural, religious, and contextual factors intersect with maternal decision-making.

Methods: A qualitative study was conducted in Tehran, Iran, between August and October 2024. Semi-structured interviews were held with twelve nursing mothers of premature infants unable to breastfeed. Data were analyzed thematically using Braun and Clarke's six-step approach, guided by SCT to capture the interplay between personal, behavioral, and environmental influences on mothers' decision-making regarding HMB. Rigorous strategies, including iterative coding and peer debriefing, were employed to ensure trustworthiness of the analysis.

Results: Three overarching themes emerged. Personal factors included emotional states, risk perceptions, self-efficacy, outcome expectations, and religious beliefs and ethics. Behavioral factors comprised trust-based decision-making and past behavioral patterns, which shaped willingness to engage with HMB. Environmental factors involved institutional accessibility, social support systems, authoritative influence, and cultural norms. Findings revealed that mothers experienced emotional conflict, mistrust in milk safety, and religious concerns about milk kinship and halal practices. Institutional and logistical barriers, coupled with lack of family and community support, further reduced HMB acceptability. Nevertheless, participants emphasized that religious endorsements, transparent regulations, health professional guidance, and improved service accessibility could enhance trust and participation.

Conclusions: This study highlights how reciprocal interactions among personal beliefs, behavioral patterns, and environmental contexts shape the acceptability of HMB among Iranian mothers. To improve uptake, culturally sensitive interventions are essential particularly those involving religious authorities, healthcare professionals, and awareness campaigns to address misconceptions and build trust. Strengthening institutional accessibility and transparency can further promote HMB as a viable feeding option. Future research should also examine the roles of socioeconomic status, healthcare access, and generational differences to broaden the evidence base for culturally adapted HMB policies in Muslim-majority contexts.

Background: Elevated human milk sodium (Na+) levels and Na+ to potassium (K+) ratios are commonly used in research to define breast inflammation in lactating mothers. Portable Na+ and K+ ion selective electrode probes (ISEPs) allow for immediate point-of-care testing by clinicians, potentially accelerating diagnosis, and treatment of inflammatory conditions of the lactating breast (ICLB). We determined validity of ISEPs compared to the reference method inductively coupled plasma - optical emission spectrometry (ICP-OES) in mothers with ICLB, and acceptability of ISEP point-of-care testing of mothers tested with clinical ICLB symptoms.

Methods: Human milk samples were collected from 43 mothers with ICLB, between December 2021 and September 2022. Mothers were recruited from private physiotherapy practices, a public women's hospital, and the local community, in Melbourne, Australia. Human milk Na+, K+ and Na+:K+ ratio levels were tested at point-of-care (ISEPs), and later, in the laboratory (ICP-OES). Adjusted limits of agreement with Bland-Altman plots compared the two measurement methods, with rank linear mixed effects models establishing their relationship. Mother's ISEP acceptability was assessed via two survey questions (0-10 numerical rating scale (NRS) and open text response) and analysed via descriptive statistics and thematic analysis.

Results: Adjusted limits of agreement (lower limit mean (95% CI) to upper limit mean (95% CI)) between the two measurement methods were: -6.12 (-7.75, -4.49) to 6.12 (4.49, 7.75) mM for Na+; 7.37 (5.82, 9.47) to 25.6 (23.5, 27.7) mM for K+; and -0.82 (-0.85, -0.79) to 0.80 (0.77, 0.82) mM for Na+:K+ ratio. For Na+:K+ ratio, 100% of values fell within the limits of agreement. For Na+ and Na+:K+ ratio, ISEPs and ICP-OES shared a substantial amount of variability (Na+: conditional R² = 0.87, p < 0.05; Na+:K+ ratio: conditional R² = 0.94, p < 0.05). Mother's acceptance of ISEP testing was high with a median (Q1, Q3) NRS score of 10 (10, 10). The most frequent theme was that the testing was 'quick and easy, and unproblematic' (n = 30).

Conclusions: Point-of-care human milk ISEP Na+:K+ ratio measurement in mothers with ICLB is valid and is rated as a highly acceptable clinical assessment tool by mothers with ICLB.

Background: Extrauterine growth restriction (EUGR), prevalent and severe in very preterm infants (< 32 weeks' gestation), means discharge growth values (weight, head circumference, or length) are ≤ 10th percentile on the Fenton 2013 chart. Many of these infants fast or have delayed oral feeding soon after birth. Oropharyngeal colostrum administration, using a syringe or sterile swab, is an alternative to early enteral colostrum feeding. As the effectiveness of oropharyngeal colostrum administration in reducing the incidence of EUGR in preterm infants remains unclear, a randomized trial design is crucial for addressing this question. This proposed study protocol investigates the impact of oropharyngeal colostrum administration on the time to regain birth weight and postnatal growth in very preterm infants, based on the interaction between early gut microbiota and the host.

Methods: We plan to perform this multicenter randomized controlled trial by recruiting 260 very preterm infants from September 2025 to August 2028. The study will be conducted at five neonatal intensive care units (NICUs) in Jiangsu Province, China. The study population will be randomly assigned to either the oropharyngeal colostrum administration group or the placebo (normal saline) group. The intervention will commence within 48-72 h of birth and and will be administered continuously for a duration of 5 days, with stool samples collected from the preterm infants before and after the intervention. The primary outcome measure is the incidence of EUGR at discharge, while the secondary outcome measures include differences in the time to regain birth weight and gut microbiota between groups. This study will use a multivariate logistic regression to evaluate the association between oropharyngeal colostrum administration and EUGR, multiple tests (T-test, Wilcoxon, repeated measures analysis of variance) for gut microbial diversity differences, and a generalized linear model for the association between the intervention and gut microbiota composition.

Discussion: This study aims to provide a scientific basis for the clinical application of oropharyngeal colostrum administration in preterm infants through rigorous clinical trials and intestinal flora analyses and to provide new insights into intervention strategies for EUGR in preterm infants.

Trial registration: ClinicalTrials.gov identifier: NCT07082881. Registered 16 July 2025.