Breastfeeding Medicine最新文献

Objective: Donor human milk (DHM) can provide many benefits to neonates. This study examines access to DHM and how structural barriers may exacerbate inequities. Study Design: The median test and analysis of variance test were used to compare the distribution of maternal race/ethnicity and insurance status variables with DHM access for California neonatal intensive care units (NICUs) in 2021. Results: Across 124 NICUs, those serving a higher percentage of white families were more likely to have access to DHM (p = 0.04). NICUs with a higher percentage of Hispanic families were less likely to have access to DHM (p = 0.03). Hospitals that had higher proportions of uninsured patients were also less likely to have access to DHM (p = 0.015). Conclusion: Inequities in DHM access and use among NICU infants begin at the structural level. Policies that reduce barriers to DHM access may reduce health inequities for Hispanic and uninsured families.

Background: Unintended pregnancy increases adverse perinatal health outcomes. Limited studies exist on the influence of pregnancy intention on breastfeeding. This study examines the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Methods: Using the National Survey of Family Growth (2017-2019), we categorized breastfeeding into three categories (never breastfed, breastfed for 6 months or less, and breastfed for more than 6 months). Multinomial logistic regression and probability marginal effects were estimated across racial categories (Hispanics, non-Hispanic [NH] White, Black, and NH-others or multiracial). Results: The probability (Pr.) of never breastfeeding was the greatest among NH-Black women for all pregnancy intentions-both intended (Pr.: 0.34), mother-only (Pr.: 0.27), father-only (Pr.: 0.45), ambivalent (Pr.: 0.55), and neither intended (Pr.: 0.37). The probability of breastfeeding for 6 months or less is highest for Hispanics for both intended (Pr.: 0.41), NH-White for mother-only intended (Pr.: 0.49), Hispanics for father-only intended (Pr.: 0.56), ambivalent pregnancy intentions (Pr.: 0.60), and NH-others or multiracial for neither intended pregnancies (Pr.: 0.48). The probability of breastfeeding for more than 6 months is highest for NH-others or multiracial for both intended (Pr.: 0.50), ambivalent (Pr.: 0.49), and neither intended (Pr.: 0.36), while highest for NH-Black for mother-only intended (Pr.: 0.43). Conclusions: Our study demonstrates the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Owing to the high volume of unintended pregnancies in the United States, the current study might help maternal and child healthcare providers understand the interaction between race and pregnancy intentions on breastfeeding initiation and duration in the United States.

Objective: To analyze the factors associated with weaning in infants with cow's milk allergy (CMA) treated at a food allergy reference center in a state in the northeast of Brazil. Method: A prospective cohort study, with a case group (children with CMA) and two control groups (symptomatic nonallergic children [SC] and asymptomatic [AC]). At the beginning of the study, 30 children comprised the CMA group, 84 the SC group, and 52 the AC group. Survival analysis was performed to compare breastfeeding time between the three groups and an adjusted linear regression model to verify the factors associated with breastfeeding time. Results: At the beginning of the study, 33.3% of children in the CMA group, 17.1% in the SC group, and 69.6% in the AC group were exclusively breastfeeding (p = 0.005). The most common factors for weaning in children with CMA were the cow's milk elimination diet (30%), allergic symptoms in the child (20%), and breast engorgement (20%). Children who used a cup as a means of offering infant formula spent 281 more days breastfeeding compared with those who used a baby bottle (B^std = 1.39; p = 0.031). Conclusion: Children with CMA and nonallergic gastrointestinal complaints weaned earlier compared with asymptomatic children. The main causes of weaning in CMA children were maternal difficulty adhering to the elimination diet, breast engorgement, and allergic symptoms in the child. Using a cup was the main factor associated with longer breastfeeding duration, regardless of gastrointestinal symptoms and socioeconomic factors.

Background: Breastfeeding is a key public health priority with known racial inequities. Despite the well-described and far-reaching health benefits of breastfeeding for mothers and infants, rates of breastfeeding initiation, continuation, and exclusivity lag meaningfully among African American and Black (AA/B) women compared with other racial and ethnic groups due in main to current and historical structural racism. Methods: The study objective was to assess the replicability of Breast for Success (BFS) on breastfeeding rates among home-visited low-income predominantly AA/B mothers. The BFS Excels a Second Time (BEST) trial was an observational study conducted at the Neighborhood Health Association, Toledo, OH, enrolling expectant women (June 2022-March 2023, followed to October 2023) participating in the Moms and Babies First (MBF) Community Health Worker (CHW)-led home visiting program. The exposure, BFS, includes 11 CHW-delivered breastfeeding-supportive modules, breastfeeding supplies, and a postnatal lactation visit. All MBF mothers received BFS; those who agreed to data sharing were BEST participants. The outcomes were breastfeeding initiation, and breastfeeding continuation, and exclusivity at 1 month. Results: The majority of participants were AA/B (48, 83%), had an income <200% poverty level (55, 95%), and were unmarried (57, 98%); mean age was 25.8 years (SD 5.5). Of the 58 participants, 57 (98%) initiated breastfeeding and continued breastfeeding at 1 month postpartum; 53 (91%) were exclusively breastfeeding at 1 month postpartum. Discussion: BFS piggybacks seamlessly onto CHW-led home-visiting curricula and increased breastfeeding rates among women at high risk for not breastfeeding. Public health programs can add BFS to fill a critical curricular and impact gap with respect to breastfeeding support.

Background: Mothers of crying babies have difficulty adapting to their roles and problems with breastfeeding and attachment. Objective: This study aimed to assess the impact of the baby calming training provided to primiparous mothers on maternal role perception, maternal attachment, and breastfeeding self-efficacy. Methods: The study was conducted in a randomized controlled experimental design between March 2023 and March 2024 in the gynecology and obstetrics services of a public hospital in northeastern Turkey (Clinical Trial Number: NCT05594836). The research was conducted with a total of 84 primiparous mothers, including 41 intervention and 43 control groups, who met the inclusion criteria. The Baby Calming Training was administered face-to-face in the intervention group, utilizing a baby swaddling blanket, a sleep companion emitting white noise, and a training booklet. The control group received routine care. Data were collected through the Mother and Baby Introductory Information Form, Semantic Difference Scale-Me as a Mother, Maternal Attachment Inventory, Breastfeeding Self-Efficacy Scale-Short Form, and Infant Sleep Activity Record. The data were analyzed using descriptive statistics, Pearson's chi-square test, independent samples t-test, Mann-Whitney U test, Wilcoxon test, mixed design ANOVA analysis, Cohen's d, and 95% confidence interval (CI). This study adhered to CONSORT research guidelines. Results: Mothers in the intervention group exhibited higher mean scores on the perception of maternal role (mean ± SD: 70.37 ± 5.92, t: 8.590, 95% confidence interval [CI]: [1.347-2.375], d: 1.865, p < 0.001), maternal attachment (mean ± SD: 100.42 ± 1.52, U: 151.500, 95% CI: [0.732-0.892], d: 0.828, p < 0.001), and breastfeeding self-efficacy (mean ± SD: 64.00 ± 5.98, t: 8.109, 95% CI: [1.248-2.258], d: 1.757, p < 0.001) than the control group. It was determined that the total sleep time of the babies in the intervention group was higher, and the total crying duration was lower (p < 0.001). Conclusion: The study revealed that infant soothing training for primiparous mothers enhanced maternal role perception, maternal attachment, breastfeeding self-efficacy, and extended infants' sleep duration. Furthermore, infants exhibited reduced crying.

Background: Cow's milk protein allergy (CMPA) is the most common food allergy in infants. The current standard of care (SOC) involves eliminating the allergen from both the infant's and mother's diet for 2-4 weeks. The purpose of this study is to assess the effectiveness of Lactobacillus rhamnosus (Ramnoflor) in reducing the duration of bleeding in these infants. Methods: This randomized clinical trial was conducted at Bahrami Children's Hospital on breastfed infants who were diagnosed with CMPA and had a positive occult blood (OB) test. Patients were randomly assigned to either the control or case groups. All patients received SOC therapy, with the case group receiving Ramnoflor and the control group receiving a placebo. Data were recorded on the checklist, and the children were followed and visited three times during the study, with an OB assessment at each visit. Results: The study enrolled 48 infants. Among the infants in the case group, the OB test was positive in four cases (8.3%) on the fifth day. However, there were no positive cases on the 14th and 30th days. The prevalence of this test was significantly lower in patients who received probiotics compared to the control group on the fifth day (p < 0.001). There were no positive OB tests on the 14th and 30th days in any of the groups, and no significant difference was observed between the groups. Conclusion: The addition of L. rhamnosus to SOC therapy led to a decrease in the duration of rectal bleeding in infants with CMPA compared to the control group.

Background: For mothers of infants with congenital anomalies, antenatal milk expression (AME), known as hand expression during late pregnancy, allows mothers to contribute to their newborn's care through colostrum collection. However, research is limited by self-report of AME adherence and colostrum volume. Objective: This study examined the ability of participants to adhere to a recommended protocol on AME for any removal and measurement of colostrum during late pregnancy. Materials and Methods: A prospective, longitudinal, observational design was used. Our recommended protocol involved hand expression of 5 minutes per breast for a total of 10 minutes for each AME session twice per 24 hours for any colostrum from 37 ^0/7 weeks gestation until birth. Women received AME education, completed milk logs, and attempted AME. The study team verified all colostrum volumes. Results: Nineteen women (10 nulliparous) participated, with 13 (68%) carrying infants with major organ system defects and 6 (32%) carrying infants with congenital heart defects. Most participants (52.6%) completed more than half but fewer than all AME sessions. Seven participants (36.8%) fully adhered, completing two AME sessions daily until hospital admission. Eighteen participants (94.7%) could remove milk (80-100% of the time). The 24-hour colostrum volume (median 0.35 mL, interquartile range [IQR] 0.065-0.845) and the total colostrum volume (median 3.99 mL, IQR 1.35-6.82) from AME varied. Conclusions: Among a small group of women of infants with congenital anomalies, adherence to a recommended protocol is feasible but varied by AME session frequency. Most women could collect colostrum for future infant feeding.

Purpose: To assess the use of gender-identity inclusive language in breastfeeding education materials publicly available on U.S. Hospital websites. Methods: Hospitals were identified through the American College of Obstetricians and Gynecologists website. Breastfeeding education materials were searched online at each hospital. The first breastfeeding material on each website was used for our evaluation. Gender-identity inclusive versus traditional sexed language terms were curated a priori by referencing the National Institutes of Health and American Psychological Associations' guidelines. Education materials were categorized into: (1) "gender-identity inclusive language," (2) "mix of inclusive and traditional sexed language," or (3) "traditional sexed language." Frequencies of the type of language and specific gender-related terms were calculated. Results: In total, n = 112 hospitals with publicly available breastfeeding education materials were included. Most hospitals used both traditional sexed and inclusive language (69%, n = 77), followed by only traditional language (31%, n = 35). None of the hospitals used solely gender-identity inclusive language. One hospital provided material "intended for LGBTQI+" populations. Conclusion: Education materials provided by hospitals for breastfeeding do not utilize gender-identity inclusive language As such, there remains uncertainty and hesitancy on how to provide appropriate breastfeeding education for all persons who identify as transgender and/or non-binary, yet choose or are able to breastfeed. Further research in this area could ascertain the impacts of using gender-identity inclusive language in breastfeeding education materials for the general, transgender, or non-binary populations.

Background: JYNNEOS is a nonreplicating modified vaccinia Ankara vaccine currently licensed to prevent monkeypox infection, and its milk immunogenicity remains unstudied. Objective: Investigate the human milk immunogenicity of the JYNNEOS vaccine in one individual and examine the milk for evidence of vaccine components. Methods: Immunogenicity of milk and plasma samples were tested by Luminex assays against Vaccinia antigens, and vaccine components were tested using PCR and sandwich ELISA. Results: Plasma antibody (Ab) response increased up to 3.7-fold in immunoglobulin G (IgG) titer and 1.4-fold in IgA compared with baseline, confirming vaccine immunogenicity in this participant 2 weeks post dose 2. Specific plasma IgG remained 1.2- to 1.7-fold above baseline 12 weeks post dose 2, while IgA returned to baseline levels. Notably, the milk response exhibited unique kinetics, particularly for IgA. Milk IgA against all three antigens increased 0.9- to 2.2-fold 2 weeks post dose 2, reaching a peak titer increase of 1.1- to 2.7-fold at 12 weeks post dose 2. Secretory (s) Ab levels increased to 1.1- to 2-fold at 2 weeks post dose 2 and reached a peak of 2- to 3.2-fold increase at the 12-week time point. Importantly, IgA and sAb responses in milk exhibited correlation, suggesting most milk IgA was sIgA. Notably, no vaccine components (VACV protein or DNA) were detected in the milk samples. Conclusion: These data suggest that the milk Ab response to this intradermal (ID) VACV-based vaccine is distinct from that observed systemically, indicating a unique mucosal immune response and highlighting its potential to elicit protective long-lasting sIgA. This case report provides strong evidence for inclusion of this vaccine platform in future studies of maternal vaccines aimed to elicit a protective milk Ab response.

Background: The good qualities of breastfeeding are well known. The aim of this study was to closely examine the impact of specific maternal, prenatal, obstetric, and early neonatal factors on the success of breastfeeding. Materials and Methods: We used data from the Kuopio Birth Cohort study and analyzed 2,521 online questionnaires, which were answered by women 1 year after giving birth. Breastfeeding variables were divided into successful breastfeeding (breastfeeding exclusively with one's own breast milk ≥4 months or breastfeeding with formula ≥6 months) and poor breastfeeding (breastfeeding exclusively with one's own milk <4 months and duration of all breastfeeding <6 months) for univariate and multivariable analyses. Results: In this study, 97.8% (N = 2,466) reported breastfeeding their newborns for ≥1 postnatal week, and 75.2% (N = 1,896) breastfed newborns for ≥6 months. The rate of breastfeeding for ≥6 months increased from 71.3% to 84.7% between 2013 and 2020. In the multivariable analysis, poor breastfeeding success was associated most significantly with smoking during pregnancy (adjusted odds ratio [aOR] 4.64; 95% confidence interval [CI] 2.75-7.81), twin pregnancy (aOR 4.13; 95% CI: 2.10-8.15), maternal obesity (body mass index > 35) (aOR 3.27; 95% CI: 2.15-4.99), fear of childbirth (aOR 2.80; 95% CI: 1.89-4.13), and birth during the period of 2013-2014 (aOR 2.94; 95% CI: 2.08-4.14) or 2015-2016 (aOR 2.62; 95% CI: 1.85-3.70). Other significant factors related to poor success were younger maternal age, nonmarried family relationships, passive or quitting smoking before or in the first trimester, any hypertensive disorder during pregnancy, birth by nonelective cesarean, and lowest or highest quartiles of birth weight. Conclusions: Mother's fear of childbirth is strongly associated with the poor breastfeeding success even after controlling for mode of birth.