Breastfeeding Medicine最新文献

Clinical guidelines for infant feeding among people with HIV in the U.S. were updated in 2023 to encourage providers to utilize a shared decision-making approach that includes breastfeeding/chestfeeding (B/CF) when appropriate. Despite this historic shift in policy to support B/CF as an infant feeding choice for people living with HIV, birthing people living with HIV who desire B/CF face many barriers, and there is currently a gap in research identifying best practices for facilitating safe and satisfying B/CF in this population. Lactation support specialists have been identified as a positive factor in successful B/CF and a key resource for supporting B/CF for people with HIV. Recent research has shown that telelactation, the provision of care from a qualified lactation consultant or counselor using telehealth, can increase access to quality lactation support in underserved areas and can effectively improve outcomes, such as increased rates of exclusive breastfeeding and decreased early breastfeeding cessation while maintaining high levels of patient satisfaction. Telelactation is an innovative approach to improving access to B/CF among birthing people living with HIV, but little is currently known about what kind of support lactation support specialists and other perinatal HIV care providers may need to meet the clinical and psychosocial needs of B/CF people living with HIV and their infants. More research is needed to identify possible gaps in knowledge and other needs within the lactation support community so that infant feeding specialists are adequately equipped with evidence-based strategies to support the unique needs of parents living with HIV.

Background: The breastfeeding aversion response (BAR) is defined as the compulsion to remove the baby from the breast in response to negative physical sensations experienced during breastfeeding. This phenomenon is characterized by involuntary and overwhelming feelings of disgust that arise during breastfeeding or at various stages of the breastfeeding process. Objectives: The aim of the study is to evaluate the frequency of BAR and affecting factors in mothers with breastfeeding experience in Türkiye. Methods: The survey was conducted online using the Google Forms® tool, accessible from November 2, 2023, to January 5, 2024. A total of 1,046 mothers with breastfeeding experience were included in the research. Results: A total of 9.8% (n = 103) of mothers participating in the study stated that they experienced BAR. Fatigue (23.3%), breastfeeding a toddler (19.4%), and breast pain (18.4%) were the most frequently reported risk factors for BAR. The BAR rate was higher among working mothers (p = 0.037), those lacking spousal support (p = 0.001), mothers diagnosed with postpartum depression (p = 0.009), and those encountering breastfeeding problems (p = 0.007). Conclusion: Further research on the factors that trigger BAR, its severity, and what symptoms it may cause may provide guidance on how midwives and nurses working with breastfeeding mothers can support these mothers, how to prevent BAR, and possible treatment options. The findings of our study revealed that BAR is especially affected by psychological processes. For this reason, it is recommended to approach breastfeeding in the postpartum period as a holistic experience that also includes psychological and sociocultural processes rather than solely from a physiological perspective.

Introduction: Dysphoric milk ejection reflex (D-MER) is a condition affecting lactating women, characterized by abrupt emotions of dysphoria that start shortly before or during milk let-down and progress for several minutes. Research on D-MER, especially with quantitative methodology, is minimal. This study aimed to validate an instrument for D-MER-related emotions, examine its prevalence and clinical features, and explore differences in maternal mental health and mother-infant bonding between mothers with and without D-MER. Methods: A total of 711 women up to 12 months postpartum participated in an online cross-sectional study. Participants fulfilled the D-MER Questionnaire (D-MERq), Edinburgh Postnatal Depression Scale, Depression, Anxiety, and Stress Scales, and the Postpartum Bonding Questionnaire. Results: The analysis showed that D-MERq had high reliability and good discriminant and divergent validity. The prevalence of D-MER was 5.9%. For the majority, D-MER manifested intensely, accompanied mostly by agitation- and anxiety-related emotions, and 45% of mothers discontinued breastfeeding due to D-MER. Mothers experiencing D-MER had higher levels of depression, anxiety, stress, previous psychiatric diagnoses, and more mother-infant bonding difficulties compared with mothers without D-MER. Conclusion: These findings demonstrate that D-MERq is a valuable tool with good psychometric properties and suitable for clinical and research use to facilitate early identification and better understanding of this phenomenon. D-MER affects a noteworthy number of women and is associated with impaired mental health, bonding difficulties, and breastfeeding discontinuation. This highlights the importance of health care providers recognizing D-MER to ensure better outcomes and a more positive breastfeeding experience.

Introduction: Breastfeeding is associated with improved health outcomes. Several social drivers of health impact breastfeeding initiation (BFI). Prior research using ecological data demonstrated that food desert residence (FDR) is associated with lower rates of BFI. The primary objective was to assess the relationship between FDR and BFI using individual-level data. The secondary objective was to assess the relationship between FDR and BFI at the county level. Methods: Individual-level birth data from the Florida Department of Health were linked to food access data from the United States Department of Agriculture Food Access Research Atlas in 2010, 2015, and 2019. Food deserts were identified per the United States Department of Agriculture definition. Adjusted risk ratios (aRR) and 95% confidence intervals (CI) were calculated using modified Poisson regression models in 573,368 births. Models were adjusted for confounders and stratified by race/ethnicity. We assessed the association between the percent of the population in low-income and low-access census tracts aggregated to the county level and the percent of mothers initiating breastfeeding per county in Florida (Center for Disease Control and Prevention) using Pearson's correlation and a bivariate map. Results: FDR was associated with BFI (aRR: 1.23, CI: 1.20-1.27). The adjusted risk of not-initiating breastfeeding for those living in a food desert was greatest among non-Hispanic Black women (aRR: 1.29, CI: 1.24-1.35) and Hispanic women (aRR: 1.29, CI: 1.21-1.37). Maternal education was the most significant predictor of BFI. Women who had 9th through 12th-grade education but without a diploma were five times (aRR: 4.96, CI: 4.72-5.20) less likely to initiate breastfeeding relative to college graduates. There was no association between FDR and BFI at the county level, though regional trends were noted. Conclusions: FDR is an important risk factor for not-initiating breastfeeding. Among Floridians, education was the most significant risk factor. Understanding how FDR influences breastfeeding can help target interventions to improve breastfeeding outcomes.

Objective: Olfactory stimulation can be used for many purposes, such as providing comfort, improving sleep, and reducing pain in newborns. However, there are only a few studies in the literature examining the effect of olfactory stimulation on newborn growth. The aim of this study was to evaluate the effect of olfactory stimulation on growth parameters of newborns. Method: This systematic review used the PRISMA checklist. No date limitation was applied, and all studies were considered for inclusion. Pubmed, Web of Science, Scopus, and Medline databases were used for the search. Results: A total of 367 publications were found in the search. Eight studies that met the inclusion criteria were included in the study. The olfactory stimulations applied were maternal odor, maternal milk odor, cinnamon, aniseed, vanilla, and formula milk odors. Olfactory stimulation was found to have a positive effect on the weight gain of newborns in three of the eight studies, and maternal odor and maternal milk odor were used in these studies. In two of the three studies evaluating the effect of maternal odor and maternal milk olfactory stimulation on the height of newborns, the result was found to be significant. The effect of maternal milk olfactory stimulation on head circumference was found to be significant in one of the two studies. Conclusion and Recommendation: Maternal odorand maternal milk odor may have a positive effect on newborn growth parameters. Further studies on this subject are needed.

Background: Bronchopulmonary dysplasia (BPD) is a common complication of preterm very low birth weight (VLBW) infants. Mother's own milk (MOM) may mitigate the severity of BPD. Pasteurized donor human milk (PDHM) is often used as an alternative when MOM is unavailable with limited information on the influence of PDHM on BPD risk and severity. Objective: To compare the influence of MOM to PDHM on risk and severity of BPD in preterm VLBW infants. Design/Methods: A retrospective chart review of preterm (<34 weeks) and VLBW (<1,500 g) infants born at the Children's Hospital of Richmond from 2019 to 2021 was performed. The analysis included demographics, type and timing of nutrition received (MOM, PDHM, Formula), and incidence/severity of BPD based on National Institute of Child Health & Human Development (NICHD) definition. Data analysis used chi-square, linear regression, and a multinomial logistic regression test. Results: A total of 200 infants met inclusion criteria, of which 116 (58%) had no BPD, 34 (17%) had mild BPD, 32 (16%) had moderate BPD, and 18 (9%) had severe BPD. Infants exposed to MOM within the first 3 days and within the first 7 days of life had lower incidence of moderate to severe BPD when compared to those with no MOM exposure (p = 0.02, p = 0.04). The percent of MOM received throughout hospitalization moderated the incidence of BPD (p = 0.01, 95% Confidence Interval (CI) [-0.14, -0.02]), such that as the percent of MOM received increased, the effect of gestational age on severity of BPD decreased. In contrast, the percent of PDHM received throughout hospitalization did not moderate BPD incidence (p = 0.61, 95% CI [2.28, 3.43]). Conclusion: These results identify that earlier and greater total exposure to MOM, but not PDHM, was associated with decreased moderate to severe BPD in <34-week preterm VLBW infants.

Introduction: Donor human milk is increasingly being utilized for both preterm and term infants when mother's milk is unavailable. With the rising prevalence of maternal overweight and obesity, it is crucial to evaluate the relationship between maternal body mass index and the fat and energy content of donor human milk. Objectives: To assess the impact of maternal body mass index on human milk fat content. Methods: A cross-sectional study was carried out using retrospective data from women who made their first human milk donation at ≥15 days postpartum at a human milk bank in São Paulo, Brazil, from January 2018 to December 2020. Data of sociodemographic, obstetric, health, and anthropometric measures were collected by the human milk bank staff. Milk fat and energy content were determined using the crematocrit test. Analysis of variance and multiple linear regression were used to compare means of crematocrit and fat. We determined the p-values using a test of heterogeneity and linear trend and presented the one with the lower p-value. Results: Most donors were between 25 and 35 years old, had higher education, were employed, and lived with a partner. At the time of milk donation, 40.9% of women were overweight or obese. The fat (1.09 g/dL) and energy (9.83 kcal/dL) content of human milk were higher in obese donor compared with eutrophic donors. Conclusions: The fat and energy content of human milk were associated with maternal body mass index, suggesting the potential value for selective use of high fat and high calorie donor milk for very low birthweight or premature infants.