Food intakes in breast-feeding mothers]

BACKGROUND: The relation between mother's diet and breastmilk composition is still an open issue. Nutritional inadequacies during lactation may affect the well-being of both the mother and the infant. For this reason breast feeding women usually pay attention about their alimentary practices and about their style of life during breast-feeding period. This research was conducted to verify the adequacy of lactating mother's diet in comparison with the Italian recommended daily assumption levels of nutrients (LARN 1996) for this category. We have also compared food intake of not breast feeding mothers with the LARN, and analyzed the differences between these groups of mothers. METHODS: Forty-eight healthy infants were selected, 23 bottle fed, 25 breast fed. Mothers's diet in the previous 48 hours was investigated using a structured questionnaire. The data collected were processed using software Dietosystem to obtain the daily nutrient intakes. RESULTS: The wetnurses's diet in comparison with the LARN 1996 resulted hypocaloric and hyperproteic, deficient in Calcium, Iron, folic acid and vitamin E. Surprisingly not breast feeding mothers's intake of nutrients is closer to LARN levels than that of breast feeding mothers. CONCLUSIONS: Mothers are not informed enough about their alimentation during lactating period. Pediatricians must improve their knowledge about this subject and give the mothers the information they need to achieve the recommended food requirements.     

Vitamin B12 deficiency in a 9-month-old boy

We present a 9-month-old boy with megaloblastic anaemia, neutropenia and hypogammaglobulinaemia due to vitamin B12 deficiency. The deficiency was secondary to prolonged exclusive breastfeeding with inadequate nutritional amounts of vitamin B12 from the mother. There were no clinical or biological signs of maternal anaemia or macrocytosis. Treatment with oral vitamin B12 rapidly improved the biological findings of the child. Vitamin B12 deficiency should be considered in infants older than 2 months presenting with failure to thrive, neurocognitive retardation or even pancytopenia and hypogammaglobulinaemia, even in the absence of any signs of maternal anaemia or macrocytosis. Therefore, evaluation of vitamin B12 status during pregnancy and lactation is necessary in order to prevent B12 deficiency and its possible long-term effects in infants. Conclusion: Further studies should be conducted to evaluate the optimal oral dosage of vitamin B12 in children since limited data on the use of oral B12 substitution are available.     

Nutritional Vitamin B12 Deficiency in a Breastfed Infant Following Maternal Gastric Bypass

Breasfed infants of women who have had gastric or intestinal bypass procedures may develop nutritional deficiencies. We describe a 10-month-old exclusively breastfed white male infant who presented with vomiting, failure to thrive, and megaloblastic anemia. He was found to have vitamin B₁₂ deficiency. His mother had undergone a gastric bypass procedure for morbid obesity 2 years Prior to her pregnancy with this child. She had subclinical vitamin B₁₂ deficiency, with an abnormal Schilling test that corrected with the addition of intrinsic factor. Therefore, we believe that the mother's gastric bypass had caused a decrease in available intrinsic factor, resulting in subclinical vitamin B₁₂ deficiency and decreased breast milk B₁₂. Although she was asymptomatic, her breastfed infant developed symptomatic B₁₂ deficiency. This is the first reported case of a maternal gastric bypass resulting in vitamin B₁₂ deficiency in an infant. These mothers should receive vitamin supplements, including vitamin B₁₂ during and after pregnancy, and my require parenterally administered vitamin B₁₂.     

Can early intake of dietary omega‐3 predict childhood externalizing behaviour?

Aim:  To determine whether maternal and child intake of dietary omega-3 (n-3) fatty acids (FA), together with the presence or absence of breast-feeding, predicted psychiatric diagnosis of externalizing disorders in childhood.
Methods:  Data concerning childhood externalizing disorders were collected from 8242 children aged 7.9 years in a large British cohort. Intake of n-3 FA was measured for the study mother during pregnancy and for the child at 3 years. Duration of breast-feeding was examined to account for moderating effects. Adjustment was made for a variety of potential confounders.
Results:  Maternal intake of n-3 and breast-feeding predicted oppositional/conduct disorder and comorbid externalizing disorder before adjustment for confounding factors. However, there was no association between intake of n-3 by mother or child and any type of externalizing disorder once socio-demographic factors were taken into account.
Conclusions:  Any association between intake of n-3 and childhood externalizing disorders appears to be strongly confounded with socio-demographic factors. This is important to note given the current popularity of n-3 as a possible treatment for behaviour problems related to inattention and impulsivity. Care must be taken that studies investigating this relationship account fully for factors associated with both behaviour and diet.     

Severe vitamin B12 deficiency in an infant associated with a maternal deficiency and a strict vegetarian diet

The authors present a case of severe megaloblastic anemia and neurologic damage due to vitamin B12 deficiency in a 6-month-old infant. The cause of the vitamin deficiency was a maternal dietary deficiency because of a strict vegetarian diet and prolonged breast-feeding. The importance of early recognition of significant maternal vitamin B12 deficiency during pregnancy and lactation in vegetarians is emphasized so that appropriate supplementation can be given and irreversible neurologic damage in the infant prevented.     

PANCYTOPENIA DUE TO VITAMIN B12 DEFICIENCY IN A BREAST-FED INFANT

Nutritional B12 deficiency in childhood is an uncommon disorder. Most cases are due to maternal insufficiency, resulting from deficient stores and intake, and is generally seen in exclusively breast fed infants. This report describes a breast-fed infant with megaloblastic anemia secondary to maternal vitamin B12 deficiency. We describe this patient to remind readers that B12 deficiency may cause severe pancytopenia and regression of motor functions. These patients can present with unexpected signs and symptoms, such as developmental delay and regression as in our patient. It is also important to take the nutritional history of both the child and the mother of early prevention and treatment. With early awareness and appropriate measures potentially irreversible neurologic damage can be prevented in the infant.     

Pancytopenia due to vitamin B12 deficiency in a breast-fed infant

Nutritional B12 deficiency in childhood is an uncommon disorder. Most cases are due to maternal insufficiency, resulting from deficient stores and intake, and is generally seen in exclusively breast fed infants. This report describes a breast-fed infant with megaloblastic anemia secondary to maternal vitamin B12 deficiency. We describe this patient to remind readers that B12 deficiency may cause severe pancytopenia and regression of motor functions. These patients can present with unexpected signs and symptoms, such as developmental delay and regression as in our patient. It is also important to take the nutritional history of both the child and the mother of early prevention and treatment. With early awareness and appropriate measures potentially irreversible neurologic damage can be prevented in the infant.     

Prenatal exposure to polychlorinated biphenyls and attention at school age

OBJECTIVE: To examine the relation of prenatal polychlorinated biphenyl (PCB) exposure to child performance on neuropsychological tests of attention and information processing.Study design In this prospective, longitudinal study, assessment of prenatal PCB exposure was based on umbilical cord serum and maternal serum and milk concentrations. The children were tested in their homes at age 11 years. Multiple regression was used to examine the relation of this exposure to performance on 15 neuropsychological tests after controlling for a broad range of potential confounding variables. RESULTS: Adverse effects were seen primarily in children who had not been breast fed. Among these children, prenatal PCB exposure was associated with greater impulsivity, poorer concentration, and poorer verbal, pictorial, and auditory working memory. There was no evidence of visual-spatial deficit or increased hyperactivity. CONCLUSIONS: These findings are consistent with earlier reports of greater vulnerability to prenatal PCB exposure in children who were not breast fed. It is not clear whether the protection offered by breast-feeding is caused by nutrients in breast milk or better quality of intellectual stimulation often provided by breast-feeding mothers.     

Allergic colitis presenting in the first day of life: report of three cases

Allergic colitis can occur within hours of birth and should be considered in the differential diagnosis of any newborn in whom hematochezia develops. This diagnosis should be considered after excluding infectious and anatomic disorders common to this age group. The diagnosis is supported by the healthy appearance of affected infants and specific proctosigmoidoscopic and histopathologic findings. Infants with allergic colitis usually respond to withdrawal of the offending antigen, by the use of hydrolyzed cow's milk protein formula or more elemental formulas, or if the infant has been breast fed, by the strict removal of the offending antigen from the breast-feeding mother's diet.     

THE IMPACT OF MOTHER'S DEPRESSION ON HER NURSING EXPERIENCES AND ATTITUDES DURING BREASTFEEDING

Abstract. Mother's depression during postpartum is rather common and it has an impact on the mother-child relationship. As breast-feeding is an important situation for the early mother—child interaction, the impact of mother's depression on her breast-feeding and nursing attitudes and experiences was decided to be studied. In this pilot study 119 healthy prim Para mothers filled in Beck's Depression Inventory, breast-feeding and childrearing attitude scales and other questionnaires. The prevalence of depression was 8%. The depressed mothers had more difficulties during breast-feeding than other mothers. The attitudes of the depressed mothers were more positive during pregnancy, but more negative during breastfeeding than those of the non-depressed mothers. The results might be clinically meaningful, although we need more detailed information about the correlations between depression and breast-feeding experiences.     

Low maternal vitamin B12 status during pregnancy is associated with reduced heart rate variability indices in young children

Vitamin B12 plays a vital role in neuronal development, particularly in myelinogenesis. Demyelination of the autonomic nervous system occurs early in vitamin B12 deficiency. However, the impact of maternal vitamin B12 deficiency during pregnancy on neuronal function in the offspring is poorly documented. The objective of this study was to assess cardiac autonomic nervous activity in children born to mothers with low vitamin B12 status during pregnancy using heart rate variability (HRV) indices in the frequency domain. Seventy‐nine healthy children between 3 and 8 years of age were evaluated from an ongoing birth cohort. The blood sample of the mother had been stored and was analysed for plasma vitamin B12 following enrolment of the child. Subjects were divided, based on the median maternal first trimester vitamin B12 status (114 pmol L^?1), into lower (n = 40) and higher (n = 39) vitamin B12 status groups. A lead II electrocardiogram was recorded in the supine posture and subjected to HRV analysis. Low‐frequency HRV in absolute units was reduced significantly in children of the lower vitamin B12 status group (P = 0.03) and was 53% that of the higher vitamin B12 status group. There was a significant association between low‐frequency and total power HRV with cord blood vitamin B12 levels (ρ = 0.31 and 0.30, both P = 0.03). In summary, children born to mothers with a lower vitamin B12 status have a reduced cardiac sympathetic activity. The long‐term implication of this needs to be evaluated by follow‐up studies.     

Feeding and urine cotinine values in babies whose mothers smoke

In Canada, 8% to 20% of infants are breast-fed by mothers who smoke. To determine whether breast-feeding increases infants' exposure to tobacco smoke products, urinary cotinine excretion was measured in 172 babies, 33 of whom were breast-fed. A milk sample was taken from the mothers who were breast-feeding, and cotinine was measured with gas chromatography. The breast-fed babies had a median cotinine to creatinine ratio of 433 ng/mg, whereas the bottle-fed babies' median was 200 ng/mg (P less than 10(-4)). Similar differences were observed after adjustment for the number of cigarettes smoked by the mother and by other smokers in the home in the previous 24 hours. The correlation coefficient between the number of cigarettes smoked by the mother and the breast milk cotinine concentration was significant (r = .69, P = 2 X 10(-4)). Moreover, urine cotinine values from the breast-fed babies increased with higher concentrations of cotinine in the mother's milk (r = .56, P = .02). These results provide evidence that breast-feeding increases exposure to tobacco smoke components in infants whose mothers smoke. This is yet another argument for strongly encouraging women who smoke to stop smoking during pregnancy and lactation.     

Breast-feeding in Bangkok, Thailand: Current status, maternal knowledge, attitude and social support

BACKGROUND: The promotion of breast-feeding is one of the essential interventions for reduction of infant mortality and improving infant development worldwide. The aim of the present study was to examine the current status of infant feeding and the influences of suspected family sociodemographic characteristics and social support as well as maternal knowledge, attitudes and behaviours in infant feeding since the Baby-Friendly Hospital Initiative was launched in Thailand. METHODS: A total of 221 mother-infant pairs were randomly drawn from six health care centers in Bangkok from 20 April to 1 May 1998. Health care staff, using a structured questionnaire, interviewed the mothers in the health care centers. RESULTS: Most sampled mothers believed that breast milk was the best food for their infants and knew that breast milk had many advantages for infants, mothers and families. Ninety-five percent of mothers breast-fed their infants up to 3 months postpartum, but the prevalence of exclusive breast-feeding was relatively low (62.4%). Multiple logistic regression analyses revealed that the following factors independently increased the risk of mixed or formula feeding during the first 3 months of life: (i) mothers with a full-time job; (ii) grandmothers and other people as the main child caretakers; (iii) mothers who did not have an antenatal plan of exclusive breast-feeding; and (iv) newborns' non-exclusive breast-feeding in hospitals after birth. However, the mother being a housewife, mother as the main child caretaker, an antenatal plan of exclusive breast-feeding and exclusive breast-feeding in hospital were more likely to improve exclusive breast-feeding. CONCLUSION: The prevalence of exclusive breast-feeding was relatively low. Antenatal plans for exclusive breast-feeding and newborn feeding type in hospital after birth may play key roles in the duration of exclusive breast-feeding. These findings suggest the importance of strengthening implementation of the Baby-Friendly Hospital policy and prenatal health education regarding breast-feeding.     

Maternal diet during pregnancy and islet autoimmunity in offspring

Background:  Recent studies on the etiology of type 1 diabetes mellitus (T1DM) suggest that the components of the infant diet are associated with islet autoimmunity (IA), a precursor of T1DM. The role of prenatal nutritional exposures has not been thoroughly investigated.
Methods:  The Diabetes Autoimmunity Study in the Young has enrolled newborns from 1993 to 2004 at increased risk for T1DM based on human leukocyte antigen (HLA) genotype and family history of T1DM. The child is tested for islet autoantibodies at 9 and 15 months, 2 yr, and annually thereafter. We conducted a cohort study of 642 subjects for whom a Willett food frequency questionnaire for the mother's third trimester diet was completed. A case is defined as a subject who tests positive for islet autoantibodies at two consecutive blood draws and is still positive (or diabetic) at last follow-up (n = 27).
Maternal consumption frequencies of potatoes, other root vegetables, gluten-containing foods, non-gluten cereal grains, cow's milk and cow's milk products, fruits, vegetables, meat and poultry, and fish were analyzed in a survival analysis.
Results:  Adjusting for breast-feeding duration, age at first cereal introduction, ethnicity, HLA genotype, family history of T1DM, and total caloric intake, higher maternal intake of potatoes (hazard ratio for one standard deviation difference: 0.49, 95% confidence interval: 0.28–0.86) was associated with a delayed time to IA onset. No other food groups ingested during pregnancy were associated with IA in the child.
Conclusions:  The composition of the maternal diet during pregnancy may play a role in the offspring's risk of development of IA and potentially T1DM.     

Dynamics of infant feeding: mothers, professionals, and the institutional context in a large urban hospital

A multidimensional approach was taken to understand the constraints to breast-feeding in a large municipal hospital. Data were collected through direct observation, chart review, and questionnaires to patients and staff. Breast-feeding had not yet begun within 24 hours postpartum in 37% of women who wanted to breast-feed. Chart review revealed that at hospital discharge no woman was breast-feeding exclusively: only 16% of infants had ever been breast-fed and all of these also had been formula fed. The most common reason for the use of supplementary formula and early weaning was the mother's perception or anticipation of insufficient milk. The existing procedures communicated the message to patients that the health care providers expected women to bottle-feed. Some practices that prevented successful breast-feeding were prolonged and/or unnecessary separation of mother and infant, routine provision of infant formula, confusion about drug contraindications for breast-feeding, and inconsistent identification of breast-feeding infants. Staff knowledge about breast-feeding management was inadequate, and staff underestimated mothers' interest in breast-feeding. Recommendations to facilitate breast-feeding include a revision of routines and procedures as well as provision of staff education and expansion of patient education.     

哺乳期营养对雌鼠阴门开启时间及卵巢功能的影响

目的通过建立哺乳期不同营养状态大鼠模型,观察哺乳期营养对雌鼠阴门开启时间及卵巢功能的影响。方法利用同系新生雌性SD大鼠制作哺乳期营养适中（1只母鼠喂养10只仔鼠,共30只）、营养过剩（1只母鼠喂养2只仔鼠,共30只）及营养不良（1只母鼠喂养20只仔鼠,共60只）模型,观察各组雌鼠阴门开启时间、体重、卵巢组织学变化。结果营养过剩组雌鼠阴门开启时间明显先于营养适中组（P〈0.05）,而营养适中组明显先于营养不良组（P〈0.05）;卵巢组织学显示不同营养状态雌鼠卵巢发育成熟度不同,营养越好卵巢发育越早、越趋于成熟。结论营养过剩即肥胖的雌鼠性发育明显提前,营养不良雌鼠性发育明显延迟,哺乳期营养是调节雌鼠性发育的重要因素。     

Associations between dietary intake and breast milk dioxin levels in Tokyo, Japan

BACKGROUND: The presence of dioxins in breast milk has gained much attention recently. However, in Japan the relationship between the consumption of different foods and the human breast milk dioxin concentrations is still unclear. METHODS: Breast milk was taken from 240 mothers residing in Tokyo, Japan to measure and analyze the concentrations of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans, and coplanar poly-chlorinated biphenyls contained in the fat. Individual milk samples were obtained from the mothers 30 days after delivery in 1999 and 2000. The data of the mothers' diets before pregnancy were collected by means of food frequency and amount estimation. Spearman correlation analysis and stepwise multiple linear regression were used to analyze the data. RESULTS: The concentrations of dioxins in breast milk were influenced mainly by the mother's age and history of breast-feeding. All the Spearman correlation coefficients were less than 0.20. Pork, roast ham, sausage, salt codfish and tempura had negative correlations with breast milk dioxins. CONCLUSIONS: History of breast-feeding and the mother's age should be considered and emphasized in this kind of analysis. The cause effect relationship between dietary intake and breast milk dioxin levels were still uncertain.     

Breast-feeding history and overweight in 11 to 13-year-old children in Iran

Background  The relationship between breast-feeding history and risk of overweight in pre-adolescent children was investigated. Methods  Children’s breast-feeding history and demographics were obtained in interviewer-administered questionnaires of a multistage cluster sample survey of 800 parents of children aged 11–13 years living in Yazd, Iran. Height and weight were measured in the children. Overweight was defined as body mass index ≥90th age- and sex-specific percentile of the 2000 Centers for Disease Control reference values. Results  One hundred and four (13.0%) of 800 children were overweight. A total of 783 (97.9%) of the children had been breast fed. There was a markedly lower overweight prevalence among breast-fed than non breast-fed children. Controlling for age and sex, children breast fed for at least 24 months were substantially less likely to be overweight than children breast fed for less than 12 months (OR 0.56, 95% CI 0.31–0.9). A longer overall duration and duration of exclusive breast-feeding were associated significantly with the decreasing prevalence of overweight. Conclusion  This sample of Iranian children shows high rates of overweight at young ages but also high rates of breast-feeding. The duration of breast-feeding is inversely related with the prevalence of overweight in pre-adolescent children.     

Perinatal cytomegalovirus infection in man.

In a prospective study of 148 children from urbanized southern Finland 3 were found to be congenitally and 48 perinatally infected with cytomegalovirus (CMV), while 6 developed "late" infection during the first year of life. During pregnancy and the first year after delivery 23 of the mothers had no CMV antibodies; none of the children of these seronegative mothers developed any type of CMV infection. Fresh blood exchange transfusions did not increase the risk of CMV infection. The data support the hypothesis that the mother is the source of perinatal CMV infection. Children with a low birthweight not due to prematurity, and first children seem to run a greater risk of acquiring perinatal CMV infection. If the child is breast fed up to the age of 2 months the risk seems to be increased. Perinatal CMV infection gave rise to no symptoms or signs and had no effect on growth or on motor and psychosocial development during the first year of life.     

Early childhood determinants of organochlorine concentrations in school-aged children

We investigated whether early childhood factors such as breast-feeding, parity, and smoking contribute to the variation of organochlorine compounds (OC: dichlorodiphenyldichloroethene, hexachlorobenzene, beta-hexachlorocyclohexane, and the sum of polychlorinated biphenyls including the congeners 101, 118, 138, 153, 170, 180, 183, and 187) at approximately 7 y of age. OC were measured in whole blood of 350 children. Pregnancy characteristics and the child's living conditions were gathered by questionnaires administered to the parents and interviews with the mother. Height and weight were determined during the medical examination. Exclusion of incomplete data and nonbiologic children of the mothers yielded a sample of 337 children. We applied regression analysis with indicator variables, controlling for confounders. No systematic association was detected for birth order or maternal smoking during pregnancy. The OC concentrations are diluted in children with a higher body mass index (>18 kg/m(2)). We found a strong, dose-dependent relationship between the duration of breast-feeding (none, 1-4 wk, 5-8 wk, 9-12 wk, >12 wk) and the concentration of all five OCs. Of the potential determinants analyzed, more of the variance of the OC concentration is accounted for by breast-feeding than by any other variable. Exclusive breast-feeding beyond 12 wk was associated with a doubling of OC whole blood concentration compared with bottle-fed children (dichlorodiphenyldichloroethene, 0.28 microg/L versus 0.55 microg/L; beta-hexachlorocyclohexane, 0.05 microg/L versus 0.14 microg/L; hexachlorobenzene, 0.14 microg/L versus 0.25 microg/L; sum of polychlorinated biphenyls, 0.25 microg/L versus 0.55 microg/L). These findings indicate that breast-feeding can lead to an extended duration of increased OC exposure in childhood.