Determinants of exclusive breastfeeding in a cohort of primiparous periurban peruvian mothers

The authors aimed to identify factors associated with exclusive breastfeeding (EBF) among 117 Peruvian mothers planning to breastfeed exclusively. Data were collected on days 0 and 3, and months 1, 3, and 6. Exclusive breastfeeding status was evaluated with a 24-hour recall of infant diet. Exclusive breastfeeding rates were 74%, 72%, and 35% at 1, 3, and 6 months, respectively. At 3 months, lower maternal education, greater breastfeeding frequency (day 3), greater breast pain (day 3), and depot medroxyprogesterone acetate use (3 months) were associated with EBF, after adjusting for EBF intentions. At 6 months, greater infant birth weight and mother-not employed were associated with EBF, after controlling for EBF intentions. More educated and working mothers, and infants with lower birth weight should be targeted in interventions to promote EBF in urban Peru. Research is also warranted to explore the factors linking depot medroxyprogesterone acetate use and breast pain with EBF duration.     

Determinants of the breastfeeding pattern among working women in S?o Paulo.

The needs of breastfeeding women who work away from home differ from those of other women, particularly those who breastfeed exclusively. Sixty-nine factory workers were interviewed in S?o Paulo, both during pregnancy and when they returned to work. Median durations of exclusive (EBF), predominant (PBF), and any breastfeeding (BF) were found to be 10 days, 70 days, and 150 days, respectively. Despite having used the 4-month leave to which they were entitled, by 1 month, 86% of the respondents had given tea, 50% water, and 42% artificial baby milk. Only 2 women were still exclusively breastfeeding when they returned to work. Various personal characteristics were associated with longer duration of breastfeeding. Maternity ward routines were generally not supportive, but duration of PBF was longer where better support was received. Duration of EBF was longer among women with support for breastfeeding at work, and shorter for those working on weekends or doing shift work. Thus, women may have adjusted their feeding patterns based on whether or not they anticipated workplace support. Only weekend work and socioeconomic status were linked to shorter duration of breastfeeding. Stronger social and health care support for EBF may be needed before the full impact of workplace support can be usefully studied in Brazil.     

Survival and health benefits of breastfeeding versus artificial feeding in infants of HIV-infected women: developing versus developed world

Infant feeding policies for HIV-infected women in developing countries differ from policies in developed countries. This article summarizes the epidemiologic data on the risks and benefits of various infant feeding practices for HIV-infected women living in different contexts. Artificial feeding can prevent a large proportion of mother-to-child HIV transmission but also is associated with increases in morbidity and mortality among exposed-uninfected and HIV-infected children. Antiretroviral drugs can be used during lactation and reduce risks of transmission. For most of the developing world, the health and survival benefits of breastfeeding exceed the risks of HIV transmission, especially when antiretroviral interventions are provided.     

Exclusive breastfeeding in 3 rural localities in Mexico.

The purpose of this study was to assess the factors associated with exclusive breastfeeding (EBF) during the first 6 months of life. A prospective, cohort study was conducted in 291 newborn children in 3 semirural localities in Mexico. Data were collected on infant-feeding practices, anthropometry, morbidity, and maternal and household characteristics. Two-stage multivariate regression models were used for statistical analysis. Prevalence of EBF was 50% at day 5. Average duration of EBF was 2.18 months. According to the 2-stage model, maternal age, maternal work, and better socioeconomic conditions were associated with EBF at day 5. Infant nutritional status, prevalence of diarrhea, giving colostrum to the newborn, and maternal experience in breastfeeding were associated with duration of EBF. The prevalence of EBF and its duration were much shorter than recommended internationally. EBF during the early days of life and EBF duration are 2 different processes that are determined by different factors.     

"They call our children "Nevirapine babies?" ": A qualitative study about exclusive breastfeeding among HIV positive mothers in Malawi

Infant feeding is estimated to be responsible for 5%-20% of the burden of HIV transmission from mother to child. HIV positive women who cannot afford safe formula feeding are advised to practise exclusive breastfeeding (EBF) followed by prompt weaning. We conducted a qualitative study using observations and in-depth individual interviews to explore patterns of EBF as well as which factors motivate or hinder women to practice EBF. HIV positive women who intended to practice EBF from urban Malawi were purposively selected and interviewed. All women were well informed and had high knowledge on HIV as well as on EBF but much less knowledge on basic facts about breastfeeding. Despite their intentions less than half of the interviewed women managed to practice EBF and the barriers were explained by perceived lack of milk, lack of control over the feeding situation, felt and enacted stigma as well as poor counselling. Women who succeeded were older, had the explicit support of their husband and lived without the presence of their mother-in-law. Weaning at the age of 6 months was reported to be as difficult for the women as EBF. Intention itself is not a sufficient determinant of successful EBF unless a number of enabling factors come together. Prolonged breastfeeding is the cultural norm in Malawi and programs must be sensitive to social expectations to mothers and involve mothers-in-law and fathers in counselling of mothers who intend to practice EBF.     

Prevention of mother-to-child transmission of HIV in resource-rich and -poor settings

Without prevention, a third of HIV-exposed infants acquire HIV in breastfeeding populations before, during, or after delivery through mother-to-child transmission (MTCT). Whereas MTCT is now a sentinel event in resource-rich countries with antiretroviral prophylaxis, caesarean section, and avoidance of breastfeeding, this is not yet the case in resource-poor settings because breastfeeding is crucial to infant survival. Recent advances in postpartum maternal and infant prophylaxis enables safer breastfeeding, and increasing numbers of women accessing treatment and prevention of MTCT services in sub-Saharan Africa is leading to optimism that MTCT could be eliminated here also, as reflected in the UNAIDS target of 2015.     

Voluntary counselling and testing (VCT) for Human Immunodeficiency Virus: a study on acceptability by Nigerian women attending antenatal clinics

This study was carried out among 345 pregnant women attending antenatal clinics at two health facilities in Lagos, Nigeria. It was undertaken to determine their knowledge and acceptability of HIV voluntary counselling and testing in pregnancy as a strategy for the prevention of mother-to-child transmission (PMTCT) of HIV. Data were collected on issues relating to mother-to-child transmission of HIV, willingness to go for voluntary counselling and testing, actions to be taken if a pregnant woman was found to be HIV positive including infant feeding options. Majority of the women (89.9%) had good knowledge of the modes of HIV transmission, however, knowledge of specific aspects of PMTCT was poor. Close to half of the women (41.7%) were not aware of the association between breast milk and HIV transmission. Almost all the women (96.1%) were willing to undergo HIV testing in pregnancy particularly if it would assist preventing transmission of HIV to their babies; but only few would undergo the test if the result would be shared with relatives. Many of the women would still prefer breastfeeding even if they were found to be HIV positive. Awareness of anti-retroviral drugs among the study group was very poor. As the country is about to embark on its PMTTCT programme, there is need to increase the level of knowledge, acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries. Innovative information and education techniques need to be developed to provide HIV positive mothers with knowledge and skills that can enable them to make informed choices about infant feeding options and other forms of care.     

Exclusive breastfeeding in the era of AIDS.

The aim of this study was to describe breastfeeding practices, as well as what pregnant women know about breastfeeding and mother-to-child transmission (MTCT) of HIV, and explore factors associated with exclusive breastfeeding, especially in the presence of HIV/AIDS. A cross-sectional interview survey of 500 pregnant women was conducted in the Kilimanjaro region, supplemented by focus group discussions with pregnant women. Among the 309 mothers having previously breastfed, 85% had initiated breastfeeding within the first few hours postpartum, and 18% of newborns received some prelacteal food. Mean duration of breast-feeding was 23.7 months, but 46% of mothers had introduced other fluids early. Knowledge of HIV-transmission through breastfeeding was not associated with breastfeeding practices. Married women (odds ratio [OR] = .09, 95% confidence interval [CI] = .04-.24) and those having knowledge of exclusive breastfeeding (OR = .08, 95% CI = .02-.31) were the least likely to end exclusive breastfeeding early. Exclusive breastfeeding is a rare practice, and MTCT of HIV may further complicate recommendations with regard to this practice.     

The impact of a new universal postpartum program on breastfeeding outcomes.

The Ontario Mother and Infant Study II examined changes in postpartum health outcomes, including breastfeeding initiation and discontinuation, for mothers and their infants and compared these results to data collected prior to the initiation of the Universal Hospital Stay and Postpartum Home Visiting Program policy change in 1998. Data were collected using cross-sectional surveys before discharge and at 4 weeks postdischarge. Ninety percent of the women surveyed at 4 weeks postpartum initiated breastfeeding. Of these, 84% were still breastfeeding at 4 weeks postpartum. None of the 3 major program components-extended length of stay, a postpartum phone call from a public health worker, or a postpartum in-home visit-were associated with breastfeeding continuation to 4 weeks. Discontinuation before 4 weeks postdischarge was associated with maternal attitudes toward breastfeeding, formula feeding or supplementation in hospital, infant readmission, and use of walk-in clinics for infant care.     

Barriers and benefits to breastfeeding with gestational diabetes

Gestational diabetes mellitus (GDM) is a disease of glucose intolerance during pregnancy and is associated with infant macrosomia, infant hypoglycemia, and increased risk of type 2 diabetes development for both mother and infant. Although breastfeeding potentially mitigates metabolic sequelae for both mother and her offspring, women with GDM are more likely to introduce formula and, therefore, are less likely to exclusively breastfeed, and some studies show less initiation and shorter breastfeeding duration as well. Therefore, women with GDM and their infants warrant investigation of methods by which to increase breastfeeding exclusivity and duration. Exploration of the barriers to breastfeeding for women with GDM demonstrate not only biologic complications such as maternal obesity, increased prevalence of cesarean section, and infant hypoglycemia, but also maternal report of less provider support of breastfeeding and reduced breastfeeding self-efficacy. Consequently, interventions designed to optimize breastfeeding outcomes in this high-risk population should not only focus on the biology but also on provider behavior and maternal social factors.     

Impact of Postnatal Depression on Breastfeeding Duration

Abstract: Background: Postnatal depression can cause adverse effects on both mother and infant, but its impact on breastfeeding duration is poorly understood. The aim of this study was to investigate the relationship between maternal postnatal depression and breastfeeding duration. Methods: A cohort of 1745 women was recruited on the postnatal wards of two large Australian obstetric hospitals. Self‐report questionnaires were completed at recruitment, and at 2, 6, and 12 months postpartum. Breastfeeding status was determined at each follow‐up, and the Edinburgh Postnatal Depression Scale was used to screen for symptoms of depression. Diagnostic psychological interviews were conducted on a subsample of women at each interval. Results: Breastfeeding was initiated by 96 percent of the participants; at 2 months 79 percent were still breastfeeding, 57 percent at 6 months, and 22 percent at 12 months. Of the 18 percent of participants diagnosed with postnatal depression, the onset occurred before 2 months in 63 percent of cases. Median duration of breastfeeding was 26 weeks for women with early‐onset depression, 28 weeks for women with late‐onset depression, and 39 weeks for women without depression. After adjustment for confounding factors, early cessation of breastfeeding was found to be significantly associated with postnatal depression (adjusted hazard ratio 1.25, 95% CI 1.03–1.52). Onset of postnatal depression occurred before cessation of breastfeeding in most cases. Conclusions: Postnatal depression has a significant negative impact on breastfeeding duration. Assistance with breastfeeding issues should be included in the management of postnatal depression. (BIRTH 30:3 September 2003)     

Pragmatic Trial to Evaluate the Effect of a Promotora Telephone Intervention on the Duration of Breastfeeding

Objective

To evaluate the effectiveness of a telephone intervention delivered by promotoras (lay health care workers) to increase the duration of exclusive breastfeeding (EBF) in Hispanic women at 12 weeks postpartum. Secondary objectives were to assess breastfeeding duration (BFD) and to evaluate background variables that may be associated with EBF and BFD.

Doula Care, Early Breastfeeding Outcomes, and Breastfeeding Status at 6 Weeks Postpartum Among Low-Income Primiparae

Objective: To examine associations between doula care, early breastfeeding outcomes, and breastfeeding duration.
Design: Prospective cohort.
Setting: Regional hospital in northern California.
Participants: Low-income, full gestation primiparae receiving doula care ( n =44) or standard care ( n =97).
Measures: Birth outcomes and newborn feeding data obtained from the hospital record. Follow-up interviews conducted at day 3 to record the timing of onset of lactogenesis and breastfeeding behavior and at 6 weeks to obtain current breastfeeding status.
Results: Adjusting for baseline differences, women receiving doula care were significantly more likely to have a short stage II labor, a noninstrumental vaginal delivery, and to experience onset of lactogenesis within 72 hours postpartum (timely onset of lactogenesis). Overall, 68% of women receiving doula care and 54% of women receiving standard care were breastfeeding at 6 weeks. In the subset with a prenatal stressor ( n =63), the doula care group was more than twice as likely to be breastfeeding at 6 weeks (89% vs. standard care, 40%). Breastfeeding at 6 weeks was also significantly associated with timely onset of lactogenesis and maternal report that the infant "sucked well" at day 3.
Conclusions: Doula care was associated with improved childbirth outcomes and timely onset of lactogenesis. Both directly and as mediated by timely onset of lactogenesis, doula care was also associated with higher breastfeeding prevalence at 6 weeks.     

The effect of postnatal breastfeeding education/support offered at home 3 days after delivery on breastfeeding duration and knowledge: a randomized trial

Objective.?The aim of this study was to determine the effects of breastfeeding education/support offered at home on day 3 postpartum on breastfeeding duration and knowledge.

Methods.?The study included a total of 60 women who gave birth at Zübeyde Han?m Maternity Hospital located in Ayd?n, Turkey. In addition to a standard breastfeeding education in the first few hours after delivery, which was provided to all women in this “baby-friendly initiative” (BFI) hospital, the mothers in the intervention group received breastfeeding education at home on day 3 postpartum from supporters.

Results.?Both groups were comparable in terms of maternal and neonatal characteristics. The breastfeeding education/support offered during a home visit on day 3 postpartum was associated with a significant increase in the percentage of exclusively breastfed infants both at 2 weeks and 6 weeks, and at 6 months, and was also associated with a significant increase in exclusive breastfeeding and in total breastfeeding duration. In addition, increased breastfeeding knowledge scores were observed in the intervention group at 2 weeks and at 6 weeks after delivery, when compared with the respective scores in the control group.

Conclusion.?Breastfeeding education offered at home on day 3 postpartum was effective in increasing the breastfeeding duration and breastfeeding knowledge.     

Prenatal exposure to passive smoking and duration of breastfeeding in nonsmoking women: Krakow inner city prospective cohort study

INTRODUCTION: The relationship between tobacco smoking in pregnancy and breastfeeding is of public health importance. The present birth cohort study provided the opportunity to investigate whether the negative relationship between passive smoking measured by the cotinine concentrations in maternal blood at delivery and breastfeeding in postpartum could also be confirmed in nonsmoking mothers. MATERIALS AND METHODS: The study sample included 441 healthy pregnant women who were recruited in the first and second trimester of pregnancy. Enrolment included only nonsmoking women of the age of 18-35 years with singleton pregnancies, without illicit drug use and free from chronic diseases. After delivery, breastfeeding duration was defined using the answers recorded in the interviews with mothers conducted every 3 months. An infant was considered to be fully breastfed when breast milk was the only source of nourishment. Any breastfeeding was defined as an infant's being fully breastfed or receiving both breast milk and formula, with or without solids. In the statistical analysis only total duration of breastfeeding up to 6 months was considered for both forms of breastfeeding. Subjects were categorized into environmental tobacco smoke (ETS) exposure groups according to maternal blood cotinine level at delivery or self-reported exposure to ETS during pregnancy. RESULTS: The adjusted relative risk of discontinuation of any breastfeeding after infant's first 6 months was more than two times higher (OR = 2.42; 95% CI: 1.42-4.14) in women whose blood cotinine level at delivery was above 75th percentile of cotinine distribution (>0.15 ng/mL); the corresponding risk of discontinuation of full breastfeeding was OR = 1.71; 95% CI: 1.03-2.82. Estimated relative risk of discontinuation of any breastfeeding based on self-reported ETS was also significant but much less marked; the corresponding risk of discontinuation of full breastfeeding was insignificant. CONCLUSION: The results obtained support the hypothesis that ETS may affect breastfeeding duration and support the avoidance of passive smoking as a necessary additional measure for breastfeeding promotion.     

Factors Associated With Breastfeeding Up To 6 Months Postpartum in Mothers With Diabetes

Objectives: To identify breastfeeding behavior in a group of women with diabetes and to determine factors that may influence breastfeeding rates in this population.
Design: A 2-year retrospective study.
Setting: Derby City General Hospital, Derby, UK.
Participants: Ninety-four women with diabetes.
Methods: Data were collected using questionnaire and maternal clinical records.
Results: Women with gestational diabetes mellitus intended to and breastfed more than women with type 1 and type 2 diabetes at 2 weeks postpartum ( p <.05). Logistic regression showed that the type of diabetes was the most significant predictor of breastfeeding at birth ( p <.05). At 1, 2, and 6 weeks and 4 months postpartum, maternal body mass index was negatively associated with breastfeeding ( p <.05). At 6 months, socioeconomic status predicted breastfeeding ( p <.05).
Conclusion: Type of diabetes is a significant predictor of breastfeeding initiation. At later stages of postpartum, maternal body mass index and socioeconomic status were significant predictors of infant feeding method. Identification of these factors can help in developing appropriate and timely interventions to more effectively promote breastfeeding.     

Perinatal HIV and its prevention: progress toward an HIV-free generation

This article reviews the epidemiology of perinatal (HIV)-1 in the United States in the past 2 decades and the international HIV epidemic among pregnant women and their infants. Since the peak of 1700 reported cases of pediatric AIDS in 1992, there has been dramatic progress in decreasing perinatal HIV transmission in the United States with fewer than 50 new cases of AIDS annually (>96% reduction) and fewer than 300 annual perinatal HIV transmissions in 2005. This success has been due to use of combination antiretrovirals given to mothers during pregnancy and labor/delivery, obstetric interventions that reduce the risk of transmission, provision of zidovudine (ZDV) prophylaxis for 6 weeks to HIV-exposed newborns and use of formula. Internationally, the burden of mother-to-child HIV transmission remains heavy with 2.1 million children less than 15 years of age estimated to be living with HIV and 430,000 new HIV infections in infants occurring each year, with most cases occurring in Africa. Current international efforts are directed at scaling up successful prevention of mother-to-child transmission interventions and new research directed at making breastfeeding safer using antiretroviral prophylaxis to either mothers or their infants.     

Breastfeeding Duration in a Multiethnic Population in Hawaii

Background: The increasing ethnic diversity in the United States necessitates a study of variations in infant feeding patterns among ethnic groups. This study was conducted as part of Hawaii's surveillance system to identify infant feeding patterns in Hawaii; specifically, to identify factors influencing duration of breastfeeding among ethnically diverse mothers. Methods: All women who delivered an infant in Hawaii between January 1 and March 31, 1989, were mailed surveys 14 to 19 months after delivery. Fifty‐one percent (n= 2011) of women responded, of whom 1574 (78%) did some breastfeeding and are included in the analysis of prediction of weaning (cessation of breastfeeding). Cox regression (survival) analysis was used to predict weaning. Results: The median duration of breastfeeding was 150 days; 45 percent of infants were still breastfeeding at age 6 months and 16 percent at age 1 year. Factors associated with early weaning were Japanese ethnicity; mother born in a country other than the United States, Japan, or the Philippines; first language other than English, or two languages at home; employed full‐time outside the home; introduced formula or fruit before age 6 months; received formula from the WIC program; and stopped breastfeeding for convenience, breast problems, problems getting breastfeeding started, insufficient milk, baby refusing the breast, and a sick baby. Factors associated with late weaning were older maternal age; college education; living on a rural island; previous breastfeeding experience; helpful breastfeeding advice from family or friends; receiving WIC for breastfeeding mothers; introducing the cup before age 6 months; and not giving fruit to the baby. Conclusion: In Hawaii, programs that address how and when to introduce foods, use of formula, and management of outside employment and breastfeeding should be made available to those groups of women at risk for early weaning to lengthen their duration of breastfeeding.