Timing of solid food introduction and association with later childhood overweight and obesity: The IDEFICS study

This study investigated associations between timing of solid food introduction and childhood obesity and explored maternal characteristics influencing early feeding practices. Cross‐sectional data from children 2–9 years (n = 10,808; 50.5% boys) residing in 8 European countries of the IDEFICS study (2007–2008) were included. Late solid food introduction (≥7 months of age) was associated with an increased prevalence of later childhood overweight/obesity among exclusively breastfed children (OR [odds ratio]: 1.38, 95% CI [confidence interval] [1.01, 1.88]). In contrast, early solid food introduction (<4 months of age) was associated with lower prevalence of overweight/obesity among children that ceased exclusive breastfeeding earlier than 4 months (OR: 0.63, 95% CI [0.47, 0.84]). Children that were introduced to solids right after 6 months exclusive breastfeeding and continued to receive breastmilk (≥12 months) were less likely to become overweight/obese (OR: 0.67, 95% CI [0.51, 0.88]) compared to children that discontinued to receive breastmilk. Analyses were adjusted for age, sex, country, birth weight, parental education level, parental body mass index, tobacco use in pregnancy, gestational weight gain, and gestational diabetes. Underweight mothers, overweight mothers, mothers who reported daily smoking during pregnancy, and low‐educated mothers were less likely to follow recommendations on breastfeeding and timely solids introduction. Future studies should examine whether guidelines for solid food introduction timing have to distinguish between exclusively breastfed, formula fed, and too early exclusive breastfeeding‐ceased infants. There is also need for more prospective studies; recall bias was an important current limitation. In conclusion, health professionals should emphasize benefits of breastfeeding and appropriate solid food introduction, especially to mothers that are less likely to follow recommendations.     

Overweight in childhood of exclusively breastfed infants with a high weight at 5 months

High infant weight increases the risk of childhood overweight, while breastfeeding may reduce the risk. However, some infants have a very high weight gain even though they are exclusively breastfed. We examined the risk of a high body mass index (BMI) and overweight in childhood for infants ≥2.5 SD above the median weight‐for‐age (WAZ) at age 5 months according to duration of exclusive breastfeeding (≤2, >2 to <4 or ≥4 months). The study is based on 13,401 7‐year‐old and 9,819 11‐year‐old children enrolled into the Danish National Birth Cohort (born 1997–2003). Linear and logistic regression analyses were used to examine the associations while adjusting for presumed confounders including birth weight. The results showed that infants ≥2.5 SD at 5 months, breastfed exclusively ≤2, >2 to <4 or ≥4 months had adjusted odds ratios (ORs) for overweight at age 7 at 3.67 (95% confidence interval [CI] [2.10, 6.43]), 3.42 (95% CI [2.32, 5.04]) and 3.19 (95% CI [1.90, 5.36]) respectively, when compared with infants <2.5 SD WAZ exclusively breastfed ≥4 months. The corresponding results for BMI z‐scores were 0.82 (95% CI [0.60, 1.04]), 0.63 (95% CI [0.48, 0.78]) and 0.57 (95% CI [0.38, 0.77]). For the ≥2.5 SD infants, the differences in risk of overweight and BMI according to duration of exclusive breastfeeding were neither significantly different among the 7‐year nor among the 11‐year‐old children. A high infant weight increases the odds of overweight and is associated with a higher BMI in childhood. Whereas the odds and BMI z‐scores tended to be lower for those exclusively breastfed longer, the differences were not statistically significant.     

Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain

Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2–4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%–5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.     

Impact of maternal obesity and breastfeeding intention on lactation intensity and duration

Exclusive breastfeeding (EBF) has numerous maternal health benefits. However, EBF rates are lower in mothers with obesity. We sought to better understand whether maternal body composition measurements in early pregnancy are also predictive of lower rates of EBF. Healthy pregnant women with prepregnancy body mass index (BMI) of 17.5–51 kg/m² underwent determination of percent body fat (% body fat) in early (12–16 weeks) and late (37 weeks) gestation. Intent and duration of EBF were determined by surveys completed at 6 weeks and 6 months postpartum (PP). Unadjusted and adjusted analyses were performed to compare EBF rates and weaning by maternal BMI and % body fat. Increasing BMI and % body fat in early pregnancy were significantly associated with lower rates of EBF among women intending EBF. Women with BMI ≥ 25 were less likely to be EBF at 6 weeks and 6 months PP compared with women of normal BMI (67 and 37% vs. 91 and 79%, P value 0.005 and 0.001, respectively). Among primiparous women intending EBF, 100% of women in the lowest two body fat quartiles in early pregnancy were EBF at 6 weeks PP compared with 66.7 and 63.6% of women in the higher quartiles (P = 0.03). Lactation cessation by 6 months PP was higher with increasing maternal BMI (P = 0.001). Maternal obesity in early gestation is associated with lower EBF rates among women intending EBF and earlier weaning. Excess adiposity in early pregnancy may impede EBF.     

Baby‐Friendly Hospital designation has a sustained impact on continued breastfeeding

The Baby‐Friendly Hospital (BFH) Initiative has led to an increase in breastfeeding rates and duration worldwide. But little is known about whether the beneficial effects persist beyond a facility's designation as a BFH. To investigate the association of BFH designation (current, former, and never) and compliance with Baby‐Friendly (BF) practices on breastfeeding in Switzerland, this study combined nationwide survey data on breastfeeding with BFH monitoring data. In this cross‐sectional study, 1,326 children were born in 34 current (N = 508), 28 former (N = 425), and 34 never designated BFHs (N = 393). We compared exclusive and any breastfeeding according to BFH designation over the first year of life, using Kaplan‐Meyer Survival curves. Logistic regression models were applied to analyse breastfeeding prevalence, and Cox‐regression models were used for exclusive (0–6 months) and continued (6–12 months) breastfeeding duration. Average duration of exclusive breastfeeding (13.1 weeks, 95% confidence interval [12.0, 17.4]) and any breastfeeding (32.7 weeks, 95% confidence interval [30.5, 39.2]) were the longest for babies born in currently accredited BFHs. Exclusive breastfeeding was associated with high compliance with monitored BF practices in current BFHs and with the number of BF practices experienced in all hospitals. Continued breastfeeding was significantly longer when babies were born in current BFHs (cessation hazard ratio 0.60, 95% confidence interval [0.42, 0.84]) or in former BFHs (cessation hazard ratio 0.68, 95% confidence interval [0.48, 0.97]). Overall, the results support continued investment into BFHs, because babies born in current BFHs are breastfed the most and the longest, whereas a former BFH designation shows a sustained effect on continued breastfeeding.     

Predictors of post‐partum weight retention in a prospective longitudinal study

Post‐partum weight retention (WR) occurs in 60–80% of women with some retaining ≥10 kg with contributing factors reported as pre‐pregnancy body mass index (BMI), gestational weight gain (GWG) and breastfeeding. A longitudinal study of pregnancy, with 12‐month post‐partum follow‐up was conducted to determine factors associated with WR. Pregnant women (n = 152) were recruited from the John Hunter Hospital antenatal clinic in New South Wales, Australia. Pre‐pregnancy weight was self‐reported; weight was measured four times during pregnancy (for GWG) and in the first 12 months post‐partum. Infant feeding data were obtained via questionnaires. Breastfeeding was categorised as exclusive, predominant, complementary or not breastfeeding. Linear mixed models tested the predictors of WR, with and without adjustment for potential confounders. Compared with pre‐pregnancy weight, 68% of women retained weight at 12 months, median (interquartile range) [4.5 kg (2.1–8.9)]. After adjustment, GWG was positively associated with WR (P < 0.01), but pre‐pregnancy weight did not predict WR. For each additional week of any breastfeeding, 0.04 kg less weight was retained. Compared with women who retained weight, those women who did retain had higher rates of exclusive breastfeeding at three months (P < 0.05), but the number of weeks of exclusive breastfeeding failed to predict WR for all women. WR following childbirth is common and associated with GWG, while the number of weeks of ‘any’ breastfeeding contributed to post‐partum weight loss. Whether these factors are modifiable strategies to optimise the weight status of women at this life stage requires further research.     

Hospital breastfeeding support and exclusive breastfeeding by maternal prepregnancy body mass index

Overweight and obese mothers in the United States have disproportionately lower rates of exclusive breastfeeding than mothers of normal weight. The Ten Steps to Successful Breastfeeding (Ten Steps), a series of evidence‐based practices designed to support breastfeeding initiation, duration, and exclusivity, demonstrate effectiveness at the population level. It is unknown, however, whether they are consistently provided to women across all maternal body mass index (BMI) categories. We sought to determine whether pre‐pregnancy BMI is associated with the implementation and effectiveness of the Ten Steps. We used data from Listening to Mothers III, a cross‐sectional survey administered to a sample of mothers who delivered in U.S. hospitals between July 2011 and June 2012. Measures of the Ten Steps were based on maternal self‐report on Listening to Mothers III. Our analytic sample was limited to mothers of term infants intending to breastfeed (N = 1,506, weighted). We conducted chi‐square testing and constructed weighted multivariable logistic regression models to account for potential confounders. Results suggest that two practices (i.e., holding their babies skin‐to‐skin for the first time and being encouraged to breastfeed on demand) were more strongly associated with exclusive breastfeeding among mothers with obesity than other mothers. Additionally, mothers with obesity reported holding babies skin‐to‐skin significantly less often than other mothers. Thus, interventions aimed at helping mothers with obesity to hold their babies skin‐to‐skin in the first hour and teaching them to breastfeed on demand have the potential to decrease the breastfeeding disparities in this population.     

Breastfeeding duration,age of starting solids and high BMI risk and adiposity in Indian children

This study utilized data from a prospective birth cohort study on 568 Indian children, to determine whether a longer duration of breastfeeding and later introduction of solid feeding were associated with a reduced higher body mass index (BMI) and less adiposity. Main outcomes were high BMI (>90th within‐cohort sex‐specific BMI percentile) and sum of skinfold thickness (triceps and subscapular) at age 5. Main exposures were breastfeeding (six categories from 1–4 to ≥21 months) and age of starting regular solid feeding (four categories from ≤3 to ≥6 months). Data on infant‐feeding practices, socio‐economic and maternal factors were collected by questionnaire. Birthweight, maternal and child anthropometry were measured. Multiple regression analysis that accounted for potential confounders demonstrated a small magnitude of effect for breastfeeding duration or introduction of solid feeds on the risk of high BMI but not for lower skinfold thickness. Breastfeeding duration was strongly negatively associated with weight gain (0–2 years) [adjusted β = –0.12 standard deviation, 95% confidence interval (CI): –0.19 to –0.05 per category change in breastfeeding duration, P = 0.001], and weight gain (0–2 years) was strongly associated with high BMI at 5 years (adjusted odds ratio = 3.8, 95% CI: 2.53–5.56, P < 0.001). In our sample, findings suggest that longer breastfeeding duration and later introduction of solids has a small reduction on later high BMI risk and a negligible effect on skinfold thickness. However, accounting for sampling variability, these findings cannot exclude the possibility of no effect at the population level.     

Association between the maternal protein nutrition status during pregnancy and the risk of preterm birth

We aimed to assess protein nutrition status during pregnancy by maternal plasma total protein (MTP) levels in urban pregnant women and to explore the association between the trimester‐specific MTP levels and risk of preterm birth (PTB). A prospective design was conducted in 3,382 mother‐newborn pairs with the second‐trimester maternal MTP information and in 3,478 mother‐newborn pairs with the third‐trimester MTP information. Multiple Cox proportional hazard regression and multiple linear regression were used to analyse the associations between MTP levels and PTB risk as well as gestational duration, respectively. Nearly all the second‐trimester MTP levels were within the clinical reference range, but more than 40% of the third‐trimester MTP levels were less than the lower limit of normal. No significant association was found between the second‐trimester MTP level and PTB risk. However, the adjusted hazard ratios (HRs) of PTB across increasing quartiles of the third‐trimester MTP levels were 1.00 (reference), 0.59 (0.36, 0.95), 0.35 (0.20, 0.60), and 0.32 (0.19, 0.53) (p _{for trend} < 0.001), respectively. Each standard deviations increment of the third‐trimester MTP was associated with increase of 0.13 weeks in gestational duration. Moreover, stratified analyses showed that the effects of third‐trimester MTP on PTB risk and gestational duration were stronger in pregnant women carrying female offspring than those carrying male offspring (p _{for interaction} < 0.05). The third‐trimester MTP level was inversely associated with PTB risk and was positively associated with gestational duration. Improving third‐trimester MTP level may be helpful for preventing PTB.     

Relationship between maternal pre‐pregnancy body mass index,gestational weight gain and childhood fatness at 6–7 years by air displacement plethysmography

This study aims to investigate the effect of maternal pre‐pregnancy body mass index (BMI) and gestational weight gain (GWG) on offspring body composition. In this prospective cohort study, offspring body composition at 6 years of age was obtained through air displacement plethysmography. Linear regression was used to obtain crude and adjusted coefficients. Information regarding offspring body composition and maternal pre‐pregnancy BMI was available for 3156 children and on offspring body composition and GWG for 3129 children. There was a direct association of maternal pre‐pregnancy BMI and GWG with offspring's fat mass (FM), fat‐free mass (FFM), fat mass index (FMI), fat‐free mass index (FFMI) and body fat percent (BF%) in crude and adjusted analyses. After adjustment for co‐variables, for each kg m^?2 of maternal pre‐pregnancy BMI increase, there was a mean increment of 0.13 kg in the offspring FFM, 0.06 kg m^?2 in FFMI, 0.11 kg in FM, 0.07 kg m^?2 in FMI and 0.18% in BF%. For each kilogram of maternal GWG increase, there was a mean increment of 0.08 kg in offspring's FM, 0.05 kg m^?2 in FMI, 0.04 kg in FFM, 0.01 kg m^?2 in FFMI and 0.18 % in BF%. Mothers with a higher pre‐pregnancy BMI or GWG tend to have children with greater adiposity at age 6 years. Fetal overnutrition is more likely among mothers with greater BMI during pregnancy; as a consequence, it can accelerate the childhood obesity epidemic.     

Association of 6 months of exclusive breastfeeding with higher fat‐free mass in infants in a low‐resource setting with high HIV prevalence in South Africa

Exclusive breastfeeding for 6 months is recommended by the World Health Organisation (WHO) for optimal health and growth of infants, but it is not a common practice in South Africa. A breastfeeding counselling programme was run to inform, encourage and support mothers to exclusively breastfeed their infants for 6 months, and mother–infant pairs were invited to participate in a research project to determine breast milk intake volumes using the dose‐to‐mother deuterium dilution stable isotope technique. This technique yields objective measurements of breast milk intake volumes and also enables determination of exclusivity of breastfeeding, which is most frequently determined by maternal recall and can be subject to bias. Exclusivity of breastfeeding at 6 weeks, 3 months and 6 months following birth of the infants was correlated with infant fat‐free mass at 12 months, which was determined by the dose‐to‐infant deuterium dilution stable isotope technique. Results showed that infants who were exclusively breastfed for 6 months had a higher per cent fat‐free mass at 12 months compared with infants who were not exclusively breastfed for 6 months (P < 0.05). This objective determination of both breastfeeding patterns and infant body composition gives weight to the WHO recommendation of exclusive breastfeeding for 6 months as it demonstrated adequate fat‐free mass in infants at 12 months, even in an area with high HIV prevalence. © 2016 John Wiley & Sons Ltd     

Design of a randomised controlled trial on immune effects of acidic and neutral oligosaccharides in the nutrition of preterm infants: carrot study

Background

Overweight and obesity are increasing among children all over the world. Socio-economic factors may influence the development of overweight and obesity in childhood, and it has been proposed that breastfeeding may protect against obesity. The aim of our study was to examine the relationship between exclusive breastfeeding and obesity when potential confounders, such as socioeconomic factors, are considered.

Methods

The data analyzed was from ABIS (All Babies in Southeast Sweden), a prospective cohort study. All parents with children born between October 1, 1997 and October 1, 1999 in Southeast Sweden (n = 21,700) were asked to participate. Parents were asked to answer periodic questionnaires from the time of the child's birth (n = 16,058) until he/she was five years of age (n = 7,356). Cutoffs for overweight and obesity were defined according to Cole et al, age and gender adjusted. Short-term exclusive breastfeeding was defined as < 4 months of exclusive breastfeeding. Multiple logistic regressions were used to identify variables that predict the child's BMI (Body Mass Index) at five years of age.

Results

At five years of age, 12.9% of the children in the study wereoverweight and 4.3% were obese. At the age of three months, 78.4% of the children were being breastfed exclusively. The median exclusive breastfeeding duration was four months. High maternal BMI > 30 (AOR = 1.07; CI = 1.05–1.09; P < 0.001), maternal smoking (AOR = 1.43; CI = 1.05–1.95; P = 0.023) and being a single parent (AOR = 2.10; CI = 1.43–3.09; P < 0.001) were associated with short-term exclusive breastfeeding (less than 4 months). Short-term exclusive breastfeeding was less common if one of the parents had a university degree (Mother: AOR = 0.74; CI = 0.61–0.90; P = 0.003 Father: AOR = 0.73; CI = 0.58–0.92; P = 0.008) or if the father was more than 37 years old (AOR = 0.74; CI = 0.55–0.99; P = 0.045). Short-term exclusive breastfeeding was associated with obesity in five-year-old children (simple logistic regression: OR = 1.44; CI = 1.00–2.07; P = 0.050), but when including other independent factors in the analysis, short-term exclusive breastfeeding did not attain statistical significance.

Conclusion

We cannot exclude the possibility that exclusive breastfeeding influences weight development, but it does not seem to protect against obesity at five years of age.     

Association between maternal prepregnancy obesity and breastfeeding duration: Data from a nationwide prospective birth cohort

Association of maternal obesity with shorter breastfeeding duration may involve different factors and might be modified by parity. In a national birth cohort, we aimed to estimate the association between prepregnancy body mass index (pBMI) and breastfeeding duration after adjustment for sociodemographic, pregnancy, and other characteristics and assess the effect modification of parity in such associations. In 2012, 3,368 mother–infant dyads were randomly included at birth in the French Epifane cohort. Breastfeeding information was collected in maternity wards and by phone interview at 1, 4, 8, and 12 months postpartum. Poisson regression analyses estimated the association of pBMI with the number of days of “any breastfeeding” (ABF) and “exclusive breastfeeding” (EBF) in unadjusted and adjusted models. Interactions between parity and pBMI were tested. Obesity before pregnancy was independently associated with shorter ABF duration (incidence rate ratio [IRR] = 0.86, 95%CI [0.74, 0.99]) compared to normal‐weight status. Parity showed an effect modification only with EBF duration. Among primiparae, no association was found for obesity, but overweight was significantly associated with shorter EBF duration independently of all covariates (IRR = 0.74 [0.58, 0.95]). Among multiparas, obesity was associated with shorter EBF duration after controlling for sociodemographic factors (IRR = 0.71 [0.53, 0.95]). This association was no longer statistically significant after controlling for other covariates. Obesity appears to be a strong risk factor in shorter ABF duration. Furthermore, parity is a key factor in the relationship of pBMI to shorter EBF duration. Overweight primiparous and obese multiparous women need additional support to prolong breastfeeding duration.     

Postpartum obesity and weight gain among human immunodeficiency virus‐infected and human immunodeficiency virus‐uninfected women in South Africa

In South Africa, up to 40% of pregnant women are living with human immunodeficiency virus (HIV), and 30–45% are obese. However, little is known about the dual burden of HIV and obesity in the postpartum period. In a cohort of HIV‐uninfected and HIV‐infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa, we examined maternal anthropometry (weight and body mass index [BMI]) from 6 weeks through 12 months postpartum. Using multinomial logistic regression, we estimated associations between baseline sociodemographic, clinical, behavioural, and HIV factors and being overweight–obese I (BMI 25 to <35), or obese II‐III (BMI >35), compared with being underweight or normal weight (BMI <25), at 12 months postpartum. Among 877 women, we estimated that 43% of HIV‐infected women and 51% of HIV‐uninfected women were obese I‐III at enrollment into antenatal care, and 51% of women were obese I‐III by 12 months postpartum. On average, both HIV‐infected and HIV‐uninfected women gained, rather than lost, weight between 6 weeks and 12 months postpartum, but HIV‐uninfected women gained more weight (3.3 kg vs. 1.7 kg). Women who were obese I‐III pre‐pregnancy were more likely to gain weight postpartum. In multivariable analyses, HIV‐infection status, being married/cohabitating, higher gravidity, and high blood pressure were independently associated with being obese II‐III at 12 months postpartum. Obesity during pregnancy is a growing public health concern in low‐ and middle‐income countries, including South Africa. Additional research to understand how obesity and HIV infection affect maternal and child health outcomes is urgently needed.     

Breastfeeding rates in immigrant and non‐immigrant women: A systematic review and meta‐analysis

Breastfeeding benefits mothers and infants. Although immigration in many regions has increased in the last three decades, it is unknown whether immigrant women have better breastfeeding outcomes than non‐immigrants. The aim of this study was to conduct a systematic review and meta‐analysis to determine whether breastfeeding rates differ between immigrant and non‐immigrant women. We searched Medline, Embase, PsycINFO, CINAHL and Google Scholar, 1950 to 2016. We included peer‐reviewed cross‐sectional and cohort studies of women aged ≥16 years that assessed and compared breastfeeding rates in immigrant and non‐immigrant women. Two independent reviewers extracted data using predefined standard procedures. The analysis included 29 studies representing 1,539,659 women from 14 countries. Immigrant women were more likely than non‐immigrants to initiate any (exclusive or partial) breastfeeding (pooled adjusted prevalence ratio 1.13, 95% confidence interval [CI] 1.07–1.19; 11 studies). Exclusive breastfeeding initiation was higher but borderline significant (adjusted prevalence ratio 1.20, 95% CI 1.00–1.45; 5 studies, p = 0.056). Immigrant women were more likely than non‐immigrants to continue any breastfeeding between 12‐ and 24‐week postpartum (pooled adjusted risk ratio 2.04, 95% CI 1.79–2.32; 3 studies) and > 24 weeks (adjusted risk ratio 1.33, 95% CI 1.02–1.73; 6 studies) but not exclusive breastfeeding. Immigrant women are more likely than non‐immigrants to initiate and maintain any breastfeeding, but exclusive breastfeeding remains a challenge for both immigrants and non‐immigrants. Social and cultural factors need to be considered to understand the extent to which immigrant status is an independent predictor of positive breastfeeding practices.     

Maternal pre‐pregnancy obesity and risk for inattention and negative emotionality in children

Objective: This study aimed to replicate and extend previous work showing an association between maternal pre‐pregnancy adiposity and risk for attention deficit hyperactivity disorder (ADHD) symptoms in children. Methods: A Swedish population‐based prospective pregnancy–offspring cohort was followed up when children were 5 years old (N = 1,714). Mothers and kindergarten teachers rated children’s ADHD symptoms, presence and duration of problems, and emotionality. Dichotomized outcomes examined difficulties of clinical relevance (top 15% of the distribution). Analyses adjusted for pregnancy (maternal smoking, depressive symptoms, life events, education, age, family structure), birth outcomes (birth weight, gestational age, infant sex) and concurrent variables (family structure, maternal depressive symptoms, parental ADHD symptoms, and child overweight) in an attempt to rule out confounding. Results: Maternal pre‐pregnancy overweight and obesity predicted high inattention symptom scores and obesity was associated with a two‐fold increase in risk of difficulties with emotion intensity and emotion regulation according to teacher reports. Means of maternal ratings were unrelated to pre‐pregnancy body mass index (BMI). Presence and duration of problems were associated with both maternal over and underweight according to teachers. Conclusions: Despite discrepancies between maternal and teacher reports, these results provide further evidence that maternal pre‐pregnancy overweight and obesity are associated with child inattention symptoms and extend previous work by establishing a link between obesity and emotional difficulties. Maternal adiposity at the time of conception may be instrumental in programming child mental health, as prenatal brain development depends on maternal energy supply. Possible mechanisms include disturbed maternal metabolic function. If maternal pre‐pregnancy obesity is a causal risk factor, the potential for prevention is great.     

Breastfeeding practices in the United Kingdom: Is the neighbourhood context important?

Breastfeeding is an important public health issue worldwide. Breastfeeding rates in the United Kingdom, particularly for exclusive breastfeeding, are low compared with other OECD countries, despite its wide‐ranging health benefits for both mother and child. There is evidence that deprivation in the structural and social organisation of neighbourhoods is associated with adverse child outcomes. This study aimed to explore whether breastfeeding initiation, exclusive breastfeeding for at least 3 months, and any type of breastfeeding for at least 6 months were associated with neighbourhood context measured by neighbourhood deprivation and maternal neighbourhood perceptions in a nationally representative U.K. sample. A cross‐sectional analysis was conducted using data from the Millennium Cohort Study. Logistic regression was carried out on a sample of 17,308 respondents, adjusting for individual‐ and familial‐level socio‐demographic characteristics. Neighbourhood deprivation was independently and inversely associated with breastfeeding initiation. Compared with the least deprived areas, the likelihood of initiating breastfeeding was 40% lower in the most deprived neighbourhoods (OR: 0.60, 95% CI [0.50, 0.72]). The relationship between both exclusive and any type of breastfeeding at 3 and 6 months respectively with neighbourhood deprivation after adjustment for potential confounders was not entirely linear. Breastfeeding initiation (OR: 0.78, 95% CI [0.71, 0.85]), exclusivity for 3 months (OR: 0.84, 95% CI [0.75, 0.95]), and any breastfeeding for 6 months (OR: 0.82, 95% CI [0.73, 0.93]) were each reduced by about 20% among mothers who perceived their neighbourhoods lacking safe play areas for children. Policies to improve breastfeeding rates should consider area‐based approaches and the broader determinants of social inequalities.     

Online participatory intervention to promote and support exclusive breastfeeding: Randomized clinical trial

The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post‐partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network. A randomized clinical trial was performed involving 251 mother–child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age. The duration of exclusive breastfeeding was calculated through survival analysis, and the effect of the intervention was estimated through the Cox regression model. The exclusive breastfeeding frequencies were higher in the intervention group in all follow‐up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001). This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.     

孕期增重对婴幼儿体重和肥胖风险影响的随访研究

目的：研究孕期增重对子代0~24个月内体重和肥胖风险的影响。方法：对317名孕产妇进行孕前体重、分娩前体重和一般人口统计学信息调查,在子代出生时及3、6、9、12、18、24个月龄时进行体重、身高测量和母乳喂养调查。结果：Logistic回归分析显示,孕期增重过多会显著增加子代6月龄(RR=3.56, 95% CI: 1.31~8.35)和9月龄(RR=2.87, 95% CI:1.04~3.28)时肥胖的风险,但并未增加12月龄以后的肥胖风险。线性回归模型结果显示,孕期增重与子代在出生时(β=0.032, 95% CI:0.008~0.057)、3月龄(β=0.037, 95% CI: 0.013~0.062)、6月龄(β=0.043, 95% CI: 0.017~0.068)、9月龄(β=0.038, 95% CI: 0.013~0.063)和12月龄(β=0.034, 95% CI: 0.009~0.059)时体重的Z分值间存在显著的线性关联,但这种关联在子代12个月龄后均无统计学意义。结论：孕期增重过多对子代体重发育的影响可从胎儿期持续至整个婴儿期,这种影响在生后第2年会暂时消失。     

Breastfeeding duration in infancy and adult risks of type 2 diabetes in a high‐income country

Observed associations between breastfeeding and reduced risk of type 2 diabetes in adulthood may be confounded. We examined if the duration of breastfeeding in infancy was associated with the risk of type 2 diabetes in adulthood after adjustment for a range of prenatal and postnatal risk factors. We prospectively followed 6,044 individuals from the Copenhagen Perinatal Cohort born 1959–1961. Duration of any breastfeeding (≤0.5, >0.5–1, >1–2, >2–4, >4 months) was assessed at the infant's 1‐year health examination. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for type 2 diabetes (at age ≥30 years, 237 persons) by breastfeeding duration without and with adjustment for parental social status and education, maternal pre‐pregnancy body mass index (BMI), maternal diabetes and smoking during pregnancy, gestational weight gain, parity, preterm birth, birth weight, sex, and BMI at ages 7 and 41–43 years. In the unadjusted analysis, compared with infants breastfed for ≤0.5 month, those breastfed for >4 months had a 51% reduced risk of type 2 diabetes (HR = 0.49; 95% CI [0.32, 0.75]). After the stepwise adjustment for putative early life confounders, this was attenuated to a nonsignificant 31% reduced risk (HR = 0.69; 95% CI [0.44, 1.07]). Adjustment for childhood and adulthood BMI minimally changed the results. We found that the inverse association between the duration of breastfeeding and risk of type 2 diabetes in adulthood is considerably weakened and no longer significant after adjustment for prenatal and postnatal factors in the infant and mother.