Effectiveness of interventions on breastfeeding self‐efficacy and perceived insufficient milk supply: A systematic review and meta‐analysis

The aim of this systematic review and meta‐analysis was to assess the efficacy on an intervention on breastfeeding self‐efficacy and perceived insufficient milk supply outcomes. The literature search was conducted among 6 databases (CINAHL, Medline, PsyncInfo, Scopus, Cochrane, and ProQuest) in between January 2000 to June 2016. Two reviewers independently assessed the articles for the following inclusion criteria: experimental or quasi‐experimental studies; healthy pregnant women participants intending to breastfeed or healthy breastfeeding women who gave birth to a term singleton and healthy baby; intervention administered could have been educational, support, psycho‐social, or breastfeeding self‐efficacy based, offered in prenatal or postnatal or both, in person, over the phone, or with the support of e‐technologies; breastfeeding self‐efficacy or perceived insufficient milk supply as outcomes. Seventeen studies were included in this review; 12 were randomized controlled trials. Most interventions were self‐efficacy based provided on 1‐to‐1 format. Meta‐analysis of RCTs revealed that interventions significantly improved breastfeeding self‐efficacy during the first 4 to 6 weeks (SMD = 0.40, 95% CI 0.11–0.69, p = 0.006). This further impact exclusive breastfeeding duration. Only 1 study reported data on perceived insufficient milk supply. Women who have made the choice to breastfeed should be offered breastfeeding self‐efficacy‐based interventions during the perinatal period. Although significant effect of the interventions in improving maternal breastfeeding self‐efficacy was revealed by this review, there is still a paucity of evidence on the mode, format, and intensity of interventions. Research on the modalities of breastfeeding self‐efficacy should be pursued.     

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.     

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.     

Effectiveness of Baby‐friendly community health services on exclusive breastfeeding and maternal satisfaction: a pragmatic trial

The WHO/UNICEF Baby‐friendly Hospital Initiative has been shown to increase breastfeeding rates, but uncertainty remains about effective methods to improve breastfeeding in community health services. The aim of this pragmatic cluster quasi‐randomised controlled trial was to assess the effectiveness of implementing the Baby‐friendly Initiative (BFI) in community health services. The primary outcome was exclusive breastfeeding until 6 months in healthy babies. Secondary outcomes were other breastfeeding indicators, mothers' satisfaction with the breastfeeding experience, and perceived pressure to breastfeed. A total of 54 Norwegian municipalities were allocated by alternation to the BFI in community health service intervention or routine care. All mothers with infants of five completed months were invited to participate (n = 3948), and 1051 mothers in the intervention arm and 981 in the comparison arm returned the questionnaire. Analyses were by intention to treat. Women in the intervention group were more likely to breastfeed exclusively compared with those who received routine care: 17.9% vs. 14.1% until 6 months [cluster adjusted odds ratio (OR) = 1.33; 95% confidence interval (CI): 1.03, 1.72; P = 0.03], 41.4% vs. 35.8% until 5 months [cluster adjusted OR = 1.39; 95% CI: 1.09, 1.77; P = 0.01], and 72.1% vs. 68.2% for any breastfeeding until 6 months [cluster adjusted OR = 1.24; 95% CI: 0.99, 1.54; P = 0.06]. The intervention had no effect on breastfeeding until 12 months. Maternal breastfeeding experience in the two groups did not differ, neither did perceived breastfeeding pressure from staff in the community health services. In conclusion, the BFI in community health services increased rates of exclusive breastfeeding until 6 months. © 2015 Blackwell Publishing Ltd     

Acculturative type is associated with breastfeeding duration among low‐income Latinas

We sought to assess the relationship between acculturative type and breastfeeding outcomes among low‐income Latinas, utilising a multidimensional assessment of acculturation. We analysed data derived from a breastfeeding peer counselling randomised trial. Acculturation was assessed during pregnancy using a modified Acculturation Rating Scale for Mexican Americans scale. Analyses were restricted to Latinas who completed the acculturation scale and had post‐partum breastfeeding data (n = 114). Cox survival analyses were conducted to evaluate differences in breastfeeding continuation and exclusivity by acculturative type. Participants were classified as integrated‐high (23.7%, n = 27), traditional Hispanic (36.8%, n = 42), integrated‐low (12.3%, n = 14) and assimilated (27.2%, n = 31). The integrated‐low group was significantly more likely to continue breastfeeding than the traditional Hispanic, assimilated, and integrated‐high groups (P < 0.05, P < 0.05, and P < 0.01, respectively). The traditional Hispanic group was marginally more likely to continue breastfeeding than the integrated‐high group (P = 0.06). Breastfeeding continuation rates vary significantly between acculturative types in this multinational, low‐income Latina sample. Multidimensional assessments of acculturation may prove useful in better tailoring future breastfeeding promotion interventions.     

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     

Meta‐analysis of physiological effects of skin‐to‐skin contact for newborns and mothers

Background: Skin‐to‐skin care has been adopted all over the world, although physiological changes during or after it have not been evaluated very well. The purpose of the present study was therefore to investigate whether skin‐to‐skin contact for newborn babies and their mothers affects body temperature, heart rate and oxygen saturation of the babies. Methods: Studies investigating body temperature, heart rate and oxygen saturation of babies during and/or after skin‐to‐skin contact were systematically searched and reviewed. Meta‐analyses to examine the effects and meta‐regression analyses to investigate correlations between the effects and birthweight, duration of the care, environmental temperature, and resources of the setting, were conducted. Results: A total of 23 studies were included. Meta‐analyses showed evidence of an increase in body temperature (weighted mean difference [WMD] 0.22°C, P < 0.001) and a decrease in saturation of babies (WMD ?0.60%; P= 0.01) during skin‐to‐skin care, compared with those before skin‐to‐skin care. Increase in body temperature was more evident in middle–low‐income settings (WMD, 0.61°C, P < 0.001) than high‐income settings (WMD 0.20°C, P < 0.001). Both the positive effect on body temperature and the negative effect on saturation were more marked in cold environments than where the environmental temperature was higher (WMD 0.18°C, P < 0.001; WMD ?0.82%, P= 0.02). Conclusion: Skin‐to‐skin care is effective in increasing the body temperature of babies, especially where resources are limited and the environment is cold. Decreased oxygen saturation of the babies, however, warrants further prospective studies to confirm the findings.     

Periconceptional folic acid fortification for the risk of gestational hypertension and pre‐eclampsia: a meta‐analysis of prospective studies

Published literatures report controversial results about the association of folic acid–containing multivitamins with gestational hypertension and pre‐eclampsia. A comprehensive search was performed to identify related prospective studies to assess the effect of folic acid fortification on gestational hypertension and pre‐eclampsia. The Q test and I² statistic were used to examine between‐study heterogeneity. Fixed or random effects models were selected based on study heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias. Eleven studies conformed to the criteria. Pooled results indicated that folic acid fortification alone was not associated with the occurrence of gestational hypertension [relative risk (RR) = 1.03, 95% confidence interval (CI): 0.98–1.09, P = 0.267] and pre‐eclampsia (RR = 0.99, 95% CI: 0.90–1.08, P = 0.738). However, supplementation of multivitamins containing folic acid could prevent gestational hypertension (RR = 0.57, 95% CI: 0.43–0.76, P < 0.001) and pre‐eclampsia (RR = 0.64, 95% CI: 0.48–0.84, P = 0.001). The difference between folic acid fortification alone and multivitamins containing folic acid was significant. This meta‐analysis suggests that periconceptional multivitamin supplementation with appropriate dose, not folic acid alone, is an appropriate recommendation for pregnant women. The effect should be further confirmed by conducting large‐scale randomised controlled trials.     

Factors associated with breast milk intake among 9–10‐month‐old Malawian infants

Exclusive breastfeeding is recommended during the first 6 months of life; thereafter, continued breastfeeding along with nutritious complementary foods is recommended. Continued breastfeeding contributes a substantial proportion of nutrient needs and promotes healthy growth and development, but the quantity of breast milk consumed may be highly variable and little is known about the factors associated with breast milk intake after 6 months of age. The present study was conducted to assess factors associated with breast milk intake of Malawian infants at 9–10 months of age. Breast milk intake was measured using the dose‐to‐mother deuterium oxide dilution method in a subsample of 358 Malawian infants who were participating in a randomized controlled trial of lipid‐based nutrient supplements. Regression analysis was used to assess associations between breast milk intake and several maternal and infant variables. Mean (standard deviation) breast milk intake was 752 (244) g day^–1. In multiple regression, breast milk intake was positively associated with infant weight (+62 g per kg body weight, P < 0.01) and maternal height (P < 0.01) and negatively associated with maternal education and age (P < 0.01). There was a non‐significant (P = 0.063) inverse association between energy from non‐breast milk sources and breast milk intake. In this rural Malawian population, infant weight is the main predictor of breast milk intake, even after the first 6 months of life.     

Breastfeeding and maternal weight changes during 24 months post‐partum: a cohort study

The relationship between breastfeeding and the loss of weight gained during pregnancy remains unclear. This study aimed to investigate the association between breastfeeding and maternal weight changes during 24 months post‐partum. We studied a dynamic cohort comprising 315 women living in two cities in the state of Bahia, Brazil. The outcome variable was change in the post‐partum weight; the exposure variable was the duration and intensity of breastfeeding. Demographic, socio‐economic, environmental, reproductive and lifestyle factors were integrated in the analysis as covariates. The data were analysed using multiple linear regression and linear mixed‐effects models. The average cumulative weight loss at 6 months post‐partum was 2.561 kg (SD 4.585), increasing at 12 months (3.066 kg; SD 5.098) and decreasing at 18 months (1.993 kg; SD 5.340), being 1.353 kg (SD, 5.574) at 24 months post‐partum. After adjustment, the data indicated that for every 1‐point increase in breastfeeding score, the estimated average post‐partum weight loss observed was 0.191 kg at 6 months (P = 0.03), 0.090 kg at 12 months (P = 0.043), 0.123 kg at 18 months (P < 0.001) and 0.077 kg at 24 months (P = 0.001). Based on these results, we concluded that despite the low expressiveness, the intensity and duration of breastfeeding was associated with post‐partum weight loss at all stages of the study during the 24‐month follow‐up.     

Community‐based father education intervention on breastfeeding practice—Results of a quasi‐experimental study

Although the benefits of breastfeeding are well‐documented, little is known about how best to encourage fathers to support breastfeeding. A quasi‐experimental study of a community‐based intervention was designed to examine whether health education to promote fathers' involvement in supporting women is associated with early initiation and exclusive breastfeeding practices. At baseline, 802 couples of fathers with pregnant wives from 12 to 27 weeks of gestational age were recruited to either the intervention group (n = 390) or a control group (n = 412) consisting of couples seeking care through routine maternal and child health services. Fathers in the intervention area received breastfeeding education and counselling services in health facilities and at home visits during the antenatal, delivery, and post‐partum periods. Peer education and social exchange concerning breastfeeding were organized in fathers' clubs. After 1 year of the intervention, mothers in the intervention group were more likely to initiate early breastfeeding 49.2 and 35.8% in the intervention and control group respectively, P < 0.001. At 1, 4, and 6 months after birth, 34.8, 18.7, and 1.9% of the mothers in the intervention group were exclusively breastfeeding their children because of birth, respectively, compared with 5.7, 4.0, and 0.0% of those in the control group (P < 0.001). Those practices were associated with the intervention in bivariate and multivariate logistic and Cox regression analyses. Intervention targeting fathers at antenatal and postnatal periods may positively influence the breastfeeding practices of mothers, and it should be an important component of breastfeeding programs.     

Breastfeeding practices and child growth outcomes in Haiti: an analysis of data from Demographic and Health Surveys

Haiti's national nutrition policy prioritises breastfeeding, but limited data are available to inform strategy. We examined national trends in early initiation of breastfeeding (ErIBF) and exclusive breastfeeding (EBF) over a 10‐year period using data from three Haitian Demographic and Health Surveys (1994–1995, 2000 and 2005–2006). We used multivariate regression methods to identify determinants of ErIBF and EBF in the 2005–2006 data set and to examine relationships to growth. There was no change in ErIBF across surveys [1994–1995: 36.6%, 95% confidence interval (CI) 29.9–43.9; 2000: 49.4%, 95% CI 44.1–54.8; 2005–2006: 43.8%, 95% CI 40.5–47.1]. EBF among 0–5‐month‐olds increased sharply (1994–18995: 1.1%, 95% CI 0.4–3.2; 2000: 22.4%, 95% CI 16.5–29.5; 2005–2006: 41.2%, 95% CI 35.4–47.2). The proportion of breastfeeding children 0–5 months who received soft, solid or semi‐solid foods decreased (1994–1995: 68.5%, 95% CI 57.3–77.9; 2000: 46.3%, 95% CI 39.3–53.4; 2005–2006: 30.9%, 95% CI 25.9–36.5). Child age at time of survey [odds ratio (OR) 1.73; P = 0.027], lower maternal education (OR = 2.14, P = 0.004) and residence in the Artibonite Department (OR 0.31; P = 0.001) were associated with ErIBF among children 0–23 months. Age group and department were significant predictors of EBF among children 0–5 months. ErIBF was associated with higher weight‐for‐age z‐scores [effect size (ES) 0.22; P = 0.033] and height‐for‐age z‐scores (ES 0.20; P = 0.044). There was no statistically significant relationship between EBF and growth. The 10‐year ErIBF and EBF trends in Haiti echo global and regional trends. ErIBF and EBF are related practices but with different determinants in the Haitian context. These differences have implications for intervention delivery.     

Determinants of infant formula use and relation with growth in the first 4 months

The wide variety of infant formula available on the market can be confusing for parents and physicians. We aimed to determine associations between predominant type of formula used from birth to 4 months and parental and child characteristics and type of physician consulted, and then to describe relations between type of formula used and growth. Our analyses included 1349 infants from the EDEN mother–child cohort. Infant's feeding mode and type of formula used were assessed at 4 months by maternal self‐report. Infant's weight and height from birth to 4 months, measured in routine follow‐up, were documented by health professionals in the infant's personal health record. Anthropometric z‐scores were calculated by using World Health Organization growth standards. Multinomial logistic regression was used to identify factors associated with the type of formula predominantly used; relations with growth were analysed by linear regressions. Partially hydrolysed formulas were more likely to be used by primiparous women (P < 0.001), those breastfeeding longer (P < 0.001) and for infants with family history of allergies (P = 0.002). Thickened formulas were more often used by mothers returning to employment in the first 4 months (P = 0.05) and breastfeeding shortly (P < 0.001). No significant relation was found between infant's growth and type of formula (P > 0.20). Infants breastfed shorter showed higher weight‐for‐age (P < 0.001) and length‐for‐age (P = 0.001) z‐score changes between birth and 4 months. The use of a specific type of infant formula seems to be mainly related to parental characteristics. Infant's growth in the first 4 months is related to other factors than to the type of formula used.     

Breastfeeding is associated with the intelligence of school-age children in Mexico

Breastfeeding has been consistently associated with higher intelligence since childhood. However, this relation could be confounded due to maternal selection bias. We estimated the association between predominant breastfeeding and intelligence in school-age children considering potential selection bias and we simulated the intelligence gap reduction between low versus higher socioeconomic status children by increasing breastfeeding. We analysed predominant breastfeeding practices (breastmilk and water-based liquids) of children 0–3 years included in the Mexican Family Life Survey (MxFLS-1). Intelligence was estimated as the z-score of the abbreviated Raven score, measured at 6–12 years in the MxFLS-2 or MxFLS-3. We predicted breastfeeding duration among children with censored data with a Poisson model. We used the Heckman selection model to assess the association between breastfeeding and intelligence, correcting for selection bias and stratified by socioeconomic status. Results show after controlling for selection bias, a 1-month increase in predominant breastfeeding duration was associated with a 0.02 SD increase in the Raven z-score (p < 0.05). The children who were predominantly breastfed for 4–6 months versus <1 month had 0.16 SD higher Raven z-score (p < 0.05). No associations were found using multiple linear regression models. Among low socioeconomic status children, increasing predominantly breastfeeding duration to 6 months would increase their mean Raven z-score from −0.14 to −0.07 SD and reduce by 12.5% the intelligence gap with high socioeconomic status children. In conclusion, predominant breastfeeding duration was significantly associated with childhood intelligence after controlling for maternal selection bias. Increased breastfeeding duration may reduce poverty-driven intelligence inequities.     

Weight‐related self‐efficacy in relation to maternal body weight from early pregnancy to 2 years post‐partum

Excessive gestational weight gain may lead to long‐term increases in maternal body weight and associated health risks. The purpose of this study was to examine the relationship between maternal body weight and weight‐related self‐efficacy from early pregnancy to 2 years post‐partum. Women with live, singleton term infants from a population‐based cohort study were included (n = 595). Healthy eating self‐efficacy and weight control self‐efficacy were assessed prenatally and at 1 year and 2 years post‐partum. Body weight was measured at early pregnancy, before delivery, and 6 weeks, 1 year and 2 years post‐partum. Behavioural (smoking, breastfeeding) and sociodemographic (age, education, marital status, income) covariates were assessed by medical record review and baseline questionnaires. Multi‐level linear regression models were used to examine the longitudinal associations of self‐efficacy measures with body weight. Approximately half of the sample (57%) returned to early pregnancy weight at some point by 2 years post‐partum, and 9% became overweight or obese at 2 years post‐partum. Body weight over time was inversely related to healthy eating (β = ?0.57, P = 0.02) and weight control (β = ?0.99, P < 0.001) self‐efficacy in the model controlling for both self‐efficacy measures as well as time and behavioural and sociodemographic covariates. Weight‐related self‐efficacy may be an important target for interventions to reduce excessive gestational weight gain and post‐partum weight gain.     

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.     

Breastfeeding and childhood obesity: A 12‐country study

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (P_trend = .020) and 1.00, 0.64, 047, and 0.64 for high body fat (P_trend = .012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries.     

Randomized controlled trial of early skin‐to‐skin contact: effects on the mother and the newborn

Objective: To estimate the influence of skin‐to‐skin care on the thermal regulation of the infant and the rate of breastfeeding at different points of time. We also aim to establish whether skin‐to‐skin contact reduces maternal pain during episiotomy repair and decreases the time to expel the placenta. Methods: A randomized control study was performed with 137 patients in each branch of the study. Differences between the study groups were analysed with the unpaired t‐test, Fisher test or chi‐square test as appropriate. Results: Greater thermal stability in the skin‐to‐skin care group was found where an average temperature rise of 0.07°C was observed. Mothers in the skin‐to‐skin care group exclusively breastfed more frequently at discharge. Mean time to expel the placenta was lesser in the skin‐to‐skin care group. Conclusion: This study shows that skin‐to‐skin care implies better thermal regulation and a better proportion of exclusive breastfeeding at hospital discharge.     

Individualized breastfeeding support for acutely ill,malnourished infants under 6 months old

Reestablishing exclusive breastfeeding is the cornerstone of the 2013 World Health Organization (WHO) treatment guidelines for acute malnutrition in infants less than 6 months. However, no studies have investigated guideline implementation and subsequent outcomes in a public hospital setting in Africa. To facilitate implementation of the WHO 2013 guidelines in Kilifi County Hospital, Kenya, we developed standard operating procedure, recruited, and trained three breastfeeding peer supporters (BFPS). Between September 2016 and January 2018, the BFPS provided individual breastfeeding support to mothers of infants aged 4 weeks to 4 months admitted to Kilifi County Hospital with an illness and acute malnutrition (mid‐upper‐arm circumference < 11.0 cm OR weight‐for‐age z score < ?2 OR weight‐for‐length z score < ‐2). Infants were followed daily while in hospital then every 2 weeks for 6 weeks after discharge with data collected on breastfeeding, infant growth, morbidity, and mortality. Of 106 infants with acute malnutrition at admission, 51 met the inclusion criteria for the study. Most enrolled mothers had multiple breastfeeding challenges, which were predominantly technique based. Exclusive breastfeeding was 55% at admission and 81% at discharge; at discharge 67% of infants had attained a weight velocity of >5 g/kg/day for three consecutive days on breastmilk alone. Gains in weight‐for‐length z score and weight‐for‐age z score were generally not sustained beyond 2 weeks after discharge. BFPS operated effectively in an inpatient setting, applying the 2013 updated WHO guidelines and increasing rates of exclusive breastfeeding at discharge. However, lack of continued increase in anthropometric Z scores after discharge suggests the need for more sustained interventions.     

Influence of early life factors on body mass index trajectory during childhood: a population‐based longitudinal analysis in the Western Brazilian Amazon

Low‐ to middle‐income countries may experience the occurrence of a dual burden of under and overnutrition. To better understand the overall progression of body mass index (BMI) during childhood, we estimated average BMI‐for‐age z‐score (BAZ) growth curves in a population‐based longitudinal study of 255 children living in the Brazilian Amazon. Children were aged 0.1–5.5 years at recruitment (2003). We collected data on socio‐economic and maternal characteristics, children's birthweight and infant feeding practices. Child anthropometric measurements were taken in 2003, 2007 and 2009. BAZ differences among categories of exposure variables were calculated at 6 and 12 months, and 2, 7 and 10 years. At baseline, the mean (standard deviation) age was 2.6 (1.4) years; 12.9% were overweight and 3.9% thin. After adjustment, mean BAZ estimates were mostly negative. Boys were close to the median value for BAZ until 12 months, whereas girls were below the median (P = 0.05). Children from households above the wealth median were 0.36 z‐ and 0.49 z‐less underweight than poorer children at 7 and 10 years, respectively (P < 0.01). Maternal BMI was positively associated with children's BAZ since 12 months old; BAZ in children from overweight mothers was higher by 0.69 compared with their counterparts at 10 years (P < 0.01). Birthweight was positively related to BAZ up until 2 years (P = 0.01). Socio‐economic background and maternal nutritional status are important predictors of BAZ throughout childhood. Although excessive weight gain is a public health concern, it is critical to restrict inequities, while promoting healthier growth in developing countries.