Breastfeeding pattern and the duration of lactational amenorrhea in urban Chilean women

The influence of the breastfeeding pattern and several clinical variables upon the duration of postpartum amenorrhea was assessed in a group of healthy women selected for having had a normal pregnancy and delivery and being highly motivated for prolonged breastfeeding on demand. 676 women who were fully nursing at the second month postpartum entered the study. Supplements were administered to 11% and 48% of the infants by the end of the 3rd and 6th month, respectively. The first bleeding was experienced before the end of the sixth month postpartum by 57% of the cases. Supplementation had a strong negative influence while nursing frequency had a significant positive influence upon the length of amenorrhea. Notwithstanding, a frequency of 8+ suckling episodes per 24 h could not maintain amenorrhea in around half of the subjects. Age and parity had a moderate negative influence upon the risk of experiencing the first postpartum bleeding. Maternal weight and ponderal index, infant sex, birth weight and growth rate showed no significant influence upon the length of amenorrhea. In this urban population selected for having the highest motivation and best breastfeeding performance, the association of breastfeeding with amenorrhea was weak in comparison with what has been described for other populations. The risk of experiencing the first bleeding was reduced while fully breastfeeding with a high number of nursing episodes per day and night, particularly in older women with higher parity. But even in such situation 25% and 50% of the women had started to cycle by the end of the fifth and eight postpartum month.     

Breastfeeding: its relationship with postpartum amenorrhea and postpartum sexual abstinence in a Nigerian community

Breastfeeding, together with its two related postpartum variables--amenorrhea and abstinence--govern both the tempo and quantum of fertility in traditional African societies. Decline in breastfeeding also implies decline in postpartum amenorrhea and abstinence practice. Changes in breastfeeding practices in tropical Africa, therefore, has fertility implications and consequences. This paper examines how breastfeeding is functionally related to postpartum amenorrhea and abstinence in Ilorin, an urban community in Nigeria. Results indicated that the effect of breastfeeding on fertility, through its relationship with postpartum abstinence, might be more important than its effect through lactational amenorrhea in this society. This is more true among women with little or no education than among women with secondary or higher education. The population or family planning implications of these relationships are discussed.     

Progestin-only contraception prevents bone loss in postpartum breastfeeding women

BackgroundThere are an increase in bone loss during the first 6 months postpartum and a complete recovery postweaning. A few studies of steroid contraceptive use during this period provide some evidence towards protection of bone loss with progestin-only contraceptive methods.ObjectiveThe study was conducted to evaluate forearm bone mineral density (BMD) of breastfeeding postpartum women using nonhormonal and progestin-only contraceptive methods.Study DesignA prospective cohort study of postpartum women had an analysis performed at 6 months postpartum correlating BMD with contraceptive use. Forearm BMD was measured 7–10 days, 3 months and 6 months postpartum. Eighty-two women were analyzed, comparing nonhormonal (54) and progestin-only (28) contraceptive methods. Information about breastfeeding duration, amenorrhea and body mass index was collected.ResultsBaseline characteristics of the study population showed no statistical differences between the groups. The median duration of breastfeeding for both groups was 183 days. A significant BMD decrease was observed for the nonhormonal group (p<.001); however, no statistical difference was detected for the progestin-only group. Body mass index, BMD at 7–10 days postpartum and total duration of breastfeeding were positively correlated with BMD at 6 months.ConclusionsOur findings suggest a preventive effect towards postpartum bone loss with progestin-only contraception in breastfeeding women.     

A study of breastfeeding and the return of menses and pregnancy in Karachi, Pakistan

A longitudinal study of breastfeeding women was conducted to determine whether breastfeeding frequency is associated with the length of postpartum amenorrhea. The data are also conducive to testing the guidelines of the "Bellagio Consensus" (i.e., that there is no more than a 2% chance of pregnancy during breastfeeding in the first six months postpartum in the absence of vaginal bleeding and regular supplements). Twenty-eight breastfeeding women were followed-up weekly in Karachi, Pakistan. The frequency of breastfeeding was found to be a poor correlate of the duration of amenorrhea. Thirty-six percent of the women became pregnant during the study. However, all were having menses and/or giving regular supplements before the estimated date of conception, consistent with the Bellagio Consensus. In countries such as Pakistan, where contraceptive use is low, active promotion is needed to prevent the further decline of breastfeeding in order to retain its contraceptive as well as other maternal and child health benefits.     

The contraceptive effect of breastfeeding

The fertility-reducing impact of breastfeeding, the hormonal mechanism of lactational amenorrhea, the cultural and individual behavioral variables that influence the hormonal mechanism and the duration of amenorrhea, and the policy implications of extending postpartum protection by using lactational amenorrhea as a complementary contraceptive are discussed. Recent studies indicate that the contraceptive effect of lactational amenorrhea is considerable, with use-effectiveness rates comparable to those of oral contraceptives, the condom, or the diaphragm; according to 1 estimate, breastfeeding provides 35 million couple-years of protection annually in developing countries, compared with 27 million provided by family planning programs. The contraceptive effect of breastfeeding is largely lost after the return of menstruation. The physiological processes by which lactation inhibits the ovulatory cycle in humans are poorly understood, although a close association is known to exist between frequent sucking, high prolactin levels, altered LH secretion, and amenorrhea. The length of the breastfeeding period and the timing of the addition of supplementary foods influence both the duration of amenorrhea and the frequency and intensity of nursing. Maternal age and demand vs. scheduled feeding may be secondary factors affecting the duration of amenorrhea. Cultural beliefs and norms regarding breastfeeding practices are of extreme significance in determining the duration of lactational amenorrhea. Flexible family planning programs which encourage the continuation of breastfeeding while promoting the use of appropriate contraceptive methods initiated when they will affect fertility are needed in developing countries.     

Does Use of the Calendar in Surveys Reduce Heaping?

This study examines heaping of reported durations of three postpartum variables in five countries based on two methods of data collection in retrospective surveys. Two Demographic and Health Surveys were conducted for each of the countries, one that used a five-year month-by-month calendar to record the durations and a subsequent survey in which duration information was collected from simple questions in the body of the questionnaire. Heaping indexes were calculated for breastfeeding, amenorrhea, and abstinence at six, 12, 18, and 24 months postpartum. Use of the calendar was associated with a significant reduction in the proportion of heaped responses for both breastfeeding and amenorrhea, and the effect increased for longer durations. To obtain more accurate information about these variables, the authors recommend the use of the calendar.     

Statement on breast feeding,fertility and contraception

An important part of the human reproductive process, breastfeeding also plays a key role in infant nutrition while protecting the infant from exposure to infection. Breastfeeding also plays a major role in the natural regulation of fertility, but breastfeeding patterns are changing along with urbanization and lifestyle changes. These changes are tending towards a shortening of the duration of breastfeeding, a reduction in the daily frequency of breastfeeding episodes, and an earlier introduction of food supplements. Consequently, the risk of pregnancy during lactation has increased. The literature suggests considerable variability in the length of breastfeeding and postpartum amenorrhea and in the duration of lactational infertility among different populations. Both the return of ovarian activity and fertility depends on the time elapsed since delivery. Variables that play a primary role in the length of amenorrhea and infertility include: the duration of breastfeeding the frequency and duration of suckling; the administration of supplements to the infant; the mother's nutritional status; and geographic, social, and cultural factors. Knowledge of local breastfeeding practices and the associated risks of pregnancy should be a prerequisite for those counseling nursing women. All women should be advised and encouraged to breastfeed fully, as far as is practicable. Women also need to be informed that it is difficult to predict exactly the duration of lactational infertility for each woman. The timing of the introduction of contraception depends on the risk factors and some programmatic aspects, such as the possibility that the woman may not return after delivery or after the 1st postpartum visit as well as the type of contraceptive chosen. Current information on the influence of contraceptive methods -- IUDs, oral contraceptives, injectable contraceptives, norplant, barrier methods, periodic abstinence, and sterilization -- upon breastfeeding are summarized.     

Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US

Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.     

Effectiveness of professional breastfeeding home-support

The effect of professional home-support on the success of breastfeeding was investigated to determine whether breastfeeding women who received professional home-support would breastfeed longer than similar women who did not receive this support. Fifty-two volunteers of lower socio-economic status were recruited for this study from four obstetrical clinics and were randomly assigned to an intervention or a comparison group. Both groups received the standard clinic and in-hospital breastfeeding teaching and were given breastfeeding instruction in the hospital by the researcher. The women in the intervention group received, in addition, an average of seven home breastfeeding support contacts by the researcher over two months postpartum, and were provided with the researcher's phone number. Women in the comparison group did not receive home visits but had access to the clinic nutritionist if any questions or problems arose.More than half (61.5%) of the intervention group subjects were still breastfeeding at two months post-partum versus approximately one-third (34.6%) of the comparison group (p < 0.01). These results suggest that professional home breastfeeding support programs may be effective in increasing the duration of breastfeeding among this population, thereby achieving one of the Surgeon General’s health objectives.     

产后返岗女性母乳喂养持续时间及其影响因素的研究

目的 调查产后返岗女性母乳喂养现况,探讨母乳喂养持续时间的影响因素。 方法 采用一般资料调查表、母乳喂养知识量表、IOWA 婴儿喂养态度量表、母乳喂养家庭支持问卷、母乳喂养支持的员工感知问卷对344名产后返岗女性进行调查,应用Cox回归探讨产后返岗女性母乳喂养持续时间的影响因素。 结果 产后返岗女性6个月纯母乳喂养率为38.7%;母乳喂养持续时间均值为10.07个月;Cox回归显示,家庭月收入、最小孩子年龄、IOWA婴儿喂养态度对母乳喂养持续时间有显著影响（P<0.05）。 结论 产后返岗女性6个月纯母乳喂养率较低,母乳喂养持续时间不容乐观,应重点关注经济水平较低的家庭,完善母乳喂养体系,保障持续母乳喂养的成功实现。     

健康教育在产后访视中的应用体会

目的总结与探讨健康教育在产后访视中的应用价值。方法将本中心辖区樟洋社区内产妇分访视组(观察组)和未访视组(对照组)各60例,了解两组母婴健康状况,访视组给予母乳喂养知识、婴儿护理保健、产褥保健等健康教育指导并评价健康教育的效果。结果访视组产妇明显提高自我保健意识和育儿知识水平,更好地促进母婴健康。结论健康教育在产后访视中的实施,解决了产妇出院后知识面不足的问题,消除或减轻了影响母婴健康的危险因素,提高母婴生活质量及社会效益,是保障母婴健康的重要环节。     

Lactational amenorrhea and the recovery of ovulation and fertility in fully nursing Chilean women

The probability of experiencing the first postpartum bleeding, the first ovulation and the risk of pregnancy during exclusive breastfeeding was assessed in a selected group of urban Chilean women. Admission criteria included having had a normal pregnancy and a vaginal term delivery of a healthy infant and the desire to maintain breastfeeding for as long as possible. The risk of bleeding and the recovery of ovulation was assessed in 48 women selected for being amenorrheic and fully nursing at day 75 postpartum and their willingness to participate in the blood sampling protocol. The first bleeding and ovulation was experienced while fully nursing by 28% and 26% of these subjects, respectively, at day 180 postpartum. The probability of experiencing the first bleeding and the probability of pregnancy during full nursing were calculated for 236 women not contracepting who were enrolled during the first month postpartum. The cumulative probability of bleeding and of pregnancy was 52% and 9.4% at day 180 postpartum, respectively. The risk of pregnancy was less than 2% in the subset of amenorrheic cases. In this urban population selected for having the highest motivation and best breastfeeding performance, the association of breastfeeding with infertility was too weak to serve as an effective birth spacer, except for the period of lactational amenorrhea. When the first postpartum bleeding took place before the sixth postpartum month in fully nursing women, it had a good predictive value to indicate the onset of a higher risk period.     

Contraceptive efficacy of lactational amenorrhea in urban Chilean women.

The contraceptive efficacy of breastfeeding was assessed in 236 healthy urban women who were followed at monthly intervals during the first postpartum year. Proportional hazard models were used to evaluate the influence of time postpartum, menstrual status and breastfeeding pattern upon the risk of pregnancy. Time and menstrual status had a highly significant effect on this risk. Those women who remained in amenorrhea had cumulative probabilities of pregnancy of 0.9% and 17% at 6 and 12 months postpartum, respectively. In those who recovered menstrual cycles, the risk rose to 36% and 55% at 6 and 12 months, respectively. Milk supplementation also increased significantly the risk when considered alone but not when time and/or menstrual status were included in the analysis. However, amenorrheic women who introduced bottle feeding, had a higher risk of pregnancy after 6 months postpartum than those who remained fully nursing. The analysis was unable to detect a significant influence of the nursing frequency. The results confirm that lactational amenorrhea is an effective contraceptive during the first six months postpartum. The first postpartum bleeding marks a great increase in the risk of pregnancy. Supplementation also increases the risk, particularly in amenorrheic women.     

Breastfeeding effects on birth interval components: a prospective child health study in Gaza

Data that were collected prospectively from a child health study conducted in Gaza show a strong relationship between breastfeeding and two major components of birth intervals, the postpartum anovulatory period and the waiting time to conception. The Gaza population is similar to other populations in the Middle East in having moderate durations of breastfeeding and short intervals between births. The finding of a strong positive association between breastfeeding and the length of postpartum amenorrhea is as expected from numerous other studies. The relationship between breastfeeding behavior and the waiting time to conception is examined using hazard model analysis. Women who are breastfeeding when menstruation resumes and continue to do so are less likely to conceive than other women, according to the analysis.     

Breastfeeding and postpartum weight retention in a cohort of Brazilian women

BACKGROUND: The relation between postpartum weight retention and breastfeeding practices is controversial. OBJECTIVE: Defining breastfeeding as the period when a child is exclusively or predominantly breastfed, we studied the association between breastfeeding duration and postpartum weight retention. DESIGN: We followed 405 women aged 18-45 y who were assessed at 0.5, 2, 6, and 9 mo postpartum. The outcome variable, postpartum weight retention, was expressed as the difference between the observed weight at each follow-up and the reported prepregnancy weight. The main statistical procedure used was the longitudinal mixed-effects model. RESULTS: Mean postpartum weight retention at the end of the study was 3.1 kg. Single women aged > or = 30 y retained more weight than did younger single women or married women. The combined effect of breastfeeding duration and percentage of body fat at baseline was significant only for women with < 30% body fat. According to the model's prediction, when women who had 22% body fat and breastfed for 180 d were compared with those who had 22% body fat and breastfed for only 30 d, each month of breastfeeding contributed -0.44 kg to postpartum weight retention. When only the percentage of body fat was varied, the total effect was 3.0, 1.7, 1.2, and 0.04 kg in women with 18%, 25%, 28%, and 35% body fat, respectively. CONCLUSIONS: These results support the hypothesis of an association between breastfeeding and postpartum weight retention and suggest that encouraging prolonged breastfeeding might contribute to decreases in postpartum weight retention.     

The contraceptive benefit of breastfeeding

Breastfeeding has long been a means of fertility regulation in traditional communities but only recently have attempts been made to characterize and quantify this attribute. Breastfeeding encompasses behavioral, geographical, and cultural factors, which account for the differences in the prevalence and practice of breastfeeding in different communities. Ovarian activity is suppressed in the breastfeeding mother. Initially the suppression is complete and the woman is amenorrheic. This is followed by anovulatory menstrual cycles or ovulatory cycles that manifest luteal phase deficiency or normal ovulatory cycles. The duration of ovarian follicular suppression is variable and recent work suggests that lactation suppresses ovarian activity by disturbing the pulsatile pattern of luteinizing hormone (LH) secretion. During lactational amenorrhea, prolactin levels are high, LH levels are low to normal. Follicle stimulating hormone concentrations are normal by four weeks postpartum, and estrogen and progesterone levels are low. The degree of ovarian suppression is enhanced by increased frequency of suckling, longer duration of feeds, and more frequent night-time feeds. Introduction of supplementary feeds inhibits ovarian suppression. These and other factors account for variations in the length of lactational amenorrhea in an individual and between populations. The Bellagio Consensus Statement affirms that the risk of pregnancy in a fully breastfeeding, amenorrheic woman in the first six months of lactation is less than 2%. After the sixth month it is increasingly likely that ovulation will precede the first menstruation. The Bellagio Consensus has given scientific validity to birth-spacing in developing countries and the lactational amenorrhea method (LAM) as a means of contraception. If breastfeeding ceases to be full, menstruation resumes, or the baby is more than six months old, alternative methods of contraception should be used. Breastfeeding should feature more prominently in fertility regulation programs and counseling, especially in developing countries.     

哺乳期闭经的影响因素分析

利用世界卫生组织课题“健康教育对哺乳和避孕行为的影响—上海市产后妇女哺乳和避孕行为队列研究”的调查资料,分析了不同因素对哺乳期闭经的影响。多元COX回归分析结果发现市区(黄浦区和普陀区)对象中闭经时间短,月经初潮年龄小的妇女闭经时间也短。按时喂养、每昼夜喂奶次数少、哺乳时间短的对象闭经时间短。哺乳期闭经时间的长短因受多种因素的影响(尤其是哺乳的情况),在作为一种避孕方法使用时应注意其避孕效率。     

婴幼儿母乳喂养持续时间的影响因素研究——基于广州市越秀区抽样调查研究

目的 了解一线大城市母乳喂养现状,探讨影响母乳喂养时间的因素,为相关卫生法规的制定、社区宣教内容和模式的确定提供参考依据.方法 通过编制调查问卷对广州市越秀区3岁以下婴幼儿母亲进行抽样调查(共调查383人).利用生存分析的方法分析母乳喂养持续时间,通过Log-rank检验进行单因素分析,运用Cox比例危险模型分析影响母乳喂养持续时间的因素.结果 所调查的383名3岁以下婴幼儿母乳喂养持续时间的中位数为7个月.多因素分析显示,婴儿能否顺利吸食母乳(P=0.002)、是否过早给婴儿添加奶粉(P<0.0001)以及母亲对母乳喂养的认知程度(P=0.0025)显著影响母乳喂养持续时间;母亲对合理母乳喂养时间的认可(P<0.001)以及非城市户籍(P=0.002)会延长母乳喂养持续时间;此外,母亲文化程度较低和较高的婴幼儿母乳喂养时间较长.结论 母亲正确的母乳喂养意识在婴儿喂养中起到至关重要的作用;参加母乳喂养培养班有助于增强母亲对母乳喂养的认知;建议对中等学历和城市户籍的母亲进行有针对性的宣教,并制定相关保护性的政策法规.     

Predictors of anticipated breastfeeding in an urban, low-income setting

BACKGROUND: Although the proportion of women who breastfeed is known to vary by demographic group, breastfeeding practices have not been sufficiently studied among urban, lower income African American populations seen in family medicine centers. METHODS: A cross-sectional design was used to examine demographic, clinical, and attitudinal factors that affect anticipated infant feeding practices reported by postpartum women from a low-income, urban family practice setting. Data was analyzed using chi-square, odds ratios (OR), and multiple logistic regression techniques. RESULTS: Among 66 respondents, only 3 subjects (4.5%) indicated that they planned to breastfeed exclusively, while an additional 11 subjects (16.7%) reported plans to use a combination of bottle-feeding and breastfeeding. Based on univariate analyses, women with less than 12 years of education were less likely to report anticipated breastfeeding. Otherwise, breastfeeding plans were not associated with subject demographic features or with reproductive characteristics. Respondents planning to bottle-feed noted that breastfeeding was too complicated. Logistic regression demonstrated an inverse relationship between level of maternal education and anticipated breastfeeding (OR=0.13, 95% confidence interval [CI], 0.05-0.35), and a direct association for encouragement from the baby's father or the woman's mother to breastfeed and anticipated breastfeeding (OR=12.4; 95% CI, 4.92-31.4). CONCLUSIONS: This study reports unique data regarding anticipated infant feeding practices among patients from an urban, low-income community served by a family medicine center. Findings from this study will be used to develop a family-centered educational intervention involving the mothers, grandmothers, and partners of pregnant patients to promote the benefits of breastfeeding in this community.