Effects of Parity and Breastfeeding Duration on Bone Density in Postmenopausal Women

PurposeThis study aimed to identify the effect of parity and breastfeeding duration and the occurrence of lumbar vertebral and femoral neck osteoporosis in Korean postmenopausal women.MethodsThis study analyzed the data of 1,770 women based on the 2010–2011 results of the Korea National Health and Nutrition Examination Survey. Extracted data concerning bone density included variables known to be associated with osteoporosis. Complex sample multivariate logistic regression analysis was conducted to determine whether parity and breastfeeding duration were associated with osteoporosis in postmenopausal women.ResultsParity was not associated with postmenopausal osteoporosis in the femoral neck or lumbar vertebrae; however, the risk of femoral neck osteopenia was significantly higher in women with a history of 12–24 months of breastfeeding than in women who breastfed for less than 12 months (odds ratio = 2.12, 95% confidence interval = 1.07–4.21). In women who breastfed for 24 months or longer, the risk of lumbar vertebral osteoporosis was significantly higher than in those who breastfed for less than 12 months (odds ratio = 2.73, 95% confidence interval = 1.18–6.32).ConclusionBreastfeeding duration may affect the occurrence of lumbar vertebral or femoral neck osteopenia or osteoporosis. Therefore, women who breastfeed for one year or more require education on the risk of bone loss and the need for preventive measures such as adequate calcium intake and physical exercise.     

Reexamination of ultra‐thin nipple shield use,infant growth and maternal satisfaction

Aims and objectives. The primary objective of the multi‐site, international study was to examine trends in weight gain for term infants breastfed with and without ultra‐thin silicone nipple shields to determine the effect of nipple shield use on infant weight gain over two months. Additionally, the study examined maternal satisfaction with nipple shield use using a structured survey. Background. The nipple shield may facilitate successful breastfeeding outcomes when indicated. There has been question regarding infant weight gain with nipple shield use. A published pilot study using within‐subject design indicated no significant difference in infant test weights and maternal prolactin levels when breastfeeding with and without nipple shields. The current study builds and expands upon the pilot study. Design. Prospective, multi‐site, non‐randomised, between‐subject study. Method. Maternal‐infant dyads (n = 54) who used a nipple shield for breastfeeding were studied. Results. Results demonstrate no statistically significant difference in infant weight gain at two weeks, one month and two months between infants who breastfed with and infants who breastfed without a nipple shield. A majority (89·8%) of the women reported a positive experience with nipple shield use and 67·3% of the women reported that the nipple shield helped prevent breastfeeding termination. Conclusion. Infant weight gain was similar in maternal‐infant dyads using nipple shields for two months compared to those not using the shields. Maternal positive report of nipple shield use lends to the clinical importance of nipple shield use when appropriately indicated. Relevance to clinical practice. Nipple shield use may facilitate breastfeeding when clinically indicated in maternal‐infant dyads without risk of decreased infant weight gain.     

The influence of duration of breastfeeding on bone mass in postmenopausal women of different age groups

This study examines the influence of duration of breastfeeding on bone mineral density (BMD) and investigates the relationship between duration of breastfeeding and bone mass at four sites in postmenopausal women of different ages. A total of 509 postmenopausal women aged 45-86 years were included in the study. Patients were divided into three groups: never breastfed (n=67), < 96 months (n=157) and > or = 96 months (n=285); they were further classified into two age groups, 40-59 years (n=233) and 60-80 years (n=276). In all patients and in the 40-59 year age group, BMD of the spine was found to be significantly lower in the never-breastfed group, while BMD of the trochanter was significantly lower in the > or = 96 month breastfeeding group. BMD of the spine and femur tended to decrease with longer breastfeeding in all groups, while BMD of the spine and trochanter tended to decrease with longer breastfeeding in the 40-59 year group. Of patients in the 60-80 year group who had never breastfed, spinal BMD was significantly higher than that of the > or = 96 month group, while in the > or = 96 month group trochanter BMD was significantly lower than in other groups. In the never-breastfed group, ward's triangle BMD was significantly higher than that of other groups. There was a significant correlation between duration of breastfeeding and BMD of the spine, neck, trochanter and ward's triangle. The study suggests that duration of breastfeeding has an effect on BMD, and extended breastfeeding leads to lower BMD.     

Inherited understandings: the breast as object

This paper discusses findings from a research study that investigated the experience of being a breastfeeding woman in New Zealand. The study was motivated by a desire to better understand why the majority of New Zealand women wean their infants before 6 months of age, despite the benefits of prolonged breastfeeding being well accepted. Nineteen women, who were breastfeeding or had recently breastfed, were engaged in unstructured interviews about their experience, and the results were examined using a reflective lifeworld research methodology. The findings presented here demonstrate that women often employ an interpretive framework that is aligned with the philosophical tradition of Descartes' mind–body split, also know as Cartesian dualism. This leads to a widely held perception of the breast as an object, which emerged in the participants' narratives and is explored using Heidegger's philosophical interpretation of equipment. We conclude that the objectification of the breast in our society fails to provide women with language that describes the breastfeeding experience in a meaningful way, thus undermining women's ability to articulate and reconcile their embodied breastfeeding experiences.     

Infant hospitalization and breastfeeding post-caesarean section

BACKGROUND: Breastfeeding has been shown to protect infants from illness, but there is minimal published research on the relationship between illness and breastfeeding following caesarean delivery. AIM: To examine the association between post-caesarean breastfeeding and infant hospitalization in the first year of life. STUDY DESIGN AND METHODS: A retrospective cohort study of 468 term infants examined the relationship between infant hospitalizations and breastfeeding, using hospital admissions records and surveys from a post-caesarean breastfeeding intervention study in an Israeli hospital. RESULTS: A significantly lower proportion of Jewish infants breastfed for at least 4 months (40%; 42) was hospitalized in the first year, compared with non-breastfed infants (60%; 62) (P = 0.003). Among the Muslim infants who were breastfed, a significantly lower proportion were hospitalized (33%; 35) than those who were not hospitalized (67%; 71) and a greater proportion of non-breastfed infants were hospitalized (80%; 8) than those who were not hospitalized (20%; 2) (P = 0.005, Fisher's exact test). In the logistic regression models, the significant variables decreasing the likelihood of hospitalization for Jewish infants were being born to a non-immigrant mother, higher maternal education, and being breastfed, and for Muslim infants the only significant variable was being breastfed. CLINICAL IMPLICATIONS: Breastfeeding in post-caesarean women has a protective effect on infant health, as demonstrated by a decrease in illness-related hospitalizations in the first year of life.     

Predictors of the duration of exclusive breastfeeding among first-time mothers

Few women currently meet revised WHO recommendations to breastfeed exclusively for 6 months postpartum. In this prospective study we aimed to determine the influence of socio-demographic, psychosocial, and perinatal factors on the length of exclusive breastfeeding among 189 Canadian primiparous mothers. A majority of the participants did not meet their exclusive breastfeeding goals, and only 5% breastfed exclusively for a full 6 months. Breastfeeding self-efficacy, in-hospital formula supplementation, prenatal class attendance, and type of delivery independently predicted exclusive breastfeeding duration. Findings underscore the complex interplay of factors influencing breastfeeding, highlight the early postpartum weeks as a critical period for the establishment of exclusive breastfeeding, and suggest the need for a continuum of pre- and postnatal strategies for prolonging the exclusive breastfeeding period.     

Maternal return to work and breastfeeding: A population-based cohort study

Background

In recent decades there has been a marked rise in the participation of women with infants in the labour market, while there has been a decline in the prevalence rate of breastfeeding.

Objective

To explore the relationship between maternal return to work and breastfeeding.

Design

An on-going prospective longitudinal study.

Setting and participants

Multistage stratified systematic sampling was designed to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Participating women underwent two home interviews at 6 and 18 months after giving birth, following structured questionnaires. A total of 21,248 and 20,172 women were interviewed, and the completed interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health.

Results

The overall prevalence of initial breastfeeding was 83.7%. Postpartum women returning to work less than or equal to 1 month had the lowest initiation of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding duration less than or equal to 1 month (34.9%) than the overall population (26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12 months, respectively. Women with maternal leave of less than or equal to 6 months ceased breastfeeding earlier than those with maternal leave beyond 6 months and those who did not return to work up to 18 months after birth. After adjustment for potential confounders, odds ratios of initial breastfeeding seemed no different, except those for postpartum women who returned to work less than or equal to 1 month and those who did not return to work. Mothers returning to work within 1 year after giving birth were significantly earlier in weaning than those without return to work.

Conclusion

In our study, an early maternal return to work, especial within 6 months after giving birth, was a barrier to the initiation and continuation of breastfeeding. Thus, a comprehensive strategy is required to encourage the practice of breastfeeding in working women from pregnancy to the return to work, and nurses should work to promote breastfeeding in the different occasion.     

Becoming a role model: the breastfeeding trajectory of Hong Kong women breastfeeding longer than 6 months

While a substantial proportion of breastfeeding women stop early in the postpartum period, some women are able to breastfeed for longer periods. The aim of this research was to explore the experience of breastfeeding with a subsample of Hong Kong women who have breastfed for longer than 6 months. Participants (n=17) were recruited from a larger infant-feeding study (n=360) conducted in tertiary-care hospitals in Hong Kong. In-depth qualitative interviews were conducted and content analysis was used to analyse the data. Data analysis revealed four themes that encompassed the women's experiences: (1) making the decision, (2) maintaining family harmony, (3) overcoming barriers, and (4) sustaining lactation. Antenatally, participants anticipated that breastfeeding would be very 'difficult' and described how the practice did not fit with the image of a professional woman in Hong Kong. Despite family opposition, frequently from their mother-in-law, and lack of societal acceptance, difficulties were overcome by what the Chinese people call hung-sum or determination. This study highlights unique cultural and social findings affecting breastfeeding women in Hong Kong which may be useful to health-care providers working with Chinese women locally and internationally.     

Dietary intake of pregnant women and their infants in a poor black South African community

The aims of this study were (i) to determine the dietary intake of women in a poor rural area during pregnancy and lactation, and (ii) to determine the nutritional status and dietary intake of their infants at age 6 months. We recruited 46 women, below 40 years old, in their 2nd trimester of pregnancy. The subjects were living in a rural area of Limpopo Province. Their heights and weights were recorded, as were their diets during pregnancy and for the first 6 months after delivery. We also recorded weights, lengths, and dietary intake of the infants at 3 and 6 months after birth. The subjects were living in severe poverty: none had running water and almost all did their cooking over an open fire. None of the subjects smoked and only one consumed alcohol. The diets of the subjects consisted mainly of maize, brown bread, sweetened beverages (cold drink and tea), and small amounts of vegetables and chicken. The diets were adequate in protein but were marginal in energy and in dietary fibre, and may be deficient in numerous micronutrients, particularly calcium, iron, zinc, niacin, folate, and vitamins A, C, E, and B6. This was seen during pregnancy and lactation. Blood analysis 6 months after birth revealed normal levels of vitamins A and E and an absence of anaemia. Body mass index (BMI) of the women was 23.9 +/- 5.3 kg/m2 (mean +/- SD) when measured 6 months after birth. Those above 25 years old had a higher BMI than did younger subjects (25.5 vs. 22.2; p = 0.028). Overall, 24% were overweight (BMI 25-30) while 9% were obese (BMI > 30). Most infants (93%) were breastfed for at least 6 months but exclusive breastfeeding was only done by 65% of mothers. One-third of breastfed infants also received formula. The use of formula while breastfeeding was twice as common among mothers aged above 25 years (46% vs. 23%). Early introduction of solid foods was very common in this group. Younger mothers introduced solids in the first month (51%) more often compared with older mothers who tended to introduce solids at 2-3 months (64%). The most common solid food given was maize meal porridge (by 78% of all mothers). Mean BMI was low at birth (< 15), but this reached a normal value by 6 months. A significant fraction of the infants was underweight or short (i.e., stunted), based on being below the 3rd percentile compared with NCHS standards. Underweight was short length in girls. This study found that pregnant and lactating women had diets low in energy and micronutrients as reflected by the high prevalence of underweight at birth. Most infants were exclusively breastfed, but the benefit of this was offset by the early introduction of solid foods having a low energy and nutrient density. By 6 months, the prevalence of stunting had more than doubled.     

Infant feeding attitudes of expectant parents: breastfeeding and formula feeding

BACKGROUND: Research has indicated that parental attitudes are strong predictors of choice of infant feeding. Identification and understanding of the infant feeding attitudes of mothers and their social networks should be an early step in the design and implementation of breastfeeding interventions. AIM: To compare the infant feeding attitudes of parents of breastfed infants with those of parents of formula fed infants. METHODS: A survey was carried out with a convenience sample of pregnant women (gestational age 8-12 weeks) attending three maternity clinics in Scotland in 2000. Expectant mothers and their partners (n = 108 couples) completed the 17 item Iowa Infant Feeding Attitude Scale. Demographic information was collected by face-to-face interview and the method of feeding at discharge from hospital was obtained from medical records. RESULTS: Parents of breastfed infants had more positive attitudes towards breastfeeding than parents of formula fed infants, and were more knowledgeable about the health benefits and nutritional superiority of breastfeeding. Fathers of both breastfed and formula fed infants were more likely than their partners to disapprove of women breastfeeding in public. Parents considered their chosen method of feeding to be the more convenient alternative. Mothers of formula fed infants were more likely to think that women who occasionally drink alcohol should not breastfeed. CONCLUSION: Parents of formula fed infants had several misconceptions about breastfeeding. Use of the Iowa Infant Feeding Attitude Scale could help health professionals identify and address these in infant feeding discussions in the early antenatal period. Efforts should be made to include fathers in these infant-feeding discussions.     

Supporting breastfeeding mothers on children's wards: an overview

Just under half of all six-week-old babies in the U.K. are breastfed, and just under a quarter are still being breastfed at six months old so it is likely that children's nurses will frequently encounter breastfed babies on children's wards. Support for breastfeeding has traditionally been left to midwives but Department of Health guidance requires that all relevant staff have training in this practice. Children's nurses need to understand the principles and practice of breastfeeding support including correct positioning and attachment, prevention and management of breastfeeding problems, mothers' needs and safe use of breast pumps. Breastfeeding should be part of the curriculum for children's nursing courses, including practical sessions to observe breastfeeding support in the clinical setting. Children's nurses should be aware that literature and learning resources written for midwives might be appropriate for them to access to increase their understanding in this important area of practice.     

Differences in plasma and nipple aspirate carotenoid by lactation status

BACKGROUND: Dietary antioxidants, such as provitamin A carotenoid, have a protective effect against breast cancer. The transport of carotenoid from the blood into the breast microenvironment may be enhanced by lactation. OBJECTIVE: To examine the association between plasma and nipple aspirate carotenoid levels by lactation and post-wean status. METHODS: The sample consisted of 43 women, ages 18-45, who were at least 12 months postpartum. Women who had breastfed their last infant were at least 3 months post-wean. Women collected breast fluid every other day for 17 days and had a venipuncture for total nipple aspirate and plasma carotenoid, and completed a written health assessment. RESULTS: The association between plasma and nipple aspirate carotenoid levels was significant for breastfeeding women (r =.39, p=.03), but not for non-breastfeeding women (r =.31, p =.27). However, while the association between plasma and nipple aspirate carotenoid levels was significant for women at or less than 9 months post-wean (r =.65, p = .01), the effect for women after 9 months post-wean (r = .21, p =.45) was not significant. CONCLUSION: Lactation may be protective by enhancing the delivery of chemopreventive substances available in the blood to the cell level of the breast, even after breast involution has occurred post lactation.     

Women’s Perceptions of Hospital-Based Breastfeeding Care and the Association With Exclusive Breastfeeding

ObjectiveTo examine the differences in women’s perceptions of hospital-based breastfeeding care and the association of these perceptions with exclusive breastfeeding.DesignObservational, mixed-methods study.Setting/Local ProblemA 932-bed, Baby-Friendly Hospital Initiative–designated, university hospital with approximately 2,000 births per year, where 50% of women who wanted to breastfeed were supplementing with formula before hospital discharge.ParticipantsThirty-four women who gave birth to a term, singleton newborn and had a desire to breastfeed exclusively.MeasurementsWomen’s perceptions were assessed using a modified version of the Questionnaire for the Breastfeeding Mother.ResultsWomen’s perceptions of breastfeeding care were positively associated with exclusive breastfeeding (p = .049). In addition, the influence of how a woman’s own mother fed her as an infant was shown, because women who themselves were breastfed as infants were more likely to exclusively breastfeed their own newborns. Content analysis showed that women appreciated the care received in the hospital from lactation consultants and access to a hospital-administered breastfeeding clinic after discharge.ConclusionCreating a hospital environment supportive of breastfeeding could yield positive breastfeeding outcomes for women and newborns.     

Addressing concerns of pregnant and lactating women after the 2005 hurricanes: the OTIS response

Natural disasters are devastating for anyone affected, but pregnant and breastfeeding women often have specific concerns about the effects of certain exposures (such as infections, chemicals, medications, and stress) on their fetus or breastfed child. For this reason, the Organization of Teratology Information Specialists (OTIS) and the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention partnered to provide information for women and healthcare professionals about the effects of exposures on pregnancy and breastfeeding after the hurricanes of 2005. This service expanded on OTIS's existing telephone counseling and fact sheets. Through this project, fact sheets were created to address specific potential concerns regarding exposures after the hurricanes. The OTIS national toll-free telephone number also was modified to accommodate questions regarding hurricane-related exposures, and several strategies were used to publicize this number as a resource for obtaining hurricane-related exposure information related to pregnancy and breastfeeding. This article describes OTIS's response after the 2005 hurricanes, the challenges encountered in implementing the response, and lessons learned that might be useful to improve the response to the unique needs of this special population after any disaster or public health emergency.     

The effect of a postnatal education and support program on breastfeeding among primiparous women: a randomized controlled trial

Introduction

Women's traditional way of breastfeeding has altered in Jordan with rates declining in recent years.

Objective

The objectives of this study were to test whether the introduction of an educational program supporting breastfeeding would increase the proportion of women who breastfed fully to six months, improve the women's level of breastfeeding knowledge, and decrease the proportion of infants admitted to hospitals due to gastrointestinal illnesses.

Methods

A randomized controlled trial was conducted in 90 primiparous women who had given birth to a healthy, full term, singleton baby at two hospitals in the southern region of Jordan. Women were randomly allocated to either the intervention group (n = 45), in which they were offered a one-to-one postnatal educational session and follow-up phone calls at two months and four months postpartum, or the control group (n = 45), in which they received routine postnatal care. The primary outcomes were the proportion of women fully breastfeeding their babies at six months and the women's level of breastfeeding knowledge at six months postpartum.

Results

The postnatal education and support program significantly improved breastfeeding knowledge measured by differences between mean pre- and post-test scores. This was statistically significant for the intervention group (p < 0.001) but was not significant for the control (p = 0.23). The proportion of women fully breastfeeding their babies at 6 months was not found to be statistically significantly different between the intervention group (39%) and the control group (27%), percentage difference = 12% (95% confidence interval [−9% to 30%], Chi squared: χ² = 3.54, p > 0.05).

Conclusions

Although the postnatal education and support program improved breastfeeding knowledge among women in the study, this increase in knowledge did not translate to an increase in the duration of full breastfeeding to six months.     

Literature review. Outcomes associated with postnatal exposure to polychlorinated biphenyls (PCBs) via breast milk.

Forty years ago manufacturers commonly used polychlorinated biphenyls (PCBs) in a wide variety of products. In the late 1970s, following research demonstrating neurotoxicity in animals, even at low levels, PCBs were banned internationally. Today PCBs are widespread environmental contaminants and may be isolated from breast milk of women worldwide. This article provides an overview of the current research on the relationship between PCBs in breast milk and their effects on breastfed children with regard to neurological effects, growth and maturity, potential mitigating effects of breastfeeding, and immunologic effects. The vast majority of results from this body of research indicate that despite higher PCB loads, breastfed children continue to fare better than their formula-fed peers. At this point, there is no evidence of a threshold among the general population beyond which the risks of breastfeeding outweigh the benefits, nor is there any evidence demonstrating a clinically significant negative effect of postnatal exposure to PCBs via breast milk. To date the majority of studies conclude that despite substantially higher PCB loads among breastfed infants, breastfeeding is still preferable to formula feeding.     

Breastfeeding initiation and duration in Lebanon: Are the hospitals “mother friendly”?

Eight hundred and thirty mothers and their children aged 1 to 5 years were studied to identify the determinants of breastfeeding initiation and perseverance in relation to hospital policies. Only 18.3% of the mothers initiated breastfeeding within half an hour after birth. Mothers whose baby was brought to them every 3 hours or less were 2.5 times and mothers whose infants were brought to them for night feedings were 3 times more likely to initiate breastfeeding a few hours after birth. Mother's occupational status and whether she was breastfed were significantly associated with breastfeeding duration.     

Despite intention to breastfeed,smoking during pregnancy is associated with shorter breastfeeding duration

While maternal smoking is associated with lower breastfeeding rates, the intention to breastfeed is simultaneously related to higher breastfeeding success. This study aimed to i) analyse the association between maternal smoking and breastfeeding success in a cohort of women who intended to breastfeed and ii) characterise smokers according to a set of diverse variables in order to define efficient breastfeeding promotion interventions. This prospective observational study involved 401 pregnant women who intended to breastfeed. Breastfeeding success was evaluated in relation to maternal smoking status during pregnancy from birth to the first year, along with physiological and socio-cultural variables. Those who smoked during pregnancy had shorter breastfeeding durations when compared to non-smoking mothers. However, smoking cessation during breastfeeding was associated with longer breastfeeding duration. Mothers who smoked during pregnancy were significantly younger, had a lower level of education, gained more weight during pregnancy, used more oxytocin during labour, used a teat or pacifier more often and exclusively breastfed less during the first week. Knowledge of the characteristics of smoking mothers and their breastfeeding practices should help to improve the effectiveness of breastfeeding promotion strategies.     

Should breastfeeding mothers avoid allergenic foods?

Questions about maternal diet in lactation are common in clinical nursing practice, for nurses often work with breastfeeding women who are concerned about allergies, or who associate infant symptoms of crying or irritability to something they themselves have eaten. Can exposure to food proteins in a woman's diet actually cause food allergy in her breastfed child? Are special diets effective in managing infant allergic symptoms or gastrointestinal distress? The purpose of this article is to review the evidence related to diet for new breastfeeding mothers and make recommendations to guide clinical practice; seven such practice recommendations were developed after a thorough literature review. Nurses can use this literature summary to provide care based upon the best available research evidence.