Impact of maternal pre-pregnancy body mass index on maternal,fetal and neonatal adverse outcomes in the worldwide populations: A systematic review and meta-analysis

ObjectiveSystematic review and meta-analysis conducted to investigate the effect of stratified pre-pregnancy maternal body mass index on twenty maternal and fetal/neonatal adverse outcomes.MethodsPubMed, Google Scholar, Medline, Embase, Web of Science databases were searched from inception till July 11, 2020. Cohort studies were included. The pooled odds ratio with 95% confidence interval was reported considering the random effect and the quality effect model. The sub-group analysis and meta-regression were conducted for BMI cut-offs, geographical region, source of BMI, and sample size.ResultsOverall, 86 studies representing 20,328,777 pregnant women were included in this meta-analysis. Our study reveals that overweight and obese mothers are at increased odds of cesarean delivery, elective cesarean delivery, emergency cesarean delivery, gestational diabetes, gestational hypertension, induction of labor, postpartum hemorrhage, pre-eclampsia, pre-term premature rupture of membrane, and the fetuses/neonates of overweight and obese mothers are at increased risk of admission in the newborn intensive care unit, APGAR scores less than 7 at 5 min, large for gestational age, macrosomia, extreme pre-term birth in pregnant mothers compared with standard BMI mothers. However, the underweight mothers showed increased odds for small for gestational age infant and pre-term birth, whereas obese mothers were at higher risk for post-term birth and stillbirths. The subgroup and meta-regression analyses have shown the impact of BMI cut-offs, geographical region, source of BMI, and sample size on several maternal, fetal/neonatal adverse outcomes.ConclusionThe meta-analysis confirmed the association of elevated pre-pregnancy maternal BMI with higher odds of adverse maternal and fetal/neonatal outcomes.     

Infant Feeding Varies Across Eating Behavior and Feeding Modalities in Mothers With Low Income

ObjectiveTo examine if eating behaviors in mothers with low income relate to attitudes toward infant feeding and whether associations differed between breastfeeding and formula-feeding mothers.DesignCross-sectional study.ParticipantsForty postpartum women (aged ≥ 18 years, body mass index ≥ 25 and < 40 kg/m²) in the Louisiana Women, Infants, and Children program participated in a telehealth postpartum intervention for health and weight loss.Main Outcome Measure(s)Maternal eating behaviors and infant feeding styles, assessed 6–8 weeks after birth (baseline) using validated questionnaires.AnalysisSignificance was detected using independent t tests, chi-square tests for independence, or linear models (P < 0.05).ResultsMost mothers formula-fed (n = 27, 68%). In formula-feeding mothers, maternal disinhibition and perceived hunger were positively associated with restrictive infant feeding (β = 0.41, P <0.001 and β = 0.41, P = 0.001, respectively). These relationships were significantly higher (Δ = ?0.85, P = 0.006 and Δ = ?0.59, P = 0.003, respectively) than among breastfeeding mothers. Comparatively, pressuring/overfeeding was lower in formula-feeding mothers than among breastfeeding mothers with dietary restraint (Δ slopes: 1.06, P = 0.02).Conclusions and ImplicationsIn this cohort of mothers with low income, maternal eating behavior was associated with infant feeding styles only when feeding modality was considered. Mothers may benefit from education on how their eating behaviors can influence their infants and children.     

The effect of immediate postpartum depot medroxyprogesterone on early breastfeeding cessation

BackgroundThis study evaluated the effect of immediate postpartum depot medroxyprogesterone (DMPA) on breastfeeding cessation within 6 weeks postpartum.Study DesignAt low-income-serving obstetric and pediatric clinics, eligible mothers within 1 year postpartum were recruited to participate in a retrospective cohort study. The 183 participants completed a self-administered survey. Surveys were merged with birth certificate data and perinatal maternal/infant medical records. Kaplan–Meier distributions assessed the relationship between DMPA use and breastfeeding cessation. A multivariable Cox proportional hazards model estimated hazard ratios (HRs) and included five known risk factors (age, education, race, parity and parental cohabitation) and identified potential confounders.ResultsConsistent with the biologic model, the Kaplan–Meier results raised the possibility of a detrimental effect of DMPA on duration of any breastfeeding, but differences in these distributions did not achieve statistical significance (p=.24); after adjustment for potential confounders, this nonstatistically significant association remained (HR: 1.22; confidence interval: 0.75–1.98).ConclusionGiven the state of the evidence, it is unclear whether a causal effect does or does not exist. However, if there is a causal effect of DMPA on breastfeeding duration, it is minimal. Additional well-designed research is warranted.     

Infant and Young Child Feeding Practices among Adolescent Mothers and Associated Factors in India

Adequate infant and young child feeding (IYCF) improve child survival and growth. Globally, about 18 million babies are born to mothers aged 18 years or less and have a higher likelihood of adverse birth outcomes in India due to insufficient knowledge of child growth. This paper examined factors associated with IYCF practices among adolescent Indian mothers. This cross-sectional study extracted data on 5148 children aged 0–23 months from the 2015–2016 India National Family Health Survey. Survey logistic regression was used to assess factors associated with IYCF among adolescent mothers. Prevalence of exclusive breastfeeding, early initiation of breastfeeding, timely introduction of complementary feeding, minimum dietary diversity, minimum meal frequency, and minimum acceptable diet rates were: 58.7%, 43.8%, 43.3%, 16.6%, 27.4% and 6.8%, respectively. Maternal education, mode of delivery, frequency of antenatal care (ANC) clinic visits, geographical region, child’s age, and household wealth were the main factors associated with breastfeeding practices while maternal education, maternal marital status, child’s age, frequency of ANC clinic visits, geographical region, and household wealth were factors associated with complementary feeding practices. IYCF practices among adolescent mothers are suboptimal except for breastfeeding. Health and nutritional support interventions should address the factors for these indicators among adolescent mothers in India.     

中国产妇分娩方式与全母乳喂养率关联性的Meta分析

目的:系统评价我国产妇不同的分娩方式与婴儿4个月内全母乳喂养率的关联性。方法:检索CNKI、万方、维普数据库2000～2012年间公开发表的关于产妇分娩方式与婴儿喂养方式间关联性的研究。选择Revman 5.0软件进行统计分析,各研究间存在统计学异质性(P<0.000 01),故采用随机效应模型合并效应值OR及其95%CI。结果:检索到265篇文献,最终纳入11篇文献。Meta分析结果显示,产妇经阴道分娩后与剖宫产术分娩后的全母乳喂养率合并效应值OR及其95%CI为:OR=2.15,95%CI:1.74～2.65,P<0.000 01。根据观察时间进行亚组分析,亚组产后7天内,产后的第14天,产后28天内,产后的第42天,产后4个月内,差异无统计学意义(P=0.73)。结论:产妇不同的分娩方式与婴儿全母乳喂养率之间存在关联性,经阴道分娩的产妇产后4个月内的全母乳喂养率是经剖宫产术分娩产妇的2.15倍。产妇产后1周内所选择的喂养方式很大程度上影响了婴儿4个月内的喂养方式。     

Low rates of predominant breastfeeding in hospital after gestational diabetes,particularly among Indigenous women in Australia

Objectives: To investigate rates of ‘any’ and ‘predominant’ breastfeeding in hospital among Indigenous and non‐Indigenous women with and without gestational diabetes mellitus (GDM). Methods: A retrospective study of singleton infants born from July 2007 to December 2010 at Cairns Hospital, Australia, following GDM pregnancy, using linked hospital and birth data (n=617 infants), with a subsample of medical record reviews (n=365 infants). Aggregate data were used to compare to breastfeeding rates among infants born following non‐GDM pregnancy (n=7,894 infants). Results: More than 90% of all women reported any breastfeeding before hospital discharge. About 80% of women without GDM reported predominant breastfeeding. Despite significant increases over time (p<0.0001), women with GDM were less likely to predominantly breastfeed (OR 0.32, 95%CI 0.27–0.38, p<0.0001); with lower rates among Indigenous women (53%) compared with non‐Indigenous (60%) women (OR 0.78, 0.70–0.88, p<0.0001); and women having a caesarean birth or pre‐term infant. Conclusions: Rates of predominant in‐hospital breastfeeding were lower among women with GDM, particularly among Indigenous women and women having a caesarean or pre‐term birth. Implications: Strategies are needed to support predominant in‐hospital breastfeeding among women with GDM.     

早发型重度子痫前期79例妊娠结局分析

目的:探讨早发型重度子痫前期分娩方式与母儿结局的关系。方法:回顾分析79例早发型重度子痫前期妊娠结局,其中47例行剖宫产,32例阴道分娩,比较剖宫产组和阴道分娩组母亲并发症及围产儿结局的差异。结果:①两组孕妇年龄、体重、孕次、分娩孕周、血压、血清生化指标、尿蛋白等比较差异无统计学意义(P0.05)。②阴道分娩组产次、引产前宫颈Bishop评分显著高于剖宫产组,差异有统计学意义(P0.05);而产后出血的发生率显著低于剖宫产组,差异有统计学意义(P0.05);③两组新生儿出生胎龄、出生体重、新生儿窒息发生率、围生儿死亡率差异无统计学意义(P0.05)。结论:早发型重度子痫前期分娩方式应依据病情个体化制定,剖宫产并不能明显改善早发型重度子痫前期围产儿结局,且产后出血风险增加,需严格掌握手术指征;严格选择病例可以考虑引产和阴道分娩。     

Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy—An Evidence Analysis Center Systematic Review

BackgroundWhile obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined.ObjectiveA systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy.DesignA comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included.Main outcome measuresOutcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores.ResultsThirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent.ConclusionsBariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.     

安徽省母乳喂养现状及其影响因素分析

目的 了解安徽省2岁以内婴幼儿的母乳喂养现状及影响因素,为有效提高母乳喂养率提供可靠依据。方法 采用随机整群抽样方法,抽取安徽省3个市9个社区医院儿童保健门诊,利用自行设计的调查问卷对1 019 名带着2岁以内儿童做常规体检的母亲进行调查。结果 安徽省6个月内纯母乳喂养率达到61.9%,合肥市母乳喂养率(64.5%)和混合喂养率(31.3%)最高,阜阳市的人工喂养率(12.3%)最高;选择人工喂养的主要原因是没有母乳。关于母乳喂养的好处,合肥和芜湖的母亲知晓率明显高于阜阳;多因素分析得知合肥和阜阳两市母乳喂养率与母亲职业有关,芜湖母乳喂养率与分娩方式有关(P<0.05)。结论 医疗机构应降低剖宫产率,加强医护人员对母乳喂养知识的宣传,延长哺乳假,公共场所提供母婴保健室,全社会共同参与,提高母乳喂养率。     

阴道分娩与剖宫产对产妇母乳喂养情况比较

目的研究分析阴道分娩与剖宫产对产妇母乳喂养情况的影响。方法回顾性分析2011年6月—2012年12月期间,我院收治的70例产妇的临床资料,按照产妇采取分娩方式的不同,将其随机分为两组,对照组35例,选择剖宫产术分娩,观察组35例,采用阴道自然分娩。对两组产妇行均等的早期接触、吮吸,保持母婴同室,按需哺乳,比较两组产妇的泌乳时间和泌乳量。结果观察组产妇在开奶时间、泌乳量均明显优于对照组,两组间比较,差异具有统计学意义(P<0.05);且观察组产妇在产后7、42 d的母乳喂养成功率高于对照组,两组间比较,差异具有统计学意义(P<0.05)。结论阴道分娩有助于提前产妇的开奶时间,增加产妇泌乳量,提高母乳喂养成功率。     

健康宣教对剖宫产产妇院内纯母乳喂养的影响

目的 研究健康宣教对剖宫产产妇院内纯母乳喂养的影响,为更好地提高剖宫产术后母乳喂养成功率提供参考。方法 以824名剖宫产产妇为研究对象,采用自填式问卷收集一般情况、院内纯母乳喂养情况、健康宣教及母乳喂养认知水平。结果 剖宫产产妇院内纯母乳喂养率为64.7%。分别有80.3%和93.8%在入院前、后接受了宣教,但仅有32.9%的剖宫产产妇对母乳喂养认知水平达到熟悉。调整社会人口统计学等信息后,入院前接受宣传次数≥4次、入院后接受宣教的次数≥4次的剖宫产产妇院内纯母乳喂养的比例较高,其OR值(95%CI)分别为2.27(1.50~3.42)和3.75(2.02~6.97);母乳喂养认知水平达到熟悉的剖宫产产妇院内纯母乳喂养的可能性较大(OR=3.39,95%CI:2.17~5.28)。结论 对剖宫产产妇进行全面系统的母乳喂养知识宣教及指导,加强对母乳喂养认知水平的提高将是促进剖宫产产妇母乳喂养成功的重要手段。     

助产士门诊干预对首次剖宫产再次妊娠孕妇分娩结局的影响研究

目的探讨助产士门诊干预对首次剖宫产后再次妊娠孕妇分娩结局的影响。方法收集2016年1~11月广州市花都区妇幼保健院首次剖宫产后再次妊娠的孕妇123例作为研究对象,按照随机数字表法将其分成两组。对照组61例接受常规产检门诊宣教和参加瘢痕子宫阴道分娩专家门诊,研究组62例在对照组的基础上实施助产士门诊干预,比较两组孕妇分娩方式、产后出血量、3个产程及总产程时间、新生儿出生体重与出院前母乳喂养率。结果研究组顺产率、新生儿出生体重、产后出血量、第二产程时间、出院前母乳喂养率均优于对照组(P0.05);研究组第一产程、第三产程和总产程时间与对照组比较,差异无统计学意义(P0.05)。结论实施助产士门诊干预能提高首次剖宫产后再次妊娠孕妇的顺产率、出院前母乳喂养率,改善母婴分娩结局,值得临床推广。     

2002-2015年舟山市母乳喂养情况及其影响因素

目的 描述2002-2015年浙江省舟山市母乳喂养情况,探索可能的影响因素。方法 提取2002-2015年舟山市妇幼保健院电子医疗记录,应用Logistic回归分析各因素对母乳喂养的影响。结果 以2011年为节点,舟山市产妇的母乳喂养率呈现先下降后上升的趋势。调整相关变量后,市区的产妇第1、3、9个月的母乳喂养率更高。较高学历的产妇第1、3个月母乳喂养率较高,但第9个月则相对较低。职业类型为脑力型的产妇第6、9、12个月母乳喂养率较高。巨大儿在第6、9个月母乳喂养率较高。剖宫产、早产、低体重儿、初产妇、产妇年龄大于30岁或小于25岁均为母乳喂养的危险因素。冬春季出生的婴儿其母乳喂养率在第1、3、6个月均较低。结论 来自市区、职业类型为脑力型的产妇、巨大儿为母乳喂养的保护因素。较高的学历在第1、3个月为母乳喂养的保护因素,但在第9个月为危险因素。剖宫产、早产、低体重出生儿、初产妇、产妇年龄大于30岁或小于25岁、冬春季出生的婴儿均为母乳喂养的危险因素。     

Predictors of health in new mothers.

This survey study was conducted to determine the variables that predict mothers' mental health, work readiness, and use of health services several weeks after they give birth to, or adopt a baby. Regression analyses on 313 married women (108 first-time adoptive mothers, 72 first-time biological mothers, and 133 controls) showed a strong link between biological mothers' postpartum health and their infants' health; this relationship was not observed for adoptive mothers and their infants. Biological mothers' postpartum health problems were also related to their smoking, fatigue, and current work at a job; further, their readiness to work at a job two months postpartum was greater if they were in good general health, had not had a cesarean section, and were not currently breastfeeding. The results suggest that many mothers continue to have unique health needs several weeks after delivery and, if substantiated by future studies, these findings may have implications for postpartum health care practices and for maternity leave policy.     

Knowledge mobilization tool to promote,protect, and support breastfeeding during COVID-19

SettingThis knowledge mobilization project was conceptualized to increase awareness among breastfeeding mothers and the general public on safe infant feeding practices during the COVID-19 pandemic by addressing myths and misconceptions associated with breastfeeding practices, guiding breastfeeding mothers to make informed decisions around child feeding practices, and offering meaningful guidance in simple language through a short online animated video.InterventionThis project was undertaken in four phases. During phase 1, an informal discussion was held with the breastfeeding mothers, service providers, and community partner in identifying issues surrounding lactation counselling facilities during the COVID-19 pandemic. During phase 2, recommendations from 23 organizations with regard to breastfeeding during COVID-19 were reviewed and analyzed. During phase 3, using evidence from reliable sources, a 5-minute animated e-resource on breastfeeding during COVID-19 was conceptualized and developed. During phase 4, the e-resource was disseminated to the breastfeeding mothers, general public, post-secondary institutions, and organizations providing services to breastfeeding mothers in Canada.OutcomesThis evidence-based e-resource facilitated addressing misconceptions around breastfeeding during COVID-19 and raising public awareness on safe infant feeding practices during this pandemic. Overall, the video was described as an informative, user-friendly, useful, and easily accessible resource by breastfeeding mothers who were in self-isolation with little access to healthcare services during the pandemic.ImplicationsThis project highlighted the importance of patient engagement and collaboration with the community partner in protecting breastfeeding during the COVID-19 pandemic. It further illustrated how informational e-resources can protect breastfeeding in situations where breastfeeding mothers’ access to healthcare services is compromised.     

Aboriginal mothers, breastfeeding and smoking

Objective : To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants.
Method : A cohort of mothers was followed from the time of delivery for 12 months to obtain details of infant feeding practices. A total of 455 mothers delivered between May 2000 and July 2001 and 425 completed the baseline questionnaire.
Results : Prior to and during pregnancy, 67% of the mothers smoked regularly. While the rate appeared to decline slightly with the length of breastfeeding, the trend was not significant. The rate of smoking of Aboriginal mothers was significantly greater than for an earlier study of non-Aboriginal mothers in Perth, where the rate was 28.4%. Among Aboriginal women there was no difference in the percentage of smokers and non-smokers who initiated breastfeeding. While fewer women who smoked were still breastfeeding at 24 weeks postpartum, compared with non-smokers (58% vs. 64%), this difference was not significant.
Conclusions : The percentage of women smoking in this study is consistent with rates reported in the 2001 National Drug Strategy Household Survey. In other studies, smoking is associated with lower rates of breastfeeding initiation and duration, but this was not the case in the Aboriginal mothers.
Implications : Although the high prevalence of smoking identified in this study did not appear to adversely affect breastfeeding, smoking during and after pregnancy does contribute to increased rates of low birth weight and other health problems in early childhood. Targeted antenatal smoking cessation programs are needed for Aboriginal mothers.     

Aboriginal mothers, breastfeeding and smoking

OBJECTIVE: To document the smoking practices of Aboriginal mothers living in Perth during pregnancy and during the subsequent year while feeding their infants. METHOD: A cohort of mothers was followed from the time of delivery for 12 months to obtain details of infant feeding practices. A total of 455 mothers delivered between May 2000 and July 2001 and 425 completed the baseline questionnaire. RESULTS: Prior to and during pregnancy, 67% of the mothers smoked regularly. While the rate appeared to decline slightly with the length of breastfeeding, the trend was not significant. The rate of smoking of Aboriginal mothers was significantly greater than for an earlier study of non-Aboriginal mothers in Perth, where the rate was 28.4%. Among Aboriginal women there was no difference in the percentage of smokers and non-smokers who initiated breastfeeding. While fewer women who smoked were still breastfeeding at 24 weeks postpartum, compared with non-smokers (58% vs. 64%), this difference was not significant. CONCLUSIONS: The percentage of women smoking in this study is consistent with rates reported in the 2001 National Drug Strategy Household Survey. In other studies, smoking is associated with lower rates of breastfeeding initiation and duration, but this was not the case in the Aboriginal mothers. IMPLICATIONS: Although the high prevalence of smoking identified in this study did not appear to adversely affect breastfeeding, smoking during and after pregnancy does contribute to increased rates of low birth weight and other health problems in early childhood. Targeted antenatal smoking cessation programs are needed for Aboriginal mothers.     

Determinants of the exclusive breastfeeding abandonment: psychosocial factors

OBJECTIVE

To assess the determinants of exclusive breastfeeding abandonment.

METHODS

Longitudinal study based on a birth cohort in Viçosa, MG, Southeastern Brazil. In 2011/2012, 168 new mothers accessing the public health network were followed. Three interviews, at 30, 60, and 120 days postpartum, with the new mothers were conducted. Exclusive breastfeeding abandonment was analyzed in the first, second, and fourth months after childbirth. The Edinburgh Postnatal Depression Scale was applied to identify depressive symptoms in the first and second meetings, with a score of ≥ 12 considered as the cutoff point. Socioeconomic, demographic, and obstetric variables were investigated, along with emotional conditions and the new mothers’ social network during pregnancy and the postpartum period.

RESULTS

The prevalence of exclusive breastfeeding abandonment at 30, 60, and 120 days postpartum was 53.6% (n = 90), 47.6% (n = 80), and 69.6% (n = 117), respectively, and its incidence in the fourth month compared with the first was 48.7%. Depressive symptoms and traumatic delivery were associated with exclusive breastfeeding abandonment in the second month after childbirth. In the fourth month, the following variables were significant: lower maternal education levels, lack of homeownership, returning to work, not receiving guidance on breastfeeding in the postpartum period, mother’s negative reaction to the news of pregnancy, and not receiving assistance from their partners for infant care.

CONCLUSIONS

Psychosocial and sociodemographic factors were strong predictors of early exclusive breastfeeding abandonment. Therefore, it is necessary to identify and provide early treatment to nursing mothers with depressive symptoms, decreasing the associated morbidity and promoting greater duration of exclusive breastfeeding. Support from health professionals, as well as that received at home and at work, can assist in this process.     

1998～2003年中国母乳喂养与婴儿过渡期食物添加状况分析

[目的]从第三次国家卫生服务调查资料中了解我国婴儿喂养现状,从而发现问题、提出建议.[方法]利用第三次国家卫生服务调查的资料,对婴儿喂养情况进行描述性分析.[结果]1998～2003年间我国产妇早开奶率为19%～26%,且在县（区）级以上医院或妇幼保健院住院分娩的产妇早开奶情况并不好于不在上述医院住院分娩的产妇;城乡的母乳喂养情况较好;农村地区儿童辅食添加存在问题,普遍存在辅食添加过晚的现象,而四类农村地区存在过早添加辅食现象,在四类农村,有约50%的婴儿在4个月内添加了辅食.[结论]近年我国儿童母乳喂养率高,但产妇早开奶情况无明显改善;在农村地区,儿童辅食添加过早和过晚现象同时存在.