Breastfeeding and socioeconomic status in Southern Brazil

Patterns of breastfeeding were studied in a cohort of 5 914 infants followed from birth in Pelotas, Southern Brazil. Overall, 92% of the babies commenced breastfeeding and 54% were still breastfed by 3 months of age. This proportion dropped to 30% by 6 months, 20% by 9 months, and 16% by 12 months. The prevalence of breastfeeding soon after birth, and at 3, 6, 9 and 12 months of age was studied according to socioeconomic status as measured by family income. Children from the poorest families were less likely to be breastfed from birth than those from the richest families (89% and 97%, respectively), and also showed lower prevalence of breastfeeding at 3 and 6 months. By the age of 12 months poor children showed the highest prevalence of breastfeeding.     

Breastfeeding and overweight: longitudinal analysis in an Australian birth cohort

OBJECTIVE: To examine adiposity in relation to breastfeeding using longitudinal analysis in an Australian birth cohort. STUDY DESIGN: Repeated surveys from 16 weeks gestation to 8 years in a cohort (N = 2087) recruited through antenatal clinics. Overweight was defined by National Center for Health Statistics 95th percentiles for weight-for-length at 1 year and body mass index (BMI) at 3, 6, and 8 years. Overweight was examined using Generalized Estimating Equations with results summarized as OR. BMI Z scores were analyzed in mixed models. RESULTS: At 1 year, infants breastfed >12 months were the leanest group (mean Z score -0.16, 95% CL -0.28, -0.04; not breastfed 0.16, 95% CL 0.02, 0.29; breastfed < or = 4 months 0.31, 95% CL 0.22, 0.40; 5-8 months 0.17, 95% CL 0.06, 0.27; 9-12 months 0.11, 95% CL 0.01, 0.22). From 1 to 8 years, children breastfed < or = 4 months had the greatest risk of overweight (OR 1.29, 95% CL 0.89, 1.97) and the highest prevalence of maternal obesity, smoking, and lower education. CONCLUSIONS: Infants breastfed >12 months were leaner at 1 year but not at 8 years. Breastfeeding < or = 4 months was associated with greatest risk of overweight and adverse maternal lifestyle. Familial factors may modify associations between breastfeeding and adiposity beyond infancy.     

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     

Breastfeeding duration and current neonatal feeding practices in Emilia Romagna, Italy

A cohort of 1567 infants was studied at birth and at 3 mo of age to elucidate factors possibly affecting feeding policies in the maternity ward and the relationship with subsequent feeding patterns. During their stay in the maternity wards 89.6% of infants were breastfed, with 28.1% receiving formula in addition to mother's milk. Independent predictors of receiving a formula supplement in the maternity wards as a result of multivariate analyses were the separation of the newborn from the mother, a birthweight lower than 3000 g and a gestational age lower than 38 wk. At 3 mo of age, 66.1% infants were still at least partially breastfed and 48.9% were exclusively breastfed. An increased risk of not being breastfed at 3 mo of age was related to supplementary feeding at birth and birthweight. A weak relationship was found between the prevalence of breastfeeding at 3 mo of age and the magnitude of routine formula supplement use in the maternity ward. Given the present trends for early discharge from maternity wards and the National Health System facility for free paediatric assistance after discharge, in Italy paediatricians should be the main actors to support the continuation of breastfeeding.     

Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants

AIM: To describe the impact of prematurity, size at birth, neonatal disorders and the families' socioeconomic status (SES) on breastfeeding duration in mothers of very preterm infants. METHODS: Prospective population-based cohort study. Data on breastfeeding, registered in databases in two Swedish counties in 1993-2001, were matched with data from two national registries: the Medical Birth Registry and Statistics Sweden. Mothers of 225 very preterm singleton infants were identified and included. RESULTS: Seventy-nine percent of the mothers breastfed at 2 months, 62% at 4 months, 45% at 6 months, 22% at 9 months and 12% at 12 months. Prematurity, size at birth and neonatal disorders did not show an effect on breastfeeding duration. Being adversely exposed to any of the SES factors (maternal education, unemployment benefit, social welfare and equivalent disposable income in the household) was significantly associated with earlier weaning up to 6 months of infants' postnatal age. CONCLUSIONS: This study shows new and noteworthy results concerning breastfeeding duration in mothers of very preterm infants, which was not influenced by degree of prematurity, size at birth or neonatal disorders but was affected by SES. This highlights the need for improved support of socioeconomically disadvantaged mothers, during and after the hospital stay.     

Intergenerational breastfeeding practices among parents and children: 1993 Pelotas (Brazil) birth cohort

The objective of this study was to investigate intergenerational breastfeeding practices according to parental sex and age at delivery in the 1993 Pelotas (Brazil) birth cohort study. This is a prospective birth cohort study, and at the 22‐year follow‐up, a substudy with all children of the cohort members who had become parents was conducted (93Cohort‐II). First generation breastfeeding data were collected at 3 months and 4‐year‐old follow‐ups. In the 93Cohort‐II, parents answered a questionnaire about their children's breastfeeding practices. Adjusted Tobit and Poisson regression models with robust variance were applied to estimate the association between predominant parental breastfeeding duration and exclusive breastfeeding duration of the children at 3 and 6 months. Out of 3,810 cohort participants, 955 (25%) had delivered at least one live‐born infant, and 1,222 children were assessed. Fifty‐four percent of parents were ≤19 years old. Direct effects of predominant parental breastfeeding duration on exclusive breastfeeding duration of their children were only observed when data were stratified by parental age: children born to parents aged ≥20 years old and who were predominantly breastfed for at least 3 months presented higher exclusive breastfeeding duration and higher prevalence of being exclusively breastfed for at least 3 months. When analyses were stratified by mothers and fathers, the result remained significant only among mothers. Longer predominant breastfeeding duration in the first generation was associated with longer exclusive breastfeeding duration in the second generation, but only among older mothers. Education and social support surrounding breastfeeding should be intensified among fathers and younger parents to create a positive environment supportive of breastfeeding.     

Breastfeeding duration and current neonatal feeding practices in Emilia Romagna, Italy

A cohort of 1567 infants was studied at birth and at 3 mo of age to elucidate factors possibly affecting feeding policies in the maternity ward and the relationship with subsequent feeding patterns. During their stay in the maternity wards 89.6% of infants were breastfed, with 28.1% receiving formula in addition to mother's milk. Independent predictors of receiving a formula supplement in the maternity wards as a result of multivariate analyses were the separation of the newborn from the mother, a birthweight lower than 3000 g and a gestational age lower than 38 wk. At 3 mo of age, 66.1% infants were still at least partially breastfed and 48.9% were exclusively breastfed. An increased risk of not being breastfed at 3 mo of age was related to supplementary feeding at birth and birthweight. A weak relationship was found between the prevalence of breastfeeding at 3 mo of age and the magnitude of routine formula supplement use in the maternity ward. Given the present trends for early discharge from maternity wards and the National Health System facility for free paediatric assistance after discharge, in Italy paediatricians should be the main actors to support the continuation of breastfeeding.     

Breast vs. bottle: differences in the growth of Croatian infants

The aim of the paper was to compare the growth of rural Croatian infants with 2000 Centers for Disease Control and Prevention (CDC) growth standards and to evaluate the potential preventive influence of breastfeeding on the development of obesity in infancy. Two hundred three infant-mother pairs from Baranja, an Eastern region of Croatia, were enrolled into this study. Retrospective evaluation of infants' medical charts was used to obtain anthropometric data recorded at the birth, 1, 3, 6, 9 and 12 months of age. Infant feeding mode was self-reported by mothers. Breastfed infants gained the least weight of all observed groups. Up to 6 months of age, formula fed infants had the highest weight gain and after 6 months of age, mixed milk fed infants had the highest weight gain. At 12 months of age, 6.4% of all study infants and 7.6% of mixed milk fed infants were at risk of overweight, while the same risk for the group of breastfed infants was 4%. Most of the study infants achieved higher values of body mass and length than the child growth standards. Exclusively breastfed infants, in comparison with other study groups (formula fed infants, mixed milk fed infants and cow's milk fed infants), had lower weight-for-length z-scores during the first year, which suggests that breastfeeding may have a preventive impact on obesity development.     

Breastfeeding duration and exclusivity associated with infants' health and growth: data from a prospective cohort study in Bavaria, Germany

Aim: To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months.
Methods: Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2–6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight ≥2500 g. We compared 475 infants breastfed exclusively for ≥6 months (group A), 870 infants breastfed fully/exclusively ≥4 months, but not exclusively ≥6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C).
Results: In multivariate analysis ≥6 months of exclusive breastfeeding reduced significantly the risk for ≥1 episode of gastrointestinal infection(s) during months 1–9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44–0.82). The application of the World Health Organization (WHO) – child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores.
Conclusion: Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for ≥6 months of exclusive breastfeeding.     

中国九市不同喂养方式婴儿体格生长水平的横断面调查

目的 调查不同喂养方式婴儿体格生长水平的现状和差异。方法 1~<12月龄婴儿的母乳喂养、辅食添加及体格生长数据来自2015年“第五次中国九市7岁以下儿童体格发育调查”。1~<6月龄婴儿的喂养方式分为纯母乳喂养、部分母乳喂养和人工喂养,~<12月龄的喂养方式分为持续母乳喂养和人工喂养。不同喂养方式婴儿体重、身长及头围生长水平比较采用方差分析或t检验。结果 共纳入1~<12月龄婴儿59 170人。1~<6月龄纯母乳喂养率、部分母乳喂养率和人工喂养率分别为48.6%、37.4%和14.0%,~<12月龄持续母乳喂养率和人工喂养率分别为59.9%和40.1%。1~<6月龄纯母乳喂养婴儿平均体重略高于部分母乳喂养婴儿,差值范围为0.06~0.20 kg;也略高于人工喂养婴儿,差值范围为0.09~0.22 kg。6~<12月龄持续母乳喂养婴儿平均身长低于人工喂养婴儿,差值范围为-0.3~-0.1 cm。不同喂养方式在6~<12月龄体重、1~<6月龄身长及1~<12月龄头围上差异均无统计学意义。不同喂养方式婴儿体重、身长及头围生长模式与WHO儿童生长标准相似,但总体上体重和身长平均生长水平略高于WHO儿童生长标准。结论 不同喂养方式生长模式相似,在生后的前半年纯母乳喂养婴儿的生长水平略高于部分母乳喂养和人工喂养婴儿,在后半年持续母乳喂养婴儿的生长水平略低于人工喂养婴儿。     

Duration of exclusive breastfeeding is a positive predictor of iron status in 6‐ to 10‐month‐old infants in rural Kenya

The prevalence of iron‐deficiency anemia (IDA) is high in infants in Sub‐Saharan Africa. Exclusive breastfeeding of infants to 6 months of age is recommended by the World Health Organization, but breast milk is low in iron. Some studies suggest exclusive breastfeeding, although beneficial for the infant, may increase risk for IDA in resource‐limited settings. The objective of this study was to determine if duration of exclusive breastfeeding is associated with anemia and iron deficiency in rural Kenyan infants. This was a cross‐sectional study of 6–10‐month‐old infants (n = 134) in southern coastal Kenya. Anthropometrics, hemoglobin (Hb), plasma ferritin (PF), soluble transferrin receptor (sTfR), and C‐reactive protein were measured. Body iron stores were calculated from the sTfR/PF ratio. Socioeconomic factors, duration of exclusive breastfeeding, nature of complementary diet, and demographic characteristics were determined using a questionnaire. Mean ± SD age of the infants was 7.7 ± 0.8 months. Prevalence of anemia, ID, and IDA were 74.6%, 82.1%, and 64.9%, respectively. Months of exclusive breastfeeding correlated positively with Hb (r = 0.187; p < .05) and negatively with sTfR (r = ?0.246; p < .05). sTfR concentrations were lower in infants exclusively breastfed at least 6 months compared with those exclusively breastfed for less than 6 months (7.6 (6.3, 9) vs. 8.9 (6.7, 13.4); p < .05). Controlling for gender, birth weight, and inflammation, months spent exclusively breastfeeding was a significant negative predictor of sTfR and a positive predictor of Hb (p < .05). The IDA prevalence in rural Kenyan infants is high, and greater duration of exclusive breastfeeding predicts better iron status and higher Hb in this age group.     

Gewichtsentwicklung von Kindern aus Schwangerschaften mit Gestationsdiabetes

The somatic development of children born to mothers who had experienced with gestational diabetes (GDM) during their pregnancies was investigated, with particular attention paid to neonatal parameters and to breastfeeding. Weight and height were measured at follow-up (FU) at age 5.4 (±1.6) years in 324 children born to women who had suffered GDM. Somatometric data recorded at delivery and on routine examinations at 6, 12, and 24 months were also ascertained. The duration of breastfeeding was recorded for each. A neonatal or childhood BMI above the 90th percentile and a parental BMI of over 30 kg/m² were defined as overweight. At FU, 92 (28.4%) of the 324 children were overweight; at birth 30.9% had been overweight. The median duration of breastfeeding was 4.0 months. BMI-SDS was significantly higher (p<0.001) in these subjects at birth, at 6, 12, and 24 months and at FU than in the normal population. At FU, 37.3% of nonbreastfed children were overweight, as against to 32.5% of children breastfed for up to 3 months and 22.0% of children who had been breastfed for longer than 3 months (p=0.008). Children of mothers with GDM are at increased risk of overweight at birth and in early childhood. This seems to be due to pre- and postnatal factors affected by environment and nutrition and also to the genetic predisposition.     

Successful breastfeeding after discharge of preterm and sick newborn infants

AIM: To determine the extent and duration of breastfeeding in preterm and sick newborn infants admitted to a level IIb neonatal unit (NU). METHOD: Hospital-based follow-up of 1730 infants born in 1996, 2001 and 2004, and studied from discharge to 6 months of post-natal age. RESULTS: At discharge from the NU, 98% of term (n = 945) and 92% of preterm (n = 785) infants were exclusively or partly breastfed. Exclusive breastfeeding increased at 2 months of corrected post-natal age and 78% of term infants were still exclusively or partly breastfed at 6 months of corrected post-natal age. Duration of breastfeeding among preterm infants was significantly shorter than in infants born at term. However, even among extremely preterm infants with a gestational age <28 weeks, 41% were still breastfeeding, exclusively or in part, at 6 months of post-natal age. There was no difference in breastfeeding after neonatal care in 1996 as compared to 2004. Moreover, the study showed that the breastfeeding after neonatal care differed only slightly from population data for all infants in Sweden. CONCLUSION: Breastfeeding can be successfully established in most preterm and previously sick neonates.     

Breastfeeding modifies the impact of diarrhoeal disease on relative weight: a longitudinal analysis of 2–12 month‐old Filipino infants

Undernutrition and diarrhoeal disease are major causes of infant mortality. We investigated the combined roles of breastfeeding and diarrhoea on infant size in 2940 infants from the Cebu Longitudinal Health and Nutrition Survey. The study aimed to assess whether breastfeeding status modified the deficits associated with diarrhoeal disease. The primary exposures were combinations of current breastfeeding status (yes/no), the presence of diarrhoeal disease in previous week (yes/no) and a categorical survey variable (six surveys taken at bimonthly intervals when infants were 2–12 months of age). Relative weight (weight‐for‐length z‐scores), calculated using the WHO growth standards, was estimated using sex‐stratified, fixed‐effects longitudinal models that also adjusted for energy from complementary foods. Post‐estimation Wald tests were conducted to identify subgroup differences in relative weight. Diarrhoea was associated with reduced relative weight in both breastfed and non‐breastfed infants of 6–12 months. Diarrhoea‐related deficits in relative weight were significantly exacerbated in non‐breastfed girls of 6 and 8 months. Importantly, in infants <6 months, being breastfed and having diarrhoea was still associated with greater relative weight compared with being non‐breastfed and diarrhoea‐free. Breastfeeding emerged as a strong contributor to relative weight in younger infants (<6 months) while diarrhoeal disease strongly contributed to deficits in relative weight in older infants (6–12 months). These findings underscore the importance of breastfeeding for promoting infant nutritional status in infants with or without diarrhoea from birth to 12 months.     

母乳喂养对妊娠期糖尿病母亲子代儿童期超重的影响

目的：通过对妊娠期糖尿病（GDM）母亲子代的随访,探讨母乳喂养是否可以降低GDM子代发生超重的风险性。方法：对2003年1月至2009年12月GDM母亲子代1189例进行随访,采用logistic回归分析出生后0～3月母乳喂养方式及母乳喂养持续时间对GDM子代超重发生风险的影响。结果：在对孕前BMI、孕期增重、孕期血糖水平、性别、出生体重、年龄及父亲体重等混杂因素进行校正后,0～3月纯母乳喂养组GDM子代儿童期超重发生风险低于人工喂养组（OR：0.479,95%CI：0.256～0.897）;接受0～3月母乳喂养、4～6月母乳喂养及大于6月母乳喂养GDM子代儿童期超重发生风险均低于人工喂养组（分别OR：0.456,95%CI：0.233～0.827;OR：0.29,95%CI：0.103～0.817;OR：0.534,95%CI：0.280～0.970）;接受4～6月母乳喂养GDM子代儿童期超重发生风险低于0～3月母乳喂养组（OR：0.372,95%CI：0.129～0.874）;而接受母乳喂养时间<6月与接受母乳喂养时间≥6月与GDM子代儿童期超重发生风险无相关性（OR：0.769,95%CI：0.4701～1.258）。结论：出生后0～3月母乳喂养,尤其是纯母乳喂养可以降低GDM子代发生超重的风险,且在出生后6月内,随着母乳喂养时间的增加,GDM子代超重发生风险降低,而出生6月以后,延长母乳喂养时间可能并不能降低超重的发生风险。     

Breastfeeding in the WHO Multicentre Growth Reference Study

Aim: To document how children in the WHO Multicentre Growth Reference Study (MGRS) complied with feeding criteria and describe the breastfeeding practices of the compliant group.
Methods: The MGRS longitudinal component followed 1743 mother–infant pairs from birth to 24 mo in six countries (Brazil, Ghana, India, Norway, Oman and the USA). The study included three criteria for compliance with recommended feeding practices that were monitored at each follow-up visit through food frequency reports and 24-h dietary recalls. Trained lactation counsellors visited participating mothers frequently in the first months after delivery to help with breastfeeding initiation and prevent and resolve lactation problems.
Results: Of the 1743 enrolled newborns, 903 (51.8%) completed the follow-up and complied with the three feeding criteria. Three quarters (74.7%) of the infants were exclusively/predominantly breastfed for at least 4 mo, 99.5% were started on complementary foods by 6 mo of age, and 68.3% were partially breastfed until at least age 12 mo. Compliance varied across sites (lowest in Brazil and highest in Ghana) based on their initial baseline breastfeeding levels and sociocultural characteristics. Median breastfeeding frequency among compliant infants was 10, 9, 7 and 5 feeds per day at 3, 6, 9 and 12 mo, respectively. Compliant mothers were less likely to be employed, more likely to have had a vaginal delivery, and fewer of them were primiparous. Pacifier use was more prevalent in the non-compliant group.
Conclusion: The MGRS lactation support teams were successful in enhancing breastfeeding practices and achieving high rates of compliance with the feeding criteria required for the construction of the new growth standards.     

Breastfeeding and reported morbidity during infancy: findings from the Southampton Women's Survey

A number of studies in developed countries suggest that breastfeeding protects against infections in infancy. However, the choice to breastfeed is often related to maternal characteristics, and many of these studies are limited in the extent to which they can take account of confounding influences. In a prospective birth cohort study, we assessed the relationship between the duration of breastfeeding and the prevalence of lower respiratory tract infections, ear infections and gastrointestinal morbidity during the first year of life in 1764 infants. We considered the duration of all breastfeeding, including mixed feeding. Eighty-one per cent of the infants were breastfed initially, and 25% were breastfed up to 6 months. There were graded decreases in the prevalence of respiratory and gastrointestinal symptoms between birth and 6 months as breastfeeding duration increased; these were robust to adjustment for a number of confounding factors. The adjusted relative risks (95% confidence interval) for infants breastfed for six or more months compared with infants who were never breastfed were 0.72 (0.58-0.89), 0.43 (0.30-0.61) and 0.60 (0.39-0.92) for general respiratory morbidity, diarrhoea and vomiting, respectively. Duration of breastfeeding in the second half of infancy was less strongly related to diagnosed respiratory tract infections and gastrointestinal morbidity, although important benefits of breastfeeding were still seen. Our data provide strong support for a protective role of breastfeeding against respiratory and gastrointestinal infections in infancy. The graded inverse associations with breastfeeding duration suggest that current efforts to promote breastfeeding and increase duration will have important effects in reducing morbidity in infancy.     

Breastfeeding and asthma in young children: findings from a population-based study.

OBJECTIVE: To evaluate the association between breastfeeding and asthma in young Canadian children. METHODS: Baseline data from the National Longitudinal Survey of Children and Youth (a population-based study of child health and well-being) were used. A weighted sample of 331 100 (unweighted n = 2184) children between the ages of 12 and 24 months, whose biological mother reported data on breastfeeding and asthma, were included. Outcomes included parental report of physician-diagnosed asthma and wheeze in the previous year. Breastfeeding was categorized by duration as follows: less than 2 months, 2 to 6 months, 7 to 9 months, and longer than 9 months. Logistic regression analyses were conducted with breastfeeding duration dichotomized at various cutoffs. Important potential confounders were considered in the adjusted analyses. Published statistical methods appropriate for the sampling strategy were used. RESULTS: The prevalence of asthma was 6.3%; and wheeze, 23.9%. Almost half of the children (44.0%) were breastfed for less than 2 months. After adjustment for smoking, low birth weight, low maternal education, and sex, a duration of breastfeeding for 9 months or less was found to be a risk factor for asthma (odds ratio, 2.39; 99% confidence interval, 0.95-6.03) and wheeze (odds ratio, 1.54; 99% confidence interval, 1.04-2.29). A dose-response effect was observed with breastfeeding duration. CONCLUSIONS: A longer duration of breastfeeding appears to be protective against the development of asthma and wheeze in young children. More public health efforts should be directed toward increasing the initiation and duration of breastfeeding.     

Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study

Aim:  To identify the maternal and infant characteristics associated with an early transition from full breastfeeding to complementary or no breastfeeding during the first 2 months of life in a large, representative cohort of Australian infants.
Method:  Multinomial logistic modelling was performed on data for infants with complete breastfeeding and sociodemographic data (N = 4679) including maternal age, education, smoking, employment, pregnancy and birth outcomes.
Results:  Ninety-one percent of women initiated breastfeeding. Sixty-nine percent of infants were being fully breastfed at 1 month, and 59% were fully breastfed at 2 months. Maternal characteristics – age less than 25 years, smoking in pregnancy, early full-time postnatal employment and less educational attainment – were associated with early breastfeeding cessation. Infant factors – multiple birth, caesarean birth, infant or first birth – were associated with a transition to complementary breastfeeding in the first postnatal month.
Conclusion:  Breastfeeding duration is substantially affected by breastfeeding outcomes in the first postpartum month. The first month is an important window for evidence-based interventions to improve rates of full breastfeeding in groups of women identified as at risk of early breastfeeding cessation.     

Effects of breastfeeding on weight changes in family-based pediatric obesity treatment

Research indicates that breastfeeding may provide protective effects against the development of obesity; however, breastfed children may still become obese because of the obesogenic environment. This study is designed to examine the effects of retrospective recall of breastfeeding on weight changes in children participating in a 6-month behavioral treatment program for childhood obesity. The independent variable of breastfeeding was defined as children who were exclusively breastfed for 4 weeks (excluding water or medication) versus those who were never breastfed. Child percent overweight and body mass index changes during 6 and 12 months were evaluated for 94 families based on mother report of breastfeeding status using analysis of covariance, controlling for socioeconomic status and initial child weight status. Data were compiled for secondary analysis from pediatric obesity randomized controlled outcome studies evaluating core components of family-based treatments. Results showed that, compared with nonbreastfed (formula) children (n = 28), breastfed children (n = 66) showed significantly larger reductions in (mean +/- SEM) percent overweight at 6 months (-15.2 +/- 1.1 vs -10.2 +/- 1.7, p <.05) and 1 year (-10.3 +/- 1.3 vs -5.9 +/- 1.8, p <.05). Similarly, breastfed children showed greater reductions in body mass index at 6 months (-2.1 +/- 0.19 vs -1.1 +/- 0.28) and 1 year (-0.8 +/- 0.23 vs +0.1 +/- 0.32). Findings suggest the beneficial effects of breastfeeding may extend beyond obesity prevention to include improved outcome in family-based pediatric obesity treatment. Potential mechanisms relating breastfeeding, obesity prevention, and enhanced outcome in pediatric obesity treatment are discussed.