Maternal employment and the initiation of breastfeeding

This study examines whether planning to be employed postpartum has an effect on initiation of breastfeeding. Data were collected from questionnaires completed by mothers who were subjects in the prospective, population-based, Avon Longitudinal Study of Pregnancy and Childhood. The mothers of 10,530 full-term singleton infants gave information during pregnancy on their postpartum employment plans and their initial infant feeding methods. Information was also given by 7642 of these mothers on the timing of their postpartum employment plans. Adjusted logistic regression was performed to identify associations between (a) "any" plans to work postpartum and the initiation of breastfeeding, and (b) the timing of the commencement of work postpartum, and the initiation of breastfeeding. A total of 8316 (79%) of the women initiated breastfeeding. The decision to breastfeed was not associated with "any" plans to work postpartum. However, women who planned to commence work prior to 6 wk postpartum were significantly less likely to initiate breastfeeding compared with those not intending to work postpartum. Older, more highly educated women, women who had or were planning to attend childbirth classes, women who were breastfed as infants, women who did not smoke and women who were giving birth to their first child were significantly more likely to initiate breastfeeding. Conclusion: Planning to return to employment prior to 6 wk postpartum reduces the likelihood of initiating breastfeeding. As increasing numbers of mothers are returning to work shortly after the birth of their child, this finding could have implications for maintaining the current level of breastfeeding.     

Sucking behavior at breast during the early newborn period affects later breast-feeding rate and duration of breast-feeding

BACKGROUND: One of the objectives of health-workers is to help increase the rate and duration of breast-feeding. It could become a helpful tool if babies sucking behavior at breast in the early neonatal period could predict babies at risk of short-term breast-feeding. The aims of this study are: to determine the prevalence of a range of sucking behaviors at breast in the early neonatal period in Japan; to determine if sucking behavior in the early neonatal period affects the later breast-feeding rate; and to clarify reasons for ceasing breast-feeding for each sucking behavior. METHODS: A total of 1582 mothers of infants aged 6-12 months were surveyed. The questionnaire asked mothers their interpretation from memory of the sucking behavior of their infants in the early neonatal period. Mothers were asked to choose one out of five defined types (barracudas, excited ineffectives, procrastinators, gourmets and resters) and others. The study also included questions about the type of feeding (i.e. full, partial). Finally mothers were questioned about the time of and reasons for ceasing breast-feeding. RESULTS: Sufficient responses to the questionnaires were given by 1474 mothers (93.2%). The remainder of mothers questioned (108, 6.8%) did not provide appropriate answers. The babies whose mothers selected 'Barracudas' as the sucking behavior which best described their babies breast-feeding showed the largest number of full breast-feeding. These babies also displayed the highest breast-feeding rate all the time. The 'Procrastinators' type showed the lowest overall rate of breast-feeding. The Chi-square test revealed that sucking behavior in the early neonatal period affects the breast-feeding rate at 3 and 6 months of age (P < 0.001). The reasons for ceasing breast-feeding observed in all subtypes were perceived shortage of milk volume and elder children's anger and jealousy. CONCLUSION: Based on the sucking behavior at breast in the early neonatal period, it is possible to predict babies at risk for short-term breast-feeding.     

Single daily bottle use in the early weeks postpartum and breast-feeding outcomes.

A prospective study of breast-feeding mothers was undertaken to determine the effects of limited bottle use and infant temperament on breast-feeding outcomes. White, married, primigravida women who were committed prenatally to breast-feeding for at least 6 weeks (n = 121) were randomly assigned to one of two groups: a planned bottle group that would offer one bottle daily between the second and sixth weeks postpartum and a total breast-feeding group that would avoid bottles during the same period. Group assignment had no effect on the occurrence of breast-feeding problems, on mothers' achievement of 90% of their prenatal breast-feeding duration goals, or on weeks to weaning across the study period. At 6 months postpartum, 59% of the planned bottle group and 69% of the total breast-feeding group were still breast-feeding. No main or interactive effects of infant temperament on breast-feeding outcomes were found.     

Maternal postpartum behaviors and mother-infant relationship during the first year of life

OBJECTIVE: To assess the hypothesis that maternal postpartum behaviors toward the newborn may predict the quality of the maternal-infant relationship during the first year. DESIGN: Prospective, non-randomized, longitudinal cohort study of 174 maternal-infant dyads. METHODS: A Postpartum Parenting Behavior Scale (PPBS) was formulated to measure clearly defined observed maternal behaviors toward the infant shortly after birth. The quality of the maternal-infant relationship was assessed at 6 months after birth with the Nursing Child Assessment Satellite Training (NCAST) Feeding Scale and at 12 months after birth with the NCAST Teaching Scale and Ainsworth Strange Situation. RESULTS: The PPBS score correlated significantly with the Feeding Scale score (r =.27, P <.005) and with the Teaching Scale score (r =.23, P <.01). Mothers whose infants were later classified as securely attached in the Ainsworth Strange Situation had higher PPBS scores than mothers of infants classified as insecurely attached (mean +/- SD: 5.18 +/- 1.51 vs 4.63 +/- 1.69, respectively, P <.05). In regression models adjusting for social and demographic factors, the PPBS remained a significant predictor of the Feeding Scale score, the Teaching Scale score, and security of attachment. CONCLUSIONS: Maternal behaviors in the immediate postpartum period may aid in predicting quality of the maternal-infant relationship during the subsequent 12 months, suggesting the potential for early identification of suboptimal parenting.     

Maternal cocaine use: estimated effects on mother-child play interactions in the preschool period

The study objective was to evaluate the quality of parent-child interactions in preschool-aged children exposed prenatally to cocaine. African-American mothers and their full-term newborns (n = 343) were enrolled prospectively at birth and classified as either prenatally cocaine-exposed (n = 157) or non-cocaine-exposed (n = 186) on the basis of maternal self-report and bioassays. Follow-up evaluations at 3 years of age (mean age, 40 mo) included a videotaped dyadic play session and maternal interviews to assess ongoing drug use and maternal psychological distress. Play interactions were coded using a modified version of Egeland et al's Teaching Task coding scheme. Regression analyses indicated cocaine-associated deficits in mother-child interaction, even with statistical adjustment for multiple suspected influences on interaction dynamics. Mother-child interactions were most impaired in cocaine-exposed dyads when the mother continued to report cocaine use at the 3-year follow-up. Multivariate profile analysis of the Egeland interaction subscales indicated greater maternal intrusiveness and hostility, poorer quality of instruction, lower maternal confidence, and diminished child persistence in the cocaine-exposed dyads.     

母乳喂养对婴儿早期骨发育的影响

研究目的探讨母乳喂养对婴儿早期骨发育的影响。研究方法对北京、兰州、重庆的１７２名３月龄婴儿，按母乳喂养和人工喂养分组。采用ＴａｎｎｅｒＷｈｉｔｅｈｏｕｓｅ２法比较两组骨龄发育的状况。结果９１例母乳喂养婴儿中，迟于日历年龄者５０例，正常或超越的为４１例。人工喂养的８１例中，迟于日历年龄者５２例，正常或超越为２９例。ｘ２＝１．５２＜ｘ２０．０５（１），Ｐ＞０．０５。结论母乳喂养与人工喂养婴儿的骨龄比较未出现显著差异。     

The effect of postpartum lactation counseling on the duration of breast-feeding in low-income women

We investigated the effectiveness of a program of intensive postpartum support for low-income, breast-feeding women and identified potential predictors of prolonged breast-feeding in this population. Ninety-seven low-income women were randomized to receive intensive postpartum education and support for breast-feeding or to receive only the routine assistance provided by the obstetrical nurses. Both groups were telephoned 6 weeks post partum to determine the method of infant feeding then, and those still breast-feeding were contacted monthly until complete weaning had occurred. No significant difference in breast-feeding duration between the two groups was noted. There was no association between duration of nursing and race, marital status, or the need to return to work or school. Earlier age at introduction of supplement, younger maternal age, and participation in prenatal classes predicted breast-feeding duration by logistic regression.     

Free-radical-induced lipid peroxidation during the early neonatal period

The effect of gestational age on postnatal free-radical-mediated lipid peroxidation was studied in 19 term (gestational age 37–42 weeks) and 21 healthy preterm (gestational age 31–36 weeks) infants by measurement of expired ethane and pentane during the first 7 days of life. Ethane (11.9 versus 5.7 pmol/kg/min; p = 0.0001) and pentane (11.4 versus 7.5 pmol/kg/min; p = 0.01) were significantly higher in preterm than in term infants. Correlations were found between gestational age and ethane ( r = 0.60, p = 0.0001) for days 1–7 and pentane ( r = 0.54, p = 0.0003) for days 3–7; and between birth weight and ethane ( r = 0.58, p = 0.0001) and pentane (r = 0.55, p = 0.0003). These results indicate that during the postnatal period, immaturity is a major factor determining the rate of free-radial-mediated lipid peroxidation.     

Prevalence and patterns of intimate partner violence among adolescent mothers during the postpartum period

OBJECTIVE: To examine prevalence, frequency, severity, and patterns of intimate partner violence (IPV) during the first 24 months' post partum within a multiethnic cohort of adolescents. DESIGN: A prospective study of adolescent girls followed up for 24 months into the postpartum period. Follow-up surveys were completed at 3, 6, 12, 18, and 24 months' post partum. Overall, 74% completed at least 4 of the 5 follow-up surveys. SETTING: Postpartum unit at a university teaching hospital in Galveston, Tex. PARTICIPANTS: A total of 570 adolescents (18 years or younger; 219 Mexican Americans, 182 African Americans, and 169 European Americans) completed face-to-face interviews within 48 hours of delivery and returned at least 4 of 5 follow-up surveys. MAIN OUTCOME MEASURES: Prevalence of IPV and frequent and severe IPV. RESULTS: Prevalence of IPV was highest at 3 months' post partum (21%) and lowest at 24 months (13%). The percentage of assaulted mothers who experienced severe IPV increased from 40% to 62% across this period. Seventy-five percent of mothers reporting IPV during pregnancy also reported IPV within 24 months following delivery. Of importance, 78% who experienced IPV during the first 3 postpartum months had not reported IPV before delivery. Ethnic differences in IPV were observed at 3, 6, and 18 months' post partum. CONCLUSIONS: Adolescents are at high risk for experiencing IPV during the postpartum period. Frequent screening for IPV by health care practitioners is critical to maximize detection.     

Insulin and glucagon during the perinatal period: secretion and metabolic effects on the liver

Insulin and glucagon are detected in the plasma of most species early in gestation. In the fetus at term, insulin and glucagon secretion can be modified by long-term changes in glucose concentration but the responsiveness of A and B cells to glucose is lower than in the adult. The plasma insulin/glucagon molar ratio is high in the fetus at term, then decreases dramatically immediately after birth and remains low during the first hours of extrauterine life. This situation results in favored hepatic glycogen storage and prevented gluconeogenesis in utero, and sharp glycogen breakdown and active gluconeogenesis during the early postnatal period.     

Endothelium-derived relaxing and contracting factors during the early neonatal period

Abstract The interaction and relative potency of nitric oxide, an endothelium-derived relaxing factor, and endothelin-1, an endothelium-derived contracting factor, may be important in the transition from fetal to extrauterine life. The change in level of nitric oxide during the early neonatal period has not been measured. Accordingly, the serum levels of nitric oxide metabolites (the sum of nitrite and nitrate) and plasma endothelin-1 were determined in 20 healthy neonates at birth, at 12 and 24 h postnatally, and at the age of 5 d. The lowest serum concentration of nitric oxide metabolites was observed at birth (26.2 ± 9.1 µmol 1^-1, mean ± SD) and increased with age, whereas the highest plasma concentration of endothelin-1 was observed at birth (14.0 ± 6.7 pg ml^-1) and decreased with age. These changes suggest that nitric oxide and endothelin-1 play roles in the circulatory adaptation of the neonate to extrauterine life.     

Maternal employment and breastfeeding: results from the longitudinal study of Australian children

AIM: To investigate the effect of maternal postnatal employment on breastfeeding duration in Australia in the first 6 months after birth. METHOD: Secondary data analysis of the infant data (2004) from the Longitudinal Study of Australian Children (LSAC). Complete maternal and breastfeeding data were available for 3,697 infants. Multivariable logistic regression was used to investigate the effect of timing of resumption of maternal employment and maternal employment status on breastfeeding at 6 months postpartum after adjustment for maternal education, maternal age, maternal smoking during pregnancy and socioeconomic status of the child's area of residence. RESULTS: Fewer women employed full-time were breastfeeding their infants at 6 months (39%) than nonemployed women (56%). Participation in full-time employment before 6 months had a strong, negative effect on the likelihood of continuing breastfeeding for 6 months, adjusted OR = 0.35 (95%CI: 0.22-0.55). Compared to nonemployed women, fewer women in part-time employment were breastfeeding at 6 months (44%), adjusted OR = 0.49 (95% CI: 0.37-0.64). CONCLUSIONS: Results from this large representative cohort of Australian infants confirm that maternal employment in the first 6 months of life contributes to premature cessation of breastfeeding even when known risk factors for breastfeeding cessation are controlled for.     

Demographic factors influencing the initiation of breast-feeding in an Israeli urban population

The influence of demographic and prenatal factors on the initiation of breast-feeding in an urban Israeli population was evaluated by interviewing 1,000 parturients prior to discharge from the hospital. The mothers were all Jewish, none were single, and none were social welfare dependents. Of these mothers, 72% were breast-feeding, 6% stated an intent to breast-feed, and 22% were formula-feeding their infants. A significantly increased rate of breast-feeding was found among mothers with the following characteristics: those of orthodox religious belief, high educational level, in the academic and paraacademic professions, nonsmokers, those who worked outside of the home during the pregnancy, those who had previous breast-feeding success, and mothers whose husbands' attitude toward breast-feeding was positive. The decision to breast-feed was made prior to delivery in 85% of mothers. Participation of the mother and/or father in antenatal preparation courses did not significantly influence the initiation of breast-feeding. Multivariant analysis with a stepwise logistic regression model delineated the four factors most significantly associated with the initiation of breast-feeding: positive spousal attitude toward breast-feeding, orthodox religious belief, nonsmoking, and work outside of the home during the pregnancy. The expected probability for initiating breast-feeding was computed for the various combinations of these four categories and ranged from .94 with all factors present to .33 in the absence of these characteristics. Pediatrics 1989; 83:519-523; breast-feeding, Israel.