Breast-feeding counselling and its effect on the prevalence of exclusive breast-feeding

This prospective intervention study was undertaken to assess the impact of repeated breast-feeding counselling on the rate of exclusive breast-feeding up to five months. The study was carried out in two breast-feeding counselling sub-centres, established at the community level in the vicinity of two maternity facilities and one main centre established in an urban children hospital. Eighty-four pregnant mothers who attended the maternity facilities for delivery of babies were randomly selected and repeatedly counselled regarding breast-feeding--once just before delivery and subsequently at the completion of 1, 2, 3, 4, 5, 6, 9, and 12 month(s) of age of the child. These child-mother pairs comprised the intervention group. Another group of 90 child-mother pairs was selected from the maternity facilities. Mothers in this group (comparison group) received a single session of breast-feeding counselling just before delivery of babies. Fifty-nine and 55 child-mother pairs in the intervention and the comparison groups respectively completed the one-year follow-up. In the intervention group, 54.2% and in the comparison group 36.4% of the babies were exclusively breastfed up to five months of age. Forty-two (88%) children in the intervention group and 29 (53%) in the comparison group were given complementary foods at the optimum time, e.g. after completion of five months, and 81% of the children in the intervention group and 100% of the children in the comparison group were given complementary foods in the first year of life. It was observed that repeated organized breast-feeding counselling significantly improved the prevalence of exclusive breast-feeding to 54% which is much above the existing national prevalence (12.7%) in Bangladesh.     

产科因素对母乳喂养影响的实验研究

为调查产科制度对母乳喂养的影响,我们对在医院正常分娩的孕妇进行母乳喂养观察。结果表明,满4个月母乳喂养率实验组比对照组提高30％,新生儿肺炎减少2.25倍,腹泻减少41.67％,体重增长产后7天实验组为7.6％,对照组为4.2％。     

Improving breastfeeding outcomes: the impact of tongue-tie

A tongue-tie (ankyloglossia) is defined as a lingual frenulum that is short, tight and restricts normal tongue movement. The tongue-tied newborn baby then has a mechanical difficulty attaching to his mum's breast and maintaining attachment to feed effectively. In the hands of skilled carers, this mechanical problem can be resolved by releasing the frenulum (frenulotomy) and the baby's access to his/her mother's breast milk be preserved. Published research on this subject has undergone justifiable criticism. Robust methodology was lacking in earlier studies. An overview of the course of researchers' response to critique is discussed. The care pathway in place in mid-Norfolk for mother and baby dyads where the baby's tongue-tie compromises efficient breastfeeding is outlined.     

母乳喂养对新生儿血清胆红素的影响

分析了2075例新生儿,以探讨母乳喂养对新生儿血清胆红素的影响。发现纯母乳喂养组新生儿病理性黄疽发生率高于混合喂养组;母乳喂养组新生儿的血清平均胆红素水平也高于混合喂养组。结果提示母乳喂养与新生儿病理性黄疸有关。本文讨论母乳性黄疸的可能机制及改善措施。     

Familial ankyloglossia (tongue-tie): a case report

Ankyloglossia (tongue-tie) is a congenital anomaly with a prevalence of 4-5% and characterized by an abnormally short lingual frenulum. For unknown reasons the abnormality seems to be more common in males. The pathogenesis of ankyloglossia is not known. The authors report a family with isolated ankyloglossia inherited as an autosomal dominant or recessive trait. The identification of the defective gene(s) in these patients might reveal novel information on the pathogenesis of this disorder.     

The WHO Code and its effect on breast-feeding promotion in hospitals.

This review outlines the development of the Code on the Marketing of Breast Milk Substitutes, and the impact of the Code and factors that led to its development on breast-feeding promotion in hospitals. Breast-feeding prevalence and duration in Canada, and influencing factors, are discussed. Hospital routines that may discourage breast-feeding are described, along with changes or official statements regarding the routines, where these are available. Areas in which further efforts are needed include routine use of supplements, routine before- and after-feed weighing of the baby, attitudes of health professionals, nursing staffing approaches, disruption of breast-feeding due to minor problems in the mother or baby, and written materials given to parents. Groups of mothers requiring special attention include Indian and Inuit mothers, mothers of preterm infants, and adolescent or young teenage mothers.     

The effect of work status on initiation and duration of breast-feeding.

OBJECTIVES: In this study, longitudinal data are used to examine the effect of work status on breast-feeding initiation and duration. METHODS: Mothers from a mail panel completed questionnaires during late pregnancy and 10 times in the infant's first year. Mother's work status was categorized for initiation by hours she expected, before delivery, to work and for duration by hours she worked at month 3. Covariates were demographics; parity; medical, delivery, and hospital experiences; social support; embarrassment; and health promotion. RESULTS: Expecting to work part-time neither decreased nor increased the probability of breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and .89, P > .50), but expecting to work full-time decreased the probability of breast-feeding (OR = .47, P < .01). Working full-time at 3 months postpartum decreased breast-feeding duration by an average of 8.6 weeks (P < .001) relative to not working, but part-time work of 4 or fewer hours per day did not affect duration, and part-time work of more than 4 hours per day decreased duration less than full-time work. CONCLUSION: Part-time work is an effective strategy to help mothers combine breast-feeding and employment.     

Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview.

OBJECTIVES. The purpose of this review is to examine the plausibility of a causal relationship between maternity ward practices and lactation success. METHODS. Studies were located with MEDLINE, from our personal files, and by contacting researchers working in this field. Of the 65 studies originally reviewed, 18 met our inclusion criteria (i.e., hospital-based intervention, experimental design with randomization procedures, or quasi-experimental design with adequate documentation). RESULTS. Meta-analysis indicated that commercial discharge packs had an adverse effect on lactation performance. The impact of early mother-infant contact on lactation success was unclear. Rooming-in and breast-feeding guidance in a rooming-in context had a beneficial impact on breast-feeding among primiparae. Breast-feeding on demand was positively associated with lactation success. In-hospital formula supplementation of 48 mL per day was not associated with poor breast-feeding performance. CONCLUSIONS. Hospital-based breast-feeding interventions can have a beneficial effect on lactation success, particularly among primiparous women.     

The motivational determinants of breast-feeding: predictors for the continuation of breast-feeding

OBJECTIVE: The aim of this study was to evaluate the motivational determinants of the continuation of breast-feeding until 3 months postpartum. METHODS: A prospective cohort study using the Integrated Change Model in 341 women in 5 child health care centers. RESULTS: At birth, 73% of the mothers started with breast-feeding and 39% of them continued at least 3 months postpartum. Mothers who continued for 3 months differed in almost all the motivational determinants from mothers who discontinued. In the multiple logistic regression analysis, social support for formula feeding from significant others and situational self-efficacy for breast-feeding made a significant independent contribution to the continuation of breast-feeding. Among the predisposing determinants, the strongest positive predictor of continuation was the intention to return to work at 1 month postpartum. CONCLUSION: The Integrated Change Model is valid to explain and predict the continuation of breast-feeding. Hence, the results may be used to tailor future interventions aimed at promoting breast-feeding. In the discussion, we use the results to target interventions.     

Selenium and breast-feeding

The objective of the present review is to discuss Se nutrition during breast-feeding, encompassing environmental and maternal constitutional factors affecting breast-milk-Se metabolism and secretion. A literature search of Medline and Webofscience was used to retrieve and select papers dealing with Se and breast milk. Although Se in natural foods occurs only in organic form, breast milk responds to organic and inorganic Se in supplements. Inorganic Se (selenite, selenate), which is largely used in maternal supplements, is not detectable in breast milk. The mammary-gland regulating mechanism controls the synthesis and secretion of seleno-compounds throughout lactation, with a high total Se level in colostrum that decreases as lactation progresses. Se appears in breast milk as a component of specific seleno-proteins and seleno-amino-acids in milk proteins that are well tolerated by breast-fed infants even in high amounts. Se in breast milk occurs as glutathione peroxidase (4-32 % total Se) > selenocystamine > selenocystine > selenomethionine. The wide range of breast-milk Se concentrations depends on Se consumed in natural foods, which reflects the Se content of the soils where they are grown. Se prophylaxis, either through soil Se fertilization or maternal supplements, is effective in raising breast-milk Se concentration. In spite of wide variation, the median Se concentration from studies worldwide are 26, 18, 15, and 17 microg/l in colostrum (0-5 d), transitional milk (6-21 d), mature milk (1-3 months) and late lactation (>5 months) respectively. Se recommendations for infants are presently not achieved in 30 % of the reported breast-milk Se concentrations; nevertheless Se status is greater in breast-fed than in formula-fed infants.     

Atopic manifestations,breast-feeding protection and the adverse effect of DDE

Despite the numerous studies on the possible protective effect of breast feeding against the onset of atopic manifestations during childhood, this issue remains controversial. As part of an environmental epidemiological study, we investigated whether different blood concentrations of dichlorodiphenyl-dichloroethylene (DDE) modified the protective effect of breast feeding against atopic manifestations in 338 children. DDE concentration, duration of breast feeding and manifestation of atopic disorders were measured in 1994-95 at age 7-8 years. Information gathered on asthma, atopic eczema and hay fever was based on questionnaire data. We measured the total serum concentration of immunoglobulin E (IgE) and specific IgE levels against inhalant allergens. In 1997, we also determined bronchial hyper-reactivity with a hypertonic saline challenge test. To estimate odds ratios from our cross-sectional analysis, we applied logistic regressions, controlling for confounders. Breast feeding had a protective effect on the two asthma variables (e.g.> 12 weeks breast feeding for doctor-diagnosed asthma, OR = 0.32 [95% CI 0.11, 0.87]; for 'ever' asthma, OR = 0.13 [95% CI 0.02, 0.68]), but not on bronchial hyper-reactivity, hay fever, atopic eczema or the two IgE variables. The protective effect became stronger in children with DDE blood levels below the median of 0.29 micro g/L (e.g. doctor-diagnosed asthma,> 12 weeks breast feeding, OR = 0.24 [95% CI 0.06, 0.95]). Also, for specific IgE against inhalant allergens, the association gained statistical significance. For children with a DDE concentration of 0.29 micro g/L and higher, breast feeding did not show a significant protective effect. Our results suggest that contaminants such as DDE may modify the protective effect and may have contributed to inconsistent findings on the protective effect of breast feeding in previous studies. We recommend determining levels of breast milk contaminants in children when assessing the impact of breast feeding on atopic manifestations.     

A community study of a decade of in-hospital breast-feeding: implications for breast-feeding promotion

Information concerning a subject of interest to the health community may be gathered through simple, low-cost minisurveys. Data were gathered on postpartum breast-feeding in one community in 1974, 1979, and 1984. This community mirrored national trends and offered additional information on areas of programmatic interest; findings also confirmed the hypothesis that education and national trends over time had statistically significant relationships with the choice to breast-feed. Of special note is the finding that the level of knowledge concerning infant feeding is closely linked to the choice to breast-feed, as is the relationship between the primary influence of another woman and the choice to breast-feed. With level of education controlled for, both associated variables remained significant for women with lower levels of education, the group least likely to select breast-feeding. This would suggest the probable advantage of breast-feeding promotion based on woman-to-woman contact during preconception and antepartum periods; such a program might be particularly effective with women of lower educational levels.     

Factors associated with exclusive breast-feeding in Japan: for activities to support child-rearing with breast-feeding

BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breast-feeding. METHODS: This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n=53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses. RESULTS: Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle. CONCLUSIONS: Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system.     

Eating for pregnancy and breast-feeding

Good nutrition is essential to help support a successful pregnancy and breast-feeding. Women planning a pregnancy should follow a balanced nutrient-rich diet and consume a daily folic acid supplement up until the end of the first trimester. Many pregnancies, especially amongst teenagers, are unplanned, and educating women of childbearing age about the need to take folic acid to prevent neural tube defects is important. Maintaining a healthy body weight and weight gain is also important: if the mother is underweight, overweight or obese this can harm the health of both mother and fetus. Care should be taken to monitor the nutritional status of vulnerable groups (e.g. teenagers, vegans, women who are underweight, and those at risk of too little vitamin D) to ensure a healthy pregnancy outcome. During breast-feeding the mother needs to eat a sufficient and nutrient-rich diet to provide enough energy and nutrients to support milk production.     

The behavioral determinants of breast-feeding in The Netherlands: predictors for the initiation of breast-feeding.

The aim of this study was to evaluate the behavioral determinants of the initiation of breast-feeding at birth. The prospective cohort study used the attitude, social influence, self-efficacy (ASE) model in 373 pregnant women in five child health care centers. Prenatally, 72% of the women had the intention to breast-feed, and 73% actually started with breast-feeding at birth. Mothers who initiated breast-feeding differed in almost all the attitude, social influence, and self-efficacy determinants from others who initiated formula feeding. Intention was a very strong predictor of the initiation of breast-feeding. The components of the ASE model predicted the initiation of breast-feeding. Hence, the results may be used to tailor future interventions aimed at promoting breast-feeding.     

Erectile dysfunction: prevalence and effect on the quality of life; Boxmeer study

OBJECTIVE: To assess the prevalence of erectile dysfunction (ED), and its influence on both the quality of life, and health care seeking behaviour. METHOD: An age-stratified random sample was drawn from men aged 40-79 years in Boxmeer, the Netherlands (n = 1771), together with their partners. A questionnaire was mailed to the study population to collect data on ED, and the quality of life, both general and disorder related. The prevalence of ED was measured with the direct question 'Do you have problems getting an erection?'. The influence of ED on sexual function was measured with the Dutch version of the Sexual Function Inventory questionnaire. RESULTS: Seventy percent of all men (n = 1233) and 73% of their partners (n = 1071) responded to the questionnaire. The prevalence of ED increased with age class. To the question regarding problems to get an erection, 13% (95% confidence interval: 11-15%) of all men answered affirmatively (40-49 years: 6%; 50-59: 9%; 60-69: 22%; 70-79: 38%). All men aged 40-49 years of age with ED and 16% of men aged 70-79 with ED considered their ED as bothersome. Amongst 40 to 49 year old men with ED, 64% considered their ED as a big or rather a big problem. Amongst older men this percentage was much smaller: 50-59 years: 38%; 60-69: 37%, and 70-79: 27%. Thirty-four percent of all men with ED and 16% of their spouses were dissatisfied with their sex life. Twenty-five percent of men with ED consulted a doctor, with a mean delay of 13 months. ED bore a strong correlation with the general quality of life and comorbidity. CONCLUSION: ED was a common disorder within the population. Its prevalence was higher among older age groups, but they regarded ED as less of a problem than the younger age groups. Only a quarter of all men with ED consulted a physician.     

Mercury and lead during breast-feeding

Hg and Pb are of public health concern due to their toxic effects on vulnerable fetuses, persistence in pregnant and breast-feeding mothers, and widespread occurrence in the environment. To diminish maternal and infant exposure to Hg and Pb, it is necessary to establish guidelines based on an understanding of the environmental occurrence of these metals and the manner in which they reach the developing human organism. In the present review, environmental exposure, acquisition and storage of these metals via maternal-infant interaction are systematically presented. Though Hg and Pb are dispersed throughout the environment, the risk of exposure to infants is primarily influenced by maternal dietary habits, metal speciation and interaction with nutritional status. Hg and Pb possess similar adverse effects on the central nervous system, but they have environmental and metabolic differences that modulate their toxicity and neurobehavioural outcome in infant exposure during fetal development. Hg is mainly found in protein matrices of animal flesh (especially fish and shellfish), whereas Pb is mainly found in osseous structures. The potential of maternal acquisition is higher and lasts longer for Pb than for Hg. Pb stored in bone has a longer half-life than monomethyl-mercury acquired from fish. Both metals appear in breast milk as a fraction of the levels found in maternal blood supplied to the fetus during gestation. Habitual diets consumed by lactating mothers pose no health hazard to breast-fed infants. Instead, cows' milk-based formulas pose a greater risk of infant exposure to neurotoxic substances.