Breastfeeding Medicine

We examined the extent to which social, maternal, and infant factors and Theory of Planned Behavior (TPB) domains—attitudes, perceived control, and subjective norms—mediate the relationship between maternal race and ethnicity and birth country, and breastfeeding continuation.

A nationally representative cohort of 2,810 mothers with self-reported race, ethnicity, and birth country was used. Main outcomes included any and exclusive breastfeeding at 2–6 months of infant age. A conceptual framework with the aforementioned mediators of interest was developed. Logistic regression was used to examine main associations, and structural equation modeling was used to identify the extent to which proposed mediators explained the relationship between independent and dependent variables.

One thousand two hundred twenty-one mothers were U.S.-born non-Hispanic white (NHW), 432 U.S.-born Hispanic, 329 Mexico-born Hispanic, 107 Central- or South America-born Hispanic, 33 Caribbean-born Hispanic, and 688 U.S.-born non-Hispanic black (NHB). No differences in breastfeeding continuation among U.S.-born NHW and U.S.-born Hispanic mothers were found. In contrast, compared with U.S.-born NHW mothers, Mexico-born (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.46–2.72) and Central- or South America-born (OR 3.42, 95% CI 1.89–6.17) Hispanic mothers had higher odds, and Caribbean-born Hispanic mothers had lower odds (OR 0.45, 95% CI 0.26–0.76) of any breastfeeding. These relationships were mediated by attitudes and subjective norms.

Breastfeeding continuation among U.S. Hispanic mothers varied by birth country, highlighting the heterogeneity of breastfeeding populations of Hispanic mothers in the United States. Tailored interventions should strengthen policies supportive of positive attitudes toward and subjective norms around breastfeeding.

Gestational diabetes mellitus (GDM) is known to affect human milk composition. Aims of this study were to compare macronutrient and energy content of human milk of women with (GDM⁺) and without GDM (GDM⁻), to assess the association between maternal health and human milk macronutrient and energy content and association between human milk macronutrient and energy content and infant growth.

Two months after delivery, hindmilk samples were collected. Triglyceride (TG), lactose, and protein content of human milk were measured. An oral glucose tolerance test was performed. Infant weight and length at birth and 2 months were collected. Weight-for-age (WAZ) and weight-for-length z-scores were calculated.

Twenty-four GDM⁺ and 29 GDM⁻ women were included. Protein, lactose, and energy content of human milk were similar between groups. TG concentration was higher in GDM⁺ than in GDM⁻ women (6.3 ± 2.0 versus 5.3 ± 1.2, p = 0.04). This difference was no longer significant after adjustment for maternal age and infant sex (p = 0.23). Maternal age was associated with TG (r = 0.28, p = 0.04) and lactose (r = −0.30, p = 0.03), while fasting glucose was associated with proteins (r = 0.30, p = 0.03) and tended to be associated with TG (r = 0.27, p = 0.05) and energy (r = 0.24, p = 0.08). TG levels in human milk were associated with weight (β: 0.26, 95% confidence interval [CI]: 0.02 to 0.50) and WAZ (β: 0.40, 95% CI: 0.05 to 0.75) at 2 months among children unexposed (GDM⁻) to GDM, but not among children exposed (GDM⁺)

In conclusion, GDM status, maternal age, and fasting glucose level were associated with human milk composition. Finally, TG in human milk was associated with infant growth among GDM⁻ children but not among GDM⁺ children. ClinicalTrials.gov NCT02872402.

The aim of this study was to investigate the effects of aroma of Citrus aurantium and Lavender essence on sexual satisfaction in breastfeeding women.

This was a double-blind randomized controlled trial that was conducted on 180 breastfeeding women from January to May 2019. The participants were allocated to three groups of Citrus aurantium (n = 60), Lavender (n = 60), and control (n = 60) groups. Two groups of intervention used 2 drops of essential oil, twice a day, for 40 days as inhalation. The control group received almond oil in the same. The sexual satisfaction was evaluated using the Linda Berg's Sexual Satisfaction Questionnaire before the intervention and 40 days after the intervention started. The data were analyzed using the SPSS statistical software, version 21, and p < 0.05 was considered statistically significant.

After the 40 days of intervention, the mean score of sexual satisfaction was significantly higher in the Citrus aurantium and Lavender groups compared with the control group (59.3 ± 11.7, 59.3 ± 11.6 vs. 52.02 ± 11.5, p < 0.001). There was no significant difference between Lavender and Citrus aurantium groups.

The results of this study showed that the aroma of Citrus aurantium and Lavender essence could significantly improve the sexual satisfaction of breastfeeding women. Therefore, it is recommended that health care providers should inform the breastfeeding women and advise them to use these interventions for increase of the sexual satisfaction. Trial Registration Number: IRCT20160427027633N3.

Nipple fissure is a prevalent problem for breastfeeding mothers. Virgin coconut oil (VCO) is an herbal medicine that can heal microbial infections and wounds.

: This study aims to evaluate the efficacy of VCO and breast milk on nipple fissures in primiparous mothers.

A single-blind clinical trial was conducted with 106 breastfeeding primiparous mothers suffering from nipple fissures in health centers of Zarand, Kerman, from August 2020 to November 2020. The participants were selected randomly and allocated to two 60-member groups using block randomization. Mothers in the first group were asked to apply 0.5 mL of coconut oil on their nipples three times a day. Mothers in the second group were trained to apply three to four drops of their milk on their nipples after every breastfeeding session. The level of nipple fissures and pain intensity were examined using Storr's scale and visual analog scale, respectively. The results were analyzed using the chi-square test, repeated measures analysis of variance, and the independent samples t-test in SPSS 22. In this study, the significance level was set at p < 0.05.

Within-group comparisons revealed a significant difference between baseline scores and the scores on the 7th and 14th days (p < 0.001). Between-group comparison indicated no significant difference in nipple fissure (p = 0.419) and pain intensity (p = 0.405) at baseline. Nonetheless, there was a significant difference on the 7th day (p_fissure = 0.002, p_pain <0.001) and on the 14th day (p_fissure <0.001, p_pain = 0.036).

Given its effect on nipple fissures, VCO may be used as a complementary substance to treat nipple fissures.

This trial is registered with the Iranian Registry of Clinical Trials with the identifier: IRCT20190724044318N1.

Breast milk iodine concentration (BMIC) from vegan and vegetarian lactating mothers has not previously been evaluated. The goal of this study was to assess BMIC from vegans, vegetarians, and omnivores and to assess intake of iodine by breastfed infants.

Breast milk samples from vegans (n = 12), vegetarians (n = 6), and omnivores (n = 12) living in the United States were analyzed. BMIC was determined at the mass-to-charge ratio (m/z) 127 by inductively coupled plasma mass spectrometry (ICP-MS) using an Agilent 8800 ICP-MS/MS (Agilent Technologies).

There was a significant difference in mean BMIC between participants following a plant-based diet (vegan and vegetarian, n = 18) compared with omnivores [4.42 versus 5.02 Ln(BMIC), respectively; p = 0.0405]. In linear regression to predict BMIC, vegan diet was a negative predictor (standardized β = −0.409) and use of multi- or prenatal supplements was a positive predictor (standardized β = 0.319). There were differences in the percentage of inadequate BMIC per maternal diet (75% vegan, 67% vegetarian, omnivore 58%) but this did not reach statistical significance. In 67% of the samples (20/30) BMIC was lower than the National Academy of Medicine's adequate intake (AI), assuming infant milk consumption of 0.78 L/day.

Most samples from vegans and vegetarians contained a lower BMIC than AI for infants 0–6 months. Counseling of pregnant vegans and vegetarians should highlight importance of iodine supplementation during lactation. The findings are based on a small number of samples, especially for vegetarians, and thus, they need to be confirmed by larger studies.

Data on baseline rates of nonserious events in breastfed infants in the general population are sparse. This results in difficulty determining if there is an increase in infant nonserious events potentially due to prescription medication exposure through human milk. In this study, we determined the prevalence of nonserious events in infants consuming human milk whose mothers reported no exposure to any prescription medications, tobacco, or recreational drugs in the previous 14 days.

Between August 2014 and December 2019, 487 breastfeeding mothers without any recent exposure to prescription medications, tobacco, or recreational drugs enrolled in the Human Milk Research Biorepository at the University of California, San Diego. Participants completed a semistructured telephone interview with trained research staff and provided information on maternal and child health, breastfeeding habits, recent medication, and lifestyle exposures, and completed a standard checklist of infant adverse reactions.

We found 131 (44.1%) participants reported one or more infant nonserious adverse events in the past 14 days at the time of their study interview. The most commonly reported nonserious events were rash (12.1%), irritability (9.4%), constipation (7.8%), poor sleep (7.1%), and fever (6.3%).

These baseline frequencies provide a benchmark for rates of recent nonserious events in breastfed infants in the general population. These data can be used as a reference point for studies that examine adverse events in breastfed infants following maternal use of prescription medications or exposures due to other lifestyle habits such as tobacco or other substances. Clinical Trial Registration Number: NCT05553743.

In this study, it was aimed to investigate interruptions in breastfeeding, relactation, and relactation awareness-related factors.

This cross-sectional online survey was conducted in 2020 with women who had children between 6 and 36 months of age. Women >18 years of age and willing to consent to study participation (n = 392) were recruited throughout Turkey. Data were collected online through Google forms using the Personal Information Form, and Relactation Awareness Index (RAI). The dependent variables of the study were continuing breastfeeding, relactation, and breastfeeding awareness. Logistic and linear regression analyses were performed.

Of the participants, 53.1% exclusively breastfed their infants in the first 6 months of life, and 34.9% interrupted breastfeeding. Of those who interrupted breastfeeding, 39.4% achieved success in relactation. The rate of failed relactation was 9.16 times higher in primary school graduates and 2.37 times higher in those who perceived their milk supply as insufficient. The rate was also high in those whose RAI score was low (p < 0.05). Factors such as perception that milk supply is inadequate, lack of education and interruption of breastfeeding are associated with awareness of relactation. According to the linear regression analysis, breastfeeding within the first hour of delivery, length of time planned for breastfeeding, exclusive breastfeeding for the first 6 months of life affected relactation awareness positively, whereas the perceived milk supply affected it negatively (p < 0.05).

Awareness of relactation should be raised and trainings should be organized to increase the success of relactation. Especially mothers who have interrupted breastfeeding need supportive and professional interventions to continue breastfeeding.

Distal sensory polyneuropathy (DSP) is a common peripheral neuropathy subtype. We aimed to determine the association between breastfeeding and DSP among postmenopausal women aged 40–70 years, and the effect modification of obesity on this association.

A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey 1999–2004. Postmenopausal women aged 40–70 years were included. Women with diabetes, stroke, cancer, cardiovascular disease, thyroid disease, liver disease, weak/failing kidneys, or amputation were excluded. Binary logistic regression was used to analyze the association between breastfeeding and DSP.

Among 798 participants, 386 (44.30%) reported breastfeeding history and 51 (5.29%) were defined as having DSP using the monofilament test. A significant inverse association was observed between breastfeeding and DSP (odds ratio [OR] = 0.29; 95% confidence interval [CI]: 0.11–0.79; p = 0.017) after adjusting for other confounding variables. In subgroup analysis, this adjusted association was observed only in the obese group (OR = 0.21; 95% CI: 0.06–0.73, p = 0.013).

Breastfeeding was found to have potential benefits in the presence of DSP in postmenopausal women aged 40–70 years, and obesity modified the association between breastfeeding and DSP. Promoting breastfeeding may reduce the burden of peripheral neuropathy in middle-aged postmenopausal women.

The practice of breastfeeding in public (BFP) is associated with the perceived social norms. No sufficient knowledge is available regarding this practice, the attitudes related, and the significant associated factors in Egypt.

To assess the prevalence of BFP, attitudes, barriers, and enabling factors.

A cross-sectional study was conducted in Dakahlia Governorate, Egypt, including breastfeeding mothers whose babies were ≤12 months of age. A predesigned validated interviewer-administered questionnaire was used to collect data.

The study included 400 participants, 72.8% of them had practiced breastfeeding in public at least once. Regression analysis showed that being urban, high socioeconomic standard, having babies who were of normal birthweight and not the first in order were significant predictors of higher prevalence of BFP. Also, positive mother's attitude and having a family member who also practiced BFP were independent significant predictors. Finally, mothers who practiced breastfeeding in public are less likely to have supportive families' attitude. The most common causes of not practicing BFP is men's presence (94%), followed by husband disagreement (78.5%), absence of breast cover (69.3%), or feeling embarrassed (63.2%).

Breastfeeding in public is a frequent practice among the studied mothers. Underlying factors associated with BFP can help guide tailored health education message to nursing mothers. Privacy was the keyword behind not practicing BFP.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition of the mammary gland that presents as a painful mass, and it must be distinguished from both infectious mastitis and breast cancer. When diagnosed during lactation, it can result in significant distress and early weaning. Injection of triamcinolone has been used as a successful treatment method, but safety in breastfed infants has not been established.

We present a case of a lactating patient who received a direct injection of triamcinolone (dosage 40 mg) in her breast to treat IGM after failure of oral corticosteroids. Breastmilk samples were expressed by the patient 0, 1, 4, and 24 hours after the procedure, and then daily for 1 week. All the samples were analyzed using liquid chromatography mass spectrometry. The patient was supported by a breastfeeding and lactation medicine clinic.

After injection of triamcinolone into the granulomatous mass, breast milk samples were collected and analyzed. No samples were found to contain triamcinolone. A temporary but significant decrease in milk production was noted after injection, though only a slight decrease had been noted with 6 weeks of systemic corticosteroids. With support, the patient rebuilt milk production and continued to breastfeed from both breasts.

Triamcinolone was not found in any milk samples (≥0.78 ng/mL) following therapeutic injection of the affected breast. The patient was able to continue breastfeeding from the affected breast with intermittent symptoms.