Breastfeeding Medicine

The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments.

Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother–infant dyads.

This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.

African American women continue to experience low rates of breastfeeding initiation as well as low rates of exclusive breastfeeding for 6 months. Research has indicated that there are several social determinants that impact breastfeeding rates, but there is a dearth of literature that allows African American women to give voice to their experiences. In addition, research has shown women, infant, and children (WIC) participants to have lower breastfeeding rates than non-WIC eligible women.

The aim of this systematic review was to examine the relationship between WIC program participation and breastfeeding initiation and duration among non-Hispanic African American/Black women.

The approach for this review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Four online databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, MEDLINE, and SCOPUS, were used to search for peer-reviewed articles and grey literature.

Two hundred eighteen articles were retrieved through the database search and underwent initial screening, yielding 59 potential eligible articles. Full-text articles were further reviewed and 11 met the inclusion criteria and were included in this systematic review.

Included studies show mixed results regarding the association between WIC participation and breastfeeding initiation, but there is a general negative association between WIC participation and breastfeeding duration, especially among Black women.

The aim of this study is to examine in-hospital exclusive breastfeeding (EBF) and its association with sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support.

We conducted a retrospective cross-sectional study using medical records from 2015 to 2019 of healthy term infants without breastfeeding contraindications at a public teaching hospital serving a racially and ethnically diverse patient population. Using multivariable regression analysis, we examined the associations between in-hospital EBF and sociodemographic factors, medical factors, breastfeeding intentions, and health care system breastfeeding support (in-hospital breastfeeding education and lactation support).

The prevalence of in-hospital EBF was 29.0%. The statistically significant findings from our fully adjusted regression analysis include that there was a higher prevalence of in-hospital EBF among adult mothers (prevalence ratio [PR]: range 1.78–1.96), married mothers (PR: 1.35, 95% confidence interval [CI]: 1.23–1.44), and mothers who were White (PR: 1.41, 95% CI: 1.20–1.66, compared with Black). Factors associated with a lower prevalence of in-hospital EBF were maternal diabetes (PR: 0.82, 95% CI: 0.70–0.95), pre-eclampsia/eclampsia (PR: 0.82, 95% CI: 0.71–0.95), cesarean delivery (PR: 0.84, 95% CI: 0.77–0.92), neonatal hypoglycemia (PR: 0.46, 95% CI: 0.36–0.59), and intention in the prenatal period to formula feed only (PR: 0.15, 95% CI: 0.10–0.22). In-hospital lactation support was associated with higher prevalence of in-hospital EBF (PR: 1.24, 95% CI: 1.16–1.33).

Prioritizing lactation support for Black mothers, adolescent mothers, those intending in the prenatal period to formula feed only, and mother–infant dyads with certain medical factors could improve in-hospital EBF.

To evaluate the effect of antenatal breast milk expression (ABE) on exclusive breastfeeding.

A randomized control study was performed with the primary outcome being formula use during the postpartum hospital stay. Secondary outcomes were the exclusive breastfeeding rate at 6 months postpartum and peripartum safety outcomes. Participants included multiparous and nulliparous patients who planned to breastfeed. Exclusion criteria included exclusively breastfeeding in prior pregnancies for greater than 6 months, medical contraindications for breastfeeding, multiple gestation, history of preterm delivery, or any contraindication to vaginal delivery. ABE group participants were instructed to pump for 20 minutes, three times daily, starting at 37 weeks of gestation.

Three-hundred four participants from two clinics were enrolled. There was no significant difference in formula use during hospital admission (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.34–1.22) or in exclusive breastfeeding at 6 months postpartum (OR 0.66, 95% CI 0.34–1.29). Colostrum use was more prevalent in the ABE group (OR 5.31, 95% CI 2.63–10.76). ABE participants were more likely to present in spontaneous labor (OR 2.09, 95% CI 1.05–4.14).

ABE did not significantly improve exclusive breastfeeding rates, but safely provides women opportunities to become familiar with breastfeeding before delivery and can provide readily available colostrum. There was no negative secondary safety outcome related to ABE identified. Prenatal care providers can consider recommending ABE to patients with minimal to no experience with breastfeeding.

Cow's milk protein allergy (CMPA) is well described in term infants, as opposed to preterm infants. In preterm infants, CMPA shares many gastrointestinal symptoms with necrotizing enterocolitis (NEC).

To evaluate the presentation of CMPA in preterm infants and to investigate the different diagnostic and therapeutic options.

We searched for the relevant literature using the medical databases PubMed, Web of Science, and the Cochrane Library. We performed a post hoc analysis on the 25 case reports included in this study.

Literature was scarce and heterogeneous. The majority of preterm infants with CMPA were exposed to bovine-based milk proteins before the development of symptoms. The most common clinical manifestations were bloody stools, vomiting, and abdominal distension. Of the 25 cases, only 7 (28%) retained human milk in their diet after diagnosis. In the larger studies, no study has human milk as primary feeding choice after diagnosis.

Preterm infants exposed to a type of cow's milk-based formula in their first days of life have a higher risk of developing CMPA. Most of the preterm infants are no longer fed with human milk after the diagnosis of CMPA is made, which is in contrast with current nutrition guidelines in preterm infants. We strongly advocate that human milk with mothers on a cow's milk-free diet is the first choice of feed after the diagnosis of CMPA. Prospective studies are necessary to obtain more information regarding clinical presentation, diagnostic tools, and therapeutic approaches.

Breastfeeding has health benefits for both mothers and children. Nipple problems may result in the child being weaned prematurely before the recommended 6 months minimum period of exclusive breastfeeding.

The study aimed to compare the effectiveness of topically applying olive oil and breast milk in treating nipple pain and soreness in breastfeeding mothers during the early postpartum period.

A quasi-randomized controlled trial was conducted in a maternity ward of a medical center in northern Taiwan. Eighty breastfeeding mothers were recruited, and randomly assigned to the olive oil or breast milk group. Visual analogue pain scale (intensity of nipple pain) and nipple soreness scores were collected at 24, 48, and 72 hours after delivery. Differences in postintervention outcomes between groups were examined using the Generalized Estimating Equation model.

The results indicated that both olive oil and breast milk groups reported a significant increase in the intensity of nipple pain and nipple soreness at 24, 48, and 72 hours after delivery. However, differences in the outcome measurements between olive oil and breast milk groups were statistically insignificant at p-value >0.05.

This study found that olive oil had similar effects on nipple pain and soreness to breast milk. In addition, most breastfeeding mothers provided positive feedback on using olive oil. Olive oil can be a safe, accessible, and alternative choice for breastfeeding mothers in treating nipple pain and soreness, especially early in the breastfeeding period. The Clinical Trail Registration Number: NCT03568370.

Breastfeeding and human milk (HM) improve maternal and infant morbidities and mortality. Therefore, monitoring the safety of breastfeeding and access to HM is of critical importance. In this study, we assessed tools to monitor the presence of monkeypox virus (MPXV) in HM and whether standard Holder pasteurization inactivates MPXV.

Heat-inactivated MPXV was added to HM or viral transport media (VTM) and analyzed using both research and clinical MPXV quantitative polymerase chain reaction (qPCR) tests. Infectious MPXV was added to HM and was exposed to 1 cycle of freeze–thaw, incubation for 1 hour at room temperature, or conditions of Holder pasteurization (62.5°C for 30 minutes) followed by infectious unit quantification by plaque assay.

Research and clinical nucleic acid tests detect MPXV that was added to HM but with reduced sensitivity compared with equivalent samples in VTM at low virus inoculum. MPXV added to HM to achieve a starting concentration of 225,000 plaque forming units (pfu)/mL remains infectious after freeze–thaw or 1 hour storage at room temperature. However, Holder pasteurization reduced infectious virus below the limit of detection, >2,000-fold reduction in viral titer.

MPXV can be detected when added to HM using a clinical laboratory-developed qPCR test without modification, but the detection limit is reduced compared with equivalent samples in VTM. MPXV remains viable in HM should the virus ever gain access to HM, but Holder pasteurization reduces infectious MPXV to below detection limits and can be used to reduce the risk of MPXV transmission to infants who receive pasteurized (donor) HM.

Research on race/ethnicity and breastfeeding has consistently found lower rates for Black mothers compared with other U.S. women, due to various social, cultural, and historical factors. Aggregate analyses illuminate racial/ethnic differences, but they only provide partial insight into the factors contextualizing breastfeeding decisions and rates. We examined articles addressing Black women and breastfeeding (1980–2020) to assess publication trends.

A targeted literature search in PubMed for research on Black women and breastfeeding (1980–2020). The search used nine different keyword combinations: (“breastfeeding” OR “lactation” OR “infant feeding,”) AND (“rac*” OR “African American” OR “Black”). After removing duplicates, non-U.S. research, and irrelevant articles, 221 articles were reviewed. Articles were coded for year, type (quantitative, qualitative, mixed method, conceptual/literature review, commentary/editorial), and journal target audience (e.g., nursing).

More than 50% of all articles were published after 2013. The period of 2018–2020 accounts for 25% of all published articles. The research is also mostly quantitative (60.2%). Qualitative studies made up only 16.7% of articles. A few studies used mixed methods (5%). More than half of all qualitative studies were published after 2014.

Research on Black women and breastfeeding has slowly increased since 1980, but much of the work has only been done post-2000. Research is also mostly quantitative analyses. Quantitative and qualitative methods rely on different research aims, styles, and objectives. To provide a fuller understanding of Black women's relationship to and experience of breastfeeding, we suggest that scholars cultivate a stronger focus on qualitative and mixed methods for future research.

Although breastfeeding confers significant benefits to infants, women with diabetes in pregnancy experience unique nutrition and health challenges, which may influence infant feeding practice. This study aimed to determine the association between nutrition and exercise behaviors of women with diabetes in pregnancy and breastfeeding at birth and 6 months.

A secondary data analysis of a longitudinal study on maternal pregestational diabetes mellitus (DM) and gestational diabetes (GDM) and infant development was conducted. Women self-reported engaging in nutrition behaviors, such as using meal plans, and exercise health behaviors. Primary outcomes were exclusive breastfeeding at birth and any breastfeeding at 6 months. Logistic regression models adjusted for significant maternal-infant covariates.

Of n = 48 women with diabetes in pregnancy, 94% had GDM and 6% had pregestational type 1 or type 2 DM. Forty percent of women exclusively breastfed at birth and 68% partially or exclusively breastfed at 6 months (of n = 34 with complete 6-month data). Women who cooked their own meals had two times greater adjusted odds of exclusive breastfeeding at birth (adjusted odds ratio [AOR] = 1.94, 95% confidence interval [CI] = 1.12–5.11), and women who exercised during pregnancy had seven times greater adjusted odds of any breastfeeding at 6 months (AOR = 7.2, 95% CI = 1.10–42.8).

Nutrition and exercise behaviors were associated with exclusive breastfeeding at birth and any breastfeeding at 6 months. Health behaviors to effectively manage diabetes during pregnancy may inform efforts to improve breastfeeding initiation and duration, and future studies in a larger sample are needed.