Breastfeeding Medicine

Lack of mother's own milk (MOM) at discharge from the neonatal intensive care unit (NICU) is a global problem and is often attributable to inadequate MOM volume. Evidence suggests that the origins of this problem are during the first 14 days postpartum, a time period that includes secretory activation (SA; lactogenesis II, milk coming in).

To describe and summarize evidence regarding use of MOM biomarkers (MBMs) as a measure of SA in pump-dependent mothers of preterm infants in the NICU and to identify knowledge gaps requiring further investigation.

An integrative review was conducted using Whittemore and Knafl methodology incorporating the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. A search using electronic databases MEDLINE (through PubMed) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) and reference lists of included articles was conducted.

Of the 40 articles retrieved, 6 met the criteria for inclusion. Results revealed the following five findings: (1) Achievement of SA defined by MBMs is delayed and/or impaired in mothers of preterm infants. (2) MBMs are associated with pumped MOM volume. (3) Achievement of SA defined by MBMs is associated with pumping frequency. (4) Delayed and/or impaired achievement of SA defined by MBMs may be exacerbated by maternal comorbidities. (5) There is a lack of consensus as to which MBM(s) and analysis techniques should be used in research and practice.

MBMs hold tremendous potential to document and monitor achievement of SA in mothers of preterm infants, with multiple implications for research and clinical practice.

The prevalence of ankyloglossia and its impact on breastfeeding practices may be overestimated, leading to surgical overtreatment in newborns. The study was conducted to estimate the prevalence of ankyloglossia in the first year of life and investigate the association with exclusive and total breastfeeding duration in different regions of Brazil.

This multicenter prospective cohort study involved the recruitment of mother–infant pairs soon after childbirth in public hospitals in three state capitals in Brazil. Interviews were held with the mothers after birth, at 6 and 12 months to collect sociodemographic variables and data on exclusive and total breastfeeding duration. At 12 months of age, the children were submitted to a dental examination for classification of the lingual frenulum using the Bristol Tongue Assessment Tool. Data analysis involved Poisson regression with robust variance, with the calculation of unadjusted and adjusted relative risk (RR).

The final sample was composed of 293 children. The prevalence of defined and suspected ankyloglossia was 1% and 4.8%, respectively, totaling 5.8% (confidence interval [95% CI]: 3.1–8.5). No significant difference was found in the prevalence of exclusive and total breastfeeding at 1, 4, and 6 months between children with defined/suspected ankyloglossia and those without ankyloglossia. The multivariable analysis showed that the probability of the child achieving 6 months of breastfeeding did not differ between groups (RR = 0.98; 95% CI: 0.79–1.23; p = 0.907).

The prevalence of defined ankyloglossia was very low and defined/suspected ankyloglossia was not associated with exclusive or total breastfeeding duration.

Registered with clinicaltrials.gov (n° NCT03841123).

Acute respiratory infection (ARI) is the leading cause of childhood morbidity and mortality. Exclusive breastfeeding is considered the cornerstone of child health; however, the rate of exclusive breastfeeding is suboptimal in low- and middle-income countries (LMICs). This study aimed to assess the association between exclusive breastfeeding and ARI among infants under the age of 6 months in a LMIC.

A secondary analysis of the 2014 Egypt Demographic Health Survey data was conducted. Mothers of infants under the age of 6 months (n = 1,340) were included. The outcome of interest was ARI symptoms among infants, defined by mother's report of a cough accompanied by fast or difficult breathing in the 2 weeks preceding the survey. The exposure variable was exclusive breastfeeding, defined by giving infants only breast milk during the first 6 months of life. Descriptive statistics and multivariate regression were performed.

Forty-one percent of the infants were exclusively breastfed and 9% had ARI symptoms. Exclusive breastfeeding reduced the odds of ARI symptoms (adjusted odds ratio [AOR] = 0.450, 95% confidence interval [CI]: 0.243–0.832). Infants of mothers 20–34 years of age (AOR = 0.421, 95% CI: 0.217–0.817) and ≥35 years (AOR = 0.308, 95% CI: 0.123–0.767) at childbirth were less likely to have symptoms of an ARI when compared with adolescent mothers. The likelihood of having ARI symptoms was higher among infants 2–3 months of age (AOR = 2.437, 95% CI: 1.093–5.435), and 4–5 months (AOR = 2.888, 95% CI: 1.193–6.992) compared with infants less than 2 months.

Exclusive breastfeeding was protective against ARI symptoms among under-6-month infants, independent of potential confounders.

Melatonin in breast milk exhibits a 24-hour circadian rhythm, present in nighttime breast milk but nearly undetectable in daytime breast milk. Shift work can disrupt the circadian timing of individuals, evident in changes in melatonin in saliva and urine samples. However, it is unknown whether these changes are also reflected in breast milk from a shift working mother. The aim of this study was to investigate whether maternal circadian rhythm disturbance from shift work impacts the melatonin concentration in breast milk.

Breast milk and saliva samples were collected from 11 shift working mothers at four timepoints across five consecutive days. This included during their day shift or nonworkdays to act as a control, night shift, subsequent night shifts and postnight shift. Where possible, pre- and postfeed collections were also undertaken. Samples were grouped into four-time intervals: 12–6:30 am, 7–11:30 am, 12–6:30 pm, 7–11:30 pm, and melatonin levels (picogram per milliliter) in the breast milk and saliva samples were analyzed.

There was a significant decrease in breast milk melatonin (p = 0.026) at the 12–6:30 am time interval on subsequent night shifts, compared with control days. However, there was no overall time and shift type interaction effect (p = 0.70). In addition, no observed difference in melatonin levels was found in saliva samples, or when comparing pre- and postfeed breast milk. Breast milk melatonin however was found to be significantly higher compared with saliva (p > 0.001), at all but one time interval.

The findings suggest that there is a potential effect of maternal circadian rhythm disruption from shift work on breast milk melatonin levels. This is an important step in exploring the role of maternal circadian timing and the effect on breast milk composition. Expansion of this research and exploration of other circadian rhythm misalignment sleep disorders on breast milk is highly recommended.

Breastfeeding myths are culturally ingrained misconceptions related to breastfeeding and adversely affect the breastfeeding process. The objective of this study is to develop the Breastfeeding Myths Scale.

This methodological study was conducted with a total of 413 participants. In the first phase, exploratory factor analysis was employed, followed by confirmatory factor analysis in the second phase. Furthermore, a test–retest was conducted to assess the reliability of the scale scores.

As a result of psychometric analyses, the single-dimensional 30-item Breastfeeding Myths Scale was deemed a valid and reliable instrument. The Cronbach's alpha value of the scale was established at 0.91, and the test–retest reliability at 0.90. According to the results of the receiver operating characteristic analysis, the optimal cutoff point was determined to be 119.50, with a sensitivity of 86% and a specificity of 53%.

Breastfeeding Myths Scale was deemed significant for identifying the prevalence of breastfeeding myths. Utilization of the Breastfeeding Myths Scale is recommended for future research endeavors and individual clinical assessments.

The objective of this study was to investigate the relationship between the Edinburgh Postpartum Depression Scale (EPDS) score on the 10th day postpartum and the number of breastfeeding sessions per day among puerperal women (with no known depression risk factors and a low [<10] EPDS score after delivery).

A total of 1,451 nulliparous, 37- to 41-week pregnant women who gave birth between August 2020 and August 2022 and who underwent routine postpartum checkups on the 10th day after delivery were included in this study. Pregnant women with risk factors for depression before pregnancy, during pregnancy, and after delivery were not included. Patients with an EPDS score of ≥10 after delivery were excluded from the study. On the 10th day after birth, the mean number of breastfeeding sessions per day of the population in the study was determined. Patients with a number of breastfeeding sessions per day above the mean value were classified as Group A (n = 45), and those with values below the mean were classified as Group B (n = 67).

The mean number of breastfeeding sessions per day was 10.15. The EPDS scores of Group A (6 [0–19]) were significantly lower than those of Group B (8 [0–20]) (p < 0.05). A negative linear relationship was found between the number of breastfeeding sessions per day and the EPDS scores on the 10th day postpartum (p < 0.05). No statistically significant difference was found between the EPDS scores and the education status, age, or gestational week of the patients (p > 0.05). There was no statistically significant difference between the number of breastfeeding sessions per day and the education status or age of the patients (p > 0.05).

Higher number of breastfeeding sessions per day is associated with less risk of maternal postpartum depression. There is a need for new studies on the consequences of the number and quality of breastfeeding sessions.

To assess the effects of prenatal counseling about the maternal health benefits of lactation on postpartum knowledge, breastfeeding intentions, and infant feeding behaviors.

We conducted a randomized trial with 411 nulliparous U.S.-born women carrying a singleton gestation. Participants were recruited online; after completing a baseline survey that assessed breastfeeding knowledge and intentions, participants were randomized to receive a 10-minute virtual counseling session about the benefits of breastfeeding or attention-control counseling about smoke-free homes. We collected data on breastfeeding knowledge, intentions, and infant feeding behaviors through 12 months postpartum and conducted an intention-to-treat analysis.

On enrollment, awareness of the maternal health benefits of lactation was similarly low in both study groups. Postpartum, participants who received this prenatal counseling intervention had significantly greater awareness that breastfeeding decreases maternal risk of breast cancer, ovarian cancer, diabetes, heart disease, and rheumatoid arthritis (p < 0.001 for all). On enrollment, intended duration of breastfeeding was similar between groups (10.1 months versus 9.7 months, p = 0.41). At 1-month postpartum, intended duration of breastfeeding had increased from baseline among those who received this counseling (+0.7 months versus −0.7 months among controls, p = 0.004); among intervention participants intended duration of breastfeeding decreased less at 3 (−0.8 versus −1.6, p = 0.18), 6 (−2.0 versus −3.0, p = 0.06), 9 (−2.8 versus −4.2, p = 0.03), and 12 months postpartum (−4.8 versus −6.2, p = 0.09). Rates of exclusive breastfeeding and any breastfeeding were similar between groups.

Prenatal counseling on the maternal health benefits of lactation increases awareness of these maternal health benefits and extends intended duration of breastfeeding.

NCT04601987.

The introduction of foods or fluids other than breast milk in the first few days after birth interferes with the establishment of breastfeeding. This study aimed to investigate the association of formula introduction during the first 3 days of life with maternal sociodemographic characteristics, hospital practices, and breastfeeding duration.

Information from the National Survey of Demographic Dynamics, 2018, which includes 17,686 mother–baby pairs was analyzed. Mother–baby pairs were classified into categories according to breastfeeding duration: <5 months and ≥5 months. Statistical methods and a machine learning algorithm (Bayesian network, BN) were used to analyze the data.

In general, 3,720 (21%) mothers reported introducing formula during the first 3 days of life. A lower education level, lower sociodemographic stratum, living in a rural area, and considering oneself indigenous were factors associated with not introducing formula during the first 3 days of life. A total of 5,168 (29.2%) mother–baby pairs practiced breastfeeding for <5 months, and 12,518 (70.8%) for ≥5 months. Almost twice as many mothers who practiced breastfeeding for <5 months introduced formula during the first 3 days of life (31.7%) compared with those who practiced breastfeeding for ≥5 months (16.6%). The BN model can sufficiently predict cases with a breastfeeding duration ≥5 months (precision–recall curve area = 0.792).

Introducing formula during the first 3 days of life was associated with a shorter breastfeeding duration. BN analysis showed a probabilistic dependency between the type of delivery and variables associated with the establishment of breastfeeding.