Breastfeeding and early child development: a prospective cohort study

Aim: Breastfeeding has been associated with multiple developmental advantages for the infant; however, there have also been a number of studies that find no significant benefits to child development. We examined the relationship between breastfeeding for 4 months or longer and child development at age 1, 2 and 3 years. Methods: Women were enrolled in the Western Australian Pregnancy Cohort (Raine) Study (N = 2900) and their live born children (N = 2868) were followed to the age of 3 years (N = 2280). Infant feeding data were collected at each age, and the mothers completed the Infant/Child Monitoring Questionnaire (IMQ), which measures progress towards developmental milestones in the domains of gross and fine motor skills, adaptability, sociability and communication. Factors adjusted for in multivariable analyses included maternal sociodemographic characteristics and stressful life events. Results: Infants breastfed for 4 months or longer had significantly higher mean scores (representing better functioning) for fine motor skills at age 1 and 3, significantly higher adaptability scores up to age two, and higher communication scores at age 1 and 3 years. Infants who were breastfed for <4 months were more likely to have at least one atypical score across the five developmental domains than those who were breastfed for 4 months or longer. Conclusion: Although our effect sizes were small, breastfeeding for 4 months or longer was associated with improved developmental outcomes for children aged one to 3 years after adjustment for multiple confounding factors.     

Breastfeeding duration and exclusivity associated with infants' health and growth: data from a prospective cohort study in Bavaria, Germany

Aim: To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months.
Methods: Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2–6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight ≥2500 g. We compared 475 infants breastfed exclusively for ≥6 months (group A), 870 infants breastfed fully/exclusively ≥4 months, but not exclusively ≥6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C).
Results: In multivariate analysis ≥6 months of exclusive breastfeeding reduced significantly the risk for ≥1 episode of gastrointestinal infection(s) during months 1–9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44–0.82). The application of the World Health Organization (WHO) – child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores.
Conclusion: Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for ≥6 months of exclusive breastfeeding.     

Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study

Aim: To study the influence on breastfeeding of skin-to-skin contact after birth. Methods: Using a prospective cohort study design, a group of 1250 Polish children was investigated with 3 y followup. Results: The implementation of the practice significantly increased mean duration of exclusive breastfeeding by 0.39 mo and overall breastfeeding duration by 1.43 mo. The infants kept with the mothers for at least 20 min were exclusively breastfed for 1.35 mo longer and weaned 2.10 mo later than those who had no skin-to-skin contact after delivery. The skin-to-skin contact after birth significantly coexisted with the other hospital practices supportive to breastfeeding, especially rooming-in without separation longer than 1 h per 24 h [relative risk (RR) = 3.18, 95% confidence interval (95% CI): 2.34-4.31] and first breastfeeding within 2 h after birth (RR = 2.94, 95% CI: 2.36-3.67. Multivariate analysis performed by a general linear model with duration of exclusive breastfeeding as the dependent variable indicated skin-to-skin contact and mother education as two independent variables influencing the duration of exclusive breastfeeding. Conclusion: The results indicate that extensive mother-infant skin-to-skin contact lasting for longer than 20 min after birth increases the duration of exclusive breastfeeding.     

Infant feeding and cost of health care: a cohort study

Aim: To compare the use and cost of health care in infants with different feeding patterns. Methods: Observational study on a cohort of 842 infants born in ten hospitals in northern Italy and followed up to age 12 months. Data on feeding gathered through telephone interviews with 24-hour recall. Data on use of health services reported by mothers and checked against records. Data on hospital cost derived from Disease Related Groups codes. Data on cost of other services obtained from maternal reports and available price lists. Results: At three months, 56% of infants were fully breastfed, 17% complementary fed and 27% not breastfed. Infants fully breastfed at three months had 4.90 episodes of illness requiring ambulatory care and 0.10 hospital admissions per infant/year compared with 6.02 and 0.17, respectively, in infants not or not fully breastfed. They had also a lower cost of health care: €34.69 versus 54.59 per infant/year for ambulatory care, and €133.53 versus 254.03 per infant/year for hospital care. Higher cost of health care was significantly associated with having a hospital admission and being a twin; cost of health care decreased with each additional gram of birth weight, each month of delayed return of the mother to work after the third month, and each extra month of breastfeeding. Conclusion: Lack of breastfeeding and higher use and cost of health care are significantly associated.     

Breastfeeding and the HIV positive mother: the debate continues

Breastfeeding is a route of HIV transmission from an HIV-infected mother to her infant. However, breastfeeding is an important pillar of child survival and the ideal way of feeding an infant as well as providing a unique biological and emotional basis for child development. This article highlights the dilemma created by the risks and benefits of breastfeeding and will discuss factors which increase the risk of HIV transmission during breastfeeding as well as strategies which could be employed to reduce these risks. Many questions still remain unanswered. Until further research results are available, women should be encouraged to follow the UNAIDS guidelines "when replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended, otherwise, exclusive breastfeeding (EBF) is recommended during the first months of life". Anti-retroviral therapy to the mother and/or infant is likely to offer the possibility of maintaining breastfeeding as a safe option for HIV-infected women.     

A cohort study of term infants from Vilnius, Lithuania: feeding patterns

AIM: To present infant feeding patterns and to relate these to selected biological and social factors. METHODS: One hundred and ninety-two infants born at four delivery departments were followed prospectively from birth to 12 mo of age. Their parents were asked to tick weekly if the infant received items on a list of the most common infant foods and drinks, including breast milk. RESULTS: All infants started breastfeeding. Median duration of exclusive breastfeeding was 0.5 mo, and 3.75 mo for "any breastfeeding". Mothers who were older (>25 y), better educated (>11 y) and non-smokers breastfed significantly longer (median 4 mo). Median introduction of cow's milk was 8 (range 2-12) mo. At the age of 12 mo, 78% of infants received cow's milk and 58% of infants received cow's milk as the sole source of milk. Mothers who were younger (<21 y) and less educated (<12 y) introduced cow's milk significantly earlier. Mean (SD) start of solids was 3.4 (1.0) mo. Longer duration of breastfeeding was the only factor significantly associated with the later start of solids. Ninety-two percent of infants were introduced to fresh cheese before 12 mo. Additional liquids were widely given both to breastfed and non-breastfed infants. CONCLUSIONS: Compliance with the current infant feeding recommendations is not sufficient. Breastfeeding rates are low. Use of high-protein products is widespread. More effort should be made to educate young, less educated and smoking mothers.     

Breastfeeding patterns in exclusively breastfed infants: a longitudinal prospective study in Uppsala, Sweden

Exclusive breastfeeding was studied among 506 infants in Uppsala, Sweden, based on daily recordings during the first 6 mo. The mothers had previously breastfed at least one infant for at least 4 mo. Most of the mothers considered that they breastfed on demand. Wide variations in breastfeeding frequency and suckling duration were found both between different infants and in the individual infant over time. At 2 wk, the mean frequency of daytime feeds (based on one 13-d record) between different infants ranged from 2.9 to 10.8 and night-time feeds from 1.0 to 5.1. The daytime suckling duration (based on one 24-h record) ranged from 20 min to 4h 35 min and night-time duration from 0 to 2h 8 min. At any given age, a maximum of only 2% of the infants were not breastfed during the night. At 4 mo, 95% of the infants were breastfeeding and 40% were exclusively breastfed at this age. Longer breastfeeding duration and longer duration of exclusive breastfeeding were both associated with higher frequency of breastfeeds, longer breastfeeding of the previous child and higher education. No gender differences were found. Maternal smoking was associated with shorter duration of exclusive breastfeeding, and pacifier use was associated with shorter duration of both exclusive breastfeeding and total breastfeeding. This study confirms that every mother-infant pair needs to be understood as a unique dyad throughout lactation. These data demonstrate a wide range of patterns among women who are exclusively breastfeeding and indicate that it would be inappropriate to put pressure on individual families to adopt preconceived patterns of infant feeding.     

Clinical Practice Breastfeeding Recommendations for Primary Care: Applying a Tri-Core Breastfeeding Conceptual Model

Promotional practice efforts are needed in primary care to support and foster breastfeeding as the first and natural choice of nutrition for all infants regardless of race, ethnicity, educational, or income demographics in the United States. Societal awareness is increasing with regard to the significant protective qualities that human milk bestows upon public health. An estimated 75% of American mothers attempt to breastfeed, but according to the Centers for Disease Control and Prevention, just 13% are able to exclusively breastfeed by 6 months. Early identification of lactation issues is crucial to establishing and sustaining breastfeeding for the first 6 to 12 months of the child's life and beyond. We propose a set of primary care guidelines, applying a Tri-Core Model approach, to promote and foster breastfeeding efforts in the postpartum period. Breastfeeding promotion is a fundamental public health endeavor, and pediatric nurse practitioners and other advanced practice registered nurses (APRNs) are uniquely qualified to become specialists and experts in lactation care and management. Lactation support, which should be an integral facet of an APRN's practice and education, will aid in improving national breastfeeding rates and patient care outcomes. Application of the Tri-Core Model approach will help APRNs develop and implement evidence-based practice efforts that incorporate the mother-baby dyad and other multiprofessionals who are vested in successful breastfeeding outcomes. The goal of pediatric health care is provide safe and effective health care to all infants, children, and adolescents, and lactation care is an integral and crucial component of this effort.     

辅助生殖技术与妊娠期糖尿病孕产妇肠道菌群的特异表达

目的 通过检测和比较不同受孕方式及是否并发妊娠期糖尿病(gestational diabetes mellitus,GDM)孕产妇的肠道菌群,明确辅助生殖技术(assisted reproductive technology,ART)及GDM孕产妇肠道菌群的特异性表达,分析其机制,为今后预防干预、促进ART妊娠母婴健康...     

Breastfeeding and perceived changes in the appearance of the breasts: a retrospective study

AIM: To investigate the association between breastfeeding and the perception that women have of changes in the appearance of their breasts. METHODS: Four hundred and ninety-six Italian women were interviewed in three health centres 18 mo (SD 3.4 mo, range 12.6-23.1 mo) after the birth of their first baby in May 2002. Information was collected on pregnancy, infant feeding and bra cup size before pregnancy. The main outcome measures were self-reported changes in the appearance of the breasts (enlargement or reduction in breast size and loss of firmness) and bra cup size at the time of the interview. RESULTS: Seventy-three percent of the mothers reported that their breasts were different compared with before pregnancy; enlargement and loss of firmness representing the most common changes. The prevalence of changes among the mothers who had and had not breastfed was 75% and 69%, respectively (relative risk: 1.09, 95% CI: 0.96-1.23). Bra cup size before pregnancy was neither associated with the frequency of breastfeeding nor with the occurrence of changes in the appearance of the breasts. CONCLUSIONS: In Italy, mothers frequently report that the size and the shape of their breasts have changed after childbirth, but these changes do not seem to be associated with breastfeeding.     

Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study

AIM: To report the relationship between maternal prenatal intention to breastfeed and the actual initiation and duration of breastfeeding. METHODS: Pregnant women resident within Avon, UK, expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention (breastfeed, breast and bottle feed, bottle feed, or uncertain) at 32 wk of pregnancy: intention in the first week, intention for the rest of the first month and intention in months 2 to 4; initiation and duration of breastfeeding up to six months. RESULTS: Data were available on 10,548 women. Prenatal intention to breastfeed had an influence on both initiation and duration of breastfeeding. Of the women intending to bottle feed from birth, only 3.4% initiated breastfeeding compared with 96.6% of women planning to breastfeed for at least four months. At six months postpartum, the mean duration of breastfeeding for women intending to breastfeed for at least five months was 4.4 mo (95% CI 4.3, 4.4), compared with 2.5 mo (95% CI 2.4, 2.6) for women with a prenatal intention to breastfeed for only one month. Logistic regression, using intended duration as the only explanatory variable, correctly predicted 91.4% of breastfeeding initiation and 72.2% of infant feeding at six months. CONCLUSIONS: This large population-based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration.     

Reliability and validity of the Romanian version of a scale to measure infant feeding attitudes and knowledge

AIM: To describe the development and testing of the Romanian version of the Iowa Infant Feeding Attitude Scale (IIFAS-R). The original instrument has well-established psychometrics for use in English-speaking countries. METHODS: Questionnaires including demographics and items about prior pregnancy and opinions about breastfeeding in public were administered to women in Cluj-Napoca, Romania, attending antenatal clinic (n = 336) and to a separate cohort of mothers within 24 h of delivery (n = 276). Postpartum follow-up was conducted with a sample of maternity cohort subjects who initiated breastfeeding in the hospital (n = 52). RESULTS: Internal consistency was adequate in both cohorts (antenatal alpha= 0.50; maternity alpha= 0.63), with improved reliability for antenatal multigravid (alpha= 0.60) and university-educated women (alpha= 0.57). Score distributions were comparable and item means were approximately central across cohorts. Among pregnant women, higher scores (more positive towards breastfeeding) were associated with longer planned maternity leave (chi2= 17.8; p = 0.02). Higher maternity cohort scores were associated with age (r = 0.31, p = 0.003), urban residence (chi2= 10.2, p = 0.04), breastfeeding a prior infant for at least 6 weeks (chi2= 6.4, p = 0.04), and with intending to breastfeed for at least 6 weeks (chi2= 4.7, p = 0.03). Postpartum women still breastfeeding at follow-up also scored higher (chi2= 9.3, p = 0.009). CONCLUSION: This is the first study to report on use of the IIFAS in Eastern Europe. The IIFAS-R is easy to administer, reliable and valid in Romania. The IIFAS-R can support data collection to promote and assess breastfeeding initiatives consistent with World Health Organization recommendations.     

辅助生殖技术出生儿童的青春发育情况调查

目的了解辅助生殖技术(ART)出生儿童青春发育状况。方法回顾性收集1994~2003年北京大学第三医院ART出生儿童的青春发育资料,以"2010年中国学生体质健康调查"横断面研究结果为对照数据,比较二者首次遗精或月经初潮年龄;观察ART出生儿童中超重/肥胖者青春发育情况,并探讨青春发育与体重指数的相关性。结果纳入ART出生儿童200例,获得有效数据72例,随访率36.0%,其中男性41例,女性31例。ART出生儿童首次遗精平均年龄为13.9岁(95%CI:13.7~14.3岁),月经初潮平均年龄为12.2岁(95%CI:11.8~12.6岁),ART出生儿童首次遗精年龄和月经初潮年龄与正常对照比较差异均无统计学意义。ART出生的男女儿童中超重/肥胖者与正常体重者的首次遗精年龄或月经初潮年龄比较差异无统计学意义。ART出生的儿童超重率、肥胖率与北京市青少年超重率、肥胖率比较差异无统计学意义。ART出生的儿童首次遗精年龄和月经初潮年龄与体重指数均无明显相关性。结论 ART出生儿童青春期发育未出现延迟或提前,与正常对照人群一致;ART出生儿童青春期发育与其青春期体重指数无显著相关性。     

Growth under privileged conditions of healthy Swedish infants exclusively breastfed from birth to 4-6 months: a longitudinal prospective study based on daily records of feeding

Aim: In most studies the methodology used to study growth in relation to breastfeeding patterns cannot ensure that exclusive breastfeeding has in fact occurred since birth. The aim of this study was to investigate the growth of healthy infants in Sweden in whom exclusive breastfeeding for the first 4-6 mo was ascertained through daily feeding records and to compare the results with the World Health Organization (WHO) "12-month breastfed pooled data set" and the Euro-Growth references for exclusively breastfed infants, as well as with the National Center for Health Statistics (NCHS)/WHO reference. Methods: 147 exclusively breastfed infants and 325 non-exclusively breastfed Swedish infants, with a birthweight of 33 kg, were included. The mothers had previous breastfed at least one infant for at least 4 mo. Weight was recorded fortnightly and length monthly. Results: Infants exclusively breastfed since birth showed similar growth in weight and height to that of the non-exclusively breastfed infants. During the first 6 mo of life the growth of exclusively breastfed infants was also similar to that of the infants regularly receiving formula at 12-16 wk of age, mostly in addition to breast milk. The monthly growth increments were fairly similar to those of the "WHO pooled breastfed data set" and the Euro-Growth references for exclusively breastfed infants. Conclusion: In an affluent society truly exclusively breastfed infants seem to have the same growth during the first half year of life as non-exclusively breastfed infants with a high breastfeeding rate.     

Correlations between welfare initiatives and breastfeeding rates: a 10-year follow-up study

Aim: To evaluate the prevalence of full breastfeeding during the first 6 months of age and to discover if training programs for health caregivers and welfare initiatives at the community level could improve breastfeeding rates.
Methods: Newborn babies with gestational age ≥ 36 weeks and birth weight ≥ 2500 g, discharged from the hospital within the first week of life, without any underlying pathologies, were enrolled in 3-month long sample periods between 1997 and 2006. A questionnaire was distributed to the mothers, to be completed and submitted before hospital discharge. Data were collected from phone interviews at 1, 3 and 6 months.
Results: Full breastfeeding rates at hospital discharge showed an oscillation between 69.9% and 87%. The rate decreased in the following months and reached very low levels at 6 months of age (<24%), with the exception of the last sample period in 2006 (44.9%).
Conclusion: A simple questionnaire, combined with standardized phone interviews, can be easily reproduced and may be used as an indicator for quality of neonatal care at hospital nurseries. A social and cultural change of the whole community towards breastfeeding promotion will result in increasing breastfeeding rates.