Instruções em bulas destinadas ao uso de medicamentos para dispepsia e constipação durante a lactação / Instructions in package inserts intended for the use of medicines for dyspepsia and constipation during lactation / Instrucciones en prospectos destinados al uso de medicamentos para la dispepsia y el estreñimiento durante la lactancia

Introdução: A segurança e eficácia do uso de medicamentos durante a lactação são preocupações para mães e profissionais de saúde. Esta pesquisa analisa as orientações das bulas de medicamentos comumente prescritos para dispepsia e constipação, que visa fornecer informações essenciais para orientar as decisões terapêuticas durante esse período crucial da maternidade. Objetivos: Analisar as informações das bulas sobre contraindicações de medicamentos para dispepsia e constipação durante a amamentação, verificando se estão de acordo com as evidências científicas. Métodos: Medicamentos para dispepsia e constipação foram selecionados de acordo com a classificação da Anatomical Therapeutic Chemical (ATC) e o registro ativo no Brasil. A presença de contraindicações para o uso de medicamentos nas bulas do profissional de saúde e do paciente foi comparada com as informações contidas no manual técnico do Ministério da Saúde, Medicamentos e Leite Materno, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria e Reprotox. Resultados: Nenhuma informação sobre o uso durante a amamentação foi encontrada em 20,0 e 24,3% das bulas para dispepsia e constipação, respectivamente. A concordância entre as bulas dos medicamentos para dispepsia e as fontes consultadas foi baixa (27,2% das bulas contraindicavam o medicamento na lactação, enquanto nas fontes o percentual de contraindicação variou de 0 a 8,3%). Com relação a medicamentos para constipação, 26,3% das bulas os contraindicavam, enquanto nas fontes o percentual variou de 0 a 4,8%. Conclusões: O estudo mostrou que pelo menos duas em cada dez bulas para dispepsia e constipação não fornecem informações adequadas sobre o uso desses medicamentos em lactentes, e também que houve baixa concordância entre o texto das bulas e as fontes de referência quanto à compatibilidade do medicamento com a amamentação.

Introduction: The safety and effectiveness of medication use during lactation are concerns for mothers and healthcare professionals. This research analyzes the instructions on the leaflets of medications commonly prescribed for dyspepsia and constipation, which aims to provide essential information to guide therapeutic decisions during this crucial period of motherhood. Objectives: To analyze the information in package inserts about contraindications of drugs for dyspepsia and constipation during breastfeeding, verifying whether these are consistent with scientific evidence. Methods: Drugs for dyspepsia and constipation were selected according to the Anatomical Therapeutic Chemical (ATC) classification and active registry in Brazil. The presence of contraindications for the use of medications in the health professional's and patient's package inserts was compared with the information in the technical manual of the Ministry of Health, Medications and Mothers' Milk, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria and Reprotox. Results: No information about use during breastfeeding was found in 20.0 and 24.3% of leaflets for dyspepsia and constipation, respectively. The agreement between the leaflets of medications for dyspepsia and the sources consulted was low (27.2% of the leaflets contraindicated the medication during lactation, while in the sources the percentage of contraindication varied from 0 to 8.3%). In relation to medicines for constipation, 26.3% of the leaflets contraindicated them, while in the sources the percentage ranged from 0 to 4.8%. Conclusions: The study pointed out that at least two out of every ten package inserts for dyspepsia and constipation do not provide adequate information on the use of these drugs in infants, and also shows low concordance between the text of the package inserts and the reference sources regarding compatibility of the drug with breastfeeding.

Introducción: La seguridad y eficacia del uso de medicamentos durante la lactancia son preocupaciones para las madres y los profesionales de la salud. Esta investigación analiza las instrucciones contenidas en los prospectos de medicamentos comúnmente recetados para la dispepsia y el estreñimiento, con el objetivo de proporcionar información esencial para guiar las decisiones terapéuticas durante este período crucial de la maternidad. Objetivos: Analizar la información contenida en los prospectos sobre las contraindicaciones de los medicamentos para la dispepsia y el estreñimiento durante la lactancia, verificando si estas son consistentes con la evidencia científica. Métodos: Se seleccionaron medicamentos para la dispepsia y el estreñimiento de acuerdo con la clasificación ATC y el registro activo en Brasil. Se comparó la presencia de contraindicaciones para el uso de medicamentos en los prospectos del profesional de la salud y del paciente con la información del manual técnico del Ministerio de Salud, Medicamentos y Leche Materna, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria y Reprotox. Resultados: No se encontró información sobre su uso durante la lactancia en el 20% y el 24,3% de los prospectos para dispepsia y estreñimiento, respectivamente. La concordancia entre los prospectos de los medicamentos para la dispepsia y las fuentes consultadas fue baja (el 27,2% de los prospectos contraindicaba el medicamento durante la lactancia, mientras que en las fuentes el porcentaje de contraindicación variaba del 0% al 8,3%). Con relación a los medicamentos para el estreñimiento, el 26,3% de los prospectos los contraindicaba, mientras que en las fuentes el porcentaje osciló entre el 0% y el 4,8%. Conclusiones: El estudio señaló que al menos dos de cada diez prospectos para dispepsia y estreñimiento no brindan información adecuada sobre el uso de estos medicamentos en lactantes, y también muestra la baja concordancia entre el texto de los prospectos y la referencia. fuentes sobre la compatibilidad del fármaco con la lactancia.

O efeito conjunto de gemelaridade e prematuridade no aleitamento materno exclusivo na alta hospitalar / The joint effect of twinning and prematurity on exclusive breastfeeding at hospital discharge / El efecto conjunto de la gemelaridad y la prematuridad en la lactancia materna exclusiva al momento del alta hospitalaria

Objetivo: estimar a prevalência de Aleitamento Materno Exclusivo (AME) entre gemelares pré-termos e investigar o efeito de nascer gemelar e pré-termo no AME na alta hospitalar. Método: coorte prospectiva de recém-nascidos em uma instituição localizada no Rio de Janeiro, no período de 13 de março de 2017 a 12 de outubro de 2018. Dados coletados em questionário e prontuário médico. Foi utilizado DAG para construção do modelo conceitual, análise exploratória dos dados e regressão logística múltipla. Resultados: a prevalência de AME na alta hospitalar de gemelares pré-termos foi de 47,8%. Pré-termos apresentaram maior chance de não estarem em AME na alta hospitalar. Não gemelares apresentaram maior chance de não estarem em AME na alta hospitalar. Conclusão: pouco mais da metade dos gemelares pré-termo não estavam em AME na alta hospitalar. Prematuros tiveram maior chance de não estarem em AME. Não gemelares pré-termo apresentaram maior chance de não estarem em AME.

Objective: to estimate the prevalence of Exclusive Breastfeeding (EBF) in preterm twins and to investigate the effect of twin and preterm birth on EBF at hospital discharge. Method: prospective cohort of newborns in an institution located in Rio de Janeiro, from March 13, 2017, to October 12, 2018. Data collected through a questionnaire and medical records. A DAG was used to build the conceptual model, exploratory data analysis and multiple logistic regression. Results: prevalence of EBF at hospital discharge of preterm twins of 47.8%. Preterm infants were more likely to not be on EBF at hospital discharge. Non-twins were more likely to not be on EBF at hospital discharge. Conclusion: just over half of preterm twins were not on EBF at hospital discharge. Preterm infants had a greater chance of not being on EBF. Preterm non-twins were more likely to not be on EBF.

Objetivo: estimar la prevalencia de Lactancia Materna Exclusiva (LME) entre gemelos prematuros y investigar el efecto de nacer gemelo y prematuro en la LME al momento del alta hospitalaria. Método: cohorte prospectiva de recién nacidos en una institución ubicada en Rio de Janeiro, entre 13//marzo/2017 y 12/octubre/2018. Los datos se recolectaron mediante cuestionario y expediente médico. Se utilizó DAG para la construcción del modelo conceptual, análisis exploratorio de los datos y regresión logística múltiple. Resultados: la prevalencia de LME en el alta hospitalaria de gemelos prematuros fue del 47,8%. Los prematuros tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Los no gemelares tuvieron mayor probabilidad de no estar en LME en el alta hospitalaria. Conclusión: poco más de la mitad de los gemelos prematuros no estaban en LME en el alta hospitalaria. Los prematuros tuvieron mayor probabilidad de no estar en LME. Los no gemelos prematuros presentaron mayor probabilidad de no estar en LME.

Individualized support for breastfeeding in a case of elevated blood lead levels: A case report.

Introduction: Lead is a known toxicant that affects all tissues in the body, most notably the brains of developing children. However, there are limited data on the dynamics of lead transfer via breastmilk and its short-term and long-term consequences. Much of the available data come from areas of the world where numerous sources of lead complicate our understanding of the effects of lead exposure via breast milk. Case Presentation: We present trends in blood lead levels in a breastfeeding dyad, where the only source of lead exposure identified was prior to pregnancy, without other known ongoing lead exposures for the lactating parent or infant. Discussion and Conclusions: In this case, all lead exposure in the infant was presumed to come from in utero transmission and breastfeeding; and infant blood lead levels varied significantly with initiation and interruption of breastfeeding. This case is discussed in the context of current models for predicting transfer of lead in breastmilk and highlights pathophysiologic considerations for understanding lead transfer in the breastfeeding dyad.

Empowering Global Health Systems to Protect, Promote and Support Optimal Breastfeeding.

Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability-adjusted life years (DALYs) attributed to suboptimal breastfeeding practices-namely, non-exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years-low- and middle-income countries (LMICs) continue to bear a staggering 50-fold higher burden compared to high-income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby-Friendly Hospital Initiative (BFHI) reach through community-driven efforts such as the Baby-Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence-driven policies-such as strict monitoring and regulation of product labelling and digital media marketing-to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.

Breastfeeding Practice in Tunisia: Combined Results of Multiple Indicator Cluster Surveys (2000-2018).

Introduction. Breastfeeding practices fall short of optimal levels globally, despite its known health benefits and World Health Organization endorsements. We aimed through this study to firstly estimate the global prevalence of principal indicators of breastfeeding practice in Tunisia. Secondly, we aimed to identify their associated factors and to assess the temporal trend of breastfeeding practice in Tunsia from 2000 to 2018. Methods. We extracted data from all available reports of Multiple Indicator Cluster Surveys (MICS) surveys conducted in Tunisia (MICS2000, 2006, 2012 and 2018) that were publicly available on the MICS UNICEF website prior to 2024. Results. Never breastfeeding prevalence was 4% (95% CI [3%-7%]) with a significant increase (P < 10-3) from 2000 (2.4%) to 2018(7.8%). The prevalence of early breastfeeding initiation was 56% (95% CI [20%-87%]) with a significant decrease(P < 10-3) from 2006(87.4%) to 2018(31.5%). The prevalence of exclusive breastfeeding was 15% (95% CI [5%-35%]) with a significant decrease(P < 10-3) from 2000(46.4%) to 2018(13.4%). The prevalence of predominant breastfeeding was 41% (95% CI [31%-51%]) with a significant decrease(P < 10-3) from 2000(50.5%) to 2018(30.4%). The prevalence of continued breastfeeding up to the age of 2 years was 19% (95% CI [16%-22%]) with no significant decrease from 2000 to 2018(P = .09). The mother educational level was significantly associated with early breastfeeding initiation, exclusive and predominant breastfeeding. A higher prevalence of exclusive breastfeeding was found among mothers from rural areas. Conclusions. Tunisia has been experiencing low rates of breastfeeding practice, with a concerning decline observed over the years. Addressing this issue effectively necessitates a comprehensive, multi-faceted approach that encompasses various aspects of society, healthcare, and policymaking.

A Longitudinal Observation of Antenatal Milk Expression in Mothers of Infants with Congenital Anomalies.

Background: For mothers of infants with congenital anomalies, antenatal milk expression (AME), known as hand expression during late pregnancy, allows mothers to contribute to their newborn's care through colostrum collection. However, research is limited by self-report of AME adherence and colostrum volume. Objective: This study examined the ability of participants to adhere to a recommended protocol on AME for any removal and measurement of colostrum during late pregnancy. Materials and Methods: A prospective, longitudinal, observational design was used. Our recommended protocol involved hand expression of 5 minutes per breast for a total of 10 minutes for each AME session twice per 24 hours for any colostrum from 37 0/7 weeks gestation until birth. Women received AME education, completed milk logs, and attempted AME. The study team verified all colostrum volumes. Results: Nineteen women (10 nulliparous) participated, with 13 (68%) carrying infants with major organ system defects and 6 (32%) carrying infants with congenital heart defects. Most participants (52.6%) completed more than half but fewer than all AME sessions. Seven participants (36.8%) fully adhered, completing two AME sessions daily until hospital admission. Eighteen participants (94.7%) could remove milk (80-100% of the time). The 24-hour colostrum volume (median 0.35 mL, interquartile range [IQR] 0.065-0.845) and the total colostrum volume (median 3.99 mL, IQR 1.35-6.82) from AME varied. Conclusions: Among a small group of women of infants with congenital anomalies, adherence to a recommended protocol is feasible but varied by AME session frequency. Most women could collect colostrum for future infant feeding.

Development of a breastfeeding support scale in the workplace and psychometric properties of Turkish version: a validity and reliability.

The purpose of this study was to develop a workplace breastfeeding support scale for working mothers and examine their psychometric properties. This methodological research was conducted between February and April 2022. This study included 325 mothers who continued breastfeeding while working. The tool development stages included item generation, expert review for content validity testing, and psychometric testing. The data were collected through face-to-face interviews between February and April 2022. In data analysis, for explanatory factor analysis, the direct oblimin technique and scree plot test were performed. Structural equation modeling was performed for confirmatory factor analysis. Two sub-dimensions (manager support, environmental support) and a nine-item workplace breastfeeding support scale showed good validity and reliability. The Cronbach's alpha value of the total scale and sub-dimensions of the scale were greater than 0.70. Confirmatory factor analysis showed that the model fit indices were acceptable (χ2 = 68.658, χ2/df = 2.64, CFI = 0.94, GFI = 0.96, AGFI = 0.92, and RMSEA = 0.07). The total variance explained by the scale was 54.32 percent. This newly developed 9-item and 2-dimensional version is a valid and reliable tool for measuring the working mothers' perception of workplace breastfeeding support. This tool is recommended to be verified in other low, middle, and high-income countries.

Breastfeeding Versus Bottle Feeding and Risk of Bronchial Asthma in Children in Tabuk Area, Saudi Arabia: A Cross-Sectional Study.

Introduction Asthma is a common chronic airway disorder, particularly among children in Saudi Arabia, with an increasing global prevalence. Limited epidemiological studies in the region indicate variable asthma rates, potentially influenced by factors such as modernization and environmental changes. Given the potential health benefits of breastfeeding, it is critical to investigate the relationship between type of feeding, and asthma risk. This study aims to assess the relationship between breastfeeding and bottle-feeding practices and the risk of developing asthma, as well as to evaluate how breastfeeding practices influence the severity of asthma among children in Tabuk, Saudi Arabia.  Methods A cross-sectional study was conducted among children with bronchial asthma at King Salman Armed Forces Hospital in Tabuk City, Saudi Arabia. The study took place from June to August 2023 using convenient sampling. Data were collected through a validated, structured web-based questionnaire distributed to the parents of children with bronchial asthma. The analysis was performed using SPSS (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Results The study comprised 103 participants, of whom 66 (64.1%) were breastfed. There was no significant association between the severity of asthma and breastfeeding practices, including the initiation time, duration, or the age at which formula milk was introduced, as well as the combination of breastfeeding with bottle feeding. However, paternal smoking was significantly associated with asthma (p = 0.003), with 78.5% of children with smoking fathers affected compared to 50% of those without smoking fathers. In the multivariate analysis, having a father employed in the health sector (p = 0.040) and a maternal age over 35 years (p = 0.026) were significantly associated with an increased risk of asthma. Other factors, such as the child's age, gender, birth order, monthly income, parental education, family size, type of accommodation, and maternal diet during pregnancy, did not demonstrate significant associations with asthma. Conclusion Our study underscores the significant role of paternal smoking and specific parental sociodemographic factors, such as having a father employed in the health sector and maternal age over 35 years, in influencing the risk of childhood asthma. While breastfeeding practices, including duration and method, were not significantly associated with asthma severity, understanding these key risk factors can aid in developing targeted interventions for asthma prevention and management.

Accessing Trauma- and Violence-Informed Breastfeeding Support from Primary Care Providers among Women with Histories of Intimate Partner Violence: An Exploratory Interpretive Description Study.

BACKGROUND: Intimate partner violence (IPV) is a wicked social problem affecting women of all social strata and geographical location, globally. Pregnancy may be a time of heightened risk of IPV and more deleterious outcomes. Breastfeeding - a protective factor for maternal and child well-being - may be jeopardized or more challenging for women experiencing IPV. This study explored the experiences of postpartum women with histories of IPV who sought trauma- and violence-informed breastfeeding support from primary care providers. METHODS: Using interpretive description and philosophically underpinned by intersectionality, in-depth semi-structured interviews were completed at 12-weeks postpartum with five breastfeeding mothers with a history of IPV who sought breastfeeding support from a family physician clinic employing a trauma- and violence-informed (TVIC) model of care. FINDINGS: Four themes and two sub-themes shed light onto the experience of accessing breastfeeding support for women with a history of IPV and the perceived barriers that they faced when attempting to accesses this support, including: 1) The (demoralizing) navigation of the perinatal system; 2) Fostering trust: i) "It's support, but it's also knowledge"; and ii) TVIC: feeling safe and feeling "I mattered"; 3) Informal support: partners, family, and friends; and 4) Baby in focus: overcoming challenges and building confidence. CONCLUSIONS: TVIC may aid in the development of trusting therapeutic relationships, in turn improving access to breastfeeding support, breastfeeding self-efficacy, and breastfeeding success for women who experience violence. Further research on the implementation and evaluation of TVIC for perinatal breastfeeding education and care among women is required.

Fear of Childbirth Impairs Breastfeeding Success Independent of Mode of Birth.

Background: The good qualities of breastfeeding are well known. The aim of this study was to closely examine the impact of specific maternal, prenatal, obstetric, and early neonatal factors on the success of breastfeeding. Materials and Methods: We used data from the Kuopio Birth Cohort study and analyzed 2,521 online questionnaires, which were answered by women 1 year after giving birth. Breastfeeding variables were divided into successful breastfeeding (breastfeeding exclusively with one's own breast milk ≥4 months or breastfeeding with formula ≥6 months) and poor breastfeeding (breastfeeding exclusively with one's own milk <4 months and duration of all breastfeeding <6 months) for univariate and multivariable analyses. Results: In this study, 97.8% (N = 2,466) reported breastfeeding their newborns for ≥1 postnatal week, and 75.2% (N = 1,896) breastfed newborns for ≥6 months. The rate of breastfeeding for ≥6 months increased from 71.3% to 84.7% between 2013 and 2020. In the multivariable analysis, poor breastfeeding success was associated most significantly with smoking during pregnancy (adjusted odds ratio [aOR] 4.64; 95% confidence interval [CI] 2.75-7.81), twin pregnancy (aOR 4.13; 95% CI: 2.10-8.15), maternal obesity (body mass index > 35) (aOR 3.27; 95% CI: 2.15-4.99), fear of childbirth (aOR 2.80; 95% CI: 1.89-4.13), and birth during the period of 2013-2014 (aOR 2.94; 95% CI: 2.08-4.14) or 2015-2016 (aOR 2.62; 95% CI: 1.85-3.70). Other significant factors related to poor success were younger maternal age, nonmarried family relationships, passive or quitting smoking before or in the first trimester, any hypertensive disorder during pregnancy, birth by nonelective cesarean, and lowest or highest quartiles of birth weight. Conclusions: Mother's fear of childbirth is strongly associated with the poor breastfeeding success even after controlling for mode of birth.

Donor human milk practice in Indonesia: a media content analysis.

Introduction: Donor human milk (DHM) is recommended as the second-best alternative form of supplementation when a mother is unable to breastfeed directly. However, little is known about the experience of mothers and families in the communities regarding accessing and donating expressed breastmilk in Indonesia. This study aimed to identify the experience related to donor human milk in the society in Indonesia. Method: A search was conducted through six main online news portals. The keywords used included "donor human milk," "expressed breastmilk," and "wet nursing" in the Indonesian language, Bahasa Indonesia. A total of 107 articles were found, but only 20 articles were included for analysis using a qualitative media content analysis approach. Results: In the study, the following five themes were identified: (1) the whys and wherefores of donor human milk, (2) national and religious-based regulations, (3) recommendations from authorized organizations, healthcare professionals, and Islamic scholars, (4) the negative impact from the lack of national regulations, and (5) contradictory feelings among mothers. Conclusion: With the lack of detailed information on how to access or donate expressed human milk and the absence of a human milk bank in place, informal human milk sharing is inevitably occurring in the community. This has also raised concerns among authorized organizations, healthcare professionals, and Islamic scholars. Consequently, mothers, both donors and recipients, experienced negative impacts, which included contradictory feelings. Engaging with Islamic scholars and healthcare professionals to develop clear guidelines and regulations to enable mothers' and families' access and/or make contributions to DHM in a safe and accountable way is critical to prevent further problems from occurring in Indonesian society.

A Comprehensive Assessment of the Environmental Impact of Different Infant Feeding Types: The Observational Study GREEN MOTHER.

AIM(S): To observe and compare the environmental impacts of different types of infant feeding, considering the use of formula, infant feeding accessories, potentially increased maternal dietary intake during breastfeeding (BF) and food consumption habits. DESIGN: An observational cross-sectional multicentre study conducted in the Barcelona Metropolitan Area of the Catalan Institute of Health. METHODS: Data were collected from 419 postpartum women on infant feeding type (formula milk and accessories), maternal dietary intake (24-h register) and food consumption habits from November 2022 to April 2023. The environmental impacts (climate change (CC), water consumption and water scarcity) of the infant feeding types and maternal diet were calculated using the IPCC, ReCiPE and AWARE indicators, respectively. The differences in impacts were calculated by Kruskal-Wallis test. RESULTS: Significant differences for the three environmental impacts were observed. The CC impact of formula milk and feeding accessories was 0.01 kg CO2eq for exclusive BF, 1.55 kg CO2eq for mixed feeding and 4.98 kg CO2eq for formula feeding. While BF mothers consumed an extra 238 kcal, no significant differences were found related to maternal diet across feeding types. CONCLUSION: Exclusive BF was the most sustainable type of infant feeding, considering formula and infant feeding accessories. In our study, the difference between the impacts of BF and non-BF mothers' diet was insignificant. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Offer informative and educational support for midwives and other healthcare professionals on BF and a healthy, sustainable diet to transfer this knowledge to the general public. IMPACT: Raise the general public's awareness about BF and a healthy, sustainable diet. To reduce environmental impacts through behavioural changes. REPORTING METHOD: STROBE. PATIENT OR PUBLIC CONTRIBUTION: Patients of the Catalan Health Service reviewed the content of the data collection tools. TRIAL REGISTRATION: (for the whole GREEN MOTHER project): NCT05729581 (https://clinicaltrials.gov).

The Effects of Baby Calming Training Provided to Primiparous Mothers on Maternal Role Perception, Maternal Attachment, and Breastfeeding Self-Efficacy: A Randomized Controlled Trial.

Background: Mothers of crying babies have difficulty adapting to their roles and problems with breastfeeding and attachment. Objective: This study aimed to assess the impact of the baby calming training provided to primiparous mothers on maternal role perception, maternal attachment, and breastfeeding self-efficacy. Methods: The study was conducted in a randomized controlled experimental design between March 2023 and March 2024 in the gynecology and obstetrics services of a public hospital in northeastern Turkey (Clinical Trial Number: NCT05594836). The research was conducted with a total of 84 primiparous mothers, including 41 intervention and 43 control groups, who met the inclusion criteria. The Baby Calming Training was administered face-to-face in the intervention group, utilizing a baby swaddling blanket, a sleep companion emitting white noise, and a training booklet. The control group received routine care. Data were collected through the Mother and Baby Introductory Information Form, Semantic Difference Scale-Me as a Mother, Maternal Attachment Inventory, Breastfeeding Self-Efficacy Scale-Short Form, and Infant Sleep Activity Record. The data were analyzed using descriptive statistics, Pearson's chi-square test, independent samples t-test, Mann-Whitney U test, Wilcoxon test, mixed design ANOVA analysis, Cohen's d, and 95% confidence interval (CI). This study adhered to CONSORT research guidelines. Results: Mothers in the intervention group exhibited higher mean scores on the perception of maternal role (mean ± SD: 70.37 ± 5.92, t: 8.590, 95% confidence interval [CI]: [1.347-2.375], d: 1.865, p < 0.001), maternal attachment (mean ± SD: 100.42 ± 1.52, U: 151.500, 95% CI: [0.732-0.892], d: 0.828, p < 0.001), and breastfeeding self-efficacy (mean ± SD: 64.00 ± 5.98, t: 8.109, 95% CI: [1.248-2.258], d: 1.757, p < 0.001) than the control group. It was determined that the total sleep time of the babies in the intervention group was higher, and the total crying duration was lower (p < 0.001). Conclusion: The study revealed that infant soothing training for primiparous mothers enhanced maternal role perception, maternal attachment, breastfeeding self-efficacy, and extended infants' sleep duration. Furthermore, infants exhibited reduced crying.

Breastfeeding disparities and recommended strategies to end them in New York.

Objective: The objective of this study was to identify strategies to address breastfeeding disparities across New York in the United States. Methods: Data were collected from August-December 2021 using a qualitative research design that included 45 key informant interviews and 253 online questionnaires. Results: Ninety-six percent of participants lived in or represented New York, and four percent were national experts. Participants discussed the factors contributing to breastfeeding disparities across the social ecological continuum. They identified New York subgroups most likely to report lower rates of breastfeeding initiation and/or continuation, including: certain racial and ethnic groups; individuals working in certain employment sectors or living in specific geographic areas; people with disabilities; and the lesbian, gay, bisexual, transgender, queer, intersex, asexual and more (LGBTQIA+) community. Recommendations included addressing social and commercial determinants of health and modifying the healthcare and workplace sectors with an emphasis on policy changes. Conclusions: The findings from this study emphasize the need to address systemic and structural factors impacting breastfeeding disparities. This article makes a novel contribution by providing recommendations that can be implemented collectively across relevant settings to address breastfeeding disparities in a state with one of the largest and most diverse populations.

Mobile applications for promoting and supporting breastfeeding: Systematic review and meta-analysis.

Breastfeeding practices require improvement. We performed a systematic review of randomised controlled trials (RCTs) and analytic observational studies to assess effects of mobile applications (apps) aiming to support and promote breastfeeding targeting pregnant women, mothers of infants or their partners, on breastfeeding outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL and Association of Computing Machinery Digital Library from 1 July 2008 to 29 November 2022, with lack of coverage of the most recent period before publication date being a limitation of this review. We performed meta-analyses of findings from RCTs on primary outcomes, namely early breastfeeding initiation, exclusive and any breastfeeding rates. Joanna Briggs Institute tools were used for risk of bias assessment. Six RCTs, one quasi-experimental and two cohort studies, mainly from high-income countries, were included. Most studies focused on maternal app usage starting from pregnancy. One study targeted fathers as app-users. Population characteristics, such as parity or delivery mode, apps scope of content and applied active components varied between studies. Main methodological limitations of studies were baseline differences between groups and lack of blinding. Compared to controls, app usage tended to increase the odds of exclusive breastfeeding. This nonsignificant effect was most pronounced at 1-1.5 months (n = 1294, odds ratio 1.45 (95% Confidence Interval, CI 0.83, 2.54), with considerable heterogeneity between studies [I2 77%]), but less so at 3 and 6 months post-partum. The odds of early breastfeeding initiation, any breastfeeding at all time points were similar among groups. However, two cohort studies reported increased odds of exclusive and/or any breastfeeding at different time points. In conclusion, evidence is insufficient to show sustained beneficial effects of breastfeeding promotion and support through mobile apps on breastfeeding rates.

Effects of internet-based integrated care on breastfeeding outcomes and emotional well-being in primiparous women.

OBJECTIVE: This study investigates the impact of Internet-based integrated care on breastfeeding outcomes and emotional well-being in primiparous women. METHODS: We conducted a retrospective analysis of 154 primiparous women admitted to Baoji People's Hospital from July 2020 to September 2023. Participants were divided into an observation group (n = 58), which received internet-based integrated care, and a control group (n = 96), which received routine telephone follow-up. We compared breastfeeding outcomes, knowledge, self-efficacy, and infant physical development between the groups, and performed logistic regression to identify risk factors affecting breastfeeding. RESULTS: Before the intervention, there were no significant differences in breastfeeding knowledge and self-efficacy scores between the groups (all P > 0.05). At 6 months postpartum, the observation group had a higher breastfeeding success rate and improved scores in breastfeeding knowledge and self-efficacy (all P < 0.05). Infants in the observation group exhibited better physical development compared to those in the control group (P < 0.05). Logistic regression analysis identified age (P = 0.019), mode of delivery (P = 0.006), and nipple condition (P = 0.029) as independent risk factors for exclusive breastfeeding, while education level (P < 0.001), type of employment (P = 0.002), and daily sucking frequency (P = 0.005) were identified as independent protective factors. CONCLUSIONS: The Internet-based integrated care model significantly enhances breastfeeding knowledge, self-efficacy, and exclusive breastfeeding rates among primiparous women, while also supporting better infant physical development.

Breastfeeding: science and knowledge in pediatric obesity prevention.

The increasing prevalence of childhood obesity worldwide is a significant concern due to its link to severe health issues in adulthood, such as non-communicable diseases (NCDs). To address this issue, this review evaluates the effectiveness of various preventive measures for childhood obesity, focusing on maternal nutrition and breastfeeding. The study underscores the criticality of the periconceptional period, where the diets of both parents can influence epigenetic modifications that impact the child's metabolic pathways and obesity risks. Breastfeeding is a potent protective mechanism against early-onset obesity, significantly enhancing the infant's metabolic and immune health by modifying DNA methylation and gene expression. Furthermore, the perspective underscores the significance of the Mediterranean diet during the periconceptional period and lactation. This diet can effectively prevent gestational complications and improve breast milk quality, fostering optimal infant development. Recognizing that obesity results from genetic, epigenetic, environmental, and social factors, the paper advocates for a comprehensive, multidisciplinary approach from the earliest stages of life. This approach champions a balanced maternal diet, exclusive breastfeeding, and timely introduction to complementary foods. In conclusion, addressing pediatric obesity requires a multifaceted strategy emphasizing improving prenatal and postnatal nutrition. Further research is necessary to understand the epigenetic mechanisms influenced by nutrition and their long-term effects on children's health. This will help refine interventions that curb the obesity epidemic among future generations.

High-risk pregnancy and risk of breastfeeding failure.

BACKGROUND: There is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure. AIM: To compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes. METHODS: A prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support. RESULTS: Delivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother's illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037). CONCLUSIONS: Women with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers' health.

The Interaction of Race and Pregnancy Intentions on Breastfeeding Initiation Rates and Duration in the United States.

Background: Unintended pregnancy increases adverse perinatal health outcomes. Limited studies exist on the influence of pregnancy intention on breastfeeding. This study examines the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Methods: Using the National Survey of Family Growth (2017-2019), we categorized breastfeeding into three categories (never breastfed, breastfed for 6 months or less, and breastfed for more than 6 months). Multinomial logistic regression and probability marginal effects were estimated across racial categories (Hispanics, non-Hispanic [NH] White, Black, and NH-others or multiracial). Results: The probability (Pr.) of never breastfeeding was the greatest among NH-Black women for all pregnancy intentions-both intended (Pr.: 0.34), mother-only (Pr.: 0.27), father-only (Pr.: 0.45), ambivalent (Pr.: 0.55), and neither intended (Pr.: 0.37). The probability of breastfeeding for 6 months or less is highest for Hispanics for both intended (Pr.: 0.41), NH-White for mother-only intended (Pr.: 0.49), Hispanics for father-only intended (Pr.: 0.56), ambivalent pregnancy intentions (Pr.: 0.60), and NH-others or multiracial for neither intended pregnancies (Pr.: 0.48). The probability of breastfeeding for more than 6 months is highest for NH-others or multiracial for both intended (Pr.: 0.50), ambivalent (Pr.: 0.49), and neither intended (Pr.: 0.36), while highest for NH-Black for mother-only intended (Pr.: 0.43). Conclusions: Our study demonstrates the interaction of Race and couples' pregnancy intention on breastfeeding initiation and duration. Owing to the high volume of unintended pregnancies in the United States, the current study might help maternal and child healthcare providers understand the interaction between race and pregnancy intentions on breastfeeding initiation and duration in the United States.