COMT Variants are Associated With Breast and Nipple Pain.

Estimates suggest that only 24.9% of infants born in 2019 were exclusively breastfed before 6 months of age, despite the known health benefits of exclusive breastfeeding. Breast and nipple pain is one of the primary determinants of exclusive breastfeeding. Environmental contributions to breastfeeding success have been reported extensively in the literature, but the contribution(s) of maternal genetics has yet to be discovered. The purpose of the study was to identify an association between pain and lactation-related gene variants with exclusive breastfeeding determinants. We selected 4 genes having single nucleotide polymorphisms (SNPs) with potential functional significance in breastfeeding and pain: prolactin receptor (PRLR), oxytocin receptor (OXTR), catechol-O-methyltransferase (COMT), and milk fat globule epidermal growth factor and factor V/VIII domain containing (MFGE8). We performed a cross-sectional secondary analysis of a longitudinal randomized controlled trial study, Promoting Self-Management of Breast and Nipple Pain with Biomarkers and Technology for Breastfeeding Women (NCT05262920). Breast and nipple pain, perceived insufficient milk, and breastfeeding self-efficacy were examined using total scale scores for the Brief Pain Inventory, Visual Analog Scale, H&H Lactation Scale, and the Breastfeeding Self-efficacy Scale-short form, respectively. Of the candidate genes examined, SNPs within COMT were significantly associated with breastfeeding-related outcomes. Specifically, COMT rs4633 and rs4680 minor allele carriers (T, A) reported higher breast and nipple pain intensity than women homozygous for the major allele (C, G). COMT is the most widely researched "pain gene" and has been linked to cold, postoperative, and postpartum pain. This study is the first to identify a contribution of COMT variants to breast and nipple pain and, as a result, to breastfeeding exclusivity. PERSPECTIVE: Two SNPs in the pain gene COMT are associated with breast and nipple pain. Clinically, a minor allele in COMT rs4633 and rs4680 may increase a woman's rating of moderate breast and nipple pain. TRIAL REGISTRATION: PROMPT was registered in ClinicalTrials.gov (protocol #NCT05262920).

Retention and the Intersection of Structural Inequities in a Breastfeeding Intervention Study.

Introduction: Women below the poverty threshold have lower representation and retention in breastfeeding studies. Methods: A secondary analysis of a longitudinal randomized controlled self-management for breast and nipple pain during breastfeeding study. Participants completed online surveys at discharge, weeks 1, 2, 3, 6, 9, 12, 18, and 24, with face-to-face interviews at 6 and 24 weeks. Text messages were sent to participants when modules and surveys were due. Retention was assessed in R with descriptive statistics, Mann-Whitney, Pearson's chi-square, and Cox Proportional Hazard Regression. Results: Two hundred and forty-four women (89 ≤$50,000 and 155 >$50,000) were recruited. Retention rates at 1 (93%), 2 (87%), 6 (82%), 9 (77%) and 24 (72%) weeks. For women of low income compared to those of high income there was a hazard ratio (HR) of 2.5 (p=0.0001) for retention. For non-Hispanic Black and Hispanic women compared to the combined non-Hispanic White and Other group, HRs for retention were 3.3 and 2.6 respectively (p=0.0001). Adjustment for age in the final hazard regression model of income, age, race and ethnicity decreased the HR for women of low income to 1.6 and HRs for non-Hispanic Black and Hispanic women to 2.1 and 1.9, respectively (p=.0001). However, none of the individual factors in the model achieved statistical significance. Discussion: Retention in breastfeeding studies impacts breastfeeding duration, a key lifelong preventative health behavior. Despite accessible study design, retention of women desiring to breastfeed was adversely affected by the intersection of income, race and ethnicity, and age.

Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study.

Background: In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women. Methods: Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28). Results: The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034). Conclusion: Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.

A Novel System to Measure Infants' Nutritive Sucking During Breastfeeding: the Breastfeeding Diagnostic Device (BDD).

Breastfeeding is optimal for infant health, but more than 66% of mothers cease exclusive breastfeeding within three months after giving birth. Evaluating infants' sucking effort provides valuable diagnosis to mothers encountering barriers with breastfeeding. Sucking microstructure is defined as an array of metrics that comprehensively capture infants' ability to create a sealed latch onto mother's nipple and regulate feeding, including number of sucks, sucks per burst, number of bursts, intra suck interval, and maximal sucking pressure. In this paper, we proposed a breastfeeding diagnostic device (BDD) which allows convenient and objective measurement of infants' sucking microstructure in both home and clinical settings. BDD utilizes an air-based pressure transducer to measure infants' sucking behavior. We conducted pilot clinical studies on six dyads of mother and infant to test the feasibility of the BDD system. To facilitate comparison, both breastfeeding and bottle-feeding were conducted on the six dyads using the BDD in home settings, and the outcomes are comparable with prior recordings in research or clinical settings. By offering a convenient and objective measurement of the sucking microstructure, the BDD will provide clinically meaningful guidance and diagnosis to mothers struggling with breastfeeding. BDD will also serve as an objective metric useful in research areas relevant to infant behaviors, assessment of neurodevelopment, and potentially a screening tool for developmental disabilities.

When is it safe to initiate breastfeeding for preterm infants?

BACKGROUND: Breast milk is the gold standard of nutrition for preterm infants. Yet, initiation of direct breastfeeding before 32 weeks' postconceptional age (PCA) is not common practice in many neonatal intensive care units (NICUs). Our clinical question was, "In preterm infants, when is it safe to initiate breastfeeding in infants <32 weeks PCA receiving enteral feedings?" SEARCH STRATEGY: A review of the literature was compiled between February 2013 and January 2015 by using the following databases: CINAHL, Cochrane Systematic Review, Scopus, and PubMed. Articles found were written in English and published after 1985. Key words were utilized during searches and references were hand checked. RESULTS: Our review revealed that stable preterm infants maintain their physiological status during exposure to the breast as early as 27 to 28 weeks' PCA. Several studies demonstrated infants during breastfeeding compared with bottle-feeding experienced minimal variation in oxygen saturation and heart rate during feeding. Some infants exposed to the breast before 30 weeks' PCA were exclusively breastfeeding (direct breastfeeding and breast milk) at 32.8 weeks' PCA. Skin-to-skin mother-infant contact is crucial to the successful transition to direct breastfeeding. IMPLICATIONS FOR PRACTICE AND RESEARCH: The transition from enteral feedings to direct, exclusive breastfeeding should involve frequent mother-infant skin-to-skin contact requiring support and guidance from the NICU staff. Future research should involve creating standard protocols within NICUs to facilitate breastfeeding transition and exploring barriers that may prevent the preterm infant from achieving direct, exclusive breastfeeding.