[Maintenance of exclusive breastfeeding after three months postpartum: An experience in a health department of a Valencian Community]. / Mantenimiento de la lactancia materna exclusiva a los 3 meses posparto: experiencia en un departamento de salud de la Comunidad Valenciana.

AIMS: To investigate the prevalence of EBF at 3-months postpartum, and the early factors for discontinuation. DESIGN: Observational, retrospective study. LOCATION: Health department of La Ribera, Valencia, Spain. PARTICIPANTS: Newborns between December 2012 to January 2017. METHODS: Pregnant women were interviewed at postpartum and at 3 months regarding variables associated with breastfeeding initiation and continuation, matched with socio-demographic and obstetric-neonatal information. MAIN MEASUREMENTS: Prevalence of breastfeeding at discharge and exclusive breastfeeding at 3 months. Reasons for interrupt exclusive breastfeeding. Chi-square determination between qualitative variables. FINDINGS: One thousand three hundred and thirty-eighth women were recruited. EBF at discharge was 68.2% (913) and at 3 months 46.7% (625). EBF duration was 68.7±32.7 days (95% CI: 66.9-71.2). We found statistically significant differences between the type of breastfeeding and the variables, year of study, country of origin and parity (P<0.001, P=0.005 and P=0.05 respectively). Hypogalactia (21.8%) and lower than recommended increase in newborn weight gain (14.9%) were most frequent factors for discontinuation. CONCLUSION: The prevalence of EBF at 3 months is low compared to other similar studies, although we see an upward trend. Belief in hypogalactia influenced the maintenance of exclusive breastfeeding.

Influence of health literacy on acceptance of influenza and pertussis vaccinations: a cross-sectional study among Spanish pregnant women.

OBJECTIVES: Immunisations against influenza and Bordetella pertussis infection are recommended to pregnant women in Valencia (Spain), yet vaccination rates remain low. Health literacy (HL) appears as a crucial factor in vaccination decision-making. We explored the relation between HL of pregnant women and decisions to receive influenza and pertussis immunisations. SETTING: University hospital in Valencia (Spain). PARTICIPANTS: 119 women who gave birth at a hospital in Valencia (Spain) between November 2015 and May 2016. Women in the immediate postpartum period (more than 27 weeks of gestation), between November 2015 and May 2016 were included in the study. Women with impairments, language barriers or illiteracy which prevented completion of the questionnaires, or those who were under 18 years were excluded from enrolment. PRIMARY AND SECONDARY OUTCOME MEASURES: HL level; influenza and pertussis immunisation rate; reasons for rejection of vaccination. RESULTS: 119 participants were included (mean age 32.3±5.5 years, 52% primiparous, 95% full-term deliveries). A higher education level was associated with Short Assessment of Health Literacy for Spanish Adults _50 (adjusted R2=0.22, p=0.014) and Newest Vital Sign (adjusted R2=0.258, p=0.001) scores. Depending on the scale, 56%-85% of participants had adequate HL. 52% (62/119) and 94% (112/119) of women received influenza and pertussis immunisation, respectively. Women rejecting influenza vaccine had a higher HL level (measured by SALHSA_50 tool) than those accepting it (Kruskal-Wallis test p=0.022). 24% of women who declined influenza vaccination felt the vaccine was unnecessary, and 23% claimed to have insufficient information. CONCLUSIONS: Influenza vaccination rate was suboptimal in our study. Women with high HL were more likely to decline immunisation. Information from professionals needs to match patients' HL levels to reduce negative perceptions of vaccination.

Tobacco use in the third trimester of pregnancy and its relationship to birth weight. A prospective study in Spain.

BACKGROUND: Few studies have been carried out in Spain examining the use of tobacco amongst expectant mothers and its effect on birth weight. AIMS: To observe the proportion of expectant mothers who smoke during their pregnancy, and the impact of tobacco consumption on maternal and birth weight. We also aimed to identify the trimester of pregnancy in which tobacco use produced the greatest reduction in birth weight. METHODS: Prospective observational study in Spain. A random sampling strategy was used to select health centres and participant women. A total of 137 individuals were enrolled in the study. Exposure to tobacco was measured through a self-reported questionnaire. Regressions were performed to obtain a predictive model for birth weight related to smoking. FINDINGS: Overall, 35% of study participants were smokers during the pre-gestational period (27% in the first trimester, 21.9% in the second and 21.2% in the third). 38.7% of smoking cessation attempts took place in the third-trimester. Pregnant women who smoked up to the third trimester had a higher risk of giving birth to a baby under 3000g, compared to non-smokers (OR=5.94, CI 95%: 1.94-18.16). Each additional unit of tobacco consumed daily in the 3rd trimester led to a 32g reduction in birth weight. CONCLUSION: An important proportion of pregnant women in Spain smoke during pregnancy. Pregnant women exposed to tobacco have newborns with lower birth weight. Smoking during the 3rd trimester of pregnancy is associated with the greatest risk of lower birth weight.