Breast milk sharing via the internet: the practice and health and safety considerations.

To characterize the practice of breast milk sharing via the internet in the US and examine factors associated with participants' communication regarding potential health and safety risks. This cross-sectional study examined all original postings (n = 254) placed during 1 week in 2011 on four websites to facilitate the sharing of breast milk. Postings were characterized for intent and health and safety topics (i.e., selling vs. donating milk, hygiene/handling practices, infectious disease screening, diet/exercise habits, substance and pharmaceutical use, milk quality claims, price) communicated between milk providers and recipients. Approximately 69% of postings were providing milk and 31% were seeking milk; 47% included identifiers. Few provider postings reflected measures to potentially reduce risks to recipients: 20% mentioned using a healthy handling/hygiene practice, 11% offered specifics about infectious disease screening, 51% mentioned limiting/abstaining from 1+ substances. The presence of indications about handling/hygiene, diet/exercise, and abstaining from substances were strongly positively associated with each other (ORs 7.42-13.80), with the odds of selling (ORs 6.03-∞), and with making quality claims (ORs 3.14-13.54), but not with disease screening. One-fifth of recipients sought milk for a child with a medical condition or poor birth outcome. Most recipients (90%) did not specify any health and safety practices of a provider in their posting. Health behaviors and screening for diseases that may affect milk safety are not prominent topics in postings seeking to share milk. This lack of communication may exacerbate the health risks to recipient infants, especially infants at increased risk due to pre-existing health conditions.

Interconnections between unintended pregnancy, alcohol and other drug use, and pregnancy, birth, infant, childhood and socioeconomic outcomes: a scoping review.

BACKGROUND: Unintended pregnancy (UIP) and substance use disorder share underlying root causes with similar impacts for women and their offspring in pregnancy, birth and beyond. Furthermore, intoxication with alcohol and other drugs (AOD) increases the risk of UIP. OBJECTIVES: To assess the available evidence on associations between UIP and health, social and economic outcomes, in women who use AOD. SEARCH STRATEGY: The review utilised the Joanna Briggs Institute Methodology for Scoping Reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The search was conducted across multiple databases, including Scopus and Medline, and limited to studies published between January 2000 to June 2023. SELECTION CRITERIA: Studies reporting on interactions between AOD use and UIP, and pregnancy, birth, infant, childhood, social or economic outcomes. All patterns and types of AOD use, except isolated use of tobacco, were included. Studies were available in English and conducted in high-income countries. DATA COLLECTION AND ANALYSIS: Selected articles were reviewed, and data collected by two independent reviewers using a standardised data extraction sheet. Findings were summarised and reported descriptively. MAIN RESULTS: A total of 2536 titles and abstracts were screened, 97 full texts were reviewed, and three studies were selected for inclusion in the scoping review. There was heterogeneity in types and patterns of AOD use, differences in study design and tools to assess pregnancy intention, and each focused on disparate outcomes. No study assessed or reported on birth outcomes. CONCLUSION: There is a paucity of data examining the intersection between AOD use and UIP and further research is needed.

Fathers of children with cancer: involvement, coping, and adjustment.

INTRODUCTION: This study examined the role of fathers caring for children with cancer. Psychological adjustment, coping, and work patterns of mothers and fathers were described. METHOD: Twenty fathers of children with cancer were compared with 20 mothers of children with cancer and 20 control fathers of healthy children. Questionnaire data were collected regarding coping, parental adjustment, child adjustment, and family involvement. RESULTS: Fathers did not differ from mothers or control fathers in terms of psychological adjustment or coping. However, fathers of children with cancer spent more hours at work and more hours caring for children than did control fathers. Paternal adjustment was significantly related to child adjustment only when the child had cancer. Coping was related to work outside the home for fathers and adjustment for mothers. DISCUSSION: Models of family adaptation may be different for fathers and mothers. Treatment teams must attend to the unique needs of fathers.

Breastmilk sharing: awareness and participation among women in the Moms2Moms Study.

BACKGROUND: Feeding infants unscreened, raw human milk from a source other than the mother may pose health risks. The objectives of the Moms2Moms Study were to estimate the proportions of mothers who were aware of breastmilk sharing, considered sharing, and shared milk and to identify associated maternal and child characteristics. SUBJECTS AND METHODS: All eligible women (n=813) who delivered at The Ohio State University Wexner Medical Center (Columbus, OH) and did not indicate an intention to exclusively "bottle feed" were asked to participate in this cohort by completing a postal questionnaire at 12 months postpartum (499 [61%] responded). Women who shared milk participated in a follow-up interview. RESULTS: Awareness of milk sharing was high (77%) and positively associated with socioeconomic status, age, non-Hispanic white race, having fed one's infant at the breast, and reporting no difficulty making enough milk. Twenty-five percent considered sharing. Primiparous women (odds ratio [OR]=2.12; 95% confidence interval [CI] 1.02, 4.62) and those who delivered preterm (OR=3.27; 95% CI 1.38, 7.30) were more likely to consider feeding milk from another mother. Women with public/no insurance (OR=0.52; 95% CI 0.27, 0.97) were less likely to consider providing milk for someone else; highly educated women were more likely (OR=1.90; 95% CI 1.12, 3.32). Almost 4% of women shared milk and did so among friends or relatives or had a preterm infant who received screened and pasteurized donor milk. CONCLUSIONS: Sharing milk among friends and relatives is occurring. Many women are aware of milk sharing and have considered it.

Microbial contamination of human milk purchased via the Internet.

OBJECTIVE: To quantify microbial contamination of human milk purchased via the Internet as an indicator of disease risk to recipient infants. METHODS: Cross-sectional sample of human milk purchased via a popular US milk-sharing Web site (2012). Individuals advertising milk were contacted to arrange purchase, and milk was shipped to a rented mailbox in Ohio. The Internet milk samples (n = 101) were compared with unpasteurized samples of milk donated to a milk bank (n = 20). RESULTS: Most (74%) Internet milk samples were colonized with Gram-negative bacteria or had >10(4) colony-forming units/mL total aerobic count. They exhibited higher mean total aerobic, total Gram-negative, coliform, and Staphylococcus sp counts than milk bank samples. Growth of most species was positively associated with days in transit (total aerobic count [log10 colony-forming units/mL] ß = 0.71 [95% confidence interval: 0.38-1.05]), and negatively associated with number of months since the milk was expressed (ß = -0.36 [95% confidence interval: -0.55 to -0.16]), per simple linear regression. No samples were HIV type 1 RNA-positive; 21% of Internet samples were cytomegalovirus DNA-positive. CONCLUSIONS: Human milk purchased via the Internet exhibited high overall bacterial growth and frequent contamination with pathogenic bacteria, reflecting poor collection, storage, or shipping practices. Infants consuming this milk are at risk for negative outcomes, particularly if born preterm or are medically compromised. Increased use of lactation support services may begin to address the milk supply gap for women who want to feed their child human milk but cannot meet his or her needs.

Buying human milk via the internet: just a click away.

BACKGROUND: For past centuries, infants have been fed the milk of mothers who are not their own by latching to another woman's breast. Today, the majority of lactating women use electric pumps to extract milk from their breasts; thus, an infant now may be fed another woman's milk via a bottle or cup. The Internet is an emerging avenue to acquire pumped human milk. The purpose of our study was to participate in and describe the process of buying milk via the Internet. Our goal is to help those involved with the clinical care, research, and public health policy of mothers and infants better understand that families may be buying milk in this way. SUBJECTS AND METHODS: We anonymously bought 102 human milk samples via the Internet. We characterized the outside box, packing materials, milk container, temperature and condition of the milk, and cost. RESULTS: We bought 2,131 ounces of milk at a total cost of $8,306. Eighty-nine percent of the milk arrived above the recommended frozen temperature of -20°C; 45% of it was even above the recommended refrigerator temperature (4°C). The mean surface temperature of the milk samples in each shipment was correlated with the cost of shipping, time in transit, and condition of the milk containers. CONCLUSIONS: The prevalence and potential risks of this practice currently are unknown. Research related to milk quality and infant outcomes related to milk buying via the Internet is urgently needed.

Educational and occupational outcomes among young adults with juvenile idiopathic arthritis.

OBJECTIVE: To examine educational and occupational outcomes among young adults with juvenile idiopathic arthritis (JIA) and peers during the transition from adolescence to emerging adulthood. METHODS: Families were recruited when children with JIA were 8-14 years old. At that time, each child with JIA was matched to a classmate of similar age, sex, and race for inclusion in a comparison group. For the current followup (12.64 years postdiagnosis), 45 participants with JIA, 46 peers, and their parents completed questionnaires soon after the young person's 18th birthday. Disease type and severity were rated by health care providers. RESULTS: Young adults with JIA and peers were similar on a variety of factors, including family background, scholastic and occupational self-concept, and academic competence. The proportion of participants who graduated from high school, were working, and expressed plans to attend postsecondary education or seek employment was similar between groups. Disease type, initial severity, and time since diagnosis were generally not associated with indices of educational and occupational attainment. CONCLUSION: Despite the challenge of having a chronic illness, young adults with JIA were similar to peers on numerous educational and occupational outcomes during the transition from adolescence to emerging adulthood. Interventions to assist academic or occupational functioning may not be necessary for all children with JIA, but additional research is needed to identify subgroups at risk for long-term difficulties.