Low-Level Prenatal Toxin Exposures and Breastfeeding Duration: A Prospective Cohort Study.

Introduction Maternal exposure to tobacco smoke is associated with shortened breastfeeding duration, but few studies have examined the effects on breastfeeding outcomes of low level exposures to other toxic chemicals. Moreover, it is unclear if passive smoking is associated with duration of breastfeeding. Our objective was therefore to examine the effect of low-level prenatal exposures to common environmental toxins (tobacco smoke, lead, and phthalates) on breastfeeding exclusivity and duration. Methods We conducted an analysis of data from the Health Outcomes and Measures of the Environment (HOME) Study. Serum and urine samples were collected at approximately 16 and 26 weeks gestation and at delivery from 373 women; 302 breastfed their infants. Maternal infant feeding interviews were conducted a maximum of eight times through 30 months postpartum. The main predictor variables for this study were gestational exposures to tobacco smoke (measured by serum cotinine), lead, and phthalates. Passive smoke exposure was defined as cotinine levels of 0.015-3.0 µg/mL. Primary outcomes were duration of any and exclusive breastfeeding. Results Serum cotinine concentrations were negatively associated with the duration of any breastfeeding (29.9 weeks unexposed vs. 24.9 weeks with passive exposure, p = 0.04; and 22.4 weeks with active exposure, p = 0.12; p = 0.03 for linear trend), but not duration of exclusive breastfeeding. Prenatal levels of blood lead and urinary phthalate metabolites were not significantly associated with duration of any or exclusive breastfeeding. Conclusions Passive exposure to tobacco smoke during pregnancy was associated with shortened duration of any breastfeeding.

Hepatitis a screening for internationally adopted children from hepatitis A endemic countries.

Screening for hepatitis A virus (HAV) infection is not currently routinely recommended in internationally adopted children. International adoptees seen at the University of Minnesota International Adoption Clinic from 2006 to 2010 were assessed for acute HAV infection (positive HAV immunoglobulin M). Thirty of the 656 children screened (4.6%) were acutely HAV infected. HAV-infected children emigrated from Ethiopia (16), Guatemala (4), China (2), Colombia (2), Haiti (2), Philippines (2), Liberia (1), and Nepal (1). Infection was most frequent among children younger than 2 years (6.7%). No symptoms distinguished children with acute HAV infection from uninfected children. HAV infection caused significant social disruption, including separation of children from their ill adoptive parents during the initial weeks postarrival, a period important for postadoption adjustment and attachment. All international adoptees arriving from countries with high or intermediate HAV endemicity should be screened for HAV infection on arrival to the United States.

Infections in internationally adopted children.

Thousands of international adoptees join families in the United States every year. Many have been in institutional care and are from countries or areas with a high risk of several infectious diseases. Focused infectious disease testing is important to ensure the health of the adoptee, as well as their new family and the larger community in which they now live. Newly arrived internationally adopted children should be screened for specific infections, including viral, bacterial, and parasitic infections. They should ideally be seen shortly after arrival by a multidisciplinary team at a center specializing in international adoption.

Physician breastfeeding education leads to practice changes and improved clinical outcomes.

BACKGROUND AND OBJECTIVES: Lack of physician knowledge about breastfeeding is associated with decreased initiation and continuation of breastfeeding by patients. We evaluated the effects of a breastfeeding education program on physicians' breastfeeding knowledge, attitudes, and beliefs, measured changes in clinical practice, and examined breastfeeding rates of patients of participating physicians. STUDY DESIGN AND METHODS: Six breastfeeding sessions addressed breastfeeding problem-solving and counseling and specific clinical issues including mastitis, perceived insufficient milk, poor infant weight gain, and return to work. We measured physicians' breastfeeding knowledge, attitudes, and beliefs before and after curriculum implementation and also measured changes in practice. We analyzed breastfeeding rates of patients in the practice before, during, and after the intervention. RESULTS: We studied 24 residents and 15 faculty members at the intervention site; there were 12 residents and nine faculty in a similar control program. Attendance at education sessions improved breastfeeding knowledge (p<0.01) and attitudes/beliefs (p=0.03). Participants identified 15 unique practice changes with a strong commitment to make these changes (4.7 on a 5-point scale) and fulfillment of practice change of 3.6. Participation in education sessions improved patients' rates of any breastfeeding at 4 and 6 months and of full breastfeeding at 4 months. CONCLUSIONS: A breastfeeding education program at a semirural residency program improved physicians' breastfeeding knowledge. Implementation of practice changes was fair. Two years into the intervention, breastfeeding rates improved for patients of the physicians with high levels of participation in the program.

Delayed onset lactogenesis II predicts the cessation of any or exclusive breastfeeding.

OBJECTIVE: To evaluate the association between delayed lactogenesis II (>3 days postpartum; delayed onset lactogenesis II [DLII]) and the cessation of any and exclusive breastfeeding at 4-weeks postpartum. STUDY DESIGN: We constructed multivariable logistic regression models using data from 2491 mothers enrolled in the prospective Infant Feeding Practice Study II cohort. Models included DLII, known risk factors for breastfeeding cessation (age, education, race, parity/previous breastfeeding, and exclusive breastfeeding plan), and potential confounders identified in bivariate analyses (P ≤ .1). Backward selection processes (P ≤ .1) determined risk factor retention in the final model. RESULTS: DLII was associated with cessation of any and exclusive breastfeeding at 4-weeks postpartum (OR 1.62; CI 1.14-2.31; OR 1.62; CI 1.18-2.22, respectively); numerous independent risk factors qualified for inclusion in the multivariable model(s) and were associated with the outcome(s) of interest (eg, supplemental nutrition program for women, infants, and children enrollment, onset of prenatal care, feeding on-demand, time initiated first breastfeed, hospital rooming-in, obstetric provider preference for exclusive breastfeeding, and maternal tobacco use). CONCLUSIONS: Women experiencing DLII may be less able to sustain any and/or exclusive breastfeeding in the early postpartum period. Routine assessment of DLII in postpartum breastfeeding follow-up is warranted. Women with DLII may benefit from additional early postpartum interventions to support favorable breastfeeding outcomes.

Full breastfeeding duration and risk for iron deficiency in U.S. infants.

BACKGROUND: National and international authorities recommend exclusive breastfeeding for an infant's first 6 months. Effects of these recommendations on iron status of U.S. children are unknown. OBJECTIVE: To ascertain if full breastfeeding for 6 months versus 4 months places U.S. children at greater risk for iron deficiency. DESIGN/METHODS: Data regarding 2268 children ages 6 to <24 months from NHANES III, a nationally representative cross-sectional survey conducted from 1988-1994, were analyzed. Similar analyses were conducted for 526 children ages 12 to <24 months from NHANES 1999-2002. Anemia (low hemoglobin or history of anemia) and iron status (serum ferritin) were compared for five groups: formula fed only (n = 1142), or full breastfeeding for: 1 month "FullBF<1" (n = 425), 1 to <4 months "FullBF1-3+" (n = 343), 4 to <6 months "FullBF4-5+" (n = 222), and >or= 6 months "FullBF6" (n = 136). Laboratory data were available for children 12 to 24 months (n = 745). SUDAAN software was used to account for the complex sampling design. Logistic regression adjusted for confounding factors. RESULTS: In unadjusted analyses (NHANES III), 10.0% of "FullBF6+" versus 2.3% of "FullBF4-5+" had a history of anemia (p = 0.007) but unadjusted between group serum ferritin and hemoglobin differences were insignificant in both surveys. Adjusting for birth weight and demography revealed persistently lower risk of history of anemia (NHANES III, odds ratio [OR] 0.20, confidence interval [CI] 0.06, 0.63) and low serum ferritin (NHANES 1999-2002, OR 0.19, CI 0.06, 0.57) but not low hemoglobin at time of survey "FullBF4-5+" versus "FullBF6." CONCLUSIONS: Young children in the United States fully breastfed for 6 months may be at increased risk of iron deficiency. Adequate iron may not be provided by typical complementary infant foods. Healthcare providers should be vigilant to prevent iron deficiency in this group of infants.