Factors associated with exclusive breastfeeding at discharge during the COVID-19 pandemic in 17 WHO European Region countries.

BACKGROUND: Exclusive breastfeeding is the optimal infant nutrition, providing infants immunoprotection against many diseases including SARS-CoV-2 infection. Restrictions during the COVID-19 pandemic may have negatively affected breastfeeding practices in maternity care facilities. The aims of the study were to examine exclusive breastfeeding rates at discharge over time and to identify factors associated with exclusive breastfeeding during the pandemic. METHODS: A cross-sectional survey was conducted among mothers who gave birth in a maternity care facility in the World Health Organization (WHO) European Region countries during the COVID-19 pandemic. The socio-ecological model was employed to examine intrapersonal, interpersonal, organizational, and community/society factors associated with maternal report of exclusive breastfeeding at the time of discharge. RESULTS: There were 26,709 participating mothers from 17 European Region countries who were included in the analysis. Among the mothers, 72.4% (n = 19,350) exclusively breastfed and 27.6% (n = 7,359) did not exclusively breastfeed at discharge. There was an overall decline in exclusive breastfeeding rates over time (p = 0.015) with a significantly lower rate following the publication of the WHO breastfeeding guidelines on 23 June 2020 (AOR 0.88; 95% CI 0.82, 0.94). Factors significantly associated with exclusive breastfeeding outcomes in the logistic regression analysis included maternal age, parity, education, health insurance, mode of birth, inadequate breastfeeding support, lack of early breastfeeding initiation, lack of full rooming-in, birth attendant, perceived healthcare professionalism and attention, facility room cleanliness, timing of birth, and location of birth. CONCLUSIONS: Results from the study indicate the decline in exclusive breastfeeding rates in the WHO European Region during the COVID-19 pandemic. Using the socio-ecological model to identify factors associated with breastfeeding outcomes facilitates an integrated and holistic approach to address breastfeeding needs among women across the region. These findings demonstrate the need to augment breastfeeding support and to protect exclusive breastfeeding among mother-infant dyads, in an effort to reverse the declining exclusive breastfeeding rates. The study highlights the need to educate mothers and their families about the importance of exclusive breastfeeding, reduce maternal-infant separation, increase professional breastfeeding support, and follow evidence-based practice guidelines to promote breastfeeding in a comprehensive and multi-level manner. TRIAL REGISTRATION NUMBER: Clinical Trials NCT04847336.

Vitamin D Intake and Obesity in Occupational Asthma Patients and the Need for Supplementation.

BACKGROUND: Occupational asthma occurs in a significant number of adult unset forms of asthma. Even after exposure cessation, persistent asthma is frequent. Although recognized as important, nutrition, specifically vitamin D intake, was rarely evaluated in occupational asthma. OBJECTIVE: To assess the vitamin D intake in occupational asthma patients and the relation with body mass index, co-morbidities related to vitamin D deficit, lung function and quality of life. RESULTS: We found a reduced vitamin D intake in both irritant and allergic asthma, in obese and nonobese patients. The average intake in non-obese patients, although higher, did not reach statistical significance. We also found lower vitamin D intake in the mild asthma group versus the severe group, marginally reaching the significance level (p=0.056) at the median test. Regression analysis in asthma subpopulations revealed a different pattern of correlation, with a stronger relationship between the BMI and the impact score in irritant asthma and a closer link between vitamin D intake and symptoms score (p= 0.027) in the allergic asthma group. CONCLUSION: The relation between obesity and vitamin D on clinical scores and lung function seems to be different according to the asthma phenotype. However, our study supports the usefulness of nutritional interventions in all occupational asthma patients, targeting both the reduction of the fat mass and the achievement of the recommended daily intake of vitamin D. When analyzing the impact of the weight loss effect on asthma evolution, the vitamin D status should also be considered as an influencer.