Double Burden of Malnutrition and Its Associated Factors in Urbanized Indigenous Peoples (Orang Asli) of Peninsular Malaysia.

Double burden of malnutrition (DBM) is a global public health concern. This study determined the prevalence of DBM and its associated factors among 451 indigenous households in an urbanized state of Malaysia. Mothers and children were measured for weight and height/length. Mothers were interviewed for socio-demographics and diets of mothers and children. Prevalence of DBM (overweight/obese mother and underweight/stunted child) was 28.8%. Food insecurity, maternal height (<150 cm) and energy intake (>recommendation), child's age (≥24 months) and energy intake (

Relaxation Therapy and Human Milk Feeding Outcomes: A Systematic Review and Meta-Analysis.

Importance: Human milk feeding is a key public health goal to optimize infant and maternal/parental health, but global lactation outcomes do not meet recommended duration and exclusivity. There are connections between lactation and mental health. Objective: To appraise all available evidence on whether the provision of relaxation interventions to lactating individuals improves lactation and well-being. Data Sources: Embase, MEDLINE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and the Cochrane Library were searched on September 30, 2023, and topic experts were consulted. Study Selection: Two independent reviewers screened for eligibility. Inclusion criteria were full-text, peer-reviewed publications with a randomized clinical trial design. Techniques that were entirely physical (eg, massage) were excluded. A total of 7% of initially identified studies met selection criteria. Data Extraction and Synthesis: Two independent reviewers extracted data and assessed risk of bias with the Cochrane Risk of Bias 2 tool. Fixed-effects meta-analysis and Grading of Recommendations, Assessment, Development, and Evaluations guidelines were used to synthesize and present evidence. Main Outcomes and Measures: Prespecified primary outcomes were human milk quantity, length and exclusivity of human milk feeding, milk macronutrients/cortisol, and infant growth and behavior. Results: A total of 16 studies were included with 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years). Interventions were music, guided relaxation, mindfulness, and breathing exercises/muscle relaxation. Provision of relaxation was not associated with a change in human milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 205 participants). Provision of relaxation was associated with an increase in human milk quantity (standardized mean difference [SMD], 0.73; 95% CI, 0.57-0.89; 464 participants), increased infant weight gain in breastfeeding infants (MD, z score change = 0.51; 95% CI, 0.30-0.72; 226 participants), and a slight reduction in stress and anxiety (SMD stress score, -0.49; 95% CI, -0.70 to -0.27; 355 participants; SMD anxiety score, -0.45; 95% CI, -0.67 to -0.22; 410 participants). Conclusions and Relevance: Results of this systematic review and meta-analysis suggest that provision of relaxation was associated with an increase in human milk quantity and infant weight gain and a slight reduction in stress and anxiety. Relaxation interventions can be offered to lactating parents who would like to increase well-being and improve milk supply or, where directly breastfeeding, increase infant weight gain.

Maternal dietary and environmental factors associated with infant circadian rhythm, growth, and temperament: Research protocol for a prospective cohort study.

Introduction: Emerging evidence has been explored to determine the factors affecting the development of infant circadian rhythm. While fetal programming happens during the pregnancy period, external environmental cues and infant nutritional programming can have substantial effects on the infant circadian rhythm. Understanding prenatal and postnatal factors determining infant circadian rhythm can improve future interventions in optimizing maternal and infant health. Methods: This is a prospective observational cohort study, targeting 216 pregnant women from government maternity clinics in Kuala Lumpur, Malaysia. Pregnant women will be recruited at third trimester (baseline), and follow up at 3 months, and 6 months. A subsample will be collected for salivary cortisol analysis to determine circadian rhythm of the mother and infant at third trimester and 3 months. Data of eating misalignment, light exposure, chronotype, infant temperament, sleep quality, and mood will be collected via validated questionnaires. Anthropometric data and birth outcomes will be collected from antenatal and postnatal health records. Summary: Studies on infant circadian rhythm development have yet to be explored and established, hence this study presents a novel approach to identify the factors from prenatal to postnatal periods on infant circadian rhythm and its influence on growth and temperament. Findings from this study will provide insights in the critical timing which has larger effects on infant circadian rhythm development for future interventions to be conducted.

Development, validation, and reliability of the Chrononutrition Profile Questionnaire-Pregnancy (CPQ-P).

BACKGROUND: During pregnancy, physiological changes can affect eating and sleeping habits, which may eventually have negative consequences for maternal and foetal health. To better understand these changes, it is essential to develop a reliable questionnaire that addresses lifestyle habits such as snacking and daytime napping. This study aimed to determine the validity and reliability of the Chrononutrition Profile Questionnaire-Pregnancy (CPQ-P). METHODS: A total of 399 women in their second and third trimester of pregnancy were recruited from government maternal and child health clinics in Kuala Lumpur and Putrajaya and completed a self-administered online questionnaire. Content validity was conducted with an expert panel consisting of 4 members. Confirmatory factor analysis (CFA) using maximum likelihood was conducted to determine the construct validity. Internal consistency was determined by Cronbach's alpha coefficient (CAC), while the test-retest reliability was conducted using intraclass correlation coefficient (ICC). RESULTS: The questionnaire had an appropriate content validity index of 0.91. The CPQ-P consists of 22 items, measuring 5 constructs, including morning chrono-habits, sleeping habits, evening eating, temporal eating, and pregnancy symptoms. The factor model showed good fit with χ2/df = 2.486, GFI = 0.893, CFI = 0.912, and RMSEA = 0.065. The 22 items in CPQ-P showed fair to excellent test-retest reliability (ICC: 0.42 to 0.98). The 5 constructs in CPQ-P were found to have a good to excellent internal consistency (α = 0.612-0.963). CONCLUSIONS: The CPQ-P is a valid and reliable tool for assessing lifestyle habits during pregnancy. The questionnaire can be used to identify areas where pregnant women may need additional support or intervention to adopt healthy behaviours and reduce the risk of adverse maternal and foetal outcomes. TRIAL REGISTRATION: NCT05700136 (clinicaltrials.gov). Trial registration date: 26/01/2023.

Mother-infant postnatal experience and its association with maternal emotion and coping during the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic resulted in a partial lockdown in Malaysia known as Movement-Controlled-Order (MCO), which has affected primary care management and social life norms. Thus, psychological health is a concern for mothers, particularly during the postpartum period. This study aimed to determine factors associated with maternal emotional experiences and coping during the pandemic. METHODOLOGY: Mothers of infants aged < 18 months (n = 1449) in Malaysia completed an online survey during MCO (July 2020 to February 2021). The survey comprised questions on sociodemographics, pandemic livelihood impact, maternal experiences, and emotions. RESULTS: More than one-third of mothers expressed feeling worried (54.7%), annoyed (48.1%), and tired (42.2%) to some or a high extent. Mothers who were younger (p = .001), more educated (p = .001), faced difficulty paying rent (p = .002), and whose husbands were unemployed (p < .001) expressed higher negative emotions. In contrast, mothers who received enough support for health (p = .001) and breastfeeding (p = .008), had infants sleep less (p = .042) and had more time to focus on health (p < .001) expressed better emotions. Higher coping was expressed among mothers with a higher household income (p = .004), had more time to focus on their health (p = .010), received additional breastfeeding support (p = 0.039), and practised traditional postpartum care (p < .001). In contrast, difficulty paying for essentials (p = .023) was associated with negative coping. CONCLUSION: Maternal emotional experiences were significantly associated with sociodemographic characteristics, livelihood impact, postnatal experiences, and infant behaviours. Postpartum mental health screening is recommended to prevent severe distress, especially in first-time mothers. Coping interventions for mothers at risk may include comprehensive support and maternity care.

Association between Iron-Folic Acid Supplementation during Pregnancy and Maternal and Infant Anemia in West Java, Indonesia: A Mixed-Method Prospective Cohort Study.

The Indonesian government has provided iron-folic acid (IFA) supplementation in response to maternal pregnancy iron-deficiency anemia. However, community-based cohorts on IFA's effects on maternal and infant anemia are limited. A mixed-method study design with a primary longitudinal cohort was used to observe the association between IFA and anemia in mothers and infants. Iron-folic acid supplementation was observed throughout pregnancy. Anemia status was based on a single hemoglobin assessment using HemoCue Hb 201 + in the second or third trimester of pregnancy for the mother and at birth for the infant. Qualitative data were collected via in-depth interviews (IDIs) and a forum group discussion (FGD). Iron-folic acid supplementation with > 180 tablets throughout pregnancy was associated with lower pregnancy anemia (adjusted relative risk [aRR] = 0.25, 95% CI: 0.092-0.664, P = 0.006) after adjusting for potential confounding variables. Supplementation with IFA was not associated with infant anemia (RR = 1.033, 95% CI: 0.70-1.54, P = 0.873 for 90-180 tablets and RR = 1.07, 95% CI 0.70-1.63, P = 0.774 for > 180 tablets). The IDIs and FGD suggested that IFA and multivitamin content knowledge, IFA consumption monitoring, and paternal involvement were important in IFA supplementation and effectiveness in reducing anemia. Iron-folic acid supplementation was associated with reduced maternal but not infant anemia. Because maternal anemia is associated with infant anemia, an anemia monitoring program for women in early pregnancy is vital in addressing infant health. Paternal involvement was also identified as a major factor in maternal and child health.

Psychometric Features of the Edinburgh Postnatal Depression Scale Among Malaysian Women: A Cross-Sectional Study.

Background The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire developed to identify women at risk for postpartum depression (PD). EPDS symptom patterns appear to vary by nation. The EPDS items and their correlation with affirmative EPDS screens have thus far been minimally studied among Malaysians. Using positive predictive value (PPV) and negative predictive value (NPV), this study aims to evaluate the EPDS-based psychometric features of individual answer items. Methodology A cross-section of postpartum women receiving care at two tertiary care facilities in Malaysia underwent screening assessments in the course of receiving treatment. EPDS was employed with an aggregate cutoff score (≥12). EPDS items were assessed as predictors of abnormal EPDS screens. Results A total of 219 participants were screened, among which 66 were positive on the EPDS. EPDS item responses were collected (item responses 0-3: PPV = 0.07-0.78 and NPV = 0.93-0.22). A negative response to any item strongly predicted a negative EPDS screen (item entry = 0 and NPV = 0.93). Affirmative responses on items 8, 9, and 10 were particularly strong predictors of abnormal EPDS scores, while negative responses to items 3, 5, and 7 were strong predictors of negative EPDS scores. A substantial NPV for any item (response 0 and NPV items 1-10 = 0.93) and a moderate PPV for any affirmative response (responses 1-3, PPV items 1-10 = 0.60) were observed. Conclusions This is one of the few studies to examine the EPDS item responses among Malaysian women. The results suggest that depression remains prevalent in this postpartum population. Our findings reveal a robust NPV for any negative response to the individual items of the scale, a moderate PPV for any affirmative response, and a particularly robust validity for specific EPDS items. Physical complaints, rather than feelings of sadness, figure prominently in this population, suggesting a tendency among Malaysian women toward somatization.

Human milk: From complex tailored nutrition to bioactive impact on child cognition and behavior.

Human milk is a highly complex liquid food tailor-made to match an infant's needs. Beyond documented positive effects of breastfeeding on infant and maternal health, there is increasing evidence that milk constituents also impact child neurodevelopment. Non-nutrient milk bioactives would contribute to the (long-term) development of child cognition and behavior, a process termed 'Lactocrine Programming'. In this review we discuss the current state of the field on human milk composition and its links with child cognitive and behavioral development. To promote state-of-the-art methodologies and designs that facilitate data pooling and meta-analytic endeavors, we present detailed recommendations and best practices for future studies. Finally, we determine important scientific gaps that need to be filled to advance the field, and discuss innovative directions for future research. Unveiling the mechanisms underlying the links between human milk and child cognition and behavior will deepen our understanding of the broad functions of this complex liquid food, as well as provide necessary information for designing future interventions.

The Associations of Breastfeeding and Postnatal Experiences With Postpartum Depression Among Mothers of Hospitalized Infants in Tertiary Hospitals.

Background Postpartum depression has been linked to undesirable outcomes for mother-infant dyads, interfering with childcare and breastfeeding practices. This study aimed to determine the prevalence of depressive symptoms among mothers during the postpartum period and its association with breastfeeding and postpartum experiences. Methodology This cross-sectional study involved mothers of hospitalized infants (n = 219) at two tertiary hospitals in Klang Valley, Malaysia. Mothers were screened for postpartum depression using the Edinburgh Postnatal Depression Scale with a cut-off of ≥12 for positive screening for depression. Mothers were asked to complete questionnaires on breastfeeding experience, which included breastfeeding self-efficacy and challenges. The questionnaires also collected information on postnatal experiences, including birth outcomes, anxiety and stress levels, and social support. Multiple linear regression was used to ascertain the association of postpartum depression levels with breastfeeding and postnatal experiences. Results Overall, 30% of mothers in this study screened positive for depression. Based on multiple linear regression, a higher score of postpartum depression was significantly associated with unpleasant breastfeeding and postnatal experiences reflected by increased scores of anxiety and stress, lower infant birth weight, increased breastfeeding problems, and lower level of social support (p < 0.005). Conclusions Maternal emotions, birth outcomes, breastfeeding issues, and social support were associated with postpartum depression. Efforts should be made to increase maternal support, and screening for maternal depression during infant hospital stays should be encouraged.

Effect of Face-to-Face and WhatsApp Communication of a Theory-Based Health Education Intervention on Breastfeeding Self-Efficacy (SeBF Intervention): Cluster Randomized Controlled Field Trial.

BACKGROUND: The exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions. OBJECTIVE: This study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state. METHODS: This study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention. RESULTS: The response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F21,601=111.73, P<.001). In addition, the mean total score for breastfeeding knowledge increased significantly in the intervention group after the intervention compared to the control group (F21,601=8.33, P<.001). However, no significant difference was found in the mean total score for breastfeeding attitude after the intervention (F21,602=5.50, P=.47). CONCLUSIONS: Face-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes. TRIAL REGISTRATION: Thaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004.

The COVID-19 Infodemic Through Facebook: Comparison of Content and the Accuracy of Breastfeeding Information.

Background The coronavirus disease (COVID-19) pandemic has resulted in a significant increase in the number of people seeking online support and information, particularly on social media. Nevertheless, the nature and trend of internet information, as well as its accuracy, are questionable. This study aimed to assess and compare the content, type/form, and degree of accuracy of breastfeeding information on Facebook before and during the COVID-19 pandemic (n = 288/phase). Methodology The data were gathered from Malaysian public and group/page Facebook posts (n = 456). Keyword searches were conducted using Malay and English breastfeeding terms. The dataset was screened and entered into a structured codebook. The Delphi approach was used to assess the accuracy of posts' content performed by breastfeeding experts. Results Sharing personal experience (53.2%) was the most common topic in breastfeeding-related posts, followed by seeking questions (39.3%) and knowledge (8.0%). Sharing personal stories and knowledge posts were higher during COVID-19 than before (p = 0.001), although the seeking questions category was higher before the pandemic (p = 0.001). Most information posted was in text form (94.5%). About half of the posts (46.5%) were misleading, while (43.7%) were accurate. There was a significant difference in the accuracy of online posts before and during the COVID-19 pandemic (p = 0.001). Conclusions Compared to the pre-pandemic phase, forms/types of information on Facebook remained consistent, whereas the breastfeeding information content and its degree of accuracy differed during the pandemic.We need to explore other aspects of breastfeeding online content as well as its engagement, especially during a pandemic. Knowing the infant feeding-related topics that have been discussed and questioned on social media, as well as the accuracy of the data, allows policymakers and scientific communities to plan strategies for spreading credible breastfeeding information online. This includes creating interactive online media types of visual guidelines, web resources, and breastfeeding apps.

COVID-19 Restrictions and Maternal Experience and Infant Feeding.

BACKGROUND: The Movement Control Order (MCO), also known as the partial lockdown, was introduced in Malaysia in March 2020 to combat the COVID-19 pandemic, changing many public sector protocols and regulations. This may have implications for neonatal and maternity care and services, especially among new mothers. OBJECTIVE: The aim of this study was to compare the postnatal experiences and feeding practices between mothers who gave birth before MCO (B-MCO) and during MCO (D-MCO). METHOD: One thousand fifty-one mothers with an infant under 18 months in Malaysia completed an online survey between July 2020 and October 2020. The survey advertisement was disseminated online via various social media platforms. RESULTS: More D-MCO mothers faced a significant effect on the ability to pay rent/mortgage, with their spouses facing a higher impact on employment. D-MCO mothers were more likely to have changed their birth plans, perceived insufficient breastfeeding support, and experienced changes in postnatal services since MCO. In contrast, more B-MCO mothers had stopped breastfeeding during the MCO and started complementary feeding earlier than planned. Many mothers reported feeling down and lonely and having trouble sleeping and a poor appetite. D-MCO mothers had more time to focus on their health, whereas B-MCO mothers spent more time outdoors. DISCUSSION: MCO affected mothers' livelihood and postnatal experiences, potentially causing emotional distress. Hence, improved breastfeeding support, particularly at birth, is recommended, as is routine mental health screening during the postnatal checkup. Furthermore, because online contact was readily accessible during the pandemic, the efficacy of online breastfeeding support should be evaluated.

Chrononutrition is associated with melatonin and cortisol rhythm during pregnancy: Findings from MY-CARE cohort study.

Chrononutrition has been suggested to have an entrainment effect on circadian rhythm which is crucial for metabolic health. Investigating how chrononutrition affects maternal circadian rhythm can shed light on its role during pregnancy. This study aims to determine chrononutrition characteristics of healthy primigravida during pregnancy and its association with melatonin and cortisol rhythm across gestation. A total of 70 healthy primigravidas were recruited from ten randomly selected government maternal and child clinics in Kuala Lumpur, Malaysia. During the second and third trimesters, chrononutrition characteristics including meal timing, frequency, eating window, breakfast skipping, and late-night eating were determined using a 3-day food record. Pregnant women provided salivary samples at five time-points over a 24 h period for melatonin and cortisol assay. Consistently across the second and third trimesters, both melatonin and cortisol showed a rhythmic change over the day. Melatonin levels displayed an increment toward the night whilst cortisol levels declined over the day. Majority observed a shorter eating window (≤12 h) during the second and third trimesters (66 and 55%, respectively). Results showed 23 and 28% skipped breakfast whereas 45 and 37% ate within 2 h pre-bedtime. During the third trimester, a longer eating window was associated with lower melatonin mean (ß = -0.40, p = 0.006), peak (ß = -0.42, p = 0.006), and AUCG (ß = -0.44, p = 0.003). During both trimesters, a lower awakening cortisol level was observed in pregnant women who skipped breakfast (ß = -0.33, p = 0.029; ß = -0.29, p = 0.044). Only during the second trimester, breakfast-skipping was significantly associated with a greater cortisol amplitude (ß = 0.43, p = 0.003). Findings suggest that certain chrononutrition components, particularly eating window and breakfast skipping have a significant influence on maternal melatonin and cortisol rhythm. Dietary intervention targeting these characteristics may be useful in maintaining maternal circadian rhythm.

Relationship between Physical Activity, Sedentary Behavior, and Anthropometric Measurements among Saudi Female Adolescents: A Cross-Sectional Study.

Overweight and obesity are becoming increasingly prevalent among children and adolescents in Saudi Arabia and are an emerging cause of non-communicable diseases (NCDs). Lifestyle factors, such as insufficient levels of physical activity and sedentary behaviors, are responsible for the increased prevalence of NCDs. This study aimed to determine the association between physical activity levels, sedentary behaviors, and anthropometric measurements in Saudi female adolescents. A cross-sectional study was carried out among 399 healthy female adolescent students aged 13-14 years in Arar, Saudi Arabia. The participants were randomly selected from different schools and their anthropometric measurements were determined. The Physical Activity Questionnaire for Older Children (PAQ-C) and the Adolescent Sedentary Activity Questionnaire (ASAQ) were used to assess their physical activity levels and sedentary behaviors, and an analysis was conducted using IBM SPSS software version 25. A multiple linear regression model was used to determine the association between the variables. The majority of the participants had a normal body mass index (BMI; 79.4%) and waist circumference (WC; 62.4%). A total of 74.4% had waist to height ratio (WHtR) < 0.5. About 92.7% of the participants were not meeting PA recommendations of 60 min of moderate to vigorous physical activity daily. The overall mean time spent on sedentary activities was high on both weekdays and weekend days at 357.64 ± 86.29 and 470.51 ± 147.64 min/day, respectively. Moreover, anthropometric measurement (BMI) was positively associated with age and negatively associated with sedentary behavior on weekends, while WHtR was positively associated with age. The multiple linear regression analysis also showed that age and sedentary behavior significantly predicted BMI among the study participants (F (2, 396) = 4.346, p < 0.014) and age was the only significant predictor of WHtR (F (1, 397) = 16.191, p ≤ 0.001). This study revealed that most of the female Saudi adolescents undertook low levels of activity and high levels of sedentary behaviors. Sedentary behaviors were significantly associated with their BMI. Accordingly, an intervention program on healthy lifestyles is important to improve Saudi female adolescents' lifestyles.

Psychological state during pregnancy is associated with sleep quality: preliminary findings from MY-CARE cohort study.

Psychological distress during pregnancy may increase the risk of adverse maternal and infant outcomes. Past studies have demonstrated the association between circadian disturbances with psychological health. However, the roles of chronotype and social jetlag on psychological state during pregnancy are yet to be identified. We aimed to examine the psychological state in pregnant women and its relations to chronotype, social jetlag (SJL), sleep quality and cortisol rhythm. The current study included a subsample of participants from an ongoing cohort study. A total of 179 primigravidas (mean age 28.4 ± 4.0 years) were recruited. Chronotype and sleep quality during the second trimester were assessed using the Morning-Eveningness Questionnaire (MEQ) and Pittsburgh Sleep Quality Index (PSQI), respectively. SJL was calculated based on the difference between mid-sleep on workdays and free days. Psychological state of participants was evaluated using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Subsamples (n = 70) provided salivary samples at 5 time points over a 24 h period during the second trimester for cortisol assay. A higher proportion of pregnant women experienced moderate to severe anxiety symptoms (n = 77, 43.0%), followed by depressive (n = 17, 9.5%) and stress (n = 14, 7.8%) symptoms. No association was observed between chronotype and psychological distress during pregnancy. There was no significant difference in cortisol rhythms in relation to psychological distress. SJL and sleep quality were significantly associated with stress symptoms among pregnant women in the second trimester. Poor sleep quality, particularly daytime dysfunction (ß = 0.37, p = .006) and sleep disturbances (ß = 0.23, p = .047), were significantly associated with psychological distress (depressive, anxiety and stress symptoms) during the second trimester. The findings suggest that sleep is a potential modifiable lifestyle factor that can be targeted to improve psychological health among pregnant women.

Differences in maternal characteristics and their associations with breastfeeding attitudes among primiparous mothers.

BACKGROUND: The benefits of breastfeeding are well documented, yet substantially below half of all mothers globally meet the recommendation to exclusively breast-feed for 6 months. OBJECTIVE: This study aimed to examine whether there were differences in maternal factors, including maternal characteristics and breastfeeding attitudes, between those who were eligible versus non-eligible to be included in a randomised trial, as exclusive breastfeeding was the eligibility criteria for the trial. It also aimed to investigate associations between maternal factors and breastfeeding attitudes. METHOD: Primiparous pregnant mothers (n=88) completed questionnaires on demographic factors including maternity care and breastfeeding attitude using self-administered questionnaire and Iowa Infant Feeding Attitude Scale (IIFAS). Two weeks post-birth, mothers were screened for eligibility to be included in a randomised trial including assessing for exclusive breastfeeding (EBF). Findings were compared between inclusion (all EBF mothers) and exclusion groups (non-EBF). RESULTS: Inclusion group mothers were significantly younger than those in the exclusion group (26.7±2.8 v 28.5±2.5, p=0.007) and the majority had their husband as the primary maternity care person after birth (X2=12.8, p=0.01). Inclusion group mothers had a more positive perception toward breastfeeding in public and at work on the IIFAS scale (p<0.05). The overall IIFAS score was positively associated with higher breastfeeding confidence (r=0.285, p=0.008), education levels (r=0.31, p=0.003), household income (r=0.32, p=0.003), and age (r=0.28, p=0.008). CONCLUSION: EBF mothers (inclusion group) tend to be younger, had husband as primary care, and have more positive perception towards breastfeeding outside home. Overall, maternal characteristics and paternal support could influence breastfeeding practices and should be targeted for future intervention. Maternal attitude and perceptions about breastfeeding in public could be improved to encourage exclusive breastfeeding.

Randomized controlled trial investigating the effects of a breastfeeding relaxation intervention on maternal psychological state, breast milk outcomes, and infant behavior and growth.

BACKGROUND: Biological signaling and communication between mothers and infants during breastfeeding may shape infant behavior and feeding. This signaling is complex and little explored in humans, although it is potentially relevant for initiatives to improve breastfeeding rates. OBJECTIVES: The aim of this study was to investigate physiological and psychological aspects of mother-infant signaling during breastfeeding experimentally, testing the effects of a relaxation intervention on maternal psychological state, breast milk intake, milk cortisol levels, and infant behavior and growth. METHODS: Primiparous breastfeeding mothers and full-term infants were randomly assigned to receive relaxation therapy [intervention relaxation group; n = 33 (RG)] or to the control group [n = 31 (CG); no relaxation therapy] at 2 wk postpartum. Both groups received standard breastfeeding support. Home visits were conducted at 2 (HV1), 6 (HV2), 12 (HV3) and 14 (HV4) wk to measure maternal stress and anxiety, breast milk intake and milk cortisol, and infant behavior and growth. RESULTS: RG mothers had lower stress scores postintervention than the CG (HV3 ∆ = -3.13; 95% CI: -5.9, -0.3) and lower hindmilk cortisol at HV1 (∆ = -44.5%; 95% CI: -76.1%, -12.9%) but not at HV2. RG infants had longer sleep duration (∆ = 82 min/d; 95% CI: 16, 149 min/d) at HV2 and higher gains in weight and body mass index standardized deviation score than the CG infants (∆ = 0.76; 95% CI: 0.3, 1.22; and ∆ = 0.59; 95% CI: 0.09, 1.1, respectively). RG infants had a mean milk intake at HV3 that was 227 g/d higher than that of the CG infants (P = 0.031) after controlling for gender and milk intake at HV1. CONCLUSIONS: The trial shows the effectiveness of a simple relaxation intervention for improving maternal and infant outcomes and identifies some potential signaling mechanisms for investigation in future and larger studies, especially in settings where mothers are more stressed, such as those with preterm or low birth weight infants. This trial was registered at clinicaltrials.gov as NCT01971216.

The effectiveness of interventions using relaxation therapy to improve breastfeeding outcomes: A systematic review.

Maternal psychological state is recognised to influence lactation success, largely by affecting milk ejection. Thus, increased psychological distress can disrupt milk flow and in the long-term, affect milk synthesis. Conversely, it is possible that milk ejection could be improved by using relaxation therapy during breastfeeding. We performed a systematic review to evaluate the effectiveness of interventions using relaxation therapy to improve breastfeeding outcomes and to assess the consequent impact(s) on infant growth and behaviour. A literature search was performed using the PRISMA guidelines where we included intervention studies (including nonrandomised controlled studies) using relaxation therapy in breastfeeding mothers during the post-natal period. Out of 147 identified records at the initial search, 5 studies were eligible, of which 3 were randomised controlled trials and 2 were nonrandomised or quasi-experimental studies. These studies were conducted in Europe, America, and India and included 311 mother-infant pairs, of which 64 infants were full-term and 247 were premature infants. Relaxation therapy was shown to increase milk yield in mothers of preterm infants in 2 randomised trials, however, the milk sampling protocol for these studies could be questioned. None of the studies investigated the consequent effects on infant outcomes. Overall, limited evidence was found on the effectiveness of relaxation therapy on breast milk composition and infant outcomes. Experimental studies with better standardisation of protocol and robust methodological design are needed to investigate the effectiveness of relaxation therapy on both breastfeeding and infant growth and behavioural outcomes.