US county-level estimation for maternal and infant health-related behavior indicators using pregnancy risk assessment monitoring system data, 2016-2018.

BACKGROUND: There is a critical need for maternal and child health data at the local level (for example, county), yet most counties lack sustainable resources or capabilities to collect local-level data. In such case, model-based small area estimation (SAE) could be a feasible approach. SAE for maternal or infant health-related behaviors at small areas has never been conducted or evaluated. METHODS: We applied multilevel regression with post-stratification approach to produce county-level estimates using Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2016-2018 (n = 65,803 from 23 states) for 2 key outcomes, breastfeeding at 8 weeks and infant non-supine sleeping position. RESULTS: Among the 1,471 counties, the median model estimate of breastfeeding at 8 weeks was 59.8% (ranged from 34.9 to 87.4%), and the median of infant non-supine sleeping position was 16.6% (ranged from 10.3 to 39.0%). Strong correlations were found between model estimates and direct estimates for both indicators at the state level. Model estimates for both indicators were close to direct estimates in magnitude for Philadelphia County, Pennsylvania. CONCLUSION: Our findings support this approach being potentially applied to other maternal and infant health and behavioral indicators in PRAMS to facilitate public health decision-making at the local level.

Body Image Dissatisfaction, Breastfeeding Experiences, and Self-Efficacy in Postpartum Women with and Without Eating Disorder Symptoms.

BACKGROUND: Women during the postpartum period undergo significant changes which affect body image, eating behaviors, and, potentially, breastfeeding. There is limited research about relationships among these variables, particularly related to breastfeeding experiences and self-efficacy. RESEARCH AIMS: To determine: (1) the associations between eating disorder symptoms and body image, breastfeeding self-efficacy, and breastfeeding experiences; and (2) the differences in body image, breastfeeding self-efficacy, breastfeeding experiences, and breastfeeding status of postpartum women with and without clinically significant eating disorder symptoms. METHODS: A secondary data analysis using a 2-group correlational, cross-sectional online survey design was used. Participants with infants 2-6 months old who had breastfed their infant at least once (N = 204) were recruited nationally to complete a cross-sectional survey assessing breastfeeding and postpartum physical and mental health using validated measures. Linear and logistic regression evaluated differences between participants with and without eating disorder symptoms regarding their body image, breastfeeding experience and self-efficacy, and breastfeeding status (continued vs. discontinued) at 2 months postpartum. RESULTS: Clinical eating disorder symptoms were reported by 9.8% (n = 20). Participants with clinical eating disorder symptoms reported lower appearance evaluations (B = -0.53, 95% CI [-0.93, -0.14]) and body image satisfaction (B = -0.55, 95% CI [-0.87, -0.23]); reduced odds of breastfeeding at 2 months postpartum (AOR = 0.15, 95% CI [0.04, 0.56]); and lower breastfeeding self-efficacy (B = -7.70, 95% CI [-14.82, -0.58] relative to participants without clinical symptoms. No differences between groups were observed for breastfeeding experiences. CONCLUSIONS: Participants with clinically significant eating disorder symptoms are at risk for early breastfeeding discontinuation and lower breastfeeding self-efficacy. Our findings have implications for future research and clinical care practices, including screening for body image concerns and eating disorder symptoms and supporting breastfeeding self-efficacy.

Prevalence and Risk Factors of SARS-CoV-2 Infection among Parturients and Newborns from Luanda, Angola.

SARS-CoV-2 emerged in China in December 2019, creating a massive public health concern. Although previous studies have identified SARS-CoV-2 in pregnant women, the possibility of transmission to newborns remains uncertain. Herein, we investigated SARS-CoV-2 infection and risk factors among parturients and newborns. This was a cross-sectional study carried out with 3633 parturients from Luanda, Angola, between January and April 2021, with an age ranging from 13 to 48 years. SARS-CoV-2 infection of the parturients was further confirmed with RT-PCR after COVID-19 Ag Rapid Testing. About 0.4% of parturients tested positive on the day of delivery. Surprisingly, parturients from urbanized areas (OR: 0.18, p = 0.025) had a low chance of infection. None of the newborns tested positive in the first 24 h after birth, while one (9.1%, 1/10) of the newborns tested positive with pharyngeal swabs seven days after birth. However, whether the case was due to vertical transmission from mother to child remains to be confirmed. The mother's residence, education level, antenatal follow-up, and delivery category were related to SARS-CoV-2 transmission (p < 0.05). Our findings showed a relatively low SARS-CoV-2 infection from parturients to newborns, regardless of the severity of the maternal disease. Furthermore, these findings are an early assessment of COVID-19 cases in late pregnancy, which could indicate the need for intensive management of SARS-CoV-2 infection among parturients in Angola. Further studies are needed on the consequences of SARS-CoV-2 among pregnant women and neonates from Angola.

Neonatal Feeding Trajectories in Mothers With Bipolar Disorder Taking Lithium: Pharmacokinetic Data.

Purpose: Women who take lithium during pregnancy and continue after delivery may choose to breastfeed, formula feed, or mix these options. The aim of the study was to evaluate the neonatal lithium serum concentrations based on these three feeding trajectories. Methods: We followed 24 women with bipolar disorder treated with lithium monotherapy during late pregnancy and postpartum (8 per trajectory). Lithium serum concentrations were determined by an AVL 9180 electrolyte analyser with a 0.10 mEq/L detection limit and a 0.20 mEq/L limit of quantification (LoQ). Results: There was complete lithium placental passage at delivery, with a mean ratio of lithium concentration in the umbilical cord to maternal serum of 1.12 ± 0.17. The median times to LoQ were 6-8, 7-8, and 53-60 days for formula, mixed, and exclusive breastfeeding respectively. The generalized log-rank testing indicated that the median times to LoQ differ according to feeding trajectory (p = 0.037). According to the multivariate analysis-adjusted lithium serum concentrations at birth, times to LoQ are, on average, longer under exclusive breastfeeding (formula, p = 0.015; mixed, p = 0.012). No lithium accumulation was observed in infants under either exclusive or mixed breastfeeding. During the lactation follow-up, there was no acute growth or developmental delays in any neonate or infant. Indeed, lithium concentrations in the three trajectories declined in all cases. However, the time needed to reach the LoQ was much longer for those breastfeeding exclusively. Conclusions: In breastfeed infant no sustained accumulation of lithium and no adverse effects on development or growth were observed.

Case Report: Clinical and Pharmacokinetic Profile of Lithium Monotherapy in Exclusive Breastfeeding. A Follow-Up Case Series.

Background: Most guidelines advise that women taking lithium should not breastfeed. The variation in transfer is just one reason behind this advice. Objectives: To present clinical and pharmacokinetic data of nine mother-infant pairs exposed to lithium monotherapy during late pregnancy and exclusive breastfeeding at the Perinatal Psychiatric Unit (2006-2018). Methods: We obtained sociodemographic data, medical risk factors, obstetric variables, and family and personal psychiatric history by semi-structured interview, and assessed maternal psychopathology with the Hamilton Depression Rating Scale and Young Mania Rating Scale. A senior neonatologist reviewed neonatal outcomes at birth using the Peripartum Events Scale. Paired maternal and cord blood and infant venous blood samples were collected. During the breastfeeding period, we monitored serum lithium and creatinine concentrations in mother-infant pairs at delivery, and at days 1-5, 7-11, 30, and 60 postpartum, and monthly until 6-months. Results: Lithium equilibrated completely across the placenta [1.13 (0.10), range (1.02-1.30)]. No women presented symptoms of postpartum lithium intoxication, two of the neonates presented transient hypotonia (22%). Lithium exposure was significantly less during breastfeeding than during late pregnancy, and serum lithium concentrations decreased up to 44% overtime from delivery to the first-month, and up to 60% to the third-month postpartum. There was no growth or developmental delay in the follow-up period. One woman had a manic episode with psychotic features at 45 days postpartum. Conclusions: In carefully selected women with bipolar disorder, lithium therapy when breastfeeding can be an appropriate option if coupled with close monitoring of the mother-infant pair.

Common Mental Disorder and early interruption of exclusive maternal breastfeeding in Quilombola women: a population-based study / Transtorno mental comum e interrupção precoce do aleitamento materno exclusivo em mulheres quilombolas: estudo de base populacional

Abstract Objectives: to investigate the prevalence of exclusive maternal breastfeeding (EMBF) and evaluate whether common mental disorder (CMD) and other predictors promote its early interruption (EI-EMBF4). Methods: a cross-sectional study involving all children <24 months (n=252) residing in 50% (n=34) of the Quilombola communities in Alagoas. The EI-EMBF4 was established when EMBF was ≤4 months. The Self-Reporting Questionnaire was used to identify the occurrence of CMD. Other predictors were obtained through interviews. The measure of association was the prevalence ratio calculated by the Poisson regression, following a hierarchical theoretical model. The prevalence of EMBF for 4 and 6 months, and its median duration (survival analysis) were calculated. Results: the prevalence of EI-EMBF4 and CMD was 57.6% and 42.9%, respectively. The risk factors independently associated with EI-EMBF4 were: living in a mud house, maternal age ≤18 years, low birth weight and the use of a pacifier or baby bottle. There was no association with CMD. The prevalence of EMBF for four and six months was 42.4% and 25.4%, respectively, and the median duration was 106 days. Conclusion: EMBF indicators are below the established recommendations, justifying the implementation of measures that prioritize women subjected to risk factors identified here. CMD is not configured among these.

Resumo Objetivos: investigar a prevalência do aleitamento materno exclusivo (AME) e se o transtorno mental comum (TMC) e outros preditores promovem sua interrupção precoce (IP- AME4). Métodos: estudo transversal envolvendo todas as crianças <24 meses (n=252) residentes em 50% (n=34) das comunidades quilombolas de Alagoas. A IP-AME4 foi definida quando o AME foi ≤ 4 meses. Utilizou-se o Self-Reporting Questionnaire para identificar o TMC. Outros preditores foram obtidos por meio de entrevista. A medida de associação foi a razão de prevalência calculada por regressão de Poisson, seguindo modelo teórico hierárquico. Foram calculadas as prevalências de AME por 4 e 6 meses e sua duração mediana (análise de sobrevivência). Resultados: as prevalências de IP-AME4 e do TMC foram 57,6% e 42,9%, respectivamente. Os fatores de risco independentemente associados à IP-AME4 foram: residir em casa de taipa, idade materna ≤18 anos, baixo peso ao nascer e uso de chupeta ou de mamadeira. Não houve associação com TMC. As prevalências do AME por quatro e por seis meses foram 42,4% e 25,4%, nessa ordem, e a duração mediana foi de 106 dias. Conclusão: os indicadores de AME estão aquém das metas estabelecidas, justificando a implementação de medidas que atuem sobre os fatores de risco aqui identificados, sendo que o TMC não se configura entre esses.

Low- level laser: cost of therapy fornipple trauma / Laser de baixa intensidade: custo da terapia no trauma mamilar

Abstract Objectives: to measure the micro-cost of local laser therapy (LL) and transcutaneous laser therapy application by Irradiation Laser Intravascular of Blood (ILIB) to treat nipple trauma and compare the most effective and efficient alternative treatment. Methods: a cross-sectional analytical and quantitative study with analysis on the micro absorption cost, implemented as a clipping, from a randomized clinical trial that used two types of laser therapy to treat nipple trauma due to breastfeeding. The sample consisted of 101 nipple lesions. Patients were randomized into three groups (Control - CG, Local Laser -LLG and ILIB-ILIBG). Materials used, direct labor (DL) and laser equipment were predictors of costs. The delta calculation (effect size) was the indicator for measuring effectiveness and efficiency. Results: after three sessions, the average final cost was R$ 40.04for CG, R$ 53.55for LLG and R$ 67.29for ILIBG. After three sessions of treatment, ILIBG showed a great reduction in the lesion area, but with a higher cost (p<0.05). Conclusions: ILIBG had a better effect on healing the nipple trauma when compared to CG and LLG, even though it is more expensive, it suggests a positive cost-benefit and the most effective and efficient alternative treatment.

Resumo Objetivos: mensurar o microcusteio da aplicação de Laserterapia Local (LL) e trans-cutânea por Irradiation Laser Intravascular of Blood (ILIB) no tratamento de traumas mamilares e comparar a alternativa de tratamento mais eficaz e eficiente. Métodos: estudo transversal analítico do tipo quantitativo com análise de microcusteio de procedimento por absorção, implementado como recorte, de um ensaio clínico rando-mizado que utilizou duas modalidades de laserterapia para tratamento de traumas mamilares ocasionados pela amamentação. A amostra foi composta de 101 lesões mamilares. As pacientes foram aleatorizadas em três grupos (Controle - GG, Laser Local - GLL e ILIB -GILIB). Foram preditores de custos os materiais consumidos, Mão de obra Direta (MoD) e o equipamentos de laser O cálculo Delta (tamanho do efeito) foi o indicador para a medida da eficácia e eficiência. Resultados: após três sessões, a média do custo final foi de R$ 40,04 para o GC, R$ 53,55 para o GLL e R$ 67,29 para o GILIB. Após três sessões de tratamento, GILIB apresentou maior redução da área da lesão, contudo custo mais elevado (p<0,05). Conclusão: o GILIB teve efeito melhor na cicatrização dos traumas mamilares quando comparado com o GC e GLL, mesmo sendo mais caro sugere um custo benefício positivo e a alternativa de tratamento mais eficaz eficiente.

Evaluation of breastfeeding self-effectiveness and its associated factors in puerperal women assisted at a public health system in Brazil / Avaliação da autoeficácia para amamentação e seus fatores associados em puérperas assistidas no sistema público de saúde no Brasil

Abstract Objectives: evaluate breastfeeding self-efficacy and its associated factors in puerperal women assisted at a public health system in Brazil. Methods: it is a cross-sectional analytical study, with convenience sampling and two instruments: sociodemographic, personal and clinical, and Breastfeeding Self-Efficacy Scale (BSES-SF), applied to puerperal women in a puerperal outpatient clinic at two public maternity hospitals in Goiânia/GO, from September to November 2019. Inclusion criteria: mothers in puerperal period, age above 18 years, children born at term and on exclusive breastfeeding. Exclusion criteria: report depression and premature wean. Results: 128puerperal women were interviewed. The average age was 26.7 (± 5.9) years old. The levels of self-efficacy were high (95.3%) and no puerperal had a low level. The variables with statistical significance were: experience in breastfeeding (p= 0.0312), not having received information on breastfeeding during pregnancy (p=0.0292), did not receive other milk at the maternity (p=0.0380), did not feel pain while breastfeeding (p=0.0242), being able to breastfeed on demand (p=0.0124), presence of breast engorgement (p=0.0207), presenting protruding nipples (p=0.0427). Conclusions: clinical and personal aspects were identified as risk factors for early weaning. This can provide information for the training ofprofessionals and structuring the interventions in health services, with a view in preventing these risks.

Resumo Objetivos: avaliar a autoeficácia da amamentação e seus fatores associados em puérperas atendidas no sistema público de saúde. Métodos: estudo transversal analítico, com amostragem por conveniência e dois instrumentos: sociodemográfico, pessoal e clínico, e Escala de Autoeficácia em Amamentação, aplicada a puérperas em um ambulatório de acompanhamento puerperal de duas maternidades públicas de Goiânia/GO, de setembro a novembro de 2019. Critérios de inclusão: mães no período puerperal, idade acima de 18 anos, filhos nascidos a termo e em aleitamento materno exclusivo. Critérios de exclusão: autorrelato de depressão e desmame prematuro. Resultados: foram entrevistadas 128 puérperas. A média de idade foi de 26,7 (± 5,9). Os níveis de autoeficácia foram altos (95,3%) e nenhuma puérpera obteve nível baixo. As variáveis com significância estatística foram: experiência em amamentar (p = 0,0312), não ter recebido informações sobre aleitamento materno durante a gravidez (p = 0,0292), não ter recebido outro leite na maternidade (p = 0,0380), não sentindo dor durante a amamentação (p = 0,0242), sendo amamentada sob demanda (p = 0,0124), presença de ingurgitamento mamário (p = 0,0207), apresentando mamilos salientes (p = 0,0427). Conclusões: foram identificados aspectos clínicos e pessoais como fatores de risco para o desmame precoce. Isso pode fornecer informações para a formação de profissionais e a estruturação de intervenções nos serviços de saúde, visando a prevenção desses riscos.

Impact of a novel smartphone application on low-income, first-time mothers' breastfeeding rates: a randomized controlled trial.

BACKGROUND: Low-income women are less likely to exclusively breastfeed at postpartum day 2 compared with high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day 2. Smartphone applications provide on-demand video. OBJECTIVE: This study aimed to determine whether a novel smartphone application-Breastfeeding Friend-increases breastfeeding rates for low-income, first-time mothers. STUDY DESIGN: This double-blinded randomized trial recruited low-income, first-time mothers at 36 weeks' gestation. Consenting women received a complimentary Android smartphone and internet service before 1:1 randomization to Breastfeeding Friend or a control smartphone application. Breastfeeding Friend was created by a multidisciplinary team of perinatologists, neonatologists, lactation consultants, and a middle school teacher and was refined by end-user focus groups. Breastfeeding Friend contained on-demand education and videos on breastfeeding and newborn behavior, tailored to a fifth-grade reading level. The control smartphone application contained digital breastfeeding handouts. The primary outcome was exclusive breastfeeding at postpartum day 2; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. Primary statistical analyses compared outcomes between study groups through intention-to-treat analysis; prespecified secondary analyses did so per protocol. A total of 170 women (85 per arm) were needed to determine whether Breastfeeding Friend increased exclusive breastfeeding at postpartum day 2 from 34% (known baseline) to 56%. RESULTS: A total of 253 women were approached; 170 women enrolled. Most participants were black, with more than half reporting annual household incomes of less than $25,000. Exclusive breastfeeding rates at postpartum day 2 were low and similar among Breastfeeding Friend and control smartphone application users (n=30 [36.6%] vs n=30 [35.7%]; relative risk, 1.02; 95% confidence interval, 0.068-1.53). Breastfeeding rates until 6 months postpartum were also similar between study groups: the rate of exclusive breastfeeding was 8.3% (n=5) and 10.4% (n=7) in the Breastfeeding Friend and control smartphone application groups, respectively (relative risk, 0.8; 95% confidence interval, 0.27-2.38). At 6 weeks postpartum, most Breastfeeding Friend smartphone application users (n=34 [52.3%]) rated their smartphone application as providing the best breastfeeding support. Excluding women who did not use their study smartphone application (Breastfeeding Friend, n=18 [21.4%]; control smartphone application, n=9 [10.6%]) did not affect outcomes. CONCLUSION: Neither of the smartphone applications improved breastfeeding rates among low-income, first-time mothers above the known baseline rates, despite user perception that Breastfeeding Friend was the best breastfeeding resource at 6 weeks postpartum. By demonstrating the feasibility of smartphone application-based interventions within a particularly high-needs population, our research supports efforts in obstetrics to examine whether mobile health improves peripartum health outcomes.

Factores clínicos y sociodemográficos en lactantes con destete precoz / Clinical and socio-demographic factors in newborns with early weaning

Introducción: El abandono progresivo de la lactancia materna es una nueva situación de salud en la que influyen diversos aspectos. Objetivo: Caracterizar factores clínicos y sociodemográficos referentes al destete precoz en lactantes y su relación con aspectos sociodemográficos de sus madres. Métodos: Estudio observacional, correlacional, de corte transversal, realizado en el Hospital Pediátrico Docente de San Miguel del Padrón. Se conformó una muestra con 520 infantes con edades entre 29 días y 6 meses, destetados precozmente e ingresados en el 2014. La información se tomó de las historias clínicas y de un cuestionario aplicado a las madres. Resultados: Entre 3 y 5 meses de edad se encontraron 56,5 por ciento de los lactantes con predominio masculino (59,0 por ciento) y solo 51,3 por ciento de los casos presentó adecuado estado nutricional. Prevaleció la lactancia mixta (52,9 por ciento). El destete prevaleció entre 4 y 5 meses de edad (53,7 por ciento) y por causas comerciales (43,1 por ciento). Las madres entre 20-34 años fueron las que más destetaron (65,7 por ciento), trabajadoras (53,4 por ciento), de escolaridad media (51,6 por ciento) y en unión consensual (50,6 por ciento). Conclusiones: Los factores clínicos como tipo de destete y valoración nutricional se relacionan con factores sociodemográficos como la edad cronológica del niño y la edad del destete. La edad materna no tiene que ver con el destete precoz ni con sus causas. El abandono precoz de la lactancia materna exclusiva es común e independiente de la ocupación laboral y nivel de escolaridad materna, lo que favorece la malnutrición en los infantes(AU)

ntroduction: The progressive dropping of maternal breastfeeding is a new health situation in which different factors have influences. Objective: To characterize the clinical and socio-demographic factors related to early weaning in newborns and their relation with socio-demographic aspects of their mothers. Methods: Observational, correlational, cross-sectional study in the Pediatric Teaching Hospital of San Miguel del Padrón. It was formed a sample of 520 newborns in ages from 29 days and six months old, whom were early weaned and admitted in the hospital in 2014. The correlation of information was made through the clinical records and a questionnaire applied to the mothers. Results: 56.5 percent of the newborns were between 3 and 5 months old predominating the male sex (59.0 percent), and just 51.3 percent of the cases presented an adequate nutritional state. There was a predominance of mixed lactation (52.9 percent), and the weaning prevailed in the 4 to 5 month of life (53.7 percent), and it was due to commercial causes in the 43.1 percent. Mothers in the ages from 20 to 34 years (65.7percent), mothers who work (53.4 percent), mothers of medium education level (51.6 percent) and in consensual union (50.6 percent) were the ones that practiced weaning the most. Conclusions: There clinical factors as the type of weaning and the nutritional value that were associated with socio-demographic factors as the chronological age of the child and the age of weaning. The maternal ages were not related with early weaning or its causes. Regardless of the job or the educational level of the mother is common the early dropping of exclusive breastfeeding, which favours malnutrition in the newborns(AU)

[Coronavirus Covid-19 infection and breastfeeding: an exploratory review]. / Infección por coronavirus Covid-19 y lactancia materna: una revisión exploratoria.

BACKGROUND: The new coronavirus disease is an infectious disease caused by the SARS-Cov-2 virus, considered by the World Health Organization (WHO) an international public health emergency that may have negative consequences during breastfeeding. The objective of this work is to investigate the action plan on breastfeeding in postpartum women with SARS-CoV-2 and her newborn. METHODS: A literature search has been conducted through the Medline, Web of Science, Scopus, BVS, and Cuiden databases. The methodological quality of the articles has been assessed using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE). This study has not been registered in PROSPERO. RESULTS: A total of 14 documents have been found, of which 9 are observational empirical studies. Most of the studies were conducted in China, Italy, the USA, and Australia. A total of 114 mothers infected with coronavirus with their respective newborns have been assessed. The analyzed investigations state that it is best for the newborn to be breastfed; given that mother's milk samples were analyzed, detecting the presence of antibodies of the coronavirus in them, being a protective factor against infection. CONCLUSIONS: Breastfeeding in postpartum women with SARS-CoV-2 is highly recommended for the newborn, if the health of the mother and newborn allow it. When direct breastfeeding is favoured, the appropriate respiratory hygiene measures always have to be considered. Whether the mother's health does not permit direct breastfeeding, her breast milk should be previously extracted and kept unpasteurized. To secure the newborn feeding, milk banks are also an appropriate option.

OBJETIVO: El nuevo coronavirus es una enfermedad infecciosa causada por el virus SARS-Cov-2, considerada por la Organización Mundial de la Salud (OMS) una emergencia de salud pública de interés internacional (ESPII), la cual podría tener consecuencias negativas durante la lactancia materna. El objetivo de este trabajo fue conocer el plan de actuación sobre la lactancia materna ante una mujer recién parida enferma de SARS-CoV-2 y su recién nacido. METODOS: Se realizó una búsqueda de la literatura a través de las bases de datos Medline, Web of Science, Scopus, BVS y Cuiden. Se evaluó la calidad metodológica de los artículos mediante la herramienta "Grading of Recommendations Assessment, Development and Evaluation" (GRADE). No se registró en PROSPERO. RESULTADOS: En total se encontraron 14 documentos, de los cuales 9 estudios empíricos estaban realizados mayormente en China, Italia, EEUU y Australia, estando basados en 114 madres infectadas de coronavirus SARS-CoV-2 y sus respectivos recién nacidos. Los estudios analizados afirmaron que lo mejor para el recién nacido es ser alimentado con la leche materna, ya que se analizaron muestras de leche de madres infectadas por coronavirus detectándose la presencia de anticuerpos del virus en las mismas, siendo un factor protector contra la infección del virus. CONCLUSIONES: La lactancia materna en recién paridas con SARS-CoV-2 es muy recomendable para el recién nacido, si el estado de salud de la madre y del neonato lo permiten, favoreciéndose el amamantamiento de forma directa y teniendo siempre las medidas adecuadas de higiene respiratoria. En el caso de que el estado de salud de la madre no permita el amamantamiento directo se debería alimentar con leche materna extraída previamente de su madre y sin pasteurizar, o procedente de un banco de leche.

Longer duration of exclusive breastfeeding reduces maternal weight retention: results from the CLaB study / Maior duração do aleitamento materno exclusivo reduz retenção de peso materno: resultados do estudo CLaB

Abstract Objectives: to evaluate the relation between breastfeeding and postpartum weight reten-tion. Methods: this prospective cohort study involved 641 newborns and their mothers, followed up to twelve months postpartum. Data were collected from June 2015 to February 2017. In the first interview, we investigated data regarding socioeconomic and demographic characteristics, obstetric history, weight, and gestational age of the infant at birth. Maternal weight and breastfeeding status were obtained at 3, 6, 9 and 12 months postpartum at the mother's home. A descriptive analysis of maternal weight retention according to the lactation status was performed. Multiple linear regression models evaluated the effect on exclusive breastfeeding and total breastfeeding duration on maternal weight retention at 6 and 12 months postpartum, considering potential confounders. Results: 512 and 490 mothers were evaluated at six months and at twelve months post-partum, and the mean weight retention was 1.79 (SD=5.52) and 1.69 (SD=6.69) kg, respectively. Regardless of the confounders, the mean postpartum weight reduction for each day of exclusive breastfeeding was 11 (CI95%= -0.019 to -0.003) and 16 grams (CI95%= -0.026 to -0.007) for 6 and 12 months, respectively. The total maternal breastfeeding duration had the same effect. Conclusions: longer periods of exclusive breastfeeding and total breastfeeding are associated with lower postpartum weight retention.

Resumo Objetivos: avaliar a relação entre aleitamento materno e retenção de peso pós-parto. Métodos. estudo de coorte prospectiva com 641 recém-nascidos/mães acompanhados até doze meses pós-parto. Os dados foram coletados de junho/2015 a fevereiro/2017; na primeira entrevista, investigou-se dados socioeconômicos, demográficos, história obstétrica, peso e idade gestacional do lactente ao nascer. Pesos maternos e situação de aleitamento dos lactentes foram obtidos aos 3, 6, 9 e 12 meses pós-parto, em domicílio. Realizou-se análise descritiva da retenção de peso materno segundo situação de aleitamento nesses períodos. Modelos de regressão linear múltiplos avaliaram o efeito da duração do aleitamento materno exclusivo e aleitamento materno sobre retenção de peso materno aos 6 e 12 meses pós-parto, considerando confundidores. Resultados: seis e doze meses pós-parto foram avaliadas 512 e 490 mães, com retenção ponderal média de 1,79 (DP=5,52) e 1,69 (DP=6,69) quilos, respectivamente. Independentemente de confundidores, cada dia a mais de aleitamento materno exclusivo reduziu, em média, 11 (IC95%= -0,019; -0,003) e 16 (IC95%= -0,026; -0,007) gramas a retenção de peso nos dois períodos. A duração do aleitamento materno total teve efeito semelhante. Conclusões: maior duração do aleitamento materno exclusivo e aleitamento materno associam-se com menor retenção de peso pós-parto.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population / Validação de instrumento para avaliação da satisfação da mulher com a amamentaçãopara a população brasileira

Abstract Objective To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. Methods Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. Results The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha = 0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79). Conclusions The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Resumo Objetivo Realizar a validação de constructo e avaliar a consistência interna do instrumento Maternal Breastfeeding Evaluation Scale, visando à sua aplicação na população brasileira. Métodos Estudo transversal com aplicação do instrumento a 287 mulheres brasileiras após 30 dias do nascimento da criança. Para a análise fatorial utilizou-se a análise de componentes principais com rotação varimax, verificando o número de subescalas e a manutenção ou extração dos componentes. Para a validação de constructo quatro hipóteses foram testadas pelo teste T-student não pareado. A análise de confiabilidade foi realizada utilizando o coeficiente de alfa de Cronbach. Resultados A análise fatorial exploratória identificou a necessidade de exclusão de um item e a reformulação das subescalas. Os resultados da validade de constructo mostraram que todas as hipóteses propostas foram confirmadas: as mulheres que estavam amamentando, as que estavam em amamentação exclusiva, as que não apresentavam problemas relacionados à amamentação e aquelas com intenção de amamentar por pelo menos 12 meses apresentaram valores médios significativamente superiores na escala. O instrumento apresentou consistência interna adequada (alfa de Cronbach = 0,88; IC95%: 0,86-0,90), assim como as subescalas prazer e realização do papel materno (0,92; IC95%: 0,91-0,93), crescimento, desenvolvimento e satisfação infantil (0,70; IC95%: 0,65-0,75) e aspectos físico, social e emocional materno (0,75; IC95%: 0,70-0,79). Conclusões O processo de validação do instrumento Maternal Breastfeeding Evaluation Scale/BRASIL constatou que ele é válido e confiável para ser aplicado à população brasileira.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population.

OBJECTIVE: To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. METHODS: Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. RESULTS: The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha=0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79). CONCLUSIONS: The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Full term newborns in non-nutritive suction evaluationand their relation on feeding performance / Avaliação da sucção não nutritiva de recém-nascidos a termo e sua relação com o desempenho da mamada

Abstract Objectives: To investigate full term newborns suction pattern in non-nutritive suction and their feeding performance. Methods: An analytical descriptive study was carried out from November 2016 to March 2017, with 50 dyads mothers/newborns through the non-nutritive suction evaluation and a direct observation on the newborn's performance on feeding. The data were distributed through simple and relative frequencies (percentages) when categorical or by mean, maximum, minimum and the standard deviation when is continuous, discrete or ordinal. To evaluate the mean differences, the Student's t test was used with significance level of 5%. Results: There were significant differences among the newborn's mandible movement ("newborn's mouth slightly open" p=0,005), suction ("cheek strain during feeding" p<0,001) and dyad mother and newborn positioning ("breasts supported with fingers on the areola" p=0,041 and baby's neck or trunk turned" p=0,041). Conclusions: Newborns that presented changes in their mandible movement on the Non-Nutritive Suction (NNS) also presented difficulties in feeding. The newborn's knowledge on suction pattern through the NNS has proven to be an important strategy that may help identify possible difficulties during feeding.

Resumo Objetivos: investigar o padrão de sucção de recém-nascidos a termo na sucção não-nutritiva e sua relação com o desempenho destes na mamada. Métodos: estudo descritivo analítico, realizado de novembro de 2016 a março de 2017, com 50 díades mãe/recém-nascido, mediante avaliação da sucção não-nutritiva e observação direta do desempenho do recém-nascido na mamada. Os dados foram descritos por meio de frequências simples e relativas (percentuais) quando categóricas ou média, máximo, mínimo e desvio padrão quando contínuas, discretas ou ordinais. Para avaliar diferenças de média foi utilizado o teste T de Student com nível de significância de 5%. Resultados: houve diferenças significativas entre movimentação da mandíbula do recém-nascido e aspectos da pega ("boca do bebê pouco aberta" p=0,005), sucção ("esforço da bochecha durante a mamada" p<0,001) e posicionamento da díade mãe e recém-nascido ("mamas apoiadas com os dedos na aréola" p=0,041 e bebê com pescoço ou tronco torcidos" p=0,041). Conclusões: recém-nascidos que apresentaram alterações na movimentação da mandíbula na Sucção Não Nutritiva (SNN) tiveram também dificuldade na realização da mamada. O conhecimento do padrão de sucção do recém-nascido, através da avaliação da SNN mostrou-se como estratégia importante que pode auxiliar na identificação de possíveis dificuldades do recém-nascido durante a mamada.

Comportamiento de la lactancia materna exclusiva en madres indígenas / Behaviour of exclusive breastfeeding in indigenous mothers

Introducción: La leche materna ha sido considerada como el alimento ideal a ser administrado de forma exclusiva en lactantes hasta los 6 meses y su consumo se ha asociado a la disminución de la morbilidad y mortalidad infantil. Objetivo: Determinar las fortalezas y debilidades que inciden en la implementación de la lactancia materna exclusiva en madres indígenas. Métodos: Se realizó un estudio descriptivo en 171 madres pertenecientes a la provincia de Chimborazo, a las cuales se les aplicó un cuestionario que permitió obtener información relacionada con sus características generales, así como las fortalezas y debilidades que influyeron en la implementación de la lactancia materna exclusiva. Resultados: Promedio de edad de 27 años; predominaron las pacientes casadas (54,38 por ciento), con nivel educacional primario terminado (46,78 por ciento) y con un único hijo (39,19 por ciento); 54,38 por ciento de las madres aplicó correctamente la lactancia materna exclusiva. La fortaleza que mayor significación presentó fue la relacionada con el mejor crecimiento de los niños (88,17 por ciento) y la debilidad más referida fue la falta de descanso de la madre (24,36 percent). Conclusiones: Existen bajos niveles del uso de la lactancia materna exclusiva motivados por debilidades como la falta de descanso de la madre, el dolor en los pezones al lactar y la falta de información sobre lactancia materna exclusiva. Las fortalezas para su uso incluyen fundamentalmente el mejor crecimiento y desarrollo del niño y la prevención de enfermedades y desnutrición(AU)

Introduction: Breast milk has been regarded as the ideal food to be administered exclusively in infants up to 6 months and its consumption has been associated with the reduction of children morbidity and mortality. Objective: To determine the strengths and weaknesses that affect the implementation of exclusive breastfeeding in indigenous mothers. Methods: A descriptive study was carried out in 171 mothers belonging to the province of Chimborazo, whom underwent a questionnaire that allowed collecting information related to their general characteristics, as well as the strengths and weaknesses that influenced the implementation of exclusive breastfeeding. Results: The average age of the mothers was 27 years; married patients predominated (54.38 percent), with primary education level completed (46.78 percent) and with one child (39.19 percent); 54.38 percent of the mothers correctly applied exclusive breastfeeding. The strength of greater significance presented was that related to the best growth of children (88.17 percent) and the most referred weakness was the lack of rest of the mother (24.36 percent). Conclusions: There are low levels of exclusive breastfeeding motivated by weaknesses such as a lack of rest of the mother, pain in the nipples to breastfeeding and the lack of information on exclusive breastfeeding. The strengths for its use primarily include the best growth and development of children and the prevention of diseases and malnutrition(AU)

Breastfeeding self-efficacy as a dominant factor affecting maternal breastfeeding satisfaction.

BACKGROUND: One of the psychological benefits of breastfeeding for mothers and infants is to get the satisfaction of breastfeeding. Maternal breastfeeding satisfaction derives from the interaction and cooperation between mothers and their babies. This research aims to identify the maternal breastfeeding satisfaction and its influential factors. METHODS: This study applied a cross-sectional design. Two hundred four breastfeeding mothers after four until 8 months postpartum were recruited using cluster sampling methods. Respondents completed the questionnaire of Maternal Breastfeeding Evaluation Scale (MBES) to identify maternal breastfeeding satisfaction. Factors affecting maternal breastfeeding satisfaction were identified using the following instruments: Breastfeeding Knowledge Questionnaire was used to identify knowledge on lactation, Infant Feeding Attitude Scale (IIFAS) to identify attitude toward lactation, and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) to identify breastfeeding self-efficacy. RESULT: We identified that 53.4% of the breastfeeding mothers had a high level of satisfaction. The results indicate that the household income, type of delivery, and breastfeeding self-efficacy was associated with breastfeeding satisfaction (p < 0.05). Breastfeeding self-efficacy is the most influential factors in maternal breastfeeding satisfaction (OR=16.64; CI 95% 7.65-35.94). CONCLUSION: Breastfeeding satisfaction is the satisfying feeling obtained during breastfeeding resulting from cooperation between the mother and the infant to fullfil desires or needs. Education and promotion of breast milk and breastfeeding provided by professional healthcare providers encouraged the successful of breastfeeding programs. Assistance by a health care provider or breastfeeding counselor during the seven contacts breastfeeding initiated during pregnancy until after delivery should be applied so that the mother is informed about breastfeeding. Breastfeeding satisfaction can keep the mother from continuing to breastfeed her baby for up to 2 years or more.

Comportamiento de la lactancia materna. Consultorio Médico de Familia No. 16. Policlínico "Manuel Piti Fajardo" / Behavior of the breastfeeding. Family Doctor´s Office Nr. 16. Policlínic

RESUMEN Introducción: que un niño reciba y se alimente con lactancia materna en las sociedades actuales, cada día es una tarea más compleja. Objetivo: caracterizar el comportamiento de la lactancia materna en el Consultorio Médico de Familia No 16. Policlínico "Manuel Piti Fajardo", municipio Cárdenas. Materiales y métodos: se realizó un estudio observacional, descriptivo, transversal. El universo lo constituyeron 68 madres de nacidos vivos pertenecientes a esa área de salud, en el período de enero 2011 -diciembre 2015. Las variables estudiadas fueron: edad, nivel escolar, ocupación, tiempo de lactancia, factores que incidieron en la suspensión de la lactancia materna, planificación familiar, conocimientos sobre lactancia materna. Los datos se obtuvieron de las historias clínicas familiares e individuales, del registro de nacimientos del Departamento de Estadística del Policlínico, del Análisis Integral de la Situación de Salud del Consultorio, la encuesta y la observación. Resultados: predominó en las madres de nacidos vivos el grupo de edad de 25 a 29 años, con el 41,7 %. El 77,9 % tenían nivel preuniversitario y el 47,0 % eran trabajadoras. El 47,5 % lactan entre 1-3 meses. Incidió en el abandono de la lactancia materna el no tener suficiente leche con un 44,1 %, el 50,0 % no planificaron el embarazo, y el 58,8 % no poseían los conocimientos adecuados. Conclusiones: un elevado porcentaje de las madres lactan hasta los 3 primeros meses de vida, la causa de abandono más frecuente de lactancia materna fue el no tener suficiente leche. Prevaleceieron los conocimientos no adecuados sobre la lactancia materna (AU).

ABSTRACT Introduction: breastfeeding in current societies is a very complex task. Objective: to characterize breastfeeding in the Family Doctor´s Office Nr. 16 of the Policlinic ¨Manuel Pity Fajardo¨, municipality of Cardenas. Materials and methods: a cross-sectional, descriptive, observational study was carried out. The universe was composed by 68 mothers of born-alive children belonging to that health area in the period January 2011-December 2015. The studied variables were age, scholarship, job, breastfeeding time, factors causing breastfeeding delay, family planning, and knowledge on breastfeeding. Data were gathered from the individual and family records, from the births´ register of the Policlinic Statistics Department, from the Comprehensive Analysis of Health Situation, enquire and observation. Results: the 25-29-years-old age group predominated among mothers of born-alive children (41.7 %). 77.9 % had senior high school scholarship, and 47.0 % were workers. 47.5 % of them breastfeed 1-3 months. Not having enough breast milk (44.1 %), a non-planed pregnancy (50.0 %), and not having the adequate knowledge (58.8 %) influenced in breastfeeding delay. Conclusions: a high percent of mothers breastfeed just during the first three months of life; the most common cause of breastfeeding delay was not having enough breast milk. There it was a prevalence of non-adequate knowledge on maternal breastfeeding (AU).

Comportamiento de la lactancia materna. Consultorio Médico de Familia No. 16. Policlínico "Manuel Piti Fajardo" / Behavior of the breastfeeding. Family Doctor´s Office Nr. 16. Policlínic "Manuel Piti Fajardo"

RESUMEN Introducción: que un niño reciba y se alimente con lactancia materna en las sociedades actuales, cada día es una tarea más compleja. Objetivo: caracterizar el comportamiento de la lactancia materna en el Consultorio Médico de Familia No 16. Policlínico "Manuel Piti Fajardo", municipio Cárdenas. Materiales y métodos: se realizó un estudio observacional, descriptivo, transversal. El universo lo constituyeron 68 madres de nacidos vivos pertenecientes a esa área de salud, en el período de enero 2011 -diciembre 2015. Las variables estudiadas fueron: edad, nivel escolar, ocupación, tiempo de lactancia, factores que incidieron en la suspensión de la lactancia materna, planificación familiar, conocimientos sobre lactancia materna. Los datos se obtuvieron de las historias clínicas familiares e individuales, del registro de nacimientos del Departamento de Estadística del Policlínico, del Análisis Integral de la Situación de Salud del Consultorio, la encuesta y la observación. Resultados: predominó en las madres de nacidos vivos el grupo de edad de 25 a 29 años, con el 41,7 %. El 77,9 % tenían nivel preuniversitario y el 47,0 % eran trabajadoras. El 47,5 % lactan entre 1-3 meses. Incidió en el abandono de la lactancia materna el no tener suficiente leche con un 44,1 %, el 50,0 % no planificaron el embarazo, y el 58,8 % no poseían los conocimientos adecuados. Conclusiones: un elevado porcentaje de las madres lactan hasta los 3 primeros meses de vida, la causa de abandono más frecuente de lactancia materna fue el no tener suficiente leche. Prevaleceieron los conocimientos no adecuados sobre la lactancia materna.

ABSTRACT Introduction: breastfeeding in current societies is a very complex task. Objective: to characterize breastfeeding in the Family Doctor´s Office Nr. 16 of the Policlinic ¨Manuel Pity Fajardo¨, municipality of Cardenas. Materials and methods: a cross-sectional, descriptive, observational study was carried out. The universe was composed by 68 mothers of born-alive children belonging to that health area in the period January 2011-December 2015. The studied variables were age, scholarship, job, breastfeeding time, factors causing breastfeeding delay, family planning, and knowledge on breastfeeding. Data were gathered from the individual and family records, from the births´ register of the Policlinic Statistics Department, from the Comprehensive Analysis of Health Situation, enquire and observation. Results: the 25-29-years-old age group predominated among mothers of born-alive children (41.7 %). 77.9 % had senior high school scholarship, and 47.0 % were workers. 47.5 % of them breastfeed 1-3 months. Not having enough breast milk (44.1 %), a non-planed pregnancy (50.0 %), and not having the adequate knowledge (58.8 %) influenced in breastfeeding delay. Conclusions: a high percent of mothers breastfeed just during the first three months of life; the most common cause of breastfeeding delay was not having enough breast milk. There it was a prevalence of non-adequate knowledge on maternal breastfeeding.

Maternal age influence in human colostrum acidity composition in a Maternity in an country side city of São Paulo State / Impacto da idade materna na acidez do colostro de nutrizes em maternidade do interior do Estado de São Paulo

INTRODUCTION: OBJECTIVE: To analyze sociodemographic and gestational characteristics and to compare colostrum acidity content in adolescent and advanced maternal age mothers METHODS: This cross-sectional study included 98 adolescents (up to 18 year-old) and 33 advanced maternal age (more than 35 year-old) mothers admitted at the maternity of Presidente Prudente Regional Hospital, Brazil. An approximated volume of 10 mL of colostrum was obtained by manual expression of the breasts within 72h postpartum and stored at -20ºC up to processing. Acidity of colostrum was evaluated in Dornic degrees. Statistical analysis was performed using Mann-Whitney test or X² RESULTS: The median age adolescents and advanced maternal age mothers were 20 years (12-24) 37 years (35-45), respectively. The majority of the adolescents (66.3%) were primiparous and C-section delivery had occurred in 66.7% of advanced age mothers. Gestational body mass index (BMI) was statically higher in advanced maternal age women (32.17±5.6 vs 26.09±3.6, p< 0.0001). Acidity measurement was similar between the studied groups CONCLUSIONS: Sociodemographic and gestational characteristics of adolescents and advanced age mothers showed population heterogeneity, thus, specific follow up and orientations should be applied at each one. Colostrum constitution was constant regarding casein and proteins content, independently of maternal age

INTRODUÇÃO: OBJETIVO: Analisar as características sociodemográficas e gestacionais e comparar a acidez do colostro de nutrizes adolescentes e idade materna avançada MÉTODO: Estudo prospectivo transversal, que incluiu 98 nutrizes adolescentes (até 18 anos) e 33 nutrizes com idade materna avançada (maior que 35) atendidas na Maternidade do Hospital Regional de Presidente Prudente. Amostras de aproximadamente 10 mL de colostro foram obtidas por meio da ordenha manual entre 48 a 72h após o parto, e armazenadas a -20ºC até o processamento. A acidez foi verificada por meio da titulação e calculada em graus Dornic. A análise estatística foi realizada utilizando-se o teste de Mann-Whitney ou X² RESULTADOS: A mediana da idade materna das nutrizes adolescentes foi de 20 (12-24) anos, e das nutrizes com idade materna avançada foi de 37 (35-45) anos. A maioria das nutrizes adolescentes (66,3%) eram primíparas e a via de parto cesárea ocorreu em 66,7% das nutrizes em idade materna avançada. O índice de massa corpórea (IMC) gestacional foi estatisticamente maior em nutrizes com idade materna avançada (31,3±5,6 vs 26,06±3,6, p< 0,0001). A acidez do colostro das nutrizes nos extremos da idade reprodutiva não apresentou diferença significativa entre os grupos de nutrizes CONCLUSÃO: As características sociodemográficas e gestacionais de adolescentes e mães com idade materna avançada evidenciam heterogeneidade dessas populações e consequentemente, atendimento e condutas específicas devem ser aplicados a cada uma. A constituição do colostro em caiseina e proteinas apresentou-se constante, independente da idade materna