Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
BackgroundBreastfeeding rates in Ireland are among the lowest in the world. Improving the prevalence of breastfeeding is an objective of the Irish Health Service Executive, with the recognition that this would improve public health. Polish people represent the largest immigrant group in Ireland, and Polish women are more likely to initiate breastfeeding than Irish women.Research aimsThis study had two aims: (1) to describe the breastfeeding experiences and attitudes among Polish mothers living in Ireland, and (2) to explore similarities and differences in infant feeding experiences, attitudes, and beliefs among Polish and Irish women, as perceived by Polish women.MethodsSemi-structured interviews were conducted in Polish with Polish mothers (N = 16) who had lived in Ireland for 10 years or less. Interviews were audio recorded, transcribed, and translated into English. Data were analyzed using qualitative thematic analysis. Coding was a cyclical process; codes were amended and refined through iterative reading of the transcripts. Themes were developed through categorization of codes and via in-depth discussion between two analysts.ResultsThree major themes were developed after analyzing the data. First, there is no universal correct way to provide support for infant feeding; women would like individualized support based on their infant-feeding decisions. Second, breastfeeding is an inherent part of Polish culture and formula feeding is part of Irish culture. Finally, the Irish social environment is supportive of breastfeeding and breastfeeding in public is acceptable in Ireland.ConclusionsAlthough the Irish social environment is supportive of breastfeeding, the infant-formula culture is a barrier to breastfeeding. Future research should explore ways to change societal attitudes towards breastfeeding in Ireland.

Journal of Human Lactation, Ahead of Print.
BackgroundCross-jurisdictional sharing is gaining traction as an option for increasing the effectiveness and efficiency of public health services in local health departments.Research aimAssess whether breastfeeding initiation among participants in the Special Supplemental Nutrition Program for Women, Infants and Children changed with the addition of a trained breastfeeding specialist funded by cross-jurisdictional integration.MethodsA longitudinal retrospective comparative difference in difference design using state-based program data, pre- and post-integration was undertaken. Three local county health departments (n = 5) that fully integrated into one Community Health Board during January 2015, and four neighboring Community Health Boards (n = 4) that did not integrate, were included.ResultsControlling for confounders and interactions, the relative rate of change over time in breastfeeding initiation rates was greater in the integrated jurisdiction than neighboring Community Health Boards, but not statistically significant. When the integrated Community Health Board’s original three local health departments were considered separately, the relative rate of change over time in breastfeeding rates was greater for one local health department in comparison to three neighbor Community Health Boards (p = .037, .048, and .034, respectively).ConclusionsThe addition of a specialized breastfeeding nutritionist led to improved breastfeeding initiation rates. The increase was significant only in the largest original local health department, which also had the lowest breastfeeding initiation rate pre-merger. The greatest positive change was seen in this local health department where the specialist staff was physically located. Public health staff specialization can lead to increases in economic efficiency and in improved delivery of public health services.

Journal of Human Lactation, Ahead of Print.
BackgroundAlthough mother’s own milk decreases prematurity-associated morbidities, mothers of infants born preterm and very low birth weight experience a significantly shorter lactation duration. Little is known regarding factors associated with lactation cessation during the hospitalization of a very low birth weight infant.Research aimTo determine demographic, social, and personal factors associated with lactation cessation by 6-weeks postpartum in mothers delivering very low birth weight infants.MethodsWe used a retrospective, longitudinal, two-group comparison design using data from a randomized control study. Mothers of very low birth weight infants (N = 142) were enrolled from a labor and delivery unit associated with a Level 4 neonatal intensive care unit. Demographic, social, and health information was obtained from the medical records. Participants were surveyed regarding lactation goals, experience, and reason(s) for cessation.ResultsParticipants who did not continue lactating for more than 6 weeks were more likely to be unemployed (p = .019), Medicaid eligible (p = .009), less educated (p < .031), smoke (p = .002), provide less skin-to-skin care (p = .007), and to delay the decision to provide their milk to their infant (p = .007). After Bonferroni adjustment, only minutes of skin-to-skin care remained statistically significant. Insufficient maternal milk production was the most common reason for lactation cessation.ConclusionWhile the etiology of lactation cessation is often non-modifiable, strategies aimed at maintaining mother’s own milk production, smoking cessation, increasing skin-to-skin care, and promoting an earlier decision to lactate, may prolong lactation duration in this vulnerable population.This RCT was registered (2012-00071) with ClinicalTrials.com on 6/28/2013.

Journal of Human Lactation, Ahead of Print.
BackgroundA primary role of human donor milk banks is to provide pasteurized human milk for the sick and preterm infant populations and to support the mothers of these infants as they establish their own milk supply. The results of human milk pasteurization continue to be studied to provide information that enables optimal nutrition in this sick and preterm population.Research aimsThe aims of our study were to determine macronutrient characteristics (fat, protein, carbohydrate) and energy content of human milk donated to the Christchurch Women’s Hospital Human Milk Bank in New Zealand, and the influence of Holder pasteurization on this macronutrient composition.MethodsThis was a retrospective, pre/post pasteurization observational design to describe the macronutrient content within two groups of donors, mature preterm PDM (n = 13; 21%) and mature term PDM (n = 50; 79%). Sixty three samples of human milk donated to the human milk bank by 27 registered participants (mothers of preterm and term infants) were analyzed. This analysis took place July–September 2018 using a human milk analyzer before and after Holder pasteurization (62.5 °C for 30 min).ResultsPreterm milk contained on average 76 kcal/100 ml energy, 4.0 g/100 ml fat, 1.1 g/100 ml protein and 8.2 g/100 ml total carbohydrate; and mature term milk contained 68 kcal/100 ml energy, 3.5 g/100 ml fat, 0.8 g/100 ml protein and 7.9 g/100 ml total carbohydrate. Wide variation between single, donor-pooled samples was demonstrated and there was no major result of pasteurization.ConclusionThis research adds to the evidence regarding the macronutrient content of preterm and term milk and that these values are unaffected by Holder pasteurization. The variance in individual pooled donor human milk indicates the importance of determining the nutrient composition of donated milk to inform fortification procedures.

Journal of Human Lactation, Ahead of Print.
IntroductionHuman milk cannot currently be considered a major source of COVID-19 infection. On the other hand, it can contain specific antibodies that could modulate a possible newborn infection by SARS-CoV-2.Main issueA 32-year-old pregnant woman, gestational age 37 and 3/7 weeks, was admitted with a flu-like syndrome caused by COVID-19. The female newborn was appropriate for gestational age, with a birth weight of 2,890 g, length 48 cm, and head circumference 34 cm.ManagementThe mother–infant dyad remained in the rooming-in unit during hospitalization, exclusively breastfeeding and following World Health Organization recommendations for contact and airway precautions. On the 3rd day after delivery, two mother’s milk samples (3 and 5 mL) were collected by hand expression. The samples were centrifuged for 10 min twice consecutively to separate fat, which was removed, and the remaining material was transferred to another tube to determine anti-SARS-CoV-2 Immunoglobulin A and Immunoglobulin G (ELISA, Kit EUROIMMUN AG, Luebeck, Germany). Anti-SARS-CoV-2 Immunoglobulin A was detected in the two samples evaluated, whose values were 2.5 and 1.9, respectively. No anti-SARSCoV-2 immunoglobulin G was detected. The exclusively-breastfed infant remained well through 45 days of age.ConclusionThe presence of SARS-CoV-2 Immunoglobulin A in the milk of mothers infected with COVID-19 may be related to protection against the transmission and severity of the disease in their infants.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundPrevious qualitative researchers have shown that Chinese American mothers experienced high rates of suboptimal breastfeeding, especially early introduction of other foods before the recommended 6-month period of exclusive breastfeeding.Research aims(1) To explore attitudes that Chinese American mothers have about the meaning and practice of exclusive breastfeeding; (2) to evaluate the extent of family pressure and support to maintain exclusive breastfeeding; and (3) to examine the influence of breastfeeding self-efficacy and the intention to continue exclusive breastfeeding.MethodGuided by the theory of planned behavior, this descriptive cross-sectional prospective online survey was conducted with Chinese American breastfeeding mothers (N = 401). Participants’ attitudes, subjective norms, and perceived behavioral control for exclusive breastfeeding behaviors were measured.ResultsThe M (SD) age of participants was 29.14 (SD = 6.90). Just over 50% reported receiving family support for exclusive breastfeeding. While participants had positive attitudes about exclusive breastfeeding and the value of colostrum, 64% (n = 257) had already introduced foods other than mother’s own milk before their infant was 6-months old. Participants also expressed concern that their infants did not receive enough nutrition from exclusive mother’s milk. Participants with more than one child had significantly greater intention to continue exclusive breastfeeding compared to participants with only one child. Perception of approval by others for exclusive breastfeeding and breastfeeding self-efficacy were significantly related to behavioral intention to continue exclusive breastfeeding.ConclusionSuboptimal infant feeding is a problem for Chinese American women and may also be a problem for mothers in other ethnic groups. We found a lack of adherence with standard recommendations for sustaining 6-months of exclusive breastfeeding.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundInduced lactation enables a woman who has not given birth to breastfeed a child. Lactation may be induced through both pharmacological and non-pharmacological methods, although the desired outcome cannot always be achieved.Research AimsThe aims of this scoping review was to assess the different methods used to induce lactation, as well as the factors related to sucking the breast effectively and the production of human milk.MethodsWe searched five databases from June 2019–February 2020 for studies referring to methods and factors related to breast suckling and/or the volume of milk produced after inducing lactation, using the following search terms and Boolean operators: breastfeeding AND induced lactation AND adoptive mothers OR surrogate mothers OR female homosexuality OR non-gestating. The final review included a total of 24 articles.ResultsPharmacological methods were not always used to produce milk, although breast stimulation was essential. The age of the child, interference due to bottle feeding, breast stimulation, and the support received were important factors in the induction of lactation. There were several factors that may account for the differences between developing and higher income countries in methods of induced lactation and the amount of milk that study participants produced. There was no consensus over whether previous pregnancy and/or breastfeeding experience influenced induced lactation.ConclusionHealth professionals need to have adequate knowledge about induction methods, the preferences of each woman, and the reasons for inducing lactation, to provide proper assistance. However, the lack of standardization about induction of lactation makes it difficult.

Journal of Human Lactation, Ahead of Print.
BackgroundMaternal pre-pregnancy obesity and human milk feeding have been associated with altered infant gut microbiota.Research aimDetermine the relationships between maternal pre-pregnancy BMI, human milk exposure, and their influence on the infant microbiota simultaneously.MethodsThis was a cross-sectional study of infants at 6 months of age (N = 36), a time when many infants are fed a mixed diet of human milk and other foods. Fecal samples and participant information were collected from a subset of dyads enrolled in two related prospective cohorts (ARCHGUT and BABYGUT) in Michigan. Sequencing the V4 region of the 16S gene was used to analyze fecal bacterial samples collected from 6-month-old infants. Participants were grouped into four categories designated by their extent of human milk exposure (100%, 80%, 50%–80%, ≤ 20% human milk in the infant diet) and by maternal pre-pregnancy BMI category (normal, overweight, obese).ResultsFewer participants with pre-pregnancy obesity were breastfeeding at 6 months postpartum compared to non-obese participants (35.7% and 81.8%, respectively). In univariate analyses, maternal pre-pregnancy BMI and human milk exposure were both significantly associated with alpha and beta diversity of the infant microbiota. However, in multivariate analyses, human milk exposure accounted for 20% of the variation in alpha diversity, but pre-pregnancy BMI was not significantly associated with any form of microbiota diversity.ConclusionsThe proportion of the infant diet that was human milk at 6 months was the major determinant of alpha and beta diversity of the infant. Maternal obesity contributes to the gut microbiota by its association with the extent of human milk feeding.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundHuman milk feeding reduces the incidence and costs of several maternal and childhood illnesses. Initiation and success of human milk feeding are influenced by race, socioeconomic status, and family support. The influence of early in-hospital lactation assistance in breastfeeding success has been not well described.Research aimsWe aimed to determine how suspected known factors influencing breastfeeding success influence in-hospital human milk feeding rates. Second, we aimed to examine how timing of lactation assistance is related to success of human milk feeding during the newborn hospitalization for healthy infants.MethodsWe conducted a retrospective cohort study of term infants born between January 1, 2014 and December 31, 2016 at a large tertiary academic hospital. We considered “success” to be 100% human milk feeding during the birth hospitalization, and compared differences in success by demographics, payor, race, and initial feeding preference. Influences of lactation assistance on success were analyzed using multivariable logistic regression.ResultsMean success with exclusive human milk feeding among 7,370 infants was 48.9%, (n = 3,601). Successful participants were more likely to be 39–40 weeks’ gestation (64.9%, n = 2,340), non-Hispanic/non-Latino (80.0%, n = 2,882), and using private insurance (69.2%, n = 2,491). Participants who had early feeding assisted by an International Board Certified Lactation Consultant (IBCLC) before being fed any formula were more likely to be successful than participants who had a feeding assisted by a non-IBCLC nurse (80% vs. 40% respectively).ConclusionsSuccess for exclusive human milk feeding during newborn hospitalization is strongly associated with several factors. Early intervention with IBCLCs can greatly improve breastfeeding success.

Journal of Human Lactation, Ahead of Print.
BackgroundCurrent breastfeeding recommendations focus on the physical benefits of breastfeeding but do not take into account the influence of a history of childhood maltreatment on mothers’ experiences breastfeeding. A better understanding of this relationship is important to be able to better support mothers during this critical time.Research aimTo review current research that examined how women’s personal experiences of childhood maltreatment has affected their breastfeeding outcomes and experiences.MethodsA scoping review was conducted to evaluate current literature on breastfeeding and childhood maltreatment. We screened 275 articles, of which eight met the sample selection criteria and were included in this review. These articles were analyzed based on common themes that emerged: Breastfeeding intention, initiation, duration, and exclusivity; medical conditions associated with breastfeeding; and participants’ experiences related to breastfeeding.ResultsHistory of childhood maltreatment was associated with decreased and shorter duration of breastfeeding. Participants’ experiences of breastfeeding varied: Some found it empowering, and others experienced great distress while breastfeeding. Challenges during this period included managing touch, struggling with the power differential between providers and participants, and coping with trauma symptoms (e.g., dissociation).ConclusionsFor some participants, it was possible to breastfeed successfully after childhood maltreatment, but others found the experience extremely difficult, even traumatizing. There is a need for a trauma-informed approach to lactation care for women with a childhood maltreatment history.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundGestational diabetes mellitus is associated with adverse maternal and fetal outcomes and increases subsequent risk of Type 2 diabetes. Researchers have shown that breastfeeding may reduce diabetes risk in women with recent gestational diabetes.Research aimTo assess association between infant feeding and postpartum glucose tolerance in mothers with recent gestational diabetes within 1 year postpartum.MethodsA literature search was performed up to December 31, 2019, retrieving articles related to infant feeding, gestational diabetes, and postpartum glucose regulation in four major databases (PubMed, Cochrane, CINAHL, and Embase). Methodological quality was assessed using tools from the United States National Institutes of Health and the National Heart, Lung, and Blood Institute.ResultsThe search yielded 15 cohort studies meeting the selection criteria. Of the 15 studies, 13 (86.7%) examined the influence of breastfeeding on postpartum glycemic status, and eight (53.4%) compared the mean blood glucose values between breastfeeding and non-breastfeeding participants. Of the 13 studies that compared postpartum glycemic status, nine (60%) of the research teams found that breastfeeding lowered rates of impaired glucose tolerance, and four (26.7%) showed no significant change. In eight of the studies reporting mean blood glucose values, six (75%) reported significantly lower fasting plasma glucose in breastfeeding participants, with reductions ranging from 3.7 to 7.4 mg/dL (0.2–0.4 mmol/L).ConclusionBreastfeeding has been associated with improved postpartum glucose regulation in mothers with gestational diabetes. In pregnant women with gestational diabetes, breastfeeding may reduce the risk of Type 2 diabetes, and women with gestational diabetes should be strongly encouraged and supported to breastfeed.

Journal of Human Lactation, Ahead of Print.
BackgroundIn many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country.Research AimTo determine the relationship between place of birth and early breastfeeding initiation in Indonesia.MethodThis study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey (N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders.ResultsThe overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively.ConclusionsPlace of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
IntroductionCetirizine hydrochloride is a second-generation H1 histamine antagonist with Food and Drug Administration approval for treatment of allergic rhinitis and urticaria. Currently, the Food and Drug Administration does not recommend use of cetirizine during breastfeeding, as there are insufficient studies on both the transference of cetirizine into human milk and the effects of cetirizine in infants.Main issueTo determine the concentration of cetirizine in human milk, samples were analyzed using high performance liquid chromatography mass spectrometry.ManagementBased on calculations, relative infant dose was found to be 1.77% at 24 hr. In addition, there were no reported adverse effects seen in the infants.ConclusionWe suggest that transfer of cetirizine into human milk is minimal and unlikely to pose a significant risk to the breastfeeding infant. This is the first report presenting the transfer of cetirizine in human milk.