-
1.
Effect of Donor Milk Supplementation on Breastfeeding Outcomes in Term Newborns: A Randomized Controlled Trial.
Kair, LR, Flaherman, VJ, Colaizy, TT
Clinical pediatrics. 2019;(5):534-540
-
-
Free full text
-
Abstract
BACKGROUND Pasteurized donor human milk (DHM) use for healthy newborns is increasing; however, no studies have explored its effect on breastfeeding outcomes. PATIENTS AND METHODS We enrolled 60 healthy, term breastfeeding newborns with ≥4.5% weight loss in the first 36 hours in a randomized controlled trial. Thirty newborns were randomly assigned to early limited-volume DHM supplementation and 30 newborns to exclusive breastfeeding. Mothers were surveyed at 1 week and 1, 2, and 3 months regarding the mode of infant feeding. Comparing infants randomized to DHM supplementation with those exclusively breastfeeding, there was no significant difference in the proportion using formula at 1 week (21% vs 7%, P = .15), nor in the proportion of any breastfeeding (79% vs 90%, P = .30) or breastfeeding without formula at 3 months (62% vs 77%, P = .27). Conclusion For newborns with ≥4.5% weight loss in the first 36 hours, early limited-volume supplementation with DHM is unlikely to have a significant favorable impact on breastfeeding outcomes.
-
2.
Prolactin, autoimmunity, and motherhood: when should women avoid breastfeeding?
Vieira Borba, V, Shoenfeld, Y
Clinical rheumatology. 2019;(5):1263-1270
Abstract
The sexual dimorphic prevalence of autoimmunity represents one of the most alluring observations among the mosaic of autoimmunity. Sex hormones are believed to be a mainstay of this asymmetry. The greater prevalence of autoimmunity among fertile women, disease onset/relapses during pregnancy, and postpartum are some of the points that support this theory. Undeniably, motherhood represents one of the most remarkable challenges for the immune system that not only has to allow for the conceptus but also deal with extraordinary hormonal alterations. Prolactin has a recognized immune-stimulatory effect, mainly inhibiting the negative selection of autoreactive B lymphocytes. In accordance, hyperprolactinemia has been associated with several autoimmune diseases, interfering with its pathogenesis and activity. During the pregnancy and lactation period, assorted autoimmune patients experience relapses, suggesting an active interference from increased levels of prolactin. This association was found to be significant in systemic lupus erythematosus, rheumatoid arthritis, and peripartum cardiomyopathy. Furthermore, treatment with bromocriptine has shown beneficial effects specially among systemic lupus erythematosus patients. In this review, we attempt to provide a critical overview of the link between prolactin, autoimmune diseases, and motherhood, emphasizing whether breastfeeding should be avoided among women, both with diagnosed disease or high risk for its development.
-
3.
Are All Breast-fed Infants Equal? Clustering Metabolomics Data to Identify Predictive Risk Clusters for Childhood Obesity.
Kirchberg, FF, Grote, V, Gruszfeld, D, Socha, P, Closa-Monasterolo, R, Escribano, J, Verduci, E, Mariani, B, Langhendries, JP, Poncelet, P, et al
Journal of pediatric gastroenterology and nutrition. 2019;(3):408-415
Abstract
OBJECTIVES Fetal and early life represent a period of developmental plasticity during which metabolic pathways are modified by environmental and nutritional cues. Little is known on the pathways underlying this multifactorial complex. We explored whether 6 months old breast-fed infants could be clustered into metabolically similar groups and that those metabotypes could be used to predict later obesity risk. METHODS Plasma samples were obtained from 183 breast-fed infants aged 6 months participating in the European multicenter Childhood Obesity Project study. We measured amino acids along with polar lipid concentrations (acylcarnitines, lysophosphatidylcholines, phosphatidylcholines, sphingomyelins). We determined the metabotypes using a Bayesian agglomerative clustering method and investigated the properties of these clusters with respect to clinical, programming, and metabolic factors up to 6 years of age. RESULTS We identified 20 metabolite clusters comprising 1 to 39 children. Phosphatidylcholines predominantly influenced the clustering process. In the largest clusters (n ≥ 14), large differences existed for birth length (unadjusted P < 0.0001) and length and weight at 6 months (unadjusted P < 0.0001 and P = 0.012, respectively). Infants tended to cluster together by country (unadjusted P < 0.001). The body mass index (BMI) z score at 6 years of age tended to differ (unadjusted P = 0.07). CONCLUSIONS Our exploratory study provided evidence that breast-fed infants are not metabolically homogeneous and that variation in metabolic profiles among infants may provide insight into later development and health. This work highlights the potential of metabotypes for identifying inter-individual differences that may form the basis for developing personalized early preventive strategies.
-
4.
Stratifying management of rheumatic disease for pregnancy and breastfeeding.
Giles, I, Yee, CS, Gordon, C
Nature reviews. Rheumatology. 2019;(7):391-402
Abstract
The management of inflammatory rheumatic diseases during pregnancy and breastfeeding has undergone considerable change in the past few years. Modern therapeutics, including biologic and targeted synthetic DMARDs, have enabled substantial improvements in the control of rheumatic diseases, resulting in more patients with severe disease considering pregnancy. Therefore, management of disease for these patients needs to be discussed with clinicians before, during and after pregnancy and patients need to know what complications they might experience before they become pregnant. This Review summarizes the effects pregnancy has on various rheumatic diseases and the effects these diseases have on pregnancy, as well as providing advice regarding the alteration and monitoring of therapy before, during and after pregnancy.
-
5.
Breastfeeding and the Risk of Illness among Young Children in Rural China.
Li, S, Yue, A, Abbey, C, Medina, A, Shi, Y
International journal of environmental research and public health. 2019;(1)
Abstract
Poor rural areas in China exhibit the country's highest rates of child mortality, often stemming from preventable health conditions such as diarrhea and respiratory infection. In this study, we investigate the association between breastfeeding and disease among children aged 6⁻24 months in poor rural counties in China. To do this, we conducted a longitudinal, quantitative analysis of socioeconomic demographics, health outcomes, and breastfeeding practices for 1802 child⁻caregiver dyads across 11 nationally designated poverty counties in southern Shaanxi Province in 2013⁻2014. We found low rates of continued breastfeeding that decreased as children developed: from 58.2% at 6⁻12 months, to 21.6% at 12⁻18 months, and finally to 5.2% at 18⁻24 months. These suboptimal rates are lower than all but one other country in the Asia-Pacific region. We further found that only 18.3% of children 6⁻12 months old met the World Health Organization (WHO)-recommended threshold for minimum dietary diversity, defined as consuming four or more of seven specific food groups. Breastfeeding was strongly associated with lower rates of both diarrhea and cough in bivariate and multivariate analyses. As the first analysis to use longitudinal data to examine the relationship between continued breastfeeding and child illness in China, our study confirms the need for programmatic interventions that promote continued breastfeeding in order to improve toddler health in the region.
-
6.
The Safety of Mother's Milk® Tea: Results of a Randomized Double-Blind, Controlled Study in Fully Breastfeeding Mothers and Their Infants.
Wagner, CL, Boan, AD, Marzolf, A, Finch, CW, Morella, K, Guille, C, Gardner, Z, Marriott, BP
Journal of human lactation : official journal of International Lactation Consultant Association. 2019;(2):248-260
Abstract
BACKGROUND Various natural products are reported to improve maternal milk supply yet are not necessarily safe for infants. Researchers have not systematically studied galactagogue teas for safety. RESEARCH AIM This study evaluates the safety of a galactagogue tea in breastfeeding women and their infants, assessing short- and long-term adverse effects. METHODS Healthy, exclusively/fully breastfeeding women ( N = 60) with no milk insufficiency were randomized into (1) an all-natural tea containing fruits of bitter fennel, anise, and coriander; fenugreek seed; and other herbs (Mother's Milk® herbal tea; test) group or (2) a lemon verbena leaf (placebo) group. Maternal diaries captured self-reported maternal and infant adverse effects, tea consumed, and perceived infant satisfaction. Maternal quality of life and psychological state were assessed at baseline and 2 and 4 weeks. Poststudy calls assessed adverse effects through the infants' age of 12 months. RESULTS No adverse effects attributable to the interventions were reported at any time point. No differences were found between test and placebo groups in sociodemographic characteristics, maternal or infant adverse symptoms, quality of life, breastfeeding self-efficacy, maternal psychological measures, infant growth, and infant satisfaction (all p >.05). CONCLUSIONS This double-blind, randomized controlled trial (RCT) of an herbal galactagogue versus placebo among healthy, exclusively/fully breastfeeding mothers and infants found no adverse events associated with the test tea across the 30-day study or the first year of their infant's life. This composite tea appears to present no safety risk for mothers or their young babies.
-
7.
Breastfeeding Disparities between Multiples and Singletons by NICU Discharge.
Porta, R, Capdevila, E, Botet, F, Ginovart, G, Moliner, E, Nicolàs, M, Gutiérrez, A, Ponce-Taylor, J, Verd, S
Nutrients. 2019;(9)
Abstract
Multiple pregnancy increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure. However, studies on predictive factors of breastfeeding duration in preterm twin infants have a conflicting result. The purpose of this observational study was to compare feeding practices, at hospital discharge, of twin and singleton very low birth weight infants. The study is part of a prospective survey of a national Spanish cohort of very low birth weight infants (SEN1500) that includes 62 neonatal units. The study population comprised all infants registered in the network from 2002 to 2013. They were grouped into singletons and multiples. The explanatory variables were first analyzed using univariate models; subsequently, significant variables were analyzed simultaneously in a multiple stepwise backward model. During the twelve-year period, 32,770 very low birth weight infants were included in the database, of which 26.957 were discharged alive and included in this analysis. Nine thousand seven hundred and fifty-eight neonates were multiples, and 17,199 were singletons. At discharge, 31% of singleton infants were being exclusively breastfed, 43% were bottle-fed, and 26% were fed a combination of both. In comparison, at discharge, only 24% of multiple infants were exclusively breastfed, 43% were bottle-fed, and 33% were fed a combination of both (p < 0.001). On multivariable analysis, twin pregnancy had a statistically significant, but small effect, on cessation of breastfeeding before discharge (OR 1.10; 95% CI: 1.02, 1.19). Risks of early in-hospital breastfeeding cessation were also independently associated with multiple mother-infant stress factors, such as sepsis, intraventricular hemorrhage, retinopathy, necrotizing enterocolitis, intubation, and use of inotropes. Instead, antibiotic treatment at delivery, In vitro fertilization and prenatal steroids were associated with a decreased risk for shorter in-hospital breastfeeding duration. Multiple pregnancy, even in the absence of pathological conditions associated to very low birth weight twin infants, may be an impeding factor for in-hospital breastfeeding.
-
8.
Physical Analysis of the Breast After Direct Breastfeeding Compared with Hand or Pump Expression: A Randomized Clinical Trial.
Francis, J, Dickton, D
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 2019;(10):705-711
Abstract
Background: Expressing human milk using commercially available pumps has increased. Most women use mechanical means to transfer their milk at some point during lactation. Yet, there is very little quantification of any breast tissue changes that occur when using mechanical devices to facilitate milk transfer. Objective: Women comfortable with breastfeeding were recruited to participate in a study to measure physical changes of the breast with a variety of human milk transfer modalities under close observation. Materials and Methods: Direct breastfeeding with their infant, hand expression, and mechanical milk transfer using two commonly available breast pumps were utilized over four milk transfer sessions with each participant. Each participant directly breastfed on the first milk transfer session and the remaining modalities were randomized. Measurements were taken before and after each modality using digital calipers. Participants completed a modified pain scale after each observation. Measurements taken after breastfeeding were used as the control for data interpretation for each participant. After a 20-minute rest period, breast tissue was again examined, and tissue appearance was recorded. Within-subject modality differences were calculated, and paired analysis mean difference and standard error of the mean are presented. Results: Fifty eligible women were approached with 92% participating. The "before" measurements were not significant for all the modalities. The "after" measurements were significantly different at p < 0.003 for breast pumps but not for breastfeeding or hand expressing. Many participants indicated pain with pumping. Conclusion: Mechanical pump use correlated with significantly increased length and diameter of the nipple compared with the post-breastfeeding and hand expressing dimensions. Pump use correlated with significant pain scores and resulted in localized inflammatory changes. Understanding how pumps affect breast tissue is helpful in improving experiences with breast pumps and may improve breastfeeding outcomes. Additional research is needed to better understand ramifications of long-term use of breast pumps.
-
9.
Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis.
Tseng, PT, Yen, CF, Chen, YW, Stubbs, B, Carvalho, AF, Whiteley, P, Chu, CS, Li, DJ, Chen, TY, Yang, WC, et al
European child & adolescent psychiatry. 2019;(1):19-30
Abstract
Previous studies have suggested environmental factors may contribute to the risk of attention-deficit/hyperactivity disorder (ADHD). The current meta-analysis examined (1) the difference in the duration of maternal breastfeeding between children with and without ADHD, and (2) the association between maternal breastfeeding and ADHD in children. The data of individual studies were synthesized with a random-effects model. Eleven articles were included in this meta-analysis. Children with ADHD had significantly less breastfeeding duration than controls (Hedges' g = - 0.36, 95% confidence intervals (CIs) = - 0.61 to - 0.11, p = 0.005; difference in means: - 2.44 months, 95% CIs = - 3.17 to - 1.71, p < 0.001). In addition, the rates of non-exclusive breastfeeding in children with ADHD is significantly higher in "under 3 months" (odds ratio (OR) = 1.90, 95% CIs = 1.45 to 2.48, p < 0.001) but lower in "6 to 12 months" (OR = 0.69, 95% CIs = 0.49 to 0.98, p = 0.039) and "over 12 months" (OR = 0.58, 95% CIs = 0.35 to 0.97, p = 0.038) than controls. Children with ADHD received significantly higher rate of exclusive breastfeeding duration "under 3 months" (OR = 1.51, 95% CIs = 1.20 to 1.89, p < 0.001) but lower in "over 3 months" (OR = 0.52, 95% CIs = 0.29 to 0.95, p = 0.033) than controls. Furthermore, an association was found between non-breastfeeding and ADHD children (adjusted OR = 3.71, 95% CI = 1.94 to 7.11, p < 0.001). Our results suggest maternal breastfeeding is associated with a lower risk of ADHD in children. Future longitudinal research is required to confirm/refute these findings and to explore possible mechanisms underlying this association.
-
10.
Hospitalising preterm infants in single family rooms versus open bay units: a systematic review and meta-analysis.
van Veenendaal, NR, Heideman, WH, Limpens, J, van der Lee, JH, van Goudoever, JB, van Kempen, AAMW, van der Schoor, SRD
The Lancet. Child & adolescent health. 2019;(3):147-157
Abstract
BACKGROUND The effect of the hospital environment on health and specifically neurodevelopment in preterm infants remains under debate. We assessed outcomes of preterm infants hospitalised in single family rooms compared with common open bay units. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycInfo, CENTRAL (the Cochrane Central Register of Controlled Trials), Web of Science, and ClinicalTrials.gov from inception to Aug 13, 2018, using controlled terms (ie, MeSH terms) and text words related to prematurity and neonatal intensive care unit design. We included randomised and non-randomised studies investigating clinical outcomes of preterm infants. We assessed methodological quality using the Cochrane Collaboration's Risk of Bias Tool for randomised controlled trials and the Cochrane Risk of Bias Tool for Non-randomised Studies of Interventions. We calculated summary estimates for meta-analysis using random effects models. The primary outcome was age appropriate long-term neurodevelopment. Secondary outcomes were length of hospital stay, sepsis, breastfeeding, growth, bronchopulmonary dysplasia, intraventricular haemorrhage, retinopathy of prematurity, and mortality. This systematic review is registered with PROSPERO, number CRD42016050643. FINDINGS We identified 487 records. 13 study populations (n=4793) were included. No difference in cognitive neurodevelopment was found on the Bayley Scales of Infant and Toddler Development-III at 18-24 months of corrected age (680 infants analysed; mean difference 1·04 [95% CI -3·45 to 5·52], p=0·65; I2=42%). The incidence of sepsis was lower (4165 infants analysed; 108 035 days in hospital [hospitalisation days]; risk ratio 0·63 [95% CI 0·50 to 0·78], p<0·0001; I2=0%) and exclusive breastfeeding at discharge was higher (484 infants analysed; 1·31 [1·07 to 1·61], p=0·01; I2=0%) in single family rooms than in open bay units. We found no differences in length of hospital stay, growth, bronchopulmonary dysplasia, intraventricular haemorrhage, retinopathy of prematurity, and mortality. INTERPRETATION Single family rooms should be considered to hospitalise preterm infants because incidence of sepsis is reduced and exclusive breastfeeding is higher. No difference in long-term neurodevelopment was detected. FUNDING None.