Special Issue "Breastfeeding: Short and Long-Term Benefits to Baby and Mother"

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 September 2019).

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Kingsley E. Agho
Website
Guest Editor
School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith NSW 2571, Australia
Interests: Biostatistics and Global Maternal and Child Health
Assoc. Prof. Dr. Ben Wheeler
Website
Guest Editor
Department of Women’s and Children’s Health, University of Otago, Dunedin 9054, New Zealand
Interests: early life nutrition; vitamin D and bone health during pregnancy, lactation, and infancy; new technologies for children and young people affected by diabetes; factors that impact on glycaemic control in diabetes

Special Issue Information

Dear Colleagues,

Breastfeeding is the preferred method of feeding in early life.  It is also one of the most cost-effective childhood survival interventions. Breastfeeding practices are important for preventing child mortality, and morbidity, as well as ensuring the optimal growth, health, and development of infants. The public health benefits of breastfeeding have been well documented in the medical literature, and include the following:  associations with decreased risk for early-life diseases such as otitis media, respiratory tract infection, diarrhoea, and early childhood obesity (to name but a few).

In the late 1990’s, The Baby Friendly Hospital Initiative (BFHI), based on appropriate training and a system of hospital accreditation, was introduced and has proven to be an effective health systems approach to improving breastfeeding outcomes. Since the introduction of the BFHI approach, breastfeeding has improved mothers' health because breastfeeding practices burn extra calories, which could help mothers to lose pregnancy weight faster and lower the risk of developing heart disease, breast, and ovarian cancer. Breastfeeding also improves mothers' emotional health, and plays an important role in child spacing, which strongly correlates with improved maternal and child survival and health. 

In 2008, The World Health Organization (WHO) also developed guidelines for assessing infant and young child feeding practices, including 10 indicators for assessing breastfeeding and another five indicators for assessing complementary feeding practices to achieve the optimal growth, development, and health of infants. These measures aim to provide public health researchers with a consistent measure for assessing breastfeeding indicators.

While all of the above have led to an improved understanding of the benefits of breastfeeding and improved rates of breastfeeding in many locations, more research and efforts are needed if we are to continue to make gains in this area and realise the full potential of breastfeeding for both mothers and babies. 

This Special Issue invites submissions on the use of novel methods to improve breastfeeding rates, and research exploring the short and long-term benefits of breatfeeding to baby and mom including technology-based approaches.

Dr. Kingsley E. Agho
Assoc. Prof. Dr. Ben Wheeler
Guest Editors

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Keywords

  • Breastfeeding
  • Complementary feeding
  • Food insecurity
  • Bottle feeding

Published Papers (18 papers)

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Open AccessArticle
Exclusive Breastfeeding Rates and Associated Factors in 13 “Economic Community of West African States” (ECOWAS) Countries
Nutrients 2019, 11(12), 3007; https://doi.org/10.3390/nu11123007 - 09 Dec 2019
Cited by 1
Abstract
Exclusive breastfeeding (EBF) has important protective effects on child survival and also increases the growth and development of infants. This paper examined EBF rates and associated factors in 13 “Economic Community of West African States” (ECOWAS) countries. A weighted sample of 19,735 infants [...] Read more.
Exclusive breastfeeding (EBF) has important protective effects on child survival and also increases the growth and development of infants. This paper examined EBF rates and associated factors in 13 “Economic Community of West African States” (ECOWAS) countries. A weighted sample of 19,735 infants from the recent Demographic and Health Survey dataset in ECOWAS countries for the period of 2010–2018 was used. Survey logistic regression analyses that adjusted for clustering and sampling weights were used to determine the factors associated with EBF. In ECOWAS countries, EBF rates for infants 6 months or younger ranged from 13.0% in Côte d’Ivoire to 58.0% in Togo. EBF decreased significantly by 33% as the infant age (in months) increased. Multivariate analyses revealed that mothers with at least primary education, older mothers (35–49 years), and those who lived in rural areas were significantly more likely to engage in EBF. Mothers who made four or more antenatal visits (ANC) were significantly more likely to exclusively breastfeed their babies compared to those who had no ANC visits. Our study shows that EBF rates are still suboptimal in most ECOWAS countries. EBF policy interventions in ECOWAS countries should target mothers with no schooling and those who do not attend ANC. Higher rates of EBF are likely to decrease the burden of infant morbidity and mortality in ECOWAS countries due to non-exposure to contaminated water or other liquids. Full article
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Open AccessArticle
A Moderated Mediation Model of Maternal Perinatal Stress, Anxiety, Infant Perceptions and Breastfeeding
Nutrients 2019, 11(12), 2981; https://doi.org/10.3390/nu11122981 - 06 Dec 2019
Abstract
This study examined a moderated mediation model of relations among maternal perinatal stress/anxiety, breastfeeding difficulties (mediator), misperceptions of infant crying (moderator), and maternal breastfeeding duration to understand risk factors for early breastfeeding termination. It was hypothesized that more breastfeeding difficulties would mediate the [...] Read more.
This study examined a moderated mediation model of relations among maternal perinatal stress/anxiety, breastfeeding difficulties (mediator), misperceptions of infant crying (moderator), and maternal breastfeeding duration to understand risk factors for early breastfeeding termination. It was hypothesized that more breastfeeding difficulties would mediate the relation between greater prenatal stress/anxiety and shorter breastfeeding duration, and that perceptions of response to infant crying as spoiling would moderate the relation between more breastfeeding difficulties and reduced breastfeeding duration. Additionally, it was hypothesized that participants who breastfed through 6 months would demonstrate less postnatal stress/anxiety and there would be a positive relation between fewer breastfeeding difficulties and less postnatal stress/anxiety through 6 months. Participants included 94 expectant mothers at 33–37 weeks gestation and 6 months (±2 weeks) postpartum. Greater prenatal anxiety was associated with shorter breastfeeding duration. Results presented are the first to document negative relations between prenatal (as opposed to postnatal) anxiety and breastfeeding duration (as opposed to frequency or other indicators) in a U.S. sample. Future studies should seek to replicate findings in a more diverse sample and compare findings from clinical and non-clinical samples. Studies may also wish to explore the effects of anxiety prevention/intervention on breastfeeding duration. Full article
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Open AccessArticle
Human Milk Omega-3 Fatty Acid Composition Is Associated with Infant Temperament
Nutrients 2019, 11(12), 2964; https://doi.org/10.3390/nu11122964 - 04 Dec 2019
Cited by 1
Abstract
There is growing evidence that omega-3 (n-3) polyunsaturated fatty-acids (PUFAs) are important for the brain development in childhood and are necessary for an optimal health in adults. However, there have been no studies examining how the n-3 PUFA composition of human milk influences [...] Read more.
There is growing evidence that omega-3 (n-3) polyunsaturated fatty-acids (PUFAs) are important for the brain development in childhood and are necessary for an optimal health in adults. However, there have been no studies examining how the n-3 PUFA composition of human milk influences infant behavior or temperament. To fill this knowledge gap, 52 breastfeeding mothers provided milk samples at 3 months postpartum and completed the Infant Behavior Questionnaire (IBQ-R), a widely used parent-report measure of infant temperament. Milk was assessed for n-3 PUFAs and omega-6 (n-6) PUFAs using gas-liquid chromatography. The total fat and the ratio of n-6/n-3 fatty acids in milk were also examined. Linear regression models revealed that infants whose mothers’ milk was richer in n-3 PUFAs had lower scores on the negative affectivity domain of the IBQ-R, a component of temperament associated with a risk for internalizing disorders later in life. These associations remained statistically significant after considering covariates, including maternal age, marital status, and infant birth weight. The n-6 PUFAs, n-6/n-3 ratio, and total fat of milk were not associated with infant temperament. These results suggest that mothers may have the ability to shape the behavior of their offspring by adjusting the n-3 PUFA composition of their milk. Full article
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Open AccessArticle
Validation of the Breastfeeding Score—A Simple Screening Tool to Predict Breastfeeding Duration
Nutrients 2019, 11(12), 2852; https://doi.org/10.3390/nu11122852 - 21 Nov 2019
Cited by 1
Abstract
Easy to use screening tools to identify mothers in risk of early breastfeeding cessation are needed. The purpose was to validate a revised version of the breastfeeding score, consisting of four questions addressing completed education, earlier breastfeeding duration, self-efficacy, and sense of security [...] Read more.
Easy to use screening tools to identify mothers in risk of early breastfeeding cessation are needed. The purpose was to validate a revised version of the breastfeeding score, consisting of four questions addressing completed education, earlier breastfeeding duration, self-efficacy, and sense of security not knowing the exact amount of milk the baby ingests. We used two cohorts from 2004 (n = 633) and 2017 (n = 579) to explore the predictive validity of the breastfeeding score to identify mothers at risk of breastfeeding cessation within the first 17 weeks postpartum. The analyses included sensitivity and specificity, clinically relevant cut-points, and calibrations plots. A cut-point ≥5 points identified 61% of first-time and 42% of multiparous mothers in the validation cohort 2017 to be at risk of early breastfeeding cessation with a sensitivity and specificity of 80% and 60% for first-time, and 69% and 82% for multiparous, respectively. The corresponding numbers in the 2004 cohort were almost identical. The area under the receiver operating characteristic (ROC) curves were 0.77 and 0.78 and the calibration plots showed good agreement for the two cohorts. The breastfeeding score indicated good ability to discriminate between mothers at risk of early exclusive breastfeeding cessation. The simple form of the tool makes it easy to use in daily practice. Full article
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Open AccessArticle
Is There an Association between Breastfeeding and Dental Caries among Three-Year-Old Australian Aboriginal Children?
Nutrients 2019, 11(11), 2811; https://doi.org/10.3390/nu11112811 - 18 Nov 2019
Abstract
An unresolved question about breastfeeding is its effect on caries, in particular, early childhood caries (ECC). In secondary analyses of data from an ECC intervention, we describe breastfeeding among Aboriginal children and associations between breastfeeding and ECC. Breastfeeding (duration and exclusivity to six [...] Read more.
An unresolved question about breastfeeding is its effect on caries, in particular, early childhood caries (ECC). In secondary analyses of data from an ECC intervention, we describe breastfeeding among Aboriginal children and associations between breastfeeding and ECC. Breastfeeding (duration and exclusivity to six months) was grouped into mutually exclusive categories. ECC was observed by a calibrated dental professional. Outcomes were prevalence of ECC (% decayed, missing, and filled teeth in the primary dentition (% dmft>0)) and caries severity (mean number of decayed, missing, and filled surfaces (mean dmfs)) in children aged three years. Analyses were adjusted for confounding. Multiple imputation was undertaken for missing information. Of 307 participants, 29.3% were never breastfed, 17.9% exclusively breastfed to six months, and 9.3% breastfed >24 months. Breastfeeding >24 months was associated with higher caries prevalence (adjusted prevalence ratio (PRa) 2.06 (95%CI 1.35, 3.13, p-value = 0.001) and mean dmfs (5.22 (95% CI 2.06, 8.38, p-value = 0.001), compared with children never breastfed. Exclusive breastfeeding to six months with breastfeeding <24 months was associated with 1.45 higher caries prevalence (95% CI –0.92, 2.30, p-value = 0.114) and mean dmfs 2.04 (−0.62, 4.71, p-value = 0.132), compared with never breastfeeding. The findings are similar to observational studies on breastfeeding and caries but not with randomized controlled trials of breastfeeding interventions. Despite attending to potential biases, inconsistencies with trial evidence raises concerns about the ability to identify causal effects of breastfeeding in observational research. Full article
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Open AccessArticle
DNA Methylation Signatures of Breastfeeding in Buccal Cells Collected in Mid-Childhood
Nutrients 2019, 11(11), 2804; https://doi.org/10.3390/nu11112804 - 17 Nov 2019
Cited by 2
Abstract
Breastfeeding has long-term benefits for children that may be mediated via the epigenome. This pathway has been hypothesized, but the number of empirical studies in humans is small and mostly done by using peripheral blood as the DNA source. We performed an epigenome-wide [...] Read more.
Breastfeeding has long-term benefits for children that may be mediated via the epigenome. This pathway has been hypothesized, but the number of empirical studies in humans is small and mostly done by using peripheral blood as the DNA source. We performed an epigenome-wide association study (EWAS) in buccal cells collected around age nine (mean = 9.5) from 1006 twins recruited by the Netherlands Twin Register (NTR). An age-stratified analysis examined if effects attenuate with age (median split at 10 years; n<10 = 517, mean age = 7.9; n>10 = 489, mean age = 11.2). We performed replication analyses in two independent cohorts from the NTR (buccal cells) and the Avon Longitudinal Study of Parents and Children (ALSPAC) (peripheral blood), and we tested loci previously associated with breastfeeding in epigenetic studies. Genome-wide DNA methylation was assessed with the Illumina Infinium MethylationEPIC BeadChip (Illumina, San Diego, CA, USA) in the NTR and with the HumanMethylation450 Bead Chip in the ALSPAC. The duration of breastfeeding was dichotomized (‘never‘ vs. ‘ever’). In the total sample, no robustly associated epigenome-wide significant CpGs were identified (α = 6.34 × 10–8). In the sub-group of children younger than 10 years, four significant CpGs were associated with breastfeeding after adjusting for child and maternal characteristics. In children older than 10 years, methylation differences at these CpGs were smaller and non-significant. The findings did not replicate in the NTR sample (n = 98; mean age = 7.5 years), and no nearby sites were associated with breastfeeding in the ALSPAC study (n = 938; mean age = 7.4). Of the CpG sites previously reported in the literature, three were associated with breastfeeding in children younger than 10 years, thus showing that these CpGs are associated with breastfeeding in buccal and blood cells. Our study is the first to show that breastfeeding is associated with epigenetic variation in buccal cells in children. Further studies are needed to investigate if methylation differences at these loci are caused by breastfeeding or by other unmeasured confounders, as well as what mechanism drives changes in associations with age. Full article
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Open AccessArticle
Factors Associated with the Early Initiation of Breastfeeding in Economic Community of West African States (ECOWAS)
Nutrients 2019, 11(11), 2765; https://doi.org/10.3390/nu11112765 - 14 Nov 2019
Cited by 3
Abstract
The early initiation of breastfeeding (EIBF) within one hour after birth enhanced mother–newborn bonding and protection against infectious diseases. This paper aimed to examine factors associated with EIBF in 13 Economic Community of West African States (ECOWAS). A weighted sample of 76,934 children [...] Read more.
The early initiation of breastfeeding (EIBF) within one hour after birth enhanced mother–newborn bonding and protection against infectious diseases. This paper aimed to examine factors associated with EIBF in 13 Economic Community of West African States (ECOWAS). A weighted sample of 76,934 children aged 0–23 months from the recent Demographic and Health Survey dataset in the ECOWAS for the period 2010 to 2018 was pooled. Survey logistic regression analyses, adjusting for country-specific cluster and population-level weights, were used to determine the factors associated with EIBF. The overall combined rate of EIBF in ECOWAS was 43%. After adjusting for potential confounding factors, EIBF was significantly lower in Burkina Faso, Cote d’Ivoire, Guinea, Niger, Nigeria, and Senegal. Mothers who perceived their babies to be average and large at birth were significantly more likely to initiate breastfeeding within one hour of birth than those mothers who perceived their babies to be small at birth. Mothers who had a caesarean delivery (AOR = 0.28, 95%CI = 0.22–0.36), who did not attend antenatal visits (ANC) during pregnancy, and delivered by non-health professionals were more likely to delay initiation of breastfeeding beyond one hour after birth. Male children and mothers from poorer households were more likely to delay introduction of breastfeeding. Infant and young child feeding nutrition programs aimed at improving EIBF in ECOWAS need to target mothers who underutilize healthcare services, especially mothers from lower socioeconomic groups. Full article
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Open AccessArticle
Prevalence and Associated Factors of Caesarean Section and its Impact on Early Initiation of Breastfeeding in Abu Dhabi, United Arab Emirates
Nutrients 2019, 11(11), 2723; https://doi.org/10.3390/nu11112723 - 10 Nov 2019
Abstract
The World Health Organization (WHO) recommends the early initiation of breastfeeding. Research shows that factors such as mode of delivery may interfere with the early initiation of breastfeeding. However, data in the United Arab Emirates (UAE) on these findings is limited. Thus, the [...] Read more.
The World Health Organization (WHO) recommends the early initiation of breastfeeding. Research shows that factors such as mode of delivery may interfere with the early initiation of breastfeeding. However, data in the United Arab Emirates (UAE) on these findings is limited. Thus, the aim of this study was to describe the prevalence of caesarean sections (CSs) and evaluate their effect on breastfeeding initiation among mothers of children under the age of two years in Abu Dhabi. Data were collected in clinical and non-clinical settings across various geographical areas in Abu Dhabi during 2017 using consent and structured questionnaires for interviews with mothers. Data analysis included both descriptive and inferential statistics. Among the 1624 participants, one-third (30.2%) reportedly delivered by CS, of which 71.1% were planned, while 28.9% were emergency CS. More than half of all mothers (62.5%) initiated early breastfeeding. Multivariable logistic regression indicated factors that were associated positively with CS included advanced maternal age, nationality, and obesity. However, gestational age (GA) was negatively associated with CS. This study shows that the prevalence of CS is high in Abu Dhabi, UAE. CS is associated with lower early initiation rates of breastfeeding. The early initiation rates of breastfeeding were 804 (79.2%) 95% confidence interval (CI) (76.4, 82.0), 162 (16.0%) 95% CI (10.4, 21.6), and 49 (4.8%) 95% CI (1.2, 10.8) among vaginal delivery, planned CS, and emergency CS, respectively. Regarding the mode of delivery, vaginal were 2.78 (Adjusted Odd Ratio (AOR)): CI (95%), (2.17–3.56, p < 0.001) times more likely related to an early initiation of breastfeeding. CS in general, and emergency CS, was the main risk factor for the delayed initiation of breastfeeding. The study provides valuable information to develop appropriate strategies to reduce the CS rate in UAE. Maternal literacy on CS choices, the importance of breastfeeding for child health, and additional guidance for mothers and their families are necessary to achieve better breastfeeding outcomes. Full article
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Open AccessFeature PaperArticle
Impact of Fenugreek on Milk Production in Rodent Models of Lactation Challenge
Nutrients 2019, 11(11), 2571; https://doi.org/10.3390/nu11112571 - 24 Oct 2019
Cited by 3
Abstract
Fenugreek, a herbal remedy, has long been used as galactologue to help mothers likely to stop breastfeeding because of perceived insufficient milk production. However, few studies highlight the efficacy of fenugreek in enhancing milk production. The aims of our study were to determine [...] Read more.
Fenugreek, a herbal remedy, has long been used as galactologue to help mothers likely to stop breastfeeding because of perceived insufficient milk production. However, few studies highlight the efficacy of fenugreek in enhancing milk production. The aims of our study were to determine whether fenugreek increased milk yield in rodent models of lactation challenge and if so, to verify the lack of adverse effects on dam and offspring metabolism. Two lactation challenges were tested: increased litter size to 12 pups in dams fed a 20% protein diet and perinatal restriction to an 8% protein diet with eight pups’ litter, with or without 1 g.kg−1.day−1 dietary supplementation of fenugreek, compared to control dams fed 20% protein diet with eight pups’ litters. Milk flow was measured by the deuterium oxide enrichment method, and milk composition was assessed. Lipid and glucose metabolism parameters were assessed in dam and offspring plasmas. Fenugreek increased milk production by 16% in the litter size increase challenge, resulting in an 11% increase in pup growth without deleterious effect on dam-litter metabolism. Fenugreek had no effect in the maternal protein restriction challenge. These results suggest a galactologue effect of fenugreek when mothers have no physiological difficulties in producing milk. Full article
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Open AccessArticle
No Association between Glucocorticoid Diurnal Rhythm in Breastmilk and Infant Body Composition at 3 Months
Nutrients 2019, 11(10), 2351; https://doi.org/10.3390/nu11102351 - 02 Oct 2019
Cited by 1
Abstract
Objective: Glucocorticoids (GCs) in breastmilk have previously been associated with infant body growth and body composition. However, the diurnal rhythm of breastmilk GCs was not taken into account, and we therefore aimed to assess the associations between breastmilk GC rhythmicity at 1 month [...] Read more.
Objective: Glucocorticoids (GCs) in breastmilk have previously been associated with infant body growth and body composition. However, the diurnal rhythm of breastmilk GCs was not taken into account, and we therefore aimed to assess the associations between breastmilk GC rhythmicity at 1 month and growth and body composition at 3 months in infants. Methods: At 1 month postpartum, breastmilk GCs were collected over a 24-h period and analyzed by LC-MS/MS. Body composition was measured using air-displacement plethysmography at 3 months. Length and weight were collected at 1, 2, and 3 months. Results: In total, 42 healthy mother–infant pairs were included. No associations were found between breastmilk GC rhythmicity (area-under-the-curve increase and ground, maximum, and delta) and infant growth trajectories or body composition (fat and fat free mass index, fat%) at 3 months. Conclusions: This study did not find an association between breastmilk GC rhythmicity at 1 month and infant’s growth or body composition at 3 months. Therefore, this study suggests that previous observations linking breastmilk cortisol to changes in infant weight might be flawed by the lack of serial cortisol measurements and detailed information on body composition. Full article
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Open AccessArticle
Lactoferrin in Human Milk of Prolonged Lactation
Nutrients 2019, 11(10), 2350; https://doi.org/10.3390/nu11102350 - 02 Oct 2019
Cited by 5
Abstract
Among the immunologically important bioactive factors present in human milk, lactoferrin (Lf) has emerged as a key player with wide-ranging features that directly and indirectly protect the neonate against infection caused by a variety of pathogens. The concentration of Lf in human milk [...] Read more.
Among the immunologically important bioactive factors present in human milk, lactoferrin (Lf) has emerged as a key player with wide-ranging features that directly and indirectly protect the neonate against infection caused by a variety of pathogens. The concentration of Lf in human milk is lactation-stage related; colostrum contains more than 5 g/L, which then significantly decreases to 2–3 g/L in mature milk. The milk of mothers who are breastfeeding for more than one year is of a standard value, containing macronutrients in a composition similar to that of human milk at later stages. The aim of this study was to evaluate lactoferrin concentration in prolonged lactation from the first to the 48th month postpartum. Lactating women (n = 120) up to 48 months postpartum were recruited to the study. The mean value of lactoferrin concentration was the lowest in the group of 1–12 months of lactation (3.39 ± 1.43 g/L), significantly increasing in the 13–18 months group (5.55 ± 4.00 g/L; p < 0.006), and remaining at a comparable level in the groups of 19–24 month and over 24 months (5.02 ± 2.97 and 4.90 ± 3.18 g/L, respectively). The concentration of lactoferrin in mother’s milk also showed a positive correlation with protein concentration over lactation from the first to the 48th month (r = 0.3374; p = 0.0002). Our results demonstrate the high immunology potential of human milk during prolonged lactation and that Lf concentration is close to the Lf concentration in colostrum. Evidence of stable or rising immunoprotein levels during prolonged lactation provides an argument for foregoing weaning; however, breastfeeding must be combined with solid foods meet the new requirements of a rapidly growing six-month or older baby. Full article
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Open AccessArticle
Breastfeeding Disparities between Multiples and Singletons by NICU Discharge
Nutrients 2019, 11(9), 2191; https://doi.org/10.3390/nu11092191 - 12 Sep 2019
Cited by 2
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 [...] Read more.
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. Full article
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Open AccessArticle
Determinants of Exclusive Breastfeeding Cessation in the Early Postnatal Period among Culturally and Linguistically Diverse (CALD) Australian Mothers
Nutrients 2019, 11(7), 1611; https://doi.org/10.3390/nu11071611 - 16 Jul 2019
Cited by 5
Abstract
There are limited epidemiological data on exclusive breastfeeding (EBF) among culturally and linguistically diverse (CALD) Australian mothers to advocate for targeted and/or culturally-appropriate interventions. This study investigated the determinants of EBF cessation in the early postnatal period among CALD Australian mothers in Sydney, [...] Read more.
There are limited epidemiological data on exclusive breastfeeding (EBF) among culturally and linguistically diverse (CALD) Australian mothers to advocate for targeted and/or culturally-appropriate interventions. This study investigated the determinants of EBF cessation in the early postnatal period among CALD Australian mothers in Sydney, Australia. The study used linked maternal and child health data from two local health districts in Australia (N = 25,407). Prevalence of maternal breastfeeding intention, skin-to-skin contact, EBF at birth, discharge, and the early postnatal period (1–4 weeks postnatal), were estimated. Multivariate logistic regression models were used to investigate determinants of EBF cessation in the early postnatal period. Most CALD Australian mothers had the intention to breastfeed (94.7%). Skin-to-skin contact (81.0%), EBF at delivery (91.0%), and at discharge (93.0%) were high. EBF remained high in the early postnatal period (91.4%). A lack of prenatal breastfeeding intention was the strongest determinant of EBF cessation (adjusted odds ratio [aOR] = 23.76, 95% CI: 18.63–30.30, for mothers with no prenatal breastfeeding intention and aOR = 6.15, 95% CI: 4.74–7.98, for those undecided). Other significant determinants of EBF cessation included a lack of partner support, antenatal and postnatal depression, intimate partner violence, low socioeconomic status, caesarean birth, and young maternal age (<20 years). Efforts to improve breastfeeding among women of CALD backgrounds in Australia should focus on women with vulnerabilities to maximise the benefits of EBF. Full article
Open AccessArticle
Breastfeeding Status and Duration and Infections, Hospitalizations for Infections, and Antibiotic Use in the First Two Years of Life in the ELFE Cohort
Nutrients 2019, 11(7), 1607; https://doi.org/10.3390/nu11071607 - 15 Jul 2019
Cited by 4
Abstract
In low- and middle-income countries, the protective effect of breastfeeding against infections is well established, but in high-income countries, the effect could be weakened by higher hygienic conditions. We aimed to examine the association between breastfeeding and infections in the first 2 years [...] Read more.
In low- and middle-income countries, the protective effect of breastfeeding against infections is well established, but in high-income countries, the effect could be weakened by higher hygienic conditions. We aimed to examine the association between breastfeeding and infections in the first 2 years of life, in a high-income country with relatively short breastfeeding duration. Among 10,349 young children from the nationwide Etude Longitudinale Française depuis l’Enfance (ELFE) birth cohort, breastfeeding and parent-reported hospitalizations, bronchiolitis and otitis events, and antibiotic use were prospectively collected up to 2 years. Never-breastfed infants were used as reference group. Any breastfeeding for <3 months was associated with higher risks of hospitalizations from gastrointestinal infections or fever. Predominant breastfeeding for <1 month was associated with higher risk of a single hospital admission while predominant breastfeeding for ≥3 months was associated with a lower risk of long duration (≥4 nights) of hospitalization. Ever breastfeeding was associated with lower risk of antibiotic use. This study confirmed the well-known associations between breastfeeding and hospitalizations but also highlighted a strong inverse association between breastfeeding and antibiotic use. Although we cannot infer causality from this observational study, this finding is worth highlighting in a context of rising concern regarding antibiotic resistance. Full article
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Open AccessArticle
Carbohydrates in Human Milk and Body Composition of Term Infants during the First 12 Months of Lactation
Nutrients 2019, 11(7), 1472; https://doi.org/10.3390/nu11071472 - 28 Jun 2019
Cited by 9
Abstract
Human milk (HM) carbohydrates may affect infant appetite regulation, breastfeeding patterns, and body composition (BC). We investigated relationships between concentrations/calculated daily intakes (CDI) of HM carbohydrates in first year postpartum and maternal/term infant BC, as well as breastfeeding parameters. BC of dyads ( [...] Read more.
Human milk (HM) carbohydrates may affect infant appetite regulation, breastfeeding patterns, and body composition (BC). We investigated relationships between concentrations/calculated daily intakes (CDI) of HM carbohydrates in first year postpartum and maternal/term infant BC, as well as breastfeeding parameters. BC of dyads (n = 20) was determined at 2, 5, 9, and/or 12 months postpartum using ultrasound skinfolds (infants) and bioelectrical impedance spectroscopy (infants/mothers). Breastfeeding frequency, 24-h milk intake and total carbohydrates (TCH) and lactose were measured to calculate HM oligosaccharides (HMO) concentration and CDI of carbohydrates. Statistical analysis used linear regression/mixed effects models; results were adjusted for multiple comparisons. Higher TCH concentrations were associated with greater infant length, weight, fat-free mass (FFM), and FFM index (FFMI), and decreased fat mass (FM), FM index (FMI), %FM and FM/FFM ratio. Higher HMO concentrations were associated with greater infant FFM and FFMI, and decreased FMI, %FM, and FM/FFM ratio. Higher TCH CDI were associated with greater FM, FMI, %FM, and FM/FFM ratio, and decreased infant FFMI. Higher lactose CDI were associated with greater FM, FMI, %FM, and FM/FFM, ratio and decreased FFMI. Concentrations and intakes of HM carbohydrates differentially influence development of infant BC in the first 12 months postpartum, and may potentially influence risk of later obesity via modulation of BC. Full article
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Open AccessArticle
Comprehensive Preterm Breast Milk Metabotype Associated with Optimal Infant Early Growth Pattern
Nutrients 2019, 11(3), 528; https://doi.org/10.3390/nu11030528 - 28 Feb 2019
Cited by 7Correction
Abstract
Early nutrition impacts preterm infant early growth rate and brain development but can have long lasting effects as well. Although human milk is the gold standard for feeding new born full-term and preterm infants, little is known about the effects of its bioactive [...] Read more.
Early nutrition impacts preterm infant early growth rate and brain development but can have long lasting effects as well. Although human milk is the gold standard for feeding new born full-term and preterm infants, little is known about the effects of its bioactive compounds on breastfed preterm infants’ growth outcomes. This study aims to determine whether breast milk metabolome, glycome, lipidome, and free-amino acids profiles analyzed by liquid chromatography-mass spectrometry had any impact on the early growth pattern of preterm infants. The study population consisted of the top tercile-Z score change in their weight between birth and hospital discharge (“faster grow”, n = 11) and lowest tercile (“slower grow”, n = 15) from a cohort of 138 premature infants (27–34 weeks gestation). This holistic approach combined with stringent clustering or classification statistical methods aims to discriminate groups of milks phenotype and identify specific metabolites associated with early growth of preterm infants. Their predictive reliability as biomarkers of infant growth was assessed using multiple linear regression and taking into account confounding clinical factors. Breast-milk associated with fast growth contained more branched-chain and insulino-trophic amino acid, lacto-N-fucopentaose, choline, and hydroxybutyrate, pointing to the critical role of energy utilization, protein synthesis, oxidative status, and gut epithelial cell maturity in prematurity. Full article
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Review

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Open AccessReview
Role of Vitamin A in Mammary Gland Development and Lactation
Nutrients 2020, 12(1), 80; https://doi.org/10.3390/nu12010080 - 27 Dec 2019
Cited by 2
Abstract
Vitamin A (all-trans-retinol), its active derivatives retinal and retinoic acid, and their synthetic analogues constitute the group of retinoids. It is obtained from diet either as preformed vitamin A or as carotenoids. Retinal plays a biological role in vision, but most [...] Read more.
Vitamin A (all-trans-retinol), its active derivatives retinal and retinoic acid, and their synthetic analogues constitute the group of retinoids. It is obtained from diet either as preformed vitamin A or as carotenoids. Retinal plays a biological role in vision, but most of the effects of vitamin A are exerted by retinoic acid, which binds to nuclear receptors and regulates gene transcription. Vitamin A deficiency is an important nutritional problem, particularly in the developing world. Retinol and carotenoids from diet during pregnancy and lactation influence their concentration in breast milk, which is important in the long term, not only for the offspring, but also for maternal health. In this study, we review the role of vitamin A in mammary gland metabolism, where retinoid signaling is required not only for morphogenesis and development of the gland and for adequate milk production, but also during the weaning process, when epithelial cell death is coupled with tissue remodeling. Full article
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Open AccessReview
What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?—A Narrative Review
Nutrients 2019, 11(5), 974; https://doi.org/10.3390/nu11050974 - 28 Apr 2019
Cited by 3
Abstract
Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological [...] Read more.
Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological intervention with medications used to augment lactation, commonly referred to as galactagogues, is common. Galactagogues exert their pharmacological effects through altering the complex hormonal milieu regulating lactation, particularly prolactin and oxytocin. This narrative review provides an appraisal of the existing evidence regarding the efficacy and safety of pharmaceutical treatments for lactation insufficiency to guide their use in clinical practice. The greatest body of evidence surrounds the use of domperidone, with studies demonstrating moderate short-term improvements in breast milk supply. Evidence regarding the efficacy and safety of metoclopramide is less robust, but given that it shares the same mechanism of action as domperidone it may represent a potential treatment alternative where domperidone is unsuitable. Data on remaining interventions such as oxytocin, prolactin and metformin is too limited to support their use in clinical practice. The review provides an overview of key evidence gaps and areas of future research, including the impacts of pharmaceutical galactagogues on breast milk composition and understanding factors contributing to individual treatment response to pharmaceutical galactagogues. Full article
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