Search Results (2,175)

Perinatal mental illness affects up to 20% of new mothers worldwide, yet despite a growing research interest over the past decade, the etiology is still not fully understood, and clinical treatment guidelines remain inconsistent across countries and services. In this review, recent findings on neurobiological processes and evolutionary mechanisms, as they occur during the menstrual cycle, pregnancy, birth, postpartum and breastfeeding, are discussed. The intention is to raise awareness of physiological changes in pregnancy that might be relevant to the differential diagnosis and clinical treatment of perinatal psychiatric disorders such as depression, anxiety, PTSD after childbirth, bipolar relapse, postpartum psychosis, obsessive-compulsive symptoms, substance-use disorders, and suicidality. Areas addressed include the activities of the immune system, thyroid gland, cortisol, sleep and individual sensitivity to ovarian hormone fluctuations. Evolutionary biological mechanisms intended to sustain pregnancy and to ensure the survival of the newborn are assumed to have potent effects on the maternal brain. These non-pathological adaptations could provide grounds for a better understanding of risk factors and the etiology of perinatal mental illness. Full article

Objectives: To assess maternal readiness for newborn self-care and its associations with breastfeeding readiness and psychophysical condition in early postpartum rooming-in care. Methods: This cross-sectional study included 200 women at 48–72 h postpartum. Maternal readiness was assessed with three 0–10 self-report scales: daytime newborn care, nighttime newborn care, and breastfeeding readiness. Psychometric, pain, anxiety, obstetric, haemoglobin, and haematocrit data were analysed using stepwise ordinal regression with bootstrap sensitivity analyses. Results: Breastfeeding readiness was the strongest correlate of daytime and nighttime caregiving readiness, with a marked and partially non-linear gradient (OR ≈ 13 for linear trend, p < 0.001). Higher anxiety on day 2 was associated with lower readiness across all domains (daytime care: OR = 0.61; nighttime care: OR = 0.69; breastfeeding: OR = 0.73; all p < 0.001). Daytime readiness was associated with sleep disturbance (lower readiness; OR = 0.63, p = 0.006) and goal-directed behaviour despite low mood (higher readiness; OR = 1.47, p < 0.001). Nighttime readiness correlated with concentration under emotional strain (OR = 1.63, p < 0.001) and was reduced in women reporting suicidal ideation (OR = 0.24, p = 0.012). Breastfeeding readiness was associated with greater current engagement in breastfeeding (OR = 1.90, p < 0.001) and higher parity (OR = 2.46, p = 0.002), while sleep disturbance was associated with lower readiness (OR = 0.69, p = 0.013). Somatic factors and social support were not independent predictors, while psychological variables showed stronger associations with readiness. Conclusions: Maternal readiness for newborn self-care is related to breastfeeding readiness but remains a distinct, psychologically shaped construct. These findings question the assumption that breastfeeding readiness reflects readiness for continuous newborn care. Assessment of maternal readiness may help identify support needs and guide flexible postpartum care. Full article

Background/Objectives: Gestational Diabetes Mellitus (GDM) involves metabolic alterations that may affect breast milk composition. Imbalances in protein and fatty acid (FA) profiles have been reported in mature milk from mothers with GDM. However, evidence for colostrum and transitional milk is limited, despite the key role of ω-3 and ω-6 Polyunsaturated fatty acids (PUFAs) in neonatal neurodevelopment. This study compared ω-3 and ω-6 PUFAs and protein concentrations in colostrum and transitional milk from women with and without GDM. Methods: This cross-sectional study was conducted from January 2023 to December 2024. Women aged ≥ 18 years with GDM and non-GDM pregnancies recruited at Hospital General de México “Dr. Eduardo Liceaga” were included. Colostrum and transitional milk samples were collected at 0–5 and 6–14 days postpartum, respectively. To assess whether postpartum time (hours) and maternal group (non-GDM vs. GDM) affected milk volume, an analysis of covariance (ANCOVA) was performed. Differences in milk composition between the GDM and non-GDM groups were assessed using Student’s t test or the Mann–Whitney U test, according to variable distribution. Results: A total of 71 milk samples were analyzed: 51 colostrum samples (25 from women with GDM and 26 from women with non-GDM) and 20 transitional milk samples (10 from women with GDM and 10 from women with non-GDM). A moderate correlation was observed between milk volume and postpartum time, with no significant differences between the GDM and non-GDM groups. Colostrum from women with GDM had lower protein content compared with milk from women with non-GDM (3.8 ± 0.4 vs. 5.2 ± 0.5 g/dL, p = 0.02) and transitional milk (1.4 ± 0.2 vs. 2.2 ± 0.2 g/dL, p = 0.02). Transitional milk from GDM group showed higher total fat (5.7 ± 1.8 vs. 2.0 ± 0.4 g/100 g, p = 0.05) and fat-to-protein ratio (3.9 ± 1.1 vs. 1.0 ± 0.3, p = 0.02), along with an increased ω-6/ω-3 ratio driven by higher linoleic acid and lower α-linolenic acid concentrations. Conclusions: GDM was associated with variations in breast milk protein and FA profiles with a potential negative impact on the newborn’s neurodevelopment. Full article

Human milk is widely recognised as the optimal source of nutrition for newborns and infants, providing not only an ideal macronutrient composition but also a range of bioactive components that exert important non-nutritional functions, and as such it represents the first functional food consumed in early life. Among these bioactive components, the human milk oligosaccharides (HMOs)—a structurally diverse family of glycans present in human milk at concentrations 100- to 1000-fold higher than in the milk of other mammalian species—have emerged as multifunctional contributors to the establishment of the intestinal microbiome, immune development, anti-infective defence, and epithelial barrier integrity during a developmental window characterised by immune immaturity. The aim of the present narrative review is to synthesise current evidence on the anti-infective properties of HMOs in infancy and to integrate, within a single framework, five interconnected mechanisms through which HMOs protect the infant against infection: glycan-mimicry-based competitive inhibition of pathogen adhesion, direct antimicrobial and antibiofilm activity, selective prebiotic shaping of the gut microbiome, modulation of innate and adaptive immune responses, and reinforcement of mucosal barrier integrity in the gut and lungs. Breastfeeding constitutes a natural strategy for anti-infective protection in early childhood, while infant formulas supplemented with biotechnologically produced HMOs that are structurally identical to those in human milk provide measurable benefits for non-breastfed infants. Full article

Introduction: Prelacteal feeding, the practice of giving newborns substances other than breast milk within the first few days of life, remains a common yet harmful practice in many low- and middle-income countries, including Ethiopia. No evidence in Ethiopia indicates that mHealth can help improve prelacteal feeding. This study aimed to evaluate the effect of mobile health (mHealth) intervention on reducing prelacteal feeding practices and improving antenatal care (ANC) and postnatal care (PNC) utilization among mothers in South Ethiopia. Methods: A cluster-randomized controlled trial (CRT) was conducted in rural areas of South Ethiopia. A total of 20 clusters were selected using simple random sampling for intervention (mHealth) and control groups, each containing 340 women. Mothers in the intervention group received automated weekly SMS messages and reminders on exclusive breastfeeding, prelacteal feeding risks, ANC, and PNC. Mothers were only selected if they could read, write, and use mobile phones. Results: The mHealth intervention significantly reduced prelacteal feeding practice (AOR = 0.19, 95% CI: 0.06–0.58); p < 0.05). Higher ANC visits related to decreased prelacteal feeding (AOR = 0.28, 95% CI: 0.21–0.39; p < 0.001). The log count of ANC visit increased by 0.14 among intervention groups (IRR = 1.15, 95% CI: 1.06–1.25; p < 0.001). The PNC time was delayed 2.05 days among controls (β = −2.05, 95% CI: −2.66–−1.42; p < 0.001). Maternal and partner education, postnatal time, and ANC visits influenced prelacteal feeding. Conclusions: This finding might suggest that mHealth can reduce prelacteal feeding practices and improve maternal healthcare behaviors such as ANC attendance and timely PNC. These findings highlight the potential of mobile health interventions in promoting healthy maternal and infant practices in rural settings, where healthcare access is limited. Further research is needed to explore the long-term impacts of such interventions on maternal and child health outcomes. Multi-level analysis reduced variability. However, an unexplained variance could be reduced by including more cluster-level variables. Full article

Background/Objectives: Nipple trauma is one of the most common complications during breastfeeding and may lead to pain, discomfort, and the premature cessation of lactation. This systematic review aimed to synthesize and critically appraise recent evidence (2020–2026), reflecting current clinical practices and emerging interventions, for the prevention and management of nipple trauma in breastfeeding women. The primary emphasis was on pain reduction and healing with a secondary consideration of their impact on breastfeeding continuation and duration. Methods: The review was conducted according to the PRISMA guidelines and included a literature search in the PubMed and Scopus databases. Primary research studies published between 2020 and 2026 focusing on interventions in breastfeeding women experiencing nipple trauma or nipple pain were included. A total of 22 studies met the inclusion criteria. Results: The interventions included the topical applications of natural products such as olive oil, expressed breast milk, coconut oil, beeswax-based products, and lanolin, nipple shields, and educational interventions focusing on correct breastfeeding techniques. The findings suggest that several of these interventions may reduce nipple pain and promote the healing of nipple trauma, while breastfeeding education and professional support appear to improve breastfeeding experience and continuation. Conclusions: The heterogeneity of the included studies highlights the need for further well-designed clinical research. Full article

Background/Objectives: Pregnant and breastfeeding people require special considerations for enrollment in clinical trials. However, the baseline proportion of cardiovascular clinical trials including pregnant and breastfeeding people remains unclear. The objective of this study was to characterize the representation of pregnant and breastfeeding people in cardiovascular randomized clinical trials (RCTs) and to determine whether inclusion has increased following the 2018 removal of pregnancy from the FDA’s “vulnerable population” designation. Methods: We screened eight high-impact general medicine and specialty journals for cardiovascular RCTs published between 1 January 2019 and 31 December 2023. We included RCTs examining pharmacological, behavioral, educational, device, or procedural interventions. We excluded RCTs that recruited exclusively male, pediatric, geriatric, or postmenopausal populations, and those specifically designed for obstetrical populations. We also excluded publications reporting follow-up or subgroup, pooled, or secondary analyses of previously published trials. Data from RCTs were independently extracted in duplicate following the PRISMA guidelines. We examined each RCT for pregnancy and breastfeeding inclusion criteria, rationale for exclusion, and contraception requirements. Results: Of 3764 citations identified, 586 met the inclusion criteria. In total, four (0.7%) RCTs permitted inclusion of pregnant people, 382 (65%) explicitly stated their exclusion, and 200 (34%) did not provide specific enrolment criteria for them. The few studies that explicitly stated exclusion of pregnant people (31/382, 8.1%) provided a rationale. 225 (38%) RCTs explicitly stated exclusion of breastfeeding people, and none explicitly permitted inclusion. There was no significant difference in the proportion of pregnant or breastfeeding people included or excluded from RCTs that began enrollment before 2018 versus after 2018. Conclusions: Pregnant and breastfeeding people are primarily excluded from cardiovascular RCTs, and the justification for their exclusion is rarely provided. Full article

Background: Breastfeeding benefits mothers and infants, and the promotion of breastfeeding is important. Feeding strategies include exclusive breastfeeding, feeding with both human milk and formula, and exclusive formula feeding. Objectives: This study was conducted to clarify the actual situation by assuming that mixed feeding comprises several groups with different characteristics. At the same time, the study also aimed to clarify the factors associated with breastfeeding. Methods: Single-term infants without underlying disease born at Tokyo Metropolitan Hospital between 2019 and 2024 participated in this study. The distribution of formula intake among infants receiving both human milk and formula was analyzed using a Gaussian mixture model, and the optimal number of distribution components was calculated using the Bayesian information criterion. Using linear regression analysis, factors associated with formula intake were identified. Results: A total of 2628 participants (exclusive breastfeeding, 842 (32.0%); mixed feeding with human milk and formula, 1496 (56.9%); and exclusive formula feeding, 290 (11.0%)) were included in the study. Linear regression analysis showed that the factors associated with amount of formula intake were late preterm birth (coefficient 39.7, p < 0.01), maternal age (reference under 30 y, age ≥ 30 y and <35 y coefficient 6.3, p = 0.66, age ≥ 35 y and <40 y coefficient 45.5, p < 0.01, age ≥ 40 y coefficient 106.9, p < 0.01) and delivery mode (cesarean section, coefficient 53.6, p < 0.01). Conclusions: Feeding strategies involving both human and formula milk are not homogeneous, and interventions should be developed based on these differences. Moreover, several factors were found to be associated with breastfeeding, which may help promote breastfeeding. Full article

Background: Breastfeeding is considered the optimal source of nutrition for infants admitted to Neonatal Intensive Care Units (NICUs). Despite these well-documented benefits, establishing and sustaining breastfeeding in NICU settings remains challenging due to inadequate uptake of breastfeeding support measures. This scoping review aimed to examine the evidence on factors influencing the uptake of breastfeeding support practices in NICUs. Methods: The search was undertaken across four electronic databases: PubMed, MEDLINE, CINAHL, and the Cochrane Library. Primary studies published in English between 1994 and 2025 were included. Eligible studies focused on factors influencing breastfeeding support, implementation, or uptake of breastfeeding-related interventions in NICU settings. Exclusion criteria included studies not involving NICU populations, studies not addressing breastfeeding outcomes or support, secondary literature, and non-English publications. A total of 30 peer-reviewed studies met the inclusion criteria. Data were charted and synthesized using thematic analysis. Results: A total of 30 studies met the inclusion criteria. Four major themes influencing breastfeeding support uptake in NICUs were identified: (1) institutional commitment to the Neonatal Baby-Friendly Hospital Initiative (Neo-BFHI), (2) NICU breastfeeding protocols and care practices, (3) breastfeeding training for NICU staff and mothers, and (4) parental breastfeeding motivation and family support. Across studies, breastfeeding support was strengthened by organizational breastfeeding policies, staff education, lactation support services, family-centred care practices, and parental involvement. However, variations in NICU resources, institutional practices, and staff support contributed to inconsistencies in breastfeeding implementation and continuation. Conclusions: Breastfeeding support in NICUs is influenced by interconnected organizational, clinical, educational, and psychosocial factors. The findings highlight the importance of integrated breastfeeding-supportive approaches that combine institutional commitment, standardized NICU practices, healthcare provider education, and family-centred care to improve breastfeeding support for vulnerable infants in NICU settings. Full article

Human milk is highly rich in miRNAs, with differential expression amongst its fractions, including cells, fat, and skim milk. Various factors, such as the stage of lactation or milk removal during breastfeeding, have been shown to influence the miRNA content of. Here, we sought to determine the effect of maternal and/or infant infection on the miRNA profile of cell and fat fractions analyzed using next-generation sequencing. Breastfeeding mother/infant dyads (n = 18) were followed during one or more infection episodes as well as upon recovery. Cells and fat together contain 1780 known miRNA species, which is the highest number of known miRNAs assayed in human body fluids to date. In addition, 592 novel miRNAs were predicted, of which 95 were of high confidence. Comparisons between samples collected when the participants were healthy and when infected yielded 453 differentially expressed (p < 0.05) known miRNAs. Of these, 70 were highly expressed and differentially regulated during infection, with 62 upregulated and 8 downregulated known miRNAs during infection. Most of the highly and differentially expressed miRNAs are known to play critical roles in immunity and immune system development. These findings support the use of miRNAs as biomarkers of the health status of the lactating breast and the breastfeeding mother/infant dyad. Full article

Background/Objectives: The practices that parents use to feed their infants have important implications for life course health and well-being. However, little is known about the infant feeding experiences and decisions of parents with developmental disabilities. This study used a mixed methods design to gain an in-depth understanding of the infant feeding experiences and decisions of parents with developmental disabilities in the United States. Methods: Between July 2024 and June 2025, 18 parents with developmental disabilities completed a one-time quantitative survey, seven of whom also completed three individual qualitative interviews. Analytical procedures included descriptive statistics of quantitative survey data and thematic analysis of qualitative interviews, followed by integration of the two forms of data. All interview participants completed member checking of preliminary themes. Results: Parents with developmental disabilities described varied experiences with breastfeeding, formula feeding, and introducing solid foods to their infants at around six months. Four disability-related factors influenced parents’ decisions across different infant feeding practices: (1) sensitivity to sensory stimuli; (2) demands on executive function; (3) “rigid thinking” about breastfeeding; and (4) medication use. Conclusions: Findings suggest parents with developmental disabilities may benefit from direct and customized support with infant feeding. Changes to improve access to disability-affirming care are warranted. Full article

Background/Objectives: Iron deficiency early in life can impair infant growth and cognitive development. Here, we follow infants’ plasma ferritin levels—an indicator of iron stores—over the first year of life and relate these to birth characteristics, maternal characteristics, and infant feeding. Methods: Children and their mothers enrolled in the Swedish birth cohort NICE (ClinicalTrials.gov identifier: NCT05809479) were followed from pregnancy to twelve months postpartum. Plasma ferritin was quantified in umbilical cord blood at birth (n = 345), in venous plasma at four months after birth (mother–infant dyads, n = 133), and at twelve months of age (n = 158), using sandwich ELISA. Perinatal and postnatal growth, together with infant and maternal characteristics, were extracted from medical birth records. Breastfeeding and formula feeding were assessed using repeated monthly questionnaires during the first year. Longitudinal changes were analyzed using linear mixed-effects models, and factors associated with ferritin concentrations were examined using Spearman correlations, linear regression models, and segmented generalized additive models. Results: The ferritin concentration declined over time (birth: 267 ng/mL; four months: 146 ng/mL; twelve months: 30 ng/mL). Boys had lower ferritin levels than girls at all timepoints. Ferritin status at four and twelve months was positively associated with ferritin concentrations in cord blood and with gestational age. Breastfeeding and formula feeding were not associated with ferritin concentrations. Conclusions: Infant sex, cord ferritin concentrations, and maternal ferritin concentrations were independently associated with infant ferritin concentrations across the first year of life, whereas neither breastfeeding nor formula feeding was associated with ferritin concentrations in the present analyses. Infant sex, cord ferritin, and maternal ferritin measured four months postpartum may help identify children at risk of low iron stores, with maternal ferritin potentially offering a less intrusive alternative to repeated infant sampling. However, the clinical relevance and potential use of maternal ferritin as a proxy for infant ferritin concentrations require further investigation. Full article

Background: Short sleep and formula feeding during infancy are associated with increased risk of childhood obesity. Feeding practices and sleep arrangements vary during infancy and may also be dynamic, yet their impact on infant night sleep duration remains unclear. Understanding these relationships is crucial for formulating recommendations to support breastfeeding and address sleep concerns. Objective: We examined the association between feeding mode and parent-reported infant night sleep duration during the first postnatal year, while additionally evaluating night-weaning and bedsharing as contextual sleep-related practices. Methods: Infants in the Phoenix Metropolitan Area (n = 193) were followed up at 3, 8, 13, 26, 39, and 52 weeks post-birth. Sleep and feeding questionnaires were answered at each visit. A multilevel growth model estimated infant night sleep duration trajectories by feeding mode (ordinal: exclusive formula, mixed, exclusive breastfeeding), night-weaning, and bedsharing as time-variant predictors. Maternal education and household income were covariates to account for differences in study attrition. Results: Infant night sleep duration followed a curvilinear trajectory, starting at 7.92 h (95% CI: 5.78, 10.06) and increasing by 0.40 h/month (95% CI: 0.21, 0.60), with a deceleration over time (0.02 h/month², p < 0.001). Each increase in levels of breast milk consumption was associated with an increase in infant night sleep duration (B = 0.87 h, p < 0.001), but the association weakened as the infant aged (B = −0.07 h/month, p < 0.001). Despite 59.7% of bedsharing infants being exclusively breastfed, bedsharing was not significantly associated with infant night sleep duration. Similarly, night-weaning was not significantly associated with infant night sleep duration. Conclusions: Breastfeeding is associated with longer infant night sleep duration, whereas bedsharing showed no association despite its correlation with breastfeeding. This research highlights the importance of breastfeeding in early life, not only for its developmental benefits but also for its relationship with infant night sleep duration, an essential component of healthy infant growth. Full article

Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6–11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health. Full article

Nutrition in the early years of life plays a fundamental role in newborn growth, immune maturation, metabolic regulation, endocrine signaling, and neurological development, specifically through its interaction with the developing gut microbiota. Breast milk is the biological gold standard for infant nutrition; however, when breastfeeding is not possible, the development of formulations supplemented with bioactive substances can improve functional outcomes in comparison to standard milk formula. This narrative review discusses current evidence on formulas enriched with prebiotics, probiotics, postbiotics, synbiotics, human milk oligosaccharides, and other bioactive molecules. The review focuses on gut microbiota modulation, gastrointestinal function, growth and nutritional adequacy, immune development, infection-related outcomes, safety and tolerability, endocrine signaling, intestinal stem-cell regulation, obesity-related metabolic pathways, and emerging gut–brain axis interactions. Overall, available data indicate that bioactive-supplemented formulas are generally safe, well tolerated, and able to support normal growth, including in selected infants with specific clinical conditions. The most consistent effects are observed in the gastrointestinal tract, where supplementation promotes a more bifidogenic microbial profile, improves stool characteristics, supports intestinal barrier function, and influences microbial metabolic activity. By contrast, evidence regarding systemic immune effects, endocrine modulation, obesity prevention, and neurodevelopmental outcomes remains promising but heterogeneous and is still largely derived from preliminary human studies and experimental models. Therefore, these formulas may be considered a useful option when breastfeeding is not feasible, provided that their use is clinically appropriate and evidence based. Further studies are needed to clarify their long-term functional and clinical implications. Full article