Search Results (92)

Background/Objectives: Cesarean delivery often leads to delayed breastfeeding initiation, potentially affecting infant health compared with vaginal delivery. This prospective observational study (conducted between August 2022 and January 2024) comparatively evaluates the impact of delivery method—vaginal, planned cesarean, and emergency cesarean—on breastfeeding initiation and continuation and examines the maternal factors influencing these outcomes. Materials and Methods: We enrolled 338 mother–infant pairs at a tertiary university hospital. Breastfeeding effectiveness was assessed using the Bristol Breastfeeding Assessment Tool (BBAT) at birth and at one, three, and six months postpartum. Rates of breastfeeding continuation and formula supplementation were documented through structured interviews. Results: The mothers who delivered vaginally had a significantly higher rate of breastfeeding within one hour after birth (85.5%) compared with planned (57.9%) and emergency cesarean sections (64.9%) (p < 0.001). Baseline BBAT scores were higher for vaginal births but converged across the groups by one month postpartum (p > 0.05). At six months, breastfeeding continuation rates remained high (94.4–95.2%) irrespective of delivery method. Conclusions: Delivery method exerts a transient effect on breastfeeding initiation. With lactation support, the mothers delivering by cesarean section achieved comparable breastfeeding outcomes within the first month postpartum. These findings reinforce the importance of Baby-Friendly Hospital Initiative (BFHI) practices, including immediate skin-to-skin contact, effective pain management, and lactation counseling, in ensuring equitable breastfeeding outcomes. Full article

Gender-specific cardiology has gained increasing recognition in recent years, emphasizing the need for tailored management strategies for women with cardiovascular disease. Among these, cardiomyopathies—dilated, arrhythmogenic, hypertrophic, and restrictive—pose unique challenges throughout a woman’s reproductive life, affecting contraception choices, pregnancy outcomes, and breastfeeding feasibility. Despite significant advances in cardiovascular care, there is still limited guidance on balancing maternal safety and neonatal well-being in this complex setting. This review provides a comprehensive overview of the current evidence on reproductive counseling, pregnancy management, and postpartum considerations in women with cardiomyopathies. We discuss the cardiovascular risks associated with each cardiomyopathy subtype during pregnancy, highlighting risk stratification tools and emerging therapeutic strategies. Additionally, we address the safety and implications of breastfeeding, an often overlooked but increasingly relevant aspect of postpartum care. A multidisciplinary approach involving cardiologists, gynecologists, obstetricians, and anesthesiologists is crucial to optimizing maternal and fetal outcomes. Improved risk assessment, tailored patient counseling, and careful management strategies are essential to ensuring safer reproductive choices for women with cardiomyopathy. From now on, greater attention is expected to be given to bridging existing knowledge gaps, promoting a more personalized and evidence-based approach to managing these patients throughout different stages of reproductive life. Full article

Late-preterm (34^0/7–36^6/7 weeks) and early-term (37^0/7–38^6/7 weeks) newborns were, up until recently, erroneously categorized as low-risk and were conflated with full-term (39^0/7–40^6/7 weeks) deliveries. However, emerging evidence refuted this notion and demonstrated that late-preterm and, to a lesser extent, early-term newborns have a significantly higher risk of experiencing various neonatal morbidities, including respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, jaundice, hypoglycemia, and breastfeeding difficulties, compared to their full-term counterparts—reflecting their relative physiologic and developmental immaturity. Recent evidence also unravels the lingering adverse effects of late-preterm and early-term delivery up until mid-adulthood, with the increased susceptibility of these newborns to neurodevelopmental delays, behavioral and neuropsychiatric problems, and adult chronic diseases. Moreover, apart from increased neonatal and infant mortality rates, these newborns continue to encounter a heightened risk of mortality even up to mid-adulthood. As the full spectrum of the complications these newborns face is gradually being unveiled, this review presents and discusses the current knowledge base, identifies gaps in the literature, and highlights future research implications. Full article

Background/Objectives: Despite high breastfeeding initiation rates nationwide, disparities in breastfeeding continuation among Black mothers remain a public health issue. The BreastFeed Iowa Black Immigrant Project aimed to improve breastfeeding rates among low-income Black immigrant mother-infant dyads in Johnson County, Iowa by exploring factors influencing breastfeeding retention and developing a framework for culturally sensitive breastfeeding interventions. Methods: Using a descriptive cross-sectional study design, we employed a convergent, parallel mixed-methods approach to explore factors that influence breastfeeding duration among Black immigrant mothers with children 0–2 years old. Nine focus group discussions (FGDs) were conducted on Zoom among 40 participants with a semi-structured guide on breastfeeding beliefs, experiences, and feeding practices. Additionally, a 22-item survey was administered to 33 participants. Results: Based on the survey, one out of five participants indicated that they were unable to breastfeed for as long as they had planned. The top five reasons why mothers stopped breastfeeding included having received formula from the Supplemental Nutrition Program for Women, Infants and Children; being sick and having to take medicine; the baby was hungry too often; the baby was sick and could not breastfeed; and not producing enough milk. The top five themes that emerged from FGDs as barriers to breastfeeding included lack of lactation support, knowledge gaps on breastfeeding benefits, perception of inadequate milk supply, lack of comfort with breast milk expression, and work-related barriers. Conclusions: The community needs assessment identified the elements needed to develop a culturally sensitive framework with targeted interventions to address breastfeeding barriers in the Black immigrant community. Full article

Background: Human milk (HM) provides critical immunological support to neonates, serving as a key component of passive immunity during early life. Objectives: The main aim of this cohort study was to compare the concentrations of lactoferrin (Lf), secretory immunoglobulin A (SIgA), C-reactive protein (CRP), and their ratios to total protein levels in the colostrum of postpartum women infected with SARS-CoV-2 and healthy controls. Methods: Colostrum samples (3–5 mL) were collected from 40 mothers (20 infected, 20 healthy) during the first wave of the COVID-19 pandemic in Poland. Concentrations of Lf, SIgA, and CRP were analyzed using ELISA, and total protein content was measured using the bicinchoninic acid assay (BCA). Results: The presence of specific anti-SARS-CoV-2 SIgA antibodies was assessed via cassette serological lateral flow detection tests. Significant differences were observed in Lf (p = 0.04) and SIgA (p = 0.03) concentrations, both lower in the COVID-19 group. Lactoferrin medians were 12.30 g/L (infected) and 14.95 g/L (healthy), and for SIgA: 9.15 g/L vs. 15.01 g/L, respectively. No significant difference was found in CRP levels. Interestingly, the Lf/Protein ratio was significantly higher in the infected group (p = 0.03), whereas the SIgA/Protein ratio did not differ. Furthermore, 75% of infected mothers had positive anti-SARS-CoV-2 SIgA results. These mothers also showed a higher Lf/Protein ratio. Among healthy controls, 90% had negative test results. Conclusions: These findings suggest a potential compensatory role of lactoferrin in the nonspecific immune response to SARS-CoV-2, though stress-related reductions in SIgA levels cannot be excluded. Full article

Background/Objectives: The number of children with overweight and obesity is gradually increasing worldwide. This is an emergent public health problem as overweight and obesity persist through the next stages of human life, being associated with high risk of morbidity and mortality. In this respect, the purpose of the current cross-sectional survey is to explore whether the overweight/obesity of children aged 6–9 years may be related to the risk of developing perceived stress and poor sleep quality symptoms. Methods: This study recruited 4350 primary school children from diverse Greek rural and urban regions. The mothers of the enrolled children completed relevant questionnaires on children and maternal sociodemographics, anthropometric parameters, perinatal outcomes, breastfeeding practices, and lifestyle factors. The enrolled mothers also completed the Perceived Stress Scale (PSS) and the Pittsburgh Sleep Quality Index (PSQI) to evaluate the perceived stress and sleep quality of their matched children, respectively. Results: Our analysis reveals independently significant associations between diverse factors and children’s overweight/obesity such as child’s gender, family economic status, maternal gestational weight gain, childbirth weight, kind of delivery, exclusive breastfeeding, and children physical activity. Childhood overweight and obesity were independently associated with a more than three-fold higher risk of perceived stress and a more than two-fold higher likelihood of poor sleep quality after adjustment for multiple confounding factors. Conclusions: Obesity and overweight are related to enhanced risk of perceived stress and poor sleep quality in children aged 6–9 years. Public policies and dietary counseling interventions should be applied to inform new mothers about the harmful effects of childhood overweight/obesity and to direct them to adopt healthy dietary practices for their children. Full article

Background: Almost half of all deaths worldwide in children under five are related to malnutrition. Malnutrition encompasses a wide array of nutritional conditions and emerging evidence indicates a growing overlap of these different forms of malnutrition. Nutrimetry, which combines assessments of height-for-age (HAZ) with BMI-for-age (BMIZ) to offer a more integrated assessment of nutritional status, can be particularly useful in low-resource settings to correctly reflect the complex interplay of stunting and overweight. Objective: The objective of this study is to explore the impact of malnutrition on children in Madagascar and demonstrate how integrating HAZ assessments with BMIZ can reveal the double burden of malnutrition—encompassing both undernutrition and overnutrition—within the same population. Methods: This cross-sectional observational study employing Nutrimetry was carried out in rural communities in the Itasy region of Madagascar. A systematic random sampling method was used to choose the 500 women to invite to participate from the approximately 5000 who formed the pool of potential participants. A total of 437 were able to be invited and all invited women agreed to participate, resulting in 437 mother–child (0–24 months) pairs being included in the study. Results: Chronic undernutrition or thinness (31.6%), overweight and obesity (21.3%), and stunting (57.6%) were prevalent among the children included in the study. Among children with chronic undernutrition, 55.06% were identified as stunted. Among children with overweight or obese, 61.03% were identified as stunted. This highlights a significant overlap between inadequate weight and stunting. A socioeconomic analysis revealed significant barriers, including limited financial resources and poor dietary diversity, exacerbating malnutrition. Maternal nutritional status and breastfeeding practices also emerged as critical determinants of child nutritional outcomes. Conclusions: The study underscores the importance of prioritizing height assessments as a preliminary step in nutritional evaluations to prevent undetected acute malnutrition. Full article

The increasing global burden of allergic diseases and multimorbidity underscores the urgent need for innovative strategies to strengthen immune health. This review explores the complex relationships among nutrition, gut microbiota, immune regulation, allergic diseases, and multimorbidity. It highlights how targeted nutritional and microbial interventions may influence disease outcomes. Dietary components and microbial metabolites dynamically modulated immune function, highlighting the critical role of the gut–immune–metabolism axis in disease pathogenesis and management. Personalized nutrition, guided by advances in diagnostics such as component-resolved diagnostics, basophil activation tests, and epigenetic biomarkers, allows for precise dietary interventions tailored to individual allergy phenotypes and multimorbidity profiles. The Mediterranean diet, breastfeeding, and microbiota-targeted therapies have emerged as effective strategies to enhance immune resilience, reduce inflammation, and manage allergic reactions. Technological advancements, including artificial intelligence-driven dietary assessments, wearable devices, and mobile applications, have further revolutionized personalized dietary management, enabling real-time, precise nutritional monitoring and intervention. Despite these advances, challenges in implementing personalized nutrition persist, including variability in dietary patterns, cultural and socioeconomic factors, and accessibility concerns. Future research should focus on long-term interventional and longitudinal studies to validate precision nutrition strategies and enhance clinical applicability. This integrative approach, combining nutrition, microbiome science, technology, and personalized healthcare, holds substantial promises for sustainable disease prevention and enhanced immune resilience across diverse populations. Full article

Gestational diabetes mellitus (GDM) leads to increased lifelong cardiometabolic risk in both mothers and their offspring. The identification of effective strategies to contain the future risk of type 2 diabetes (T2D) and cardiovascular disease (CVD) is of utmost importance to reduce the burden of the disease. Breastfeeding (BF) is effective in reducing short- and long-term child morbidity. In recent years, BF has emerged as a candidate low-cost intervention to prevent future cardiometabolic complications both in mothers and infants exposed to GDM. The aim of this review is to provide an overview of the evidence about the possible metabolic benefits of BF for both mothers with a history of GDM and their offspring. Increasing evidence supports the positive effects of exclusive BF over formula feeding (FF) or mixed feeding on glucose homeostasis and the lipid profile in women with previous GDM in the early postpartum period. Studies with a longer observation suggest clear benefits of intensive and longer BF on the risk of diabetes and prediabetes in mothers after adjustment for confounders. In regards to infants, in most studies, the intensity and duration of BF are positively associated with slower infant growth curves compared with FF, indicating that the positive effect of BF on growth trends might contrast the increased risk of obesity and metabolic diseases observed in infants exposed to GDM. Considering these findings, a global effort should be made to support BF practice to possibly reduce cardiometabolic morbidity after GDM. Full article

Breastfeeding after kidney transplantation remains a complex and underexplored topic, primarily due to concerns regarding the safety of immunosuppressive therapies during lactation. Individuals who have received kidney transplants face a higher likelihood of delivering preterm infants and giving birth to babies with a low birth weight when compared with the general population. In this context, breastfeeding is increasingly important because of its advantages for preterm infants. Despite the well-established benefits of breastfeeding for both the mother and infant, the traditional recommendation has been to avoid nursing due to potential drug transmission through breast milk. However, emerging evidence suggests that certain immunosuppressants may be compatible with breastfeeding, challenging long-standing clinical guidelines. In this review, we examine the current literature on the pharmacokinetics, safety profiles, and clinical outcomes associated with key immunosuppressive agents, including cyclosporine, tacrolimus, everolimus, azathioprine, corticosteroids, and belatacept. Our work highlights that all published reports to date on the studied treatments indicate that the amount of the drug reaching breast milk is considered safe for the child’s health. These conclusions, however, are derived from very short-term measurements and small numbers of patients. Therefore, we emphasize the need to design structured prospective studies to assess safety in the medium and long term. Our review aims to equip clinicians with the most up-to-date evidence on this topic, enabling them to make informed decisions regarding the compatibility of post-kidney transplant treatments with breastfeeding. Full article

Aim: This article aims to explore the role of the human gut microbiota (GM) in the pathogenesis of neurological, psychiatric, and neurodevelopmental disorders, highlighting its influence on health and disease, and investigating potential therapeutic strategies targeting GM modulation. Materials and Methods: A comprehensive analysis of the gut microbiota’s composition and its interaction with the human body, particularly, its role in neurological and psychiatric conditions, is provided. The review discusses factors influencing GM composition, including birth mode, breastfeeding, diet, medications, and geography. Additionally, it examines the GM’s functions, such as nutrient absorption, immune regulation, and pathogen defense, alongside its interactions with the nervous system through the gut–brain axis, neurotransmitters, and short-chain fatty acids (SCFAs). Results: Alterations in the GM are linked to various disorders, including Parkinson’s disease, multiple sclerosis, depression, schizophrenia, ADHD, and autism. The GM influences cognitive functions, stress responses, and mood regulation. Antibiotic use disrupts GM diversity, increasing the risk of metabolic disorders, obesity, and allergic diseases. Emerging therapies such as probiotics, prebiotics, and microbiota transplantation show promise in modulating the GM and alleviating symptoms of neurological and psychiatric conditions. Conclusions. The modulation of the GM represents a promising approach for personalized treatment strategies. Further research is needed to better understand the underlying mechanisms and to develop targeted therapies aimed at restoring GM balance for improved clinical outcomes. Full article

Although global neonatal mortality rates have significantly decreased, Black infant mortality in the US continues to be a major issue. This study identifies, assesses, and illustrates women’s views on infant mortality and the resources needed to address the problem. Women of diverse demographic backgrounds were recruited via purposive sampling, with 91 participating. Seventy percent of participants were aged 18 to 39 (n = 64), and forty three percent lived in Indiana (n = 39). Access to care, sleeping issues, supporting breastfeeding, awareness, affordability challenges, healthcare provider factors, and creating sustainable programs and policies to address infant mortality emerged as prominent themes in the data. This study highlights the importance of cultural congruency in addressing maternal and child health issues, emphasizing the need for stakeholder involvement to ensure interventions are acceptable, practical, and sustainable. Full article

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices in breastfeeding healthy, sick and preterm babies. The research was organized as a systematic search in PubMed and the study was performed as a narrative review after applying the PRISMA protocol. Finally, n = 57 studies were included. Both barriers and support factors emerge as a complex interaction of individual, group and societal factors, the precise understanding of which is relevant to increasing breastfeeding rates in the future. Knowledge as well as practical skills proved to be generally helpful, whereas the lack of breastfeeding support for mothers, who are often separated from their premature babies in hospital, was identified as a key risk factor for this subgroup. Appropriate training for healthcare professionals can improve the situation as a result. After discharge, workplace-related barriers are of major concern to allow further breastfeeding when maternity leave ends. Thus, the promotion of breastfeeding must be perceived as a task for society as a whole. Full article

Infantile occult exposure to cocaine in domestic environments represents a complex clinical and medico-legal problem, which can be associated with abuse and neglect and with potential short- and long-term health risks for children. The authors present a retrospective study on 764 children under 14 years old who accessed the Emergency Department of IRCCS Meyer from 2016 to 2023 and were included in the GAIA (Child and Adolescent Abuse Group) protocol for suspected maltreatment and abuse, and for which a urine toxicology analysis was performed. The aim is to discuss the medico-legal implications and highlight the need for a thorough evaluation and management of such situations. Urine screening tests for substances of abuse (e.g., cocaine, opiates, etc.) were performed with an EMIT^® Siemens VIVA-E drug testing system (Siemens, Newark DE) in 124 cases for which the child’s clinical condition raised suspicion of intoxication, or the family context indicated distress or substance abuse dependency. The screening results revealed the presence of cocaine and its main metabolite, benzoylecgonine, in the urine of 11 children. In one case, a single girl was brought to the Emergency Department by staff from the facility where she and her mother were staying. In most of the cases, children were brought to the Emergency Department by their parents who accessed the Emergency Department due to various clinical manifestations (drowsiness, agitation, seizures, hypotonia, diarrhea, vomiting, etc.), except for one case of eye trauma suspected to be caused by abuse or neglect by one of the parents. Three of the children did not have signs or symptoms attributable to substance exposure, whilst eight of the cases presented some of the symptoms associated with occult infant exposure to cocaine, such as neurological manifestations, seizures, gastrointestinal symptoms, and respiratory depression. The probable mode of intake was mostly through breastfeeding and continuous environmental exposure due to domestic contamination or inhalation of “crack”. In the case of a 12-hour-old infant, there was probable prenatal in utero exposure. All the children were hospitalized, some for medical reasons and others solely as a precautionary measure for proper care. In all cases, a report was made to the Prosecutors as required by the Italian Penal Code, as well as to the Court of Minor. The study highlighted the importance of a multidisciplinary approach involving pediatricians, social workers, and forensics, as well as close collaboration with the relevant authorities, as the Gaia service at IRCCS Meyer offers. The occasional detection of cocaine in cases that showed no suspicion of intoxication led to a modification of the procedure and the development of a standardized protocol at IRCCS Meyer both in terms of prevention and in the detection and interception of hidden cases, in order to intervene early and initiate the necessary care pathways (secondary prevention). This protocol includes routine toxicological urine testing in all suspected or confirmed cases of child abuse, not just in those where symptoms might suggest a suspicion of intoxication. Full article

The postpartum period represents a critical phase of profound transition for women. This timeframe encompasses the physical recuperation associated with childbirth, the intricate psychosocial adjustments inherent in assuming the role of motherhood and also important alterations in steroid and peptide hormones. Hence, as women navigate the reconfiguration of relationships and strive to address the diverse needs of their infants and family members, they concurrently grapple with dramatic transformations which are characteristic of the postpartum phase. In fact, relevant prevalence ranges are reported for maternity blues, a mild condition characterized by self-limited and transient depressive symptoms, but also a well-established risk factor for more serious postpartum mood disorders, such as depression (PPD), with an incidence of 10–15%. Unlike in the US, at the European level, there are no concrete recommendations for the routine integration of the assessment of the mother’s emotional state by healthcare professionals, with a considerable risk of underdiagnosing or undertreating these conditions. In this regard, there is a growing body of scientific evidence on the important role of breastfeeding in reducing the risk of PPD and also of the importance of mothers’ compliance with this practice. Indeed, sucking the baby regulates the circadian rhythm of the HPA axis and, together with the action of prolactin, the stress response is decreased. In addition, other positive consequences of breastfeeding, which are inversely correlated with the onset of PPD, include the regulation of sleep and waking patterns for mother and baby, the improvement of the mother’s self-efficacy and her emotional involvement. It should also be considered that the request for support for breastfeeding can often conceal a request for support for motherhood itself and for the mother’s emotional well-being. It therefore emerges that the personnel involved in primary pediatric care to provide adequate support in the transition to motherhood must support mothers in their breastfeeding choices, whether breastfeeding or formula feeding, so that each choice is made conscientiously and serenely. Therefore, neonatal feeding assumes a decisive role, since if, on the one hand, it regulates specific neurohormonal pathways that are protective for maternal emotional well-being (breastfeeding), on the other hand, support in mothers’ breastfeeding choices, even in the case of formula feeding, means validating their being mothers in the absence of judgement and counteracting any feelings of inadequacy, conditions that are inversely correlated to DPP. Full article