Search Results (401)

Human milk bacteria contribute to gut microbiome establishment in breastfed infants. Although breastfeeding is recommended throughout infancy, temporal variation in the milk microbiome—particularly beyond solid food introduction—remains understudied. We analyzed 539 milk samples from 83 mother–infant dyads between 1 week and 12 months postpartum using full-length 16S rRNA gene sequencing. The microbiota was dominated by Streptococcus (34%), Cutibacterium (12%), and Staphylococcus (9%), with marked inter-individual variation. Microbiome profiles remained largely stable across lactation, with only six taxa showing temporal fluctuations, including increases in typical oral bacteria such as Streptococcus salivarius, Streptococcus lactarius, Rothia mucilaginosa, and Granulicatella adiacens. Richness and evenness were higher at 1 week compared to 1 month postpartum (p = 0.00003 and p = 0.007, respectively), then stabilized. Beta diversity also remained stable over time. Maternal pre-pregnancy BMI was positively associated with Gemella haemolysans (p = 0.016), while Haemophilus parainfluenzae was more abundant in milk from mothers with allergies (p = 0.003) and those who gave birth in autumn or winter (p = 0.006). The introduction of solid food was linked to minor taxonomic shifts. Overall, the milk microbiome remained robustly stable over the first year of lactation, with limited but notable fluctuations in specific taxa. This study supports the role of human milk as a consistent microbial source for infants and identifies maternal BMI, allergy status, and birth season as key variables warranting further investigation. Full article

Background: Postoperative pain management after a cesarean section remains a significant challenge, as inadequate control can delay maternal recovery and hinder early bonding and breastfeeding. While multimodal analgesia is the standard approach, non–pharmacological strategies like immediate skin–to–skin contact (SSC) are often underused despite their potential benefits in reducing pain, improving uterine contractions, and increasing maternal satisfaction. Objective: To evaluate the effects of immediate SSC on postoperative pain perception, uterine contraction quality, and maternal satisfaction, and to explore ways to incorporate SSC into routine post–cesarean care to promote recovery and humanized care. Method: A randomized clinical trial was conducted with 80 women undergoing elective cesarean sections, divided into two groups: SSC (40 women) and control (40 women). Postoperative pain was measured using the Visual Analog Scale (VAS) at various intervals, while uterine contraction quality and maternal satisfaction were assessed through clinical observation and a Likert scale, respectively. Results: We found that women in the SSC group experienced significantly lower pain scores (VAS2 and VAS3, p < 0.001), stronger infraumbilical uterine contractions (92.5%, p < 0.001), and higher satisfaction levels (average 9.98 vs. 6.50, p < 0.001). An inverse correlation was observed between pain intensity and satisfaction, indicating that SSC enhances both physiological and psychological recovery. Conclusions: Immediate SSC after cesarean is an effective, humanizing intervention that reduces pain, supports uterine contractions, and boosts maternal satisfaction. These findings advocate for integrating SSC into standard postoperative care, aligning with ethical principles of beneficence and autonomy. Further research with larger samples is necessary to confirm these benefits and facilitate widespread adoption in maternity protocols. Full article

Obesity is a multifactorial condition that influences metabolic, endocrine, inflammatory, circadian, and behavioral systems. These disruptions can adversely affect the initiation of lactogenesis II—the critical process marking the onset of copious milk secretion following childbirth. In mothers with obesity, prolonged inflammation within the mammary gland, a blunted hormonal response (notably of prolactin), altered progesterone and estrogen dynamics, high leptin levels, and misaligned circadian rhythms contribute significantly to delayed lactogenesis. In addition, mechanical difficulties and psychological factors further hinder effective breastfeeding. This report synthesizes evidence from human epidemiological studies and animal models that elucidate the diverse mechanisms linking maternal obesity to delayed lactogenesis. We review the role of obesity-associated inflammatory mediators in impairing mammary tissue remodeling, the endocrine aberrations that impair lactogenic signaling, the consequences of circadian disruption on hormonal rhythmicity, and the behavioral influences that challenge effective breastfeeding. Finally, we discuss the clinical implications of these findings and propose future research directions targeting endocrine modulation, anti-inflammatory therapy, circadian interventions, and enhanced lactation support strategies for mothers with obesity. Full article

Discourses on breastfeeding extend beyond simple scientific evidence, framed within a dialogue between diverse sociocultural perspectives throughout history. Building on this premise, this article aims to explore, from the perspective of the sociology of deviance, the maternal experiences of women who choose not to breastfeed or cease breastfeeding within the hospital setting. To this end, this qualitative and phenomenological study was conducted, using semi-structured interviews with mothers in the municipality of Lorca who had decided not to breastfeed or had discontinued breastfeeding as a data collection tool. The results indicate that breastfeeding is influenced by the repercussions of delivery room routines and a challenging learning process where complications often arise, contradicting the prevailing innatist discourse of maternal instinct. Within this framework, mothers feel pressured by professionals to breastfeed, and their identities are undermined by symbolic stigma when they express their decision not to breastfeed. We conclude that it is essential to propose clinical approaches and support models that genuinely consider the sociocultural, historical, and experiential factors influencing breastfeeding, moving beyond an exclusive focus on its biological or nutritional aspects. Full article

Background/Objectives: Breastmilk offers numerous benefits for the health and development of preterm infants, while prolonged hospitalization may impair neurodevelopment. At our institution, the implementation of enhanced family-centered care (FCC) has enabled earlier discharge of preterm infants. This study aimed to assess the impact of early discharge on breastfeeding and breastmilk provision. Methods: This analysis is based on data from a prospective single-center longitudinal cohort study conducted from October 2020 to November 2023, involving six consecutive cohorts (one baseline and five intervention cohorts; n = 184). FCC was progressively enhanced across cohorts. The primary outcome of the main study was postmenstrual age (PMA) at discharge. In this secondary analysis, breastfeeding and breastmilk provision were assessed at four time points: 4 weeks postnatal age, at discharge, 4 weeks post-discharge, and at 3 months PMA. Results: From baseline to intervention cohort 5, the PMA at discharge declined significantly from 37.8 ± 2.1 to 35.7 ± 0.91 weeks (p = 0.03), while the percentage of infants necessitating home nasogastric tube feeding increased from 6.3% to 66.7% (p < 0.01). The proportion of breastmilk of daily feeding volume remained unchanged at 4 weeks postnatal age (0.66 ± 0.42 vs. 0.9 ± 0.28) and at discharge (0.6 ± 0.45 vs. 0.79 ± 0.36). At 4 weeks post-discharge, 65.8% vs. 62.5% of the infants were on partial or exclusive breastmilk (p = 0.91) feeding. Similarly, the percentage of exclusively breastfed infants at 4 weeks post-discharge (23.7% vs. 19.8%) and at 3 months PMA (20% vs. 28.6%) did not differ significantly between baseline and intervention cohort 5. Conclusions: Early discharge did not reduce breastmilk supply or exclusive breastfeeding. However, the persistently low rate of exclusive breastfeeding post-discharge highlights the need for additional support strategies during and after hospitalization. Full article

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

Pregnancy-related discrimination at work is a concern for many employees who navigate the pregnancy and postpartum stages of parenthood while working in the early-to-middle stages of their careers. Although there is legislation prohibiting pregnancy-related discrimination and ensuring accommodations postpartum, empirical evidence indicates many pregnant and postpartum employees still experience such behaviors. In this narrative review, we focus on describing the range of behaviors assessed in studies on pregnancy-related discrimination in several cultures, situating the occurrence of discrimination within theoretical frameworks related to stereotypes and gendered expectations. We also review evidence of employees’ postpartum experiences with a focus on the transition back to work, along with breastfeeding challenges related to pumping and storing milk at work. Regarding coping with pregnancy-related workplace discrimination and postpartum challenges during a return to work, we review the importance of social support, including instrumental and emotional support from allies and role models. Full article

Background and Objective: Large language model (LLM)–based chatbots are increasingly utilized by postpartum individuals seeking guidance on breastfeeding. However, the chatbots’ content quality, readability, and alignment with clinical guidelines remain uncertain. This study was conducted to evaluate and compare the quality, readability, and factual accuracy of responses generated by three publicly accessible AI chatbots—ChatGPT-4o Pro, Gemini 2.5 Pro, and Copilot Pro—when prompted with common maternal questions related to breast-milk supply. Methods: Twenty frequently asked breastfeeding-related questions were submitted to each chatbot in separate sessions. The responses were paraphrased to enable standardized scoring and were then evaluated using three validated tools: ensuring quality information for patients (EQIP), the simple measure of gobbledygook (SMOG), and the global quality scale (GQS). Factual accuracy was benchmarked against WHO, ACOG, CDC, and NICE guidelines using a three-point rubric. Additional user experience metrics included response time, character count, content density, and structural formatting. Statistical comparisons were performed using the Kruskal–Wallis and Wilcoxon rank-sum tests with Bonferroni correction. Results: ChatGPT-4o Pro achieved the highest overall performance across all primary outcomes: EQIP score (85.7 ± 2.4%), SMOG score (9.78 ± 0.22), and GQS rating (4.55 ± 0.50), followed by Gemini 2.5 Pro and Copilot Pro (p < 0.001 for all comparisons). ChatGPT-4o Pro also demonstrated the highest factual alignment with clinical guidelines (95%), while Copilot showed more frequent omissions or simplifications. Differences in response time and formatting quality were statistically significant, although not always clinically meaningful. Conclusions: ChatGPT-4o Pro outperforms other chatbots in delivering structured, readable, and guideline-concordant breastfeeding information. However, substantial variability persists across the platforms, and none should be considered a substitute for professional guidance. Importantly, the phenomenon of AI hallucinations—where chatbots may generate factually incorrect or fabricated information—remains a critical risk that must be addressed to ensure safe integration into maternal health communication. Future efforts should focus on improving the transparency, accuracy, and multilingual reliability of AI chatbots to ensure their safe integration into maternal health communications. Full article

Background: The Baby-Friendly Hospital Initiative (BFHI) promotes, protects, and supports optimal breastfeeding through facility-based strategies. While prior studies have examined individual BFHI components in specific contexts, global evidence on its overall impact remains limited. This systematic review and meta-analysis aimed to evaluate the BFHI’s effectiveness in improving early initiation and exclusive breastfeeding practices worldwide. Methods: A comprehensive search was conducted in PubMed, Web of Science, Scopus, and Google for English-language studies. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-experimental designs assessing BFHI’s effect on breastfeeding outcomes. Random-effects meta-analysis models were used to estimate the pooled effects with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistics and p-values. Study quality was appraised using the GRADE approach. Results: Thirty studies met the inclusion criteria. The BFHI was associated with increased early initiation of breastfeeding (pooled RR 1.43; 95% CI: 1.12–1.81; I² = 97.1%). Positive associations were also observed for exclusive breastfeeding at four months (RR 1.18, 95% CI: 1.08–1.29; I² = 61.7%) and at six months (RR 1.56, 95% CI: 1.14–2.14; I² = 82.8%). Substantial heterogeneity reflected variability in study design, BFHI implementation fidelity, and context. Conclusions: Our findings suggest that the BFHI is effective in improving breastfeeding practices globally. However, study variability and partial implementation may limit the generalizability of results. High-quality RCTs assessing full BFHI implementation are needed to strengthen evidence and guide global maternal–child health policy. Full article

Background/Objectives: The under-five mortality rate (U5MR) remains a serious health challenge in Indonesia, with low birth weight (LBW) being a key risk factor. This study aimed to identify predictors of survival among under-five children with LBW using data from the 2017 Indonesia Demographic and Health Survey (IDHS). Methods: This cross-sectional study included 625 children under five with LBW. The dependent variable was under-five mortality (children aged 0–59 months), while the independent variables include child (gender), maternal (age at delivery, education, empowerment, delivery complications, and breastfeeding history), health service (antenatal care-ANC and place of delivery), and household (wealth quintile and residence) factors. Data were obtained from the 2017 IDHS using household and women’s questionnaires and analyzed using univariate analysis, Kaplan–Meier estimation, and Cox regression. Results: 41 of 625 children born with LBW died before the age of five. The Kaplan–Meier estimation found that maternal (delivery complications and breastfeeding history), health service (ANC history and place of delivery), and household factors (residence) significantly influenced the survival of LBW children. The Cox regression results showed that LBW children who were breastfeed and whose mother had adequate antenatal care visits had a lower risk of under-five mortality. Surprisingly, children born in health facilities had a significantly higher risk of death compared to those born elsewhere. Conclusions: Exclusive breastfeeding, adequate antenatal care, and place of delivery are important determinants of survival among children born with LBW. This support targeted interventions to improve the survival chances of children born with LBW, particularly in their early years of life. Full article

Background: Breastfeeding is the ideal source of nutrition for babies. Despite its benefits, breastfeeding practices and attitudes vary across cultures, influenced by societal norms, education, and personal experiences. This article shows the attitude differences among female students in Syria and Hungary and how sociocultural aspects impact their attitude towards breastfeeding. Methods: The questionnaire was a part of a multi-section questionnaire presented to 317 Syrian students and 303 Hungarian students. It assessed students’ attitudes towards breastfeeding through the Iowa Infant Feeding Attitude Scale (IIFAS). In addition to cross-tabulations, an exploratory data categorisation method, i.e., cluster analysis, was used in analysing the data. Results: Participants in both countries demonstrated strong agreement with statements highlighting the emotional and nutritional advantages of breastfeeding. In total, 67.2% of the participants disagreed with the idea that formula feeding is more convenient; similarly, 66.3% of them disagreed that breastfeeding causes fathers to feel emotionally excluded. Attitudes toward breastfeeding in public were more divided, reflecting the sensitivity of the topic and varying degrees of acceptance, with 48.7% of respondents disagreeing. Multivariate analysis demonstrated that nationality or age were significant predictors of belonging to various attitude clusters (SBM, SFF, FT): Syrian respondents and younger participants aged 21–30 years were more likely to belong to the Supporters of Breast Milk (SBM) cluster. In addition, paternal education level and urban residence also influenced feeding attitudes. Conclusions: This study shows the differences in attitude among Syrian and Hungarian female students, which is rooted in cultural diversity and its effect on individuals’ decisions. 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/Objectives: The transition to motherhood can be particularly challenging for women with limited socioeconomic resources or mental health concerns. The FAmily Clinic And Municipality (FACAM) intervention was designed to provide additional support through health visitors or family therapists, starting in pregnancy and continuing until the child reached school age. This paper evaluates the effects of the FACAM intervention on the secondary outcomes, maternal mental health and parental functioning during the child’s first year of life. Methods: A total of 331 pregnant women were randomized to either the FACAM intervention (n = 163) or usual care (n = 168). Participants completed questionnaires at baseline and at 3 (N = 284) and 12 (N = 248) months postpartum. Outcomes included maternal mental well-being, satisfaction with motherhood, depressive symptoms, parental stress, parental reflective functioning, worries, and breastfeeding duration. Results: At 12 months postpartum, FACAM mothers reported greater concern about housing issues (b = 0.56, 95% CI [0.06, 1.06], p = 0.03). No other significant differences in the reported outcomes were observed between the groups. Conclusion: The FACAM intervention did not demonstrate superiority over usual care in improving maternal mental health and parental functioning during the first year postpartum. The high-quality and needs-based approach of standard care in Denmark may have limited the potential for additional interventions to yield measurable improvements in maternal outcomes. Full article

Breastfeeding is universally recognized for its extensive health benefits for both infants and mothers. However, for some women, the experience of breastfeeding can be complicated by intense negative emotional and physical reactions, including phenomena such as dysphoric milk ejection reflex and breastfeeding aversion/agitation. This review explores the neuroendocrine underpinnings of these conditions, emphasizing the interplay between oxytocin, prolactin, and dopamine. Oxytocin, traditionally viewed as a hormone promoting bonding and emotional regulation, can paradoxically provoke a stress response in vulnerable individuals. Prolactin, a key hormone for lactation and maternal behaviors, is implicated in stress resilience and mood regulation, but its dysregulation may contribute to depressive states. Dopamine, critical for reward processing and emotional stability, may underlie the acute emotional dysregulation seen in dysphoric milk ejection reflex. Together, disturbances in these neurohormonal systems may explain the aversive emotional experiences during breastfeeding. An improved understanding of these mechanisms offers critical insights into maternal mental health during lactation and underscores the importance of supportive clinical approaches for affected women. Full article

Background and Objectives: Infant feeding practices play a crucial role in shaping the oral microbiome, modulating inflammatory responses, and maintaining epithelial health during the first year of life. Breastfeeding promotes the growth of beneficial bacteria and supports a diverse, stable microbial community. In contrast, formula feeding is associated with increased colonization by potentially pathogenic bacteria, such as Staphylococcus and Escherichia coli, which may elevate the risk of infections, oral diseases, and inflammation. This study investigates the effects of breastfeeding versus formula feeding on oral bacterial growth, epithelial cell integrity, and interleukin-17 (IL-17) expression in infants aged 1–12 months. Materials and Methods: A total of 60 infants (30 breastfed and 30 formula-fed) were recruited from pediatric clinics in the Qassim region. Microbial cultures quantified bacterial colony-forming units (CFUs), and epithelial cell morphology was assessed through the microscopic analysis of mucosal scrapings. IL-17 concentrations were quantified from the oral mucosa through enzyme-linked immunosorbent assay. Statistical analyses, including t-tests and chi-square tests, compared bacterial loads, IL-17 levels, and indicators of epithelial health between groups. Adjustment for potential confounders was achieved through multivariate statistical analysis. Results: Formula-fed infants showed significantly higher IL-17 levels than breastfed infants (p < 0.001), indicating a stronger pro-inflammatory profile. Breastfed infants exhibited lower inflammation, improved epithelial health, and reduced cellular debris compared to formula-fed infants, who had higher bacterial loads. A significant correlation was found between epithelial health and bacterial clustering, with clearer epithelial cells associated with lower bacterial colonization. Conclusions: Formula feeding was associated with increased salivary IL-17 levels, greater bacterial colonization, and compromised epithelial integrity, indicating a heightened pro-inflammatory state and potential vulnerability to mucosal irritation or infection. Breastfeeding appeared to confer protective effects by promoting healthier microbial balance, epithelial integrity, and reducing inflammatory responses. These findings underscore the immunological and microbial benefits of breastfeeding in supporting oral health during infancy. Full article