Background: To investigate the incidence and timing of lactational breast engorgement and its correlation with food intake and brassiere choices within one month postpartum.
Methods: We recruited postpartum women between 20 and 45 years old who completed 37 weeks of gestation, expressed willingness to breastfeed, and signed an informed consent form at a medical center in Northern Taiwan. Participants completed questionnaires and 24-hour dietary recall for dietary analysis on the third or fourth day postpartum and during a one-month postpartum follow-up visit. We adopted descriptive statistics, logistic regression, and multiple linear regression for data analysis.
Results: The incidence rate of lactational breast engorgement was 69% (n=84), with a higher occurrence in cesarean deliveries (95%, χ2=4.66, p=.031) compared with vaginal births (71%). A higher rate of engorgement was associated with lower water intake (OR=0.997, p<.001) and higher fat intake (OR=1.035, p=.033). Only 9.5% of participants wore underwire bras postpartum, which did not show a significant correlation with the occurrence of engorgement (p=.057). Perceived breast changes within one month postpartum (β=2.83, p=.008) predicted the severity of the lactational breast engorgement.
Conclusions: Lower water intake and higher fat intake increase the risk of lactational breast engorgement, typically occurring around four days postpartum. This study provides a reference for postpartum clinical dietary guidance and the incidence rate of lactational breast engorgement.
The milk transfer studies of remdesivir and favipiravir, the medications of interest in COVID-19:2 Case Reports
Background: Breastfeeding is recommended even during COVID-19. However, due to a lack of information on drug transfer, the decision to continue breastfeeding is challenging. We investigated the transfer of remdesivir and favipiravir into breast milk.
Methods: Remdesivir: The mother was a 28-year-old and received 200 mg of remdesivir on day 1 and 100 mg from day 2 to day 5. On days 3 and 5, blood samples were collected just before administration and 24 and 72 h after the end of administration. On day 5, breast milk was collected just before and 1, 3, 6, and 24 h after the end of administration. We measured the level of remdesivir and that of GS-441524, which is a metabolite of remdesivir.
Favipiravir: The mother was a 38-year-old and received 1800 mg of favipiravir twice daily on day 1 and 800 mg twice daily on days 2 to 10. Breast milk and blood samples were collected immediately before favipiravir administration, 1.5 h after administration (the mean time to peak), and the day after the last dose.
Results: Remdesivir: The milk-to-plasma drug concentration ratio (M/P) was 0.089. The relative infant dose (RID) was 0.0070%.
Favipiravir: The M/P was 0.99. The RID was 37–65%. However, the RID calculated as the favipiravir concentration in breast milk immediately before dosing (10–13.5 hours) was 3.5%–6.2%, which is below the safety standard of 10%.
Conclusions: Breastfeeding is recommended when a lactating mother receives remdesivir. Breastfeeding immediately before taking favipiravir is relatively safe. The benefits of continued breastfeeding and the information about breastfeeding during favipiravir therapy must be discussed with the mother to determine the infant’s nutrition.
Pesticide Exposure and Lactation in California: A Comprehensive Review of the Research Landscape and Gaps
Background: Exposure to pesticides poses health risks for pregnant individuals and their children. Reducing this exposure is vital, especially for farmworkers during pregnancy and breastfeeding. Medical providers, key in advising and facilitating work adjustments, frequently lack necessary data to safeguard farmworkers from pesticide dangers during the perinatal period. To our knowledge, no published literature review assesses the current state of knowledge regarding pesticide exposure and lactation. The objective of this paper is to address this problem by conducting an investigation into the existing data concerning pesticide exposure in breastfeeding women. Our goal is to establish a framework so healthcare providers may educate pesticide-exposed patients and make recommendations for legislative protections.
Methods: A comprehensive literature search was carried out across various databases, including PubMed, Google Scholar, and Scopus, without date restrictions. The search utilized keywords like ‘pesticides,' ‘lactation,' ‘breast milk,' and ‘pregnancy,' along with specific pesticide names.
Results: Out of 162 records, we identified 109 studies for comprehensive review. We analyzed the top 50 pesticides as per the Pesticide Use Report (PUR) Summary for Monterey County in 2018. Four pesticides (malathion, 1,3-dichloropropene, chlorothalonil, and glyphosate) were found to have documented human milk studies (9 papers). 7 pesticides (mancozeb, captan, glufosinate-ammonium, malathion, acephate, thiram, and metam sodium) had information from animal models (16 papers). Utilizing pharmacokinetic parameters, we identified 2 pesticides (elemental sulfur, mineral oil) that exhibit non-persistent characteristics within breast milk. For the remaining pesticides, no pertinent literature was available.
Conclusions: There is a significant research gap in understanding the relationship between pesticide exposure and lactation. Most existing studies focus on older bioaccumulating pesticides and omit newer compounds. It is essential that this deficiency be addressed in order to improve understanding of the relationship between pesticide exposure, breast milk composition, and infant health.
Breastfeeding and its psychological aspects on the breastfeeding dyad
Background: There is a body of research from different countries providing evidence for a link between breastfeeding experience and cognitive development later in life, including improved memory retention, greater language skills, and intelligence.
Methods: This is a review of recent studies that examined the psychological impact of breastfeeding on the cognitive function of children and psychological impact of the breastfeeding mother herself.
Results: The cognitive benefits of breastfeeding seen in infancy have been shown to endure into childhood and adolescence. Children who were exclusively breastfed were longitudinally followed and showed higher intelligence scores and higher teacher ratings of academic proficiency at the age of 6.5 years. Also, clinical evidence-based studies showed that longer duration of breastfeeding during infancy was positively associated with cognitive performance as adults and that the duration of exclusive breastfeeding was positively associated with increased intelligence, educational attainment, and income at 30 years of age. Breastfeeding mothers report reductions in anxiety, negative mood, and stress when compared with formula-feeding mothers; this is attributed to positive effect of breastfeeding on emotional well-being.
Conclusions: Breastfeeding is the biologically normal way to feed infants and children. Its benefits form a mile-long list, ranging from establishing the baby’s microbiome to preventing obesity to helping mom’s uterus contract after birth.
Achieving breastfeeding in exclusive pumping mother with severe postpartum depression and mother with breast abscess post bromocriptine therapy - case reports of babies with Tethered Oral Tissue
Background: Breastfeeding provides various benefits for both the mother and the baby. Nonetheless, Tethered Oral Tissues (TOTs) can result in breastfeeding challenges. The following scenarios depict infants with TOTs whose mother is solely pumping and facing severe postpartum depression, and another dealing with a breast abscess followed with surgery and bromocriptine treatment. By implementing comprehensive therapy designed for both the mother and the baby, it is feasible to reinstate the advantages of breastfeeding.
Methods: We present two cases involving mothers. The first mother, who was exclusively pumping and suffering from severe postpartum depression, sought our clinic's help when her baby was five months old. We provided counseling and recommended hospitalization for both the mother and the baby, following the Praborini Method of Relactation. This involved skin-to-skin contact, breastfeeding with a supplementary nursing system, and a frenotomy for the baby. In the second case, a mother couldn't breastfeed her baby due to a right breast abscess, leading to formula feeding with a bottle. Despite this, the mother expressed interest in trying our relactation method, along with frenotomy and acupuncture therapy.
Results: After undergoing hospitalization and utilizing the Praborini Method for relactation, the mother in the first scenario successfully breastfed her baby without the need for a supplementary nursing system anymore and the baby receiving complementary feeding. In the second scenario, the mother could exclusively breastfeed using formula and a supplementary nursing system; after the baby received complementary feeding, the formula supplementary was stopped. Both babies, aged 13 months and 14 months, are currently breastfeeding.
Conclusions: By approaching relactation holistically and incorporating techniques like at the breast supplementation, frenotomy, acupuncture, and complementary feeding, mothers and babies who faced breastfeeding challenges in the past can once again experience the advantages of breastfeeding.
Receipt of breastfeeding support and duration of breastfeeding in US women
Adrienne Hoyt-Austin1, Sarah Haynes1, Laura Kair1, Daniel Tancredi1, Eleanor Schwarz2, Susan Brown1
1University of California, Davis Medical
2University of California, San Francisco
Abstract Category: Research
Background: Connection to breastfeeding support after birth hospitalization discharge is fragmented. Understanding the characteristics associated with breastfeeding duration and the types of support received are important for designing and adapting effective support programs.
Methods: We analyzed population-level data from the 2016-2021 CDC PRAMS survey from 6 states to describe types of breastfeeding support received and characteristics of US women who did and did not reach a breastfeeding duration of ≥10 weeks. We report unadjusted percentages and p-values from chi-square tests for the association of breastfeeding with maternal age, household income, marital status, race, ethnicity, mode of delivery, maternal pre-pregnancy BMI, and parity. Bivariate analyses of any breastfeeding at 10 weeks by types of breastfeeding support received were conducted. Unweighted frequencies and weighted percentages are reported to account for the PRAMS complex survey design.
Results: Most survey participants (N=19,072) reported receiving some form of breastfeeding support after their baby was born (95.5%). 87% endorsed that they had someone to answer their questions; 84.4% got help getting their baby positioned correctly; 78.8% got help knowing if their baby was getting enough milk; 64.4% received help with managing nipple pain; 62.1% received information about breastfeeding support groups; and 9.1% received some other type of support. Receiving any type of breastfeeding support was significantly associated with breastfeeding duration ≥10 weeks (66.0% versus 45.9%, p<0.001). There were significant disparities in breastfeeding outcomes associated with participant characteristics where those who are Black, Hispanic, younger, unmarried, primiparous, low-income, or having a c-section delivery were less likely to breastfeed at 10 weeks.
Conclusions: Receipt of breastfeeding support is associated with better breastfeeding outcomes. Unfortunately, significant disparities impact breastfeeding outcomes including racism, classism, and lack of access to breastfeeding support. Further work is needed to design and provide targeted breastfeeding support strategies.
A Collaborative QI Project to decrease the inappropriate use of topical mupirocin ointment for the indication of “nipple pain” in postpartum individuals at a large tertiary care center
Leigh Campbell, Marianna Riley
University of Mississippi Medical Center
Abstract Category: Quality Improvement Advocacy
Background: Nipple pain and discomfort is common in the postpartum period and often leads to early breastfeeding cessation (1). In our tertiary care institution, topical mupirocin 2% ointment is a standing prn order offered to postpartum individuals who experience “nipple pain” related to breastfeeding. Topical mupirocin use is indicated for the treatment of impetigo and secondarily infected superficial cutaneous wounds identified by a wound culture (2). The American Academy of Dermatology Choosing Wisely List recommends against the use of routine topical antibiotic use for wounds (3). Postpartum pain and discomfort associated with breastfeeding is common, and per ABM protocol #26, assessment of pain requires a careful history and assessment of both mother and infant by a clinician trained in lactation medicine (4). We promote evidence-based practice in our institution and sought to eliminate the use of topical mupirocin for postpartum nipple pain through a collaborative QI project.
Methods: Baseline data of 2% mupirocin ointment packets prescribed for nipple pain over the number of births by month were obtained. 43% to 59% of postpartum individuals received mupirocin in the 12 months prior to the initiation of our QI project. We had 7 interventions over 12 months consisting of collaboration, education, informative handouts, and alternative management of nipple pain and wound care.
Results: There was a dramatic decrease in mupirocin use over time. In the last 6 months of our project, postpartum mupirocin declined significantly to </= 10%.
Conclusions: A collaboration among obstetrics, newborn, lactation consultants, and administration to support evidence-based care for nipple pain significantly decreased the inappropriate use of 2% mupirocin ointment of postpartum individuals in a large tertiary care center. Prophylactic use of mupirocin as a prevention strategy is inappropriate and leads to antibiotic resistance. Other causes of nipple pain were addressed per ABM protocol #26 and individualized care was promoted.
Development of nipple trauma evaluation system with deep learning
Background: Nipple trauma is conventionally assessed visually, but there is a lack of consensus on evaluation methods. Notably, the application of deep learning in breastfeeding support has been underexplored in previous research. This study aims to develop an innovative nipple trauma evaluation system utilizing deep learning methodologies.
Methods: An exploratory sequential-design study was conducted. Deep learning was employed for nipple trauma assessment using existing imaging data. Using object detection and classification, this Japanese study retrieved 753 images from a previous study. The classification protocol, based on the “seven signs of nipple trauma associated with breastfeeding,” categorized the images into eight classes. For practical purposes, the eight original classes were consolidated into four broader categories: “None,” “Minor,” “Mild,” and “Severe,” using data augmentation procedures consistent with the original classification system. Precision, Recall, Overall Accuracy, and Area Under the Curve (AUC) were calculated, and the model’s efficiency was evaluated using Frames Per Second (FPS).
Results: The object detector demonstrated a high mean Average Precision (mAP) and FPS rate for nipple and areola detection, confirming exceptional accuracy. The eight-class image classifier returned notable AUC values, with fissures, peeling, purpura, and scabbing exceeding 0.8. The highest average recall and precision were for scabbing but the lowest for blistering. The four-class classifier accurately predicted severe conditions, with an average AUC > 0.7, whereas categories without classifications and those deemed minor had lower recall and precision rates.
Conclusions: Highly accurate automatic detection and image classification of nipple trauma have been achieved using deep learning. This technology holds promise as a supportive tool for the caregivers of breastfeeding patients.
Breastfeeding Interest Groups as a Useful Tool to Improve Medical Student Education
Abigail Dupre1, Kendall Johnson1, Akua Nyarko-Odoom1, Margaret Kobelski1, Ann Kellams1, Karen Bodnar2
1UVA School of Medicine
2Inova Fairfax Hospital
Abstract Category: Medical Education
Background: Despite well documented evidence of the benefits of breastfeeding for the mother-infant dyad, studies have shown that medical students do not receive adequate education on the topic in their preclinical or clinical years. Structured sessions are often limited to one minimal overview of the topic. Thus, each student's knowledge is highly dependent on their exposure to specific patients during their clerkship years and the expertise level of supervising faculty members. Further, while all doctors care for lactating patients, students entering non-primary care fields are unlikely to get any further training in residency. Current options to increase breastfeeding education include formal curriculum changes or extracurricular organizations. While curriculum changes would ensure increased exposure to breastfeeding on a schoolwide level, they take time to implement with potential to decrease coverage of other topics in an already densely packed curriculum. Interest groups can serve as a useful tool to bridge this gap in education.
Methods: Students at the University of Virginia School of Medicine created an interest group alongside prominent faculty members in breastfeeding medicine. Events planned by this group include journal clubs reviewing current research, multidisciplinary education panels, and live breastfeeding demonstrations. Monthly hands-on lecture series help to address specific topics like mastitis, lactation cessation post-abortion, and breast pathology on varying skin tones.
Results: The group has garnered interest within the school, and it is our hope to continue expanding and to serve as a launching point to create similar groups across the country.
Conclusions: Breastfeeding interest groups can be utilized within medical schools to increase student understanding of breastfeeding and the physician’s role in managing lactation. Moreover, they can reach students who will enter a variety of specialties.
Lactation Care Management as an Alternate Care Model for Lactating Dyads in Rochester, New York
Background: Breastfeeding rates in Rochester, New York, fall well below US goals. Evidence demonstrates integrating lactation consultation into prenatal practices improves breastfeeding initiation/exclusivity. Black women exhibit some of the lowest breastfeeding rates in the United States, although literature demonstrates that culturally concordant healthcare can reduce inequities in this area. We developed a Lactation Care Management (LCM) model to address inequities including:
Hiring: Engaged community organizations to hire staff experienced in equitable lactation support
Training:
Clinical
CLC training, track toward IBCLC certification
Supervised by two MD, IBCLCs
Equity training
Care plan: Incorporates evidence-based support, provided longitudinally in a hybrid model (virtual and in-person) to patients at three medical practices in urban Rochester.
Methods: Groups include no LCM utilization and light or heavy utilization. We will use bioinformatics to extract demographics and our data to determine breastfeeding goals/intention, self-efficacy scores, and breastfeeding rates at hospital discharge, the 1-3 week visit, and 6 weeks postpartum. We will compare variables between groups: race, ethnicity, and insurance type and breastfeeding rates. Our primary goal is demonstrating sustainability of the program after the grant period. We will thus also evaluate:
% of patients eligible for home health care management
Acute visits for early childhood illness
Revenue generated from Breastfeeding Medicine referrals
Results: Demographics of birthing people served include 61% Black, 35% Latina/x/e, 18% white and 1.3% other. To date LCMs have engaged with 120 dyads since July 2023, with 30% in the antenatal period. We will have 12 months of data with a larger number of participants to present by November 2024 and will report on the outcomes noted above.
Conclusions: We expect to demonstrate improved lactation outcomes with LCM, making this standard of care in primary care in Rochester, New York, and to create a scalable model for other communities.
Does skin exposure differ in breastfeeding images when taken in public versus private spaces?
Lianna Scherer, Lauren Dinour, Melanie Shefchik
Montclair State University
Abstract Category: Research
Background: Despite the skin-to-skin nature of breastfeeding, skin exposure deviates from sociocultural norms and elicits negative responses, especially in public. This project qualitatively analyzes skin exposure differences in public versus private spaces within breastfeeding images available through a commercial image bank.
Methods: In June 2022, Adobe Stock was searched for “breastfeeding” and “lactation,” resulting in 331,090 hits. After applying filters, images were sorted by relevance, and the first 2% (n=2231) were coded for setting and breastfeeding parent’s skin exposure. Images taken in homes, health-related locations, and photo studios/nondescript backgrounds were considered private spaces, while vehicles, restaurants, offices/workplaces, and the outdoors were categorized as public spaces. The breastfeeding parent’s skin exposure was dichotomously coded (i.e., yes/no) for the following mutually exclusive areas: neck or chest, stomach, breast, and nipple or areola. A skin exposure scale was calculated by summing the number of exposed areas (possible range 0-4). Differences in skin exposure location and mean number of areas exposed between public and private spaces were analyzed with the Chi-square test and independent samples t-test, respectively.
Results: Most images (91.1%) were photographed in private spaces, whereas only 8.9% were taken in public spaces. Compared with images in private settings, those in public settings were less likely to show stomach skin (13.4% vs. 7.5%, p<0.05), breast skin (83.4% vs. 66.8%, p<0.001), and nipple/areola (41.8% vs. 18.1%, p<0.001), though no significant differences were noted for neck/chest exposure (85.6% vs. 90.5%). Additionally, the mean number of areas exposed was significantly higher for images in private compared with public spaces (2.2 +/- 1.8 vs. 0.87 +/- 0.86, p<0.001).
Conclusions: Breastfeeding parents portrayed in public spaces less frequently show stomach, breast, and nipple/areola skin compared with parents depicted in private settings. Commercially available images may thus perpetuate the stigma that exposing skin while breastfeeding in public is non-normative.
Comparing predictors of breastfeeding self-efficacy among mothers of full-term infants with and without NICU admission
Yoko Asaka, Mika Nakatani
Mie University
Abstract Category: Research
Background: Breastfeeding self-efficacy (BSE) contributes to continuation of breastfeeding. However, for mothers of term infants, even a short stay in the neonatal intensive care unit (NICU) inhibits breastfeeding. This study aimed to clarify the predictors of BSE in mothers of full-term infants, depending on whether the infants were admitted to the NICU or not.
Methods: Questionnaire surveys were conducted twice for mothers who delivered full-term infants: 3–7 days after and 1 month after starting breastfeeding. The participants were divided into two groups: 77 mothers of infants admitted to the NICU (N group) and 104 mothers of infants not admitted to the NICU (non-N group). Multiple regression analysis using the forced entry method was performed in each group with the dependent variable as BSE at 1 month after starting breastfeeding. This study was approved by the ethical review committee (approval number U2018-005).
Results: The N group had fewer breastfeeding frequency (p< 0.001) than the non-N group and took longer to begin rooming-in (p< 0.001). The multiple regression analysis showed that the predictors of BSE at 1 month after starting breastfeeding in the N group were lower Perceived Insufficient Milk (PMI) at 3–7 days and higher sense of coherence (β= 1.05, p < 0.001; β= 0.71, p < 0.001, respectively). The predictors of BSE at 1 month after starting breastfeeding in the non-N group were lower PMI at 3–7 days and breastfeeding intention at 3–7 days (β= 1.37, p < 0.001; β= 7.39, p < 0.001, respectively).
Conclusions: In both groups, PMI at 3–7 days after was a predictor for increasing BSE at 1 month after breastfeeding started. Breastfeeding intention at 3–7 days was a predictor of BSE only in the non-N group. This may be due to differences in the breastfeeding frequency and the timing of rooming-in between the two groups.
Breastfeeding Medicine Academic Half-Day Curriculum for Pediatric Residents
Ellen Ribar, Sheridan Schulte, Barry Seltz
University of Colorado School of Medicine
Abstract Category: Medical Education
Background: Pediatric residents (PRs) recognize the important role they play in supporting breastfeeding for their patients, yet many lack the knowledge and skill to manage breastfeeding problems. A local needs assessment identified a gap in PR ability to provide effective breastfeeding education for families. Thus, a breastfeeding curriculum is needed for residency programs.
Methods: Informed by self-determination theory, we developed a breastfeeding curriculum for senior (PGY-2/3) PR within the residency program’s existing academic half-day (AHD) 3-hour conference format. Learning activities were a large group overview (‘Breastfeeding 101’) and three small group discussions: ‘Achieving an Effective Latch’, ‘Assessing Growth in Breastfeeding Infants’, and ‘Troubleshooting Breastfeeding Challenges’. Topics were chosen based on program directors and PRs input and review of the American Academy of Pediatrics’ Breastfeeding Curriculum. This pilot curriculum was delivered in October 2023. At the end, PRs were asked to complete an anonymous on-line survey evaluation of this breastfeeding AHD.
Results: Of 66 senior PRs in the residency program, 13 attended the breastfeeding AHD. Twelve PRs completed the evaluation (92% response rate). PRs rated each session’s teaching effectiveness on a 4-point Likert scale (1=not at all effective and 4=very effective). Mean session scores were: ‘Breastfeeding 101’ (3.9), ‘Achieving an Effective Latch’ (3.2), ‘Assessing Growth in Breastfeeding Infants’ (3.8), and ‘Troubleshooting Breastfeeding Challenges’ (3.7). Compared with how they felt before the AHD, PRs rated a 3.4 (1=about the same, 4=a lot more) for ‘to what degree they are now able to support breastfeeding for their patients’. Themes identified through free response included the absence of this education elsewhere in their training and appreciating hands-on education.
Conclusions: Senior PRs valued breastfeeding education. Further work is needed to provide this education to all PRs during their training and to explore this curriculum's impact on PR behavior in the clinical setting.
Design, Implementation, and Evaluation of a Breastfeeding Medicine Clinic for High-Risk Dyads Embedded Within a General Pediatrics Practice
Background: Many of the mothers seen in our academic clinic have high-risk pregnancies and deliver preterm and or have comorbid conditions that result in suboptimal breastfeeding. A premature infant lactation clinic was established within our practice; however, there was no comprehensive breastfeeding clinic. Our objective was to implement and evaluate a physician-run breastfeeding clinic specializing in high-risk dyads.
Methods: Three pediatrician breastfeeding experts worked with clinic leadership to design our clinic model and integrate one session per week into the pediatric practice. The lactating parent and infant are registered as patients. A satisfaction survey was completed by mothers who participated in the lactation visit and a control group of mothers who were or previously were breastfeeding but did not attend the lactation clinic during the study period.
Results: Fifty-six of 172 respondents had a lactation appointment. There was no difference in demographics between groups. Gestational age was lower in the lactation visit group (25% <37 weeks) as compared with the no lactation visit group (6.5% <37 weeks) (p=0.009). More infants in the lactation group (28.6%) had NICU stays as compared with the non-lactation group (14%) (p=0.042). Of the participants who had a lactation visit, 62.5% agreed or strongly agreed that the help received made a difference in their breastfeeding experience while only 25.9% of those who did not have a lactation visit agreed or strongly agreed that the help received in the office made a difference in their breastfeeding experience (p <0.001).
Conclusions: The increased incidence of preterm and or NICU admitted infants is likely due to the pre-existing premature infant lactation clinic. The expanded lactation service increased access to early lactation care of high-risk dyads and made a difference in breastfeeding experience. Integration of a physician-run breastfeeding medicine clinic into the general pediatric practice is feasible and effective.
Assessing Sacubitril/Valsartan Transfer into Human Milk: Implications for Breastfeeding and Heart Failure Treatment
Background: In the past decade, there has been a notable rise in the occurrence of Peripartum Cardiomyopathy (PPCM), the leading cause of heart failure (HF) during pregnancy. Concurrently, advancements in medication have significantly enhanced the outcomes for heart failure patients. One such breakthrough is the first-line treatment with sacubitril/valsartan (Entresto). However, due to concerns about potential adverse effects on infant development, sacubitril/valsartan is not recommended for breastfeeding women, and there is a lack of published data to support its safety. This study aims to investigate the transfer of sacubitril/valsartan into human milk and assess the risk of drug exposure to infants.
Methods: The InfantRisk Human Milk Biorepository released samples and corresponding health information from 5 breastfeeding maternal-infant dyads exposed to sacubitril/valsartan. Sacubitril, valsartan, and LBQ657 (sacubitril active metabolite) concentrations were determined using liquid chromatography-mass spectrometry (LC/MS/MS) from eight timed samples following medication administration under steady-state conditions.
Results: Valsartan levels were below the detection limit of 0.19 ng/mL in all milk samples. Sacubitril and its active metabolite LBQ657 was measurable in milk in all five participants, peaking one hour after drug administration at a mean concentration of 1.52 ng/mL and 12.2 ng/mL, respectively, with a relative infant dose (RID) calculated at 0.01% and 0.22%, respectively. Two participants fed their infant with breast milk while taking sacubitril/valsartan with no reported adverse effects.
Conclusions: The transfer of sacubitril/valsartan into human milk is minimal. These concentrations are unlikely to pose a significant risk to breastfeeding infants with a combined calculated relative infant dose of <0.25%, far lower than the industry safety standards (RID <10%).
Weaning and parental skills
Alondra Ramírez
Más Corazón
Abstract Category: Research
Background: A great majority of mothers end up weaning exhausted and without many means to do it in a transitional and not abrupt way for their children. This is why we should look at the end of breastfeeding not only as the fact of separating a baby or child from her mother's breast but also as a dyadic bonding process. The aim of this research was to compare two categories: maternal weaning and parental skills in order to determine which parental competencies are important for weaning processes to be smooth, gradual, with as little crying or suffering as possible, and to be respectful and congruent to the needs of the mother and the infant or child.
Methods: The sample included 773 mothers between 25 and 45 years of age, with children between 1 and 4 years of age. Two questionnaires and a survey were used in this study. The first is composed of 17 Likert-type items that evaluate weaning difficulties. The second questionnaire is the E2P Positive Parenting Scale (Gómez & Contreras, 2019), which evaluates parental skills grouped in 4 categories: bonding, protective, formative, and reflective. The final survey was composed of 11 multiple-choice questions that delved into the weaning process.
Results: All competencies showed low but inversely proportional and statistically significant correlation. Reflective skills showed the highest correlation. Among other important correlations found was that the higher the score on the parental skills scale, the less crying and resistance in the weaning process and the greater the comfort in other ways besides breastfeeding.
Conclusions: Reflective skills, which in fact had the highest correlation with difficulty in weaning, are in charge of the anticipation of relevant scenarios, the deployment of which helps mothers to visualize and prepare alternatives for action in the face of various events or challenges that may arise. Anticipating a weaning, for example, is an activity of this competency. Planning according to my child's development what is to be expected, what are the appropriate conditions, how I could act and how and where to ask for support are tools that not all mothers have and that greatly facilitate the weaning process.
Lactation Know-How: An Innovative, Fast Track to Staff Education
Jennifer Albert, Jody Heinrichs-Breen
Advocate Health
Abstract Category: Quality Improvement Advocacy
Background: Step 2 of the Baby-Friendly Hospital Initiative states that hospitals must “ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.” However, the extent to which this education and training occurs lacks standardization, which can result in parents receiving incorrect and inconsistent advice. Despite knowledge of the benefits of breastfeeding, many healthcare professionals lack the knowledge and skills to support infant feeding. The need for evidence-based breastfeeding practices is of utmost importance to guarantee good quality breastfeeding counseling.
Methods: Targeted to maternity care staff, a lactation team member would chose a topic and create an evidence-based presentation. During each shift report, a short, 1-2-minute presentation discusses lactation practice tips and relates them to real-life patient scenarios. Each topic is presented for one week. The lactation department conducted a survey aimed to evaluate the effectiveness of the education initiative.
Results: The majority of participants found the lactation topics highly relevant to their needs. On a scale where 1 indicates high relevance, the average score was close to 1 (mean = 1.07), showing strong agreement on the topics’ applicability. The overall rating for the program was very positive. Most staff members rated it highly, with an average rating again close to 1 (mean = 1.10), where 1 represents the best possible rating. The program seems to have had a positive effect on participants’ confidence. When asked about their ability to manage common breastfeeding problems before and after the program, there was a noticeable increase in confidence levels, with the average score shifting from around the midpoint before the program to a higher confidence rating after the program.
Conclusions: The Lactation Know-How program was well-received, with participants reporting high relevance and overall satisfaction. Additionally, the initiative appears to have successfully enhanced the confidence of staff in managing breastfeeding-related queries and issues.
Breast Pump Subsidy - A Novel Method To Reduce Disparities in Breast Milk Provision in the NICU
Kara Kuhn-Riordon, Shoshana Newman-Lindsay
University of California Davis Medical Center
Abstract Category: Advocacy
Background: Recent practice in the UC Davis Neonatal Intensive Care Unit (NICU) supported lactating mothers with a prescription for home breast pump through insurance and the opportunity to pay out of pocket to rent a hospital-grade breast pump during the NICU stay. Both options create gaps in access to a breast pump and add unnecessary barriers to providing optimal lactation support.
Methods: Our team created a proposal to have the NICU subsidize the cost of hospital-grade breast pump rental for mothers of all very low birth weight (VLBW) infants admitted to the NICU. The pump is covered from the infant’s arrival on unit until receipt of hospital-grade pump through insurance or WIC, or until discharge, whichever is sooner.
Results: Our program began in April 2023 and initially rented only to VLBW infants. We have subsequently increased to infants with congenital anomalies such as gastroschisis and cardiac anomalies. We have rented to 55 parents thus far. We have also expanded from 10 pumps to 15 pumps. This ongoing project tracks breast milk at discharge, breast milk volume, and pump availability outside of the subsidy program.
Conclusions: We describe a program to subside the rental fees for a hospital-grade breast pump for dyads in the UC Davis NICU. We have successfully been able to subsidize rental breast pumps for 55 mothers. This has allowed mothers to establish successful breast milk supply for their hospitalized neonates and reduced barriers for low-income and minority households. We have improved breast milk rates at discharge from our baseline and continue to monitor progress in this ongoing quality improvement project.
Revolutionizing Breast Pump Access in the NICU: A Multidisciplinary Approach at UCLA Ronald Reagan Medical Center
Mina Jasovic-Ognjanovic
University of California Los Angeles
Abstract Category: Quality Improvement Advocacy
Background: At UCLA Ronald Reagan Medical Center, the process for acquiring hospital-grade breast pumps for NICU mothers was identified as inefficient, leading to delays in lactation support and an increased financial burden for families.
Methods: A multidisciplinary team restructured the ordering process by integrating a “Lactation” tab in the Electronic Health Record (EHR) system and streamlining ordering processes and communication within the multidisciplinary team. This innovation aimed to streamline the acquisition of breast pumps, reduce waiting times, and alleviate financial stress for NICU families.
Results: The new system significantly decreased the waiting time for breast pumps and reduced out-of-pocket expenses for families. Data demonstrated improved patient satisfaction and financial relief.
Conclusions: The revised breast pump ordering process at UCLA Ronald Reagan Medical Center illustrates the effectiveness of collaborative efforts in healthcare innovation. The initiative has enhanced the quality of care for NICU mothers and their infants by simplifying access to essential lactation support.
Assessment of Pediatric Resident Breastfeeding and Lactation Education at an Academic Medical Center
Background: Pediatricians play a crucial role in supporting the breastfeeding goals of families. Pediatric residents in the United States receive limited training on lactation, and there are no breastfeeding-related requirements for residency training. This study aims to understand the current landscape of breastfeeding education at an academic pediatric residency program.
Methods: An online survey was distributed to all pediatric residents at an academic institution. The study was determined to be exempt by IRB review. The survey assessed six domains: demographics, perceived importance of breastfeeding/lactation knowledge, current experience and education, perceived confidence in providing breastfeeding and lactation care, knowledge, and interest in additional training. Knowledge was assessed with questions adapted from the AAP Breastfeeding Curriculum, used with permission.
Results: Response rate was 27% (30 respondents, 60% of respondents completed entire survey). All respondents agreed that pediatricians play an important role in supporting families’ breastfeeding goals. The majority agreed that breastfeeding knowledge is important to their current clinical practice as a resident (93%) and relevant to their future career (80%). 79% reported having received breastfeeding education during residency, but only 34.6% were satisfied with the education and 37.5% agreed that residency had adequately prepared them. Only 54% reported confidence in providing breastfeeding care with lowest confidence in assessing latch (21% confident), counseling on medication safety (37.5% confident), and evaluating supply concerns (42% confident). The mean score on knowledge questions was 63%. The majority (89%) were interested in additional training and 94% felt additional training would improve patient care.
Conclusions: Pediatric residents recognize the importance of breastfeeding knowledge in their current and future medical careers. Most did not feel adequately prepared by their training to provide breastfeeding counseling, and objective knowledge scores identified significant gaps. Residents are interested in additional breastfeeding education, and our project provides further insight on areas where U.S. residency programs could improve that education.
Identifying Risk of Breastfeeding Failure and Early Lactation Referral Within 24 Hours Postpartum
Jennifer Pintiliano-Gemmo, Yanique Ellis, Oneilia Brooks, Uday Patil
NYC Health and Hospitals Elmhurst
Abstract Category: Quality Improvement Advocacy
Background: It is well known that breastfeeding, especially in the first six months of life, boasts a myriad of maternal and infant health benefits. However, breastfeeding difficulties prove to be a barrier to this beneficial practice with one study showing 70.3% of mothers experiencing breastfeeding difficulties and only half feeling supported by medical personnel. With this disparity in initiation and continuation of breastfeeding, the early identification of barriers to breastfeeding success and subsequent intervention to mitigate this risk is of paramount importance.
Methods: We conducted a quality improvement project using five PDSA cycles over a 5-month period (September 2023- January 2024). A screening tool for risk for breastfeeding failure was developed based on the ABM Clinical Protocol #5. Our process entailed all term infants admitted to MBU were assessed using this screen and mother-baby dyads with a total score of two or more risk factors were referred for lactation consultation within the first 24 hours of the postpartum period.
Results: At baseline there was 0% rate for screening for mothers at risk for breastfeeding failure and lactation referral. Throughout PDSA cycle 1 to PDSA cycle 5 we reviewed 787 admissions to MBU: Screening rates ranged from 89.3% to 100% (median 100%). Positive screening rates were 28.3%-42.3% (median 35%) and lactation referral rates for those who screened at risk were 24.5%-49% (median 32%).
Conclusions: Education, email, informal messages, and EMR format changes helped to identify women at risk for breastfeeding failure through screening and increased lactation referrals due to identifiable risk factors. We speculate that increased lactation referrals for mothers at risk for failure should increase breastfeeding success.
Providing a Latch Key: Increasing Lactation Education for Obstetric Residents and Medical Students
Elizabeth Wagman1, Santosh Coorg1, Cheryl Godcharles2
1Thomas Jefferson University
2Tampa General Hospital
Abstract Category: Quality Improvement Advocacy
Background: Current Healthy People 2030 data suggest that only up to 25% of infants are exclusively breastfed at six months of life, but target rates are upward of 40%. Though this trend is multifactorial, an actionable solution is to increase lactation education for residents and medical students to better equip them to counsel patients. Institutions where a breastfeeding curriculum was implemented showed a four-fold increase in exclusive breastfeeding at six months, achieved through a combination of didactic and hands-on sessions. Given that residents and students directly care for all admitted postpartum patients, we plan to target education to train providers who are patients’ first point of contact during critical periods in lactation.
Methods: Preclerkship medical students at Thomas Jefferson University were recruited to participate in breastfeeding rounds by visiting postpartum patients to assess their breastfeeding progress, needs, and concerns. They assessed patient comfort with latching, ensured patients had a breast pump prior to discharge, connected patients with in-house lactation consultants, and set up patients with the Pacify app (free 24/7 virtual lactation support). Students documented all patient encounters and worked directly with residents and nursing to ensure smooth hand-offs. Students were asked to reflect on their experiences and identify opportunities for growth.
Results: Students rounded on 172 postpartum breastfeeding patients at Thomas Jefferson University Hospital between December 2023 and February 2024. Of those, 27.3% (47) of patients were identified as needing a breast pump for home and were connected to the proper resources.
Conclusions: Implementation of lactation education for medical students and residents remains an area for growth and has the potential to improve both patient outcomes and student/provider confidence. Future directions include engagement in antenatal setting, follow-up with patients to assess changes in lactation comfort, and expansion of breastfeeding rounds into the OB/GYN clerkship curriculum.
BREASTFEEDING CONSULTATIONS AT THE NATIONAL LACTATION STUDY CENTER (LSC). JUNE 2018 TO DECEMBER 2023
Rogelio Perez-D’Gregorio, Casey Rosen-Carole, Sandra Jee, Michele Burtner, Richard Miller
Background: The National Lactation Study Center (LSC) was developed by Ruth Lawrence, MD, in 1982 to offer consultations on complex breastfeeding and lactation problems. Our objectives are to identify (1) provider location and types who access our service and (2) key areas of concern of providers and consumers who seek consultation.
Methods: We completed a retrospective, observational review from June 2018 to December 2023 of cases included in a RedCap database developed in 2018. We report frequencies of exposures (medication and toxin), along with geographic area, provider type, and lactation concerns.
Results: We recorded 4,336 consultations (4,172 exposures and 164 breastfeeding managements). There were 4,314 cases from 44 States (United States) and 22 cases from other countries. Most occurred by telephone (n=3,070, 71%), with fewer by email (n=1,220, 28%). There were 787 cases from consumers/patients and 3,549 from providers. Of these, lactation consultants were the primary users (n=2,553, 72%), with physicians accounting for 14% (n=508). Medication/Toxin Exposures: There were 9,670 total medications reviewed, with most cases involving ≤2 medications/toxins (n=3,970, 41%). Drugs with central nervous system (CNS) activity accounted for the largest portion of queries (n=3,885, 41%). Environmental/toxic exposures included COVID-19, lead, arsenic, mercury, and solvents. Lactation Management: Most lactation management cases were primarily maternal-side concerns such as low milk supply or oversupply (n=116, 85%), fewer were primarily infant concerns such as rare metabolic and cardiac conditions (n=21, 15%), and questions related to human milk such as milk storage and properties (n=17, 11%).
Conclusions: The LSC serves many providers across 44 states and internationally. Inquiries regarding medications with CNS activity were the most prevalent. Of management concerns, most were related to low or oversupply of milk. The use of this service reflects an ongoing need for information on medication use and complex concerns in breastfeeding and lactation.
The breastfeeding experience and goals of the lactating person
Julia Parker, Bharti Garg, Nicole Marshall
Oregon Health & Science University
Abstract Category: Research
Background: There are few breastfeeding studies that have centered the experience and goals of the lactating person. We examined the differences between lactating people who self-reported that they met or did not meet their own breastfeeding goals as an opportunity to target effective interventions.
Methods: This was a secondary analysis of a prospective, longitudinal study that collected information from 189 individuals on infant feeding patterns via survey at 6 weeks, 6 months, and 12 months postpartum. On the 6-week postpartum survey, 154 individuals answered the question “So far, have you met your own goals for breastfeeding?” We stratified and compared individuals based on their breastfeeding goals response (129 [83.8%] = met, 24 [16.2%] = did not meet) using chi-square/Fisher’s exact test (categorical variables) and two-sample t-test (continuous variables).
Results: Individuals who did not meet their breastfeeding goals were less satisfied with how they were currently feeding their baby (3.36 +/- 0.91 vs. 4.71 +/- 0.53, p<0.001) and more likely to report needing help with nursing (80% vs. 52.7%, p=0.014) when compared with individuals who met their breastfeeding goals. They were also more likely to report that they did not have enough milk (68% vs. 11.6%, P<0.001), that it took too long for their milk to come in (20% vs 7.0%, p = 0.038), and that their baby did not gain enough weight or lost too much weight (48% vs 14.7%, p =<0.001). This difference in infant weight gain was confirmed upon review of infant growth charts.
Conclusions: Centering the patient's experience and assisting individuals to meet their own lactation goals should be a primary focus for all breastfeeding professionals. These data suggest that efforts focused on assistance with low milk supply and lactation support in the first few weeks may be a key intervention, especially for first time parents.
Exploring the Efficacy of Therapeutic Ultrasound in Managing Galactocele: A Case Study in Lactating Patient
Michelle Mandala
No affiliation
Abstract Category: Other
Background: Galactocele formation occurs due to ductal narrowing, impeding milk flow. Therapeutic ultrasound, considered in the mastitis spectrum, serves as a supplementary treatment. However, there is a scarcity of information regarding the efficacy of therapeutic ultrasound in addressing galactocele.
Methods: Therapeutic ultrasound sessions were administered six times per week, and the evaluation of effectiveness was conducted through periodic ultrasonography. This encompassed assessments conducted before the commencement of treatment, after one week of therapy, and subsequent to two weeks of the therapeutic intervention. Additionally, the patient diligently engaged in regular pumping activities, with a frequency of six sessions per day.
Results: After a two-week therapeutic ultrasound regimen, no significant changes in the size of the galactocele were observed based on ultrasonography assessments.
Conclusions: The size of the galactocele remained unchanged, showing no significant alterations following the conducted observations and assessments. Further research and comprehensive studies are needed to address this knowledge gap and develop a more comprehensive understanding of how therapeutic ultrasound can effectively manage galactocele cases.
Effect of Medication on Breastfeeding Continuation in Postpartum Women: Initial Findings from a Systematic Review
Rachel Pilgrim1, Matthew Jones1, Sarah Chapman2
1University of Bath
2Kings College London
Abstract Category: Research
Background: Although many medicines are not licensed for use during breastfeeding, post-marketing data often suggest they are safe. Yet, breastfeeding women often remain apprehensive about using medication. Healthcare professionals may also see maternal medication as a barrier to breastfeeding. Understanding medication-related breastfeeding discontinuation could guide interventions supporting continued breastfeeding while addressing maternal health needs. This review aims to determine the incidence of medication-related breastfeeding discontinuation, explore factors influencing this decision, and identify any risk factors in a woman's socio-economic, demographic, geographic, or health background.
Methods: Embase, PubMed, The Cochrane Library, PsycINFO, Scopus, and CINAHL were searched, with a 20-year date limit. Forward and backward citation searches of included papers were conducted. Only studies from high-income countries were included. Combination feeding and the use of expressed breastmilk were permitted. Data must be taken directly from women themselves. Exclusions include unpublished studies, conference proceedings, abstracts, case studies and series, articles in non-English languages, studies involving alternative or illicit medicines, and studies focussing on women who never initiate breastfeeding. An initial narrative synthesis has been completed.
Results: Seventeen papers were included. Breastfeeding discontinuation due to medicine initiation appears more common in women with chronic diseases (range 4-58%, n=751) than in undifferentiated populations (2-19%, n=184). Drugs linked to discontinuation often have data supporting use in breastfeeding. Five studies mention factors influencing women’s behaviour; healthcare professional advice appears important, although overall data is limited. No studies described associations with socio-economic, geographic, or demographic background.
Conclusions: Despite the availability of safety data, medication-related breastfeeding remains common. This represents an unnecessary barrier to breastfeeding. Study is needed to understand factors influencing this decision-making process, identify risk factors for this decision, as well as to delineate the role of healthcare professionals’ role in supporting women to continue breastfeeding whilst using medication.
The impact of informational support during pregnancy ON FURTHER breastfeeding in Ukraine
Background: Parent support is crucial for their self-efficacy. The more breastfeeding knowledge is gained, especially during pregnancy, the more confident and successful a woman will be.
Methods: The aim is to determine the impact of informational preparation in different ways on childbirth. 578 families were interviewed and divided into 5 groups (1-no preparation, 2-reading literature, 3-reading literature, attending courses at antenatal care, 4-reading literature, attending commercial courses, 5-reading literature, attending all courses).
Results: During pregnancy almost all planned breastfeeding (92.3%), with no differences. 43.3% of mothers planned breastfeeding during the first year, up to two years and longer - 41.2%, with no differences. After birth, 69.7% gave formula at least once, and in the hospital, it was 5.1 times higher than at home. The chance also depended on the parental training level - it was almost 2 times lower in group 5. 72.5% had breastfeeding problems, mostly plugged duct (37.0%), nipple pain and cracking (34.1%), and milk quantity problems (20.2%). 69.7% asked for help; the chance of seeking help was 2-3 times higher in groups 4 and 5, respectively. The 1st group had the highest chance (12.5) of help from social networks or trying to self-solve the problem (3.5); the 2nd had the highest chance - from friends or relatives (4.5), groups 4, 5 - from lactation consultants/IBCLC (2.0-2.5). The chance of non-solving problems was highest in group 1 (33.3) as well as the chance of several problems during feeding in group 1 (4.2). Regarding the breastfeeding duration, 10.4% breastfed to 6 months, 8.0% to 1 year, 28.2% to 2 years and more, and the rest are still breastfeeding. However, the chance of stopping breastfeeding by 6 months was 4 times higher in the 1st group.
Conclusions: Consequently, the breastfeeding may be more successful if the family is more informed during pregnancy about breastfeeding.
HERPETIC MASTITIS IN A PUERPERAL WOMAN AT LEON GENERAL HOSPITAL: CASE REPORT
Sandra Edith Sierra Muro, Miranda Acosta Prieto
Leon General Hospital, Universidad de Guanajuato
Abstract Category: Medical Education
Background: The most common sites of infection by herpes simplex virus (HSV) are the oral and genital area. Viral inoculation can be produced through contact with skin or mucosal microabrasions of an infected person. The breast is a rare site of infection; cases reported in the medical literature are extremely limited. The most frequent etiology of transmission of herpetic mastitis in the mother-infant dyad is via breastfeeding.
Methods: We report a case of a 31-year-old woman with exclusive breastfeeding, primigravida, who had partum by c-section due to fetal pelvic presentation, with no added pathologies, who presented at our service with bilateral burning pain in nipple-areola complex not related to breastfeeding, which did not improve after administration of analgesic measures and was exacerbated during the feeding. Physical examination revealed painful vesicular dermic lesions in both areolas of 2mm of diameter, erythema, and swallowing. After 24 hours, lesions evolved to blisters with containing clear fluid. To interrogation the patient apparently had no risk factors for HSV yet presented with a compatible clinical description in the literature for this entity.
Results: We started empirical treatment with Acyclovir 400mg every 8 hours and transitory suspension of breastfeeding. This led to an appropriate clinical improvement until complete remission of the condition and successful relactation.
Conclusions: This diagnosis must be considered in every patient with or without risk factors presenting with ulcerative lesions in nipple areola complex, burning pain, erythema, and swelling, and most initiate treatment promptly. Diagnosis of herpetic mastitis is crucial as it poses a risk to both mother and infant, who may develop life-threatening complications secondary to disseminated infection.
Associations Between Hospital Feeding Patterns and Asthma
Jennifer McAllister1, Laura Ward1, Qing Duan1, Nichole Nidey2
1Cincinnati Children's Hospital
2University of Iowa
Abstract Category: Research
Background: Breast milk is the optimal nutrition for newborns, and breastfed infants have a decreased risk of developing many childhood illnesses, including asthma. Studies have shown that longer periods of exclusive breastfeeding confer greater protection against asthma, but few studies have evaluated the impact of birth hospital feeding patterns on childhood asthma.
Methods: We utilized the Maternal Infant Data Hub (MIDH), a regional perinatal data repository of maternal and infant dyads born within a large academic hospital system and linked to childhood data within the regional children’s hospital. Children born between 2017 and 2019 were included. Demographic information, feeding data, and asthma diagnoses were collected.
We used descriptive statistics to examine demographic characteristics and multiple regression models to examine feeding type and asthma. Odds ratios were calculated from the bivariate and multivariable analyses.
Results: There were 9649 children included. Of those, 81% received any breast milk and 31% exclusively received breast milk durring the birth hospitalization. Five percent had a diagnosis of asthma. Infants who received only breast milk had a lower rate of asthma diagnosis compared with those who did not receive any breast milk or did not receive breast milk exclusively after adjusting for sex, race, and insurance status. Additionally, infants whose first feeding was breastmilk also had a lower rate of asthma compared with those whose first feeding was not breast milk.
Conclusions: We demonstrated that feeding patterns early in life and during the birth hospitalization are associated with risk of childhood asthma. Receiving breastmilk for the first feed and exclusivity of breastmilk confer lower risk of childhood asthma in our study. Although external factors may impact those who develop asthma, this work highlights the importance of early breastfeeding in mitigating risk. Further work is needed to examine additional variables including prenatal, postnatal, and environmental factors and the influence of asthma outcomes.
Birth Hospital Feeding Patterns Among Infants with Opioid Exposure
Jennifer McAllister1, Nichole Nidey2, Laura Ward1, Scott Wexelblatt1, Qing Duan1, Jae Kim1
1Cincinnati Children's Hospital
2University of Iowa
Abstract Category: Research
Background: Breast milk offers the potential for improved health outcomes for both mothers and infants. There are specific benefits of breast milk for infants with prenatal opioid exposure including decreased risk of opioid withdrawal, need for pharmacologic treatment, and a shorter length of hospital stay. Breastfeeding is generally recommended for mothers who discontinue nonprescribed substance use by the time of delivery. Despite this, breast milk feeding rates for infants with POE are lower than those without exposure. Little is known about specific feeding patterns during the birth hospitalization in infants with POE.
Methods: We utilized the Maternal Infant Data Hub (MIDH), a regional perinatal data repository of dyads born within a large academic hospital system. Infants born between 2017 and 2019 were included. POE was identified based on maternal toxicology testing on admission, newborn toxicology testing, and/or newborn diagnosis code of POE. Descriptive statistics and chi-squared or Fisher’s exact test were used to examine the relationship between feeding variables and POE.
Results: Of the 9649 children included, 685 (7)% had POE. Among infants with POE, 65.3% received any breast milk during birth hospitalization, and 10.9% received breast milk exclusively, compared with 82.6% and 32.3% in those infants without POE. In addition, infants with POE had significantly lower odds of receiving their first feeding as breast milk, to be receiving any breast milk at discharge, or exclusive breast milk at discharge.
Conclusions: Breast milk is recommended for infants with POE and is considered a major treatment modality for Neonatal Opioid Withdrawal Syndrome. Our study demonstrated infants with POE are less likely to start and continue receiving breastmilk during the birth hospitalization compared with those without POE. Further work is needed to understand reasons for lower hospital breastfeeding rates including potential systemic biases, lack of breastfeeding support, and feeding problems or weight loss specific for this population.
Exposure of human milk to infants less than 34 weeks gestation after discharge from level III NICU in San Diego
Samantha Fine, Sandra Leibel
University of California San Diego
Abstract Category: Research
Background: Breast milk provides immunologic, neurodevelopmental, and nutritional benefits to infants. There are many factors that improve or challenge the success of providing human milk to the preterm baby in the NICU. We examined a cohort of infants born less than 34 weeks gestation from a level III NICU in San Diego to examine the type of nutrition they received before and after discharge.
Methods: Forty four infants born less than 34 weeks gestation were enrolled in the MAP (Microbiome, Atopic disease, and Prematurity) Study, which was a prospective, multicenter cohort study. Milk feeds were collected on a weekly basis in the NICU and monthly after discharge. The cohort was analyzed to determine what type of nutrition the infants were receiving prior to discharge and whether human milk was continued post discharge.
Results: The demographics of the cohort included 50% identifying as Hispanic, 40% Caucasian and 10% African American. Fifty percent of babies were exposed to human milk one month post discharge. This number decreased to 14% by month 4 and 0% by month 5. Formula feeds increased from 30% at month 1 to 86% by month 4 and 100% by month 5. The number of babies exposed to a mix of formula and breast milk also decreased over time, with 27% exposed to mixed feeding at month 1, which decreased to 11% by month 3 and 0% by month 5.
Conclusions: The 44 infants who were discharged home on human milk were on formula feeds by 5 months post NICU discharge, which highlights a large gap in human milk support pre and post NICU discharge. The precise reason for reduction in human milk is likely multifactorial. We have initiated a prospective survey to better understand the barriers and supportive factors to provide preterm infants with human milk during and after NICU discharge.
Preserving Breastfeeding in Dyads with Maternal Breast Abscess after Drainage Surgery: A Case Series
Dyah Febriyanti, Asti Praborini, Sarwan Mohan
Puri Cinere Hospital
Abstract Category: Research
Background: Breastfeeding is widely acknowledged for its numerous benefits in scientific research. However, ineffective management of breastfeeding-related complications can lead to acute inflammation, pus accumulation, and tissue damage in the breast, potentially resulting in large breast abscesses. Such complications may necessitate hospitalization, incisions, and drainage surgeries, ultimately increasing the risk of premature cessation of breastfeeding.
Methods: We present a retrospective analysis of 15 clinical cases of breast abscesses occurring among breastfeeding dyads treated at the lactation department of Puri Cinere General Hospital from September 1, 2020, to October 31, 2022. Diagnosis was confirmed through physical examination and ultrasonography. Hospitalization of both mother and baby was deemed necessary to ensure uninterrupted breastfeeding. Tailored multidisciplinary care involving a surgeon, pediatrician, and lactation consultant was employed to manage the abscess while prioritizing on-demand direct breastfeeding. This approach facilitated wound healing in the breast, ensured adequate nutrition for the baby, and promoted maternal-infant attachment and well-being.
Results: Among the analyzed dyads, all presented with unilateral breast abscesses following breastfeeding difficulties, scheduled breast pumping, and bottle feeding of expressed breast milk. Three dyads supplemented with formula milk. Nearly all infants (n=14) were under two months of age. Eight infants experienced frequent breast refusal, with three never directly breastfeeding. Ankyloglossia was observed in twelve infants. Fourteen dyads were hospitalized for fewer than 4 days, achieved wound closure within one month, and continued breastfeeding until the baby was 6-27 months (14 months in average). However, one dyad required a 5-day hospitalization, declined attempts at re-lactation post-surgery, and opted for bottle feeding.
Conclusions: This study demonstrates the feasibility of continued breastfeeding for the long term (14 months on average), through multidisciplinary management, emphasizing the breastfeeding and promoting rooming-in for both mother and baby during hospitalization. The prevalence of ankyloglossia in twelve infants underscores the necessity for further investigation in this area.
Medical Trainee Breastfeeding Education: Descriptive implementation of collaborative education models
Nidha Khan1, Samantha Walters2, Ann Witt2
1Ohio University Heritage College of Osteopathic Medicine
2Breastfeeding Medicine of Northeast Ohio
Abstract Category: Medical Education
Background: Primary care breastfeeding support is critical to breastfeeding success, though physicians lack training. Studies show that training improves knowledge, attitude, confidence, and breastfeeding rates. Residency programs face challenges implementing breastfeeding education and novel approaches are needed.
Methods: Surveys were conducted regarding knowledge, attitude, and confidence of trainees at 5 primary care pediatric, obstetric, and family medicine programs prior to implementing curriculum changes. Seven programs collaborated with a breastfeeding medicine physician and integrated a 5 hour online course. Clinical lactation training varied by program. Upon completion, descriptive overviews of each program’s implementation, challenges experienced, and post-course survey on resident confidence were collected.
Results: Pre-implementation survey had a 60% response (n= 97/161). 95% of respondents agreed they influence an individual’s decision to breastfeed, yet only 13% reported feeling very confident or confident managing common breastfeeding problems. Following completion of the online course (n= 41), residents reported valuing the education and an increase in feeling very confident or confident (66% n= 41,p=0.000) in managing common breastfeeding challenges. Residencies integrated online training at different time points. Clinical lactation experience depended on time and availability. The two most common reported barriers included difficulty obtaining dedicated didactic (n= 6) or clinical time (n=3) with some programs reporting limited access to clinical lactation experience. Descriptive lessons learned include completion of education more likely if it is a required part of a rotation, dedicated time to complete online learning, faculty monitoring for course completion, and inclusion of didactic asynchronous learning and clinical lactation experience in the curriculum.
Conclusions: Breastfeeding education increases physician confidence, yet limited time and availability remain barriers to education. Multidisciplinary collaboration with community breastfeeding medicine providers, faculty champions, and asynchronous didactic education highlighted in this case series remain important options as programs look to increase education, confidence, and support.
Nurturing Healthy Eating Habits: The Importance of Transitioning from Breastfeeding to Solid Foods
Background: The transition from exclusive breastfeeding to solid foods marks a critical period in infant development, laying the foundation for healthy eating habits and growth. However, the introduction of solid foods poses challenges in establishing a balanced feeding schedule. Failure to harmonize breastfeeding and solid food schedules may lead to infants preferring breastfeeding over solid foods after the age of 1 year, potentially increasing the risk of stunting.
Methods: A subset of mothers struggled to synchronize breastfeeding and solid food schedules for their infants. As a consequence, some infants exhibited extended period of a preference for breastfeeding over solid foods, leading to inadequate intake of essential nutrients. Notably, infants who predominantly breastfed beyond the age of 1 year demonstrated lower weight and height per age scores, indicating an increased risk of stunting. Rather than rigid schedules, healthcare providers need to advocate for a flexible approach that considers individual infant needs and feeding cues.
Results: By empowering mothers with knowledge about responsive feeding practices, healthcare providers can help them develop confidence in adapting feeding routines to accommodate breastfeeding alongside solid food introduction.
Conclusions: Transitioning to solid foods introduces changes in breastfeeding patterns, necessitating adjustments in the infant's feeding schedule. While breastfeeding frequency may decrease, maintaining regular breastfeeding sessions remains essential for ensuring adequate nutrition and continued bonding between mother and infant. Healthcare providers should educate mothers on optimizing breastfeeding schedules during the transition to solid foods, emphasizing the importance of responsive feeding and flexibility in meeting the infant's nutritional needs. Further research is warranted to explore strategies for effectively managing breastfeeding alongside solid food introduction to support optimal infant health and development.
Doula Intervention on Breastfeeding Outcomes: A Systematic Review
Background: Breastfeeding is considered the ideal source of infant nutrition and has been shown to enhance maternal-infant health, but most women do not achieve their breastfeeding goals. Significant racial, ethnic, and socioeconomic disparities exist in breastfeeding outcomes. The current literature indicates a positive impact of doula support on overall breastfeeding outcomes; however, it is less clear which specific breastfeeding measures are impacted by doulas. Our objective was to synthesize the existing literature on breastfeeding outcomes when doulas are utilized.
Methods: Electronic searches were conducted in February 2022, and primary studies that investigated doulas' impact on breastfeeding outcomes (intention, initiation, duration, exclusivity, knowledge, education, support) were included. Animal studies and studies outside the perinatal period were excluded. Data were extracted and synthesized narratively, and risk of bias was assessed.
Results: A total of 1564 deduplicated studies were screened and 20 were included. Twelve studies were quantitative and eight were qualitative. Most studies (n=14) focused on indicators of social disadvantage, such as adolescence, low-income status, and racially/ethnically minoritized groups. Doula utilization in the perinatal period was associated with improved breastfeeding intention, initiation, duration, and exclusivity. Doulas were an important source of support, education, and knowledge for breastfeeding women. Doulas reported a need for more education and training regarding breastfeeding, and healthcare providers had limited knowledge on doulas’ role in promoting breastfeeding.
Conclusions: Doulas improve breastfeeding outcomes, especially among disadvantaged communities. Increased breastfeeding education in doula training and greater inclusion and awareness of doulas among the healthcare team could further maximize this benefit.
DURATION OF SUPPLEMENTARY HUMAN DONOR MILK PROVISION TO VERY LOW BIRTH WEIGHT INFANTS
Monika Berns, Ariane Kusztrich, Irina Schroen, Christoph Bührer
Charité - University Medicine Berlin
Abstract Category: Research
Background: Feeding very low birth weight (VLBW) infants with human milk reduces the risk of necrotizing enterocolitis. Pasteurized donor milk (DM) is recommended as supplementary feed if there is not enough mother’s own milk (MOM) available. Little is known about how long preterm infants get DM and how this influences MOM provision.
Methods: To investigate the duration and the impact of DM on MOM provision to very low birth weight infants in a single-center retrospective cohort study. We compared infants born in 2019 to 2021 regarding the median duration of DM supplementation and the feeding type at discharge. The Kruskal-Wallis test and Bonferroni correction were used for multiple comparisons and post hoc statistical analyses.
Results: A total of 342/364 infants received at least some DM, with a median duration of DM of 6 days [interquartile range 3-30]. Duration of DM supplementation was 5 [3-7] days in infants discharged home with MOM (55.8%) and 33 [13-58] in infants with MOM and supplementary formula feeding at discharge (32.2%) (p<0.001). 22/364 (6%) did not receive any DM (9/364 [2.5%] received MOM only, 13/364 [3.5%] MOM and formula), and 22/364 (6%) DM and formula (no MOM).
Conclusions: A high amount of VLBW infants received MOM at discharge and getting the mother in a good milk production is associated with a short duration of DM feeding.
Allergic to Breastmilk? No Way!
Agustina Santi
No affiliation
Abstract Category: Medical Education
Background: Infants' immature digestive systems and developing immune systems predispose them to potential allergic reactions. Breast milk, with its diverse biochemical and immunological composition, plays a pivotal role in preventing allergies.
Methods: A comprehensive literature review was conducted to analyze existing research studies, clinical trials, and meta-analyses related to the relationship between breast milk and allergic reactions in infants. Relevant databases including PubMed, Google Scholar, and Cochrane Library were searched using keywords such as “breast milk allergy,” “infant allergies,” and “immune development.” Studies published between 2000 and 2023 were included, with a focus on peer-reviewed articles written in English. Data extraction and synthesis were performed to identify key findings regarding the immunological benefits of breastfeeding, factors contributing to allergic susceptibility in breastfed infants, and mechanisms underlying immune development and allergic prevention. Additionally, expert opinions and guidelines from reputable medical organizations such as the American Academy of Pediatrics and the World Health Organization were consulted to inform the discussion on promoting breastfeeding practices and addressing potential allergenic triggers.
Results: Breastfeeding confers numerous immunological benefits, reducing the incidence of allergic diseases such as eczema, food allergies, and asthma. However, some breastfed infants still develop signs of allergy. Genetic predisposition, allergen absorption through the small intestine, environmental factors like air pollution or cigarette smoke, and maternal diet contribute to allergic susceptibility in breastfed infants.
Conclusions: Medical education is crucial in dispelling misconceptions surrounding allergic reactions to breast milk. Understanding breast milk's immunological properties and its impact on gut microbiota can help healthcare professionals accurately diagnose and manage infants with allergy-like symptoms. Promoting breastfeeding practices and addressing potential allergenic triggers in maternal diets and environments are essential for optimizing infant health.
Assessment of nirmatrelvir with ritonavir administration in breastfeeding mothers through quantification of drug transmission to breastmilk
Taylor Fuquay1, Jean Dai1, Samuel Huseman2, Yue Dai3, Palika Datta1, Dhavalkumar Patel1, Kaytlin Krutsch1
1Texas Tech University Health Science Center
2Mountain View Regional Medical Center
3No affiliation
Abstract Category: Research
Background: This research investigates the intricate relationship among COVID-19, maternal and infant health, and breastfeeding practices, with a specific focus on assessing the transfer of nirmatrelvir and ritonavir into human milk. Our aim is to generate critical insights to support emergency medicine practitioners in managing COVID-19 treatment for lactating mothers. Through this study, we seek to bridge a crucial knowledge gap in lactation pharmacology and enhance the safety of therapeutic interventions in this unique patient dyad.
Methods: The InfantRisk Center Human Milk biorepository contained human milk and corresponding health information for eight mother-infant dyads exposed to maternal nirmatrelvir with ritonavir. Main outcomes measured were drug levels in milk, estimating the relative infant dose (RID), using liquid chromatography mass spectrometry (LCMS).
Results: Nirmatrelvir with ritonavir was measurable in all participants at a mean concentration of 33.48 ng/mL (ritonavir) and 729 ng/mL (nirmatrelvir). The estimated infant dose via milk was 0.0024 mg/kg/12 hrs (ritonavir) and 0.054 mg/kg/12 hrs (nirmatrelvir). The estimated RID was 0.19% (ritonavir) and 1.43% (nirmatrelvir). No adverse effects in infants were reported.
Conclusions: Nirmatrelvir with ritonavir is the recommended treatment for high-risk patients with COVID-19 including recently pregnant people. Though its use is recommended in lactating women, there are no previous studies on the transfer of nirmatrelvir into human milk. The RIDs of nirmatrelvir (1.43%) and ritonavir (0.19%) described in this study are well under the standard 10% safety threshold. These findings support current practices of nirmatrelvir/ritonavir use in lactating women.
Access to lactation consult services during the COVID-19 pandemic and the impact on breastfeeding outcome variables
Caroline Maltese, Nicole Hackman, Kristin Sznajder, Chintan Gandhi, Sarah Ramirez
Penn State College of Medicine
Abstract Category: Research
Background: Professional support from healthcare providers as well as social influences from family, friends, and peers have been shown to affect breastfeeding (BF) choices and sustainability. The COVID-19 pandemic introduced many barriers to BF, access to lactation support, and social connection.
Methods: This analysis was part of a longitudinal prospective study examining the impact of the COVID-19 pandemic on pregnant individuals and their newborns. Patients were recruited and survey data were collected during pregnancy and at one month postpartum. Survey data were combined with data from the electronic medical record, and the data were examined using descriptive analysis and both unadjusted and adjusted logistic regression models.
Results: 88.3% (N=203) of patients received a lactation consult while they were admitted in the hospital during the pandemic. 76.5% (N=176) of new mothers breastfed during the birth hospitalization and 63% (N=145) continued to breastfeed at one month postpartum. Having a COVID-19 infection during pregnancy did not change the access to lactation support (p= 0.0961). Multiple regression models assessing BF in the hospital found significant associations with having a lactation consult (OR 2.50, 95% CI 1.04, 6.04), having an infant in the neonatal intensive care unit (OR 0.29, 95% CI 0.11, 0.73), and having reported social support during pregnancy (OR 1.09, 95% CI 1.01,1.18). Multiple regression models assessing BF at one month postpartum found significant associations with BF exclusivity in the hospital (OR 8.11, 95% CI 3.63, 18.13) and having at least a college degree (OR 2.69, 95% CI 1.21, 5.97).
Conclusions: Exclusive BF during the birth hospitalization continued to be a critical variable in BF continuation. This study highlights the importance of having a lactation consult on both BF exclusivity and continuation during the COVID-19 pandemic.
Hospitalization for Nipple Confusion
Ayi Septarini
Permata Bekasi Hospital
Abstract Category: Research
Background: Nipple confusion is a common cause of breast-feeding failure. The World Health Organization has encouraged all facilities providing maternity services and care for newborn infants to adopt the “10 steps” of successful breastfeeding. This includes counseling mothers on the use and risks of feeding bottles, teats, and pacifiers because they may cause nipple confusion. We present an inpatient protocol for infants (Praborini Method) with nipple confusion to allow them to return to the mother's breast. Praborini Method has been legalized in Indonesia by the Ministry of Law and Human Rights of the Republic of Indonesia.
Methods: Data related to nipple confusion in patients hospitalized between Januari and December 2021 at Bintaro Women and Children Clinic (BWCC) Bekasi, West Java, Indonesia, were reviewed.
Results: There were 51 cases of nipple confusion during the study period. Forty-nine cases (96%) used bottles because of ankyloglossia. The length of hospitalization varied from 1 to 3 days (76.6%) and 4 to 7 days (23.4%). Forty-nine cases (94.1%) were able to successfully breastfeed using our protocol. In the follow-up of patients who successfully breastfed again, it was found that 32 patients (66%) continued breastfeeding for up to 2 years, 14 patients (29.1%) breastfed for 6-23 months, and 2 (4.9%) patients breastfed for less than 6 months.
Conclusions: Hospitalization for nipple confusion with multimodal management is effective for treating nipple confusion. Ankyloglossia can lead to difficulties in initiating breastfeeding, and early introduction to bottles can lead to nipple confusion. Early detection and treatment are desirable.
SELENIUM CONCENTRATION IN MATERNAL AND UMBILICAL CORD BLOOD AND ITS IMPACT ON SOME NEONATAL CHARACTERISTICS AND BREASTFEEDING
Background: Some experimental studies have shown that maternal selenium deficiency is associated with fetal malformations and mental development disorders in infants. During selenium deficiency, oxidative stress is inadequately controlled and, therefore, there is a possibility of morphological and histological developmental damage in the neonatal period. The aim of the study was to assess an impact of maternal and umbilical cord blood selenium level on breastfeeding status and some neonatal characteristics.
Methods: Cohort Prospective Study: Inclusion criteria: 13-17 weeks of pregnancy; the informed consent of pregnant women. Mean age - 28.2 years. Plasma selenium concentrations were measured in maternal blood on the 13-17 weeks of gestation in 32 pregnant women (method-Atomic absorption spectroscopy) and in umbilical cord blood specimens were obtained after delivery.
Results: Maternal Se low level during pregnancy were associated with delayed breast fullness, lower milk volume, short duration breastfeeding. A low maternal selenium level in pregnancy was negatively related to infant breastfeeding practice and duration at 6 months (r=-.582, p = 0.001). Selenium level in umbilical cord blood has no impact on the duration of breastfeeding period. It was expected that breastfeeding period should be under influence of other factors (culture, education, social factors, etc.). Selenium levels in maternal blood were significantly correlated with: small for gestational age (SGA) - r=0.448, p=0.010; referrals in NICU- r=0.497, p=0.004; low birth weight < 2500 g - r=0.497, p=0.004; and neonatal RDS - r=0.366, p=0.001.
Conclusions: The association of selenium with some characteristics of newborns should indicate the importance of selenium levels for fetal development and breastfeeding practice. There is insufficient evidence to recommend selenium supplementation during pregnancy as part of routine antenatal care. Selenium supplementation is recommended during pregnancy based on individual selenium status.
Got Donor Milk? A Year of Dispensing Outpatient Donor Milk in Northeast Ohio
Background: Inpatient pasteurized donor human milk (PDHM) is increasingly available, but outpatient use remains limited. To address increasing demand for outpatient PDHM, further studies on feasibility, barriers, and reasons for and frequency of use are needed.
Methods: Descriptive study regarding opening of outpatient PDHM dispensary in December 2022 and follow-up through one year. Survey results of patient reported reasons for obtaining outpatient PDHM. Retrospective chart review for a subset of patients receiving routine access to outpatient PDHM at collaborating pediatric practice (CPP).
Results: In the first year, 72,180 mL of outpatient PDHM were dispensed to 57 families with 85% (46/55) having received inpatient PDHM. Median volume obtained per family was 720 mL (range 90 to 10,170). Median infant age at first purchase was 3 days (range 0-260 days). Fifty-two families responded to open-ended survey questions on reasons for obtaining PHDM with all citing reasons related to low milk supply and over half citing “bridging” until milk supply increased (60%). Some families (13%) cited pain, taking a break, latching difficulties, prematurity, and jaundice as additional reasons. Fifty percent of the families (n= 28) received primary care at the CPP, which has a typical newborn volume of approximately 550 per year. Approximately 5% of CPP families obtained PDHM, although chart review found 9% were candidates for “bridge” milk. At the 1 month well visit, any breastfeeding (BF) rates were similar between infants requesting PDHM and the CPP breastfeeding rates (86% vs 90%, p=0.537). Review of 4 infants (14%) switching to formula at 1 month identified 3 had mothers with low milk supply and 1 had a medical indication for formula.
Conclusions: The most common reason for purchasing PDHM was low milk supply. Outpatient dispensaries can help families with delayed lactogenesis “bridge” with PDHM until their milk supply increases.
Effectiveness Essential Care for Small Babies training in India- The Success Stories
Background: Essential Care for Small Babies (ECSB) training has been developed by the American Academy of Paediatrics in collaboration with Laerdal Global Health, as a part of the Survive & Thrive Alliance. In India, it aims to train health professionals on topics like identification of small babies of low birth weight and counseling for families, kangaroo mother care, breastfeeding, breast milk expression, cup-feeding and nasogastric feeding, detection of danger signs, and others.
Methods: 8 hours of on-site training, including simulation-based skills practice in pairs, for support breastfeeding, express breast milk, cup feeding, inserting a Nasogastric Tube, and providing appropriate volume of breast milk. Mama Breast, PreemieNatalie, Penguin Suction, and CarePlus wrap for KMC, poster and flip chart on ECSB, videos on breastfeeding, danger signs of newborns, kangaroo mother care, and breastfeeding readiness assessment are used to train paramedic/nursing staff from maternity homes and NICU. Knowledge assessment and certificate of participation were part of the training.
Results: 719 health care professionals were trained from 210 different hospitals, in 15 states of India between 2018 and 2019.
The success stories of care of babies from the implementation:
Baby of Ufra Asad with a birth weight of 1.85 kgs was provided with exclusive breastfeeding and continuous skin-to-skin care for 4 hours/3 times a day and discharged for home care on the 5th day from Ratna Hospital (Hyderabad).
A female baby, at 28 weeks of gestation with a birth weight of 1.5 kgs, shifted from warmer to achieve 6 hours of continuous skin-to-skin care and was discharged at the 10th day with a weight of 1.9 kgs. “The baby gained 40g each day” -ESIC, Kolkata
Conclusions: The simulation-based skills training helps achieve not only knowledge and skills but also the desired clinical practice in the care of small babies with exclusive breast milk feeding along with kangaroo mother care.
How expectation about the breastfeeding experience can lead to success of breastfeeding journey
Shereen Abdelghani
No affiliation
Abstract Category: Research
Background: There have been extensive studies examining factors that contributed to breastfeeding initiation, continuation, and exclusivity. Common identified individual factors included maternal socio-demographic factors (e.g., education and employment), smoking status, health conditions, knowledge, perception of breast milk supply, and perceived breastfeeding self-efficacy. A variety of contextual factors were also identified including social support, medical and healthcare-related factors, and sociocultural factors. The expectations of new mothers about breastfeeding affect the end of the journey whether successful or not.
Methods: This is a qualitative research, where participants were recruited through paid social media advertisements (Facebook, Instagram, and Twitter) between December 2022 and December 2023 targeting mothers from the United States, Canada, Egypt, and Gulf countries including Saudi Arabia and Kuwait. A questionnaire was answered online twice, once during pregnancy and then after 2 weeks of delivery. The participants were divided into two groups: one group recieved an online antenatal education about breastfeeding and the other group did not get any training.
Results: The mothers' breastfeeding experiences after birth were characterized by a range of emotions from deep frustration to confidence and a sense of capability of doing anything that was necessary for their baby. The mothers' descriptions of their breastfeeding experiences had focus on the expectations they had, why they started, why they continued or stopped, and how they regarded the professional help that they did or did not receive.
Conclusions: Those who had corrected expectations through antenatal education had fewer complications.
Early Frenotomy on an 8-Day-Old Infant with Poor Nutritional Status Resulted in Achieving a Healthy Nutritional State within 2 Months and 15 Days - A Case Report
Background: Breastfeeding, a natural and integral aspect of early infant nutrition, plays a crucial role in promoting optimal health and development. The mechanism of breastfeeding is influenced by the anatomy of the baby’s mouth. Ankyloglossia, a congenital abnormality of the tongue commonly called tongue tie, can make breastfeeding difficult and exhausting for the infant. Frenotomy, a surgical procedure to release restrictive lingual or labial frenula, has gained prominence as an intervention for conditions such as ankyloglossia in infants. Based on the time it is carried out, frenotomy is divided into early and late frenotomy. In this case report, we performed an early frenotomy on an 8-day-old baby girl with poor nutrition.
Methods: We present a case of frenotomy carried out on an 8-day-old baby with poor nutrition. The baby had a posterior tongue tie and a third-grade lip tie. The mother complained that her nipples were always sore, and the baby had difficulty latching, nursed for a long time, detached frequently, and made clicking noises. After frenotomy, the mother and the baby underwent tongue and lip exercises, supplementation, and regular follow-ups at the hospital.
Results: After the frenotomy, a significant increase in the baby's weight gain was observed, the mother's breast milk production was maintained, the baby's latch improved, and optimal breast milk transfer was achieved. Monitoring weight gain revealed that the baby's weight gain per day was consistently > 25 g/day. The baby's nutritional status also changed from poor nutrition (<-3 SD) to good nutrition (-2 SD) between September 29, 2023, and December 14, 2023 (2 months and 15 days). In the breastfeeding process evaluation, the mother also noticed a significant difference, and the initial complaints no longer existed.
Conclusions: Early frenotomy in this case showed a significant positive effect in terms of the quality and quantity of breastfeeding.
“That Purgatory Realm Was Just Probably the Worst of It”: Women's Experiences With Chronic Low Milk Supply
Susanna Scott1, Julie Searcy1, Izabella Jordan2
1Butler University
2Marian University
Abstract Category: Research
Background: Women who experience chronic low milk supply face a situation for which there are no standard testing or treatment plans. Chronic low milk supply impacts between 5% and 15% of lactating individuals and is linked to hormonal imbalances, thyroid disorders, insufficient glandular tissue (IGT), insulin resistance, and polycystic ovary syndrome (PCOS). This study is needed to understand women’s experiences and identify communication needs for both patients and providers as they navigate challenges in breastfeeding.
Methods: We conducted in-depth interviews with 30 women recruited from the online IGT and Low Milk Supply Support Group to explore their experiences. Women in our study had between one and four live births. Of the participants, 20% (n=6) identified as Hispanic/Latino, 83% (n=25) identified as White, 10% (n=3) as Asian, and 7% (n=2) as Other. We analyzed the data using a phronetic iterative approach, which is inquiry guided by coding in cycles and memo-writing.
Results: Our overarching finding is that women experiencing low milk supply were caught in a liminal space described as a state of purgatory. Women articulated purgatory as the uncertain transition between achieving their goal of exclusive breastfeeding and accepting alternative and originally undesirable scenarios, such as supplementing with formula. In addition, women struggled to find accurate information and expertise to help them achieve their goals and perceived that there was overall low awareness and education about the issue among clinical providers.
Conclusions: Women who report having low milk supply are situated in a liminal space and struggle to identify evidence-based expertise to address their issues. This study highlights the importance of increasing awareness about chronic low milk supply and developing clearer guidelines for patient provider communication and diagnosis.
Impact of Dysphoric Milk Ejection Reflex on Mental Health
Nalan Karabayir, Aybüke Kacır, Mine Başıbüyük, Demet Deniz Bilgin, Övgü Büke, Ozlem Öcal, Abdullah Ferhat Karademir
Background: Postpartum mental health is one of the most crucial factors affecting breastfeeding. Dysphoric Milk Ejection Reflex (D-MER) is defined as a negative emotional reaction to milk ejection, such as unpleasant feelings, anger, irritability, and a strange feeling in the stomach. The aim of our study is to investigate the effects of D-MER on maternal mental health who experience unpleasant emotions while breastfeeding.
Methods: The cross-sectional, descriptive study was conducted between July 1 and September 30, 2023, among mothers who had babies aged 0-2 and who experienced unpleasant feelings while breastfeeding. Mothers reached via Instagram and Facebook were invited to a semi-structured survey of 45 questions created with open access Google Forms.
Results: Out of 141 participating mothers 27.7% (n: 39) had D-MER findings. Most frequently experienced emotions were found to be tension (48%), exhaustion (43%), intolerance (41%), hypersensitivity (35%), and restlessness (33%). Symptoms reported to begin within the first month of breastfeeding in 59% of D-MER cases. Nausea or a feeling of emptiness in the stomach before the milk ejection reflex was reported in 30% of mothers. The most common conditions that increased the severity of D-MER symptoms were insomnia, stress, and breast fullness. Sleeping or resting, being alone, doing something else, drinking cold water, listening to music, and talking to mothers who had similar experiences helped the mothers relax. It was determined that 17.9% of D-MER cases thought about stopping breastfeeding, and 7.7% stopped breastfeeding for this reason. The postpartum depression score was 13 and above in 59% of D-MER cases.
Conclusions: D-MER, alongside causing early cessation of breastfeeding, also negatively affects the mental health of the mother. Raising awareness about D-MER and equipping health professionals on this subject are of great importance in the continuity of breastfeeding
Association Between Breastfeeding and Maternal Sleep Quality Among Mothers With Opioid Use Disorder
Arushi Chalke, Linnea Linde-Krieger, Stacey Tecot, Alicia Allen
University of Arizona
Abstract Category: Research
Background: The escalating prevalence of opioid use disorder (OUD) among pregnant women is a public health crisis. Breastfeeding benefits new mothers by increasing self-efficacy, protecting against postpartum depression, and improving maternal sleep quality. Sleep quality is an important predictor of postpartum well-being, and poor sleep quality is linked to postpartum mood disorders and increased OUD relapse risk. Due to limited research on breastfeeding and sleep quality among postpartum individuals with OUD, our study aims to assess breastfeeding/lactating influence on sleep quality among postpartum individuals with OUD.
Methods: Participants were drawn from an ongoing study (DP2HD105541) of individuals with OUD (N = 52) followed from late pregnancy through five months postpartum. Breastfeeding status was assessed weekly via participant reports of lactation, including both breastfeeding and pumping. Sleep quality (including duration, latency, disturbance, etc.) and daytime sleepiness were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively, at weeks 4, 8, and 12 postpartum. Point biserial correlations estimated the magnitude and direction of associations between breastfeeding status, sleep quality, and daytime sleepiness concurrently and prospectively across time points.
Results: Results indicated that 42.3% of participants reported breastfeeding/lactating (i.e., exclusive pumping) at week 4, decreasing to 25.0% at week 8 and 17.3% at week 12. Breastfeeding/lactating at week 4 was prospectively associated with greater sleep duration at week 8 (r=0.36, p=0.04). Breastfeeding at week 12 was concurrently associated with greater overall daytime sleepiness (r=0.41, p=0.02).
Conclusions: This longitudinal investigation of breastfeeding among postpartum individuals with OUD suggests that early breastfeeding/lactating may be linked to benefits for sleep duration. However, findings also suggest that breastfeeding/lactating may be associated with increased daytime sleepiness, possibly due to sleep disturbances. The study highlights the complexities between breastfeeding status and sleep quality among OUD postpartum population and emphasizes the need for further exploration.
Enhancement of Employee Lactation Support Services in a Large Academic Health System- A Quality Improvement Project
Courtney Bilodeau
Warren Alpert Medical School of Brown University
Abstract Category: Quality Improvement Advocacy
Background: Lifespan is the largest health system in Rhode Island, encompassing almost 17,000 employees spread out over 5 hospitals and multiple specialty and primary care offices. Lifespan is a major teaching center for The Warren Alpert Medical School of Brown University and several other nursing and allied health professional training programs. In 2021, Lifespan identified enhancing employee lactation support as a part of a strategic plan to create a healthier future for patients and employees.
Methods: A group of highly invested stakeholders across the health system developed and implemented a plan to enhance employee lactation support services. The plan included a system-wide anonymous employee survey, a comprehensive assessment of all available employee lactation support spaces currently in use, and an update of the employee lactation support policy. Finally, there was an updating of all lactation spaces to a minimum set of requirements and lactation pods were purchased to augment the lactation space availability in high-need areas.
Results: Three hundred and ninety employees responded to the survey; 64% of respondents reported they planned to pump in the future, and 42% in the next year. From January 2023 to January 2024, between 4 lactation pods across 2 different hospitals, there were 1855 pumping sessions, and the average pumping time was 23 minutes. A review from one employee using a lactation pod stated, “Feels good to be included and cared for as a mother. We are important too!”
Conclusions: Returning to work is a common reason given for lactation cessation. Health care workers are particularly vulnerable to suboptimal lactation outcomes. Employee lactation support is important for employee wellness and the achievement of lactation goals. This project demonstrates how a comprehensive plan that includes critical stakeholders, including a breastfeeding medicine physician, can enhance employee lactation support.
Documentation of Pump Initiation and Coming to Volume for Mothers of VLBW Infants
Gillian Bremer, Cheryl Dunton, Kate Tauber
Albany Medical College
Abstract Category: Quality Improvement Advocacy
Background: Breastmilk is important for the health and development of very low birth weight (VLBW) infants. Mothers of VLBW infants struggle with delayed lactogenesis II and coming to volume (CTV). Literature suggests pump initiation within 6 hours after delivery contributes to breastmilk volume after 7 days. Due to suboptimal rates of breastmilk intake in infants >7 days of age, we wanted to look at the timing of the first pump and CTV within the first month.
Methods: A retrospective chart review of infants born <33 weeks gestation at our institution. Mothers’ charts were reviewed for documentation of the feeding plan, time to first pump (TFP), and volume of breastmilk produced in the first 30 days after delivery. Demographic data collected included self-reported race, time of birth, and gestational age of the infant. Lactation reports were analyzed to determine if mothers achieved coming to volume (CTV), defined as >500 mL in 24 hours. Exclusion criteria were drug use or maternal medications that were contraindicated to breastfeeding.
Results: 94 charts were reviewed between January and September 2023 and 10 charts were excluded. Twenty-four charts had recorded TFP and 6/18 mothers with TFP <6hr achieved CTV by day 7 and 4 more by day 28. Of the 6 mothers with TFP >6hrs only 1 achieved CTV by day 7. Of the 60 mothers with no documented TFP only 8 achieved CTV by day 7 and 16 more by day 28. Mothers with a documented TFP <6 hours were more likely to achieve CTV although not statistically significant due to a small sample size.
Conclusions: Our data support prior research that earlier initiation of pumping improves achieving CTV during the first month after birth. Ongoing QI initiatives are focused on L&D staff awareness of the importance of pumping initiation (and documentation) and the benefits of breastmilk for preterm infants.
Work Schedules and Breastfeeding Outcomes in the First Postpartum Year
Rachel Sielaty, Alison Stuebe
University of North Carolina at Chapel Hill
Abstract Category: Research
Background: Employment in the postpartum period separates the infant from the lactating parent, disrupting breastfeeding. We sought to quantify the association between work schedule, workplace support, and breastfeeding outcomes in the first postpartum year.
Methods: We performed a secondary analysis of data from participants in the Mood, Mother and Infant longitudinal cohort study. Monthly interviews assessed work schedule, perceived workplace support, and breastfeeding behaviors. We quantified perceived workplace support (low or high) and work hours (None, <20h/wk, ≥20hr/wk) at 3 and 6 months postpartum, and we assessed ≥50% breastfeeding (mother’s milk for ≥50% vs <50% of milk feedings) at 6 and 12 months. We used logistic regression to adjust for education and household income.
Results: Data on work and infant feeding were available for 205/222 study participants at 3 months and 204/222 at 6 months, among whom 180/205 (87.8%) were breastfeeding at 3 months, and 159/204 (77.9%) were breastfeeding at 6 months. Few reported low workplace support (seven at 3 months, five at 6 months), precluding analysis of this group. We therefore compared those not working (NW) with those working in supportive workplaces <20h/wk or ≥20h/wk. Among those breastfeeding at 3 months, work at 3 months was not associated with ≥50% breastfeeding at 6 months (3mo NW: 78.3%; <20h/wk: 83.3%; ≥20h/wk: 70.2%, p=0.33), but it was associated with ≥50% breastfeeding at 12 months (3mo NW: 53.1%; <20h/wk: 41.9%; ≥20h/wk: 19.0%, p<0.001). Among those breastfeeding at 6 months, work at 6 months was associated with ≥50% breastfeeding at 12 months (6mo NW: 73.5%; <20h/wk: 56.0%; ≥20h/wk: 22.1%, p<0.0001). Adjustment for education and household income did not materially change our results.
Conclusions: We found work schedule correlated with breastfeeding intensity at 6 and 12 months. Offering employment <20h/wk may support longer breastfeeding duration and intensity.
Gender Inclusivity in Lactation Care Textbooks
Lukas Daniels-Day1, Sarah Lacy2, Elizabeth Quinn1
1Washington University in Saint Louis
2University of Delaware
Abstract Category: Research
Background: Lactation support is crucial, but the specific needs related to breast/chestfeeding among sexual and gender minority (SGM) individuals, especially transgender people, have been largely overlooked. The International Board of Lactation Consultant Examiners (IBLCE) establishes clinical practice and education standards; the current IBLCE standards encompass education on family lifestyles and cultural competency but lacks explicit guidance on the use of gendered terms and pronouns and working effectively with SGM patients.
Methods: To assess the impact of these omissions on educational materials that lactation consultants (LCs) use in their training, I examined eight lactation care textbooks. Textbooks were selected based on date of publication, language, and recommendation by the IBLCE to represent the past 20 years of lactation care guidance recommended to English-speaking care providers. A pre-designed, five-point magnitude coding rubric (adapted from Saldana, 2013) was employed to analyze the textbooks. This rubric assessed the inclusivity of SGM people in lactation care information across five categories, with full points awarded for comprehensive coverage and half points for inclusion limited to cisgender/heterosexual women.
Results: The average score for the analyzed textbooks was 2.38 out of 5, but the variation in scores significantly increased from pre-2020 publications to post-2020 publications. Pre-2020 publications averaged 1.0 (SD = 0.91), whereas publications post-2020 averaged 3.75 (SD = 2.5). Of books published since 2020, 75% were inclusive of SGM parents, but prior to 2020 inclusion of SGM parents in the texts was limited to sexual minorities.
Conclusions: As more SGM individuals share their experiences of family planning, gestating, birthing, and breast/chestfeeding, the need for comprehensive and culturally sensitive informative materials for the soon-to-be parenting population and their lactation care providers is increasing. Lactation textbooks should include considerations for SGM parents throughout the text both explicitly and implicitly through language and pronoun usage to increase inclusivity.
Promoting Breastfeeding Education to Medical Students through Volunteerism
Franki Walsh
University of Arizona
Abstract Category: Medical Education
Background: Wesley Community and Health Centers (WCHC) is a Federally Qualified Health Center that provides primary care services at four locations across the Phoenix metro area, including prenatal care to about 120 patients per year. 65% of WCHC’s patient population is uninsured and 65% is best served in a language other than English, primarily Spanish; thus the patients face unique barriers to breastfeeding. Students at the University of Arizona College of Medicine - Phoenix are able to volunteer at the clinic, a popular choice for many students to obtain clinical volunteer hours. However, despite pre-clinical and clinical education and interests in Pediatrics or OB/Gyn, many students are unable to discuss breastfeeding.
Methods: A third-year medical student volunteer created patient-directed educational materials on various breastfeeding topics after completing a breastfeeding course and shadowing an IBCLC on staff at the clinic. These presentation topics include Introduction to Breastfeeding, Breastfeeding Positions and Latch, Caring for your Breasts, Is My Baby Getting Enough, and Prenatal Colostrum Harvesting. All of the educational material was reviewed and approved by the IBCLCs at WCHC. The current first-year medical student lead for the program is expanding the materials and has created a resource page for future student volunteers to learn more, including a link the American Academy of Pediatrics' Residency “Breastfeeding Curriculum.” Student volunteers will be surveyed before starting the program, after 1 month and 6 months of volunteering, and after finishing their volunteer commitment.
Results: This community project is ongoing. There have been five medical student volunteers to date, and when the next class of medical students starts in July 2024, the current lead will recruit more students to volunteer.
Conclusions: The project is still ongoing, but positive feedback has been received from medical students - as well as the patients being served by this project.
Why do patients attend telehealth Lactation Groups?
Jennifer Somers, Taylor Lautzenhiser
Greater Lawrence Family Health Center
Abstract Category: Research
Background: There are significant barriers to successful lactation; these barriers often include decreased access to support, education, and acute-care lactation appointments. In August 2020, a virtual lactation support group started at Greater Lawrence Family Health Center as a collaboration with the Lawrence WIC office and has been active for 3 years. The aim of the study was to discover the motivations of patients who attended breastfeeding support group more than three times and why they found it useful.
Methods: Ten patients were interviewed using 22 structured interview questions in the patients’ preferred language (Spanish or English). The interviews were transcribed and coded to reach thematic saturation.
Results: The results of our paper found that patients attended the lactation groups for the educational content and for peer support. They stopped attending groups when they returned to work full-time and their schedules no longer allowed it, they weaned, and/or they moved.
Conclusions: Through this qualitative, thematic analysis we found that patients attend the virtual lactation groups for educational content and peer support. Both education and support are protective for lactation success, and tele-lactation support is an innovative area of Lactation Medicine. Exploring alternative modalities of providing lactation support maybe beneficial in low-resource communities, rural areas, and maternity care deserts. Future study is needed to see if virtual lactation group visits improve lactation outcomes.
Effectiveness of a Breastfeeding Training Curriculum in a Pediatrics Residency Program
Grecia Ferreyra, Alejandra Frauenfelder, Maria Miranda
Nicklaus Children's Hospital
Abstract Category: Medical Education
Background: Many inconsistencies exist in breastfeeding counseling among healthcare providers because of lack of medical breastfeeding training. The residency program at Nicklaus Children's Hospital did not have a formal breastfeeding training curriculum. To increase breastfeeding rates, a pediatric resident breastfeeding curriculum was created to provide the knowledge, skills, and confidence to promote breastfeeding practices.
Methods: The aim of this project was to increase breastfeeding rates throughout the organization by educating Pediatric residents. Using Bloom’s Taxonomy framework of learning and the American Academy of Pediatrics Curriculum, a mixed method approach was utilized. Quantitative Business Intelligence Reports measured percentage of patients discharged on human milk feedings. Post-intervention surveys measured percentage of counseling comfort during clinical encounters. A pre- and post-test measured increased knowledge after the training. A five-point Linkert Scale survey was utilized to evaluate the training program. The number of medical residents participating in the breastfeeding parenting elective program was analyzed.
Results: Quantitative reports showed patients discharged on human milk feedings for 2022 were as follows; Q1 64.29%, Q2 69.53%, Q3 63.61%, Q4 67.59%. After training, for 2023 rates were as follows: Q1 72.24%, Q2 73.21%, Q3 67.37%, Q4 69.98%. Post-training resident confidence survey improved from 45% to 66%. Pre- and post-training knowledge tests showed a 28.16% knowledge increase, where 100% of medical residents strongly agreed the lactation training was effective. Quantitative Data Analysis showed a total of 17.80% of residents completed the Breastfeeding Curriculum as their parenting elective training.
Conclusions: Based on these results, a Breastfeeding Curriculum for a Pediatric Residency Program is an effective way to protect, promote, and support breastfeeding practices in any healthcare organization. Implementing the program enhances clinical confidence, increases breastfeeding rates, increases medical knowledge on breastfeeding best-practices, and promotes adherence to Baby Friendly Initiative in healthcare settings.
Bedsharing Among Breastfeeding Physicians: Results of a Nationwide Survey
Adetola Louis Jacques1, Melissa Bartick2, Adeola Awomolo3, Jiaqi Zhang4, Lori Feldman-Winter5, Stephanie Leonard4, Joan Meek6
1University of Florida
2Mount Auburn Hospital/Beth Israel Lahey
3University of Arizona College of Medicine
4Stanford University School of Medicine
5Cooper Medical School of Rowan University
6Florida State University College of Medicine
Abstract Category: Research
Background: Bedsharing is common among the US population, but the American Academy of Pediatrics advises against all bedsharing. Physicians would be expected to be aware of this recommendation and are often responsible for conveying this recommendation to patients. It is unclear if breastfeeding physicians adhere to this recommendation themselves. Bedsharing is associated with a longer duration of breastfeeding in multiple studies. It is unclear if this is also true for physicians.
Methods: An online survey was adapted from surveys administered by the Centers for Disease Control and Prevention. The survey was administered to physicians and medical students who birthed children. Participants were recruited through social media platforms from October 2020 through July 2021. Respondents were asked to report on a singleton birth that occurred during the most strenuous period in their career, and questions centered around sleep practices and breastfeeding. Bedsharing was defined as a baby being “in bed with” mother. Survival analysis was used to examine the association between bedsharing and breastfeeding duration.
Results: Of 546 respondents with bedsharing data, 68% reported some history of bedsharing, and 77% were in specialties that involved caring for pregnant people and/or infants. Those who bedshared breastfed an average of four months longer than those who never bedshared (18.08 versus 14.08 months p<0.001). The adjusted risk of breastfeeding cessation was markedly lower for those who bedshared compared with those who did not (hazard ratio 0.57, 95% confidence interval 0.45, 0.71). The primary reason for bedsharing was to breastfeed (73%); the primary reason for not bedsharing was safety concerns (92%). Among those who bedshared (n=373), 52% did not inform their child’s healthcare provider.
Conclusions: Despite current recommendations, bedsharing is common among breastfeeding physicians, including those who care for pregnant people and/or infants. It is also associated with longer duration of breastfeeding.
Empowering Mothers for Breastfeeding Retention And Counseling on Exclusivity (EMBRACE)
Jennifer Merrill, Abigail Rodriguez, Kelsey Testman, Marisa Van Patten, Elaine Hart
Loma Linda University
Abstract Category: Research
Background: At birth, 62.6% of babies are exclusively breastfed and the rates drop to a meager 24.9% by 6 months of age. By extrapolation, the number falls to 55% by the six-week mark and declines steadily from there (CDC Report Card, 2022). From the information that exists on breastfeeding retention rates and barriers, it can be concluded that continued efforts are needed to support new mothers on their breastfeeding journey.
Methods: Subjects of this study were first-time mothers who exhibited the intent to exclusively breastfeed after delivery and were recruited during their postpartum stay at Loma Linda University Medical Center in CA. Subjects were randomized to either an intervention group that received weekly phone calls providing breastfeeding support or a control group with no such intervention. Assessments of breastfeeding status and barriers were collected via weekly Qualtrics surveys to the intervention group. Those in the control group received one phone call and text survey to assess their breastfeeding journey at 6 weeks postpartum.
Results: In the pilot run of the study, 9 patients were initially enrolled; 6 were randomized into the intervention group and 3 were randomized into the control group. Of the 6 patients in the intervention group, 3 were lost to follow-up. The 3 remaining were exclusively breastfeeding by weeks 2-3 of the protocol and continued to exclusively breastfeed. Of the 3 control group participants, two of them were using formula and one was exclusively breastfeeding at the 6-week mark.
Conclusions: Preliminary data are promising as the intervention group participants who were retained in the study were exclusively breastfeeding. As this study is novel in using trained medical students as lactation counselors, future goals include comparing data from knowledge pre- and post-tests given to student researchers to assess the effectiveness of the training program.
Preparing Doctors in Training to Meet the Requirements for the International Board Certified Lactation Consultation (IBCLC) Exam
Sheela Geraghty, Ellen Springer, Laura Ward, Sarah Lawler, Julie Ware, Sue Poynter
Cincinnati Children's Hospital Medical Center
Abstract Category: Medical Education
Background: Doctors in training are interested in learning about breastfeeding and lactation in a clinical setting. At the Cincinnati Children’s Hospital Medical Center (CCHMC) Center for Breastfeeding Medicine, we have developed a program in which we guide dedicated doctors in training through the requirements to become International Board Certified Lactation Consultants (IBCLCs).
Methods: Doctors in training at CCHMC self-identify as being interested in learning more about breastfeeding. These individuals meet with the director of the CCHMC Center for Breastfeeding Medicine to discuss the most appropriate breastfeeding education desired by each doctor in training. The doctors in training who choose to work toward becoming an IBCLC follow Pathway 1 as outlined by the IBCLC Commission. A plan of how to obtain both the clinical and the didactic hours is delineated and reviewed regularly by residency program leadership and the Center for Breastfeeding Medicine members.
Results: Four doctors in training have passed the IBCLC exam; two are in private practice: one in a combined primary care/breastfeeding clinic setting at CCHMC and the other just starting a neonatology fellowship. Two doctors in training are waiting for their results; one will be working in private practice and the other is starting 3rd year of residency. Three residents have registered for the exam in the fall of 2024; one is planning for a fellowship in gastroenterology, another going to help staff a maternity hospital, and the third joining a private practice. Four other residents are currently in various stages of Pathway 1.
Conclusions: We have found that with a keen awareness of the IBCLC requirements, acute mindfulness of deadlines, and a continual reassessment of timelines, Pathway 1 can be incorporated into a busy pediatric residency program. Formalized discussions among leaders of doctors in training programs worldwide would be helpful for all to better understand how to guide doctors in training in a multitude of breastfeeding-related clinical settings.
Determination of Semaglutide (Ozempic) in Human Breastmilk Following Dosing
Hanin Diab, Palika Datta, Jon Thompson, Taylor Fuquay, Kaytlin Krutsch
Texas Tech University Health Science Center
Abstract Category: Research
Background: Pregnancy can lead to a sustained increase in weight, and obesity can have a potential negative impact on both physical and psychological well-being. Postpartum mothers and their healthcare providers are faced with the challenge of limited data regarding the safety of infant exposure to maternal drug therapies during lactation. Semaglutide, a glucagon like peptide 1 (GLP1) receptor agonist long used to treat type 2 diabetes, slows gastric emptying, which reduces food intake, leading to weight loss. Lactating mothers have expressed overwhelming interest in taking semaglutide for weight loss while breastfeeding, leading to concerns of growth restriction in the infant. This study investigates the transmission of semaglutide into human milk at various time intervals following maternal self-administration.
Methods: Samples from 8 women taking semaglutide were released from the InfantRisk Center Human Milk Biorepository. Liquid chromatography-mass spectrometry was performed to quantify semaglutide in milk.
Results: Semaglutide was not detected in any of the milk samples with a limit of quantification of 5.7 ng/ml. To evaluate infant risk with nondetectable levels, Relative Infant Doses were calculated using LOD and LOQ, which will overestimate infant risk. Maternal subcutaneous dose was converted to available oral doses to account for low drug oral bioavailability.
Conclusions: The maximum RID observed was 2.71%, well below established safety thresholds of 10%, indicating low infant risk from direct exposure to semaglutide via milk. Additional research is needed to determine the indirect effects of maternal semaglutide, and potential nutrient restriction, on breastfed infants.
Triple Negative Inflammatory Breast Cancer presenting as Mastitis in a Lactating Mother with Hypergalactia
Background: A 38-year-old G2P2002 female with history of extreme hypergalactia after prior pregnancy presented to our family medicine clinic on day 3 postpartum, with three-week history of right breast engorgement and erythema. Pregnancy was uncomplicated and a healthy infant male was delivered via cesarean section due to failed induction of labor. Differential diagnosis for our patient’s presentation included mastitis, abscess, galactocele, and malignancy. Clinical course will be described in this poster.
Methods: We will present a case study on triple negative inflammatory breast cancer in a lactating mother.
Results: Our patient had a desired decrease in milk supply and improved pain following appropriate medical interventions. Her imaging results and pathology revealed a final diagnosis of triple negative inflammatory breast cancer.
Conclusion: This case highlights the importance of history and physical examination in every encounter with a perinatal patient. Past providers had declined the patient’s request for breast exams during the prenatal and delivery course, supposedly due to perceived association of her unilateral breast fullness and discomfort with pregnancy. This case also allows for a review of the differential diagnosis of a breast mass in a lactating patient. It provides an opportunity to learn about challenges that can present with hyperlactation and how symptoms associated with hyperlactation can be similar to breast cancer presentations, and in this case, the patient had both hyperlactation and breast cancer. We will review our interdisciplinary approach for this patient, which supported her through the end of her lactation journey and her cancer treatment journey.
Advocating for Kangaroo Mother Care: Our Malaysian Experience
Siew Cheng Foong
RCSI & UCD Malaysia Campus
Abstract Category: Research
Background: The World Health Organization declared Kangaroo Mother Care (KMC) as essential care for preterm infants in 2003. Since then, there has been increasing high certainty evidence that it improves survival and other outcomes for preterm infants.
Methods: In 2013, KMC was introduced in four Malaysian hospitals by the SEA URCHIN project, but despite an evidence-based educational intervention, KMC uptake was limited. RCSI & UCD Malaysia Campus’ Paediatric Department undertook to provide training and advocacy, both in-person and also by interactive KMC webinar series during the Covid-19 pandemic. The Cochrane Millennium Development Goal project selected KMC to be incorporated into the Malaysian Neonatal National Registry, but this had not happened and might reflect that there were additional barriers to implementation. We also established a national-level NGO, the Kangaroo Mother Care Advocates Malaysia (KAMY), to provide a platform for healthcare staff to optimize KMC practices and engage parent advocates. In September 2018, KAMY joined the Asia-Oceania KMC Network, bringing together KMC coordinators from the Asia-Oceania region. KMC awareness booths are held regularly during public events at hospitals and public places, live streaming in social media during Covid-19 restrictions. We engaged with the Premature Infant Association Malaysia and also introduced KMC to traditional postpartum centers. In 2022, we launched a website for parents to engage them as KMC champions.
Results: Despite these efforts, KMC uptake in Malaysia remains low. To understand the factors influencing KMC, we conducted key informant interviews with parents and healthcare professionals, which highlighted several issues, some of which we are trying to address and hope to work together with the National Lactation Centre moving forward. We are also in the process of a study on KMC implementation in Malaysian hospitals.
Conclusion: Our experience confirms WHO's assertion about the challenges of implementing KMC, both in hospitals and at home.
Podium Presentations
BABE 2: Breastfeeding and Antenatal Breast Milk Expression; Hand Expression versus Pumping RCT
Danielle Liu, Merai Estafanous, So Ye Son, Young Choi, Celeste Richardson, Maya Louis, Elaine Hart
Loma Linda University School of Medicine
Abstract Category: Research
Background: It is well-established that breastfeeding confers health benefits for both mother and baby. However, the rates of exclusive breastfeeding in 2019 in the United States were only 62.6% in the initial postpartum period and 24.9% at 6 months postpartum, leaving room for improvement.
Methods: A randomized control study was performed with multiparous and nulliparous women enrolled at 2 clinics in San Bernardino County, CA. Exclusion criteria included prior breastfeeding for 6 months or greater, contraindications to breastfeeding, multiple gestations, and history of preterm delivery. Participants were randomly assigned to pump (n=51) or hand express (n=49) and were instructed to express breast milk for 20 minutes 3 times daily, starting at 37 weeks gestation. Data were collected from Qualtrics surveys and maternal electronic medical charts.
Results: There was no significant difference between the two groups in postpartum hospital formula administration (pumping: 23.5%; hand expression: 24.5%, p=0.52). Women in both groups rated the study protocol as “very or extremely helpful” (pumping: 76%; hand expression: 65%, p=0.44). The amounts of antenatal colostrum produced in the two intervention groups did not yield significant differences (pumping mean: 47 cc, range: 0-533.7 cc; hand expression mean: 25.9 cc, range: 0-204.5 cc, p=0.17). Although the difference in mean cervical dilation on admission was notable, it was not statistically significant (pumping: 2.6 cm; hand expression: 3.2 cm, p=0.195).
Conclusions: Antenatal colostrum expression safely provides women the opportunity to familiarize themselves with breastfeeding and potentially produce colostrum prior to delivery. As baseline exclusive breastfeeding rates in Loma Linda University Medical Center’s postpartum unit are 48%, both antenatal pumping and hand expression demonstrated improved rates (76.5% and 75.5% respectively) of exclusive breastfeeding in the initial postpartum period. This study suggests that both pumping and hand expression are similarly helpful and efficacious. Thus, prenatal care providers can consider recommending either intervention to patients.
Breastfeeding Equity for Black Women: A Case Study of Baby-Friendly Hospitals
Kim Gadsden-Knowles
University of Illinois at Chicago
Abstract Category: Research
Background: There is evidence that the Baby-Friendly Hospital Initiative increases breastfeeding initiation for Black women. However, how baby-friendly hospitals use an equity approach to improve breastfeeding rates for Black women is not well understood. The aim of this research is to explore equity-oriented approaches and practices intended to support breastfeeding, uncover barriers and facilitators to breastfeeding equity, and identify opportunities to increase the focus on equity.
Methods: An exploratory case study using an action research and appreciative inquiry approach was conducted with two baby-friendly hospitals in the Atlanta, GA, metropolitan area. The researcher reviewed publicly available hospital documents, conducted semi-structured interviews with hospital maternity care leaders and providers and community-based key informants, and facilitated a focus group of Black women. An advisory committee was convened and provided recommendations for practice during one cycle of action research. The researcher used a priori codes based on the predefined conceptual framework and emergent codes from the data and performed quantitative content analysis and thematic analysis using MS Excel and MAXQDA.
Results: Despite being from the same hospital system, racial equity approaches for one hospital were more equity-oriented while racial equity approaches for the other hospital were more equality-oriented. While barriers and facilitators were found at all levels of the social ecological model, most were related to racism and antiracism and included differential access to donor milk by race and practices to address implicit bias. Key themes for enhancing breastfeeding equity that spanned across the continuity of care spectrum were increasing access to culturally matched and respectful prenatal care and providing community-based breastfeeding support post discharge.
Conclusions: Changing systems at the organizational level and incorporating policies and practices that mitigate interpersonal, institutional, and structural racism may be beneficial to advancing breastfeeding equity for Black women.
Breastfeeding in Individuals with Self-Reported Functional Impairments: Secondary Analysis of PRAMS Phase 8
Margarita Berwick, Adetola Louis Jacques
University of Florida
Abstract Category: Research
Background: Individuals with disabilities constitute a large proportion of the general population and experience pregnancy at rates similar to individuals without disabilities. Data regarding breastfeeding rates, practices, and challenges in this population are limited.
Methods: Secondary data analysis of PRAMS 2016-2022 from states utilizing Disability Quiestionnaire. Statistical methods included Kruskal-Wallis, chi-square, and descriptive statistics.
Results: Disability Questionnaire was administered to 47955 individuals. 41.3 percent self-identified as having at least one mild impairment in one of six functional domains, and 16.5 at least two. 34.3 percent self-identified as having mild impairment, 6.3 percent moderate, and 0.7 percent severe. Among types of impairment, memory/cognition/communication category was most common, at 14.6 percent, followed by sensory (8.5%), mobility (1.2%), and self-care difficulties (0.2%). Higher percentage of those with impairments decided not to breastfeed prenatally (11.9 vs 8.3%, p<0.05), and fewer initiated breastfeeding (87.6 vs 88.7%, p<0.05). Significantly lower percentage were breastfeeding at their postpartum visit (74.4 vs 82.7%, p<0.05). Differences were more pronounced by severity of impairment: 76.1% of those with moderate, and 72.8% with severe impairments initiated breastfeeding compared with 83.4% of those with mild impairments. Lowest percentage of initiation was in those with mobility impairments (79.7%), followed by sensory impairments (81.4%). Median duration of breastfeeding was 8 weeks in those without impairment, 6 weeks for those with mild or moderate impairments, and 4.5 weeks for those with severe impairments. By impairment type, those with mobility difficulties had median duration of 8 weeks, those with cognitive and mental difficulties 7 weeks, and those with sensory impairments 6 weeks.
Conclusions: Large percentage of individuals identify as having at least mild impairments in function. Even small impairments are associated with significant differences in breastfeeding initiation and continuation, with notable difference by type and severity of impairments.
Influence of Social Determinants of Health on Maternal Breastmilk Composition and Neonatal Growth for Infants Admitted to the Neonatal Intensive Care Unit
Ellen Ribar, Jane Stremming
University of Colorado School of Medicine
Abstract Category: Research
Background: Although maternal breast milk (MBM) is the best source of nutrition for preterm infants, MBM macronutrient composition and energy content can vary widely. How maternal social determinants of health (SDH) impact milk composition has not been studied, but SDH are known to impact birth outcomes and maternal nutrition.
Methods: This retrospective chart review at a tertiary care children’s hospital in a level IV neonatal intensive care unit included infants < 2200 grams, older than one week of age, receiving MBM, and not meeting predefined growth goals. Infants with cyanotic congenital heart disease and intestinal abnormalities were excluded. MBM caloric density and macronutrient content were quantified using an FDA-approved human milk analyzer. Data were analyzed using GraphPad Prism with unpaired t-tests or Mann Whitney tests for non-normally distributed data and linear regressions. P value of < 0.05 was considered statistically significant. Values indicate means ± SD.
Results: MBM for 36 infants was analyzed; 15 met inclusion criteria. MBM energy and macronutrient content was not correlated with median income. MBM from mothers with private insurance had higher energy content than those with public insurance (84 ± 9 vs. 73 ± 6 kcal/100 ml, P=0.02), higher protein content (1.3 ± 0.2 vs. 1.0 ± 0.3 g/100 ml, P=0.03), and higher fat content (4.8 ± 0.9 vs. 3.8 ± 0.7 g/100 ml, P=0.04). Carbohydrate content was similar. Daily weight gain was similar between groups.
Conclusions: MBM composition varied by public versus private insurance status, although infant growth was similar and not correlated with billing zip code or median income. This highlights SDH and systemic inequities may impact MBM composition, indicating an area for further investigation.
Response of Breast Milk IgA to Supervised Moderate Aerobic Exercise: A Randomized Controlled Trial
Amal El Taweel (ELTAWIL) 1, Doaa Osman2, Salwa El-Badry2, Amel Yousef2
1Egyptian Lactation Consultant Association
2Cairo University
Abstract Category: Research
Background: Breastmilk is well known to be an immunologically reactive system.
It is also well documented that moderate aerobic exercise boosts the immune system; however, none of the previous studies had studied the effect of supervised moderate aerobic exercise on breast milk immunoglobulin A (IgA).
Methods: Forty-seven exclusively breastfeeding mothers from the first to the fifth month postpartum were randomized into two groups. The control group followed only counseling on optimum breastfeeding and maternal nutritional practices for 4 weeks (n = 24), while the exercise group followed the same counseling on optimum breastfeeding and maternal nutritional practices, and also, they were enrolled in a program of regular, thrice weekly, supervised, moderate aerobic exercise for 4 weeks (n = 23). Maternal anthropometric measures, infant's weight, and breast milk IgA were evaluated before and after the program for both groups.
Results: Comparing both groups after the program revealed statistically non-significant differences in maternal weight and BMI, as well as infant's weight (p>0.05), while there was a statistically significant increase in breast milk IgA (p<0.05) in favor of the exercise group.
Conclusions: Postnatal moderate aerobic exercise may be associated with favorable effects not only on the exclusively breastfeeding mothers but also on their infants through increasing the breast milk IgA.
The Effect of Reflective Writing and Breastfeeding on Self-Efficacy Scores
Rachel Lorson, Merai Estafanous, So Ye Son, Alexandra Maidan, Alexander Thomas, Elaine Hart
Loma Linda University
Abstract Category: Research
Background: Breastfeeding is known to have a multitude of health benefits, such as lower risk of diabetes and obesity as well as better mood and stress reduction in mothers. Similarly, engaging in reflective writing has been associated with lower scores of depression, anxiety, and stress scales. However, to the authors’ knowledge, no study has yet examined the role that reflective writing may have on new mothers’ self-efficacy.
Methods: Conducted as a randomized control trial, the study administered a reflective writing exercise on postpartum day 1 to intervention participants. On day 1 and week 6, all participants completed three questionnaires assessing self-efficacy and growth mindset; exclusive breastfeeding rates were assessed at these times.
Results: There was a statistically significant increase in self-efficacy survey scores from postpartum day 1 compared with postpartum week 6 for both the intervention and control groups (p < 0.05). The effect was greatest in mothers who were exclusively breastfeeding at week 6 (p < 0.05) and the effect was even greater for those in the intervention group (p < 0.01).
Conclusions: Self-efficacy scores increased in mothers from postpartum day 1 to week 6. This impact was more pronounced in mothers who were exclusively breastfeeding at week 6 and, even more so, those who engaged in reflective writing. The findings of this study suggest that mothers’ self-efficacy is malleable in the immediate postpartum period. Further research is needed to elucidate additional methods to bolster new mothers’ self-efficacy.
The postpartum period is a sensitive time for both mother and baby, requiring a unique approach for both research and standardized patient care. We must be careful to balance patient interventions and support with respect for the mother’s desires and abilities, working to address outside factors.
The LATCH Program In-Person Support Group: Improving Lactation Support During NICU Stay
Sarah Harter, Margriet VanDerwerker, Amanda Despart, Jasmine Glaspy, Gillian Bremer, Bryar Knox, Cheryl Dunton, Kate Tauber
Albany Medical College
Abstract Category: Quality Improvement Advocacy
Background: Breastmilk is the best nutrition for term and preterm infants. Approximately 60% of infants <33 weeks gestation at birth receive >50% of mother's milk after 7 days of age in our unit. To increase the amount of breastmilk feeding, the Lactation Advocacy Through Continuous Help (LATCH) program was initiated in October 2022. The goal is to provide lactation support to parents through weekly check-ins from medical students who are Certified Lactation Counselors (CLCs), as well as provide camaraderie among NICU mothers. To further support lactating parents, an in-person support group was started in October 2023.
Methods: All mothers with NICU infants <33 weeks gestation are eligible to participate. Exclusion criteria included drug use or medications contraindicated for breastmilk use for infants. In-person support groups were scheduled twice weekly. A pre- and post-survey was given at each session.
Results: A total of 79 mothers have enrolled in the LATCH program. Since the implementation of the in-person support group in October 2023, six mothers have participated in the lactation support sessions. Pre-survey data show that 100% of the moms have described their lactation journey as challenging. In an open response format when moms were asked what they hoped to gain from the sessions, we received responses such as help with nursing and how to produce more milk. We asked moms to describe how they were feeling after attending the support session in post-surveys, and 100% of moms said they felt either “supported” or “understood.”
Conclusions: Expanding the LATCH program to provide in-person support has improved mothers’ confidence and commitment to their lactation journeys. We will continue to tailor our in-person support to the needs of mothers as we trial different options. We expect to see an increase in the rates of infants getting >50% breastmilk in the NICU at our institution.
WELL+ Group Visit: Combining the Trifecta Approach and Group Well-Child Care to Support Postpartum Mental Health and Breastfeeding
Background: Studies confirm ongoing breastfeeding and mental health support improves breastfeeding duration yet barriers exist. The Trifecta model combines medical, lactation, and breastfeeding support in one visit. Studies show infant group well-child care (GWCC) improves postpartum depression screening (PPDS) and breastfeeding support. We report on a pediatric practice change to integrate the Trifecta model with GWCC to improve screening and access to breastfeeding and mental health support in the fourth trimester.
Methods: Descriptive study of WELL+ Group practice implementation which combines GWCC, lactation consultant (LC), and behavioral health (BH) therapist during a 2 hour group visit with 5-8 dyads. Group included WCC assessment, LC feeding evaluation, PPDS screening, and BH discussion in a group environment. Retrospective chart review reports on group utilization along with pre/post intervention comparison of PPDS and LC visits after 1 month. Post-group surveys assessed patient feedback.
Results: Practice change started in September 2023 with a 1-month group visit. In the year prior to implementation, the practice saw 544 newborns for a 1 month WCC, 49% of families completed the EPDS, and 98% initiated breastfeeding with 17% participating in LC visits after 1 month WCC. In the four months following implementation, 64 out of 254 families (30%) chose to participate in WELL+. Compared with pre-implementation, group participants were more likely to complete PPDS screening (89% vs. 52%, p=0.000) and receive ongoing LC visits following 1 month (30% vs. 15%, p=0.007). Post-visit survey response rate was 31% (n=17/54) with participants agreeing they were satisfied with their care (94%), received the infant feeding support they needed (88%), and received helpful postpartum mental health information (82%).
Conclusions: The WELL+ Group model was determined to be a feasible practice change associated with desirable outcomes including positive parent feedback, improved PPDS, and increased lactation services utilization.
