Breastfeeding Medicine

Some studies have explored the effects of amino acid-based formulas (AAF), extensively hydrolyzed formulas (EHF), and soy-based formulas (SF) on growth indices, weight-for-age z-scores, length-for-age z-scores, and weight in children with cow’s milk allergy (CMA).

This review aimed to evaluate and differentiate the effectiveness of AAF, EHF, and SF on growth parameters in children with CMA.

A systematic review was conducted in three databases—PubMed, Web of Science, and Scopus—up to March 2023 to identify eligible studies. Eight articles were analyzed in this study. Effect sizes were reported as weighted mean difference with 95% confidence intervals (CI). Statistical heterogeneity between studies was assessed using Cochran’s Q-test. The risk of bias was evaluated using the ROBINS-I tool.

A total of eight studies, encompassing 469 participants, met the inclusion criteria. The meta-analysis demonstrated a significant positive effect of the AAF and EHF on weight and weight-for-age z-scores, while no significant changes were observed for length-for-age z-scores. Furthermore, pooled effect sizes indicated that AAF had a more pronounced impact in weight-for-age z-scores (+0.30) compared with EHF (+0.25). Soy-based formulas had negligible effects on growth parameters.

The findings suggest that AAF and EHF are more effective in improving growth parameters, particularly weight-for-age z-scores, in children with CMA compared with SF. Among the formulas studied, AAF showed the greatest positive impact on weight-for-age z-scores. These results highlight the importance of formula selection for optimizing growth outcomes in children with CMA.

Breastfeeding provides essential nutrition and disease protection for infants while reducing the risk of type 2 diabetes and breast cancer in mothers. Despite these benefits, significant racial and ethnic disparities exist in breastfeeding initiation, particularly among Black women. This study examines racial differences in the receipt of breastfeeding information from varying sources and their association with breastfeeding initiation.

Data were obtained from the Phase 8 Core Pregnancy Risk Assessment Monitoring System for 2016–2020 (n = 163,724). The analysis focused on comparing the likelihood of breastfeeding initiation (yes/no) across racial groups and the impact of receiving breastfeeding information from varying clinical (mother’s doctor/nurse/baby’s doctor, etc.) and social sources (support group/family/friends, etc.). Univariate and multivariable analysis was conducted in SAS 9.4.

Black women consistently exhibited lower odds of breastfeeding initiation compared with other racial groups, across all informational sources. The study found that while information from both clinical and social sources increased breastfeeding initiation overall, Black women remained less likely to initiate breastfeeding than White women (p < 0.0001).

Systemic barriers, including racism and bias in health care, contribute to the racial disparities in breastfeeding initiation. Culturally tailored interventions and improved health care provider training are necessary to address these gaps. Future efforts should aim to bridge the divide between clinical and social breastfeeding information sources to improve breastfeeding rates among minority women.

Many breastfeeding mothers fast during Ramadan month despite being exempted from fasting. This study aims to estimate the prevalence rate of Ramadan fasting during breastfeeding and detect its associated factors among Egyptian Muslim mothers.

A cross-sectional study was conducted on 1,130 lactating mothers selected through a multistage stratified random sampling technique in Dakahlia Governorate, Egypt. The data were collected through a structured questionnaire including sociodemographic data, the Arabic Scale of Intrinsic Religiosity (ASIR), and data about breastfeeding and fasting practices during Ramadan. Binary logistic regression analysis was used to detect the significant predictors of fasting among lactating mothers.

Of 1,130 study participants, more than half (53.5%) were aged ≥27 years old and had secondary education (54.6%). About four in every five (83.7%) of them fasted during Ramadan. Secondary education (adjusted odds ratio [AOR] = 2.71, p ≤ 0.001), university and postgraduate education (AOR = 4.88, p ≤ 0.001), non-working (AOR = 1.88, p = 0.011), being in debt and just meeting routine expenses (AOR = 1.75, p = 0.007), having high intrinsic religiosity (AOR = 2.70, p ≤ 0.001), having infants aged 6 months and more (AOR = 2.60, p ≤ 0.001), giving prelacteal feeding (AOR = 2.56, p ≤ 0.001), giving supplements (AOR = 2.11, p ≤ 0.001), and breastfeeding on demand (AOR = 1.92, p = 0.01) were the significant predictors of the higher fasting rates among the lactating mothers.

Fasting is a prevalent practice among breastfeeding mothers of infants during Ramadan. Ramadan fasting does not significantly influence maternal outcomes or infant weight. Therefore, it is advisable for lactating mothers to consult with healthcare professionals prior to deciding to fast during Ramadan.

Social determinants of health account for racial inequities in breastfeeding rates in the United States. There is a gap in the role of neighborhood socioeconomic status (NSES) as it relates to breastfeeding disparities.

Using longitudinal data from the Black Women’s Health Study, we assessed associations of NSES with breastfeeding initiation and duration in a cohort of primiparous U.S. Black women. We also explored associations within strata of important economic indicators, including education, occupation, and marital status.

Breastfeeding initiation (n = 2,705) increased with NSES quartile, from 75.2% in the lowest quartile to 88.3% in the highest quartile (p < 0.0001). Compared with women living in the highest NSES quartile, those in the lowest quartile had a 41% (odds ratio: 0.59 [95% confidence interval: 0.43, 0.81]) decreased odds of initiating breastfeeding. For breastfeeding duration (n = 2,172), women residing in NSES quartiles 1–3 were significantly less likely (p < 0.0001) to breastfeed (44.4%) for 6+ months compared with those living in the highest quartile (62.8%). Adjusted relative risks for those in quartiles 1–3 compared with 4 (highest) were 0.63 (0.45, 0.87), 0.50 (0.37, 0.68), and 0.64 (0.47, 0.86), respectively (p = 0.0001). There was no statistically significant evidence of effect modification by education, occupation, marital status, and region (P_interaction = >0.05).

Living in a lower NSES environment was associated with reduced breastfeeding initiation and duration compared with a higher NSES environment. Research is needed to understand the mechanisms by which neighborhood-level factors influence breastfeeding initiation and duration for Black women in the United States.

This study analyzes the impact and experiences of hospitalization for any reason on breastfeeding women.

Cross-sectional online survey (November 2019–March 2020). Adults admitted to a Spanish hospital for at least one night, when actively breastfeeding, were included. The questionnaire aimed at assessing breastfeeding, breast complications, and support and perceived health care workers’ attitudes to breastfeeding.

Of the 266 included participants, 70 (26%) stopped breastfeeding during hospitalization, and 13 (5%) interrupted it permanently. A total of 24 (10%) participants reported that hospitalization meant problems for later breastfeeding, and 67 (25%) reported experiencing breast complications. The most common negative comment was that the child was too old to be breastfed (median age, 15 months [interquartile range (IQR) 11–25]). Problems for later breastfeeding due to the hospitalization were more likely if breastfeeding was interrupted (odds ratio [OR] 3.68, 95% confidence interval [CI] 1.32–10.5) or breast problems were experienced (OR 4.11, 95% CI 1.51–11.7). Problems were less likely when patients felt encouraged (OR 0.38, 95% CI 0.21–0.69) and hospitalized in a surgical inpatient area (OR 0.15, 95% CI 0.03–0.65).

Hospitalizations can cause breastfeeding and breast problems. Hospital services must update protocols to integrate breastfeeding into usual care.

To determine whether women with polycystic ovary syndrome (PCOS) were less likely to initiate breastfeeding or have shorter breastfeeding duration.

Cross-sectional analysis was performed of the Pregnancy Risk Assessment Monitoring System dataset, a national questionnaire from the Centers for Disease Control and Prevention of postpartum women, from 2016 to 2018. Logistic regression assessed the odds of any breastfeeding initiation. Cox proportional hazards assessed duration of any breastfeeding.

Sample included 2,382,290 women (6.1% PCOS). In univariable analysis, PCOS was associated with increased odds of any breastfeeding initiation (89.9% versus 87.9%; odds ratio [OR]: 1.23 [95% confidence interval: 1.02, 1.47]; p = 0.03). This outcome remained significant after controlling for body mass index (BMI; OR_adj: 1.3 [1.1, 1.6]; p = 0.005) but not after controlling for education and prior live births (OR_adj: 1.10 [0.89, 1.37]; p = 0.37). With increasing BMI, the odds of any breastfeeding initiation decreased, with the lowest odds seen in women with class III obesity (OR_adj: 0.74 [0.60, 0.9]; p = 0.003). In a subanalysis of racial/ethnic groups, PCOS did not impact any breastfeeding initiation in White or Black non-Hispanic groups but increased odds of any breastfeeding initiation in Hispanic women (OR_adj: 2.0 [1.1, 3.7]; p = 0.03). In multivariable models, there was no difference in the duration of any breastfeeding in women with PCOS compared with those without.

Understanding predictors of breastfeeding success is paramount. In this national survey measuring any breastfeeding, PCOS did not decrease breastfeeding initiation or duration, despite confirming the association between overweight/obesity and decreased breastfeeding. However, because the data did not distinguish between exclusive breastfeeding and supplementation, we cannot rule out the possibility that PCOS affects breastfeeding exclusivity or necessitates supplementation. This limitation suggests that important trends could be obscured, and therefore, our findings should be interpreted with caution regarding breastfeeding exclusivity. Interventions aimed at increasing breastfeeding should target populations that would benefit the most; our data support that PCOS-specific targeting is not needed. Additional prospective studies are necessary to fully understand the association between different PCOS phenotypes and breastfeeding.

Rapid weight gain in infancy is associated with an increased risk of later adiposity. Very rarely, however, exclusively breastfed infants experience excessive weight gain (EWG) during the period of exclusive breastfeeding (EBF) when breast milk is the only source of nutrition. We investigated growth and body composition at 36 months in children experiencing EWG during EBF.

Ten infants with EWG during the first 6 months of EBF were followed up at 36 months. The infants had been followed from age 5 months. Examinations included anthropometry, body composition by bioimpedance, and blood samples. Body composition and plasma leptin concentrations were available for eight and five children, respectively.

From 5 to 36 months, body mass index-for-age z-scores (BAZ) decreased from (mean ± standard deviation) 2.33 ± 0.94 to 1.48 ± 0.57, and only one child still being overweight (BAZ >2). Fat mass and fat mass index (FMI) decreased from 18 to 36 months (4.71 ± 0.56 to 3.57 ± 0.67 kg and 6.50 ± 0.34 to 3.66 ± 0.72 kg/m², respectively) with a concurrent 45% decrease in leptin. The increase in lean mass was higher than the increase in weight (5.27 versus 3.65 kg, respectively) due to fat loss. There was substantial conformity within the sample in the patterns of body composition change.

This unusual group of children continued to decrease in BAZ and FMI with a concomitant increase in fat-free mass, indicating an ongoing normalization of body weight and composition.

Pain management is an important issue in newborns. This study aimed to compare the effects of three different sensory interventions (mother’s voice [hearing], mother’s milk smell [smell], and mother’s holding [touch]) during heel lance on pain levels in term newborns.

In this randomized controlled trial, 120 term newborns included in the study were divided into four groups. Pain scores were assessed with Neonatal Infant Pain Scale during and after the procedure.

When compared in terms of interventions, newborns in mother’s voice and mother’s holding groups showed statistically significantly less pain response during the procedure compared with the control group (p = 0.005). But no significance was found in terms of mother’s milk smell.

In conclusion, mother’s holding and mother’s voice are effective methods to reduce pain during heel prick procedure in newborns. In addition, both maternal smell and maternal touch may have had an effect in the mother’s holding group. Nevertheless, future studies with different designs on the effect of breast milk smell are recommended. (Trial registration: https://clinicaltrials.gov/study/NCT05526378.)

Despite many well-documented benefits of breastfeeding, only 44% of babies worldwide are exclusively breastfed for the first 6 months. The aggressive marketing of formula food companies may be contributing to why mothers are choosing artificial feeding over breastfeeding.

To identify when and how mothers become aware of infant formula food and the impact it has on breastfeeding.

Four commonly used formula food logos were modified to unbranded versions using photoshop and shown to 444 participants at a tertiary level hospital. The participants included first-time pregnant women and mothers of infants aged 0–6 months. They were asked if they recognized the logos and how they knew them. Breastfeeding practices and media usage were also examined with a questionnaire.

The overall rate of logo recognition was 60.8%, increasing with the baby’s age. Of the mothers who had never used formula, 51.6% still recognized them. Of the participants, 70.5% admitted to getting baby care ideas from the media, with the logo recognition rate being higher among them. Exclusive breastfeeding was lower among the mothers who were aware of the logos.

The awareness of formula food was quite high among the group that needed to breastfeed exclusively. More than half of those who recognized the logos stated that they saw them through the media, highlighting its role in formula awareness.

Transfeminine individuals are capable of developing breast tissue that is indistinguishable from cis-females, allowing them to breastfeed effectively. Breastfeeding affords known health benefits for both members of a lactating individual–infant dyad and supporting this experience for transfeminine individuals fosters reproductive equity.

This study assessed experiences, attitudes, and knowledge regarding breastfeeding and lactation among a group of transfeminine individuals receiving hormone therapy within a specialized gender care clinic.

Transfeminine individuals on estrogen therapy who were part of the Duke Research for Equitable Access to Medicine (DREAM) Registry were invited to complete a 15-question online survey about experiences, goals, attitudes, and knowledge regarding lactation and breastfeeding.

A total of 71 out of 130 eligible DREAM individuals completed the survey (54.6%). No survey participants had breastfed and three (4.2%) had experienced lactation. One in four participants designated lactation a health care goal. Four out of five participants reported it was important, most commonly to affirm their gender identity (n = 41, 57.7%) and/or to bring their breasts to full maturity (n = 36, 50.7%). One in eight participants designated breastfeeding as a health care goal. Four out of five participants reported it was important, most commonly for parent–child bonding (n = 34, 47.9%) and/or health/nutritional benefits to the newborn (n = 34, 47.9%).

Transfeminine individuals may be interested in experiencing lactation for multifaceted reasons, including goals for parent–infant feeding (breastfeeding-dyad bonding and breast milk health benefits) and for their gender transition (affirming gender and breast maturity). Future community-engaged research is warranted to inform both clinical practice and lactation protocols for transfeminine individuals hoping to breastfeed.