Journal of Human Lactation

Exclusive breastfeeding (EBF) is recommended until about 6 months of age. Pediatricians are at the forefront of encouraging mothers to achieve this goal, yet pediatricians who parent during their training may face substantial barriers in achieving their own breastfeeding goals.

This study aimed to assess breastfeeding support available to US pediatricians in training and the effect of trainees’ personal experiences on their attitude toward breastfeeding.

An online survey was emailed to American Academy of Pediatrics Section on Medical Students, Residents, and Fellowship Trainees members.

There were 927 respondents, of which 421 had children and 346 breastfed their children. Almost 80% agreed that 6 months is the ideal duration for EBF. One in 4 did not have access to or were not aware of a private room to express milk or breastfeed. Forty percent needed to extend the duration of their training for a longer maternity leave, with breastfeeding a factor for longer leave among 44%. One in 4 did not meet their breastfeeding duration goal, and 1 in 3 did not meet their goal for EBF. Negative emotions were common among those not meeting goals. Ninety-two percent felt that their or their partner’s experience with breastfeeding affected their clinical interaction with patients’ mothers.

A majority of respondents cited problems with breastfeeding support during training, and many failed to meet their intended goals. Not meeting personal breastfeeding goals was associated with negative emotions and influenced how they counsel about breastfeeding as a result of personal and often negative attitudes.

Insufficient milk supply is 1 of the most commonly reported reasons for discontinuation of infant breastfeeding. Although domperidone is often used to improve milk supply, knowledge of factors associated with the use of domperidone in clinical practice is scarce.

This study aimed to examine factors associated with the use of domperidone as a galactogogue at the Women’s and Children’s Hospital (WCH), Adelaide.

A retrospective cohort study was conducted, involving women who delivered live-born singletons (N = 21 914) at the WCH between January 2004 and December 2008. Women dispensed domperidone were identified using WCH pharmacy dispensing records. Maternal and infant clinical data were obtained from the WCH Perinatal Statistics Collection. Relationships between maternal/infant demographic and clinical variables and the use of domperidone were examined through univariate and multivariate logistic regression analyses.

Key factors associated with an increased likelihood of women receiving domperidone were increasing maternal age (adjusted odds ratio [aOR] = 1.04; 95% confidence interval [CI], 1.03-1.06), maternal obesity (aOR = 1.41; 95% CI, 1.16-1.77), primiparity (aOR = 1.94; 95% CI, 1.63-2.30), delivery by cesarean section (aOR = 1.31; 95% CI, 1.10-1.55), preterm birth (aOR = 3.54; 95% CI, 2.79-4.50), and neonatal hospitalization (aOR = 2.51; 95% CI, 2.01-3.14). In addition, statistically significant trends were observed between increasing socioeconomic status and year of delivery and an increased likelihood of women receiving domperidone (all Ps < .004).

These findings are of clinical importance as they not only reinforce previous findings regarding risk factors for women experiencing lactation difficulties but also highlight the need for improved research regarding the rational and efficacious use of domperidone to improve breastfeeding outcomes.

Milk production is under the influence of autocrine control such that the rate of milk synthesis decreases as the breast fills with milk. Effective elimination of milk from the alveoli via the milk ejection reflex will therefore result in increased milk synthesis. It has been assumed that milk ejection occurs in all alveoli simultaneously; however, animal studies have indicated that full alveoli eject milk sooner than less full alveoli, suggesting heterogeneous emptying of the mammary gland.

The aim of this study was to determine whether milk ejection occurs asynchronously in the human lactating breast.

Retrospective analysis of videos made of ultrasound monitoring of milk ducts during pumping. Six video clips (4 women) of ultrasound monitored milk ejections showed obvious differences in the timing of milk flow between different main milk ducts. Duct diameter was simultaneously measured every second in 2 different ducts that drained 2 separate lobes of the breast.

For 5 of 6 ultrasound duct monitoring sessions, both duct dilation and visualization of milk flow in the 2 separate main milk ducts differed by 2 to 8 seconds. For the remaining woman, milk was observed to eject from 1 part of the lobe, and when not removed, it flowed in a retrograde fashion into a different part of the lobe.

Asynchrony of milk ejection occurs in the human lactating breast, suggesting that the timing of myoepithelial cell response differs, resulting in heterogeneous emptying of the gland.

Formal policies can establish guidelines and expectations for workplace breastfeeding support. However, interpersonal communication between employees and managers is the context where such policies are explained, negotiated, and implemented. As such, this article focuses on interpersonal communication about breastfeeding support in the workplace.

The objective of this article is to describe interpersonal communication related to workplace breastfeeding support.

We conducted 3 focus groups with 23 business representatives from a rural city in the Midwest United States. Participants were recruited through the area chamber of commerce. We analyzed the transcripts of the focus groups and derived themes related to the study objective.

Our analysis of responses from business representatives in the focus groups revealed 3 major themes about interpersonal communication concerning breastfeeding support in the workplace: (1) interpersonal communication may be more important than written communication for enacting breastfeeding support, (2) multiple factors (age, sex, and power dynamics) complicate the interpersonal communication required to enact breastfeeding support in local businesses, and (3) positive interpersonal communication strategies may improve the success of workplace breastfeeding support.

Interpersonal communication between employees and managers is where the specifics of workplace breastfeeding support (eg, policies) are determined and applied. Interpersonal communication about breastfeeding can be challenging due to issues such as age, sex, and power dynamics. However, positive and open interpersonal communication can enhance workplace breastfeeding support.

Although introduction of inappropriate foods and liquids in early childhood and their association with breastfeeding is commonly reported in US children, coffee use in very young US children and its association with breastfeeding is not.

This study aimed to determine the proportion of 1- and 2-year-olds in an urban population consuming coffee, their rate of consumption, and predictors of consumption, including breastfeeding status.

We used data from a prospective cohort study on infant weight gain and diet, and body mass index at age 2. We used bivariate analyses to examine variables associated with coffee consumption at 1 and 2 years and multivariate logistic regression to control for variables of interest.

This study included 315 mother-infant dyads. At 1 year, the rate of coffee consumption reported was 2.5%; at 2 years, it was 15.2% and average daily consumption was 1.09 oz (range, 0.01- 4.00 oz). The only characteristic associated with coffee consumption at 1 year was breastfeeding at 1 year (P = .0275), which did not remain significant after controlling for confounding variables. Variables significantly associated with coffee consumption at year 2 were lower maternal education (P = .0016), non-US maternal place of birth (P = .0015), maternal Hispanic ethnicity (P < .0001), infant female sex (P = .0495), and receiving any breast milk at 1 year of age (P = .0189). After multivariate logistic regression, maternal Hispanic ethnicity (P = .0139) and infant female sex (P = .0371) remained significant.

Coffee consumption is not uncommon among toddlers in Boston, Massachusetts, USA. After controlling for possible confounding factors, maternal ethnicity and infant sex were significantly associated with this practice.

Human milk contains many metabolic hormones that may influence infant growth. Milk leptin is positively associated with maternal adiposity and inversely associated with infant growth. Most research has been conducted in populations with higher leptin levels; it is not well understood how milk leptin may vary in lean populations or the associations that reduced leptin may have with infant size for age. It is also largely unknown if associations between maternal body composition and milk leptin persist past 1 year of age.

We investigated the association between maternal body composition and milk leptin content in a sample of lean Filipino women and the association between milk leptin content and infant size for age.

Milk samples were collected at in-home visits from 113 mothers from Cebu, Philippines. Milk leptin content was measured using EIA techniques; anthropometric data, dietary recalls, and household information were also collected.

Mean ± standard deviation (SD) milk leptin in this sample was 300.7 ± 293.6 pg/mL, among the lowest previously reported. Mean ± SD maternal percentage body fat was 24.8% ± 3.5%. Mean ± SD infant age was 9.9 ± 7.0 months, and mean ± SD weight for age z-score was −0.98 ± 1.06. Maternal percentage body fat was a significant, positive predictor of milk leptin content. Milk leptin was a significant, inverse predictor of infant weight and body mass index z-scores in infants 1 year old or younger.

The association between maternal body composition, milk leptin, and infant growth persists in mothers with lean body composition. Milk leptin is not associated with growth in older infants.

The mechanisms regulating postpartum anovulation (PPA) are not well understood, although poor nutritional status and “intense” breastfeeding behaviors are associated with longer durations.

This study was designed primarily to investigate the hypothesis that higher body fat and leptin concentrations are related to shorter PPA in healthy, lactating US women. Nutrient intake, breastfeeding behaviors, prolactin, and insulin levels were also evaluated.

Fasting serum was collected during the third trimester of pregnancy, at 2 and 4 weeks postpartum, and every 4 weeks until the occurrence of the first postpartum menses. Body composition and breastfeeding behaviors were assessed at the same times postpartum. Women (n = 13) were categorized based on initial percentage body fat and timing of first postpartum menses.

There were no consistent relationships between body composition, leptin, or breastfeeding behaviors and duration of PPA. However, there was an interaction (P = .005) between ovulation group and time on adiposity; earlier ovulating women had less percentage body fat in early lactation than did later ovulating women. There was also an interaction (P = .1) between ovulation group and time postpartum on leptin, such that leptin concentrations tended to be greater in later than earlier ovulating groups beginning at 12 weeks postpartum.

In summary, although baseline percentage body fat and leptin were not related to duration of PPA, fertility returned earlier in women who lost greater percentage body fat during the early postpartum period.

At present, the Italian Association of Donor Human Milk Banks (Associazione Italiana Banche del Latte Umano Donato, AIBLUD) consists of 31 milk banks, whose management is based on Italian Guidelines. In 2013, AIBLUD performed a systematic survey to collect data on the activities of banks operating in Italy in the years previous to this date.

The purpose of this survey was to evaluate the operational procedures of Italian Human Milk Banks in order to identify both areas of strength and room for improvement.

A questionnaire was utilized to obtain national data from the 28 banks active in the year 2012 in order to evaluate the number of donors, volume of human milk collected, and other information relating to the period 2007 to 2012.

In all, 89% of the banks (25/28) responded to the survey. Data received primarily concerned the number of donors, volume of milk collected, and average amount of milk from each donor in the period 2007 to 2012. It was evident that in 2012 human milk banks collected a higher volume of milk than in 2007. Further, the average amount of milk from each donor was higher. Most of the milk banks were following the Italian Guidelines for traceability, control of donors, bacteriological checks, method of pasteurization, storage, thawing, type of containers, and utilization of the Hazard Analysis and Critical Control Points system.

This survey identified both areas of strength and room for improvement in the Italian human milk banks.

Few clinical reports have been published on amlodipine passage into breast milk in lactating women.

The aims of this study were to evaluate the plasma concentration of amlodipine and its passage into breast milk in lactating women with pregnancy-induced hypertension and to estimate the risk for breastfeeding infants.

Thirty-one lactating women receiving oral amlodipine once daily for pregnancy-induced hypertension were enrolled. Pre-dose plasma and milk concentrations of amlodipine were determined at day 6 or later after starting the medication. Relative infant dose (RID) as an infant risk for breastfeeding was calculated by dividing the infant dose via milk by the maternal dose.

The mean maternal dose of amlodipine was 6.0 mg. The medians of the plasma and milk concentrations of amlodipine were 15.5 and 11.5 ng/mL, respectively. Interindividual variation was observed in the amlodipine dose and body weight–adjusted milk concentrations (interquartile range [IQR], 96.7-205 ng/mL per mg/kg). The median and IQR of the amlodipine concentration ratio of milk to plasma were 0.85 and 0.74 to 1.08, respectively. The medians of infant birth weight and daily amlodipine dose via milk were 2170 g and 4.2 μg/kg, respectively. The median of the RID of amlodipine was 4.2% (IQR, 3.1%-7.3%).

Lactating women with pregnancy-induced hypertension had higher plasma concentrations of amlodipine during the early postpartum period. Oral amlodipine transferred into breast milk at the same level as that of plasma. However, the RID of amlodipine in most patients was less than 10%.

Although Hispanic mothers in the United States have slightly higher rates of breastfeeding initiation than the national average, they are more likely to supplement with formula.

To describe infant feeding decisions in a sample of 72 urban Hispanic mothers and assess whether demographic and personal factors influence exclusive breastfeeding (EBF) status at 4 months postpartum.

The study was longitudinal and included assessments during pregnancy, in the hospital following childbirth, and monthly up to 4 months following birth.

Nearly all of the 72 mothers were breastfeeding at discharge after the birth of their infant (94%); half of these were EBF. By 2 months postpartum, the rate of EBF had declined to 26%, dropping to 22% by 4 months. Significant predictors of EBF status at 4 months included the baseline indicator for mother’s partner as the most important person in life (adjusted odds ratio [AOR], 5.42; 95% confidence interval [CI], 1.03-28.66) and breastfeeding self-efficacy score at 1 month (AOR, 1.20; 95% CI, 1.07-1.34).

These findings have particular relevance in this population, given the high rate of breastfeeding initiation coupled with breastfeeding self-efficacy being a modifiable factor. Support during pregnancy and postpartum, including consultation with a lactation consultant, may increase the self-efficacy of EBF in this low-income population, leading to higher rates of extended EBF among Hispanics.