Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundInappropriate marketing of human milk substitutes negatively influences efforts to protect breastfeeding. Although healthcare professionals can positively influence infant feeding decisions, government regulations permit manufacturers to communicate messages to them through advertising.Research Aims(1) To identify the extent of human milk substitute advertising in publications aimed at United Kingdom healthcare professionals and (2) to describe compliance with the International Code of Marketing of Breast-Milk Substitutes and United Kingdom Formula and Follow-on Formula Regulations.MethodsThis was a cross-sectional observational study. We reviewed publications targeting healthcare professionals working with families in the United Kingdom (N = 19). Quantity and type of human milk substitute advertisements, as a proportion of all advertising, in each publication were recorded. All unique advertisements were double assessed for compliance.ResultsHuman milk substitute advertising was found in nine (47%) of the 19 publications (four affiliated with professional associations), making up 10.3% (n = 196) of these publications’ total advertising. Of human milk substitute advertisements found, 65.4% (n = 110) were for products used to manage cows’ milk protein allergy. Of the 32 unique human milk substitute advertisements found, none complied with the International Code of Marketing of Breast Milk Substitutes or United Kingdom Formula and Follow-on Formula Regulations.ConclusionsMany healthcare professionals’ publications had non-compliant human milk substitute advertisements. There is an urgent need to ensure full compliance with international and local regulation in future advertisements and to consider whether advertisements are justified at all.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundIt has been demonstrated that human milk from mothers who have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contains antibodies against the virus, which could play an important role in protecting the recipient infant against coronavirus disease 2019 (COVID-19). Seroconversion is measured frequently around the world, but the milk conversion rate is unknown.Research AimsTo determine (1) the prevalence and (2) the dynamics of immunoglobulin A (IgA) antibodies against SARS-CoV-2 in human milk amongst lactating mothers in the Netherlands.MethodsIn this large prospective cohort study, lactating mothers (N = 2312) were included between October 12, 2020 and February 24, 2021. Enzyme-linked immunosorbent assay was used to determine levels of IgA antibodies in human milk and immunoglobulin G (IgG) antibodies in serum against the ectodomain of the SARS-CoV-2 spike protein.ResultsA total of 691 (30.6%) participants had SARS-CoV-2 specific antibodies in human milk and/or serum. Of these participants, 524 (23.1%) had IgA antibodies against SARS-CoV-2 in human milk, and 356 (15.7%) had IgG antibodies against SARS-CoV-2 in serum. A total of 199 (8.8%) participants had antibodies in both human milk and serum. SARS-CoV-2 specific IgA antibodies in human milk remain present at least 10 months after a polymerase chain reaction confirmed infection.ConclusionThe prevalence of IgA antibodies against SARS-CoV-2 in human milk was 23.1% in our cohort. This high prevalence of antibodies in human milk might lead to passive immunity in many breastfed infants and may serve as protection against COVID-19.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundHuman milk is the best food for infants; however, when breastfeeding is not possible, pasteurized milk from human milk banks is the best alternative. Little has been reported about variations in the bacterial microbiota composition of human milk after pasteurization.Research aimTo characterize and compare the bacterial microbiota composition and diversity within human milk among Mexican mothers before and after the Holder pasteurization process.MethodsA cross-sectional, observational, and comparative design was used. The effect of the pasteurization process on the bacterial composition and diversity of human milk samples of donors (N = 42) from a public milk bank was assessed before and after pasteurization by high throughput deoxyribonucleic acid sequencing of V3-16S rRNA gene libraries. Sequencing data were examined using the Quantitative Insights into Microbial Ecology software and Phyloseq in R environment.ResultsA varied community of bacteria was found in both raw and pasteurized human milk. The bacterial diversity of the milk samples was increased by the pasteurization, where some thermoduric bacteria of the phyla Proteobacteria, Firmicutes, and Actinobacteria were more abundant. The source tracker analysis indicated that at most 1.0% of bacteria may have come from another source, showing the safety of the process used to treat milk samples.ConclusionThe pasteurization process increased the bacterial diversity. We selected taxa capable of surviving the process, which could proliferate after the treatment without being a risk for infants.

Journal of Human Lactation, Ahead of Print.
IntroductionA woman was able to relactate 7 years after breastfeeding her children. She donated her expressed milk to her friends, a same-sex male couple, who had a child through surrogacy in the United States. She lived in London and shipped her milk to Hong Kong, where they lived. The infant thrived on the donated expressed milk received during the first 3 months of his life.Main issueThis case is unusual because the woman was not breastfeeding at the time, which would have made expressing easier, and she was not adopting. She consulted a National Childbirth Trust Breastfeeding Counsellor and an International Board Certified Lactation Consultant® who helped her explore non-puerperal relactation protocols.ManagementHer plan started 6 months before the birth and included the use of domperidone, frequent expressing by hand and with a hospital-grade pump. A breastfeeding specialist physician made suggestions on the dosage of domperidone. She donated a total of 35.06 L. She had the full support of her partner and family.ConclusionNon-puerperal induced lactation and relactation offer ways to make human milk accessible to all infants, particularly those from LGBTQ+ families in which no parent is lactating, as was the case with the same-sex male couple participating in this study. It is essential to disseminate the knowledge and skills needed to support non-puerperal induced lactation and relactation among all healthcare professionals involved.

Journal of Human Lactation, Ahead of Print.
BackgroundBreastfeeding rates for United States women with lower incomes fall below the government’s Healthy People 2020 Goals. Breastfeeding recommendations combined with support from providers and peer counselors help women decide to begin and sustain breastfeeding, but peer counselor uptake is low.Research AimTo evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention.MethodIn this pre-post intervention study (2015–2016; upstate New York), providers implemented a Toolkit to discuss infant feeding recommendations and initiate peer counselor referral. We surveyed women pre- and post-implementation (after delivery; 1 month postpartum) about prenatal breastfeeding intentions, provider support, and breastfeeding outcomes. Analyses controlled for secular trends.ResultsPre-intervention (n = 71) and post-intervention (n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding support.ConclusionsImplementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

Journal of Human Lactation, Ahead of Print.
BackgroundThe expansion of the Baby-Friendly Hospital Initiative to neonatal wards, known as the Neo-BFHI, provides recommendations to support breastfeeding, as outlined in the Three Guiding Principles, the expanded Ten Steps, and the International Code for Marketing of Breast-Milk Substitutes. In 2017, Russia participated in an international survey about compliance with the Neo-BFHI.Research AimTo assess breastfeeding support policies and practices in Russian neonatal wards at the country and federal district level in accordance with the Neo-BFHI recommendations.MethodsThis study was a prospective cross-sectional survey. We used the Neo-BFHI Self-Assessment questionnaire to collect data from neonatal wards that had all levels of care. A total of N = 60 Russian neonatal wards in hospitals that have ever been designated Baby-Friendly or planned to do so participated in the survey.ResultsCompliance scores at the federal district and country level ranging from 0–100 were used to summarize results. The median country overall score was 90 (IQR = 83 – 93). Respect for mothers, continuity of care, having a breastfeeding policy, and rooming-in had the highest median scores. Family-centered care, antenatal informing, skin-to-skin contact, and human milk use had the lowest median scores. Neonatal wards in the hospitals that were ever designated as Baby-Friendly had significantly higher scores than those that were never designated. Most respondents (n = 48, 80%) expressed a desire to obtain Neo-BFHI designation in their neonatal wards.ConclusionNeo-BFHI recommendations can be successfully implemented in Russian neonatal wards at hospitals designated Baby-Friendly or planning to be designated.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundHuman milk banks play an essential role by providing human milk to infants who would otherwise not be able to receive mother’s milk.Study aimTo determine the opinions and attitudes among possible donor mothers regarding human milk banks in one rural region in Bangladesh.MethodsA prospective, cross-sectional study following a probability type of stratified cluster sampling technique was used. Included in the study (N = 121) were mothers aged 20–49 years, with at least one child, who was currently lactating or had breastfed her child, and who resided in the rural community of Bangladesh where the study was conducted. Data were collected through a 21-item, close-ended questionnaire and a face-to-face interview conducted by the researcher at each participant’s home.ResultsAmong the participants, 98.3% (n = 119) said that they had not heard about human milk banks before speaking with the researchers. Most participants (71.9%, n = 87) said would obtain human milk from milk banks if necessary, but 28% (n =34) of mothers indicated that they would not receive milk from a milk bank, even if it was necessary for their children. Only 8.3% (n = 10) said human milk banks were not appropriate according to Islam and 99.2% (n = 120) did not know about the acceptance of human milk banking practices in Bangladesh.ConclusionsFor those with religious concerns, a framework for both the donors and recipients can be established. It can be recommended that health education through healthcare personnel (midwives, nurses, gynecologists, pediatricians, and other health professionals) and religious leaders may strengthen the belief and increase awareness among family members about milk banking practices.

Journal of Human Lactation, Ahead of Print.
BackgroundApproximately 54.8% of patients with breast abscesses discontinue breastfeeding due to the lack of adequate breastfeeding support.Research aimsWe aimed to (1) examine the difference in milk volume produced by healthy breasts and breasts with abscesses; and (2) to explore the changes in milk volume before and after comprehensive management.MethodA prospective, consecutive series study was designed. Lactating patients (N = 50) with breast abscesses were selected from March 2017 to November 2018. The volume and frequency of milk expression of the affected and the unaffected breast were recorded every 24 hr before and after comprehensive management. The difference in the milk volume produced by healthy breasts (control) and breasts with abscesses, as well as the milk volume produced by each breast before and after comprehensive management, was determined.ResultsThere was a significant difference in the milk volume produced by healthy breasts and breasts with abscess before (t = 3.016; p = .004) and after (t = 4.336; p < .001) comprehensive management. The frequency of milk expression was significantly higher after comprehensive management than before it (z = −6.145; p < .001); the milk volume produced by each side significantly increased after comprehensive management (healthy breasts: t = −4.789; p < .001; breasts with abscess: t = 2.555; p = .014).ConclusionThe total milk volume produced by breasts with abscesses can be less than that produced by healthy breasts. The management of abscesses by increasing the frequency of milk expression and degree of emptying can help mothers increase their milk volume.

Journal of Human Lactation, Ahead of Print.
BackgroundThe immune system of milk protects against infections and guides immune system development. A system-level understanding of milk immune activity is critical for research into infant infectious disease risk and lifelong health.Research aimTo describe a protocol to characterize immune activity in human milk via in vitro stimulation for use in population-based (rather than clinical) research.MethodsThis study proceeded in two phases, each with a cross-sectional design. Human milk specimens were incubated for 24 hr at 37 °C in mammalian cell culture medium with stimuli (e.g., Salmonella enterica) in a CO2-enriched environment. Immune responses to stimuli were characterized as the change in cytokine: [stimulated]/[baseline]. Predictors of cytokine responses were evaluated with generalized linear models.ResultsPatterns were detectable across mother–child dyads: Interleukin-6 responses to stimuli were generally positively associated with child age and with maternal autoimmune disease.ConclusionsOur method allows characterization of pro-inflammatory milk immune activity in vitro in population-based (rather than clinical) research settings. In vitro activity has a system-level interpretation and is likely to be of broad utility in global health research in settings with high infectious disease risk, where understanding the immune system of milk is critical to understanding maternal and child health.