Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
Background:There are different approaches to breastfeeding interventions, but the global 6-month exclusive breastfeeding rates remain suboptimal. The COVID-19 pandemic has brought extra difficulties in promoting breastfeeding.Research Aim:To test the feasibility and effectiveness of a theory-based, real-time online educational and support program for breastfeeding related outcomes.Methods:An assessor-blinded, prospective pilot randomized controlled trial with parallel-group, repeated-measures design was used. The sample was low-risk primiparous mothers (N = 40) who delivered in the local public hospitals. Study outcomes consisted of exclusive breastfeeding rate, breastfeeding self-efficacy, and other breastfeeding outcomes measured by a self-reported questionnaire, including the Breastfeeding Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Comparisons between the differences in the intervention and control groups were carried out.Results:Thirteen participants in the intervention group successfully completed the program. They had a higher exclusive breastfeeding rate, breastfeeding self-efficacy, breastfeeding initiation rate, and longer exclusive breastfeeding duration than the control group. Additionally, the intervention group had a lower partial breastfeeding rate, and a higher maternal postnatal depression score and infant’s morbidity at postnatal 2 months. However, all the results were not statistically significant (p > .050). Overall, the intervention was highly valued by all participants who appreciated the regular postnatal follow-ups.Conclusions:Despite showing the satisfactory feasibility of the program, no significant improvements were found in all study outcomes. Considering the participants’ comments, we suggest refining and further testing the intervention with a larger sample size over a longer-term follow-up to confirm its effectiveness.This study has been registered at ClinicalTrials.gov (NCT04741425)

Journal of Human Lactation, Ahead of Print.
IntroductionA 28-year-old woman was able to maintain lactation for her 21-month-old child through the process of an En Bloc Total Capsulectomy Breast Implant Removal. This case study is important as it exemplifies collaborative care to achieve maintenance of lactation through a surgical procedure.Main IssueThe participant was providing human milk to her 21-month-old child 4 times per day through breastfeeding and pumping and bottle feeding, and desired to continue lactation through explant surgery. The participant was experiencing Breast Implant Illness, yellowing of the skin and whites of the eyes, bottoming out of the right implant, severe capsular contracture of the right implant causing constant pain, limited mobility of the right arm and shoulder, and concern about an active recall on the brand implant she received.ManagementThe lactation management began 3 weeks prior to the procedure with the participant expressing enough milk prior to the surgery to allow for human milk feeding from a bottle during the 7-day recovery period as desired. The surgical team and IBCLC selected an appropriate bra for recovery to allow for both appropriate surgical site healing and ease of access for pumping. Exclusive pumping was utilized until surgical drains were removed, after which the participant was able to reintroduce breastfeeding.ConclusionEn Bloc Total Capsulectomy Breast Implant Removal can be performed while an individual is lactating without complication, given the appropriate multidisciplinary support. A temporary reduction of ease and efficiency of milk removal is possible post-operatively, in this case resolving within 24 hr.

Journal of Human Lactation, Ahead of Print.
Background:The most utilized pasteurization method in donor human milk banks is Holder pasteurization (heating 62.5 °C for 30 min). However, many bioactive proteins are heat sensitive and are inactivated.Research Aim:To determine the results of a range of heating regimes on the activities of xanthine oxidase, lactoperoxidase and lysozyme, the concentrations of immunoglobulin A and lactoferrin, as well as bacterial inactivation.Method:This prospective, cross-sectional, intervention study was designed to measure the influence of heating temperatures on bioactive components in donor human milk. Milk samples were processed at 40, 50, 55, 62.5, 75, 127 °C and the activities of the enzymes, and the concentration of immune proteins, were measured.Results:No bacterial colonies were detectable, using standard culture methods, after heating above 50 ºC. All proteins studied retained over 60% concentrations or activities when the pasteurization temperature was 50 ºC or lower, while their concentrations or activities were lost at higher temperatures. For lactoferrin, the residual concentration was above 80% when heating temperature was under 55 °C, while only 20% remained after Holder pasteurization. Both xanthine oxidase and lactoperoxidase had little residual activity when temperatures were above Holder pasteurization. Lysozyme retained a greater proportion of residual activity than other proteins, following heating at all temperatures.Conclusions:The concentrations or activities of immune proteins and bioactive enzymes decreased when heated above 50 °C. The results of this study can be used to design temperature control guidance during alternative methods of pasteurization.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Maternal social support promotes healthy infant feeding practices, which influence healthy growth and development. Less is known about how the interplay of social support networks and multicultural health beliefs may influence infant feeding practices, particularly among immigrant Chinese American mothers with economic disadvantage and low breastfeeding rates.Research Aim:To explore the role of social support networks in the development of infant feeding practices in immigrant Chinese American mothers with infants.Methods:This was a prospective, cross-sectional qualitative study where we conducted semi-structured interviews in Mandarin, Cantonese, or English with Chinese American mothers of infants (N = 25) at a federally qualified health center in the Sunset Park neighborhood of Brooklyn, New York. Data were analyzed by a multicultural, multidisciplinary team using qualitative thematic analysis and the constant comparative method to identify and iteratively refine emerging codes.Results:Three themes emerged describing how broad transnational communities and close family and friends influence maternal-infant feeding practices: (1) Gathering and processing infant feeding information from broad transnational resources (i.e., from both the mother’s country of residence and the mother’s country of origin); (2) aligning maternal feeding attitudes with cultural health beliefs of local social networks; and (3) gaining confidence with transactional maternal–infant feeding interactions.Conclusions:Strategies to promote healthy infant feeding should consider how family supports and culturally-relevant coaching can help align multilevel transnational social networks with healthy infant feeding practices.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care.Research Aim:To describe the development, content validation, and interrater reliability of the LACT.Methods:This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants (N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff’s alpha.Results:An acceptable degree of interrater reliability (α = 0.70) among participants was detected for the 16 measures included in the instrument.Conclusion:This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding is the biological norm and is associated with numerous superior health outcomes for children and mothers when compared to human milk substitutes. Yet, breastfeeding difficulties and the inability to meet one’s breastfeeding goals are common in the United States and maybe more common among mothers who have experienced trauma.Research Questions:(1) Are mothers’ adverse childhood experiences, and current experiences of discrimination, material hardship, and decreased social support associated with breastfeeding challenges; and (2) are these experiences associated with the number of breastfeeding challenges reported?Methods:A prospective, non-probability, cross-sectional study design with a diverse sample who had delivered a live baby within the previous year (N = 306) was conducted.Results:Over 70% of participants reported breastfeeding challenges and 45.2% reported material hardship. Among those who attempted breastfeeding (n = 286), 74.1% had at least one adverse childhood experience; 30.3% had four or more. Logistic and negative binomial regression models determined that adverse childhood experiences, experiences of discrimination, material hardship, and decreased social support were not associated with experiencing any breastfeeding challenges. However, adverse childhood experiences were associated with the number of breastfeeding challenges reported. (The adjusted rate ratio was 1.05; 95% CI [1.00, 1.09], p = .034).Conclusion:We recommend further research on adverse childhood experiences and potential relationships with discrimination, material hardship, and social support to prevent and intervene in cases of breastfeeding challenges to maximize infant, maternal, and public health.

Journal of Human Lactation, Ahead of Print.
Leah Margulies was Director of the Infant Formula Program at the Interfaith Center on Corporate Responsibility in New York City (NYC) from 1975 to 1985. She is a founder of the International Nestle Boycott, Corporate Accountability (formerly INFACT), and one of the founders of the International Baby Food Action Network (IBFAN). She was hired at UNICEF in 1982 to set up the legal office for implementation of the International Code of Marketing Breastmilk Substitutes, as part of the Baby Friendly Hospital Initiative. Previously, she was legal advisor to the Environment Unit of the United Nations Centre on Transnational Corporations. From 2006 to 2016, she was Project Director of LawHelpNY at the NYC Bar Association. Currently, she works for a legal non-profit, representing low-income Brooklynites, defending them against eviction. She is a lawyer, a Second Wave Feminist, and a member of Veteran Feminists of America. She is also a musician and founding member of a pioneering women’s rock band that played at the first national women’s march for abortion rights in Washington, DC, 1972.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:Insulin, insulin-like Growth Factor-1 (IGF-1), and obestatin in human milk originate from the circulation. There is also limited knowledge about the influence of body fat on the levels of these hormones in human milk.Research Aim:To determine (1) the influence of body fat on levels of insulin, IGF-1, and obestatin in human milk and serum/plasma during the postpartum period; (2) the changes in the levels of these hormones in human milk and serum/plasma postpartum; and (3) the presence of IGF-1 mRNA in human milk.Methods:In this prospective, longitudinal, observational cohort study, levels of insulin, IGF-1, and obestatin were measured up to 30 days postpartum in milk and serum/plasma of 58 participants with adequate (≤ 32%) or excess (> 32%) total body fat determined by electrical bioimpedance. Student’s t test and repeated-measures analysis of variance were used to evaluate the differences between groups. Pearson’s test was used to analyze the associations.Results:The milk from participants with excess body fat had higher insulin and IGF-1 levels and lower obestatin levels than that of participants with adequate body fat at 3–7, 14–15, and 30 days postpartum (adjusted p < .001). The levels of insulin, IGF-1, and obestatin were significantly higher in human milk than in serum/plasma (p < .05) and correlated with maternal body fat (p < .001).Conclusions:Maternal body fat was associated with elevated insulin and IGF-1 levels and decreased obestatin levels in human milk up to 30 days postpartum.

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.

Journal of Human Lactation, Ahead of Print.
Background:Severe Acute Respiratory Syndrome Coronavirus 2 has spread globally, causing the coronavirus disease 2019 (COVID-19) pandemic. To control the pandemic and to achieve herd immunity, four vaccines have obtained market authorization in Europe. Researchers have reported that the sequence of administration of the vaccines depends on the risk of exposure to COVID-19 and age, recommending the vaccine to pregnant and breastfeeding women.Research Aim:To examine the knowledge, willingness and attitudes of breastfeeding women in Spain regarding the possibility of receiving the COVID-19 vaccine.Methods:An observational descriptive cross-sectional study in two tertiary-level hospitals from Valencia was conducted. Breastfeeding women (N = 301) were recruited by non-probability sampling of consecutive cases. Questionnaires were collected in June 2021.Results:More than one in every two participants would accept a COVID-19 vaccine, and the percentage rose in participants who were older, more educated, or worked in high-risk jobs. Their main source of information was the Internet, and midwives were the professionals who most recommended vaccination. Participants who would not accept vaccination during lactation reported reasons linked to lack of information regarding vaccination in their condition and how it might affect newborns.Conclusion:It is of primary concern for healthcare professionals to foster a greater understanding by providing updated information regarding the need, safety, and efficacy of the vaccine for both lactating mothers and their newborns.

Journal of Human Lactation, Ahead of Print.
Background:Maternity protection rights incorporate comprehensive benefits that should be available to pregnant or breastfeeding working women.Research Aim:To describe South Africa’s maternity protection legal and policy landscape and compare it to global recommendations.Method:A prospective cross-sectional comparative policy analysis was used to review and describe national policy documents published from 1994–2021. Entitlements were mapped and compared to International Labour Organization standards. The document analysis was supplemented by interviews conducted with key national government department informants. Thematic analysis was used to evaluate policy and interview content.Results:Elements of maternity protection policy are incorporated into South Africa’s constitutional dispensation, and some measures are consistent with international labor and social security standards. However, the policy framework is fragmented and difficult to interpret. The fragmented policy environment makes it challenging for employees to know their maternity rights’ entitlements and for employers to understand their responsibilities. Confusion regarding maternity protection rights is amplified by the complexity of ensuring access to different forms of maternal protection in pre- and postnatal stages, oversight by multiple government departments, and heterogenous working environments.Conclusions:Maternity protection in South Africa is fragmented and difficult to access. Overcoming these challenges requires legislative and implementation measures to ensure greater policy coherence and comprehensive guidance on maternity protection rights. Addressing gaps in maternity protection in South Africa may provide insights for other countries with shortcomings in maternity protection provisions and could contribute to improved breastfeeding practices.

Journal of Human Lactation, Ahead of Print.