Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
Wet-nurses themselves rarely left written accounts. In this article, I have reconstructed their experiences and work situations breastfeeding other women’s infants in colonial Australia through examining available sources concerning their employment situations and the fate of their infants when they were boarded out, as they commonly were. The employment of wet-nurses by royal households or prominent families has long been the topic of historical accounts, whereas the situation of the more numerous wet-nurses further down the social spectrum has received disproportionately little examination. In this article, I do not discuss informal, altruistic wet nursing by family or neighbors but, rather, the situation of those women for whom it was an occupation, by its very nature short term. Primary material sighted for this study included a considerable number of advertisements for positions placed by employers, their intermediaries (e.g., family physicians) and wet-nurses themselves, and newspaper reports when the wet-nurse’s children came to the attention of the courts. Death for boarded-out infants who succumbed to inappropriate feeding and substandard care was typically ascribed to “natural causes.”

Journal of Human Lactation, Ahead of Print.
BackgroundDietary long-chain polyunsaturated fatty acids are known to benefit infant development. After birth, human milk provides arachidonic, eicosapentaenoic, and docosahexaenoic acids to the infant. Endocannabinoids are endogenous lipid mediators derived from the long-chain polyunsaturated fatty acids. Although the roles and the mechanisms of action are not fully understood, previous researchers have suggested that endocannabinoids might play a role in infant feeding behavior.Research AimsTo assess (i) maternal dietary intake of long-chain polyunsaturated fatty acids and (ii) their relationship to concentrations of fatty acids and derived endocannabinoids in human milk.MethodsFor this exploratory-longitudinal study, participants (N = 24) provided dietary intake data and milk samples. Fatty acids and derived endocannabinoids: Arachidonylethanolamide, arachidonoylglycerol, docosahexaenoyl glycerol, eicosapentaenoyl ethanolamide, and eicosapenaenoyl glycerol were identified in their milk by liquid chromatography-mass spectrometry and correlations to dietary fatty acids were assessed.ResultsParticipants were not consuming recommended amounts of docosahexaenoic acid. Significant correlations (p ≤ .05) were only found between dietary docosahexaenoic and eicosapentaenoic acids and the concentrations of these in human milk. Moreover, only dietary docosahexaenoic acid was correlated (p = .031) with its corresponding endocannabinoid, docosahexaenoyl glycerol.ConclusionsTo the best of our knowledge, this may be one of the first studies evaluating relationships between dietary long-chain polyunsaturated fatty acids and multiple endocannabinoids in human milk. Our findings suggest that endocannabinoid concentrations could be modulated by dietary precursors. Future research studies can be designed based on these data to better elucidate the roles of endocannabinoids in human milk for infant health and development.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
In this issue’s Lactation Newsmakers: Documenting our History, we are featuring two emerging leaders in the field of lactation. Rachel Davis and Janiya Williams are both International Board Certified Lactation Consultants and hold positions as directors for the only two Pathway 2 Lactation Consultant Training Programs in Historically Black Colleges / Universities. Rachel is Program Director for the Lactation Consultant Training Program at Johnson C. Smith University in Charlotte, North Carolina, while Janiya directs the Human Lactation Training Program at North Carolina Agricultural and Technical State University an hour and a half away in Greensboro, North Carolina. While their backgrounds are quite different, both women care passionately about increasing diversity and equity in the field of lactation support, as well as normalizing nursing for Black and brown families transitioning into parenthood. In this interview they speak to relationships they have developed with their students, their students have developed with each other, and the strength of community created within and between their programs. They describe the difficulties their students encounter with institutional racism within the medical system, and the additional preparation they receive to navigate it. Both programs experience high volumes of applicants—almost 350 for the 12 positions at Johnson C. Smith University—demonstrating the significant need for this curriculum in Historically Black Universities/Colleges. The importance of this model in diversifying the field of lactation cannot be underestimated, and the outspoken women doing this work will be influencers in this field for years to come. (RD = Rachel Davis; JW = Janiya Williams; EC = Ellen Chetwynd).

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundBreast/Chestfeeding remains a public health issue for African Americans, and increased rates would mitigate many health disparities, thus promoting health equity.Research AimsTo explore the interplay of generational familial roles and meaning (or value) ascribed to communicating infant feeding information across three generations.MethodThis prospective, cross-sectional qualitative study used an asset-driven approach and was guided by Black Feminist Thought and Symbolic Interactionism. African American women (N = 35; 15 family triads/dyads), residing in the southeastern United States were interviewed. Data were analyzed using thematic analysis.ResultsThe older two generations described their role using assertive yet nurturing terms, while the younger generation carefully discussed the flexibility between their familial roles. Emergent themes described the meaning each generation attributed to communicating infant feeding information: “My Responsibility,” “Comforting,” “Bonding Experience,” “She Cared,” and “Gained Wisdom.”ConclusionsOur findings have potential to contribute to achieving health equity in African American families. Future breast/chestfeeding promotion efforts may benefit from reframing the current approach to including protection language and not solely support language. Lactation professionals should further recognize and support strengths and resource-richness of intergenerational infant feeding communication within African American families using strength-based, empowerment-oriented, and ethnically sensitive approaches.

Journal of Human Lactation, Ahead of Print.
BackgroundThe Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, adherence of hospitals to the Baby-Friendly 10 Steps, as determined from the perspective of women participating in the United States Special Supplemental Nutrition Program for Women, Infants, and Children, has not been assessed.Research Aims(1) To compare maternal perceptions about maternity practices in Baby-Friendly Hospitals and non-Baby-Friendly Hospitals; (2) to evaluate the associations between degree of exposure to the Baby-Friendly 10 Steps and breastfeeding practices through the first 6 months; and (3) to evaluate whether the receipt of specific Steps was associated with breastfeeding practices through 6 months.MethodsThis study was a cross-sectional 2 group comparison, using prospective data collected through a self-report telephone survey and retrospective data gathered from participants’ records. Women (N = 182) participating in four Maryland Special Supplemental Nutrition Program for Women, Infants and Children agencies were recruited. One hundred and eight (59%) participants delivered at designated Baby-Friendly Hospitals; 74 (41%) delivered in non-Baby-Friendly designated hospitals. Logistic regression models were utilized to determine the influence of perceived Step adherence on exclusive breastfeeding.ResultsReported adherence to 10-Steps policies ranged from 10%–85% (lowest for Step 9, highest for Step 10) and only Step 9 (give no pacifiers or artificial nipples to breastfeeding infants) differed according to Baby-Friendly Hospital status. Greater exposure to the 10 Steps was positively associated with exclusive breastfeeding during hospitalization. The lack of perceived adherence to Step 6 (no food or drink other than human milk), Step 9, and the International Code of Marketing of Breast-milk Substitutes (no formula, bottles, or artificial nipples) significantly decreased the likelihood of exclusive breastfeeding through 6 months.ConclusionMaternal perception of Baby-Friendly Step adherence was associated with exclusive breastfeeding.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundThere is growing recognition that current food systems and policies are environmentally unsustainable. There is an identified need to integrate sustainability objectives into national food policy and dietary recommendations.Research AimsTo (1) describe exploratory estimates of greenhouse gas emission factors for all infant and young child milk formula products and (2) estimate national greenhouse gas emission association with commercial milk formulas sold in selected countries in the Asia Pacific region.MethodWe used a secondary data analysis descriptive design incorporating a Life Cycle Assessment (LCA) concepts and methodology to estimate kg CO2 eq. emissions per kg of milk formula, using greenhouse gas emission factors for milk powder, vegetable oils, and sugars identified from a literature review. Proportions of ingredients were calculated using FAO Codex Alimentarius guidance on milk formula products. Estimates were calculated for production and processing of individual ingredients from cradle to factory gate. Annual retail sales data for 2012–2017 was sourced from Euromonitor International for six purposively selected countries; Australia, South Korea, China, Malaysia, India, Philippines.ResultsAnnual emissions for milk formula products ranged from 3.95–4.04 kg CO2 eq. Milk formula sold in the six countries in 2012 contributed 2,893,030 tons CO2 eq. to global greenhouse gas emissions. Aggregate emissions were highest for products (e.g., toddler formula), which dominated sales growth. Projected 2017 emissions for milk formula retailed in China alone were 4,219,052 tons CO2 eq.ConclusionsPolicies, programs and investments to shift infant and young child diets towards less manufactured milk formula and more breastfeeding are “Triple Duty Actions” that help improve dietary quality and population health and improve the sustainability of the global food system.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundMother’s milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal–infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population.Research AimsTo determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother’s milk and (2) recorded number and volume of pumped mothers’ milk bottles, between two models of lactation care in a referral neonatal intensive care unit.MethodsThis retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at ≤ Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017–March, 2018; May, 2018–April, 2019). The reactive care model (n = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model (n = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and t-tests.ResultsA proactive lactation approach was associated with an increase in the receipt of any mother’s milk from 74.3% to 80.2% (p = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 (SD 788) to 6620 (SD 1314) bottles (p < .01).ConclusionsIn this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother’s milk provision for a high-risk population.

Journal of Human Lactation, Ahead of Print.
BackgroundLittle is known about breastfeeding initiation and duration in the context of postpartum marijuana use and safety beliefs.Research Aims(1) To describe characteristics of women who used marijuana postpartum; (2) to evaluate the relationship between postpartum marijuana use and breastfeeding behaviors; and 3) to assess, among women who used marijuana postpartum, how safety perceptions are associated with breastfeeding behaviors.MethodsData from the cross-sectional Pregnancy Risk Assessment Monitoring System, a United States national governmental survey, 2017, were analyzed for participants with infants aged ≥ 12 weeks (seven states, unweighted N = 4604). Chi-square tests were used to compare characteristics and counseling for postpartum marijuana use. For participants with postpartum use, adjusted prevalence ratios (aPR) were calculated to evaluate relationships between safety perceptions and breastfeeding initiation and duration.ResultsOverall, 5.5% (95% CI [4.6, 6.6]) of participants reported postpartum marijuana use; among these women, 47.2% (CI [37.6, 56.9]) were breastfeeding at the time of the survey. Overall, 25.7% of participants indicated that they had been advised, by their prenatal care provider, against marijuana use while breastfeeding. Breastfeeding initiation or duration did not differ by postpartum marijuana use. Among participants with postpartum use, those who perceived marijuana was safe for breastfeeding women to use were more likely to have breastfed (aPR = 1.22, CI [1.04, 1.43]) and have a breastfeeding duration > 12 weeks (aPR = 1.57, CI [1.08, 2.27]) compared to those who perceived it to be unsafe.ConclusionsUnderstanding maternal safety beliefs and provider education about the latest evidence and guidance related to postpartum marijuana use may improve clinical care.

Journal of Human Lactation, Ahead of Print.
IntroductionDuring the Coronavirus Disease 2019 global pandemic, maternal and newborn wellbeing has received much attention. Detailed reports of infected women breastfeeding their infants are uncommon. Due to incomplete information available, full data about those infants’ outcomes are lacking, and evidence of infectivity through breastfeeding has not been documented.Main IssueHere, we report about a mother who breastfed her infant until she was confirmed with the SARS-Cov-2 infection. After follow-up, we have confirmed that the infant, who was breastfed by the infected mother, was not infected.MethodsA 33-year-old woman gave birth to a full-term male infant on November 8, 2019. Since birth, she had been exclusively breastfeeding the baby until she was confirmed with the SARS-Cov-2 infection on February 8, 2020. She was hospitalized, isolated from her baby, and stopped breastfeeding. Even though she remained asymptomatic, her milk was expressed using a breast pump and discarded. The mother’s milk sample was collected on February 9, 2020, and the result of the nucleic acid test for COVID-19 was negative. Her infant was asymptomatic and remained virus negative. Her laboratory findings and chest Computed Tomography imaging was normal. She was treated according to the national protocol with aerosolized interferon α2β, lopinavir/ritonavir and ribavirin. Her serum SARS-CoV-2 specific antibodies(IgG and IgM) tested positive when discharged. She returned to breastfeeding after discharge.ConclusionOur findings suggest that breastfeeding may be less of a risk than anticipated. Additional research is needed to explore this possibility.

Journal of Human Lactation, Ahead of Print.
BackgroundBreast hypoplasia is one reason for insufficient milk supply. Case reports use wide intra-mammary width and certain breast appearances as markers of breast hypoplasia. However, the reliability of these variables has not been determined.Research aimsTo test the (i) interrater and intrarater reliability of intra-mammary width measurement and interrater reliability of categorizing women’s breasts into breast types, and (ii) feasibility and acceptability of study procedures for the participants.MethodsThis was a prospective, longitudinal, non-experimental design with survey and observational components of a convenience sample of early postpartum women (N = 31). Interrater and intrarater reliability were measured using intraclass correlation coefficient for agreement for intra-mammary width measurements. Interrater reliability was measured using weighted kappa for agreement for categorizing breast type. Feasibility and acceptability of study procedures were collected 1 month later.ResultsExcellent intrarater and interrater reliability for the intra-mammary width measurement (ICC = 0.99, 95% CI [0.99, 0.997] and ICC = 0.88, 95% CI [0.74, 0.94], respectively) and fair interrater reliability for breast type categorization (k = 0.35, 95% CI [−0.05, 0.75]) with high level of agreement between raters (97%) were achieved. Proportions of participants agreeing to breast photography and acceptability of study procedures were 68% (21/31) and 100% (28/28) respectively.ConclusionThe excellent reliability for the intra-mammary width measurement means it provides a useful measure for future research. Since the “fair” reliability of categorizing breast type was due to lack of breast shape range in our sample, future research could assess the breasts of women with different medical profiles.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundExclusive breastfeeding has a wide range of benefits for maternal health. However, the benefit of exclusive breastfeeding for maternal mental health needs to be further explored.Research AimTo determine the moderating role of exclusive breastfeeding at 3 months on the association between prenatal and postpartum depression.MethodsThis study had a prospective, longitudinal, and comparative design with two groups and three assessment waves. The sample comprised 334 participants (70 depressed and 264 non-depressed) recruited at public health services in northern Portugal. Participants completed a measure of depression symptoms between the second and the third trimester of pregnancy and between 3 and 6 months, and a measure of breastfeeding status at 3 months.ResultsExclusive breastfeeding at 3 months moderated the association between prenatal and postpartum depression. Participants with prenatal depression who were exclusively breastfeeding at 3 months showed fewer symptoms of depression and lower rates of depression between 3 and 6 months postpartum, compared to participants with prenatal depression who were not exclusively breastfeeding. Participants without prenatal depression who were exclusively breastfeeding at 3 months showed similar depression symptoms and similar rates of depression between 3 and 6 months postpartum, compared to participants without prenatal depression who were not exclusively breastfeeding.ConclusionExclusive breastfeeding has a potential protective influence on postpartum depression among women with prenatal depression. Public health policies targeting women with prenatal depression should be implemented and include practices to promote and support exclusive breastfeeding in order to enhance women’s exclusive breastfeeding and mental health.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundThe continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding.Research aimTo compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care.MethodsChinese primigravida (N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group (n = 84) or the control group (n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups.ResultsSignificant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum (p < .05) and feeding patterns at 3 months and 6 months postpartum (p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points (p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI (p < .05).ConclusionsA prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health.This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

Journal of Human Lactation, Ahead of Print.
BackgroundIt is known that breastfeeding protects the infant from enteric and respiratory infections; however, the antiviral properties of human milk against enteric and respiratory viruses are largely unexplored.Research aimsTo explore the antiviral activity of human preterm colostrum against rotavirus and respiratory syncytial virus and to assess whether the derived extracellular vesicle contribute to this activity.MethodsWe used a cross-sectional, prospective two-group non-experimental design. Colostra were collected from mothers of preterm newborns (N = 10) and extracellular vesicles were purified and characterized. The antiviral activity of colostra and derived extracellular vesicles were tested in vitro against rotavirus and respiratory syncytial virus and the step of viral replication inhibited by extracellular vesicles was investigated.ResultsEach sample of colostrum and colostrum-derived extracellular vesicles had significant antiviral activity with a wide interpersonal variability. Mechanism of action studies demonstrated that extracellular vesicles acted by interfering with the early steps of the viral replicative cycle.ConclusionWe demonstrated the intrinsic antiviral activity of human colostrum against rotavirus and respiratory syncytial virus and we showed that extracellular vesicles substantially contribute to the overall protective effect. Our results contribute to unravelling novel mechanisms underlying the functional role of human milk as a protective and therapeutic agent in preterm infants.

Journal of Human Lactation, Ahead of Print.
Since 1980, alongside IBFAN partners, Patti Rundall has worked to build collaborative networks that help countries bring in legally binding controls based on the International Code of Marketing of Breastmilk Substitutes and the United Nations World Health Assembly (WHA) Resolutions. Conflicts of interest and their impact on policymaking, research, education, and health systems has been a cross-cutting theme of her work, which has focused on the adoption and strengthening of the European Union’s baby food legislation and the improvement of Codex Global Trading Standards. With IBFAN, she helped countries adop many resolutions including WHA Resolution 49.15 https://www.who.int/nutrition/topics/WHA49.15_iycn_en.pdf?ua=1 (1996) about conflicts of interest; she helped found and launch the Conflicts of Interest Coalition at the UN General Assembly. Patti is a founder of Baby Feeding Law Group (the alliance of 23 United Kingdom health professional and mother-support organizations), a member of the Infant Feeding in Emergencies core group and a leader in company campaigns (e.g., the Nestlé Boycott). She represented IBFAN on the European Commission’s Platform for Action on Diet and Physical Activity from 2007 until 2019. In the year 2000 she was awarded the title Officer of the British Empire (OBE) for her service to infant nutrition. (This is a verbatim interview: MA = Maryse Arendt; PR = Patti Rundall.)