Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
BackgroundGestational diabetes mellitus is associated with adverse maternal and fetal outcomes and increases subsequent risk of Type 2 diabetes. Researchers have shown that breastfeeding may reduce diabetes risk in women with recent gestational diabetes.Research aimTo assess association between infant feeding and postpartum glucose tolerance in mothers with recent gestational diabetes within 1 year postpartum.MethodsA literature search was performed up to December 31, 2019, retrieving articles related to infant feeding, gestational diabetes, and postpartum glucose regulation in four major databases (PubMed, Cochrane, CINAHL, and Embase). Methodological quality was assessed using tools from the United States National Institutes of Health and the National Heart, Lung, and Blood Institute.ResultsThe search yielded 15 cohort studies meeting the selection criteria. Of the 15 studies, 13 (86.7%) examined the influence of breastfeeding on postpartum glycemic status, and eight (53.4%) compared the mean blood glucose values between breastfeeding and non-breastfeeding participants. Of the 13 studies that compared postpartum glycemic status, nine (60%) of the research teams found that breastfeeding lowered rates of impaired glucose tolerance, and four (26.7%) showed no significant change. In eight of the studies reporting mean blood glucose values, six (75%) reported significantly lower fasting plasma glucose in breastfeeding participants, with reductions ranging from 3.7 to 7.4 mg/dL (0.2–0.4 mmol/L).ConclusionBreastfeeding has been associated with improved postpartum glucose regulation in mothers with gestational diabetes. In pregnant women with gestational diabetes, breastfeeding may reduce the risk of Type 2 diabetes, and women with gestational diabetes should be strongly encouraged and supported to breastfeed.

Journal of Human Lactation, Ahead of Print.
BackgroundIn many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country.Research AimTo determine the relationship between place of birth and early breastfeeding initiation in Indonesia.MethodThis study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey (N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders.ResultsThe overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively.ConclusionsPlace of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
IntroductionCetirizine hydrochloride is a second-generation H1 histamine antagonist with Food and Drug Administration approval for treatment of allergic rhinitis and urticaria. Currently, the Food and Drug Administration does not recommend use of cetirizine during breastfeeding, as there are insufficient studies on both the transference of cetirizine into human milk and the effects of cetirizine in infants.Main issueTo determine the concentration of cetirizine in human milk, samples were analyzed using high performance liquid chromatography mass spectrometry.ManagementBased on calculations, relative infant dose was found to be 1.77% at 24 hr. In addition, there were no reported adverse effects seen in the infants.ConclusionWe suggest that transfer of cetirizine into human milk is minimal and unlikely to pose a significant risk to the breastfeeding infant. This is the first report presenting the transfer of cetirizine in human milk.

Journal of Human Lactation, Ahead of Print.
BackgroundNecrotizing enterocolitis is associated with a high incidence of morbidity and mortality in premature infants. Human milk minimizes necrotizing enterocolitis risk, although the mechanism of protection is not thoroughly understood. Increasingly, dysbiosis of the infant gut microbiome, which is affected by infant diet, is hypothesized to play a role in necrotizing enterocolitis pathophysiology.Research aimThe aim of this scoping review was to summarize the state of the science regarding the hypothesis that the gut microbiome composition is a mediator of the relationship between human milk and decreased incidence of necrotizing enterocolitis within a sample of human infants.MethodsElectronic databases and reference lists were searched for peer-reviewed primary research articles addressing the link between human milk, gut microbiome composition, and subsequent incidence of necrotizing enterocolitis among human infants.ResultsA total of four studies met criteria for inclusion in this review. Of these, evidence supporting the link between human milk, gut microbiome composition, and necrotizing enterocolitis was found in two (50%) studies.ConclusionSome evidence linking all three variables is provided in this review. Given the small number of available studies, and the limitations of those studies, more research is urgently needed to thoroughly understand the protection against necrotizing enterocolitis gained through the provision of human milk.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Qualitative sampling methods differ from quantitative sampling methods. It is important that one understands those differences, as well as, appropriate qualitative sampling techniques. Appropriate sampling choices enhance the rigor of qualitative research studies. These types of sampling strategies are presented, along with the pros and cons of each. Sample size and data saturation are discussed.

Journal of Human Lactation, Ahead of Print.
Lactation insufficiency is variously defined and includes the inability to produce milk, not producing enough milk to exclusively meet infant growth requirements, and pathological interruption of lactation (e.g., mastitis). Of women with intent-to-breastfeed, lactation insufficiency has been estimated to affect 38%–44% of newly postpartum women, likely contributing to the nearly 60% of infants that are not breastfed according to the World Health Organization’s guidelines. To date, research and clinical practice aimed at improving feeding outcomes have focused on hospital lactation support and education, with laudable results. However, researchers’ reports of recent rodent studies concerning fundamental lactation biology have suggested that the underlying pathologies of lactation insufficiency may be more nuanced than is currently appreciated. In this article, we identify mucosal biology of the breast and lactation-specific liver biology as two under-researched aspects of lactation physiology. Specifically, we argue that further scientific inquiry into reproductive state-dependent regulation of immunity in the human breast will reveal insights into novel immune based requirements for healthy lactation. Additionally, our synthesis of the literature supports the hypothesis that the liver is an essential player in lactation—highlighting the potential that pathologies of the liver may also be associated with lactation insufficiency. More research into these biologic underpinnings of lactation is anticipated to provide new avenues to understand and treat lactation insufficiency.

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.
BackgroundMother-to-mother breastfeeding support organizations provide important information and guidance for helping mothers initiate and maintain breastfeeding, postpartum. However, the availability of this support is limited by a constellation of barriers, including race, culture, socioeconomic status, and geography.Research aimsTo identify the geodemographic composition of communities where breastfeeding support was available from the mother-to-mother support organizations Breastfeeding USA and La Leche League, identify underlying issues of equity, and highlight locations where more support resources may be needed.MethodsThe locations of mother-to-mother support meetings were collected by ZIP code (N = 180) and were combined with a geodemographic database and exploratory spatial data analysis to explore the compositional characteristics of communities served (N = 1,173).ResultsSignificant gaps in the geographic distribution of breastfeeding support existed. While many metropolitan areas benefited from numerous mother-to-mother support groups and peer counselors, the geographic footprint of this support favored communities that were white, affluent, and suburban.ConclusionSpatial analytics combined with geodemographic analysis provide a unique perspective into the diverse landscape of mother-to-mother breastfeeding support groups at a local level. Our results highlighted inequities in the distribution of support provided and prescriptive guidance regarding where more resources may be needed.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
BackgroundThe human milk microbiome is an emerging scientific area. Careful, accurate collection and measurement for microbial sequencing is imperative. There is controversy about a core microbiome, and little is known about factors that influence composition. Even less known are ways that the milk microbiome might seed the infant gut and affect health.Research aimThe aim of this paper is to provide a critical appraisal of milk microbiome research. The four areas of critical appraisal were collection and measurement, composition, effects on composition, and potential health effects for infants related to the milk microbiome.MethodsUsing a PRISMA-ScR scoping review, we reviewed sources of evidence extracted from PubMed, Web of Science, CINAHL, Academic Search Complete, and PSYCHINFO data sets using the following criteria: English language, published in past 6 years, primary data, and sequencing using Next Generation Sequencing. Charting of sources of evidence included authors, title, journal year, sample, design, and results. The research questions posed were: How is human milk collected and how are the microbes identified? What is the composition and what factors affect the human milk microbiome? What is the relationship of the human milk microbiome to infant biology and health?ResultsThe reviewed studies were quantitative, cross sectional, or longitudinal. A core microbiome may be present. The microbiome may seed the early infant gut and promote physiological functions and thus influence human health.ConclusionsWe have suggested concerns about collection and measurement that lead to gaps in knowledge generation, and mechanistic studies are lacking.

Journal of Human Lactation, Ahead of Print.
BackgroundThe use of donor human milk is rising. Maternal awareness of donor human milk use, milk donation, and milk banks has not been well described in the United States.Research AimsTo explore maternal experience, knowledge, and attitudes regarding donor human milk use and milk donation. We also assessed counseling by medical providers about donor human milk use and donation.MethodsA cross-sectional prospective survey design was used in this study. We anonymously surveyed mothers (N = 73) attending the 1 to 2-week well newborn appointment. Analyses were completed using one-way ANOVA and logistic regression.ResultsParticipants’ infants primarily received their own mother’s milk (87%, n = 61). No infants received donor human milk, but 4% (n = 3) of participants donated milk. The majority of participants had positive responses to attitudinal statements about donor milk. When presented with a hypothetical scenario, participants chose formula (89%, n = 59) over donor human milk (11%, n = 7) for their infant. Moreover, if donor human milk was the only option available, they chose donor human milk from a relative or friend (60%, n = 40) over a milk bank (40%, n = 26). Medical providers had discussed donor human milk use or donation with 4% (n = 3) of participants.ConclusionsThe majority of participants previously had minimal experience using donor human milk and limited knowledge regarding donor human milk and milk banks. According to participants, medical providers did not routinely discuss milk donation and the role of donor human milk with families.

Journal of Human Lactation, Ahead of Print.
BackgroundDonor milk is the preferred substitute to mother’s own milk, which can protect high-risk infants from many complications. Several milk banks have been established in China. However, the small number of donors and insufficient milk donated have become the primary obstacles for these milk banks.Research aimsTo explore the level of, and the factors influencing, knowledge and attitude about donor milk among currently lactating women across mainland China and to provide a reference for the development of Chinese milk banks.MethodsA brief, self-reporting, prospective, cross-sectional, online survey was conducted in 2018 using The Knowledge and Attitude Questionnaire of Human Donor Milk for Hospitalized Women. Lactating women aged >18 years and willing to consent to study participation were recruited throughout China.ResultsAll completed questionnaires (N = 489) were included. 40.1% (n = 196) of the participants had heard of donor milk or milk banks, and 76.7% (n = 375) were willing to donate their milk. In the multiple linear regression analysis, educational level, cohabitation status, parity, history of delivering preterm or low-birth-weight infants, education provided by health professionals, and infants’ gestational age, weight, and feeding patterns were associated with the participants’ knowledge about donor milk (F = 12.387, p < .001). The parity, delivery mode, mothers’ milk production, history of delivering preterm or low-birth-weight infants, education provided by health professionals, and infants’ age were associated with their attitude (F = 9.420, p < .001).ConclusionThe participants’ attitudes about donor milk were positive. However, there were gaps in their knowledge about donor milk.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.