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.
Background:Breastfeeding women are at risk of developing mastitis during the lactation period. Staphylococcus aureus has emerged as the community-acquired pathogen responsible for virulence (methicillin resistance and Panton-Valentine leukocidin toxin producing).Research aim:The aim was to compare the microorganisms responsible for mastitis and breast abscesses during breastfeeding.Methods:This observational study was conducted with a sample of women (N = 60) admitted to our hospital between 2016 and 2018. Participants affected by mastitis and breast abscess were studied and cared for by a multidisciplinary working group. A diagnostic breast ultrasound identified the pathology.Results:Twenty-six participants (43.3%) were affected by mastitis and 34 (56.7%) by breast abscess. The most common microorganism identified was Staphylococcus aureus (S. aureus; mastitis, n = 13; abscesses, n = 24). Methicillin resistance was identified in 21 (44.7%) S. aureus strains: 17 (80.9%) cases of abscess and four (19.1%) cases of mastitis. The median number of months of breastfeeding was smaller in the methicillin-resistant S. aureus (MRSA) cases (median = 3, range = 1–20 months) than in the methicillin-sensitive S. aureus (MSSA) cases (median = 6.5, range = 3–21 months). The Panton-Valentine leukocidin toxin gene was detected in 12 (25.5%) cases (MRSA, n = 8, 66.7%; MSSA, n = 4, 33.3%). Hospitalization was required more frequently in MRSA (n = 8, 38%; five Panton-Valentine leukocidin positive) than in MSSA cases (n = 5, 19%; one Panton-Valentine leukocidin positive). Four women out of the eight MRSA cases (50%) that were Panton-Valentine leukocidin positive stopped breastfeeding during mammary pathologies, three (37.5%) participants continued breastfeeding until the follow-up recall, and one case was lost at follow-up.Conclusion:Clinical severity was probably complicated by the presence of the Panton-Valentine leukocidin toxin, which required hospitalization more frequently.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding women are at risk of developing mastitis during the lactation period. Staphylococcus aureus has emerged as the community-acquired pathogen responsible for virulence (methicillin resistance and Panton-Valentine leukocidin toxin producing).Research aim:The aim was to compare the microorganisms responsible for mastitis and breast abscesses during breastfeeding.Methods:This observational study was conducted with a sample of women (N = 60) admitted to our hospital between 2016 and 2018. Participants affected by mastitis and breast abscess were studied and cared for by a multidisciplinary working group. A diagnostic breast ultrasound identified the pathology.Results:Twenty-six participants (43.3%) were affected by mastitis and 34 (56.7%) by breast abscess. The most common microorganism identified was Staphylococcus aureus (S. aureus; mastitis, n = 13; abscesses, n = 24). Methicillin resistance was identified in 21 (44.7%) S. aureus strains: 17 (80.9%) cases of abscess and four (19.1%) cases of mastitis. The median number of months of breastfeeding was smaller in the methicillin-resistant S. aureus (MRSA) cases (median = 3, range = 1–20 months) than in the methicillin-sensitive S. aureus (MSSA) cases (median = 6.5, range = 3–21 months). The Panton-Valentine leukocidin toxin gene was detected in 12 (25.5%) cases (MRSA, n = 8, 66.7%; MSSA, n = 4, 33.3%). Hospitalization was required more frequently in MRSA (n = 8, 38%; five Panton-Valentine leukocidin positive) than in MSSA cases (n = 5, 19%; one Panton-Valentine leukocidin positive). Four women out of the eight MRSA cases (50%) that were Panton-Valentine leukocidin positive stopped breastfeeding during mammary pathologies, three (37.5%) participants continued breastfeeding until the follow-up recall, and one case was lost at follow-up.Conclusion:Clinical severity was probably complicated by the presence of the Panton-Valentine leukocidin toxin, which required hospitalization more frequently.

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.

Journal of Human Lactation, Ahead of Print.
Background:A woman’s prior breastfeeding history may influence future decisions regarding infant feeding. Few quantitative tools utilizing this information have been demonstrated to predict breastfeeding success.Research aim:To evaluate the efficacy of a prenatal breastfeeding history (BAP) questionnaire administered in prenatal care to predict in-hospital formula supplementation among multiparous women.Methods:This is a prospective observational study of multiparous women with singleton pregnancies who presented to a Baby-Friendly urban tertiary care center for 1st prenatal visit at < 20 weeks’ gestation. The BAP tool generates a numerical score, with higher score (≥ 2) indicating prior successful breastfeeding experiences. The primary outcome was occurrence of non-medically indicated formula supplementation during the postpartum hospital stay. Student’s t test and Pearson’s chi-square test were used to compare continuous and categorical variables. A multivariable logistic regression was performed to assess the relationship of BAP score to formula supplementation. Of 587 women screened, 433 (73.8%) mother–infant dyads were analyzed.Results:Rates of formula supplementation in women with BAP scores ≤ 1 were 67% (156/234) compared with 37% (73/199) in women with higher scores (p < 0.0001). After controlling for race/ethnicity, insurance, and obesity, women with BAP scores of ≤ 1 were 2.6 times more likely to supplement formula than women with higher scores (aOR 2.62, 95% CI [1.70, 4.04], p < .0001).Conclusion:In this prospective validation study, women with negative prior breastfeeding experiences, as evidenced by a lower BAP score, were more likely to supplement formula during the postpartum hospital stay.

Journal of Human Lactation, Ahead of Print.
Background:With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking.Research aim:We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China.Methods:The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model.Results:The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0–5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]).Conclusions:The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

Journal of Human Lactation, Ahead of Print.
Background:With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking.Research aim:We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China.Methods:The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model.Results:The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0–5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]).Conclusions:The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding and optimal birth spacing are associated with improved maternal and infant health outcomes worldwide. Provision of contraceptive advice that is aligned with recommendations for breastfeeding has potential to maximize maternal and infant health. Although there is broad agreement regarding the breastfeeding compatibility of specific postpartum contraceptive methods, it is not known whether maternal breastfeeding intention influences prenatal provider contraceptive counseling.Research aim:We aimed to determine if maternal feeding intention is considered by prenatal providers during contraceptive counseling.Methods:This was a cross-sectional online author-created survey including all prenatal providers (N = 40) at two academic safety-net institutions in Cleveland, Ohio. Of 100 obstetrics/gynecology faculty members, 40 (40%) completed the survey, which included multiple-choice questions. Nominal and ordinal survey results were reported with percentages and frequencies, and categorical variables were compared using the Fisher exact test.Results:Participants appropriately promoted breastfeeding-compatible postplacental intrauterine device placement, even though maternal feeding intention was specifically considered by just 12 (30%). Endorsed barriers to contraception for breastfeeding mothers included provider medical worries, patient concerns, and colleague resistance. Postplacental levonorgestrel intrauterine devices were recommended for all mothers by 92.5% of participants (n = 37). Recommendations regarding progestin-only and combined oral contraceptive pills were influenced by maternal breastfeeding versus formula-feeding intention.Conclusion:Asking expectant women about their feeding intentions within each contraceptive discussion may create opportunities for shared decision making that can optimize perinatal outcomes for both mother and infant worldwide.

Journal of Human Lactation, Ahead of Print.
Background:Breastfeeding and optimal birth spacing are associated with improved maternal and infant health outcomes worldwide. Provision of contraceptive advice that is aligned with recommendations for breastfeeding has potential to maximize maternal and infant health. Although there is broad agreement regarding the breastfeeding compatibility of specific postpartum contraceptive methods, it is not known whether maternal breastfeeding intention influences prenatal provider contraceptive counseling.Research aim:We aimed to determine if maternal feeding intention is considered by prenatal providers during contraceptive counseling.Methods:This was a cross-sectional online author-created survey including all prenatal providers (N = 40) at two academic safety-net institutions in Cleveland, Ohio. Of 100 obstetrics/gynecology faculty members, 40 (40%) completed the survey, which included multiple-choice questions. Nominal and ordinal survey results were reported with percentages and frequencies, and categorical variables were compared using the Fisher exact test.Results:Participants appropriately promoted breastfeeding-compatible postplacental intrauterine device placement, even though maternal feeding intention was specifically considered by just 12 (30%). Endorsed barriers to contraception for breastfeeding mothers included provider medical worries, patient concerns, and colleague resistance. Postplacental levonorgestrel intrauterine devices were recommended for all mothers by 92.5% of participants (n = 37). Recommendations regarding progestin-only and combined oral contraceptive pills were influenced by maternal breastfeeding versus formula-feeding intention.Conclusion:Asking expectant women about their feeding intentions within each contraceptive discussion may create opportunities for shared decision making that can optimize perinatal outcomes for both mother and infant worldwide.

Journal of Human Lactation, Ahead of Print.
Background:Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers.Research aim:To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh.Methods:A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors’ influence on breastfeeding practices.Results:Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed.Conclusions:Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

Journal of Human Lactation, Ahead of Print.
Background:Thirty-six percent of females are employed in Bangladesh, many in the readymade garments manufacturing industry. Inadequate access to health information, care, and long working hours makes exclusive breastfeeding particularly challenging for these employed mothers.Research aim:To describe the influence of a breastfeeding education and support program on breastfeeding patterns of mothers working in garment and other factories in Bangladesh.Methods:A descriptive two-group prospective, mixed methods, longitudinal prospective study was conducted from May 2015 to March 2017. Peer counselors were trained to provide home-based counseling from 6 months of pregnancy until infants completed 6 months for pregnant and lactating factory workers and neighboring unemployed women. The total evaluation sample (N = 304) consisted of participants still employed (n = 190) and unemployed (n = 144). Peer counselors recorded socioeconomic information, weights, and infant feeding patterns. Descriptive statistical analyses examined the peer counselors’ influence on breastfeeding practices.Results:Initiation of breastfeeding within 1 hr was high in both groups, 173 (91%) among the employed, and 101 (89%) among the unemployed participants. Exclusive breastfeeding at 6 months was reported by 107 out of 125 (86%) of the employed participants versus 72 out of 76 (95%) of those unemployed.Conclusions:Community-based peer counselors can help to inform, encourage, and support both factory workers and unemployed women with optimal breastfeeding patterns. Factories who have female workers should consider employing outreach peer counselors as part of their community social responsibility, and as a way to contribute to the sustainability of these programs.

Journal of Human Lactation, Ahead of Print.
Peer-review publishing has long been the gold standard for disseminating research. The peer-review process holds researchers accountable for their work and conveys confidence that the article is of value to the reader. Predatory journals and publishing pose a global threat to the quality of scientific literature, accuracy of educational resources, and safety of patient care. Predatory publishing uses an exploitative business model, substandard quality control measures, and deceptive publishing practices. Given the proliferation of these journals and the extreme measures utilized to disguise substandard publishing practices, avoiding them can prove difficult. Understanding the nature of predatory publishing and how to recognize the warning signs provide helpful measures to authors, researchers, students, and readers. Additional resources known to help avoid predatory publishers have been discussed in addition to reviewing the Journal of Human Lactation guidelines for publishing.

Journal of Human Lactation, Ahead of Print.