Journal of Human Lactation - online first articles

Journal of Human Lactation, Ahead of Print.
Background:Pregnant and recently pregnant people have lower vaccination rates against SARS-CoV-2 than the general population, despite increased risk of adverse outcomes from infection. Little is known about vaccine hesitancy in this population.Research Aim:To characterize SARS-CoV-2 and other vaccine attitudes of lactating people who accepted the SARS-CoV-2 vaccine, describing their vaccine experiences to further contextualize their beliefs.Methods:A prospective cross-sectional online survey design was used. We administered the survey to 100 lactating people in Pennsylvania from April to August 2021, upon enrollment into a longitudinal study investigating SARS-CoV-2 vaccine antibodies in human milk. This survey assessed SARS-CoV-2 vaccine attitudes, vaccine counseling from providers, and vaccine decision making. Associations between vaccination timing and beliefs were analyzed by Pearson chi-square.Results:Of 100 respondents, all received ≥ 1 SARS-CoV-2 vaccine before or shortly after enrollment, with 44% (n = 44) vaccinated in pregnancy and 56% (n = 56) while lactating. Participants reported vaccination counseling by obstetric (n = 48; 70%) and pediatric (n = 25; 36%) providers. Thirty-two percent (n = 32) received no advice on SARS-CoV-2 vaccination from healthcare providers, while 69% (n = 69) were counseled that vaccination was safe and beneficial.While 6% (n = 6) and 5% (n = 5) reported concerns about the safety of maternal vaccines for lactating people or their infants, respectively, 12% (n = 12) and 9% (n = 9) expressed concerns about the safety of maternal SARS-CoV-2 vaccination in particular.Conclusions:Despite high uptake of SARS-CoV-2 vaccine among participants, safety concerns persisted, with many reporting a lack of direct counseling from providers. Future research should investigate how variability in provider counseling affects SARS-CoV-2 vaccine uptake in perinatal populations.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Background:It is well known that the best nutritional option for infants is human milk, and that when breastfeeding is not possible, human milk banks are a possible alternative. However, in the case of infants with fat transport disorder like chylothorax, defatting of human milk is mandatory.Research Aim:The aim of the study was to reduce milk fat content without reducing other nutrients, increasing oxidative stress, or introducing harmful microorganisms.Methods:In this prospective, cross-sectional, observational study, we examined the influence of defatting and pasteurization of 50 donor samples on fat, macro- and micronutrients, as well as on oxidative stress markers.Results:Low-temperature centrifugation proved to be very efficient in defatting, reducing the concentration of triglycerides by 85% and cholesterol by 50%. The macronutrients (proteins, albumin, and Immunoglobulin A) did not undergo significant changes due to defatting and pasteurization procedures, while iron decreased by 36%. However, as the majority of iron is retained, this result does not remarkably change the milk composition. Furthermore, oxidative stress markers and antioxidant levels were unchanged, and the milk result was microbiologically safe.Conclusions:Cold milk centrifugation proved to be an effective technique that allows the reduction of human milk lipids. The determination of triglycerides and cholesterol can be used as an indicator of skimming. This procedure is not accompanied by substantial modifications of other components present in the milk.

Journal of Human Lactation, Ahead of Print.
Background:Despite limited clinical consensus regarding surgery for tethered oral tissues (“tongue-tie”) for resolving breastfeeding-related issues, the procedure has been increasing in the United States. Greater understanding of maternal experiences with obtaining surgical release may help to improve breastfeeding outcomes.Research Aim:To explore experiences of breastfeeding mothers with infants having undergone “tongue-tie” surgery.Method:This online, cross-sectional, observational survey occurred between August and September 2020. Eligibility included being ≥ 18 years of age and previously or currently breastfeeding an infant with ≥ 1 tissue surgically released. Of 463 screens, 318 mothers were eligible and 115 consented. The final sample was 90.Results:The sample was predominantly white (n = 86; 95%), non-Hispanic (n = 84; 93%), married/cohabitating (n = 85; 94%), and currently providing their own milk (n = 81; 89%).Difficult latch was the primary reason for seeking help. Participants reported lingual (n = 84; 93%), labial (n = 79; 88%), and buccal (n = 16; 17%) tissue-release, with 80% (n = 73) reporting > 1 released. For each tissue released, > 80% (n = 72) of participants felt “very confident” in their ability to correctly identify it and 97% (n = 87) felt “very involved” and “strongly agreed” with surgical release. International Board Certified Lactation Consultants® were the most frequently identified source of information (n = 45; 50%) and referrals (n = 38; 42%), while pediatric dentists most frequently performed interventions (n = 60; 67%).Conclusions:Participants reported being confident, involved, and in agreement with surgical release and lactation support professionals were frequent information and referral sources.

Journal of Human Lactation, Ahead of Print.
Background:Parents with visual impairment can have difficulty in breastfeeding their babies. This situation may cause mothers to have negative feelings towards the care of their babies and to have problems during breastfeeding process.Research Aims:To examine in detail (1) the breastfeeding experiences of mothers with visual impairment, and (2) the factors that facilitate and prevent these mothers from continuing to breastfeed.Methods:This study was a cross-sectional, prospective generic qualitative design. The study sample (N = 15) consisted of mothers with visual impairment aged 18 and over, residing in Turkey, speaking Turkish, having an infant under the age of 2, and with breastfeeding experience. The analysis process was a content analysis approach. Data were collected through video or audio interviews using a semi-structured interview form.Results:Three main themes and 12 subthemes were determined: (1) negative emotions caused by breastfeeding, (2) barriers to initiating and maintaining breastfeeding, and (3) facilitators in initiating and maintaining breastfeeding.Conclusion:The participants in our study stated that health personnel had limited information on how to communicate with and support them. For this reason, it is important that breastfeeding counselors and health care providers receive training about breastfeeding counseling for mothers with visual impairment so that they can provide information and advice to these mothers.

Journal of Human Lactation, Ahead of Print.
Background:Since December 2020, the second wave of COVID-19 in Thailand has had a considerable impact, and mothers have struggled to receive breastfeeding support in hospitals. In this situation, there has been limited research that addresses social support for breastfeeding and the influences of support in determining breastfeeding outcomes.Research Aims:(1) To describe the influence of COVID-19 on social support for breastfeeding and breastfeeding practices in the Thai context, and (2) to examine breastfeeding duration with different levels of social support from families and healthcare providers.Method:This descriptive, cross-sectional online survey design was part of a larger multi-methods project about breastfeeding behaviors and experiences among postpartum mothers during the COVID-19 pandemic. Online questionnaires were administered from August to November 2021 to participants (N = 390) who were from three provinces in Thailand and had given birth 6–12 months prior to the survey.Results:Exclusive breastfeeding for 6 months was observed in less than half of the participants (n = 146, 37.4%). Perceptions of breastfeeding support were generally high overall among both family (Mdn = 45, IQR = 7) and healthcare providers (Mdn = 43, IQR = 7). Participants who perceived more breastfeeding support from families than the median had significantly longer exclusive breastfeeding durations than those who perceived less breastfeeding support than the median (z = −2.246, p = .025). The same pattern was present for breastfeeding support from healthcare providers (z = −2.380, p = 0.017).Conclusions:While the exclusive breastfeeding rate was better than the pre-pandemic rate, successful breastfeeding was more common when participants perceived that they had received breastfeeding support. Policymakers should execute breastfeeding support systems along with COVID-19 management.

Journal of Human Lactation, Ahead of Print.
Background:Human milk is a complex source of nutrition and other bioactives that protects infants from disease, holding a lifetime of beneficial effects. The field of metabolomics provides a robust platform through which we can better understand human milk at a level rarely examined.Research Aim:To Identify, describe, synthesize, and critically analyze the literature within the past 5 years related to the human milk metabolome.Methods:We conducted a scoping literature review and quality analysis of the recent science reflecting untargeted metabolomic approaches to examining human milk. We searched six databases using the terms “breast milk,” “metabolome,” “metabolite,” and “human milk,” Out of more than 1,069 abstracts, we screened and identified 22 articles that met our inclusion criteria.Results:We extracted data related to the study author, geographic location, research design, analyses, platform used, and results. We also extracted data related to human milk research activities, including collection protocol, infant/maternal considerations, and time. Selected studies focused on a variety of phenotypes, including maternal and infant disease. Investigators used varying approaches to evaluate the metabolome, and differing milk collection protocols were observed.Conclusion:The human milk metabolome is informed by many factors—which may contribute to infant health outcomes—that have resulted in disparate milk metabolomic profiles. Standardized milk collection and storage procedures should be implemented to minimize degradation. Investigators may use our findings to develop research questions that test a targeted metabolomic approach.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.

Journal of Human Lactation, Ahead of Print.
Karen Wambach recently retired from a distinguished career in nursing education and breastfeeding research in the United States, practicing her craft during the formative years of the field of lactation consulting. Her research focused on the description of biopsychosocial influences on breastfeeding initiation and duration, as well as interventions for promoting and supporting breastfeeding among vulnerable childbearing populations, for example, adolescent mothers. Her research career trajectory mirrors the development of breastfeeding research more broadly. She began with descriptive studies and theory testing, which included the development of the Breastfeeding Experience Scale quantifying early breastfeeding problems. She then moved on to randomized clinical trials of breastfeeding education/support for adolescent mothers, and finished her funded research using a multi-behavioral, technology-based education and support intervention to promote breastfeeding, healthy lifestyle, and depression prevention in adolescent mothers. As researcher and educator in a clinical science area, she has supported evidence-based practice and translational science through her work as lead editor of many editions of the textbook Breastfeeding and Human Lactation. She is a consummate teacher, having mentored many upcoming researchers during her teaching career, and directed the undergraduate nursing honors program and PhD program at the University of Kansas School of Nursing in the United States. She also believes in serving her profession and has been an active member of American Academy of Nursing, the Midwest Nursing Research Society, the Association of Women’s Health, Obstetric, and the Neonatal Nursing and the International Lactation Consultant Association, including serving on JHL’s Editorial Review Board for many years. (This conversation was recorded on October 14, 2022 then transcribed and edited for readability. EC = Ellen Chetwynd; KW = Karen Wambach)

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.

Journal of Human Lactation, Ahead of Print.
Background:Breastfed infants depend on human milk calcium and phosphorus for bone mineral accretion and growth. We reported greater mobilization of bone mineral and delayed skeletal recovery in lactating Ugandan women with HIV initiated on tenofovir-based antiretroviral therapy during pregnancy compared to HIV-uninfected counterparts in the Gumba Study. However, it is unknown if these disruptions in maternal bone metabolism affect milk mineral concentrations.Research Aim:To compare concentrations and patterns of change in milk calcium and phosphorus between lactating women with and without HIV.Methods:A longitudinal observational study was conducted to compare milk mineral concentrations between women with HIV receiving tenofovir-based ART and uninfected women in the Gumba Study. Milk collected at 2, 14, 26, and 52 weeks lactation was analyzed for calcium and phosphorus. Sodium and potassium were measured at 2 and 14 weeks to detect sub-clinical mastitis. Differences in milk composition between 84 women with HIV and 81 uninfected women were investigated.Results:Women with HIV had higher milk calcium than uninfected women at 14 weeks. The percent difference was +10.2% (SE = 3.0, p = .008) and there was a tendency to greater values at 2 and 26 weeks. Milk calcium decreased in both groups during lactation (p ≤ .001) but was more pronounced in women with HIV. The magnitude of change within individuals in the 1st year of lactation from 2 to 52 weeks was −28.3% (SE 3.9) versus −16.5% (SE 3.5), p for interaction = .05. Differences in milk phosphorus and calcium-to-phosphorus ratio were smaller and mostly not significant.Conclusions:Participants with HIV on tenofovir-based antiretroviral therapy had altered milk mineral composition. Studies are needed to investigate mechanisms and health implications for the woman and infant.

Journal of Human Lactation, Ahead of Print.
In this issue, we are featuring an interview with two medical doctors from Ukraine, who are specialists in breastfeeding, and work with the implementation of the Baby-Friendly Hospital Initiative (BFHI) in Ukraine. The authors met during the Eleventh BFHI Network Meeting of Country Coordinators from Industrialized Countries, Eastern Europe, and the Commonwealth of Independent States, in Brussels in June 2022 (Hernández-Aguilar, M. T., 2022). Ukrainian citizens have lived in a war situation since February 24, 2022, when Russia first attacked; this has had a huge impact on infant feeding issues.

Journal of Human Lactation, Ahead of Print.