Brief summaries of some of the 18 000 articles catalogued by the Lactation Resource Centre. Some of these articles are reproduced in the Australian Breastfeeding Association's magazine - Essence

2008

• Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy.
• Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations.
• Effects of energy density and feeding frequency of complementary foods on total daily energy intakes and consumption of breast milk by healthy breastfed Bangladeshi children.
• Training for Perfect Breastfeeding or Metochlopramide: Which One Can Promote Lactation in Nursing Mothers?

2007

• Randomized Controlled Trial of Very Early Mother-Infant Skin-to-Skin Contact and Breastfeeding Status
• Which women stop smoking during pregnancy and the effect on breastfeeding duration.
• Attention behaviour and hyperactivity at age 4 and duration of breast-feeding
• Benefits of breastfeeding in cystic fibrosis: A single-centre follow-up survey
• Short duration of skin-to-skin contact: Effects on growth and breastfeeding
• Breastfeeding increases sleep duration of new parents
• Lactation and Changes in Maternal Metabolic Risk Factors
• A prospective study of iron status in exclusively breastfed term infants up to 6 months of age
• Breastfeeding and child cognitive development: New evidence from a large randomized trial

2006

• Royal Australasian College of Physicians Paediatric Policy - Breastfeeding
• Drug Information Centres - Australia
• Fatigue and Breastfeeding: An Inevitable Partnership?
• Volume and frequency of breastfeeding and fat content of breast milk throughout the day.
• Human newborns prefer human milk: Conspecific milk odor is attractive without postnatal exposure.
• The relationship of breastfeeding to antimicrobial exposure in the first year of life.
• Effect of breastfeeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies.
• Duration of breastfeeding and risk of overweight: A meta-analysis
• Duration of lactation and incidence of type 2 diabetes.
• Breastfeeding and intelligence of preschool children
• Breastfeeding and risk of schizophrenia in the Copenhagen Perinatal Cohort.
• Breastfeeding and Atherosclerosis: Intima-Media Thickness and Plaques at 65-Year Follow-Up of the Boyd Orr Cohort.

2008

Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy.

Nohr EA, Valeth M, Backer JL, Sorensen T, Olsen J, Rasmussen KM 2008, Am J Clin Nutr 87:1750-9.

This study attempts to correlate prepregnancy body mass index (BMI) and gestational weight gain (GWG) with the health of both the mother and the infant. It was a very large study that included data from 60,892 pregnancies in the Danish National Birth Cohort.
The results indicated that high maternal BMI caused increased pregnancy complications such as hypertension, gestational diabetes and preeclampsia independent of GWG. When high maternal BMI was combined with high GWG, the infant was less likely to be underweight, however, it increased the risk of cesarean delivery due to larger infants. Inversely, low maternal BMI combined with low GWG had a 47% risk of giving birth to growth-restricted infants, which was 5 times more likely compared to underweight women with normal GWG.
The findings support IOM recommendations for gestational weight gain, that underweight women may gain weight freely without adverse effects. This study also suggests that women with high body mass indexes should avoid high weight gain during pregnancy.
Summarised by Yi Wen Qian

 

Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations.

Collett-Solberg PF, Kappy M, Misra M, Pacaud D, Petryk A 2008, Am J Clin Nutr 87:1818-24.

This is a general review on the cause and the management of vitamin D deficiency in children.
The risk of vitamin D deficiency is higher in exclusively breastfed infants and children and infants born to vitamin D deficient mother. Twelve percent of women from 20-29 years of age were reported to be vitamin D deficient in a US study and it seemed to be more common in darker-skinned women. Low vitamin D levels during pregnancy are associated with intrauterine growth retardation, premature labor and hypertension, all which increase the risk of low birth weight. Decreased vitamin D levels in mothers resulted in decreased vitamin D stores of their infants at birth.
Exclusive breastfeeding, without sun exposure, does not provide enough vitamin D through milk. A review of 166 children with rickets aged 2-45 months between 1986 and 2003 in was found that 96% were breastfed. Therefore, vitamin D supplementation is required, either through sun exposure or medication.
Artificially-fed infants can also develop rickets. In a prospective study in the UK, 50% of children between 0-5 years of age with rickets were artificially-fed, indicating that the vitamin D content of formulas may be insufficient to compensate for the impact of prenatal maternal vitamin D deficiency.
This paper suggests that 25(OH)-D levels should be maintained at least about 50 nmol/L (20ng/dL) in infants and children, and 80 nmol/L (32ng/mL) for adults. The level of supplementation should take into account the time of the year, latitude, and skin colour.
Summarised by Yi Wen Qian

 

Effects of energy density and feeding frequency of complementary foods on total daily energy intakes and consumption of breast milk by healthy breastfed Bangladeshi children.

Ahmed T, Brown KH, Dewey KG, Islam MM, Khatun M, Mollah MAH, Peerson JM 2008, Am J Clin Nutr 88:84-94.

This study tested the effect of complementary food on breast milk intake in Bangladeshi children.
In lower income countries, infants aged between 3 and 15 months weigh less when compared to international reference data and, therefore, complementary foods are recommended in their diet. Eight male and 10 female infants between 8 and 11 months were fed complementary food of varying dietary energy density. They were given complementary feeds 3, 4, or 5 times a day, in addition to breast milk.
The results indicated a decrease in milk consumption when there was an increase in complementary food energy and feeding frequency. Nursing frequency decreased 7% during the course of the study. Infants were nursed 13% less when dietary energy was increased from 0.5 to1.5 kcal/g. The infants nursed 9% less when meal frequency was increased from 3 to 5 times per day. After controlling for dietary energy density and feeding frequency, total energy intake expressed as kcal/d did not change over the course of the study, but when analysed in relation to body weight, there is a gradual reduction in total energy intake. Therefore, increases in complementary food do not increase total energy consumption but rather decrease it. It is important to note, however, that their total energy intake was approximately 20% greater than their theoretical requirements since the infants had as much food as they wish.
The data indicated that, to reach theoretical energy requirement appropriate for infants in this age required an additional 227-322 kcal per day from complementary foods to achieve a total consumption of 686 kcal per day. It has been shown that complementary food should be taken in moderation to avoid a reduction in breast milk intake.
Summarised by Yi Wen Qian

 

Training for Perfect Breastfeeding or Metochlopramide: Which One Can Promote Lactation in Nursing Mothers?

Sakha K, Behbahan AG 2008, Breastfeeding Medicine 3:120-123.

This paper tested the effect on lactation of breastfeeding training, with or without metoclopramide. Metoclopramide is a medication which increases pituitary prolactin production and subsequently milk production. This was a radomised, controlled trial and the subjects were 20 nursing mothers who had a term newborn with a weight gain of less then 500g/month. All mothers passed a short training course about latch and positioning techniques for breastfeeding. They were divided into groups of 10, one group received metoclopramide tablets while the other received placebo tablets for a period of 15 days.
Results showed that, in 9 out of 10 cases in each group, the infants grew at a normal rate. The mean weight gain was higher in the metoclopramide-treated group, however, the difference was not significant (P = 0.68).
This study confirmed the power of breastfeeding training in increasing lactation and that for most mothers successful and sustained breastfeeding will be possible without the help of medication.
Summarised by Yi Wen Qian

 

Randomized Controlled Trial of Very Early Mother-Infant Skin-to-Skin Contact and Breastfeeding Status

Moore ER, Anderson GC 2007, J Midwifery Womens Health 52:116-125.

The aim of this small study was to evaluate the effects of maternal-infant skin-to-skin contact during the first two hours postbirth, compared to standard care of holding the infant swaddled in blankets, on breastfeeding outcomes up to one month.
Twenty mothers and infants were randomly assigned to either skin-to-skin contact (ten mother/babies) or standard care of swaddled in blankets (ten mother/babies).
In the standard care group, the infants were briefly shown to their mothers immediately postbirth and placed under a radiant warmer for a brief physical examination, suctioned if necessary and swaddled in two prewarmed blankets and returned to the mother. The infant's hands were left unswaddled.
For the skin-to-skin contact group, the infant was placed prone (face down) and skin-to-skin on the mother's abdomen or chest during the first minute postbirth, where they were gently dried and their head covered with a dry cap. After the cord was cut the infant was moved to the radiant warmer for the same admission procedures as the control group, and then returned to the mother, again skin-to-skin and covered across the back with a prewarmed blanket. The infant remained skin-to-skin with the mother for almost two hours.
The skin-to-skin infants tended to exhibit prefeeding behaviours earlier (i.e. mouthing, lip smacking movements and hand to mouth activity). Significantly more infants held skin-to-skin compared to swaddled suckled competently during their first breastfeeding and established breastfeeding sooner, however this was also related to the mothers' erect nipples. This suggests that in addition to skin-to-skin contact, interventions may be needed to improve maternal nipple protractility for successful breastfeeding.
The authors conclude that very early skin-to-skin contact enhanced breastfeeding success during the early postpartum period. No significant differences were found at one month postpartum.
Summarised by Kathryn Wood.

 

Which women stop smoking during pregnancy and the effect on breastfeeding duration.

Roslyn Giglia, Colin Binns and Helman Alfonso 2007, BMC Pub Health. 6: 195 freely available www.biomedcentral.com.

This study was conducted in Perth, Australia and examined factors associated with quitting smoking in women who smoked before pregnancy. A total of 587 women filled in questionnaires and 226 of them reported smoking before becoming pregnant. Thirty four percent of women who smoked before pregnancy gave up smoking during pregnancy. Women who were having their first baby were twice as likely to quit as multiparous mothers. Women who drank alcohol before pregnancy were three times more likely to quit during pregnancy than non-drinkers (previous research has found that stopping smoking during pregnancy is associated with not drinking alcohol in the week immediately postpartum). And women who smoked more than 10 cigarettes per day before pregnancy were less likely to quit than women who smoked fewer than 10 cigarettes per day. It was theorised that women who smoked fewer cigarettes were less firmly addicted to smoking.
Postnatally, women who stopped smoking during pregnancy were more likely to breastfeed for at least six months than women who had not quit smoking.
Women are often motivated to stop smoking during pregnancy and it is an area of potential public health gains. It is estimated that smoking during pregnancy costs the health care system 23 million dollars each year in Australia. With the potential for savings in that area, and savings due to increased breastfeeding rates with a decreased rate of smoking, smoking cessation during pregnancy is an area deserving of public health attention.
Summarised by Elizabeth McGuire

 

Attention behaviour and hyperactivity at age 4 and duration of breast-feeding

Jordi Julvez, Nuria Ribas-Fito, Maria Forns, Raquel Garcia-Esteban, Maties Torrent and Jordi Sunyer 2007, Acta Paediatr. 96: 842-847.

Spanish children from Menorca and Ribera d'Ebre were the subjects of this study. These two sites are sociologically distinct. Menorca is a tourist destination, whereas Ribera d'Ebre is a rural area in Catalonia. The children were followed from birth to four years of age and psychologically tested, to compare neurological and behavioural scores as they correlate with duration of breastfeeding. The results show that longer breastfeeding (duration grouped as less than 2 weeks, 2 to 12 weeks, 12-20 weeks, 20-28 weeks or greater than 28 weeks) was associated with higher social competence scores and lower attention-deficit hyperactivity symptom scores. Differences between mothers who chose to breastfeed and those who chose not to breastfeed did not account for the findings, as excluding those who breastfed for less than 2 weeks did not change the results. Including maternal IQ in the models also did not change the findings. An interaction was found between breastfeeding and mother's education level, yet for mothers with less than 8 years of formal education, the association of breastfeeding with better outcome scores was more marked than in mothers with more education. It was not possible in this study to exclude all possible confounding influences, such as parental mental health and parenting skills, however the authors felt that there are plausible biological mechanisms for explaining the results. Breastmilk provides long chain polyunsaturated fats for brain development and there is evidence that fatty acids may play a role in ADHD, dyslexia and autistic disorders. Breastfeeding stimulates maternal oxytocin which over time may promote bonding and attachment and hence infant neurodevelopment. Summarised by Elizabeth McGuire

 

Benefits of breastfeeding in cystic fibrosis: A single-centre follow-up survey

Colombo C, Zazzeron L, Costantini D, Faelli N, Russo MC, Chieleni D, Gatelli I, Giovannini M, Riva E, Zetterstrom R, Agostoni C 2007, Acta Paediatr. 96: 1228-1232.

People with cystic fibrosis are at increased risk of respiratory infections and poor nutrition. Lung function and nutritional status are two major indicators of prognosis in cystic fibrosis sufferers. Normal growth in early childhood is associated with improved lung function compared with those children with cystic fibrosis who do not grow well between 3 to 6 years of age.
This survey measured numbers of infections during the first 3 years of life and lung function in children with cystic fibrosis at 5-18 years of age. The children were grouped according to duration of breastfeeding as follows, any breastfeeding for more than 4 months (23%), any breastfeeding for less than 4 months (38%), and no breastfeeding (38%).
Lung function was measured as 'forced expiratory volume in one second' (FEV1) and 'forced vital capacity' (FVC) and was best in those breastfed longest. Maternal smoking was associated with poorer lung function. Children breastfed for the longest duration also had fewer infections during the first 3 years of life, but the number of hospital admissions did not differ among the groups. Weight for age and height for age z scores were not significantly different between the three groups.
The findings of this survey support the recommendation that infants with cystic fibrosis should be breastfed. They may need supplementation with sodium chloride, and extra calories from 5 - 6 months as infants with cystic fibrosis have higher needs than healthy infants, but they also need the immunological protection and appropriate nutrition provided by breastmilk.
Summarised by Elizabeth McGuire

 

Short duration of skin-to-skin contact: Effects on growth and breastfeeding

Boo NY, Jamli FM 2007, Journal of Paediatrics and Child Health (OnlineEarly Articles). doi:10.1111/j.1440-1754.2007.01198.x

This Malaysian study investigated the effects of short durations of kangaroo mother care on very low birthweight infants. Kangaroo mother care has been shown to have positive effects on the development of low birthweight babies, but it is usually practised in developing countries as continuous skin to skin contact between a mother and her infant. In developed countries skin to skin care is more often provided over short time frames while low birthweight infants spend most of their time in incubators. This study measured weight gain, head growth, breastfeeding success and hospital stay in infants either given short duration skin to skin care (STSC), or no STSC during their time in the Neonatal Intensive Care Unit (NICU). The infants in the study had very low birthweights, below 1501g, and were randomised to the test (STSC) or control groups. Babies in the test group received one hour's STSC per day, unless they were too ill. The results showed that the babies receiving STSC had greater weekly increases in head circumference and had shorter hospital stays. There were no significant differences in weight gain between the groups. A higher proportion of babies in the STSC group were breastfeeding at discharge, but this difference disappeared when results were adjusted according to the proportions in the groups receiving breastmilk at entry to the study. The authors interpret their findings cautiously, noting that long term study is needed to establish whether there are any beneficial outcomes to the greater head growth observed in the STSC group. The authors also noted that the provision of STSC was not easy for Malaysian mothers because of cultural and practical barriers to daily hospital visits. Summarised by Elizabeth McGuire

 

Breastfeeding increases sleep duration of new parents

Doan T, Gardiner A, Gay CL, Lee KA. Journal of Perinatal & Neonatal Nursing 2007 21(3): 200-206.

Sleep, or the lack of it, is an important issue for new parents. As part of a larger study of an educational intervention, this paper reported on parental sleep as a function of infant feeding at an infant age of three months. Couples wore wrist actigraphs to allow an objective measure of total sleep time (TST). The actigraph is a microprocessor that records movement and since it is only the size of a wristwatch it gives a measure of sleep time without interfering in the sleep of the wearer. The measures given by actigraphy are comparable with those obtained from more cumbersome methods of sleep assessment. Participants in the study also recorded diaries of sleep disturbance and whether breastmilk or artificial baby milk was given in the evenings (6pm to 12mn) and nights (12mn to 6am). In these results, 'breastmilk only' is contrasted with giving formula, either exclusively or as a supplement to breastfeeding.
Mothers and fathers who fed their baby only breastmilk in the evening slept on average about 45 minutes longer than those whose babies received formula in the evening. Sleep disturbance as reported in the sleep diaries did not differ between the group who gave only breastmilk in the evening and those who gave formula in the evening.
Mothers who gave their baby only breastmilk in the night slept 47 minutes more than mothers who gave formula in the night. Fathers of babies given only breastmilk slept 38 minutes longer than those whose babies had formula in the night. Parents whose babies were fed only breastmilk at night reported less sleep disturbance than those parents who gave formula at night. This difference was more marked for fathers, as would be expected.
Surprisingly, in couples who shared responsibility for night time feeding both partners slept less than couples where the mother had sole responsibility for night feeding, even if she was feeding artificial baby milk.
It is a common perception that giving an artificial supplementary feed in the evening will encourage babies to sleep longer at night and so allow parents to sleep better. This study does not support that perception. In exclusive breastfeeding families, both parents got more sleep than in mixed feeding or exclusively formula feeding families.
Summarised by Elizabeth McGuire

 

Lactation and Changes in Maternal Metabolic Risk Factors

Gunderson EP, Lewis CE, Wei GS, Whitmer RA, Quesenberry CP, Sidney S Obstet Gynecol 2007; 109:729-738

This prospective study measured cardiovascular risk factors in over one thousand women at two time points, three years apart. Between the two measurements, some women had given birth and some of them had also lactated. So the three groups for comparison were; those who had not given birth in that time, those who had given birth but not lactated and those who had given birth, lactated and weaned in that time. The women who had not given birth served as a control group. Compared to the control group, women who had given birth gained more weight, their waists enlarged and their high density lipoprotein (HDL) fell. These changes were also seen in the control group, but were larger in the women who had babies. Comparing the two groups who had given birth, the Low Density Lipoprotein (LDL) fell among those who had lactated and weaned, while among those who had not lactated the average LDL had risen. Changes in weight, waist measurement, LDL, plasma insulin, HDL, and index of insulin resistance were more favourable among the lactated and weaned group than among those who had given birth but not lactated, but these differences were not statistically significant. There were also differences in the cardiovascular risk factors between women who lactated for more or less than three months, and these differences favoured those who had lactated longer, but only the change in HDL was large enough to be statistically significant. One reason why the other risk factors did not reach significance was the small sample size.
These findings are consistent with other studies which have shown that lactation attenuates risk of diabetes and cardiovascular disease, and adds to them by showing that these changes persist after weaning.
Summarised by Elizabeth McGuire

 

A prospective study of iron status in exclusively breastfed term infants up to 6 months of age

Shashi Raj, MMA Faridi, Usha Rusia, Oma Singh International Breastfeeding Journal 2008, 3:3

Iron deficiency is the most common nutritional deficiency and iron is a nutrient of concern in infants because of the potentially serious implications of anaemia and the low levels of iron in breastmilk. This study followed anaemic and non-anaemic Indian mothers to determine whether their babies' iron status was affected by the mothers' status and whether exclusive breastfeeding would maintain normal iron status in the infants.
Fifty term infants in each group were followed to 6 months. There was no significant difference between the two groups of babies' iron status at birth, at 14 weeks or at six months. Breastmilk iron and lactoferrin levels were also not correlated with the mothers' iron status or the babies' iron status. After 6 months of exclusive breastfeeding, both groups of infants had normal haemoglobin and iron status. One infant of an anaemic mother had a marginally low haemoglobin, but was not iron deficient.
Breastmilk levels of iron and lactoferrin fell over time in both groups. The levels of iron fell from 0.9 mg/L on day one to 0.3 mg/L at 14 weeks and 6 months. Lactoferrin was measured at 12 mg/ml on day one and fell to 6 mg/ml at 14 weeks and 6 months. Infants' haemoglobin and ferritin levels also fell over time, as is normal. Growth also remained within normal limits in both infant groups.
The findings of this study were consistent with others that have found that exclusive breastfeeding, in spite of the low, and falling, levels of iron in breastmilk, supports normal iron status in infants to six months.
Summarised by Elizabeth McGuire

 

Breastfeeding and child cognitive development: New evidence from a large randomized trial

Kramer MS et al Arch Gen Psychiatry 2008, 65(5):578-584

The PROBIT (Promotion of Breastfeeding Intervention Trial) is a large, cluster-randomised trial carried out in Belarus. Maternity hospitals and their associated clinics were randomised to either a breastfeeding promotion intervention, or to continuing the standard procedures in place at the time of the intervention. Mothers in the intervention hospitals who intended to breastfeed were encouraged to breastfeed exclusively and to maintain breastfeeding longer than they may otherwise have done. This protocol was developed to overcome the problems with observational studies. It allows comparison between groups with similar demographic and educational characteristics. The only differences between the two groups' results should be as a result of the exclusivity and duration of breastfeeding, because in both groups the same considerations affected the initial decision of whether or not to breastfeed. In the intervention group, 43.3% breastfed exclusively to at least three months, compared to 6.4% in the control group, and 19.7% still breastfed at 12 months compared to 11.4% in the control group.
This paper compares the cognitive abilities of the two groups as measured by IQ scores on the Wechsler Abbreviated Scales of Intelligence (WASI) and teacher evaluations at 6.5 years of age. The follow up included 13 889 children. All the differences between the groups' results favoured the intervention group, though some did not reach statistical significance. Verbal IQ showed the greatest difference between groups, 7.5 IQ points. The differences between the groups on the nonverbal subtests and performance IQ, were smaller and nonsignificant. The full-scale IQ difference between the groups was 5.9 IQ points.
Further analysis of individual test results showed that longer breastfeeding and longer exclusive breastfeeding (to six months compared to three months) were associated with higher IQ scores. Exclusive breastfeeding to 3 months was associated with a full scale IQ 3.3 points higher than the control group, while exclusive breastfeeding to at least 6 months was associated with a difference of 4.2 IQ points.
The fact that a randomised trial finds these differences, and the dosage effects, suggest a causal relationship between breastfeeding and cognitive measures, but provides no clue as to the mechanism. Whether the biochemistry of human milk, or a quality of breastfeeding interaction, or both, account for the measured differences remains to be discovered.
Summarised by Elizabeth McGuire

 

2006

November

Royal Australasian College of Physicians Paediatric Policy - Breastfeeding

The Royal Australasian College of Physicians (RACP) has revised their paediatric policy on breastfeeding. The document can be found on the internet at www.racp.edu.au/hpu/paed/index.htm
In this document breastfeeding is recognized as the biological norm. The RACP also recognizes the role of paediatricians to protect, encourage, support and promote breastfeeding.
Importantly, the RACP supports the International Code of Marketing of Breastfeeding Substitutes, which aims to protect the well being of all infants through protecting, promoting and supporting breastfeeding.
The RACP policy summarises the key steps to successful initiation of breastfeeding as outlined by the Baby Friendly Hospital Initiative, with hospital practices such as rooming in and baby led feeding supported. Also included is discussion of the risks of early use of dummies.
The policy discusses the association between co-sleeping and increased breastfeeding rates and states that all parents should be informed about how to safely co-sleep with their infants.
The differing growth of breastfed infants is discussed and the new WHO growth curves for infants are mentioned.
The use of maternal medication whiles breastfeeding is also discussed, noting that only a small number of maternal medications are incompatible with breastfeeding. The policy recommends that paediatricians should consult their local drug information center before suggesting that breastfeeding be interrupted or ceased because of maternal medications.
Summarised by Kathryn Wood.

 

Drug Information Centres - Australia

NATIONAL -	Medicines Line - 1300 888 763 9:00am-6pm AEST (for mothers)
NATIONAL -	Therapeutic Advice and Information Service (TAIS) - 1300 138 677 (for health professionals only)
ACT/NSW -	(02) 9382 6539 Mothersafe (Sydney Metropolitan) Mon-Fri.
ACT/NSW -	1800 647 848 Mothersafe (Non-metropolitan) Mon-Fri.
SA -	(08) 8161 7222 Women's and Children's Hospital.
VIC -	(03) 9594 2361 Monash Medical Centre.
VIC -	(03) 9344 2277 Royal Women's Hospital 8:15am-5:30pm.
WA -	(08) 9340 2723 Mon-Fri, 8:30am-5pm.
TAS -	1300 888 763 Medicines Line (National number)
QLD -	1300 888 763 Medicines Line (National number)

 

September

Fatigue and Breastfeeding: An Inevitable Partnership?
Callahan S, Sejourne N, Denis A 2006, Journal of Human Lactation 22(2):182-187.

Fatigue and motherhood are commonly associated, particularly in the first trimester of pregnancy and in the early postpartum period. Fatigue is one of the most common reasons cited for early weaning, and is often linked as a cause of insufficient milk supply, and yet the relationship between fatigue and breastfeeding has never been established.
This French study aims to examine the relationship between fatigue and method of infant feeding. The group studied consisted of 247 mothers (129 who had chosen to exclusively breastfeed, 118 who had chosen to exclusively artificially feed). The mothers were questioned on day 2-4, 6 weeks and 12 weeks postpartum. Their perceived fatigue was measured via the Pichot Depression/Fatigue/Anxiety Scale (widely used in France).
There were no significant differences in fatigue between the group of breastfeeding and artificially feeding mothers, suggesting that perceived fatigue in the early postpartum period is not dependent on feeding choice.
The authors conclude that all mothers should be prepared for feelings of fatigue during the postpartum period but they should be reassured that breastfeeding is not the likely cause of this fatigue.
Summarised by Kathryn Wood.

 

Volume and frequency of breastfeeding and fat content of breast milk throughout the day.
Kent J, Mitoulas LR, Cregan M, Ramsay DT, Doherty DA, Hartmann PE 2006, Pediatrics 117(3):387-395.

This article investigated the normal range of breastfeeding frequencies and volumes throughout a 24 hour period in exclusively breastfed, fed on demand, healthy term Australian infants between 1 and six months old. Seventy-one mother baby pairs were involved. The average number of feeds per day was 11, with a range of 6-18 feeds recorded. Of these, 44.5% were feeds from one breast only; 53% were paired breastfeeds, that is, the baby took some milk from each breast within a 30 minute time span; and 2.3% were cluster breastfeeds, that is the baby took milk from both breasts and went back to the first within a 30 minute period.
The average time between feeds was 2 hours 18 minutes, with a range of 4 minutes to 10 hours 58 minutes. On average, infants took 67% of the milk available in the breast, at a feed.
There were no changes in the breastfeeding frequency with the age of the infant, and no change in 24 hour breastmilk production with age of infant, age of mother or number of other children of mother. The average 24 hour milk production was 788 g (range 478-1356), and in 76% of mothers the right breast was more productive than the left breast, regardless of the mother's right or left-handedness. Mothers of boys produced significantly more milk than mothers of girls, consistent with boys' higher growth rates.
Most babies (64%) fed at night, having 1-3 feeds between 10pm and 4am. This did not change with the age of the baby between 4 and 26 weeks. There was no significant difference in the storage capacity of the breasts of women whose infants did or did not wake at night, nor in the number of feeds in 24 hours. Infants who fed at night had a smaller percentage of feeds at night (10pm to 4am) than in any other 6 hour interval of a 24 hour day. Infants who fed at night took on average, 20% of their intake then.
There was a range of fat content in the breastmilk of different mothers, average 41.1 grams per litre, range 22.3-61.6. The average 24 hour fat intake of the infants was 32.0 g (range 15.4-49.5) and was not related to frequency of breastfeeds. Thus infants who have frequent small breastfeeds have the same daily fat intake as those who take fewer, larger breastfeeds.
This is an article everyone concerned with normal breastfeeding should read. It supplies evidence for a range of normal breastfeeding behaviours. And it is freely available on the web. Go to www.pediatrics.org Choose back issues from the menu, then you are looking for March 2006. Search for an article containing the word breastfeeding…and you're there.
Summarised by Elizabeth McGuire

 

July

Human newborns prefer human milk: Conspecific milk odor is attractive without postnatal exposure.
Marlier L, Schaal B. Child Development 2005, 76(1):155-168

This study tested whether newborns prefer the odour of human milk to that of artificial baby milk, when neither is exactly what they have been fed since birth. Babies' preferences were judged by giving them a choice between two soaked pads and recording the length of time they turned toward each pad, and how much mouthing they did while turned to that pad. Babies' preference for their own mother's milk was not tested, donor milk was used.
Breastfed babies turned towards human milk more often than artificial milk, and toward artificial milk more often than to a water soaked pad. Babies fed artificial baby milk since birth turned more often toward the nonfamiliar human milk than to a nonfamiliar formula.
This indicates that in spite of the fact that these four-day-old infants were offered a choice between smells not associated with their feeding experience, (i.e. not their own mother's milk or the formula they had been fed) they preferred the smell of human milk. Next artificially fed infants were offered a choice between nonfamiliar human milk and the formula they had been given as food since birth. There was no significant difference in the time spent turned toward either smell, but they showed more mouthing when facing human milk.
Lastly, artificially fed infants were offered a choice between human milk and their familiar artificial baby milk diluted so that the smell was the same intensity as human milk. The infants turned more often toward human milk.
In conclusion, human infants prefer the smell of human milk to that of artificial baby milk, even when they have not learned to associate the smell with the comfort of being fed. This may be because of a particular component in milk that causes an inborn response, (this is the case in rabbits) or because the smell of human milk reminds babies of the smell of amniotic fluid.
Summarised by Elizabeth McGuire

 

The relationship of breastfeeding to antimicrobial exposure in the first year of life.
Flores MS, Fairchok MP, Clinical Pediatrics 2004, 43(7):631-636

This study compared the use of antimicrobial medication in breastfed and non-breastfed infants in a US military population. Breastfed infants were defined as those who received at least 75% of their feeds as breastmilk for at least 2 months. Artificially fed infants were those who were breastfed for less than 2 months or who received less than 25% of their feedings as breastmilk. At six months 44.3% of the artificially fed infants had received at least one course of antimicrobials, compared to 28% of the breastfed infants. By 12 months of age, 71.5% of artificially fed infants had received antimicrobials compared to 50% of breastfed infants. Looked at as number of days taking antimicrobial medication, at six months, artificially fed infants had spent just over twice as many days taking antimicrobials as had breastfed fed infants.
After controlling for tobacco use in the home, and daycare exposure, infants receiving breastmilk for at least 75% of their milk for more than six months, had less antimicrobial exposure at 12 months; 38% compared to 67% in all other infants (breastfed to less than 6 months and artificially fed combined).
This study illustrates a practical benefit of breastfeeding in a developed country, and in particular, a continuing benefit to babies breastfed beyond six months.
Summarised by Elizabeth McGuire

 

May

Effect of breastfeeding on risk of coeliac disease: a systematic review and meta-analysis of observational studies.
Akobeng AK, Ramanan AV, Buchan I, Heller RF. Arch Dis Child. 2006. 91(1): 39-43.

Coeliac disease (which is also known as 'gluten sensitive enteropathy') is a permanent intolerance to gluten, associated with mucosal disease of the proximal small bowel. Gluten is a protein found in cereals such as wheat, rye and barley. This study is a review and meta-analysis of the studies published between 1966 and 2004 that look at the association between breastfeeding and coeliac disease. The authors were particularly interested in 3 areas: the effect of breastfeeding compared with no breastfeeding, the effect of duration of breastfeeding and the effect of breastfeeding at the time of introduction of dietary gluten. There were 15 articles found on the association between coeliac disease and breastfeeding. Nine of these studies were excluded because they were reviews or the study design did not meet the criteria. This left six studies that matched the inclusion criteria, all of which were case-control studies.
There were not enough data in the six primary studies to allow comparison between ever breastfed and never breastfed and the risk of coeliac disease. All but one of the studies included showed a statistically significant association between increasing duration of breastfeeding and reduced risk of coeliac disease. Meta-analysis of four studies indicated that children being breastfed at the time of gluten introduction had a 52% reduction in risk of developing coeliac disease compared with their peers who were not breastfeeding at time of gluten introduction. It was not possible to tell from the results of the included studies whether breastfeeding provides permanent protection against coeliac disease development or whether breastfeeding only delays the onset of symptoms. The authors conclude that the results of this study suggest that breastfeeding may offer protection against the development of coeliac disease, and that breastfeeding during the introduction of dietary gluten and increasing duration of breastfeeding were associated with decreased risk of developing coeliac disease. Long-term prospective cohort studies are required to further investigate this association.
Summarised by Kathryn Wood.

 

Duration of breastfeeding and risk of overweight: A meta-analysis
Harder T, Bergmann R, Kalllschnlgg G, Plagemann A. Am J Epidemiol. 2005. 162: 397-403.

The authors of this study previously published a meta-analysis that showed breastfeeding, compared with formula feeding, to be associated with a decreased risk of overweight. This meta-analysis identified 17 studies that met the inclusion criteria for examining the association between the duration of breastfeeding and the risk of overweight later in life.
Three different techniques of statistical analysis were used on the 17 studies and it was found that longer duration of breastfeeding is associated with a larger decrease in risk of overweight. The risk of overweight was reduced by four percent for each month of breastfeeding up to nine months, with no further effect after nine months. The mechanisms by which this occurs are still unclear. The authors suggest that possibly a lower body weight gain during neonatal life (caused by lower average caloric intake in breastfed infants) may influence the development of parts of the brain that regulate appetite control and body weight.
Summarised by Kathryn Wood.

 

March

Duration of lactation and incidence of type 2 diabetes.
Stuebe AM, Rich-Edwards JW, Willett WC, Manson JAE, Michels KB JAMA 2005 294(20): 2601-2610.

Several previous studies, in humans and animals, have demonstrated improved glucose tolerance and insulin sensitivity during lactation compared to non-lactating women. This study is the first to evaluate the association between lactation history and incidence of type 2 diabetes. Subjects were women enrolled in the Nurses' Health Study, 2 large cohorts enrolled in a long-term study of women's health (initiated in 1976 and 1989) that used detailed biennial questionnaires. Total duration of breastfeeding and total duration of exclusive breastfeeding were calculated. The researchers found that duration of lactation was inversely associated with risk of type 2 diabetes in young and middle-aged women. These results were independent of other diabetes risk factors such as body mass index, diet, exercise and smoking. This reduction in risk of type 2 diabetes appeared to wane with time since last birth. Exclusive breastfeeding was associated with a greater risk reduction than total breastfeeding. The authors also assessed the impact of lactation on diabetes risk among women with a history of gestational diabetes and no association with duration of lactation was found. The authors conclude that their results demonstrating an increased duration of breastfeeding associated with a reduced risk of type 2 diabetes, together with clinical evidence of improved glucose metabolism in lactating women, suggest that lactation may reduce the risk of type 2 diabetes in young and middle-aged women.
Summarised by Kathryn Wood.

 

Breastfeeding and intelligence of preschool children
Slykerman RF, Thompson JMD, Becroft DMO, Robinson E, Pryor JE, Clark PM, Wild CJ ,Mitchell EA Acta Paediatr 2005 94: 832-837.

Previous research on breastfeeding and intelligence has tended to focus on full term infants or premature infants. Many of these studies have demonstrated a positive effect of breastfeeding during infancy on later intelligence, although the poor design of many of these studies has meant that further research is necessary. This study concentrates on infants who are full term but small for gestational age (SGA), and investigates whether breastfeeding during infancy is a determinant of intelligence at 3.5 years. The subjects were 550 European infants enrolled in the Auckland Birthweight Collaborative Study. Approximately half of these infants were appropriate for gestational age and half were small for gestational age. Duration of breastfeeding, including exclusive breastfeeding, was recorded at an interview with the infant's mother. The intelligence of the 3.5 year old children was assessed using the Stanford Binet Intelligence Scale, a test that gives a composite score representing overall intelligence and four subset scores representing verbal reasoning, quantitative reasoning, abstract visual reasoning and short-term memory.
The results showed no difference in intelligence scores between the SGA group and the appropriate for gestational age group. The results for both groups of infants combined show a trend for longer periods of breastfeeding to be associated with higher intelligence scores however these results were not significant.
The statistically significant results were shown in the SGA group, where breastfeeding was significantly related to IQ at 3.5 years. The SGA children who were not breastfed at all had adjusted intelligence scores 6.0 points lower than SGA children breastfed for longer than 12 months and 5.9 points lower than children exclusively breastfed for 5 months or longer. The authors conclude that breastfeeding may be particularly important for the cognitive development of preschool children born small for gestational age.
Summarised by Kathryn Wood.

 

January

Breastfeeding and risk of schizophrenia in the Copenhagen Perinatal Cohort.
Sorensen HJ, Mortensen EL, Reinisch JM, Mednick SA Acta Psychiatr Scand 2005 112: 26-29.

Two previous studies have found that breastfeeding is less common in babies who have become schizophrenic in adult life, however other studies have not been able to find an association. This study aimed to assess whether early weaning may be associated with an increased risk of schizophrenia.
The sample of people used for this study came from 6841 individuals from the Copenhagen Perinatal cohort of whom 24 percent had been breastfed for 2 weeks or less (early weaning) and 76 percent had been breastfed for longer. The Copenhagen Perinatal cohort comprises 9125 individuals born between in 1959 to 1961. Duration of breastfeeding was collected from the mothers at the 1-year examination. Of this cohort 93 (1.4 percent) had been independently identified as having schizophrenia (using the Danish Psychiatric Central Register). The researchers examined the incidence of schizophrenia in the early weaning and later weaning categories. The results showed a 1.7-fold higher risk of schizophrenia in the offspring of mothers who did not breastfeed or stopped breastfeeding within 2 weeks. The results remained significant after adjustment for gender, social status, maternal schizophrenia and single mother status. The authors conclude that further studies are needed to research the protective effect of breastfeeding on the development of schizophrenia and to replicate the findings of this study.
Summarised by Kathryn Wood.

 

Breastfeeding and Atherosclerosis: Intima-Media Thickness and Plaques at 65-Year Follow-Up of the Boyd Orr Cohort.
Martin RM, Ebrahim S, Griffin M, Smith GD, Nicolaides AN, Georgiou N, Watson S, Frankel S, Holly JMP, Gunnell D Arterioscler Thromb Vasc Bio 2005 25: 1-7.

Atherosclerosis is described as the narrowing of the inner lining of the arteries due to the formation of plaques. It can cause illness such as coronary heart disease, and can cause death from heart attack or stroke.
Some previous studies have found an association between later coronary heart disease and breastfeeding, whereas other studies have found no relationship. This study examined the relationship between atherosclerosis and breastfeeding.
The group of people used for the study come form the Boyd Orr cohort, which consisted of 4999 participants from England and Scotland who participated in a 1 week survey of diet and health when aged 0 to 19 years between 1937 and 1939. For this study 405 underwent clinical examination and 339 returned for arterial ultrasound scans. Infant feeding information was obtained from the original survey. The mean age of participants was 71.
Breastfeeding was found to be inversely associated with atherosclerosis, as measured by intima-media thickness and the prevalence of plaques using ultrasound scans. This association of breastfeeding with reduced risk of atherosclerosis was independent of other possibly confounding factors such as birth weight, nutrition, socioeconomic factors and factors (smoking and alcohol) operating later in life.
The authors were unable to establish a mechanism by which breastfeeding may influence atherosclerosis, but does discuss the possibility of an association between blood pressure, cholesterol levels and insulin resistance as underlying mechanisms. Acute and chronic viral/bacterial infections have been associated with atherosclerosis in other studies (although the research is not conclusive) and this study was unable to investigate whether breastfeeding protects against atherosclerosis by reducing exposure to infections in infancy.
The authors conclude that it is possible that the promotion of breastfeeding could be a component of the public health strategy to reduce future levels of heart disease.
Summarised by Kathryn Wood.

 

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