搜索结果：Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine

This study aimed to investigate the relationship between breastfeeding and precancerous cervical lesions. A case control study was conducted at a tertiary training and research hospital between September 1 and November 1, 2023. A total of 168 patients who attended the gynecology outpatient clinic and reported their breastfeeding experiences were included. Patients with abnormal cervical cytology formed the study group (n = 37), while patients with normal cytology formed the control group (n = 131). Breastfeeding duration and patterns were compared between groups. The control group had normal smear results. In the study group, 15 patients had high-grade squamous intraepithelial lesions, and 22 patients had low-grade squamous intraepithelial lesions. Human papillomavirus (HPV) was positive in 54.1% of the study group versus 9.2% of the control group. The mean breastfeeding duration was shorter in the study group (9.18 &#xb1; 3.43 months) than the control group (23.6 &#xb1; 3.35 months; p < 0.05). Most control group patients breastfed for 13-36 months (35.1%), while most study group patients breastfed for <6 months (48.6%; p < 0.05). Shorter breastfeeding (<6 months) and HPV positivity were the strongest predictors of abnormal cytology. Breastfeeding <6 months increased the risk 9.883-fold compared with >36 months, while HPV positivity increased the risk 27.612-fold. Breastfeeding and longer breastfeeding duration appear to be associated with a lower risk of cervical intraepithelial neoplasia. Given its multiple health benefits, including prevention of gynecological cancers, promoting breastfeeding through public health policies is strongly recommended. Early recognition and prevention of precancerous lesions remain essential to reducing the risk of cervical cancer.

Although breastfeeding is a common practice in T&#xfc;rkiye, breastfeeding rates remain below the levels recommended by the World Health Organization. This study aimed to determine the effects of simulation-based breastfeeding education given in the antenatal period on the breastfeeding success of primiparous women in the postnatal period, their perceptions of breastfeeding self-efficacy, and their attitudes and knowledge regarding breastfeeding. This randomized controlled study included 128 primigravida women (intervention group: 64, control group: 64). The intervention group received simulation-based breastfeeding education during the antenatal period, while the control group watched the routine hospital breastfeeding education video. Data were collected using the Personal Information Form, Postnatal Follow-Up Form, Breastfeeding Attitudes and Knowledge Questionnaire (BAKQ), LATCH Assessment Tool, and Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). The BSES-SF and BAKQ were administered at baseline and within 24 hours after delivery, while breastfeeding success was evaluated twice postnatally using the LATCH Assessment tool. Data analysis involved chi-squared tests, independent-samples t-tests, and multiple linear regression. The postintervention scores of these scales were significantly higher in the intervention group compared with the control group (p < 0.001). The LATCH Assessment tool score was significantly higher in the intervention group at both postnatal follow-ups (p < 0.001). Women who received simulation-based breastfeeding education had more successful breastfeeding practices, greater knowledge and better attitudes toward breastfeeding, as well as better perceptions of breastfeeding self-efficacy, than women who received routine breastfeeding education.

A reliable method of measuring the severity of inflammatory conditions of the lactating breast (ICLB) enables health care professionals to provide individual care for mothers. There is a need to triage and prioritize mothers with severe ICLB symptoms reliably. The aim of this study was to determine the inter-scenario reliability of the Breast Inflammatory Symptoms Severity Index when completed electronically by the mother, verbally administered over the phone by administration staff and when completed face-to-face by a health care professional before treatment. An inter-scenario, repeated measures reliability study of the Index, which is an 80-point clinician-administered patient-reported outcome measure used to assess and monitor mothers with symptoms of inflammatory conditions of the lactating breast. The study was conducted with mothers across 3 scenarios with symptoms of inflammatory conditions of the lactating breast in Australia. Standard Error of Measurement (SEM), Measurement Error (ME) and Intraclass Correlation Coefficients (ICCs) were calculated to determine interscenario reliability of the Index. Data were collected for 20 mothers. Statistical analysis identified that the Index had good reliability among the three scenarios, evidenced by low measurement errors and high correlation. When comparing administration mode, phone method was more reliable than electronic administration. Interscenario reliability was good, aiding the use of the Index in the community, research and clinical practice. This tool provides lactating mothers who experience lactating breast conditions and their clinicians with surety that they are using a reliable outcome measure for assessment when taken electronically or via phone.

Given the functional, emotional, and symbolic challenges imposed by cleft lip and/or palate (CL/P) on exclusive breastfeeding (EBF), mothers often experience early breastfeeding cessation with impacts on maternal identity and the mother-infant bond. This study aimed to explore the meanings, feelings, and experiences of mothers of children with CL/P regarding breastfeeding in the face of these adversities. This qualitative study applied the Clinical-Qualitative Method as proposed by Turato. Six in-depth semistructured interviews were conducted with biological mothers of children with CL/P, recruited from a specialized craniofacial reference center in Brazil. Data were analyzed using a qualitative content analysis approach, grounded in psychodynamic concepts from the Medical Psychology theoretical framework. Based on the analysis of the collected material, three analytical categories were identified and constructed: (1) "Existential conflict regarding the inability to fulfill the ideal maternal role"; (2) "Duality between the need and the fear of caregiving"; and (3) "The anguish experienced between tangible and intangible support during breastfeeding."Conclusions:Although the inability to EBF in children with CL/P generates emotional distress, motherhood is reimagined through adaptive forms of care and bonding, highlighting gaps in institutional support and the need for more humanized, emotionally sensitive health practices.

Early identification of breastfeeding difficulties is crucial for targeted interventions. However, the comparative effectiveness of these assessment tools remains unclear. To compare the predictive validity of the LATCH and Bristol Breastfeeding Assessment Tool (BBAT) scores measured at 24 hours and day 7 postpartum for exclusive breastfeeding at 42 days and to evaluate their combined predictive performance. This prospective cohort study included 157 mother-infant dyads (September 2024-March 2025) at a university hospital in Turkey. LATCH and BBAT scores were assessed at 24 hours and on day 7 postpartum. The primary outcome was exclusive breastfeeding at 42 days. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off values and predictive performance. The rate of exclusive breastfeeding (EBF) was 83.4% (n = 132) in the first 24 hours and 68.8% (n = 108) on day 42 of life. The LATCH score in the first week showed the highest specificity for predicting EBF on day 42. (cut-off value &#x2265;10: area under the curve [AUC] 0.671 (95% CI: 0.582-0.760; p < 0.001), sensitivity 55.6%, specificity 72.3%, false positive rate 27.7%). A multiple ROC analysis was conducted to determine which of the four scores was better at predicting EBF on the 42nd day. The cutoff values were 8 for the first-week Bristol score alone, 10 for the first-week LATCH score, 5 for the first 24-hour Bristol score, and 7 for the first 24-hour LATCH score. Combined early assessment using LATCH and BBAT scores provides a superior prediction of EBF at 42 days compared with single indicators. The implementation of systematic screening using these tools may facilitate targeted lactation support for at-risk dyads.

Pediatricians play a central role in breastfeeding support, yet educational gaps persist in training programs worldwide. Understanding how educational priorities vary across career stages may help optimize breastfeeding education for health care professionals. This study aimed to identify distinct professional profiles among physicians providing pediatric care attending the Brazilian Congress of Pediatrics and to characterize their self-reported educational priorities regarding breastfeeding in order to inform continuing education initiatives tailored to the needs of different professional profiles. A cross-sectional electronic survey was conducted during the 41st Brazilian Congress of Pediatrics (Florian&#xf3;polis, Brazil; October 2024). Participants included 290 physicians providing pediatric care-board-certified pediatricians (n = 164), pediatric residents (n = 109), and physicians without pediatric specialty certification providing pediatric care (n = 17). Fourteen binary variables representing clinical practice context and perceived causes of early weaning were used for cluster analysis. Educational priorities were assessed through classification of open-ended responses into thematic categories. Three distinct clusters were identified, forming a career-stage gradient. Cluster 1 (n = 111, 38.3%) comprised predominantly early career professionals (mean age, 31.7 years; 64.9% residents) who prioritized technique/management. Cluster 2 (n = 44, 15.2%) showed intermediate characteristics, with emphasis on mother/family education and support network. Cluster 3 (n = 135, 46.6%) included mostly senior pediatricians (mean age, 44.7 years; 77.8% board-certified) who prioritized legislation/work, myths/misinformation, and the pediatrician's role. This gradient emerged despite demographic variables being excluded from the clustering algorithm. Three distinct professional profiles with differing educational priorities were identified. Educational needs followed a career-stage gradient, ranging from practical clinical skills among early-career professionals to leadership, coordination, and policy competencies among senior pediatricians. The emphasis on the pediatrician's role among senior professionals underscores a perceived need to reassert the pediatrician as the central coordinator of the breastfeeding support team. These findings support the development of career-stage-tailored educational strategies to maximize the relevance and effectiveness of continuing education initiatives.

This study was conducted to evaluate the effects of foot massage applied to the mother in the early postpartum period on breastfeeding success, sleep quality, and newborn stress levels. The study was conducted using a parallel-group randomized controlled trial design. The study included 70 primiparous postpartum women who had vaginal deliveries at a public hospital in southern T&#xfc;rkiye between December 2024 and August 2025. Participants were randomized into intervention (n = 35) and control (n = 35) groups. The intervention group received a total of 12 sessions (30 minutes each) of foot massage, three times a week for four weeks, starting from the first week postpartum, in addition to standard postpartum care. The control group received only standard postpartum care. Data were collected using the Personal Information Form, LATCH Breastfeeding Charting System and Documentation Tool, Pittsburgh Sleep Quality Index (PSQI), and the Newborn Stress Scale (NSS). The Mann-Whitney U test, Wilcoxon signed-rank test, and Friedman test were used for data analysis; statistical significance was set at p < 0.05. Initially, the groups were similar in sociodemographic and clinical characteristics (p > 0.05). Lactation success (LATCH) scores increased significantly in the intervention group in weekly measurements, and statistically significant differences were found at the 1st, 2nd, and 3rd follow-ups compared with the control group (p < 0.001). Sleep quality (PSQI) scores decreased significantly in the intervention group in the pre-test-post-test comparison (improvement in sleep quality) (p < 0.001). At the same time, no significant change was observed in the control group (p = 0.087). NSS scores decreased more markedly in the intervention group, with significant between-group differences observed at the 2nd and 3rd follow-ups (p < 0.001). Foot massage applied to the mother in the postpartum period increases breastfeeding success, improves maternal sleep quality, and reduces newborn stress levels. Foot massage can be considered an effective, safe, and feasible nonpharmacological intervention in postpartum care practices.

Lactation care providers (LCPs) are vital in supporting breastfeeding mothers. However, research on the emotional aspects of their work remains limited. This study investigated mothers' and LCPs' perceptions of the emotional aspects of lactation care and whether they differed by background characteristics and LCPs qualifications. Following phone calls or written correspondence, 149 LCPs (43.6% International Board-Certified Lactation Consultants [IBCLCs], 29.5% Registered Nurses Lactation Consultants [RNLCs], and 26.8% Lactation Educators [LEs]) and 201 mothers completed an identical 10-item online quantitative questionnaire assessing expectations of emotional support in lactation care and perceptions of providers' competence and training adequacy in this domain. Mothers reported the duration of lactation care received. LCPs perceived emotional support as part of their role but hesitated to engage in this domain. Confidence in providing emotional support was higher among RNLCs compared to IBCLCs and LEs. Mothers expected emotional support from their LCPs but questioned whether they were adequately trained. Mothers assisted by IBCLCs perceived them as significantly more capable of providing emotional support than those assisted by RNLC or LEs. A longer lactation care duration was associated with mothers' positive perceptions of emotional support in lactation care. LCPs and mothers perceive emotional support as an important aspect of lactation care. However, they reported challenges in delivering and engaging in this aspect. These findings underscore the need to incorporate structured training in emotional support into the education and professional development of LCPs.

Supporting women during the perinatal period helps build confidence, strengthens early bonding between mother and baby, and encourages successful breastfeeding. Continuous midwifery care models are one of the ways that support women in this periods. This study aimed to evaluate the effect of integrated continuous team midwifery care (ICTMC) in enhancing breastfeeding success in the Iranian health system. In this randomized controlled trial, 200 low-risk primiparous women with a gestational age of less than 12 weeks were recruited from public health centers. Participants were randomly assigned to either the intervention group, which received continuous midwifery care throughout pregnancy, childbirth, and postnatal follow-up, or the control group, which received routine care. The primary outcomes were early skin-to-skin contact and breastfeeding success at the time of discharge and at 4-6 weeks postpartum. Data were analyzed using Stata, employing descriptive statistics, Chi-square, independent t-test, Phi/Cramer's V, and Cohen's d. The p < 0.05 is significant. Data were analyzed with SPSS 26. ICTMC groups were significantly more likely to initiate skin-to-skin contactearly skin-to-skin contact immediately after birth (92% vs. 74%, p < 0.001) and achieve successful breastfeeding at the discharge time (88% vs. 70%, p = 0.002) compared to the control group. At 6 weeks postpartum, breastfeeding success remained higher in the intervention group (82% vs. 65%, p = 0.004). Women with ICTMC, effectively support skin-to-skin contactearly mother-infant bonding and enhance breastfeeding success among low-risk primiparous women. Integrating this model into routine maternal care may improve perinatal outcomes.

Diaper dermatitis (DD) is a very common problem in infants between 1 and 6 months. While it rarely causes long-lasting problems, it can cause serious short-term problems for both infants and parents. Accordingly, this study compared the effect of breast milk and diaper rash cream containing Hamamelis virginiana (12 mg/100 g) on the healing process in 0-6 month-old infants with DD. This randomized, single-blinded trial was conducted with 60 infants aged 0-6 months diagnosed with DD. Participants were assigned to either the breast milk group (BG) or the comparison group (CG) receiving Hamamelis virginiana cream. Demographic characteristics and DD severity were assessed using a structured demographic questionnaire and the validated Assessment of the Severity of Uncomplicated DD in Infants Scale. Statistical analyses included Shapiro-Wilk, Mann-Whitney U, Wilcoxon signed rank, Chi-square, and Fisher's exact tests. Significance was set at p < 0.05. Before the intervention, the mean scale score was 5.17&#x2009;&#xb1;&#x2009;0.46 in the BG, 2.83&#x2009;&#xb1;&#x2009;1.37 in the CG, which was a statistically significant difference. After the intervention, there was a significant decrease in the mean scale score in the BG to 0.03&#x2009;&#xb1;&#x2009;0.18, whereas the mean decrease was smaller in the CG (1.53&#x2009;&#xb1;&#x2009;1.11). The difference in the mean scale scores between the groups was statistically significant (p < 0.001). Furthermore, the postintervention mean scale score of the BG was significantly lower than that of the CG. However, baseline severity differences limit direct comparison of treatment efficacy. Topically applied breast milk appears to be a safe, accessible, and cost-effective option for treating uncomplicated DD, with greater improvement than cream containing Hamamelis virginiana. However, baseline severity differences limit direct comparison. Further studies using block randomization are recommended.

The purpose of the current study was to assess the effect of couple counseling on maternal distraction and attention levels during breastfeeding and nonfeeding childcare in mothers experiencing distractions in Hamadan, western Iran. In this randomized controlled trial, mothers attending comprehensive health centers for routine postpartum care who reported distraction during breastfeeding were enrolled. Participants were assigned via block randomization to an intervention group (standard care plus couple-centered counseling) or a control group (standard care alone). The maternal distraction was measured using the maternal distraction questionnaire at baseline, immediately post-intervention, and at two-, three-, and 4-month follow-ups. The analysis included 64 participants in each group. At 4 months, 40.6% more mothers in the intervention group than in the control group reported not being at all distracted during breastfeeding, with a 36% difference in favor of the intervention group for very high attention. Corresponding figures during childcare were 42.2% and 37.5%, respectively. A significant interaction between time and group was observed for both maternal distraction during breastfeeding and during childcare (p < 0.001). In the intervention group, maternal distraction during breastfeeding decreased from 17.89 &#xb1; 2.53 at baseline to 8.31 &#xb1; 1.27 at 4 months, and during childcare from 18.03 &#xb1; 1.94 to 8.98 &#xb1; 2.06. In the control group, these scores decreased only slightly, from 16.84 &#xb1; 2.50 to 15.52 &#xb1; 2.37 for breastfeeding and from 17.84 &#xb1; 2.44 to 15.19 &#xb1; 2.29 for childcare. Our study showed that a couple-centered counseling intervention significantly reduced maternal distraction and improved attention during breastfeeding and childcare.

Painful procedures are frequently performed in neonatal care, yet their repeated exposure is associated with adverse short- and long-term neurodevelopmental outcomes. Nonpharmacological, physiological, and parent-involved interventions such as breastfeeding and breast milk sensory stimuli have emerged as promising strategies for procedural pain management. This umbrella review and meta-analytic reanalysis aimed to synthesize the evidence from systematic reviews and meta-analyses evaluating the analgesic effects of breastfeeding, breast milk odor, and breast milk taste during painful procedures in term and preterm infants. A comprehensive umbrella review approach was applied, and the methodological quality of all included reviews was assessed using the Assessment of Multiple Systematic Reviews-2 tool. Effect sizes from existing meta-analyses were reanalyzed using random-effects models, incorporating heterogeneity, prediction intervals, and clinical variation across interventions and populations. Breastfeeding demonstrated the strongest analgesic effect, with large reductions in pain scores, crying duration, and heart rate during procedural pain. Breast milk odor and taste also reduced behavioral and physiological pain indicators, particularly among preterm infants, though with smaller effect sizes compared with direct breastfeeding. Despite generally consistent effect directions, substantial heterogeneity was observed across meta-analyses due to variation in populations, procedures, intervention timing, and outcome measures. High-quality Cochrane reviews contributed the strongest evidence base, while non-Cochrane reviews showed moderate-to-low methodological confidence due to limitations such as lack of protocol registration or incomplete reporting. Breastfeeding and breast milk-related sensory interventions are effective, feasible, and safe nonpharmacological strategies for managing procedural pain in neonates. These findings support the integration of breastfeeding or maternal milk sensory exposure as first-line approaches in neonatal pain management protocols. Further research is needed to clarify optimal timing, dosing, and combinations with other nonpharmacological interventions.

Breastfeeding has been shown to reduce the risk of several diseases-including those that disproportionately affect Black or African American women and children. Adverse social determinants of health (SDOH) have been associated with a higher prevalence of postpartum depressive symptoms and are negatively associated with breastfeeding outcomes and the timing of solid food introduction. Prior research has focused on each individual SDOH in isolation and has not, to the best of our knowledge, examined the mediating role of depressive symptoms and timing of introduction to solid foods. This study aimed to examine (1) the association between multiple adverse SDOH and timing of breastfeeding cessation and (2) if this relationship is mediated by maternal depressive symptoms and the timing of introduction to solid food. This secondary data analysis used data from an existing, longitudinal birth cohort study with Black or African American women (n = 242). Multivariable logistic regression and regression-based causal mediation analyses were used to address the objectives of this study. Findings showed multiple adverse SDOH were associated with increased odds of stopping breastfeeding at 4 and 6 months of age (4 months: odds ratio [OR] = 3.49, 95% confidence interval [CI]: 1.11, 10.97; 6 months: OR = 5.03, 95% CI: 1.54, 16.47). This relationship was partially mediated by the introduction of solid foods at 4 months of age (indirect effect: OR = 1.53, 95% CI = 1.18, 2.34) but not mediated by maternal depressive symptoms. Multiple adverse SDOH demonstrated relationships with the timing of both breastfeeding cessation and introduction to solid foods.

Fibroadenomas, common benign breast tumors in women of reproductive age, are increasingly managed with minimally invasive radiofrequency ablation (RFA) or surgical excision. However, their impact on breastfeeding outcomes remains underexplored. We aimed to assess breastfeeding ability and breast tissue changes in women treated with RFA or surgery compared to those with untreated fibroadenomas. In this retrospective cohort study, we evaluated 153 women with biopsy-confirmed fibroadenomas across five groups: RFA with prior breastfeeding (RFA-PreBF; n = 26), RFA with posttreatment breastfeeding (RFA-PostBF; n = 22), surgical excision with prior breastfeeding (Surgical-PreBF; n = 30), surgical excision with posttreatment breastfeeding (Surgical-PostBF; n = 20), and noninterventional with breastfeeding (Observation-BF; n = 55). Breastfeeding ability was assessed using a 5-point scale, and breast tissue changes were evaluated via ultrasound at 18 months, and all breastfeeding attempts occurred at a minimum of 12 months postprocedure. Fisher's exact test compared complete lactation failure rates, and a power analysis validated the study design (Fig. 1). The combined RFA group (n = 48) had a higher complete lactation failure rate (14.6%) than the Observation-BF group (3.6%; Fisher's exact test, p = 0.045). Similarly, the combined surgical group (n = 50) had a higher complete lactation failure rate (16.0%) than the Observation-BF group (p = 0.034). When pooled, the combined intervention group (n = 98) showed a complete lactation failure rate of 15.3% versus 3.6% in the Observation-BF group. Residual tissue correlated with lactation impairment in the RFA group (Spearman's &#x3c1;, p < 0.05). Ultrasound showed no tumor recurrence, with cystic changes in some cases not linked to breastfeeding impairment. Power analysis confirmed 80% power to detect a medium effect size (f = 0.25, Fig. 1), supporting the study's robustness.7 RFA-PreBF (n = 26), RFA-PostBF (n = 22), Surgical-PreBF (n = 30), Surgical-PostBF (n = 20), and Observation-BF (n = 55). Breastfeeding ability was assessed using a 5-point scale, and breast tissue changes were evaluated via ultrasound at 18 months. Fisher's exact test compared complete lactation failure rates, and a power analysis validated the study design (Fig. 1).[Figure: see text]Interpretation:RFA and surgical excision are effective for fibroadenoma management but increase the risk of complete lactation failure compared to untreated fibroadenomas. Careful patient selection, precise procedural techniques, and vigilant posttreatment monitoring are essential to optimize breastfeeding outcomes, particularly for women planning future pregnancies.

Feeding difficulties in premature infants often delay the transition to breastfeeding, prolong hospitalization, and impact oral motor development. While non-nutritive finger feeding (NNFF) has been studied in maternal care, limited evidence exists on paternal involvement. This randomized controlled trial examined the effect of father-administered NNFF on breastfeeding transition, sucking success, and hospitalization outcomes in premature infants. This single-blind, parallel-group randomized controlled trial was conducted in a Level III NICU in eastern Turkey. Sixty-seven premature infants born at 29-32 weeks of gestation and their fathers were randomized into intervention (n = 34) and control (n = 33) groups. Fathers in the intervention group performed standardized NNFF for 5 minutes, three times daily over 7 consecutive days. The control group received routine care without NNFF. Primary outcome was time to first successful breastfeeding. Secondary outcomes included sucking success (LATCH scores) and hospitalization duration. Statistical analyses included t-tests, Mann-Whitney U tests, repeated measures ANOVA, and logistic regression. The intervention group achieved earlier breastfeeding initiation (9.65 &#xb1; 5.78 versus 13.88 &#xb1; 6.27 days, p = 0.005), faster breastfeeding acceptance (8.94 &#xb1; 5.59 versus 12.61 &#xb1; 5.74 days, p = 0.010), and shorter hospitalization (11.79 &#xb1; 7.19 versus 15.85 &#xb1; 6.76 days, p = 0.021). Logistic regression confirmed the predictive value of NNFF on breastfeeding initiation, hospital stay, and LATCH scores. Father-led NNFF is a safe, feasible intervention that accelerates breastfeeding transition, improves early sucking success, and reduces hospitalization in premature infants.

To examine hospital breastfeeding initiation trends and their association with COVID-19 pandemic and the infant formula shortage. Using a multivariable logistic regression model, we examined associations between breastfeeding initiation and exposure to the COVID-19 pandemic and infant formula shortage, and the modifying roles of race/ethnicity, residence, and WIC participation in 1,060,057 individuals aged 15-49 years with institutional childbirths in Florida between January 1, 2018, and December 31, 2022. Overall, 922,922 (87.06%) initiated breastfeeding before hospital discharge. Initiation declined as COVID-19 progressed, but started increasing as the formula shortage hit and continued. The rates show a declining trend once the shortage was addressed. Compared with non-Hispanic White, the odds of breastfeeding initiation were higher for all groups except for non-Hispanic Black, and for urban than rural mothers. The odds increased with formula shortage onset for WIC beneficiaries across race/ethnicities and among urban WIC beneficiaries compared with nonbeneficiaries. The combined pressures of COVID-19 pandemic and formula scarcity increased breastfeeding initiation rates, especially in WIC beneficiaries. However, breastfeeding initiation rates returned to prepandemic levels as the formula shortage resolved.

Exclusive breastfeeding (EBF) provides health benefits, yet its continuation remains limited. Maternal endocrine disorders, including gestational hypothyroidism, may impair lactogenesis through hormonal dysregulation; however, evidence regarding the association between gestational hypothyroidism and breastfeeding outcomes remains limited. To investigate the association between maternal gestational hypothyroidism and breastfeeding outcomes in term infants, with a focus on EBF at the end of the first month and formula-free breast milk feeding at 6 months. This retrospective matched case-control study compared term infants of mothers with gestational hypothyroidism treated with levothyroxine (n = 103) and matched controls (n = 103). Feeding data were obtained from medical records and 6-month telephone follow-up, and factors associated with early formula supplementation were analyzed using multivariable logistic regression. EBF rates were significantly lower in the case group at 1 month (58.3% versus 81.6%, p < 0.001). Formula supplementation within the first postnatal day was more frequent in the case group than in controls (46.6% versus 21.4%; &#x3c7;2 = 14.63, p < 0.001). At 6 months, formula feeding-either alone or combined with breastfeeding and/or complementary foods-was significantly more frequent in the case group (45.6% versus 25.2%, p = 0.003). Among infants who ever received formula (n = 84), formula was initiated during the first postnatal month more frequently in the case group (82.7% versus 59.4%, p = 0.018), with earlier mean age at formula initiation (1.4 &#xb1; 0.97 versus 2.3 &#xb1; 1.51 months, p = 0.003). Multivariable logistic regression showed that higher maternal gravidity was independently associated with early formula supplementation (odds ratio = 3.16; 95% confidence interval: 1.09-9.10; p = 0.033). Gestational hypothyroidism was associated with lower EBF rates at 1 month and increased early formula supplementation. These findings underscore the need for targeted lactation support and careful postpartum follow-up in mothers with gestational hypothyroidism.

Magnesium sulfate is widely prescribed postpartum for seizure prophylaxis in women with preeclampsia and other hypertensive disorders of pregnancy, yet its potential effects on lactation outcomes remain underexplored. To evaluate and synthesize the current evidence on how postpartum magnesium sulfate therapy affects lactation outcomes, including breastfeeding initiation, exclusivity, duration, pumping habits, and secretory activation (SA). This integrative review followed PRISMA guidelines and Whittemore and Knafl's framework. Literature was obtained from five databases without date restrictions. A total of 11 studies met the inclusion criteria. Methodological quality was evaluated using the Joanna Briggs Institute tools and Melnyk and Fineout-Overholt's hierarchy of evidence. Data were synthesized from 11 studies published between 1993 and 2023, encompassing 2,842 participants across diverse hospital settings. Findings indicate that extended postpartum magnesium sulfate administration is associated with delayed breastfeeding initiation, delayed maternal perception of SA, and greater reliance on milk expression. Most researchers did not report maternal side effects or quantitatively measure the frequency of breastfeeding or pumping. Studies reported hospital policies that restricted rooming-in and breastfeeding during magnesium infusion. Postpartum magnesium sulfate administration is associated with delays in lactation initiation, missing the evidence-based critical window for frequent early milk removal. However, studies in this review rarely examine maternal side effects or feeding frequency in detail. Future research should use standardized definitions, document both frequency and mode of milk removal, evaluate objective measures of SA, evaluate maternal experience, and hospital policies.

Background: More than 20% of newborn infants in the United States are fed formula to supplement breastfeeding in their first 2 days. Most hospitals that provide pasteurized donor human milk (PDHM) for supplemental feeding limit its use to infants <32 weeks' gestation or <1,500 g at birth. Cost is one perceived barrier to PDHM use among late preterm or full-term infants that do not meet premature age or low birth weight criteria. Objectives: The aim of the project was to identify and describe the current literature on the financial feasibility of providing donor breast milk instead of formula among a wider population. Methods: We performed an integrative review using The Johns Hopkins Evidence-Based Practice Model framework for article appraisal. The search used PubMed, CINAHL and JBI electronic databases for articles from 2011 to 2022. Results: From 536 articles retrieved, five met criteria for inclusion. Analyzed articles reported on trends, indications, costs, and accessibility of PDHM. Results revealed various methods of incorporating PDHM in their operational budget. Conclusions: Use of PDHM instead of the formula is increasing for supplementation. Facilities using PDHM beyond these limits have included its costs in their operational budget. This article reveals the multifactorial elements that contribute to the cost of PDHM, thus underscoring the lack of evidence demonstrating cost as a barrier to providing PDHM for infants >32 weeks or >1,500 g. More studies are needed to identify the cost-benefit ratio of the use of PDHM for this population.