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Health care providers can offer employment-related support to pregnant patients by providing information about occupational risks and benefits, discussing adjustments, and/or completing paperwork to help patients obtain accommodations or benefits, but little research has examined whether and how this support is provided. We conducted interviews with 20 adults who had been employed while pregnant within the 5 years preceding data collection. Eligible participants had low incomes, were hourly wage earners, or were employed in service or retail occupations. Applied thematic analysis was used to identify emergent themes. People who had been employed while pregnant described a range of experiences during that time, including physical and psychological demands from work, lack of access to appropriate accommodations, difficulties combining breastfeeding with work, and work-related challenges accessing health care. Participants described four primary roles that health care providers played: 1) completing paperwork needed to apply for benefits or receive work modification; 2) providing information about how to mitigate employment-related risks; 3) providing referrals to social or medical services; and 4) advocating for patients to ensure receipt of accommodations, resources, and information. Strategies identified by patients that could be enacted within health care to help them better navigate the work-pregnancy interface include increasing appointment flexibility, providing information about work-related risks and benefits programs and referrals to legal support, and helping providers to understand and support their patients' individual work-related concerns. Health care providers have a critical role to play in supporting employed pregnant people to achieve flexibility in managing their work and to be active participants in discussions about recommended workplace accommodations. [ABSTRACT FROM AUTHOR]

U.S. veterans of childbearing age represent one of the fastest growing populations using Veterans Affairs (VA) health care. The VA does not provide obstetric care directly but pays for VA-enrolled veterans to obtain outside obstetric care. The VA also provides maternity care coordination (MCC) services, including lactation support. Breastfeeding benefits mothers and babies; however, previous research shows that veteran mothers quit exclusive breastfeeding earlier than the American Academy of Pediatrics and World Health Organization recommendation of 6 months. This study aimed to understand facilitators and barriers to breastfeeding among a cohort of veterans who used VA maternity care benefits. Qualitative data from an open-ended question from a national sample of postpartum veterans using VA pregnancy benefits were coded using deductive and inductive content analysis within a matrix framework. Quantitative data were used to contextualize the responses. Four themes emerged from the data: (1) impacts on health of baby/mother; (2) the ability to breastfeed; (3) early postnatal experiences breastfeeding; and (4) cost/convenience. Among those who responded to the open-ended breastfeeding question (329/669), most participants (n = 316; 96%) attempted breastfeeding their current baby. Respondents who did not initiate breastfeeding or who discontinued breastfeeding earlier than planned cited diverse reasons. These included low milk supply, poor latch, nipple pain, mental health factors, and low confidence in their ability to continue breastfeeding. Participants cited the MCC program as a facilitator to breastfeeding, and non-VA hospital experiences were mentioned as barriers. Veterans in this cohort of 329 veterans who responded to an open-ended breastfeeding question wanted and attempted to breastfeed; however, barriers such as lactation challenges and unsupportive health care providers made it difficult to continue the practice. As the MCC program grows to include more lactation professionals, MCCs may address barriers such as lactation challenges and unsupportive non-VA health care providers. Further program development should focus on addressing these challenges prenatally. [ABSTRACT FROM AUTHOR]

We assessed awareness of the maternal health benefits of lactation among a sample of nulliparous pregnant individuals in the United States, identified variables associated with awareness of these benefits, and examined whether awareness of these benefits impacts breastfeeding attitudes or intentions. We administered a web-based survey to nulliparous U.S.-born individuals carrying a singleton gestation of at least 28 weeks. We assessed awareness of the maternal health benefits of lactation using 10 items to create a summative score. We examined variation in awareness of these benefits by demographic characteristics, health insurance, and personal or family health history and used multivariable models to estimate associations between awareness of the maternal health benefits of lactation and breastfeeding intentions. Of the 675 individuals invited to complete surveys, 451 (67%) responded. Only 50% were aware that breastfeeding lowers maternal risk of breast cancer; fewer were aware that breastfeeding lowers the risk of ovarian cancer (35%), diabetes (27%), and hypertension and heart disease (26%). Awareness of the maternal benefits of lactation did not vary by age or race/ethnicity. However, significant regional variation was noted. In multivariable models, scores of awareness of the maternal health benefits of breastfeeding were significantly associated with intentions to breastfeed for at least 12 months (adjusted odds ratio, 1.23; 95% confidence interval, 1.11, 1.37). Efforts to increase awareness of the maternal health benefits of lactation are still needed. Increasing awareness of the maternal health benefits of lactation may strengthen intentions to breastfeed as recommended. [ABSTRACT FROM AUTHOR]

U.S. breastfeeding outcomes consistently fall short of public health targets, with lower rates among rural and low-income people, as well as participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The U.S. Department of Agriculture funded a subset of local WIC agencies in Minnesota to implement Breastfeeding Peer Counseling Programs (BFPCs) aimed at improving breastfeeding rates. We examined the impact of BFPCs on breastfeeding rates among WIC participants in Greater Minnesota (outside the Minneapolis–St. Paul metropolitan area). We used data from the Minnesota WIC Information System for the years 2012 through 2019 to estimate the impact of peer counseling on breastfeeding duration using difference-in-differences models. Additionally, we examined results among rural counties and assessed the possibility of spillover effects by stratifying whether a county without BFPCs bordered one with BFPCs. Availability of BFPCs resulted in a 3.1 to 3.4 percentage-point increase in breastfeeding rates at 3 months and a 3.2 to 3.7 percentage-point increase in breastfeeding rates at 6 months among WIC participants in Greater Minnesota. Among rural counties, results showed a statistically significant 4.1 to 5.2 percentage-point increase in breastfeeding duration rates. Both border and nonborder counties experienced positive impacts of BFPCs on breastfeeding rates, suggesting wide-ranging program spillover effects. BFPCs had a significant positive impact on breastfeeding duration. Findings indicate an opportunity for improving rural breastfeeding rates through increased funding for WIC BFPCs. [ABSTRACT FROM AUTHOR]

Breastfeeding provides physical, psychological, and immunological benefits to both the mother and infant, but breastfeeding rates are suboptimal. The purpose of this study was to examine whether residing in a maternity care desert (a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with lower breastfeeding rates among birthing people in Louisiana from 2019 to 2020. Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all live births provided by the Louisiana Office of Vital Records (n = 112,151), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory geospatial analysis to examine the association between place of residence and breastfeeding initiation and racial disparities in initiation. We conducted a secondary within-group analysis by fitting the fully adjusted model stratified by race/ethnicity for non-Hispanic white and non-Hispanic Black birthing people. We found that residing in a parish with limited (odds ratio [OR] = 0.87; 95% confidence interval [CI] [0.77, 0.99]) to no access (OR = 0.88; 95% CI [0.80, 0.97]) was significantly associated with lower breastfeeding initiation rates. The within-group analysis determined that both non-Hispanic Black and non-Hispanic white birthing people residing in a parish with limited or no maternity care access had lower breastfeeding initiation rates. Reducing rural and racial inequities in breastfeeding may require structural changes and investments in infrastructure to deliver pregnancy care. [ABSTRACT FROM AUTHOR]

The use of direct oral anticoagulants (DOACs) in breastfeeding women is currently challenging due to limited safety data for breastfeeding infants, and there have been no previous studies on the drug concentration in breastfeeding infants. We treated 2 patients (one case was twin pregnancy) with venous thromboembolisms in breastfeeding women administered rivaroxaban at our institution. Blood samples from the mothers and breastmilk samples were collected at time 0 and 2 h after the rivaroxaban administration, breastfeeding was conducted 2 h after the rivaroxaban administration, and blood samples from the infants were collected 2 h after breastfeeding (4 h after maternal rivaroxaban administration). The milk-to-plasma (M:P) ratios were 0.27 in Case 1 and 0.32 in Case 2. The estimated relative infant dose (RID) was 0.82 % in Case 1 Children 1 and 2, and 1.27 % in Case 2. The rivaroxaban concentration in the infant plasma was below the lower limit of quantification in all infants. In addition, even in the high-exposure case simulation based on 5 days of breastfeeding in Case 2, the infant plasma concentration level was below the lower limit of quantification. At 3 months of follow-up, breastfeeding was continued, and all infants grew and developed without any health problems including bleeding events. The current case series showed that there were no pharmacokinetic or clinical concerns for breastfeeding women or breastfed infants, and provides support for rivaroxaban as a safe treatment option for these patients. • Direct oral anticoagulants (DOACs) are challenging in breastfeeding women. • We administered rivaroxaban in 2 breastfeeding women with venous thromboembolism. • There were no pharmacokinetic concerns on rivaroxaban for breastfeeding women. • Rivaroxaban might be a potential option for breastfeeding women with infants. [ABSTRACT FROM AUTHOR]

• The exclusive breastfeeding rate after hospital discharge was high (81%) • Adequate in-hospital breastfeeding support is important for successful breastfeeding. • First-time mothers need enhanced support for breastfeeding. • Timely access to face-to-face breastfeeding support should be ensured for mothers. Global breastfeeding rates are not optimal, and the early postpartum period represents a critical time for breastfeeding initiation. The Baby-Friendly Hospital Initiative endeavours to provide mothers with evidence-based breastfeeding support in birth hospitals. This study examined factors associated with breastfeeding exclusivity and breastfeeding difficulties in the first days after being discharged from Baby-Friendly designated hospital. The adequacy of breastfeeding support and maternal preferences for optimal support were also reported. A non-experimental correlational study was conducted between May 2021 and October 2022. A total of n = 80 breastfeeding mothers completed a semi-structured questionnaire within two weeks of discharge from Baby-Friendly hospital in Finland. The questionnaire included demographic and obstetric background information and six questions on breastfeeding exclusivity, breastfeeding difficulties, and breastfeeding support. Descriptive statistical analysis and multivariate binary logistic regression analysis were performed. The mean age of the mothers was 30.6 years (SD 5.4), and half of the mothers were primiparas (49 %). Most mothers gave birth vaginally (85 %) to a full-term infant (84 %). Most (85 %) had made some prenatal plans for breastfeeding, and the median planned duration of breastfeeding was 12 months. Half of the infants (53 %) received supplemental milk while in the hospital. Most mothers (81 %) were exclusively breastfeeding after hospital discharge. Mothers whose infants received supplemental milk in the hospital had an increased odds of non-exclusive breastfeeding (aOR 16.5 [CI 95 % 1.7–156.7], p 0.015). Approximately one-third of the mothers (39 %) experienced breastfeeding difficulties. Primiparous mothers had increased odds of experiencing breastfeeding difficulties (aOR 3.41 [CI 95 % 1.2–9.8], p 0.023). Mothers who received adequate postnatal breastfeeding support in birth hospital had decreased odds of experiencing breastfeeding difficulties (aOR 0.16 [CI 95 % 0.03–0.8], p 0.026). Mothers were mainly satisfied with breastfeeding support, although timelier access to support was preferred after hospital discharge. Adequate in-hospital postnatal breastfeeding support, including avoidance of non-medical supplementation, contributes to successful breastfeeding after hospital discharge in terms of more exclusive breastfeeding and fewer breastfeeding difficulties. Primiparous mothers need emphasized support to mitigate breastfeeding difficulties. Timelier access to breastfeeding support after discharge is needed. [ABSTRACT FROM AUTHOR]

Prematurity is one of the risk factors for sudden unexpected infant death (SUID), a phenomenon that remains poorly explained. The analysis of specific factors associated with SUID among very premature infants (VPI) was performed through a retrospective review of data collected in the French SUID registry from May 2015 to December 2018. The factors associated with SUID among VPI were compared with those observed among full-term infants (FTI). Results are expressed as means (standard deviation [SD]) or medians (interquartile range [IQR)]. During the study period, 719 cases of SUID were included in the registry, 36 (incidence: 0.60 ‰) of which involved VPI (gestational age: 29.2 [2] weeks, 1157 [364]) g] and 313 (0.18 ‰) involved FTI (gestational age: 40 [0.8] weeks, 3298 [452] g). The infants' postnatal age at the time of death was similar in the two groups: 15.5 (12.2–21.8) vs. 14.5 (7.1–23.4) weeks. We observed low breastfeeding rates and a high proportion of fathers with no occupation or unemployment status among the VPI compared to the FTI group (31% vs. 55 %, p = 0.01 and 32% vs. 13 %, p = 0.05, respectively). Among the VPI, only 52 % were in supine position, and 29 % were lying prone at the time of the SUID (compared to 63 % and 17 %, respectively, in the FTI group). This study confirms prematurity as a risk factor for SUID with no difference in the SUID-specific risk factors studied except for breastfeeding and socioeconomic status of the fathers. VPI and FTI died at similar chronological ages with a high proportion of infants dying in prone position. These results argue for reinforcement of prevention strategies in cases of prematurity. [ABSTRACT FROM AUTHOR]

Le lait de femme est vital pour la nutrition des nouveau-nés prématurés particulièrement chez ceux de moins de 32 SA et/ou de moins de 1500 g. Le don direct de lait maternel cru (LMC) dès la naissance pour tout terme et tout poids est le meilleur choix. Le don de lait anonyme sert à nourrir les nouveau-nés pour qui le lait de mère est quasi une « indication thérapeutique » dont les mamans ne peuvent pas ou ne veulent pas allaiter ou le temps que le lait de leur maman soit disponible ce qui peut parfois durer plusieurs jours au moins. Trois questions se posent : • le statut sérologique de la mère vis-à-vis du cyto mégalo virus (CMV) ; • l'intérêt ou non d'un examen bactériologique de contrôle du LMC ; • la durée de conservation du LMC. Human milk is vital for the nutrition of premature newborns, particularly those under 32 WA and/or under 1500 g. Direct donation of raw breast milk (RCM) from birth for any term and any weight is the best choice. The anonymous milk donation is used to feed newborns for whom mother's milk is almost a "therapeutic indication" whose mothers cannot or do not want to breastfeed or until their mother's milk is available, which can sometimes last several days at least. Three questions arise : • the mother's serological status with respect to cyto megalo virus (CMV) ; • the interest or not of a bacteriological control examination of CML ; • the length of the conservation of the LMC. [ABSTRACT FROM AUTHOR]

• High cumulative oxytocin dose in labour increases adverse postpartum outcomes. • High cumulative oxytocin dose almost tripled cases of severe bleedings postpartum. • Overdistended bladders were twice as common after high cumulative oxytocin doses. • More women had a negative birth experience after high cumulative oxytocin doses. This study aimed to determine the association between the total cumulative oxytocin dose during labour and adverse postpartum outcomes, childbirth experience and breastfeeding in term primiparous women with spontaneous onset of labour. A prospective observational multicentre study, including 1395 women with spontaneous labour, in seven hospitals in Southeast Sweden. Multivariable logistic regression (Crude Odds Ratios (OR) and adjusted OR (aOR) for relevant confounders) was used to analyze the association between oxytocin dose and postpartum outcomes. The exposure was the cumulative oxytocin dose during labour, classified in percentiles (<25th, 25-75th, >75th). The outcomes were occurrence of obstetric anal sphincter injury, postpartum haemorrhage (blood loss > 1000 ml), Apgar score < 7 at five minutes, umbilical cord arterial pH, postpartum bladder overdistension, exclusive breastfeeding at one week and three months, and the woman's perceived birth experience. Women receiving high amounts (>75th percentile, >4370 mU) of oxytocin infusion during labour had an increased risk of postpartum haemorrhage (OR 2.73 (1.78–4.19)), an overdistended bladder (OR 2.19 (1.11–4.31)), an infant with an Apgar score < 7 at five minutes (OR 2.89 (1.27–6.57)), a negative birth experience (OR 1.83 (1.25–2.69)), and a decreased chance of exclusive breastfeeding at one week (OR 0.63 (0.41–0.96)). After adjusting for confounders, all outcomes remained statistically significant except risk of low Apgar score and chance of exclusive breastfeeding. In women with high cumulative oxytocin dose during labour prompt, and prophylactic administration of uterotonics after delivery of the placenta should be considered to reduce the risk of postpartum haemorrhage. The risk for bladder overdistension can be reduced by implementing routines for observation for signs of bladder filling in the early postpartum period, as well as routine use of bladder scans post micturition to assess for successful bladder emptying. As women's birth experience have a major impact on their future mental health, should be routinely assessed postpartum, and support should be offered to women with negative experiences. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding is advantageous for infant neurodevelopment. Nevertheless, insufficient human milk supply in exclusively breastfed infants may elevate the risk of neonatal jaundice, which can potentially result in neurological harm. Whether mothers should adhere to exclusive breastfeeding in infants with neonatal jaundice remains unclear. Data comes from the Jiangsu Birth Cohort (JBC), a prospective and longitudinal birth cohort study in China. A total of 2,577 infants born from November 2017 to March 2021 were included in the analysis. Multivariate linear regression models were used to analyze the associations between breastfeeding status, neonatal jaundice, and their interaction with infant neurodevelopment. Analysis was performed in 2022. Compared with "exclusive breastfeeding," fine motor scores of infants were lower for "mixed feeding" (β adj , −0.16; 95% CI, −0.29 to −0.03; p =0.016) and "no breastfeeding" (β adj , −0.41; 95% CI, −0.79 to −0.03; p =0.034). Compared with "no neonatal jaundice," infants with "severe neonatal jaundice" had lower scores for cognition (β adj , −0.44; 95% CI, −0.66 to −0.23; p <0.001) and fine motor (β adj , −0.19; 95% CI, −0.35 to −0.03; p =0.024). In infants with severe neonatal jaundice, the termination of exclusive breastfeeding before 6 months was associated with worse cognition (β adj , −0.28; 95% CI, −0.57 to 0.01), while this association was not observed in those without neonatal jaundice (β adj , 0.09; 95% CI, −0.26 to 0.43). Exclusive breastfeeding for the first 6 months is beneficial to the neurodevelopment of infants, especially in those with severe neonatal jaundice. [ABSTRACT FROM AUTHOR]

To qualitatively describe breastfeeding experiences among mothers who used galactagogues to increase their milk supply. One-time, semistructured phone interviews. US. Breastfeeding mothers (n = 19) who reported ever consuming foods, beverages, or herbal supplements to increase their milk supply in a cross-sectional online survey were purposefully sampled to participate in this qualitative study. Participants were diverse in terms of race and ethnicity, education, income, infant age (0–18 months), and prior breastfeeding experience (32% first-time breastfeeding). Reasons for trying to increase milk supply, sources of information about increasing milk supply, and strategies tried to increase milk supply. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Participants expressed determination and commitment to breastfeeding but unexpectedly struggled to breastfeed and increase their milk supply. They sought information from multiple sources and used individualized approaches to address milk supply concerns on the basis of recommendations from others, as well as the perceived convenience, cost, palatability, and safety of potential strategies. Results suggest a need to expand breastfeeding education and support so that lactating parents anticipate common breastfeeding challenges and are aware of evidence-based strategies for increasing their milk supply. [ABSTRACT FROM AUTHOR]

The prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding. We conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited. Sociodemographic data of the participants were gathered by self-administered questionnaire, and their FOC was assessed using the Wijma Delivery Expectancy Questionnaire. Participants were followed up to 42 days postpartum. Information regarding their modes of delivery was retrieved from medical records, and data regarding postpartum mental health symptoms and one-month postpartum breastfeeding were obtained through self-administered questionnaires. Among 1287 participants, 461 (35.8 %) had high-level FOC (W-DEQ ≥ 66). Logistic regressions showed that women with high-level of FOC had higher rates of caesarean delivery on maternal request (CDMR) (aOR = 1.55, 95 % CI: 1.00–2.41, p = 0.049), a higher incidence of postpartum mental health symptoms (aOR = 1.68, 95 % CI: 1.09–2.59, p = 0.018), lower rates of one-month postpartum exclusive breastfeeding (aOR = 0.33, 95 % CI: 0.16–0.69, p = 0.003) and mixed feeding (aOR = 0.44, 95 % CI: 0.21–0.91, p = 0.028). The long-term implications of FOC beyond the immediate postpartum period were not explored in the study. High-level FOC during the third trimester was associated with increased CDMR and postpartum mental health symptoms and reduced breastfeeding establishment. These results underscore the significance of FOC screening and tailored interventions for affected women. • High-level fear of childbirth was associated with higher rates of cesarean delivery and postpartum mental health symptoms. • High-level fear of childbirth led to lower rates of breastfeeding. • This was among the first studies to explore the influence of fear of childbirth on breastfeeding. • This study addressed the inconsistencies in current research on fear of childbirth, by adding evidence of Chinese population. • This study suggests the integration of appropriate interventions on fear of childbirth into current perinatal care system. [ABSTRACT FROM AUTHOR]

A healthy diet is important at every stage of life. We aimed to determine the serum vitamin D and iron, folic acid, and vitamin B 12 levels in healthy children younger than 48 months and to investigate the relationship between nutrition and micronutrients in children of this age. In this observational study children who presented to the Pediatrics Clinic of our hospital during the period 2015–2022 were included. Vitamin D and other nutritional parameters (serum folate, vitamin B 12 , iron, ferritin) were evaluated from the study participants' serum samples during the outpatient clinic visit (jaundice check-up, pre-circumcision surgery, etc.). Overall, 766 cases were included in the study. Vitamin D was higher in the group that was fed only breast milk (p = 0.019), and vitamin D insufficiency was statistically higher in the formula group (p = 0.015). Hemoglobin levels were significantly higher in the formula group (p = 0.007). The folic acid level was found to be normal in all infants, and was higher in formula-fed infants (p = 0.012). Vitamin B 12 was found to be significantly higher in infants fed with formula (p = 0.001). Vitamin D deficiency was most common in infants aged 25–48 months (p < 0.001). Similarly, vitamin D insufficiency (12–20 ng/mL) was detected in infants aged between 25 and 48 months (p < 0.001). Micronutrients such as calcium, folic acid, iron, vitamin D, and iodine are critical in early fetal development from pregnancy onward. It is vital to raise awareness of this issue for mothers, starting from pregnancy, and for mothers to feed their babies more carefully in the first years of life. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding (EBF) is recommended for the first 6 months of life, yet EBF rates at 6 months (T3) in most developed countries are low. Painful and nonpainful sensory stimuli processing is linked, and while pain has been suggested to restrict breastfeeding, its coupling with sensory over-responsiveness (SOR) in relation to breastfeeding has not yet been reported. We aimed to explore whether breastfeeding-related pain, SOR, and general pain sensitivity predict nonexclusive breastfeeding (NEBF) at T3. In this prospective study, participants were recruited at 2 days postpartum (enrollment). For the assessment of breastfeeding-related pain, participants completed the visual analogue scale and the Short-Form McGill Pain Questionnaire at enrollment, and at 6 weeks after birth. At T3, they completed the Pain Sensitivity Questionnaire and the Sensory Responsiveness Questionnaire-Intensity Scale and then provided information about their breastfeeding status. Participants were divided into two groups accordingly: EBF and NEBF. A total of 164 participants were reached at T3: EBF (n = 105) and NEBF (n = 59). The incidence of SOR was significantly higher among NEBF compared with EBF participants (25.4% vs. 11.4%; p =.020). Between enrollment and 6 weeks after birth, 72.3% of the EBF participants had reported a ≥30% pain reduction, compared with 44.8% of the NEBF participants (p =.001). Logistic regression modeling revealed that both breastfeeding-related pain reduction and SOR predicted NEBF at T3 (p <.001), indicating a 3.2 times (p =.001) and 2.5 times (p =.041) odds ratio for NEBF, respectively. SOR and sustained breastfeeding-related pain predict NEBF at T3 and may emerge as substantial breastfeeding barriers. [ABSTRACT FROM AUTHOR]

En France, près de 400 nourrissons de moins de 2 ans meurent chaque année de mort inattendue du nourrisson (MIN). Il s'agit d'une « mort survenant brutalement chez un nourrisson alors que rien, dans ses antécédents connus, ne pouvait le laisser prévoir ». Les campagnes nationales de promotion du couchage sur le dos au début des années 1990 ont permis une baisse significative du nombre de MIN. Depuis une vingtaine d'années, ce chiffre stagne alors que de nombreux décès pourraient être évités en appliquant des règles simples. La MIN est souvent d'origine multifactorielle. Selon le modèle du « triple risque », elle survient chez un nourrisson présentant une vulnérabilité sous-jacente, exposé à un facteur de stress exogène, pendant une période de développement critique. La suppression des facteurs de risque externes peut permettre à l'enfant vulnérable de dépasser l'âge critique sans décéder. L'objectif est d'éviter les risques de suffocation ou de confinement liés aux conditions de couchage. L'un des facteurs de risque majeur est la position de couchage : le couchage sur le dos est recommandé jusqu'à ce que l'enfant change de position de lui-même. Les autres facteurs de risque sont l'exposition au tabac, la présence d'objet dans le lit, une température ambiante trop élevée ou encore le partage du lit. Il existe des facteurs de protection : allaitement maternel, vaccinations, partage de la chambre et sucette pendant le sommeil. La prévention de la MIN repose sur une information généralisée à l'ensemble de la population, dès la période anténatale. In France nearly 400 infants less than 2 years old die of Sudden Unexpected Death in Infancy (SUDI) each year. This is defined as a "death occurring brutally in an infant, which cannot be predicted by the medical history". National information campaigns in favor of supine sleeping in the early 1990's have lead to a significant decrease in the rate of SUDI. For the past 20 years this rate has stabilized although a large number of deaths could have been avoided thanks to simple preventive measures. SUDI is often multifactorial. According to the "triple risk model", it occurs in an infant presenting with an underlying vulnerability, exposed to an exogenous stress factor, during a critical period of development. The suppression of external risk factors can allow a vulnerable child to survive past the critical age. The aim is to avoid the risk of suffocation or confinement linked to sleeping conditions. One of the major risk factors is the sleeping position: sleeping on the back is recommended until the child shifts position on its own. Other risk factors include exposure to tobacco, the presence of objects in the bed, an excessively high bedroom temperature and sleeping in the parents' bed. There are also some protective factors including: breastfeeding, vaccinations, sleeping in the parents' bedroom and having a pacifier during sleep. Preventing SUDI requires a broad information to the entire public, starting during the prenatal period. [ABSTRACT FROM AUTHOR]

The role of nutritional interventions for the primary prevention of cow's milk allergy (CMA) remains debated as well as the role of early introduction of allergenic foods, which is largely encouraged from the beginning of complementary feeding. Considering the introduction of cow's milk protein (CMP), current recommendations suggest avoidance of any cow's milk formula (CMF) supplements in breastfed infants in the maternity ward. By contrast, based on poor evidence, some authors support systematic supplements of CMP in breastfed children at risk of allergy from the first week of life. The Committee on Nutrition of the French Society of Pediatrics considers that such a proposal requires more clinical studies and mainly randomized and placebo-controlled clinical trials before becoming a recommendation. [ABSTRACT FROM AUTHOR]

Initiation of breastfeeding has been associated with reduced post-perinatal infant mortality. Although most states have initiatives to protect, promote, and support breastfeeding, no analysis of the association between breastfeeding and infant mortality has been conducted at the state and regional levels. To understand the associations between breastfeeding and post-perinatal infant mortality, the initiation of breastfeeding with post-perinatal infant mortality was analyzed by geographic region and individual states within each region. This study was a prospective cohort analysis linking U.S. national birth and post-perinatal infant death data for nearly 10 million infants born in 2016–2018, who were then followed for one year after birth and analyzed in 2021–2022. A total of 9,711,567 live births and 20,632 post-perinatal infant deaths from 48 states and the District of Columbia were included in the analysis. The overall AOR and 95% CIs for breastfeeding initiation with post-perinatal infant mortality was 0.67 (0.65, 0.69, p <0.0001) for days 7–364. All seven U.S. geographic regions had significant reductions in postperinatal infant deaths associated with breastfeeding initiation; Mid-Atlantic and Northeast regions had the largest reductions with AOR of 0.56 (95% CI=0.51, 0.61, p <0.001 and 0.50, 0.63, p <0.001, respectively), whereas the Southeast had the smallest reduction with AOR of 0.79 (95% CI=0.75, 0.84, p <0.001). Statistically significant results were noted for 35 individual states for reduction in total post-perinatal infant deaths. Although regional and state variation in the magnitude of the association between breastfeeding and infant mortality exists, the consistency of reduced risk, together with existing literature, suggests that breastfeeding promotion and support may be a strategy to reduce infant mortality in the U.S. [ABSTRACT FROM AUTHOR]

Preterm infants are under risk of several shortcomings including sleep disturbances (SD). This cross-sectional study evaluated factors associated with SD in preterm and low birth weight infants in a reference center for preterm children at a University Hospital, southeastern Brazil. A hundred-four dyads of mothers-infants 0–3 years participated. Mothers answered an online questionnaire (Google Forms®) evaluating childbirth characteristics, gestational age, breastfeeding, bottle feeding, non-nutritive sucking habits and sociodemographic information. The Brazilian version of the Brief Infant Sleep Questionnaire (BISQ) evaluated SD. Bivariate and Logistic Regression analyses were performed (p < 0.05). SD was present in 45.2% of the sample. Multivariate Logistic Regression Model showed that infants breastfed ≥3 times at night had 5.006 more chances to have SD (CI 95% = 1.229–20.400) compared to those who did not breastfeed at night. Infants who were bottle-fed 3 ≥ times at night had 6.952 more chances to have SD (CI = 95% = 1.364–35.427) compared to those who were bottle fed less frequently. The chance of SD decreased 6.6% (CI 95% = 0.889–0.982) for each increase of a month in infant's age, and infants from families with higher income had 3.535 more chances to have SD (CI 95% = 1.006–12.416). The younger the child, a higher frequency of night feeding and belonging to higher income families were associated with SD. Recognizing the associated factors with SD in newborns and infants can aid families to better deal with this issue, promote better sleep quality and individualized counseling. • Breastfeeding 3 or more times at nighttime increases the chance of having sleep disturbances. • Bottle-feeding 3 or more times at nighttime increases the chance of having sleep disturbances compared to lower frequencies. • Increase in infant's age is a protective factor against sleep disturbances. [ABSTRACT FROM AUTHOR]

Breastfeeding has been linked to a higher consumption of fruit and vegetables at ages 4 to 5 years. More recently, it has been suggested that it may also be associated with lower ultraprocessed food (UPF) consumption in childhood. The aim of this study was to assess whether breastfeeding duration was associated with consumption of UPF in a sample of Mediterranean preschoolers. This study involved a cross-sectional analysis of baseline information of children in the Child Follow-Up for Optimal Development cohort. Children were enrolled at ages 4 to 5 years and information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative food frequency questionnaire and foods were classified based on the degree of processing according to the NOVA classification. This study used baseline information for 806 participants enrolled in the Child Follow-Up for Optimal Development cohort between January 2015 and June 2021 in Spain. Main study outcome measures were difference in grams per day and in the percentage of total energy intake from UPF consumption related to breastfeeding duration, and odds ratio that UPF represents a high percentage of total energy intake. Crude and multivariable adjusted estimates were calculated with generalized estimating equations to account for intracluster correlation between siblings. The prevalence of breastfeeding in the sample was 84%. After adjusting for potential confounders, children who were breastfed for some time reported significantly lower consumption of UPF than children who were not breastfed at all. The mean differences were –19.2 g (95% CI –44.2 to 10.8) for children who were breastfed for <6 months, –42.5 g (95% CI -77.2 to –7.80) for those who were breastfed for 6 to 12 months, and –43.6 g (95% CI –79.8 to –7.48) for those who were breastfed for 12 months or more (P value for trend = 0.01). After adjusting for potential confounders, compared with children who were not breastfed, those who were breastfed for ≥12 months had consistently lower odds of UPF representing more than 25%, 30%, 35%, and 40% of total energy intake. Breastfeeding is associated with lower consumption of UPF in Spanish preschoolers. [ABSTRACT FROM AUTHOR]

L'objet de notre propos concerne la place que devrait avoir la mère dans la stratégie de soins de son enfant né à la limite de la viabilité. Dans ce contexte, il s'agit de mettre à la disposition des enfants nés à la limite de la viabilité, tous les moyens disponibles à leur survie et dans le meilleur des cas sans séquelle. Mais, au préalable, on rappellera certaines notions en rapport avec la vitalité et la viabilité du fœtus. Puis, nous examinerons les conséquences sur sa maturation dès lors qu'il se trouve séparé de son placenta. Au-delà de la limite supérieure de la « zone grise » (25 SA), les équipes proposent une prise en charge, active, systématique ou quasi systématique, à tous les enfants. Cependant, de notre point de vue, la mère devrait être totalement intégrée à cette stratégie. Les effets physiologiques, validés du contact peau à peau, devraient profiter le plus tôt possible (dès la prise en charge médicale accomplie à la naissance) aux prématurés stables, mais surtout aux instables. L'importance du lait maternel dans cette stratégie de soins n'est plus à démontrer. Dès leurs naissances et indépendamment de leur âge gestationnel et de leur état clinique (stable ou instable), les extrêmes prématurés devraient recevoir une alimentation entérale avec le colostrum de leurs mères sécrété pendant les trois à cinq premiers jours de vie. L'implication de la mère contribuera grandement au développement optimal de son enfant. The subject of our discussion concerns the place that the mother should have in the care strategy of her child born at the limit of viability. In this context, it is a question of making available to children born at the limit of viability, all the means available to their survival and in the best cases without sequel. But, first, we will recall certain notions related to the vitality and viability of the fetus. Then, we will examine the consequences on its maturation as soon as it is separated from its placenta. Beyond the upper limit of the "gray zone" (25 SA), the teams offer active, systematic or quasi-systematic care to all children. However, from our perspective, the mother should be fully integrated into this strategy. The physiological effects, validated from skin-to-skin contact, should benefit as soon as possible (as soon as the medical management accomplished at birth) to stable premature babies, but especially to unstable. The importance of breast milk in this care strategy no longer needs to be demonstrated. From birth and regardless of their gestational age and clinical status (stable or unstable), extremely premature babies should receive enteral nutrition with the colostrum of their mothers secreted during the first three to five days of life. The involvement of the mother will greatly contribute to the optimal development of her child. [ABSTRACT FROM AUTHOR]

New mothers generally experience poor and/or disrupted sleep. A range of infant care and mental health factors may impact new mothers' sleep quality. A cross-sectional online survey was completed by a sample of 101 Australian new mothers with children under 12 months (M = 5.52 months, SD = 3.29 months) to examine the relationship between infant feeding method, infant sleeping location, and postpartum depression with maternal sleep quality. Subjective maternal sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and postpartum depression was measured using the Edinburgh Postpartum Depression Scale (EPDS). Overall, new mothers experienced poor subjective sleep quality, with high average PSQI scores, above the cut-off of 5 (M = 9.63, SD = 4.07). The majority of new mothers did not experience postpartum depression, with an average EPDS score below the cut-off of 11 (8.66, SD = 5.20). Mothers who breastfed their infants experienced significantly better subjective sleep quality than mothers who bottle-fed, with a medium effect size (ηp2 = 0.458). Subjective maternal sleep quality did not differ based on infant sleeping location. Poor subjective maternal sleep quality was a significant predictor of postpartum depression. While poor sleep was common in this sample of Australian new mothers, this study demonstrated that new mothers who breastfeed may experience slightly better subjective sleep quality than other feeding methods. Further research into, and better services for the education and advocation of, new mothers' sleep quality will be beneficial to both new mothers and clinicians. • New mothers typically experience poor and/or disrupted sleep. • Their sleep can be impacted by personal factors and factors relating to infant care. • Breastfeeding was associated with better maternal sleep quality. • Maternal sleep quality was associated with infant sleeping location. • Poor maternal sleep quality predicted postpartum depression. [ABSTRACT FROM AUTHOR]

Practical information is needed on the extent to which elite and competitive female athletes can continue to train and compete safely during pregnancy, without risk for themselves or their child, as well as advice for the postpartum period, including breast-feeding. Such information is also needed to recommend cycling for non-athlete women who wish to exercise. For this reason, the International Cycling Union (UCI) has produced this guide to provide information for all those who participate in recreational cycling activities and UCI sanctioned competitions during pregnancy. This policy has been developed utilising the AGREE II instrument and has had input from elite female cyclists, including those who have came back to compete following pregnancy. Supported by clinical evidence, the UCI encourages women to continue cycling throughout their pregnancy. Although cycling exercise is generally safe during pregnancy, some general principles are required for women, especially when cycling in the heat. No competitive cycling events included in the UCI calendar are possible beyond the 1st trimester of pregnancy, mainly to prevent the risk of trauma to the uterus and foetus in the event of an accident. However, the UCI encourages pregnant women to participate in recreational/leisure cycling as a form of physical activity throughout their pregnancy; but the ability to participate in organised recreational activities is only possible up to the end of the 1st trimester. Exercise, and especially cycling exercise, should be viewed as an important component to improve women's psychological health and common complaints during the postpartum period. Breast-feeding is highly recommended when women return to exercise and there is no impact of exercise on the quantity and quality of breast-milk. There are no significant disadvantages with regard to foetal and/or maternal conditions with high-intensity training programmes when they are subjectively tolerated and carefully monitored, at least during the first trimester of pregnancy. For the global population, exercises at moderate-intensity during pregnancy have many positive effects for both the mothers and their unborn children. That is why it is highly recommended that pregnant women begin or continue biking at moderate-intensity at least 150 minutes a week with at least 3 sessions of a duration longer than 30 minutes each. [ABSTRACT FROM AUTHOR]

Assess the quality of free, commercially available infant-feeding mobile applications (apps) and their appropriateness for audiences with low income and of racial and ethnic diversity using the App Quality Evaluation tool. Researchers selected apps using an iterative process (n = 6). Health professionals (n = 10) who work with mothers with infants and low income who completed the App Quality Evaluation tool for each app, consisting of 7 domains of app quality. Average domain scores were calculated for each app (> 8 indicates high quality). Evaluators highly rated app function and purpose for WebMD Baby (8.0 ± 1.8 and 8.2 ± 0.9, respectively) and Baby Center (8.0 ± 2.1 and 8.0 ± 2.6, respectively). For other apps, no domains were highly rated. No apps were rated highly for appropriateness (range 5.7–7.7) nor provided high-quality infant-feeding information for mothers with low income. Few apps were rated highly appropriate for mothers who are Black or Hispanic. Commercially available infant-feeding apps are of limited quality, indicating the need to develop high-quality apps for audiences with low income and Black and Hispanic identities. [ABSTRACT FROM AUTHOR]

Early feeding practices have a great impact on the growth and development of infants, and the health of mothers. Maternal emotional regulation (ER) is closely related to infant feeding practices. Exploring the relationship between ER strategy and feeding practice can inform early exclusive breastfeeding (EBF) interventions. Using baseline survey of a longitudinal study, 965 mothers in Chongqing municipality, Guangzhou city, and Huizhou city were enrolled. At baseline, the study used self-administrated questionnaires to investigate the socio-demographic characteristics, maternal ER strategies and feeding practice within 72 h of delivery. Chi-square test and logistic regression were used to determine the associations of the mothers' ER and feeding practices within 72 h postpartum. Among 965 participants, 27.8 % of mothers practiced EBF, and 69.5 % of mothers reported getting breastfeeding education from health providers. The average scores on the cognitive reappraisal and the expressive suppression of the ERQ were 29.95 ± 7.24 and 14.47 ± 5.16 respectively. Multivariable analysis showed women with expressive suppression were less likely to practice EBF (aOR = 0.96, 95%CI: 0.93–0.98, p = 0.002), while receiving breastfeeding education was positively associated with EBF (aOR = 1.52, 95%CI: 1.09–2.12, p = 0.013). Because the study started during the COVID-19 pandemic, the lock-down measures paused recruitments for quite some time reducing the enrollment of participation. The data we used was within 72 h postpartum, hence the period of time to study feeding practices was short. Mothers' ER strategy and breastfeeding education need to be addressed as part of interventions designed to improve EBF rates during the newborn period in China. • The average scores on the cognitive reappraisal and the expressive suppression(ER) were 30±7.2 and 14.5±5.2 respectively. • Of all, 27.8% of mothers practiced EBF, and 69.5% of mothers reported getting breastfeeding education from health providers. • Women with ER were less likely to practice EBF, while receiving education facilitated EBF within 72h of delivery. [ABSTRACT FROM AUTHOR]

Pregnancy-related anxiety (PRA) is a distinct type of anxiety from general anxiety, affects many pregnant women, and is correlated with poor behavioral development in children. However, the mediation paths were unclear. A total of 2032 mother-infant pairs from the Ma'anshan Birth Cohort were included in the current study. Maternal PRA was assessed in the second and third trimesters. Children's behavioral development was evaluated at the age of 18 months. In addition, information on parenting styles and breastfeeding methods was obtained at postpartum. Multivariate regression and structural equation modeling were used to examine the associations between maternal PRA and children's behavioral development. Significant intercorrelations were found between maternal PRA, the potential mediators (parenting styles and breastfeeding methods), and 18-month-old children's ASQ scores. Parenting styles played an intermediary role in the relationship between maternal PRA and children's behavioral development (β = 0.030, 95 % confidence interval: 0.017–0.051), and the mediating effect accounted for 29.1 % of the total effect. However, breastfeeding methods did not mediate the link between PRA and children's behavior. Depression and postpartum anxiety were not controlled for in our analysis, which left us unable to estimate the independent impact of PRA on children's behavior. Parenting rather than breastfeeding is the mediating factor of behavioral problems in children caused by PRA. • Pregnancy-related anxiety negatively associated with children's ASQ results. • Pregnancy-related anxiety negatively associated with positive parenting. • Mediating effect of parenting styles accounted for 29.1 % of the total effect. • The mediating effect of breastfeeding methods was not significant. [ABSTRACT FROM AUTHOR]

To examine the association between female reproductive factors and the risk of depression. A retrospective cohort study was performed using a national database in South Korea. Among 945,729 eligible postmenopausal women, the associations between female reproductive factors including the age at menarche, age at menopause, parity, duration of oral contraceptive (OC) use, duration of breastfeeding, and use of menopausal hormone therapy (MHT), and the occurrence of depression were investigated. Compared to women with menarche at the age of ≤12 years, those with menarche at the age of ≥15 showed an increased risk of depression [adjusted hazard ratio (aHR) of 1.09 for 15–16 years and 1.18 for ≥17 years]. Compared to women with menopause at the age of 50–54, those with menopause at an earlier age showed an increased risk of depression (aHR of 1.20 for <40 years), and those with menopause at a later age showed a decreased risk of depression (aHR of 0.94 for ≥55 years). Use of MHT was associated with an increased risk of depression (aHR of 1.30 for ≥5 years). Duration of breastfeeding and duration of OC use had U-shaped but weak associations with depression. Whereas parity did not show a significant association with depression. Late menarche, early menopause, and the use of MHT were associated with an increased risk of depression in postmenopausal women. • Association between female reproductive factors and depression in postmenopausal women. • Late menarche and early menopause increased the risk of depression. • Oral contraceptive use and menopausal hormone therapy increased the risk. [ABSTRACT FROM AUTHOR]

This study aimed to identify significant antenatal and postnatal factors associated with neonatal death at 2–7 days and at 2–28 days in the Indian subcontinent. Results from this study may help guide strategies to improve antenatal and postnatal care services and reduce neonatal mortality. Nationally representative recent Demographic and Health Survey data sets from five countries, including Bangladesh, India, Pakistan, Maldives and Nepal, were used. Survey-weighted univariate distributions were used for study population characteristics and bivariate distributions, along with the chi-squared test for unadjusted associations. Finally, multilevel logistic regression models were performed to determine the association of antenatal care (ANC) and postnatal care (PNC) factors with neonatal deaths. Among 200,499 live births, the highest neonatal death rate was observed in Pakistan, followed by Bangladesh, whereas the lowest rate was in Nepal. After adjusting for sociodemographic and maternal control variables, the multilevel analysis showed a significantly lower likelihood of neonatal death at 2–7 days and 2–28 days with ANC visits <12 weeks' gestation, at least four ANC visits during pregnancy, PNC visits within the first week after birth and breastfeeding. Delivery at home by a skilled birth attendant compared to unskilled birth attendant was significantly associated with lower neonatal death at 2–7 days. Multifoetal gestation was significantly associated with higher neonatal death at 2–7 days and at 2–28 days. The findings suggest that strengthening ANC and PNC services will improve newborn health in the Indian subcontinent and decrease neonatal mortality. [ABSTRACT FROM AUTHOR]

To examine the effect of delayed umbilical cord clamping on the infant's betaendorphin level, mother–infant attachment and breastfeeding. This study had an experimental design with a control group. The study was undertaken between October and December 2017 in a maternity hospital in the east of Turkey. In total, 107 pregnant women [55 in the experimental group (delayed cord clamping) and 52 in the control group (early cord clamping)] participated in the study. The beta-endorphin level in the umbilical cord was 775.80 ± 229.35 in the experimental group and 547.91 ± 290.01 in the control group, and the difference was significant (t = 4.492, p = 0.000). Similarly, the prolactin level in the umbilical cord was 174.26 ± 47.20 in the experimental group and 119.06 ± 47.74 in the control group, and the difference was significant (t = 6.012, p = 0.000). Mother–infant attachment and breastfeeding success were higher in the experimental group. Beta-endorphin and prolactin levels in the umbilical cord, mother–infant attachment and breastfeeding success were higher in the group which underwent delayed cord clamping. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding, a longer breastfeeding duration, and interaction with the baby during lactation improve mothers' mental health. However, few studies have targeted women around 2.5 years after childbirth, when women are still considered to have been in a period of mental and physical health vulnerability. This study examined this aspect in a large cohort of mother-child pairs. Data were obtained from 85,735 mothers in an ongoing nationwide birth cohort study in Japan. Exposures were exclusive breastfeeding (yes/no), continued breastfeeding up to 2 years (yes/no), and interaction with the baby during feeding (yes/no). Outcomes were mothers' mental and physical health 2.5 years after childbirth measured using Mental and Physical Component Summary scores (MCS and PCS scores, respectively) from the 8-item Short-Form Health Survey. Generalized additive mixed model analysis was used to derive each estimate for the three exposures and their interactions, with each "no" answer as reference. Exclusive breastfeeding and interaction with the baby during feeding were associated with MCS score increases of 0.28 (95%CI: 0.10–0.47) and 0.41 (95%CI: 0.29–0.54), respectively. However, no associations were found for continued breastfeeding up to 2 years and no interactions were identified. No significant differences were observed for PCS scores. All variables were measured using a self-administered questionnaire. Continued exclusive breastfeeding until 6 months and interaction with the baby during feeding may help to promote mother's mental health 2.5 years after childbirth. These findings further strengthen the rationale for the World Health Organization's recommended lactation practices. • We examined infants' feeding patterns and mothers' mental and physical health. • Data from 85,735 mothers were analyzed. • Exclusive breastfeeding was associated with the mother's mental health. • Interaction with a baby during feeding was associated with the mother's mental health. [ABSTRACT FROM AUTHOR]

L'accouchement des enfants de grossesse gémellaire peut représenter une situation à risque, et la prise en charge à la naissance des nouveau-nés multiples est souvent plus spécialisée que celle des nouveau-nés uniques. Même en cas d'accouchement physiologique, et en l'absence de prématurité ou faible poids de naissance, les professionnels de santé périnatale sont confrontés à de nombreux challenges pour favoriser une prise en charge et une adaptation optimale à la naissance, en contexte de gémellité. La connaissance des indicateurs épidémiologiques de santé périnatale et la compréhension des spécificités physiopathologiques de la période d'adaptation, permettent d'identifier les risques néonatals et d'instaurer des prises en charge ciblées pour les nouveau-nés issus de grossesses multiples. L'objectif de cette mise au point est de décrire les spécificités de la prise en charge à la naissance de jumeaux à terme – ou prématurés tardifs – en situation d'accouchement physiologique. Cette approche vise à optimiser les premiers soins en salle de naissance et réduire la survenue de complications et morbidités sévères chez ces enfants plus vulnérables. Twin pregnancy has risks of adverse outcomes for mother and baby. Outcome reporting of multiple pregnancies should be standardized. Implementing knowledge of infant-centered outcomes following multiple birth would help healthcare providers to recognize risk factors, and to provide targeted interventions and support to these vulnerable infants and their families. The implementation of specific clinical practice strategies is often necessary to delivery adequate care to multiple births, since the first hour of life. Mother education to breastfeeding initiation and duration should occur as part of antenatal care, and requires proper training, guidance and support from healthcare professionals. [ABSTRACT FROM AUTHOR]

Swiss national recommendations advise, since end of 2018, supporting women with HIV who wish to breastfeed. Our objective is to describe the motivational factors and the outcome of these women and of their infants. mothers included in MoCHiV with a delivery between January 2019 and February 2021 who fulfilled the criteria of the "optimal scenario" (adherence to cART, regular clinical care, and suppressed HIV plasma viral load (pVL) of <50 RNA copies/ml) and who decided to breastfeed after a shared decision-making process, were approached to participate in this nested study and asked to fill-in a questionnaire exploring the main motivating factors for breastfeeding. Between January 9, 2019 and February 7, 2021, 41 women gave birth, and 25 decided to breastfeed of which 20 accepted to participate in the nested study. The three main motivational factors of these women were bonding, neonatal and maternal health benefits. They breastfed for a median duration of 6.3 months (range 0.7–25.7, IQR 2.5–11.1). None of the breastfed neonates received HIV post-exposure prophylaxis. There was no HIV transmission: 24 infants tested negative for HIV at least 3 months after weaning; one mother was still breastfeeding when we analyzed the data. As a result of a shared decision-making process, a high proportion of mothers expressed a desire to breastfeed. No breastfed infant acquired HIV. The surveillance of breastfeeding mother-infant pairs in high resource settings should be continued to help update guidelines and recommendations. [ABSTRACT FROM AUTHOR]

To evaluate the association between breastfeeding history, including lifetime exclusive breastfeeding, and risk of adenomyosis. We used data from a case-control study designed with 2 control groups to address the challenge of selecting noncases for a valid epidemiologic study when cases are identified by hysterectomy. The case-control study was conducted among premenopausal and postmenopausal enrollees aged 18–59 years in a large, integrated health care system in western Washington state. Cases were enrollees with incident, pathology-confirmed adenomyosis diagnosed during 2001–2006 (n = 386). The 2 control groups were as follows: (1) randomly selected age-matched enrollees with intact uteri ("population controls," n = 323) and (2) hysterectomy controls (n = 233). Data on breastfeeding history were collected by in-person interviews. For each reported live birth, participants were asked whether they breastfed, along with infant age at supplemental feeding introduction and breastfeeding discontinuation. Among participants with at least 1 live birth (330 cases, 246 population controls, and 198 hysterectomy controls), we used unconditional logistic regression to estimate adjusted odds ratios and 95% confidence intervals (CIs) for the associations between the following: (1) ever breastfeeding, (2) ever breastfeeding for ≥8 weeks, (3) lifetime breastfeeding, and (4) lifetime exclusive breastfeeding and risk of adenomyosis. Analyses were adjusted for age, reference year, smoking, education, and parity. In analyses comparing cases with population controls, we observed a 40% decreased odds of adenomyosis with a history of ever breastfeeding (adjusted odds ratio, 0.6; 95% CI, 0.3–1.0) and breastfeeding for ≥8 weeks (adjusted odds ratio, 0.6; 95% CI, 0.4–0.8). The strongest associations, 60%–70% decreased odds of adenomyosis, were observed with ≥12 months of lifetime breastfeeding (vs. <3 months) (adjusted odds ratio, 0.4; 95% CI, 0.2–0.6) and 9 to <12 months of lifetime exclusive breastfeeding (vs. <3 months) (adjusted odds ratio, 0.3; 95% CI, 0.2–0.6), comparing cases to population controls. In analyses using hysterectomy controls, we observed similar patterns of associations slightly attenuated in magnitude. Breastfeeding history was associated with a 40% decreased odds of adenomyosis, a condition that can confer substantial morbidity and requires hysterectomy for definitive treatment. The consistency of our findings with that of a previous study lends support that breastfeeding may modify risk of adenomyosis. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding has important benefits for both children and mothers. However, the proportion of exclusive breastfeeding is still not evenly distributed among regions, including in Indonesia. The purpose of this study was to analyze the practice of exclusive breastfeeding by region in Indonesia and its influencing factors. This study was cross-sectional study. This study used secondary data from the Indonesia Demographic and Health Survey 2017. The total sample was 1621 respondents, which consisted of mothers whose last child was under six months old and was still alive; the mothers did not have twins and lived with their child. Data were analyzed by using Quantum GIS and binary logistic regression statistical tests. This study shows that 51.6% of respondents gave exclusive breastfeeding in Indonesia. The highest proportion was in the Nusa Tenggara region (72.3%), whereas the lowest was in Kalimantan province (37.5%). Mothers who lived in the regions of Nusa Tenggara, Sulawesi, Java-Bali, and Sumatra had a higher chance of exclusive breastfeeding compared to those in the Kalimantan region. The factors associated with the exclusive breastfeeding vary widely across all regions, and the child's age is the only common factor associated with the exclusive breastfeeding in all regions, except Kalimantan. This study shows wide variation in regional proportions and determinants of exclusive breastfeeding in Indonesia. Therefore, appropriate policies and strategies are needed to increase equitable exclusive breastfeeding practices across all regions in Indonesia. [ABSTRACT FROM AUTHOR]

Introduction: Social support is a modifiable social determinant of health that shapes breastfeeding outcomes and may contribute to racial and ethnic breastfeeding disparities. This study characterizes the relationship between social support and early breastfeeding.Methods: This is a cross-sectional analysis of baseline data collected in 2019-2021 for an RCT. Social support was measured using the Enhancing Recovery in Coronary Heart Disease Social Support Instrument. Outcomes, collected by self-report, included (1) early breastfeeding within the first 21 days of life, (2) planned breastfeeding duration, and (3) confidence in meeting breastfeeding goals. Each outcome was modeled using proportional odds regression, adjusting for covariates. Analysis was conducted in 2021-2022.Results: Self-reported race and ethnicity among 883 mothers were 50% Hispanic, 17% Black, 23% White, and 10% other. A large proportion (88%) of mothers were breastfeeding. Most breastfeeding mothers (82%) planned to breastfeed for at least 6 months, with more than half (58%) planning to continue for 12 months or more. Most women (65%) were confident or very confident in meeting their breastfeeding duration goal. In adjusted models, perceived social support was associated with planned breastfeeding duration (p=0.042) but not with early breastfeeding (p=0.873) or confidence in meeting breastfeeding goals (p=0.427). Among the covariates, maternal depressive symptoms were associated with lower breastfeeding confidence (p<0.001).Conclusions: The associations between perceived social support and breastfeeding outcomes are nuanced. In this sample of racially and ethnically diverse mothers, social support was associated with longer planned breastfeeding duration but not with early breastfeeding or breastfeeding confidence. [ABSTRACT FROM AUTHOR]

Describe long-term breastfeeding initiation trends by prenatal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and race/ethnicity. Cross-sectional study of birth certificate data from 2009 to 2017 in 24 states that adopted the 2003 birth certificate revision by 2009. Term births with hospital costs covered by Medicaid (N = 6,402,704). Breastfeeding initiation. The descriptive characteristics of WIC participants and WIC-eligible nonparticipants were compared by year and race/ethnicity using the chi-square test of independence or t tests. Adjusted breastfeeding initiation prevalence was estimated using linear regression models with county fixed effects, controlling for sociodemographic and obstetric/health factors. Trends were compared by WIC status overall and within racial/ethnic groups. Differences and P values were assessed using interaction terms between WIC and year. Breastfeeding initiation increased for WIC participants and nonparticipants. Special Supplemental Nutrition Program for Women, Infants, and Children participants had lower adjusted breastfeeding initiation (2009: 69.0%; 2017: 78.5%) than nonparticipants (2009: 70.8%; 2017: 80.1%) (P < 0.001 per year). Breastfeeding initiation increased more rapidly in WIC participants than in nonparticipants for non-Hispanic Asian/Pacific Islander (21.4% and 8.6%, respectively; P < 0.001) and American Indian/Alaskan Native (13.6% and 8.1%, respectively; P = 0.02)—narrowing the gap between WIC participants and nonparticipants over time. Annual birth certificate data provide detailed information for monitoring trends and disparities in breastfeeding initiation by prenatal WIC status. These findings can inform WIC and maternal child health program efforts to improve breastfeeding promotion for populations with low-income and racial/ethnic groups. [ABSTRACT FROM AUTHOR]

Maternal antenatal depression experienced around conception or during pregnancy may adversely affect child development. This study explores three potential mechanisms of the effects of antenatal depression on children's developmental delays at 2–3 years: gestational age of the child, continued depressive symptoms postnatally, and interrupted breastfeeding practices. Mothers (N = 2888) of 3450 children, including 2303 singletons and 1147 multiples from the Upstate KIDS cohort provided data. Linked hospital discharge data was combined with mothers' reports to identify women with moderate to severe antenatal depression. Gestational age was extracted from birth certificates. Mothers completed a depression screener at 4 months postpartum, reported about their breastfeeding practices from 4 to 12 months postpartum, and completed a developmental delay screener when children were 24, 30, and 36 months. In unadjusted path analysis models, mothers with antenatal depression had more postnatal depressive symptoms and breastfed fewer months, which translated into children being more likely to have developmental delays. Gestational age was not a mediator. Effects were similar across girls and boys and singletons and twins, and largely held when adjusting for covariates. Main limitations were the relatively advantaged sample and reliance on maternal report. Maternal antenatal depression may impact child development through continued depressive symptoms in the postpartum period and through reduced breastfeeding duration suggesting additional targets for intervention. • This study explored 3 potential mechanisms of antenatal depression's effects on children's developmental delays at 2-3 years. • Associations were partially mediated by postnatal depression symptoms and breastfeeding duration, but not gestational age. • Models were similar across singletons and twins as well as girls and boys. • Beyond treating depression, this study suggests that breastfeeding may be a viable target for intervention. [ABSTRACT FROM AUTHOR]

There are few data on lactating women's concerns about receiving COVID-19 vaccination during breastfeeding. This research investigated breastfeeding women's attitudes towards and acceptance or rejection of vaccination. This prospective, descriptive, implementation study was conducted in the postpartum ward of Siriraj Hospital, Bangkok, Thailand. In Phase I, 40 breastfeeding women in the postpartum ward at Siriraj Hospital who were willing to participate in the study were interviewed. Phase II comprised questionnaire development and data validation. The combined multiple choice and scaling questionnaires designed based on the results from comprehensive interviews of phase I were used in the study. The questionnaire was administered to 400 participants in Phase III. Breastfeeding women's attitudes towards and acceptance and rejection of COVID-19 vaccination. The vast majority of participants (372/400 [93.0 %]) were vaccinated predelivery. Most of the subgroup of women rejecting vaccination while breastfeeding were unsure whether too frequent vaccination would harm their unborn child (52/99 [52.5 %]; crude odds ratio [cOR], 6.50; 95 % CI, 1.47–28.68; P < 0.001). The level of immunity to the COVID-19 virus did not influence their vaccination decisions (19/99 [19.2 %]; cOR, 2.38; 95 % CI, 1.26–4.47; P < 0.001). Multivariable analysis found a significant association for women agreeing with the proposition that vaccination during pregnancy should not be performed (adjusted odds ratio [aOR], 4.83; 95 % CI, 1.41–16.57; P = 0.043). Most women who rejected vaccination knew its benefits (aOR, 31.84; 95 % CI, 7.16–141.65; P < 0.001). Breastfeeding women generally believed that vaccines reduce infection and disease severity. The women's COVID-19 immunity levels did not affect their acceptance or rejection of vaccination. Some mothers rejected vaccination because of concerns about possible harm to them or their newborns. [ABSTRACT FROM AUTHOR]

The association between menopause, postmenopausal hormone therapy, and kidney stone disease has long been a topic of discussion and is still unclear. Moreover, most previous research has focused on Caucasians. Therefore, we aimed to explore this issue in an Asian population. In this cross-sectional study, we enrolled female participants aged between 30 and 70 years from the Taiwan Biobank. The presence of kidney stone disease (KSD) was defined through a self-reported questionnaire. The participants were divided into two groups according to the presence of menopause; premenopausal and postmenopausal groups. The associations among menopause, postmenopausal hormone therapy, and KSD were examined using binary logistic regression models. A total of 17,460 women with available information were recruited, including 5976 in the premenopausal group and 11,484 in the postmenopausal group. Compared to the premenopausal group, the postmenopausal group had a significantly higher prevalence of KSD (3% vs. 6%). The odds ratio for KSD was higher in the postmenopausal group than in the premenopausal group (odds ratio = 1.50; 95% confidence interval = 1.17–1.92) after adjusting for confounders. We also examined associations between the type of menopause (natural and surgical) and KSD, and found that both types of menopause were associated with KSD in age-adjusted and multivariable models. Compared with those who had never received postmenopausal hormone therapy, those who had received postmenopausal hormone therapy were not associated with a higher risk of KSD. Our study suggests that natural and surgical menopause were associated with KSD. However, we found no association between the postmenopausal hormone therapy and KSD in the postmenopausal women. [ABSTRACT FROM AUTHOR]

Neonicotinoid pesticides (NNs) have been reported to have neurobehavioral effects on offspring after fetal and lactational exposure. In this study, clothianidin (CLO), an NN, was administered orally as a single dose (6.5 mg/kg: 1/10 of the no-observed-adverse-effect level in the current Pesticide Evaluation Report) to 10-day post-partum ICR mice, and CLO and its metabolites desmethyl-CLO (dm-CLO) were quantified using liquid chromatography-electrospray ionization/tandem mass spectrometry (LC-ESI/MS/MS) after collecting maternal breast milk and blood samples over time (1, 3, 6, 9, 12, and 24 h after administration). CLO and dm-CLO were detected in the breast milk at 1 h after the administration, and their concentrations were significantly higher than those in blood at all time points. The concentrations of CLO and dm-CLO in the breast milk were at their highest levels at 1 and 3 h, respectively, and then decreased over time to become almost undetectable at 24 h after the administration. These results show that CLO is metabolized in the mother's body and is rapidly transferred to and concentrated in the breast milk. Since CLO concentrations in breast milk are higher than those in the blood, there is concern about the effects of CLO during lactation. • CLO is metabolized maternally in mice and rapidly transferred in breast milk. • CLO and metabolites are more highly concentrated in breast milk than maternal blood. • Most of CLO and its metabolites were eliminated from the mother's body within 24 h. • Infants are sensitive to chemicals, so adverse CLO effects in infants are a concern. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is known to protect against febrile seizure (FS). Whether its impact continues throughout the childhood period is still controversial. Our objective was to investigate the protective effect of breastfeeding against FS stratified by age.Methods: We included children who participated in the National Health Screening Program for Infants and Children (NHSPIC) aged between four and six months between 2008 and 2014. Feeding type was confirmed based on the NHSPIC questionnaire, and data from the Korean National Health Insurance Service were used to determine FS cases during a five-year follow-up period.Results: Among the 1,791,335 children, the most prevalent feeding type was exclusive breastfeeding (EB) (42.3%). FS occurred most frequently in the exclusive formula feeding (EF) group (12.2%), followed by the partial breastfeeding (PB) (11.3%) and EB groups (10.7%). Compared with the EF group, the adjusted odds ratio for FS was 0.87 (95% confidence interval, 0.86 to 0.88, P < 0.001) and 0.93 (0.92 to 0.94, P < 0.001) in the EB and PB groups, respectively. The protective effect by age 2.5 years was significant in both the EB (0.85; 0.84 to 0.86, P < 0.001) and PB (0.92; 0.90 to 0.93, P < 0.001) groups. In contrast, the protective effect was not significant in the PB group and inconsistent in the EB group after 2.5 years.Conclusion: Breastfeeding has a protective effect against FS in the most prevalent age period, from 0 to 2.5 years. Despite the limited effect after age 2.5 years, we support the current recommendation for prolonged breastfeeding to promote childhood health. [ABSTRACT FROM AUTHOR]

To assess the impact of the addition of 12 maternity leave (ML) weeks (2011), a pay for performance (P4P) exclusive breastfeeding (EBF) promotion strategy (2015), and the COVID-19 pandemic in EBF inequalities in Chile. Interrupted time-series analyses (ITSAs). Aggregated national EBF data by municipality and month were collected from 2009 to 2020. We assess the impact of the three events in EBF inequalities using two procedures: 1. ITSA stratified by municipal SES quintiles (Q1-Q5); 2. Calculating the EBF slope index of inequality (SII). The EBF prevalence was higher in lower SES municipalities before and after the three time-events. No impact in EBF inequalities was observed after the extended ML. The P4P strategy increased EBF at six months in all SES quintiles (effect size between 4% and 5%), but in a higher level in poorer municipalities (SII: −0.36% and −1.05%). During COVID-19, wealthier municipalities showed a slightly higher EBF at six months prevalence (SII: 1.44%). The null impact of the extended ML in EBF inequalities could be explained by a low access to ML among affiliated to the public health system (20%). The P4P strategy includes multiple interventions that seemed effective in increasing EBF across all SES quintiles, but further in lower quintiles. The restrictions in healthcare access in poorer municipalities could explain EBF inequalities during COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Repetitive negative thinking (RNT) is a transdiagnostic feature that predicts increased mental health risks, inflammation, and reduced engagement in health promoting behaviors. Depression, anxiety, stress, inflammation, higher body mass index (BMI), and low engagement in health behaviors are associated with adverse outcomes during pregnancy as well as postpartum. However, there is limited literature on the associations between RNT and these contributing factors in the perinatal period, an at-risk time during which women may benefit from clinical interventions directed at RNT.Methods: This study examined the contribution of RNT to inflammation [interleukin (IL)-6] and breastfeeding duration through mediating indicators of mental health and BMI. Behavioral and biological assessments occurred during late pregnancy as well as at 4-6 weeks, 4 months, 8 months, and 12 months postpartum.Results: RNT was positively associated with depressive symptoms, anxiety, and perceived stress (ps ≤ .001) at each assessment timepoint, with the strongest associations observed at the pregnancy assessment and significant, but attenuated, associations during postpartum (ps < .01). In modeling of the association between RNT and IL-6, the indirect effect of BMI was significant at each timepoint (95%CIs 0.0013, 0.0052). Women with lower RNT exhibited longer breastfeeding duration (p = .02). These effects were not significantly mediated by mental health indicators.Conclusions: Clinically meaningful relationships, in which RNT predicts mental health, inflammation, and health behavior engagement during pregnancy and postpartum were observed. Clinical interventions to reduce RNT may have unique benefits this time.Limitations: Further research is warranted to determine if therapies to reduce RNT confer unique benefits for maternal and child health. [ABSTRACT FROM AUTHOR]

Background Pregnant participants who perceived that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) recommends breastfeeding only were more likely to have better early breastfeeding outcomes. Objectives Our objective was to examine the association between prenatal perception of WIC's breastfeeding recommendations and breastfeeding duration through the first year of infant life. Methods This observational study used a national longitudinal sample of 1594 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 in 2013. Four measures of breastfeeding duration were used: 1) a discrete measure of exclusive breastfeeding through 5 mo; 2) a continuous measure of exclusive breastfeeding (in days up to 7 mo); 3) a discrete measure of any breastfeeding through 11 mo; and 4) a continuous measure of any breastfeeding (in days up to 13 mo). The primary explanatory variable was the participant's prenatal perception of whether WIC recommended breastfeeding only. The univariate analyses of time to breastfeeding cessation were performed using Kaplan–Meier curves. The Cox regression model was adopted to estimate the likelihood of breastfeeding outcomes over time. All analyses accounted for complex survey design effects. Results Compared with their peers who perceived WIC to recommend formula only or both breastfeeding and formula equally, participants who perceived WIC as recommending breastfeeding only were less likely to stop exclusive breastfeeding through 5 mo (HR = 0.83; 95% CI: 0.69, 0.99) or to stop any breastfeeding through 11 mo (HR = 0.80; 95% CI: 0.69, 0.92), without controlling for prenatal infant feeding intentions. Similar patterns were observed in the 2 continuous measures, as they were also less likely to stop exclusive breastfeeding by 7 mo (HR = 0.78; 95% CI: 0.69, 0.90) or to stop any breastfeeding by 13 mo (HR = 0.82; 95% CI: 0.71, 0.95). Conclusions Prenatal perception of WIC's breastfeeding recommendation can be a useful predictor of breastfeeding duration in WIC participants. [ABSTRACT FROM AUTHOR]

Background Obesity is associated with chronic inflammation and is a risk factor for insufficient milk production. Inflammation-mediated suppression of LPL could inhibit mammary uptake of long-chain fatty acids (LCFAs; >16 carbons). Objectives In an ancillary case–control analysis, we investigated whether women with low milk production despite regular breast emptying have elevated inflammation and disrupted transfer of LCFAs from plasma into milk. Methods Data and specimens from a low milk supply study and an exclusively breastfeeding control group were analyzed, with milk production measured by 24-h test-weighing at 2–10 wk postpartum. Low milk supply groups were defined as very low (VL; <300 mL/d; n  = 23) or moderate (MOD; ≥300 mL/d; n  = 20) milk production, and compared with controls (≥699 mL/d; n  = 18). Serum and milk fatty acids (weight% of total) were measured by GC, serum and milk TNF-α by ELISA, and serum high-sensitivity C-reactive protein (hsCRP) by clinical analyzer. Group differences were assessed by linear regression models, chi-square exact tests, and Kruskal–Wallis nonparametric tests. Results VL cases, as compared with MOD cases and controls, had higher prevalence of elevated serum hsCRP (>5 mg/L; 57%, 15%, and 22%, respectively; P  = 0.004), detectable milk TNF-α (67%, 32%, and 33%, respectively; P  = 0.04), and obesity (78%, 40%, and 22%, respectively; P  = 0.003). VL cases had lower mean ± SD LCFAs in milk (60% ± 3%) than MOD cases (65% ± 4%) and controls (66% ± 5%) (P  < 0.001). Milk and serum LCFAs were strongly correlated in controls (r  = 0.82, P  < 0.001), but not in the MOD (r  = 0.25, P  = 0.30) or VL (r  = 0.20, P  = 0.41) groups (P int < 0.001). Conclusions Mothers with very low milk production have significantly higher obesity and inflammatory biomarkers, lower LCFAs in milk, and disrupted association between plasma and milk LCFAs. These data support the hypothesis that inflammation disrupts normal mammary gland fatty acid uptake. Further research should address impacts of inflammation and obesity on mammary fatty acid uptake for milk production. [ABSTRACT FROM AUTHOR]

Background: Our previous studies revealed that human milk oligosaccharides (HMOs) have health benefits for nursing infants and their concentrations change dynamically over 24-months of lactation. Yet, the extent to which HMOs vary over the short-term (days) and in response to acute factors such as maternal diet is unclear.Objectives: The purpose of this study is to determine the stability of HMO concentrations over 7-days and in response to a standard meal and sugar-sweetened beverage (SSB) over 6-hours.Methods: In this ancillary study, lactating mothers were enrolled at 6-weeks postpartum. Participants received in-person instructions and materials to complete procedures at home. In the one-week experiment (N = 11), mothers pumped a milk sample at 07:00-hours for 7-consecutive days. In the 6-hour experiment (N = 35), mothers pumped a milk sample after an overnight fast at 06:00-hours and then consumed a standard meal plus SSB provided by the study team. Mothers pumped a milk sample every hour for 6-consecutive hours. Samples were analyzed for the 19 most abundant HMOs. Repeated measures ANOVA was used to test changes in HMO concentrations over time, reported as F(dftime, dferror) = F-value, P-value.Results: Concentrations of all assayed HMOs were stable over 7-consecutive days, including, for example, the most widely studied HMOs in relation to infant health, 2'-fucosyllactose (2'FL) (F(2,17) = 0.39, P = 0.65), disialyl-lacto-N-tetraose (DSLNT) (F(4, 37) = 0.60, P = 0.66), and lacto-N-neotetraose (LNnT) (F(3, 32) = 1.5, P = 0.23). Concentrations of all assayed HMOs were stable in response to a standard meal plus SSB. For example, fasted baseline concentrations of 2'FL, DSLNT, and LNnT were 2310 ± 1620 μg/mL, 560 ± 290 μg/mL, and 630 ± 290 μg/mL, respectively, and there were no changes in 2'FL (F(4, 119) = 1.9, P = 0.13), DSLNT (F(4, 136) = 0.39, P = 0.83), and LNnT (F(4, 120) = 0.64, P = 0.63) over 6-consecutive hours.Conclusions: HMO concentrations are stable over one-week of lactation and are not acutely affected by a standard meal plus SSB in mothers. [ABSTRACT FROM AUTHOR]

Background Mothers in low-income settings who work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relation of these benefits with BF practices is poorly understood. Objectives We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF). Methods We conducted repeated cross-sectional surveys among formally employed mothers at 1–4 d and 6, 14, and 36 wk (to estimate 24 wk) postpartum in Naivasha, Kenya. We used logistic regression adjusted for maternal age, education, physical burden of work, HIV status, and income to evaluate associations between workplace supports and EBF practices. Results Among formally employed mothers (n  = 564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 wk (95.7% compared with 82.4%, P  = 0.030) and 14 wk (60.6% compared with 22.2%, P  < 0.001; adjusted OR: 5.11; 95% CI: 2.3, 11.7). Likewise, at 14 wk among mothers who currently used daycare centers, a higher proportion of mothers who visited daycare centers at or near workplaces practiced EBF (70.0%) than of those not visiting daycare centers (34.7%, P  = 0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than among mothers without such spaces (84.6% compared with 55.6%, P  = 0.037), and among mothers who lived in workplace housing than those without onsite housing (adjusted OR: 2.06, 95% CI: 1.25, 3.41). Conclusions Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can all support BF and EBF among employed mothers. [ABSTRACT FROM AUTHOR]