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: Introduction: Several HIV‐related syndemics have been described among adults. We investigated syndemic vulnerability to hazardous drinking (HD), intimate partner violence (IPV) and household food insecurity (HFIS) in breastfed children born without HIV in urban South Africa. We compared those who were perinatally HIV exposed (CHEU) to those who were not (CHU), under conditions of universal maternal antiretroviral therapy (ART) and breastfeeding. Methods: A prospective cohort of pregnant women living with HIV (WLHIV), and without HIV, were enrolled and followed with their infants for 12 months postpartum (2013–2017). All WLHIV initiated antenatal efavirenz‐based ART. Measurements of growth (∼3 monthly), infectious cause hospitalisation, ambulatory childhood illness (2‐week recall) and neurodevelopment (BSID‐III, measured at ∼12 months’ age) were compared across bio‐social strata using generalised linear regression models, with interaction terms; maternal data included interview‐based measures for HD (AUDIT‐C), IPV (WHO VAW) and HFIS. Results: Among 872 breastfeeding mother‐infant pairs (n = 461 CHEU, n = 411 CHU), WLHIV (vs. HIV negative) reported more unemployment (279/461, 60% vs. 217/411, 53%; p = 0.02), incomplete secondary education (347/461, 75% vs. 227/411, 55%; p < 0.0001), HD (25%, 117/459 vs. 7%, 30/411; p < 0.0001) and IPV (22%, 101/457 vs. 8%, 32/411; p < 0.0001) at enrolment; and HFIS at 12 months (45%, 172/386 vs. 30%, 105/352; p > 0.0001). There were positive interactions between maternal HIV and other characteristics. Compared to food secure CHU, the mean difference (95% CI) in weight‐for‐age Z‐score (WAZ) was 0.06 (−0.14; 0.25) for food insecure CHU; −0.26 (−0.42; −0.10) for food secure CHEU; and −0.43 (−0.61; −0.25), for food insecure CHEU. Results were similar for underweight (WAZ < −2), infectious‐cause hospitalisation, cognitive and motor delay. HIV‐IPV interactions were evident for ambulatory diarrhoea and motor delay. There were HIV‐HD interactions for odds of underweight, stunting, cognitive and motor delay. Compared to HD‐unexposed CHU, the odds ratios (95% CI) of underweight were 2.31 (1.11; 4.82) for HD‐exposed CHU; 3.57 (0.84; 15.13) for HD‐unexposed CHEU and 6.01 (2.22; 16.22) for HD‐exposed CHEU. Conclusions: These data suggest that maternal HIV‐related syndemics may partly drive excess CHEU health risks, highlighting an urgent need for holistic maternal and family care and support alongside ART to optimise the health of CHEU., INTRODUCTION In 2021, the global population of children who are perinatally HIV exposed but HIV negative (CHEU) was almost 16 million, with another one million CHEU born annually [1, 2]. [...]

Introduction Under-nutrition (body mass index < 18.5 kg/m.sup.2) is a global problem with an increasing trend in recent years. The burden is high in low and middle-income countries, especially in Africa. Lactating mothers are among the most vulnerable groups for under nutrition; particularly in sub-Saharan Africa. In Ethiopia, the prevalence of under-nutrition among this group is inconsistent and inconclusive. Therefore, we aimed to assess the pooled prevalence of under-nutrition and its associated factors among lactating mothers in Ethiopia. Methods To write this review and meta-analysis, we followed the preferred reporting items for systematic review and meta-analysis guidelines. Primary articles were searched from PubMed, Hinari, Cochrane Library, science direct databases, Google, and Google scholar. STATA version 16 software and a standardized Microsoft excel format were used for analysis and data extraction, respectively. Heterogeneity between studies was checked. To determine the pooled prevalence of under-nutrition, we used a random-effect model. Begg's and Egger's tests were done to detect publication bias. Subgroup analysis was also steered and association was uttered by a pooled odds ratio with 95% CI. Results The pooled prevalence of under-nutrition among lactating mothers was 23.84% [95% CI (19.40, 28.27)]. Educational status (no formal education) {Pooled OR 2.30 [95% CI (1.34, 3.96)]} was significantly associated with under-nutrition. Conclusion The pooled prevalence of under-nutrition was high. Maternal educational status was significantly associated with under-nutrition. Therefore, the federal ministry of health and the concerned stakeholders should give attention to these most vulnerable groups and strengthen the implementation of the previously designed strategies., Author(s): Bekahegn Girma [sup.1] , Jemberu Nigussie [sup.1] , Alemayehu Molla [sup.2] , Moges Mareg [sup.3] Author Affiliations: (1) grid.472268.d, 0000 0004 1762 2666, Department of Nursing, College of Medicine [...]

Research has linked prenatal alcohol and tobacco use with Attention Deficit Hyperactivity Disorder (ADHD), and variably with Autism Spectrum Disorder (ASD). Lactational use has been scantly considered. This study examined whether it may alter ADHD or ASD risk. Participants were 5107 infants recruited in 2004 and assessed longitudinally for the Growing Up in Australia Study. Logistic regression did not find any associations between maternal alcohol and tobacco use while breastfeeding and ADHD or ASD diagnosis at ages 6-7 or 10-11 years. Alcohol and tobacco use during lactation may not increase ADHD or ASD risk. Abstaining from alcohol and tobacco, however, may still be the safest option. Analyses were limited by lack of alcohol timing and retrospective variables that future research should address., Author(s): Louisa Gibson [sup.1] , Melanie Porter [sup.1] Author Affiliations: (1) grid.1004.5, 0000 0001 2158 5405, Department of Psychology, Faculty of Medicine, Health and Human Sciences, Macquarie University, , Balaclava [...]

Objectives The importance of breastfeeding exposure and children's development of self-regulation, independently, are well established. Each of these domains also has been linked to better cognitive development and academic achievement in children. However, little is known about how breastfeeding affects development of early self-regulation skills or whether self-regulation mediates the relationship between breastfeeding and academic achievement, particularly for disadvantaged children. This study examined breastfeeding exposure, self-regulation, and academic achievement in kindergarten among a population of children who previously attended Head Start. Methods Children were recruited from Head Start classrooms in the Pacific Northwest. Breastfeeding exposure was assessed via parent report. Children's self-regulation (Day Night Stroop, Dimensional Change Card Sort, Head-Knees-Toes-Shoulders-Revised) and academic achievement [Letter-Word Identification and Applied Problems subtests of Woodcock Johnson Tests of Achievement (English) or the Batería III Woodcock-Muñoz (Spanish)] were directly assessed in fall and spring of kindergarten. Regressions were performed using Stata v14.1 and included breastfeeding exposure as the primary independent variable, controlling for child age, sex, and language spoken. Results Of the 246 children, 56% were reported as White, 34% Latino/a, 4% African American, and 6% other; 83% were ever exposed to breastfeeding. Breastfeeding exposure was predictive of both fall kindergarten academic achievement (emergent math/literacy scores) and self-regulation (p < 0.05) and related to higher math performance in the spring of kindergarten, which was associated with stronger self-regulation in the fall (p = 0.04). Conclusions These findings extend our understanding of the positive effects of breastfeeding exposure on children's development and support breastfeeding promotion, particularly for children at risk of academic difficulty., Author(s): Jasmine Tua Karing [sup.1] , Alexis Tracy [sup.1] , Christopher R. Gonzales [sup.2] , Alexandra F. Nancarrow [sup.1] , Emily J. Tomayko [sup.3] , Shauna Tominey [sup.1] , Hannah [...]

BACKGROUND: Human breast milk is a primary route of exposure to perfluoroalkyl substances (PFAS) in infants. To understand the associated risks, the occurrence of PFAS in human milk and the toxicokinetics of PFAS in infants need to be addressed. OBJECTIVES: We determined levels of emerging and legacy PFAS in human milk and urine samples from Chinese breastfed infants, estimated renal clearance, and predicted infant serum PFAS levels. METHODS: In total, human milk samples were collected from 1,151 lactating mothers in 21 cities in China. In addition, 80 paired infant cord blood and urine samples were obtained from two cities. Nine emerging PFAS and 13 legacy PFAS were analyzed in the samples using ultra high-performance liquid chromatography tandem mass spectrometry. Renal clearance rates (C[L.sub.renals]) of PFAS were estimated in the paired samples. PFAS serum concentrations in infants (< 1 year of age) were predicted using a first-order pharmacokinetic model. RESULTS: All nine emerging PFAS were detected in human milk, with the detection rates of 6:2 CI-PFESA, PFMOAA, and PFO5DoDA all exceeding 70%. The level of 6:2 CI-PFESA in human milk (median concentration = 13.6 ng/L) ranked third after PFOA (336 ng/L) and PFOS (49.7 ng/L). The estimated daily intake (EDI) values of PFOA and PFOS exceeded the reference dose (RfD) of 20ng/kg BW per day recommended by the U.S. Environmental Protection Agency in 78% and 17% of breastfed infant samples, respectively. 6:2 CI-PFESA had the lowest infant C[L.sub.renal] (0.009 mL/kg BW per day), corresponding to the longest estimated half-life of 49 y. The average half-lives of PFMOAA, PFO2HxA, and PFO3OA were 0.221, 0.075, and 0.304 y, respectively. The C[L.sub.renals] of PFOA, PFNA, and PFDA were slower in infants than in adults. CONCLUSIONS: Our results demonstrate the widespread occurrence of emerging PFAS in human milk in China. The relatively high EDIs and halflives of emerging PFAS suggest potential health risks of postnatal exposure in newborns. https://doi.org/10.1289/EHP11403, Introduction Per- and polyfluoroalkyl substances (PFAS) are a broad range of synthetic chemicals widely used as water- and oil-repellents in textiles, food packaging, and leather; processing aids in the fluoropolymer [...]

Background: Infancy perfluoroalkyl substances (PFAS) exposure from breastfeeding is partially determined by the transfer efficiencies (TEs) of PFAS from maternal serum into breast milk. However, to our knowledge there are no studies of such TEs in highly exposed populations. Objectives: We estimated the TEs of PFAS from maternal serum into colostrum and breast milk in a cohort of women with a wide range of PFAS exposures. Methods: The Ronneby Mother-Child Cohort was established in 2015 after PFAS contamination was discovered in the public drinking water of Ronneby, Sweden. We measured seven PFAS in matched samples of maternal serum at delivery and colostrum and breast milk. We calculated the TE (in percentage) as the ratio of PFAS in colostrum or breast milk to serum multiplied by 100 and evaluated whether TEs varied by PFAS, lactation stage, or exposure level using a series of linear mixed-effects models with a random intercept for each woman. Results: This study included 126 mothers. PFAS associated with firefighting foams [i.e., perfluorohexane sulfonic acid (PFHxS) and perfluorooctane sulfonic acid (PFOS)] were substantially elevated in the serum, colostrum, and breast milk samples of highly exposed women in the cohort and showed strong correlation. PFHxS and PFOS also contributed the largest fraction of total PFAS on average in colostrum and breast milk. Median TEs varied from 0.9% to 4.3% and were higher for perfluoroalkyl carboxylic acids, including perfluorooctanoic acid, than perfluoroalkane sulfonic acids, including PFHxS and PFOS. TEs varied by exposure level, but there was not a consistent pattern in this variation. Discussion: PFAS concentrations in the colostrum and breast milk of highly exposed women were higher than the concentrations in low-exposed women, and TEs were of a similar magnitude across exposure categories. This implies that breastfeeding may be an important route of PFAS exposure for breastfeeding infants with highly exposed mothers, although the relative contribution of breastfeeding vs. prenatal transplacental transfer remains to be clarified. https://doi.org/10.1289/EHP11292, Introduction Perfluoroalkyl substances (PFAS) are a diverse class of synthetic chemicals containing an aliphatic fluorinated carbon chain. (1) PFAS have unique chemical properties, including chemical and thermal stability and water [...]

* Context: When medical trainees choose to breastfeed, they often do not receive adequate support from their institutions and colleagues and do not meet their breastfeeding goals. It is important for physicians in training to be supported in reaching their breastfeeding goals because their personal experience can have long term impacts for themselves and on the education and support they provide their patients. The American Academy of Pediatrics (AAP) & American Academy of Family Physicians (AAFP) created a learning collaborative to foster and evaluate uptake and implementation of the AAFP model policy, Breastfeeding & Lactation Support for Medical Trainees. Objective: Support, facilitate, and evaluate residency program implementation of the AAFP model policy through an action-oriented virtual learning collaborative. Study Design and Analysis: Evaluation of the virtual learning collaborative, including each site's written policy, policy implementation, and culture concerning breastfeeding support for medical trainees. Setting: Two cohorts of ten residency programs over a two-year period (20 total) participated in an eight-month virtual learning collaborative. Population Studied: Multidisciplinary teams from family medicine, pediatric, and OB/Gyn residency programs including administration, nursing, faculty, and medical trainee representatives. Intervention/Instrument: Six educational sessions including speakers, resources, homework, and sharing of ideas for each cohort. Instruments included pre/post surveys assessing how current organizational policy and practices align with the tenets of the model policy and pre-intervention survey of resident attitudes and experiences with lactation during training. Outcome Measures: Alignment with the model policy domains: culture of support, lactation facilities, protected time, and roles and responsibilities. Results: Alignment scores improved. Each site successfully wrote a policy. Resident surveys from cohorts 1 and 2 showed positive attitudes toward protected time and support for lactation. Conclusions: Support exists among medical trainees for implementation of lactation policies. External resources, education, and a dedicated time for team collaboration allowed teams to develop an implementation plan for breastfeeding and lactation policies at their respective programs/institutions., Presenters Angie Lanigan, MPA, RD, Kristina Bridges, PhD, Christina Hester, PhD, MPH, Maureen Cooney, MPH, Kera [...]

Background Micronutrient intake and status in lactating women may impact micronutrient levels in milk. Objectives This study aimed to determine the micronutrient intake and status in lactating women, and their association with micronutrient levels in human milk. Methods Lactating women were enrolled at 4-6 months postpartum. A 24h food recall was examined and nutrient intakes were analyzed using INMUCAL software. Human milk samples were collected to analyze calcium, copper, iron, and zinc levels. Plasma zinc and serum ferritin levels were determined. Results Thirty-four women participated; 19 were classified as full breastfeeding and 15 as partial breastfeeding. Mean levels of calcium, copper, iron, and zinc in human milk were 243, 0.2, 0.2, and 1.56 mg/L, respectively. The prevalence of zinc deficiency (plasma zinc < 10.7 [micro]mol/L) was 11.8%. No lactating women had iron deficiency. Nutrient intakes were lower than the recommended amounts in 38%-70% of participants, and were not correlated with corresponding nutrient levels in human milk. Multiple linear regression showed significant association between zinc levels in human milk and plasma for lactating women with full breastfeeding ([beta] = 0.034, 95% confidence interval [0.003, 0.067], p = 0.040). Conclusions Lactating women were at risk of micronutrient deficiency. There was an association between zinc levels in human milk and plasma of lactating women with full breastfeeding. As the nutritional status of lactating women influences the quality of human milk, we should encourage good nutrient intake for lactating women., Author(s): Oraporn Dumrongwongsiri [sup.1] , Nalinee Chongviriyaphan [sup.1] , Suthida Chatvutinun [sup.2] , Phanphen Phoonlabdacha [sup.1] , Areeporn Sangcakul [sup.3] , Atitaya Siripinyanond [sup.4] , Umaporn Suthutvoravut [sup.1] Author Affiliations: [...]

Tobacco smoking is still a widespread habit in pregnant and breastfeeding women. While the role of these risk factors on neonatal outcomes has been deeply studied, their effect on human milk composition is still not completely clear. This study aimed to report the most up to date evidence about the alteration of breast milk composition of smoking breastfeeding mothers compared to non-smoking ones. We performed a systematic review by searching PubMed, Embase, and Cochrane Library databases. Evaluated data were extracted and critically analyzed by two independent authors. PRISMA guidelines were applied, and the risk of bias was assessed (ROBINS), as was the methodological quality of the included studies (GRADE). After applying the inclusion criteria, we included 20 studies assessed as medium or high quality. In all the studies, we analyzed data regarding 1769 mothers (398 smokers and 971 nonsmokers). Smoking was associated with a lower content of lipids, calories, and proteins. Moreover, it was characterized by decreased antioxidant properties and an altered immune status. Smoking during pregnancy and breastfeeding is significantly associated with an alteration of milk metabolic properties. Further studies are needed to investigate how these changes can alter newborns' development and outcomes and which molecular patterns are involved., Author(s): Marina Macchi [sup.1] , Laura Bambini [sup.2] , Simone Franceschini [sup.3] , Ioana Diana Alexa [sup.2] , Carlo Agostoni [sup.4] [sup.5] Author Affiliations: (1) University of Milan, Milano, Italy [...]

Background We investigated etiology and prognosis of infantile nephrolithiasis, including whether lithogenic and anti-lithogenic content of breast milk affects its formation. Methods Thirty infants with nephrolithiasis and 30 healthy infants exclusively breastfed for the first 6 months of life were included in this prospective cohort case-control study. At entry, age, sex, and timing of birth of patients and controls were recorded. All patients were diagnosed and followed up periodically using ultrasonography. All infants received oral vitamin D (400 units/day). Lithogenic (calcium, oxalate, uric acid, phosphate) and anti-lithogenic (citrate, magnesium) components of maternal milk, serum calcium, phosphate, magnesium, 25-hydroxy vitamin D and parathormone, as well as spot urine calcium, uric acid, cystine, oxalate, magnesium, citrate/creatinine ratio, and calcium/citrate ratio were compared. Results Mean follow-up period was 56.1 ± 6.8 months. There was no difference concerning lithogenic and anti-lithogenic content of breast milk. Serum calcium, phosphorus, alkaline phosphatase, and 25-hydroxy vitamin D levels (49.1 ± 19 vs. 26.7 ± 4 ng/ml, p < 0.001) were significantly higher and parathormone level significantly lower in patients. Random urine calcium/creatinine and calcium/citrate ratios were significantly higher in patient group (0.63 ± 0.40 vs. 0.42 ± 0.10 and 0.62 ± 0.12 vs. 0.41 ± 0.25 mg/mg, respectively, p < 0.01). Three patients were lost to follow-up after the first year. At last follow-up, calculi disappeared in 25/27 remaining patients without interventions or therapy. Conclusions Breast milk does not have an etiologic effect in infantile nephrolithiasis. Higher serum vitamin D levels may have roles in development of lower levels of PTH and higher levels of serum and urine calcium, leading to stone formation. The prognosis for infantile stones is excellent. Graphical abstract, Author(s): Neslihan Yilmaz [sup.1] , Selçuk Yüksel [sup.1] , Fatih Altintas [sup.2] , Ali Koçyigit [sup.3] Author Affiliations: (1) grid.411742.5, 0000 0001 1498 3798, Department of Pediatric Nephrology, Pamukkale University [...]

Background Child eating behaviours can negatively contribute to the development of childhood obesity. This study investigated associations between breastfeeding habits, maternal eating behaviours and child eating behaviours, in 5-year-old children. Methods Secundigravida women were recruited to the ROLO dietary randomised controlled trial (Dublin, Ireland) and were followed up with their children to 5 years of age. Breastfeeding exposure and duration were obtained at postnatal and infant follow-up at 2 and 6 months and 2 and 5 years. At 5 years, maternal and child eating behaviours were measured using the Three Factor Eating Questionnaire and the Child Eating Behaviour Questionnaire, respectively. Regression determined associations between breastfeeding habits and maternal eating behaviours with child eating behaviours, controlling for RCT group, maternal education level, maternal BMI at 5 years, childcare exposure and child BMI centile at 5-year follow-up. Results There were 230 mother and child pairs analysed. One hundred and fifty-eight mothers had initiated breastfeeding. Median breastfeeding duration was 22 (IQR 33) weeks. Children who were never breastfed were more likely to express a desire to drink (B = -1.01, p = 0.022). Longer breastfeeding duration was associated with lower food responsiveness (B = -1.71, p = 0.003). Maternal uncontrolled eating was positively associated with child food responsiveness, emotional overeating and emotional undereating (B = 0.21, p < 0.001; B = 0.14, p = 0.005; B = 0.14, p = 0.005, respectively). Maternal emotional eating was associated with child emotional overeating and undereating (B = 0.27, p < 0.001, B = 0.29, p = 0.004, respectively). Conclusion Not breastfeeding and short breastfeeding duration may contribute to the development of obesogenic eating behaviours in children, alongside maternal eating behaviours including uncontrolled and emotional eating. These 'food approach' eating behaviours may increase risk of overweight/obesity as they are associated with increased energy intake, hence the importance of research surrounding eating behaviours., Author(s): Cara A. Yelverton [sup.1] , Aisling A. Geraghty [sup.1] , Eileen C. O'Brien [sup.1] , Sarah Louise Killeen [sup.1] , Mary K. Horan [sup.1] , Jean M. Donnelly [sup.1] [...]

Introduction: Pregnant women living with HIV can achieve viral suppression and prevent HIV mother-to-child transmission (MTCT) with timely HIV testing and early ART initiation and maintenance. Although it is recommended that pregnant women undergo HIV testing early in antenatal care in Malawi, many women test positive during breastfeeding because they did not have their HIV status ascertained during pregnancy or they tested negative during pregnancy but seroconverted postpartum. We sought to estimate the association between the timing of last positive HIV test (during pregnancy vs. breastfeeding) and outcomes of maternal viral suppression and MTCT in Malawi's PMTCT programme. Methods: We conducted a two-stage cohort study among mother-infant pairs in 30 randomly selected high-volume health facilities across five nationally representative districts of Malawi between 1 July 2016 and 30 June 2017. Log-binomial regression was used to estimate prevalence ratios (PR) and risk ratios (RR) for associations between timing of last positive HIV test (i.e. breastfeeding vs. pregnancy) and maternal viral suppression and MTCT, controlling for confounding using inverse probability weighting. Results: Of 822 mother-infant pairs who had available information on the timing of the last positive HIV test, 102 mothers (12.4%) had their last positive test during breastfeeding. Women who lived one to two hours (PR = 2.15; 95% CI: 1.29 to 3.58) or >2 hours (PR = 2.36; 95% CI: 1.37 to 4.10) travel time to the nearest health facility were more likely to have had their last positive HIV test during breastfeeding compared to women living Conclusions: MTCT in Malawi occurred disproportionately among women with a last positive HIV test during breastfeeding. Testing delayed until the postpartum period may lead to higher MTCT. To optimize maternal and child health outcomes, PMTCT programmes should focus on early ART initiation and providing targeted testing, prevention, treatment and support to breastfeeding women. Keywords: antiretroviral therapy; mother-to-child transmission; HIV; Option B+; PMTCT; viral suppression, 1 | INTRODUCTION Antiretroviral therapy (ART) for HIV-positive pregnant and breastfeeding women (PBFW) has proved to be life-saving for both mother and infant. As a treatment for HIV, ART improves [...]

PE23.01 Identifying regional disparities in access to HIV and sexual health resources for young men who have sex with men in the United States: The iREACH Study A. Walsh (1) [...]

Objectives Breastfeeding is protective against childhood obesity, but the role of childhood lifestyle in this association is unclear. We investigated whether physical activity and dietary pattern at age 5 differed between breastfed and non-breastfed children, and how they relate to Body Mass Index (BMI) Z-scores. Methods 1477 children of the Dutch GECKO Drenthe birth cohort were included. At one month, children were categorized as breastfed (receiving breast milk exclusively or in combination with formula milk) or non-breastfed (receiving formula milk exclusively). At age 5, height and weight were objectively measured, physical activity was measured by ActiGraph GT3x and dietary patterns were assessed with a parent-reported food pattern questionnaire, assessing the consumption frequency of selected food items at seven occasions over the day. Results Non-breastfed children had higher BMI Z-scores (0.36 ± 0.90 vs. 0.20 ± 0.80 SD, p = 0.002), more frequently consumed sugar-sweetened beverages (25.0 ± 10.5 vs. 22.5 ± 9.71 times per week, p < 0.001), and consumed relatively less whole-wheat or brown bread (p = 0.007). Differences in sugar-sweetened beverage consumption were most pronounced during main meals. Total fruit consumption, sedentary time and moderate-to-vigorous physical activity levels did not differ between the groups. Multivariable adjusted linear regression analyses showed that the differences in BMI-z score between non-breastfed and breastfed children were not explained by the differences in sugar-sweetened beverages or type of bread consumed. Conclusions Infant breastfeeding itself is indicative of healthy dietary behaviors in early life, and is also more likely to be followed by a favorable dietary pattern at toddler age. However, the differences in dietary habits between breastfed and non-breastfed children did not explain the difference in BMI Z-score at the age of 5., Author(s): Petra Corianne Vinke [sup.1] , Carolien Tigelaar [sup.1] , Leanne Karen Küpers [sup.1] [sup.2] , Eva Corpeleijn [sup.1] Author Affiliations: (1) grid.4830.f, 0000 0004 0407 1981, Department of Epidemiology, [...]

Introduction In 2015, a community health center implemented a multipronged, Chinese language, health education initiative to increase breastfeeding. Perinatal education, hospital visits after delivery, and postpartum support were implemented to provide informational and emotional support. This study evaluates the impact of the breastfeeding program for Chinese American women. Methods This is a quasi-experimental study to assess the change in any and exclusive breastfeeding at 4-6 weeks postpartum. A difference-in-differences regression analysis was used to determine change in breastfeeding attributable to the program at an intervention site after adjusting for change in a control site during the same period. Change in breastfeeding was also examined by sociodemographic characteristics. Results A total of 1475 women who received perinatal care at two community center sites in 2014 and 2016 were included in the study. Within the women who received the intervention, any breastfeeding increased by 24 percentage points to 71% and exclusive breastfeeding increased by 13 percentage points to 27%. After adjusting for the change in the control group during the same period, the increases in any and exclusive breastfeeding attributable to the program were 17 (p < 0.01) and 9 percentage points (p < 0.05), respectively. Primiparous women and those who have been in the US longer than 5 years experienced the highest increase in any breastfeeding from the program. Exclusive breastfeeding was most improved in those with non-Medicaid insurance. Conclusions A bilingual and bicultural breastfeeding program incorporated into routine pregnancy care at an intervention site experienced increases in both any and exclusive breastfeeding, even after adjusting for changes in breastfeeding in a control group. Significance Statement What is known on this subject? Chinese Americans are the least likely to breastfeed among all ethnicities in New York City. Cultural and language barriers plus the lack of Chinese language resources contribute to low breastfeeding rates. What this study adds? A bilingual and bicultural breastfeeding program of perinatal education and postpartum support incorporated into routine pregnancy care increased both any and exclusive breastfeeding in a Chinese American population. Increase in any breastfeeding was the greatest in primiparous women and those who had been in the US for a longer time and increase in exclusive breastfeeding was greatest in women not using Medicaid insurance., Author(s): Jennifer D. Lau [sup.1] , Yajie Zhu [sup.1] , Shalini Vora [sup.1] [sup.2] Author Affiliations: (1) Charles B. Wang Community Health Center, , 268 Canal Street, 10013, New York, [...]

: Introduction: As new antiretrovirals (ARVs), including long‐acting ARVs for treatment and prevention, are approved and introduced, surveillance during pregnancy must become the safety net for evaluating birth outcomes, especially those that are rare and require large numbers of observations. Historically, drug pharmacovigilance in pregnancy has been limited and fragmented between different data sources, resulting in inadequate data to assess risk. The International Maternal Pediatric Adolescent AIDS Clinical Trials Network and World Health Organization convened a Workshop which reviewed strengths and weaknesses of existing programs and discussed an improved framework to integrate existing safety data sources and promote harmonization and digitalization. Discussion: This paper highlights that although robust sources of safety data and surveillance programs exist, key challenges remain, including unknown denominators, reporting bias, under‐reporting (e.g. in voluntary registries), few data sources from resource‐limited settings (most are in North America and Europe), incomplete or inaccurate data (e.g. within routine medical records). However, recent experiences (e.g. with safety signals) and current innovations (e.g. electronic record use in resource‐limited settings and defining adverse outcomes) provide momentum and building blocks for a new framework for active surveillance of ARV safety in pregnancy. A public health approach should be taken using data from existing sources, including registries of pregnancy ARV exposure and birth defects; observational surveillance and cohort studies; clinical trials; and real‐world databases. Key facilitators are harmonization and standardization of outcomes, sharing of materials and tools, and data linkages between programs. Other key facilitators include the development of guidance to estimate sample size and duration of surveillance, ensuring strategic geographic diversity, bringing partners together to share information and engaging the community of women living with HIV. Conclusions: Looking ahead, critical steps to safely introduce new ARVs include (1) adopting harmonized standards for measuring adverse maternal, birth and infant outcomes; (2) establishing surveillance centres of excellence in areas with high HIV prevalence with harmonized data collection and optimized electronic health records linking maternal/infant data; and (3) creating targets and evaluation goals for reporting progress on implementation and quality of surveillance in pregnancy. The platform will be leveraged to ensure that appropriate contributions and strategic actions by relevant stakeholders are implemented., INTRODUCTION Data on new antiretroviral (ARV) drugs in pregnancy are often delayed until years after initial approval [1, 2]. Additionally, the most vulnerable period for adverse foetal effects is in [...]

Introduction: India's national AIDS Control Organization implemented World Health Organization's option B+ HIV prevention of mother-to-child transmission (PMTCT) guidelines in 2013. However, scalable strategies to improve uptake of new PMTCT guidelines to reduce new infection rates are needed. This study assessed impact of Mobile Health-Facilitated Behavioral Intervention on the uptake of PMTCT services. Methods: A cluster-randomized trial of a mobile health (mHealth)-supported behavioural training intervention targeting outreach workers (ORWs) was conducted in four districts of Maharashtra, India. Clusters (one Integrated Counselling and Testing Center (ICTC, n = 119), all affiliated ORWs (n = 116) and their assigned HIV-positive pregnant/postpartum clients (n = 1191)) were randomized to standard-of-care (SOC) ORW training vs. the COMmunity home Based INDia (COMBIND) intervention--specialized behavioural training plus a tablet-based mHealth application to support ORW-patient communication and patient engagement in HIV care. Impact on uptake of maternal antiretroviral therapy at delivery, exclusive breastfeeding at six months, infant nevirapine prophylaxis, and early infant diagnosis at six months was assessed using multi-level randomeffects logistic regression models. Results: Of 1191 HIV-positive pregnant/postpartum women, 884 were eligible for primary outcome assessment; 487 were randomized to COMBIND. Multivariable analyses identified no statistically significant differences in any primary outcome by study arm. COMBIND was associated with higher uptake of exclusive breastfeeding at two months (adjusted Odds Ratio (aOR), 2.10; 95% CI 1.06 to 4.15) and early infant diagnosis at six weeks (aOR, 2.19; 95% CI 1.05 to 3.98) than SOC. Conclusions: The COMBIND intervention was easily integrated into India's existing PMTCT programme and improved early uptake of two PMTCT components that require self-motivated health-seeking behaviour, thus providing preliminary evidence to support COMBIND as a potentially scalable PMTCT strategy. Further study would identify modifications needed to optimize other PMTCT outcomes. Keywords: PMTCT uptake; HIV; mhealth; outreach workers; behavioural intervention; India, 1 | INTRODUCTION World Health Organization (WHO) HIV Prevention of Mother-to-Child Transmission (PMTCT) guidelines have been adopted by many high HIV burden countries [1], including India, yet uptake of these [...]

The gut of healthy human neonates is usually devoid of viruses at birth, but quickly becomes colonized, which--in some cases--leads to gastrointestinal disorders.sup.1-4. Here we show that the assembly of the viral community in neonates takes place in distinct steps. Fluorescent staining of virus-like particles purified from infant meconium or early stool samples shows few or no particles, but by one month of life particle numbers increase to 10.sup.9 per gram, and these numbers seem to persist throughout life.sup.5-7. We investigated the origin of these viral populations using shotgun metagenomic sequencing of virus-enriched preparations and whole microbial communities, followed by targeted microbiological analyses. Results indicate that, early after birth, pioneer bacteria colonize the infant gut and by one month prophages induced from these bacteria provide the predominant population of virus-like particles. By four months of life, identifiable viruses that replicate in human cells become more prominent. Multiple human viruses were more abundant in stool samples from babies who were exclusively fed on formula milk compared with those fed partially or fully on breast milk, paralleling reports that breast milk can be protective against viral infections.sup.8-10. Bacteriophage populations also differed depending on whether or not the infant was breastfed. We show that the colonization of the infant gut is stepwise, first mainly by temperate bacteriophages induced from pioneer bacteria, and later by viruses that replicate in human cells; this second phase is modulated by breastfeeding. The infant gut is colonized first by temperate bacteriophages induced from pioneer bacteria and later by viruses that replicate in human cells, the populations of which are modulated by breastfeeding., Author(s): Guanxiang Liang [sup.1] [sup.2] , Chunyu Zhao [sup.2] , Huanjia Zhang [sup.2] , Lisa Mattei [sup.2] , Scott Sherrill-Mix [sup.1] , Kyle Bittinger [sup.2] , Lyanna R. Kessler [sup.1] [...]

Objective Higher rates of adverse outcomes have been reported for early term (37 0 to 38 6 weeks) versus full term ([greater than or equal to] 39 0 weeks) infants, but differences in breastfeeding outcomes have not been systematically evaluated. This study examined breastfeeding initiation and exclusivity in early and full term infants in a large US based sample. Methods This secondary analysis included 743 geographically- and racially-diverse women from the Measurement of Maternal Stress Study cohort, and 295 women from a quality assessment at a hospital-based clinic in Evanston, IL. Only subjects delivering [greater than or equal to] 37 weeks were included. Initiation of breastfeeding (IBF) and exclusive breastfeeding (EBF) were assessed via electronic medical record review after discharge. Associations of IBF and EBF with early and full term delivery were assessed via univariate and multivariate logistic regression. Results Among 872 women eligible for inclusion, 85.7% IBF and 44.0% EBF. Early term delivery was not associated with any difference in frequency of IBF (p = 0.43), but was associated with significantly lower odds of EBF (unadjusted OR 0.61, 95% CI 0.466, 0.803, p < 0.001). This association remained significant (adjusted OR 0.694, 95% CI 0.515, 0.935, p = 0.016) after adjusting for maternal diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal age, race/ethnicity, parity, Medicaid status, NICU admission, current smoking, and delivery hospital. Conclusions for Practice Despite comparable breastfeeding initiation frequencies, early term infants were significantly less likely to be exclusively breastfed compared to full term infants. These data suggest that women with early term infants may benefit from counseling regarding the potential for breastfeeding difficulties as well as additional breastfeeding support after delivery., Author(s): Lauren S. Keenan-Devlin [sup.1] [sup.2] , Yetunde F. Awosemusi [sup.2] , William Grobman [sup.3] [sup.4] , Hyagriv Simhan [sup.5] [sup.6] , Emma Adam [sup.7] , Jennifer Culhane [sup.8] [sup.9] [...]

Objective HIV-exposed uninfected infants are almost twice as likely to die compared to infants born to HIV-uninfected women. HIV-exposed uninfected children whose mothers are on ART and who are breastfed have the lowest risk of dying by 24 months of age. Interventions to improve breastfeeding among HIV-infected mothers are needed. We aimed to assess the association between support/counseling provided by healthcare workers following delivery and the rate of exclusive breastfeeding (EBF) at 6-week postpartum. Methods This is a secondary analysis of data collected as part of a trial to evaluate the effect of conditional cash transfers on retention in and uptake of PMTCT services. Between April 2013 and August 2014, newly diagnosed HIV-infected women, [less than or equal to] 32 weeks pregnant, registering for antenatal care (ANC), in 89 clinics in Kinshasa, Democratic Republic of Congo, were recruited and followed through 6 weeks postpartum. At 6-week, participants were asked if they had given anything other than breastmilk to their infant in the 24 h preceding the interview (No = EBF) and whether a nurse or a doctor talked to them about breastfeeding after they gave birth (YES = received breastfeeding support/counseling). Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CI) measuring the strength of the association between EBF and receiving breastfeeding support/counseling by a healthcare provider following delivery. Results Of 433 women enrolled, 328 attended a 6-week postpartum visit including 320 (97%) with complete information on EBF. Of those 320, 202 (63%) reported giving nothing other than breastmilk to their infant in the previous 24 h; 252 (79%) reported that a healthcare provider came to talk to them about breastfeeding following delivery. Mothers who reported receiveing breastfeeding support/counseling from a healthcare provider were more likely to exclusively breastfeed compared to those who did not (69% vs. 38%, OR 3.74; 95% CI 2.14-6.54). Adjustment for baseline sociodemographic characteristics did not change the association substantially, (adjusted OR 3.72; 95% CI 2.06-6.71). Conclusion for Practice Receipt of breastfeeding support/counseling from a healthcare provider after delivery among HIV-infected mothers in care at 6-weeks postpartum in Kinshasa almost quadrupled the odds of EBF., Author(s): Christian Mpody [sup.1] , Travis Reline [sup.2] , Noro Lantoniaina Rosa Ravelomanana [sup.3] , Bienvenu Kawende [sup.3] , Emile W. Okitolonda [sup.3] , Frieda Behets [sup.4] , Marcel Yotebieng [...]

The vaccines do not pass through breastmilk, but antibodies do -- providing hope that breastfed babies might have some level of protection. The vaccines do not pass through breastmilk, but antibodies do -- providing hope that breastfed babies might have some level of protection., Author(s): Shannon Hall Author Affiliations: COVID vaccines and breastfeeding: what the data say A mother breastfeeds her newborn at a hospital in Belgium. Credit: Francisco Seco/AP/Shutterstock A mother, wearing a [...]