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Background: The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire developed to identify women at risk for postpartum depression (PD). EPDS symptom patterns appear to vary by nation. The EPDS items and their correlation with affirmative EPDS screens have thus far been minimally studied among Malaysians. Using positive predictive value (PPV) and negative predictive value (NPV), this study aims to evaluate the EPDS-based psychometric features of individual answer items. Methodology: A cross-section of postpartum women receiving care at two tertiary care facilities in Malaysia underwent screening assessments in the course of receiving treatment. EPDS was employed with an aggregate cutoff score (≥12). EPDS items were assessed as predictors of abnormal EPDS screens. Results: A total of 219 participants were screened, among which 66 were positive on the EPDS. EPDS item responses were collected (item responses 0-3: PPV = 0.07-0.78 and NPV = 0.93-0.22). A negative response to any item strongly predicted a negative EPDS screen (item entry = 0 and NPV = 0.93). Affirmative responses on items 8, 9, and 10 were particularly strong predictors of abnormal EPDS scores, while negative responses to items 3, 5, and 7 were strong predictors of negative EPDS scores. A substantial NPV for any item (response 0 and NPV items 1-10 = 0.93) and a moderate PPV for any affirmative response (responses 1-3, PPV items 1-10 = 0.60) were observed. Conclusions: This is one of the few studies to examine the EPDS item responses among Malaysian women. The results suggest that depression remains prevalent in this postpartum population. Our findings reveal a robust NPV for any negative response to the individual items of the scale, a moderate PPV for any affirmative response, and a particularly robust validity for specific EPDS items. Physical complaints, rather than feelings of sadness, figure prominently in this population, suggesting a tendency among Malaysian women toward somatizat

Lactation is a dynamic process in which the mother and the infant actively compete over how much of the mother's resources will be invested in breast milk during lactation. The infant's demand for milk can be expressed through behaviour, appetite, vocalisation, and/or non-nutritive suckling, while the mother's response can be shown in nursing behaviour, milk production, and/or milk composition. It is hypothesised that these relationships may shape infant behaviour and feeding, particularly appetite regulation, and may thus influence infant growth and development. However, there are many unanswered questions about this tug-of-war, including who is more in charge, how the mother allocates her energy economically to maximise her offspring's fitness, and whether, for instance, an abundance of maternal energy will result in a lessening of tension. However, it is also acknowledged that maternal emotion could influence breast milk synthesis and ejection, highlighting the need for minimising maternal stress or promoting relaxation during the postpartum period. Furthermore, the mother's energy reserves might be considerably depleted during the early postnatal period as she recovers from birth while continuing to invest in her infant, primarily through breast milk. Because breastfeeding requires high energy, postpartum distress may intensify the tug-of-war by affecting the mother's energy budget. Aiming to reduce this mother-infant conflict, we conducted a randomised controlled trial by manipulating the maternal psychological state using relaxation therapy (breastfeeding meditation) to see the effect on maternal stress, breast milk production, and infant behaviour and growth. The trial was conducted in Malaysia among first-time mothers and their full-term infants (n = 64), who were followed up on from birth to 16 weeks in three home visit sessions. Maternal stress and infant behaviour were assessed, infant growth was monitored, and breast milk samples were collected at all vi

Human milk is a highly complex liquid food tailor-made to match an infant’s needs. Beyond documented positive effects of breastfeeding on infant and maternal health, there is increasing evidence that milk constituents also impact child neurodevelopment. Non-nutrient milk bioactives would contribute to the (long-term) development of child cognition and behavior, a process termed ‘Lactocrine Programming’. In this review we discuss the current state of the field on human milk composition and its links with child cognitive and behavioral development. To promote state-of-the-art methodologies and designs that facilitate data pooling and meta-analytic endeavors, we present detailed recommendations and best practices for future studies. Finally, we determine important scientific gaps that need to be filled to advance the field, and discuss innovative directions for future research. Unveiling the mechanisms underlying the links between human milk and child cognition and behavior will deepen our understanding of the broad functions of this complex liquid food, as well as provide necessary information for designing future interventions.

Background: Postpartum depression has been linked to undesirable outcomes for mother-infant dyads, interfering with childcare and breastfeeding practices. This study aimed to determine the prevalence of depressive symptoms among mothers during the postpartum period and its association with breastfeeding and postpartum experiences. Methodology: This cross-sectional study involved mothers of hospitalized infants (n = 219) at two tertiary hospitals in Klang Valley, Malaysia. Mothers were screened for postpartum depression using the Edinburgh Postnatal Depression Scale with a cut-off of ≥12 for positive screening for depression. Mothers were asked to complete questionnaires on breastfeeding experience, which included breastfeeding self-efficacy and challenges. The questionnaires also collected information on postnatal experiences, including birth outcomes, anxiety and stress levels, and social support. Multiple linear regression was used to ascertain the association of postpartum depression levels with breastfeeding and postnatal experiences. Results: Overall, 30% of mothers in this study screened positive for depression. Based on multiple linear regression, a higher score of postpartum depression was significantly associated with unpleasant breastfeeding and postnatal experiences reflected by increased scores of anxiety and stress, lower infant birth weight, increased breastfeeding problems, and lower level of social support (p < 0.005). Conclusions: Maternal emotions, birth outcomes, breastfeeding issues, and social support were associated with postpartum depression. Efforts should be made to increase maternal support, and screening for maternal depression during infant hospital stays should be encouraged.

Background: The coronavirus disease (COVID-19) pandemic has resulted in a significant increase in the number of people seeking online support and information, particularly on social media. Nevertheless, the nature and trend of internet information, as well as its accuracy, are questionable. This study aimed to assess and compare the content, type/form, and degree of accuracy of breastfeeding information on Facebook before and during the COVID-19 pandemic (n = 288/phase). Methodology: The data were gathered from Malaysian public and group/page Facebook posts (n = 456). Keyword searches were conducted using Malay and English breastfeeding terms. The dataset was screened and entered into a structured codebook. The Delphi approach was used to assess the accuracy of posts’ content performed by breastfeeding experts. Results: Sharing personal experience (53.2%) was the most common topic in breastfeeding-related posts, followed by seeking questions (39.3%) and knowledge (8.0%). Sharing personal stories and knowledge posts were higher during COVID-19 than before (p = 0.001), although the seeking questions category was higher before the pandemic (p = 0.001). Most information posted was in text form (94.5%). About half of the posts (46.5%) were misleading, while (43.7%) were accurate. There was a significant difference in the accuracy of online posts before and during the COVID-19 pandemic (p = 0.001). Conclusions: Compared to the pre-pandemic phase, forms/types of information on Facebook remained consistent, whereas the breastfeeding information content and its degree of accuracy differed during the pandemic.We need to explore other aspects of breastfeeding online content as well as its engagement, especially during a pandemic. Knowing the infant feeding-related topics that have been discussed and questioned on social media, as well as the accuracy of the data, allows policymakers and scientific communities to plan strategies for spreading credible breastfeeding information

Human milk is a highly complex liquid food tailor-made to match an infant's needs. Beyond documented positive effects of breastfeeding on infant and maternal health, there is increasing evidence that milk constituents also impact child neurodevelopment. Non-nutrient milk bioactives would contribute to the (long-term) development of child cognition and behavior, a process termed 'Lactocrine Programming'. In this review we discuss the current state of the field on human milk composition and its links with child cognitive and behavioral development. To promote state-of-the-art methodologies and designs that facilitate data pooling and meta-analytic endeavors, we present detailed recommendations and best practices for future studies. Finally, we determine important scientific gaps that need to be filled to advance the field, and discuss innovative directions for future research. Unveiling the mechanisms underlying the links between human milk and child cognition and behavior will deepen our understanding of the broad functions of this complex liquid food, as well as provide necessary information for designing future interventions.

Background : The Movement Control Order (MCO), also known as the partial lockdown, was introduced in Malaysia in March 2020 to combat the COVID-19 pandemic, changing many public sector protocols and regulations. This may have implications for neonatal and maternity care and services, especially among new mothers. Objective : The aim of this study was to compare the postnatal experiences and feeding practices between mothers who gave birth before MCO (B-MCO) and during MCO (D-MCO). Method: One thousand fifty-one mothers with an infant under 18 months in Malaysia completed an online survey between July 2020 and October 2020. The survey advertisement was disseminated online via various social media platforms. Results: More D-MCO mothers faced a significant effect on the ability to pay rent/mortgage, with their spouses facing a higher impact on employment. D-MCO mothers were more likely to have changed their birth plans, perceived insufficient breastfeeding support, and experienced changes in postnatal services since MCO. In contrast, more B-MCO mothers had stopped breastfeeding during the MCO and started complementary feeding earlier than planned. Many mothers reported feeling down and lonely and having trouble sleeping and a poor appetite. D-MCO mothers had more time to focus on their health, whereas B-MCO mothers spent more time outdoors. Discussion: MCO affected mothers’ livelihood and postnatal experiences, potentially causing emotional distress. Hence, improved breastfeeding support, particularly at birth, is recommended, as is routine mental health screening during the postnatal checkup. Furthermore, because online contact was readily accessible during the pandemic, the efficacy of online breastfeeding support should be evaluated.

Background: Promoting breastfeeding is an important public health intervention, with benefits for infants and mothers. Even modest increases in prevalence and duration may yield considerable economic savings. However, despite many initiatives, compliance with recommendations is poor in most settings – particularly for exclusive breastfeeding. Mothers commonly consult health professionals for infant feeding and behavioural problems. Main body: We argue that broader consideration of lactation, incorporating evolutionary, comparative and anthropological aspects, could provide new insights into breastfeeding practices and problems, enhance research and ultimately help to develop novel approaches to improve initiation and maintenance. Our current focus on breastfeeding as a strategy to improve health outcomes must engage with the evolution of lactation as a flexible trait under selective pressure to maximise reproductive fitness. Poor understanding of the dynamic nature of breastfeeding may partly explain why some women are unwilling or unable to follow recommendations. Conclusions: We identify three key implications for health professionals, researchers and policymakers. Firstly, breastfeeding is an adaptive process during which, as in other mammals, variability allows adaptation to ecological circumstances and reflects mothers’ phenotypic variability. Since these factors vary within and between humans, the likelihood that a ‘one size fits all’ approach will be appropriate for all mother-infant dyads is counterintuitive; flexibility is expected. From an anthropological perspective, lactation is a period of tension between mother and offspring due to genetic ‘conflicts of interest’. This may underlie common breastfeeding ‘problems’ including perceived milk insufficiency and problematic infant crying. Understanding this – and adopting a more flexible, individualised approach – may allow a more creative approach to solving these problems. Incorporating evolutionary concept

Background: Circadian rhythm plays an important role as our internal body’s clock that synchronizes behavior and physiology according to the external 24-h light-dark cycle. Past studies have associated disrupted circadian rhythm with higher risk of miscarriages, preterm birth and low birth weights. This paper described the protocol of a prospective cohort study which aims to determine the circadian rhythm in pregnant women, identify its association with maternal factors during pregnancy, gestational weight gain, birth and infant outcomes. Methods: Ten government maternal and child health clinics in Kuala Lumpur, Malaysia will be randomly selected. Sample size of 438 first-trimester pregnant women will be followed-up until the birth of their infant. Salivary melatonin and cortisol concentration among subsample will be determined using enzyme-linked immunosorbent assay. Data on sleep quality, psychological distress and morningness/eveningness chronotype of pregnant women will be collected using validated questionnaires. Pedometer will be used to measure 5-day physical activity data. Total gestational weight gain will be determined at the end of pregnancy. Utilization of 3-day food record is to capture meal timing and nutrient intake. All measurements will be done in 2nd and 3rd trimester. Birth outcomes will be collected through clinic records and Centers for Disease Control and Prevention (CDC) Neonatal questionnaire. Infants will be followed-up at 6 and 12 months old to obtain anthropometric measurements. Discussion: There is a growing recognition of the role of maternal circadian rhythm, which entrains fetal circadian rhythms that may subsequently have long-term health consequences. The present study will identify the effect of circadian rhythm on pregnancy outcomes and infant growth in the first year of life.

This cross-sectional study aimed to determine the association of psychosocial factors with physical activity levels among undergraduate students aged 18 to 30 years. A sample of 261 students from Universiti Putra Malaysia (n = 261; 138 males; 123 females) participated in the study. The respondents have been selected through a probability-based cluster sampling. A self-administered questionnaire was used to gather information regarding the socio-demographic characteristics(age, ethnicity, family household number, allowance income, and parent’s monthly income), psychosocial factors (self-efficacy, social support, and perceived benefit), and physical activity levels, which was accessed using Global Physical Activity Questionnaire (GPAQ). Multiple linear regression analysis was performed to determine factors associated with physical activity levels. The highest percentage of respondents (63.2%) were classified as having a moderate physical activity, followed by vigorous (24.9%)and low physical activity (11.9%). The findings of multiple linear regression revealed that self-efficacy (Beta = 0.137, p = 0.049) and physical performance (Beta = 0.193, p = 0.002) were significant predictors of physical activity levels. Therefore, enhancements in self-efficacy and positive perception toward having better physical performance could be used as a strategy to increase physical activity levels among students in the university.

Introduction: Baby-friendly hospital practices and family support are recognised to improve the chances of successful breastfeeding. The associations between support and maternal psychological state and breastfeeding problems are less explored. This study aimed to assess the influence of professional and family support on breastfeeding adverse events and postpartum depression at 2 weeks and exclusive breastfeeding (EBF) status at 12 weeks postpartum, and to identify predictors of positive outcomes. Methods: 64 primiparous Malaysian mothers were interviewed face-to-face, at 2, 6 and 12 weeks post-delivery, to collect data regarding family support, hospital and infant feeding practices, breastfeeding problems and pain, maternal perceptions and depression. Logistic regression and correlation were used to ascertain associations between support and EBF, adverse events and postpartum depression. Results: Neither professional nor family support predicted EBF at 12 weeks. Eighty-five percent of the mothers received high family support, which was associated with lower depression scores (r=-0.36, p=0.005); higher depression scores were associated with more breastfeeding problems. EBF discontinuation before 12 weeks was predicted by maternal perception of insufficient milk supply (OR=8.96, CI=1.78, 45.18). Earlier breastfeeding initiation (r=0.26, p=0.04) and skin-to-skin contact (r=0.25, p=0.048) were associated with lower breastfeeding pain. EBF in hospital was correlated with fewer breastfeeding problems (r=0.31, p=0.01). Conclusion: Mothers with greater family support suffered from less depressive symptoms, which could lower the incidence of breastfeeding problems and prolong EBF duration. Skin-to-skin contact, early breastfeeding initiation and EBF in hospital were associated with less adverse events, thus better compliance with these Baby-Friendly practices is recommended.

Maternal psychological state is recognised to influence lactation success, largely by affecting milk ejection. Thus, increased psychological distress can disrupt milk flow and in the long‐term, affect milk synthesis. Conversely, it is possible that milk ejection could be improved by using relaxation therapy during breastfeeding. We performed a systematic review to evaluate the effectiveness of interventions using relaxation therapy to improve breastfeeding outcomes and to assess the consequent impact(s) on infant growth and behaviour. A literature search was performed using the PRISMA guidelines where we included intervention studies (including nonrandomised controlled studies) using relaxation therapy in breastfeeding mothers during the post‐natal period. Out of 147 identified records at the initial search, 5 studies were eligible, of which 3 were randomised controlled trials and 2 were nonrandomised or quasi‐experimental studies. These studies were conducted in Europe, America, and India and included 311 mother–infant pairs, of which 64 infants were full‐term and 247 were premature infants. Relaxation therapy was shown to increase milk yield in mothers of preterm infants in 2 randomised trials, however, the milk sampling protocol for these studies could be questioned. None of the studies investigated the consequent effects on infant outcomes. Overall, limited evidence was found on the effectiveness of relaxation therapy on breast milk composition and infant outcomes. Experimental studies with better standardisation of protocol and robust methodological design are needed to investigate the effectiveness of relaxation therapy on both breastfeeding and infant growth and behavioural outcomes.

Objective: To explore the iodine and selenium status and intakes, and iodine nutritional knowledge of women of childbearing-age in Palmerston North, New Zealand (NZ), after the implementation of mandatory fortification of bread with iodine. Method: Fifty women of childbearing-age (non-pregnant and not breastfeeding) were interviewed (recruited) for the assessment of dietary intake and nutritional knowledge using a researcher-led questionnaire, including a semi-quantitative food frequency questionnaire and 24-hour dietary recall. Fifty 24-hour urine samples were obtained and total volumes were measured. Iodine and selenium were analysed using the inductive-coupled plasma mass spectrometry. Result: The median urinary iodine concentration was 64.7 mcg/l, which represents a mild iodine deficiency (ID), according to the WHO. Based on the individual iodine status, 70% of the participants were iodine deficient, categorised as marginal (30%), mild (30%) and moderate (10%). Iodine intake estimated from urinary iodine excretion (UIE) showed that 34% did not achieve the Estimated Average Requirement (EAR)(<100 mcg/day) and 46% met the Recommended Dietary Intake (RDI)(150 mcg/day). The median iodine intake was 129.8 mcg/day, indicating suboptimal intake. The major contributors to iodine intake were milk (35.6%), bread (24.6%), fish and seafood (15%) and egg (13.8%). The majority of respondents were unaware of the mandatory fortification of bread with iodine (70%) and also unaware of the ID problem in NZ (52%). The median excretion of selenium was 31.6 mcg/day and the intake estimated from urinary excretion was 57.5 mcg/day, with both values above the safe range for women (30 mcg/day), according to the WHO. Based on the 24-hour recall, the majority (70%) had inadequate selenium intake (<50 mcg/day), whilst only 20% met the RDI intake of 60 mcg/day. There was a moderate correlation between the urinary selenium excretion and UIE (Spearman’s rank order; r (50)=0.547,p<0.05). Conclu