Breastfeeding and Neonatal Age Influence Neutrophil‐Driven Ontogeny of Blood Cell Populations in the First Week of Human Life
Sebastiano MontanteRym Ben-OthmanNelly AmenyogbeAsimenia AngelidouAnita H.J. van den BiggelaarBing CaiYixuan ChenAlansana DarboeJoann Diray‐ArceRebecca FordOlubukola T. IdokoAmy Huei‐Yi LeeMandy LoKerry McEnaneyMehrnoush MalekDavid MartinoGeraldine MasiriaOludare A. OdumadeWilliam PomatCasey P. ShannonKinga K. SmolenThe EPIC ConsortiumAl OzonoffPeter RichmondScott J. TebbuttOfer LevyBeate KampmannRyan R. BrinkmanTobias R. Kollmann
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The first few days of life are characterized by rapid external and internal changes that require substantial immune system adaptations. Despite growing evidence of the impact of this period on lifelong immune health, this period remains largely uncharted. To identify factors that may impact the trajectory of immune development, we conducted stringently standardized, high‐throughput phenotyping of peripheral white blood cell (WBC) populations from 796 newborns across two distinct cohorts (The Gambia, West Africa; Papua New Guinea, Melanesia) in the framework of a Human Immunology Project Consortium (HIPC) study. Samples were collected twice from each newborn during the first week of life, first at Day of Life 0 (at birth) and then subsequently at Day of Life 1, 3, or 7 depending on the randomization group the newborn belongs to. The subsequent analysis was conducted at an unprecedented level of detail using flow cytometry and an unbiased automated gating algorithm. The results showed that WBC composition in peripheral blood changes along patterns highly conserved across populations and environments. Changes across days of life were most pronounced in the innate myeloid compartment. Breastfeeding, and at a smaller scale neonatal vaccination, were associated with changes in peripheral blood neutrophil and monocyte cell counts. Our results suggest a common trajectory of immune development in newborns and possible association with timing of breastfeeding initiation, which may contribute to immune‐mediated protection from infection in early life. These data begin to outline a specific window of opportunity for interventions that could deliberately direct WBC composition, and with that, immune trajectory and thus ontogeny in early life. This trial is registered with NCT03246230 .Abstract Background High breastfeeding attrition rates have been attributed to a number of factors, but the effect of previous breastfeeding experience on subsequent breastfeeding duration has not been adequately investigated. Methods In this study, 559 multiparous mothers were recruited and followed prospectively for 12 months or until the infant was weaned. Results When compared with having previously breastfed for > 3 months, no previous breastfeeding experience ( HR 3.24 [95% CI 2.37–4.42]) or a breastfeeding duration of ≤ 3 months ( HR 2.56; 95% CI 2.05?3.20) substantially increased the risk of early weaning. Similarly, participants who had not exclusively breastfed ( HR 1.82 [95% CI 1.46?2.26]) or who had exclusively breastfed for ≤ 2 months ( HR 1.65 [95% CI 1.29?2.10]) were more likely to stop exclusive breastfeeding when compared with those who had exclusively breastfed for > 2 months. More than 40 percent of the participants who had previously breastfed for > 3 months had shorter current breastfeeding durations. The median decreases in any and exclusive breastfeeding for this group were 16.4 weeks and 13.1 weeks, respectively. Conclusions Multiparous women with no previous breastfeeding experience and those with a short duration of previous breastfeeding should be provided with greater support to promote a longer duration of breastfeeding. Multiparous women with a longer duration of breastfeeding should be strongly encouraged to meet or exceed this duration with their current infant.
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The purpose of this study was to examine the effect of a breastfeeding education program on breastfeeding initiation rates, breastfeeding knowledge, and attitude towards breastfeeding among teenage mothers at an urban school for pregnant and parenting teens. Breastfeeding initiation rose from 35.7% in the control group to 85.2% in the treatment group. The mean score on the Breastfeeding Knowledge Subscale was significantly higher for the treatment group but not the control group. There was not a significant increase in mean scores on the Breastfeeding Attitude Subscale. Participants who initiated breastfeeding scored also had a significant increase in scores from pretest to posttest on the Breastfeeding Knowledge Subscale, while participants who did not initiate breastfeeding did not.
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Duration of breastfeeding was studied in 556 women delivering at 2 maternity hospitals in Perth, Australia. At discharge 83.8% of women were breastfeeding their infants, including 6% who were giving complementary feeds. At 3 and 6 months, 61.8% and 49.9%, respectively, were still breastfeeding. In a Cox survival analysis of factors associated with duration of breastfeeding a positive association was found with maternal education, age and intended duration of breastfeeding. Male infants were more likely to be weaned before female infants and women whose partners were unemployed, or did not have a preference for breastfeeding, breastfed for shorter duration. There is still a need for programmes which support and encourage breastfeeding, focusing particularly on younger, less well‐educated women who intend to breastfeed for less than the recommended 4–6 months.
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Duration of breastfeeding was studied in 556 women delivering at 2 maternity hospitals in Perth, Australia. At discharge 83.8% of women were breastfeeding their infants, including 6% who were giving complementary feeds. At 3 and 6 months, 61.8% and 49.9%, respectively, were still breastfeeding. In a Cox survival analysis of factors associated with duration of breastfeeding a positive association was found with maternal education, age and intended duration of breastfeeding. Male infants were more likely to be weaned before female infants and women whose partners were unemployed, or did not have a preference for breastfeeding, breastfed for shorter duration. There is still a need for programmes which support and encourage breastfeeding, focusing particularly on younger, less well-educated women who intend to breastfeed for less than the recommended 4–6 months.
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The aim of this study was to examine the effect of duration of earlier breastfeeding on the duration of breastfeeding with subsequent births. Medical records of 327 women who had had at least two deliveries were analysed; 89 of these women had had three deliveries. The average duration of breastfeeding increased from 6.01 mo to 6.85 mo with the second baby, but did not increase significantly with the third. A significant negative correlation was found between duration of first breastfeeding and change of breastfeeding duration at the second breastfeeding. Mothers who breastfed their first child for 0–7 mo significantly increased the duration of breastfeeding with the second child, whereas mothers who breastfed their firstborn for 8 mo or longer significantly reduced breastfeeding with the second baby. Conclusion : Results support earlier studies showing that duration of breastfeeding of the second child is significantly related to previous breastfeeding experience. Results also suggest that previous breastfeeding experience may lead mothers to regulate duration of subsequent breastfeeding toward a level that is optimal for them. The results are interpreted with respect to societal changes in breastfeeding patterns, as well as the role of maternal learning in breastfeeding behaviour.
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There is wide variation in the duration of breastfeeding across Europe which may in part be due to the between-country differences in mothers' and societal attitudes towards breastfeeding in public. The objective of this study was to quantify and compare the maternal attitudes to, and practice of, breastfeeding in public in four European centers and investigate the association with duration of breastfeeding.Participants (n = 389) were mothers recruited from maternity wards of hospitals in Glasgow (Scotland), Stockholm (Sweden), Granada (Spain), and Reggio-Emilia (Italy).Among those who had breastfed, Scottish (adjOR 0.25 [95% CI 0.12-0.50]) and Italian mothers (adjOR 0.30 [95% CI 0.14-0.63]) were significantly less likely than Swedish mothers to have ever breastfed in public. Mothers who had a negative attitude toward breastfeeding in public were less likely to have ever breastfed in public (adjOR 0.05 [95% CI 0.02-0.17]), and those who had never breastfed in public were in turn more likely to discontinue breastfeeding earlier.Perceived social norms may exert a stronger influence on breastfeeding outcomes than a woman's breastfeeding attitudes and knowledge. Differences between European countries in the duration of breastfeeding may be explained in part by differences in societal attitudes to breastfeeding in public.
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Our aim was to study factors affecting the initiation, progress and duration of breastfeeding in Greece.We studied 938 infants born in 2001 in 17 maternity hospitals in Greece.The percentage of breastfeeding infants was 85.5%. The actual progress of breastfeeding was different from the one that the mothers intended to follow. Although the majority of women claimed in the beginning that they would breastfeed mainly for four to six months (23.2%) and 12-14 months (23.1%), the majority had discontinued breastfeeding by the fourth month (58.5%) and only 7.3% breastfed for more than one year. The initiation time of breastfeeding was positively influenced by natural delivery (p = 0) and pleasant delivery (p = 0.397). Smoking was negatively associated with the duration of breastfeeding (p = 0) and the infants of smokers breastfed mainly for one to two months (38.7%). Exclusive breastfeeding in the maternity hospital was positively associated with the mother's intention to refuse to use a mixed diet after being discharged (p = 0).Greater support is needed so that women can implement their original intentions concerning the progress of breastfeeding.
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How Breastfeeding Behavior is Affected by the Breastfeeding Perspectives of Fathers in Georgia (USA)
Background: Father support has recently been associated with increasing breastfeeding rates, but research is limited on how the American father’s perspectives of breastfeeding influence breastfeeding behavior. The aim of the study was to investigate the perspectives of fathers residing in Georgia on breastfeeding and to understand if it contributed to mothers’ decisions to breastfeed.
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Increasing the rates of both initiation of breastfeeding and duration of breastfeeding are national health objectives. In the United States, the actual in-hospital breastfeeding initiation rate is 64%, and duration rate (at 6 months postpartum) is 29%. These percentages fall short of the Healthy People 2010 goal for breastfeeding, which states that we should increase the proportion of mothers who initiate breastfeeding to at least 75%, and increase the proportion of mothers who continue to breastfeed until their infant is 6 months old to at least 50%. Factors influencing breastfeeding such as sociodemographics, maternal attitudes toward breastfeeding, influence of significant others, and the workplace environment are examined. Approaches to increasing the initiation and prolonging the duration of breastfeeding are discussed.
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