Tag: breastfeeding

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More than a Quarter of New Mothers have Fallen Asleep while Breastfeeding

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Photo by Wendy Wei

More than a quarter of new mothers have fallen asleep recently while feeding their babies, putting the infants at increased risk of sudden infant death syndrome (SIDS), research published in Pediatrics reveals.

More than 80% had not intended to fall asleep, and many had chosen to feed in chairs or on sofas rather than in a bed. Unfortunately, the cushions and confines of those locations can be very unsafe for babies, raising the risk of death by 49 to 67 times.

The researchers, with UVA Health and UVA Health Children’s, are urging care providers to provide additional guidance for new parents on safe feeding practices, such as informing new moms that a hormone naturally released during breastfeeding will make them feel sleepy.

“While falling asleep while feeding young infants is not in itself too surprising, what is very alarming is that the majority of mothers did not plan to fall asleep, so the sleep space was potentially unsafe for the baby while both slept,” said researcher Fern Hauck, MD, MS, a safe-sleep expert at UVA Health and the UVA School of Medicine. “This highlights the need for parents to be educated about the potential risk of falling asleep while feeding and to plan for that possibility by making the space around the baby as safe as possible. That would include removing pillows and blankets to ensure an open airway for the baby.”

Safe infant feeding

Hauck and her collaborators, including UVA’s Ann Kellams, MD, and Rachel Moon, MD, analysed survey results collected from more than 1250 new mothers as part of the Social Media and Risk-reduction Training (SMART) study conducted at 16 US hospitals in 2015 and 2016. Most respondents completed the survey when their infant was between 2 and 3 months of age.

Among the respondents, more than 28% said they had “usually” or “sometimes” fallen asleep during feeding in the prior two weeks. Of those, a whopping 83.4% said falling asleep was unplanned.

Women who fed in bed were more likely to fall asleep (33.6%) than those who fed on a chair or couch (16.8%). The American Academy of Pediatrics (AAP) recommends mothers at risk of falling asleep while breastfeeding should do so in an adult bed rather than a chair or couch.

Many of the women who fell asleep on chairs or sofas said they chose those locations specifically to avoid falling asleep, to avoid locations (such as a bed) they had been told were unsafe or to avoid disturbing someone else. (The AAP warns moms against sharing a bed or other sleep space with an infant because of the risk the parent might accidentally roll over and smother the child, or that the child could become tangled in bedding. But the group also says that beds are safer than chairs and sofas if falling asleep while feeding is a possibility.)

“We need to meet families where they are and come up with a nighttime plan for sleeping and feeding their baby that works for them and is as safe as possible,” said Kellams, a paediatrician and breastfeeding and lactation medicine specialist at UVA Health Children’s. “Our data suggest that too many of these falling asleep incidents are not planned, so discussions about how to plan for feeding your baby when you are very tired are important.”

The researchers note that providing parents with information about safe sleep and feeding has been shown to reduce risk of unexpected death significantly. But this educational outreach needs to be expanded, they say. Care providers should acknowledge that moms face a very real risk of falling asleep while feeding, even if they are trying not to, and provide practical advice on how to reduce that risk. Further, the researchers are urging additional studies to find ways to assist parents in both safe-sleep practices and breastfeeding.

“We hope that parents of young infants will think proactively about what might happen in the middle of the night,” said Moon, a paediatrician and safe-sleep expert at UVA Health Children’s. “Feeding your baby in your bed is safer than feeding on a couch or armchair if you might fall asleep.”

Source: University of Virginia Health System

Categories : Gastrointestinal PaediatricsTags :

Breastfeeding Shapes the Gut Microbiome and Protects against Asthma

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Photo by Wendy Wei

Human breast milk regulates a baby’s mix of microbes, known as the microbiome, during the infant’s first year of life, in turn lowers the child’s risk of developing asthma, according to a new study published in Cell.

Led by researchers at NYU Langone Health and the University of Manitoba, the study results showed that breastfeeding beyond three months supports the gradual maturation of the microbiome in the infant’s digestive system and nasal cavity, the upper part of the respiratory tract. Conversely, stopping breastfeeding earlier than three months disrupts the paced development of the microbiome and was linked to a higher risk of preschool asthma.

Some components in breast milk, such as complex sugars called human milk oligosaccharides, can only be broken down with the help of certain microbes. This provides a competitive advantage to microbes capable of digesting these sugars. By contrast, infants who are weaned earlier than three months from breast milk and who then rely solely on formula feeding, become home to a different set of microbes –ones that will help the infant to digest the components in formula. While many of these microbes that thrive on formula do eventually end up in all babies, the researchers showed that their early arrival is linked to an increased risk of asthma.

“Just as a pacemaker regulates the rhythm of the heart, breastfeeding and human milk set the pace and sequence for microbial colonisation in the infant’s gut and nasal cavity, ensuring that this process occurs in an orderly and timely manner,” said study co-senior investigator and computational biologist Liat Shenhav, PhD. “Healthy microbiome development is not only about having the right microbes. They also need to arrive in the right order at the right time,” said Dr Shenhav, an assistant professor at NYU Grossman School of Medicine, its Institute for Systems Genetics, and the school’s Department of Microbiology.

For the study, Dr Shenhav, who is also an assistant professor at NYU’s Courant Institute of Mathematical Sciences, worked in collaboration with study co-senior investigator Meghan Azad, PhD, director of the Manitoba Interdisciplinary Lactation Center, and a professor of paediatrics and child health, at the University of Manitoba.

Another key study finding was that the bacterium Ruminococcus gnavus appeared much sooner in the guts of children who were weaned early from breast milk than in those of children who were exclusively breastfed. The bacterium is known to be involved in the production of molecules called short-chain fatty acids, and the formation and breakdown of the amino acid tryptophan. Both tryptophan and its metabolites have been linked to immune system regulation and disruption in previous research, including an increased risk of asthma. The study authors noted that beyond aiding in digestion, an infant’s microbiome plays a crucial role in the immune system’s development.

The study tracked the ebb and flow of microbes in the guts and noses of infants during the first year of life, as well as details on breastfeeding and the composition of their mothers’ milk. All the children and their mothers were participating in the CHILD Cohort Study, a long-term research project that has been studying the same 3500 Canadian children at different stages of life from the womb well into adolescence.

The data provided by the CHILD Cohort Study enabled researchers to detangle the impact of breastfeeding on an infant’s microbiome from a range of other environmental factors, including prenatal smoke exposure, antibiotics, and the mother’s asthma history.

Even when these factors were accounted for, they found that breastfeeding duration remained a powerful determinant for the child’s microbial makeup over time. They also used these microbial dynamics and data on milk components to train a machine learning model that accurately predicted asthma years in advance. Finally, they created a statistical model to learn causal relationships, which showed that the primary way breastfeeding reduces asthma risk is through shaping the infant’s microbiome.

“The algorithms we developed provide valuable insights into microbial dynamics during an infant’s first year of life and how these microbes interacted with the infant,” said Dr Shenhav. “These insights allowed us to move beyond identifying associations, enhancing our ability to make predictions and explore causal relationships.

“Our research highlights the profound impact of breastfeeding on the infant microbiome and breastfeeding’s essential role in supporting respiratory health. By uncovering the mechanisms behind the protective effects of breast milk, as demonstrated in this study, we aim to inform national guidelines on breastfeeding and weaning from breast milk in a data-driven manner.

“With further research, our findings could also contribute to developing strategies to prevent asthma in children who cannot be breastfed for at least three months,” she added.

Source: NYU Langone Health / NYU Grossman School of Medicine

Categories : Obstetrics & Gynaecology PaediatricsTags :

Health and Economic Benefits of Breastfeeding Quantified

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Among half a million Scottish infants, those exclusively breastfed were less likely to use healthcare services and incurred lower costs to the healthcare system

Photo by Wendy Wei

Breastmilk can promote equitable child health and save healthcare costs by reducing childhood illnesses and healthcare utilisation in the early years, according to a new study published this week in the open-access journal PLOS ONE by Tomi Ajetunmobi of the Glasgow Centre for Population Health, Scotland, and colleagues.

Breastfeeding has previously been found to promote development and prevent disease among infants. In Scotland – as well as other developed countries – low rates of breastfeeding in more economically deprived areas are thought to contribute to inequalities in early childhood health. However, government policies to promote child health have made little progress and more evidence on the effectiveness of interventions may be needed.

In the new study, researchers used administrative datasets on 502,948 babies born in Scotland between 1997 and 2009. Data were available on whether or not infants were breastfed during the first 6-8 weeks, the occurrence of ten common childhood conditions from birth to 27 months, and the details of hospital admissions, primary care consultations and prescriptions.

Among all infants included in the study, 27% were exclusively breastfed, 9% mixed fed and 64% formula fed during the first 6-8 weeks of life. The rates of exclusively breastfed infants ranged from 45% in the least deprived areas to 13% in the most deprived areas.

The researchers found that, within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed any formula milk. On average, breastfed infants had lower average costs of hospital care per admission (£42) compared to formula-fed infants (£79) in the first six months of life and fewer GP consultations (1.72, 95% CI: 1.66 – 1.79) than formula-fed infants (1.92 95% CI: 1.88 – 1.94). At least £10 million of healthcare costs could have been avoided if all formula-fed infants had instead been exclusively breastfed for the first 6-8 weeks of life, the researchers calculated.

The authors conclude that breastfeeding has a significant health and economic benefit and that increasing breastfeeding rates in the most deprived areas could contribute to the narrowing of inequalities in the early years.

Provided by PLOS

Categories : Paediatrics Substance UseTags :

THC Lingers in Breastmilk with no Clear Peak or Decline

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The psychoactive component THC of cannabis showed up in breastmilk in a study published in the journal Breastfeeding Medicine. Unlike alcohol, when THC was detected in milk there was no consistent time when its concentration peaked and started to decline.

Importantly, the researchers discovered that the amount of THC they detected in milk was low – they estimated that infants received an average of 0.07mg of THC per day. For comparison, a common low-dose edible contains 2mg of THC. The research team stressed that it is unknown whether this amount has any impact on the infant.

“Breastfeeding parents need to be aware that if they use cannabis, their infants are likely consuming cannabinoids via the milk they produce, and we do not know whether this has any effect on the developing infant,” said Courtney Meehan, a WSU biological anthropologist who led the project and is the study’s corresponding author.

Since other research has shown that cannabis is one of the most widely used drugs during breastfeeding, the researchers aimed to uncover how long cannabinoids, like THC, persisted in breastmilk.

For this Washington State University-led study, the researchers analysed milk donated by 20 breastfeeding mothers who used cannabis. The participants, who all had infants younger than six months, provided detailed reports on their cannabis use. They collected milk after abstaining from using cannabis for at least 12 hours and then at regular intervals after use. All of this was done in their own homes, at a time of their choosing and with cannabis they purchased themselves.

The researchers then analyzed the milk for cannabinoids. They found that the milk produced by these women always had detectable amounts of THC, even when the mothers had abstained for 12 hours.

“Human milk has compounds called lipids, and cannabinoids are lipophilic, meaning they dissolve in those lipids. This may mean that cannabinoids like THC tend to accumulate in milk – and potentially in infants who drink it,” said Meehan.

The research also revealed that people had different peak THC concentrations in their milk. For participants who used cannabis only one time during the study, cannabinoids peaked approximately 30 minutes to 2.5 hours after use and then started to decline. For participants who used multiple times during the study, the majority showed a continual increase in concentrations across the day.

“There was such a range. If you’re trying to avoid breastfeeding when the concentration of THC peaks, you’re not going to know when THC is at its peak in the milk,” said lead author Elizabeth Holdsworth, who worked on this study while a WSU post-doctoral researcher and is now on the faculty of The Ohio State University.

A related qualitative study by the research team revealed that many breastfeeding moms are using cannabis for therapeutic purposes: for the management of anxiety, other mental health issues or chronic pain. The mothers often chose cannabis over using other medications because they felt it was safer.

“Our results suggest that mothers who use cannabis are being thoughtful in their decisions,” said co-author Shelley McGuire, a University of Idaho professor who studies maternal-infant nutrition. “These women were mindful about their choices. This is far from a random lifestyle choice.”

While in most cases, the women were using cannabis as alternative treatment for a variety of conditions, McGuire pointed out that there is no evidence yet whether it is safer or more harmful. In fact, scientists know almost nothing about how many commonly used drugs may impact breastfeeding babies, partly because women, especially those who are breastfeeding, have historically been left out of clinical trials on medicines.

“This is an area that needs substantial, rigorous research for moms to know what’s best,” McGuire said.

Some research has been done regarding alcohol with guidelines for new mothers to wait at least two hours after consuming alcohol before breastfeeding. Nothing similar has been developed for cannabis, which has been growing in popularity.

The collaborative research team is currently working to address some of that knowledge gap with further research on cannabis use in breastfeeding moms, holistic composition of the milk they produce and its effects on infant development.

Source: Washington State University

Categories : PaediatricsTags :

Adding Complex Milk Component to Infant Formula Confers Long-term Cognitive Benefits

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Breastfeeding in infancy has been shown to confer cognitive and health benefits. For decades, researchers have sought to create a viable complement or alternative to breast milk to give children their best start for healthy development. New research out of the University of Kansas and published in the Journal of Pediatrics has shown how a complex component of milk that can be added to infant formula has been shown to confer long-term cognitive benefits, including measures of intelligence and executive function in children.

The research by John Colombo, KU Life Span Institute director and investigator, along with colleagues at Mead Johnson Nutrition and in Shanghai, China, adds to the growing scientific support for the importance of ingredients found in milk fat globule membrane (MFGM) in early human development.

The study showed that feeding infants formula supplemented with MFGM and lactoferrin for 12 months raised IQ by 5 points at 5 ½ years of age. The effects were most evident in tests of children’s speed of processing information and visual-spatial skills. Significant differences were also seen in children’s performance on tests of executive function, which are complex skills involving rule learning and inhibition.

All forms of mammalian milk contain large fat globules that are surrounded by a membrane composed of a variety of nutrients important to human nutrition and brain development, Colombo said. When milk-based infant formula is manufactured, the membrane has typically been removed during processing.

“No one thought much about this membrane,” Colombo said, “until chemical analyses showed that it’s remarkably complex and full of components that potentially contribute to health and brain development.”

The 2023 study was a follow-up to a 2019 one also published in the Journal of Pediatrics, which showed that babies who were fed formula with added bovine MFGM and lactoferrin had higher scores on neurodevelopmental tests during the first year and on some aspects of language at 18 months of age.

The global nutrition research community has been looking at MFGM for about a decade, Colombo said. Because the membrane is made up of several different components, it isn’t known whether one of the components is responsible for these benefits, or whether the entire package of nutrients act together to improve brain and behavioural development.

These benefits were seen in children long after the end of formula feeding at 12 months of age.

“This is consistent with the idea that early exposure to these nutritional components contribute to the long-term structure and function of the brain,” said Colombo, who has spent much of his career researching the importance of early experience in shaping later development.

Source: University of Kansas

Categories : Obstetrics & GynaecologyTags :

New Study Finds Marijuana THC Persists in Breast Milk

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A new study has found that tetrahydrocannabinol (THC) from marijuana can linger in breast milk for up to six weeks after ceasing marijuana use.

Marijuana is the most commonly used dependent substance in pregnancy, with up to half of users continuing through pregnancy. The use of marijuana through pregnancy is likely due to its perceived safety as well as   THC readily crosses the placental barrier, and cannabinoid receptors have been identified in both the placenta and the foetus. However, most studies done on marijuana and pregnancy dates from the 1980s –  this study is the first of its kind to examine the levels of THC in breast milk since one in 1982.

“With the increasing utilisation of marijuana in society as a whole, we are seeing more mothers who use marijuana during pregnancy,” said primary investigator Erica Wymore, MD, MPH, Neonatologist, Children’s Colorado and Assistant Professor of Pediatrics, University of Colorado School of Medicine. “However, given the lack of scientific data regarding how long THC persists in breast milk, it was challenging to provide mothers with a definitive answer regarding the safety of using marijuana while breastfeeding and simply ‘pumping and dumping’ until THC was no longer detectable in their milk. With this study, we aimed to better understand this question by determining the amount and duration of THC excretion in breast milk among women with known prenatal marijuana use.”

The researchers screened women at the Children’s Colorado and UC Health’s University of Colorado Hospital for reported marijuana use or detected THC, who were willing to abstain from marijuana for the six week duration of the study. Of the 394 women screened, 25 enrolled in the study. Seven of these women were able to abstain from their marijuana use, while the others were not able to due depending on it for stress, sleep, and pain relief.

“This study provided invaluable insight into the length of time it takes a woman to metabolise the THC in her body after birth, but it also helped us understand why mothers use marijuana in the first place,” said Maya Bunik, MD, MPH, senior investigator, medical director of the Child Health Clinic and the Breastfeeding Management Clinic at Children’s Colorado and professor of pediatrics at the CU School of Medicine. “To limit the unknown THC effects on foetal brain development and promote safe breastfeeding, it is critical to emphasise marijuana abstention both early in pregnancy and postpartum. To help encourage successful abstention, we need to look at – and improve – the system of supports we offer new moms.”

While the study was not about the impact of maternal marijuana use on childhood development, longitudinal studies dating from the 1980s show that for children born to mothers who smoked marijuana during pregnancy, there are long-term issues with cognitive and executive functioning, including impulsivity, as well as deficits in learning, sustained attention and visual problem-solving skills. One recent retrospective study has also linked marijuana use in pregnancy to autism in children. Dr Wymore points out that this is cause for concern as currently available marijuana has a potency five to six times greater than what was available prior to legalisation.

Source: News-Medical.Net

Journal information: Wymore, E.M., et al. (2021) Persistence of Δ-9-Tetrahydrocannabinol in Human Breast Milk. JAMA Pediatrics. doi.org/10.1001/jamapediatrics.2020.6098.