The influence of perception of care and maternal protection on breastfeeding practices on the infants' third month of life / Influência da percepção do cuidado e da proteção materna sobre as práticas de aleitamento materno em lactentes no terceiro mês de vida

Abstract Objectives: to evaluate the influence of perception of care and maternal protection on breastfeeding practices on the infants' third month of life. Methods: longitudinal study with mother-infant pairs distributed in five groupsof gestational clinical conditions. The recruitment occurred in the period 2011 to 2016 at three hospitals in the public health systems in Porto Alegre, Brazil. The Parental Bonding Instrument and the Edinburgh Postpartum Depression Scale were assessed. Exclusive and prolonged breastfeeding were analyzed by questionnaires. Data were analyzed by one-way ANOVA with Tukey's post-hoc test, Kruskal-Wallis with Dunn's post-hoc test, or Pearson's chi-squared test. The significance was set at 5%. Results: 209 mother-infant pairs were investigated. Among those who did not practice breastfeeding, a lower perception of care, a higher perception of maternal protection, and a higher score of postpartum depression were observed (p=0.022, p=0.038, and p<0.001, respectively), when compared to peers who practiced. The control group had a significantly higher perception of care when compared to thediabetes mellitus group (p=0.006), and the perception of maternal protection and postpartum depression had no differences between the intrauterine groups (p>0.05). Conclusions: the perception of care and maternalprotection and the postpartum depressive symptomatology influenced breastfeeding at three months. It is possible to assume a transgenerational effect on breastfeeding, suggesting the existence of a complex model related to mental health in a sample of women who had different backgrounds of gestational clinical conditions

Resumo Objetivos: avaliar a influência da percepção do cuidado e da proteção materna sobre as práticas de aleitamento materno em lactentes no terceiro mês de vida. Métodos: estudo longitudinal, com pares mães-lactentes distribuídos em cinco grupos de diferentes condições clínicas gestacionais. O recrutamento ocorreu no período de 2011 a 2016 em três hospitais da rede pública de saúde de Porto Alegre, Brasil. Foram utilizados o Parental Bonding Instrument e o Edinburgh Postpartun Depression Scale. O aleitamento materno exclusivo e continuado foi analisado por questionários. Na análise de dados foram utilizados os testes de ANOVA com post-hoc de Tukey, Kruskal-Wallis com post-hoc de Dunn e Qui-quadrado. Resultados: foram investigados 209 pares mães-lactentes. Entre aqueles que não praticaram o aleitamento materno foi observadouma menor percepção de cuidado materno, uma maior percepção de proteção materna e ummaior escore de depressão pós-parto (p=0,022, p=0,038 e p<0,001, respectivamente) quandocomparados aos pares mães-lactentes que praticaram. O grupo controle teve significativamente maior percepção do cuidado materno quando comparado ao grupo com diabetes mellitus (p=0,006) enquanto a percepção de proteção materna e a depressão pós-parto não apresentaram diferenças entre os cinco grupos intrauterinos (p>0,05). Conclusões: a percepção de cuidado e proteção materna e asintomatologia depressiva pós-parto influenciaram o aleitamento materno aos três meses. É possível assumir um efeito transgeracional no aleitamento materno, sugerindo a existência de um modelo complexo relacionado à saúde mental numa amostra de mulheres que tinham diferentes antecedentes de condições clínicas gestacionais.

Influence of intra- and extrauterine factors on infant sleep in the first 6 months of life

ABSTRACT Objective: Infant sleep problems can affect the child's health. Maternal characteristics have been associated with the quality of infant sleep, but few studies have investigated the impact of intrauterine conditions. The aim of the study was to evaluate the association between adverse intrauterine environments (maternal smoking, hypertension, diabetes, and intrauterine growth restriction) and extrauterine factors on infant sleep in the first 6 months of life. Methods: Prospective cohort study, including singleton and at-term infants. Mothers were interviewed after delivery and at 30 days, 3 months, and 6 months of life. Socioeconomic, breastfeeding, and sleep data were self-reported by mothers using semi-structured interviews. Maternal stress (Perceived Stress Scale) and postpartum depression symptoms (Edinburgh Postpartum Depression Scale) were assessed. Results: There was no statistically significant association between intrauterine environments and the sleep of infants of the 359 mother-child dyads investigated. Total infant sleep time decreased from approximately 13-11 h from 30 days to 6 months of age (p < 0.001) and the longest period of uninterrupted sleep increased from approximately 4-6 h during the same period (p < 0.001). Breastfed infants slept longer in 24-h periods in the first month, but they woke up more often throughout the night when compared to infants receiving formula. Mothers with depressive symptoms reported increased sleep latency time. Conclusions: Adverse intrauterine environments did not significantly affect sleep measures in the first 6 months of life. Maternal characteristics and practices, however, were associated with infant sleep, suggesting that environmental factors significantly contribute to sleep quality early in life.

Cross-cultural adaptation and validation of the Karitane Parenting Confidence Scale of maternal confidence assessment for use in Brazil / Adaptação transcultural e validação da Karitane Parenting Confidence Scale para avaliação da confiança materna para uso no Brasil

Abstract Objectives To transculturally adapt and validate the Karitane Parenting Confidence Scale to the Brazilian Portuguese language and culture and verify the combination of the results with the maternal sociodemographic characteristics. Methodology This is a validation and transcultural adaptation nestled in a longitudinal and observational study in Porto Alegre, RS, Brazil, assessing mother-infant pairs from different gestational and perinatal environments. The original authors authorized the translation into Brazilian Portuguese, unified version creation, back-translation, analysis by specialists, final version implementation, and acceptance. Cronbach's alpha analysis was performed. The Kruskal-Wallis test with post-hoc Dunn's test was used to compare the study groups. Socioeconomic and demographic characteristics, obtained through a questionnaire in the first 24-48 h of the newborns' life, were associated with maternal results by the Brazilian version of the scale, using Spearman's correlation and Mann-Whitney's test. Results The sample consisted of 251 postpartum women, with the confidence maternal questionnaire being applied at 15 days postpartum. The median score of the mothers' confidence was 40.00 (37.00-43.00). The protocol obtained a Cronbach's alpha of 0.717. There were significant weak positive correlations between maternal confidence and age (p = 0.013, r = 0.157) and between maternal confidence and schooling (p = 0.048, r = 0.125). Additionally, a significant association was observed between maternal confidence and parity (p = 0.030). Conclusion The transcultural adaptation and validation of the confidence maternal questionnaire into Brazilian Portuguese language and culture showed good reliability for this sample. The results of its use demonstrated that maternal confidence was associated with schooling, age and parity.

Resumo Objetivos Adaptar transculturalmente e validar a ferramenta Karitane Parenting Confidence Scale para a língua portuguesa e cultura brasileira, além de verificar a associação de seus resultados com as características sociodemográficas maternas. Metodologia Trata-se da validação e adaptação transcultural aninhada a estudo observacional longitudinal feito em Porto Alegre (RS), com puérperas de diferentes condições gestacionais e perinatais. Os processos ocorreram mediante autorização dos autores originais da escala Karitane Parenting Confidence Scale para a tradução para o português brasileiro, montagem de versão unificada, retradução, análise por experts, aplicação da versão final e validação. Realizou-se a análise Alpha de Cronbach. Para a comparabilidade entre os grupos do estudo utilizou-se o teste de Kruskal-Wallis com post hoc de Dunn. As características socioeconômicas e demográficas das puérperas, obtidas através de questionário estruturado nas 24-48 h pós-parto, foram relacionadas com a confiança materna obtida através da aplicação da escala, utilizando-se a correlação de Spearman e o teste de Mann-Whitney. Resultados A amostra foi composta por 251 puérperas, com a aplicação do questionário sobre confiança materna aos 15 dias pós-parto. A mediana da pontuação de confiança materna foi 40,00 [37,00-43,00]. O protocolo obteve valor de Alpha de Cronbach de 0,717. Houve correlações fracas significativas positivas entre confiança e idade materna (p = 0,013; r = 0,157) e entre confiança e escolaridade materna (p = 0,048; r = 0,125). Além disso, houve associação significativa entre a confiança materna e a paridade (p = 0,030). Conclusão A adaptação transcultural e validação da ferramenta sobre a confiança materna para o português brasileiro mostrou boa confiabilidade. Os resultados de sua aplicação demonstraram que a confiança materna esteve associada à escolaridade, à idade e à paridade.