Women's Satisfaction with Breastfeeding and Risk of Exclusive Breastfeeding Interruption.

This prospective cohort study was conducted to evaluate the association between women's satisfaction with breastfeeding at 1 month post-partum and the risk of exclusive breastfeeding (EBF) interruption before 6 months. 287 mother-infant dyads randomly selected from two maternity hospitals were followed from birth to 24 months of infant's age. Women's satisfaction with breastfeeding was assessed using the Maternal Breastfeeding Evaluation Scale (MBFES) at 1 month. The association between women's satisfaction with breastfeeding and risk of EBF interruption before 6 months was estimated using Cox proportional hazards model. Kaplan-Meier survival curves for EBF were compared between women with lower satisfaction with breastfeeding (MBFES score < median 124) and those with higher satisfaction (MBFES score ≥ 124). Median EBF duration in women with higher satisfaction was 120 days (95%CI 109-131), vs. 26 days (95%CI 19-33) in less satisfied women. Each additional point on MBFES promoted a reduction of 2.0% in the risk of EBF interruption. Among women with satisfaction scores < 124, the risk of EBF interruption was 86% higher when compared with those ≥ 124 (adjusted hazard ratio 1.86; 95%CI 1.41-2.46). Lower maternal satisfaction with breastfeeding in the first month post-partum is associated with a higher risk of EBF interruption before 6 months.

Trends of breastfeeding indicators in Brazil from 1996 to 2019 and the gaps to achieve the WHO/UNICEF 2030 targets.

BACKGROUND: The comprehension of breastfeeding patterns and trends through comparable indicators is essential to plan and implement public health policies. OBJECTIVE: To evaluate the trends of breastfeeding indicators in Brazil from 1996 to 2019 and estimate the gap to achieve the WHO/UNICEF 2030 targets in children under 5 years. METHODS: Microdata from two National Surveys on Demography and Health of Women and Children (PNDS-1996 and PNDS-2006) and the Brazilian National Survey on Child Nutrition-2019 were used. The indicators of early initiation of breastfeeding (EIBF), exclusive breastfeeding of infants 0-5 months of age (EBF<6 mo), continued breastfeeding at 1 year of age (CBF1yr) and CBF at 2 years of age (CBF2yr) were analysed using prevalence and 95% CI. The average annual variation and years to achieve the WHO/UNICEF 2030 targets were calculated for Brazil and the macroregions. Statistical analyses considered the survey's complex sample design for each database. RESULTS: EIBF increased from 36.3% (95% CI 33.6% to 39.0%) in 1996 to 60.9% (95% CI 56.5% to 65.3%) in 2006 (statistically significant) and 62.5% (95% CI 58.3% to 66.6%) in 2019. EBF<6 mo increased from 26.9% (95% CI 21.3% to 31.9%) in 1996 to 39.0% (95% CI 31.0% to 47.1%) in 2006 and 45.8% (95% CI 40.9% to 50.7%) in 2019 (significant increases for 1996-2019 for Brazil, Northeast and Midwest regions). CBF1yr rose from 36.6% (95% CI 30.8% to 42.4%) in 1996 to 48.7% (95% CI 38.3% to 59.0%) in 2006, and 52.1% (95% CI 45.4% to 58.9%) in 2019. CBF2yr increased from 24.7% (95% CI 19.5% to 29.9%) in 1996 to 24.6% (95% CI 15.7% to 33.5%) in 2006 and 35.5% (95% CI 30.4% to 40.6%) in 2019 (significant increase for 1996-2019). The South and Southeast regions need to double the 2019 prevalence to reach the target for the CBF1yr and CBF2yr; the Northeast and North need to increase 60% the current prevalence for the indicator of EBF<6 mo. CONCLUSION: A substantial improvement in breastfeeding indicators occurred in Brazil from 1996 to 2019, although at an insufficient rate to achieve the WHO/UNICEF 2030 targets.

Skin-to-skin contact after birth: Developing a research and practice guideline.

AIM: Skin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, the implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. METHODS: The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. RESULTS: The developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. CONCLUSION: The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.

Complementary feeding methods and introduction of ultra-processed foods: A randomized clinical trial.

Introduction: Complementary feeding (CF) is defined as a period when foods, other than milk, are introduced to the infant's diet. Unfortunately, frequent consumption of ultra-processed foods (UPF) has become highly prevalent early in an infant's life. The aim was to verify the association of CF methods with the introduction of UPF in early childhood. Methods: This randomized clinical trial involved pairs of mother-infants, allocated in groups receiving different CF interventions: strict Parent-Led Weaning (PLW); strict Baby-Led Introduction to SolidS (BLISS), or mixed-method. The intervention consisted of a counseling session on healthy eating at the child's 5.5 months of age. A structured questionnaire was created based on the NOVA classification for the definition of UPF and applied at 9 and 12 months. The effect of the CF method intervention was measured by a survival curve for UPF offered for the first time in early childhood between groups. Cox regression was used to estimate its magnitude. The primary analysis was done in three groups (PLW, BLISS, and Mixed) and the secondary analysis was done in two groups (PLW, and BLISS + Mixed). Results: A total of 139 mother-infant pairs were eligible and 129 followed the study. The prevalence of infants who were exposed to UPF in early childhood was 58.9% (n = 76), being 71.4% in the PLW group, 53.3% in the BLISS group, and 52.4% in the Mixed group, without differences between them (p = 0.133). The PLW group intervention had a greater chance of exposure to ice cream or popsicles (p = 0.032) and sweet crackers (p = 0.009), compared with the other two CF groups. The Cox regression did not find significant differences between the three groups. However, the regression with two groups estimated a 38% reduction in the offer of UPF in the BLISS + Mixed group intervention (p = 0.049). Discussion: The CF intervention promoting greater infant autonomy (BLISS and Mixed) was associated with a reduction in the offer of UPF in early childhood. This knowledge may contribute to supporting strategies aimed at reducing UPF consumption by the young infant. Brazilian registry of clinical trials ReBEC: [https://ensaiosclinicos.gov.br/rg/RBR-229scm], identifier [RBR-229scm U1111-1226-9516].

Association between mistreatment of women during childbirth and symptoms suggestive of postpartum depression.

BACKGROUND: Postpartum depression is a common condition in the pregnancy and postpartum cycle. The development of this condition is multifactorial and can be influenced by previous traumas. This study sought to verify whether there is an association between having been exposed to mistreatment during childbirth and presenting symptoms suggestive of postpartum depression. METHODS: This is a cross-sectional study, with the inclusion of 287 women without complications in childbirth, randomly selected from two maternity hospitals of Porto Alegre, southern Brazil, in 2016. Four weeks after delivery, the postpartum women answered a face-to-face interview about socioeconomic aspects, obstetric history, health history, and childbirth experience (practices and interventions applied) and completed the Edinburgh Postnatal Depression Scale (EPDS). From the perception of women regarding the practices performed in the context of childbirth care, a composite variable was created, using item response theory, to measure the level of mistreatment during childbirth. The items that made up this variable were: absence of a companion during delivery, feeling insecure and not welcome, lack of privacy, lack of skin-to-skin contact after delivery, not having understood the information shared with them, and not having felt comfortable to ask questions and make decisions about their care. To define symptoms suggestive of postpartum depression, reflecting on increased probability of this condition, the EPDS score was set at ≥ 8. Poisson Regression with robust variance estimation was used for modeling. RESULTS: Women who experienced mistreatment during childbirth had a higher prevalence of symptoms suggestive of postpartum depression (PR 1.55 95% CI 1.07-2.25), as well as those with a history of mental health problems (PR 1.69 95% CI 1.16-2.47), while higher socioeconomic status (A and B) had an inverse association (PR 0.53 95% CI 0.33-0.83). CONCLUSIONS: Symptoms suggestive of postpartum depression seem to be more prevalent in women who have suffered mistreatment during childbirth, of low socioeconomic status, and with a history of mental health problems. Thus, qualifying care for women during pregnancy, childbirth and postpartum and reducing social inequalities are challenges to be faced in order to eliminate mistreatment during childbirth and reduce the occurrence of postpartum depression.

Development of an instrument to measure mistreatment of women during childbirth through item response theory.

The objective of this study was to structure a proposal for an instrument to measure the mistreatment level of women during childbirth, through item response theory, based on the birth experience of postpartum women. A cross-sectional study was conducted, with the inclusion of 287 women who did not suffer complications during childbirth, randomly selected from two maternity hospitals in the capital of Rio Grande do Sul-Brazil, in 2016. Approximately 30 days after delivery, the women answered questions in a face-to-face interview about their birth experience (practices and interventions applied) and were inquired about their perception of having suffered disrespect, mistreatment or humiliation by health professionals. The set of practices was included in the item response theory model to design the instrument. Of the 36 items included in the model, 21 dealt with practices applied exclusively to women who went into labor, therefore two instruments were developed. The instrument including all women, containing 09 items, identified 23.7% prevalence of mistreatment to women during childbirth, while the instrument for women going into labor included 11 items and identified 22% prevalence. The items with the highest discrimination were: not having had a companion during labor (2.05; and 1.26), not feeling welcome (1.81; and 1.58), and not feeling safe (1.59; and 1.70), for all women and for those who went into labor, respectively. For those who went into labor, the items, did not have a companion during labor (1.22; PE 0.88) and did not feel comfortable asking questions and participating in decisions (1.20; PE 0.43) also showed greater discrimination. In contrast, when directly questioned, only 12.5% of women said they had experienced disrespect or mistreatment, suggesting that harmful practices are often not recognized as violent. Standardizing the measurement of mistreatment of women during childbirth can create more accurate estimates of its prevalence and contribute to the proposal of strategies to eliminate obstetric violence.

Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital. / Fatores associados à continuidade do aleitamento materno por 12 meses ou mais em mulheres trabalhadoras de um hospital geral.

This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months' prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child's caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

O objetivo deste estudo é identificar fatores associados à continuidade da amamentação por 12 meses ou mais em mulheres trabalhadoras. Estudo transversal realizado por meio de entrevista com 251 trabalhadoras de um hospital, com filhos biológicos entre 12 e 36 meses de idade, não gemelares e sem doença que afetasse a amamentação, e amamentando quando do seu retorno ao trabalho. Para a associação entre a continuidade da amamentação e as variáveis de exposição utilizou-se a regressão multivariável de Poisson. Apenas uma variável relacionada ao local de trabalho da mulher mostrou associação significativa com o desfecho. Trabalhar durante o dia aumentou em 37% a prevalência da amamentação por 12 meses ou mais. Os fatores não relacionados ao trabalho da mulher que mostraram associação positiva com o desfecho: mãe sem curso superior, experiência de amamentação superior a 12 meses; criança não receber outro leite quando a mãe retornou ao trabalho e não ter usado chupeta. Por outro lado, maior idade da mãe, maior idade gestacional, apoio do cuidador da criança e apoio profissional na amamentação associaram-se negativamente ao desfecho. Fatores não relacionados diretamente ao trabalho materno tiveram maior participação na continuidade da amamentação por 12 meses ou mais.

Fatores associados à continuidade do aleitamento materno por 12 meses ou mais em mulheres trabalhadoras de um hospital geral / Factors associated with breastfeeding continuation for 12 months or more among working mothers in a general hospital

Resumo O objetivo deste estudo é identificar fatores associados à continuidade da amamentação por 12 meses ou mais em mulheres trabalhadoras. Estudo transversal realizado por meio de entrevista com 251 trabalhadoras de um hospital, com filhos biológicos entre 12 e 36 meses de idade, não gemelares e sem doença que afetasse a amamentação, e amamentando quando do seu retorno ao trabalho. Para a associação entre a continuidade da amamentação e as variáveis de exposição utilizou-se a regressão multivariável de Poisson. Apenas uma variável relacionada ao local de trabalho da mulher mostrou associação significativa com o desfecho. Trabalhar durante o dia aumentou em 37% a prevalência da amamentação por 12 meses ou mais. Os fatores não relacionados ao trabalho da mulher que mostraram associação positiva com o desfecho: mãe sem curso superior, experiência de amamentação superior a 12 meses; criança não receber outro leite quando a mãe retornou ao trabalho e não ter usado chupeta. Por outro lado, maior idade da mãe, maior idade gestacional, apoio do cuidador da criança e apoio profissional na amamentação associaram-se negativamente ao desfecho. Fatores não relacionados diretamente ao trabalho materno tiveram maior participação na continuidade da amamentação por 12 meses ou mais.

Abstract This article aims to identify factors associated with breastfeeding continuation for at least 12 months among working mothers in a hospital in the south of Brazil. We conducted a cross-sectional study, interviewing 251 women who breastfed after returning to work. Eligibility criteria included non-twin biological children aged between 12 and 36 months and the absence of an illness (mother and/or child) that could affect breastfeeding. The association between breastfeeding continuation and the exposure variables was tested using Poisson multivariate regression. Only one work-related variable showed a significant association with the outcome. Working only during the day increased the prevalence of BF continuation for at least 12 months by 37%. The following non-work-related factors showed a positive association with the outcome: mothers without a college degree; mothers with at least 12 months' prior breastfeeding experience; child not given milks other than breast milk when the mother returned to work, and not using a pacifier. The following variables showed a negative association with the outcome: older maternal age; older gestational age; mother receiving support from the child's caregiver; and mother receiving professional breastfeeding support. Non-work-related factors had a greater influence on breastfeeding continuation for at least 12 months among working mothers.

Factors associated with women's satisfaction with prenatal care in Porto Alegre, Rio Grande do Sul, Brazil. / Fatores associados à satisfação das mulheres com a atenção pré-natal em Porto Alegre, Rio Grande do Sul, Brasil.

This article aims to identify factors associated with full satisfaction with prenatal care in health services in Porto Alegre (RS), Brazil. This is a cross-sectional study with 287 women that attended prenatal care in the state capital. Women were randomly selected at two large maternity hospitals (public and private) and interviewed at their homes around 30 days after delivery, from January to August 2016. Satisfaction was measured by a Likert scale (very satisfied to very unsatisfied). Prevalence ratios (PR) were estimated by Poisson regression with robust variance, using a hierarchical model. Factors associated with greater satisfaction were higher education (PR=1.49; 95% CI: 1.08-2.06); multiprofessional care (PR=1.29; 95% CI: 1.00-1.66); receiving information about breastfeeding (PR=1.33; 95% CI: 1.05-1.68) and place of delivery (PR=1.56; 95% CI: 1.12-2.17); and women feeling comfortable asking questions and participating in decisions (PR=5.17; 95% CI: 1.79-14.96). The findings suggest that prenatal care services that offer multiprofessional care, provide guidance, and make pregnant women feel comfortable asking and deciding about their care may generate greater satisfaction.

O objetivo deste artigo é identificar fatores associados à plena satisfação com a atenção pré-natal em serviços de saúde de Porto Alegre, Rio Grande do Sul. Estudo transversal, com 287 mulheres que realizaram pré-natal na capital gaúcha. As mulheres foram selecionadas aleatoriamente em duas maternidades de grande porte (pública e privada) e entrevistadas nos seus domicílios, cerca de 30 dias após o parto, entre janeiro e agosto de 2016. A satisfação foi aferida por meio de escala Likert (muito satisfeita a muito insatisfeita). Foram estimadas razões de prevalência (RP) por regressão de Poisson com estimação robusta da variância, utilizando modelo hierarquizado. Os fatores associados à plena satisfação foram: ingresso no ensino superior (RP=1,49; IC95%:1,08-2,06); atendimento multiprofissional (RP=1,29; IC95%:1,00-1,66); recebimento de orientações sobre amamentação (RP=1,33; IC95%:1,05-1,68) e sobre local do parto (RP=1,56; IC95%:1,12-2,17); e sentimento da mulher de estar à vontade para fazer perguntas e participar das decisões (RP=5,17; IC95%:1,79-14,96). Os achados sugerem que serviços de pré-natal que oferecem cuidado multiprofissional, que dão orientações, e que oportunizam às gestantes o sentimento de estar à vontade para questionar e decidir sobre seu cuidado, proporcionam maior satisfação.

Fatores associados à satisfação das mulheres com a atenção pré-natal em Porto Alegre, Rio Grande do Sul, Brasil / Factors associated with women's satisfaction with prenatal care in Porto Alegre, Rio Grande do Sul, Brazil

Resumo O objetivo deste artigo é identificar fatores associados à plena satisfação com a atenção pré-natal em serviços de saúde de Porto Alegre, Rio Grande do Sul. Estudo transversal, com 287 mulheres que realizaram pré-natal na capital gaúcha. As mulheres foram selecionadas aleatoriamente em duas maternidades de grande porte (pública e privada) e entrevistadas nos seus domicílios, cerca de 30 dias após o parto, entre janeiro e agosto de 2016. A satisfação foi aferida por meio de escala Likert (muito satisfeita a muito insatisfeita). Foram estimadas razões de prevalência (RP) por regressão de Poisson com estimação robusta da variância, utilizando modelo hierarquizado. Os fatores associados à plena satisfação foram: ingresso no ensino superior (RP=1,49; IC95%:1,08-2,06); atendimento multiprofissional (RP=1,29; IC95%:1,00-1,66); recebimento de orientações sobre amamentação (RP=1,33; IC95%:1,05-1,68) e sobre local do parto (RP=1,56; IC95%:1,12-2,17); e sentimento da mulher de estar à vontade para fazer perguntas e participar das decisões (RP=5,17; IC95%:1,79-14,96). Os achados sugerem que serviços de pré-natal que oferecem cuidado multiprofissional, que dão orientações, e que oportunizam às gestantes o sentimento de estar à vontade para questionar e decidir sobre seu cuidado, proporcionam maior satisfação.

Abstract This article aims to identify factors associated with full satisfaction with prenatal care in health services in Porto Alegre (RS), Brazil. This is a cross-sectional study with 287 women that attended prenatal care in the state capital. Women were randomly selected at two large maternity hospitals (public and private) and interviewed at their homes around 30 days after delivery, from January to August 2016. Satisfaction was measured by a Likert scale (very satisfied to very unsatisfied). Prevalence ratios (PR) were estimated by Poisson regression with robust variance, using a hierarchical model. Factors associated with greater satisfaction were higher education (PR=1.49; 95% CI: 1.08-2.06); multiprofessional care (PR=1.29; 95% CI: 1.00-1.66); receiving information about breastfeeding (PR=1.33; 95% CI: 1.05-1.68) and place of delivery (PR=1.56; 95% CI: 1.12-2.17); and women feeling comfortable asking questions and participating in decisions (PR=5.17; 95% CI: 1.79-14.96). The findings suggest that prenatal care services that offer multiprofessional care, provide guidance, and make pregnant women feel comfortable asking and deciding about their care may generate greater satisfaction.

Risk factors for and protective factors against breastfeeding interruption before 2 years: a birth cohort study.

BACKGROUND: Little is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years. The objective of this study was to identify risk factors for and protective factors against breastfeeding interruption before 2 years of age. METHODS: In this live birth cohort, mother and infant dyads were followed for 2 years. Data collection was performed at the maternity ward and subsequently at the children's homes, monthly during the first 6 months of life and then at 9, 12, 18, and 24 months. The outcome of interest was breastfeeding interruption before 2 years of age. Median duration of breastfeeding was estimated using Kaplan-Meier's survival analysis, and the associations were tested using Cox's hierarchical multivariate model. Significance was set at 5%. RESULTS: Data from a total of 1344 dyads were assessed. Median breastfeeding duration was 385 days. The following risk factors for breastfeeding interruption were identified: white skin color (adjusted hazard ratio [HRa]: 1.31; 95% confidence interval [95%CI]: 1.10-1.56), primiparity (HRa: 1.21; 95%CI: 1.05-1.40), working outside the home (HRa: 1.52; 95%CI: 1.30-1.77), child sex male (HRa: 1.18; 95%CI: 1.03-1.35) and use of a pacifier (HRa: 3.46; 95%CI: 2.98-4.01). Conversely, the following protective factors were identified: lower family income (HRa: 0.81; 95%CI: 0.71-0.94), mother-infant bed-sharing (HRa:0.61, 95%CI: 0.52-0.73), on-demand breastfeeding in the first month (HRa: 0.64; 95%CI: 0.47-0.89) and exclusive breastfeeding at 4 months (HRa: 0.58, 95%CI: 0.48-0.70). CONCLUSIONS: The findings allowed to identify both risk factors for and protective factors against breastfeeding interruption before 2 years of age. Knowledge of these factors may help prevent this event and aid in the development of programs that help women maintain breastfeeding for at least 2 years, as recommended by the WHO.

Factors associated with a positive childbirth experience in Brazilian women: A cross-sectional study.

BACKGROUND: Having a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women's satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women. METHODS: This cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31-37 days after delivery, at the mothers' homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance. RESULTS: Following hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR=1.30; 95% confidence interval [95%CI]=1.06-1.59), understanding the information provided by health professionals during labor and delivery (PR=1.40; 95%CI=1.01-1.95), not having reported disrespect and abuse (PR=1.53; 95%CI=1.01-2.31), and having had the baby put to the breast within the first hour of life (PR=1.63; 95%CI=1.26-2.11). No association was observed with type of delivery or hospital status (public or private). CONCLUSIONS: A higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.

Association between maternal satisfaction with breastfeeding and postpartum depression symptoms.

BACKGROUND: Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth. METHODS: This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) and negative PPD screening test was assessed using Poisson regression with robust variance, adjusting for specific covariables. Adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated. RESULTS: The prevalence of increased satisfaction with breastfeeding (defined as women with scores above the median) was 47% higher among women who screened negative for PPD when compared to those with a positive result (aPR 1.47; 95%CI 1.01-2.16). This result was adjusted for maternal age and skin color, cohabitation with the infant's father, planned pregnancy, type of delivery, exclusive breastfeeding, and occurrence of breastfeeding problems. CONCLUSIONS: The findings of this study showed an association between higher maternal satisfaction with breastfeeding and absence of PPD symptoms, reinforcing the importance of caring for the mental health of pregnant and puerperal women and paying attention to their satisfaction with breastfeeding.

Why do some countries do better or worse in life expectancy relative to income? An analysis of Brazil, Ethiopia, and the United States of America.

BACKGROUND: While in general a country's life expectancy increases with national income, some countries "punch above their weight", while some "punch below their weight" - achieving higher or lower life expectancy than would be predicted by their per capita income. Discovering which conditions or policies contribute to this outcome is critical to improving population health globally. METHODS: We conducted a mixed-method study which included: analysis of life expectancy relative to income for all countries; an expert opinion study; and scoping reviews of literature and data to examine factors that may impact on life expectancy relative to income in three countries: Ethiopia, Brazil, and the United States. Punching above or below weight status was calculated using life expectancy at birth and gross domestic product per capita for 2014-2018. The scoping reviews covered the political context and history, social determinants of health, civil society, and political participation in each country. RESULTS: Possible drivers identified for Ethiopia's extra 3 years life expectancy included community-based health strategies, improving access to safe water, female education and gender empowerment, and the rise of civil society organisations. Brazil punched above its weight by 2 years. Possible drivers identified included socio-political and economic improvements, reduced inequality, female education, health care coverage, civil society, and political participation. The United States' neoliberal economics and limited social security, market-based healthcare, limited public health regulation, weak social safety net, significant increases in income inequality and lower levels of political participation may have contributed to the country punching 2.9 years below weight. CONCLUSIONS: The review highlighted potential structural determinants driving differential performance in population health outcomes cross-nationally. These included greater equity, a more inclusive welfare system, high political participation, strong civil society and access to employment, housing, safe water, a clean environment, and education. We recommend research comparing more countries, and also to examine the processes driving within-country inequities.

Maternal satisfaction with breastfeeding in the first month postpartum and associated factors.

BACKGROUND: Breastfeeding success has been measured based on its duration, disregarding satisfaction with the maternal experience. Studies to investigate maternal satisfaction with breastfeeding are rare, especially in Brazil, and little is known about their determinants. The aim of this study was to measure the level of satisfaction with breastfeeding in a group of women in the first month of their child's life, and to identify factors associated with higher maternal satisfaction. METHODS: A cross-sectional study nested within a cohort was conducted with 287 women recruited at two (one public, one private) maternity services in the city of Porto Alegre, southern Brazil, from January to July 2016. Women residing in the municipality who had given birth to a healthy singleton born at term, were rooming in, and had initiated breastfeeding were randomly included. During the week after the child was 30 days old, women were interviewed at their homes to measure the level of maternal satisfaction with breastfeeding, using the Maternal Breastfeeding Evaluation Scale (MBFES), validated for use in the Brazilian population. Associations between maternal satisfaction and explanatory variables were estimated using multivariate Poisson regression with robust variance in a four-level hierarchical approach. Satisfaction level was categorized using as cutoff point the median score obtained with the MBFES. Women with scores equal to or above the median were considered to have higher levels of satisfaction, whereas those scoring below the median were considered to be less satisfied. RESULTS: Maternal satisfaction with breastfeeding in the first month postpartum was high, with a median score of 124 on MBFES, close to the maximum score (145 points). The prevalence of more elevated levels of satisfaction with breastfeeding was higher among women with brown (pardo) and black skin color (prevalence ratio [PR] 1.33, 95%CI 1.05;1.69), those who lived with the partner (PR 1.75, 95%CI 1.05;2.94), who planned to breastfeed for 12 months or more (PR 1.48, 95%CI 1.02;2.17), and who did not report low milk supply (PR 1.47, 95%CI 1.03;2.10) or cracked nipples (PR 1.29, 95%CI 1.01;1.65). CONCLUSIONS: The factors associated with maternal satisfaction with breastfeeding in the first month postpartum include individual factors and maternal expectations, family constitution, as well as breastfeeding-related problems.

Influence of pacifier use on the association between duration of breastfeeding and anterior open bite in primary dentition.

BACKGROUND: The literature is controversial with regard to the association between longer breastfeeding duration and lower prevalence of anterior open bite. Pacifier use may be involved in this controversy. Thus, the objective of the study was to assess the influence of pacifier use and its duration on the association between longer breastfeeding duration and lower prevalence of anterior open bite in children with primary dentition. METHODS: This was a cross-sectional study nested in a cohort study involving 153 infants recruited at a maternity hospital in the municipality of Porto Alegre, southern Brazil. The study outcome (anterior open bite) was assessed when the children were between 3 and 5 years old. Data on breastfeeding and pacifier use were collected at 7, 30, 60, 120, and 180 days of life and on the date of the evaluation here described. Poisson regression with robust variance was used to analyze the association between the prevalence of anterior open bite and breastfeeding duration, expressed in months. RESULTS: The univariate analysis showed a protective effect of breastfeeding against anterior open bite (prevalence ratio [PR] 0.96; 95% confidence interval [95%CI] 0.95-0.98). This effect remained significant after adjustment for pacifier use at any time between birth and the date of dental assessment (PR0.98; 95%CI; 0.96-0.99), i.e., there was a reduction of 2% in the prevalence of anterior open bite for each month of breastfeeding. However, this effect lost significance when pacifier use duration was included in the multivariate analysis (PR1.00; 95%CI; 0.99-1.01). CONCLUSIONS: Pacifier use duration influences the association between longer breastfeeding duration and lower prevalence of anterior open bite. It is likely that prolonged pacifier use reduces the magnitude of this association.

Breastfeeding is associated with children's dietary diversity in Brazil / Amamentação está associada à diversidade alimentar infantil no Brasil

Abstract The aim of this study was to describe food consumption patterns in Brazilian children aged 6-24 months and to assess differences between breastfed children who do not consume non-human milks, breastfed children who consume non-human milks, and non-breastfed children. This study used data from the Brazilian National Demographic and Health Survey (2006). The food consumption patterns of 1,455 children were assessed using a food frequency questionnaire. One indicator adopted in this study was the healthy diverse diet. The association between breastfeeding and food consumption was tested using multivariate Poisson regression. At the interview, 15.8% of the children were breastfed without consuming non-human milk, 30.7% consumed breast milk in conjunction with non-human milk, and 53% were not breastfed anymore. Over half consumed the recommended foods, 78% consumed foods rich in sugar, fat, and salt, and only 3.4% were on a healthy diverse diet. The breastfed children who did not consume non-human milks were almost five times more likely to be on a healthy diverse diet and were 19% less likely to consume foods rich in sugar, fat, and salt than the breastfed children who also consumed non-human milks and the non-breastfed children.

Resumo O objetivo foi descrever o padrão de consumo alimentar em crianças brasileiras entre 6 e 24 meses e verificar as diferenças entre crianças em aleitamento materno (AM) que consomem ou não outros tipos de leites não-humano (LNH), e aquelas não amamentadas (NAM). Foram usados dados da Pesquisa Nacional de Demografia e Saúde (2006). O consumo alimentar de 1455 crianças foi avaliado usando um questionário de frequência alimentar. Avaliou-se a presença de dieta saudável e diversificada. A associação entre AM e o consumo alimentar foi testado pela regressão de Poisson. Na entrevista, 15,8% das crianças estavam em AM sem consumo de LNH, 30,7% estavam em AM com consumo de LNH e 53% não estavam em AM. Mais da metade consumiam os alimentos recomendados, 78% consumiam alimentos ricos em açúcar, gordura e sal, e apenas 3,4% estavam em uma dieta saudável e diversificada. As crianças em AM que não consumiam LNH tinham quase cinco vezes mais chances de ter uma dieta saudável e diversificada e tinham 19% menos chance de consumir alimentos ricos em açúcar, gordura e sal, comparadas àquelas que também consumiam LNH e àquelas que não estavam em AM.

Breastfeeding is associated with children's dietary diversity in Brazil.

The aim of this study was to describe food consumption patterns in Brazilian children aged 6-24 months and to assess differences between breastfed children who do not consume non-human milks, breastfed children who consume non-human milks, and non-breastfed children. This study used data from the Brazilian National Demographic and Health Survey (2006). The food consumption patterns of 1,455 children were assessed using a food frequency questionnaire. One indicator adopted in this study was the healthy diverse diet. The association between breastfeeding and food consumption was tested using multivariate Poisson regression. At the interview, 15.8% of the children were breastfed without consuming non-human milk, 30.7% consumed breast milk in conjunction with non-human milk, and 53% were not breastfed anymore. Over half consumed the recommended foods, 78% consumed foods rich in sugar, fat, and salt, and only 3.4% were on a healthy diverse diet. The breastfed children who did not consume non-human milks were almost five times more likely to be on a healthy diverse diet and were 19% less likely to consume foods rich in sugar, fat, and salt than the breastfed children who also consumed non-human milks and the non-breastfed children.

Combined pro-breastfeeding practices are advantageous in facilities providing maternity and newborn services.

This study aimed to evaluate the association between a set of pro-breastfeeding practices in facilities providing maternity and newborn services and the prevalence of exclusive breastfeeding at 30 days postpartum, considering the contribution of each practice. A cross-sectional study nested within a cohort study was conducted with 287 women who delivered healthy term infants in two hospitals in southern Brazil. They were interviewed at home at 30 days postpartum. The following practices were evaluated: skin-to-skin contact soon after birth, breastfeeding in the first hour, uninterrupted rooming-in, professional support with breastfeeding, breastfeeding guidance, encouragement to breastfeed on demand, no supplementation with infant formula, and no pacifier use. A score of pro-breastfeeding practices was calculated using a logistic model, which allowed each practice to have its discriminatory capacity and difficulty estimated individually. Poisson regression was used to estimate the association between exclusive breastfeeding at 30 days and the pro-breastfeeding practice score. The prevalence of exclusive breastfeeding at 30 days was 61.7%. The practices with greatest discriminatory capacity, that is, those that contributed most to the score estimates, were professional support with breastfeeding, breastfeeding guidance, and encouragement to breastfeed on demand. The most difficult ones were breastfeeding in the first hour, encouragement to breastfeed on demand, and non-utilization of infant formula. For each unit (standard deviation) of increase in the score, there was an increase of 20% in the prevalence of exclusive breastfeeding at 30 days. We conclude that the set of pro-breastfeeding practices assessed here increased the effect of these practices on exclusive breastfeeding rates at 30 days.

Involvement of maternal grandmother and teenage mother in intervention to reduce pacifier use: a randomized clinical trial / Participação da avó materna e mãe adolescente na intervenção para redução do uso de chupeta: um ensaio clínico randomizado

Abstract Objective: To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life. Methods: This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction. Results: The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this group, the intervention delayed by 64 days the introduction of a pacifier (21-85 days), compared to 25 days in the group without the participation of grandmothers (65-90 days). Conclusions: The intervention reduced pacifier use in the first six months of life and delayed its introduction until beyond the first month when grandmothers were involved. The intervention did not have a significant impact when only teenage mothers were involved.

Resumo Objetivo: Avaliar o impacto de uma intervenção para mães adolescentes com a participação de avós maternas na prevalência de uso de chupeta nos primeiros seis meses de vida. Métodos: Este ensaio clínico randomizado envolveu 323 mães adolescentes, alocadas para quatro grupos: intervenção com somente adolescentes, intervenção com adolescentes e suas mães e respectivos controles. Seis sessões de aconselhamento para amamentação, incluindo a recomendação de evitar o uso de chupeta, foram realizadas na maternidade e posteriormente nas casas das adolescentes ao 7°, 15°, 30°, 60° e 120° dias. Os dados sobre alimentação infantil e uso de chupeta foram coletados mensalmente por entrevistadores cegos a respeito da alocação dos grupos. O impacto da intervenção foi medido comparando as curvas de sobrevida para uso de chupeta nos primeiros 6 meses de vida e o tempo médio de introdução de chupetas. Resultados: A intervenção apresentou um impacto significativo sobre a redução do uso de chupeta somente no grupo em que as mães estiveram envolvidas. Nesse grupo, a intervenção mostrou atraso de 64 dias na introdução de chupeta (21 a 85 dias), em comparação a 25 dias no grupo sem a participação das avós (65 a 90 dias). Conclusões: A intervenção reduziu o uso de chupeta nos primeiros 6 meses de vida e atrasou sua introdução além do primeiro mês com a participação das avós. A intervenção não teve impacto significativo somente com o envolvimento das mães adolescentes.