Pandemic policies and breastfeeding: A cross-sectional study during the onset of COVID-19 in the United States.

The United States is one of the few countries, and the only high-income country, that does not federally mandate protection of postpartum employment through paid postpartum maternity and family leave policies. At the onset of the COVID-19 pandemic in the U.S., stay-at-home orders were implemented nationally, creating a natural experiment in which to document the effects of de facto paid leave on infant feeding practices in the first postpartum year. The purpose of this cross-sectional, mixed-methods study was to describe infant and young child feeding intentions, practices, decision-making, and experiences during the first wave of the COVID-19 pandemic in the U.S. Quantitative and qualitative data were collected March 27-May 31, 2020 via online survey among a convenience sample of respondents, ages 18 years and older, who were currently feeding a child 2 years of age or younger, yielding 1,437 eligible responses. Nearly all (97%) respondents indicated an intention to feed their infant exclusively with human milk in the first 6 months. A majority of respondents who were breastfeeding (66%) reported no change in breastfeeding frequency after the implementation of COVID-19 stay-at-home orders. However, thirty-one percent indicated that they breastfed more frequently due to stay-at-home orders and delayed plans to wean their infant or young child. Key themes drawn from the qualitative data were: emerging knowledge and perceptions of the relationship between COVID-19 and breastfeeding, perceptions of immune factors in human milk, and the social construction of COVID-19 and infant and young child feeding perceptions and knowledge. There were immediate positive effects of stay-at-home policies on human milk feeding practices, even during a time of considerable uncertainty about the safety of breastfeeding and the transmissibility of SARS-CoV-2 via human milk, constrained access to health care services and COVID-19 testing, and no effective COVID-19 vaccines. Federally mandated paid postpartum and family leave are essential to achieving more equitable lactation outcomes.

Human Milk Oligosaccharide Compositions Illustrate Global Variations in Early Nutrition.

BACKGROUND: Human milk oligosaccharides (HMOs) are an abundant class of compounds found in human milk and have been linked to the development of the infant, and specifically the brain, immune system, and gut microbiome. OBJECTIVES: Advanced analytical methods were used to obtain relative quantitation of many structures in approximately 2000 samples from over 1000 mothers in urban, semirural, and rural sites across geographically diverse countries. METHODS: LC-MS-based analytical methods were used to profile the compounds with broad structural coverage and quantitative information. The profiles revealed their structural heterogeneity and their potential biological roles. Comparisons of HMO compositions were made between mothers of different age groups, lactation periods, infant sexes, and residing geographical locations. RESULTS: A common behavior found among all sites was a decrease in HMO abundances during lactation until approximately postnatal month 6, where they remained relatively constant. The greatest variations in structural abundances were associated with the presence of α(1,2)-fucosylated species. Genomic analyses of the mothers were not performed; instead, milk was phenotyped according to the abundances of α(1,2)-fucosylated structures. Mothers from the South American sites tended to have higher proportions of phenotypic secretors [mothers with relatively high concentrations of α(1,2)-fucosylated structures] in their populations compared to the rest of the globe, with Bolivia at ∼100% secretors, Peru at ∼97%, Brazil at ∼90%, and Argentina at ∼85%. Conversely, the cohort sampled in Africa manifested the lowest proportion of secretors (South Africa ∼ 63%, the Gambia ∼ 64%, and Malawi ∼ 75%). Furthermore, we compared total abundances of HMOs in secretors compared with nonsecretors and found that nonsecretors have lower abundances of HMOs compared to secretors, regardless of geographical location. We also observed compositional differences of the 50+ most abundant HMOs between milk types and geographical locations. CONCLUSIONS: This study represents the largest structural HMO study to date and reveals the general behavior of HMOs during lactation among different populations.

Lower hemoglobin levels in first time mothers from Cebu, Philippines.

OBJECTIVES: The association between parity and hemoglobin status in mothers is unclear. Closely spaced pregnancies may predict decreased hemoglobin in women, as these shorter intervals may limit the time available for iron repletion, or maternal age may be associated with general declines in hemoglobin. This study investigated the association between parity and hemoglobin status in a 1-year birth cohort of mothers from Cebu, Philippines, with variable parities. It was hypothesized that maternal parity would be inversely associated with hemoglobin status and that among multiparous mothers, interbirth interval, and prior breastfeeding duration would be positively associated with hemoglobin level. METHODS: The study design was cross-section with participants (n = 125) recruited from the Cebu Longitudinal Health and Nutrition Survey; all mothers were 24-25 years of age at the time of the study and currently breastfeeding infants less than 3 years of age. Hemoglobin was measured using B-Hemocue Analyzer. Detailed dietary information, health recalls, anthropometrics, and reproductive histories were available on all mothers. RESULTS: Maternal parity ranged from 1 to 6 with an average of 2.2 (1.0) births. In this cross section of parity among similarly aged women, hemoglobin levels were significantly lower for primiparous (12.1 ± 1.8) compared to multiparous mothers (13.2 ± 1.5; P = 0.03), despite similar antianemic usage during gestation. There was no significant association between prior interbirth interval, prior, or current breastfeeding duration and hemoglobin in multiparas. CONCLUSIONS: Low hemoglobin levels of primiparous women in this sample might indicate increased nutritional stress associated with first pregnancy.

Field and laboratory methods in human milk research.

Human milk is a complex and variable fluid of increasing interest to human biologists who study nutrition and health. The collection and analysis of human milk poses many practical and ethical challenges to field workers, who must balance both appropriate methodology with the needs of participating mothers and infants and logistical challenges to collection and analysis. In this review, we address various collection methods, volume measurements, and ethical considerations and make recommendations for field researchers. We also review frequently used methods for the analysis of fat, protein, sugars/lactose, and specific biomarkers in human milk. Finally, we address new technologies in human milk research, the MIRIS Human Milk Analyzer and dried milk spots, which will improve the ability of human biologists and anthropologists to study human milk in field settings.

A dose-response relationship between fish consumption and human milk DHA content among Filipino women in Cebu City, Philippines.

AIMS: Human milk is the primary source of docosahexaenoic acid (DHA) for most infants, an important fatty acid for neurological development. Milk DHA is largely incorporated from the maternal diet. Little is known about whether milk DHA varies within populations with differences in maternal fish consumption. Here, we investigate this association in a sample of marginally nourished Filipino women. METHODS: Milk samples were collected during in-home interviews with 117 lactating Filipino mothers from Cebu City, Philippines, nursing infants <24 months of age. Anthropometric data and dietary recalls were also collected. Samples were analysed for total fatty acid composition using gas chromatography. Multivariate regression was used to test the association between fish consumption and milk DHA. RESULTS: Milk DHA showed a positive, dose-response relationship with maternal fish consumption (p < 0.011, r(2 ) =( ) 0.21). Milk DHA was also positively related to protein intake, likely reflecting the association between fish and protein intake (p < 0.009). Unlike prior studies, parity predicted increased milk DHA (p = 0.03). CONCLUSIONS: Increasing fish consumption during lactation may be a cost-effective means of maximizing DHA delivery to infants particularly in populations with marginal energy intakes during lactation. However, this must be weighed against the potential dangers of increasing exposure to fish-based pollutants.

Protein conformational stability in the hydrofluoroalkane propellants tetrafluoroethane and heptafluoropropane analysed by Fourier transform Raman spectroscopy.

Due to the inherent structural instability of proteins, development of chlorofluorocarbon (CFC) free metered dose inhalers (MDIs) containing these biomolecules is beset with numerous challenges. In assessing the conformation of proteins in any medium, both secondary and tertiary structures need to be elucidated. This study uses Fourier transform (FT-) Raman spectroscopy to probe protein conformational stability in hydrofluoroalkane (HFA) propellants. Assignments of molecular modes for lysozyme as a solid and in aqueous solution, and for the first time, HFAs tetrafluoroethane (HFA 134a) and heptafluoropropane (HFA 227) are given. The Raman spectra provided molecular structural information on the peptide backbone, disulfide bonds and C-C stretching vibrations of hen egg lysozyme, enabling the secondary conformation of protein in HFA propellants to be determined; structural integrity of this robust model protein was maintained in both propellants. These results demonstrate that FT-Raman may be a useful tool for the optimisation of protein MDI formulations.

Assessing child development.

The family practitioner has an important role in the detection of infants and young children with developmental delays. The physician may be the first or only professional in regular contact with infants and young children. Interpretation of a child's developmental status is best done with a clear understanding of the child's family and social environment, and the family practitioner is in a unique position to possess this knowledge by virtue of his or her established relationship with the family.

Variations in quantity-frequency measures of alcohol consumption from a general population survey.

This paper examines differences in quantity-frequency (QF) measures of alcohol consumption from the 1988 US National Health Interview Survey. Three methods--global QF, beverage-specific QF, and beverage-specific QF with drink size (QFS)--were used to estimate the average daily ethanol consumption (ADC) of current drinkers. These ADC estimates then were used to categorize drinkers into light, moderate or heavier drinking levels. Total prevalence estimates of heavier drinking were not significantly different among men, but were significantly higher with the QFS measure among women. All mean ADC scores were significantly different for both sexes. The global QF showed the lowest mean consumption, followed by the higher beverage-specific QF and QFS measures. Adding beverage type and drink size to the QF measures increased mean ADC scores for both men and women. However, moderately high correlations (0.84 for men and 0.88 for women) were found with ADC scores from the beverage-specific QF and QFS measures.

Adherence and accuracy. Self-medication during inpatient psychiatric treatment.

1. The goals of the Medication Education and Self-Administration Program were to develop a way to assess inpatient self-medication accuracy; create a comprehensive intervention that would address individual characteristics that may produce nonadherence; and evaluate the effectiveness of the intervention. 2. The majority of program participants demonstrated significant errors within days when given the opportunity to administer their own medications, suggesting that participants' in-hospital self-administration may be an accurate predictor of postdischarge performance. 3. Even in cases where training failed to influence self-administered performance, program participation provided valuable information that guided subsequent treatment decisions and programmatic refinements.

Varicella serology in institutional exposure management.

A resident of a large facility for developmentally disabled persons developed chickenpox, exposing the other residents on his unit prior to diagnosis. Only 4 of the 20 exposed had previous histories. Indirect fluorescent antibody (IFA) testing for varicella-zoster antibodies done on the day the index patient was diagnosed demonstrated protective antibody levels in 18 of 21 residents. These residents returned to habilitative activities earlier than anticipated, maintaining program continuity. We suggest that varicella immunity might be more common in this population than supposed. Cost analysis of laboratory screening versus providing additional staffing during isolation supports screening in similar circumstances.