The interplay between emotional and breastfeeding difficulties in first-time mothers.

AIM/BACKGROUND: Both mental maternal health and breastfeeding difficulties impact maternal and infant health. The present study analyses the association between psychosocial and breastfeeding variables and maternal mental health. DESIGN/METHODS: The participants were 107 first-time mothers from Chile. Sociodemographic variables and breastfeeding difficulties were assessed at 6 weeks postpartum. Depression and anxiety symptoms, parental self-efficacy, and perceived social support were measured using validated, self-report questionnaires at 6 weeks and 5 months postpartum. This study is a secondary analysis of an intervention trial. RESULTS: 76% of the women reported having experienced some breastfeeding difficulty in the first postpartum weeks. The number of breastfeeding difficulties was associated with maternal mental health symptoms at 6 weeks postpartum and parental self-efficacy at both assessment times. Women who did not experience breastfeeding difficulties presented significantly fewer depressive (t(102) = 2.5, p = .015) and anxiety symptoms (t(50) = 2.3, p = .028) at 6 weeks postpartum than those who did. Mothers who exclusively breastfed at 5 months postpartum presented significantly higher parental self-efficacy (t(94) = 2.4, p = .044). A higher number of breastfeeding difficulties and low perceived social support contributed to higher depressive symptoms (R2 = .30; F(3,103) = 14.6, p < .001), anxiety symptoms (R2 = .32, F(3.103) = 17.27, p < .001) and lower parental self-efficacy at 6 weeks postpartum (R2 = .39; F(2,103) = 9.4, p < .001). CONCLUSION: Breastfeeding difficulties and social support are associated with fewer mental health symptoms and higher parental self-efficacy during early postpartum in first-time mothers.

Mecanismos neuroendocrinos a la base de la asociación entre salud mental materna y lactancia / Neuroendocrine mechanisms underlying the association between maternal mental health and breastfeeding

La lactancia materna es fundamental para la salud del infante y se ve influida por diversos factores, entre ellos la salud mental materna. En particular, las madres que tienen síntomas depresivos tienen mayor riesgo de presentar dificultades de lactancia y de interrumpir tempranamente la lactancia exclusiva y la lactancia en general. Por otra parte, la lactancia materna actúa como un factor protector de la salud mental materna en algunas circunstancias, en tanto las dificultades de lactancia tienen un impacto negativo en la salud mental de la mujer. La presente revisión describe algunos de los mecanismos fisiológicos que subyacen al establecimiento y la mantención de la lactancia, asociados a la prolactina, la oxitocina, la dopamina y la serotonina, así como a la experiencia de la lactancia y la presencia de dificultades en esta área, y como estas interactúan con las dificultades emocionales de la madre. Se ofrece un modelo integrativo que considera aspectos hormonales y fisiológicos para comprender la asociación compleja y bidireccional entre el establecimiento de una lactancia exitosa y la salud mental materna.

Breastfeeding is essential for infant health and development. It is influenced by multiple factors, including maternal mental health. In particular, mothers who present depressive symptoms are at greater risk of presenting breastfeeding difficulties and presenting shorter exclusive breastfeeding and breastfeeding in general. On the other hand, breastfeeding acts as a protective factor for maternal mental health in some circumstances. Also, breastfeeding difficulties have a negative impact on womens mental health. This review describes some of the physiological mechanisms underlying the establishment and maintenance of lactation, associated with prolactin, oxytocin, dopamine, and serotonin. As well as how the lactation experience and the presence of difficulties in this area interact with the mothers emotional functioning. An integrative model is proposed, which considers hormonal and physiological aspects involved in the complex and bidirectional association between breastfeeding successful establishment and maternal mental health.

Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study.

Background: Maternity care practices such as skin-to-skin care, rooming-in, and direct breastfeeding are recommended, but it is unclear if these practices increase the risk of clinically significant COVID-19 in newborns, and if disruption of these practices adversely affects breastfeeding. Methods: We performed a retrospective cohort study of 357 mothers and their infants <12 months who had confirmed or suspected COVID-19. Subjects came from an anonymous worldwide online survey between May 4 and September 30, 2020, who were recruited through social media, support groups, and health care providers. Using multivariable logistic regression, Fisher's exact test, and summary statistics, we assessed the association of skin-to-skin care, feeding, and rooming-in with SARS-CoV-2 outcomes, breastfeeding outcomes, and maternal distress. Results: Responses came from 31 countries. Among SARS-CoV-2+ mothers whose infection was ≤3 days of birth, 7.4% of their infants tested positive. We found a nonsignificant decrease in risk of hospitalization among neonates who roomed-in, directly breastfed, or experienced uninterrupted skin-to-skin care (p > 0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms' reach, were significantly less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms (p ≤ 0.02 for each). Nearly 60% of mothers who experienced separation reported feeling "very distressed," and 29% who tried to breastfeed were unable. Presence of maternal symptoms predicted infant transmission or symptoms (adjusted odds ratio = 4.50, 95% confidence interval = 1.52-13.26, p = 0.006). Conclusion: Disruption of evidence-based quality standards of maternity care is associated with harm and may be unnecessary.

The Role of Perinatal Anxiety and Depression in Breastfeeding Practices.

Objective: Maternal mental health difficulties are common during the perinatal period and have a negative impact on breastfeeding practices. Most research has focused on the role of postpartum depression, whereas maternal anxiety has been less studied, despite its high prevalence. A better understanding of the mental health variables that impact breastfeeding practices is necessary to support maternal and infant health and well-being. The aim of this study is to explore the association between breastfeeding practices and maternal mental health, with an emphasis on maternal anxiety. Materials and Methods: Two hundred twenty-nine women were followed from the third trimester of gestation to 3 and 6 months postpartum. The participants provided self-reports of depression, anxiety, and breastfeeding practices. Mental health symptoms were compared between participants who reported exclusive versus mixed breastfeeding at 3 months postpartum, and between mothers who maintained breastfeeding versus those who had weaned their infants at 6 months postpartum. Logistic regression analysis was used to explore the variables contributing to breastfeeding practices. Results: High levels of depressive symptoms during pregnancy were associated to nonexclusive breastfeeding at 3 months postpartum. At 3 months postpartum, both high levels of anxiety and depression were associated with nonexclusive breastfeeding at that time. Logistic regression analyses revealed that exclusive breastfeeding at 3 months postpartum predicted breastfeeding continuation at 6 months after childbirth. Conclusion: Both maternal depression and anxiety negatively impact breastfeeding practices. Early identification of maternal mental health problems during the perinatal period is relevant to promote maternal emotional well-being and to prevent breastfeeding difficulties.

Aspectos bioéticos y jurídicos del acompañamiento en la ley chilena de interrupción voluntaria del embarazo en tres causales / Bioethical and legal aspects of abortion counseling under Chilean law / Aspectos bioéticos e jurídicos do acompanhamento da lei chilena de interrupção voluntária da gravidez em três causas

La ley que regula la despenalización de la interrupción voluntaria del embarazo en tres causales contempla un programa de acompañamiento que garantiza el derecho a la autonomía de la paciente. En la práctica, sin embargo, no todos los modelos de acompañamiento que se ofrecen en Chile cumplen con este estándar normativo. El artículo analiza el acompañamiento desde las perspectivas jurídicas y bioética, y explora las características que debiera tener un programa de acompañamiento respetuoso de la autonomía de la mujer embarazada. El texto concluye afirmando que el profesional de salud que ofrece acompañamiento debe involucrarse en un diálogo respetuoso y genuino con la paciente, proveer información adecuada, abstenerse de imponer su propia interpretación sobre la experiencia de la mujer, apoyarla en su deliberación y asumir que las preferencias y valores de la mujer deben guiar el proceso de toma de decisiones. Los programas que no cumplen con estos estándares pueden estar infringiendo obligaciones legales.

The Chilean statute decriminalizing abortion under three specific grounds provides for a counseling program which guarantees patient's autonomy. However, the reality is that not all counseling programs that are offered in Chile comply with this normative standard. The article analyzes abortion counseling from a legal and bioethical perspective, and examines the features of a counseling program respectful of the pregnant woman's autonomy. The text concludes stating that the health care professional that offers support he/she should be involved in a respectful and genuine dialogue with the patient, provide adequate information, refraining from imposing his/her own interpretation about the experience of the woman, support her in deliberating and assume that her preferences and values must guide the process of decision making. The programs which do not fulfill these standards may be contravening legal obligations.

A lei que regula a descriminalização da interrupção voluntária de gravidez em três causal inclui um programa de acompanhamento que garante o direito à autonomia do paciente. Na prática, no entanto, nem todos os modelos de acompanhamentos oferecidos no Chile cumprem com esse padrão normativo. O artigo analisa o acompanhamento com base nas perspectivas jurídicas e bioética e explora as características que devem ter um programa de apoio respeitoso da autonomia da mulher grávida. O texto conclui afirmando que o profissional de saúde que fornece acompanhamento deve estabelecer um diálogo genuíno e respeitoso com a paciente, fornecer informações adequadas, abster-se de impor sua própria interpretação sobre a experiência da mulher, apoiá-la em sua deliberação e assumir que as preferências e os valores da mulher devem orientar o processo de tomada de decisão. Os programas que não cumpram com estas normas podem estar infringindo obrigações legais.

[The benefits of breastfeeding and associated risks of replacement with baby formulas]. / Beneficios de la lactancia materna y riesgos de no amamantar.

Breastfeeding is the nourishment designed by nature for the newborn and the infant; however its prevalence is nowadays not optimal. The aim of this article is to review the current evidence of the benefits of breastfeeding for children and society, and to elaborate the risks associated with the replacement of lactation with baby formulas. Breastfeeding is a protective factor for several infectious, atopic, and cardiovascular diseases as well as for leukaemia, necrotising enterocolitis, celiac disease, and inflammatory bowel disease. It also has a positive impact on neurodevelopment, improving IQ and reducing the risk of attention deficit disorder, and generalised developmental and behavioural disorders. Lactation can decrease the risk of sudden infant deaths syndrome by 36% and prevent 13% of infant mortality worldwide. Breastfeeding result in direct saving on the use of infant formulas and bottles, and indirectly on associated health costs, premature deaths, and quality-adjusted life years, among others. In addition, breastfeeding is environmentally friendly; it does not leave an ecological footprint in its production and consumption. The use of baby formulas and bottles have inherent risks, because they increase the risk of oral diseases, such as mouth breathing, malocclusion, alteration of bite, and tooth decay. Finally, the intestinal microbiota, oxygenation, and thermoregulation of infants are negatively affected by their use.

Beneficios de la lactancia materna y riesgos de no amamantar / The benefits of breastfeeding and associated risks of replacement with baby formulas

La lactancia materna (LM) es el alimento diseñado por la naturaleza para el recién nacido y el lactante, sin embargo su prevalencia actual no es la óptima. El objetivo de este artículo es revisar la evidencia actualizada de los beneficios de la LM para el niño y la sociedad, y recordar los riesgos asociados al reemplazo de ésta con fórmulas lácteas. La lactancia ha demostrado ser un factor protector contra distintas enfermedades infectocontagiosas, del espectro atópico y cardiovasculares, así como contra la leucemia, enterocolitis necrotizante, enfermedad celíaca y enfermedades inflamatorias intestinales. Asimismo, tiene un impacto positivo en el neurodesarrollo, mejorando el coeficiente intelectual y pudiendo tener una disminución del riesgo de otras condiciones como el déficit atencional, trastorno generalizado del desarrollo y alteraciones de conducta. La LM puede prevenir un 13% de la mortalidad infantil en el mundo, y disminuye el riesgo de muerte súbita del lactante en un 36%. La lactancia implica un ahorro directo en el uso de fórmulas lácteas y mamaderas, e indirecto en costos de salud asociados, muertes prematuras y años de vida ajustados por calidad, entre otros. Además, es medioambientalmente amigable sin dejar trazas de huella de carbono en su producción y consumo. El uso de fórmulas lácteas y mamaderas tienen riesgos inherentes asociado, aumentan el riesgo de las alteraciones de la cavidad oral, tales como respiración bucal, maloclusión, alteración de la mordida y caries. Por último, la microbiota intestinal, la oxigenación y la termorregulación de los lactantes se ven afectadas negativamente por su uso.

Breastfeeding is the nourishment designed by nature for the newborn and the infant; however its prevalence is nowadays not optimal. The aim of this article is to review the current evidence of the benefits of breastfeeding for children and society, and to elaborate the risks associated with the replacement of lactation with baby formulas. Breastfeeding is a protective factor for several infectious, atopic, and cardiovascular diseases as well as for leukaemia, necrotising enterocolitis, celiac disease, and inflammatory bowel disease. It also has a positive impact on neurodevelopment, improving IQ and reducing the risk of attention deficit disorder, and generalised developmental and behavioural disorders. Lactation can decrease the risk of sudden infant deaths syndrome by 36% and prevent 13% of infant mortality worldwide. Breastfeeding result in direct saving on the use of infant formulas and bottles, and indirectly on associated health costs, premature deaths, and quality-adjusted life years, among others. In addition, breastfeeding is environmentally friendly; it does not leave an ecological footprint in its production and consumption. The use of baby formulas and bottles have inherent risks, because they increase the risk of oral diseases, such as mouth breathing, malocclusion, alteration of bite, and tooth decay. Finally, the intestinal microbiota, oxygenation, and thermoregulation of infants are negatively affected by their use.

A Review of Adverse Reactions in Infants From Medications in Breastmilk.

The types and rate of adverse drug reactions experienced by breastfed infants whose mothers are taking medications has not been well defined. This article reviews the literature on adverse drug reactions in infants since a previous review in 2002. Case reports and studies of adverse drug reactions in breastfed infants whose mothers were taking a prescribed or over-the-counter medication were selected. Fifty-three case reports and 16 studies were located. Serious acute adverse drug reactions from drugs in breastmilk appear to be uncommon. Infants under 2 months of age, and especially those under 1 month, appear to be most susceptible. Similar to previous reviews, free iodine, opioids, and the use of multiple central nervous system drugs simultaneously were identified as drugs of concern. A few narrowly focused studies are now available on long-term effects of maternal drug therapy on breastfed infants and they are mostly reassuring.

A critical review of pharmaceutical galactagogues.

Use of plant and drug products to enhance lactation is widespread, and numerous papers have been published in the medical literature claiming efficacy for various products. This paper will review and evaluate the published literature on the most widely used pharmaceuticals that are used as galactagogues. Breastfeeding physiology is reviewed with the aim of creating a framework for understanding galactagogue pharmacology. Published articles were selected and evaluated using the principles of evidence-based medicine, and were also evaluated using the principles of good lactation management. Only three studies on oxytocin and seven studies on dopamine antagonists were found to be useful. Oxytocin is probably not useful as a galactagogue, except possibly in rare circumstances of tetraplegic mothers. Dopamine antagonists appear not to enhance milk supply if mothers are given good lactation support and employ these practices. The safety of the dopamine antagonists has not been adequately evaluated, so their use should be avoided unless other measures have failed.

Leche humana para niños pretermino / Human milk for children pretermino

Presenta resumen del estudio sobre la Leche Humana para los Niños Preterminos. Se realiza la evaluación de dos concentraciones de calcio y fósforo como fortificadores para la leche humana: 40 mg C/22 mg P y 85 mg Ca/45 mg P en 100 ml. La segunda concentración dió los mejores resultados. La retención neta de calcio y fósforo se acercaron al incremento intrauterino estimado de estos minerales. Los indicadores bioquímicos mostraron un mayor nivel plasmático de P y menores fosfatasas alcalinas en el grupo 85-45. También se realizó un estudio de seguimiento a los niños préterminos alimentados con lecha materna fortificada. Durante el primer año de vida los niños préterminos amamantados también tenían concentraciones séricas de fósforo menores y fostasas alcalina mayores que los alimentados con fórmula comerciales. Los niveles de mineralización osea de los niños pretérminos alimentados con fórmula llegaron a ser similares a los de los niños a las 52 semanas de vida. Estos datos sugieren que la fortificación intrahospitalaria debe llegar a los niveles intrauterinos de calcio y fósforo a extender la suplementación más allá del período de hospitalización. Se estan desarrollando nuevos estudios para probar estas hipotesis.

Patología intrahospitalaria derivada por médicos generales en un Hospital tipo cuatro / Intrahospitalaty pathology derivated by general physicians to a type 4 hospital

En 1990, en el Hospital de Molina, estratificado como tipo 4, se analizó las principales causales mórbidas de traslado en 3 de sus servicios (medicina, pediatría y urgencia), con el fin de detectar su magnitud y conocer el grado de resolutividad de cada uno de ellos. Pro tal motivo para recoger esta información se recurrió a todos los informes de egresos hospitalarios, fichas clínicas y libro de urgencias. Se detectó que son el grupo de traumatisno y envenenamientos, seguido por el grupo enfermedades del aparto digestivo y respiatorio quienes ocupan las principales causales de derivación tanto en la población pediátrica como adulta. En la primera destaca también la presencia significativa de las enfermedades infecciosas y parasitarias. El procentaje de resolución del servicio de pediatría y medicina alcanza un 93,6 por ciento, siendo mayor en el servicio de urgencia con un 99,3 por ciento