RESUMO
BACKGROUND: To assess the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum. METHODS: This was a cross-sectional study nested in a cohort of mothers living in Feira de Santana, state of Bahia, northeastern Brazil. Data from 1,243 mother-child dyads assessed both at the maternity ward and 30 days after delivery were analyzed. The association between cracked nipples as reported by mothers and their possible determinants was analyzed using Poisson regression in a model where the variables were hierarchically organized into four levels: distal (individual characteristics), distal intermediate (prenatal characteristics), proximal intermediate (delivery characteristics), and proximal (postnatal characteristics). RESULTS: The prevalence of cracked nipples was 32 % (95 % confidence interval [95 % CI] 29.4-34.7) in the first 30 days postpartum. The following factors showed significant association with the outcome: poor breastfeeding technique (prevalence ratio [PR] = 3.18, 95 % CI 2.72-3.72); breast engorgement (PR = 1.70, 95 % CI 1.46-1.99); birth in a maternity ward not accredited by the Baby-Friendly Hospital Initiative (PR = 1.51, 95 % CI 1.15-1.99); cesarean section (PR = 1.33, 95 % CI 1.13-1.57); use of a feeding bottle (PR = 1.29, 95 % CI 1.06-1.55); and higher maternal education level (PR = 1.23, 95 % CI 1.04-1.47). CONCLUSIONS: The prevalence of cracked nipples was high in our sample. Most of the factors associated with cracked nipples were related to postnatal characteristics, especially poor breastfeeding technique, which could be improved to help prevent the condition.
Assuntos
Doenças Mamárias/epidemiologia , Mamilos , Adolescente , Adulto , Alimentação com Mamadeira/estatística & dados numéricos , Brasil/epidemiologia , Aleitamento Materno/métodos , Cesárea/estatística & dados numéricos , Criança , Estudos Transversais , Escolaridade , Feminino , Humanos , Transtornos da Lactação/epidemiologia , Pessoa de Meia-Idade , Período Pós-Parto , Prevalência , Fatores de Risco , Adulto JovemRESUMO
The aim of this study was to determine the incidence and risk factors for early lactation problems [suboptimal infant breastfeeding behaviour (SIBB), delayed onset of lactogenesis (OL) and excessive neonatal weight loss] among mother-infant pairs in Lima, Peru. All primiparous mothers who gave birth to a healthy, single, term infant at a government hospital in a peri-urban area of Lima during the 8-month recruitment period were invited to participate in the study. Data were collected at the hospital (day 0) and during a home visit (day 3). Infant breastfeeding behaviour was evaluated using the Infant Breastfeeding Assessment Tool; SIBB was defined as < or = 10 score. OL was determined by maternal report of breast fullness changes; delayed OL was defined as perceived after 72 h. Excessive neonatal weight loss was defined as > or = 10% of birthweight by day 3. One hundred seventy-one mother-infant pairs participated in the study. SIBB prevalence was 52% on day 0 and 21% on day 3; it was associated with male infant gender (day 0), < 8 breastfeeds during the first 24 h (days 0 and 3), and gestational age < 39 weeks (day 3). Delayed OL incidence was 17% and was associated with infant Apgar score < 8. Excessive neonatal weight loss occurred in 10% of neonates and was associated with maternal overweight and Caesarean-section delivery. Early lactation problems may be influenced by modifiable factors such as delivery mode and breastfeeding frequency. Infant status at birth and maternal characteristics could indicate when breastfeeding dyads need extra support.
Assuntos
Peso ao Nascer/fisiologia , Aleitamento Materno/estatística & dados numéricos , Comportamento do Lactente/fisiologia , Recém-Nascido/fisiologia , Transtornos da Lactação/epidemiologia , Índice de Apgar , Aleitamento Materno/epidemiologia , Aleitamento Materno/psicologia , Cesárea/efeitos adversos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido/crescimento & desenvolvimento , Transtornos da Lactação/etiologia , Transtornos da Lactação/psicologia , Masculino , Paridade/fisiologia , Peru , Gravidez , Fatores de Risco , Fatores Sexuais , Apoio Social , Comportamento de Sucção/fisiologia , Fatores de Tempo , Redução de Peso/fisiologia , Adulto JovemRESUMO
Survival analysis and logistic regression were used to identify factors associated with the onset of perceived insufficient milk among 165 healthy mothers who planned to breast-feed and gave birth by vaginal delivery, without complications, to a healthy term infant in either a nursery (n = 58) or a rooming-in-hospital where formula supplementation was not allowed (n = 107). Women were interviewed in the hospital and at 1 wk, 2 mo and 4 mo postpartum. Women from both hospitals were similar in socioeconomic, demographic, anthropometric, previous infant feeding experience and prenatal care variables. Eighty percent of the women reported perceived insufficient milk at some point during the study. The cue interpreted most often as indicating insufficient milk was the crying of the infant. Multivariate analyses indicated that lack of confidence in breast-feeding, delayed onset of milk production, maternal education, multiparity, sore nipples, early introduction of formula to the previous child and mother breast-fed as a child were significantly associated (P < 0.05) with perceived insufficient milk. Among women who reported perceived insufficient milk before 1 wk, breast-feeding confidence and maternal education interacted with the hospital in which they delivered.
Assuntos
Aleitamento Materno/psicologia , Transtornos da Lactação/psicologia , Adulto , Alimentação com Mamadeira , Feminino , Hospitais de Ensino , Humanos , Recém-Nascido , Entrevistas como Assunto , Transtornos da Lactação/epidemiologia , Estudos Longitudinais , Masculino , México/epidemiologia , Berçários Hospitalares , Educação de Pacientes como Assunto , Pobreza , Gravidez , Análise de Regressão , Alojamento Conjunto , Análise de Sobrevida , População UrbanaRESUMO
Anthropometry, body composition and dietary intake of 30 lactating Otomi Indians of Capulhuac, Mexico, were studied to identify maternal factors which potentially limit lactation and thereby infant growth. Human milk production, milk composition, and maternal dietary intake, body weight, skinfold thicknesses, and body composition were measured at 4 and 6 months postpartum. The 2H2O dose-to-mother method was used to estimate milk production and maternal total body water (TBW). Fat-free mass (FFM) was calculated as TBW/0.73. Body fat was computed as body weight minus FFM. Human milk samples were analyzed for energy, nitrogen, lactose and fat using standard analytical methods. Maternal diet was assessed by three 24-h intake recalls. Mean (SD) milk production was 885 (146) and 869 (150) g/d at 4 and 6 months, respectively. Milk concentrations of protein nitrogen (1.23 (0.17) mg/g) and lactose (66.6 (2.8) mg/g) were comparable to, but the concentrations of fat (22.2 (6.7) mg/g) and energy (0.54 (0.06) kcal/g) were lower than, values observed in economically privileged populations. Maternal height, weight, and BMI were 1.47 (0.06) m, 50.3 (6.0) kg, and 23.4 (3.1) kg/m2, respectively. Maternal TBW, FFM and body fat were 55.8 (4.6)%, 76.4 (6.3)%, and 23.6 (6.4)%, expressed as a percentage of body weight, respectively. Maternal energy and protein intakes averaged 1708 (338) kcal/d and 40 (10) g/d, respectively. Milk production was negatively correlated with maternal body fat (P = 0.006). Energy and fat concentrations in the milk of the Otomi women were positively related to their weight (P = 0.002), BMI (P = 0.05), and body fat (P = 0.004). Energy concentrations in milk were not related to rates of milk production (r = 0.24; P = 0.23). Nor was milk production or composition significantly associated with maternal dietary intake. Lactation performance of these Otomi women correlated significantly with maternal body size and composition, but not current dietary intake.
PIP: Researchers analyzed data on 30 postpartum women from the Otomi Indian community living in rural Capulhuac, Mexico to examine interrelationships among lactation performance, maternal body size/composition, and dietary intake to learn which maternal factors limit lactation and thus infant growth. Infant food supplementation was minimal. Current diet did not affect milk production or levels of energy and fat in milk. Even though the body mass index (BMI) was lower than the normal range (19.8-26 kg/sq meter) for only 2 women, 8 women had 20% body fat indicating considerable undernutrition. Women consumed a mean of 68% and 80% of energy and protein requirements. Mean energy intakes (kcal/kg/day) at 4 and 6 months postpartum were 33.8 and 35.1 respectively, compared with the recommended 51. Mean protein intakes (g/kg/day) were 0.75 and 0.84 respectively compared with the recommended 1.1 3-day intake records based on memory, estimation of portion sizes, food preparation, and food composition data led to the above energy intake results, but they may not have been accurate since a mean of 35 would not allow much physical activity. Fats and carbohydrates mainly from maize made up 17% and 76% respectively of the Otomi diet suggesting a suboptimal diet. Yet human milk production rates (885 g/day at 4 months and 869 g/day at 6 months) tended to equal or be higher than those of women of higher socioeconomic status (711-925 g/day) and other poor women (525-789 g/day). The greater the levels of maternal body fat the smaller the amount of milk women produced (p=.006). Total nitrogen, protein nitrogen, lactose, and nonprotein nitrogen levels fell within the range of that of privileged women. Fat and energy levels in the milk were lower than those of privileged women, however heavy women (p=.002) with high BMI (p=.05) and body fat (p=.004) levels tended to have high levels of energy and fat in the milk. Energy levels in milk were not linked with milk production. Neither milk production nor composition were related to dietary intake.