Search Results (1,715)

Background/Objectives: Breast milk is a dynamic, personalized nutrition source, influenced by maternal diet, lifestyle, and environmental factors, which shape its composition and impact infant health. This review synthesizes evidence on the associations between maternal lifestyles (e.g., diet, physical activity, smoking), breast milk composition, and child health, offering insights for interventions to optimize breastfeeding benefits. Methods: We searched Web of Science, Medline, Embase, and PubMed for studies published up to March 2024 using predefined terms. Results: Out of 5244 articles, 20 studies met the inclusion criteria. Maternal Body Mass Index and macronutrient intake significantly affected breast milk fatty acid composition, influencing infant growth, cognitive development, and metabolic health. Micronutrient intake, particularly iodine, omega-3 fatty acids, and vitamins, was linked to better neurodevelopment and reduced atopic risks. Maternal diet and supplementation improved breast milk nutrient profiles and infant outcomes, though exposure to toxins like ochratoxin A raised concerns. Smoking was associated with altered milk composition, including lower osteopontin levels, potentially affecting infant immunity and growth. Conclusions: This review emphasizes that adequate intake of key nutrients is essential for infant development, highlighting the need for policies that address nutritional deficiencies, promote healthy lifestyles, and reduce socio-economic barriers. These efforts can improve outcomes for both mothers and children, enhancing public health and reducing disparities. Full article

Breastfeeding is fundamental for the development and protection of the newborn, and microorganisms present in breast milk are associated with the development of the infant’s intestinal microbiota. However, there are factors that interfere with breastfeeding, resulting in the need to supply donated milk to milk banks for these children. Even though there is a restriction on medications prescribed for pregnant and breastfeeding women, some antimicrobials are accepted, as long as they are used correctly and as they can increase the selection pressure for resistant bacteria. The microorganisms present in breast milk from a human milk bank were evaluated and the resistance of the isolates to antimicrobials was phenotypically characterized. In total, 184 microbial isolates were identified by mass spectrometry, of 12 bacterial genera and 1 yeast genus. There was a high prevalence of bacteria of the genus Staphylococcus, mainly S. epidermidis (33%). Resistance to antimicrobials varied among species, with a higher percentage of isolates resistant to penicillins and macrolides. Multidrug resistance was identified in 12.6% of 143 isolates. Breast milk contains a wide variety of microorganisms, mainly those of the Staphylococcus and Enterobacter genera. There was a high percentage of resistant isolates, and multidrug resistance in Klebsiella oxytoca (66.7%; 4/6) and S. epidermidis (15.0%; 9/60) isolates, which increases the public health concern. Full article

Breastfeeding supplies nutrition, immunity, and hormonal cues to infants. Feeding expressed breast milk may result in de-phased milk production and feeding times, which distort the real-time circadian cues carried by breast milk. We hypothesized that providing expressed breast milk alters the microbiotas of both breast milk and the infant’s gut. To test this hypothesis, we analyzed the microbiota of serial breast milk and infant fecal samples obtained from 14 mother–infant dyads who were lactating, half of which were providing expressed breast milk. Infant fecal microbiota showed lower α-diversity than breast milk microbiota. Bacterial amplicon sequence variant sharing occurred between breast milk and infant feces with no feeding group differences. However, the age-dependent gain in breast milk α-diversity was only significant in the expressed breast milk group and not in the direct breastfeeding group, suggesting that decreased contact with the infant’s mouth influences the milk microbiota. Trending lower connectivity was also noted with breast milk microbes in the direct breastfeeding group, consistent with regular perturbations of the developing baby’s oral microbiota by latching on the breast. The results of this preliminary study urge further research to independently confirm the effects of providing expressed breast milk and their health significance. Full article

Background/Objectives: Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome, often referred to as PFAPA syndrome, may enigmatically recur for an undetermined time in affected children: a potential reason to explain its recurring pattern for an unpredictable period or its self-limitation is currently unknown. We explored the relationship between different general, demographic, clinical, and laboratory features of PFAPA children and disease evolution over the course of a decade. Methods: We have retrospectively screened 150 Italian children with a history of PFAPA syndrome attending the Outpatients Clinic of Pediatric Rheumatology in our Institution during the period 2014–2024, all without any recognized chronic diseases: 88 males, 62 females, mean age at onset of 2.5 ± 1.7 years, age range of 0.3–9.4 years, and mean age at diagnosis of 4.5 ± 2.0 years. The whole cohort of PFAPA patients had been followed up for a median period of 5 years (IQR: 4–7). Results and Conclusions: After dividing patients into two groups based on either the disappearance or persistence of PFAPA symptoms during follow-up, we found that positive family history of recurring fevers, cervical lymphadenopathy, arthralgia, myalgia, and breastfeeding for more than 6 months were associated with the disappearance of febrile attacks for at least six months. Performing a multivariate analysis adjusted for sex and age, we found that only breastfeeding duration longer than 6 months and higher education level of PFAPA patients’ mothers were independently associated with the resolution of PFAPA symptoms. Full article

Aim: This article aims to explore the role of the human gut microbiota (GM) in the pathogenesis of neurological, psychiatric, and neurodevelopmental disorders, highlighting its influence on health and disease, and investigating potential therapeutic strategies targeting GM modulation. Materials and Methods: A comprehensive analysis of the gut microbiota’s composition and its interaction with the human body, particularly, its role in neurological and psychiatric conditions, is provided. The review discusses factors influencing GM composition, including birth mode, breastfeeding, diet, medications, and geography. Additionally, it examines the GM’s functions, such as nutrient absorption, immune regulation, and pathogen defense, alongside its interactions with the nervous system through the gut–brain axis, neurotransmitters, and short-chain fatty acids (SCFAs). Results: Alterations in the GM are linked to various disorders, including Parkinson’s disease, multiple sclerosis, depression, schizophrenia, ADHD, and autism. The GM influences cognitive functions, stress responses, and mood regulation. Antibiotic use disrupts GM diversity, increasing the risk of metabolic disorders, obesity, and allergic diseases. Emerging therapies such as probiotics, prebiotics, and microbiota transplantation show promise in modulating the GM and alleviating symptoms of neurological and psychiatric conditions. Conclusions. The modulation of the GM represents a promising approach for personalized treatment strategies. Further research is needed to better understand the underlying mechanisms and to develop targeted therapies aimed at restoring GM balance for improved clinical outcomes. Full article

Background and Objectives: Donor human milk (DHM) from a human milk bank (HMB) is used to feed low-birthweight (LBW) and preterm infants when mothers cannot provide their own breastmilk. The misuse of DHM could interfere with mothers’ breastmilk and weaken breastfeeding efforts. This study aimed to identify factors behind prolonged DHM usage during the first six years of Vietnam’s first HMB. Methods: Data were extracted from the Da Nang HMB’s digital monitoring system. We defined prolonged DHM use as four or more days in the neonatal unit and two or more days in postnatal wards. Results: Over six years, 25,420 infants received DHM, with 45.3% of the infants being female, 54.7% being male, 70.0% being born via cesarean section, and 77.2% being full-term. In the neonatal unit (n = 7001), 38.0% of infants used DHM for ≥4 days. Adjusted odds ratios (aORs) for prolonged use were 0.14 for infants weighing <1000 g, 0.78 for infants weighing 1000–<1500 g, and 0.67 for infants weighing ≥2000 g (p < 0.01), compared to those weighing 1500–<2000 g. Compared to gestational ages of 32–<34 weeks, the aORs were 0.26 for <28 weeks, 0.71 for 34–<37 weeks, and 0.35 for ≥37 weeks (p < 0.01). In postnatal wards (n = 18,419), 53.1% of infants used DHM for ≥2 days. Compared to term, normal-weight infants, the aORs were 1.25 for LBW–preterm, 1.17 for LBW–term, and 1.21 for normal-weight–preterm infants (p < 0.05). Prolonged DHM use was associated with cesarean births in neonatal units (aOR 2.24, p < 0.01) and postnatal wards (aOR 1.44, p < 0.01). Conclusions: DHM is used briefly to bridge nutritional gaps and transition to mothers’ breastmilk, but LBW, preterm births, and cesarean births are linked to prolonged use. Healthcare providers should support those at risk of prolonged DHM use and prioritize reducing unnecessary cesarean births. Full article

(1) Background: Chagas disease is a public health problem affecting nearly 2 million women of reproductive age in Latin America. From these, 4–8% can transmit the infection to the foetus through the vertical route, whereas horizontal transmission through milk during breastfeeding remains controversial. Therefore, the presence of Trypanosoma cruzi (T. cruzi) DNA in the milk of women seropositive for Chagas disease was analysed to determine whether a relationship with the infection of their children can exist. (2) Methods: 260 pairs (mother–child) from four hospitals located in rural areas endemic to T. cruzi (state of Oaxaca) were studied. The presence of anti-T. cruzi antibodies in the serum of lactating women were determined by ELISA, whereas parasitic DNA in either breast milk or newborn’s blood was identified by PCR; (3) Results: The seroprevalence of infection in lactating women was 5.76%, and the frequency of infection detected by PCR in breast milk was 1.92%, while the frequency of infection in the blood of newborns was 1.92%. Pochutla-Oaxaca presented the highest number of positive cases in both breast milk and blood. The only risk factor found was the presence of the vector in the geographical area analysed, favouring the parasite’s transmission. Overall, the results suggest a probable transmission of T. cruzi, although whether it was through breastfeeding or through the blood during delivery could not be determined. (4) Conclusions: T. cruzi DNA was identified in lactating women’s milk and newborn blood, which is probable evidence of transmission through breastfeeding; nevertheless, future studies must be performed to confirm the presence of the parasite, alive or dead. Full article

Background/Objectives: Breastfeeding during pediatric hospitalization is often challenging, especially in a setting where nursing work environments can affect breastfeeding support. This study examines the relationship between nursing work environments and the prevalence of breastfeeding during child hospitalization, focusing on aspects such as nursing workload, stress levels, and quality of work life (QoWL). Methods: A cross-sectional multicenter study was conducted in Italian pediatric hospitals from October 2023 to January 2024. Each ward head nurse completed a form daily for 30 consecutive days to record the number of children breastfed. Nurses’ workload, stress, and QoWL were measured using validated self-report questionnaires. Multivariate regression was employed to examine the associations between organizational variables and breastfeeding prevalence. Results: A total of 256 nurses from low- and medium-intensity pediatric wards completed the survey (86.7% female, mean age = 39.2, SD = 9.96). Nurses reported low stress levels (M = 2.74; SD = 0.54) and a good QoWL (M = 3.03; SD = 0.50) despite high workloads (M = 3.34; SD = 0.95). The breastfeeding prevalence mean was 1.12 (SD = 1.38), which was highest in surgical units. Regression analysis revealed that higher breastfeeding prevalence was associated with nurses’ female gender (β = 0.17), clinical setting, and higher levels of nurses’ QoWL (β = 0.14) (R² = 0.23; p < 0.001). Conclusions: To enhance breastfeeding support during child hospitalizations, healthcare policies should address workload management, stress reduction, and work–life balance. Future longitudinal research should expand to other clinical settings and include detailed patient data to understand these relationships. Full article

Background: Despite the short- and long-term acknowledged benefits of breastfeeding for mothers and their infants, worldwide rates trail behind international goals. Prior research confirms that breastfeeding is a nurse sensitive indicator and that problems with latching the baby and painful breastfeeding rank high among the reasons given for not continuing to breastfeed. The Lactation Assessment Tool (LAT^TM) was previously evaluated in a study conducted in Latvia by nurse midwives. Use of the LAT to assess breastfeeding and suggesting corrective interventions were shown to decrease pain and promote healing in traumatized nipples. The inter-rater reliability for that study was by test/re-test amongst participating researcher midwives. The aim of the current study is to expand the understanding of LAT inter-rater reliability to include novice and expert assessors. Methods: A convenience sample of twenty participants, including both novices (nine nursing students) and 11 self-identified experts, assessed four videos of breastfeeding dyads using the assessment tool, the LAT. Novice participants received a 2 h training session before final tool assessment. Each video was viewed three times, with a 3 min pause between viewings. All elements of the LAT that could be visually evaluated were included, with each element appearing in at least two of the videos. Results: Acceptable internal consistency of the LAT tool was found, with Cronbach’s alpha measuring 0.799, 0.740, 0.756 and 0.735 for each video, respectively. The reliability of the novice assessors improved over the course of the four videos, from 0.484 and 0.610 to 0.714 and 0.711. All of the experts had Cronbach’s alpha numbers that were acceptable, ranging from 0.769 to 1.00. Conclusions: Results indicate that experts perform much better using the tool than trained novices. However, the subsequent use of the tool resulted in the last two video assessments having an acceptable measure for the trained novice group. The LAT is a reliable tool for trained novices and experts to assess breastfeeding positioning and latch. Full article

Background: Inflammatory bowel disease (IBD) frequently manifests at a young age, during the peak fertility years. Understanding the risks of negative pregnancy outcomes associated with IBD is crucial for effective pregnancy management and support. Additionally, it is essential to provide patients with the necessary knowledge to make informed choices and foster their confidence in navigating pregnancy while maintaining effective disease management. Although IBD frequently appears during the peak fertility years, knowledge about managing pregnancy in the context of IBD remains limited and often inaccurate among both physicians and patients. Our study aims to assess the complications occurring during pregnancy in patients with IBD, considering the level of disease activity, and to evaluate the standard of care provided to patients with chronic inflammatory conditions through a cohort analysis. Methods: Patients with IBD who had children were included in this single-center mixed-method (retrospective and prospective) study. Clinical data, disease progression, course of pregnancy, and complications were examined in women. Outcomes for children of men with IBD were also analyzed. To supplement the data, a survey addressing various pregnancy-related topics, including all patients from the university outpatient clinic for IBD, was conducted over a period of six months. Results: A total of 410 patients were screened retrospectively between 2010 and 2021. In total, 134 patients who had children were included in the study: 51.4% (n = 69) had Crohn’s disease, 44% (n = 59) had ulcerative colitis, and 4.6% (n = 6) had unclassified inflammatory bowel disease. Of the women, 85% (n = 34) were in remission for at least three months before pregnancy, 14.6% (n = 6) experienced an acute flare-up during pregnancy, and 10.3% (n = 4) and 7.7% (n = 3) had active disease at the time of delivery and during breastfeeding, respectively. Patients with IBD who were in remission before pregnancy did not experience a higher risk of pregnancy complications (no cases of pre-eclampsia or placental abruption were reported in this group). However, the rates of gestational diabetes and fever during pregnancy were 10% for those in remission, compared to 25% for those with active disease. Conclusions: Patients with IBD in remission did not present an increased risk of pregnancy complications. However, our survey indicates that those with active disease at conception were more likely to experience complications such as gestational diabetes and fever. These findings underscore the importance of adequate patient education regarding the safety of various IBD medications during pregnancy in order to avoid pregnancy-related complications. Full article

Women diagnosed with gestational diabetes mellitus (GDM) face a significantly heightened risk of developing type 2 diabetes mellitus (T2DM) later in life. Breastfeeding (BF) has been identified as a potential strategy to delay or prevent T2DM; however, women with GDM often encounter barriers in initiating and maintaining adequate BF practices compared to those with uncomplicated pregnancies. This paradox prompts an exploration into the causes of these BF challenges and considers the possibility of reverse causation: Does prolonged and intensive BF mitigate the risk of subsequent glucose dysregulation and T2DM? Alternatively, do women with compromised insulin secretion and sensitivity, who are predisposed to T2DM, struggle to sustain intensive BF practices? This narrative review aims to explore the interplay between GDM, BF, and T2DM development by examining the different factors that present BF challenges among women with GDM. Understanding these dynamics is crucial for establishing realistic BF expectations and developing effective clinical and public health strategies to support BF in this high-risk population. Full article

Background: Mediterranean diet (MD) constitutes a commonly examined dietary model. It includes a plethora of bioactive ingredients with strong antioxidant, anti-inflammatory, antithrombotic and anticancer properties. Several substantial studies support strong evidence that MD can exert preventing actions against human morbidity and mortality, promoting human well-being and quality of life. The present study aims to evaluate whether childhood MD compliance may be associated with socio-demographic, anthropometric, and lifestyle factors in children at the age of 6–9 years. Methods: This is a cross-sectional survey on 3875 children aged 6–9 years old with their matched mothers. Qualified questionnaires were used to evaluate and collect by one-to-one interviews with trained professionals the above data. Results: Elevated MD adherence was observed only in 22.2% of the enrolled children, while 37.5% of children maintained intermediate MD adherence and 40.3% of children adopted lower MD levels. Children MD compliance was related at an independent manner with maternal education level, childhood anthropometric factors such as Body Mass Index (BMI), Waist circumference to Height ratio (WtHR), quality of life, and exclusively breastfeeding behaviors after adjusting for several possible confounders (p ˂ 0.05). Conclusions: Elevated MD adherence of children aged 6–9 years old showed a lower obesity of overweight/obesity, including abdominal obesity. A higher maternal educational status and adopting exclusively breastfeeding practices were associated with greater levels of children’s MD adherence, promoting their quality of life and well-being. Based on the present results, future prospective surveys need to be performed to evaluate if there is a causality relation concerning this topic. Full article

Background: Levels of adherence to recommended protocols in an intervention trial can affect outcomes and confound the results. To broaden the evidence about the selection and utility of adherence measures in varying contexts, we describe the level of adherence to the Mycotoxin Mitigation Trial (MMT) randomized intervention using caregiver-reported survey questions and compare inferences of adherence between multi-module surveys and interactive 24 h dietary recalls based on our program theory. Methods: The MMT was a two-arm cluster-randomized trial conducted in 52 health facilities (clusters) in central Tanzania. Surveys were conducted with all trial participants at three time points and dietary recalls were conducted in a cohort at 12 mo. Results: The 12 mo survey was conducted with 2112 caregivers and the 18 mo survey was conducted with 2527 caregivers. A cohort of participants (n = 282, 20 clusters) was selected for dietary recalls, balanced by arm. Reported feeding of blended porridge flours, whether MMT-provided or own-sourced, was high at 12 and 18 mo, between 73 and 95%, with only slight differences between the surveys and recalls. Inferences were similar for continuation of breastfeeding, feeding frequency, and dietary diversity. Only the amount of porridge fed the previous day differed statistically by method, with higher amounts reported in the recalls compared to the survey. Conclusions: Detailed analysis of reported behaviors, based on the MMT program theory, supports high adherence to the recommended trial behaviors. Survey data and 24 h dietary recalls were convergent for almost all indicators, strengthening the trial’s conclusions and allowing for either method to be selected for similar research. Full article

Background/Objective: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides breastfeeding support to participating women in low-income households. This study aimed to determine the relationships between prenatal maternal and household characteristics and breastfeeding duration, as well as whether these characteristics modify associations of prenatal breastfeeding intention with breastfeeding duration. Methods: This is a prospective cohort study of pregnant respondents to Los Angeles County (LAC), California, WIC surveys conducted between 2005 and 2020 (n = 1014). Associations of prenatal breastfeeding intention with duration (months) of any or fully breastfeeding, determined by WIC infant food package issuance, were assessed with linear regression models. Results: Most women reported the intention to breastfeed (67.7%) and perceived breastfeeding support during pregnancy from WIC and family/friends was associated with breastfeeding intention (both p-values < 0.0001). Stronger breastfeeding intention, lower maternal BMI, greater maternal age, greater maternal education, paternal cohabitation and employment, and greater breastfeeding support from family/friends were associated with longer duration of any or fully breastfeeding in multivariable models. Stronger breastfeeding intention was more strongly associated with longer duration of any breastfeeding among women with lower BMI (interaction p-value 0.03). Conclusions: Breastfeeding support from WIC is an important contributor to stronger breastfeeding intention. Given the robust association of breastfeeding intention with breastfeeding duration, regardless of maternal and household characteristics, WIC breastfeeding support during pregnancy represents an important mechanism to improve breastfeeding outcomes in this population. Further research is needed to understand the directionality of associations between breastfeeding support and intention among WIC participants. Full article

Background/Objectives: One of the most effective strategies to mitigate morbidity associated with preterm birth is the use of human milk. The first choice is the mother’s milk; if that is not available, human milk donated to milk banks is the second choice. The recruitment of milk donors is essential for enhancing the effectiveness and efficiency of donation. This study aims to profile the donors of a southern Italian milk bank, examine how maternal and neonatal factors impacted the volume and duration of donation and analyze the trend over the last ten years. Materials and Methods: Data were collected from the milk bank database and hospitalization medical records, encompassing 593 donors and 13 years of activity of the Human Milk Bank from 2010 to 2022. Several variables were assessed: maternal characteristics—maternal age, employment status and the type of profession; pre and perinatal characteristics—type of delivery, parity, previous breastfeeding experience, birth weight and gestational age; milk donation characteristics—volume of milk donated and duration of donation. The trend of the characteristics was studied over time. Statistical correlations were conducted to assess the relationships between variables and the volume and duration of the milk donation. Results: In our cohort of donors, the most prevalent category consists of women over 30 years of age who are multiparous, have prior breastfeeding experience, are workers and have given birth to full-term babies. Maternal age and gestational age significantly influence both the volume and duration of milk donation. The type of delivery and occupation impact the volume of donated milk. There has been a decline in the number of donors over time. However, the trends in both the quantity and duration of milk donations have remained stable over the past decade, with the exception of the year immediately following the COVID-19 pandemic. Conclusions: We have outlined the prevailing average profile of the milk donor to a milk bank in Southern Italy. Factors impacting the volume and duration of donation, such as maternal age, occupation, type of delivery and gestational age, were identified. The volume and duration of donations have remained largely stable, with the exception of 2021, when the pandemic significantly reduced milk donations to the milk bank. Full article