Preparation and validation of a predictive model of breastfeeding initiation in the first hour of life

Objective: The objective was to develop and validate a predictive model of initiation of breastfeeding in the first hour after delivery. Methods: Retrospective cohort study on women who gave birth between 2013 and 2018 in Spain. For data collection, an ad hoc questionnaire was designed to be filled in by the mothers, which was distributed to the different Spanish breastfeeding associations which, in turn, shared it with their associate partners. The development of the predictive model was made on a cohort of 3218 women (2/3) and was validated on a cohort of 1609 women (1/3). Mothers whose children were admitted to hospital at the time of birth were excluded. A multivariate analysis was performed by means of logistic regression, and predictive ability was determined by areas under the ROC curve (AUC). Results: 81.0 % (2608) women started breastfeeding in the first hour in the derivation cohort, and 80.1 % (1289) in the validation cohort. The predictive factors in the final model were: the highest number of children and skinto- skin contact at birth as flattering factors, while dystocic delivery reduced the likelihood of the onset of breastfeeding. The predictive ability (ROC AUC) in the derivation cohort was 0.89 (CI 95 %: 0.87–0.90), while in the validation cohort it was 0.89 (CI 95 %: 0.87–0.92). Conclusions: This three-variable predictive model has excellent predictive ability in both the derivation cohort and the validation cohort. This model can identify women who are at high risk of non-initiating breastfeeding within the first hour after delivery.Departamento de Biología Ambiental y Salud Públic

Lactancia materna: factores que influyen sobre el amamantamiento y modelos predictivos

La lactancia materna es considerada una medida de salud pública gracias a los múltiples beneficios que aporta tanto al recién nacido como a la madre tanto a corto como a largo plazo. A pesar de la evidencia existente a favor de la lactancia y las múltiples recomendaciones de diferentes organismos nacionales e internacionales las tasas de lactancia tanto a nivel mundial como a nivel nacional no son tan altas como cabría esperar. Objetivos: Evaluar los factores que influencian la decisión prenatal de lactar, determinar la relación entre el índice de masa corporal y los problemas asociados a la lactancia materna, así como elaborar y validar dos modelos predictivos, uno acerca de lactancia materna exclusiva al alta hospitalaria y otro sobre el inicio de lactancia materna en la primera hora tras el parto. Metodología: Para el estudio de la relación entre el IMC y la lactancia la muestra fue de 5871 mujeres, para determinar los factores asociados a la decisión prenatal de amamantar la muestra fue de 5671 mujeres y para la creación de los modelos predictivos la muestra total de participantes se dividió en cohorte de derivación con 3387 mujeres y cohorte de validación con 1694. La muestra se recogió mediante un cuestionario online autoadministrado difundido a las diferentes asociaciones de lactancia de España. Para el análisis de los datos, se empleó análisis multivariante mediante regresión lineal múltiple y regresión logística binaria para el control de la confusión y la elaboración de los modelos predictivos, así como áreas bajo la curva ROC para determinar la capacidad predictiva de los modelos. Resultados: Se observó una relación lineal entre las cifras más altas de índice de masa corporal y la reducción de la probabilidad de inicio del contacto piel con piel (AOR para obesidad tipo III de 0.51 [IC 95% 0.32, 0.83]), lactancia materna en la primera hora (AOR para obesidad tipo III de 0,58 [IC 95% 0,36; 0,94]), y lactancia materna exclusiva al alta hospitalaria (AOR para obesidad tipo III de 0,57 [IC del 95%: 0,35; 0,94]), en comparación con las mujeres con normopeso. En cuanto a los factores prenatales que influencian la decisión de amantar identificamos cinco: asistir a las clases de educación maternal (ORa 2,10; IC del 95%: 1,32; 3,34), tener dos (ORa 0,52; IC del 95%: 0,28; 0,99) y tres hijos (ORa 0,24; IC del 95%). 0,10, 0,59), tener experiencia previa en lac- tancia materna (ORa 6,99; IC del 95% 3,46, 14,10), contar con el apoyo de la pareja (ORa 1,58; IC del 95% 1,09,2,28) y tener alguna complicación durante el embarazo (ORa 0,62; IC del 95% 0,43, 0,91). En el modelo predictivo de lactancia exclusiva la alta hospitalaria, los factores predictivos iden- tificados en el modelo final fueron: edad materna al nacimiento; índice de masa corporal; número de hijos; lactancia materna previa; plan de parto; parto inducido; analgesia epidural; tipo de parto; prematuridad; embarazo múltiple; macrosomía; inicio de la lactancia materna dentro de la primera hora y contacto piel con piel. La capacidad predictiva (ROC AUC) en la cohorte derivación fue 0,76 (IC 95%: 0,74-0,78), mientras que en la cohorte de validación fue 0,74 (IC 95%: 0,71-0,77). En el modelo predictivo inicio de la lactancia materna en la primera hora de vida los factores predictores en el modelo final fueron: El mayor número de hijos y el contacto piel con piel al nacimiento que se presentaron como factores favorecedores y el parto distócico que redujo la probabilidad de inicio de lactancia materna. La capacidad predictiva (AUC de ROC) en la cohorte de derivación fue de 0.89 (IC95%:0.87-0.90), mientras que en la cohorte de validación fue de 0.89 (IC95%:0.87-0.92). Conclusiones: El mayor índice de masa corporal se asocia con menores posibilidades de iniciar el contacto piel con piel, de inicio precoz de la lactancia y de salir del hospital con lactancia materna exclusiva, además tienen más posibilidades de abandonar la lactancia de manera precoz y de padecer problemas asociados a la misma. Dado que la lactancia materna se considera una medida de salud pública, los mecanismos de apoyo a estas mujeres deben estar presentes tanto durante su ingreso hospitalario como dentro de la comunidad. Los factores asociados con la decisión materna prenatal de lactar identificados son: el apoyo de la pareja, la experiencia previa en lactancia, tener dos o más hijos, asistir a clases sobre lactancia materna y presentar algún problema de salud durante la gestación. Dada la influencia que tiene la pareja en la toma de decisiones, consideramos que se debe potenciar su participación activa durante el proceso, tanto en las consultas individuales como en las clases de educación maternal. El modelo predictivo de lactancia materna al alta hospitalaria y el de inicio precoz de la lactan- cia materna presentan una buena y excelente capacidad predictiva respectivamente, por lo tanto, su implantación dentro de la rutina hospitalaria podría llevar a la identificación precoz de las mujeres con mayor riesgo de no lactar y en consecuencia, poner en marcha medidas de apoyo dirigidas a esta población de manera que se puedan elevar las tasas de inicio de la lactancia materna

Effects of cord milking in late preterm infants and full-term infants: A systematic review and meta-analysis

Background: Umbilical cord milking (UCM) consists of performing several milkings of the cord from the placenta to the newborn. The objective was to evaluate the effects of UCM on newborns ≥34 weeks’ gestation. Methods: Searches were conducted in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, and the clinicaltrails.gov database for randomized clinical trials (RCT), with no time or language restrictions, and for articles that compared UCM with other strategies. The main results were initial hemoglobin and hemoglobin after 6 weeks. The data were collected by two reviewers and the quality of the studies was assessed using the Cochrane Manual methodology. Results: The sample included 1845 newborns in 10 RCTs. The use of UCM in ≥34 weeks’ gestation newborns was not related to initial hemoglobin levels (pooled weighted mean difference: (PWMD = 0.40 g/L [−0.16 to 0.95]) or after 6 weeks (PWMD = 0.07 g/L [−0.29 to 0.27]). A reduction in hemoglobin levels was also observed at 6 weeks when the control group had undergone late clamping (PWDM = 0.16g/L [−0.26 to −0.06]). Conclusions: UCM produced no differences in hematologic variables for newborns with ≥34 weeks of gestation relative to controls. However, a slight decrease in hemoglobin levels is observed at 6 weeks when the control group is made up of newborns with late clamping

Influence of Family Income Level on Obstetric and Perinatal Outcomes in Spain

For pregnant women, having a low family income status is associated with late prenatal attendance and an increased risk of adverse outcomes during pregnancy, delivery, and immediately after delivery. However, the influence of the socioeconomic level on maternal and child health may be minimal as long as the health system model is able to neutralise health inequity. For this reason, the objective of this study is to determine the relationship between the socioeconomic level assessed through monthly household income and obstetric and perinatal outcomes in the Spanish Health System, where midwives play a relevant role. To meet this objective, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The final study population was 5942 women. No statistically significant differences with linear trend were found between income level and obstetric and perinatal outcomes after the adjustment by confounding factors (pregnancy composite morbidity, p = 0.447; delivery composite morbidity, p = 0.590; perinatal composite morbidity, p = 0.082; postpartum composite morbidity, p = 0.407). The main conclusion is that, in the current Spanish health system, household income as an indicator of socioeconomic status is not related to perinatal outcomes after the adjustment by confounding factors. These results are likely due to the public model of our health system that serves all citizens on equal footing, although other social and individual factors may have influenced these results

Factors that influence mothers’ prenatal decision to breastfeed in Spain

Background: Parents’ decisions about how to feed their newborns are influenced by multiple factors. Our objective was to identify the factors that can influence the decision to breastfeed. Methods: Cross-sectional observational online study was conducted in Spain on women who gave birth between 2013 and 2018. The total number of participants was 5671. Data collection was after approval by the ethics committee in 2019. The data were collected retrospectively because the information was obtained from women who were mothers during the years 2013–2018. An online survey was distributed to breastfeeding associations and postpartum groups. Multivariate analysis with binary logistic regression was done to calculate the Adjusted Odds Ratios (aOR). The main result variable was “intention to breastfeed”. Results: Ninety-seven percent (n = 5531) of women made the decision to breastfeed prior to giving birth. The internet played a role in deciding to breastfeed in 33.7% (n = 2047) of women, while 20.1% (n = 1110) said the same thing about their midwife. We identified five significant factors associated with the mother’s prenatal decision to breastfeed: attending maternal education (aOR 2.10; 95% CI 1.32, 3.34), having two (aOR 0.52; 95% CI 0.28, 0.99) and three children (aOR 0.24; 95% CI 0.10, 0.59), previous breastfeeding experience (aOR 6.99; 95% CI 3.46, 14.10), support from partner (aOR 1.58; 95% CI 1.09,2.28) and having a condition during pregnancy (aOR 0.62; 95% CI 0.43, 0.91). Conclusions: Factors related with previous breastfeeding experience and education for mothers are decisive when it comes to making the decision to breastfeed. Given the proven influence that partners have in decision-making, it is important for them to be fully involved in the process

Relationship between maternal body mass index with the onset of breastfeeding and its associated problems: an online survey

Background: Obesity is a worldwide public health problem that demands significant attention. Several studies have found that maternal obesity has a negative effect on the duration of breastfeeding and delayed lactogenesis. The World Health Organization has classified Body Max Index (BMI) as normal weight (normoweight) (BMI:18.5–24.9), overweight (BMI:25–29.9), obesity grade I (30.0–34.9), obesity grade II (BMI: 35.0–39.9) and obesity grade III (BMI 40.0). The objective of this study is to describe the relationship between maternal BMI and breastfeeding rates, as well as breastfeeding-associated problems and discomfort in women assisted by the Spanish Health System. Methods: To this end, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The data was collected through an online survey of 54 items that was distributed through lactation associations and postpartum support groups between March and June 2019. Five thousand eight hundred seventy one women answered the survey. In the data analysis, Crude Odds Ratios (OR) and Adjusted Odds Ratios (AOR) were calculated through a multivariate analysis through binary and multinomial regression. Results: A linear relationship was observed between the highest BMI figures and the reduction of the probability of starting skin-to-skin contact (AOR for obesity type III of 0.51 [95% CI 0.32, 0.83]), breastfeeding in the first hour (AOR for obesity type III of 0.58 [95% CI 0.36, 0.94]), and exclusive breastfeeding to hospital discharge (AOR for obesity type III of 0.57 [95% CI 0.35, 0.94]), as compared to women with normoweight. Conclusions: Women with higher BMI are less likely to develop successful breastfeeding than women with normoweight

Influencia de la fatiga posparto sobre el tipo de alimentación en el primer mes de vida

For more than two decades, western women have mentioned postpartum fatigue among their main worries during the post-natal period. Postpartum fatigue is not a simple health problem, most of the time, it is a progressive pattern which instead of settling, goes on for more than six weeks postpartum. Although breastfeeding advantages are widely known, there are different factors related to its failure, one of them is postpartum fatigue related to obstetric or nursing period problems.Internationally we can find a large number of studies about postpartum fatigue, its prevalence, risk factors or consequences, however only a few of them focus on the connection between fatigue and breastfeeding.In Spain we can find some researches about postpartum fatigue but none of them studied breastfeeding along with fatigue.The aim of this study is to determine the effect of postpartum fatigue above breastfeeding rates when women leave the hospital and one month postpartum, among women delivering at the General Hospital of Albacete from May to August 2013. This is a prospective analytical cohort study. Data collection will be made in two periods of time: T1 before women leave hospital (they will fill in the questionnaire themselves); and T2 one month postmantal ( the questionnaire will be completed in by phone). In order to measure fatigue, we will use the Fatigue Asassement Scale, and for breastfeeding status, we will use a questionnaire using WHO’s definitions. We have also created a record to collect social and clinical variables as well as neonate onesDurante más de dos décadas las mujeres occidentales han clasificado la fatiga posparto entre sus cinco principales preo-cupaciones después del parto. La fatiga posparto no es un simple problema de salud común, en muchas ocasiones tiene un patrón progresivo, y en lugar de resolverse espontáneamente continua más allá de 6 semanas posparto. Aunque son ampliamente conocidas las ventajas de la lactancia materna, existen diferentes factores que influyen en su fracaso; siendo la fatiga posparto uno de ellos relacionado con problemas obstétricos y/o de crianza.A nivel internacional existe una amplia literatura respecto a la fatiga posparto que informan sobre la prevalencia del tras-torno, factores de riesgo, consecuencias e intervenciones efectivas para tratarlo; sin embargo, son pocas las que se han abocado a la búsqueda de su relación con la lactancia materna.En España, algunas investigaciones han abordado el tema de la fatiga, pero no existen estudios publicados cuyo objetivo central sea su relación con la lactancia.El objetivo de esta investigación es determinar el efecto de la fatiga sobre el estado y las tasas de lactancia materna al alta y al mes posparto, en las mujeres que den a luz en el Hospital General de Albacete, durante los meses mayo-agosto 2013. Se realizará un estudio de cohortes analítico prospectivo. La recogida de datos se realizará en dos tiempos: T1 antes del alta (mediante un cuestionario autocumplimentado); y T2 al mes posparto (mediante un cuestionario administrado telefó-nicamente). Se medirá la Fatiga Posparto mediante la Fatigue Assessment Scale, adaptada y validada a nuestro medio, y el Estado de Lactancia Materna (Inicio, Duración y Exclusividad de la Lactancia Materna) mediante un formulario adaptado a la clasificación OMS 2004. Además se confeccionará un registro ex profeso para este estudio donde se recogerán las variables sociodemográficas, clínicas y del recién nacido que describan las características de la muestr

Relationship between Maternal Body Mass Index and Obstetric and Perinatal Complications

Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06–3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01–15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16–2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68–5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13–6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17–11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia

Umbilical Cord Milking in Infants Born at <37Weeks of Gestation: A Systematic Review and Meta-Analysis

Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects ofUCMin newborns <37 weeks’ gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomizedUCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest thatUCMin premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67–0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55–1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55–3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03–2.29]), compared to the control groups. In infants born at <33 weeks,UCMwas associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66–0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50–1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls