The use of oral contraceptive before pregnancy and breastfeeding duration: A cross-sectional study with retrospective ascertainment

<p>Abstract</p> <p>Background</p> <p>Various studies have identified risk factors associated with decreased breastfeeding duration. The aim of this study was to investigate whether there is an association between oral contraceptive (OC) use before pregnancy and breastfeeding duration.</p> <p>Methods</p> <p>In 1994/95, as part of a 3-year epidemiologic follow-up study of school children, reproductive interviews were conducted with their mothers. The study population consists of 663 women residing in Hesse, Central Germany; 575 provided information on their reproductive history. The interview included retrospective ascertainment of OC use, its timing before pregnancy, and duration of breastfeeding. To estimate its effect on duration of breastfeeding, survival analysis was applied controlling for maternal age, socio-demographic characteristics, smoking during pregnancy, age at menarche, planning of the pregnancy and birth order. Hazard ratios and median breastfeeding duration were estimated.</p> <p>Results</p> <p>The mean age of the women at delivery was 27.3 years. Among participants, 34.9% had high school education or less, 10.4% had more than 2 children, and 30.1% smoked during pregnancy. In total, oral contraceptive use in the 12 months before conception was reported by 40.4% of the women, within 3 months of conception by 18.4%. 81.4% (468/575) of women initiated breastfeeding. Compared to those who did not use OC in the 12 months preceding pregnancy, mothers who used OC during the 3 months before conception had a shorter duration of breastfeeding (HR = 1.29; 95% CI: 1.03, 1.61), as did mothers who stopped OC use 4–12 months before conception (HR = 1.27, 95% CI: 1.02, 1.58). Smoking during pregnancy and lower education were also significantly associated with shorter duration of breastfeeding.</p> <p>Conclusion</p> <p>The results suggest that OC use during the 12 months prior to conception may affect breastfeeding duration. These findings may be due to the endocrine disrupting effect of OC. Alternatively, both OC use and shorter duration of breastfeeding may represent lifestyle-related conditions.</p

Applying Time Series Modeling to Assess the Dynamics and Forecast Monthly Reports of Abuse, Neglect and/or Exploitation Involving a Vulnerable Adult

Background Application of time series modeling to predict reports related to maltreatment of vulnerable adults can be helpful for efficient early planning and resource allocation to handle a high volume of investigations. The goal of this study is to apply: (1) autoregressive integrated moving average (ARIMA) time series modeling to fit and forecast monthly maltreatment reports accepted for assessment reported to adult protective services (APS), and (2) interrupted time series analysis to test whether the implementation of intake hubs have a significant impact in the number of maltreatment reports after the implementation period. Methods A time series analysis on monthly APS intake reports was conducted using administrative data from SC Child and Adult Protective Services between January 2014 and June 2018. Monthly APS data were subjected to ARIMA modeling adjusting for the time period when intake hubs were implemented. The coefficient of determination, normalized SBC, AIC, MSE, and Ljung-Box Q-test were used to evaluate the goodness-of-fit of constructed models. The most parsimonious model was selected to predict the monthly APS intakes from July to December 2018. Poisson regression was fit to examine the association of the implementation of the hubs and the number of intake reports received to APS, adjusting for confounders. Results Over 24,000 APS intakes accepted for investigation were identified over a period of four calendar years with an increase in the monthly average of APS intakes between 2014 and 2017. An increase in the number of monthly APS intakes was found after the intake hubs were implemented in 2015 (Phase-1) and 2017 (Phase-2). Of all the models tested, an ARIMA (12), 1, 1 model was found to work best after evaluating all fit measures for both models. For Phase-1, the optimum model predicted an average of 488 APS intake reports between July and December 2018, representing a 9% increase from January–June 2018 (median = 445). For Phase-2, the percent increase was 32%. Conclusions The implementation of the intake hubs has a significant impact in the number of reports received after the implementation period. ARIMA time series is a valuable tool to predict future reports of maltreatment of vulnerable adults, which could be used to allow appropriate planning and resource allocation to handle a high volume of monthly intake reports

Evaluating the efficacy of breastfeeding guidelines on long-term outcomes for allergic disease

Background: WHO guidelines advocate breastfeeding for six months, and EAACI recommends exclusive breastfeeding for 4-6 months. However, evidence for breastfeeding to prevent asthma and allergic disease is conflicting. We examined whether following recommended breastfeeding guidelines alters the long-term risks of asthma, eczema, rhinitis, or atopy.Methods: The effect of non-exclusive (0, &gt;0-6, &gt;6 months), and exclusive breastfeeding (0, &gt;0-4, &gt;4 months) on repeated measures of asthma (10, 18 years), eczema, rhinitis, and atopy (1-or-2, 4, 10,18 years) risks were estimated in the IoW cohort (n=1456) using log-linear models with generalised estimating equations. The Food Allergy and Intolerance Research (FAIR) cohort (n=988), also from the IoW, was examined to replicate results.Results: Breastfeeding (any or exclusive) had no effect on asthma and allergic disease in the IoW cohort. In the FAIR cohort, any breastfeeding for &gt;0-6 months protected against asthma at 10 years (RR=0.50, 95%CI=0.32-0.79, p=0.003) but not other outcomes, while exclusive breastfeeding for &gt;4 months protected against repeated rhinitis (RR=0.36, 95%CI=0.18-0.71, p=0.003). Longer breastfeeding was protective against late-onset wheeze in the IoW cohort.Conclusion: The protective effects of non-exclusive and exclusive breastfeeding against long-term allergic outcomes were inconsistent between these co-located cohorts, agreeing with previous observations of heterogeneous effects. Although breastfeeding should be recommended for other health benefits, following breastfeeding guidelines did not appear to afford consistent protection against long-term asthma, eczema, rhinitis or atopy. Further research is needed into the long-term effects of breastfeeding on allergic disease

The interplay of DNA methylation over time with Th2 pathway genetic variants on asthma risk and temporal asthma transition

BackgroundGenetic effects on asthma of genes in the T-helper 2 (Th2) pathway may interact with epigenetic factors including DNA methylation. We hypothesized that interactions between genetic variants and methylation in genes in this pathway (IL4, IL4R, IL13, GATA3, and STAT6) influence asthma risk, that such influences are age-dependent, and that methylation of some CpG sites changes over time in accordance with asthma transition. We tested these hypotheses in subsamples of girls from a population-based birth cohort established on the Isle of Wight, UK, in 1989.ResultsLogistic regression models were applied to test the interaction effect of DNA methylation and SNP on asthma within each of the five genes. Bootstrapping was used to assess the models identified. From 1,361 models fitted at each age of 10 and 18 years, 8 models, including 4 CpGs and 8 SNPs, showed potential associations with asthma risk. Of the 4 CpGs, methylation of cg26937798 (IL4R) and cg23943829 (IL4) changes between ages 10 and 18 (both higher at 10; P?=?9.14?×?10?6 and 1.07?×?10?5, respectively).At age 10, the odds of asthma tended to decrease as cg12405139 (GATA3) methylation increased (log-OR?=??12.15; P?=?0.049); this effect disappeared by age 18. At age 18, methylation of cg09791102 (IL4R) was associated with higher risk of asthma among subjects with genotype GG compared to AG (P?=?0.003), increased cg26937798 methylation among subjects with rs3024685 (IL4R) genotype AA (P?=?0.003) or rs8832 (IL4R) genotype GG (P?=?0.01) was associated with a lower asthma risk; these CpGs had no effect at age 10. Increasing cg26937798 methylation over time possibly reduced the risk of positive asthma transition (asthma-free at age 10???asthma at age 18; log-OR?=??3.11; P?=?0.069) and increased the likelihood of negative transition (asthma at age 10???asthma-free at age 18; log-OR?=?3.97; P?=?0.074).ConclusionsThe interaction of DNA methylation and SNPs in Th2 pathway genes is likely to contribute to asthma risk. This effect may vary with age. Methylation of some CpGs changed over time, which may influence asthma transition

Maternal Immune Markers In Serum During Late Gestation and In Breast Milk and the Risk of Asthma-Like Symptoms At Ages 6 and 12 Months: A Longitudinal Study

Background: The role of breast milk components on childhood asthma is controversial. The aims of this prospective study are to determine the relationship of immune markers in maternal serum during gestation and breast milk to asthma-like symptoms (AS) in infancy, and the association between fatty acids (FAs) in colostrum and breast milk with AS and atopy. A second goal is to conduct cluster analyses to obtain different immune marker profiles in serum and in whey in order to estimate the risk of these immune clusters for AS in infancy. Methods: Pregnant women were recruited in Columbia and Charleston, South Carolina. Blood (median: 3 weeks before delivery), colostrum and breast milk (two days and three weeks after delivery, respectively) samples were collected. Concentrations of interferon (IFN)-gamma, IFN gamma-induced protein 10 (IP-10 or CXCL10), CCL11, interleukin (IL) 1-beta;, IL-4, IL-5, IL-6, CXCL8, IL-10, IL-12(p70), IL-13, transforming growth factor (TGF)-beta-1, and immunoglobulin (Ig) A in both maternal serum and milk whey were determined via immunoassays. FAs concentrations of n-3 and n-6 were determined by gas chromatography. AS of the infant were ascertained at 6 and 12 months, respectively. Cluster analyses (k-means method) identified different profiles of immune marker. Generalized estimating equations estimated the relative risks (RRs) of repeated measurements of AS related to individual immune markers, fatty acids, and immune clusters, considering intra-individual correlations and adjusting for confounders. To provide comparable risk estimates, I used quartiles of the immune markers, except for IL-5 in whey, which was dichotomized. FAs were dichotomized (high vs. median and low). Children were invited to participate in a clinical exam including a skin prick test to measure allergic sensitization (atopy) against 6 allergens (cat dander, milk, egg, peanut, mix of Dermatophagoides farina and pteroniyssimus, and Alternaria). These data were analyzed using log-binomial models. Results: Of 178 women, 161 provided blood, 33 colostrum, and 115 breast milk samples. Asthma-like symptoms were ascertained in 140 children, 45 children participated in the clinical exam. Most immune markers in serum and milk whey were moderately or highly correlated; however, IgA was negatively correlated. Infants in the highest quartile of IL-13 in both serum and whey were at a higher risk of AS (RR = 3.02 and 4.18; respectively) compared to infants in the first quartile. High levels of IL-5 in serum and whey were also identified as risk factors for AS. In addition, increased secretory IgA and TGF-beta-1 in breast milk reduced the risks of AS. Regarding FAs, high levels of total n-6 FAs (lipid-based) in breast milk were associated with an increased risk of AS in infants (RR=2.91), even after controlling for total n-3 FAs (RR = 2.07). High levels of total n-3 FAs controlling for n-6 decreased the risk of atopy at age 12 months. Four immune clusters were identified having similar immune profiles within and between clusters. One cluster with higher levels of Th2 cytokines (IL-13, IL-5) and lower levels of IgA and TGF-beta-1 in whey was associated with a higher incidence of repeated AS (RR = 2.62). A maternal serum protein cluster with higher levels of Th2 markers and lower levels of TGF-beta-1 (RR = 2.02) was also linked to AS at ages 6 and 12 months. Conclusions: Maternal serum and whey levels of IL-5 and IL-13 are risk markers for AS; whey IgA and TGF-beta-1 seem to be protective. Only focusing on breast milk indicates that milk cytokines IL-5 and IL-13 have adverse effects. However, similar immune markers measured in maternal serum during late gestational period and in breast milk suggest that both maternal serum and breast milk whey may increase AS among infants. Regarding FAs, high levels of total n-6 PUFA in breast milk are associated with an increased risk for AS, whereas high levels of total n-3 PUFA decreased the risk of atopy. The findings suggest that the risk related to IL-5 and IL-13 and the protection due to whey IgA and TGF-beta-1 needs further research. In addition, effects of n-3 and n-6 PUFA on allergic disorders should be further explored. Cluster analyses combining individual risk markers should be applied in future studies to detect immune profiles associated with asthma-like symptoms

Infant feeding pattern in the first six months of age in USA: A follow-up study

Background: Infant feeding may consist of direct breastfeeding (DBF), pumping and bottle feeding (P&F), formula feeding (FF), solid food feeding (SFF), and any combination. An accurate evaluation of infant feeding requires descriptions of different patterns, consistency, and transition over time. Methods: In United States of America, the Infant Feeding Practice Study II collected information on the mode of feeding on nine occasions in 12 months. We focused on the first 6 months with six feeding occasions. To determine the longitudinal patterns of feeding the latent class transition analyses was applied and assessed the transition probabilities between these classes over time. Results: Over 6 months, 1899 mothers provided feeding information. In month 1 the largest latent class is FF (32.9%) followed by DBF (23.8%). In month 2, a substantial proportion of the FF class included SFF; which increases over time. A not allocated class, due to missing information was identified in months 1-3, transitions to SFF starting in month 4 (8.9%). In month 1, two mixed patterns exist: DBF and P&F combined with FF (13.9%) and DBF combined with P&F (18.7%). The triple combination of DBF, P&F, and FF (13.9%) became FF in month 2 (transition probability: 24.8%), and DBF in combination with P&F (transition probability: 49.1%). The pattern of DBF combined with P&F is relatively stable until month 4, when at least 50% of these infants receive solid food. Only 23-26% of the infants receive direct breastfeeding (DBF) in months 1-4, in month 5-6 SFF is added. Mothers who used FF were less educated and employed fulltime. Mothers who smoke and not residing in the west of the United States were also more likely to practice formula feeding. Conclusion: Infant feeding is complex. Breastfeeding is not predominant and we additionally considered the mixed patterns of feeding. To facilitate direct breastfeeding, a substantial increase in the duration of maternal leave is necessary in the United States

Association between Infant Feeding Modes and Gastroesophageal Reflux: A Repeated Measurement Analysis of the Infant Feeding Practices Study II

Background: Gastroesophageal reflux in neonates is frequently reported by parents, potentially motivating changes in infant feeding mode and/or addition of solid food. Objective: The authors prospectively analyzed associations between repeated measurement of feeding modes and reflux in infancy. Methods: The Infant Feeding Practices Study II, conducted between 2005 and 2007 (2,841 infants), provides data on reflux and feeding modes at nine time points from months 1 to 12. Feeding modes were defined based on direct breastfeeding, feeding of bottled human milk, formula feeding, their combinations, and use of solid food. Repeated measurements were investigated using 1-month delayed models to estimate risk ratios (RRs) and their 95% confidence intervals (CIs). Risk ratios of different feeding modes were estimated for reflux; addressing a reverse association, RRs for feeding mode were estimated as responses to prior reflux. Results: Compared to direct breastfeeding, combinations with formula feeding showed a statistically significant risk for reflux (bottled human milk plus formula feeding: RR = 2.19, 95% CI [1.11, 4.33]; formula feeding: RR = 1.95, 95% CI [1.39, 2.74]; and mixed breastfeeding plus formula feeding: RR = 1.59, 95% CI [1.40, 2.42]). Addition of solid food was not protective (RR = 1.21, 95% CI [0.86, 1.70]). Analyses of reverse association (reflux †\u27 feeding) showed fewer breastfed infants among those with reflux in the prior month. Conclusion: Any combination of infant feeding with formula seems to be a risk for reflux. Although breastfeeding was protective, mothers with a child with reflux were more likely to wean their child