Relación del retraso de la lactogénesis II con la percepción materna de leche insuficiente: un estudio longitudinal

Aim: To analyze the relationship of delayed lactogenesis II with maternal perception of insufficient milk. Methods: A prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5 months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model. Results: A total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesis II. During postpartum admission, delayed lactogenesis II (OR = 2.26; 95%CI = 1.07–4.79), difficulty in breastfeeding (OR = 1.02; 95%CI = 1.00–1.03), and professional help in breastfeeding (OR = 0.70; 95%CI = 0.50–0.97) were associated with maternal perception of insufficient milk. Conclusions: The occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesis II, should be considered risk indicators, suggesting the need for additional support to standardized care. The PIM is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions.Objetivo: Analizar la relación del retraso de la lactogénesis II con la percepción materna de leche insuficiente. Método: Se realizó un estudio observacional longitudinal prospectivo, multicéntrico. Se obtuvieron datos al alta y entre 1 y 5 meses postparto sobre la percepción de leche insuficiente y las variables relacionadas, mediante un cuestionario autoadministrado, y posterior seguimiento postal y online. Para el desarrollo del modelo explicativo, se realizó un análisis de Regresión Logística. Resultados: Participaron un total de 260 puérperas. El 31,9% de ellas percibió leche insuficiente y el 23,6% presentó retraso de la lactogénesis II. Durante el ingreso posparto, se relacionó con la percepción materna de leche insuficiente el retraso de la lactogénesis II (OR = 2,26; IC95% = 1,07–4,79), la dificultad para amamantar (OR = 1,02; IC95% = 1,00–1,03), y la ayuda de los profesionales en la lactancia (OR = 0,70; IC95% = 0,50–0,97). Conclusiones: La aparición de dificultades en la lactancia durante el ingreso posparto y al alta, especialmente cuando existe un retraso de la lactogénesis II, deben considerarse indicadores de riesgo, que sugieren la necesidad de un apoyo adicional a los cuidados estandarizados. La PIM es un indicador adecuado para evaluar la calidad del apoyo profesional a la lactancia en intervenciones de mejora.This work has been funded by Project PI11/02124 within the Government’a R&D&I plan 2013–2016 and co-funded by the ISCIII Subdirectorate General for Evaluation and Research Promotion of the European Regional Development Fund (ERDF)

Longitudinal Study of Dyadic Adjustment in a Sample of Spanish Fathers

The objectives of this study were to examine the evolution of fathers’ long-term dyadic adjustment after the birth of a child and to analyze their evolution considering related factors. A total of 113 Spanish fathers with a mean age of 35.72 years (SD = 3.84 years) participated. In general, there was a decline in the dyadic adjustment of the fathers until 6–12 months after childbirth, after which their level of adjustment remained stable until 13–24 months. We observed different patterns when analyzing the evolution by subgroups formed based on these different variables, previous experience of paternity, and anxiety. The intrinsic differences between fathers should also be considered because these differences can influence the way in which men face the parental process as well as the evolution of the quality of their relationship with their partner.The present study was granted by the General Sub-Directorate for Evaluation and Promotion of Research (Institute of Health Carlos III, ISCIII) and co-funded by the European Regional Development Fund (FEDER) (No. PI14/01549)

Does the global activity limitation indicator measure participation restriction? Data from the European Health and Social Integration Survey in Spain

Purpose The global activity limitation indicator (GALI) is the only internationally agreed and harmonised participation restriction measure. We examine if GALI, as intended, is a reflective measure of the domains of participation; furthermore, we determine the relative importance of these domains. Also, we investigated the consistency of response to GALI by age and gender and compared the performance of GALI with that of self-rated health (SRH). Methods We used Spanish data from the European Health and Social Integration Survey and selected adults aged 18 and over (N = 13,568). Data analysis, based on logistic regression models and Shapley value decomposition, were also stratified by age. The predictors of the models were demographic variables and restrictions in participation domains: studies, work, mobility, leisure and social activities, domestic life, and self-care. The GALI and SRH were the response variables. Results GALI was strongly associated with all participation domains (e.g. for domestic life, adjusted OR 24.34 (95% CI 18.53–31.97) in adult under 65) and performed differentially with age (e.g. for domestic life, adjusted OR 13.33 (95% CI 10.42–17.03) in adults over 64), but not with gender. The relative importance of domains varied with age (e.g. work was the most important domain for younger and domestic life for older adults). The results with SRH were parallel to those of GALI, but the association of SRH with participation domains was lowest. Conclusions GALI reflects well restrictions in multiple participation domains and performs differently with age, probably because older people lower their standard of good functioning.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Natur

Relationship of Delayed Lactogenesis II to Maternal Perception of Insufficient Milk: a longitudinal study

Objetivo: Analizar la relación del retraso de la lactogénesis II con la percepción materna de leche insuficiente. Método: Se realizó un estudio observacional longitudinal prospectivo, multicéntrico. Se obtuvieron datos al alta y entre 1 y 5 meses posparto sobre la percepción de leche insuficiente y las variables relacionadas mediante un cuestionario autoadministrado y el posterior seguimiento postal y online. Para el desarrollo del modelo explicativo, se realizó un análisis de regresión logística. Resultados: Participaron un total de 260 puérperas. El 31,9% de ellas percibieron leche insuficiente y el 23,6% presentaron retraso de la lactogénesis II. Durante el ingreso posparto, se relacionó con la percepción materna de leche insuficiente el retraso de la lactogénesis II (OR = 2,26; IC 95% = 1,07-4,79), la dificultad para amamantar (OR = 1,02; IC 95% = 1,00-1,03) y la ayuda de los profesionales en la lactancia (OR = 0,70; IC 95% = 0,50-0,97). Conclusiones: La aparición de dificultades en la lactancia durante el ingreso posparto y al alta, especialmente cuando existe un retraso de la lactogénesis II, deben considerarse indicadores de riesgo, que sugieren la necesidad de un apoyo adicional a los cuidados estandarizados. La percepción de leche insuficiente es un indicador adecuado para evaluar la calidad del apoyo profesional a la lactancia en intervenciones de mejora.Aim: To analyze the relationship of delayed lactogenesis II with maternal perception of insufficient milk. Methods: A prospective, multicenter, longitudinal observational study was conducted. Data were obtained at discharge and between 1 and 5 months postpartum on the perception of insufficient milk and related variables, by means of a self-administered questionnaire, and subsequent postal and online follow-up. Logistic regression analysis was used to develop the explanatory model. Results: A total of 260 puerperal mothers participated. Of these, 31.9% had insufficient milk and 23.6% had delayed lactogenesis II. During postpartum admission, delayed lactogenesis II (OR = 2.26; 95% CI = 1.07-4.79), difficulty in breastfeeding (OR = 1.02; 95% CI = 1.00-1.03), and professional help in breastfeeding (OR = 0.70; 95% CI = 0.50-0.97) were associated with maternal perception of insufficient milk. Conclusions: The occurrence of breastfeeding difficulties during postpartum admission and at discharge, especially when there is delayed lactogenesis II, should be considered risk indicators, suggesting the need for additional support to standardized care. The perception of insufficient milk is a suitable indicator to assess the quality of professional breastfeeding support in improvement interventions.Este trabajo ha sido financiado por el Proyecto PI11 / 02124 dentro del plan de I + D + i del Gobierno 2013-2016 y cofinanciado por el ISCIII Subdirección General de Evaluación y Fomento de la investigación del Fondo Europeo de Desarrollo Regional (FEDER)

Relationships between parent–infant bonding, dyadic adjustment and quality of life, in an intra-partner sample

The transition to parenthood represents a moment of change and adaptation in which the dyadic marital relationship becomes a triadic relationship. Facilitating a positive transition requires a thorough understanding of the explanatory model of the relationship between parental–infant bonding, dyadic adjustment and quality of life (QoL) from an integrative perspective of the family unit. The aim of this work was to analyse the relationships between parent–infant bonding, dyadic adjustment and QoL from an intra-partner perspective, 6–12 months after the birth of a child. A cross-sectional observational study was performed in a convenience sample of 222 couples 6–12 months postpartum, enrolled from October 2013 to March 2016. The mean age of the mothers was 34.07 years (SD = 3.67), and for the fathers, it was 35.75 years (SD = 4.02). Mothers perceived better QoL and greater mother–infant bonding compared to fathers. The perception of an adequate dyadic adjustment, together with positive parent–infant bonding, had positively influenced the individual QoL of both members of the couple 6–12 months after birth. From an intra-partner perspective, the positive transition was influenced by the relationship between parent–infant bonding, dyadic adjustment and QoL. Positive parent–infant bonding in mothers and fathers, as well as promotion of the quality of the relationships between couples, can help promote a better QoL. Positive health results can be achieved in terms of individual and family well-being by designing healthcare interventions that encourage the presence and participation of the family unit.The present study was granted by the General Sub-Directorate for Evaluation and Promotion of Research (Institute of Health Carlos III, ISCIII) and co-funded by the European Regional Development Fund (FEDER) (No. PI14/01549)

Predictors of childbirth experience: Prospective observational study in eastern Spain

Background. In recent years, birth experience has been highlighted by national and international organisations as a relevant value in measuring maternal health care quality. According to a standardised tool, we aimed to assess which clinical indicators had the most significant influence on the birth experience. Methods. This prospective observational study was carried out in fourteen hospitals in eastern Spain. 749 women consented to the collection of birth variables at discharge, and subsequently, at 1-4 months, data were collected on the birth experience as measured by the Spanish version of the Childbirth Experience Questionnaire. Next, a linear regression analysis was performed to determine which clinical birth indicators greatly influence the birth experience measure. Result. The study sample (n = 749) was predominantly Spanish and primipara, with 19.5% vaginal births. The predictors that emerged in the linear regression model were to have a birth companion (B = 0.250, p = 0.028), drink fluids during labour (B = 0.249, p < 0.001), have early skin-to-skin contact (B = 0.213, p < 0.001) and being transferred to a specialised room for the second stage of labour (B = 0.098, p = 0.016). The episiotomy (B = -0.100, p < 0.015) and having an operative birth (B = -0.128, p < 0.008) showed a negative influence. Conclusion. Our study supports that intrapartum interventions recommended according to clinical practice guidelines positively influence the mother's birth experience. Episiotomy and operative birth should not be used routinely as they negatively influence the birth experience.This work has been funded by the Project PI11/02124 and PI14/01549 within the Government R&D&I plan 2013–2016 and co-funded by ISCIII General Sub-Directorate for Evaluation and Promotion of research the European Regional Development Fund (FEDER) "A way to make Europe"

The combined effect of family environment and parents' characteristics on the use of food to soothe children

Parental feeding practices, such as the use of food to soothe, can be shaped by various factors, including the family environment and parents' psychological characteristics and capacities. To our knowledge, the combined effect of these factors has not been studied. Furthermore, parental feeding practices have mainly been studied in women, resulting in a gender gap in the research. This study aims to investigate the combined effect of family environment and parental characteristics on the likelihood of using food to soothe children, taking the gender of both parents into account. This cross-sectional study included a sample of 846 parents (36.3% men) of 1-year-old children from different regions of Spain. Participants completed an online survey that included questionnaires to measure whether parents used food to soothe children, the family environment, parents' characteristics, and their psychological capacities. Binary logistic regression analyses were performed to identify associations between the variables. The final model showed that, within the family environment, higher levels of dyadic adjustment between couples (OR = 0.965; p = .026) were associated with a reduced likelihood of using food to soothe children, whereas the psychological characteristic of parental fatigue (OR = 1.053; p = .007) appeared to be associated with an increased likelihood. Also associated with an increased likelihood of this practice were higher parental sense of competence (OR = 1.028; p = .029) and the attention dimension of emotional intelligence (OR = 1.043; p = .007). Our study suggests that using food to soothe children may be influenced by factors at different levels, from the quality and adjustment of the couple's relationship to parental fatigue, self-competence, and emotional intelligence. For future research, it may be worthwhile contextualizing parental practices to gain a better understanding of children's behavior.Mar Lozano-Casanova would like to thank the Ministerio de Universidades for the FPU21/04232 grant

Satisfaction with life and its predictive factors in a cohort of fathers 24-months postpartum

Satisfaction with life is considered an essential indicator of quality of life and has implications not only for parents but also for the general health of society. It is relevant to know the factors that could explain differences in parents’ satisfaction with life. The objectives of this study were to analyse the degree of satisfaction with life of a cohort of fathers 13–24 months after the birth of their child and to analyse the predictive capacity of sociodemographic, physical, psychological, and social factors on their long-term life satisfaction. This was a longitudinal study with follow-up at 6–12 months and at 13–24 months (n = 152 fathers). The Fatigue Assessment Scale, Athens Insomnia Scale, Parental Stress Scale and short version of the Dyadic Adjustment Scale were completed online at 6–12 months. Finally, Satisfaction with Life Scale was assessed between 13 and 24 months after birth. The mean score of life satisfaction of the participants 13–24 months after the birth of their child was 18.72 (SD = 3.71) and was negatively correlated with fatigue, insomnia, and stress (p < 0.01), and positively correlated with dyadic adjustment (p < 0.01). The final hierarchical regression model showed that educational levels and insomnia were the main predictive variables for life satisfaction during the second-year postpartum. This work has important implications for clinical practice because it allows health professionals to understand the factors influencing satisfaction with life and health among fathers and to plan more effective antenatal and postnatal care.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. The present study was granted by Institute of Health Carlos III, ISCIII and the European Regional Development Fund (FEDER) (No. PI14/01549

Breastfeeding in women who conceived using fertility treatments: a systematic review

Las mujeres sometidas a tratamientos de fertilidad (TF) presentan necesidades de atención médica y procesos de toma de decisiones antes y después del parto que pueden influir sobre los comportamientos de lactancia materna (LM). Esta revisión examinó el efecto de los TF (invasivos como inyección intracitoplasmática y/o fecundación in vitro, y menos invasivos como medicación y/o inseminación intrauterina) sobre el inicio, duración y exclusividad de la LM a partir de los estudios observacionales que compararon algún resultado de LM en función del modo de concepción (TF versus concepción espontánea). El efecto de los TF sobre el inicio, duración y exclusividad de la LM fue pequeño o no significativo y en ocasiones contradictorio. La evidencia es limitada debido al bajo número de artículos incluidos con calidad suficiente. Por ello se recomienda, hasta que se tengan más y mejores estudios al respecto, un apoyo individualizado a cada diada madre-hijo según sus características.Women subjected to fertility treatment present needs requiring medical attention and decision-making processes before and after delivery that might influence their behaviour in maternal breastfeeding. This review examined the effect of fertility treatments on the start, duration and exclusiveness of maternal lactation based on all the observational studies that compared some result of maternal lactation according to the form of conception. Two reviewers extracted the data and evaluated the risk of bias. The effect of fertility treatments on the results of maternal lactation was small or not significant, and on occasions contradictory. The evidence is limited due to the low number of articles of sufficient quality included. For the time being, fertility treatments do not seem to influence the start, duration and exclusiveness of maternal lactation, but until more and better studies are available, individualized support is recommended for each mother-child dyad according to its characteristics

Spanish reference values for the Breastfeeding Self-Efficacy Scale-Short Form BSES-SF

Fundamento. Describir los valores de referencia para la versión española de la Escala de Autoeficacia para la Lactancia Materna en su versión reducida (BSES-SF), considerando las diferencias según la experiencia previa en lactancia y la paridad. Metodología. Estudio transversal realizado en cinco hospitales de Alicante y uno de la Región de Murcia, con una muestra accidental de 949 mujeres que ofrecieron lactancia materna en el posparto, sin problemas médicos, propios o del recién nacido, que dificultaran la lactancia. Se obtuvieron datos sociodemográficos, obstétricos y sobre autoeficacia materna para la lactancia mediante la escala BSES-SF. Se calcularon datos de tendencia central, dispersión y percentiles de las puntuaciones de la escala BSES-SF para generar valores de referencia para toda la muestra y según la paridad y experiencia previa. Resultados. El nivel de autoeficacia fue significativamente menor (p<0,001) entre las mujeres primíparas (media =47,67±11,03) o sin experiencia previa (media =47,30±11,18) que entre las multíparas (media =52,87±10,66) o con experiencia anterior (media =53,93±9,93). La puntuación de los percentiles P25 y P75 de la escala BSES-SF fue, respectivamente, para toda la muestra de 42 y 59; para las mujeres sin hijos o sin experiencia previos de 39 y 56; para madres con hijos de 46 y 61; y para las madres con experiencia previa de 47 y 62. Conclusión. Los percentiles específicos obtenidos, según la paridad o la experiencia previa, pueden considerarse como valores de referencia para comparar el nivel de autoeficacia de un caso dado, evaluar intervenciones educativas y planificar intervenciones de apoyo durante el posparto.Background. To describe the reference values for the Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), considering the differences according to parity and previous breastfeeding experience. Methods. Cross-sectional study in five hospitals in Alicante and one in Murcia, Spain, in a convenience sample of 949 in-hospital breastfeeding women, with no medical problems in the mothers or newborns hindering breastfeeding. Data on sociodemographic and obstetric variables, and on breastfeeding self-efficacy, using the BSES-SF, were collected. Central tendency, dispersion and percentile data were calculated to generate reference values for the entire sample, and by parity and previous experience. Results. The level of self-efficacy was significantly lower (p<0.001) among primiparous women (mean =47.67±11.03) or those without previous experience (mean =47.30±11.18) than among multiparas (mean =52.87±10.66) or women with previous experience (mean =53.93±9.93). The P25 and P75 percentiles for the BSES-SF were, respectively, 42 and 59 for the entire sample; 39 and 56 for women without children or without previous experience; 46 and 61 for mothers with children; and 47 and 62 for mothers with previous experience. Conclusions. The specific percentiles obtained by parity or previous experience should be considered the reference values for comparing the level of self-efficacy of a given case, and for evaluating educational interventions and planning postpartum support interventions.Este estudio recibió financiación del Ministerio de Ciencia e Innovación (nº de expediente PI09/90899)