Alcohol consumption and cigarette smoking by Australian women: changes with pregnancy and lactation

The consumption of alcohol and smoking of cigarettes are both common practices in Australian society. With continued public health efforts exposure to both alcohol and nicotine during pregnancy has diminished, however little is known about exposure to these toxins in the postnatal period and the effect on the breastfed infant. To investigate the pattern of alcohol consumption and cigarette smoking in the postnatal period and the effect on breastfeeding outcomes, a longitudinal study was conducted in two public hospitals with maternity wards in Perth, Australia. Data for the Perth Infant Feeding Study (PIFSII) were collected from 587 mothers between mid-September 2002 and mid-July 2003. While in hospital participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital related and psychosocial factors. Further analysis of alcohol data was undertaken on the 1995 and 2001 National Health Survey (NHS) data sets to provide a national perspective. Alcohol and smoking related data were analysed and described using frequency distributions, means and medians. Univariate logistic regression was used to screen for potentially significant variables for subsequent incorporation in the multivariate analysis. Multivariate logistic regression analysis was employed to determine the effect of alcohol consumption and cigarette smoking on breastfeeding outcomes prenatally, antenatally and postnatally, after adjusting for factors identified in the literature as being associated with breastfeeding initiation and duration. The relationship between smoking status and breastfeeding duration was determined using survival analysis.Analysis of the relationship between breastfeeding duration and the level of postpartum intake was investigated using a Cox hazards model with repeated measures for alcohol consumption. Results showed that: 1. PIFSII. During pregnancy approximately 32% of women stopped drinking alcohol. Thirty five percent of pregnant women continued to consume alcohol during their pregnancy with 82.2% of these women consuming two or fewer standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. 2. NHS. Sixteen point four percent and 1.3% of pregnant women from the 1995 and 2001 NHS, respectively were consuming more than that recommended in ‘Guideline 11’ from the National Health and Medical Research Council of Australia (ie >7 standard drinks/week). 3. NHS. Thirteen percent of lactating mothers from the 1995 NHS and 16.8% from the 2001 NHS were consuming seven or more standard drinks of alcohol in the reference week, thus exceeding the NHMRC recommended level. 4. PIFSII. After 6 months of follow up, women who consumed alcohol at levels of more than two standard drinks per day were almost twice as likely to discontinue breastfeeding earlier than women who drank below these levels (HR 1.9, 95% CI 1.1, 3.0). 5. PIFSII. With regard to smoking, 226 (39%) of mothers reported smoking pre- pregnancy. Mothers who smoked were more likely to have a partner who smoked, to have consumed alcohol prior to pregnancy and less likely to attend antenatal classes.They were also less likely to know how they were going to feed their baby before conception and be more inclined to consider stopping breastfeeding before four months postpartum. 6. PIFSII. Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 weeks versus 11 weeks, 95% CI: 8.3-13.7). This effect remained even after adjustment for age, education, income, father’s smoking status, mother’s country of birth, intended duration of breastfeeding >6 months and birth weight (risk ratio HR 1.59, 95% CI 1.22 to 2.08). 7. PIFSII. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70, 95% CI 1.55 to 8.83; p<0.05). The results of the present study suggest a negative association between drinking alcohol in the postpartum period and breastfeeding outcomes. Similarly, smoking cigarettes before, during and after pregnancy negatively affects breastfeeding. There is a need for guidelines outlining the safe intake of alcohol during lactation and for the cessation of cigarette smoking in the prenatal and antenatal period

Adopting and adapting an Internet intervention to support breastfeeding duration and breastfeeding research throughout regional Western Australia

Adopting and adapting an Internet intervention to support breastfeeding duration and breastfeeding research throughout regional Western Australia Breastfeeding is the normal and safest way to nurture an infant, and prolonged exclusive breastfeeding duration of at least six months will yield the greatest gains in optimum infant development. Despite this knowledge breastfeeding rates in Australia plummet in the postpartum period with approximately 20% of babies no longer being exclusively breastfed after one week and less than this experiencing full breastfeeding at six months. Breastfeeding duration at four and six months is currently one of the Commonwealth’s category two indicators for the progress of chronic disease, however there is limited data on regional breastfeeding rates against which comparisons can be made. Breastfeeding initiation is almost universal and what is required are interventions that promote extended duration of any or exclusive breastfeeding. Providing social, professional and lay support for women to breastfeed is important and the availability of social support is a predictive factor in both initiating and sustaining breastfeeding. Women requiring breastfeeding assistance who live in regional Australia are often challenged by the limited availability of support services and lack of family and social support networks. The opportunities for the sharing of breastfeeding knowledge are diminished with the tyranny of distance.With the advent of the Internet has been the development of many varied e-Health interventions. The use of the Internet to deliver breastfeeding information is not new, however the incorporation of Webinars, chat rooms, Web cameras and discussion forums has taken the use of the Internet to support breastfeeding to a new level. In effect a virtual community can be created in a real and isolated geographical area. This research uses a Website intervention to support breastfeeding mothers and was initially implemented in the Midwest Region of Western Australia. A success of the research has been the adoption and adaption of this intervention by other regional dieticians working state wide. Mothers recruited to the study are randomised to receive the Internet intervention or normal services already available. The primary outcome of the research is to determine the effectiveness of the intervention in supporting breastfeeding duration. Data is collected longitudinally for a 12 month period. An overarching outcome from the research will be the collection of robust regional breastfeeding data that uses nationally agreed breastfeeding definitions. This presentation will present preliminary key findings from the research. It will provide much needed contemporary regional breastfeeding data required to help support the policy recommendation that WA health services become recognised as baby friendly institutes

Breastfeeding in Saudi Arabia: A review

Background: Breastfeeding is viewed as the optimal method of infant feeding that provides many benefits to both the infant and the mother. The monitoring and reporting of breastfeeding indicators are essential for any country to plan and implement effective promotion programs for sustainable breastfeeding. The aim of this review is to examine the available studies and data on breastfeeding in Saudi Arabia, and determine the potential factors that affect breastfeeding practices and duration in this country. Methods: The databases of Web of Knowledge, Science Direct and PubMed were searched using the relevant key words. Only studies that reported breastfeeding practices, rates and indicators in Saudi Arabia were included. Standard WHO definitions for breastfeeding categories were used in this review.Results: Seventeen cross-sectional studies were identified and reviewed and five stated they used standard definitions. The self-administered questionnaire as a measurement tool was the predominant method of data collection. Infants' ages range from less than six months up to five years. Initiation rates were high (mostly above 90%), but a few studies reported low rates of timely initiation (within the first hour). The exclusive breastfeeding rate could not be accurately determined as rates range from 0.8% to 43.9% among studies due to the lack of clear definitions and the nature of study design. The partial (mixed) feeding method was common and the category of 'any breastfeeding' has generally high rates. The mean duration of breastfeeding has showed a progressive decline over time from 13.4 months in 1987 to 8.5 months in 2010. Factors associated with a high prevalence of breastfeeding and longer duration include increased maternal age, low educational levels, rural residence, low income, multiparity and avoiding contraceptives. The most common reason for breastfeeding cessation was insufficient breast milk. Other reasons include sickness, new pregnancy and breastfeeding problems. Conclusions: Breastfeeding indicators in Saudi Arabia could not be monitored or compared relying on the available data because no longitudinal studies have been conducted in this country. A cohort study design would be the most appropriate procedure to rigorously assess and report valid results on breastfeeding practices and patterns in the Saudi society

Assessing motor skills to inform a fetal alcohol spectrum disorder diagnosis focusing on persons older than 12 years: A systematic review of the literature

Background Motor impairments are one of the difficulties present in people prenatally exposed to alcohol, and are included in the diagnostic criteria for Fetal Alcohol Spectrum Disorder. Objectives The aim of this review was to examine the extent and common types of motor impairment present in persons aged over 12 years prenatally exposed to alcohol as evidence for determining the skills that should be assessed and addressed in intervention. Methods A systematic review of curren t evidence using various electronic databases was conducted. Studies were appraised using a recognized clinical appraisal tool. Results Seven studies published between 1998 and 2014 met the inclusion criteria. There is some evidence that difficulties with fine motor skills, visual motor integration, and balance skills persist in people who have been prenatally exposed to alcohol. Most studies did not focus on adolescent or adult participants in isolation, making it difficult to generalize results. Varied methodological designs made it difficult to compare studies as few used common standardized assessments. Conclusion A review of functional difficulties in each individual would be required to determine if a motor assessment is warranted. Further research is required using assessments recommended in diagnostic guidelines to determine the common motor difficulties seen in adolescents and adults

Which mothers smoke before, during and after pregnancy?

Objective. To investigate the sociodemographic factors associated with cigarette smoking in women before, during and after pregnancy. Study design. A 12-month longitudinal study. Method. All eligible mothers at two public maternity hospitals in Perth, Australia were asked to participate in a study of infant feeding. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital-related and psychosocial factors associated with the initiation and duration of breastfeeding. Results. A total of 587 (55%) mothers participated in the study. Thirty-nine percent of mothers reported smoking pre-pregnancy. Mothers who smoked were more likely to have a partner who smoked and to have consumed alcohol prior to pregnancy, and less likely to have attended antenatal classes. They were also less likely to have known how they were going to feed their baby before conception and likely to be more inclined to consider stopping breastfeeding before four months postpartum.Conclusions. Having a partner (father of the newborn infant) who smoked and maternal alcohol consumption prenatally were factors associated with pre-pregnancy smoking. In addition, if a woman decided how she would feed her infant before the pregnancy occurred and intended to breastfeed for longer than four months she was less likely to smoke in the prenatal period. Having a father (of the newborn infant) who smoked during pregnancy continued to be a factor significantly associated with maternal smoking in the antenatal and postnatal period. Not attending antenatal classes and not intending to breastfeed for longer than four months were also factors associated with maternal smoking. At ten weeks postpartum being of Caucasian origin and having a low Iowa Infant Feeding Attitude Score were factors significantly associated with smoking postnatally

Mothers understanding of infant feeding guidelines and their associated practices: a qualitative analysis

There is limited evidence to describe Australian mothers&#8217; understanding of the Australian Infant Feeding Guidelines (AIFG). A qualitative inductive methodological approach was used in this study to explore experiences with the introduction of solid food. Seven focus groups with 42 mothers of children aged 4&#8211;18 months were conducted in disadvantaged areas in Perth, Australia. The mean age of infants was 9.6 months and mean age of introduction of solid food was 4.3 months (range 1.2 to 7.5 months). Almost half of the mothers in this study were aware of the AIFG however, only half again could correctly identify the recommended age for introducing solid food. Four themes and nine subthemes emerged from the analysis. Themes were (1) Every child is different (judging signs of readiness); (2) Everyone gives you advice (juggling conflicting advice); (3) Go with your gut&#8212;(being a &#8220;good&#8222; mother); and (4) It&#8217;s not a sin to start them too early or too late (&#8212;guidelines are advice and not requirements). The findings indicated that in spite of continued promotion of the AIFG over the past ten years achieving the around six months guideline is challenging. Professionals must address barriers and support enablers to achieving infant feeding recommendations in the design education materials and programs

Exclusive Breastfeeding Increased by an Internet Intervention

Background: Exclusive breastfeeding for 6 months is acknowledged universally as the optimal feeding method for infants in order to provide the greatest health and well-being gains for the infant and mother. Despite this, many women stop short of attaining this desired outcome for their infant. With the permeation of the Internet into most of society, the aim of this study was to evaluate the effect of a breastfeeding support Internet intervention on breastfeeding outcomes on women living in regional Western Australia. Materials and Methods: A nested intervention design within a longitudinal cohort titled the Regional Infant Feeding Study examined the effect of an Internet support Web site on the infant feeding practices of women living in regional Western Australia. Results: In total, 414 women participated in the Internet study and were randomly assigned to the control group (n=207) or the intervention group (n=207). Women enrolled in the intervention were significantly more likely to be exclusively breastfeeding at 6 months postpartum compared with control group participants. Those women experiencing breastfeeding problems were more likely to access the Internet. Conclusions: This breastfeeding support intervention study demonstrated a positive effect on longer-term exclusive breastfeeding for those enrolled in the intervention group. Together with more traditional methods of support, the Internet provides another possible method for promoting positive long-term breastfeeding outcomes

Measuring User Engagement with a Socially Connected, Gamified Health Promotion Mobile App

Participant engagement is an important consideration in mHealth interventions and there are no standardised measurements available to guide researchers. This paper describes the engagement index customised for the Milk Man app, a mobile app designed to engage fathers with breastfeeding and parenting information. Participants were recruited from maternity hospitals in Perth, Western Australia. An engagement index with scores ranging from 0 to 100 was calculated. Kaplan Meier survival analysis was used to determine difference in duration of exclusive breastfeeding, and Pearson’s chi square analysis was conducted to investigate the association of engagement level with demographic characteristics and exclusive breastfeeding at 6 weeks. While overall, partners of participants who installed Milk Man were less likely to have ceased exclusive breastfeeding at any time point from birth to six weeks postpartum, this result was modest and of borderline significance (log rank test p = 0.052; Breslow p = 0.046; Tarone-Ware p = 0.049). The mean engagement score was 29.7% (range 1–80%), median 27.6%. Engagement level had no impact on duration of exclusive breastfeeding and demographic factors were not associated with engagement level. This research demonstrates a range of metrics that can be used to quantify participant engagement. However, more research is needed to identify ways of measuring effective engagement

Online video instruction on hand expression of colostrum in pregnancy is an effective educational tool

The use of antenatal colostrum expression in the weeks prior to birth may help improve long-term breastfeeding, but few large-scale studies exist. Typically, antenatal colostrum expression instruction relies on face-to-face education, making large interventions costly. We aimed to determine whether an expert online instructional video can improve knowledge and confidence around antenatal colostrum expressing. Pregnant women were asked to complete a questionnaire pre- and post-watching the instructional video online. Ninety five pregnant women completed both pre- and post-questionnaires. Total antenatal colostrum expression knowledge scores improved after watching the video, from a mean of 3.05 ± 1.70 correct out of a maximum of 7, to 6.32 ± 0.76 (p \u3c 0.001). Self-reported confidence around hand expressing in pregnancy also improved from an average ranking of not confident (2.56 ± 1.17, out of a possible 5) to confident (4.32 ± 0.80, p \u3c 0.001). Almost all women (98%) reported that they would recommend the video to a friend or family member if antenatal colostrum expression was suggested by their healthcare provider. Findings suggest that the use of an online expert video is an acceptable and effective way to educate pregnant women in antenatal colostrum expression