OBJECTIVETo investigate the current status of exclusive breastfeeding for the second child in the context of the universal two-child policy and the factors influencing exclusive breastfeeding.

METHODSA self-designed questionnaire for the current status of breastfeeding and related factors influencing breastfeeding for the second child were used to survey 836 mothers with a second child, who were selected by cluster sampling, in Quzhou, Zhejiang, China.

RESULTSA total of 680 usable questionnaires were obtained. The rate of exclusive breastfeeding for the second child was significantly lower than for the first child (34.9% vs 42.2%; P<0.05). The univariate analysis revealed that there were significant differences between the exclusive and non-exclusive breastfeeding groups in the mother′s age, education background, occupation and time of maternity leave, mode of delivery of the first child, sex of the first child, feeding pattern of the first child, mode of delivery of the second child, whether the second child was admitted to the intensive care unit, whether the father supported breastfeeding, and whether the grandmother/maternal grandmother supported breastfeeding (P<0.05). The multivariate logistic regression analysis showed that artificial feeding+partial breastfeeding for the first child (OR=12.286, P<0.05), cesarean section for the second child (OR=1.724, P<0.05), and having no breastfeeding support from the maternal grandmother (OR=1.651, P<0.05) were main factors for influencing exclusive breastfeeding.

CONCLUSIONSThe current status of exclusive breastfeeding for the second child is not optimistic in the context of the universal two-child policy. Education about breastfeeding should be taken seriously at the birth of the first child, the rate of cesarean section should be reduced, and the family members should support exclusive breastfeeding, in order to improve the status of exclusive breastfeeding.

Adult ; Breast Feeding ; statistics & numerical data ; China ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Pregnancy

INTRODUCTIONWe studied the effects of ethnicity on early infant growth patterns in exclusively breast-fed (EBF) infants from a Singaporean multiethnic population. This was a prospective cohort study conducted in National University Hospital, Singapore.

MATERIALS AND METHODSHealthy, EBF infants born at-term completing 37 weeks and above, and whose birthweight was appropriate for gestational age (>10 centile, <90 centile) were recruited. Infants were required to be EBF at least until the minimum age of weaning. All infants who were preterm and premature, formula-fed, required Intensive/High Dependency care, or born with major congenital anomalies were excluded. A multivariable linear regression analysis was conducted at 5 predetermined time-points (birth; 4-8 weeks; 3-4, 5-8, 12 months) to study the effects of antenatal/parental factors on infant growth.

RESULTSA total of 213 infants were recruited. Maternal age, height and body mass index positively influenced birthweights while maternal hypertension and paternal smoking negatively influenced birthweights. Mean duration of breastfeeding was 8.9 months. Chinese ethnicity did not influence birth anthropometry, but was the single consistent factor that significantly increased weight and length Z-scores from 4-8 weeks until 8 months of life. Chinese ethnicity did not influence head growth throughout the first year of life.

CONCLUSIONEBF Chinese infants have increased weights and lengths compared to non-Chinese infants until 8 months' age, despite similar birth anthropometry. This period of discrepant growth coincides with the average duration of breastfeeding. We hypothesise that ethnic variations in breast milk macronutrient composition influence early somatic growth in infants.

Anthropometry ; methods ; Asian Continental Ancestry Group ; statistics & numerical data ; Birth Weight ; Body Mass Index ; Breast Feeding ; ethnology ; Child Development ; physiology ; Ethnic Groups ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Male ; Singapore ; epidemiology

OBJECTIVETo investigate the status of exclusive breastfeeding(EBF) and possible influencing factors during 0-7 days postpartum in China.

METHODSDuring 2011 to 2013, healthy mothers and neonates who were in the period of 0- 7 days postpartum from 8 provinces across different regions of China were recruited to take the questionnaire investigations and physical examinations. Information about socio-economic, pregnant, and delivery status, infant healthy situation and feeding indicators was collected to calculate the rate of exclusive breastfeeding during 0- 7 days postpartum and analyze the influencing factors.

RESULTSA total of 1 882 pairs of mothers and neonates were covered by this study. The rate of EBF was 13.3% (250 cases) during 0- 7 days postpartum. Bottle feeding (OR=0.08, 95% CI: 0.05- 0.12), the mothers themselves mixed fed at their 0-4 months old (OR=0.22, 95%CI: 0.08-0.58), the mothers who had used methods to stimulate milk secretion (OR=0.58, 95% CI: 0.35- 0.94) might decrease the EBF rate. Compared with the mothers who believed that their breast milk was not enough for their infants, the mothers who believed breastmilk was enough may increase the EBF rate (OR=6.04, 95%CI: 3.34-10.94). Comparing to the EBF rate of Beijing, Yunnan (OR=0.10, 95%CI: 0.04-0.24), and Gansu(OR=0.03,95%CI: 0.01-0.08) had lower EBF rate during 0-7 days postpartum. What's more, the EBF rate increased with the increasing neonates' age (OR=1.33, 95% CI: 1.16- 1.53).

CONCLUSIONThe EBF rate during 0- 7 days postpartum is still low in China and had significant differences in different regions. Suboptimal feeding knowledge and practices affected the EBF rate significantly.

Bottle Feeding ; Breast Feeding ; statistics & numerical data ; China ; Female ; Humans ; Infant, Newborn ; Milk, Human ; Mothers ; Postpartum Period ; Pregnancy ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to assess the differences in the prevalence of metabolic syndrome in women in their 30s and 40s by breastfeeding experience, using the the fifth Korea National Health and Nutrition Examination Survey (2010) data. METHODS: In this cross-sectional study, a total of 1,053 healthy women in their 30s and 40s, who had given birth was analyzed. To compare women with and without breastfeeding experience, chi-square test and t test were used. The relationship between metabolic syndrome and breastfeeding was assessed using logistic regression analysis adjusted demographic and lifestyle covariates. RESULTS: The breastfeeding experience ofwomen in their 30swas associated with a decreased risk of elevated triglyceride after controlling for income, education, exercise andthe last childbirthage [odds ratio (OR)=0.44, 95% confidence interval (CI) (0.21, 0.95)]. In addition, women who breastfed more children had high odds of metabolic syndrome [OR = 4.03, 95%CI (2.03, 8.00)], and components of metabolic syndrome [abdominal obesity: OR = 2.02, 95%CI (1.17, 3.51), elevated triglyceride: OR = 1.98, 95%CI (1.14, 3.45), elevated blood pressure: OR = 2.65, 95%CI (1.28, 5.49)] than those who never breastfed children. CONCLUSIONS: This study found that postpartum breastfeeding may play a significant role in reducing the risk of metabolic syndrome and also that childbearing is associated with a higher incidence of metabolic syndrome among women in their 30s. For women in their 40s, the risk of metabolic syndrome did not significantly differ depending on the breastfeeding experience. This study indicated that breastfeeding can be a way to reduce metabolic health burdens in women in their 30s.
Adult ; Alcohol Drinking/epidemiology ; Breast Feeding/*statistics & numerical data ; Cross-Sectional Studies ; Exercise/physiology ; Female ; Gravidity ; Humans ; Life Style ; Metabolic Syndrome X/*epidemiology ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Risk Reduction Behavior ; Social Class

OBJECTIVETo study the effect of breastfeeding quality improvement on the breastfeeding rate in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in the neonatal intensive care unit (NICU).

METHODSA retrospective analysis was performed for the clinical data of VLBW and ELBW infants who were admitted from July 2014 to July 2015 (pre-improvement group) and those who were admitted from August 2015 to June 2016 after the implementation of breastfeeding quality improvement measures (post-improvement group). The parameters including condition of breastfeeding (breastfeeding rate, breastfeeding amount, and breastfeeding time), duration of parenteral nutrition, time to enteral feeding, and incidence of feeding intolerance were compared between the two groups.

RESULTSThe implementation of breastfeeding quality improvement measures significantly increased breastfeeding rate and amount, significantly shortened time to addition of human milk fortifier, duration of parenteral nutrition, and time to enteral feeding, and significantly decreased the incidence of feeding intolerance.

CONCLUSIONSBreastfeeding quality improvement measures can increase breastfeeding rate in the NICU and decrease gastrointestinal complications in preterm infants.

Breast Feeding ; statistics & numerical data ; Enteral Nutrition ; Female ; Humans ; Infant, Extremely Low Birth Weight ; growth & development ; Infant, Newborn ; Infant, Very Low Birth Weight ; growth & development ; Intensive Care Units, Neonatal ; Male ; Parenteral Nutrition ; Quality Improvement ; Retrospective Studies ; Weight Gain

PURPOSE: The objective of this study was to examine the factors associated with initiation and continuation of breastfeeding among Korean women in relation to their employment status. METHODS: Data were collected using a web-based self-administered questionnaire from 1,031 Korean mothers living in Seoul with babies younger than 24 months. Demographic characteristics, education on breastfeeding, rooming in, breastfeeding during hospital stay, and breastfeeding knowledge were examined. Multivariate logistic regression analyses were performed to identify factors associated with initiation and continuation at 1, 6 and 12 months according to mothers' employment status. RESULTS: Breastfeeding initiation rates were similar regardless of mothers' employment status. Continuation rates decreased for both groups of mothers, but were significantly lower among employed mothers at all duration points. Unemployed mothers who were able to keep their babies in the same room during the hospital stay were more likely to initiate breastfeeding. The factor that was consistently associated with breastfeeding continuation for all duration points among unemployed mothers was whether the mother breastfed during the hospital stay. Higher knowledge scores and having an infant with atopic dermatitis were also associated with breastfeeding continuation at 6 months and 12 months, respectively for unemployed mothers, and receiving education on breastfeeding was associated with 12-month continuation for employed mothers. CONCLUSION: These results emphasize the significant roles of hospitals for breastfeeding initiation and continuation, with rooming-in, initial breastfeeding practice and education during hospital stay as important practices. In addition, for working mothers to continue their breastfeeding, significant support from the workplace is crucial.
Adult ; Asian Continental Ancestry Group ; Breast Feeding/*statistics & numerical data ; Dermatitis, Atopic/pathology ; *Employment ; Female ; Humans ; Infant ; Infant, Newborn ; Internet ; Logistic Models ; Male ; Mothers/psychology ; Odds Ratio ; Republic of Korea ; Social Support ; Surveys and Questionnaires ; Workplace

PURPOSE: Maternal knowledge, positive attitudes and interest toward breastfeeding may improve the sustainability of breastfeeding. This study examined the associations of knowledge, attitudes, and interest toward breastfeeding with the duration of breastfeeding in Korean mothers who used the internet. METHODS: We conducted a cross-sectional study of 604 Korean mothers who breastfed their babies. Mothers were recruited through the internet and their knowledge, attitudes and interest toward breastfeeding were assessed using a web-based self-administered questionnaire. Geometric means and odds ratio (OR) with 95% confidence intervals were calculated. RESULTS: Higher knowledge, attitudes, and interest toward breastfeeding were associated with longer duration of breastfeeding in Korean mothers. In particular, mothers who had optimal breastfeeding duration were more likely to be aware of the easiness of breast milk stimulation and breastfeeding, the development of attachment between mother and child, and pleasure from breastfeeding compared to those mothers with shorter duration. The association with optimal breastfeeding duration was more pronounced among mothers who graduated from high school for total attitude scores and total interest scores, compared to mothers who graduated from college or above. CONCLUSION: The results of this study suggest that it is important to improve maternal knowledge, attitudes, and interest toward breastfeeding in Korean mothers who use the internet as a source of knowledge. Also, the study results imply that the development of strategies to target mothers with relatively low education levels may improve breastfeeding rates.
Adult ; Breast Feeding/*statistics & numerical data ; Cross-Sectional Studies ; Female ; *Health Knowledge, Attitudes, Practice ; Humans ; Infant ; Internet ; Mothers/psychology ; Program Evaluation ; Surveys and Questionnaires

OBJECTIVETo evaluate the current feeding status of infants and young children under 2 years old in rural areas of Hubei province.

METHODSThe study was conducted by cluster random sampling from September 2009 to march 2010. The data on breastfeeding and complementary food supplement of the 1 197 infants and young children aged 0-23 months in 8 counties of Hubei province were collected through questionnaires. The feeding status was analyzed according to the WHO 2008 edition of Indicators for assessing infant and young child feeding practices.

RESULTSA total of 1 197 children aged 0-23 months were investigated. The rate of ever breastfeeding of children aged 0-23 months reached up to 93.9% (1 124/1 197), while the percentage of early initiation of breastfeeding was only 22.0% (263/1 197). The rates of exclusive breastfeeding under 6 months, continued breastfeeding for 1 year, and continued breastfeeding for 2 years were 72.1% (277/384), 17.0% (26/153) and 4.9% (7/144), respectively. The median time of giving complementary food was the 6th month and the weaning time was the 9th month. The rate of complementary food supplemented from 6th-8th month in time was 61.8% (444/718) . The rates of minimum dietary diversity, minimum meal frequency, minimum acceptable diet, and consumption of iron-rich or iron-fortified foods among children aged 6-23 months were 61.7% (502/813), 81.5% (663/813), 54.4% (442/813) and 50.1% (407/813), respectively.

CONCLUSIONLate initiation of breastfeeding, non-continued breastfeeding, giving complementary food too early or too late, inadequate category and frequency of complementary food, and the low rate of consumption of iron-rich or iron-fortified foods were the main issues to be concerned on infant feeding in rural areas of Hubei province.

Breast Feeding ; statistics & numerical data ; Child, Preschool ; China ; Diet Surveys ; statistics & numerical data ; Feeding Behavior ; Humans ; Infant ; Infant Food ; statistics & numerical data ; Rural Population ; Surveys and Questionnaires ; Weaning

PURPOSE: Maternal-fetal attachment in a pregnant woman is important for her health and for her child's emotional stability. This study was done to identify the contribution of maternal fatigue, social support, and Taegyo to maternal-fetal attachment based on a survey of pregnant women. METHODS: The study was a descriptive correlation study. Participants were 211 from two women's health clinic centers. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients and stepwise multiple regression. RESULTS: Mean scores for maternal-fetal attachment, Taegyo, maternal fatigue, and social support were 93.74 (range 25-125), 64.76 (17-85), 24.12 (10-40), and 54.43 (22-132), respectively. There were significant differences in maternal-fetal attachment according to parity, breast feeding experience, and putting prenatal education into practice. Multiple regression analysis showed that the key determinants of maternal-fetal attachment, were Taegyo (beta=.67), maternal fatigue (beta=.21), and social support (beta=.13), and these explained 55% of the total variance of attachment. CONCLUSION: The results suggest a need to encourage Taegyo in prenatal management program and provide methods for fatigue resolution and promotion of social support.
Breast Feeding ; Fatigue* ; Female ; Humans ; Maternal-Fetal Relations ; Parity ; Pregnancy* ; Pregnant Women ; Prenatal Care ; Prenatal Education ; Statistics as Topic ; Women's Health

PURPOSE: The study was done to construct and test a structural model to explain primipara breastfeeding behavior. METHODS: The participants were 213 primiparas on postpartum wards. Data were analyzed using the PASW 18.0 and AMOS 19.0 programs. RESULTS: Fitness statistics for the hypothetical model were appropriate (chi2 =38.50, p=.070, GFI=.96, RMSEA=.05, AGFI=.93, NFI=.95, TLI=.97, CFI=.98, PNFI=.57, chi2/df=1.43). Breastfeeding behaviors were directly influenced by intention to breastfeed, perceived effectiveness of breastfeeding, and the amount of supplementary feeding. The amount of supplementary feeding had the largest direct impact on breastfeeding behavior. The largest total effect on breastfeeding behavior was intention to breastfeed. The environment of the maternity hospital indirectly influenced breastfeeding behavior. These factors explained 18.9% of variance in the primipara breastfeeding behavior. CONCLUSION: The results of the study indicate that in order to promote primipara breastfeeding the amount of supplementary feeding immediately after the birth should be limited and an environment that encourages exclusive breastfeeding in the hospital should be provided. The results also suggest it is necessary to provide nursing interventions that increase the intention to breastfeed and the perceived effectiveness of breastfeeding.
Adult ; Bottle Feeding ; Breast Feeding/*statistics & numerical data ; Female ; Humans ; Infant, Newborn ; Intention ; *Models, Structural ; Mothers/psychology ; Questionnaires ; Young Adult