Archive for the ‘In the news’ Category
A recent study linking longer breastfeeding with higher IQ in adulthood seems to be pushing some people’s buttons. The study followed several thousand children, recruited in the early 1980s, through adulthood, and assessed years of education, IQ, and income in their early 30s. Compared with those who were not breastfed, individuals who had been breastfed for at least a year earned about $100 more each month, completed an additional year of schooling, and had IQs that were 3.76 points higher. These estimates accounted for multiple sociodemographic founders, increasing the chance that the differences were due to breastfeeding itself, rather than to other confounding factors.
On its face, this study adds to the ample evidence that how babies are fed is an important predictor of health and wellbeing. Yet several in the media have gone the great lengths to pick apart they study and its methods. The Independent’s Matilda Battersby took on the study with a pointed commentary, entitled “So breastfeeding improves your child’s IQ? Try telling that to the women who physically can’t.”
In her commentary, Battersby writes, “What none of these studies or news reports ever seem to acknowledge is quite how difficult breastfeeding actually is.” She goes on to compare her first weeks of breastfeeding to sitting “for hours at a time with a needle sticking in their nipple.” She writes, “Around 69 per cent of mothers breastfeed their babies at birth, but this falls to 23 per cent at six weeks – and for a very good reason. It is tough.”
I suspect that Battersby wanted to assuage the very real feelings of guilt and regret experienced by women who were unable to achieve their feeding goals. But as Shannon Tierney has so eloquently written, “Things can matter, without being the only things that matter. Breastfeeding matters, and it still matters even for women who cannot do it.”
Battersby goes on to write, “while we’d all like to think we’re doing the best for our bambinos we’re stuck between the Earth-motherish pressure to be constantly attached via a teat to our sprogs, versus the “Put it away, dear” mentality – thank you, Nigel Farage – which suggests that breastfeeding is embarrassing and dirty.”
And here, for me, is where her argument falls apart. The “breastfeeding problem” is not that studies have found that breastfeeding is different from formula feeding – rather, the problem is our collective failure to convert those data into a sustained commitment to provide women with the care and support that they need to achieve their infant feeding intentions. It’s the system that did not provide Battersby with help to resolve her pain during the hours of “needles sticking in her nipples.” It is Nigel Farage, and our collective cultural neglect of – and often open hostility toward – mothers and children. Read the rest of this entry »
I #March4Nutrition because breastfeeding is a powerful predictor of health and wellbeing for mothers and infants — and yet, too many families face barriers that prevent them from achieving their own breastfeeding goals.
Families who want to breastfeed navigate a veritable minefield of “Booby Traps.” Many maternity providers have minimal training in lactation support, and providers may not ask about breastfeeding during prenatal care — or spend only seconds on the topic — missing the opportunity to address concerns and provide guidance. Parents are inundated with misleading materials from infant formula manufacturers, promising that their product is “designed to be like breast milk” or will magically convince fussy babies to sleep through the night. Indeed, in a study, mothers looking at formula advertisements voiced concerns that their milk didn’t have added vitamins, so perhaps it would be healthier to formula feed.
At birth, too few families receive evidence-based maternity care that gets infant feeding off to an optimal start. For example, putting a baby skin-to-skin for the first hour of life increases breastfeeding duration by as much as 6 weeks — yet 28% of US hospitals do not provide such care to most women. Skin-to-skin is one of the World Health Organization Ten Steps to Successful Breastfeeding. Hospitals that implement all ten can be designated as “Baby Friendly” – but currently, only 11.5% of US maternity centers meet that standard. It’s worth noting that we are making progress — just 2.9% of hospitals were Baby Friendly in 2007 — but 88% of families are still hobbled at the starting gates when they start their breastfeeding journey.
Over the past 3 decades, an increasing number of studies and reviews have examined the relationship of breastfeeding and childhood obesity. The authors of Agency for Healthcare Research and Quality’s (AHRQ) Evidence Report on Breastfeeding meta-analysis concluded that children who were breastfed for at least 3 months were less likely to be obese than those never breastfed, taking into account multiple confounding factors.1 The duration of breastfeeding was found to be inversely related to the risk of being overweight; each month of breastfeeding being associated with a 4% reduction in risk. A WHO meta-analysis from 2007 also concluded that longer breastfeeding (typically durations of 3 to 9 months), in comparison to no breastfeeding, was associated with lower rates of obesity.2 The Framingham Offspring study noted a relationship of breastfeeding and a lower BMI in adults.3 A sibling difference model study showed that the breastfed siblings weighed 13 pounds less than formula fed siblings at a mean age of 14 and were less likely to reach BMI obesity threshold.4 Based upon these studies, the promotion of breastfeeding to prevent obesity has been recommended by the CDC, the Institute of Medicine, and the Surgeon General.
However, there are, however, other important studies that failed to find a relationship. The PROBIT study, the only randomized trial of breastfeeding in term infants, randomized an intervention to promote increased duration and exclusivity of breastfeeding in Belarus and found no significant differences in BMI, percent body fat, and obesity between the experimental and control group children at 11.5 years of age.5 The “discordant sibling study” looked at data obtained from the National Longitudinal Survey of Youth study and found that breastfeeding was not associated with significant improvements in childhood obesity when siblings who were fed differently during infancy, one breastfed, the other bottle fed, were compared.6
So how are we to interpret these conflicting studies? My opinion has been that, as the etiology of obesity is multifactorial, breastfeeding can play an important role in its prevention, but is unlikely to entirely prevent it. The limitation of most of these studies is that they look at breastfeeding alone. Future studies need to focus on the role of multiple modifiable factors on these conditions.7 Read the rest of this entry »
ABM, as a worldwide organization dedicated to the promotion, protection and support of breastfeeding, has been involved in promoting breastfeeding at the UN for the past 10 years. ABM became a Non-Governmental Organization (NGO) in consultative status with the UN Economic and Social Council (ECOSOC) and is a member of the NGO Committee on UNICEF. As it is impossible to accomplish anything at the UN without collaboration, we partner with ILCA, WABA and CGBI as members of the “UN Breastfeeding Advocacy Team” known as “UNBAT”, to raise breastfeeding awareness at the UN and UNICEF.
This has been a busy year for advocacy. UNICEF drafted a Breastfeeding Advocacy Strategy in March which was improved with our input. We look forward to working with UNICEF in refining the advocacy strategy and developing an implementation plan over the next year. ABM representatives participated in events celebrating the 25th Anniversary of the Convention on the Rights of the Child which frames good health, including breastfeeding, as a fundamental right, in November in New York.
We are currently collaborating with our partners to include breastfeeding in the post-2015 Sustainable Development Goals (SDGs) which will be finalized by December, 2015 to replace the Millennium Development Goals which are expiring. Getting breastfeeding promotion into the post-2015 agenda is extremely important. We worked with our UNBAT partners and the Health NGO Group to request that breastfeeding be included as one of the “critical health-related issues to achieve sustainable development.”
ABM and its partners have applied to sponsor a “parallel event” at the annual Commission on the Status of Women in New York in March to raise the profile of breastfeeding as an important measure which improves the health of women and children.
We are encouraged by the increasing attention to breastfeeding at the UN and UNICEF and feel that there will be more opportunities to promote breastfeeding as part of the post-2015 Sustainable Development agenda, through the UNICEF Advocacy Strategy, during the CSW events and through ongoing collaboration with other health and nutrition groups. If any ABM members want to assist in this important work, please contact us.
Susan Vierczhalek, MD, FABM is ABM representative to the UN, Associate Professor of Clinical Pediatrics at New York University School of Medicine, medical Director of the Bellevue Hospital Newborn Service and Breastfeeding Program, Chair of the NY State Breastfeeding Coalition, Medical Director of the New York Milk Bank.
Larry Noble, MD, FABM, IBCLC is ABM representative to the UN with Susan, a neonatologist and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai in New York City and a Board member of ABM.
When I was a surgical resident, I donated 150 ounces of breastmilk to a woman I’d never met, a woman who had undergone a bilateral mastectomy for cancer. It was an easy decision – I had more than I could use, she had none that she could provide. This experience became a major one in my decision to specialize in breast surgery. The dichotomy of breasts fascinated me. Breasts are highly sexualized, yet the source of comfort and food to babies. Breasts can make life-sustaining milk, and they can develop a cancer in up to 1 in 8 women that can be life-threatening. It is no wonder that society’s relationship with breasts and breastfeeding is complicated.
I have had many patients (too many) in my practice who were young and pre-childbearing, or even pregnant or breastfeeding at the time of diagnosis. Most experience the same terror that Ms. Wax-Thibodeux felt. Many choose bilateral mastectomies, prioritizing their health and a minimization of future risk. I also care for young women with benign breast disease, that still require surgical biopsies. I do discuss the potential impact of any surgery on breastfeeding. For a lot of women, this is a side effect they hadn’t even considered. It often does not ultimately change their mind about their own most appropriate surgical choice, but there can be a pause. A moment where they consider what that means, when they reconcile themselves to that consequence, when they have the moment to grieve. Unfortunately, I suspect that not all of my colleagues do this. I wasn’t ever trained to discuss it. We spent more time, significantly more time, discussing the cosmetic changes of the breasts than any functional changes (including, unfortunately, changes in sensation that may affect sexual enjoyment.) So, for women whose world has been rocked by a cancer diagnosis at a young age, who are terrified about their survival, there is probably not the opportunity to mourn the loss of breastfeeding, until that moment comes when they hold their babies in their arms. Read the rest of this entry »
Both families and physicians are anxious about the potential impact of the Ebola virus for mothers and infants.
The CDC has recently issued guidelines for field and partner organizations regarding how to advise breastfeeding women with probably or confirmed Ebola infection:
“When safe alternatives to breastfeeding and infant care exist, mothers with probable or confirmed Ebola virus disease should not have close contact with their infants (including breastfeeding).
In resource-limited settings, non-breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease.”
The Ebola virus has been detected in the milk of infected women. For mothers who recover from Ebola, it is not known when it is safe to resume breastfeeding. The CDC recommends waiting to resume breastfeeding until milk can be shown to be Ebola-free in laboratory testing.
As the Ebola outbreak continues to evolve, the Academy of Breastfeeding Medicine recommends consulting CDC guidance on how to minimize risk for infants of affected mothers.
The recently published article by Josephson and colleagues confirms that serious infections due to postnatally acquired CMV in very low birth weight infants are a real concern. The study documented that properly screened (CMV seronegative) and filtered blood and blood components effectively blocks transmission of CMV from these previously documented sources and in turn confirmed that the primary source of transmission is maternal milk from seropositive mothers. Of the infants who were exposed to mother’s breast milk that was positive for CMV, 15 % developed serologic evidence of CMV disease and less than 3% developed significant clinical disease, including NEC, with a mortality of 60% (3/5).
Of importance to note was the fact that the study was performed primarily by a team of hematologists and transfusion experts and unfortunately lack any details as to the clinical course of the infected infants — there were no data on birth weight or gestational age data, no indication as to quantity of milk ingested, when breastfeeding was initiated, the percentage of raw milk ingested versus frozen thawed milk, post natal age of onset if disease, bowel biopsy or post mortem findings. Furthermore not all the mothers had their milk tested for presence of CMV. Thus, these significant methodological limitations preclude accurate mathematical calculations as to actual risk of feeding human milk to the VLBW infant. Furthermore, the absence of any basic clinical data precludes identifying who are the truly high-risk infants. Read the rest of this entry »