RESUMO
Breastfeeding has been shown to benefit infants and mothers. Women who have caesarean deliveries (C-sections) are expected to be less likely to initiate and continue breastfeeding than those who have vaginal deliveries. Given the high rate of C-sections in Nicaragua, the importance of breastfeeding, and the centrality of culture in choices about breastfeeding, this study sought to examine if mode of delivery relates with breastfeeding initiation and exclusivity in Nicaragua. Two hundred fifty mothers were surveyed about birth experiences and breastfeeding behaviour in 3 public clinics in León, Nicaragua, between June and August 2015. Logistic regression analyses were performed to examine the association of mode of delivery with initiation of breastfeeding within 1 hr of birth (early initiation) and exclusive breastfeeding for 6 months post-partum. The rate of early initiation was 68.8% and that of exclusively breastfeeding for 6 months was 12.7%. Mode of delivery was not significantly associated with early initiation (p = .383) or exclusive breastfeeding (p = .518). Early initiation was negatively associated with prelacteal feeding, AOR = 0.30, 95% CI [0.16, 0.58]; p = .001. Mothers who had perceived their infants as large at birth were significantly less likely to exclusively breastfeed for 6 months, AOR (95%CI) = 0.25 (0.06-0.97); p = 0.046. Mode of delivery was not significantly associated with optimal breastfeeding initiation and exclusivity among mothers in Nicaragua. The 2 risk factors identified for delayed initiation of breastfeeding and lack of exclusive breastfeeding were prelacteal feeding and maternal perception of a large infant at birth, respectively.
Assuntos
Aleitamento Materno , Cesárea/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , Mães , Saúde da População Urbana , Adulto , Peso ao Nascer , Alimentação com Mamadeira/etnologia , Aleitamento Materno/etnologia , Estudos Transversais , Autoavaliação Diagnóstica , Métodos de Alimentação , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente/etnologia , Recém-Nascido , Transtornos da Lactação/diagnóstico , Transtornos da Lactação/etnologia , Transtornos da Lactação/etiologia , Transtornos da Lactação/fisiopatologia , Masculino , Nicarágua , Inquéritos Nutricionais , Gravidez , Atenção Primária à Saúde , Pesquisa Qualitativa , Estudos Retrospectivos , Saúde da População Urbana/etnologiaRESUMO
The aim of this study was to determine the incidence and risk factors for early lactation problems [suboptimal infant breastfeeding behaviour (SIBB), delayed onset of lactogenesis (OL) and excessive neonatal weight loss] among mother-infant pairs in Lima, Peru. All primiparous mothers who gave birth to a healthy, single, term infant at a government hospital in a peri-urban area of Lima during the 8-month recruitment period were invited to participate in the study. Data were collected at the hospital (day 0) and during a home visit (day 3). Infant breastfeeding behaviour was evaluated using the Infant Breastfeeding Assessment Tool; SIBB was defined as < or = 10 score. OL was determined by maternal report of breast fullness changes; delayed OL was defined as perceived after 72 h. Excessive neonatal weight loss was defined as > or = 10% of birthweight by day 3. One hundred seventy-one mother-infant pairs participated in the study. SIBB prevalence was 52% on day 0 and 21% on day 3; it was associated with male infant gender (day 0), < 8 breastfeeds during the first 24 h (days 0 and 3), and gestational age < 39 weeks (day 3). Delayed OL incidence was 17% and was associated with infant Apgar score < 8. Excessive neonatal weight loss occurred in 10% of neonates and was associated with maternal overweight and Caesarean-section delivery. Early lactation problems may be influenced by modifiable factors such as delivery mode and breastfeeding frequency. Infant status at birth and maternal characteristics could indicate when breastfeeding dyads need extra support.
Assuntos
Peso ao Nascer/fisiologia , Aleitamento Materno/estatística & dados numéricos , Comportamento do Lactente/fisiologia , Recém-Nascido/fisiologia , Transtornos da Lactação/epidemiologia , Índice de Apgar , Aleitamento Materno/epidemiologia , Aleitamento Materno/psicologia , Cesárea/efeitos adversos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido/crescimento & desenvolvimento , Transtornos da Lactação/etiologia , Transtornos da Lactação/psicologia , Masculino , Paridade/fisiologia , Peru , Gravidez , Fatores de Risco , Fatores Sexuais , Apoio Social , Comportamento de Sucção/fisiologia , Fatores de Tempo , Redução de Peso/fisiologia , Adulto JovemRESUMO
OBJECTIVE: The profound impairment in litter growth produced by untreated maternal hypothyroidism (HypoT) may be a consequence of maternal metabolic dysfunctions affecting lactation. In this work we studied the effects of HypoT on mammary and liver lipid metabolism and its consequences on milk quality. DESIGN: We studied the effects of prolonged 6-propyl-2-thiouracil (PTU)-induced HypoT (0.01% PTU in drinking water starting 8 days before mating until sacrifice) on milk macronutrient composition, liver and mammary lipid metabolism and content and serum lipid, and glucose and insulin concentrations in rats on days 7, 15 (L15), and 20 (L20) of lactation. Mammary and hepatic mRNA abundances of lipogenic enzymes were measured using semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) on L15 and L20. MAIN OUTCOME: Milk lactose and triglycerides (TG) were reduced by HypoT, as well as mammary acetyl CoA carboxylase (ACC) activity on L15 and L20, and ACC and lipoprotein lipase (LPL) mRNA on L20. HypoT also decreased hepatic ACC activity on both days, ACC mRNA on L15 and liver [(3)H]H(2)O incorporation to TGs and TG content on L20. HypoT diminished insulinemia, increased serum total lipids, and decreased serum TGs on some or all the days of lactation studied. CONCLUSION: HypoT produces a drastic decrease in milk TGs; the main cause for this seems to be the decreases in liver TG synthesis and in circulating TGs, which, along with reduced mammary uptake of fatty acids caused by decreased LPL expression and possibly diminished mammary lipogenesis, result in an impaired mammary output of TGs to the milk. Thus, the impaired growth of the litters of HypoT mothers can be largely attributed to the low milk quality along with the impaired milk ejection.
Assuntos
Hipotireoidismo/metabolismo , Transtornos da Lactação/metabolismo , Lipogênese/fisiologia , Fígado/metabolismo , Glândulas Mamárias Animais/metabolismo , Animais , Animais Lactentes , Glicemia/metabolismo , Feminino , Hipotireoidismo/complicações , Insulina/sangue , Lactação/fisiologia , Transtornos da Lactação/etiologia , Lactose/metabolismo , Leite/metabolismo , Ejeção Láctea/fisiologia , Proteínas do Leite/metabolismo , Ratos , Ratos Wistar , Tireotropina/sangue , Tiroxina/sangue , Triglicerídeos/metabolismo , Tri-Iodotironina/sangueRESUMO
OBJECTIVE: To present an updated review on common problems associated with breastfeeding and their management. SOURCE OF DATA: A comprehensive bibliographic review on the issue was performed by searching publications from the MEDLINE database and from national and international organizations. Books and some key articles cited in other sources were also selected. SUMMARY OF THE FINDINGS: Several common problems that may arise during the breastfeeding period, such as breast engorgement, plugged milk duct, breast infection and insufficient milk supply, originate from conditions that lead the mother to inadequate empty the breasts. Incorrect techniques, not frequent breastfeeding and breastfeeding on scheduled times, pacifiers and food suppliers are important risk factors that can predispose to lactation problems. The adequate management of those conditions is fundamental, as if not treated they frequently lead to early weaning. There are specific measures that should be taken to empty the breasts effectively. Besides, the emotional support and actions that yield more comfort to the lactating mother can not be neglected. CONCLUSIONS: Most common problems associated with breastfeeding can be prevented if the mother empties her breasts effectively. If they occur, they should be carefully and adequately approached, thus avoiding the early weaning resultant from painful and stressing situations the mother may face.
Assuntos
Aleitamento Materno/efeitos adversos , Transtornos da Lactação/terapia , Alimentação com Mamadeira/efeitos adversos , Doenças Mamárias/etiologia , Doenças Mamárias/prevenção & controle , Doenças Mamárias/terapia , Feminino , Humanos , Lactação/metabolismo , Transtornos da Lactação/etiologia , Transtornos da Lactação/prevenção & controle , Leite Humano/metabolismo , Chupetas/efeitos adversos , DesmameRESUMO
Objetivo: Apresentar uma revisão atualizada sobre problemas comuns relacionados à lactação e seu manejo. Fonte dos dados: Foi realizada extensa revisão bibliográfica sobre o tópico, sendo utilizadas publicações selecionadas a partir de pesquisa na base de dados MEDLINE e de organismos nacionais e internacionais. Foram utilizados também livros-texto e alguns artigos-chave selecionados a partir de citações em outros artigos. Síntese dos dados: Vários dos problemas comuns enfrentados durante a lactação - ingurgitamento mamário, traumas mamilares, bloqueio de ducto lactífero, infecções mamárias e baixa produção de leite - têm a sua origem em condições que levam a um esvaziamento mamário inadequado. Assim, má técnica de amamentação, mamadas infreqüentes e em horários predeterminados, uso de chupetas e de complementos alimentares constituem importantes fatores que podem predispor ao aparecimento de complicações da lactação. Nessas condições, o manejo adequado é imprescindível, pois, se não tratadas adequadamente, com freqüência levam ao desmame precoce. Para a abordagem dos fatores que dificultam o esvaziamento adequado das mamas, há medidas específicas. Além disso, o suporte emocional e medidas que visem dar maior conforto à lactante não podem ser negligenciadas. Conclusões: A maioria dos problemas comuns relacionados à lactação pode ser prevenida com esvaziamento adequado das mamas. Uma vez presentes, os problemas devem ser manejados adequadamente, evitando-se, assim, o desmame precoce decorrente de situações dolorosas e, por vezes, debilitantes para a nutriz.
Assuntos
Humanos , Feminino , Recém-Nascido , Aleitamento Materno/efeitos adversos , Transtornos da Lactação/terapia , Alimentação com Mamadeira/efeitos adversos , Transtornos da Lactação/etiologia , Transtornos da Lactação/prevenção & controle , Lactação/metabolismo , Leite Humano/metabolismo , Chupetas/efeitos adversos , DesmameRESUMO
A delayed onset of lactation (OL) is likely to have a negative influence on breast-feeding outcomes. Thus, it is important to identify risk factors for delayed OL. We examined prospectively the association between stress during labor and delivery and OL in a cohort of urban Guatemalan women. Healthy women (n = 136) were recruited during the first stage of labor in the labor unit of a social security hospital in Guatemala City. Women provided salivary samples for cortisol determinations 3.2 +/- 3.2 h before birth and 1.7 +/- 1.9 h and 17.1 +/- 4.7 h after delivery. At the same time points women were asked to respond to a 17-item psychosocial stress and anxiety questionnaire. Women were called daily until OL occurred. Primiparous women had higher antepartum and early postpartum cortisol levels that were twice as high as those among multiparous women (P < 0.05). The parity differential in salivary cortisol concentrations vanished with time. General linear model multivariate analysis indicate that multiparous women (n = 77), irrespective of mode of delivery, had an earlier OL (P < 0.05) than primiparae who underwent emergency cesarean section deliveries (n = 11) (adjusted mean +/- SEM, 2.5 +/- 0.1 vs. 3.4 +/- 0.3 d postpartum, respectively). OL took longer to occur among multiparous women with prenatal salivary cortisol levels above (vs. below) the 40th percentile [3 +/- 0.2 (n = 28) vs. 2.4 +/- 0.2 d postpartum (n = 38), respectively; P = 0.02]. Thus, stress during labor and/or delivery is likely to be a significant risk factor for delayed OL in urban Guatemala.
Assuntos
Trabalho de Parto/psicologia , Transtornos da Lactação/etiologia , Lactação/fisiologia , Complicações do Trabalho de Parto/fisiopatologia , Estresse Fisiológico/fisiopatologia , Adulto , Aleitamento Materno/psicologia , Estudos de Coortes , Parto Obstétrico , Países em Desenvolvimento , Feminino , Guatemala , Humanos , Hidrocortisona/análise , Trabalho de Parto/fisiologia , Lactação/psicologia , Transtornos da Lactação/sangue , Transtornos da Lactação/psicologia , Estudos Longitudinais , Complicações do Trabalho de Parto/psicologia , Paridade , Gravidez , Saliva/química , Estresse Fisiológico/complicações , Estresse Fisiológico/psicologia , Estresse Psicológico/complicações , Estresse Psicológico/fisiopatologia , Inquéritos e Questionários , Fatores de Tempo , População UrbanaRESUMO
Se realizó un estudio descriptivo y transversal de todos los lactantes (113) que nacieron entre enero y diciembre de 1998, pertenecientes a 5 consultorios del médico de la zona urbana de la policlínica Rolando Monterrey, con el objetivo de contribuir al conocimiento de las características epidemiológicas relacionadas con la lactancia materna en el área de salud de la policlínica. En Cuba la lactancia materna exclusiva, tal como está planteada en el plan de acción de la Cumbre Mundial a Favor de la Infancia, debe ser un elemento de extraordinaria importancia para mantener la tendencia descendente de la mortalidad hasta el año 2000 en el niño menor de 5 años. Se seleccionó la entrevista individual como método de recolección de datos para profundizar en la información y se contó con el consentimiento informado de las madres lactantes que apoyaron la realización de este trabajo. Se consideran factores que influyen al destete precoz y las posibles dificultades relacionadas con el tiempo de duración de la lactancia materna. Se concluye que las mujeres entre 20 y 34 años de edad, amas de casa, casadas con el nivel secundario y con un solo hijo fueron las que lograron una mayor efectividad en la lactancia materna. Entre las causas de abandono precoz de la lactancia se encontró la hipogalactia y como causa más frecuente en estos niños se observaron las infecciones respiratorias agudas. El médico y la enfermera de la familia por ser el puntal fundamental en la divulgación de este tipo de alimentación deben continuar su labor educativa para lograr una mejor preparación psicológica de la madre(AU)
A descriptive and crosswise study of all the infants (113) that were born from January to December, 1998 in an urban area attended by 5 physician´s offices of Rolando Monterrey polyclinics was performed, with the objective of expanding the knowledge on the epidemiological characteristics related with breast-feeding in this health care area. In Cuba exclusive breast-feeding, as it is stated in the plan of action of the World Summit for the Child, should be an element of great importance to keep the decreasing tendency of mortality rate in under five years-old children up to the year 2000. Personal interviews was the method of choice for gathering data to obtain good information and the informed consent for this study was given by the nursing mothers who supported it. Factors affecting early weaning and the possible difficulties with the duration of breast-feeding were considered. It was concluded that women aged 20-34 years, housewives, married women with junior high educational level and women with only one child were the ones that achieved higher effectiveness in breast-feeding. Hypogalactia was found as a frequent cause of early weaning whereas the most frequent problem observed in these children was acute respiratory infection. Since family physician and nurse are fundamental pillars in the development of this kind of feeding, then they should continue to carry out their educational work so that mothers have a better psychological preparation(AU)
Assuntos
Humanos , Feminino , Adulto , Atenção Primária à Saúde , Desmame , Aleitamento Materno/métodos , Promoção da Saúde/tendências , Transtornos da Lactação/etiologia , Leite Humano , Epidemiologia Descritiva , Estudos TransversaisRESUMO
A síndrome de Sheehan é um tipo de hipopituitarismo primário decorrente da hemorragia pós-parto. É de natureza lentamente progressiva. As pacientes cursam com falência da lactaçäo puerperal, amenorréia pós-parto, queda de pêlos axilares e pubianos, atrofia genital e mamária, e xerodermia. Ocorre deficiência de GH, gonadotropinas, ACTH e TSH. A deficiência de ACTH gera a insuficiência adrenal crônica que pode ser sobreposta pela insuficiência adrenal aguda. O objetivo do estudo é descrever o caso de uma paciente internada em choque hipovolêmico e hipoglicêmico decorrente de insuficiência adrenal aguda secundária à síndrome de Sheehan. Análise da anamnese , das evoluçöes diárias durante o período de internaçäo, dos exames solicitados e das medicaçöes prescritas da paciente. A paciente tinha história de parto cesária há dez anos no qual houve hemorragia importante, chegando a realizar histerectomia. Desde entäo apresentou sintomas decorrentes de necrose isquêmica pituitária. Com exames realizados se confirmou o diagnóstico de insuficiência supra-renal aguda secundária à sindrome de Sheehan. Na sindrome de Sheehan ocorrem manifestaçöes clínicas e laboratoriais de hipopituitarismo. Em nosso trabalho descrevemos as características clínicas da patologia que foram primeiramente caracterizadas por Sheehan. Concluímos que esta síndrome, quando näo diagnosticada precocemente, pode levar a um quadro grave de insuficiência adrenal aguda.(au)