ABSTRACT. Objective. Despite cultural pressure to wean when a new pregnancy occurs, some women choose to continue breastfeeding. We determined the effect of an overlap of lactation and late pregnancy on breastfeeding and growth in early infancy.Methods. We studied 133 Peruvian pregnant women who were >18 years of age, had a child <4 years old, and who then had a vaginal birth with a healthy, normal weight infant. Of the 133 women, 68 breastfed during the last trimester of pregnancy (BFP), and 65 had not breastfed during pregnancy (NBFP). On day 2 and at 1-month postpartum, 24-hour intake of breast milk and other liquids was measured. Twice weekly home surveillance documented infant morbidity and dietary intakes. Anthropometry was taken at birth and at 1 month. Maternal anthropometric, health, and socioeconomic status data were collected pre-and postpartum.Results. Pregnant BFP mothers breastfed 5.3 ؎ 4.3 times/day. BFP and NBFP infants did not differ in breastfeeding behavior or in colostrum intake on day 2. BFP infants breastfed longer per feed and per 24 hours (35.2 minutes/24 hours) than did NBFP infants; however, 1-month intakes per feed tended to be lower among the BFP infants. After controlling for confounders, BFP infants gained 125 g less than did NBFP infants (about 15% of mean weight gain). A sustained decline would result in a ؊0.7 z score change in weight-for-age by 6 months.Conclusions. A lactation-pregnancy overlap had a negative effect on early infant outcomes. Additional studies are needed to determine whether the effect continues past 1 month of age. Pediatrics 2002;109(4). URL: http://www.pediatrics.org/cgi/content/full/109/4/e56; breastfeeding, pregnancy, overlap, breast milk volume, weight gain, infant feeding, Peru.ABBREVIATIONS. BFP, breastfed during pregnancy; NBFP, did not breastfeed during pregnancy; BMI, body mass index; SES, socioeconomic status; CI, confidence interval; OR, odds ratio. M any women throughout the world breastfeed for as long as possible to give their children the nutritional, immunologic, and emotional benefits of breastfeeding. When lactation overlaps a new pregnancy, some women choose not to wean their toddlers, although there may be strong cultural taboos against continuing to breastfeed. 1,2 The practice of continuing to breastfeed during pregnancy has been reported among US women but might not be discussed with health professionals because of anticipated criticism of the practice. [3][4][5] Breastfeeding during pregnancy is more common in some low-income countries than in the United States because shorter birth intervals increase the likelihood of a pregnancy-lactation overlap.It has been suggested that an overlap could produce suboptimal outcomes for both pregnancy and subsequent lactation. 6 -8 Dairy research has demonstrated that a complete overlap of lactation during pregnancy dramatically compromises the total production of mature milk during the next lactation period. 9 -14 A dry (nonmilking) period of approximately 2 months before calving is usual in the da...

This paper describes the design, implementation and evaluation of an intervention to promote improved hygiene practices in a shanty town area of Lima, Peru. Following formative research, the intervention focused on behaviors associated with the hygienic use of potties by children aged 15-47 months and keeping the home environment free from feces. A health communications strategy was developed involving delivery through routine health services, and using video presentations, leaflets and counseling by health staff during consultations. Intervention activities occurred during a 6-month period in health centers and posts of four intervention communities; four other communities acted as a comparison group. Process and impact indicators were measured through questionnaires and 4-h structured observations conducted in over 600 households both pre- and post-intervention implementation, and through intervention monitoring activities. The intervention materials and approach were well received by the study community; however, in the time-frame of the project only limited coverage of the target audience was achieved, which was insufficient to result in an impact on behaviors. Nevertheless sufficient positive features existed to suggest that with higher coverage, an impact on target behaviors might have been achieved. Reasons for the intervention's shortcomings are discussed and suggestions made for more effective implementation.

An overlap of breast-feeding and late pregnancy is associated with decreased intake of human milk and reduced infant growth. We evaluated the association of an overlap with macronutrient and immunological components of milk, infant urinary IgA, and infant and maternal morbidity. On d 2 and 1 mo postpartum, staff measured 24-h intake of breast milk and collected samples from 133 Peruvian women; 68 had breast-fed during the last trimester of pregnancy (BFP) and 65 had not breast-fed during pregnancy (NBFP). Data on maternal and infant anthropometry and health were collected for 1 mo. On d 2, lactose and lysozyme concentrations were higher, total lysozyme intake was higher and concentration and total intake of lactoferrin were lower in the BFP than the NBFP group (P < 0.05). The total 1-mo IgA intake was lower among BFP than NBFP infants (P = 0.01). Urinary IgA concentration was correlated with breast milk IgA concentration (r = 0.29; P = 0.01) but not with breast-feeding during pregnancy. An overlap was not associated with diarrhea but BFP infants were 5 times as likely to have a cough for at least 7 d than NBFP infants (P < 0.05). Reported mastitis was rare and occurred only in the NBFP group (P = 0.05). An overlap of breast-feeding and late pregnancy was associated with changes in milk composition, an increased frequency in symptoms of infant respiratory illness but decreased reported mastitis. Further in-depth studies are warranted to determine the cumulative effects associated with a breast-feeding/pregnancy overlap on infant and maternal outcomes.

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Differences in test-taker perceptions between overt and personality-based integrity tests were examined. Following administration of both types of integrity tests, 255 undergraduate students provided ratings of perceived face validity and perceived predictive validity. Following receipt of actual test scores, 126 test takers participated in a second phase of the study in which they reported perceptions of distributive justice. Test takers perceived overt integrity tests as having greater face validity and predictive validity than personality-based integrity tests. Perceptions of job-relatedness were not strongly related to test performance on either test type. Distributive justice perceptions were related to test performance, but not type of integrity test.