High levels of breastmilk feeding despite a low rate of exclusive breastfeeding for 6 months in a cohort of vulnerable women in Toronto, Canada

Mildon, Alison; Francis, Jane; Stewart, Stacia; Underhill, Bronwyn; Ng, Yi Man; Rousseau, Christina; Ruggiero, Erica Di; O'Connor, Deborah L; Sellen, Daniel

doi:10.1111/mcn.13260

Cited by 10 publications

(6 citation statements)

References 37 publications

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“…The global recommendation is exclusive HM feeding for 6 months, 1 but a separate analysis of Study B data showed that this practice was frequently compromised after 4 months by introduction of solids and non-formula fluids. 31 We therefore assessed non-exclusive HM feeding to both 4 and 6 months in order to examine associations with and without the influence of complementary feeding.…”

Section: Methodsmentioning

confidence: 99%

“…Outcome measures were: (i) cessation of any HM feeding before 6 months postpartum; (ii) non-exclusive HM feeding postdischarge to 4 months postpartum and (iii) non-exclusive HM feeding postdischarge to 6 months postpartum. The global recommendation is exclusive HM feeding for 6 months,1 but a separate analysis of Study B data showed that this practice was frequently compromised after 4 months by introduction of solids and non-formula fluids 31. We therefore assessed non-exclusive HM feeding to both 4 and 6 months in order to examine associations with and without the influence of complementary feeding.…”

Section: Methodsmentioning

confidence: 99%

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Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada

et al. 2022

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ObjectivesTo examine whether use of expressed human milk in the first two weeks postpartum is associated with cessation of human milk feeding and non-exclusive human milk feeding up to 6 months.DesignPooled data from two prospective cohort studiesSettingThree Canada Prenatal Nutrition Program (CPNP) sites serving vulnerable families in Toronto, Canada.Participants337 registered CPNP clients enrolled prenatally from 2017 to 2020; 315 (93%) were retained to 6 months postpartum. Exclusions: pregnancy loss or participation in prior related study; Study B: preterm birth (<34 weeks); plan to move outside Toronto; not intending to feed human milk; hospitalisation of mother or baby at 2 weeks postpartum.Primary and secondary outcome measuresMain exposure variable: any use of expressed human milk at 2 weeks postpartum. Outcomes: cessation of human milk feeding by 6 months; non-exclusive human milk feeding to 4 months and 6 months postpartum.ResultsAll participants initiated human milk feeding and 80% continued for 6 months. Exclusive human milk feeding was practiced postdischarge to 4 months by 28% and to 6 months by 16%. At 2 weeks postpartum, 34% reported use of expressed human milk. Any use of expressed human milk at 2 weeks was associated with cessation of human milk feeding before 6 months postpartum (aOR 2.66; 95% CI 1.41 to 5.05) and with non-exclusive human milk feeding to 4 months (aOR 2.19; 95% CI 1.16 to 4.14) and 6 months (aOR 3.65; 95% CI 1.50 to 8.84).Trial registration numbersNCT03400605, NCT03589963.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada

et al. 2022

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“…Regardless, use of this standard indicator is not feasible in a retrospective survey like the CCHS, which captures practices of individuals who gave birth in the previous 5 years. In addition, previous research has shown that infant feeding is not a static process during the first 6 months postpartum and predominant (vs. exclusive) breastfeeding is common (Bodnarchuk et al 2006;Noel-Weiss et al 2012;Mildon et al 2022;Netting et al 2022). Feeding expressed human milk by bottle is also an increasingly common practice in highincome settings (Johns et al 2013).…”

Section: Measuring Breastfeeding Exclusivitymentioning

confidence: 99%

Breastfeeding in Canada: predictors of initiation, exclusivity, and continuation from the 2017–2018 Canadian Community Health Survey

Chan

Labonté

Francis

et al. 2023

Appl. Physiol. Nutr. Metab.

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Human milk is the ideal source of nutrition for infants, however adherence to breastfeeding recommendations is suboptimal and availability of Canadian breastfeeding data is limited. Using the 2017-2018 Canadian Community Health Survey Public Use Microdata File (Maternal Experiences Module, n=5,558, weighted n=1,669,462) we computed breastfeeding indicators, and explored sociodemographic, health and geographical predictors of breastfeeding with univariate logistic regression models. Nationally, of all participants who gave birth in the preceding 5 years, 91% initiated breastfeeding, 43% exclusively breastfed to ≥5 months and 35% to ≥6 months, 56% reported any breastfeeding at ≥6 months, and 31% reported breastfeeding at ≥12 months. Breastfeeding cessation was most commonly attributed to insufficient milk supply (25%), but reasons differed significantly by breastfeeding duration. Breastfeeding initiation, exclusivity for ≥5 months, and extended ≥12 months all differed by geographic region, and by most sociodemographic and health characteristics. Positive breastfeeding outcomes were highest in British Columbia, and lowest in Quebec and the Atlantic region, and generally higher if caregivers had recently immigrated to Canada, were married, >30 years of age, not White, non-smoking, had completed post-secondary education, and had an annual household income >$40,000. These disparities indicate the need for tailored, equitable approaches to breastfeeding support, and continued regional monitoring of breastfeeding outcomes.

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“…Detailed methods for both studies have been reported elsewhere, as have participant demographics and results for breastfeeding metrics (19)(20)(21)(22) . Study A examined the infant feeding practices of clients enrolled at the 5Ps CPNP site, which also implements a postpartum lactation support programme through additional charitable funds from The Sprott Foundation (19) .…”

Section: Study Setting and Participantsmentioning

confidence: 99%

Household food insecurity is prevalent in a cohort of postpartum women who registered in the Canada Prenatal Nutrition Program in Toronto

Mildon

Francis

Stewart

et al. 2023

Public Health Nutr.

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Objective: To assess the prevalence, severity and socio-demographic predictors of household food insecurity among vulnerable women accessing the Canada Prenatal Nutrition Program (CPNP), and to examine associations between household food insecurity and breastfeeding practices to six months. Design: Cohort investigation pooling data from two studies which administered the 18-item Household Food Security Survey Module at six months postpartum and collected prospective infant feeding data at two weeks and two, four and six months. Household food insecurity was classified as none, marginal, moderate or severe. Logistic regression analyses were performed to assess predictors of household food insecurity and associations between household food security (any and severity) and continued and exclusive breastfeeding. Setting: Three Toronto sites of the CPNP, a federal initiative targeting socially and/or economically vulnerable women. Participants: 316 birth mothers registered prenatally in the CPNP from 2017-2020 Results: Household food insecurity at six months postpartum was highly prevalent (44%), including 11% in the severe category. Risk of household food insecurity varied by CPNP site (p<0.001) and was higher among multiparous participants (OR 2.08; 95% CI 1.28-3.39). There was no association between prevalence or severity of food insecurity and continued or exclusive breastfeeding to six months postpartum in the adjusted analyses. Conclusions: Household food insecurity affected nearly half of this cohort of women accessing the CPNP. Further research is needed on household food insecurity across the national CPNP and other similar programmes, with consideration of the implications for programme design, service delivery and policy responses.

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High levels of breastmilk feeding despite a low rate of exclusive breastfeeding for 6 months in a cohort of vulnerable women in Toronto, Canada

Cited by 10 publications

References 37 publications

Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada

Associations between use of expressed human milk at 2 weeks postpartum and human milk feeding practices to 6 months: a prospective cohort study with vulnerable women in Toronto, Canada

Breastfeeding in Canada: predictors of initiation, exclusivity, and continuation from the 2017–2018 Canadian Community Health Survey

Household food insecurity is prevalent in a cohort of postpartum women who registered in the Canada Prenatal Nutrition Program in Toronto

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