BackgroundThe caesarean section (c-section) rate in Canada is 27.1 %, well above the 5–15 % of deliveries suggested by the World Health Organization in 2009. Emergency and planned c-sections may adversely affect breastfeeding initiation, milk supply and infant breastfeeding receptivity compared to vaginal deliveries. Our study examined mode of delivery and breastfeeding initiation, duration, and difficulties reported by mothers at 4 months postpartum.MethodsThe All Our Babies study is a prospective pregnancy cohort in Calgary, Alberta, that began in 2008. Participants completed questionnaires at <25 and 34–36 weeks gestation and approximately 4 months postpartum. Demographic, mental health, lifestyle, and health services data were obtained. Women giving birth to singleton infants were included (n = 3021). Breastfeeding rates and difficulties according to mode of birth (vaginal, planned c-section and emergency c-section) were compared using cross-tabulations and chi-square tests. A multivariable logistic regression model was created to examine the association between mode of birth on breastfeeding duration to 12 weeks postpartum.ResultsMore women who delivered by planned c-section had no intention to breastfeed or did not initiate breastfeeding (7.4 % and 4.3 % respectively), when compared to women with vaginal births (3.4 % and 1.8 %, respectively) and emergency c-section (2.7 % and 2.5 %, respectively). Women who delivered by emergency c-section were found to have a higher proportion of breastfeeding difficulties (41 %), and used more resources before (67 %) and after (58 %) leaving the hospital, when compared to vaginal delivery (29 %, 40 %, and 52 %, respectively) or planned c-sections (33 %, 49 %, and 41 %, respectively). Women who delivered with a planned c-section were more likely (OR = 1.61; 95 % CI: 1.14, 2.26; p = 0.014) to discontinue breastfeeding before 12 weeks postpartum compared to those who delivered vaginally, controlling for income, education, parity, preterm birth, maternal physical and mental health, ethnicity and breastfeeding difficulties.ConclusionsWe found that when controlling for socio-demographic and labor and delivery characteristics, planned c-section is associated with early breastfeeding cessation. Anticipatory guidance around breastfeeding could be provided to women considering a planned c-section. As well, additional supportive care could be made available to lactating women with emergency c-sections, within the first 24 hours post birth and throughout the early postpartum period.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0876-1) contains supplementary material, which is available to authorized users.

ResearchM ilk is an important source of vitamin D, calcium, riboflavin, protein and energy during pregnancy, yet many women choose or are advised to avoid drinking milk for a variety of reasons, including the prevention of allergies in their children.1 Limiting milk intake compromises the quality of the maternal diet; 2-5 women who avoid milk may not obtain adequate levels of vitamin D, calcium, protein or riboflavin. Milk restriction is a risk factor for pregnancy-associated hypertension.6 Low vitamin D intake is associated with neonatal rickets 7 and decreased birth weight. 8Inadequate consumption of riboflavin is associated with decreases in weight, 9 length and head circumference of babies at birth. 10Although most nutrients in milk may be replaced from other foods or with supplements, vitamin D is found in few commonly consumed foods except for milk fortified with the vitamin.11 Dermal conversion of the precursor cholecalciferol to activated vitamin D is a seasonally unreliable source, particularly when the exposure of skin to sunlight is limited, 12and may not compensate for low nutritional intake. Under optimal conditions, 15 minutes of daily exposure of the hands and face to sun is required to produce adequate vitamin D, 13 but this conversion is reduced by the prolonged winter season at more polar latitudes, 14,15 by use of sunscreens with a sun protection factor (SPF) above 8, 16 and by ozone air pollution. 13People whose skin pigmentation is dark are more vulnerable than others to insufficient vitamin D conversion. 16In this study we compared the birth weight, crown-heel length and head circumference of newborns whose mothers restricted their intake of milk during pregnancy with the babies of those who did not. MethodsBetween May 1997 and June 1999 we screened 2091 women who attended prenatal classes at 3 hospitals in Calgary, Alberta. The study was approved by the Institutional Review Board of McGill University as well as by the Calgary Health Region Ethics Board.Women were given an anonymous questionnaire that asked whether they would be willing to participate in an indepth study on dietary intake and pregnancy outcomes, and if they restricted dairy products for any reason. For consenting participants, a second questionnaire asked for demographic data, lifestyle characteristics (e.g., smoking habits, highest level of education achieved) and if they had certain metabolic conditions (e.g., diabetes, hypertension) or a multiple pregnancy. Only healthy mothers with singleton pregnancies were Association of low intake of milk and vitamin D during pregnancy with decreased birth weightB Ba ac ck kg gr ro ou un nd d: : Some pregnant women may be advised or choose to restrict milk consumption and may not take appropriate supplements. We hypothesized that maternal milk restriction during pregnancy, which can reduce intakes of protein, calcium, riboflavin and vitamin D, might represent a health risk by lowering infant birth weight. M Me et th ho od ds s: : We screened women between the ages of 19 and 45 years...

BackgroundMany women find breastfeeding challenging to sustain beyond the first three postpartum months. Women rely on a variety of resources to aid and encourage breastfeeding, including ‘partner support’. Women’s perception of partner support during breastfeeding may influence maternal satisfaction and confidence but it remains understudied. We asked women about their perceptions of partner support during breastfeeding and measured the effect on maternal confidence, commitment, and satisfaction with respect to breastfeeding.MethodsUsing a descriptive, cross sectional design, we recruited 76 mothers from community health clinics in Calgary, Alberta. Participants completed a questionnaire addressing perceptions of partner support, the Breastfeeding Self-Efficacy Scale (BSES) measuring maternal confidence and ability to breastfeed, and the Hill and Humenick Lactation Scale (HHLS) measuring commitment, perceived infant satiety, and breastfeeding satisfaction. Descriptive analysis was performed on socio-demographic and survey responses. Multiple regression modeling was used to examine the association between partner support and breastfeeding outcomes.ResultsWomen who reported active/positive support from their partners scored higher on the BSES (p < 0.019) than those reporting ambivalent/negative partner support when we controlled for previous breastfeeding experience and age of infant. There were no significant differences between the two groups of women on total score of HHLS or any of the subscales with respect to perceptions of partner support.ConclusionMothers feel more capable and confident about breastfeeding when they perceive their partners are supportive by way of verbal encouragement and active involvement in breastfeeding activities. Mothers with partners who seemed ambivalent, motivated only by “what’s best for baby,” or provided negative feedback about breastfeeding, felt less confident in their ability to breastfeed. It is important that health care professionals appreciate the influence that positive and active partner support has upon the development of maternal confidence in breastfeeding, a known predictor for maintaining breastfeeding. Common support strategies could be communicated to both the partner and mother in the prenatal and postpartum periods. Health professionals can provide information, invite partners to become active learners and discuss supportive partner functions. Further research should address those functions that are perceived as most supportive by mothers and that partners are willing to perform.

BackgroundGeophagy, a form of pica, is the deliberate consumption of soil and is relatively common across Sub-Saharan Africa. In Tanzania, pregnant women commonly eat soil sticks sold in the market (pemba), soil from walls of houses, termite mounds, and ground soil (kichuguu). The present study examined geophagy practices of pregnant women in a gold mining area of Geita District in northwestern Tanzania, and also examined the potential for exposure to chemical elements by testing soil samples.MethodWe conducted a cross sectional study using a convenience sample of 340 pregnant women, ranging in age from 15–49 years, who attended six government antenatal clinics in the Geita District, Tanzania. Structured interviews were conducted in June-August, 2012, to understand geophagy practices. In addition, soil samples taken from sources identified by pregnant women practicing geophagy were analysed for mineral element content.ResultsGeophagy was reported by 155 (45.6%) pregnant women with 85 (54.8%) initiating the practice in the first trimester. A total of 101 (65%) pregnant women reported eating soil 2 to 3 times per day while 20 (13%) ate soil more than 3 times per day. Of 155 pregnant women 107 (69%) bought pemba from local shops, while 48 (31%) consumed ground soil kichuguu. The estimated mean quantity of soil consumed from pemba was 62.5 grams/day. Arsenic, chromium, copper, iron, manganese, nickel and zinc levels were found in both pemba and kichuguu samples. Cadmium and mercury were found only in the kichuguu samples. Based on daily intake estimates, arsenic, copper and manganese for kichuguu and copper and manganese for pemba samples exceed the oral Minimum Risk Levels designated by the U.S. Agency for Toxic Substance and Disease Registry.ConclusionAlmost 50% of participants practiced geophagy in Geita District consistent with other reports from Africa. Both pemba and kichuguu contained chemical elements at varying concentration, mostly above MRLs. As such, pregnant women who eat soil in Geita District are exposed to potentially high levels of chemical elements, depending upon frequency of consumption, daily amount consumed and the source location of soil eaten.

The prevalence of type 2 diabetes (T2DM) is increasing rapidly and the age of presentation is falling. These changes are likely to be linked to the current obesity epidemic. Our objective was to compare the characteristics of younger patients with T2DM (diagnosed at age < 40 years) with those of older patients (diagnosed at age 50-70 years). We identified 149 younger patients with T2DM, from our diabetes clinic database, and compared them with 217 older T2DM patients randomly identified from the same database. Younger patients with T2DM were more obese, more hypertriglyceridaemic, with lower high-density lipoprotein (HDL) cholesterol, higher total cholesterol/HDL ratio and worse initial and ongoing glycaemic control than older patients from the same clinic. Additional cardiovascular risk factors are associated with T2DM in the young. Treatment should be aimed at early modification of lifestyle and other forms of therapy to avoid long-term complications.