Breastfeeding by Women Living With Human Immunodeficiency Virus in a Resource-Rich Setting: A Case Series of Maternal and Infant Management and Outcomes

Nashid, Nancy; Khan, Shahed U. M.; Loutfy, Mona; MacGillivray, Jay; Yudin, Mark H.; Campbell, Douglas M.; Barozzino, Tony; Baqi, Mahin; Read, Stanley; Bitnun, Ari

doi:10.1093/jpids/piz003

Cited by 29 publications

(25 citation statements)

References 16 publications

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“…Yet, the scarcity of data in HICs presents ongoing challenges to standardizing those recommendations for WLWHIV in HICs. To our knowledge, there is only one published report of the clinical management of WLWHIV ( N = 2) in a HIC wishing to breastfeed that did not result in HIV transmission to the infants ( N = 3; Nashid et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis

Griswold

Pagano-Therrien

2020

J Hum Lact

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Background: Recommendations to avoid breastfeeding for women living with HIV in high income countries has resulted in a gap in the literature on how healthcare professionals can provide the highest standard of lactation counseling. Research aims: (1) Describe social and emotional experiences of infant feeding for women living with HIV in high income countries; (2) raise ethical considerations surrounding the clinical recommendation in high income countries to avoid breastfeeding. Methods: A systematic literature search was conducted between January 1, 2008 and June 20, 2019. A total of 900 papers were screened and six met the inclusion criteria: (a) the sample was drawn from a high-income country regardless of the nativity of participants; (b) some or all participants were women living with HIV. Metasynthesis, according to Noblit and Hare (1988), was used to synthesize the experiences of women living with HIV in high-income countries and their experiences in infant feeding decisions. Results: Participants in this sample suffered a substantial emotional burden associated with infant feeding experiences potentially leading to risk of internalized stigma, suggesting that infant feeding considerations may contribute to HIV stigma in unique ways. Four overarching themes were identified expressing the meaning of avoidance of breastfeeding: maternal self-worth, deculturalization, surveillance, and intersectionality. Conclusion: Women in high-income countries living with HIV deserve the highest standard of lactation care and counseling available. Healthcare professionals in high-income countries are ethically obligated to provide evidenced-based lactation care and counseling to women living with HIV.

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Section: Introductionmentioning

confidence: 99%

Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis

Griswold

Pagano-Therrien

2020

J Hum Lact

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“…33 None of 3 Canadian infants were infected with 2 WLWH breastfeeding with nondetectable mVL and triple infant prophylaxis after 6 weeks, respectively, 12 weeks of nursing. 34 To the best of our knowledge, no VT has been shown in optimal scenarios in high-income countries.…”

Section: Discussionmentioning

confidence: 97%

Brief Report: HIV-Positive and Breastfeeding in High-Income Settings: 5-Year Experience From a Perinatal Center in Germany

Weiß

Both

Rack-Hoch

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Exclusive breastfeeding is recommended for women living with HIV (WLWH) in low-income-but not in high-incomecountries, where milk substitutes are preferred. Some guidelines for highincome countries opted for a shared decision-making process regarding breastfeeding in optimal scenarios with adherence to antiretroviral therapy (cART), suppressed maternal viral load (mVL), and clinical monitoring. Although vertical transmission (VT) risk under cART is estimated below 1% in low-income settings, data from high-income countries are rare. Methods:We retrospectively analyzed all 181 live births from WLWH at the LMU Munich university hospital perinatal center in Germany between January 2016 and December 2020. We focused on VT, suppressed mVL and optimal scenario rates, breastfeeding frequency, cART regimens, and infant prophylaxis. All women were counseled according to current guidelines, foremost recommending avoidance of breastfeeding.Results: In the 5-year cohort, no VT was observed. One hundred fifty-one WLWH (83.4%) decided not to breastfeed, even in optimal scenarios. Thrity infants (16.6%) were nursed, of which 25 were within an optimal scenario, whereas in 5 cases, breastfeeding was performed with a detectable VL in pregnancy or the postpartum period. All WLWH were treated with cART at delivery, and 91.7% sustained suppressed mVL. Zidovudine infant prophylaxis was given between 2 and 8 weeks but not necessarily over the whole breastfeeding duration and was declined from 5 breastfeeding WLWH.Conclusions: Although the cohort is too small to assess VT risk through breastfeeding with cART-suppressed mVL, breastfeeding might be an alternative even in high-income countries, but further studies are needed.

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“…As seen before, there are different factors that can influence the newborn’s feeding practice, such as socioeconomic level, family size, work, and belief systems, among others [ 8 , 9 , 10 , 59 , 60 ]. The discussion about newborn feeding for medical students is even more relevant when dealing with family situations that are not commonly presented, such as the challenges of single-father families created by surrogacy [ 61 ], women with HIV [ 62 , 63 ], diabetes, or in the case of mothers who are unwilling or unable to breastfeed their babies [ 59 , 64 ]. These families may need different approaches and different recommendations from the medical team.…”

Section: Discussionmentioning

confidence: 99%

Newborn Feeding Knowledge and Attitudes among Medical Students

Pereira

Campos

Silva

et al. 2023

EJIHPE

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This study sought to assess newborn feeding knowledge and attitudes among medical students. A sample of 649 Portuguese medical students completed an online survey containing a sociodemographic questionnaire, the Newborn Feeding Ability Questionnaire (NFA), and the Iowa Infant Feeding Attitudes Scale (IIFAS). The overall sample showed moderate scores for all variables. Gender analysis identified significant differences only for the dimension related to the benefits of skin-to-skin contact between mother and newborn where women scored higher. Analysis by year of training found that students with more years of training scored higher on all variables of newborn feeding knowledge that were positively correlated and were positive predictors of newborn feeding attitudes. Students with fewer years of training scored higher on work practices interfering with newborn feeding ability, which were negatively correlated and were negative predictors of newborn feeding attitudes. These results demonstrate that medical students with more years of training are the most prepared, however, the moderate results of the sample raise concerns. Our results point to the importance of providing medical students with adequate knowledge in order to influence their attitudes toward newborn feeding and contribute to better working practices for future health professionals.

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Breastfeeding by Women Living With Human Immunodeficiency Virus in a Resource-Rich Setting: A Case Series of Maternal and Infant Management and Outcomes

Cited by 29 publications

References 16 publications

Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis

Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis

Brief Report: HIV-Positive and Breastfeeding in High-Income Settings: 5-Year Experience From a Perinatal Center in Germany

Newborn Feeding Knowledge and Attitudes among Medical Students

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