The Secret to Pain Free Breastfeeding

Breastfeeding Help And Baby Care For New Parents

The Breastfeeding Help Video Compilation By Australian International Board Certified Lactation Consultant Kate Hale is full of useful information about breastfeeding and how to manage low supply. It is very clear and concise in its content. It also has a lot handy tips for new mothers, including how to bath, massage and dress an infant. Learn how to care for a new-born, including how to deeply latch your baby and breastfeed without pain within minutes for a contented baby and an end to sore nipples. It is the only Dvd of which I am aware that is readily available to new mothers with an actual demonstration on how to correctly latch a baby on and off the breast using a couple of alternative feeding positions. Reading about breastfeeding in a book is nowhere near as useful as watching the Dvd. Read more here...

Breastfeeding Help And Baby Care For New Parents Summary


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The author has done a thorough research even about the obscure and minor details related to the subject area. And also facts weren’t just dumped, but presented in an interesting manner.

I give this ebook my highest rating, 10/10 and personally recommend it.

Recent Trials of Combination ARVs in Breastfeeding Populations

The shortcomings of the above West African trial are the small proportions of breastfeeding women (46 -54 ), and the very early end point at 4-6 weeks for establishing the transmission rates. In many parts of Africa and Asia women breastfeed for longer periods and transmission of HIV occurs as long as they breastfeed. In the MASHI trial in Botswana (Shapiro et al., 2004), antenatal AZT from 34 weeks provided the backbone for a number of subsequent interventions. Breastfed infants were given AZT for 6 months and there was an 86 adherence to this prophylactic drug. Median duration of breastfeeding was 5.8 months, and 18 of the women breastfed exclusively, whilst 50 gave mixed feeding. The MTCT rates in breast- and formula fed infants are given in Table 17.6. The incremental transmission due to breastfeeding (i.e. between 1-7 months) with AZT was 4.5 there was no comparison group of breastfed infants who had not been given AZT. In order to provide a rough idea of the benefits of the AZT,...


A collaborative reanalysis of data from 47 epidemiological studies has established that, in the general population, women who breastfeed are at a slightly lower risk of breast cancer, and that each cumulative year of breastfeeding reduces risk by 4.3 (20). This association is independent of parity. Three published studies have investigated this association among BRCA1 and BRCA2 mutation carriers. Based on analyses of 1930 carriers of both mutations from a subset of collaborators in the consortium led by Narod (32), it was found that increasing the duration of breastfeeding was associated with increasing protection from breast cancer among carriers of mutations in BRCA1 (approximately 22 per year of breastfeeding). However, this effect was not seen for BRCA2 mutation carriers, although the latter group consisted of fewer (560) carriers. The Polish study of 696 BRCA1 mutation carriers previously mentioned, which may have included some of the data in the paper by Jernstrom et al. (32),...

Modulation of Specific Immune Responses The IgA Anti Rotavirus Response

This fact is of particular importance in babies where the poorly diversified intestinal microbiota is strongly influenced by the type of milk. Indeed, it is well known that breastfed babies are more resistant to enteric infections than formula-fed babies (69,70). Human breast milk contains abundant bioactive components that may provide direct protective effects to infants against enteric pathogens (71), but breast-feeding also influences the intestinal microbiota composition enhancing Bifidobacterium development. To test the influence of the intestinal microbiota on the modulation of a specific intestinal sIgA-Ab response, a sIgA anti-rotavirus response was established in a mouse model. This involved an original model of adult gnotobiotic mice colonized with the fecal microbiota of a breast- or a bottle-fed infant and then orally inoculated with a heterologous simian rotavirus strain SA-11. As previously described, the adult mouse model described here excluded breast milk effects and...

Characteristics of HIV infection in childhood

More than 95 of children are infected by perinatal transmission of the virus from the mother to the child (vertical infection). Transmission by transfusion, sexual transmission and drug abuse are much less prevalent. In most cases (75-90 ) HIV is transmitted peri- or intrapartum. Only a small proportion of children are infected in utero (10-25 ). Transmission by breastfeeding is important in resource-poor settings, but plays a minor role in developed countries, where breastfeeding by known HIV-infected mothers is strongly discouraged. The increasing knowledge about how HIV is vertically transmitted has led to a highly effective transmission prophylaxis and significant reduction of the transmission rate to less than 2 . However, new infections in HIV-exposed children still occur

The Behavioral Environment

1 Breastfeeding Breastfeeding may protect against subsequent overweight in childhood. Two review papers on this topic published in 1999 and in 2001 both failed to find conclusive evidence of a significant positive effect of breastfeeding (79,94). Nonetheless, well-designed studies with large samples that controlled for potential confounders have demonstrated a protective effect of breastfeeding against overweight in childhood. Von Kries et al. (95) found that infants who were ever breastfed were 0.75 (95 Confidence Interval CI 0.57-0.98) times as likely to be overweight (BMI > 90th centile German schoolchildren) at 5-6 years of age. Gillman et al. (96) found that infants who were exclusively or mostly breastfed were 0.78 (95 CI 0.66-0.81) times as likely to be overweight (BMI > 95th centile NCHS CDC reference) at 9-14 years of age. Both studies found a dose-response effect breastfeeding of at least 6 or 7 months was more protective than < 3 months. Although the Hediger et al....

Summary And Implications For Clinical Practice And Public Health

And extended duration of breastfeeding, and the elimination of the barriers that lead to early termination of breastfeeding, must become high priorities. Work site facilities and policies that allow mothers who must return to work to continue to provide breast milk for their infants may represent one of the policy shifts necessary to help address the overweight epidemic (137).

Delivery of the placenta

Symptomatic Medications Acetaminophen codeine (Tylenol 3) 1-2 tab PO q3-4h prn OR Oxycodone acetaminophen (Percocet) 1 tab q6h prn pain. Milk of magnesia 30 mL PO q6h prn constipation. Docusate Sodium (Colace) 100 mg PO bid. Dulcolax suppository PR prn constipation. A and D cream or Lanolin prn if breast feeding. Breast binder or tight brazier and ice packs prn if not to breast feed. Labs Hemoglobin hematocrit in AM. Give rubella vaccine if titer < 1 10.

Brief History Of The Development Of Bifidus Factors And Prebiotics

Interest in bifidogenic compounds accelerated with the identification of non-digestible oligosaccharides (NDOs) in human milk as major factors responsible for maintaining an intestinal microbiota numerically dominated by bifidobacteria in breastfeeding infants. In contrast, infants fed cow's milk-based formula developed a mixed microbiota, including higher levels of potentially deleterious organisms (23,24). Human

Penetrance of BRCA1 and BRCA2 Mutations

The New York Ashkenazi Jewish study found that the risk of breast cancer by age 50 in carriers of a BRCA1 or BRCA2 founder mutation was 24 in women born prior to 1940 but 67 in those born after this date (53). The meta-analysis of population-based studies also found the relative risk of breast cancer associated with a BRCA1 mutation to be significantly higher for more recent birth cohorts (the same trend was seen for BRCA2 but was not statistically significant) (41). This could reflect less accurate reporting of cancers in the earlier decades. However, changes in a wide range of lifestyle factors, including diet, exercise, reproductive factors such as age at first pregnancy, family size, breast-feeding preferences, and oral contraceptive use, or in other environmental factors, might also be contributory factors.

Lepirudin in Pregnancy

A case report described a breastfeeding woman diagnosed with HIT who was treated with sc lepirudin, 50 mg twice daily (Lindhoff-Last et al., 2000a). No lepirudin was detected in her breast milk, although plasma levels were within therapeutic range. Neither bleeding nor thrombosis occurred in mother or infant.

Neurological Effects

Alzheimer's dementia A 2003 prospective study conducted with a random sample of 81 5 older volunteers (aged 65-94 years) who initially were unaffected by Alzheimer's dementia (AD) found that consumption of fish once weekly was associated with a 60 reduced risk of developing the disease compared with those who rarely or never ate fish, after adjustment for age and other risk factors (Morris et al 2003). A review of the evidence prepared for the US Department of Health and Human Services in 2005 concluded that there is a significant correlation between fish consumption and reduced incidence of AD. Total n-3 EFA and DHA consumption correlated with this risk reduction however, ALA and EPA did not (Maclean et al 2005). A recent Cochrane review came to a similar conclusion and reported that there is a growing body of evidence from biological, observational and epidemiological studies to suggest a protective effect of omega-3 PUFAs against dementia however, further research is required...

Infant Feeding And Obesity

A recent study of 15,000 children aged 9-14 years found that in those who had been only or mostly fed breast milk, the odds ratio for being overweight was 0.78 (95 CI 0.66-0.91) compared with children who had been only or mostly fed infant formula (31). This apparent protective effect of breastfeeding against obesity persisted after adjustment for energy intake, physical activity, mother's body mass index, and other variables. The same association has not been found consistently in younger children, and there may be a latent period during childhood before it is manifest. A mechanistic explanation of the association is that breastfed babies have greater control of their intake than bottle-fed babies, and therefore develop better self-regulatory mechanisms. Another possibility is that hormones and growth factors in breast milk permanently change the baby's metabolism. There is no specific evidence for this, but breastfeeding has been shown to be associated with lower levels of...

Breast And Ovarian Analysis Of Disease Incidence And Carrier Estimation Algorithm Boadicea

Nongenetic risk factors, e.g., parity, breast feeding, and age at menopause may be possible when the contribution of these factors to the overall risk to BRCA carriers has been more comprehensively assessed by long-term studies such as Epidemiological Study of Familial Breast Cancer (EMBRACE) (27).

Hormonal Carcinogenesis

Logically, identifiable murine mammary tumor virus or type B virus in human breast milk. We undertook our first epidemiological study of breast cancer in young women to address the possibility that a transmissible agent causing breast cancer might also exist in human breast milk. We were unable to substantiate this hypothesis as there was no evidence of excess risk associated with breast-feeding, and the excess familial risk of breast cancer was seen in both the paternal and the maternal family trees.12 However, we were very impressed with the evidence supporting a role for endogenous estrogen and the key importance of age at menarche as an expression of this susceptibility. Over the subsequent 25 years, we as well as others13,14 have continued to utilize epidemiological and sero-logical studies to accumulate evidence that endogenous estrogens played a pivotal role in breast cancer.15 At the same time, it became increasingly clear that endogenous hormones were likely to be important...

Do the therapeutic effects outweigh any negative aspects

All effective drugs have side-effects, usually unwanted ones. Many psychotropics react adversely with other drugs or alcohol, and impair driving skills. Elderly patients, women who are pregnant or breast-feeding, and patients with medical disorders are at greatest risk of unwanted effects. Tolerance and or dependence seldom cause problems except with benzodiazepines, but patients are often

Reflection of Environmental Factors

Amongst the best examples of factors which have been clearly shown to influence the development of the gut microbiota and have also been implicated in allergic diseases include the mode of delivery and breast-feeding (116-123). Indeed, it is plausible that the characteristics of fecal microbiota associated with atopic eczema and allergic sensitization may partly reflect dietary factors. It is well known that changes in diet may dramatically affect the microbial composition of the gut. Then again, in allergic infants the diet can reflect the child's health status due to food restrictions. In 39-63 of all infants and young children, atopic eczema is triggered by one or more challenge-confirmed food allergies (124-126). Moreover, the development of manifestations of allergic diseases in children correlates with differences in the composition and immunological characteristics of breast-milk, which on the other hand are affected by maternal gut microbiota and atopy (127-133). For example,...

Ramona Sunderworth md

The link between infant, child, and maternal health is one of the most powerful. Half of infant deaths are due to inadequate maternal and newborn care. A mother's death doubles the death rate among surviving sons and quadruples the death rate among surviving daughters. Most programs addressing infant child survival include interventions directed at maternal health. The EPI, the GOBI-FFF program (growth monitoring, oral rehydration, breastfeeding, immunization, food supplementation, female literacy and family planning), the Combating Childhood Communicable Diseases (focusing on immunization and treatment of diarrhea and malaria), the CVI (children's vaccine initiative), the Child Survival Campaign, the Mother and Baby Package, the Safe Motherhood Initiative, and numerous other child and maternal health projects have been launched. The Integrated Management of Childhood Illness strategy integrates elements of existing diarrheal disease and respiratory infection control, immunization,...

Research Exemplars

Infant and child mortality levels showed little evidence of a trend before 1900, but there were important differentials between the villages that are part of the sample. Infant mortality was highest in Bavarian villages and lowest in East Frisian villages, with Baden and Waldeck villages occupying an intermediary position. There was direct survey evidence, collected in the late 19th century to investigate mortality differentials, that women avoided breast-feeding their children in Bavaria and in other parts of southern Germany. This suggested that child feeding patterns provided an explanation of mortality differentials. Two analytical techniques confirmed such an explanation. First, the interval between confinements was considerably reduced in Waldeck and the East Frisian Villages when the first child had died during the first month of life, a circumstance that would interrupt suckling in populations that would commonly practice breastfeeding. In Bavaria, however, the reduction...

Developmental Effects From Neonatal Exposure

For breast-fed children, the main source of metals during the neonatal period is maternal milk. The nutritional habits of the mother and her current or past environmental or occupational exposure strongly influence the kind and level of xenobiotics excreted by the milk, caused, in part, by the redistribution of cumulative maternal bone stores. Ettinger et al. (2004) studied the relationship between maternal breast milk lead and infant blood lead levels among 255 mother-infant pairs exclusively or partially breast-feeding in Mexico City. Although the levels of lead in breast milk were low, they clearly influenced infant blood lead levels. These findings are balanced by the fact that human milk is an excellent source of nutrition for young infants, and environmental sources of lead contribute more to neonatal lead intake than do dietary sources (Lin-Fu, 1980) despite the more recent significant lowering of environmental lead pollution in many industrialized countries.

Development of Resistance To Nevirapine

On balance, it would be reasonable to exclude the infant dose of NVP if AZT had been provided during the antenatal period. However, a case could be made for simply retaining the sdNVP doses to both mother and infant, as it acts on the intra-partum transmission and may reduce early breastfeeding transmission.

Industrialized Countries

The landmark PACTG 076 trial with an efficacy of 68 had established the principle and value of ARVs (AZT) in markedly reducing MTCT (Conner et al., 1994). However, there were a number of reasons why the results were inapplicable to poorer populations in Africa and Asia. These, inter alia, included affordability (the price of ARVs were very high at the time), health services required for implementation (especially antenatal and delivery services), and avoidance of breastfeeding (breastfeeding is the norm in developing countries). With the subsequent precipitous fall in the price of ARVs after the year 2000 the cost of these drugs fell away as an inhibitory element.

An Example HIV Screening in Pregnant Women

Throughout this chapter, the following health care program will serve to illustrate some of the advantages and limitations of cost effectiveness analysis, which will be referred to as the pregnant women example. Screening pregnant women for HIV infection offers opportunities to initiate prenatal antiretroviral therapy, a medical intervention proven to decrease the rates of HIV transmission from mothers to infants. Additionally, identifying women early in their infection provides opportunities for counseling about breast feeding and safe sex. The newborn baby also benefits from early identification and appropriate therapy for HIV infection. However, recent studies estimate about 25 of HIV-seropositive individuals are unaware of their status (Fleming, et al., 2000). Furthermore, a significant proportion of women are still not tested during pregnancy or in labor (Bulterys, et al., 2004 Lansky, et al., 2001 Aynalem, et al., 2004). As an alternative to testing women (with consent), some...

Special case Needlestick injury or other occupational HIV exposure

In exposed babies, at least two negative HIV PCR results are required in order to exclude HIV infection the first one between the 1st and the 4th month of life, the second after the 4th month, as only then it reaches its full significance for exclusion (Rossi 1992). In addition, PCR should be performed already during the first month of life (however not within the first days after delivery, as contamination with maternal virus may occur), as the earliest possible diagnosis of a neonatal infection is important to allow Pneumocystis prophylaxis and early antiretroviral therapy in the first months of life. If already this first sample tests positive (and is confirmed), this points to an intrauterine infection (less frequent) in case of perinatal transmission during birth (most common scenario), virus will only be detectable in the samples obtained later. Attention Breastfeeding carries a significant risk of transmission what stated above is only valid if postnatal acquisition of...

Glaucoma Medical Therapy During Lactation

There are few studies in the literature regarding the safety of glaucoma mediations during breast-feeding. Any medication with any degree of systemic absorption must be assumed to have a measurable level in breast milk. Due to the extreme reluctance to used any medications in pregnant and lactating women, these data are difficult to

Deficiency Signs And Symptoms

Secondary deficiency is caused by an increased requirement, as in hyperthyroidism, pregnancy, lactation, fever, acute infection, increased carbohydrate intake, folate deficiency, malabsorption states, hyperemesis, prolonged diarrhoea, strenuous physical exertion, breast feeding, adolescent growth, and states of impaired utilisation such as severe liver disease, alcoholism and people taking loop diuretics long term. Additionally, pyruvate dehydrogenase deficiency can result in deficiency (Beers & Berkow 2003, Wahlqvist et al 1997, Wardlaw et al 1997).

Theoretical Issues

The proximate determinants paradigm provides a second organizing framework. It rests on the observation that the sequential biological process is influenced through only a few mechanisms, specifically, variables that influence sexual activity, the likelihood of conception, and the likelihood that conceptions result in live births (see Davis and Blake 1956). Bongaarts and Potter's (1978) operationalization of the proximate determinants demonstrates that most fertility variability between populations and over time can be accounted for by the following four determinants (1) marriage and marital disruption (as indicators of the segments of the life cycle when women are sexually active), (2) postpartum infecundability (the period after a birth without ovulation its length is determined primarily by the duration and intensity of breastfeeding), (3) use and effectiveness of contraception, and (4) induced abortion. Three other determinants are

Risks of Motherto ChildTransmission of HIV1

The timing and transmission of HIV-1 from Mother-to Infant is shown in the Table 17.1 (Cock et al., 2000). Transmission takes place in utero, intrapartum, and postnatally through breastfeeding. The in utero rate is 5-10 , intrapartum rate is 10-20 , and the postnatal (breastfeeding) rates vary according to the duration of breastfeeding. Avoidance of breastfeeding which works well in richer populations, is not a realistic option for developing countries because the dangers of formula feeding often outweigh the hazards of breastfeeding transmission of HIV During breastfeeding Overall without breastfeeding Overall with breastfeeding till 6 months Overall with breastfeeding till 18 to 24 months Table 17.2. Transmission rates ( ) month for prevailing (presumed Exclusive and Mixed*) breastfeeding practice Exclusive breastfeeding an infant receives only breastmilk, and no other liquids or solids, not even water, with the exception of drops or syrups consisting of vitamins, mineral...

Factors affecting acquisition of HHV6 infection

Some epidemiologic studies of HHV6 infection in children have suggested that the risk of acquiring HHV6 infection or acquiring it earlier correlates with having one or more older siblings and a lower family income (Lanphear et al., 1998 Zerr et al., 2005). Breastfeeding, racial background, and daycare attendance have not been shown to be independent risk factors (Lanphear et al., 1998 Zerr et al., 2005). The occurrence of HHV6 infection does not appear to be significantly affected by season, although cases of clinical roseola have been reported as being more frequent in the spring (Breese, 1941 Asano and Grose, 1994 Lanphear et al., 1998 Zerr et al., 2005).

Additional contraceptive method

Active liver disease, hepatic adenoma, thrombophlebitis, history of or active thromboembolic disorder, cardiovascular or cerebrovascular disease, known or suspected breast cancer, undiagnosed abnormal vaginal bleeding, jaundice with past pregnancy or hormone use, pregnancy, breast-feeding, smoking in women over age 35

Reflection of Effects on Th1 Th2 and Treg Differentiation

Also Lactobacillus strains have been shown to confer differential effects on cytokine production and expression of surface markers on murine dendritic cells (85). Furthermore, lactobacilli induced in vitro, in a strain dependent manner, Treg-like low proliferating Th population producing TGF-b and IL-10 (86). TGF-b is the key cytokine in induction of T-cell differentiation towards Tregs (Fig. 2) (87). In a clinical study, improvement in atopic eczema symptoms following oral administration of lactobacilli was accompanied by increased serum concentrations of TGF-b (17). Interestingly, oral supplementation of lactobacilli in breast-feeding mothers was followed by increased TGF-b concentrations in breast-milk (88). This increase may have contributed to subsequently lower prevalence of atopic eczema in children. It should be noted, however, that allergic sensitization was not affected and allergic rhinitis and asthma may have increased in frequency (89). Nevertheless, these studies are not...

Antiretroviral agents in pregnancy

In approximately 75 of cases, HIV is transmitted prior to, or during the last weeks prior to birth. About 10 of vertical HIV infections occur before the third trimester, and 10-15 are caused by breastfeeding. Premature rupture of membranes of > 4 h Pre-term infants (< 37 weeks of gestation) Breastfeeding No breastfeeding

Risk Factors for Vitamin A Deficiency

And boys are affected more often than girls. Breast-feeding practices such as no breastfeeding, early weaning, or rapid weaning are associated with an increased risk of vitamin A deficiency. Pregnant women and nonpregnant women of childbearing age are at higher risk of vitamin A deficiency. Vitamin A deficiency tends to cluster in households and in villages, with higher risk of xerophthalmia among children within the same family, and within mothers and their children. The relationships of risk factors for vitamin A deficiency are shown in Fig. 17.


Women who are breast-feeding and people who have decreased kidney functioning should discuss the risks and benefits of this drug with their physician. Women who are or wish to become pregnant will also require a careful assessment of the risks and benefits of gabapentin.


Breastfeeding 2001, Part I. The evidence for breastfeeding. The role of breastfeeding in obesity. Gillman MW, Rifas-Shiman SK, Camargo CA Jr, et al. Risk of overweight among adolescents who were breastfed as infants. JAMA 2001 285 2461-2467. Hediger ML, Overpeck MD, Kuczmarski RJ, Ruan WJ. Association between infant breastfeeding and overweight in young children. JAMA 2001 285 24532460. 137. Dietz WH. Breastfeeding may help prevent childhood overweight. JAMA 2001 285 2506-2507.

Developing Countries

Among non-breastfeeding populations the efficacy of AZT ranged from 70 (Lallemant et al., 2000) to 50 (Shaffer et al., 1999). In breastfeeding populations, the important indicator of success is the transmission at the time when breastfeeding is discontinued this is often between 18 months to 24 months among poor women. The higher efficacies obtained at 6 weeks of age, 63 in the PETRA trial (Arm A) (Petra Study Team 2002) and 47 in HIVNET012 (Guay et al., 1999), and between 3 months and 6 months in the West African Studies of 36-48 (Wiktor et al., 1999 Dabis et al., 1999 LeRoy et al., 2002) had decreased between 18-24 months to 41 in HIVNET012 (Jackson et al., 2003), 33 in PETRA (Arm A) (Petra Study Team, 2002), and 23-28 in the West African studies (Leroy et al., 2002). Table 17.4. Antiretroviral interventions to reduce mother-to-child transmission of HIV Non-breastfeeding Table 17.4. Antiretroviral interventions to reduce mother-to-child transmission of HIV Non-breastfeeding Table...

Global Distribution

Serum vitamin A concentrations were low among children and pregnant and breast-feeding women from refugee camps and nearby villages in the Sahel region (705). A national survey conducted in 1988 showed that 2 of children aged 6-72 mo had night blindness. The prevalence of night blindness was high in Tera, Tillaberi, and Ouallam Provinceds (600). High-dose vitamin A capsule distribution was integrated with national immunization days in 1997 (706).

Topical Reactions

A 38-year-old woman developed a garlic burn after applying a poultice made from fresh, uncooked garlic to her breast for treatment of a self-diagnosed Candida infection secondary to breastfeeding her 6-month-old son (101). Despite a burning sensation upon application, she left the poultice in place for 2 days. The infant continued to feed with no apparent adverse effects. She presented to the emergency room 2 days after removal of the poultice. Physical exam revealed that the area where the poultice had been applied appeared as a burn with skin loss, ulceration, crusting, hyperpigmentation, granulation tissue, serous discharge, minor bleeding, and erythema on the periphery. The area was tender. The patient was treated with 1 silver sulfadiazine cream.

Amiodarone Cordarone

Adverse effects may cause severe sinus bradycardia, ventricular arrhythmias, AV block, liver and thyroid function test abnormalities, hepatitis, cirrhosis pulmonary fibrosis may follow long-term use increases serum levels of digoxin, oral anticoagulants, diltiazem, quinidine, procainamide, and phenytoin. Comments avoid during pregnancy and while breast feeding use with caution in renal failure.


A larger study that involved 30 women who were taking St. John's wort and breastfeeding compared results to women who were not taking St. John's wort. There were no differences in maternal events, including duration of breastfeeding, decreased lactation, or maternal demographics. Women taking St. John's wort did report a significantly higher level of infant side effects, such as lethargy and colic, vs one case of infant colic in 97 women not taking St. John's wort. None of these infants required medical attention (94).

Of Cities

Several public health approaches to childhood obesity reduction especially among those living in the urban environment are under investigation. Preliminary data suggest that such strategies as behavior modification (Moon, et al., 2004), reduction in TV and movie watching, and decreased video gaming (Robinson, 1999), and early initiation of breast feeding (Armstrong and Reilly, 2002) may be beneficial in reducing overweight and obesity levels in children (Campbell, et al., 2001). Experience with obesity prevention is limited, and the need for more research remains a priority.


Lactation has been increasingly reported to provide protection against breast cancer development. If the cumulative number of ovulatory cycles is directly related to breast cancer risk, a beneficial effect of long duration of nursing would be expected since nursing results in a delay in re-establishing ovulation following a completed pregnancy. With only a small proportion of mothers having a large number of cumulative nursing months, most epidemiological studies have been unable to provide precise estimates of the effects of lactation on breast cancer risk. However, studies in non-Western populations have consistently reported an inverse relationship between lactation and breast cancer risk.25,39-43 Further, when attention is focused on premenopausal women, studies have fairly consistently shown a 20 -30 reduction in risk among women who have ever breast-fed.44 London45 noted that recent changes in breastfeeding, i.e., on-demand feeding rather than scheduled feedings, may result in a...

Postnatal depression

A 29-year-old professional woman lived comfortably with her husband and two small children. Her third pregnancy was unplanned, but the couple seemed to accept it well. Midway through the pregnancy, the husband was made redundant, and they began to experience some marital difficulties. During the third trimester, the patient became increasingly tearful and tired. She had a prolonged and painful labour, but the baby was well, and breast-feeding was established satisfactorily. The health visitor called the GP, who visited the family and confirmed the diagnosis of depression, prescribed a tricyclic antidepressant (compatible with breast-feeding), and encouraged the health visitor to offer supportive counselling in addition to monitoring the baby's well-being.


Comments Warnings sulfadiazine is contraindicated in sulfonamide hypersensitivity and allergies to sulfonyl urea antidiabetics, acetazolamide or thiazide diuretics also in G6PD deficiency, renal failure and severe hepatic disease or dysfunction (e.g. acute hepatitis) and during pregnancy and breastfeeding.


Breastfeeding (> 12 months vs. never) Age at menarche (per year) Oral contraceptive use (ever) > 30 years) Induced abortion (ever) Miscarriage (ever) Breastfeeding (> 12 months vs.never) BRCA2 carriers Parity (ever) Breastfeeding (> 12 months vs. never) Pooled carriers Parity (per birth) Breastfeeding (> 12 months vs. never) Breastfeeding (> 12 months vs. never)

Parous Phenotypes

International studies by MacMahon, et al. (12,13) suggested that women undergoing a full-term pregnancy before the age of 18, with or without lactation, have about one-third the risk for developing BC compared to women undergoing a first pregnancy after the age of 35. Recently, meta-analysis of BC risk reduction related to breast feeding has been performed based on data from 47 epidemiological studies from 30 countries (3). Their analysis shows that breast-feeding is associated with a substantial risk reduction. The risk for developing BC decreases by 4.3 for each 12 mo of nursing in addition to a decrease of 7 for each birth.

Risk Factors for AOM

AOM occurs most frequently in winter months, and is usually preceded by a viral upper respiratory tract infection (Henderson et al., 1982 Arola et al., 1990). Apart from young age (< 2 years), and a history of a previous episode of AOM, other risk factors for AOM include the risk factors for viral upper respiratory infections attending day care outside the home, exposure to cigarette smoke, having at least one sibling, and possibly use of a dummy (pacifier) (Uhari et al., 1996 Owen et al., 1993). The protective effect of breast feeding is unclear, with studies showing both a beneficial effect, as well as either no effect or increased incidence (Rovers et al., 2004).

Ovarian Cancer

A woman has a 1-in-70 risk of developing ovarian cancer in her lifetime. The incidence is 1.4 per 100,000 women under age 40, increasing to approximately 45 per 100,000 for women over age 60. The median age at diagnosis is 61. A higher incidence of ovarian cancer is seen in women who have never been pregnant or who are of low parity. Women who have had either breast or colon cancer or have a family history of these cancers also are at higher risk of developing ovarian cancer. Protective factors include multiparity, oral contraceptive use, a history of breastfeeding, and anovulatory disorders.

Figure 2235

The act of suckling during breast-feeding initiates sensory impulses from receptors in the nipple to the hypothalamus. The impulses inhibit the release of prolactin-inhibiting factor, and prolactin is then released from the adenohypophysis. The sensory impulses also cause the release of oxytocin in the neurohypophysis. Oxytocin stimulates the myoepithelial cells that surround the base of the alveolar secretory cells and the base of the cells in the larger ducts, causing them to contract and eject the milk from the alveoli and the ducts. In the absence of suckling, secretion of milk ceases, and the mammary glands begin to regress. The glandular tissue then returns to an inactive condition.

HIV Infection

Vitamin A supplementation may have some benefit for HIV-infected children and pregnant women in developing countries. Low plasma or serum concentrations of vitamin A or intake of vitamin A has been associated with increased disease progression, mortality, and higher mother-to-child transmission of HIV (486). Periodic high-dose vitamin A supplementation seems to reduce morbidity among children born to HIV-infected mothers (487) and diarrheal disease morbidity in HIV-infected children after discharge from the hospital for acute lower respiratory infection (488). A recent controlled clinical trial in Uganda shows that periodic high-dose vitamin A supplementation, 30 RE every 3 mo, reduces morbidity and mortality of HIV-infected children (489). A study in Malawi, which used vitamin A supplementation, 10,000 IU day, found no increased risk of mother-to-child transmission of HIV, and in fact, the results were suggestive that vitamin A was protective against late mother-to-child transmission...


In the absence of any intervention an estimated 15-30 of mothers with HIV infection will transmit the infection during pregnancy and delivery. In approximately 75 of these cases, HIV is transmitted during late pregnancy or during delivery. About 10 of vertical HIV infections occur before the third trimester, and 10-15 are caused by breastfeeding.

Pregnancy and HIV

Perinatal (vertical) HIV infection has become rare since the introduction of antiret-roviral transmission prophylaxis and elective cesarean section. While the vertical HIV transmission rate ranged from 15 to 20 in the United States and Europe at the beginning of the nineties, it now amounts to only a few percent (Connor 1994, European Collaborative Study 2001, Marcollet 2002, Hollwitz 2004). Postpartum HIV infections are avoidable provided that HIV-infected mothers do not breastfeed. At the same time as transmission prophylaxis was introduced, the treatment of HIV infection changed too. Nowadays, pregnancy is no longer a contraindication for antiretroviral therapy as long as individual maternal circumstances are taken into consideration (Cooper 2002, CDC 2005).

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.

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