Duration of lactation and incidence of type 2 diabetes. The value of a pilot study in breast-feeding research. Breastfeeding Rates in the United States by Characteristics of the Child, Mother, or Family: The 2002 National Immunization Survey CONSORT statement: extension to cluster randomised trials Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Breast feeding and cognitive development in childhood: a prospective birth cohort study. Randomized controlled trial of very early mother-infant skin-to-skin contact and breastfeeding status. Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum Randomized controlled trial to determine effects of prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration. Home breastfeeding support by health professionals: findings of a randomized controlled trial in a population of Italian women Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs Exclusive breastfeeding protects against bacterial colonization and day care exposure to otitis media. Does breastfeeding protect against pediatric overweight? Analysis of longitudinal data from the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Menstrual and reproductive factors in relation to ovarian cancer risk Exclusive breast-feeding for at least 4 months protects against otitis media. Breastfeeding duration, costs, and benefits of a support program for low-income breastfeeding women. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding The association between duration of breastfeeding and adult intelligence. Breast feeding and cognitive development at age 1 and 5 years Influence of parity and lactation on hip fracture risk. A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low-income community. Breastfeeding expectations versus reality: a clusterrandomised controlled trial Association of degree and timing of exposure to breastfeeding peer counseling services with breastfeeding duration. Factors influencing the relation of infant feeding to asthma and recurrent wheeze in childhood Randomized trial of postpartum care after hospital discharge. Effect of lifetime lactation on breast cancer risk: a Korean women's cohort study. Two mid-pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial. A breast-feeding promotion and support program a randomized trial in The Netherlands. Can support and education for smoking cessation and reduction be provided effectively by midwives within primary maternity care? Prospective assessment of exclusive breastfeeding in relation to weight change in women A Mother's Feelings for Her Infant Are Strengthened by Excellent Breastfeeding Counseling and Continuity of Care The effect of peer support on breast-feeding duration among primiparous women: a randomized controlled trial. Home versus hospital breastfeeding support for newborns: a randomized controlled trial. Randomized, Controlled Trial of a Prenatal and Postnatal Lactation Consultant Intervention on Duration and Intensity of Breastfeeding up to 12 Months Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. Breastfeeding Attitudes, Intention, and Initiation in Low-Income Women: the Effect of the Best Start Program A randomised controlled trial in the north of England examining the effects of skin-to-skin care on breast feeding. Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. Simple Antenatal Preparation to Improve Breastfeeding Practice: A Randomized Controlled Trial Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use. The decline in the incidence of SIDS in Scandinavia and its relation to risk‐intervention campaigns How should relative risk estimates for acute otitis media in children aged less than 2 years be perceived? Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Predictors, prodromes and incidence of postpartum depression Mother‐infant skin‐to‐skin contact after delivery results in early recognition of own mother's milk odour Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Comparison of the effect of two systems for the promotion of exclusive breastfeeding Postpartum positioning and attachment education for increasing breastfeeding: a randomized trial. Pacifier use, early weaning, and cry/fuss behavior: a randomized controlled trial. Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support? A randomised-controlled trial in England of a postnatal midwifery intervention on breast-feeding duration. Postnatal home visits in teenage mothers: a randomised controlled trial
CONTEXT Lactation is associated with improved glucose and insulin homeostasis , independent of weight change . OBJECTIVE To evaluate the association between lactation history and incidence of type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational cohort study of 83,585 parous women in the Nurses ' Health Study ( NHS ) and retrospective observational cohort study of 73,418 parous women in the Nurses ' Health Study II ( NHS II ) . MAIN OUTCOME MEASURE Incident cases of type 2 diabetes mellitus . RESULTS In the NHS , 5145 cases of type 2 diabetes were diagnosed during 1,239,709 person-years of follow-up between 1986 and 2002 , and in the NHS II , 1132 cases were diagnosed during 778,876 person-years of follow-up between 1989 and 2001 . Among parous women , increasing duration of lactation was associated with a reduced risk of type 2 diabetes . For each additional year of lactation , women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15 % ( 95 % confidence interval , 1%-27 % ) among NHS participants and of 14 % ( 95 % confidence interval , 7%-21 % ) among NHS II participants , controlling for current body mass index and other relevant risk factors for type 2 diabetes . CONCLUSIONS Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women . Lactation may reduce risk of type 2 diabetes in young and middle-aged women by improving glucose homeostasis OBJECTIVE To test the integrity of a protocol for a r and omised controlled trial ( RCT ) to examine the effectiveness of skin-to-skin care compared to routine care on the initiation and duration of breast feeding and to provide data to be used in the power calculation for a proposed trial . DESIGN R and omised pilot study . SETTING Warrington Hospital , Cheshire , UK . PARTICIPANTS Women at 36 weeks ' gestation with healthy singleton pregnancies , who intended to breast feed , who had ' booked ' for care at Warrington Hospital and had given informed consent to participate . Twenty-eight women were r and omised in the pilot study . METHOD Women were r and omly allocated to receive either routine or skin-to-skin care following birth . The first breast feed was assessed using the Breast-feeding Assessment Tool ( BAT ) .  Mothers were followed up at discharge from hospital and again at four months to provide details of duration of breast feeding . FINDINGS 66 women were approached to participate in the trial and 44 consented ( 67 % consent rate ) . Twenty-eight women were r and omised in the study and 26 breast feeds were observed ( 93 % ) . The pilot study identified procedural changes that were required in the design of the main study , provided an estimate of recruitment rates and confirmed the previously calculated sample size . CONCLUSION The pilot study demonstrated that a large RCT of skin-to-skin versus routine care was feasible . This is an example of how a pilot study has the ability to identify unforeseen challenges in the conduct of the trial as well as allowing necessary changes to be made to the design that will increase the quality of the subsequent research Objective . In the third quarter of 2001 , the National Immunization Survey ( NIS ) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding . Using the data from the 2002 NIS , this study estimates breastfeeding rates in the United States by characteristics of the child , mother , or family . Methods . The NIS uses r and om-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations  and then vali date s the information through a mail survey of the health care providers who gave the vaccinations . In 2002 , ∼3500 households from the NIS were r and omized to 1 of the 3 rotating topical modules that covered breastfeeding . Results . More than two thirds ( 71.4 % ) of the children had ever been breastfed . At 3 months , 42.5 % of infants were exclusively breastfed , and 51.5 % were breastfed to some extent . At 6 months , these rates dropped to 13.3 % and 35.1 % , respectively . At 1 year , 16.1 % of infants were receiving some breast milk . Non-Hispanic black children had the lowest breastfeeding rates . Breastfeeding rates also varied by participation in day care or the Women , Infants , and Children program , socioeconomic status , and geographic area of residence . Conclusions . Although the rate of breastfeeding initiation in the United States is near the national goal of 75 % , at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50 % and 25 % , respectively . In addition , rates of exclusive breastfeeding are low . Strenuous public health efforts are needed to improve breastfeeding behaviors , particularly among non-Hispanic black women and socioeconomically disadvantaged groups Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement OBJECTIVE To enhance breastfeeding practice s , the World Health Organization discourages pacifiers and bottle-feeding . However , the effect of artificial nipples on breastfeeding duration is poorly defined . The effects of 2 types of artificial nipple exposure on breastfeeding duration were evaluated : 1 ) cupfeeding versus bottle-feeding for the provision of in-hospital supplements and 2 ) early ( 2 - 5 days ) versus late ( > 4 weeks ) pacifier introduction . METHODS A total of 700 breastfed newborns ( 36 - 42 weeks , birth weight > or=2200 g ) were r and omly assigned to 1 of 4 intervention groups : bottle/early pacifier ( n = 169 ) , bottle/late pacifier ( n = 167 ) , cup/early pacifier ( n = 185 ) , or cup/late pacifier ( n = 179 ) . The cup/bottle intervention was invoked for infants who received supplemental feedings : cup ( n = 251 ) , bottle ( n = 230 ) . Data were collected at delivery and at 2 , 5 , 10 , 16 , 24 , 38 , and 52 weeks ' postpartum . Intervention effects on breastfeeding duration were evaluated with logistic regression and survival analyses . RESULTS Supplemental feedings , regardless of method ( cup or bottle ) , had a detrimental effect on breastfeeding duration . There were no differences in cup versus bottle groups for breastfeeding duration . Effects were modified by the number of supplements ; exclusive and full breastfeeding duration were prolonged in cup-fed infants given > 2 supplements . Among infants delivered by cesarean , cupfeeding significantly prolonged exclusive , full , and overall breastfeeding duration . Exclusive breastfeeding at 4 weeks was less likely among infants exposed to pacifiers ( early pacifier group ; odds ratio : 1.5 ; 95 % confidence interval : 1.0 - 2.0 ) . Early , as compared with late , pacifier use shortened overall duration ( adjusted hazard ratio : 1.22 ; 95 % confidence interval : 1.03 - 1.44 ) but did not affect exclusive or full duration . CONCLUSIONS There was no advantage to cupfeeding for providing supplements to the general population of healthy breastfed infants , but it may have benefitted mother-infant dyads who required multiple supplements or were delivered by cesarean . Pacifier use in the neonatal period was detrimental to exclusive and overall breastfeeding . These findings support recommendations to avoid exposing breastfed infants to artificial nipples in the neonatal period The aim of this study was to examine prospect ively the relation between duration of breast feeding and cognitive outcomes . A cohort study of 2860 children enrolled before birth provided data from 2393 term infants of English-speaking mothers . Of these , complete infant feeding data in the first year of life and verbal cognitive IQ ( Peabody Picture Vocabulary Test - PPVT-R ) were available for 1450 children at 6 years , and a performance subtest ( Perceptual organisation WISC - Block Design ) for 1375 children at 8 years . Full breast feeding was categorised as none , > 0 to < 4 months , 4 - 6 months and > 6 months . Associations between breast-feeding duration and PPVT-R at 6 years and Block Design at 8 years were estimated before and after adjustment for gender , gestational age , maternal age , maternal education , parental smoking and the presence of older siblings . The early cessation of full breast feeding was associated with reduced verbal IQ and the performance subtest . In unadjusted analysis , mean st and ardised PPVT-R scores were 6.44 points greater ( P < 0.0001 ) in children fully breast fed for > 6 months compared with those never breast fed . After adjustment , mean PPVT-R scores were 3.56 points higher in children fully breast fed for > 6 months compared with those children never breast fed ( P = 0.003 ) . Similarly , Block Design scores were higher in those fully breast fed for > 6 months compared with those never breast fed in unadjusted ( P = 0.001 ) but not adjusted analyses ( P = 0.223 ) . Interactions between maternal education ( four levels ) and breast feeding demonstrated a positive association of maternal education on verbal IQ ( F = 2.64 ; P = 0.005 ) in children breast fed for longer but not on performance ( F = 0.74 ; P = 0.67 ) . The early introduction of milk other than breast milk was associated with reduced verbal IQ after adjustment for social and perinatal confounders . Although these effects were interacting with maternal education , they may act through undefined mechanisms in human milk This study was done to evaluate effects of maternal-infant skin-to-skin contact during the first 2 hours postbirth compared to st and ard care ( holding the infant swaddled in blankets ) on breastfeeding outcomes through 1 month follow-up . Healthy primiparous mother-infant dyads were r and omly assigned by computerized minimization to skin-to-skin contact ( n = 10 ) or st and ard care ( n = 10 ) . The Infant Breastfeeding Assessment Tool  was used to measure success of first breastfeeding and time to effective breastfeeding ( time of the first of three consecutive scores of 10 - 12 ) . Intervention dyads experienced a mean of 1.66 hours of skin-to-skin contact . These infants , compared to swaddled infants , had higher mean sucking competency during the first breastfeeding ( 8.7 + /- 2.1 vs 6.3 + /- 2.6 ; P < .02 ) and achieved effective breastfeeding sooner ( 935 + /- 721 minutes vs 1737 + /- 1001 ; P < .04 ) . No significant differences were found in number of breastfeeding problems encountered during follow-up ( 30.9 + /- 5.51 vs 32.7 + /- 5.84 ; P < .25 ) or in breastfeeding exclusivity ( 1.50 + /- 1.1 vs 2.10 + /- 2.2 ; P < .45 ) . Sucking competency was also related to maternal nipple protractility ( r = .48 ; P < .03 ) . Very early skin-to-skin contact enhanced breastfeeding success during the early postpartum period . No significant differences were found at 1 month OBJECTIVES : ( 1 ) To describe the relative importance of gestational weight gain , postpartum exercise , food intake and breastfeeding to weight change from early pregnancy to 1 y postpartum ; and ( 2 ) to identify subgroups of women at greatest risk for major weight gain surrounding childbearing . DESIGN : A prospect i ve cohort study of women who registered for obstetrical care in a hospital and primary care clinic system serving a 10 county area of upstate New York . SUBJECTS : A total of 540 healthy adult women who gave birth to full-term singleton infants . MEASUREMENTS : Sociodemographic characteristics , exercise , food-related behaviors and breastfeeding were assessed using the medical record and a mailed question naire .  Body weight was measured at prenatal visits and 1 y postpartum . Weight retained and major weight gain ( 4.55 kg ) at 1 y postpartum were the main outcomes . ANALYSIS : Linear and logistic regression analyses were conducted . RESULTS : Women were on average 1.51±5.95 kg heavier at 1 y postpartum than they were in early pregnancy . Nearly 25 % of women experienced a major weight gain of 4.55 kg or more at 1 y postpartum . Gestational weight gain , exercise frequency , change in food intake and breastfeeding were each significantly related to postpartum weight retention . With the exception of breastfeeding , all of these factors were also associated with major weight gain .  Women under 20 y or over 40 y at delivery , and single women retained significantly more weight .  Lower income women with gestational weight gains above the Institute of Medicine ( IOM ) range retained 3.73 kg more than lower income women who gained within the range . They were also 4.7 times more likely to experience major weight gain with childbearing . The impact of exceeding the IOM gestational weight gain guidelines was three times greater in lower income women than it was in higher income women . CONCLUSION : Gestational weight gain , postpartum exercise frequency , and food intake are significantly associated with weight change from early pregnancy to 1 y postpartum and major weight gain with childbearing . Lower income women who gain more weight in pregnancy than the IOM recommends are at high risk for major weight gain with childbearing OBJECTIVE To determine the effects of a prenatal breastfeeding workshop on  maternal breastfeeding self-efficacy and breastfeeding duration . DESIGN R and omized controlled trial . SETTING Large tertiary hospital in Ontario , Canada . PARTICIPANTS 110 primiparous women expecting a single child , an uncomplicated birth , and planning to breastfeed . INTERVENTION 2.5-hour prenatal breastfeeding workshop based on adult learning principles and self-efficacy theory . MAIN OUTCOME MEASURE Maternal breastfeeding self-efficacy and the numbers of days and amount of breastfeeding were measured at four and eight weeks postpartum . RESULTS / DATA ANALYSIS : Over time , maternal breastfeeding self-efficacy scores increased in both groups . Women who attended the workshop had higher self-efficacy scores and a higher proportion were exclusively breastfeeding compared to women who did not attend the workshop . There was little difference in the average number of days of breastfeeding , but the intervention group had less weaning . CONCLUSIONS The workshop increased maternal breastfeeding self-efficacy and exclusive breastfeeding Aim : We conducted a r and omized controlled trial to assess the effectiveness of a support intervention delivered by health professionals to increase the rate and duration of breastfeeding . Methods : A r and omized controlled intervention study was conducted in the period 2000–2001 among 605 mothers who had given birth in a public maternity ward located in the city of Rome , Italy . The intervention consisted of a home visit by a midwife from the maternity ward of the hospital . The outcome of the study was the infant 's feeding habits , assessed by a 24‐h recall . The effect of the intervention on the duration of breastfeeding was estimated by the Kaplan‐Meier method and by the Cox multivariate regression model . Results : According to intention‐to‐treat analysis , there was no significant difference between the intervention and the control group , after controlling for confounding factors ( hazard ratio ( HR ) 1.04 ; 95 % confidence interval ( 95 % CI ) : 0.85–1.26 ) . The duration of breastfeeding was shorter ( HR 1.61 ; 95 % CI : 1.13–2.31 ) for women in the intervention group who refused the obstetric visit Background . Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health , the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal . The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks . Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed , problems with the infant latching or suckling , and lack of individualized encouragement from their clinicians in the early postdischarge period . Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practice s during routine preventive visits . However , robust scientific evidence based on r and omized , controlled trials is currently lacking . Objective . The purpose of this study was to determine whether attending an early , routine , preventive , outpatient visit delivered in a primary care physician ’s office would improve breastfeeding outcomes . Design . The study was a prospect i ve , r and omized , parallel-group , open trial . Setting . Participants were recruited at a level 3 maternity facility , with an average of 2000 births per year , in France . Participants . A total of 231 mothers who had delivered a healthy singleton infant ( gestational age : ≥37 completed weeks ) and were breastfeeding on the day of discharge were recruited and r and omized ( 116 were assigned to the intervention group and 115 to the  control group ) between October 1 , 2001 , and May 31 , 2002 ; 226 mother-infant pairs ( 112 in the intervention group and 114 in the control group ) contributed data on outcomes . Intervention . Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members , a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge , provision of the telephone number of a peer support group , m and atory routine , preventive , outpatient visits at 1 , 2 , 3 , 4 , 5 , and 6 months of infant age , and 10 weeks of paid maternity leave ( extended to 18 weeks after the birth of the third child ) . In addition to the usual predischarge and postdischarge support , the mothers in the intervention group were invited to attend an individual , routine , preventive , outpatient visit in the office of 1 of the 17 participating primary care physicians ( pediatricians or family physicians ) within 2 weeks after the birth . The participating physicians received a 5-hour training program on breastfeeding , delivered in 2 parts in 1 month , before the beginning of the study . Outcome Measures . The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks ( defined as giving maternal milk as the only food source , with no other foods or liquids , other than vitamins or medications , being given ) . The secondary outcomes included any breastfeeding reported at 4 weeks , breastfeeding duration , breastfeeding difficulties , and satisfaction with breastfeeding experiences . Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall . Results . Ninety-two mothers ( 79.3 % ) assigned to the intervention group and 8 mothers ( 7.0 % ) assigned to the control group reported that they had attended the routine , preventive , outpatient visit in the office of 1 of the 17 primary care physicians participating in the study . Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks ( 83.9 % vs 71.9 % ; hazard ratio : 1.17 ; 95 % confidence interval [ CI ] : 1.01–1.34 ) and longer breastfeeding duration ( median : 18 weeks vs 13 weeks ; hazard ratio : 1.40 ; 95 % CI : 1.03–1.92 ) . They were less likely to report any breastfeeding difficulties ( 55.3 % vs 72.8 % ; hazard ratio : 0.76 ; 95 % CI : 0.62–0.93 ) . There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks ( 89.3 % vs 81.6 % ; hazard ratio : 1.09 ; 95 % CI : 0.98–1.22 ) and the rate of mothers fairly or very satisfied with their breastfeeding experiences ( 91.1 % vs 87.7 % ; hazard ratio : 1.04 ; 95 % CI : 0.95–1.14 ) . Conclusions . Although we can not exclude the possibility that findings might differ in other health care systems , this study provides preliminary evidence of the efficacy of breastfeeding support through an early , routine , preventive visit in the offices of trained primary care physicians . Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes . Multifaceted interventions aim ing to support breastfeeding should involve primary care physicians OBJECTIVE We followed a cohort ( N = 306 ) of infants at well-baby visits in two suburban pediatric practice s to assess the relation of exclusive breastfeeding , and other environmental exposures , to episodes of acute otitis media ( AOM ) and otitis media with effusion ( OME ) .  METHODS Detailed prospect i ve information about the exclusiveness of breastfeeding , parental smoking , day care attendance , and family history was obtained at scheduled clinic visits .  Tympanometric and otoscopic examinations  were used in the diagnosis of otitis media ( OM ) . Nasopharyngeal cultures  were performed at 1 - 6 months , and at 8 , 10 , 12 , 15 , 18 , and 24 months of age to detect colonization with middle-ear pathogens . RESULTS Between 6 and 12 months of age , cumulative incidence of first OM episodes increased from 25 % to 51 % in infants exclusively breastfed and from 54 % to 76 % in infants formula-fed from birth . Peak incidence of AOM and OME episodes was inversely related to rates of breastfeeding beyond 3 months of age . A twofold elevated risk of first episodes of AOM or OME was observed in exclusively formula-fed infants compared with infants exclusively breast-fed for 6 months . In the logistic regression analysis , formula-feeding was the most significant predictor of AOM and OME episodes , although age at colonization with middle-ear pathogens and day care ( outside the home ) were significant competing risk factors . A hazard health model suggested additionally that breastfeeding , even for short duration s ( 3 months ) , reduced onset of OM episodes in infancy . CONCLUSIONS Modifiable factors in the onset of AOM and OME episodes during the first 2 years of life include early age at colonization ( < /=3 months of age ) , day care outside the home , and not being breastfed OBJECTIVE To examine whether increasing duration of breastfeeding is associated with a lower risk of overweight in a low-income population of 4-year-olds in the United States . METHODS Visit data were linked to determine prospect ively the duration of breastfeeding ( up to 2 years of age ) and weight status at 4 years of age . Overweight among 4-year-old children was defined as a body mass index ( BMI ) -for-age at or above the 95th percentile based on the 2000 Centers for Disease Control and Prevention growth charts . Logistic regression was performed , controlling for gender , race/ethnicity , and birth weight . In a subset of states , links to maternal pregnancy records also permitted regression analysis controlling for mother 's age , education , prepregnancy BMI , weight gain during pregnancy , and postpartum smoking . Data from the Pediatric Nutrition Surveillance System , which extracts breastfeeding , height , and weight data from child visits to public health programs , were analyzed . In 7 states , data were linked to Pregnancy Nutrition Surveillance System data . A total of 177 304 children up to 60 months of age were included in our final pediatric-only analysis , and 12 587 were included in the pregnancy-pediatric linked analysis . RESULTS The duration of breastfeeding  showed a dose-response , protective relationship with the risk of overweight only among non-Hispanic whites ; no significant association was found among non-Hispanic blacks or Hispanics . Among non-Hispanic whites , the adjusted odds ratio of overweight by breastfeeding for 6 to 12 months versus never breastfeeding was 0.70 ( 95 % confidence interval : 0.50 - 0.99 ) and for > 12 months versus never was 0.49 ( 95 % confidence interval : 0.25 - 0.95 ) . Breastfeeding for any duration was also protective against underweight ( BMI -for-age below the 5th percentile ) . CONCLUSION Prolonged breastfeeding is associated with a reduced risk of overweight among non-Hispanic white children . Breastfeeding longer than 6 months provides health benefits to children well beyond the period of breastfeeding We assessed menstrual and reproductive factors in relation to  ovarian cancer risk  in a large , population -based , case – control study . 563 cases in Massachusetts and New Hampshire were ascertained from hospitals and statewide tumour registries ; control women ( n= 523 ) were selected through r and om digit dialing  and matched to case women by age and  telephone sampling  unit . We used multivariate logistic regression to evaluate factors in relation to risk of ovarian cancer and the major tumour histologic subtypes . Ovarian cancer risk was reduced among parous women , relative to nulliparous women ( OR = 0.4 ; 95 % CI = 0.3−0.6 ) . Among parous women , higher parity ( P = 0.0006 ) , increased age at first ( P = 0.03 ) or last ( P = 0.05 ) birth , and time since last birth ( P = 0.04 ) were associated with reduced risk . Early pregnancy losses , abortions , and stillbirths were unrelated to risk , but preterm , term , and twin births were protective . Risk was lower among women who had breast-fed , relative to those who had not ( OR = 0.7 ; 95 % CI = 0.5–1.0 ) , but the average duration of breast-feeding per child was unrelated to risk ( P for trend = 0.21 ) . Age at menarche and age at menopause were unrelated to risk overall , although increasing menarcheal age was protective among premenopausal women ( P = 0.02 ) . Menstrual cycle characteristics and symptoms were generally unrelated to risk , although cycle-related insomnia was associated with decreased risk ( OR = 0.5 ; 95 % CI = 0.3–0.8 ) . We found no association between the type of sanitary product used during menstruation and ovarian cancer risk . In analyses by histologic subtype , reproductive and menstrual factors had most effect on risk of endometrioid/clear cell tumours , and least influential with regard to risk of mucinous tumours . Overall , our findings offer some support to current hypotheses of ovarian pathogenesis , and show aetiologic differences among the tumour subtypes . © 2001 Cancer Research OBJECTIVE This study was design ed to assess the relation of exclusive breast-feeding , independent of recognized risk factors , to  acute and recurrent otitis media in the first 12 months of life . METHODS Records of 1220 infants who used a health maintenance organization and who were followed during their first year of life as part of the Tucson Children 's Respiratory Study were review ed . Detailed prospect i ve information about the duration and exclusiveness of breast-feeding was obtained , as was information relative to potential risk factors ( socioeconomic status , gender , number of siblings , use of day care , maternal smoking , and family history of allergy ) . Acute otitis media and recurrent otitis media , defined as three or more episodes of acute otitis media in a 6-month period or four episodes in 12 months , were the outcome variables . RESULTS Of the 1013 infants followed for their entire first year , 476 ( 47 % ) had at least one episode of otitis and 169 ( 17 % ) had recurrent otitis media . Infants exclusively breast-fed for 4 or more months had half the mean number of acute otitis media episodes as did those not breastfed at all and 40 % less than those infants whose diets were supplemented with other foods prior to 4 months . The recurrent otitis media rate in infants exclusively breast-fed for 6 months or more was 10 % and was 20.5 % in those infants who breast-fed for less than 4 months . This protection was independent of the risk factors considered . CONCLUSION These findings suggest that exclusive breast-feeding of 4 or more months protected infants from single and recurrent episodes of otitis media BACKGROUND Breastfeeding can ameliorate some of the complex health issues faced by low-income families . Women who breastfeed and their infants have lower health care costs compared with those who formula feed . Increasing the duration of breastfeeding is recognized as a national priority , particularly for low-income women . This community-based r and omized clinical trial involving low-income mothers compared usual care with an intervention comprising hospital and home visits , and telephone support by a community health nurse/peer counselor team for 6 months after delivery . METHODS Forty-one women were recruited after delivery of a full-term singleton infant and r and omly assigned to intervention or usual care groups . RESULTS Women receiving the community health intervention  breastfed longer than the women receiving usual care . The infants in the intervention group had fewer sick visits and reported use of fewer medications than infants in the usual care group . The intervention cost ( $ 301/mother ) was partially offset by cost savings on formula and health care . CONCLUSIONS Community health nurse and peer counselor support can increase breastfeeding duration in low-income women , and has the potential to reduce total costs including the cost of support Abstract Objective To investigate whether offering volunteer support from counsellors in breast feeding would result in more women breast feeding .  Design R and omised controlled trial . Setting 32 general practice s in London and south Essex . Participants 720 women considering breast feeding . Main outcome measures Primary outcome was prevalence of any breast feeding at six weeks . Secondary outcomes were the proportion of women giving any breast feeds , or bottle feeds at four months , duration of any breast feeding , time to introduction of bottle feeds , and satisfaction with breast feeding . Results Offering support in breast feeding did not significantly increase the prevalence of any breast feeding to six weeks ( 65 % ( 218/336 ) in the intervention group and 63 % ( 213/336 ) in the control group ; relative risk 1.02 , 95 % confidence interval 0.84 to 1.24 ) . Survival analysis up to four months confirmed that neither duration of breast feeding nor time to introduction of formula feeds differed significantly between control and intervention groups . Not all women in the intervention group contacted counsellors postnatally , but 73 % ( 123/179 ) of those who did rated them as very helpful . More women in the intervention group than in the control group said that their most helpful advice came from counsellors rather than from other sources . Conclusions Women valued the support of a counsellor in breast feeding , but the intervention did not significantly increase breastfeeding rates , perhaps because some women did not ask for help CONTEXT A number of studies suggest a positive association between breastfeeding and cognitive development in early and middle childhood . However , the only previous study that investigated the relationship between breastfeeding and intelligence in adults had several method ological shortcomings . OBJECTIVE To determine the association between duration of infant breastfeeding and intelligence in young adulthood . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve longitudinal birth cohort study conducted in a sample of 973 men and women and a sample of 2280 men , all of whom were born in Copenhagen , Denmark , between October 1959 and December 1961 . The sample s were divided into 5 categories based on duration of breastfeeding , as assessed by physician interview with mothers at a 1-year examination . MAIN OUTCOME MEASURES Intelligence , assessed using the Wechsler Adult Intelligence Scale ( WAIS ) at a mean age of 27.2 years in the mixed-sex sample and the Børge Priens Prøve ( BPP ) test at a mean age of 18.7 years in the all-male sample . Thirteen potential confounders were included as covariates : parental social status and education ; single mother status ; mother 's height , age , and weight gain during pregnancy and cigarette consumption during the third trimester ; number of pregnancies ; estimated gestational age ; birth weight ; birth length ; and indexes of pregnancy and delivery complications . RESULTS Duration of breastfeeding was associated with significantly higher scores on the Verbal , Performance , and Full Scale WAIS IQs . With regression adjustment for potential confounding factors , the mean Full Scale WAIS IQs were 99.4 , 101.7 , 102.3 , 106.0 , and 104.0 for breastfeeding duration s of less than 1 month , 2 to 3 months , 4 to 6 months , 7 to 9 months , and more than 9 months , respectively ( P = .003 for overall F test ) . The corresponding mean scores on the BPP were 38.0 , 39.2 , 39.9 , 40.1 , and 40.1 ( P = .01 for overall F test ) . CONCLUSION Independent of a wide range of possible confounding factors , a significant positive association between duration of breastfeeding  and intelligence was observed in 2 independent sample s of young adults , assessed with 2 different intelligence tests AIM To examine whether duration of breast feeding has any effect on a child 's cognitive or motor development in a population with favourable environmental conditions and a high prevalence of breast feeding . METHODS In 345 Sc and inavian children , data on breast feeding were prospect ively recorded during the first year of life , and neuromotor development was assessed at 1 and 5 years of age . Main outcome measures were Bayley 's Scales of Infant Development at age 13 months ( Mental Index , MDI ; Psychomotor Index , PDI ) , Wechsler Preschool and Primary Scales of Intelligence ( WPPSI-R ) , and Peabody Developmental Scales at age 5 . RESULTS Children breast fed for less than 3 months had an increased risk , compared to children breast fed for at least 6 months , of a test score below the median value of MDI at 13 months and of WPPSI-R at 5 years . Maternal age , maternal intelligence ( Raven score ) , maternal education , and smoking in pregnancy were significant confounders , but the increased risk of lower MDI and total IQ scores persisted after adjustment for each of these factors . We found no clear association between duration of breast feeding and motor development at 13 months or 5 years of age . CONCLUSION Our data suggest that a longer duration of breast feeding benefits cognitive development Several studies indicate that parity and lactation are associated with modest , short-term bone loss , but the long-term effect on osteoporotic fracture risk is uncertain . The authors therefore analyzed data from a population -based case-control study among Swedish postmenopausal women aged 50 - 81 years between October 1993 and February 1995 .  Mailed question naires and telephone interviews were used to collect data on 1,328 incident cases with hip fracture and 3,312 r and omly selected controls . In age-adjusted analyses , the risk of hip fracture among all women was reduced by 10 % per child ( 95 % confidence interval ( CI ) : 5 , 14 ) . After multivariate adjustment including body mass index as a covariate , the risk reduction was 5 % per child ( 95 % CI : 0 , 10 ) . Oral contraceptive use modified the association of parity with hip fracture risk . Among never users of oral contraceptives , the risk of hip fracture was reduced by 8 % per child ( 95 % CI : 2 , 13 ) , whereas among ever users of oral contraceptives , the risk was in the opposite direction , with an increase in risk by 19 % per child ( 95 % CI : 0 , 41 ) . After parity was considered , there was no association of duration of lactation period with fracture risk . The authors conclude that parity is modestly associated with a reduced hip fracture risk among women who had not used oral contraceptives previously OBJECTIVE To assess the efficacy of peer counseling to promote exclusive breastfeeding ( EBF ) among low-income inner-city women in Hartford , Conn. DESIGN Participants recruited prenatally were r and omly assigned to either receive support for EBF from a peer counselor plus conventional breastfeeding support ( peer counseling group [ PC ] ) or only conventional breastfeeding support ( control group [ CG ] ) and followed through 3 months post partum . SETTING Low-income predominantly Latina community . PARTICIPANTS Expectant mothers , less than 32 weeks gestation and considering breastfeeding ( N = 162 ) . Intervention Exclusive breastfeeding peer counseling support offering 3 prenatal home visits , daily perinatal visits , 9 postpartum home visits , and telephone counseling as needed . MAIN OUTCOME MEASURES Exclusive breastfeeding rates at hospital discharge , 1 , 2 , and 3 months post partum ( n = 135 ) . RESULTS At hospital discharge , 24 % in the CG compared with 9 % in the PC had not initiated breastfeeding , with 56 % and 41 % , respectively , nonexclusively breastfeeding . At 3 months , 97 % in the CG and 73 % in the PC had not exclusively breastfed ( relative risk [ RR ] = 1.33 ; 95 % CI , 1.14 - 1.56 ) during the previous 24 hours . The likelihood of nonexclusive breastfeeding throughout the first 3 months was significantly higher for the CG than the PC ( 99 % vs 79 % ; RR = 1.24 ; 95 % CI , 1.09 - 1.41 ) . Mothers in the CG were less likely than their PC counterparts to remain amenorrheic at 3 months ( 33 % vs 52 % ; RR = 0.64 ; 95 % CI , 0.43 - 0.95 ) . The likelihood of having 1 or more diarrheal episode in infants was cut in half in the PC ( 18 % vs 38 % ; RR = 2.15 ; 95 % CI , 1.16 - 3.97 ) . CONCLUSION Well-structured , intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income , inner-city women in the United States Objective To evaluate the affect of an antenatal educational breastfeeding intervention on women 's breastfeeding duration R and omized trials conducted in developing countries have demonstrated that breastfeeding peer counseling increases rates of breastfeeding initiation and improves the duration of breastfeeding ( Morrow et al. 1999 ; Haider et al. 2000 ) . We are conducting a r and omized community trial , design ed to evaluate the effectiveness of an existing  community-based breastfeeding peer counseling program serving mostly low income Latinas ( i.e. , women from Spanish-speaking countries in Latin America or the Caribbean ) in Hartford , CT . Preliminary data from this on-going study previously have shown that subjects r and omized to receive breastfeeding peer counseling  have a median breastfeeding duration one month greater than their counterparts who did not receive breastfeeding peer counseling  ( 1.75 mo vs. 0.8 mo , P<0.05 ) ( Chapman et al. 2002 ) . The objectives of this analysis are to : a ) report on a process evaluation of the program , focusing on actual coverage of pre- , peri- , and postnatal services ; and b ) determine if differences in the degree and timing of the exposure to breastfeeding peer counseling services are associated with breastfeeding duration BACKGROUND The relationship between infant feeding and childhood asthma is controversial . This study tested the hypothesis that the relation between breast feeding and childhood asthma is altered by the presence of maternal asthma . METHODS Healthy non-selected newborn infants ( n=1246 ) were enrolled at birth . Asthma was defined as a physician diagnosis of asthma plus asthma symptoms reported on ⩾2 question naires at 6 , 9 , 11 or 13 years . Recurrent wheeze ( ⩾4 episodes in the past year ) was reported by question naire at seven ages in the first 13 years of life . Duration of exclusive breast feeding was based on prospect i ve physician reports or parental question naires completed at 18 months . Atopy was assessed by skin test responses at the age of 6 years . RESULTS The relationship between  breast feeding , asthma , and wheeze differed with the presence or absence of maternal asthma and atopy in the child . After adjusting for confounders , children with asthmatic mothers were significantly more likely to have asthma if they had been exclusively breast fed ( OR 8.7 , 95 % CI 3.4 to 22.2 ) . This relationship was only evident for atopic children and persisted after adjusting for confounders . In contrast , the relation between recurrent wheeze and breast feeding was age dependent . In the first 2 years of life exclusive breast feeding was associated with significantly lower rates of recurrent wheeze ( OR 0.45 , 95 % CI 0.2 to 0.9 ) , regardless of the presence or absence of maternal asthma or atopy in the child . Beginning at the age of 6 years , exclusive breast feeding was unrelated to prevalence of recurrent wheeze , except for children with asthmatic mothers in whom it was associated with a higher odds ratio for wheeze ( OR 5.7 , 95 % CI 2.3 to 14.1 ) , especially if the child was atopic . CONCLUSION The relationship between breast feeding and asthma or recurrent wheeze varies with the age of the child and the presence or absence of maternal asthma and atopy in the child . While associated with protection against recurrent wheeze early in life , breast feeding is associated with an increased risk of asthma and recurrent wheeze beginning at the age of 6 years , but only for atopic children with asthmatic mothers OBJECTIVE Harmful effects of short postpartum hospital stays include dehydration and malnutrition of breastfed infants . These may be prevented by adequate breastfeeding frequency ; however , rigorous research to determine the relative effectiveness of various follow-up strategies in supporting breastfeeding frequency is absent . This study addressed the question , " Is there a difference in breastfeeding frequency or infant weight gain for singleton infants discharged within 36 hours ' postpartum who received either community nurse ( home visit ) or hospital nurse ( clinic ) follow-up ? " METHODS A r and omized , controlled trial was conducted at a university teaching hospital ( 3700 births/y ) and affiliated community health centers . A consecutive sample of 586 healthy mother-infant pairs were recruited from January 1997 to September 1998 before discharge ; 513 ( 87.5 % ) contributed data on 1 or more outcomes . Forty-eight-hour postpartum telephone contact and day 3 nurse contact in the home ( experimental ) or at the hospital ( control ) were provided . The main outcomes measured were breastfeeding frequency and infant weight gain assessed at 2 weeks ' postpartum by maternal diary and weight at home by research assistants , masked to group allocation . RESULTS No clinical ly important or statistically significant group differences were found in daily breastfeeding frequency ( mean difference experimental minus control = 0.1 feeds [ 95 % confidence interval : -0.1 - 0.3 ] ) or daily rate of infant weight gain ( -1.1 g [ -2.5 - 0.3 ] ) based on intention-to-treat analyses . CONCLUSIONS Follow-up by nurses after short postpartum hospital stays , in either the home or a hospital-based clinic , of healthy infants discharged at < 36 hours seems associated with satisfactory infant breastfeeding outcomes The objective of our study was to examine the effect of lifetime lactation on  breast cancer  risk among premenopausal women . The data were from a prospect i ve cohort study with a follow-up period of 6 years in Korea ( 1995 - 2000 ) . The cohort was composed of 110,604 premenopausal parous Korean women , aged 20 years and older , who received health insurance from the Korea Medical Insurance Corporation and who had medical evaluations in 1992 and 1994 . Multivariate Cox proportional hazard models were tested , controlling for age , age at menarche , number of children , age at first pregnancy , oral contraceptive use , smoking , exercise and obesity . At baseline , 57,440 ( 51.9 % ) reported  breastfeeding and 4,584 ( 4.1 % ) reported breastfeeding more than 24 months . From 1995 - 2000 , 360 incident cases of breast cancer ( 61.8/100,000 person-years ) occurred . Compared to parous women who had no history of lactation , a period of lactation of 13 - 24 months decreased the risk of breast cancer ( RR , 0.7 ; 95 % CI , 0.5 - 1.1 ) , and this risk was decreased even further for those who breastfed for more than 24 months ( RR , 0.6 ; 95 % CI , 0.3 - 1.0 ) . There was a clear trend of decreasing breast cancer risk with the duration of lactation ( p for trend < 0.001 ) . In conclusion , our study of a large Korean cohort provides additional empirical evidence to current theoretical conjecture that lactation decreases the risk of breast cancer among premenopausal women BACKGROUND Despite high levels of breastfeeding initiation in Australia , only 46 percent of women are still breastfeeding ( exclusively or partially ) 6 months later , with marked differences between social groups . This study aim ed to determine the influence of mid-pregnancy breastfeeding education on the proportions of women breastfeeding at hospital discharge , and on the duration of breastfeeding . METHODS A r and omized controlled trial to compare two strategies for increasing the initiation and duration of breastfeeding was conducted , in which 981 primiparas who attended a public , tertiary women 's hospital in Melbourne , Australia , were r and omized to one of two interventions or to st and ard care ( 327 in each group ) . The interventions were a 1.5-hour class on practical aspects of breastfeeding using a previously tested tool ( Practical Skills ) , and two 1-hour classes exploring family and community attitudes toward , and experiences of , breastfeeding ( Attitudes ) . Both interventions took place in interactive small groups when women were in mid-pregnancy . Breastfeeding initiation was ascertained by interview 2 to 4 days after birth , and breastfeeding duration was assessed by telephone interview 6 months after birth . RESULTS Neither intervention increased breastfeeding initiation or duration compared with st and ard care . Rates at initiation were 97 percent ( 296/306 ) for the Practical Skills intervention , 95 percent ( 291/308 ) for the Attitudes intervention , and 96 percent ( 297/310 ) for st and ard care . Rates at 6 months were , respectively , 55 percent ( 162/297 ) , 50 percent ( 146/293 ) , and 54 percent ( 162/299 ) . CONCLUSIONS In setting s where breastfeeding initiation is already high , neither study intervention could be recommended as an effective strategy to increase breastfeeding initiation or duration BACKGROUND In the Netherl and s , the initiation rate of breast-feeding ( BF ) was 80 % in 2002 , but only 35 % of the mothers continued to breast-feed for 3 months . This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding . METHODS A cluster-r and omized intervention trial was used . Ten child health care centers in three regions of the home health care were r and omly allocated to the program or usual care . Elements in the program were health counseling , measures to enhance cooperation , early signaling of breast-feeding problems and continuity of care , and lactation consultancy .  Pregnant mothers who applied for home health care in the intervention or usual care regions were enrolled and were followed up from pregnancy until 6 months postpartum ( n = 683 ) . The primary outcome measure was the continuation of breast-feeding until at least 3 months . RESULTS The 3-month breast-feeding rate was 32 % in the intervention and 38 % in the control groups ( OR = 0.79 , 95 % CI = 0.58 - 1.08 ) . CONCLUSION The program was not effective . We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program , such as the categories of caregivers involved and the number and duration of contacts after parturition OBJECTIVE To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care , can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding . DESIGN , SETTING AND PARTICIPANTS In a cluster r and omised trial of smoking education and breast-feeding interventions in the lower North Isl and , New Zeal and , midwives were stratified by locality and r and omly allocated into a control group and three intervention groups . The control group provided usual care . Midwives in the intervention groups delivered either a programme of education and support for smoking cessation or reduction , a programme of education and support for breast feeding or both programmes .  Sixty-one midwives recruited a total of 297 women . INTERVENTIONS Structured programmes provided by midwives . FINDINGS Women receiving only the smoking cessation or reduction programme were significantly more likely to have reduced , stopped smoking or maintained smoking changes than women in the control group , at 28 weeks and 36 weeks gestation . Women receiving both the smoking cessation and breast-feeding education and support programmes were significantly more likely than women in the control group to have changed their smoking behaviour at 36 weeks gestation . There was no difference in rates of cessation or reduction between the groups in the postnatal period . There was no difference in rates of full breast feeding between the control and intervention groups for women who planned to breast feed . KEY CONCLUSIONS Education and support by midwives , as part of primary midwifery , can facilitate smoking cessation and reduction during pregnancy OBJECTIVE : To study prospect ively the relation of parity , prepregnancy body mass index ( BMI ) , and exclusive breastfeeding to weight gain . DESIGN : The cohort of the Nurse 's Health Study II , with analysis restricted to women who were aged 24 to 40 y at baseline ( 1989 ) , who had a history of no more than one past full-term pregnancy at baseline , gave birth to one child between 1990 and 1991 , but had no other pregnancies during the follow-up . SUBJECTS : 1538 of the 33 082 nulliparous women and 2810 of the 20 261 primiparous , in 1989 . MEASUREMENTS : Introduction of daily formula/milk was assumed to represent the end of exclusive breastfeeding period . Duration of exclusive breastfeeding  was categorized into 0 , 1–3 , 4–7 , 8–11 , and 12 months or more . RESULTS : After adjusting for age , physical activity , and BMI in 1989 , lactation was associated with a weight gain from 1989 to 1993 of approximately 1 kg ( statistically significant only for women nulliparous in 1989 with a BMI < 25 kg/m2 ( P=0.02 ) and for those women primiparous in 1989 , with a BMI ≥25 kg/m2 ( P=0.04 ) ) comparing women who breastfed with women who did not , and duration of lactation was unrelated to the magnitude of weight change ( P>0.40 for all comparisons ) . CONCLUSIONS : Although promotion of breastfeeding has high priority because of its enormous advantages for a newborn child , the associated maternal weight reduction is minimal . Dietary guidelines for pregnant and breastfeeding women should include ways to prevent weight retention after parity OBJECTIVE . Continuous support during the childbirth process ultimately may strengthen the mother 's self-esteem and her capacity to interact with and nurture her infant and also may improve paternal involvement in general . In the present study , we investigated whether mothers , who were attended by midwives and nurses who had had a process-oriented training program in breastfeeding counseling  , perceived stronger maternal feelings for their infant than mothers who had received only routine care . METHODS . In a previous study , an intervention that included a process-oriented program on breastfeeding counseling for health professionals and continuity in family classes through childbirth was conducted . The 10 largest municipalities were classified in pairs that were similar in size and had similar figures of breastfeeding duration . The municipalities were r and omized pairwise to either an intervention or a control group . The present study is a follow-up study on women 's feelings for their infants in relation to the kind of care that they had had and was undertaken between April 2000 and January 2003 . The sampling frame was based on women who were cared for at either the intervention clinic or control clinics . The mothers at the control clinics had received st and ard routine care and had attended family classes through the point of birth . Data collection for control group A started before effects of the intervention could be studied . Data for control group B were collected simultaneously with data collection for the intervention group ( n = 540 ) . The mothers responded to 3 question naires at 3 days and at 3 and 9 months postpartum . Background data of the mothers were collected . The perception of support that was provided by the health professionals and the perception of mother – infant relationship and feelings for the infant were rated on Likert scales . RESULTS . At 3 days postpartum , both the intervention group and control group B versus the control group A thought that their underst and ing of the infant was better , they perceived more strongly that the infant as their own , and they enjoyed more breastfeeding and resting with the infant . Although there was no significant difference between the intervention group and control group B at 3 days and 3 months observation , mothers in the intervention group talked more to their infant , perceived their infant to be more beautiful than other infants , and perceived more strongly that the infant was their own than did the mothers in control group B at 9 months observation . In addition , the mothers in the intervention group felt significantly more confident with the infant and felt the infant to be closer than did the mothers in control group B. CONCLUSION . A process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention that guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant BACKGROUND Most mothers stop breast-feeding before the recommended 6 months post partum . A systematic review showed that breast-feeding support programs by health care professionals did not substantially improve breast-feeding outcomes beyond 2 months post partum . We conducted a r and omized controlled trial to evaluate the effect of peer ( mother-to-mother ) support on breast-feeding duration among first-time breast-feeding mothers . METHODS We recruited 256 breast-feeding mothers from 2 semi-urban community hospitals near Toronto and r and omly assigned them to a control group ( conventional care ) or a peer support group ( conventional care plus telephone-based support , initiated within 48 hours after hospital discharge , from a woman experienced with breast-feeding who attended a 2.5-hour orientation session ) . Follow-up of breast-feeding duration , maternal satisfaction with infant feeding method and perceptions of peer support received was conducted at 4 , 8 and 12 weeks post partum . RESULTS Significantly more mothers in the peer support group than in the control group continued to breast-feed at 3 months post partum ( 81.1 % v. 66.9 % , p = 0.01 ) and did so exclusively ( 56.8 % v. 40.3 % , p = 0.01 ) . Breast-feeding rates at 4 , 8 and 12 weeks post partum were 92.4 % , 84.8 % and 81.1 % respectively among the mothers in the peer support group , as compared with 83.9 % , 75.0 % and 66.9 % among those in the control group ( p < or = 0.05 for all time periods ) . The corresponding relative risks were 1.10 ( 95 % confidence interval [ CI ] 1.01 - 2.72 ) at 4 weeks , 1.13 ( 95 % CI 1.00 - 1.28 ) at 8 weeks and 1.21 ( 95 % CI 1.04 - 1.41 ) at 12 weeks post partum . In addition , when asked for an overall rating of their feeding experience , significantly fewer mothers in the peer support group than in the control group were dissatisfied ( 1.5 % v. 10.5 % ) ( p = 0.02 ) . Of the 130 mothers who evaluated the peer support intervention , 81.6 % were satisfied with their peer volunteer experience and 100 % felt that all new breast-feeding mothers should be offered this peer support intervention . INTERPRETATION The telephone-based peer support intervention was effective in maintaining breast-feeding to 3 months post partum and improving satisfaction with the infant feeding experience . The high satisfaction with and acceptance of the intervention indicates that breast-feeding peer support programs , in conjunction with professional health services , are effective BACKGROUND The advantages of breastfeeding have been well established for both mothers and their infants . Existing research reports equivocal effects of early discharge and postpartum home care on breastfeeding success . The purpose of this study was to compare the effects of breastfeeding support offered in hospital and home setting s on breastfeeding outcomes and maternal satisfaction for mothers of term and near-term newborns who experienced st and ard or early discharge . METHODS In a r and omized controlled trial with prognostic stratification for gestational age , 101 term and 37 near-term ( 35 - 37 weeks ' gestational age ) mother-newborn pairs were r and omized to either a st and ard care group ( st and ard care and st and ard length of hospitalization ) or an experimental group ( st and ard hospital care with early discharge and home support from nurses who were certified lactation consultants ) . Data collection occurred before r and omization , at discharge from hospital , and from 5 to 12 days postpartum . Primary outcomes included breastfeeding rates and maternal satisfaction . RESULTS More mothers of term newborns in the experimental group were breastfeeding exclusively at follow-up ( p = 0.02 ) compared with the control group . No significant breastfeeding differences occurred among mothers with near-term newborns in the experimental and st and ard care groups . CONCLUSIONS In-home lactation support appears to facilitate positive breastfeeding outcomes for mothers of term newborns . This may also be a beneficial model of postpartum care for mothers of near-term newborns ; however , further research is required . The findings suggest implication s for health caregivers and policy makers with respect to postpartum lactation and health care services Objective . To determine whether an individualized , prenatal and postnatal , lactation consultant intervention result ed in increased cumulative intensity of breastfeeding up to 52 weeks . Design . The r and omized , nonblinded , controlled trial recruited women from prenatal care . Baseline prenatal interviews covered demographic data and breastfeeding experience , intention , and knowledge . Interviews at 1 , 2 , 3 , 4 , 6 , 8 , 10 , and 12 months after birth collected data on weekly feeding patterns , infant illness , and infant health care use . Setting . Two community health centers serving low-income , primarily Hispanic and /or black women . Participants . The analytic sample included 304 women ( intervention : n = 145 ; control : n = 159 ) with ≥1 postnatal interview . Intervention . Study lactation consultants attempted 2 prenatal meetings , a postpartum hospital visit , and /or home visits and telephone calls . Control subjects received the st and ard of care .  Outcome Measures . Cumulative breastfeeding intensity at 13 and 52 weeks , based on self-reports of weekly feeding , on a 7-level scale . Results . The intervention group was more likely to breastfeed through week 20 ( 53.0 % vs 39.3 % ) . Exclusive breastfeeding rates were low and did not differ according to group . In multivariate analyses , control subjects had lower breastfeeding intensity at 13 weeks ( odds ratio [ OR ] : 1.90 ; 95 % confidence interval [ CI ] : 1.13–3.20 ) and 52 weeks ( OR : 2.50 ; 95 % CI : 1.48–4.21 ) . US-born control subjects had lowest breastfeeding intensity at 13 weeks ( OR : 5.22 ; 95 % CI : 2.43–11.22 ) and 52 weeks ( OR : 5.25 ; 95 % CI : 2.44–11.29 ) . There were no significant differences in breastfeeding intensity among the US-born intervention , foreign-born intervention , and foreign-born control groups . Conclusions . This “ best- practice s ” intervention was effective in increasing breastfeeding duration and intensity . Breastfeeding promotion should focus on US-born women and exclusive breastfeeding OBJECTIVE Recognizing that an expectant father may influence a mother 's decision to breast- or formula-feed , we tested the effectiveness of a simple , educational intervention that was design ed to encourage fathers to advocate for breastfeeding and to assist his partner if she chooses to breastfeed . STUDY DESIGN We conducted a r and omized controlled trial in which expectant fathers ( n = 59 ) were assigned r and omly to attend either a 2-hour intervention class on infant care and breastfeeding promotion ( intervention ) or a class on infant care only ( control group ) . The classes , which were led by a peer-educator , were interactive and informal and utilized different media to create an accessible environment for participants . Couples were recruited during the second trimester from a university obstetrics practice . RESULTS Overall , breastfeeding was initiated by 74 % of women whose partners attended the intervention class , as compared with 41 % of women whose partners attended the control class ( P = .02 ) . CONCLUSION Expectant fathers can be influential advocates for breastfeeding , playing a critical role in encouraging a woman to breastfeed her newborn infant BACKGROUND Peer support may improve  breastfeeding rates  but the evidence is inconclusive . Previous studies and review s recommend trials in different healthcare setting s. AIM To test if a specified programme of peer support affects the initiation and /or the duration of breastfeeding . DESIGN OF STUDY A two-group r and omised controlled trial of peer support for breastfeeding with evaluation of breastfeeding initiation and duration on an intention-to-treat basis . SETTING General practice in Ayrshire , Scotl and . METHOD Following informed consent , 225 women at 28 weeks gestation were allocated to control or peer support group by post-recruitment concealed allocation . All peer support and control group mothers received normal professional breastfeeding support . Additionally , those in the  peer support group still breastfeeding on return home from hospital had peer support until 16 weeks . RESULTS Thirty-five of the 112 ( 31 % ) women in the peer support group were breastfeeding at 6 weeks compared to 33/113 ( 29 % ) in the control group , a difference of 2 % ( 95 % confidence interval = -10 % to 14 % ) . The median breastfeeding duration for all women in the peer support group was 2 days compared to 1 day for the control group and the Kaplan-Meier survival plot shows the peer support group overall breastfeeding slightly longer than the control group , with no statistically significant difference by logrank test ( P = 0.5 ) . The median breastfeeding duration among primagravidae in the peer support group was 7 days , compared to 3 days for the control group . Among women who started to breastfeed the medians were 72 days in the peer support group and 56 days in the control group . These differences were not statistically significant . CONCLUSIONS Peer support did not increase breastfeeding in this population by a statistically significant amount This study compared breastfeeding attitudes , intention , and initiation among low-income women exposed or not exposed to the Best Start program .  A between- ( experimental vs control group ) and within-factor ( pretest vs posttest ) repeated measures design was employed . A nonprobability sample of 54 subjects was r and omly assigned to a control group ( n = 28 ) or an experimental group ( n = 26 ) . Using the Breastfeeding Attrition Prediction Tool , statistically significant group by time interaction effects were found for negative breastfeeding sentiment , positive breastfeeding sentiment , and breastfeeding control scales . Compared to the control group , the experimental group had significantly increased positive breastfeeding sentiment ( P < .01 ) , decreased negative breastfeeding sentiment ( P < .01 ) , and increased breastfeeding control ( P < .01 ) from pretest to posttest . Following exposure to the Best Start program , subjects in the experimental group showed statistically significantly higher breastfeeding intention and initiation than did those in the control group . Practical implication s are discussed . J Hum Lact . 20(3):300 - 305 OBJECTIVE to examine the effect of early skin-to-skin contact between mothers and their healthy full-term babies on initiation and duration of breast feeding . DESIGN a r and omised controlled trial comparing skin-to-skin with routine care . SETTING Warrington Hospital , Cheshire , UK . PARTICIPANTS 204 mother and baby pairs ; 102 r and omised to each group . OUTCOME MEASURES success of first breast feed , maternal satisfaction with skin-to-skin care and preference for future post-delivery care , baby-body temperature 1 hr after birth , partial or exclusive breast feeding at 4 months . FINDINGS in the skin-to-skin group , 89 out of 98 ( 91 % ) babies had a successful first feed compared with 82 out of 89 ( 83 % ) in the routine care group . The difference in the success rate was 8 % , 95 % confidence interval ( CI ) ( -1.6 % , 17.6 % ) ; chi(2)=2.7 ; df=1 ; P=0.10 . Forty-two out of 97 ( 43 % ) babies given skin-to-skin were partially or exclusively breast feeding at 4 months compared with 40 out of 100 ( 40 % ) of babies in the routine care group . The difference in breast-feeding rate at 4 months was 3.3 % , 95 % CI ( -10.3 % , 16.7 % ) ; chi(2)=0.22 ; df=1 ; P=0.64 . The mean temperature 1 hr after birth was higher with skin-to-skin than routine care . The difference in means was 0.15 degrees C ; 95 % CI ( 0.03 , 0.28 ) ; P=0.02 . A larger proportion of mothers ( 87/97 [ 90 % ] ) were very satisfied with skin-to-skin care , compared with 60 out of 102 ( 59 % ) in the control group ; 83 out of 97 ( 86 % ) of the mothers in the intervention group said that they would prefer to receive the same care in the future compared with 31 out of 102 ( 30 % ) mothers in the control group . CONCLUSIONS the difference between the groups in the success rate for the first breast feed and rates at 4 months was not statistically significant . However , mothers who had skin-to-skin contact enjoyed the experience , and most reported that they would choose to have skin-to skin care in the future . In this , the largest trial to date , previous concerns about baby-body temperature after skin-to-skin care were dispelled CONTEXT Current evidence that breastfeeding is beneficial for infant and child health is based exclusively on observational studies . Potential sources of bias in such studies have led to doubts about the magnitude of these health benefits in industrialized countries . OBJECTIVE To assess the effects of breastfeeding promotion on breastfeeding duration and exclusivity and gastrointestinal and respiratory infection and atopic eczema among infants . DESIGN The Promotion of Breastfeeding Intervention Trial ( PROBIT ) , a cluster-r and omized trial conducted June 1996-December 1997 with a 1-year follow-up . SETTING Thirty-one maternity hospitals and polyclinics in the Republic of Belarus . PARTICIPANTS A total of 17 046 mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed , 16491 ( 96.7 % ) of which completed the entire 12 months of follow-up . INTERVENTIONS Sites were r and omly assigned to receive an experimental intervention ( n = 16 ) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children 's Fund , which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support , or a control intervention ( n = 15 ) of continuing usual infant feeding practice s and policies . MAIN OUTCOME MEASURES Duration of any breastfeeding , prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life and occurrence of 1 or more episodes of gastrointestinal tract infection , 2 or more episodes of respiratory tract infection , and atopic eczema during the first 12 months of life , compared between the intervention and control groups . RESULTS Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months ( 19.7 % vs 11.4 % ; adjusted odds ratio [ OR ] , 0.47 ; 95 % confidence interval [ CI ] , 0.32 - 0.69 ) , were more likely to be exclusively breastfed at 3 months ( 43.3 % vs 6.4 % ; P<.001 ) and at 6 months ( 7.9 % vs 0.6 % ; P = .01 ) , and had a significant reduction in the risk of 1 or more gastrointestinal tract infections ( 9.1 % vs 13.2 % ; adjusted OR , 0.60 ; 95 % CI , 0.40 - 0.91 ) and of atopic eczema ( 3.3 % vs 6.3 % ; adjusted OR , 0.54 ; 95 % CI , 0.31 - 0.95 ) , but no significant reduction in respiratory tract infection ( intervention group , 39.2 % ; control group , 39.4 % ; adjusted OR , 0.87 ; 95 % CI , 0.59 - 1.28 ) . CONCLUSIONS Our experimental intervention increased the duration and degree ( exclusivity ) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life . These results provide a solid scientific underpinning for future interventions to promote breastfeeding OBJECTIVE : To address the impact of simple antenatal educational interventions on breastfeeding practice . METHODS : A r and omized controlled trial was carried out in a tertiary referral center from May 2002 to December 2004 . A r and om sample of eligible low-risk antenatal patients was recruited from clinics in the National University Hospital , Singapore . Group A received breastfeeding educational material and individual coaching from a lactation counselor . Group B received breastfeeding educational material with no counseling . Group C received routine antenatal care only . RESULTS : A total of 401 women were recruited . Mothers receiving individual counseling and educational material  practice d exclusive and predominant breastfeeding more often than mothers receiving routine care alone at 3 months ( odds ratio [ OR ] 2.6 , 95 % confidence interval [ CI ] 1.2–5.4 ) and 6 months ( OR 2.4 , 95 % CI 1.0–5.7 ) postpartum . More mothers practice d exclusive and predominant breastfeeding at 6 months among women receiving individual counseling compared with women exposed to educational material alone ( OR 2.5 , 95 % CI 1.0–6.3 ) . CONCLUSION : Where breastfeeding practice s are suboptimal , simple one-encounter antenatal education and counseling significantly improve breastfeeding practice up to 3 months after delivery . Provision of printed or audiovisual educational material is not enough . Health care workers should make every effort to have one face-to-face encounter to discuss breastfeeding with expectant mothers before they deliver . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT002770192 LEVEL OF EVIDENCE : OBJECTIVE To determine whether infants of women r and omized to a prenatal and postpartum lactation support intervention  incur fewer otitis media- , respiratory tract- , or gastrointestinal-related visits than controls . DESIGN R and omized , unmasked controlled trial recruiting women from prenatal care setting s. Breastfeeding sensitive ( BFS ) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months . SETTING Two urban community health centers . PARTICIPANTS Analytic sample of 338 low-income , primarily Hispanic and /or black mother-infant dyads ( n = 163 for the intervention group and n = 175 for the control group ) . INTERVENTION Study lactation consultants attempted 2 prenatal meetings , 1 postpartum hospital and /or home visit , and telephone calls as needed . Controls received the st and ard of care . MAIN OUTCOME MEASURES Combined outpatient and emergency department visits with illness and BFS illness diagnoses . RESULTS There was a significant interaction between treatment and Medicaid ; among those not receiving Medicaid , the number of otitis media visits was higher among controls ( P</=.03 ) . Visits for any illness and BFS , gastrointestinal , or respiratory tract illnesses did not differ by treatment group . Intervention group infants received more breast milk than controls , but exclusive breastfeeding rates remained low and did not differ between groups at any point . CONCLUSIONS Only the number of otitis media visits was reduced , in a subset of the intervention group . The intervention did not reduce visits for respiratory tract or gastrointestinal illness . Limited intervention contact and low exclusive breastfeeding rates may have attenuated intervention effects . Future interventions design ed to yield markedly increased breastfeeding rates may show greater effects in low-income multiethnic sample s. Health coverage for visits may moderate intervention effects A prospect i ve case‐control study of  sudden infant death syndrome ( SIDS ) in Norway , Denmark and Sweden between September 1,1992 and August 31,1995 comprised 244 cases and 869 matched controls . After the introduction of risk‐intervention campaigns , the SIDS incidence decreased from 2 . 3/1000 live births in Norway , 1 . 6 in Denmark and 1 . 0 in Sweden to 0 . 6/1000 or fewer in all the Sc and inavian countries in 1995 . The decrease paralleled a decline in the prone sleeping position and there was an accompanying parallel fall in total postneonatal mortality in all three countries . Thus , the risk‐reducing campaigns for SIDS have been successful not only in Norway and Denmark , starting from relatively high incidences , but also in Sweden , starting from a low incidence . During the study period , a gradual increase was observed for the effects of prone sleeping , smoking and bottle‐feeding as risk factors for SIDS To determine how the effects of certain risk factors for  acute otitis media ( AOM )  vary according to the values of other risk determinants , and thus to obtain risk estimates more applicable to individual children , the medical records of a r and om sample of 2,512 children in northern Finl and were monitored for the disease for up to an average age of 22 months . Information on determinants of AOM was obtained from parental question naires . The risk of the first AOM episode and that of later episodes were modelled separately by logistic regression using time-dependent values for some determinants . The odds ratio ( OR ) estimates for the alterable risk factors varied markedly over categories of other determinants as follows : nursery day care versus home care ( OR from 1.1 to 3.0 ) , parental smoking ( OR from 0.9 to 1.5 ) , and breast-feeding ( OR from 0.5 to 1.0 ) . Hence , to assess the significance of each risk factor for an individual child , the values for other relevant factors must be considered concurrently OBJECTIVE Breastfeeding initiation rates were compared at Boston Medical Center before ( 1995 ) , during ( 1998 ) , and after ( 1999 ) Baby-Friendly policies were in place . Boston Medical Center , an inner-city teaching hospital that provides care primarily to poor , minority , and immigrant families , achieved Baby-Friendly status in 1999 . METHODS Two hundred complete medical records , r and omly selected by a computer , were review ed from each of 3 years : 1995 , 1998 , and 1999 . Infants were excluded for medical records missing feeding data , human immunodeficiency virus-positive parent , neonatal intensive care unit admission , maternal substance abuse , adoption , incarceration , or hepatitis C-positive mother . All infant feedings during the hospital postpartum stay were tallied , and each infant was categorized into 1 of 4 groups : exclusive breast milk , mostly breast milk , mostly formula , and exclusive formula . RESULTS Maternal and infant demographics for all 3 years were comparable . The breastfeeding initiation rate increased from 58 % ( 1995 ) to 77.5 % ( 1998 ) to 86.5 % ( 1999 ) . Infants exclusively breastfed increased from 5.5 % ( 1995 ) to 28.5 % ( 1998 ) to 33.5 % ( 1999 ) . Initiation rates increased among US-born black mothers in this population from 34 % ( 1995 ) to 64 % ( 1998 ) to 74 % ( 1999 ) . CONCLUSIONS Full implementation of the Ten Steps to Successful Breastfeeding leading to Baby-Friendly design ation is an effective strategy to increase breastfeeding initiation rates in the US hospital setting The purpose of this study was to determine the incidence of clinical ly significant depression occurring between 7 and 4 months postpartum and to investigate whether somatic complaints , subsyndromal depressive symptoms , or birth-related concerns among non-depressed women at 1 month were predictive of postpartum depression . This is a prospect i ve cohort study of 465 women from the Wisconsin Maternity Leave and Health Project ( WMLHP ) . Women who were not depressed at 1 month postpartum were reassessed 3 months later for depression occurring at any time in the interval between 1 and 4 months postpartum . Depression was defined as either meeting the criteria for major depression on the National Institute of Mental Health ( NIMH ) Diagnostic Interview Schedule ( DIS ) or scoring above 15 on the Center for Epidemiologic Studies Depression Scale ( CES-D ) . Physical symptoms were assessed by an adapted Health Responses Scale . Other measures were developed specifically for the WMLHP . Of 465 women , 27 ( 5.8 % ) became clinical ly depressed between 1 and 4 months postpartum . In a logistic regression analysis , four variables ( maternal age , depression during pregnancy , thoughts of death and dying at 1 month postpartum , and difficulty falling asleep at 1 month postpartum ) were predictive of depression at 4 months postpartum . Breast-feeding , mode of delivery , family income , parity and mother‘s education did not predict depression . The existence of subsyndromal depressive symptoms , particularly thoughts of death and dying , may represent a prodromal phase of depression and should alert clinicians to the possibility of future postpartum depression . Women with a history of depression during pregnancy should be monitored for signs of postpartum depression for a minimum of 4 months . Obstetricians are in a unique position during the postpartum check-up to screen women for these predictors of future postpartum depression and possibly to avert the development of a clinical ly significant depressive episode Aim : To determine the effects of mother‐infant skin‐to‐skin contact immediately after birth on infant recognition of their own mother 's milk odour and breastfeeding duration until 1 y of age . Methods : Sixty healthy , full‐term neonates were r and omly assigned to group A with skin‐to‐skin contact and group B without . One and 4d after birth , infant responses to the following odour stimuli were observed : own mother 's milk , another mother 's milk , formula , orange juice and distilled water . Infant facial action was videotaped and the frequency of mouthing movements was evaluated for each stimulus . Nutritional assessment , focused particularly on breastfeeding , was performed every 3 mo on participating infants . Statistical analysis comparing the frequency of mouthing movements with the aforementioned five different odour exposures was performed by ANOVA with Fisher 's PLSD . Kaplan‐Meier analysis with a log‐rank test was used to compare breastfeeding rates between groups . Results : Infants in both groups responded differently to mother 's milk odour ( either their own or another mother 's milk ) compared to the other stimuli on days 1 and 4 . However , infants in group A demonstrated a larger difference in mouthing movements between their own and another mother 's milk odour at 4 d of age ( 2.6 ± ; 1.6 ) compared to infants in group B ( 0.9 ± ; 2.0 , p= 0.01 ) . Infants in group A were breastfed an average of 1.9 mo longer than the others OBJECTIVES To identify the risk factors for sudden infant death syndrome ( SIDS )  following a national campaign to prevent SIDS . METHODS For 2 years ( October 1 , 1991 through September 30 , 1993 ) data were collected by community child health nurses on all infants born in New Zeal and at initial contact and at 2 months . RESULTS There were 232 SIDS cases in the postneonatal age group ( 2.0/1000 live births ) and these were compared with 1200 r and omly selected control subjects . Information was available for 127 cases ( 54.7 % ) and 922 ( 76.8 % ) of controls . The previously identified modifiable risk factors were examined . The prevalence of prone sleeping position of the infant was very low ( 0.7 % at initial contact and 3 . 0 % at 2 months ) , but was still associated with an increased risk of SIDS . In addition , the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position ( at 2 months : adjusted odds ratio ( OR ) = 6.57 ; 95 % confidence interval ( CI ) = 1.71 , 25.23 ) . Maternal smoking was found to be the major risk factor for SIDS . Bed sharing was also associated with an increased risk of SIDS . There was an interaction between maternal smoking and bed sharing on the risk of SIDS . Compared with infants not exposed to either bed sharing or maternal smoking , the adjusted OR for infants of mothers who smoked was 5.01 ( 95 % CI = 2.01 , 12.46 ) for bed sharing at the initial contact and 5.02 ( 95 % CI = 1.05 , 24 . 05 ) for bed sharing at 2 months . In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS . The other risk factors for SIDS identified were : unmarried mother , leaving school at a younger age , young mother , greater number of previous pregnancies , late attendance for antenatal care , smoking in pregnancy , male infant , Maori ethnicity , low birth weight , and shorter gestation . CONCLUSIONS After adjustment for potential confounders , prone and side sleeping positions , maternal smoking , and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS . A change from the side to the supine sleeping position could result in a substantial reduction in SIDS .  Maternal smoking is common in New Zeal and and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country . However , smoking behavior has been difficult to change . Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke . Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third . Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders , but as breastfeeding rates are comparatively good in New Zeal and , this result should be interpreted with caution as the power of this study to detect a benefit is small BACKGROUND Promotion of breastfeeding is an important child-survival intervention , yet little is known about which promotional strategies are the most effective . We aim ed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil -- a hospital-based system and the same system combined with a programme of home visits . METHODS In February , 2001 , maternity staff from two hospitals in Pernambuco , Brazil , were trained according to the Baby-Friendly Hospital Initiative ( BFHI ) . In a r and omised trial between March and August , 2001 , 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding ( n=175 ) or no home visits ( n=175 ) . Breastfeeding practice s were studied on days 1 , 10 , 30 , 60 , 90 , 120 , 150 , and 180 by research ers unaware of group allocation . The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months . Analyses were by intention to treat . FINDINGS The hospital-training intervention achieved a high rate ( 70 % ) of exclusive breastfeeding in the hospitals , but this rate was not sustained at home and at 10 days of age only 30 % of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10 - 180 differed significantly ( p<0.0001 ) , with a mean aggregated prevalence of 45 % among the group assigned home visits compared with 13 % for the group assigned none . INTERPRETATION The BFHI achieves high rates of exclusive breastfeeding in hospital ; however , in Brazil at least , the rates fall rapidly thereafter . Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed . A combination of promotional systems ( hospital-based and in the community ) is needed BACKGROUND Although lactation experts suggest that a correct positioning and attachment technique reduces breastfeeding problems and enhances long-term breastfeeding , evidence from r and omized trials is lacking . The objective of this study was to evaluate the effect of postpartum positioning and attachment education on breastfeeding outcomes in first-time mothers . METHOD A r and omized trial was performed in a public hospital in Adelaide , South Australia , where 160 first-time mothers were r and omly allocated to receive either structured one-to-one education ( experimental group ) or usual postpartum care ( control group ) within 24 hours of birth . The primary outcome was breastfeeding at 6 weeks and 3 and 6 months postpartum ; other outcomes were nipple pain and trauma in hospital and at 6 weeks and 3 and 6 months , and satisfaction with breastfeeding . RESULTS No significant differences occurred in breastfeeding rates between the groups at each endpoint , although a trend in the direction of lower rates was seen at each endpoint in the experimental group . This group reported less nipple pain on days 2 ( p = 0.004 ) and 3 ( p = 0.04 ) , but this was not sustained on follow-up . No differences were observed in nipple trauma in hospital or in self-reported nipple pain and /or trauma at the three endpoints . Experimental group women were less satisfied with breastfeeding at 3 and 6 months postpartum when using a one-item measure ; however , a multiple-item measure showed no significant differences at the three endpoints . CONCLUSIONS The intervention did not increase breastfeeding duration at any assessment time or demonstrate any differences between the groups on secondary outcomes . The trend toward lower breastfeeding rates in the experimental group suggests a need for a larger trial to evaluate whether or nor postpartum positioning and attachment education may negatively affect breastfeeding CONTEXT The World Health Organization and the United Nations Children 's Fund strongly discourage use of pacifiers because of their perceived interference with breastfeeding . Observational studies have reported a strong association between pacifier use and early weaning , but such studies are unable to determine whether the association is causal . OBJECTIVES To test whether regular pacifier use is causally related to weaning by 3 months postpartum and to examine differences in results according to r and omized intervention allocation vs observational use or nonuse of pacifiers . DESIGN Double-blind , r and omized controlled trial conducted from January 1998 to August 1999 . SETTING Postpartum unit of a university teaching hospital in Montreal , Quebec . PARTICIPANTS A total of 281 healthy , breastfeeding women and their healthy , term singleton infants . INTERVENTIONS Participants were r and omly allocated to 1 of 2 counseling interventions provided by a research nurse trained in location counseling . The experimental intervention ( n = 140 ) differed from the control ( n = 141 ) by recommending avoidance of pacifier use and suggesting alternative ways to comfort a crying or fussing infant . MAIN OUTCOME MEASURES Early weaning , defined as weaning within the first 3 months , compared between groups ; 24-hour infant behavior logs detailing frequency and duration of crying , fussing , and pacifier use at 4 , 6 , and 9 weeks . RESULTS A total of 258 mother-infant pairs ( 91.8 % ) completed follow-up . The experimental intervention increased total avoidance of pacifier use ( 38.6 % vs 16.0 % in the control group ) , reduced daily use ( 40.8 % vs 55.7 % ) , and decreased the mean number of pacifier insertions per day ( 0.8 vs 2.4 at 4 weeks [ P<.001 ] ; 0.8 vs 3.0 at 6 weeks [ P<.001 ] ; and 1.3 vs 3.0 at 9 weeks [ P = .004 ] ) . In the analysis based on r and omized intervention allocation , the experimental intervention had no discernible effect on weaning at 3 months ( 18.9 % vs 18.3 % in the experimental vs control group ; relative risk [ RR ] , 1.0 ; 95 % confidence interval [ CI ] , 0.6 - 1.7 ) , and no effect was observed on cry/fuss behavior ( in the experimental vs control groups , respectively , total daily duration , 143 vs 151 minutes at 4 weeks [ P = .49 ] ; 128 vs 131 minutes at 6 weeks [ P = .81 ] ; and 110 vs 104 minutes at 9 weeks [ P = .58 ] ) . When r and omized allocation was ignored , however , we observed a strong observational association between exposure to daily pacifier use and weaning by 3 months ( 25.0 % vs 12.9 % of the exposed vs unexposed groups ; RR , 1.9 ; 95 % CI , 1.1 - 3.3 ) . CONCLUSIONS We found a strong observational association between pacifier use and early weaning . No such association was observed , however , when our data were analyzed by r and omized allocation , strongly suggesting that pacifier use is a marker of breastfeeding difficulties or reduced motivation to breastfeed , rather than a true cause of early weaning BACKGROUND Social support has been shown to be greatly important for breastfeeding success . The objective of this study was to investigate if  mothers who were attended by midwives and nurses specially trained in breastfeeding counseling  perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care . METHOD Ten municipalities , each with an antenatal center and child health center , in southwest Sweden were r and omized either to intervention or control municipalities . The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers . Primiparas were asked to evaluate the care given , and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups . The 540 mothers responded to 3 question naires at 3 days and at 3 and 9 months postpartum . The perception of support provided by the health professionals and from the family classes was rated on Likert scales . RESULTS Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups , and better than control group B mothers at 3 months postpartum ; compared with both control groups , intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby 's needs . At 9 months , intervention group mothers were more satisfied with knowledge about social rights , information about the baby 's needs , and their social network than control group B mothers . Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy . At 3 and 9 months , intervention group mothers perceived that postnatal nurses were more sensitive and underst and ing compared with both control groups . CONCLUSIONS After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care , the mothers were more satisfied with emotional and informative support during the first 9 months postpartum . The results lend support to family classes incorporating continuity of care OBJECTIVE To determine whether postnatal ' h and s off ' care by midwives on positioning and attachment of the newborn baby improves breast-feeding duration . DESIGN Mothers were r and omised at the first postnatal feed  to receive either care by a midwife trained in the experimental protocol or by a control midwife undertaking routine care . SETTING Eight wards in four English Midl and s hospitals . PARTICIPANTS 370 primiparous mothers with term babies who intended to breast feed , and could sit out of bed to do so . INTERVENTIONS Experimental protocol of verbal-only advice on positioning and attachment , delivered at the first postnatal ward feed compared with routine care by a qualified midwife . MAIN OUTCOME MEASURES Duration of breast feeding up to 17 weeks as assessed by diaries and interviews with mothers and protocol adherence from self-completed checklist by the midwife . The mothers ' self-reported experience of care and support before , during and after delivery were assessed at 6 weeks , and feeding outcomes and employment status at 17 weeks . FINDINGS Experimental group mothers more often held the baby across their lap and received ' h and s off advice ' , but fewer babies in the experimental than control groups attached and fed : 59 % ( 106/180 ) vs. 67 % ( 118/175 ) , p=0.1 . No significant differences were found in the numbers of mothers breast feeding at 6 or 17 weeks in the experimental and control groups ( stopped exclusive breast feeding : 76 % ( 130/172 ) vs. 77 % ( 126/163 ) at 6 weeks ; 96 % ( 167/174 ) vs. 96 % ( 161/168 ) at 17 weeks ; odds ratio 1.02 , 95 % CI 0.77 to 1.22 ; p=0.8 ; stopped any breast feeding : 35 % ( 61/172 ) vs. 32 % ( 53/167 ) at 6 weeks ; 63 % ( 109/173 ) vs. 60 % ( 101/167 ) at 17 weeks ; odds ratio 1.10 , 0.84 to 1.45 ; p=0.5 ) . There were no significant differences in the incidence of problems with breast feeding and care experienced by mothers before or during hospitalisation ( other than at the first postnatal ward feed ) , nor after discharge home . CONCLUSIONS No significant beneficial effect was found on breast-feeding duration of the verbal- only advice on positioning and attachment , perhaps because aspects of the intervention are already within routine UK practice . Other care practice s at subsequent feeds may negate benefits of care at earlier feeds . ' H and s off ' care at the first feed may be less important to subsequent feeding than achieving a first feed under supervision in the postnatal ward . IMPLICATION S FOR PRACTICE Midwives can be trained in a 4-hr workshop to achieve improved knowledge of ' h and s off ' positioning and attachment care , and these can be translated into clinical practice . Future studies should differentiate the elements of the care that are effective in achieving postnatal feeds , and apply this advice consistently at successive feeds BACKGROUND Teenage pregnancies are associated with negative socioeconomic effects . Our aim was to ascertain whether a postnatal home-visiting service for teenage mothers younger than age 18 years could reduce the frequency of adverse neonatal outcomes and improve knowledge of contraception , breastfeeding , and infant vaccination schedules in this parent group . METHODS We enrolled 139 adolescents , attending a teenage pregnancy clinic , in a r and omised controlled trial . After completing an antenatal question naire design ed to assess their knowledge of contraception , infant vaccination , and breastfeeding , we assigned participants to either receive five structured postnatal home visits by nurse-midwives ( n=65 ) or not ( n=71 ) . Assessment interviews were done 6 months postpartum . Our primary endpoint was unadjusted difference in knowledge between groups , and incidence of predefined adverse neonatal outcomes . Analysis was by intention to treat . FINDINGS Three women withdrew before r and omisation because of late fetal loss , 11 mothers withdrew because of adverse neonatal outcomes  ( adverse neonatal outcome was a primary endpoint , but result ed in withdrawal from the study for knowledge outcomes ) , and one left voluntarily . Follow-up data were , therefore , available for 124 teenagers . Postnatal home visits were associated with a reduction in adverse neonatal outcomes ( intervention : 2 ; control : 9 ; relative risk 0.24 , 95 % CI 0.05 - 1.08 ) , and a significant increase in contraception knowledge ( mean difference 0.92 , 95 % CI 0.32 - 1.52 ) . However , there was no significant increase in knowledge with respect to breastfeeding or infant vaccination schedules associated with the home visits . INTERPRETATION Postnatal home-visiting services by nurse-midwives reduce adverse neonatal events and improve contraception outcomes , but do not affect breastfeeding or infant vaccination knowledge or compliance
Human milk is the natural nutrition for all infants .
According to the American Academy of Pediatrics , it is the preferred choice of feeding for all infants ( 1 ) .
The goals of Healthy People 2010 for breastfeeding are an initiation rate of 75 % and continuation rate of 50 % at 6 months and 25 % at 12 months after delivery ( 2 ) .
In children , breastfeeding has been associated with a reduction in the risk for acute otitis media , nonspecific gastroenteritis , severe lower respiratory tract infections , atopic dermatitis , childhood leukemia , and the sudden infant death syndrome .
In mothers , a history of lactation has been associated with a reduced risk for type 2 diabetes and breast and ovarian cancer ( 4 ) .
What are the effects of breastfeeding interventions on child and maternal health outcomes ?
2 .
What are the effects of breastfeeding interventions on breastfeeding initiation , duration , and exclusivity ?
3 .
Are there harms from interventions to promote and support breastfeeding ?
4 .
What are the benefits and harms of breastfeeding on infant or child health outcomes ?
5 .
What are the benefits and harms of breastfeeding on maternal health outcomes ?
Classification of Breastfeeding Interventions Breastfeeding interventions can include a combination of individual components , such as structured breastfeeding education or professional or lay support .