scholarly journals Delayed Lactogenesis Is Associated with Suboptimal Breastfeeding Practices: A Prospective Cohort Study

2019 ◽  
Vol 150 (4) ◽  
pp. 894-900 ◽  
Author(s):  
Li Huang ◽  
Shangzhi Xu ◽  
Xi Chen ◽  
Qian Li ◽  
Lixia Lin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Normal Weight ◽  
Face To Face ◽  
Gestational Weight ◽  
Breastfeeding Practices ◽  
Suboptimal Breastfeeding ◽  
Adjusted Model

ABSTRACT Background Breastfeeding has many established health benefits to both babies and mothers. There is limited evidence on the association between delayed lactogenesis and breastfeeding practices. Objective We assessed the association between delayed lactogenesis and breastfeeding practices in women initiating breastfeeding. Design We used data from a prospective cohort study in Wuhan, China, which enrolled pregnant women at 8–16 weeks of gestation and followed up to postpartum. Women were included who had a singleton live birth, initiated breastfeeding, and provided information on infant feeding. Maternal lactogenesis status was assessed by face-to-face interview at day 4 postpartum. Breastfeeding practices (full breastfeeding and/or any breastfeeding) were queried by telephone interview at 3, 6, and 12 mo postpartum. Poisson regression and Cox regression were used to identify the association between delayed lactogenesis and breastfeeding practices. Results Delayed lactogenesis was reported by 17.9% of the 2877 participants. After adjusting for potential confounders, when compared with timely lactogenesis, delayed lactogenesis was significantly associated with higher risk of inability to sustain full breastfeeding at 3 mo postpartum (RR: 1.24, 95% CI: 1.10, 1.39) and 6 mo postpartum (RR: 1.14, 95% CI: 1.04, 1.24). Delayed lactogenesis was also significantly associated with early termination of any breastfeeding (HR: 1.15, 95% CI: 1.01, 1.30) in the adjusted model. In a combined analysis, women with higher gestational weight gain (GWG, ≥16 kg for underweight and normal weight, 15 kg for overweight/obesity) and who subsequently experienced delayed lactogenesis had the highest risk of ending any breastfeeding earlier (adjusted HR: 1.32, 95% CI: 1.11, 1.55) compared with those who gained less GWG and experienced timely lactogenesis. Conclusions This study shows that delayed lactogenesis was associated with low rate of full breastfeeding and shorter duration of any breastfeeding. Greater efforts to promote breastfeeding should be targeted towards women with delayed lactogenesis.

scholarly journals Delayed Onset of Lactogenesis Is Associated with Suboptimal Breastfeeding Practices in the TMCHC Study: A Prospective Cohort Study (OR30-05-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Li Huang ◽  
Xi Chen ◽  
Qian Li ◽  
Lixia Lin ◽  
Duan Gao ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cox Regression ◽  
Chinese Women ◽  
Basic Research ◽  
Delivery Mode ◽  
Face To Face ◽  
Delayed Onset ◽  
Funding Sources ◽  
Breastfeeding Practices ◽  
Suboptimal Breastfeeding

Abstract Objectives Whether delayed onset of lactogenesis (delayed OL) was linked to successful breastfeeding is unclear. We aimed to assess the association between delayed OL and breastfeeding practices in Chinese women. Methods Women form the TMCHC (Tongji Maternal and Child Health Cohort) study, who had OL assessment by face-to-face interview at day 4 postpartum and breastfeeding practices collected at 3, 6 and 12 months postpartum, were selected for the study. Poisson regression and Cox regression were used to identify the association between delayed OL and breastfeeding practices. Results Delayed OL was reported by 17.7% of the 2691 participants. After adjusting for maternal age, ethnicity, education, income, parity, pre-pregnancy BMI, GDM, gestational weight gain, gestational age, delivery mode, birth weight and breastfeeding information at day 1 postpartum, delayed OL was significantly associated with a higher risk of an inability to sustain full breastfeeding at 3 months postpartum (RR:1.31, 95% CI: 1.16, 1.48) and 6 months postpartum (RR:1.17, 95% CI: 1.07, 1.28), when compared with timely OL. Delayed OL was also significantly associated with early termination of any breastfeeding (HR:1.17, 95% CI: 1.01, 1.34) in adjusted model. Conclusions This study shows that women with delayed OL had a higher risk of suboptimal breastfeeding practices. Comprehensive efforts should be targeted towards women with delayed OL to promote breastfeeding. Funding Sources Funding was received from National Program on Basic Research Project of China (NO.2013FY114200) and the Fundamental Research Funds for the Central Universities (HUST2016YXZD040) for Nianhong Yang. Supporting Tables, Images and/or Graphs

scholarly journals Patterns and predictors of gestational weight gain in Addis Ababa, Central Ethiopia: a prospective cohort study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Fekede Asefa ◽  
Allison Cummins ◽  
Yadeta Dessie ◽  
Maralyn Foureur ◽  
Andrew Hayen
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
Weight Gain ◽  
Pregnant Women ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Addis Ababa ◽  
Normal Weight ◽  
Obese Women ◽  
Gestational Weight

Abstract Introduction Gaining excessive or inadequate gestational weight is associated with many adverse maternal and fetal outcomes. Inadequate gestational weight gain (GWG) increases the risk of fetal growth restriction, pre-term birth, and low birth weight. It is a public health concern in sub-Saharan Africa. The aim of this study was to assess the patterns and predictors of GWG in Addis Ababa, Ethiopia. Methods We conducted a prospective cohort study among pregnant women who attended antenatal care in health centres in Addis Ababa, from January to September 2019. Data were collected by a structured questionnaire and checklists and analysed using Stata version-14. Weight at or before 16 weeks gestation was used as a proxy for pre-pregnancy weight. Women’s height and baseline weight were measured by data collectors, and we obtained weight at the end of the 24th and 36th weeks of gestation from women’s medical records. GWG was categorized as inadequate, adequate and excessive based on the United States Institute of Medicine criteria. Predictors of GWG were identified using multinomial logistic regression. Results A total of 395 pregnant women were enrolled in the study. GWG was assessed for 369 (93%) women. The median GWG was 8.7 kg with inter quartile ranges (25th, 75th percentiles) of 7.0 kg and 11.6 kg. More than two-third of the participants, 248 (67.2% [95% CI: 62.2, 72.0%]), gained inadequate weight; 103 (27.9% [95% CI: 23.4, 32.8%]) gained adequate weight; and 18 (4.9% [95% CI: 2.9%, 7.6%]) gained excessive weight. Three quarters (75%) of underweight women gained inadequate gestational weight, whereas 43% of overweight or obese women gained inadequate gestational weight. Being underweight (AOR = 3.30 [95% CI: 1.32, 8.24]) or normal weight (AOR = 2.68 [95% CI: 1.37, 5.24]) before pregnancy increased the odds of gaining inadequate gestational weight compared to overweight or obese women. Not having paid employment was associated with higher odds of gaining inadequate gestational weight compared to women employed outside the home (AOR = 2.17 [95% CI: 1.16, 4.07]). Conclusions Most pregnant women in Addis Ababa gain inadequate gestational weight. In particular, three quarters of underweight women gained inadequate gestational weight. Being underweight, normal weight or having no paid employment were associated with higher odds of inadequate GWG. Promoting adequate GWG in Addis Ababa among underweight and normal weight women may be an important public health initiative.

scholarly journals The effects of weight fluctuation on the components of metabolic syndrome: a 16-year prospective cohort study in South Korea

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Young Ran Chin ◽  
Eun Sun So
Keyword(s):  
Metabolic Syndrome ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Abdominal Obesity ◽  
Prospective Cohort ◽  
Weight Control ◽  
Normal Weight ◽  
Health Concern ◽  
Care Providers ◽  
Weight Fluctuation

Abstract Background Weight fluctuation (WF) is highly prevalent in parallel with the high prevalence of intentional or unintentional dieting. The health risks of frequent WF for metabolic syndrome (MS) have become a public health concern, especially for health care providers who supervise dieting as an intervention to prevent obesity-related morbidity or to improve health, as well as for the general population for whom dieting is of interest. The aim of this study was to investigate the long-term effect of WF on the risk of MS in Koreans. Methods This study analyzed secondary data from the Korean Genome and Epidemiology Study, a 16-year prospective cohort study, on 8150 individuals using time-dependent Cox regression. Results WF did not increase the risk of MS in either normal-weight or obese subjects. In an analysis of the components of MS, greater WF significantly increased the risk of abdominal obesity (HR = 1.05, 95% CI = 1.02–1.07, p < 0.001) in normal-weight individuals. However, WF did not increase the risk of hyperglycemia, low high-density lipoprotein cholesterol levels, elevated blood pressure, or raised fasting glucose in normal-weight individuals, and it did not influence any of the components of MS in obese individuals. Conclusion Since WF was found to be a risk factor for abdominal obesity, which is the most reliable predictor of MS, it should be considered when addressing weight control. Further studies on cut-off points for the degree of weight loss in a certain period need to be conducted to help clinicians provide guidance on appropriate weight control.

scholarly journals HIV diagnosis period influences ART initiation: findings from a prospective cohort study in China

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Tinglong Yang ◽  
Xueying Yang ◽  
Linghua Li ◽  
Huifang Xu ◽  
Lirui Fan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Hiv Diagnosis ◽  
Initiation Rate ◽  
Art Initiation ◽  
Significant Difference ◽  
New Strategy ◽  
New Treatment

Abstract Background We estimated the predictive effects of ART-related perceptions on the actual ART uptake behavior among ART naïve PLWH stratified by different time of HIV diagnosis under the new strategy. Methods A prospective cohort study was conducted among ART naïve PLWH in Guangzhou, China from June 2016 to June 2017. Cox regression model was used to evaluate the predictive effects of ART-related perceptions on ART initiation among PLWH stratified by different timepoint of HIV diagnosis (i.e., before or after the update of the new treatment policy). Results Among 411 participants, 150 and 261 were diagnosed before (pre-scaleup group) and after (post-scaleup group) the implementation of the new strategy, respectively. The ART initiation rate in the post-scaleup group (88.9%) was higher than that in the pre-scaleup group (73.3%) (p < 0.001). A significant difference of mean score was detected in each HBM construct between pre- and post-scaleup groups (p < 0.05). After adjusting for significant background variables, among all participants, only the self-efficacy [adjusted HR (HRa) = 1.23, 95% CI 1.06 to 1.43, p = 0.006], has a predictive effect on ART initiation; in pre-scaleup group, all constructs of HBM-related ART perceptions were predictors of ART initiation (HRa = 0.71 to 1.83, p < 0.05), while in post-scaleup group, no significant difference was found in each construct (p > 0.05). Conclusions The ART initiation rate was high particularly among participants who diagnosed after the new treatment strategy. The important role of the time of HIV diagnosis on ART initiation identified in this study suggested that future implementation interventions may consider to modify the ART-related perceptions for HIV patients who diagnosed before the implementation of the new ART strategy, while expand the accessibility of ART service for those who diagnosed after the implementation of the new strategy.

Influences of Cesarean Delivery on Breastfeeding Practices and Duration: A Prospective Cohort Study

2018 ◽  
Vol 34 (3) ◽  
pp. 526-534 ◽  
Author(s):  
Cheng Chen ◽  
Yan Yan ◽  
Xiao Gao ◽  
Shiting Xiang ◽  
Qiong He ◽  
...  
Keyword(s):  
Cohort Study ◽  
Regression Model ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Prospective Cohort Study ◽  
Exclusive Breastfeeding ◽  
Prospective Cohort ◽  
Breastfeeding Duration ◽  
Breastfeeding Initiation ◽  
Breastfeeding Practices

Background: Mothers are encouraged to exclusively breastfeed for the first 6 months. However, cesarean delivery rates have increased worldwide, which may affect breastfeeding. Research aim: This study aimed to determine the potential effects of cesarean delivery on breastfeeding practices and breastfeeding duration. Methods: This was a 6-month cohort study extracted from a 24-month prospective cohort study of mother–infant pairs in three communities in Hunan, China. Data about participants’ characteristics, delivery methods, breastfeeding initiation, use of formula in the hospital, exclusive breastfeeding, and any breastfeeding were collected at 1, 3, and 6 months following each infant’s birth. The chi-square test, logistic regression model, and Cox proportional hazard regression model were used to examine the relationship between breastfeeding practices and cesarean delivery. Results: The number of women who had a cesarean delivery was 387 (40.6%), and 567 (59.4%) women had a vaginal delivery. The exclusive breastfeeding rates at 1, 3, and 6 months were 80.2%, 67.4%, and 21.5%, respectively. Women who had a cesarean delivery showed a lower rate of exclusive breastfeeding and any breastfeeding than those who had a vaginal delivery ( p < .05). In addition, cesarean delivery was related with using formula in the hospital and delayed breastfeeding initiation. Cesarean delivery also shortened the breastfeeding duration (hazard ratio = 1.40, 95% confidence interval [1.06, 1.84]). Conclusion: Healthcare professionals should provide more breastfeeding skills to women who have a cesarean delivery and warn mothers about the dangers of elective cesarean section for breastfeeding practices.

scholarly journals Kidney transplant outcomes in recipients with visual, hearing, physical and walking impairments: a prospective cohort study

2019 ◽  
Vol 35 (7) ◽  
pp. 1262-1270
Author(s):  
Alvin G Thomas ◽  
Jessica M Ruck ◽  
Nadia M Chu ◽  
Dayawa Agoons ◽  
Ashton A Shaffer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Visual Impairment ◽  
Kidney Transplant ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Targeted Interventions ◽  
The Us ◽  
Independent Association ◽  
Poor Outcomes

Abstract Background Disability in general has been associated with poor outcomes in kidney transplant (KT) recipients. However, disability can be derived from various components, specifically visual, hearing, physical and walking impairments. Different impairments may compromise the patient through different mechanisms and might impact different aspects of KT outcomes. Methods In our prospective cohort study (June 2013–June 2017), 465 recipients reported hearing, visual, physical and walking impairments before KT. We used hybrid registry-augmented Cox regression, adjusting for confounders using the US KT population (Scientific Registry of Transplant Recipients, N = 66 891), to assess the independent association between impairments and post-KT outcomes [death-censored graft failure (DCGF) and mortality]. Results In our cohort of 465 recipients, 31.6% reported one or more impairments (hearing 9.3%, visual 16.6%, physical 9.1%, walking 12.1%). Visual impairment was associated with a 3.36-fold [95% confidence interval (CI) 1.17–9.65] higher DCGF risk, however, hearing [2.77 (95% CI 0.78–9.82)], physical [0.67 (95% CI 0.08–3.35)] and walking [0.50 (95% CI 0.06–3.89)] impairments were not. Walking impairment was associated with a 3.13-fold (95% CI 1.32–7.48) higher mortality risk, however, visual [1.20 (95% CI 0.48–2.98)], hearing [1.01 (95% CI 0.29–3.47)] and physical [1.16 (95% CI 0.34–3.94)] impairments were not. Conclusions Impairments are common among KT recipients, yet only visual impairment and walking impairment are associated with adverse post-KT outcomes. Referring nephrologists and KT centers should identify recipients with visual and walking impairments who might benefit from targeted interventions pre-KT, additional supportive care and close post-KT monitoring.

P6143Body-mass index, blood pressure, diabetes and cardiovascular mortality in Cuba: prospective cohort study of 146,665 participants

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B W H Lacey ◽  
N Armas ◽  
J A Burrett ◽  
R Peto ◽  
A Duenas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Metabolic Risk Factors ◽  
Metabolic Risk ◽  
Reverse Causality ◽  
Cvd Mortality

Abstract Background Cardiovascular disease (CVD) is a leading cause of premature death in Cuba, accounting for about one third of all deaths under age 70 years. Substantial uncertainty remains, however, about the relevance of major metabolic risk factors to CVD mortality in this population. Purpose To relate body-mass index (BMI), systolic blood pressure (SBP), and diabetes to risk of CVD death in Cuba. Methods In a prospective cohort study, 146,665 adults were recruited from the general population in five areas of Cuba between 1996 and 2002. Participants were interviewed, measured (height, weight and blood pressure) and followed up by electronic linkage to Cuban national death registries to Jan 1 2017; 24,345 participants were resurveyed between 2006 and 2008. After excluding all with missing data or chronic disease at recruitment or, to further limit reverse causality, those who died in the first 5 years, Cox regression (adjusted for age, sex, education, smoking, alcohol and, where appropriate, BMI) was used to relate mortality rate ratios (RRs) at ages 35–79 years to BMI, SBP and diabetes. Correlations of baseline and resurvey values were used to corrected RRs for regression dilution, and thereby estimate associations with long-term average (“usual”) levels of SBP and BMI. Results After exclusions, there were 117,008 participants age 35–79 (mean age 52 [SD 12]; 55% women). At recruitment, mean SBP was 124 mm Hg (SD 15), mean BMI was 24.2 kg/m2 (SD 3.6) and 5% had diabetes; mean SBP and diabetes prevalence were both strongly related to BMI. Correlations of resurvey and baseline measurements were 0.48 for SBP and 0.60 for BMI. At ages 35–79 years, there were 3780 CVD deaths (1871 ischaemic heart disease [IHD], 766 stroke, and 1143 other). CVD mortality was positively associated with BMI (down to about 22–23 kg/m2; figure), SBP and diabetes: 10 kg/m2 higher usual BMI approximately doubled CVD mortality (RR 1.90, 95% CI 1.61–2.24), as did 20 mmHg higher usual SBP (2.03, 1.88–2.20), and a prior diagnosis of diabetes (2.18, 1.97–2.42). The associations were similar in men and women. Given these associations, about one quarter (27%) of CVD deaths in this study were attributable to these metabolic risk factors combined. Conclusion These associations differ to those reported from other parts of Latin America, and are more consistent with studies in Europe and North America, highlighting the need for many more large-scale prospective studies in low and middle income countries. This study provides direct evidence for the expected benefit on CVD mortality of addressing major metabolic risk factors in Cuba. As the levels of these metabolic risk factors are increasing in Cuba, so too is their importance as determinants of premature CVD death. Acknowledgement/Funding Medical Research Council, British Heart Foundation, Cancer Research UK

scholarly journals Serum magnesium and cardiovascular mortality in peritoneal dialysis patients: a 5-year prospective cohort study

2018 ◽  
Vol 120 (4) ◽  
pp. 415-423 ◽  
Author(s):  
Hongjian Ye ◽  
Peiyi Cao ◽  
Xiaodan Zhang ◽  
Jianxiong Lin ◽  
Qunying Guo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peritoneal Dialysis ◽  
Prospective Cohort Study ◽  
Cardiovascular Mortality ◽  
Prospective Cohort ◽  
Cox Regression ◽  
Serum Magnesium ◽  
Study Endpoint ◽  
Lower Serum ◽  
All Cause Mortality

AbstractThe aim of this study was to explore the association between serum Mg and cardiovascular mortality in the peritoneal dialysis (PD) population. This prospective cohort study included prevalent PD patients from a single centre. The primary outcome of this study was cardiovascular mortality. Serum Mg was assessed at baseline. A total of 402 patients (57 % male; mean age 49·3±14·9 years) were included. After a median of 49·9 months (interquartile range: 25·9–68·3) of follow-up, sixty-two patients (25·4 %) died of CVD. After adjustment for conventional confounders in multivariate Cox regression models, being in the lower quartile for serum Mg level was independently associated with a higher risk of cardiovascular mortality, with hazards ratios of 2·28 (95 % CI 1·04, 5·01), 1·41 (95 % CI 0·63, 3·16) and 1·62 (95 % CI 0·75, 3·51) for the lowest, second and third quartiles, respectively. A similar trend was observed when all-cause mortality was used as the study endpoint. Further analysis showed that the relationships between lower serum Mg and higher risk of cardiovascular and all-cause mortality were present only in the female subgroup, and not among male patients. The test for interaction indicated that the associations between lower serum Mg and cardiovascular and all-cause mortality differed by sex (P=0·008 andP=0·011, respectively). In conclusion, lower serum Mg was associated with a higher risk of cardiovascular and all-cause mortality in the PD population, especially among female patients.

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