A relationship between a level of hemoglobin after delivery and exclusive breastfeeding initiation at a baby friendly hospital in Japan

Environmental Health and Preventive Medicine, Apr 2017

Background The recent National Nutrition Survey of 2013 demonstrated that 16.7% of women in childbearing age are underweight, and 5.0–10.0% of these women manifested a Hemoglobin (Hb) level less than 11.0 g/dl. The purpose of this study was to investigate if such maternal nutritional status affects success of exclusive breastfeeding (EBF) practice. Methods This cross-sectional study investigated 1532 dyads of mothers and infants with full-term singleton pregnancies delivered during 2011 at a perinatal center in Tokyo. Outcome is EBF initiation defined as the successful practice at discharge and 1 month after discharge. A logistic regression model was applied to investigate the impact of Hb levels (<9.0, 9.0–10.9, and ≥11.0 g/dl) measured within 2–3 days after delivery on successful EBF initiation adjusting for covariates including bleeding at delivery. Results Mean age was 34 years, 23.0% were underweight and 63.0% were nulliparous. The success rate for EBF initiation at discharge and at 1 month after discharge was 72.7 and 63.0% for a Hb level <9.0 g/dl, 81.9 and 68.9% for a Hb level of 9.0–10.9 g/dl, and 85.7 and 75.9% for a Hb level ≥11.0 g/dl, respectively. A logistic regression model showed that risk factors of unsuccessful EBF practice at discharge and 1 month after discharge included lower level Hb categories (P < 0.001 and P < 0.001), postpartum hemorrhage > 500 ml (P = 0.089 and P = 0.011), maternal age (P < 0.001 and P < 0.001), nulliparity (P < 0.0001 and P < 0.001), pregnancy-induced hypertension (P = 0.002 and P = 0.012), gestational week (P = 0.006 and P = 0.002), Low Birth Weight (LBW) (P < 0.001 and P < 0.001), and immediate separation (P < 0.001 and P = 0.020). After adjusting for the covariates, compared with a Hb level ≥11.0 g/dl, a Hb level <9.0 g/dl was significantly associated with unsuccessful EBF initiation at discharge [odds ratio (OR): 2.15; 95% confidence interval (CI): 1.37–3.39] and at 1 month after discharge (OR: 1.63; 95% CI: 1.10–2.42), and a Hb level of 9.0–10.9 g/dl also was significant at 1 month after discharge (OR: 1.35; 95% CI: 1.04–1.75). Pre-pregnancy underweight was not associated with success of EBF practice both at hospital discharge and 1 month after discharge. Conclusion Maternal severe anemia after delivery was associated with the risk of unsuccessful initiation of EBF even after adjusting for bleeding at delivery, suggesting the importance of dietary management especially in the later trimester.

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A relationship between a level of hemoglobin after delivery and exclusive breastfeeding initiation at a baby friendly hospital in Japan

Horie et al. Environmental Health and Preventive Medicine A relationship between a level of hemoglobin after delivery and exclusive breastfeeding initiation at a baby friendly hospital in Japan Saki Horie Kyoko Nomura 0 Shinichi Takenoshita 0 Junko Nakagawa Michiko Kido Mitsuhiro Sugimoto 0 Department of Hygiene and Public Health, School of Medicine, Teikyo University , 2-11-1 Kaga, Itabashi-ku Zip 173-8605, Tokyo , Japan Background: The recent National Nutrition Survey of 2013 demonstrated that 16.7% of women in childbearing age are underweight, and 5.0-10.0% of these women manifested a Hemoglobin (Hb) level less than 11.0 g/dl. The purpose of this study was to investigate if such maternal nutritional status affects success of exclusive breastfeeding (EBF) practice. Methods: This cross-sectional study investigated 1532 dyads of mothers and infants with full-term singleton pregnancies delivered during 2011 at a perinatal center in Tokyo. Outcome is EBF initiation defined as the successful practice at discharge and 1 month after discharge. A logistic regression model was applied to investigate the impact of Hb levels (<9.0, 9.0-10.9, and ≥11.0 g/dl) measured within 2-3 days after delivery on successful EBF initiation adjusting for covariates including bleeding at delivery. Results: Mean age was 34 years, 23.0% were underweight and 63.0% were nulliparous. The success rate for EBF initiation at discharge and at 1 month after discharge was 72.7 and 63.0% for a Hb level <9.0 g/dl, 81.9 and 68.9% for a Hb level of 9.0-10.9 g/dl, and 85.7 and 75.9% for a Hb level ≥11.0 g/dl, respectively. A logistic regression model showed that risk factors of unsuccessful EBF practice at discharge and 1 month after discharge included lower level Hb categories (P < 0. 001 and P < 0.001), postpartum hemorrhage > 500 ml (P = 0.089 and P = 0.011), maternal age (P < 0.001 and P < 0.001), nulliparity (P < 0.0001 and P < 0.001), pregnancy-induced hypertension (P = 0.002 and P = 0.012), gestational week (P = 0.006 and P = 0.002), Low Birth Weight (LBW) (P < 0.001 and P < 0.001), and immediate separation (P < 0.001 and P = 0.020). After adjusting for the covariates, compared with a Hb level ≥11.0 g/dl, a Hb level <9.0 g/dl was significantly associated with unsuccessful EBF initiation at discharge [odds ratio (OR): 2.15; 95% confidence interval (CI): 1.37-3.39] and at 1 month after discharge (OR: 1.63; 95% CI: 1.10-2.42), and a Hb level of 9.0-10.9 g/dl also was significant at 1 month after discharge (OR: 1.35; 95% CI: 1.04-1.75). Pre-pregnancy underweight was not associated with success of EBF practice both at hospital discharge and 1 month after discharge. Conclusion: Maternal severe anemia after delivery was associated with the risk of unsuccessful initiation of EBF even after adjusting for bleeding at delivery, suggesting the importance of dietary management especially in the later trimester. Exclusive breastfeeding; Anemia; Hemoglobin; Underweight; Postpartum hemorrhage - Background The World Health Organization (WHO) recommends breastfeeding only breast milk without water or anything else until 6 months of age. They also recommend continuing breastfeeding even after 2 years of age with supplementation with the appropriate diet. Increasing the breastfeeding rate not only reduces children’s diarrheal diseases and respiratory infections but also leads to increased intelligence levels, obesity prevention, diabetes mellitus even during subsequent growth, and maternal breast and ovarian cancer. In Japan, the rate of successful exclusive breastfeeding (EBF) practice at 1 month after delivery is 42.0% according to the National Infants Nutrition Survey of 2005 [1], which is very low compared to other countries, although more than 96.0% of those expectant mothers intended to breastfeed before delivery. Thus, it requires epidemiological studies conducted to elucidate factors associated with unsuccessful breastfeeding practice, and then a useful countermeasure should be immediately introduced for a improved health outcome of mothers and infants. Among factors associated with unsuccessful EBF practice, poor maternal nutritional status is considered as one of the biggest public health concerns in Japan. The recent National Nutrition Survey of 2013 demonstrated that 16.7% of women in childbearing age are underweight, defined as a body mass index (BMI) <18.5 kg/m2: 21.5% in their 20’s, 17.6% in their 30’s and 11.0% in their 40’s are underweight. Such prevalence of being underweight may be brought by reduced caloric intake; the survey reported the caloric intake of women of child-bearing age (i.e., 20’s to 40’s) to be 1628–1665 kcal/day, a value far below the requirements established by the 2015 Dietary Reference Intakes for Japanese of 1950 kcal/day for women 18–29 years and 2000 kcal/day for women 30–49 years of age with moderate physical activity levels. Moreover, maternal underweight status is related to iron-deficiency anemia. According (...truncated)


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Saki Horie, Kyoko Nomura, Shinichi Takenoshita, Junko Nakagawa, Michiko Kido, Mitsuhiro Sugimoto. A relationship between a level of hemoglobin after delivery and exclusive breastfeeding initiation at a baby friendly hospital in Japan, Environmental Health and Preventive Medicine, 2017, pp. 40, Volume 22, Issue 1, DOI: 10.1186/s12199-017-0650-7