Podium Research Presentations- Lecture Pack #2

This presentation was originally presented at the 21st Annual International Meeting of the Academy of Breastfeeding Medicine.
This lecture pack consist of three presentations presented during the Podium Research Presentations on Saturday, October 15th.
This lecture just offers CERPs, if you are looking for CME,CNE credits please purchase The Academy of Breastfeeding Medicine Lecture Package.

$10.00 USD
Total CE Hours: 0.75   Access Time: 2 Weeks  
Lectures in this bundle (3):
Durations: 15 mins
Laurie Nommsen-Rivers, PhD, RD, IBCLC
Milk Production in Mothers with and without Signs of Insulin Resistance
USA Laurie Nommsen-Rivers, PhD, RD, IBCLC

Laurie Nommsen-Rivers has been a Registered Dietitian since 1990 and an International Board Certified Lactation Consultant (IBCLC) since 1993. Laurie served as the Associate Editor of the Journal of Human Lactation from 1997- 2006. Laurie received her master’s degree in Nutrition from UC Davis, after which she worked with hundreds of breastfeeding mother-infant dyads during her 18 years as a research associate with Kathryn Dewey. Motivated by a desire to advance the field of human lactation, Laurie returned to the University of California in 2004 to obtain a PhD in epidemiology. Between 2009 and 2016 Laurie was an Assistant Professor of Pediatrics in the Division of Neonatology at Cincinnati Children’s Hospital Medical Center. Since September of this year she is an Associate Professor of Nutrition, and the Ruth Rosevear Endowed Chair of Maternal and Child Nutrition, at the University of Cincinnati. She has co-authored over 70 research publications related to the breastfeeding dyad with a focus on barriers that impede lactation success.

Objective 1: insulin plays a direct and significant role in stimulating milk synthesis in the mammary gland
Objective 2: among mothers with low milk supply striving to exclusively breastfeed, mothers with signs of insulin resistance made significantly less milk than mothers without signs of insulin resistance
Objective 3: not all obese mothers have trouble breastfeeding, but those with signs of insulin resistance may be particularly at risk for lactation difficulty
Objective 4: inability to exclusively breastfeed may be more common than previously believed, especially in settings where poor metabolic health is common

USA Laurie Nommsen-Rivers, PhD, RD, IBCLC
Abstract:

Laurie Nommsen-Rivers, PhD; Sarah Riddle1, MD; Amy Thompson2, MD; Laura Ward1, MD; and Erin Wagner1, MS. 1Cincinnati Children’s Hospital Medical Center and 2University of Cincinnati College of Medicine, Cincinnati, Ohio

Background: Maternal obesity is associated with shortened breastfeeding duration. Insulin resistance is a physiologic hallmark of obesity and may underlie lactation difficulties.
Objective: Our objective is to compare 24-hour milk production in mothers with signs of insulin resistance (IR) versus those without.
Methods: We examined baseline data from the MALMS study, a randomized placebo-controlled trial of metformin to augment low milk supply. Baseline eligibility includes: mother 1-8 weeks postpartum, healthy term infant, and currently supplementing, but strong desire to achieve exclusive breastfeeding. At baseline, all women record 24 hour milk production and are evaluated for the following signs of IR: fasting plasma glucose > 95 mg/dL, abdominal obesity, recent gestational diabetes, or polycystic ovary syndrome. We compared baseline 24-hour milk production in IR versus no IR groups, and then in obese versus non-obese groups. Results: 33 (69%) exhibited signs of IR and 15 had no IR signs. Mean age (+SD) of mother (31+5 years) and infant (4+2 weeks) did not differ between groups, but BMI was significantly higher in the IR group (36.9+7.9 versus 25.4+3.6 kg/m2, P<0.001). Relative ranking of milk production was significantly lower in IR versus no-IR: Median [interquartile range], 216[158-332] versus 377[294-598] mL/day, P=0.004; and differences were less pronounced when milk output compared for obese versus non-obese, P=0.05.

Conclusion: While poor lactation management may have contributed to low production in some participants, our results point to an additional deficit associated with IR.
Funding source: NIH 5 K12 HD051953 (PI, Tsevat), Bridging Interdisciplinary Research Careers in Women’s Health (BIRCWH award to LN-R).

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Durations: 15 mins
Ellen Chetwynd, PHD, MPH, RN, BSN, IBCLC
Cumulative Lactation and Middle Aged Onset of Hypertesnsion in African American women
USA Ellen Chetwynd, PHD, MPH, RN, BSN, IBCLC

Ellen is a breastfeeding researcher and lactation consultant working on postdoctoral research at North Carolina State University after completing her doctoral work at UNC in Maternal/Child Health and Epidemiology. Her career in perinatal health has included work as a Program Director, Lactation Consultant, and Perinatal Nurse. She founded two lactation consultant practices, one in a Family Medicine service, and the second in an out of hospital birth center, where she maintains an active practice. Her specialty is working with maternal pain through assessment and treatment of infant physiology. Her goal is to bring her model to communities with limited existing lactation support. She co-directs her professional organization, and works with a legislative committee on reimbursement of lactation services by Medicaid. Her breastfeeding research includes pain with breastfeeding, breast milk induction, the profession of lactation consulting, and metabolic health and breastfeeding. Today’s presentation is from her dissertation.

Objective 1: Review importance of equity in research populations for both breastfeeding and hypertension
Objective 2: Describe the benefits of a nested case control design in limiting both selection and survival bias when studying the association between cumulative lifetime lactation and hypertension
Objective 3: Quantify the protective association between cumulative lifetime lactation and hypertension.

USA Ellen Chetwynd, PHD, MPH, RN, BSN, IBCLC
Abstract:

Hypertension affects nearly one of three women in the United States. Breastfeeding leads to metabolic changes that could reduce risks of hypertension. Hypertension disproportionately affects black women, but rates of breastfeeding lag behind the general population. In the Black Women’s Health Study (N = 59,001), we conducted a nested case control analysis using unconditional logistic regression to estimate the association between breastfeeding and incident hypertension at ages 40-65. Controls were frequency matched 2:1 to 12,513 hypertensive cases by age and questionnaire cycle. Overall, there was little evidence of association between ever-breastfeeding and incident hypertension (Odds ratio 0.97, 95% CI: 0.92, 1.02). However, age modified the relationship (P = 0.02): breastfeeding was associated with reduced risk of hypertension at ages 40-49 (Odds ratio 0.92, 95% CI: 0.85, 0.99) but not older ages. Our results suggest long-duration breastfeeding may reduce incident hypertension in middle age.

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Durations: 15 mins
Determinatns of Timely Introduction of Complimentary Feeding in India: Secondary Analysis of National Survey Data 1992- 2006

Dr. Nomita Chandhiok is Senior Deputy Director General/Scientist ‘G’ at the Indian Council of Medical Research, the apex research organization and advisory body to the government of India. She is the programme officer for Women’s Health and HIV prevention technologies at the Council and responsible for coordinating and promoting programmatically relevant research in these areas. Specializing in Obstetrics and Gynecology, she has been involved in conducting multicentre clinical evaluation of newer reproductive health technologies and clinical and operational research studies in the field of sexual and Reproductive Health since 1981. Her keen involvement in issues related to the sexual and reproductive health of women and adolescents has led to several studies addressing the high maternal mortality and morbidity in India being translated into policy. Dr. Chandhiok is a member of several international advisory groups, professional bodies and Task Force committees of various scientific organizations and has over 60 publications in peer reviewed journals.

Objective 1: Significance of appropriate complementary feeding interventions for optimal growth
Objective 2: Usefulness of national survey data to study prevalence and change over time in the key determinants of early and timely complimentary food
Objective 3: Breast feeding practices in India continue to be sub-optimal with no appreciable gains in the last 13 years.Need for renewed focus and vitality in health programs for promoting and supporting IYCF practices

Abstract:

To determine the changes in the prevalence andkey determinants of timely initiation of complementary feeding among infants in India, secondary data analysis of two rounds of India’s National surveys conducted in the year 1992-93(NFHS-1)and 2005-06 (NFHS-3) was carried out. Early and timely introduction of complementary feeding at four and six months of age respectively are taken as the study variables and examined against demographic, socio-economic and health service availed variables using multinomial logistic regression along with multiple classification analysis.The early introduction of complementary feeding among 39% infants in NFHS-3 as compared to 30% in NFHS-1 is indicative of a worsening trend. Overall, there is a 10% increase in timely introduction of complementary feeding in NFHS-3 with 54% infants receiving it. Urban place of residence, higher educational attainment of mother, medium wealth index and perceived small size of baby at birth are associated with early introduction of complimentary feeding. Living in urban area, and perceived small size at birth are associated with timely complimentary feeding rates in both the surveys. Mothers being more literate, in non-gainful occupation and belonging to high wealth index were the other predictors associated with enhanced timely complimentary feeding in NFHS-1. While in NFHS-3, in infants of mothers who had availed health services like antenatal/natal care, there was a greater likelihood of timely introduction of complementary feeding.

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Accreditation

CERPs - Continuing Education Recognition Points
GOLD Conferences has been designated as a Long Term Provider of CERPs by the IBLCE--Approval #CLT114-07
This program is approved for 0.75 CERPs ( 0.75 L CERPs)

Tags / Categories

Breastfeeding and Lactation

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