The Secret to Pain Free Breastfeeding

Breastfeeding Help And Baby Care For New Parents

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

Breastfeeding Help And Baby Care For New Parents Overview


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Author: Kate Hale
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My Breastfeeding Help And Baby Care For New Parents Review

Highly Recommended

This is one of the best e-books I have read on this field. The writing style was simple and engaging. Content included was worth reading spending my precious time.

As a whole, this e-book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Benefits of breastfeeding in the general population

One of the most beneficial attributes of breast milk is that it protects against common childhood infections such as diarrhoea, pneumonia, neonatal sepsis and acute otitis media (Habicht et al., 1986 and 1988 Victora et al., 1987 WHO Collaborative Study Team, 2000). Whether it confers similar protection in areas of high HIV-prevalence is less clear, however. Results from a recently published pooled analysis of six studies carried out from 1983 to 1991 with data on all-cause death for 1123 children under the age of two years, in Brazil, Ghana, Gambia, Senegal, Pakistan, and the Philippines, confirm that breastfed infants are at lower risk of mortality than those who are not breastfed (WHO Collaborative Study Team, 2000). In the three non-African studies, in which outcomes for breastfed infants could be compared with those for infants who had not been breastfed, mortality rates were significantly higher for the non-breastfed through the first eight months of life. This was particularly...

Benefits of breastfeeding for children born to HIVinfected mothers

There is little information on the benefits of breastfeeding to HIV-infected infants further study is needed. In a randomized trial in Nairobi to evaluate the effect of mode of infant feeding on the risk of mother-to-child transmission of HIV (Nduati et al., 2000), the cumulative two-year mortality rate among infants in the formula-feeding group was 20 , not significantly different from the 24 in the breastfeeding group (hazard ratio 0.8, 95 confidence interval 0.5-1.3), even after adjusting for HlV-infec-tion status (hazard ratio 1.1, 95 confidence interval 0.7-1.7). In addition, the rate of HIV-free survival at two years was significantly lower in the breastfed than in the formula-fed group (58 and 70 respectively, P 0.02). The incidence of diarrhoea during the first two years of life was also similar in both groups 155 and 149 per 100 child-years of follow-up in the formula and breastfeeding groups respectively, while the incidence of pneumonia was identical at 62 per 100...

Mortality among HIVinfected breastfeeding mothers

Results from a secondary analysis of data collected in the randomized trial of breastfeeding compared with formula feeding, in Nairobi, Kenya, suggested a threefold higher mortality rate in HIV-infected women in the breastfeeding arm than in those in the formula-feeding arm (Nduati et al., 2001). Overall, 24 of the 397 women died in the two years after delivery 18 of 197 women allocated to breastfeeding and six of 200 randomized to the formula-feeding group. Since assessment of mortality was not the main aim of the trial, this unexpected observation must be interpreted with caution (Newell, 2001a). The authors suggest that the high energy-demands of breastfeeding in HIV-infected mothers may accelerate the progression to HIV-related death. If this is the case, women who exclusively breastfeed their infants would be expected to have a higher death rate than those who give their infants food supplements or avoid breastfeeding altogether. In a study in Durban, South Africa, women made an...

HIV transmission through breastfeeding

Transmission of HIV through breastfeeding has been well documented. The first reports indicating the possibility of HIV-1 transmission through breast milk were of breastfed infants of women who had been infected postnatally through blood transfusion or through heterosexual exposure (Palasanthiran et al., 1993 Van de Perre et al., 1991 Stiehm and Vink, 1991 Hira et al., 1990 Lepage et al., 1987 Ziegler et al., 1985). Other reports related to infants with no other known exposure to HIV, whose source of infection was wet-nursing or pooled breast milk (Nduati et al., 1994).

Rates of breastfeeding transmission

According to the limited data available in the early 1990s, the estimated additional risk of transmission from breast milk, above that of transmission during pregnancy and delivery, among women with established HIV infection, was approximately 15 when breastfeeding continued for two years or more (Dunn et al., 1992). The risk of transmission through breastfeeding among women with recent infection (acquired postpartum) was nearly twice as high. More recent and more reliable data, including the results of a randomized clinical trial in Nairobi, confirm these initial findings HIV-infected pregnant women were randomly allocated to either breastfeeding (n 212) or artificial feeding (n 213) (Nduati et al., 2000). Compliance with the assigned feeding modality was 96 in the breastfeeding arm and 70 in the formula arm. Median duration of breastfeeding was 17 months. The cumulative probability of HIV infection at 24 months of age in the breastfeeding and formula-feeding arms was, respectively,...

Timing of postnatal transmission through breastfeeding

HIV can be transmitted through breast milk at any point during lactation, and thus the rate of infection in breastfed infants increases with duration of breastfeeding. The persistence of maternal antibodies and the presence of a window period during which infection is undetectable by current technology make it difficult to determine whether an infant has been infected during delivery (intrapartum) or - through breastfeeding - immediately after birth. There is too little information to estimate the exact association between duration of breastfeeding and risk of transmission. There is strong evidence, however, that the longer the duration of breastfeeding the greater the risk of transmission - in other words, the risk is cumulative (Miotti et al., 1999 Leroy et al., 1998 Read et al., 2003 Leroy et al., 2002 The Petra Study Team, 2002). It is difficult to draw any conclusions about the relative risk of transmission by colostrum and mature breast milk (Ruff et al., 1994 Van de Perre et...

Factors associated with risk of transmission through breastfeeding

There is limited, though gradually increasing, reliable quantification of the effect of risk factors associated with an increased or decreased likelihood of breastfeeding transmission. Many of the factors known to influence overall risk of transmission are also likely to influence transmission through breastfeeding maternal RNA viral load in plasma and breast milk HIV-related maternal immune status breast conditions, including mastitis and abscesses nutritional status of

Mechanisms of breastfeeding transmission

Although HIV has been detected in breast milk (Nduati et al., 1995 Ruff et al., 1994 Van de Perre et al., 1993), mechanisms of transmission through breastfeeding remain incompletely understood. Not yet reliably quantified are the respective roles of cell-free and cell-associated virus in transmission through breastfeeding or the association between virus levels in plasma and milk. The portal of entry for the virus via the infant mucosa also merits further investigation animal models have shed some light on this issue (Featherstone, 1997 Amerongen et al., 1991 Bomsel, 1997).


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

Hormonal Carcinogenesis

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

Special case Babies born to HIVinfected mothers

Important many methods for the detection of HIV nucleic acid may fail in case of unusual HIV-1 subtypes (and with HIV-2) and yield false-negative results (Haas 1996). To exclude this, a maternal sample should also be tested if necessary (e.g. if the mother or her source of infection are from regions with exotic subtypes) to ensure the test's ability to detect the viral strain in question. If the mother (before therapy) tests PCR-positive with the same assay, a negative test result on the child may be used otherwise a suitable method must be chosen in a specialized laboratory or one has to resort to antibody testing alone with its limitations. In exposed babies, at least two negative HIV PCR results are required in order to exclude HIV infection the first one between the 1st and the 4th month of life, the second after the 4th month, as only then does it reach its full significance for exclusion of infection (Scarlatti 1991). In addition, PCR should be performed during the first month...

Penetrance of BRCA1 and BRCA2 Mutations

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

Other dairy products to improve infant health

Human breast milk is recognised as being the best functional food for infants due to its undisputed optimal health-promoting effects by specific and nonspecific factors, such as enhancement of the immature immunologic system of the newborn baby and strengthening of defence mechanisms against infective agents. Breastfeeding seems to protect from infections, the development of Infant formulas or so called breast milk substitutes aim to provide an efficient and safe alternative diet for infants of those women who are not able to continue breastfeeding until six months of life. Infant formula can be fed directly after birth when breastfeeding is not possible follow-on formulas are designed for children after the sixth month of life. Breast milk substitutes aim to mimic the composition of human breast milk concerning protein, fat and carbohydrate composition. The only carbohydrate of infant formulas is lactose, whereas follow-on formulas contain other carbohydrates, too. Protein sources...

Prevention of mothertochild transmission

HIV-infected pregnant women should consider their infant feeding options. They should seek to balance the nutritional and other benefits of breastfeeding with the risks of transmitting HIV to their infants and choose between exclusive breastfeeding and replacement feeding (commercial infant formula or home-modified animal milk) or other breast-milk options (heat-treated expressed breast milk, wet-nursing, or donors' milk from a milk bank). When replacement feeding is acceptable, feasible, affordable, sustainable and safe, HIV-infected mothers should avoid breastfeeding completely. When these conditions are not present, HIV-infected women who choose to breastfeed are recommended to do so exclusively for the first few months, and then, over a period of a few days to a few weeks rather than abruptly, to stop breastfeeding (exclusive breast In an observational study in South Africa, exclusive breastfeeding during the first three months of life was associated with a lower transmission risk...

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

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

Current or prospective research into mothertochild transmission

The main current public-health research question is whether breastfeeding by HIV-infected mothers can be made safer as to transmission risk, given the possible adverse effects of refraining from breastfeeding. Various ongoing or planned trials and studies concern either mode of infant feeding (exclusive or mixed) or antiretroviral therapy to either the mother or the infant over the breastfeeding period. or planned are the mechanisms of breastfeeding transmission, in particular the parts played by cell-free and cell-associated HIV the association between virus levels in plasma and milk the possibly protective effect of HIV-specific cells with immune function in the breast milk of HIV-infected women the correlation between risk of transmission and the presence of anti-infective substances in the breast milk of HIV-infected women, including immunoglobulins, lactoferrin, and mucins the effect of antiretroviral prophylaxis on either the uninfected infant or the breastfeeding mother...

Modulation of Specific Immune Responses The IgA Anti Rotavirus Response

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

Antiinfective properties of breast milk of HIVinfected women

The most abundant is secretory IgA (Lawrence, 1994). Investigation of the inhibiting action of breast-milk HIV-specific antibodies on transmission of HIV through breastfeeding has found that (i) the breast milk of women with established HIV infection has HIV-specific IgG, with a wide spectrum of activity against HIV proteins, comparable to HIV-specific IgG in serum and (ii) the spectrum of activity of serum IgA against HIV is similar to that of serum IgG, but that of HIV-specific secretory IgA (sIgA) in breast milk affects only a limited number of viral proteins (env protein, gp 160, core proteins). In a study of breast-milk samples from 215 HIV-infected women in Rwanda (Van de Perre et al., 1993), the most frequently identified HIV-specific antibody in breast milk was IgG (in > 95 of samples) the next was IgM (in 41-78 of samples) and the least frequent was IgA (in 23-41 of samples). Lack of persistence of HIV-specific IgM in breast milk collected at 18 months was...

Characteristics of HIV infection in childhood

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

Factors affecting acquisition of HHV6 infection

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

HIV infection in women

The risk of mother-to-child transmission is increased if a breastfeeding mother is newly infected, owing to the initially high levels of virus. Preliminary evidence from a study in Zimbabwe suggests that about 4 of women who were HIV-negative when giving birth become infected in the first year postpar-tum, and that the risk continues into the second year (J. Humphrey, personal communication, 2002). This merits attention as in this population 85 of women still breastfeed at 15 months and 30 at 21 months. Similar findings have been reported from another study in Zimbabwe, with 66 new infections among 372 women, nearly 5 , over the two years postpartum (Mbizvo et al., 2001). HIV- prevention interventions directed at pregnant and lactating women could contribute greatly to reducing mother-to-child transmission, but this possibility has so far attracted little research or programmatic effort.

Potential Advantages of Therapeutic Antibodies

Where available, ART of infected mothers has dramatically lowered transmission rates (De Cock et al. 2000 UNAIDS 2006). Antibody therapeutics have been suggested as a potential adjunct to ART therapy in MTCT as they could extend protection throughout the breast-feeding period. Passive immunization to prevent MTCT has been considered for a long time and may provide an option, as not all HIV drugs are approved for pediatric use. In untreated mothers, transmission rates before and during birth are high and an almost equally high proportion of infant infections is thought to be acquired through breast feeding (De Cock et al. 2000 UNAIDS 2006). While bearing the risk of HIV infection, abstaining breast feeding in these settings is problematic as it can lead to malnutrition of the newborn and increased mortality due to other infections. Likewise, passive immunization or combination of active and passive immunization, as successfully employed against HBV infection (Kabir et al. 2006), could...

Rates of mothertochild transmission and risk factors

Mother-to-child transmission of HIV can occur before, during or after delivery, but only rarely in early pregnancy. Without specific interventions to reduce the risk of transmission, estimated rates of mother-to-child, or vertical, transmission range from 14 to 25 in Europe and America and from 13 to 42 in developing countries (Msellati et al., 1995). The difference in risk between populations is largely attributable to the characteristics of the population studied as they relate to HIV infection and to the prevalence of factors influencing the likelihood of transmission. In particular, the additional risk posed by breastfeeding explains a large part of the estimated differences (Table 1) (Newell, 2001 Dabis and Ekpini, 2002). During breastfeeding Overall without breastfeeding Overall with breastfeeding to six months Overall with breastfeeding to 18-24 months Note Rates vary because of differences in population characteristics such as maternal CD4+ cell counts, RNA viral load and...

Reflection of Effects on Th1 Th2 and Treg Differentiation

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

Reflection of Environmental Factors

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

Mutual Adaptation of the Host and the Intestinal Bacterial Flora

Interest in the relationships between animals and their intestinal bacteria has a long history (Cushing and Livingood 1900 Metchnikoff 1908). Classic observations established that nutrition has a profound influence on the composition of the intestinal flora reviewed by Dubos and Schaedler (1960) , including the special medically important situation when formula feeding is substituted for breast feeding in human infants (Tissier 1905), causing the luminal content of lactobacilli to fall and gram-negative bacilli and clostridia to rise.

Oxytocin and Vasopressin Information from Animal Models

Ejaculation in males, and formation of long-term pair bonds in those species when monogamy is typical (for reviews, see Carter, 1998 Insel and Young, 2001). During and after pregnancy, oxytocin functions to advance labor and uterine contractions and is involved in initiation of most maternal behaviors including breast feeding, nest building, licking, and warm contact with offspring. Oxytocin is involved in many basic non-reproductive social behaviors as well, including the simple act of socially recognizing a familiar individual (Young, 2002). Oxytocin knockout mice, lacking the gene to produce oxytocin, are less able to recognize a formerly familiar con-specific despite having no deficits in underlying learning or sensory functions. This lack of social recognition disappears if oxytocin is administered to the animal's medial amygdala, while the behavioral deficit can be mimicked in normal mice by administering an oxytocin antagonist to the same region (Ferguson et al, 2000, 2001).

Late postnatal transmission

Another way of estimating the risk associated with breastfeeding is to start with infants who had been born to infected mothers and had tested negative for HIV early in life, and to follow them until after they ceased being breastfed, to determine the rate at which they become HIV-infected through breastfeeding. If infants with evidence of not being infected at an early age are taken as the denominator, the rate is estimated from the number of breastfed children who have subsequent positive virological tests or persistent antibodies beyond 15-18 months or after cessation of breastfeeding. The time at which the exposure begins is determined by the age at which infants are tested. This is now usually around four to six weeks, but in earlier studies was between three and six months different 'start' times may explain why different studies gave different estimates of rates of late postnatal transmission (LPT) (Table 3). Estimated rates of LPT range from about 9 to 13 at 18 months. In...

Information from Human Studies

Preliminary evidence from human mothers suggests that oxytocin helps modulate their affective state, and this may, in turn, influence their stress responses. In mothers who both breast and bottle feed their infants, the act of breast feeding (which typically elicits greater rises in plasma OT) is associated with less perceived stress, depression, and anxiety than bottle feeding (Mezzacappa and Katkin, 2002). Women who are breast feeders also report less anxiety than bottle-feeding women and show lower blood pressure before and during stress (Altemus et al, 2001). However, one randomized trial of intranasal oxytocin administration to enhance milk expression while using a breast pump in mothers of preterm infants found only faster initial let-down, but no other benefit (Fewtrell et al, 2006). In our research with mothers of infants, we found that high oxytocin responders to mother-infant interaction have lower overall blood pressure levels both in laboratory stress studies and during 24...

Dietary strategies for preventing the onset of diabetes

It has been suggested that for type 1 diabetes an early exposure to cows' milk proteins may play a role in triggering the immune response that destroys pancreatic beta-cells.2 Observational studies have shown that breastfeeding is associated with a lower incidence of type 1 diabetes.3'4 It is hoped that the multicentre study, 'Trial to Reduce Type 1 Diabetes in the Genetically at Risk' (TRIGR) started in May 2002 will give a definite answer to this hypothesis. In this study, an offspring of someone with diabetes or first degree relative who possesses a high-risk genetic susceptibility to type 1 diabetes should be breastfed for at least 6 months of life. If the mother is unable to exclusively breastfeed, her child will then be randomly assigned to one of two groups. One group receives breastfeeding supplements of a special formula based on extensively hydrolysed cows' milk proteins the other group receives a normal formula containing cows' milk with a small amount of hydrolysed...

Lepirudin in Pregnancy

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

RNA viral load in plasma and breast milk

The risk of transmission through breastfeeding is probably strongly related to RNA levels in the milk, but the degree of risk has not yet been adequately determined. Limited evidence suggests that RNA viral load in blood is only partly correlated with that in breast milk and RNA load in breast milk is highly variable between breasts and over time (Willumsen, 2001, 2003). In a study in Durban, South African women in whom RNA viral load in breast milk was detectable at any time during the first six months postpartum were more likely to transmit than those in whom it was undetectable (Pillay et al., 2000). A study in Malawi found that the risk of transmission was increased fivefold if RNA virus had been detected in breast-milk samples taken at six weeks postpartum (Semba et al., 1999). In West Africa, the rate of late postnatal transmission increased 2.6 times for every one log10 increase in plasma RNA viral load measured in late pregnancy (Leroy et al., 2003).

Development of bifidobacteria in the intestine and beneficial effects

Despite the variable results obtained in the numerous clinical trials, many scientists argue in favour of bifidobacteria for adjunct therapy. The main reason is the observation that bifidobacteria are the dominant commensal microbiota of most breast-fed babies, and the negative effects seen upon delayed colonization of bifidobacteria in pre-term babies (Westerbeek et al., 2006). The underlying assumption is that at least part of the protective effect of breast-feeding is linked to the presence of bifidobacteria.

HIVrelated immune status

More data are available on the association between maternal immune status (CD4+ cell counts) and transmission of HIV through breastfeeding than on that between RNA viral load and transmission. The recent analysis of pooled data from the two West African zidovudine trials (Leroy et al., 2003) found that a maternal CD4+ cell count lower than 500 mm3 in plasma close to time of delivery was associated with an increase in risk of late postnatal transmission three times that of women with CD4+ cell counts equal to or greater than 500 mm3 (Leroy et al., 2003). In the Ugandan trial comparing nevirapine with zidovudine (Nakabiito et al., 2002), children whose mothers had a low CD4+ cell count around the time of delivery were especially liable to become infected. Low CD4+ counts in plasma have also been associated with detection of HIV-DNA in breast milk (Nduati et al., 1995). In the meta-analysis of data from nine intervention trials in sub- Saharan Africa, the risk of postnatal occurrence of...

Brief History Of The Development Of Bifidus Factors And Prebiotics

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

Nutritional risk factors in the onset and prevention of type 1 diabetes

Large geographical differences in incidence and linearly increasing incidence seen in many countries during the last five decades cannot be explained solely by genetic factors (Onkamo et al. 1999 Karvonen et al. 2000 Green et al. 2001). The relatively low concordance of identical twins also confirm the important role of environmental factors in the aetiology of this disease (Barnett et al. 1981). So far there is little firm evidence on the role of nutritional factors. Breastfeeding, vitamins C, D and E, nicotinamide and zinc have been reported as possibly protecting from type 1 diabetes, whereas N-nitroso compounds, cow's milk, some cereals, increased linear growth, and obesity may increase the risk (Virtanen & Knip 2003).

Infant feeding patterns

Whether breastfeeding protects from or early introduction of supplementary foods causes type 1 diabetes, remains unsolved, although these aspects of the diet have received more research attention than many other areas in the etiology of type 1 diabetes (Virtanen & Knip 2003). Findings from prospective studies with enough statistical power are awaited. Putative protecting effects of breastfeeding could be due to protection against infections provided by breast milk through, for example, secretory IgA antibodies and enhancement of the infant's own immune responses, increased beta-cell proliferation (Juto 1985), or delayed exposure to foreign food antigens. Breast milk contains cytokines and growth factors, which affect the maturation of the gut-associated lymphoid tissue (GALT) (Srivastava et al. 1996). An early introduction of cow's milk-based infant formulas and other cow's milk products may increase the risk of type 1 diabetes according to case-control evidence, although the...

Human secretory leukocyte protease inhibitor

Perhaps the best-characterized innate factor considered as protective against mucosal transmission of HIV-1 is secretory leukocyte protease inhibitor (SLPI). Infant salivary SLPI has also been associated with lower risk of late transmission of HIV-1 through breast milk (Farquhar et al, 2003). However, in a study of 43 unselected HIV-infected breastfeeding mothers in Bangui, with breast-milk samples obtained at one week and one and six months after delivery, the mean levels of SLPI in breast milk of mothers of infants who became infected did not differ significantly from those in the case of infants who remained uninfected (Becquart et al., 1999). Further controlled studies are needed to confirm the role of maternal and infant SLPI in transmission, either alone or in combination with other innate and specific immune factors.

Mode of infant feeding

A factor of particular relevance at population level as regards rates of breastfeeding transmission is mode of infant feeding. In most populations worldwide, breastfeeding is usually initiated, but at an early age is supplemented with water or other drinks or feeds (Nicoll et al., 2000) exclusive breastfeeding for the recommended six months is rare. In a study in Durban, South Africa, 551 HIV-infected women, after counselling, chose whether to breastfeed or formula-feed (Coutsoudis et al., 2001a). Those who chose to breastfeed were encouraged to do so exclusively for three to six months. A total of 157 formula-fed from birth and never breastfed, 118 breastfed exclusively for three months or more, and 276 practised mixed breastfeeding. The three groups did not differ in any of the significant risk factors for transmission, and at birth the rate of infection in their infants had been similar at about 7 . Infants who received both breast milk and other feeds were significantly more...

Glaucoma Medical Therapy During Lactation

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

Treatment of breast milk

Women have to be taught and supported to sustain this process for long periods, to avoid such problems as mastitis. This should not prevent the option being offered infant feeding counselling should be provided when women choose this option, and issues of hygiene and stigma should be addressed. Expression and heat treatment could be a temporary solution during periods of increased risk of transmission as in cases of cracked nipples or breast abscess, and for low-birth-weight or sick infants for whom the risk of replacement feeding is greater, and during transition from exclusive breastfeeding to replacement feeding (Rollins et al., 2004). Heat treatment, however, also reduces much of the immune and protective components of breast milk. Breast milk contains substances that inhibit infectious agents (Goldman, 1993). Several studies have reported that HIV is inactivated when milk is left to stand at room temperature for half an hour (Orloff et al., 1993 Newburg et al., 1992). In these...

Current or planned research

The main public-health research question currently is whether breastfeeding by HIV-infected mothers can be made safer as to transmission risk, given the potential adverse effects of refraining from breastfeeding (for an update on ongoing research see www. Various ongoing or planned trials and studies concern either mode of infant feeding (exclusive or mixed) or antiretroviral therapy to either the mother or the infant over the breastfeeding period. Results from an analysis of data on nearly 4500 infants born to HIV-positive mothers in the Zvitambo study in Zimbabwe will help to confirm or disprove the association between infant feeding modality and risk of transmission through breastfeeding. Studies in South Africa, Zambia and West Africa are assessing whether a recommendation of exclusive breastfeeding is acceptable, feasible and safe, and how the risk of infection to the infants concerned compares with that of infants who are mixed-fed. In these studies women are...

Dairy products and probiotics in childhood disease

3.2.1 Development of the intestinal microbiota in the first years of life - role of breast feeding, prebiotics and infant diet flora of mother, mode of birth, breast feeding, immune status of mother, diet, antibiotics flora of mother, mode of birth, breast feeding, immune status of mother, diet, antibiotics In the recent years three high quality randomised controlled trials (RCTs) have evaluated the effect of probiotics on the prevention of necrotising enterocolitis (Bin-Nun et al., 2005 Dani et al., 2002 Lin et al., 2005). Two of them evaluated supplemented formula, one breast feeding plus dissolved probiotics administered directly by spoon. investigated probiotics strains were L. rhamnosus GG and probiotic mixtures, one containing B. infantis plus Streptococcus thermophilus plus Bifidobacterium bifidum (ABC Dophilus, Solgar, Wyeth Consumer Healthcare), the other containing L. acidophilus plus B. infantis (both ATCC 1973) (Bin-Nun et al., 2005 Dani et al., 2002 Lin et al., 2005). The...

Risk Factors for Vitamin A Deficiency

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

Ramona Sunderworth md

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

Nipple retraction inversion

Congenital nipple inversion (of variable degree) occurs in up to one-fifth of all women. This is usually of no clinical significance unless it interferes with breast feeding. The woman may present because of the cosmetic deformity. However, two of the most common causes of nipple retraction are mammary duct ectasia and periductal mastitis. Clinically, this manifests as a transverse depression in the nipple which progresses to complete retraction (there may also be an associated nipple discharge). This process may be intermittent in its early stages and can be present in both breasts. Nipple retraction may also occur in patients with breast cancer. In the latter this is unilateral and there may be an associated breast lump, with or without a nipple discharge (often blood stained).

Integrity of mucous membranes

Conditions that damage the mucous membrane of infants, such as oral thrush (Candida infection), may be associated with an increased risk of transmission through breastfeeding. It is difficult, however, to determine which is cause and which effect, since thrush may be a feature of early HIV-1 infection (Ekpini et al., 1997 Embree et al., 2000). Infant oral thrush can also cause nipple thrush and fissures. Damage to the

Htlv Vaccine Development

On the HTLV-I envelope glycoproteins may be feasible. It has been shown that antibodies against the HTLV-I envelope glycoprotein have the ability to protect monkeys from challenge with cell-associated HTLV-I.22 Antienvelope antibodies in patient sera have been shown to cross-neutralize HTLV-I strains originating from disparate geographic regions around the world. Therefore, a vaccine developed against one strain may be effective in neutralizing other strains.23 Additionally, maternal antibodies delivered through breast-feeding are able to provide newborns with immunity and protection from congenital transmission.24

HCMV Vaccine What Is the Ideal Target Population Perinatal and Early Childhood HCMV Infection

One strategy for vaccine-mediated prevention of HCMV would be to target acquisition of primary infection in infancy and early childhood. Perinatal acquisition of HCMV may occur by one of three different routes exposure to HCMV in the birth canal during labor and delivery, transmission of HCMV by blood transfusion, or transmission by breast-feeding. In a prospective study in premature infants receiving breast milk containing HCMV, transmission was observed in 33 of 87 exposed infants, and approximately half of these babies developed disease, including hepatitis, neutropenia, thrombocytopenia, and sepsis-like state (Maschmann et al. 2001). It is uncertain if HCMV infection of low-birth-weight premature infants by this route carries any risk of long-term sequelae, and highly speculative as to whether maternal immunization programs would play a role in elimination of transmission by breast milk in this vulnerable population.

Infant feeding options designed to prevent mothertochild transmission

The infant feeding options designed to prevent mother-to-child transmission are described in detail in other documents (WHO UNICEF UNFPA UNAIDS, 2003a and b). Several investigators have attempted to use mathematical models to guide policymakers in weighing the relative risks and benefits of breastfeeding and other infant feeding options in this context (Nagelkerke et al., 1995 Nicoll et al., 2000). These models are limited by the scarcity of data on the risks associated with various methods of infant feeding and by the inability of such data to take account of all the factors that influence individual decisions about infant feeding. According to current WHO recommendations, infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. After six months, they should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to 24 months or beyond. Given the need, however, to reduce the risk...


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

Epithelial Cells

Epithelial cells are a major target of HCMV infection (Sinzger et al. 1995) and can therefore be assumed to play an important role during host-to-host transmission as they line all external body surfaces. Most likely, HCMV enters a new host by infection of mucosal epithelium. For example, HCMV newborns and infants can be infected by breast milk of a seropositive mother, a highly efficient transmission route which accounts for the majority of HCMV transmissions during early childhood (Stagno and Cloud 1994). More than 95 of seropositive breastfeeding women reactivate HCMV locally, shed cell-free infectivity into the milk, and 30 -40 of them will transmit HCMV to their children (Hamprecht et al. 2001). The infants' mucosal surfaces throughout the gastrointestinal tract are exposed during feeding, and epithelial cells in all parts of the gastrointestinal tract are susceptible and obviously support productive infection. They are the most likely candidates for primary replication of...

Glossary of terms

Cessation of breastfeeding completely stopping breastfeeding, including suckling. Exclusive breastfeeding an infant receives only breast milk, and no other liquids or solids, not even water, with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines. Mother-to-child transmission transmission of HIV to a child from an HIV-infected woman during pregnancy, delivery or breastfeeding. The term is used here because the immediate source of the child's HIV infection is the mother. Use of the term mother-to-child transmission implies no blame, whether or not a woman is aware of her own infection status. A woman can contract HIV from unprotected sex with an infected partner, from receiving contaminated blood, from non-sterile instruments (as in the case of injecting drug users), or from contaminated medical procedures. Postnatal transmission mother-to-child transmission of HIV after delivery, through breastfeeding. Wet-nursing breastfeeding by a woman other...

Executive summary

Exclusive breastfeeding - breastfeeding with no other food or drink, not even water - is the ideal mode of infant feeding for the first six months of life. For optimal growth, development and health, infants should be exclusively breastfed for their first six months, and should then receive nutritionally adequate and safe complementary foods, while breastfeeding continues up to 24 months or beyond. With the onset of the HIV AIDS epidemic, however, and the recognition that HIV-infected mothers can transmit HIV to their infants through breastfeeding, specific recommendations apply to infants born to HIV-infected mothers. The overall aim of these recommendations is to achieve the ultimate goal of increasing child survival, while reducing HIV infection in infants and young children. Mother-to-child transmission of HIV can occur during the second and third trimesters of pregnancy, during delivery, or at any point during breastfeeding. The risk through breastfeeding is cumulative the longer...

Acute diarrhoea

Breastfeeding is the best way to protect newborn and young infants against viral infections (Mastretta et al., 2002). On the other hand, probiotics are supposed to reduce the risk of diarrhoea, and a few studies have been conducted to evaluate that potential. Table 4.1 summarises prophylactic studies in children, including those conducted by using infant formulae supplemented with probiotic bacteria, as well as those where probiotic strains were given in powder form or included in fermented milk products (see also Chapter 3 in this volume). Bifidobacteria are more commonly studied and used in infant formulae than are lactobacilli, maybe because bifidobacteria are the natural dominating bacteria in the intestinal microbiota of a breast-fed infant. Significant reduction in the incidence or number of episodes of diarrhoea is reported for both lactobacilli and bifidobacteria. overall, the studies though few in number indicate that the incidence of diarrhoea may be reduced significantly....


The Global Strategy for Infant andYoung Child Feeding (IYCF), adopted by the World Health Organization and UNICEF, states that the optimal feeding pattern for overall child survival is exclusive breastfeeding for the first six months, and continued breastfeeding for up to two years and beyond, with complementary feeding from age six months, together with related maternal nutrition and support (WHO, 2003). The Global Strategy contains specific recommendations for children in exceptionally difficult circumstances, including those born to HIV-positive women.

Parous Phenotypes

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

Pregnancy and HIV

Perinatal (vertical) HIV infection has become rare in since the introduction of antiretroviral transmission prophylaxis and elective cesarean section. While the vertical HIV transmission rate ranged amounted to about 15 in Europe at the beginning of the nineties, it now amounts to only a few percent (Connor 1994, European Collaborative Study 2005). Postpartum HIV infections are avoidable provided that HIV-infected mothers do not breastfeed. At the same time as transmission prophylaxis was introduced, the treatment of HIV infection changed too. Nowadays, pregnancy is no longer a general contraindication for antiretroviral therapy (Agangi 2005, CDC 2006 a)).


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


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


Majority of transmissions occur during heterosexual intercourse. Other methods of transmission include homosexual intercourse, breastfeeding by infected mothers, sharing of contaminated needles by intravenous drug users. Infections from blood or blood products transfusions is rare now in countries where screening of donated blood is routine.

Topical Reactions

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

Nipple discharge

Tests suggest underlying pathology (e.g. prominent red blood cell content, atypical or malignant cells), then the duct should be removed surgically (microdochectomy). In older women or those not intending to conceive and breast feed, if the duct cannot be identified or the discharge comes from several ducts, then subareolar central duct excision is undertaken through a circumareolar incision.

HIV Infection

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

Global Distribution

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

Breast conditions

Cohort study in Nairobi, transmission was independently associated with nipple lesions, maternal CD4+ cell count lower than 400 mm3, infant oral thrush under the age of six months, and prolonged duration of breastfeeding (Embree et al., 2000 John-Stewart et al., 2004 Rollins et al., 2004). Whether, at a population level, treatment of breast lesions results in a reduction of the rate of transmission through breastfeeding is not clear, and further studies are in progress.

Nutritional status

Maternal nutritional status may influence risk of transmission overall, as well as breastfeeding transmission. A recent paper presented results from an additional analysis of data from a randomized trial investigating the effect of micronutrients and vitamin A on risk of transmission (Fawzi et al., 2002, 2003). Micro-nutrients excluding vitamin A, given to the mother during pregnancy and breastfeeding, had no effect on the overall risk of transmission, but vitamin A alone was associated with a slight increase of mother-to-child-transmission rates overall, and an increased risk of transmission during breastfeeding. Micronutrients were associated with a non-significant reduction in breastfeeding transmission and mortality in the first two years of life. Further analysis of these data showed that children of women who had been randomized to receive micronutrients during pregnancy and lactation had a significantly lower risk of diarrhoea (p 0.03) and a substantially higher mean CD4+ cell...

Maternal diet

Maternal diet and composition of breast milk may play a role in the development of immune-mediated diseases. It has been shown that small amounts of cow's milk proteins may be carried over to breast milk from the maternal diet (Axelsson et al. 1984), and sensitive infants may develop cow's milk allergy on exclusive breastfeeding (Host 1994). Per capita coffee consumption correlated positively with incidence of type 1 diabetes in an international ecological comparison (Tuomilehto et al. 1990). However, maternal coffee or tea consumption during pregnancy was not related to the risk of type 1 diabetes in the offspring in two case-control series (Virtanen et al. 1994a Soltesz et al. 1994). A positive association was seen between maternal nitrite intake and the risk of diabetes in the child independently of the child's own intake and when adjusted for several sociodemographic factors (Virtanen et al. 1994b). Paternal use of coffee or tea or intake of nitrate or nitrite at the time of...


Short, exclusive breastfeeding or an early age at introduction of supplementary feeding has been suggested as a risk determinant of both type 1 and type 2 diabetes (Pettitt et al. 1997). Increased weight gain may be a risk predictor of not only type 2, but also of type 1 diabetes (e.g., Hyppanen et al. 2000 Wilkin 2001 EURODIAB Substudy 2 Study Group 2002). Overweight was associated with the presence of autoantibodies to glutamate decarboxylase (GAD) antibodies in unaffected male first-degree relatives of subjects with type 1 diabetes (Weets et al. 2001) and among glucose-intolerant men and women (Rolandsson et al. 1999). Evidence is inconclusive whether type 1 and type 2 diabetes overlap within families (e.g. Dahlquist et al. 1989 Quatraro et al. 1990 Douek et al. 2002).

Sex of infant

In the recent meta-analysis of late postnatal transmission (LPT) (Read et al., 2003) covariates that could affect the relationship between breastfeeding and LPT of HIV-1 were evaluated, including maternal variables (age, parity, CD4+ count) and child variables (birth weight, sex). Maternal age, parity or birth weight was not significantly associated with LPT, but maternal CD4+ cell counts and sex of child were females were 40 less likely than males to become infected through breastfeeding after four weeks of age (Hazard ratio 0.6, 95 CI 0.4-0.9, p 0.014). The risk of LPT was highest for males breastfed by mothers with CD4+ cell counts lower than 200 mm3, followed by males breastfed by mothers with counts of 200-499 cells mm3, and then females breastfed by mothers with counts lower than 200 cells mm3. Duration of breastfeeding was similar for both sexes, but no information was available on the age at which other foods were introduced or on type of food. The sex difference in risk of...

Primary prevention

The prevention of all HIV transmission to infants and young children should be linked to programmes that provide education to young people on safer sex, and diagnosis and treatment of sexually transmitted infections, and that ensure the safety of medical procedures. HIV prevention should be emphasized for women who test seronegative in pregnancy (a high percentage of whom may become infected in the two years after delivery, while breastfeeding) because of the particularly high risk of mother-to-child transmission if mothers become HIV-infected during breastfeeding.


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


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

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

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

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