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Background: There is an increasing prevalence of expressed human milk feeding. The reasons for expressed human milk feeding of healthy term infants may differ from those for preterm infants. The process of adopting expressed human milk feeding for healthy full-term infants has not been well-described in the existing literature. Research Aim: To describe the reasons for, and antecedents to, expressed human milk feeding among Chinese women who used a high proportion of expressed human milk for feeding. Methods: A descriptive, prospective cross-sectional qualitative design was used. Participants (N = 25) who used a high proportion of expressed human milk feeding were recruited from a larger perspective cohort study in two public hospitals in Hong Kong. Semi-structured, in-depth, one-to-one interviews were conducted 2017–2018. Data collection and thematic analysis were guided by the Breastfeeding Self-Efficacy Theory. Results: The authors conducted thematic analysis and identified six core themes: (1) perceived maternal roles; (2) breastfeeding role models; (3) negative feedback from social networks; (4) negative direct breastfeeding experiences; (5) expressed human milk feeding as a solution to a problem; and (6) advice from health care professionals to express human milk. These themes were consistent with the four antecedents of the Breastfeeding Self-Efficacy Theory (e.g., physiological and affective state, vicarious experiences, performance accomplishments, and verbal persuasion). Conclusions: The main reason for participants to feed expressed human milk was experiencing difficulties with direct breastfeeding. Expressed human milk feeding was used as an immediate solution for breastfeeding problems. Strengthening breastfeeding support in the early postpartum period may decrease the perceived need for human milk expression. [ABSTRACT FROM AUTHOR]

Expressed breast milk feeding has increased substantially in the past two decades. Once used primarily for preterm infants, feeding expressed breast milk is now more common in mothers giving birth to healthy term infants. However, the effect of expressed breast milk feeding on breastfeeding duration is unclear. To assess the association between breast milk expression practices and breastfeeding duration in women giving birth to healthy infants. From 2017 to 2018, we recruited 821 new mothers from two public hospitals in Hong Kong. Participants were followed up at 1.5, 3, and 6 months postpartum or until they stopped breastfeeding. The proportion, type, and mode of all milk feeding were assessed at each follow-up. At 1.5 months postpartum, 47.9%, 37.7%, and 14.4% of participants were feeding by direct breastfeeding only, mixed-mode feeding, and expressed breast milk only, respectively. Participants feeding expressed breast milk only were more likely to be supplementing with infant formula. When compared with participants who provided only direct breastfeeding, participants who gave only expressed breast milk at 1.5 months had 57% lower odds of breastfeeding continuation at three months postpartum. After stratification by infant formula supplementation, expressed breast milk feeding only at 1.5 months was associated with an increased risk of breastfeeding cessation in participants supplementing with infant formula (adjusted hazard ratio [aHR] = 1.86, 95% CI = 1.17–2.95). In the first six months postpartum, giving only expressed breast milk is associated with early breastfeeding cessation, especially in participants who are also supplementing with infant formula. [ABSTRACT FROM AUTHOR]

Abstract Background When compared with full-term birth (39 to <42 weeks), early-term birth (37 to <39 weeks) is associated with adverse neonatal outcomes that may impede breastfeeding. Breastfeeding provides numerous benefits to infants and could potentially offset the effects of early-term birth. However, the effect of early-term birth on any and exclusive breastfeeding duration among healthy normal weight infants is unclear. Objectives The objective of this study was to examine the association between early-term birth and breastfeeding duration and exclusivity among healthy term infants. Methods Two prospective cohorts of 2704 healthy mother-infant pairs were recruited in Hong Kong in 2006–07 and 2011–12. Participants were followed prospectively for 12 months or until they stopped breastfeeding. Results Approximately one-third (32.8%) of the infants were born early-term. More than one-half of all participants had stopped breastfeeding by three months postpartum and approximately one-half of the infants were not being exclusively breastfed by two weeks postpartum. There was no significant difference in the odds of any (adjusted odds ratio [aOR] = 1.05; 95% 0.85, 1.31) or exclusive (aOR = 0.89; 95% 0.73, 1.08) breastfeeding at one-month postpartum between infants born early-term and at full-term. There was also no significant difference in the duration of any (adjusted hazard ratio [aHR] = 1.0; 95% 0.91, 1.10) or exclusive (aHR = 1.0; 95% 0.91, 1.09) breastfeeding between early-term and full-term infants. Conclusion In this cohort, early-term birth was not associated with breastfeeding duration and exclusivity. This suggests that, in the absence of neonatal complications, early-term birth itself may not lead to a shorter duration of any or exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the validity of the self-/home-measured waist circumference (WC) method in children/adolescents at three sites: at the level of the umbilicus, immediately above the iliac crest, and at the midpoint of the lower margin of the last palpable rib and top of the iliac crest. A cross-sectional study of 3360 Hong Kong Chinese children/adolescents was conducted, with 2980 (88.7%) participants included in the final analysis. The WC of children aged 6 to 9 was measured at the three sites by their parent/guardian at home followed by measurement by trained assessors at school within one week. Children/adolescents between the ages of 10 and 17 self-measured their WC at the three sites during school hours, followed by measurements by the trained assessors. Bland-Altman limits of agreement (LOA) analysis was performed to evaluate between-measurement agreement. The difference between assessor- and self-/home-measured WC was defined as ≤ ±2.5 cm for the upper and lower LOA at all three sites as an a priori criterion based on the assessor-measured inter-rater results. The results showed that most measurements (about 96%) at each site was within 95% of the LOA. Of the three measurement sites, the smallest LOA interval width was found at the umbilicus site, with an upper LOA of 5.08 and 7.13 and lower LOA of -2.61 and -3.43 in boys and girls, respectively. In conclusion, the range of LOA was relatively large, exceeding the acceptable limits of the predefined a priori criterion of upper and lower LOA, and thus suggesting disagreement between the two measurement methods. The use of WC as a measure of abdominal obesity in clinical practice/epidemiological studies should be restricted to measurement by trained health professionals/research staff. [ABSTRACT FROM AUTHOR]

Abstract: Background: Researchers have found breastfeeding disparities between immigrant and native‐born women in many countries. However, most studies on immigration and breastfeeding practices have been in Western countries. The aim of this study was to examine the effect of length of time since immigration on the breastfeeding practices of Mainland Chinese immigrants living in Hong Kong. Methods: We recruited 2704 mother‐infant pairs from the postnatal wards of four public hospitals in Hong Kong. We examined the effect of migration status on the duration of any and exclusive breastfeeding. Results: Breastfeeding duration was progressively shorter as the time since immigration increased. When compared with mothers who had lived in Hong Kong for <5 years, Hong Kong‐born participants had a 30% higher risk of stopping any breastfeeding (hazard ratio [HR] 1.34 [95% confidence interval {CI} 1.10‐1.63]) and exclusive breastfeeding (HR 1.33 [95% CI 1.11‐1.58]). In both Hong Kong‐born and immigrant participants, breastfeeding cessation was associated with return to work postpartum and the husband's preference for infant formula or mixed feeding. Intention to exclusively breastfeed and to breastfeed for >6 months, and previous breastfeeding experience substantially reduced the risk of breastfeeding cessation for both Hong Kong‐born and immigrant participants. Conclusions: Health care professionals should consider immigration history in their assessment of pregnant women and provide culturally adapted breastfeeding support and encouragement to this population. [ABSTRACT FROM AUTHOR]

Background Maternal breastfeeding intentions are strongly associated with breastfeeding exclusivity and duration. Factors that affect new mothers’ exclusive breastfeeding intentions have not been adequately examined. Objective The purpose of this study was to examine the association between family member's infant feeding preferences, breastfeeding exposures, and womens’ exclusive breastfeeding intentions. Methods 1277 breastfeeding mother-infant pairs were recruited from four public hospitals in Hong Kong. We used multiple logistic and linear regression models to explore the impact of the family members’ infant feeding preferences and breastfeeding exposures on exclusive breastfeeding intentions. Results 78.1% mothers reported an intention to exclusively breastfeed, and the median intended duration of exclusive breastfeeding was 26 weeks. The husband's preference for breastfeeding (aOR = 1.67; 95% CI 1.20–2.31), previous breastfeeding experience (aOR = 1.56; 95% CI 1.10–2.23) and attendance at an antenatal breastfeeding class (aOR = 2.09; 95% CI 1.45–3.02) were all strongly associated with higher maternal intention to exclusively breastfeed. For every additional family member who preferred breastfeeding, the odds of intending to exclusively breastfeed increased by 32% (aOR1.32; 95% CI, 1.13–1.55). Similarly, the proportion of participants intending to exclusively breastfeed increased progressively with more breastfeeding exposures. Conclusions Including fathers and other significant family members in antenatal breastfeeding education can help to maximize breastfeeding support for the new mother and encourage new mothers to exclusively breastfeed. [ABSTRACT FROM AUTHOR]

Background: The relationship between support from members of a mother’s social network and breastfeeding continuation is receiving increased attention. Objectives: The objectives of this study were to describe the infant feeding preferences of Chinese mothers’ immediate social network and to examine the association between these preferences and early breastfeeding cessation. Methods: In total, 1172 mother-infant pairs were recruited from 4 public hospitals in Hong Kong and followed prospectively for 12 months or until breastfeeding stopped. Results: Over 40% of participants’ partners preferred breastfeeding and half had no infant feeding preference. Only about 20% of participants’ mothers or mothers-in-law preferred breastfeeding, and less than 10% reported that all of the 3 significant family members (partner, mother, and mother-in-law) preferred breastfeeding. The partner’s preference for infant formula or mixed feeding (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.43-4.71) or having no preference (OR, 1.64; 95% CI, 1.16-2.30) was strongly associated with higher odds of stopping breastfeeding before 1 month. For every additional family member who preferred breastfeeding, the odds of stopping breastfeeding was reduced by almost 20% (OR, 0.81; 95% CI, 0.68-0.97). However, living with a parent-in-law (OR, 1.45; 95% CI, 1.02-2.07) was also a predictor of early breastfeeding cessation. Knowing someone who had breastfed for ≥ 1 month (OR, 0.64; 95% CI, 0.42-0.97) or having been breastfed as a child (OR, 0.67; 95% CI, 0.45-0.98) significantly lowered the odds of early breastfeeding cessation. Conclusions: The infant feeding preferences of mothers’ immediate social network are significantly associated with breastfeeding continuation. Prenatal breastfeeding education programs should involve significant family members to promote breastfeeding. [ABSTRACT FROM AUTHOR]

Background: In recent years there has been a steady influx of immigrants into Hong Kong from Mainland China, where breastfeeding patterns differ. Studies in other regions have found substantial differences in breastfeeding rates between native-born and immigrant mothers. The purpose of this study was to examine factors associated with breastfeeding initiation in Hong Kong born and Mainland China born mothers living in Hong Kong.Methods: We used a multi-center cross-sectional study design and recruited 2761 new mothers from the postnatal wards of all eight public hospitals in Hong Kong that offer obstetric services. We assessed breastfeeding status as well as various socio-demographic, maternal and birth characteristics. Chi-square tests and multivariable logistic regression were used to identify the predictors of breastfeeding initiation in Hong Kong born and Mainland China born participants.Results: 80.3 % of Hong Kong and 81.1 % of Mainland Chinese born women initiated breastfeeding. In the fully adjusted models, multiparity (Odds Ratio [OR] 0.53, 95 % CI 0.43-0.66) and maternal smoking (OR 0.29, 95 % CI 0.18-0.45) were strongly associated with failure to initiate breastfeeding in both Hong Kong and Mainland China born participants. In Hong Kong born mothers, participants with lower maternal education and those who had a cesarean section were significantly less likely to breastfeed. For Mainland China born mothers, paternal smoking (OR 0.70, 95 % CI 0.49-0.99) and having a pregnancy-related health problem (OR 0.60, 95 % CI 0.38-0.94) were both additional risk factors for not breastfeeding.Conclusion: This study has identified predictors of breastfeeding initiation in Hong Kong and Mainland China born mothers. Given the current high breastfeeding initiation rates among both groups, antenatal breastfeeding education and promotion programmes need to specifically intervene with sub-groups of pregnant women at risk for not breastfeeding so that their efforts are more strategic and cost-effective. [ABSTRACT FROM AUTHOR]

There is an increasing prevalence of breast milk expression and expressed breast milk feeding in healthy full-term infants. The purpose of this study was to provide up-to-date evidence on the practice of expressed breast milk feeding and to identify factors associated with expressed breast milk feeding in Hong Kong Chinese mothers of healthy full-term infants. We used a prospective cohort study design to recruit 821 mothers who gave birth to healthy full-term infants in two public hospitals in Hong Kong. Participants completed self-administered baseline questionnaires during their postpartum stay and were followed-up by a series of telephone calls over a 6 months period or until they stopped breastfeeding, whichever came first. The proportion, mode, and type of infant feeding (direct breastfeeding, expressed breast milk feeding and infant formula feeding) were assessed at each telephone follow-up. In our sample, 14.6%, 20.2% and 15% of the participants fed expressed breast milk only to their infants at 1.5, 3 and 6 months respectively. Less than one-half were giving only direct breastfeeding only at 1.5 and 3 months. Within the first six months postpartum, 84.6% of the participants had given expressed breast milk. More than 80% of participants obtained a breast pump before giving birth, with the majority obtaining electric pumps. The most common reason for expressing breast milk within the first 1.5 months postpartum was experiencing breastfeeding difficulties (35%). Returning to employment was the strongest predictor of expressed breast milk feeding at three months postpartum (adjusted odds ratio [aOR]=8.71, 95% Confidence interval [CI]= 5.12–14.8). A high proportion of Hong Kong Chinese mothers of healthy, full-term infants pump and feed expressed breast milk at some point during the first 6 months postpartum. Participants purchase or obtain breast pumps before giving birth, often in anticipation of breastfeeding difficulties and returning to work. [ABSTRACT FROM AUTHOR]