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1.  ABM Clinical Protocol #21: Guidelines for Breastfeeding and the Drug-Dependent Woman 
Breastfeeding Medicine  2009;4(4):225-228.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
doi:10.1089/bfm.2009.9987
PMCID: PMC2989871  PMID: 19835481
2.  INADEQUATE: A Metaphor for the Lives of Low-Income Women? 
Exclusive breastfeeding of infants for the first six months of life with continued breastfeeding for at least six more months occurs only 11.9% of the time in the US. Efforts of the past 30 years to promote optimal breastfeeding practices have had little impact. In order to create significant change in the way we feed infants in this country, we need to change the way we look at this public health issue and examine the cultural logic that makes bottle feeding the preferred choice of most US women. This paper analyzes the term ‘inadequate’ not just as self-description of a woman’s milk supply, but also as a metaphor for the lives of low-income women in the US, the group least likely to breastfeed. Low-income women in the US not only have inadequate incomes as compared to the general population, but inadequate child-care, education, preventive health services, and lives saturated with violence, leaving them inadequately safe even in their own homes. Here we outline a research agenda to explore the relationship between socially determined inadequacies and the cultural logic that makes bottle feeding a preferred form of infant feeding. (190 words)
doi:10.1089/bfm.2009.0035
PMCID: PMC2763322  PMID: 19827922
3.  Inadequate: A Metaphor for the Lives of Low-Income Women? 
Breastfeeding Medicine  2009;4(Suppl 1):S-41-S-43.
Abstract
Exclusive breastfeeding of infants for the first 6 months of life with continued breastfeeding for at least 6 more months occurs only 11.9% of the time in the United States. Efforts of the past 30 years to promote optimal breastfeeding practices have had little impact. In order to create significant change in the way we feed infants in this country, we need to change the way we look at this public health issue and examine the cultural logic that makes bottle feeding the preferred choice of most U.S. women. This article analyzes the term “inadequate” not just as self-description of a woman's milk supply, but also as a metaphor for the lives of low-income women in the United States, the group least likely to breastfeed. Low-income women in the United States not only have inadequate incomes as compared to the general population, but inadequate child care, education, preventive health services, inadequate lifespans, and lives saturated with violence, leaving them inadequately safe even in their own homes. Here we outline a research agenda to explore the relationship between socially determined inadequacies and the cultural logic that makes bottle feeding a preferred form of infant feeding.
doi:10.1089/bfm.2009.0035
PMCID: PMC2763322  PMID: 19827922
4.  Breastfeeding and Health Outcomes 
Breastfeeding Medicine  2009;4(Suppl 1):S-13-S-15.
doi:10.1089/bfm.2009.0066
PMCID: PMC2998971  PMID: 19827918
5.  Breastmilk from Allergic Mothers Can Protect Offspring from Allergic Airway Inflammation 
Breastfeeding Medicine  2009;4(3):167-174.
Abstract
Objective
Breastfeeding is associated with a reduced risk of developing asthma in children. Using a murine model we previously demonstrated that mothers with Th1-type immunity to ovalbumin (OVA) transfer antigen-specific protection from OVA-induced allergic airway disease (AAD) to their offspring. The aim of this study was to evaluate the contribution of breastmilk and maternal B cell immunity from allergic mothers in the vertical transmission of protection from AAD.
Methods
This was investigated using an adoptive nursing strategy. Naive offspring were nursed by allergic wild-type or B cell-deficient foster mothers with histories of Th2-type immunity to OVA. Following weaning, offspring were immunized with OVA-Al(OH)3 and challenged with aerosolized OVA to induce AAD.
Results
Offspring nursed by wild-type OVA-immune foster mothers demonstrated lower levels of OVA-specific immunoglobulin E, interleukin-5, and airway eosinophilia than progeny nursed by naive control mothers. In contrast, offspring nursed by B cell-deficient OVA-immune foster mothers had similar parameters of OVAinduced AAD as progeny nursed by naive control mothers.
Conclusions
These data demonstrate the ability of breastmilk from allergic mothers to protect offspring from AAD was dependent on intact maternal B cell immunity. Nursing alone, when done by wild-type mothers with AAD, was sufficient for offspring to acquire the antigen-specific protective factor(s) from breastmilk.
doi:10.1089/bfm.2008.0130
PMCID: PMC2757118  PMID: 19301986
6.  Subclinical Mastitis May Not Reduce Breastmilk Intake During Established Lactation 
Breastfeeding Medicine  2009;4(3):161-166.
Abstract
Objective
This study determined the effect of subclinical mastitis (SCM) on infant breastmilk intake.
Design
Participants (60 Ghanaian lactating mothers and their infants) were from periurban communities in the Manya Krobo district of Ghana in 2006–2007. Bilateral breastmilk samples were obtained once between months 3 and 6 postpartum and tested for SCM using the California mastitis test (CMT) and the sodium/potassium (Na/K) ratio. Infants' 12-hour breastmilk intake was assessed by test weighing. CMT scoring for SCM diagnosis was scaled as ≥1 = positive (n = 37) and <1 = negative (n = 23). SCM diagnosis was confirmed as a Na/K ratio of >1.0 (n = 14).
Results
Breastmilk intake was nonsignificantly lower among infants whose mothers had elevated Na/K ratios of >1.0 (−65.1 g; 95% confidence interval −141.3 g, 11.1 g). Infants whose mothers were positive for SCM with both CMT and Na/K ratio criteria had significantly lower breastmilk intake (−88.9 g; 95% confidence interval −171.1 g, −6.9 g) compared to those whose mothers tested either negative with both tests or positive on only one. Infant weight (p < 0.01) and frequency of feeding (p = 0.01) were independently associated with breastmilk intake. However, the effect of SCM on breastmilk intake disappeared when infant weight and feeding frequency were included in a multiple linear regression model.
Conclusions
The results of this study did not show an effect of SCM on breastmilk intake among 3–6-month-old infants. A larger sample size with a longitudinal design will be needed in future studies.
doi:10.1089/bfm.2008.0131
PMCID: PMC2932540  PMID: 19243263
7.  Human Milk Adiponectin Is Associated with Infant Growth in Two Independent Cohorts 
Breastfeeding Medicine  2009;4(2):101-109.
Abstract
Background
Adiponectin, a circulating adipocyte protein, is associated with lower obesity. We have previously shown that adiponectin is present in human milk. This study determined whether higher milk adiponectin is associated with infant growth and investigated milk adiponectin's oligomeric form.
Design and Methods
This is a study of two parallel longitudinal cohorts of breastfed infants born between 1998 and 2005. Forty-five mother–infant pairs from Cincinnati, OH and 277 mother–infant pairs from Mexico City, Mexico were analyzed. All participants were healthy, term infants breastfed at least 1 month who completed 6 months of follow-up. Monthly milk samples (n = 1,379) up to 6 months were assayed for adiponectin by radioimmunoassay. Infant weight-for-age, length-for-age, and weight-for-length Z-scores up to 6 months of age were calculated using World Health Organization standards. Repeated-measures analysis was conducted. The structural form of human milk adiponectin was assessed by western blot.
Results
In the population studies, initial milk adiponectin was 24.0 ± 8.6 μg/L and did not differ by cohort. Over the first 6 months, higher milk adiponectin was associated with lower infant weight-for-age Z-score (−0.20 ± 0.04, p < 0.0001) and weight-for-length Z-score (−0.29 ± 0.08, p = 0.0002) but not length-for-age Z-score, adjusted for covariates, with no difference by cohort. By western blot, human milk adiponectin was predominantly in the biologically active high-molecular-weight form.
Conclusions
Our data suggest milk adiponectin may play a role in the early growth and development of breastfed infants.
doi:10.1089/bfm.2008.0137
PMCID: PMC2779028  PMID: 19500050
9.  Response to Brody et al. 
Breastfeeding Medicine  2009;4(2):123.
doi:10.1089/bfm.2009.0017
PMCID: PMC2932547  PMID: 19500056
10.  An Examination of Attitudes, Knowledge, and Clinical Practices Among Pennsylvania Pediatricians Regarding Breastfeeding and Smoking 
Breastfeeding Medicine  2009;4(2):83-89.
Abstract
Background and Objective
The most recent American Academy of Pediatrics policy statement clearly supports breastfeeding for smoking mothers. The impact of this recommendation on pediatricians' counseling and prescribing practices is unclear. This study describes Pennsylvania pediatricians' attitudes, knowledge, and practices regarding breastfeeding, maternal smoking, and smoking cessation.
Methods
A descriptive study was conducted using a web-based, anonymous survey. The survey consisted of three clinical vignettes followed by knowledge and attitude questions.
Results
Among 296 respondents, more than half reported one or more conversations about breastfeeding and smoking in the past year. Most were comfortable counseling on breastfeeding, but few were comfortable counseling about smoking and breastfeeding. Respondents scored poorly on five knowledge items; 27% answered zero items correctly, and only 21% answered four or five items correctly. Less than half reported breastfeeding was safe for smoking mothers. Compared to pediatricians with high knowledge scores, those with a low score were less likely to tell a smoking mother that breastfeeding is safe (38% vs. 69%, p < 0.01) and more likely to recommend formula feeding (19% vs. 3%, p < 0.01). Most pediatricians were uncertain about the safety of nicotine replacement therapy and bupropion (Zyban®, GalxoSmithKline, Research Triangle Park, NC) with breastfeeding.
Conclusions
Pennsylvania pediatricians lack knowledge and comfort related to the topic of breastfeeding and maternal smoking. Additional efforts to inform and educate pediatricians on the subjects of breastfeeding, maternal tobacco use, and smoking cessation products are needed.
doi:10.1089/bfm.2008.0119
PMCID: PMC2981379  PMID: 19210131
11.  Intestinal Permeability in Preterm Infants by Feeding Type: Mother's Milk Versus Formula 
Breastfeeding Medicine  2009;4(1):11-15.
Abstract
Background and Objective
Intestinal permeability in preterm infants represents a critical balance between absorption of nutritional agents and protection from dangerous pathogens. This study identified the relationship between feeding type (human milk and formula) and intestinal permeability as measured by lactulose to mannitol ratio in preterm infants in the first postnatal month.
Study Design
Sixty-two preterm (≤32 weeks of gestation) infants had assessment of feeding type and evaluation with enteral lactulose and mannitol administration and urinary measurement at three time points in the first postnatal month.
Results
Infants who received the majority of feeding as human milk (>75%) demonstrated significantly lower intestinal permeability when compared to infants receiving minimal or no human milk (<25% or none) at postnatal days 7, 14, and 30 (p = 0.02, 0.02, and 0.047, respectively). When infants receiving any human milk were compared to infants receiving formula only, a significant difference existed at day 7 and day 14 but not for day 30 (p = 0.04, 0.02, and 0.15, respectively). With evaluation over the complete study period, exclusively formula-fed infants demonstrated a 2.8-fold higher composite median lactulose/mannitol ratio when compared with those who received any human milk. Infants who received >75% of enteral feeding as mother's milk demonstrated a 3.8-fold lower composite median ratio when compared to infants receiving <25% or no mother's milk.
Conclusion
Preterm infant intestinal permeability was significantly decreased for those receiving human milk versus formula in a dose-related manner in the first postnatal month.
doi:10.1089/bfm.2008.0114
PMCID: PMC2932544  PMID: 19196035
12.  Academy of Breastfeeding Medicine Founder's Lecture 2008: Breastfeeding—An Extrauterine Link Between Mother and Child 
Breastfeeding Medicine  2009;4(1):3-10.
Abstract
In addition to a near-optimal combination of nutrients for the growing infant, breastmilk contains a wide array of bioactive molecules that are known to protect the infant against infectious disease and modulate the composition of the indigenous intestinal microbiota. A growing number of factors that modulate the infant's immunophysiology have also been identified in breastmilk. We suggest that this early immunomodulation via breastmilk is vital for infant health and may explain the epidemiological data indicating that breastmilk reduces the risk of immunoinflammatory conditions in infancy and also later in life. The body of scientific data regarding the role of transforming growth factor-β in breastmilk in enhancing healthy immune maturation and reducing the risk of disease is reviewed in this article.
doi:10.1089/bfm.2009.0004
PMCID: PMC2932545  PMID: 19292608
13.  Breastmilk from Allergic Mothers Can Protect Offspring from Allergic Airway Inflammation 
Objective
Breastfeeding is associated with a reduced risk of developing asthma in children. Using a murine model we previously demonstrated that mothers with Th1-type immunity to ovalbumin (OVA) transfer antigen-specific protection from OVA-induced allergic airway disease (AAD) to their offspring. The aim of this study was to evaluate the contribution of breastmilk and maternal B cell immunity from allergic mothers in the vertical transmission of protection from AAD.
Methods
This was investigated using an adoptive nursing strategy. Naive offspring were nursed by allergic wild-type or B cell-deficient foster mothers with histories of Th2-type immunity to OVA. Following weaning, offspring were immunized with OVA-Al(OH)3 and challenged with aerosolized OVA to induce AAD.
Results
Offspring nursed by wild-type OVA-immune foster mothers demonstrated lower levels of OVA-specific immunoglobulin E, interleukin-5, and airway eosinophilia than progeny nursed by naive control mothers. In contrast, offspring nursed by B cell-deficient OVA-immune foster mothers had similar parameters of OVA-induced AAD as progeny nursed by naive control mothers.
Conclusions
These data demonstrate the ability of breastmilk from allergic mothers to protect offspring from AAD was dependent on intact maternal B cell immunity. Nursing alone, when done by wild-type mothers with AAD, was sufficient for offspring to acquire the antigen-specific protective factor(s) from breastmilk.
doi:10.1089/bfm.2008.0130
PMCID: PMC2757118  PMID: 19301986

Results 1-13 (13)