Interruption of breastfeeding by child death and pregnancy

This paper estimates the mean monthly losses and proportionate interruptions of breastfeeding intervals due to child death and pregnancy. The paper uses a microanalytic model with stochastic risks for the basic processes of human reproduction. The model results show that a high proportion of women, depending upon mortality level and length of breastfeeding, have their breastfeeding interrupted by either child death or pregnancy. The results of this work suggest the need for caution in interpreting observed durations of breastfeeding. Child death and pregnancy causes bias in the reported length of breastfeeding, and this bias needs to be taken into account in statistical analysis.     

Birth spacing,breastfeeding, and early child mortality in a traditional Indian society: A hazards model analysis

Abstract

There are few studies of the interrelationships among breastfeeding, child spacing, and child mortality in traditional societies that incorporate extensive controls for social and demographic characteristics of the mother and child. In this paper, we investigate the impact of breastfeeding and the length of the preceding birth interval on early child mortality (defined as a death in the first two years of life) using data from a traditional society of India. Multivariate hazards models are used to analyze the data. Most prior analyses related the impact of breastfeeding duration to the duration of child survivability by taking breastfeeding as a fixed covariate. The present study has a methodological focus in the sense that breastfeeding information from retrospective survey data is treated as a time‐dependent covariate both as a status variate as well as a duration—with empirical findings compared across the two specifications. The effects of postpartum amenorrhoea and various other demographic and socioeconomic characteristics of mother and child are also studied. The results suggest that breastfeeding duration has a strong impact in reducing the relative risk of early child mortality; but it does not explain the effect of the length of the preceding birth interval on early child mortality.     

Postpartum amenorrhoea in Ethiopia: The role of weaning,child death,and socioeconomic factors

Abstract

Using data from the 1990 National Family and Fertility Survey (NFFS) and employing discrete‐time hazards models, we examine the effect of weaning, child death, and socioeconomic factors on postpartum amenorrhoea in Ethiopia. The results show that 91 in every 100 mothers breastfed their child for at least 6 months. The median duration of breastfeeding stands at 18 months, and amenorrhoea lasts for a median duration of 12 months. Significant variations in breastfeeding and amenorrhoea duration are also observed among the different categories of breastfeeding women. The median duration of breastfeeding for lactating women is 24 months, 6 months for those who weaned, and 2 months for those whose child died. The median duration of postpartum amenorrhoea is 14 months for breastfeeding women, 12 months for those who weaned, and 6 months for those whose child died. Discrete‐time hazard models reveal that child death has the strongest effect on the resumption of menses. Net of other factors, the risk of returning to menses increased 3 times for mothers whose child died. The effect of child death, however, decreases over time. Weaning also has a significant positive effect; and, like child death, its effect diminishes as time passes. The study further shows significant differences in the risk of returning to postpartum menses by socioeconomic characteristics of the women, even though they are breastfeeding.     

Correlates and implications of breast-feeding practices in Bas Zaire

A sample of 1871 women having a child under 3 years old in Bas Zaire was studied to determine the correlates of breastfeeding practices and to examine the interrelationships among breastfeeding, contraceptive practices and desire for pregnancy. The methods of analysis applied were life table analysis and its multivariate extensions. Most of the findings in this analysis are consistent with current literature on the correlates of the duration of breastfeeding. Maternal education, economic status, age, parity, urban residence, pregnancy, and sex of the index child were significantly related to the length of breastfeeding. Among non-pregnant women, current desire for pregnancy was also related to breastfeeding status when the length of time since birth of the last child was taken into consideration. Rural women were reportedly ready for another pregnancy sooner after the birth of their last child than were urban women. Breastfeeding appears to be the most important means of contraceptive protection in the study population. The effective traditional method of extended postpartum abstinence is not widely prevalent, particularly among the urban sample, and indeed seems to be on the decline. The data presented here also suggest that breastfeeding pratices are changing in this area of Africa where little economic development has occurred in the past 20 years. This research suggests that if current trends continue, fertility levels are likely to increase significantly. The findings also indicate that Bas Zairian mothers want to space their births and for this reason may be receptive to family planning programs that use appropriate strategies.     

Developmental Predictors of Inattention-Hyperactivity from Pregnancy to Early Childhood

ObjectiveThe objective of the study was to characterize the developmental sequence of pre- and postnatal risk factors for inattention-hyperactivity symptoms in preschoolers.ResultsA low family socioeconomic status before pregnancy was the main environmental risk factor for inattention-hyperactivity symptoms at 3 years, and its effect occurred via two pathways. The first was a risk pathway, where lower SES was associated with higher maternal depression and anxiety during pregnancy; then to higher maternal and child distress and dysregulation in infancy; and in turn to higher levels of inattention-hyperactivity at 3 years. The second was a protective pathway, where higher SES was associated with longer duration of breastfeeding during infancy; then to better child neurodevelopmental status in toddlerhood; and in turn to lower levels of inattention-hyperactivity at 3 years.DiscussionThis study identified psychosocial factors at several developmental periods that represent potential targets for preventing the emergence of inattention-hyperactivity symptoms in early childhood.     

Puerperal morbidity: A neglected area of maternal health in Sri Lanka

Abstract

Data on women with at least two children are used to examine how the breastfeeding experience with the first child affects whether subsequent children are breastfed. Our results indicate that women most often repeat with later children the feeding decision they made with their first child. That is, those who breastfed their first child are very likely to breastfeed a later child and those who did not breastfeed their firstborn are unlikely to breastfeed a later‐bom. Among those who did not breastfeed their first child, education beyond high school increases the likelihood that they will switch to breastfeeding with a later‐born. Those who breastfed their first child are less likely to breastfeed a later‐born if the first breastfeeding experience was of short duration or was perceived to be unsuccessful or unsatisfactory or if the woman had not gone beyond high school or received anesthesia at the later birth. Hence, educational differences are greater at higher parities than at first parity.     

Determinants of breastfeeding initiation among mothers in Sydney,Australia: findings from a birth cohort study

Background

Breastfeeding has short-term and long-term benefits for both the infant and the mother. The objective of this study was to identify the incidence of breastfeeding initiation among women in South Western Sydney, and the factors associated with the initiation of breastfeeding.

Methods

Child and Family Health Nurses recruited mother-infant dyads (n = 1035) to the Healthy Smiles Healthy Kids birth study in South Western Sydney, an ethnically and socio-economically diverse area, at the first post-natal home visit. A sample of 935 women completed a structured, interviewer-administered questionnaire at 8 weeks. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.

Results

In total, 92% of women (n = 860) commenced breastfeeding in hospital. Women who completed a university degree were more likely to initiate breastfeeding compared to those who did not complete high school (AOR = 7.16, 95% CI 2.73, 18.79). Vietnamese women had lower odds of breastfeeding initiation compared to Australian born women (AOR = 0.34. 95% CI 0.13, 0.87). Women who had more than one child were less likely to breastfeed than those who had one child (AOR = 0.38, 95% CI 0.19, 0.79). Women who gave birth via a caesarean section were less likely to breastfeed their baby compared to those who had a vaginal delivery (AOR = 0.27, 95% CI 0.14, 0.52). Women who drank alcohol during pregnancy had 72% lower odds to breastfeed compared to those who did not drink alcohol during pregnancy (AOR = 0.28, 95% CI 0.11, 0.71). Women who reported that their partner preferred breastfeeding were more likely to initiate breastfeeding (AOR = 11.77, 95% CI 5.73, 24.15) and women who had chosen to breastfeed before pregnancy had more than 2.5 times the odds of breastfeeding their baby compared to those women who made their decision either during pregnancy or after labour (AOR = 2.80, 95% CI 1.31, 5.97).

Conclusions

Women with lower levels of education, who consume alcohol during pregnancy, have more than one child, and make infant feeding decision after becoming pregnant, and those born in Vietnam should be targeted when implementing breastfeeding promotion programs. Further, women who deliver by caesarean section require additional breastfeeding support post-delivery and it is important to include fathers in breastfeeding related decisions and encourage them to participate in antenatal programs.

     

Contraceptive practices and fertility among Southeast Asian,black, and white mothers attending a maternal infant care program

Abstract

The purpose of this analysis was to determine if there were differences in selected fertility characteristics including parity, pregnancy spacing, age at first pregnancy, age of menarche, breastfeeding postpartum, and contraceptive practices among white, black, Hmong, and other Southeast Asian mothers attending a maternal infant care program in Minneapolis, Minnesota, during 1980–82.

White and black mothers were younger than the Hmong and other Asian mothers. The lowest mean age of first pregnancy was among blacks. Ages of first pregnancy were similar for whites, Hmong, and other Asians, although the mean age of menarche was approximately two years later for Hmong and other Southeast Asian mothers compared to the white and black mothers.

Based on self reports at the first postpartum visit one month after delivery, 39 per cent of the whites and 25 per cent of the blacks were breastfeeding. In comparison 8.7 per cent of the Hmong and 17 per cent of the other southeast Asian mothers were breastfeeding.

Maternal age and age at first pregnancy were significant predictors of parity for whites, blacks, Hmong, and the other Southeast Asians. Ever‐use of contraception was a significant predictor of parity only for Hmong.

The highest proportion of ever‐users of contraception was among the white mothers (80 per cent) followed by the blacks (69.3 per cent) and other Asian mothers (34.8 per cent). Hmong mothers had the lowest proportion having used contraception (17.1 per cent).     

Relationships between pregnancy spacing,sex of infants,maternal age,and birth order,and neonatal and post‐neonatal mortality in Bangladesh

Abstract

The relationships between length of the interpregnancy interval, outcome of the pregnancy preceding the interval, sex of the infants, pregnancy order, maternal age, and maternal history of previous child deaths and neonatal and postneonatal mortality were explored in a rural Bangladeshi population using a multiple regression analysis. Specific interactions between the interpregnancy interval, outcome of the pregnancy preceding the interval, sex of the infants, and history of previous child deaths were examined. An inverse relationship was observed between postneonatal mortality and the length of the interpregnancy interval when the pregnancy preceding the interval was a surviving infant. No such trend was observed for neonatal mortality. Post‐neonatal mortality rates among children whose mothers had experienced two or more previous child deaths were essentially the same as that for infants whose mothers had experienced 0–1 child deaths when the interpregnancy intervals were more than 24 months. Although female infants have a lower neonatal mortality than male infants, the neonatal mortality rate for female infants conceived less than twelve months following a male infant birth was higher than for a male infant conceived less than twelve months following another male infant birth. Post‐neonatal mortality is consistently higher for female compared to male infants in all interval categories.     

Breastfeeding and the Basal Insulin Requirement in Type 1 Diabetic Women

ObjectiveTo evaluate whether breastfeeding in women with type 1 diabetes mellitus is associated with a decreased insulin requirement.MethodsIn this prospective study conducted between September 2006 and August 2008, type 1 diabetic pregnant women were recruited before the third trimester of pregnancy. Eligible women had no evidence of diabetes-related complications and were treated with continuous subcutaneous insulin infusion pump therapy. During pregnancy and in the first 8 weeks of the postpartum period, participants performed daily fingerstick blood glucose monitoring with at least 12 measurements per day; insulin dosages were adjusted to maintain normoglycemia. Participant characteristics, diabetic parameters, and neonatal growth were compared between women who breastfed exclusively and women who did not breastfeed.ResultsOf 18 women, 12 breastfed and 6 did not. Compared with nonbreastfeeding mothers, breastfeeding mothers showed a decreased need for total daily basal insulin (0.21 ± 0.05 units/kg per day vs 0.33 ± 0.02 units/kg per day). The mean value of total daily basal insulin was significantly lower in the breastfeeding group than in the nonbreastfeeding group. The mean number of hyperglycemic episodes in the first 2 weeks post partum and during the third to eighth weeks was not different between the groups.However, the mean number of hypoglycemic episodes in the first 2 weeks post partum in the breastfeeding group was significantly higher than in the nonbreastfeeding group (11.9 ± 2.6 episodes vs 5.5 ± 1.6 episodes, P < .001). No differences were observed between the groups in neonatal birth weight or infant weight after 8 weeks of age.ConclusionsDecreased need in total daily basal insulin is caused by increased glucose use during lactation. We recommend that the starting total daily basal insulin dosage for type 1 diabetic women who breastfeed be calculated as 0.21 units times the weight in kg per day. This regimen results in normoglycemia and minimizes the risk of severe hypoglycemia associated with lactation. (Endocr Pract. 2009;15:187-193)     

Factors Associated with Maternal Serum Levels of Perfluoroalkyl Substances and Organochlorines: A Descriptive Study of Parous Women in Norway and Sweden

IntroductionPerfluoroalkyl substances (PFASs) and organochlorines (OCs) are ubiquitous and persistent in the environment and proposed endocrine disrupting chemicals (EDCs). They can be transferred across the placenta during pregnancy, and studies suggest that the prenatal period may be particularly sensitive for influences on fetal growth and development. Several studies have investigated socio-demographic and pregnancy related factors associated with maternal serum PFAS and OC levels, but few studies have been conducted in time periods with increasing emissions of PFASs and recent emissions of OCs.MethodsSerum from 424 pregnant women participating in the NICHD Scandinavian Successive Small-for-gestational Age (SGA) births study was collected in 1986–1988, and analyses of two PFASs and six OCs were conducted. Associations between EDCs and geographic, time dependent, socio-demographic and pregnancy related variables were evaluated by using multivariable linear regression models.ResultsPrevious breastfeeding duration, time since last breastfeeding period, sampling date and country of residence were important factors associated with serum levels of PFOS and PFOA. Smoking status and pre-pregnancy BMI were negatively associated with PFOS, and maternal height was borderline negatively associated with PFOS and PFOA. Glomerular filtration rate (GFR) was negatively associated with PFOS in a sub-sample. Maternal serum levels of OCs were positively associated with maternal age, and negatively associated with previous breastfeeding duration and sampling date. Smoking had a consistently negative association with PCB 118 in a dose-dependent manner. Education level, pre-pregnancy BMI and alcohol consumption varied in importance according to the compound under study.ConclusionsSeveral maternal factors, including potentially modifiable factors, markers of pregnancy physiology and factors also related to perinatal outcomes were associated with EDC levels. Results from this study are relevant to populations with still high PFAS and OC levels, i.e. developing countries. Moreover, we can use this knowledge about associated factors on emerging EDCs with similar properties.     

Family networks in prenatal and postnatal health

Abstract

This paper examines the effects of kin access on prenatal health practices, birth outcome, and postnatal health practice for infants born to black and white mothers ages 21 to 28 in the U.S. during 1984–86. The data used for this research were compiled from three sources: (1) The National Longitudinal Survey of Youth; (2) The Children of the National Longitudinal Survey of Youth; (3) special kin access data files, which were created specifically for this study. Logistic regression procedures are used to assess the effects of kin proximity, maternal grandmother proximity, and presence of the child's father on health practices (N = 1,030) and birth outcome (N = 1,385), controlling for the mother's educational attainment, work experience, poverty, presence of the child's father, and birth order of the child. We find no evidence supporting the notion that kin access positively affects the prenatal and postnatal health practices of young mothers. The results suggest that young mothers who reside with their mothers or other adult kin, and those who are in close proximity to them, are no more likely to seek prenatal care during the first trimester, or to avoid smoking or drinking during pregnancy. Mothers who live with a sexual partner or husband are, however, somewhat more likely to seek prenatal care and to avoid alcohol use during pregnancy. Closer kin access is associated with a lower probability of breastfeeding. These results suggest that it will not be adequate to rely on kin networks or kin assistance to improve the prospect of healthy birth outcomes.     

不同喂养方式对婴儿骨密度及维生素A的影响

目的:探讨不同喂养方式对婴儿骨密度、维生素A的影响。方法:选择2015~2016年来我院体检的婴儿120例,根据不同喂养方式的不同分为母乳喂养组、混合喂养组及人工喂养组,比较三组婴儿1、3、6月的身长、头围、体质量、骨密度,6月时的维生素A及6月内的患病率。结果:三组婴儿1、3、6月内身长、体质量及头围对比差异无统计学意义(P0.05);1月、3月时,母乳喂养组与混合喂养组骨密度与明显高于人工喂养组(P0.05);母乳喂养组与人工喂养组对比差异无统计学意义(P0.05);6月时,混合喂养组婴儿的骨密度显著高于人工喂养组和母乳喂养组(P0.05),人工喂养组显著低于母乳喂养组(P0.05)。6月时,母乳喂养组的维生素A明显低于人工喂养组及混合喂养组(P0.05)。母乳喂养组6月内的患病率明显低于混合喂养组及人工喂养组(P0.05)。结论:6个月前不同喂养方式对婴儿的体格发育无明显影响,而6个月左右母乳喂养的婴儿骨密度及维生素A含量均低于混合喂养,母乳喂养可降低婴儿的患病率,6个月内应提倡母乳喂养。     

Dysphoric milk ejection reflex: A case report

Background

Breastfeeding and complementary feeding practices have profound implications for the maternal and child health status of a society. Feeding practices in Pakistan are suboptimal, leading to adverse outcomes on child health. In Pakistan, the Maternal, Neonatal and Child Health (MNCH) Program, in collaboration with several international organizations, including WHO and UNICEF, is working to improve these feeding practices in the country. The aim of this paper is to evaluate the effectiveness of these programs.

Methods

Estimates on the various indicators for infant and young child feeding proposed by WHO were analyzed in light of the Pakistan Demographic and Health Surveys (1990-91 and 2006-07) and several other national studies conducted since 1995.

Results

Nearly half the core and optional indicators have improved over the years, though modestly; the others have demonstrated no statistically significant improvement over the years. Of the five indicators required in the WHO tool for the assessment of infant and young child feeding, introduction of complementary foods, bottle-feeding, and early initiation of breastfeeding, stand in the poor category, while exclusive breastfeeding and duration of breastfeeding fall in the fair category, suggesting an overall poor status.

Conclusions

There is considerable scope to improve breastfeeding and complementary feeding in Pakistan. Further programs should focus on improving the following indicators that have shown no significant development: early initiation of breastfeeding, exclusive breastfeeding under six months, continued breastfeeding at two years, age appropriate feeding, and bottle feeding. Effective implementation of interventions that are known to improve breastfeeding practices is imperative, as is further research to yield data that can lead future endeavors.     

Focus: The Science of Stress: Can Maternal Prenatal Self-Reported and Physiological Distress Predict Postnatal Caregiving Practices?

Maternal prenatal distress is associated with child outcomes, including health, neurocognitive, and socio-emotional development. Knowledge on underlying mechanisms is limited, yet relevant for prevention and intervention. This study investigated whether maternal prenatal distress predicts specific caregiving practices that are known for their effects on child outcomes. Caregiving practices studied were maternal caregiving quality and the initiation and course of breastfeeding and room-sharing. We hypothesized that more maternal prenatal distress would be associated with altered caregiving practices. Participants were 174 healthy mother-child dyads. During the 37^th week of pregnancy maternal self-reported distress was assessed using questionnaires, and physiological stress by collecting saliva cortisol. Maternal caregiving quality was observed in postnatal week 5 during infant bathing. Weekly diaries on breastfeeding and daily diaries on room-sharing were completed during the first 6 postnatal months. In a regression analysis, no associations between maternal prenatal distress and caregiving quality were found. Multilevel analyses indicated that maternal prenatal evening cortisol was positively related to the initiation of breastfeeding and room-sharing. Replications are warranted, but these results suggest that breastfeeding and room-sharing initiation may be part of a mechanism underlying links between maternal prenatal physiological stress and child outcomes. As other prenatal cortisol markers and self-reported distress were not found to be related to the caregiving practices, it is likely that alternative mechanisms (co-)exist in explaining links between maternal prenatal distress and child outcomes. Future replication research including child outcomes and (other) potential mechanisms will inform prevention and intervention programs fostering healthy pregnancies and child development.     

A biobehavioral model for breastfeeding effects on return to menses postpartum in Javanese women

Abstract

This paper examines the effects of nursing behavior on the duration of lactation amenorrhea in 382 rural Indonesian women who experienced resumption of menses while breastfeeding or were breastfeeding and amenorrheic at the end of a two‐year prospective study. Three primary breastfeeding variables (number of night‐time nursing bouts, number of day‐time nursing bouts, and minutes per bout) were used to develop a behavioral model for breastfeeding. Four breastfeeding patterns were identified for these women. These were designated as: (1) low intensity, (2) medium‐low intensity, (3) medium‐high intensity, and (4) high intensity breastfeeding behavior. Menses resumed at medians of 11.2,16.0,17.6, and 20.8 months, respectively, for these groups. The relationships among the breastfeeding variables in the behavioral model and return to menses were developed and tested by life table and proportional hazards models. Ten per cent of the high intensity breastfeeding group (6 women) delayed menses between 33 and 52 weeks, while 90 per cent (56 women) postponed return of menses for over one year.     

Pregnancy,delivery, and breastfeeding after total gastrectomy for gastric cancer: a case report

Background

The reports of pregnancy after total gastrectomy for gastric cancer are rare.

Case presentation

We report a case of a 35-year-old woman, gravida 0, para 0, who became pregnant and delivered a baby 2?years and 6?months after laparoscopic-assisted total gastrectomy for early gastric cancer. Postoperatively, she showed a good progress during the follow-up and was continuously taking oral iron supplement and administered with methylcobalamin intramuscular injection. Two years after gastrectomy, she became pregnant. During the pregnancy, she kept taking iron and vitamin B₁₂ supplementation and had a good course of pregnancy and a normal delivery. However, 2?months after the delivery, liver dysfunction was detected via blood examination. The patient switched from exclusive breastfeeding to combined feeding with formula, and her laboratory results returned to normal. During 10?years of follow-up after the delivery, the patient was in good condition without any recurrence and nutritional deficiencies, and her child had thrived.

Conclusions

Careful monitoring and management of iron and vitamin deficiencies are essential during pregnancy and the lactation periods for patients who previously underwent total gastrectomy. During the lactation period, a combination of formula and breastfeeding provides maternal and fetal nutritional support.

     

Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil

BackgroundThere is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances.Methods and findingsWe conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available.ConclusionsIn this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.

In a study of linked population-based data, Enny Paixao and colleagues study the associations between cesarean section and child mortality among 17.8 million live births in Brazil.     

Caesarean Delivery and Postpartum Maternal Mortality: A Population-Based Case Control Study in Brazil

BackgroundCesarean delivery rates continue to increase worldwide and reached 57% in Brazil in 2014. Although the safety of this surgery has improved in the last decades, this trend is a concern because it carries potential risks to women’s health and may be a modifiable risk factor of maternal mortality. This paper aims to investigate the risk of postpartum maternal death directly associated with cesarean delivery in comparison to vaginal delivery in Brazil.MethodsThis was a population-based case—control study performed in eight Brazilian states. To control for indication bias, deaths due to antenatal morbidity were excluded. We included 73 cases of postpartum maternal deaths from 2009–2012. Controls were selected from the Birth in Brazil Study, a 2011 nationwide survey including 9,221 postpartum women. We examined the association of cesarean section and postpartum maternal death by multivariate logistic regression, adjusting for confounders.ResultsAfter controlling for indication bias and confounders, the risk of postpartum maternal death was almost three-fold higher with cesarean than vaginal delivery (OR 2.87, 95% CI 1.63–5.06), mainly due to deaths from postpartum hemorrhage and complications of anesthesia.ConclusionCesarean delivery is an independent risk factor of postpartum maternal death. Clinicians and patients should consider this fact in balancing the benefits and risks of the procedure.     

Regression analysis of “current status” life tables on duration of breastfeeding in Sri Lanka

Abstract

This paper illustrates the application of conventional regression techniques to the analysis of breastfeeding rates derived from the birth dates of respondents’ recent children and their breastfeeding status at date of interview. Rates of this type have been found to be less biased than rates based on recall of the duration of breastfeeding, but require new analytical approaches to be fully exploited.