Browsing by Author "Scime, Natalie V."

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    Association of lifetime lactation and characteristics of menopause: a longitudinal cohort study
    (2024-11-11) Scime, Natalie V.; Huang, Beili; Brockway, Meredith M.; Brown, Hilary K.; Brennand, Erin A.
    Abstract Background Lactation has many established benefits for women’s long-term health; however, its influence on menopause is less clear. This study investigated the association between lifetime duration of lactation and the timing and type of menopause in midlife women. Methods We analyzed survey data on 19,783 parous women aged 40 to 65 years at enrollment in the Alberta’s Tomorrow Project (2000–2022), a prospective community-based cohort study in Alberta, Canada. Duration of lifetime lactation across all births was categorized as: <1 month (reference group; 19.8% of women), 1–3 months (12.1%), 4–6 months (11.7%), 7–12 months (18.8%), and ≥ 13 months (37.7%). Women were classified as premenopause, natural menopause (age at 1 year after the final menstrual period), surgical menopause (age at bilateral oophorectomy), or indeterminate menopause (age at premenopausal hysterectomy with ovarian preservation). Flexible parametric survival analysis and multinomial logistic regression were used to analyze menopause timing and type, respectively, according to lactation status and controlling for birth year, education, parity, hormonal contraceptive use, and smoking. Results In a dose-response manner, longer lactation was associated with reduced risk of natural menopause before age 50 (for ≥ 13 months of lactation, adjusted hazard ratio at age 45: 0.68, 95% CI 0.59–0.78), surgical menopause before age 55 (age 45: 0.56, 0.50–0.63), and indeterminate menopause before age 50 (age 45: 0.75, 0.69–0.82). Longer lactation was associated with lower odds of surgical (adjusted odds ratio 0.54, 95% CI 0.45–0.66) and indeterminate menopause (0.63, 0.55–0.73), compared to natural menopause. Conclusions Optimizing the timing of natural menopause and reducing risks of early surgical and indeterminate menopause may be novel maternal benefits of breastfeeding.
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    Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort
    (2021-09-15) Scime, Natalie V.; Metcalfe, Amy; Nettel-Aguirre, Alberto; Tough, Suzanne C.; Chaput, Kathleen H.
    Abstract Background Prenatal medical risk describes physical health issues or biological factors that predate or arise during pregnancy which heighten the risk of adverse outcomes, and often warrant specialized obstetric care. The influence of the nature and magnitude of prenatal risk on breastfeeding outcomes remains poorly understood. The objective of this study was to determine the association between prenatal medical risk and breastfeeding initiation and duration up to 1 year postpartum. Methods We analysed a subset of data from the All Our Families longitudinal cohort (n = 2706) of women in Calgary, Canada who delivered a liveborn infant between 2008 and 2010. Data were collected from self-report questionnaires and medical records. Women with complete data on prenatal medical risk factors and breastfeeding outcomes were included in this analysis. Prenatal medical risk was operationalized as one integer score of risk severity and four binary risk types capturing pre-pregnancy characteristics, past obstetric problems, current obstetric problems, and substance use. Outcomes were breastfeeding initiation defined as the infant ever receiving breast milk, and duration operationalized as still breastfeeding at 4 months, at 12 months, and time to breastfeeding cessation in weeks. We used logistic regression and Cox regression with right censoring at 52 weeks or attrition to calculate odds ratios (OR) and hazard ratios (HR), respectively, adjusting for sociodemographic vulnerability, parity, mode of delivery, and gestational age. Results Prenatal medical risk severity and type were not significantly associated with breastfeeding initiation, with the exception of pre-pregnancy risk type (OR 0.45; 95% CI 0.26, 0.77). Risk severity was associated with lower odds of breastfeeding to 4 months (OR 0.94; 95% CI 0.90, 0.99), 12 months (OR 0.93; 95% CI 0.87, 0.98), and earlier breastfeeding cessation (HR 1.05; 95% CI 1.02, 1.08). Associations with shorter breastfeeding length across the first postpartum year were observed for pre-pregnancy, current obstetric, and substance use risk types, but not past obstetric problems. Conclusion Prenatal medical risk is associated with shortened duration of breastfeeding. Women with prenatal medical risk may benefit from the proactive arrangement of lactation support before and following delivery to promote continued breastfeeding.
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    Breastfeeding difficulties in the first 6 weeks postpartum among mothers with chronic conditions: a latent class analysis
    (2023-02-02) Scime, Natalie V.; Metcalfe, Amy; Nettel-Aguirre, Alberto; Nerenberg, Kara; Seow, Cynthia H.; Tough, Suzanne C.; Chaput, Kathleen H.
    Abstract Background Breastfeeding difficulties frequently exacerbate one another and are common reasons for curtailed breastfeeding. Women with chronic conditions are at high risk of early breastfeeding cessation, yet limited evidence exists on the breastfeeding difficulties that co-occur in these mothers. The objective of this study was to explore clusters of breastfeeding difficulties experienced up to 6 weeks postpartum among mothers with chronic conditions and to examine associations between chronic condition types and breastfeeding difficulty clusters. Methods We analyzed 348 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study from Alberta, Canada. Data were collected through self-report questionnaires. We used latent class analysis to identify clusters of early breastfeeding difficulties and multinomial logistic regression to examine whether types of chronic conditions were associated with these clusters, adjusting for maternal and obstetric factors. Results We identified three clusters of breastfeeding difficulties. The “physiologically expected” cluster (51.1% of women) was characterized by leaking breasts and engorgement (reference outcome group); the “low milk production” cluster (15.4%) was discerned by low milk supply and infant weight concerns; and the “ineffective latch” cluster (33.5%) involved latch problems, sore nipples, and difficulty with positioning. Endocrine (adjusted relative risk ratio [RRR] 2.34, 95% CI 1.10–5.00), cardiovascular (adjusted RRR 2.75, 95% CI 1.01–7.81), and gastrointestinal (adjusted RRR 2.51, 95% CI 1.11–5.69) conditions were associated with the low milk production cluster, and gastrointestinal (adjusted RRR 2.44, 95% CI 1.25–4.77) conditions were additionally associated with the ineffective latch cluster. Conclusion Half of women with chronic conditions experienced clusters of breastfeeding difficulties corresponding either to low milk production or to ineffective latch in the first 6 weeks postpartum. Associations with chronic condition types suggest that connections between lactation physiology and disease pathophysiology should be considered when providing breastfeeding support.
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    Breastfeeding intentions, difficulties, and outcomes in mothers with chronic physical health conditions: the Motherhood and Chronic Illness (MaCI) prospective cohort study
    (2022-07-11) Scime, Natalie V.; Chaput, Kathleen H; Tough, Suzanne C; Metcalfe, Amy; Nettel-Aguirre, Alberto
    Breastfeeding from birth to 6 months has numerous benefits for maternal and child health. Mothers with chronic conditions are at risk for suboptimal breastfeeding outcomes, yet the underlying reasons for this are poorly understood. This thesis research investigated the factors associated with breastfeeding intentions, difficulties, and outcomes in mothers with chronic conditions. We conducted a prospective, community-based pregnancy cohort study called the Motherhood and Chronic Illness (MaCI) Study following 405 women from Alberta who reported living with a long-term physical health condition, carrying a singleton pregnancy, and intending to try breastfeeding. Women completed questionnaires at 32 weeks gestation, 6 weeks postpartum, and 6 months postpartum (overall response rate, 86.7%). In the prenatal period, we found that women who perceived their chronic condition to worsen during pregnancy were less likely to plan to exclusively breastfeed to 6 months per the global recommendation (adjusted odds ratio [OR] 0.50, 95% CI 0.30–0.82). From birth to 6 weeks postpartum, we identified three clusters of breastfeeding difficulties corresponding to physiologically expected lactation changes (51.1% of women), low milk production (15.4%), and ineffective latch (33.5%). Mothers with endocrine (adjusted relative risk ratio [RRR] 2.41, 95% CI 1.13–5.13), cardiovascular (adjusted RRR 2.87, 95% CI 1.02–8.09), and gastrointestinal (adjusted RRR 2.57, 95% CI 1.13–5.82) conditions were more likely to belong to the low milk production cluster and mothers with gastrointestinal (adjusted RRR 2.47, 95% CI 1.27–4.81) conditions were more likely to belong to the ineffective latch cluster, relative to the physiologically expected cluster. By 6 months postpartum, we found that one third (31.2%) of mothers had stopped breastfeeding, nearly all of whom did so earlier than planned. Compared to mothers who adhered to their pre-existing medications, mothers who did not adhere to pre-existing medications had shorter breastfeeding duration (adjusted hazard ratio [HR] 1.69, 95% CI 1.04–2.74) and greater odds of earlier than planned breastfeeding cessation (adjusted OR 1.85, 1.01–3.41). The MaCI Study highlighted three unique determinants of breastfeeding in mothers with chronic conditions, which can be addressed through person-centred support that jointly considers the ways in which breastfeeding patterns influence, and are influenced by, chronic condition status and management.