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PubMed1997

Longitudinal study of plasma cortisol and 17-hydroxyprogesterone in very-low-birth-weight infants during the first 16 weeks of life.

There are few published data on plasma cortisol and 17-hydroxyprogesterone (17-OHP) in very-low-birth-weight (VLBW) infants beyond the 1st week of life. We therefore measured plasma cortisol and 17-OHP longitudinally in 26 infants (median birth weight 930 g, median gestational age 28 weeks) from 1 to 16 postnatal weeks to document normative values. We also examined the effect of clinical state on plasma cortisol and 17-OHP levels. Median plasma cortisol decreased with postnatal age from 1 to 8 weeks (110 vs. 60 nmol/l; p = 0.0007) and with postconceptional age from 25 to 36 weeks (104 vs. 47 nmol/l; p = 0.002). Median plasma 17-OHP decreased with postnatal age from 1 to 16 weeks (17.0 vs. 7.1 nmol/l; p < 0.0005) and also with postconceptional age from 25 to 42 weeks (21.1 vs. 7.1 nmol/l; p < 0.0005). Plasma cortisol was not influenced by the clinical state. Median plasma 17-OHP was significantly higher for 'unwell' versus 'well' infants at 5-8 weeks postnatal age (23.0 vs. 12.5 nmol/l; p = 0.012) but not at other postnatal age intervals. These data provide information on adrenocortical function in VLBW infants during the first 4 months of life.

17-alpha-Hydroxyprogesterone↗
PubMed2001

Characterization of multiple organ dysfunction syndrome in very low birthweight infants: a new sequential scoring system.

To define multiple organ dysfunction in newborns, we established a sequential scoring system NEOMOD (Neonatal Multiple Organ Dysfunction Score). It was developed to describe the process of increasing physiologic derangement in critically ill newborns. It provides, during the first 28 days of life, information concerning function of organ systems having a primary influence on mortality in very low birth weight (VLBW) infants. Our scoring system has been used in 142 VLBW infants. It evaluates moderate (1 point) or severe dysfunction (2 points) in 7 organ systems (central nervous system, cardiovascular, renal, respiratory, and gastrointestinal systems, and hemocoagulation and acid-base balance) in 24-h intervals from day 1 to 28 of life. Maximum possible value of NEOMOD was 14 points. Receiver operating characteristic curve was used for assessing predictive accuracy of maximum NEOMOD score obtained by daily scoring for mortality rate. AUC (area under curve) attained by NEOMOD was 0.95 for mortality within the first 28 days and 0.91 for hospital mortality, respectively. In the study group, NEOMOD score of > or = 9 was associated with 100% mortality. An analysis of specific organ dysfunctions in the non-survivors group (n = 16) disclosed, in all patients, dysfunction of more than two organ systems 24 h before death. Similar to critically ill adults, secondary multiple organ dysfunction can be described also in a majority of critically ill VLBW infants. NEOMOD scores may help to evaluate daily the severity of the syndrome and risk of death.

Female↗
PubMed2003

Age at first reproduction in philopatric female muriquis ( Brachyteles arachnoides hypoxanthus).

Female northern muriquis ( Brachyteles arachnoides hypoxanthus or B. hypoxanthus) at the Estação Biológica de Caratinga/RPPN-FMA, Minas Gerais, Brazil typically disperse from their natal groups at an average age of 6.1+/-0.6 years (median =6.0 years, range =5.3-7.8 years, n =22), prior to the onset of puberty and sexual activity. Immigrants do not conceive until at least their second mating season, and the minimum interval from immigration to first reproduction has been 2.0 years. Age at first reproduction in dispersing females, previously estimated at 8.9 years, has now been documented at 9.0 and 9.25 years for two females whose birth dates are known. This is older than the 7.5 years at which the only female previously known to have reproduced in her natal group gave birth. Here, we present new data from a second female that reproduced in her natal group. This female (BA) was first observed to copulate at 5.5 years, and gave birth to her first infant at 7.25 years of age. Her 1.75-year cycling-to-first conception delay was only slightly shorter than the minimum recorded for immigrant females, and thus was not responsible for her young age at first reproduction compared to dispersing females. Although our sample size is small, our findings suggest that early puberty may permit females to reproduce in their natal group, implying a possible link between life history trade-offs and dispersal patterns. Because the only two females that have reproduced in their natal group were maternal sisters, it is also possible that maternal effects on age at puberty can impact dispersal patterns, particularly in small populations of primates.

Age Factors↗
PubMed2006

Acid-base balance of umbilical artery blood of liveborn piglets at birth and its relation with factors affecting delivery of individual piglets.

In the limited number of studies that reported on the relation between factors affecting birth of individual piglets and acid-base balance values at birth, predominantly simple correlation coefficients have been used. The aim of the present study was to analyse the relation between factors affecting delivery of individual liveborn piglets and acid-base balance values (pH, PCO(2) , HCO(3)(-) and BE(ecf)) at birth. In total 201 piglets originating from 44 litters were used for the collection of blood samples from the umbilical artery immediately after birth, preferably in the period of apnea. Blood samples were analysed with the iStat Portable Clinical Analyser. Significantly lower pH, HCO(3)(-), BE(ecf) and significantly higher PCO(2) levels were found in posteriorly presented piglets, independently of the condition of the umbilical cord, birth weight and cumulative birth interval/rank. Independently of presentation, birth weight and rank, piglets born with ruptured umbilical cords showed significantly lower pH values. Next to that, increasing birth weights resulted in increasing HCO(3)(-) and BE(ecf) values at birth, independently of presentation, condition of the umbilical cord and cumulative birth interval/rank. Both an increase in cumulative birth interval and in rank was associated with a significant decrease of pH, HCO(3)(-), BE(ecf) and increase of PCO(2) levels in umbilical cord blood at birth. Together these results demonstrate for the first time that a clear relation exists between (factors affecting) the progress of delivery and acid-base balance values in a polytocous species like the pig.

Acid-Base Equilibrium↗
PubMed1985

Acute splenic sequestration in homozygous sickle cell disease: natural history and management.

Of a cohort of 308 children with homozygous sickle cell disease diagnosed at birth, 89 experienced 132 clinically significant attacks of acute splenic sequestration (ASS) over a 10-year period. The age at first attack ranged from 3 months to 6 years. Survival curve analysis of the interval until first attack indicated a cumulative probability of 0.225 by 2 years, and 0.265 by 3 years, and 0.297 by 5 years of age. Thirteen events were fatal, 11 during the first attack, and all before transfusion could be instituted. Recurrences occurred in 49% of survivors of the first attacks, and there were diminishing intervals between subsequent events. Respiratory symptoms were associated with 52 of 132 events, but bacterial isolates on blood culture were less frequent, and ASS was not prevented by pneumococcal vaccine or penicillin prophylaxis. A high fetal hemoglobin level protected against attacks of ASS. A parental education program aimed at early diagnosis of ASS was followed by an increase in the incidence rate for ASS from a mean of 4.6 per 100 patient-years to 11.3 per 100 patient-years, probably reflecting increased awareness of the complication. During the same periods, the fatality rate fell from 29.4 per 100 events to 3.1 per 100 events. The improvement in outcome is likely to have resulted from improvement in medical management and earlier detection of ASS.

Acute Disease↗
PubMed2001

Sex of first child and breast cancer survival in young women.

Two studies have reported that young women with breast cancer face increased risk of early mortality if their first child was male rather than female. An immunological mechanism has been suggested. We sought to confirm these results in a larger, historical cohort study of 223 parous women who were aged <45 years at breast cancer diagnosis during 1983-1987. Subjects were identified through the Maine Cancer Registry. Follow-up data were obtained from hospitals, physicians, and death certificates. Reproductive history data were obtained from the next of kin of the deceased women, birth certificates, physicians, hospitals, and lastly, subjects. With a 7-year follow-up, multivariate modeling found a lower mortality risk in women with a male first child (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32-0.81, log-rank comparison). The survival advantage remained for at least 13 years in women with a male firstborn. Thus, previous studies were not confirmed. Mortality risk in young women with breast cancer is not increased by having borne a male first child rather than a female first child.

Adult↗
PubMed2005

In-hospital formula supplementation of healthy breastfeeding newborns.

The UNICEF/WHO Baby-Friendly Hospital Initiative suggests that breastfeeding activities in hospital are important to later breastfeeding. Understanding reasons for in-hospital supplementation may help to optimize the successful implementation of this initiative. The objective was to identify predictors of in-hospital initial formula supplementation of healthy, breastfeeding newborns. The authors analyzed 564 Canadian mother-infant pairs and interviewed nurses. Half of the study infants (47.9%) received formula in hospital; the median age at first supplementation was 8.4 hours. Risk for supplementation was affected by birth occurring between 7 PM and 9 AM (hazard ratio [HR] varied with time) and high maternal trait anxiety (HR=1.61, 95% confidence interval [CI]=1.01, 2.59). The following variables were protective against supplementation: planning to exclusively breastfeed (HR=0.46, 95% CI=0.33, 0.64), planning to breastfeed for >or=3 months (HR=0.56, 95% CI=0.37-0.86), childbirth education (HR=0.61, 95% CI=0.43, 0.86), mother born in Canada (HR=0.68, 95% CI=0.53, 0.87), completion of community college (HR=0.76, 95% CI=0.59, 0.98), male infant (HR=0.78, 95% CI=0.61, 0.99), and breastfeeding at delivery (HR varied with time). Nurses reported breastfeeding problems, infant behavior, and maternal fatigue as reasons for supplementing. Reassessing patterns of night feeds and encouraging breastfeeding at delivery may decrease supplementation. Trait anxiety reduction and the role of infant gender in supplementation merit further study.

Adult↗
PubMed1987

Effect of 188-day treatment with somatotropin on health and reproductive performance of lactating dairy cows.

Health and reproductive performance were observed in a lactational study involving 188 d of treatment with bovine somatotropin. Treatments commenced 84 +/- 10 d postpartum and consisted of 27 mg/d of pituitary somatotropin and 0, 13.5, 27, and 40.5 mg/d of recombinantly derived somatotropin (six cows per treatment group). Cows were high yielding (greater than 9600 kg/305 d), and somatotropin increased milk yield by 16 to 41% depending on source and dose. Somatotropin had no discernible effect on mammary health based on somatic cell count and incidence of clinical mastitis. Cows receiving somatotropin averaged 96% conception rate, 2.0 services per conception, and 116 d open, which were comparable to controls. No subclinical or clinical evidence of ketosis or milk fever was observed. Thirty-two blood chemistry and physical examination variables were examined at several intervals during the study and no adverse treatment effects of physiologic importance for any of the variables were observed. Somatotropin treatment had no discernible effect on gestation length or birth weight and growth rate (first 28 d) of calves. Milk yields for the first 60 d postpartum were compared for the period just prior to start of treatment and the lactation subsequent to treatment; no treatment effects were observed. Overall, our results for a well-managed herd demonstrate somatotropin treatment did not cause any serious health effects. However, examination of subtle health effects will require large numbers of animals treated under a range of environmental and management conditions.

Animals↗
PubMed1984

Neutron irradiation of late mouse embryos (15-19 days) in utero.

Pregnant female C57B1/6 mice were irradiated with a single whole-body dose of 0.5 Gy neutrons. The F1 hybrid embryos were exposed to the neutrons in utero on Day 17 +/- 2 of gestation. 178/439 (40.6%) of the irradiated fetuses and 26/217 (12%) of the control mice died within 2 weeks after birth. In both irradiated and control mice, most deaths (95 and 77%, respectively) occurred within 3 days of birth: most animals in both groups died on Day 2. There was no significant difference in the number of living young born per litter (7.2) between the neutron-irradiated mothers and their unirradiated controls. The irradiated mice weighed significantly less than their controls. On the first day after birth, body weights of mice irradiated in utero averaged only 85% of control weights. Body weights did not reach control levels until 6 months after birth. Several organs were weighed at regular intervals in both irradiated and control mice. Spleens and thymus glands showed no significant differences between the two groups. The livers and kidneys of the irradiated mice weighed slightly less than their controls. The brain weight of 21-day-old neutron-irradiated mice was 30-35% less than control brains. The weight loss of the brain was not only a relative loss, but also an absolute one, based on brain weight/body weight ratios. Histological analysis of the central nervous system showed pycnotic nuclei, inhibition of mitosis in neuroblasts, and cell death in the irradiated brains. The weight reduction of the brain was not due to water loss. Our hypothesis is that the early mortality after birth is related to the killing of the radiation-sensitive neuroblasts. When newborn mice (1-7 days old) were irradiated in vivo with the same neutron dose of 0.5 Gy, neither the reduction in brain weight nor the early mortality was observed. The early deaths of the neutron-irradiated mouse embryos does not appear to be caused by either the hematological or the gastrointestinal radiation syndrome.

Animals↗
PubMed1999

Birth outcomes of women with celiac disease: a nationwide historical cohort study.

OBJECTIVE: We aimed to examine birthweight, low birthweight (<2500 g), and intrauterine growth retardation in offspring of women with celiac disease in relation to their first hospitalization for the disease. METHODS: This was a historical cohort study based on The Danish Medical Birth Registry data of celiac women discharged from Danish hospitals from 1977-1992. The study included 211 newborns to 127 mothers with celiac disease, and 1260 control deliveries. RESULTS: Before celiac women were first hospitalized the mean birthweight of their newborns was 238 g (95% confidence interval [95% CI] = 150, 325 g) lower than that of the control women, after adjustment for potential confounders. After the first hospitalization the mean birthweight for newborns of diseased women was higher than that of controls, by 67 g (95% CI = -88, 223 g) after adjustment for potential confounders. Before celiac women were first hospitalized we found an increased risk of low birthweight (odds ratio [OR] = 2.6, 95% CI = 1.3-5.5) and intrauterine growth retardation (OR = 3.4, 95% CI = 1.6-7.2). After celiac women were first hospitalized we found no increased risk of low birthweight and no babies with intrauterine growth retardation. CONCLUSIONS: Offspring of mothers with celiac disease had lower birthweight than expected and more than a three-fold higher risk of intrauterine growth retardation when birth occurred before the first hospitalization for the disease. After the mother's first hospitalization the birthweight was similar to controls and no increased risk of low birthweight was seen. Our study indicates that treatment of celiac women is important in the prevention of fetal growth retardation.

Adult↗
PubMed2004

Adult hemoglobin levels at birth and risk of sudden infant death syndrome.

BACKGROUND: During the final weeks of gestation, infants normally begin a transition from the production of fetal to adult hemoglobin. Delayed or faulty transition to the production of adult hemoglobin might play a role in the etiology of sudden infant death syndrome (SIDS). OBJECTIVE: To examine the association between adult hemoglobin levels measured at birth and the subsequent risk of SIDS. DESIGN AND SETTING: Cohort study of all infants born in California between March 1, 1990, and December 31, 1997, who were enrolled in the state's Newborn Screening Program and followed up during the first year of life to identify deaths attributed to SIDS. PARTICIPANTS: Population-based sample of 3.2 million infants. MAIN OUTCOME MEASURE: Risk of death attributed to SIDS. RESULTS: The study included 2425 infants whose deaths were attributed to SIDS. There was an inverse relationship between adult hemoglobin level, expressed as a percentage of total hemoglobin, and the subsequent incidence of SIDS. After adjustment for infant sex, race/ethnicity, length of gestation, maternal age, maternal education, maternal smoking, intrauterine growth restriction, and preeclampsia/eclampsia, the relative risks of SIDS for infants in the lower 4 quintiles of adult hemoglobin level were, in descending order, 1.12 (95% confidence interval [CI], 0.96-1.32), 1.38 (95% CI, 1.19-1.59), 1.55 (95% CI, 1.34-1.80), and 2.15 (95% CI, 1.87-2.47) compared with infants in the highest quintile. CONCLUSIONS: These findings suggest that infants with low levels of adult hemoglobin in the first hours after birth are at elevated risk of SIDS. Delayed maturation in production of adult hemoglobin may play a role in the etiology of some SIDS cases.

California↗
PubMed2004

Perinatal factors and development of islet autoimmunity in early childhood: the diabetes autoimmunity study in the young.

The objective of this study was to test whether maternal age at delivery, child's birth order, cesarean section, complicated delivery, maternal smoking during pregnancy, or neonatal jaundice predict islet autoimmunity in children at genetically increased risk of type 1 diabetes in a birth cohort with blood draws at ages 9, 15, and 24 months and yearly thereafter. Newborns with diabetes-associated human leukocyte antigen genotypes (n = 938) and offspring or siblings of persons with type 1 diabetes (n = 428) from the Denver, Colorado, metropolitan area were examined from January 1994 to February 2003. Information on perinatal factors was collected by using questionnaires soon after the birth. Islet autoimmunity was defined as positivity for > or = 1 autoantibody to glutamic acid decarboxylase65, insulin, or protein tyrosine phosphatase-2/ICA512 at > or = 2 consecutive visits (n = 52; mean follow-up, 3.9 years). Complicated delivery (breech, forceps, vacuum extraction) predicted a higher risk of islet autoimmunity (hazard ratio = 2.10, 95% confidence interval: 1.09, 4.05). Increasing maternal age was related to risk of islet autoimmunity among first-degree relatives of persons with type 1 diabetes (hazard ratios = 3.96 and 8.88 for maternal ages 25-34 and > or = 35 years, respectively, compared with < 25 years; p for trend = 0.008. Other factors evaluated were not related to risk of islet autoimmunity. In conclusion, influences in utero or during delivery may affect the fetal immune system.

Adult↗
PubMed2005

Metamizol (dipyrone, optalgin) in pregnancy, is it safe? A prospective comparative study.

AIM: To assess the teratogenic effect of metamizol when used during the first trimester of pregnancy. METHODS: One hundred and eight women who used metamizol during the first trimester of pregnancy were recruited from 4 teratogen information centers in Israel (3) and in Italy (1). The study group was paired for age, smoking habits and alcohol consumption with a comparative group exposed to acetaminophen. RESULTS: Maternal demographics and history, birth weight, gestational age at delivery, rate of live births, spontaneous abortions and fetal distress were comparable in both groups. The rate of major malformations in the metamizol group (3%) did not differ significantly from the rate in the comparative group (2%) (P = 0.57, relative risk = 1.55, 95% confidence interval 0.26-9.05). CONCLUSIONS: Our data may suggest that exposure to metamizol during the first trimester of pregnancy is probably not associated with a significantly increased risk for malformations or spontaneous abortions.

Abortion, Spontaneous↗
PubMed1993

Siblings' neonatal mortality risks and birth spacing in Bangladesh.

This paper studies the familial association of neonatal mortality in Matlab, Bangladesh and its relationship to birth-spacing effects on mortality. Findings show that familial association is strongest for siblings of adjacent birth orders. Moreover, birth-spacing effects on neonatal mortality are stronger when the preceding child has survived the neonatal period than when it has died. Transitional (Markov), random-effects, and marginal models for correlated data are introduced, and are contrasted in interpretation and technique. Familial association of neonatal mortality can be approximately well by a first-order Markov model using generalized estimating equations (GEE) to allow for higher-order correlation.

Adult↗
PubMed1985

Lead and cadmium in breast milk. Higher levels in urban vs rural mothers during the first 3 months of lactation.

Breast milk from 10 women each from the city of Hamburg and from a rural area was analyzed by atomic absorption spectrometry for contamination with lead and cadmium. Samples were examined at regular intervals for 3 months after birth. On day 5 a diurnal profile was analyzed; on the other days milk was taken before and after the morning feed. Daily permissible intake (DPI) for lead is 5 micrograms/kg/day for children; the DPI for cadmium has as yet been determined only for adults as 400-500 micrograms/week, equivalent to about 1 microgram/kg/day (WHO 1972). For breast milk as the main source of nutrition in infants, this study shows values of 9.1 +/- 2.5 (SD) microgram/l for lead in the rural population, with a tendency to decrease towards the end of lactation. Urban mothers had 13.3 +/- 5.5 (SD) microgram/l, with a tendency to increase. This difference was significant only on day 45. Mean cadmium content in rural mothers was 17.3 +/- 4.9 micrograms/l, with much higher values in the colostrum and a decrease after 15 days. Urban mothers had 24.6 +/- 7.3 micrograms/l, again with high colostrum values and a subsequent decrease. These latter values are not significantly different. Calculated daily intake according to these values is presented, based on 840 ml breast milk for a 5.5 kg infant per day. Rural infants ingested 0.9-1.3 micrograms/kg/day of lead, and in the city 1.5-2.3 micrograms/kg/day. Cadmium intake in rural infants amounted from 1.2-1.8 micrograms/kg/day; in Hamburg it was 1.6-2.2 micrograms/kg/day.(ABSTRACT TRUNCATED AT 250 WORDS)

Cadmium↗
PubMed2004

Feeding practices and growth of infants from birth to 12 months in the central region of the Limpopo Province of South Africa.

OBJECTIVE: We evaluated feeding practices and growth patterns of infants in the central region of the Limpopo Province over the first 12 mo of life. METHODS: A follow-up study on a cohort of term infants born to 276 mothers recruited during their third trimester of pregnancy was undertaken. The mothers were recruited by the nursing staff at nine randomly selected clinics. From this sample, 219 women gave birth at the local hospital and the infants were followed from birth to 12 mo. Data collected included infant feeding practices and anthropometry at regular intervals (1, 3, 6, 9 and 12 mo). The anthropometric measurements taken were body weight, length, and head circumference. RESULTS: At birth 8.8% of infants had a low birth weight, 9.6% were stunted, 48.9% were underweight, and 7.3% were wasted. Mothers in this study breastfed their infants for long periods with more than 80% still breastfeeding by the ninth month. However, exclusive breastfeeding during the first 3 mo was uncommon as mothers tended to introduce supplementary feeds at an early age, with 56% of the infants receiving some form of supplement by the end of the first month. The most common supplementary foods were maize meal porridge and mabella (sorghum). Stunting became increasingly apparent in the early months with 30% of infants being stunted (<-2 standard deviations [SD] of the National Center for Health Statistics [NCHS] reference curves) by the first month, and this percentage remained high for the 12-mo period, remaining at below - 1 SD NCHS height-for-age standard. Increased weight gain was seen during the first 3 mo and then declined until mean weight-for-age at 12 mo was below 0 SD NCHS. Twelve percent of infants were overweight (>2 SD NCHS) by the 12th month. Postnatally the infants showed a pattern of gradual stunting. Postnatal factors associated with this pattern were related to maternal socioeconomic status, and these included the mother's level of education, employment status, parity, and access to electricity. CONCLUSION: There was a high frequency of underweight infants at birth but stunting was less common. With respect to feeding practices, the mothers tended to introduce supplementary feeds at an early age.

Anthropometry↗
PubMed1996

First-trimester Down syndrome screening: free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A.

OBJECTIVE: Our purpose was to determine the feasibility of a first-trimester Down syndrome screening protocol including free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A. STUDY DESIGN: First-trimester maternal blood samples from 22 Down syndrome and 483 control cases were assayed for free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A by enzyme-linked immunosorbent assay procedures. False-positive and detection rates were determined on the basis of Down syndrome risks calculated from the levels of biochemical markers and maternal age. Because 11 of the 22 Down syndrome cases were from older pregnancies (> or = 35 years old), rates were recalculated with the United States age distribution of live births to get a more representative estimate of false positives and detection efficiency. RESULTS: The median free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A levels in cases of Down syndrome was 2.09 (95% confidence interval 1.69 to 2.62) and 0.405 multiples of the median (95% confidence interval 0.28 to 0.67), respectively. At a 5.0% false-positive rate, 15 (68.2%) Down syndrome cases were detected. By the use of the age distribution of live births, 63% of cases could be expected to be detected at a 5.0% false-positive rate. CONCLUSION: First-trimester free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A screening for Down syndrome can achieve detection rates as high as those associated with alpha-fetoprotein and human chorionic gonadotropin or alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol screening in the second trimester. Prospective studies are needed to further assess first-trimester screening.

Biomarkers↗
PubMedDate not supplied

Longitudinal study of the frequency and duration of breastfeeding in rural Bangladeshi women.

A 27-month longitudinal study of 140 Bangladeshi mothers living in three tea gardens examined the effect of maternal factors (mother's age, number of live births, birth interval, and mother's work status) and sex of the infant on the duration and bout frequency of breastfeeding over 8-hr daytime periods. Prolonged breastfeeding of the infant was observed, but there was a sharp decline in duration of breastfeeding over the first 6 months, followed by a more gradual diminution thereafter. The feeding bouts showed a different pattern, with a more gradual decline over time. Housewives consistently showed a greater duration and bout frequency than women in paid employment as tea-pluckers. Over the first 6 months, primigravid mothers breastfed more frequently, but not thereafter. Older mothers (>35 years of age) breastfed with higher frequency during the first 2 months, but thereafter, the bout frequency decreased with increasing age of the infant. Over the 27-month study, maternal work status was the main factor associated with the duration and frequency of breastfeeding, with significantly higher frequency and duration among housewives. However, in the first 6 months after birth, there was very little difference in frequency or duration of breastfeeding between tea-workers and housewives, indicating that working mothers probably adjusted their time to breastfeed their infants before going, or after coming back, from work.

Adult↗