Clare L Taylor1,2, Hilary K Brown1,2,3,4,5, Natasha R Saunders6,2,4,7, Lucy C Barker1,2,4,5, Simon Chen2, Eyal Cohen6,2,4,7, Cindy-Lee Dennis8,5,9, Joel G Ray8,6,2,4,10, Simone N Vigod1,2,5. 1. Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. 2. ICES, Toronto, ON, Canada. 3. Department of Health & Society, University of Toronto, Scarborough, Toronto, ON, Canada. 4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 5. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 6. The Hospital for Sick Children, Toronto, ON, Canada. 7. Department of Paediatrics, University of Toronto, Toronto, ON, Canada. 8. St Michael's Hospital, Toronto, ON, Canada. 9. Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. 10. Department of Medicine, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: The World Health Organization recommends mothers and infants be in direct skin-to-skin contact immediately after birth and initiate breastfeeding as soon as possible. Little is known in women with schizophrenia. METHODS: We conducted a population-based cohort study using administrative health data from Ontario, Canada (2012-2014), comparing women with (n = 471) and without schizophrenia (n = 218 435), and their infants, on the primary outcomes of any skin-to-skin contact and opportunity to initiate breastfeeding within the first 2 h after birth. For dyads with available data, secondary outcomes of intention to breastfeed, breastfeeding support, any breastmilk, and exclusive breastmilk at discharge were assessed. Modified Poisson regression was used to generate relative risks (aRR) and 95% confidence intervals (CI), adjusted for maternal age, parity, neighbourhood income, region of residence, smoking in pregnancy, and maternal medical and non-psychotic psychiatric comorbidity for all outcomes. RESULTS: Maternal schizophrenia was associated with lower likelihood of skin-to-skin contact (65.2% vs 78.1%; aRR 0.88, 95% CI: 0.82-0.94), and breastfeeding initiation post-delivery (38.9% vs 52.6% aRR 0.80, CI: 0.71-0.90) compared to dyads unexposed to maternal schizophrenia. Secondary outcomes followed a similar pattern. The magnitude of the effect was slightly less when restricting the cohort to full-term, vaginal deliveries, not admitted to NICU, and infant not discharged to social services. CONCLUSIONS: Reduced maternal-infant skin-to-skin contact and breastfeeding initiation immediately after birth may significantly impact maternal-child bonding and the establishment breastfeeding in this population. Mothers with schizophrenia may require individualized support to promote these WHO recommended hospital practices in the early post-natal period.
BACKGROUND: The World Health Organization recommends mothers and infants be in direct skin-to-skin contact immediately after birth and initiate breastfeeding as soon as possible. Little is known in women with schizophrenia. METHODS: We conducted a population-based cohort study using administrative health data from Ontario, Canada (2012-2014), comparing women with (n = 471) and without schizophrenia (n = 218 435), and their infants, on the primary outcomes of any skin-to-skin contact and opportunity to initiate breastfeeding within the first 2 h after birth. For dyads with available data, secondary outcomes of intention to breastfeed, breastfeeding support, any breastmilk, and exclusive breastmilk at discharge were assessed. Modified Poisson regression was used to generate relative risks (aRR) and 95% confidence intervals (CI), adjusted for maternal age, parity, neighbourhood income, region of residence, smoking in pregnancy, and maternal medical and non-psychotic psychiatric comorbidity for all outcomes. RESULTS: Maternal schizophrenia was associated with lower likelihood of skin-to-skin contact (65.2% vs 78.1%; aRR 0.88, 95% CI: 0.82-0.94), and breastfeeding initiation post-delivery (38.9% vs 52.6% aRR 0.80, CI: 0.71-0.90) compared to dyads unexposed to maternal schizophrenia. Secondary outcomes followed a similar pattern. The magnitude of the effect was slightly less when restricting the cohort to full-term, vaginal deliveries, not admitted to NICU, and infant not discharged to social services. CONCLUSIONS: Reduced maternal-infant skin-to-skin contact and breastfeeding initiation immediately after birth may significantly impact maternal-child bonding and the establishment breastfeeding in this population. Mothers with schizophrenia may require individualized support to promote these WHO recommended hospital practices in the early post-natal period.
Authors: Cesar G Victora; Rajiv Bahl; Aluísio J D Barros; Giovanny V A França; Susan Horton; Julia Krasevec; Simon Murch; Mari Jeeva Sankar; Neff Walker; Nigel C Rollins Journal: Lancet Date: 2016-01-30 Impact factor: 79.321
Authors: Nigel C Rollins; Nita Bhandari; Nemat Hajeebhoy; Susan Horton; Chessa K Lutter; Jose C Martines; Ellen G Piwoz; Linda M Richter; Cesar G Victora Journal: Lancet Date: 2016-01-30 Impact factor: 202.731