HIV-infected mothers in sub-Saharan Africa who breastfeed exclusively for more than the first 4 months of life have lower levels of the virus in their breastmilk than HIV-infected mothers who stopped breastfeeding exclusively or completely before 4 months, according to researchers from Columbia University's Mailman School of Public Health. Women who discontinued breastfeeding before 4 months had the highest levels of HIV in their breastmilk, while women who breastfed and gave their infants formula had virus levels somewhere in between.
Generally, the chance of HIV-positive mothers transmitting the virus to their babies through breastmilk is about 10% to 15%, but in the context where infectious diseases are widespread, such as sub-Saharan Africa, breastfeeding is crucial to infant health.
Louise Kuhn, PhD, professor of epidemiology at the Mailman School of Public Health, and her colleagues conducted a randomized clinical trial to investigate the effectiveness of early weaning in reducing HIV transmission and infant mortality. More than 950 HIV-infected women in Zambia were enrolled in the study and advised to breastfeed their babies from birth until at least 4 months of life. At 4 months, half the women were advised to wean (stop breastfeeding completely), and the other half was advised to continue breastfeeding. Infants were tested regularly for HIV throughout the study. Breastmilk was collected from the mothers at 4 and a half months.
Mothers who breastfed, but not exclusively, had higher levels of HIV in their breastmilk than did mothers who breastfed exclusively, and those who stopped breastfeeding completely at 4 months had the highest concentrations of HIV in their breastmilk. Dr. Kuhn and her colleagues conclude that their results “have profound implications for prevention of mother-to-child HIV transmission programs in settings where breastfeeding is necessary to protect infant and maternal health.” In contrast with some other studies on this issue, Dr. Kuhn states that, “Our data demonstrate that early and abrupt weaning carries significant risks for infants.” (Adapted from Medical Express; http://medicalxpress.com; April 27, 2013).
U.S. infant mortality rate decreases are associated with declines for non-Hispanic blacks, several southern states, and four of the five leading causes of infant death. The U.S. infant mortality rate fell 12% from 2005 to 2011 according to a new report from the Center for Disease Control and Prevention's National Centers for Health Statistics (MacDorman MF, Hoyert DL, Mathews TJ. Recent declines in infant mortality in the United States, 2005-2011. NCHS data brief, no 120. Hyattsville, MD: National Center for Health Statistics, 2013.). The decline in the infant mortality rate of decline was steady during the study period, which was a welcome change from the stagnant rate observed from 2000 to 2005. The rate dropped from 6.87 infant deaths per 1,000 live births in 2005 to 6.05 per 1,000 in 2011 (based on preliminary 2011 data).
Infant mortality rates declined most rapidly, by 16%, for non-Hispanic black women, and least rapidly for Hispanic women (9%). Non-Hispanic white women had a rate of decline similar to the national rate of decline (12%). This is a notable change in that, historically, the rate among non-Hispanic black women has been more than twice that of white women; Hispanic women have had rates similar to those of white women.
Geographic differences were observed in that infant mortality declined most rapidly for selected southern states, which have historically had the highest rates of infant mortality in the United States. Four southern states (Georgia, Louisiana, North Carolina, and South Carolina), which have typically had among the highest infant mortality rates in the United States, experienced declines of at least 20% in their infant mortality rates from 2005 to 2011. No states had a statistically significant increase in infant mortality during the study period. Despite large declines in infant mortality rates in several southern states, rates were highest among selected states in the southern and midwestern regions of the United States.
Infant mortality rates declined for four of the five leading causes of infant death in the United States from 2005 through 2011. Declines were observed for infant deaths due to short gestation/low birth weight (−9%), maternal complications (−7%), and congenital malformations (−6%). A decline of 20% was observed for infant deaths due to SIDS (Sudden Infant Death Syndrome); however, the authors caution that this decline may be partly due to changes in the way SIDS is now diagnosed and reported. Despite all of these declines, in comparing U.S. 2011 infant mortality rates to international rates in 2008, the U.S. would retain its rank of 27th globally.
Most rape victims in Mexico have no guarantee they will be given either emergency contraception or an option to terminate a rape-related pregnancy. A report from Grupo de Información en Reproducción Elegida (GIRE [Information Group on Reproductive Choice], April 9, 2013), a women's reproductive rights group, reveals that although Mexico's public health care facilities are required to offer women emergency contraception within 120 hours of rape, only 15 of 32 states in Mexico offer it. Furthermore, although abortion is legal in Mexico in cases of rape, most of the state attorneys general do not issue the required authorizations for such post-rape abortions; in the past 5 years, only 39 authorizations were issued throughout Mexico. As a result, many women seek illegal abortions, subjecting themselves to health- and life-threatening risks. In 2009, it is estimated that 1.02 million illegal abortions were performed in Mexico, corresponding to one of the highest rates in the world—38 of every 1,000 Mexican women aged 15–44 years. In addition, access to reproductive health in Mexico is restricted among indigenous women. While about 73% of Mexican women have contraception coverage, it decreases to 61% for women with low levels of formal education and to just 58% among Indian women.
U.S. Surgeon General announces the launch of a new initiative, It's Only Natural, to raise awareness among African American women of the importance and benefits of breastfeeding and to provide helpful tips (News release, http://www.hhs.gov/news/press/2013pres/04/20130415a.html, April 15, 2013). As part of the launch, Surgeon General Regina Benjamin spoke of breastfeeding as being one of the most highly effective preventive measures a mother can undertake to protect the health of her infant and herself, and went on to explain the multiple levels of influence on a mother's ability to breastfeed. She said, “By raising awareness [of the importance of breastfeeding], the success rate among mothers who want to breastfeed can be greatly improved through active support from their families, their friends, and the community.” The initiative is designed to provide new mothers with emotional support from peers and with practical information about breastfeeding that enables them to make it feasible in their own lives. All educational materials are tailored specifically for African American women, and includes video testimonials with tips about breastfeeding and overcoming challenges; articles on various breastfeeding-related topics, such as legal rights to breastfeeding in public; fact sheets about latching and holding techniques, managing breastfeeding-related pain, and how to know babies receive enough breastmilk; and radio public service announcements. Information about It's Only Natural is available at www.womenshealth.gov/ItsOnlyNatural.
China reports additional cases of new avian influenza. As of May 8, 2013, China reported a total of 131 cases of human infection with the new avian influenza A (H7N9) virus, 32 of which have resulted in death. Case counts have fallen off since April, and both China and the World Health Organization (WHO) have moved to weekly (rather than daily) reporting of H7N9 cases. While there are no reported cases of H7N9 anywhere outside of China, the U.S. Department of Health and Human Services and its partners are taking routine preparedness precautions, including beginning to develop H7N9 candidate vaccine viruses and are preparing for H7N9 vaccine clinical trials.
Chinese National authorities first reported human infections with H749 to WHO on March 31, 2013. In China, some of the infected people have experienced mild illness, but most individuals who have been infected so far have experienced severe illness. The H7N9 virus considered to be a “novel” influenza virus with pandemic potential. After the first human infections with H7N9 were identified, Chinese authorities found H7N9 viruses in poultry in the same area where human infections have occurred. They are still assessing the extent of the avian outbreak in poultry. Among the individuals infected with H7N9, many are reported to have had contact with poultry; however, some cases reportedly have not had such contact. Chinese public health officials are conducting follow-up investigations among close contacts of people infected with H7N9 to try to assess whether evidence of human-to-human spread of the virus exists. Thus far, the investigations suggest no sustained (ongoing) person-to-person spread of the virus, but small family clusters have occurred where human-to-human transmission cannot be ruled out.
Human infections with avian influenza viruses are rare and most often occur after people are in contact with an infected bird. However, non-sustained person-to-person spread of other avian influenza viruses is thought to have occurred in the past. Based on this previous experience, it's likely that some limited human-to-human spread of this H7N9 virus will be detected, but the extent to which it may occur is not yet known. The U.S. Centers for Disease Control and Prevention provides information about the H749 virus at www.cdc.gov/flu/avianflu/h7n9-virus.htm.
Canadian study finds that women who have gestational diabetes and preeclampsia during pregnancy have an increased risk of developing diabetes later. The study was conducted by researchers including Dr. Denice Feig, associate professor of medicine and obstetrics and gynecology at the University of Toronto Department of Medicine in Canada (Feig DS, Shah BR, Lipscombe LL, Wu CF, Ray JG, Lowe J, Hwee J, Booth GL. Preeclampsia as a risk factor for diabetes: a population-based cohort study. PLoS Med 2013;10(4): e1001425.). Feig and her colleagues examined associations between certain complications of pregnancy and later development of diabetes using data on more than 1 million women aged 15 to 50 years who gave birth in Ontario, Canada, between April 1994 and March 2008. Feig identified women who had only preeclampsia (n = 22,933), only gestational hypertension (n = 27,605), only gestational diabetes (n = 30,852), both gestational diabetes and gestational hypertension (n = 2,100), and both gestational diabetes and preeclampsia (n = 1,476). The researchers used records from the Ontario Diabetes Database to determine whether these women went on to develop diabetes any time from 180 days post-delivery until March 2011. They found that 3.5% of the women developed diabetes during the follow-up period. Analyses revealed that women who experienced gestational diabetes plus either preeclampsia or gestational hypertension had a 20- to 21-fold increased rate of developing diabetes compared to women without gestational diabetes, gestational hypertension, or preeclampsia. Using the same comparison groups, women who had gestational diabetes alone experienced a 15-fold increased rate of developing diabetes. After adjusting for age, income, pre-pregnancy hypertension, and comorbidity, risks were slightly reduced but similar. The researchers were limited by a lack of data regarding obesity and body mass index, both of which are associated with an increased risk of developing diabetes. Their findings, however, still highlight new possible risk factors for diabetes, and strongly suggest that clinicians caring for women of reproductive age should be aware of the need for preventive measures and should ensure that women are screened for diabetes before, during, and after pregnancy.