In this paper robustness properties of the maximum likelihood estimator (MLE) and several robust estimators for the logistic regression model when the responses are binary are analysed. It is found that the MLE and the classical Rao's score test can be misleading in the presence of model misspecification which in the context of logistic regression means either misclassification's errors in the responses, or extreme data points in the design space. A general framework for robust estimation and testing is presented and a robust estimator as well as a robust testing procedure are presented. It is shown that they are less influenced by model misspecifications than their classical counterparts. They are finally applied to the analysis of binary data from a study on breastfeeding.

Infant sleep quality is increasingly regarded as an important factor for children long-term functioning and adaptation. The early roots of sleep disturbances are still poorly understood and likely involve a complex interplay between prenatal and postnatal factors. This study investigated whether exclusive breastfeeding during the first 6 months moderated the association between maternal prenatal pandemic-related stress (PRS) and sleep problems in 24-months children born during the COVID-19 pandemic. We also explored the potential contribution of maternal postnatal anxiety in these relations. Seventy-eight infants (50% males) and their mothers provided complete data from birth to 24 months. Between 12 and 48 h from birth, maternal PRS during pregnancy was retrospectively reported as well as maternal anxiety and exclusive breastfeeding. Maternal anxiety and exclusive breastfeeding were also reported at 3 and 6 months after childbirth. Children sleep disturbances were reported at 24 months. Bayesian analyses revealed that maternal PRS was positively associated with sleep problems in children who were not exclusively breastfed from birth to 6 months. Findings add to the growing literature on the lasting impact of early pre- and postnatal experiences on child well-being and development.

The practice of antenatal colostrum expression (ACE), or the extraction of colostrum from the breasts during pregnancy, has an interesting history and continues to evolve. This narrative review aims to describe how perception and practices of ACE have changed over time, summarise the evidence on ACE in maternal and infant care, and highlight areas for future research. The literature demonstrates that ACE is safe for low-risk women when done from around 36 weeks’ gestation. Women should be reassured that the skill of hand expressing is a valuable tool post-birth, regardless of whether they are able to collect colostrum antenatally or not. The collection and storage of colostrum in pregnancy can help avoid formula use in hospital, which may have follow on effects immune function and other areas. Ideally, colostrum collected during pregnancy would be kept safely frozen during the hospital stay and only defrosted and used during the stay if medically indicated, with parents supported through that process. Although ACE does not appear to improve long-term breastfeeding rates at present, it can increase confidence around breastfeeding. Further research in more diverse population groups, long-term breastfeeding and long-term health outcomes of using frozen antenatally expressed colostrum for babies (as compared to formula or fresh colostrum) would be valuable to gain a better understanding of the importance of ACE in maternity care.

Folate and vitamin B12 (cobalamin) are essential for growth and development. This cross-sectional study aims to describe folate and vitamin B12 status according to infant age and breastfeeding practices in Norwegian infants. Infants aged 0–12 months (n = 125) were recruited through public health clinics. We registered breastfeeding status and measured serum concentrations of folate, cobalamin, total homocysteine (tHcy), and methylmalonic acid (MMA). The associations between infant age, breastfeeding, and biomarker concentrations were estimated in regression models. The mean (SD) age was 24 (16) weeks, and 42% were exclusively breastfed, 38% were partially breastfed, and 21% were weaned. Overall, median (IQR) folate, cobalamin, tHcy, and MMA concentrations were 47 (35–66) nmol/L, 250 (178–368) pmol/L, 6.99 (5.69–9.27) µmol/L, and 0.35 (0.24–0.83) µmol/L, respectively. None of the infants were folate deficient, 15% were vitamin B12 deficient (< 148 pmol/L), and 23% had low vitamin B12 status (148–221 pmol/L). Elevated tHcy (> 6.5 μmol/L) and MMA (> 0.26 μmol/L) were found in 62% and 69% of the infants, respectively. Compared to weaned, exclusively or partially breastfed infants were younger and had 46% higher tHcy concentrations (P < 0.001), in addition to 47% and 39% lower cobalamin concentrations (P < 0.001), respectively. However, the observed biomarker concentrations appeared to be independent of infant age. In conclusion, low vitamin B12 status was prevalent and appeared to be more common in the younger exclusively breastfed compared to older weaned infants. The implications of low vitamin B12 status in infancy are unknown and require further investigation.

Breastfeeding represents a strong selective factor for shaping the infant gut microbiota. Besides providing nutritional requirements for the infant, human milk is a key source of oligosaccharides, human milk oligosaccharides (HMOs), and diverse microbes in early life. This study aimed to evaluate the influence of human milk microbiota and oligosaccharides on the composition of infant faecal microbiota at one, three, and nine months postpartum. We profiled milk microbiota, HMOs, and infant faecal microbiota from 23 mother–infant pairs at these time points. The predominant genera in milk samples were Streptococcus, Staphylococcus, and an unclassified Enterobacteriaceae genus-level taxon (Enterobacteriaceae uncl.), whereas the infant faecal microbiota was predominated by Bifidobacterium, Bacteroides, and Enterobacteriaceae uncl. Mother–infant dyads frequently shared bacterial amplicon sequence variants (ASVs) belonging to the genera Bifidobacterium, Streptococcus, Enterobacteriaceae uncl., Veillonella, Bacteroides, and Haemophilus. The individual HMO concentrations in the milk showed either no change or decreased over the lactation period, except for 3-fucosyllactose (3-FL), which increased. Neither maternal secretor status nor HMO concentrations were significantly associated with microbiota composition at the different ages or the bacterial ASVs of maternal milk and infant faeces. This study suggests an age-dependent role of milk microbes in shaping the gut microbiota, while variations in HMO concentrations show limited influence.

Breastfeeding is vital to infants’ health and development during their first year. The quality and quantity of breastmilk are closely linked to the mother’s nutrition [1]. However, for migrant women who become new mothers, various social, economic, and family factors can pose challenges that negatively affect their dietary and breastfeeding practices. Due to the limited research evidence, this study aimed to investigate the factors associated with breastfeeding duration in migrant women. The study sample was drawn from the Filipino Women’s Diet and Health Study (FiLWHEL). These women migrated to South Korea through marriage. At baseline (2014-2016), 504 women provided survey data, including demographic characteristics such as age, marital status, education, employment, income, and language proficiency. Anthropometric measures such as body mass index (BMI) and lifestyle factors were also recorded. Dietary intake of each food group was assessed using 24-hour recalls. We derived the Minimum Dietary Diversity for Women (MDD-W) from the ten food groups [2]. Breastfeeding (any) duration was defined as the average length in months per child. Multivariable logistic regression was used to evaluate the associations between participants’ characteristics and breastfeeding duration, with a cut-off of 12 months (<12 months; > = 12 months). Linear regression analysis was used to assess the relationship between each of these factors and breastfeeding duration in months. Out of the initial 504 women, 271 met the eligibility criteria, with the median age of 35 [interquartile range (IQR): 30,40] years, median breastfeeding duration of 4 [IQR: 1, 10] months, mean BMI of 23.8kg/m2, median (IQR) o fruits, vegetables, and legumes of 162.2 [76.9, 265.9] grams/day, and median of MDD-W score of 5 [IQR:4, 6]. Over 50% of the sample held a university degree or higher, but only 47.8% were employed. Most women were married (90%) and earned less than 20 million won (~AU$23,114.58) per year (65%). Over half had a good understanding of the Korean language. The cross-sectional regression analysis found no associations for breastfeeding length, except for the total fruit, vegetable, and legume intake. Women in the highest tertile of this consumption had a two-fold likelihood of breastfeeding for 12 months or longer [adj.OR (95% CI): 2.15 (0.99-4.68)]. While the MDD-W score had a positive association with breastfeeding for at least 12 months, it did not reach statistical significance [adj.OR: 1.11 (0.92-1.34)]. In the linear regression analysis, only vegetable consumption (per gram increase) was positively related to the length of breastfeeding (beta-coefficient: 0.016; SE: 0.006; p = 0.01). This study among Filipino migrant women in Korea suggests that higher consumption of fruit, vegetables, and legumes positively linked to breastfeeding for at least 12 months. Given the study’s small sample size, interpreting these results should be cautious and warrants further validation in other studies.

Optimal nutrition is essential for preterm infants as they face many barriers to achieving exclusive breastfeeding (EBF) and successfully introducing complementary foods (CF)(1). There is limited evidence of early feeding practices of preterm infants in Aotearoa, New Zealand (NZ). We aimed to investigate the facilitators and barriers to EBF and CF introduction in preterm infants in NZ. A nationwide self-completed electronic questionnaire was disseminated via social media to mothers of preterm infants. The survey collected quantitative data on hospital feeding practices, breastfeeding rates, timing of CF introduction, and fussy eating behaviours. Relationships between feeding practices and maternal and infant characteristics, such as ethnicity and level of prematurity, were explored using the Chi-Square statistical test in SPSS. Qualitative information regarding mothers’ experiences with breastfeeding, CF introduction, type of education and support received about the nutrition of preterm infants were collected for thematic analysis using Nvivo. The survey started in April and will close on 20th August 2023. Here we present preliminary findings of a subset of responses collected to date, and full results will be available for the conference. Up to 1st August 2023, 201 mothers had completed the survey. Most mothers self-identified as of New Zealand European (58%) and Māori (13%) background. Most infants (39%) were older than 12 months of chronological age (CA) and born moderate or late preterm (32+0 – 36+6 weeks’ gestation, 70%). Almost 50% of mothers required in-hospital supplementation of mothers’ milk (infant formula, 28% and donor breastmilk, 20%), and 44% of mothers were EBF at the time of hospital discharge. EBF for 5-6 months of CA was reported by 21% of mothers, and 46% provided any breastmilk for more than 6 months of CA. Among mothers who had introduced CF (n = 138), 74% reported introducing CF between 5-8 months of CA, and the infant’s first foods were primarily vegetables (65%) and fruits (60%). Fussy eating behaviour was reported by 47%, and food fussiness was significantly associated with a decreased frequency of vegetable (p<0.001) and fruit (p = 0.004) consumption. Challenges with breastfeeding included the infant’s feeding difficulties, low milk supply, maternal stressors, lack of support and education from health professionals. Challenges to CF introduction included fussiness and maternal fears such as choking and lack of confidence. Support from lactation consultants and previous experience with introducing CF were the most common enablers for breastfeeding and timely CF introduction, respectively. Our findings provide the first insight into the early feeding practices of preterm infants in Aotearoa, New Zealand. This information will support strategies to improve the nutritional management of preterm infants by increasing awareness of common challenges mothers face to achieve the recommended breastfeeding guidelines and CF practices in this vulnerable population.

Maternal pre-pregnancy body mass index is positively associated with offspring obesity, even at adulthood, whereas breastfeeding decreases the risk of obesity. The present study was aimed at assessing whether breastfeeding moderates the association of maternal pre-pregnancy body mass index with offspring body composition at adulthood, using data from 3439 subjects enrolled in a southern Brazilian birth cohort. At 30 years of age, maternal pre-pregnancy body mass index was positively associated with offspring prevalence of obesity, abdominal obesity, as well as body mass index and fat and lean mass index. Breastfeeding moderated the association of maternal pre-pregnancy obesity with offspring adiposity at 30 years of age. For those breastfed<6 months, body mass index was 4.13 kg/m2 (95% confidence interval: 2.98; 5.28) higher among offspring of obese mothers, in relation to offspring of normal weight mothers, whereas among those breastfed≥6 months the magnitude of the difference was small [2.95 kg/m2 (95% confidence interval: 1.17; 4.73)], p-value for interaction = 0.03. Concerning obesity, among those who had been breastfed < 6 months, the prevalence of obesity was 2.56 (95% confidence interval: 1.98; 3.31) times higher among offspring of obese mothers. On the other hand, among those who were breastfed ≥ 6 months, the prevalence of obesity was 1.82 (95% confidence interval: 1.09; 3.04) times higher among offspring of obese mothers. Therefore, among overweight mothers breastfeeding for more than 6 months should be supported, as it may mitigate the consequences of maternal overweight on offspring body composition.

To meet the 2030 goal to end all types of malnutrition, thoroughly investigating and addressing context-specific factors of undernutrition is crucial. Therefore, this study assessed the prevalence of undernutrition and associated factors among children aged 6–23 months in South-East Ethiopia. A community-based cross-sectional study was conducted on 580 randomly sampled mother–child pairs in February 2022. Socio-demographic, dietary intake, household food security (HFS), maternal knowledge and practices of child feeding, and the child's weight and height data were collected. A multivariable logistic regression analysis was done. The prevalence of stunted, wasted, and underweight children was 32⋅1, 7, and 9 %, respectively. Being male (AOR = 1⋅75), not using the growth monitoring and promotion (GMP) service (AOR = 1⋅50), household food insecurity (HFI) (AOR = 1⋅67), lack of improved water (AOR = 2⋅26), and bottle-feeding (AOR = 1⋅54) were significantly associated with stunting. Being male (AOR = 3⋅02), having low maternal knowledge on child-feeding practices (AOR = 3⋅89), not listening to the radio/television (AOR = 3⋅69), having a history of fever (AOR = 3⋅39), bottle-feeding (AOR = 3⋅58), and HFI (AOR = 3⋅77) were significantly predicted wasting. Being male (AOR = 3⋅44), not using GMP service (AOR = 2⋅00), having a history of fever (AOR = 4⋅24), lack of knowledge on optimal breastfeeding duration (AOR = 3⋅58), low maternal knowledge on child feeding (AOR = 2⋅21), HFI (AOR = 2⋅04), and lack of improved water (AOR = 3⋅00) showed significant association with underweight. In conclusion, stunting is alarmingly common while wasting and underweight are sub-optimal. Prevention of infectious disease, providing basic education for fathers, ensuring HFS; enhancing media access, maternal knowledge about IYCFP and improving water access; and GMP service utilisation are crucial to improve child nutrition.

An adequate alpha-tocopherol status is important for females at reproductive age. We studied the dietary intake and sources of alpha-tocopherol and alpha- and gamma-tocopherol status indicators in 14–19-year-old girls in Central Mozambique. We also explored factors associated with alpha- and gamma-tocopherol status. The participants (n 508) were from the cross-sectional ZANE Study that was conducted in 2010. We recruited two separate samples, one in January–February and the other in May–June. We collected venous blood samples and conducted 24 h dietary recall interviews. At the time of blood sampling, 11 % of participants were pregnant and 10 % were lactating. In the total sample, both seasons combined, the median intake of alpha-tocopherol was 6⋅7 mg/d, the mean plasma alpha- and gamma-tocopherol concentrations were 13⋅5 and 0⋅75 μmol/l, respectively, and the prevalence of vitamin E inadequacy (alpha-tocopherol <12 μmol/l) was 36⋅7 % (95 % CI: 31⋅9–42⋅0 %). Season and lactation status were significant predictors of alpha-tocopherol status regardless of which the three indicators (plasma concentration, alpha-tocopherol:total cholesterol ratio, gamma-tocopherol:alpha-tocopherol ratio) were used. Being a lactating mother was negatively associated and having a blood sample taken in January–February, when the main sources of alpha-tocopherol were mango and dark green leafy vegetables, was positively associated with alpha-tocopherol status. In conclusion, vitamin E inadequacy was common in Central Mozambique, and the status may fluctuate due to seasonal changes in the diet. We suggest that lactating mothers are specifically at risk of poor alpha-tocopherol status in resource-poor settings.