> Subject: Study: Breast-Feeding Ups Death Risk in HIV Mothers
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> LACTNET Digest - 24 May 2001 (#2001-293)In my daily news I found this =
> article from Reuters. Here is a snippet. Below is the link to the =
> whole article.
> -More than 425 HIV-positive women in Nairobi had been randomly selected =
> in the study to either nurse their child or use formula feed. All the =
> women have been followed up monthly in the first year and quarterly in =
> the second year after the birth.=20
>
> Nduati and her team discovered that two years after giving birth, 18 of =
> the breast-feeding mothers had died compared to three in the formula =
> group.=20
>
> Babies of the mothers who died were eight times more likely to die than =
> the formula-fed babies.-
>
> http://dailynews.yahoo.com/h/nm/20010524/sc/aids_breastfeeding_dc_1.html
>
> Kate McMurry
> [log in to unmask]
>
The report referred to above is very problematic. Although any study
which shows an increase in maternal deaths should be taken seriously, this
study seems to have a number of 'flaws' which may possibly invalidate the
data and hence the findings.
The comments below are my first thoughts on the study.
1) This is NOT a new study. It is using the cohort of women and infants
published in the JAMA study last year. (To remind you, that study claimed
that infants of women diagnosed HIV-positive who breastfed had a higher risk
of HIV transmission than those infants of mothers who did not breastfeed.
The women in Nduati's study did not exclusively breastfeed - therefore they
were partially or mixed breastfeeders.)
2) An abstract of this new use of the figures from Nduati's original JAMA
study were released at the HIV Durban 2000 lst July. They have been pending
publication ever since.
3) No other studies (to my knowledge) have shown a similar outcome. Most
importantly, the study by Coutsoudis which DID look at the effect of
exclusive breastfeeding found no increase in maternal deaths amongst those
women who breastfed (commentary available on this by Coutsoudis in AIDS,
vol, 15, no. 5, 2001) to quote: 'In brief, we found no deleterious effects
of breastfeeding on the health of HIV-infected women'.
4) The women in this latest Ndauti report were asigned their feeding method
by computer block randomisation. Theoretically, this should result in a
'balance' of variables in both groups of women - those breastfeeding and
those artificially feeding. However, even at birth - before breastfeeding
could have had an impact, double the number of infants in the breastfeeding
arm had a positive diagnosis as compared with the artificial feeding arm.
(I'm not an expert on this but it must be remembered that testing at birth
is open to all kinds of different interpretation, as it could almost be
expected that all babies of HIV-infected mothers would test positive as they
carry the antibodies for the virus.)
5) The women who were randomised into the artificial feeding arm (this
happened at 32 weeks gestation) were then given speical sessions on making
up feeds, sterilising equipment etc. At these clinic-held sessions if they
presented with health problems they may have been treated. (which would
account for the higher illness and death rate in the breastfeeding arm).
6) As Coutsoudis points out in her paper mentioned above, to randomise such
a deeply ingrained cultural practice such as breastfeeding is likely to
result in very poor compliance - this may undermine any valid interpretation
of the results.
7) The women in the breastfeeding arm had: higher rates of STDs
(particularly syphilis), higher rates of caesarian sections, lower vitamin A
levels, more episiotomies and higher rates of more than 4 hours rupture of
membranes prior to the birth. All of these are more likely to lead to higher
incidences of medical complications, infection, illness and possibly death.
To sum up, mothers in the breastfeeding arm were sicker than those in the
artificial feeding arm. This is one study and needs replication - although
with methodological improvements which take into account the questionnable
ethics of doing an RCT on infant feeding methods.
I'm not a statistician and do not fully understand the figures, but there is
enough concern with this study for us to be very cautious with the findings.
Tessa (Martyn)
--
Health Campaigns Co-ordinator
Baby Milk Action / IBFAN
THREEFOLD INCREASED RISK OF DEATH AMONG HIV-1 INFECTED BREASTFEEDING
MOTHERS
IN LESS-DEVELOPED COUNTRIES
(pp 1634, 1651)
HIV-1 infected mothers in less-developed countries who breastfeed their
infants could be more than three times more likely to die within two years
of giving birth compared with mothers who use formula milk, conclude authors
of a study in this week's issue of THE LANCET. The study also found that
illness and death was increased among children of HIV-1 infected
breastfeeding mothers .
Ruth Nduati and colleagues from the University of Nairobi, Kenya, and the
University of Washington, Seattle, USA, analysed data from a previous trial
(which investigated mother-to-child HIV-1 transmission from breastmilk) to
examine the effect of breastfeeding on maternal death rates in the first two
years after childbirth. Pregnant women attending four city council clinics
in Nairobi, Kenya, were offered HIV tests. At about 32 weeks' pregnancy, 425
HIV-1 seropositive women were randomly allocated to either breastfeed or
formula feed their infants. After delivery, mother-infant pairs were
followed up monthly during the first year and quarterly during the second
year until death, or for 2 years after delivery, or until the end of the
study.
Death among mothers was higher in the breastfeeding group than in the
formula group (18 compared with 6 deaths). The cumulative probability of
maternal death two years after delivery was 10.5% in the breastfeeding
group and 3.8% in the formula group. The attributable risk of maternal death
due to breastfeeding was 69%. Infants had an eightfold increased mortality
risk if their mothers died in the first two years after delivery.
In an accompanying Commentary (p 1634), Marie-Louise Newell from the
Institute of Child Health, London, UK, comments: "...further research may be
required to confirm or refute the disturbing possibility that their [Nduati
and colleagues'] study raises, and, if it is confirmed, to understand the
underlying mechanism. Women with clinical progression of disease are more
likely than those with stable disease to transmit the infection in utero, so
breastfeeding would pose no further risk for the infant. However, if indeed
breastfeeding by an HIV-infected woman with AIDS shortens her life, this
finding has to be taken into account in any recommendations issued. Would
nutritional and treatment support cancel out any supposed harmful effects of
breastfeeding in these circumstances? The analysis here would benefit from
being complemented by a creative analysis of actual feeding practice to
further explore this complex issue".
Contact: Dr Ruth Nduati, Department of Paediatrics, University of Nairobi,
PO 19676, Nairobi, Kenya; T) +254 2 714851; F) +254 2 712007; E)
[log in to unmask] (or [log in to unmask])
Dr Marie-Louise Newell, Department of Paediatric Epidemiology &
Biostatistics, Institute of Child Health, 30 Guildford Street, London WC1N
1EH, UK; T) (from Thursday 24 May) +44 (0)20 7905 2362/8699; F) +44 (0)20
7242 2723 or 7813 8145; E) [log in to unmask]
--
Health Campaigns Co-ordinator
Baby Milk Action
Baby Milk Action is a member of the International Baby Food Action Network
(IBFAN) - a coalition of more than 150 citizen and health worker groups in
more than 90 countries. IBFAN works for better child health and nutrition
through the promotion of breastfeeding and the elimination of irresponsible
marketing of infant foods, bottles and teats.
General office email: [log in to unmask]
Website: www.babymilkaction.org
Baby Milk Action
23 St Andrew's Street, Cambridge, CB2 3AX
Tel: +44 1223 464420, Fax: +44 1223 464417
***Virtual shop now open***
----------
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>Subject: LACTNET Digest - 24 May 2001 to 25 May 2001 - Special issue
(#2001-294)
>Date: Fri, May 25, 2001, 3:10 pm
>
> Date: Fri, 25 May 2001 10:10:36 -0400
> Reply-To: Lactation Information and Discussion <[log in to unmask]>
> Sender: Lactation Information and Discussion <[log in to unmask]>
> From: Automatic digest processor <[log in to unmask]>
> Subject: LACTNET Digest - 24 May 2001 to 25 May 2001 - Special issue
(#2001-294)
> To: Recipients of LACTNET digests <[log in to unmask]>
>
> There are 17 messages totalling 359 lines in this issue.
>
> Topics in this special issue:
>
> 1. uses and users of Lactnet
> 2. Study: Breast-Feeding Ups Death Risk in HIV Mothers
> 3. Breastfeeding celebrities
> 4. Dateline and "Extended" Breastfeeding
> 5. LACTNET Digest - 22 May 2001 - Special issue (#2001-283)
> 6. LACTNET Digest - 23 May 2001 - Special issue (#2001-287)
> 7. plugged ducts and night nursing
> 8. "extended" nursing (2)
> 9. nipple shields for large nipples?
> 10. Hale regarding herbs
> 11. "extended breastfeeding"
> 12. UNICEF Caring Practices
> 13. NICU breastfeeding in Austin
> 14. sustained breastfeeding
> 15. Sjogrens syndrome
> 16. GREAT belly laugh
>
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> Thanks- Kathleen Bruce, Kathleen Auerbach, Kathy Koch,
> Melissa Vickers, Karen Zeretzke, LACTNET Facilitators
>
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> Date: Fri, 25 May 2001 01:02:07 -0700
> From: Patricia Ellis <[log in to unmask]>
> Subject: uses and users of Lactnet
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> Do you suppose that when we offer case studies to each other on Lactnet, =
> including our feelings associated with the difficulties we encounter =
> with others in the medical profession, that we are not simply =
> complaining, but truly seeking help from our peers? Is that not a =
> legitimate use of this forum? =20
> Personally, I find working with and helping breastfeeding mothers is =
> extremely rewarding and wonderful. The environments that many of us =
> find ourselves in do not always support a woman's desire to breastfeed, =
> and that is where the frustration comes in. I am responsible for =
> education of staff, but find it very discouraging when faced with the =
> same needs for learning over and over. I have taught the same material =
> to the same people with no change in their behavior. I believe that I =
> try my best to be a support person by answering questions, encouraging =
> staff to utilize self-study materials, and praising them for the good =
> work that they do--going the extra mile and more. When I am out of =
> ideas or energy, I come here for recharging and for your expertise. The =
> variety of answers and opinions is helpful and enlightening. The =
> cumulative wisdom and experience is amazing to me.
> We are human AND professionals, and I believe that Lactnet reflects this =
> reality.
> Thank you for your support, past, present, and future.
> Patricia Ellis, RN, MA, IBCLC
>
> Date: Thu, 24 May 2001 23:04:13 -0700
> From: Chad & Kate McM <[log in to unmask]>
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