Breastfeeding and Vitamin D Supplementation

1
Breastfeeding and Vitamin D Supplementation

• Broadway Clinic QI Project
• Rakhee Bowker, Michael Goldman, Stuart Holzer,
  Lisa Kurz, Lacy-Ann Landell, Robbie Majzner,
  Lindsay McGann, Lisa McReynolds, Lisa Nowell,
  Anne Pierog, Gabe Rama, Corinna Rea, Daniel
  Stephens, Emily Whitesel, Kristal Woldu
• Heidi Beutler, Renie Eis, Mariellen Lane, Pran
  Saha, Nan Salamon, John Rausch, Laura
  Robbins-Milne

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Breastfeeding

• It is well demonstrated that breastfeeding
  provides benefits for both mothers and infants,
  including
• Infants-
• Stimulate GI motility and growth, decrease risk
  of NEC
• Increased immune response due to transmission in
  breastmilk of maternal antibodies
• Decrease risk of diseases such as asthma,
  obesity, and diabetes
• Mothers-
• Stimulate oxytocin release and acceleration of
  recovery from childbirth
• Increased weight loss
• Increased bonding with infant
• Prolonged annovulation postpartum
• Economic savings on formula
• Reduced risk of breast and ovarian cancer
• Decreased risk of cardiovascular disease

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Vitamin D

• Important in calcium homeostasis
• Transferred across the placenta from mother to
  fetus
• Often low in infants if maternal levels low or
  infant premature
• Amount of vitamin D in breastmilk is low,
  especially if mom is vitamin D deficient

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AAP Recommendations

• The AAP recommends exclusively breastfeeding
  infants until 6 months and then supplementing
  with breastmilk up to and beyond the first year
  of life
• The AAP now recommends starting vitamin D
  supplementation within the first few days of life
  to any infant breastfeeding or taking less than
  27oz of formula per day

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Baseline Data For Broadway

• Breastfeeding (exclusive and partial)
• 2 months- 32
• 4 months- 16
• Vitamin D supplementation
• 2 months- 57
• 4 months- 57 

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AIM Statement

• We aim to improve collective breastfeeding rates
  in the Washington Heights community, specifically
  to 30 at the 4 month well child visit in the
  Broadway Ambulatory Clinic pediatric population.
• Within this patient population, we aim to
  increase vitamin D supplementation per current
  AAP guidelines to 90 in all nursing infants
  (including both fully and partially breastfed
  infants).

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Interventions

• Breastfeeding Resource Sheet in English Spanish
  created and distributed to mothers at the newborn
  visit

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Interventions

• Breastfeeding Resource Sheet in English Spanish
  created and distributed to mothers at the newborn
  visit
• Didactic educating clinic providers regarding
  breastfeeding and vitamin D supplementation
  guidelines

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Interventions

• Breastfeeding Resource Sheet in English Spanish
  created and distributed to mothers at the newborn
  visit
• Didactic educating clinic providers regarding
  breastfeeding and vitamin D supplementation
  guidelines
• Breastfeeding checklist placed in all exam rooms
  with guidelines for providers regarding vitamin D
  supplementation

10
Interventions

• Breastfeeding Resource Sheet in English Spanish
  created and distributed to mothers at the newborn
  visit
• Didactic educating clinic providers regarding
  breastfeeding and vitamin D supplementation
  guidelines
• Breastfeeding checklist placed in all exam rooms
  with guidelines for providers regarding vitamin D
  supplementation
• Schedule breastfeeding newborns for a weight
  check/breastfeeding check at one month of age to
  troubleshoot and encourage continued
  breastfeeding

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Other Interventions Also Happening At Broadway
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Centering Group

• Prenatal counseling at Broadway for teenage
  expecting mothers
• Residents developed a breastfeeding and Vitamin D
  supplementation presentation. Each month the
  outpatient resident gives the presentation to the
  expectant mothers in the group

Breastfeeding Your Baby Healthy and Natural
Cross Cradle Position
Sitting comfortably with the baby at breast
height using a pillow for support (excellent
options are My Breast Friend or Boppy pillows),
tuck the baby's tush in the crook of the opposite
arm of the breast being fed. The mother's forearm
should be positioned up the length of the baby's
back. The baby's head is supported by her thumb
and forefinger, right behind the ears. The baby
is held tummy-to-tummy with the mother
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Breastfeeding Support Group

• Meets every 1st and 3rd Wednesday morning
• Mothers can walk-in
• For expecting and new mothers of Broadway Clinic
• Organized by Dr. Salamon and Alyssa Wynn

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Percent of Infants Receiving Any Breastmilk
15
Percent of Breastfed Infants Receiving Vitamin D
Supplementation
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Lessons We Learned

• We were unable to improve our 4 month
  breastfeeding rates. This reinforced that to
  positively Influence breastfeeding rates
  interventions need to reach mothers prior to the
  first outpatient office visit.
• As shown in other studies, effective prenatal
  counseling and Baby Friendly Hospitals are
  important factors in educating mothers and
  families and improving breastfeeding rates.
• Educational interventions and reminders in clinic
  aimed at providers were able to increase vitamin
  D prescription rates.

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References

• Carol L. Wagner, MD, Frank R. Greer, MD and the
  Section on Breastfeeding and Committee on
  Nutrition. Prevention of Rickets and Vitamin D
  Deficiency in Infants, Children, and Adolescents.
  Pediatrics Vol. 122 No. 5 November 2008, pp.
  1142-1152.
• Chua S, Arulkumaran S, Lim I, Selamat N, Ratnam
  SS. Influence of breastfeeding and nipple
  stimulation on postpartum uterine activity. Br J
  Obstet Gynaecol. 1994 Sep101(9)804-5.
• Dellifraine J, Langabeer J 2nd, Williams JF, Gong
  AK, Delgado RI, Gill SL. Cost comparison of baby
  friendly and non-baby friendly hospitals in the
  United States. Pediatrics. 2011
  Apr127(4)e989-94. Epub 2011 Mar 21.
• Dewey KG, Heining MJ, Nommsen LA. Maternal
  weight-loss patterns during prolonged lactation.
  Am J Clin Nutr. 1993 Aug58(2)162-6.
• Gartner LM, Morton J, Lawrence RA, Naylor AJ,
  OHare D, Schanler RJ, Eidelman AI American
  Academy of Pediatrics Section on Breastfeeding.
  Breastfeeding and the use of human milk.
  Pediatrics. 2005 , Feb115(2)496-506.
• Office of the Surgeon General. Call to Action to
  Support Breastfeeding. http//www.surgeongeneral.
  gov/topics/breastfeeding/index.html. 2011.
• Walter F. The Parathyroid and Vitamin D.
  Medical Physiology A Cellular And Molecular
  Approach, 1300, Elsevier/Saunders, Boron. 2003,
  1094.
• Wang IV, Fraser IS. Reproductive function and
  contraception in the postpartum period. Obstet
  Gynecol Surv. 1994 Jan49(1)56-63.