Different types of bariatric surgeries, such as malabsorptive and restrictive procedures, can impact nutrient absorption and metabolism. One of the concerns for reproductive-aged women and pregnancy-capable individuals undergoing bariatric surgery is the increased risk of nutritional deficiencies during pregnancy and breastfeeding. This review aimed to collate and synthesise available literature on nutritional status during pregnancy and breastfeeding post-bariatric surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework was used. It included peer-reviewed primary research studies published in English that reported the nutritional status of women with histories of bariatric surgery during pregnancy and breastfeeding. There were no time restrictions for including studies. A narrative synthesis was performed to summarise and interpret the findings. Anaemia and micronutrient deficiencies were frequently reported during pregnancy after bariatric surgery. Malabsorptive procedures were associated with greater micronutrient deficiencies during pregnancy, while the surgery-to-conception interval showed no consistent association. Macronutrient intake during pregnancy was characterised by high fat intake, low carbohydrate and fibre intake, and adequate protein intake. There was limited evidence of altered breast milk macronutrient composition following bariatric surgery. Limited qualitative studies showed that women wanted more nutritional information and support during pregnancy and breastfeeding following bariatric surgery. These findings highlight the need for individualised nutritional care, regular biochemical monitoring, and multidisciplinary management for women and pregnancy-capable individuals during pregnancy and breastfeeding following bariatric surgery, particularly after malabsorptive procedures. Further research is required to address gaps in evidence regarding mothers’ experiences and breast milk composition after bariatric surgery.

Traumatic breastfeeding experiences can lead a subset of mothers to develop moral injury and subsequent clinical presentations such as depression, anxiety and post-traumatic stress disorder (PTSD). However, to date, no clinical conceptualisation has been utilised to formulate or guide treatment for breastfeeding trauma reactions, leaving a gap for clinicians. In this clinical guidance paper, we present a cognitive formulation of breastfeeding trauma, drawing from the cognitive model of moral injury in PTSD. The paper aims to support cognitive behavioural therapists to conceptualise breastfeeding trauma through the lens of moral injury where appropriate, and provide treatment guidance through an illustrative case study.

Key learning aims

1. (1) To increase awareness of the impact that negative breastfeeding experiences can have on an individual, including moral injury, and/or the development of mental health conditions such as PTSD and depression.

2. (2) To support mental health clinicians, perinatal health professionals, infant feeding professionals, and antenatal educators in their understanding of breastfeeding trauma.

3. (3) To propose a conceptualisation of understanding and treating traumatic breastfeeding experiences, drawing from an existing formulation model for moral injury in PTSD, using cognitive therapy.

4. (4) To emphasise the importance of individualised assessment, formulation and therapy when working with individuals who have experienced traumatic breastfeeding experiences.

Human milk and direct breastfeeding are recommended for all infants, but rates are low in CHD with limited data on institutional lactation support. We aimed to describe lactation-supportive practices within US paediatric cardiac ICUs and to determine associations between these practices and human milk/breastfeeding outcomes. This retrospective cohort study and site survey included centres from Collaborative Research from the Pediatric Cardiac Intensive Care Society. Linear regression assessed associations between the total number of lactation-supportive practices and sites’ human milk and breastfeeding percentages, during the neonatal period and at discharge. Potentially strong clinical practices were identified through a phased analysis. Survey respondents represented 34 sites, with detailed data for 832 patients from 24 sites. Implementation of 22 lactation-supportive practices varied (median: 10; range: 2–20); smaller sites reported fewer practices (p = 0.006). Common practices included in-room breast pumps (100%), feeding protocols (91%), and staff training (79%), while skin-to-skin protocols (41%) and automatic lactation orders (44%) were underutilised. While total practices did not correlate with outcomes, sites with high versus low implementation of “strongest” practices demonstrated generally better lactation outcomes, especially at discharge: 11.7% higher human milk volume (95% CI: 0.1%–23.3%); 8.2% higher breastfeeding rate (95% CI: −0.3%–16.6%). These strongest practices involved institutional formalisation of lactation support. Lactation-supportive practices varied among sites. Findings suggest formalisation of practices including a developmental care protocol, comprehensive parent education/support, and protocols recommending human milk/breastfeeding may improve lactation outcomes in critical CHD.

It is well known that breastfeeding provides favourable health outcomes for both mother and baby. However, many mothers struggle to meet global breastfeeding recommendations, with Perceived Insufficient Milk Supply (PIMS) being a leading reason for early cessation(1). Currently, little is known about the relationship between PIMS, actual milk insufficiency, and human milk nutrient composition. The primary aims of the Māmā (mother) and Baby Breastfeeding Study are to describe human milk volumes produced by a diverse sample of breastfeeding mothers at 3 months postpartum with differing perceptions of milk supply, and to compare human milk composition in relation to milk volume. In this observational study in Dunedin, Aotearoa New Zealand, a sample of 150 mother-infant dyads will be recruited. A diverse range of participants in terms of ethnicity and socio-economic status will be included, with an aim of recruiting as close to 20% Māori as possible. Targeted recruitment through networks within the maternity and healthcare sector as well as through Māori researchers will be utilised. Human milk volume (milk supply) will be assessed using the ‘dose-to-mother’ stable isotope (deuterium oxide) technique. Mother participants will consume an accurate dose (30 g) of deuterium oxide after baseline saliva samples are collected from both mother and infant. Subsequent post-dose samples will be collected over 3 time-points to determine deuterium enrichment over a 14 day period using Fourier-Transform Infrared Spectrometry. Human milk macronutrient (energy, fat, carbohydrate, and crude and true protein) and mineral and trace element (sodium, magnesium, phosphorus, potassium, calcium, iron, copper, zinc, selenium, and iodine) composition of one full milk expression from one breast will be analysed using the MIRIS Human Milk Analyzer and ICP-MS, respectively. Potential predictors and maternal perception of milk supply will be assessed via questionnaire. Infant body mass index (BMI) will be calculated from measures of weight and length at three different time points over four weeks, using standard techniques. These, alongside anthropometric measurements collected at the infant’s Well Child Tamariki Ora (WCTO) visits, will be used to assess infant growth trajectory over time. Regression models will be used to assess the associations between maternal perception of milk supply, human milk volumes, and composition. Recruitment for this study began in February 2025 and is anticipated to conclude in June 2026 with analysis expected to be completed by February 2027. As of 25 August, 56 participants have been enrolled. Progress with recruitment, and the initial demographic profile of participants, will be presented. This research will provide new knowledge on whether maternal perception of milk supply aligns with actual human milk volume or nutrient composition. Such information will be beneficial to health professionals working with breastfeeding mothers with milk supply concerns and inform the design of breastfeeding support programmes and resources.

Optimal infant and young child feeding (IYCF) practices are essential for ensuring child growth, development, and survival. However, comprehensive evidence on IYCF knowledge, practices, and their determinants among rural mothers in Bangladesh remains limited. This study aimed to assess IYCF knowledge and practices and to identify the factors associated with these outcomes among rural mothers in Bangladesh. This study utilised data from the third round of the Bangladesh Integrated Household Survey (BIHS), focusing on rural mothers aged 15–49 years with children aged 0–23 months. A total of 873 samples were included in the study. Descriptive statistics and logistic regression analyses were utilised to investigate the prevalence and determinants of IYCF knowledge and practices. Findings revealed that only 30.3% of mothers had adequate IYCF knowledge, and an equal proportion adhered to overall IYCF practices. Multivariate regression analysis showed that maternal education, geographic region, and household wealth quintile were significant predictors of IYCF knowledge. Breastfeeding practices were associated with the child’s age, place of delivery, geographic region, household wealth, and maternal IYCF knowledge. Complementary feeding practices were mainly influenced by the child’s age, sex, and household wealth quintile. Overall adherence to recommended IYCF practices was significantly associated with the child’s age and geographic region. This study reveals persistently low IYCF knowledge and overall IYCF practices among rural mothers in Bangladesh. Strengthening maternal education, promoting community-based nutrition counselling, expanding access to health services in underserved regions, and targeting low-income households with tailored support are essential to improve child feeding practices.

This narrative review examines the development of the infant gut microbiota during the early months of life, highlighting the impact of delivery mode and feeding practices on microbial colonization and overall infant health. The search was conducted using the Virtual Health Library and PubMed databases, with the descriptors “gut microbiota” combined with “breastfeeding” (BF) and “infant formula.” After screening, 18 articles were selected for final analysis. Findings indicate that cesarean section reduces initial gut microbial diversity by 30%–50% and decreases Bifidobacterium colonization, while increasing the abundance of Enterobacteriaceae and Clostridium. In contrast, exclusive BF supports a more favorable microbial profile, enriched in bifidobacteria, and contributes to immune system maturation. The literature also highlights the importance of other genera, including Lactobacillus, Veillonella, and Firmicutes, in regulating inflammation, producing short-chain fatty acids, and protecting against pathogens. Supporting vaginal birth and exclusive BF emerges as a key strategy to promote a more resilient and health-promoting gut microbiota during infancy.

The objective of this study was to investigate the gene-breastfeeding interaction on BMI based on the Chinese National Twin Register (CNTR). The study included 4,573 pairs of same-sex twins aged 2–18 from CNTR. Data were collected using a self-reported questionnaire, and a structural equation model was used to analyze the gene-environment interaction of breastfeeding with BMI in six age groups. Our findings indicate that as age increases, the heritability of BMI shows an increasing trend, being the lowest (h2: 0.08; 95% CI [0.00, 0.19]) in the 6- to 8-year age group and the highest (h2: 0.57, 95% CI [0.44, 0.72]) in the 12- to 14-year age group. Additionally, breastfeeding significantly modified the additive genetic component of BMI in the 6- to 8-year age group and 12- to 14-year age group. In the 6- to 8-year age group, breastfeeding decreased the impact of genes on BMI, with a genetic effect modification coefficient (βa) of −0.19 (−0.25, −0.13). In the 12- to 14-year age group, breastfeeding increased the impact of genes on BMI, with a genetic effect modification coefficient (βa) of 0.08 (0.02, 0.15). In conclusion, as age increases, the genetic influence on children’s BMI becomes more pronounced. Breastfeeding may modulate genetic effects at the ages of 6–8 and 12–14. Given the metabolic diversity of obesity, our findings offer insight into how breastfeeding interacts with genetic background, helping to unravel the complex gene–environment interplay influencing obesity.