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Work Group 4 – Caregivers (Mothers and Others) – Factors Influencing Nutrient Needs, Infant Feeding Choice, Dietary Quality and Food Habits

Each work group developed a set of topics and questions that might be the focus of future NEL systematic reviews, identified priority data needs (to be derived either from existing data sets, e.g., NHANES, or met with new data/surveillance) and described research priorities. Work Group 4 discussed caregivers (mothers and others).  Below is the list of topics and systematic review questions identified by Work Group 4. The full topic brief for Work Group includes the data needs and research priorities for the topics as well as a reference list for each topic.
  • What maternal factors (other than dietary intake and/or nutritional status) have been documented to affect lactation initiation and success (incorporating both duration and intensity)?
    • What impact does delivery mode (c-section versus vaginal) have on lactation initiation and sustainability?
    • What impact do maternal inflammatory conditions (e.g., eclampsia, diabetes and mastitis) have on lactation initiation and sustainability?
    • What impact do breast irregularities (e.g., inverted nipples) have on lactation initiation and sustainability?
    • What impact does the post-natal hospital environment (e.g., not providing formula, having access to lactation specialist, making rooming-in available) have on lactation initiation and sustainability?
    • What impact does pharmaceutical drug use during the peripartum period (including anti-inflammatory drugs) have on lactation initiation and sustainability?
    • What impact do maternal factors, such as 1) delivery mode (c-section versus vaginal), 2) maternal inflammatory conditions (e.g., eclampsia, diabetes and mastitis), 3) post-natal hospital environment (e.g., not providing formula, making rooming-in available), have on infant growth and physical development?
  • What are the relationships of maternal feeding practices and styles (including control, pressure, restriction, responsive/intrusive/ indulgent and responsiveness to satiety and hunger cues) to infant growth and physical development, overweight/obesity and eating behaviors?
    • What is the relationship between maternal feeding style (including control, pressure, restriction, responsive/pressuring/indulgent styles and responsiveness to satiety and hunger cues) and infant/toddler growth and physical development (including rapid weight gain, weight-for-length and BMI or BMI-Z)?
    • What is the relationship between maternal feeding style (including control, pressure, restriction, responsive/pressuring/indulgent styles and responsiveness to satiety and hunger cues) and infant, toddler and childhood overweight/obesity?
    • What is the relationship between maternal feeding style (including control, pressure, restriction, responsive/pressuring/indulgent styles and responsiveness to satiety and hunger cues) and infant/toddler infant feeding/eating behaviors (e.g., speed of eating; Baby Eating Questionnaire subscales)?
  • What is the evidence for any benefit or harm of maternal fish consumption during lactation?
    • What are the effects of maternal fish consumption on milk composition and infant growth, immune function and neurological development?
  • What is the relationship between lactating mothers' energy balance (energy intake, energy expenditure and postpartum weight loss) on breast milk volume and composition, as well as infant growth and body composition?
    • What is the relationship between lactating mothers’ energy intake (including “dieting”), energy expenditure (including exercise), and postpartum weight loss (independently and in combination) with human milk volume?
    • What is the relationship between lactating mothers’ energy intake (including “dieting”), energy expenditure (including exercise), and postpartum weight loss (independently and in combination) with human milk composition?
    • What is the relationship between lactating mothers’ energy intake (including “dieting”), energy expenditure (including exercise), and postpartum weight loss (independently and in combination) with infant growth and/or body composition?
  • What are the effects of dietary patterns (such as vegan, vegetarian, macrobiotic diets) on breast milk composition?
    • What is the relationship between maternal vegan dietary pattern during lactation and human milk composition?
    • What is the relationship between maternal vegetarian dietary pattern during lactation and human milk composition?
    • What is the relationship between maternal macrobiotic diet during lactation and human milk composition?
  • What is the influence of maternal dietary intake on micronutrients (including fat soluble and water soluble vitamins) and macronutrients (including total fat, n-3 PUFA, n-6 PUFA and trans fats) on human milk composition?
    • What is the relationship between maternal dietary water-soluble vitamin intake and human milk water-soluble vitamin composition?
    • What is the relationship between maternal dietary fat-soluble vitamin intake and human milk fat-soluble vitamin composition?
    • What is the relationship between maternal dietary fat intake and human milk fat composition?
  • What are infants/children 0-24 months being fed and what are they consuming in non-parental child care settings?
    • What is the relationship between out-of-home feeding and infant/toddler dietary intake?
    • What is the relationship between out-of-home feeding and infant/toddler diet quality?
    • What is the relationship between out-of-home feeding and infant/toddler dietary behaviors?
  • Effects maternal alcohol consumption during lactation on milk production, milk composition and infant outcomes
    • What are the effects of (or associations between) maternal alcohol consumption during lactation on human milk alcohol concentration?
    • What are the effects of (or associations between) maternal alcohol consumption during lactation on human milk volume (or infant milk consumption)?
    • What are the effects of (or associations between) maternal alcohol consumption during lactation on infant (ages 0-6 months) behavior (specifically suckling and sleep)?
  • Effects (or lack-thereof) of maternal caffeine consumption during lactation on milk production, milk composition, and infant outcomes
    • What are the effects of (or associations between) maternal caffeine consumption during lactation on human milk caffeine concentration?
    • What are the effects of (or associations between) maternal caffeine consumption during lactation on human milk volume (or infant milk consumption)?
    • What are the effects of (or associations between) maternal caffeine consumption during lactation on infant (ages 0-6 months) behavior (specifically suckling and sleep) as well as growth?
  • How can we assist women across the BMI spectrum to reach national goals for breastfeeding duration?
    • What are the effects of maternal body composition/weight status on initiation (ever breastfeeds) and duration of breastfeeding?
Additional topics considered by this work group related to maternal probiotic consumption and its effects on human milk composition and infant outcomes; maternal and caregiver predictors of infant dietary quality and factors that predict maternal feeding choices (i.e., to feed human milk at the breast or with a bottle and to feed on demand or on schedule). However, questions were not drafted due to insufficient data to support any systematic reviews at this time.