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Breastfeeding Amps Up Maternal Flu Vax Protection For Infants
Breastfeeding boosted the protective effect of maternal flu vaccination during pregnancy for infants, a large retrospective cohort study showed.
Combined, maternal vaccination plus any exposure to human milk in the first 3 months of life was associated with a 56% lower likelihood of influenza in infants (adjusted odds ratio [aOR] 0.44, 95% CI 0.27-0.70), reported Anne-Marie Rick, MD, MPH, PhD, of the University of Pittsburgh.
Exclusive breastfeeding on top of vaccination exerted an even bigger benefit (aOR 0.37, 95% CI 0.21-0.67), according to findings detailed at the IDWeek annual meeting.
"The key message I'd like to share is that breastfeeding -- any amount of it -- really does work to help protect babies," Rick told MedPage Today. "As clinicians, we can communicate this and try to support our moms in any way we can, because women face so many challenges to breastfeeding."
In the study, maternal vaccination alone was associated with about a 45% reduced odds of infant influenza, while breastfeeding alone was not significantly protective (aOR 0.74, 95% CI 0.49-1.12).
Children younger than 6 months are not eligible for the flu vaccine, despite having a high risk of influenza and its complications, Rick explained. These include hospitalization, need for supplemental oxygen, and secondary bacterial infections (including pneumonia and ear infections).
And while flu deaths among infants are rare in the U.S., infant influenza is a significant cause of morbidity and mortality globally, she said. "We are lucky in the U.S. That this is not something we typically see."
Extant data already suggest that breastfeeding alone can reduce the risk of respiratory infections in infants. But Rick and her colleagues wanted to specifically know how maternal vaccination and breastfeeding work together to protect infants against the flu.
To do so, they queried the University of Pittsburgh's electronic health record database from 2012 to 2019, extracting information on 44,132 mother-infant pairs who had at least two well-child visits during the infants' first year of life. The primary outcome was lab-confirmed influenza during the infant's first 6 months.
About half of the mothers (51.3%) had received the flu vaccine during pregnancy, and this was pretty evenly split across trimesters. Most of the infants of vaccinated women (60.1%) received human milk at some time during the first 3 months of life. Among the unvaccinated pairs, 57.9% received human milk at some time during the first 3 months.
A total of 141 infants (0.3%) developed laboratory-confirmed influenza between birth and 6 months of age. Models adjusted for siblings at home and low socioeconomic status.
The researchers didn't break down the protective effect by vaccine timing. But a prior study, which Rick presented earlier this year at the European Society of Clinical Microbiology and Infectious Diseases, indicated that vaccines given during the second trimester conferred the biggest protective benefit, reducing the risk of infant influenza-like illness by 79%. First-trimester vaccination reduced the risk by 39%, while vaccination during the third trimester did not protect the infant, she said.
This finding probably has to do with the time it takes to manufacture antibodies and then transfer enough of them to build up fetal immunity, she said.
"But we shouldn't be using these data to recommend timing for a maternal vaccine," said Rick. "Pregnant women are at higher risk for influenza and its complications and should get a vaccine on board as soon as possible. The vaccine is meant to protect them, so we don't want to wait to enhance any possible benefit to the baby. Any protection to the child is secondary."
However, the information can be used to help get maternal vaccination rates up, she said, especially given the hesitation among some women and even some ob-gyns about vaccination during the first trimester.
In 2017, researchers at the Marshfield Clinic Research Institute in Wisconsin, Kaiser Permanente, and the CDC, found a doubling of miscarriage in a cohort of women who had the inactivated flu vaccine in 2010-2011 and 2011-2012. While the association was significant, no causative link was found. That study lingers, Rick said, giving some clinicians pause about early pregnancy maternal immunization.
"It's important to know that if you do wait to give it until the second trimester, there is this benefit to the infant," she said, "although we should never advise a woman to wait until then to get vaccinated."
Disclosures
Rick is a consultant for Pfizer on the Pediatric and Maternal Immunization Expert Group, and medical director for the Human Milk Science Institute and Biobank.
Primary Source
IDWeek
Source Reference: Rick AM "Protective effects of maternal influenza vaccine during pregnancy and breastfeeding on risk of infant influenza" IDWeek 2023.
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Common Breastfeeding Problems
Whether you are an experienced mom who has breastfed before, or a new mother nursing for the first time, you may run into a number of common problems.
Although most are not serious enough to keep you from breastfeeding, some can make breastfeeding a more uncomfortable and less fulfilling process for you and your baby.
The good news: Often you only need make a few minor adjustments in technique or style to get your body and your baby in perfect sync. "Breastfeeding should be a pleasurable experience for both mother and baby. If it's not, then it's important to identify the problem early on and make whatever changes are necessary," says Pat Sterner, a lactation counselor at the Mount Sinai Medical Center in New York.
Some of the more common breastfeeding problems - and solutions - follow.
"Many women find that their nipples not only feel sore after every feeding, they are red and pointy instead of round and smooth -- all indications that your baby is not 'latched on' properly," says Sterner.
The "latch" as experts call it, is the way your baby connects to your breast. When done correctly, your baby will open their mouth very wide and take in a good deal of breast tissue. This means that your nipple ends up way in the back of your baby's mouth where the hard and soft palates meet.
"When your nipple is sitting way back there in the hollow, there is nothing to pinch, so it should not cause any nipple soreness at all," Sterner tells WebMD.
If, however, your nipple is sitting in front of your baby's mouth, you're going to feel the pinch every time baby's tongue comes up -- and baby is not going to have an easy time feeding.
The solution, says Sterner, is to insert your finger into the corner of your baby's mouth to break the latch as soon as you feel pain -- and then try latching on again. Ideally, your baby should take at least one inch of your areola into the mouth.
Experts say you can further ease pain by avoiding the use of soap on your breasts, which can be drying and irritating. Instead, wash with plain water. You might also want to let some milk air dry on your breast after feeding, which can help reduce some inflammation and soreness.
To keep nipples soft and supple, try any of the lanolin-based creams specifically for nipple inflammation, such as Lansinoh, Belli Cosmetics Pure Comfort Nursing Cream, or PureLan 100 Nipple Cream by Medela.
Even when your baby is latched on correctly, you may develop a sore or tender spot in your breast, or even a painful lump. Says lactation expert Carol Huotari, this commonly results from a plugged milk duct, or the beginning of an infection known as mastitis.
"Either problem can be easily remedied, and you don't have to stop breastfeeding in the meantime. It's perfectly safe to continue, even when an infection is present," says Huotari, manager of the Breastfeeding Information Center at La Leche League International in Schaumberg, Ill.
If the pain is from a blocked milk duct, experts at La Leche say you should apply moist or dry heat compresses to your breast for 10 minutes, three times a day. Also, massage your breast in a warm shower. As the duct unplugs, you may express some milk, which helps relieve pain. Continuing to feed on that breast is important because breastfeeding helps further open the milk ducts, says Huotari.
Though early treatment will usually prevent a plugged duct from becoming infected, this is not always the case. So if you have pain and tenderness and also find you are fatigued, running a fever, and have some flu-like symptoms, you might have a breast infection.
Normally, says Huotari, the same method used to treat plugged ducts works for an infection -- heat packs, along with bed rest. If your fever does not break in 24 hours, however, you may need an antibiotic to stem the infection. Call your doctor. In the meantime, experts say don't stop breastfeeding.
"Although it may seem counterintuitive to breastfeed while you have an infection, because breast milk contains such a high level of antibodies, your baby is safe," says Huotari.
Yeast infectionis a less troubling but still uncomfortable condition on the surface of the breast skin. This problem can develop even after weeks or months of successful nursing. The culprit is thrush, a form of yeast infection that thrives on milk. This infection will likely affect both you and your baby.
Signs of thrush include red or pink shiny skin that usually itches, and may flake or peel, says pediatrician Audrey Naylor, MD. To learn if your baby is infected, look for white spots on the inside of the cheeks, or sometimes a persistent diaper rash.
You might also find that you have symptoms of a vaginal yeast infection -- a clumpy white discharge and extreme itchiness.
If you do have a breast yeast infection, Naylor says you don't have to stop breastfeeding. But you and your baby do need treatment.
"See your doctor and let her or him make a recommendation for treatment. Don't try to buy a drugstore product and treat the infection yourself," says Naylor. While some products are safe to use while breastfeeding, others are not. Only your doctor will know for certain what is right for you and your baby.
Engorgement is normal and can develop when your milk begins to flood your breasts, usually between the second and sixth day after you start nursing your baby.
"Once milk starts to come into the ducts, there is also a flooding of lymph fluid and blood, which causes the tissue in the breast to swell," says Sterner.
Because that swollen tissue pushes down on the milk ducts, the ducts can sometimes clamp shut. When milk can't be expressed, it builds up inside the breast and engorgement occurs.
Sterner says your best solution is to place cold packs on the breast, along with clean washed cabbage leaves. Leave these on your skin for about 20 minutes. Both can help reduce the swelling and allow the ducts to open.
"Right before you are ready to nurse, put a warm pack on your nipples for a few minutes -- this will also help with the 'let down' [milk flow] and can encourage feeding," says Sterner.
Showers are not recommended when you have engorged breasts, warns Sterner. The warm, pounding water can dilate blood vessels, increasing the swelling and congestion in your breast.
"Most important is to keep on nursing," Huotari tells WebMD. "The more milk that is expressed, the less chance you have of engorgement."
Nursing mothers are often surprised to discover how little their obstetrician or pediatrician knows about breastfeeding problems. Lactation consultant Katy Lebbing, IBCLC, says that as recently as the mid-1990s, a full 50% of medical schools were graduating doctors without a single day's training on breastfeeding.
In one study published in the American Journal of Preventative Medicine, the obstetrical staff of a California hospital answered just 53% of the questions correctly on a simple 15-minute quiz about breastfeeding. Only 14% of the doctors said they felt confidant about their knowledge on this subject.
If you have questions concerning any aspect of breastfeeding, including medical issues about your breast health, you'll often get the right answers fastest by contacting a lactation counselor.
Usually, the hospital where you delivered your baby will have at least one lactation counselor on staff. This counselor may have even visited you shortly after you gave birth to help you begin breastfeeding.
Most lactation counselors are also available for at-home consultations after you leave the hospital. If this isn't the case, they can suggest private practice lactation experts to help you.
Although many people experienced with childbirth, such as doulas and midwives, may be able to help you with breastfeeding, try to find lactation consultants with the initials IBCLC after their names. This stands for International Board of Certified Lactation Consultants.
An alternate credential is RLC -- for registered lactation counselor. Both credentials mean the counselor has received special training and has certified expertise in breastfeeding.
The following organizations can help you find a lactation counselor in your area:
Can Nyquil Make You Sleepy?
Nyquil is a common over-the-counter medication that's formulated to treat nighttime cold and flu symptoms. An antihistamine in Nyquil called doxylamine succinate may cause drowsiness and sleepiness.
In addition to helping alleviate a fever, stuffy nose, and cough, Nyquil can also cause drowsiness. As a result, it may help with sleep.
In this article, we'll look at the Nyquil ingredients that can cause sleepiness, as well as the other potential side effects of this medication and the safety concerns regarding its use as a sleep aid.
There are many Nyquil products to choose from, most of which can cause sleepiness. In general, you'll start to feel drowsy within a half an hour of taking Nyquil.
Nyquil products may contain several or all of the active ingredients listed below at varying doses. Nyquil Severe products tend to contain additional ingredients.
AcetaminophenAcetaminophen is a common pain reliever. It targets symptoms such as minor aches and pains, fever, headache, and sore throat. It carries a low risk of side effects when taken at the recommended dosage.
However, higher doses of acetaminophen can be dangerous. If you take more acetaminophen than is safe for you, it can cause liver damage. The recommended maximum daily dose of acetaminophen is 3,000 milligrams (mg). But the difference between a safe dose and a dose that could harm your liver is very small.
Acetaminophen is sold under many brand names, including Tylenol. It's found in the following Nyquil products:
Dextromethorphan is a cough suppressant. It works by reducing brain signals that trigger coughing.
Although side effects are typically mild, they can include:
Dextromethorphan HBr is found in the following Nyquil products:
Doxylamine succinate is an antihistamine. Antihistamines work by blocking the action of histamine, a substance associated with allergy symptoms.
By targeting histamine, doxylamine succinate helps relieve sneezing, runny nose, and sinus congestion. It causes significant drowsiness, as well as headaches and sinus dryness.
Doxylamine succinate is found in the following Nyquil products:
Phenylephrine HCl is a decongestant. It relieves symptoms associated with sinus congestion, such as a runny nose. It doesn't cause sleepiness. Other side effects include dizziness, headache, and upset stomach.
Phenylephrine HCl is found in the following Nyquil products:
There are no studies examining the safety and effectiveness of Nyquil as a sleep aid.
Some studies have examined the use of antihistamines to help with sleep. According to a 2012 literature review, some first-generation antihistamines may be helpful in treating short-term insomnia.
However, there's relatively little research on doxylamine succinate, the antihistamine that causes drowsiness in Nyquil. The authors of a 2015 literature review concluded that there weren't enough quality studies to determine its safety or effectiveness as a sleep aid.
In addition, doxylamine may cause undesirable side effects, including daytime drowsiness. Other side effects can include:
You can develop tolerance to doxylamine quite quickly, which means that if you take it regularly, its sedative effects won't be as strong.
Given that Nyquil contains additional ingredients that can cause side effects, it's safer to use a less risky nonprescription sleep aid for temporary relief from insomnia.
To take Nyquil safely, follow the instructions on the label. You should always speak with your doctor before taking Nyquil if you:
Since Nyquil causes drowsiness, you shouldn't combine it with other sleep aids, like melatonin for instance. This could cause potentially risky sedative effects, such as shallow breathing.
You should also avoid alcohol when taking Nyquil, as it can increase sleepiness, dizziness, and other side effects. In addition, since Nyquil contains acetaminophen, taking it repeatedly with alcohol can put you at risk of liver damage.
You shouldn't take Nyquil with other drugs that contain acetaminophen, or you risk exceeding the recommended daily dosage.
Lifestyle changes have been shown to help with falling asleep and staying asleep. If you have a hard time getting good quality sleep, try the following:
Most people experience difficulty sleeping from time to time. Talk with your doctor or healthcare provider if your inability to sleep lasts for more than a few weeks or if daytime drowsiness starts to interfere with your responsibilities at work or home.
Nyquil contains the active ingredients acetaminophen, dextromethorphan HBr, doxylamine succinate, and sometimes, phenylephrine HCl. Doxylamine is the main ingredient that causes sleepiness.
There's no evidence to support using Nyquil as a sleep aid. If you're having difficulty sleeping, try to make changes to your bedtime routine, stick to a regular sleep schedule, or talk with your healthcare provider about sleep aids that may help you get the restful sleep you need.
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