Prevalence and management of breastfeeding-related breast complications among postpartum women assisted at a human milk bank in the Brazilian Amazon: a retrospective cross-sectional study

Prevalence and management of breastfeeding-related breast complications among postpartum women assisted at a human milk bank in the Brazilian Amazon: a retrospective cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and management of breastfeeding-related breast complications among postpartum women assisted at a human milk bank in the Brazilian Amazon: a retrospective cross-sectional study Marcelo Tiago Balthazar Corrêa, Josivana Pontes dos Santos, Luciana Botelho Praça Melo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8544732/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Breastfeeding is a cornerstone of maternal and child health, yet its continuation is frequently compromised by breastfeeding-related breast complications during the postpartum period. These conditions are a major cause of early weaning, particularly in socially vulnerable settings. This study aimed to estimate the prevalence of breastfeeding-related breast complications and to analyze factors associated with their management among postpartum women assisted by a human milk bank in the Brazilian Amazon. Methods A retrospective cross-sectional study was conducted using medical records of postpartum women attended at a Human Milk Bank in Porto Velho, Rondônia, Brazil, between January and December 2019. A total of 300 medical records were analyzed. Breast complications—including breast engorgement, mastitis, nipple fissures, and breast abscesses—were assessed as binary outcomes. Sociodemographic characteristics, exclusive breastfeeding, and non-pharmacological management strategies (breast massage, milk expression, correction of infant latch, and positioning) were evaluated as explanatory variables. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were estimated using Poisson regression with robust variance. Results Breast complications were identified in 40.3% of postpartum women, with multiple conditions often occurring in the same individual. The most prevalent conditions were nipple fissures (46.3%) and breast engorgement (40.3%), followed by mastitis (23.0%) and breast abscess (22.0%). Exclusive breastfeeding was associated with a lower prevalence of mastitis (adjusted PR = 0.27; 95% CI: 0.20–0.41) and breast abscess (adjusted PR = 0.47; 95% CI: 0.26–0.85). Non-pharmacological interventions were significantly associated with reduced prevalence of breast complications: breast massage and milk expression were protective against breast engorgement; correction of infant latch reduced nipple fissures; and correction of infant positioning showed a strong protective effect against mastitis. Conclusions Breastfeeding-related breast complications were highly prevalent among postpartum women in the Brazilian Amazon. Early, non-pharmacological interventions delivered by trained health professionals—particularly within human milk banks and primary healthcare services—were strongly associated with reduced prevalence of these conditions. These findings reinforce the importance of structured breastfeeding support to promote exclusive breastfeeding and prevent early weaning in vulnerable populations. Breastfeeding Postpartum period Weaning Maternal and child health Introduction Breastfeeding is widely recognized as a cornerstone of maternal and child health and is strongly recommended as an exclusive feeding practice during the first six months of life. Its benefits extend beyond infancy, contributing to reductions in infant morbidity and mortality, improved maternal health outcomes, and long-term protective effects against chronic diseases. Despite these well-established advantages, the global prevalence of exclusive breastfeeding remains suboptimal, particularly in low- and middle-income countries and socially vulnerable populations. Breastfeeding-related breast complications—such as breast engorgement, nipple fissures, mastitis, and breast abscesses—are among the most common challenges encountered during the postpartum period and represent a major cause of early breastfeeding discontinuation. These conditions are often associated with pain, discomfort, and functional difficulties that negatively affect maternal confidence and breastfeeding self-efficacy. Evidence suggests that such complications are most frequent during the first weeks postpartum, a critical period for establishing and maintaining exclusive breastfeeding. Previous studies have demonstrated that non-pharmacological management strategies—including breast massage, milk expression, correction of infant latch, and proper positioning—are effective in preventing and managing breastfeeding-related breast complications. When appropriately implemented, these interventions can reduce symptom severity, prevent disease progression, and support breastfeeding continuation. However, the successful application of these strategies largely depends on timely access to trained health professionals and structured breastfeeding support services. Human milk banks and primary healthcare services play a central role in promoting, protecting, and supporting breastfeeding, particularly within public health systems. In Brazil, human milk banks are internationally recognized as a cost-effective public health strategy, offering clinical management of breastfeeding complications, maternal education, and support for exclusive breastfeeding. Nevertheless, there is limited epidemiological evidence regarding the prevalence of breastfeeding-related breast complications and the effectiveness of their management within these services, especially in socially vulnerable and geographically underrepresented regions. The Brazilian Amazon presents unique challenges to maternal and child healthcare, including social inequalities, limited access to specialized services, and geographic barriers that may exacerbate breastfeeding difficulties. Despite these contextual vulnerabilities, data on breastfeeding-related breast complications and their management in this region remain scarce. Understanding the epidemiology of these conditions and the effectiveness of clinical interventions within real-world public health settings is essential to inform policies and strengthen breastfeeding support strategies. Therefore, this study aimed to estimate the prevalence of breastfeeding-related breast complications and to analyze factors associated with their management among postpartum women assisted by a human milk bank in the Brazilian Amazon. By providing evidence from a public healthcare setting in a vulnerable region, this study seeks to contribute to the optimization of breastfeeding support practices and the prevention of early weaning. Methods Study design and setting This retrospective cross-sectional study was conducted using secondary data obtained from medical records of postpartum women assisted at the Human Milk Bank Santa Ágata, located at a referral hospital for high-risk pregnancies in Porto Velho, Rondônia, Brazil. Porto Velho is situated in the Western Brazilian Amazon, a region characterized by social vulnerabilities, geographic barriers, and limited access to specialized maternal and child healthcare services. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies. Study period and population Medical records from January to December 2019 were reviewed. During this period, 1,260 postpartum women were assisted at the human milk bank. For the present analysis, records were considered eligible if they contained complete information on breastfeeding-related breast complications and clinical management. Records with missing, illegible, or inconsistent data were excluded. Sample size Sample size was calculated using Epi Info™ software (version 7.2.6.0), assuming a conservative prevalence of 50% for breastfeeding-related breast complications, a 5% margin of error, and a 95% confidence level. The minimum required sample size was estimated at 300 records. The final sample achieved a statistical power of 95%, with a significance level set at 5%. Variables The primary outcomes were breastfeeding-related breast complications, categorized as binary variables (presence or absence): breast engorgement, mastitis, nipple fissures, and breast abscess. Explanatory variables included maternal age (≤ 19 years, 20–39 years, > 39 years), infant age (≤ 27 days, 28–60 days, > 60 days), exclusive breastfeeding (yes/no), and non-pharmacological management strategies documented in the medical records. These strategies included breast massage, milk expression (manual or using breast pumps), correction of infant latch, and correction of infant positioning during breastfeeding. Data collection and management Data were extracted from physical medical records using standardized forms to ensure consistency and minimize transcription errors. The collected information was organized into a database created specifically for this study and subsequently checked for completeness and internal consistency prior to analysis. Statistical analysis Descriptive analyses were performed using absolute and relative frequencies for categorical variables. Continuous variables were assessed for normality using the Shapiro–Wilk test and are presented as medians and interquartile ranges (IQR). Bivariate analyses were conducted using the chi-square test to evaluate associations between explanatory variables and breastfeeding-related breast complications. Variables with a p-value < 0.20 in the bivariate analysis were included in multivariable models. Multivariable analyses were performed using Poisson regression with robust variance estimation to calculate adjusted prevalence ratios (PR) and 95% confidence intervals (95% CI). This approach was chosen due to the high prevalence of the outcomes, providing more appropriate and interpretable estimates than odds ratios. A hierarchical modeling strategy was adopted, initially including distal variables (maternal and infant age), followed by proximal variables related to breastfeeding practices and clinical management. Variables with p-values < 0.05 were retained in the final models. All statistical analyses were performed using Epi Info™ (version 7.2.6), SPSS (version 27.0), and Stata (version 11.0). Ethical considerations The study was approved by the Research Ethics Committee of the Federal University of Rondônia (Comitê de Ética em Pesquisa – CEP/UNIR), under approval number 3.960.705 (CAAE: 29949920.8.0000.5300). As this study used secondary data from medical records, the requirement for informed consent was waived by the Ethics Committee. All procedures were conducted in accordance with national and international ethical standards. Results A total of 300 medical records of postpartum women met the eligibility criteria and were included in the analysis. Exclusive breastfeeding was reported in 59.7% of the women. Most participants were aged between 20 and 39 years (88.3%), with a median maternal age of 28 years (IQR: 22–34). The majority of infants were aged ≤27 days at the time of consultation (80.3%), with a median age of 13 days (IQR: 6–34). Breastfeeding-related breast complications were frequent in the study population. Breast engorgement was identified in 40.3% of women, while nipple fissures were the most prevalent condition, affecting 46.3%. Mastitis occurred in 23.0% of postpartum women, and breast abscesses were documented in 22.0%. Regarding clinical management, correction of infant latch was the most frequently recorded intervention (64.7%), followed by breast massage (59.3%), correction of infant positioning (52.3%), and milk expression (37.0%). Table 1 presents the sociodemographic characteristics, breastfeeding practices, breast complications, and clinical management of the study population. Table 1. Sociodemographic characteristics, breastfeeding practices, breast complications, and clinical management among postpartum women assisted at a human milk bank in the Brazilian Amazon (n = 300) Variables Median Interquartile Range Maternal age (years)* 28.00 22.00 – 34.00 Infant age (days)* 13.00 6.00 – 34.00 n % Maternal age (years) ≤19 18 6.0 20–39 265 88.3 >39 17 5.7 Infant age (days) ≤27 days 241 80.3 28–60 days 44 14.7 >60 days 15 5.0 Exclusive breastfeeding Yes 179 59.7 No 121 40.3 Breast complications Breast engorgement Yes 121 40.3 No 179 59.7 Mastitis Yes 69 23.0 No 231 77.0 Nipple fissure Yes 139 46.3 No 161 53.7 Breast abscess Yes 66 22.0 No 234 78.0 Clinical management strategies Breast massage Yes 178 59.3 No 122 40.7 Milk expression Yes 111 37.0 No 189 63.0 Correction of infant latch Yes 194 64.7 No 106 35.3 Correction of infant positioning Yes 157 52.3 No 143 47.7 * Continuous variables are presented as median and interquartile range (IQR). Categorical variables are presented as absolute (n) and relative (%) frequencies. Bivariate analysis In bivariate analyses, exclusive breastfeeding was associated with a lower prevalence of mastitis and breast abscesses. Women who exclusively breastfed had a 69% lower prevalence of mastitis (PR = 0.31; 95% CI: 0.20–0.43) and a 55% lower prevalence of breast abscesses (PR = 0.45; 95% CI: 0.25–0.81) compared with those who did not exclusively breastfeed. Maternal age was not significantly associated with any breastfeeding-related breast complications. Non-pharmacological interventions were associated with reduced prevalence of several breast complications. Breast massage and milk expression were associated with lower prevalence of breast engorgement. Milk expression and correction of infant latch were associated with a reduced prevalence of nipple fissures. Correction of infant positioning was strongly associated with lower prevalence of mastitis and breast abscesses. The crude associations between maternal characteristics, breastfeeding practices, non-pharmacological management strategies, and breastfeeding-related breast complications are presented in Table 2. Table 2. Crude prevalence ratios of breastfeeding-related breast complications according to maternal characteristics, breastfeeding practices, and non-pharmacological management strategies Variables Breast engorgement Mastitis Nipple fissure Breast abscess Yes No Crude PR (95% CI) p-value Yes No Crude PR (95% CI) p-value Yes No Crude PR (95% CI) p-value Yes No Crude PR (95% CI) p-value n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) Maternal age ≤ 20 years 24(40.7) 35(59.3) 1.01(0.71-1.42) 0.952 14(23.7) 45(76.3) 1.04(0.62-1.73) 0.882 26(44.1) 33(55.9) 0.94(0.68-1.29) 0.702 13(22.0) 46(78.0) 1.00(0.58-1.71) 0.994 >20 years 97(40.2) 144(59.8) 1 55(22.8) 186(77.2) 1 113(46.9) 128(53.1) 1 53(22.0) 188(78.0) Exclusive breastfeeding Yes 77(43.0) 102(57.0) 0.84 (0.63-1.13) 0.256 47(26.3) 132(73.7) 0.31 (0.20-0.43) 0.030* 87(48.6) 92(51.4) 0.88 (0.68-1.14) 0.343 44(24.6) 135(75.4) 0.45 (0.25-0.81) 0.040* No 44(36.4) 77(63.6) 1 22(18.2) 99(81.8) 1 52(43.0) 69(57.0) 1 22(18.2) 99(81.8) 1 Breast massage Yes 88(49.4) 90(50.6) 0.54 (0.39-0.75) 0.001* 40(22.5) 138(77.5) 1.05 (0.69-1.60) 0.793 89(50.0) 89 (50.0) 0.82 (0.63-1.06) 0.132 36(20.2) 142(79.8) 1.21 (0.79-1.86) 0.369 No 33(27.0) 89(73.0) 1 29(23.8) 93(76.2) 1 50(41.0) 72(59.0) 1 30(24.6) 92(75.4) 1 Milk expression Yes 58(52.3) 53(47.7) 0.63 (0.48-0.83) 0.001* 20(18.0) 91(82.0) 0.69 (0.43-1.10) 0.125 60(54.1) 51(45.9) 0.77 (0.60-0.98) 0.036* 17(15.3) 94(84.7) 0.59 (0.35-0.97) 0.039* No 63(33.3) 126(66.7) 1 49(25.9) 140(74.1) 1 79(41.8) 110(58.2) 1 49(25.9) 140(74.1) 1 Correction of infant latch Yes 82(42.3) 112(57.7) 0.66 (0.41-0.91) 0.031* 41(21.1) 153(78.9) 0.80 (0.52-1.21) 0.296 105(54.1) 89(45.9) 0.59 (0.43-0.80) 0.001* 41(21.1) 153(78.9) 1.11 (0.72-1.72) 0.623 No 39(36.8) 67(63.2) 1 28(26.4) 78(73.6) 1 34(32.1) 72(67.9) 1 25(23.6) 81(76.4) Correction of infant positioning Yes 49(31.2) 108(68.8) 0.62 (0.46-0.82) 0.001* 9(5.7) 148(94.3) 0.14 (0.07-0.26) <0.001** 72(45.9) 85(54.1) 0.97 (0.76-1.24) 0.863 9(5.7) 148(94.3) 0.14 (0.07-0.28) < 0.001** No 72(50.3) 71(49.7) 1 60(42.0) 83(58.0) 1 67(46.9) 76(53.1) 1 57(39.9) 86(60.1) 1 Abbreviations: PR, prevalence ratio; CI, confidence interval. * p < 0.05; ** p < 0.001. Multivariable analysis After adjustment in multivariable Poisson regression models, several management strategies remained significantly associated with reduced prevalence of breastfeeding-related breast complications. Breast massage was associated with a 45% reduction in the prevalence of breast engorgement (adjusted PR = 0.55; 95% CI: 0.39–0.76), while milk expression reduced the prevalence of breast engorgement by 54% (adjusted PR = 0.46; 95% CI: 0.28–0.74). Exclusive breastfeeding showed a strong protective effect against more severe complications. Women who exclusively breastfed had a 73% lower prevalence of mastitis (adjusted PR = 0.27; 95% CI: 0.20–0.41) and a 53% lower prevalence of breast abscesses (adjusted PR = 0.47; 95% CI: 0.26–0.85). Correction of infant positioning was also strongly associated with a reduced prevalence of mastitis (adjusted PR = 0.11; 95% CI: 0.05–0.25). Regarding nipple fissures, correction of infant latch was associated with a 60% reduction in prevalence (adjusted PR = 0.40; 95% CI: 0.24–0.67), while milk expression reduced the prevalence by 39% (adjusted PR = 0.61; 95% CI: 0.38–0.97). Milk expression was also associated with a reduced prevalence of breast abscesses (adjusted PR = 0.52; 95% CI: 0.28–0.95). The adjusted prevalence ratios for breastfeeding-related breast complications are shown in Table 3. Table 3. Adjusted prevalence ratios of breastfeeding-related breast complications associated with exclusive breastfeeding and non-pharmacological management strategies breast problem aPR 95% CI p-value Breast engorgement Breast massage Yes 0.55 0.39-0.76 <0.001** No 1 Milk expression Yes 0.46 0.28-0.74 0.001* No 1 Correction of infant latch Yes 0.78 0.48-0.98 0.032* No 1 Correction of infant positioning Yes 0.49 0.21-0.77 0.007* No 1 Mastitis Exclusive breastfeeding Yes 0.27 0.20-0.41 0.002* No 1 Correction of infant positioning Yes 0.11 0.05-0.25 0.001* No 1 Nipple fissure Milk expression Yes 0.61 0.38-0.97 0.039* No 1 Correction of infant latch Yes 0.40 0.24-0.67 <0.001** No 1 Breast abscess Exclusive breastfeeding Yes 0.47 0.26-0.85 0.039* No 1 Milk expression Yes 0.52 0.28-0.95 0.034* No 1 Abbreviations: aPR, adjusted prevalence ratio; CI, confidence interval. * p < 0.05; ** p < 0.001. Discussion This study demonstrated a high prevalence of breastfeeding-related breast complications among postpartum women assisted at a human milk bank in the Brazilian Amazon, with nipple fissures and breast engorgement being the most frequent conditions. These findings reinforce the vulnerability of the early postpartum period and highlight breast complications as an important barrier to the maintenance of exclusive breastfeeding, particularly in socially and geographically vulnerable settings [1–3]. The prevalence of breast complications observed in this study is consistent with reports from low- and middle-income countries, where breastfeeding difficulties frequently emerge during the first weeks postpartum [4–6]. Nipple fissures and breast engorgement are often early manifestations of inadequate breastfeeding techniques and, when not properly managed, may progress to more severe conditions such as mastitis and breast abscesses [5,7]. The high frequency of these complications underscores the importance of early identification and timely clinical management within postpartum care services. A key finding of this study is the strong protective effect of exclusive breastfeeding against severe breast complications, particularly mastitis and breast abscesses. Exclusive breastfeeding likely contributes to effective breast emptying, reducing milk stasis—a central mechanism in the development of inflammatory and infectious breast conditions [8–10]. This protective association is consistent with previous studies demonstrating that interruptions in breastfeeding and ineffective milk removal increase the risk of mastitis and abscess formation [9,11]. Non-pharmacological management strategies delivered by trained health professionals were consistently associated with reduced prevalence of breastfeeding-related breast complications. Breast massage and milk expression were particularly effective in reducing breast engorgement, supporting evidence that these techniques facilitate milk flow and prevent ductal obstruction [12–14]. Correction of infant latch showed a substantial protective effect against nipple fissures, corroborating findings that improper latch is a primary cause of nipple trauma and pain during breastfeeding [15,16]. Furthermore, correction of infant positioning demonstrated a strong association with reduced prevalence of mastitis, highlighting that breastfeeding biomechanics play a crucial role in preventing inflammatory breast conditions [9,17]. These findings emphasize the central role of structured breastfeeding support services, such as human milk banks and primary healthcare facilities, in preventing and managing breastfeeding-related breast complications [18]. In Brazil, human milk banks are internationally recognized as a cost-effective public health strategy that integrates clinical management, maternal education, and breastfeeding promotion [19]. The effectiveness of simple, low-cost, non-pharmacological interventions observed in this study reinforces their potential scalability within public health systems, particularly in resource-limited settings [20]. The regional context of the Brazilian Amazon adds an important dimension to the interpretation of these results. Social inequalities, geographic barriers, and limited access to specialized maternal care may exacerbate breastfeeding difficulties and delay appropriate interventions [21,22]. Evidence generated from real-world public health services in underrepresented regions is essential to inform context-specific policies and strengthen maternal and child health programs. The present study contributes to filling this gap by providing epidemiological data and practical insights into breastfeeding management in a vulnerable population. Some limitations should be considered when interpreting these findings. The retrospective cross-sectional design precludes causal inference and relies on the accuracy and completeness of medical records. Additionally, the study was conducted in a single human milk bank, which may limit generalizability to other settings. However, the use of standardized clinical records, a robust analytical approach appropriate for prevalent outcomes, and a well-defined sample strengthen the internal validity of the findings. Despite these limitations, this study has notable strengths. It addresses a relevant and underexplored public health issue, employs appropriate statistical methods, and provides evidence directly applicable to clinical practice. By focusing on non-pharmacological interventions delivered within routine healthcare services, the findings offer practical guidance for improving breastfeeding support and preventing early weaning. In conclusion, breastfeeding-related breast complications were highly prevalent among postpartum women in the Brazilian Amazon. Early, non-pharmacological interventions—particularly exclusive breastfeeding support, correction of infant latch and positioning, breast massage, and milk expression—were strongly associated with reduced prevalence of these conditions. Strengthening structured breastfeeding support within human milk banks and primary healthcare services is essential to promote exclusive breastfeeding, prevent maternal morbidity, and reduce early weaning, especially in socially vulnerable populations. Declarations Author contributions: J.P.S. and L.B.P.M. conceived and designed the study and were responsible for data collection. E.S.F. performed the data analysis and contributed to data interpretation. M.T.B.C. contributed to the discussion and interpretation of the results. L.M.S.J., J.P.S., and L.B.P.M. drafted the manuscript and critically revised its intellectual content. All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work. Funding: The authors received no specific funding for this study. Data availability: The datasets used and/or analyzed during the current study are not publicly available due to ethical and legal restrictions, as they contain sensitive personal information derived from medical records. Data are available from the corresponding author upon reasonable request and with permission of the relevant institutional ethics committee. Consent for publication: Not applicable Competing interests: The authors declare that they have no competing interests. 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Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review. Int Breastfeed J . 2020;15(1):70. https://doi.org/10.1186/s13006-020-00313-9 Marques BL, Tomasi YT, Saraiva SS, Boing AF, Geremia DS. Orientações às gestantes no pré-natal: a importância do cuidado compartilhado na atenção primária em saúde. Esc Anna Nery . 2021;25(1):e20200098. https://doi.org/10.1590/2177-9465-EAN-2020-0098 Ministério da Saúde (Brasil). Amamentação com foco na redução de desigualdades . Brasília: Ministério da Saúde; 2024. Muller EV, Martins CM, Borges PKO. Prevalence of anxiety and depression disorder and associated factors during postpartum in puerperal women. Rev Bras Saude Mater Infant . 2021;21(4):995–1004. https://doi.org/10.1590/1806-93042021000400003 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 08 Apr, 2026 Reviewers agreed at journal 15 Feb, 2026 Reviewers invited by journal 04 Feb, 2026 Editor invited by journal 14 Jan, 2026 Editor assigned by journal 12 Jan, 2026 Submission checks completed at journal 12 Jan, 2026 First submitted to journal 07 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8544732","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587221700,"identity":"079c1f06-4e40-4038-bd2b-d7eff5f9c09b","order_by":0,"name":"Marcelo Tiago Balthazar Corrêa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYNCCAjjLBkIxNhDSYgBnpZGu5TBhLbrtZx9++GBgw8Df3vvsw4ea84nb2dufPWDccQ+nFrMz6caSMwzSGCTOHDeeOePY7cSdPWfMDRjPFOPWciCNjZnH4DCDgUQaMzMP2+3EDTdy2CQY2xJwazn/jI35D0zLn3/nEjfcf/4Mv5YbQFsYYFoY2w4AbWEwI6DlGbNkj0Eaj8SZY8yMvX3JxhvO5JgbJJ7B57A0xg8/Kmzk+NvbmBl+fLOT3XD8+LMHH3fg1gIDPMgcNgbCGtAAG6kaRsEoGAWjYHgDACVMUdlvBkT1AAAAAElFTkSuQmCC","orcid":"","institution":"São Paulo State University","correspondingAuthor":true,"prefix":"","firstName":"Marcelo","middleName":"Tiago Balthazar","lastName":"Corrêa","suffix":""},{"id":587221702,"identity":"872056e7-3429-4f80-895e-9c2d670a2e96","order_by":1,"name":"Josivana Pontes dos Santos","email":"","orcid":"","institution":"Federal University of Rondônia","correspondingAuthor":false,"prefix":"","firstName":"Josivana","middleName":"Pontes dos","lastName":"Santos","suffix":""},{"id":587221704,"identity":"73dfc2b0-e711-4df6-8a89-4b9ce4306730","order_by":2,"name":"Luciana Botelho Praça Melo","email":"","orcid":"","institution":"Federal University of Rondônia","correspondingAuthor":false,"prefix":"","firstName":"Luciana","middleName":"Botelho Praça","lastName":"Melo","suffix":""},{"id":587221707,"identity":"839c34c3-4e19-40aa-a57f-95bd1cf3d4e7","order_by":3,"name":"Leila Matos da Silva Jacob","email":"","orcid":"","institution":"Federal University of Rondônia","correspondingAuthor":false,"prefix":"","firstName":"Leila","middleName":"Matos da Silva","lastName":"Jacob","suffix":""},{"id":587221709,"identity":"0014ccfc-56e1-44d8-9a7e-25912b15719b","order_by":4,"name":"Edson dos Santos Farias","email":"","orcid":"","institution":"Federal University of Rondônia","correspondingAuthor":false,"prefix":"","firstName":"Edson","middleName":"dos Santos","lastName":"Farias","suffix":""}],"badges":[],"createdAt":"2026-01-07 19:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8544732/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8544732/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102296846,"identity":"84446443-7108-49f9-9fc7-4ff597c6dbd7","added_by":"auto","created_at":"2026-02-10 10:22:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1258361,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8544732/v1/19794a18-0947-4702-b67d-11bee19fc804.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and management of breastfeeding-related breast complications among postpartum women assisted at a human milk bank in the Brazilian Amazon: a retrospective cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreastfeeding is widely recognized as a cornerstone of maternal and child health and is strongly recommended as an exclusive feeding practice during the first six months of life. Its benefits extend beyond infancy, contributing to reductions in infant morbidity and mortality, improved maternal health outcomes, and long-term protective effects against chronic diseases. Despite these well-established advantages, the global prevalence of exclusive breastfeeding remains suboptimal, particularly in low- and middle-income countries and socially vulnerable populations.\u003c/p\u003e \u003cp\u003eBreastfeeding-related breast complications\u0026mdash;such as breast engorgement, nipple fissures, mastitis, and breast abscesses\u0026mdash;are among the most common challenges encountered during the postpartum period and represent a major cause of early breastfeeding discontinuation. These conditions are often associated with pain, discomfort, and functional difficulties that negatively affect maternal confidence and breastfeeding self-efficacy. Evidence suggests that such complications are most frequent during the first weeks postpartum, a critical period for establishing and maintaining exclusive breastfeeding.\u003c/p\u003e \u003cp\u003ePrevious studies have demonstrated that non-pharmacological management strategies\u0026mdash;including breast massage, milk expression, correction of infant latch, and proper positioning\u0026mdash;are effective in preventing and managing breastfeeding-related breast complications. When appropriately implemented, these interventions can reduce symptom severity, prevent disease progression, and support breastfeeding continuation. However, the successful application of these strategies largely depends on timely access to trained health professionals and structured breastfeeding support services.\u003c/p\u003e \u003cp\u003eHuman milk banks and primary healthcare services play a central role in promoting, protecting, and supporting breastfeeding, particularly within public health systems. In Brazil, human milk banks are internationally recognized as a cost-effective public health strategy, offering clinical management of breastfeeding complications, maternal education, and support for exclusive breastfeeding. Nevertheless, there is limited epidemiological evidence regarding the prevalence of breastfeeding-related breast complications and the effectiveness of their management within these services, especially in socially vulnerable and geographically underrepresented regions.\u003c/p\u003e \u003cp\u003eThe Brazilian Amazon presents unique challenges to maternal and child healthcare, including social inequalities, limited access to specialized services, and geographic barriers that may exacerbate breastfeeding difficulties. Despite these contextual vulnerabilities, data on breastfeeding-related breast complications and their management in this region remain scarce. Understanding the epidemiology of these conditions and the effectiveness of clinical interventions within real-world public health settings is essential to inform policies and strengthen breastfeeding support strategies.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to estimate the prevalence of breastfeeding-related breast complications and to analyze factors associated with their management among postpartum women assisted by a human milk bank in the Brazilian Amazon. By providing evidence from a public healthcare setting in a vulnerable region, this study seeks to contribute to the optimization of breastfeeding support practices and the prevention of early weaning.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003e This retrospective cross-sectional study was conducted using secondary data obtained from medical records of postpartum women assisted at the Human Milk Bank Santa \u0026Aacute;gata, located at a referral hospital for high-risk pregnancies in Porto Velho, Rond\u0026ocirc;nia, Brazil. Porto Velho is situated in the Western Brazilian Amazon, a region characterized by social vulnerabilities, geographic barriers, and limited access to specialized maternal and child healthcare services.\u003c/p\u003e \u003cp\u003e The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy period and population\u003c/h3\u003e\n\u003cp\u003eMedical records from January to December 2019 were reviewed. During this period, 1,260 postpartum women were assisted at the human milk bank. For the present analysis, records were considered eligible if they contained complete information on breastfeeding-related breast complications and clinical management. Records with missing, illegible, or inconsistent data were excluded.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eSample size was calculated using Epi Info\u0026trade; software (version 7.2.6.0), assuming a conservative prevalence of 50% for breastfeeding-related breast complications, a 5% margin of error, and a 95% confidence level. The minimum required sample size was estimated at 300 records. The final sample achieved a statistical power of 95%, with a significance level set at 5%.\u003c/p\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe primary outcomes were breastfeeding-related breast complications, categorized as binary variables (presence or absence): breast engorgement, mastitis, nipple fissures, and breast abscess.\u003c/p\u003e \u003cp\u003eExplanatory variables included maternal age (\u0026le;\u0026thinsp;19 years, 20\u0026ndash;39 years, \u0026gt;\u0026thinsp;39 years), infant age (\u0026le;\u0026thinsp;27 days, 28\u0026ndash;60 days, \u0026gt;\u0026thinsp;60 days), exclusive breastfeeding (yes/no), and non-pharmacological management strategies documented in the medical records. These strategies included breast massage, milk expression (manual or using breast pumps), correction of infant latch, and correction of infant positioning during breastfeeding.\u003c/p\u003e\n\u003ch3\u003eData collection and management\u003c/h3\u003e\n\u003cp\u003eData were extracted from physical medical records using standardized forms to ensure consistency and minimize transcription errors. The collected information was organized into a database created specifically for this study and subsequently checked for completeness and internal consistency prior to analysis.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive analyses were performed using absolute and relative frequencies for categorical variables. Continuous variables were assessed for normality using the Shapiro\u0026ndash;Wilk test and are presented as medians and interquartile ranges (IQR).\u003c/p\u003e \u003cp\u003eBivariate analyses were conducted using the chi-square test to evaluate associations between explanatory variables and breastfeeding-related breast complications. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in the bivariate analysis were included in multivariable models.\u003c/p\u003e \u003cp\u003eMultivariable analyses were performed using Poisson regression with robust variance estimation to calculate adjusted prevalence ratios (PR) and 95% confidence intervals (95% CI). This approach was chosen due to the high prevalence of the outcomes, providing more appropriate and interpretable estimates than odds ratios. A hierarchical modeling strategy was adopted, initially including distal variables (maternal and infant age), followed by proximal variables related to breastfeeding practices and clinical management. Variables with p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were retained in the final models.\u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using Epi Info\u0026trade; (version 7.2.6), SPSS (version 27.0), and Stata (version 11.0).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Research Ethics Committee of the Federal University of Rond\u0026ocirc;nia (Comit\u0026ecirc; de \u0026Eacute;tica em Pesquisa \u0026ndash; CEP/UNIR), under approval number 3.960.705 (CAAE: 29949920.8.0000.5300). As this study used secondary data from medical records, the requirement for informed consent was waived by the Ethics Committee. All procedures were conducted in accordance with national and international ethical standards.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 300 medical records of postpartum women met the eligibility criteria and were included in the analysis. Exclusive breastfeeding was reported in 59.7% of the women. Most participants were aged between 20 and 39 years (88.3%), with a median maternal age of 28 years (IQR: 22\u0026ndash;34). The majority of infants were aged \u0026le;27 days at the time of consultation (80.3%), with a median age of 13 days (IQR: 6\u0026ndash;34).\u003c/p\u003e\n\u003cp\u003eBreastfeeding-related breast complications were frequent in the study population. Breast engorgement was identified in 40.3% of women, while nipple fissures were the most prevalent condition, affecting 46.3%. Mastitis occurred in 23.0% of postpartum women, and breast abscesses were documented in 22.0%. Regarding clinical management, correction of infant latch was the most frequently recorded intervention (64.7%), followed by breast massage (59.3%), correction of infant positioning (52.3%), and milk expression (37.0%).\u003c/p\u003e\n\u003cp\u003eTable 1 presents the sociodemographic characteristics, breastfeeding practices, breast complications, and clinical management of the study population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Sociodemographic characteristics, breastfeeding practices, breast complications, and clinical management among postpartum women assisted at a human milk bank in the Brazilian Amazon (n = 300)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterquartile Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eMaternal age (years)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e22.00 \u0026ndash; 34.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eInfant age (days)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e13.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e6.00 \u0026ndash; 34.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u0026le;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e6.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e20\u0026ndash;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e88.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u0026gt;39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfant age (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u0026le;27 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e80.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e28\u0026ndash;60 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u0026gt;60 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusive breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e59.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast engorgement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e40.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e59.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e23.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e77.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNipple fissure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e46.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast abscess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e78.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical management strategies\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast massage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e59.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e40.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMilk expression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e63.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant latch\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e64.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant positioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4231%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33.4936%;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.0833%;\"\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e* Continuous variables are presented as median and interquartile range (IQR). Categorical variables are presented as absolute (n) and relative (%) frequencies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn bivariate analyses, exclusive breastfeeding was associated with a lower prevalence of mastitis and breast abscesses. Women who exclusively breastfed had a 69% lower prevalence of mastitis (PR = 0.31; 95% CI: 0.20\u0026ndash;0.43) and a 55% lower prevalence of breast abscesses (PR = 0.45; 95% CI: 0.25\u0026ndash;0.81) compared with those who did not exclusively breastfeed. Maternal age was not significantly associated with any breastfeeding-related breast complications.\u003c/p\u003e\n\u003cp\u003eNon-pharmacological interventions were associated with reduced prevalence of several breast complications. Breast massage and milk expression were associated with lower prevalence of breast engorgement. Milk expression and correction of infant latch were associated with a reduced prevalence of nipple fissures. Correction of infant positioning was strongly associated with lower prevalence of mastitis and breast abscesses.\u003c/p\u003e\n\u003cp\u003eThe crude associations between maternal characteristics, breastfeeding practices, non-pharmacological management strategies, and breastfeeding-related breast complications are presented in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Crude prevalence ratios of breastfeeding-related breast complications according to maternal characteristics, breastfeeding practices, and non-pharmacological management strategies\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"1106\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u003cstrong\u003eBreast engorgement\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastitis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNipple fissure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast abscess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eCrude PR\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eCrude PR\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCrude PR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCrude PR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026le; 20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e24(40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e35(59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.01(0.71-1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e14(23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e45(76.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.04(0.62-1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e26(44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e33(55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.94(0.68-1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e13(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e46(78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.00(0.58-1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.994\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026gt;20 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e97(40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e144(59.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e55(22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e186(77.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e113(46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e128(53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e53(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e188(78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusive breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e77(43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e102(57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003cp\u003e(0.63-1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e47(26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e132(73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003cp\u003e(0.20-0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.030*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e87(48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e92(51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003cp\u003e(0.68-1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e44(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e135(75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003cp\u003e(0.25-0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.040*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e44(36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e77(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e22(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e99(81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e52(43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e69(57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e22(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e99(81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast massage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e88(49.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e90(50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003cp\u003e(0.39-0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e40(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e138(77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003cp\u003e(0.69-1.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e89(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e89 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003cp\u003e(0.63-1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e36(20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e142(79.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003cp\u003e(0.79-1.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.369\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e33(27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e89(73.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e29(23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e93(76.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e50(41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e72(59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e92(75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMilk expression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e58(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e53(47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003cp\u003e(0.48-0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e20(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e91(82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003cp\u003e(0.43-1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e60(54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e51(45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003cp\u003e(0.60-0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.036*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e17(15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e94(84.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003cp\u003e(0.35-0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e63(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e126(66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e49(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e140(74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e79(41.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e110(58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e49(25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e140(74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant latch\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e82(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e112(57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003cp\u003e(0.41-0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e41(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e153(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003cp\u003e(0.52-1.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e105(54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e89(45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003cp\u003e(0.43-0.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e41(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e153(78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003cp\u003e(0.72-1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.623\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e39(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e67(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e28(26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e78(73.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e34(32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e72(67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e25(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e81(76.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant positioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e49(31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e108(68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003cp\u003e(0.46-0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e148(94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003cp\u003e(0.07-0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e72(45.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e85(54.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003cp\u003e(0.76-1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e9(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e148(94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003cp\u003e(0.07-0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026lt;\u003cstrong\u003e0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e72(50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e71(49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e60(42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e83(58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e67(46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e76(53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e57(39.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e86(60.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: PR, prevalence ratio; CI, confidence interval. * p \u0026lt; 0.05; ** p \u0026lt; 0.001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariable analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter adjustment in multivariable Poisson regression models, several management strategies remained significantly associated with reduced prevalence of breastfeeding-related breast complications. Breast massage was associated with a 45% reduction in the prevalence of breast engorgement (adjusted PR = 0.55; 95% CI: 0.39\u0026ndash;0.76), while milk expression reduced the prevalence of breast engorgement by 54% (adjusted PR = 0.46; 95% CI: 0.28\u0026ndash;0.74).\u003c/p\u003e\n\u003cp\u003eExclusive breastfeeding showed a strong protective effect against more severe complications. Women who exclusively breastfed had a 73% lower prevalence of mastitis (adjusted PR = 0.27; 95% CI: 0.20\u0026ndash;0.41) and a 53% lower prevalence of breast abscesses (adjusted PR = 0.47; 95% CI: 0.26\u0026ndash;0.85). Correction of infant positioning was also strongly associated with a reduced prevalence of mastitis (adjusted PR = 0.11; 95% CI: 0.05\u0026ndash;0.25).\u003c/p\u003e\n\u003cp\u003eRegarding nipple fissures, correction of infant latch was associated with a 60% reduction in prevalence (adjusted PR = 0.40; 95% CI: 0.24\u0026ndash;0.67), while milk expression reduced the prevalence by 39% (adjusted PR = 0.61; 95% CI: 0.38\u0026ndash;0.97). Milk expression was also associated with a reduced prevalence of breast abscesses (adjusted PR = 0.52; 95% CI: 0.28\u0026ndash;0.95).\u003c/p\u003e\n\u003cp\u003eThe adjusted prevalence ratios for breastfeeding-related breast complications are shown in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Adjusted prevalence ratios of breastfeeding-related breast complications associated with exclusive breastfeeding and non-pharmacological management strategies\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003ebreast problem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eaPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast engorgement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast massage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.39-0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMilk expression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.28-0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant latch\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.48-0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant positioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.21-0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMastitis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusive breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.20-0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant positioning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.05-0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNipple fissure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMilk expression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.38-0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrection of infant latch\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.24-0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreast abscess\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusive breastfeeding\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.26-0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMilk expression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.28-0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.034*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: aPR, adjusted prevalence ratio; CI, confidence interval. * p \u0026lt; 0.05; ** p \u0026lt; 0.001.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrated a high prevalence of breastfeeding-related breast complications among postpartum women assisted at a human milk bank in the Brazilian Amazon, with nipple fissures and breast engorgement being the most frequent conditions. These findings reinforce the vulnerability of the early postpartum period and highlight breast complications as an important barrier to the maintenance of exclusive breastfeeding, particularly in socially and geographically vulnerable settings [1\u0026ndash;3].\u003c/p\u003e\n\u003cp\u003eThe prevalence of breast complications observed in this study is consistent with reports from low- and middle-income countries, where breastfeeding difficulties frequently emerge during the first weeks postpartum [4\u0026ndash;6]. Nipple fissures and breast engorgement are often early manifestations of inadequate breastfeeding techniques and, when not properly managed, may progress to more severe conditions such as mastitis and breast abscesses [5,7]. The high frequency of these complications underscores the importance of early identification and timely clinical management within postpartum care services.\u003c/p\u003e\n\u003cp\u003eA key finding of this study is the strong protective effect of exclusive breastfeeding against severe breast complications, particularly mastitis and breast abscesses. Exclusive breastfeeding likely contributes to effective breast emptying, reducing milk stasis\u0026mdash;a central mechanism in the development of inflammatory and infectious breast conditions [8\u0026ndash;10]. This protective association is consistent with previous studies demonstrating that interruptions in breastfeeding and ineffective milk removal increase the risk of mastitis and abscess formation [9,11].\u003c/p\u003e\n\u003cp\u003eNon-pharmacological management strategies delivered by trained health professionals were consistently associated with reduced prevalence of breastfeeding-related breast complications. Breast massage and milk expression were particularly effective in reducing breast engorgement, supporting evidence that these techniques facilitate milk flow and prevent ductal obstruction [12\u0026ndash;14]. Correction of infant latch showed a substantial protective effect against nipple fissures, corroborating findings that improper latch is a primary cause of nipple trauma and pain during breastfeeding [15,16]. Furthermore, correction of infant positioning demonstrated a strong association with reduced prevalence of mastitis, highlighting that breastfeeding biomechanics play a crucial role in preventing inflammatory breast conditions [9,17].\u003c/p\u003e\n\u003cp\u003eThese findings emphasize the central role of structured breastfeeding support services, such as human milk banks and primary healthcare facilities, in preventing and managing breastfeeding-related breast complications [18]. In Brazil, human milk banks are internationally recognized as a cost-effective public health strategy that integrates clinical management, maternal education, and breastfeeding promotion [19]. The effectiveness of simple, low-cost, non-pharmacological interventions observed in this study reinforces their potential scalability within public health systems, particularly in resource-limited settings [20].\u003c/p\u003e\n\u003cp\u003eThe regional context of the Brazilian Amazon adds an important dimension to the interpretation of these results. Social inequalities, geographic barriers, and limited access to specialized maternal care may exacerbate breastfeeding difficulties and delay appropriate interventions [21,22]. Evidence generated from real-world public health services in underrepresented regions is essential to inform context-specific policies and strengthen maternal and child health programs. The present study contributes to filling this gap by providing epidemiological data and practical insights into breastfeeding management in a vulnerable population.\u003c/p\u003e\n\u003cp\u003eSome limitations should be considered when interpreting these findings. The retrospective cross-sectional design precludes causal inference and relies on the accuracy and completeness of medical records. Additionally, the study was conducted in a single human milk bank, which may limit generalizability to other settings. However, the use of standardized clinical records, a robust analytical approach appropriate for prevalent outcomes, and a well-defined sample strengthen the internal validity of the findings.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, this study has notable strengths. It addresses a relevant and underexplored public health issue, employs appropriate statistical methods, and provides evidence directly applicable to clinical practice. By focusing on non-pharmacological interventions delivered within routine healthcare services, the findings offer practical guidance for improving breastfeeding support and preventing early weaning.\u003c/p\u003e\n\u003cp\u003eIn conclusion, breastfeeding-related breast complications were highly prevalent among postpartum women in the Brazilian Amazon. Early, non-pharmacological interventions\u0026mdash;particularly exclusive breastfeeding support, correction of infant latch and positioning, breast massage, and milk expression\u0026mdash;were strongly associated with reduced prevalence of these conditions. Strengthening structured breastfeeding support within human milk banks and primary healthcare services is essential to promote exclusive breastfeeding, prevent maternal morbidity, and reduce early weaning, especially in socially vulnerable populations.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e J.P.S. and L.B.P.M. conceived and designed the study and were responsible for data collection. E.S.F. performed the data analysis and contributed to data interpretation. M.T.B.C. contributed to the discussion and interpretation of the results. L.M.S.J., J.P.S., and L.B.P.M. drafted the manuscript and critically revised its intellectual content. All authors reviewed and approved the final version of the manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors received no specific funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e The datasets used and/or analyzed during the current study are not publicly available due to ethical and legal restrictions, as they contain sensitive personal information derived from medical records. Data are available from the corresponding author upon reasonable request and with permission of the relevant institutional ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval for this study was obtained from the Research Ethics Committee of the Federal University of Rond\u0026ocirc;nia (CEP/UNIR). The requirement for informed consent was waived due to the use of secondary data from medical records.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. \u003cstrong\u003eExclusive breastfeeding for optimal growth, development and health of infants\u003c/strong\u003e. Geneva: WHO; 2003.\u003c/li\u003e\n\u003cli\u003eVictora CG, Bahl R, Barros AJD, Fran\u0026ccedil;a GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effects. \u003cem\u003eLancet\u003c/em\u003e. 2016;387(10017):475\u0026ndash;90. https://doi.org/10.1016/S0140-6736(15)01024-7\u003c/li\u003e\n\u003cli\u003eKalhor M, Yazdkhasti M, Simbar M, Hajian S, Kiani Z, Khorsandi B, et al. Predictors of exclusive breastfeeding: a systematic review and meta-analysis. \u003cem\u003eInt Breastfeed J\u003c/em\u003e. 2025;20(1):52. https://doi.org/10.1186/s13006-025-00744-2\u003c/li\u003e\n\u003cli\u003eBabakazo P, Bosonkie M, Mafuta E, Mvuama N, Mapatano MA. Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa. \u003cem\u003ePLoS One\u003c/em\u003e. 2022;17(10):e0275477. https://doi.org/10.1371/journal.pone.0275477\u003c/li\u003e\n\u003cli\u003eLouis-Jacques AF, Berwick M, Mitchell KB. Risk factors, symptoms, and treatment of lactational mastitis. \u003cem\u003eJAMA\u003c/em\u003e. 2023;329(7):588\u0026ndash;9. https://doi.org/10.1001/jama.2023.0004\u003c/li\u003e\n\u003cli\u003eWilson E, Woodd SL, Benova L. Incidence of and risk factors for lactational mastitis: a systematic review. \u003cem\u003eJ Hum Lact\u003c/em\u003e. 2020;36(4):673\u0026ndash;86. https://doi.org/10.1177/0890334420907898\u003c/li\u003e\n\u003cli\u003eRashid T, Sae-Kho TM, Heuvelhorst KL, Glazebrook KN. Breast imaging of infectious disease. \u003cem\u003eBr J Radiol\u003c/em\u003e. 2023;96(1143):20220649. https://doi.org/10.1259/bjr.20220649\u003c/li\u003e\n\u003cli\u003eYu Q, Xu C, Wang M, Zhu J, Yu L, Yang Z, et al. The preventive and therapeutic effects of probiotics on mastitis: a systematic review and meta-analysis. \u003cem\u003ePLoS One\u003c/em\u003e. 2022;17(9):e0274467. https://doi.org/10.1371/journal.pone.0274467\u003c/li\u003e\n\u003cli\u003eAnderson L, Kynoch K, Kildea S, Lee N. Effectiveness of breast massage for the treatment of women with breastfeeding problems: a systematic review. \u003cem\u003eJBI Database Syst Rev Implement Rep\u003c/em\u003e. 2019;17(8):1668\u0026ndash;94. https://doi.org/10.11124/JBISRIR-2017-003932\u003c/li\u003e\n\u003cli\u003eZakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. \u003cem\u003eCochrane Database Syst Rev\u003c/em\u003e. 2020;9:CD006946. https://doi.org/10.1002/14651858.CD006946.pub4\u003c/li\u003e\n\u003cli\u003eHuda MH, Chipojola R, Lin YM, Lee GT, Shyu ML, Kuo SY. The influence of breastfeeding educational interventions on breast engorgement and exclusive breastfeeding: a systematic review and meta-analysis. \u003cem\u003eJ Hum Lact\u003c/em\u003e. 2022;38(1):156\u0026ndash;70. https://doi.org/10.1177/0890334421102927\u003c/li\u003e\n\u003cli\u003eOliveira FS, Vieira FVM, Silva AGR, Guimar\u0026atilde;es JV. Prenatal clinical demonstration for the management of breast engorgement prevention: a quasi-experimental study. \u003cem\u003eREME Rev Min Enferm\u003c/em\u003e. 2021;25:e1365. https://doi.org/10.5935/1415-2762.20210013\u003c/li\u003e\n\u003cli\u003eCamargo BTS, Sa\u0026ntilde;udo A, Kusahara DM, Coca KP. Initial nipple damages in breastfeeding women: analysis of photographic images and clinical associations. \u003cem\u003eRev Bras Enferm\u003c/em\u003e. 2024;77(1):e20220773. https://doi.org/10.1590/0034-7167-2022-0773\u003c/li\u003e\n\u003cli\u003eSilva JI, Chagas ALG, Sena BO, Lima CA, Santos GV, Campelo MCD, et al. Interven\u0026ccedil;\u0026otilde;es eficazes para tratamento de trauma mamilar decorrente da amamenta\u0026ccedil;\u0026atilde;o: revis\u0026atilde;o sistem\u0026aacute;tica. \u003cem\u003eActa Paul Enferm\u003c/em\u003e. 2022;35:eAPE01367. https://doi.org/10.37689/acta-ape/2022AR0001367\u003c/li\u003e\n\u003cli\u003eKent JC, Ashton E, Hardwick CM, Rowan MK, Chia ES, Fairclough KA, et al. Nipple pain in breastfeeding mothers: incidence, causes and treatments. \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e. 2015;12(10):12247\u0026ndash;63. https://doi.org/10.3390/ijerph121012247\u003c/li\u003e\n\u003cli\u003eDouglas P. Re-thinking lactation-related nipple pain and damage. \u003cem\u003eWomens Health (Lond)\u003c/em\u003e. 2022;18:17455057221087865. https://doi.org/10.1177/17455057221087865\u003c/li\u003e\n\u003cli\u003eDukuzumuremyi JPC, Acheampong K, Abesig J, Luo J. Knowledge, attitude, and practice of exclusive breastfeeding among mothers in East Africa: a systematic review. \u003cem\u003eInt Breastfeed J\u003c/em\u003e. 2020;15(1):70. https://doi.org/10.1186/s13006-020-00313-9\u003c/li\u003e\n\u003cli\u003eMarques BL, Tomasi YT, Saraiva SS, Boing AF, Geremia DS. Orienta\u0026ccedil;\u0026otilde;es \u0026agrave;s gestantes no pr\u0026eacute;-natal: a import\u0026acirc;ncia do cuidado compartilhado na aten\u0026ccedil;\u0026atilde;o prim\u0026aacute;ria em sa\u0026uacute;de. \u003cem\u003eEsc Anna Nery\u003c/em\u003e. 2021;25(1):e20200098. https://doi.org/10.1590/2177-9465-EAN-2020-0098\u003c/li\u003e\n\u003cli\u003eMinist\u0026eacute;rio da Sa\u0026uacute;de (Brasil). \u003cstrong\u003eAmamenta\u0026ccedil;\u0026atilde;o com foco na redu\u0026ccedil;\u0026atilde;o de desigualdades\u003c/strong\u003e. Bras\u0026iacute;lia: Minist\u0026eacute;rio da Sa\u0026uacute;de; 2024.\u003c/li\u003e\n\u003cli\u003eMuller EV, Martins CM, Borges PKO. Prevalence of anxiety and depression disorder and associated factors during postpartum in puerperal women. \u003cem\u003eRev Bras Saude Mater Infant\u003c/em\u003e. 2021;21(4):995\u0026ndash;1004. https://doi.org/10.1590/1806-93042021000400003\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breastfeeding, Postpartum period, Weaning, Maternal and child health","lastPublishedDoi":"10.21203/rs.3.rs-8544732/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8544732/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBreastfeeding is a cornerstone of maternal and child health, yet its continuation is frequently compromised by breastfeeding-related breast complications during the postpartum period. These conditions are a major cause of early weaning, particularly in socially vulnerable settings. This study aimed to estimate the prevalence of breastfeeding-related breast complications and to analyze factors associated with their management among postpartum women assisted by a human milk bank in the Brazilian Amazon.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cross-sectional study was conducted using medical records of postpartum women attended at a Human Milk Bank in Porto Velho, Rond\u0026ocirc;nia, Brazil, between January and December 2019. A total of 300 medical records were analyzed. Breast complications\u0026mdash;including breast engorgement, mastitis, nipple fissures, and breast abscesses\u0026mdash;were assessed as binary outcomes. Sociodemographic characteristics, exclusive breastfeeding, and non-pharmacological management strategies (breast massage, milk expression, correction of infant latch, and positioning) were evaluated as explanatory variables. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were estimated using Poisson regression with robust variance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBreast complications were identified in 40.3% of postpartum women, with multiple conditions often occurring in the same individual. The most prevalent conditions were nipple fissures (46.3%) and breast engorgement (40.3%), followed by mastitis (23.0%) and breast abscess (22.0%). Exclusive breastfeeding was associated with a lower prevalence of mastitis (adjusted PR\u0026thinsp;=\u0026thinsp;0.27; 95% CI: 0.20\u0026ndash;0.41) and breast abscess (adjusted PR\u0026thinsp;=\u0026thinsp;0.47; 95% CI: 0.26\u0026ndash;0.85). Non-pharmacological interventions were significantly associated with reduced prevalence of breast complications: breast massage and milk expression were protective against breast engorgement; correction of infant latch reduced nipple fissures; and correction of infant positioning showed a strong protective effect against mastitis.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBreastfeeding-related breast complications were highly prevalent among postpartum women in the Brazilian Amazon. Early, non-pharmacological interventions delivered by trained health professionals\u0026mdash;particularly within human milk banks and primary healthcare services\u0026mdash;were strongly associated with reduced prevalence of these conditions. These findings reinforce the importance of structured breastfeeding support to promote exclusive breastfeeding and prevent early weaning in vulnerable populations.\u003c/p\u003e","manuscriptTitle":"Prevalence and management of breastfeeding-related breast complications among postpartum women assisted at a human milk bank in the Brazilian Amazon: a retrospective cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 06:06:57","doi":"10.21203/rs.3.rs-8544732/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-08T17:45:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74389064810533805793729002676357750772","date":"2026-02-15T15:50:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T21:35:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-14T22:30:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-12T10:50:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-12T10:48:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-01-07T19:20:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a07a89cf-ec23-4922-8a20-6f8f24c49812","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T06:06:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 06:06:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8544732","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8544732","identity":"rs-8544732","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}