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Determinants of mastitis in women in the CASTLE study: a cohort study
journal contributionposted on 16.02.2021, 05:51 by Meabh Cullinane, Lisa Amir, SM Donath, SM Garland, SN Tabrizi, MS Payne, CM Bennett
© 2015 Cullinane et al. Background: Mastitis is an acute, debilitating condition that occurs in approximately 20 % of breastfeeding women who experience a red, painful breast with fever. This paper describes the factors correlated with mastitis and investigates the presence of Staphylococcus aureus in women who participated in the CASTLE (Candida and Staphylococcus Transmission: Longitudinal Evaluation) study. The CASTLE study was a prospective cohort study which recruited nulliparous women in late pregnancy in two maternity hospitals in Melbourne, Australia in 2009-2011. Methods: Women completed questionnaires at recruitment and six time-points in the first eight weeks postpartum. Postpartum questionnaires asked about incidences of mastitis, nipple damage, milk supply, expressing practices and breastfeeding problems. Nasal and nipple swabs were collected from mothers and babies, as well as breast milk samples. All samples were cultured for S. aureus. "Time at risk" of mastitis was defined as days between birth and first occurrence of mastitis (for women who developed mastitis) and days between birth and the last study time-point (for women who did not develop mastitis). Risk factors for incidence of mastitis occurring during the time at risk (Incident Rate Ratios [IRR]) were investigated using a discrete version of the multivariable proportional hazards regression model. Results: Twenty percent (70/346) of participants developed mastitis. Women had an increased risk of developing mastitis if they reported nipple damage (IRR 2.17, 95 % CI 1.21, 3.91), over-supply of breast milk (IRR 2.60, 95 % CI 1.58, 4.29), nipple shield use (IRR 2.93, 95 % CI 1.72, 5.01) or expressing several times a day (IRR 1.64, 95 % CI 1.01, 2.68). The presence of S. aureus on the nipple (IRR 1.72, 95 % CI 1.04, 2.85) or in milk (IRR 1.78, 95 % CI 1.08, 2.92) also increased the risk of developing mastitis. Conclusions: Nipple damage, over-supply of breast milk, use of nipple shields and the presence of S. aureus on the nipple or in breast milk increased the mastitis risk in our prospective cohort study sample. Reducing nipple damage may help reduce maternal breast infections.
The major funding was provided by the National Health and Medical Research Council Project Grant (541907) in 2009-2010. Additional funding was received by the Faculty of Health Sciences, La Trobe University (2011-2012), and from the Helen Macpherson Smith Trust (2011-2012).
JournalBMC Family Practice
Article NumberARTN 181
Rights StatementThe Author reserves all moral rights over the deposited text and must be credited if any re-use occurs. Documents deposited in OPAL are the Open Access versions of outputs published elsewhere. Changes resulting from the publishing process may therefore not be reflected in this document. The final published version may be obtained via the publisher’s DOI. Please note that additional copyright and access restrictions may apply to the published version.
Science & TechnologyLife Sciences & BiomedicinePrimary Health CareMedicine, General & InternalGeneral & Internal MedicineBreastfeedingMastitisBreast infectionStaphylococcus aureusBREAST-FEEDING WOMENSTAPHYLOCOCCUS-AUREUSLACTATIONAL MASTITISMEDICAL-MANAGEMENTRISK-FACTORSPAINPREVALENCEPOSTPARTUMEXPERIENCEDURATIONHumansCandida albicansStaphylococcal InfectionsCandidiasisIncidenceRisk FactorsFollow-Up StudiesProspective StudiesBreast FeedingPostpartum PeriodPregnancyAdolescentAdultMiddle AgedVictoriaFemaleYoung AdultSurveys and QuestionnairesPublic Health