{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:59:18Z","timestamp":1787313558747,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,27]],"date-time":"2022-11-27T00:00:00Z","timestamp":1669507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Child Health Research program at the Institute of Child Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Breastfeeding involves signaling between mother and offspring through biological (breast milk) and behavioral pathways. This study tested this by examining the effects of a relaxation intervention in an understudied infant population. Breastfeeding mothers of late preterm (340\/7\u2013366\/7 weeks) and early term (370\/7\u2013386\/7 weeks) infants were randomized to the relaxation group (RG, n = 35), where they were asked to listen to a meditation recording while breastfeeding from 3 weeks post-delivery, or the control group (CG, n = 37) where no intervention was given. Primary outcomes-maternal stress and infant weight-were assessed at 2\u20133 (baseline) and 6\u20138 weeks post-delivery. Secondary outcomes included infant length, infant behavior, maternal verbal memory, salivary cortisol, and breast milk composition. Infants in the RG had significantly higher change in weight-for-age Z-score compared to those in CG (effect size: 0.4; 95% CI: 0.09, 0.71; p = 0.01), and shorter crying duration [RG: 5.0 min, 0.0\u2013120.0 vs. CG: 30.0 min, 0.0\u2013142.0; p = 0.03]. RG mothers had greater reduction in cortisol (effect size: \u22120.08 ug\/dL, 95% CI \u22120.15, \u22120.01; p = 0.03) and better maternal verbal learning score (effect size: 1.1 words, 95% CI 0.04, 2.1; p = 0.04) than CG mothers, but did not differ in stress scores. A simple relaxation intervention during breastfeeding could be beneficial in promoting growth of late preterm and early term infants. Further investigation of other potential biological and behavioral mediators is warranted.<\/jats:p>","DOI":"10.3390\/nu14235041","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T07:01:30Z","timestamp":1669618890000},"page":"5041","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["A Breastfeeding Relaxation Intervention Promotes Growth in Late Preterm and Early Term Infants: Results from a Randomized Controlled Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8603-1833","authenticated-orcid":false,"given":"Sarah","family":"Dib","sequence":"first","affiliation":[{"name":"Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-8025","authenticated-orcid":false,"given":"Jonathan C. K.","family":"Wells","sequence":"additional","affiliation":[{"name":"Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0892-9204","authenticated-orcid":false,"given":"Simon","family":"Eaton","sequence":"additional","affiliation":[{"name":"Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Fewtrell","sequence":"additional","affiliation":[{"name":"Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1053\/j.semperi.2006.01.009","article-title":"Changes in the gestational age distribution among US singleton births: Impact on rates of late preterm birth, 1992 to 2002","volume":"30","author":"Davidoff","year":"2006","journal-title":"Semin. Perinatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1542\/peds.114.2.372","article-title":"Clinical outcomes of near-term infants","volume":"114","author":"Wang","year":"2004","journal-title":"Pediatrics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.earlhumdev.2011.01.035","article-title":"Psychological distress and early lactation performance in mothers of late preterm infants","volume":"87","author":"Zanardo","year":"2011","journal-title":"Early Hum. Dev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.clp.2011.06.009","article-title":"Morbidity and mortality in late preterm and early term newborns: A continuum","volume":"38","author":"Engle","year":"2011","journal-title":"Clin. Perinatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1093\/ije\/dyt251","article-title":"Neonatal morbidity associated with late preterm and early term birth: The roles of gestational age and biological determinants of preterm birth","volume":"43","author":"Brown","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/MPG.0000000000002397","article-title":"Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition","volume":"69","author":"Lapillonne","year":"2019","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S0140-6736(15)01024-7","article-title":"Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect","volume":"387","author":"Victora","year":"2016","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1089\/bfm.2015.0122","article-title":"Reduced breastfeeding rates in firstborn late preterm and early term infants","volume":"11","year":"2016","journal-title":"Breastfeed. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/birt.12135","article-title":"Hospital care and early breastfeeding outcomes among late preterm, early-term, and term infants","volume":"41","author":"Goyal","year":"2014","journal-title":"Birth"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"F479","DOI":"10.1136\/archdischild-2014-307347","article-title":"Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: A prospective population-based study","volume":"100","author":"Boyle","year":"2015","journal-title":"Arch. Dis. Child. Fetal. Neonatal. Ed."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1089\/bfm.2020.0379","article-title":"Barriers and Facilitators to Breastfeeding in Moderate and Late Preterm Infants: A Systematic Review","volume":"16","author":"Carpay","year":"2021","journal-title":"Breastfeed. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jogn.2017.01.006","article-title":"Integrative Review of Interventions to Promote Breastfeeding in the Late Preterm Infant","volume":"46","author":"Cartwright","year":"2017","journal-title":"J. Obs. Gynecol. Neonatal Nurs."},{"key":"ref_13","first-page":"781","article-title":"Interventions to Improve Breastfeeding Outcomes in Late Preterm and Early Term Infants","volume":"17","author":"Dib","year":"2022","journal-title":"Breastfeed Med"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/ANC.0b013e31824d9842","article-title":"The effect of music-based listening interventions on the volume, fat content, and caloric content of breast milk-produced by mothers of premature and critically ill infants","volume":"12","author":"Keith","year":"2012","journal-title":"Adv. Neonat. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1542\/peds.83.1.57","article-title":"Increasing breast milk production for premature infants with a relaxation\/imagery audiotape","volume":"83","author":"Feher","year":"1989","journal-title":"Pediatrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/ajcn\/nqz033","article-title":"Randomized controlled trial investigating the effects of a breastfeeding relaxation intervention on maternal psychological state, breast milk outcomes, and infant behavior and growth","volume":"110","author":"Wells","year":"2019","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_17","first-page":"249","article-title":"Parent-offspring conflict","volume":"14","author":"Trivers","year":"1974","journal-title":"Integr. Comp. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1002\/evan.1360020303","article-title":"Life history theory and evolutionary anthropology","volume":"2","author":"Hill","year":"1993","journal-title":"Evol. Anthropol. Issues News Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"206","DOI":"10.3389\/fpubh.2019.00206","article-title":"Low maternal capital predicts life history trade-offs in daughters: Why adverse outcomes cluster in individuals","volume":"7","author":"Wells","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S0140-6736(17)30572-X","article-title":"Evolutionary public health: Introducing the concept","volume":"390","author":"Wells","year":"2017","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1186\/s13063-020-4225-3","article-title":"Mother And late Preterm Lactation Study (MAPLeS): A randomised controlled trial testing the use of a breastfeeding meditation by mothers of late preterm infants on maternal psychological state, breast milk composition and volume, and infant behaviour and growth","volume":"21","author":"Dib","year":"2020","journal-title":"Trials"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e9217","DOI":"10.7717\/peerj.9217","article-title":"A within-subject comparison of different relaxation therapies in eliciting physiological and psychological changes in young women","volume":"8","author":"Dib","year":"2020","journal-title":"PeerJ"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J. Health Soc. Behav."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/1471-0528.12047","article-title":"The objectives, design and implementation of the INTERGROWTH-21st Project","volume":"120","author":"Villar","year":"2013","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1192\/bjp.150.6.782","article-title":"Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale","volume":"150","author":"Cox","year":"1987","journal-title":"Br. J. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e1992","DOI":"10.1002\/icd.1992","article-title":"The Maternal (Non) Responsiveness Questionnaire: Initial Factor Structure and Validation","volume":"26","author":"Leerkes","year":"2017","journal-title":"Infant Child Dev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1891\/1061-3749.2.2.129","article-title":"A questionnaire to measure mother-to-infant attachment","volume":"2","author":"Muller","year":"1994","journal-title":"J. Nurs. Meas."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.appet.2011.05.324","article-title":"Development and factor structure of the Baby Eating Behaviour Questionnaire in the Gemini birth cohort","volume":"57","author":"Llewellyn","year":"2011","journal-title":"Appetite"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1136\/adc.63.4.380","article-title":"Parental diary of infant cry and fuss behaviour","volume":"63","author":"Barr","year":"1988","journal-title":"Arch. Dis. Child"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1002\/gps.1010","article-title":"Rey verbal learning test is a useful tool for differential diagnosis in the preclinical phase of Alzheimer\u2019s disease: Comparison with mild cognitive impairment and normal aging","volume":"18","author":"Kulisevsky","year":"2003","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1079\/BJN20051464","article-title":"Metabolisable energy consumption in the exclusively breast-fed infant aged 3\u20136 months from the developed world: A systematic review","volume":"94","author":"Reilly","year":"2005","journal-title":"Br. J. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jpeds.2017.10.005","article-title":"An attempt to standardize the calculation of growth velocity of preterm infants\u2014Evaluation of practical bedside methods","volume":"196","author":"Fenton","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1136\/bmj.320.7240.967","article-title":"Association between postnatal catch-up growth and obesity in childhood: Prospective cohort study","volume":"320","author":"Ong","year":"2000","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1089\/bfm.2020.0027","article-title":"The Effects of Listening to Music on Breast Milk Production by Mothers of Premature Newborns in the Neonatal Intensive Care Unit: A Randomized Controlled Study","volume":"15","year":"2020","journal-title":"Breastfeed. Med."},{"key":"ref_35","first-page":"CC04","article-title":"Impact of music therapy on breast milk secretion in mothers of premature newborns","volume":"9","author":"Jayamala","year":"2015","journal-title":"J. Clin. Diagn. Res. JCDR"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"128","DOI":"10.31372\/20200503.1100","article-title":"Effects of Breastfeeding on Stress Measured by Saliva Cortisol Level and Perceived Stress","volume":"5","author":"Mizuhata","year":"2020","journal-title":"Asian\/Pac. Isl. Nurs. J."},{"key":"ref_37","first-page":"093202","article-title":"LTP after stress: Up or down?","volume":"2007","author":"Krugers","year":"2007","journal-title":"Neural Plast."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.bandc.2007.02.007","article-title":"The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition","volume":"65","author":"Lupien","year":"2007","journal-title":"Brain Cogn."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s40750-014-0010-4","article-title":"Hormones, stress, and cognition: The effects of glucocorticoids and oxytocin on memory","volume":"1","author":"Wirth","year":"2015","journal-title":"Adapt. Hum. Behav. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1152\/jappl.1998.85.1.223","article-title":"Direct measurement of the energy expenditure of physical activity in preterm infants","volume":"85","author":"Thureen","year":"1998","journal-title":"J. Appl. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/(SICI)1520-6300(1996)8:4<465::AID-AJHB6>3.0.CO;2-X","article-title":"Relationship between behavior and energy expenditure in 12-week-old infants","volume":"8","author":"Wells","year":"1996","journal-title":"Am. J. Hum. Biol. Off. J. Hum. Biol. Counc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s002650000248","article-title":"The effect of pup vocalisations on food allocation in a cooperative mammal, the meerkat (Suricata suricatta)","volume":"48","author":"Manser","year":"2000","journal-title":"Behav. Ecol. Sociobiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/0003-3472(95)80105-7","article-title":"Calling by domestic piglets: Reliable signals of need?","volume":"50","author":"Weary","year":"1995","journal-title":"Anim. Behav."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/BF00163989","article-title":"Nestling American robins compete with siblings by begging","volume":"29","author":"Smith","year":"1991","journal-title":"Behav. Ecol. Sociobiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1098\/rspb.1995.0102","article-title":"When do canary parents respond to nestling signals of need?","volume":"260","author":"Kilner","year":"1995","journal-title":"Proc. R. Soc. Lond. Ser. B Biol. Sci."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/23\/5041\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:27:40Z","timestamp":1760146060000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/23\/5041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,27]]},"references-count":45,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["nu14235041"],"URL":"https:\/\/doi.org\/10.3390\/nu14235041","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,27]]}}}