Carolina Lechosa-Muñiz

Background: The COVID-19 pandemic exacerbated pre-existing inequities in maternity care, particularly among culturally diverse and migrant women. Although data were collected during the early pandemic phase, revisiting these experiences offers valuable insights for strengthening equity, cultural safety, and system preparedness in maternal healthcare. Methods: A qualitative phenomenological–hermeneutic study was conducted in a tertiary maternity hospital in Spain. Semi-structured interviews were carried out with six women from diverse cultural backgrounds. Data were analysed inductively through thematic analysis, followed by a secondary interpretive review in 2024 to identify enduring implications for culturally safe, equitable, and crisis-resilient maternity care. Results: Four main themes emerged: (1) heightened fear and uncertainty surrounding hospital care; (2) emotional distress linked to restrictions on companionship and support; (3) disruption of culturally embedded postpartum practices, resulting in isolation; and (4) health literacy barriers and dependence on informal information sources. Despite these challenges, participants demonstrated notable adaptability and resilience. Conclusions: COVID-19 amplified structural inequities in maternity care for culturally diverse mothers. The findings highlight the need to reinforce cultural safety, health literacy support, language mediation, family-centred care, and emotional wellbeing. These insights may inform efforts to strengthen resilient and equitable maternal health systems and improve preparedness for future public health emergencies.

Background: The COVID-19 pandemic exacerbated pre-existing inequities in maternity care, particularly among culturally diverse and migrant women. Although data were col-lected during the early pandemic phase, revisiting these experiences offers valuable in-sights for strengthening equity, cultural safety, and system preparedness in maternal healthcare. Methods: A qualitative phenomenological–hermeneutic study was conducted in a tertiary maternity hospital in Spain. Semi-structured interviews were carried out with six women from diverse cultural backgrounds. Data were analysed inductively through thematic analysis, followed by a secondary interpretive review in 2024 to identify endur-ing implications for culturally safe, equitable, and crisis-resilient maternity care. Results: Four main themes emerged: (1) heightened fear and uncertainty surrounding hospital care; (2) emotional distress linked to restrictions on companionship and support; (3) dis-ruption of culturally embedded postpartum practices, resulting in isolation; and (4) health literacy barriers and dependence on informal information sources. Despite these chal-lenges, participants demonstrated notable adaptability and resilience. Conclusions: COVID-19 amplified structural inequities in maternity care for culturally diverse mothers. The findings highlight the need to reinforce cultural safety, health literacy support, lan-guage mediation, family-centred care, and emotional wellbeing. These lessons offer ac-tionable guidance for strengthening resilient, equitable maternal health systems and im-proving preparedness for future public health emergencies.

Background: The medical literature indicates gaps in the knowledge and skills of nurses regarding breastfeeding. Studies show a need for updated knowledge and skills, which can affect breastfeeding rates and practices. The regulated specialty of Pediatric Nursing in Spain requires specific training, yet there are concerns about the adequacy of this training regarding breastfeeding. Aim: To evaluate the level of knowledge and skills in breastfeeding among pediatric nursing residents in Spain. Design: An exploratory observational study was conducted in 2022 following the STROBE guidelines. Methods: The study invited all pediatric nursing residents training units in Spain to participate. Data were collected through an online questionnaire, including the “Survey on Breastfeeding Knowledge in Nurses” (ECoLaE), which evaluates basic breastfeeding knowledge and daily problem‐solving skills. Sociodemographic and professional variables were collected. Data analysis was performed using SPSS 15.0, with descriptive statistics and bivariate analyses to identify key variables associated with breastfeeding knowledge and skills. Results: The study received 128 responses. Most respondents were female (96.9%), with a mean age of 26 years. The average score on the ECoLaE questionnaire was 19.18 ± 3.05 points, with 74.2% having good knowledge. No significant differences were found between breastfeeding knowledge and sociodemographic/professional variables, except for training hours in breastfeeding, which showed significant differences. Conclusions: The study highlights the importance of specific and continuous training in breastfeeding for healthcare professionals, particularly pediatric nursing residents. Although general knowledge about breastfeeding is good, there is a need for improved and expanded training programs to achieve excellence. Training hours are crucial for better preparation, and practical experience should be integrated into education programs to enhance confidence and effectiveness in managing breastfeeding.

Background: Breastfeeding is associated with lower incidence and severity of lower respiratory tract disease. However, little is known about the relationship between feeding type and breastfeeding duration with bronchiolitis in a child’s first year. Methods: A prospective cohort study of 969 newborn babies were followed-up for 12 months to determine breastfeeding duration, feeding type, feeding trajectory, and bronchiolitis episodes at Marqués de Valdecilla University Hospital, Spain in 2018. Type of feeding was recorded by interviewing mothers at the time of hospital discharge and at 2, 4, 6, 9 and 12 months of life, in three categories: breastfeeding, mixed feeding and infant formula. Type of feeding at hospital discharge refers to feeding from birth to discharge. In any other times studied, it refers to feeding in the last 24 h. The association between the feeding type and bronchiolitis was analysed using logistic regression. Poisson regression was used to evaluate the association between feeding type and the number of bronchiolitis episodes with Kaplan-Meier estimators presenting the cumulative probability of suffering bronchiolitis. The results were adjusted for mother and child characteristics. Results: Our data shows exclusive breastfeeding and mixed breastfeeding reduce the number of episodes of bronchiolitis. Regarding feeding at 4 months, exclusive breastfeeding reduced by 41% the number of episodes of bronchiolitis (adjusted incidence Ratio (aIR) 0.59, 95% CI 0.46, 0.76) and mixed feeding by 37% (aIR 0.63, 95% CI 0.47, 0.86). Moreover, changing from exclusive breastfeeding to mixed feeding increased the incidence of bronchiolitis compared with continuing exclusive breastfeeding. An early swap to mixed breastfeeding before months 2 or 4, was associated with a reduced the number of episodes of bronchiolitis, (aIR 0.53, 95% CI 0.39, 0.73 if introduction of mixed breastfeeding before month 2, and aIR 0.61, 95% CI 0.45, 0.83 if introduction of mixed breastfeeding before month 4), when compared with infant formula alone. Conclusions: Any breastfeeding was associated with lower incidence of bronchiolitis and number of episodes of bronchiolitis in the first year of life. Consequently, promoting programmes facilitating exclusive or mixed breastfeeding would be a relevant measure in the prevention of bronchiolitis.

The COVID-19 pandemic placed pregnant women at high risk, but behavioural changes have also led to lower rates of preterm births in high-income countries. The main goal of this article is to study the ongoing impact of the COVID-19 pandemic on pregnancy control and outcomes; this is a joint analysis of two cohorts. The pre-pandemic cohort includes 969 pregnant women recruited in 2018. The pandemic cohort comprises 1168 pregnant women recruited in 2020. Information on demographic and socioeconomic characteristics, reproductive history, characteristics of the current pregnancy and its outcome were obtained from medical records. Birth by Caesarean section was more frequent in the pre-pandemic cohort (adjusted odds ratio (OR) = 0.71, 95% confidence interval (CI): 0.55–0.92). A birth weight lower than 2500 g and higher than 4000 g occurred more frequently in the pre-pandemic cohort (adjusted OR = 0.62, 95% CI: 0.41–0.93 for lower than 2500 g and adjusted OR = 0.30, 95% CI: 0.20–0.46 for higher than 4000 g). Exclusive breastfeeding upon hospital discharge was more frequent in the pandemic cohort than in the pre-pandemic cohort (60% vs. 54%, p = 0.005), with adjusted OR = 0.67, 95% CI: 0.52–0.86 for mixed breastfeeding and infant formula. In conclusion, we report reductions in Caesarean sections and reduced numbers of low birth weight babies during the pandemic in a hospital located in northern Spain. Further analysis will clarify if these reductions are related to changes in health-related behaviour or healthcare operation.

Little is known on socio-economic factors associated with SARS-CoV-2 infection in pregnant women. Here, we analyze the relationship between educational, occupational, and housing variables with SARS-CoV-2 infection in a cohort of 988 pregnant women in Spain. Pregnant women were recruited at the University Hospital Marques de Valdecilla, Santander, Spain, among those delivering from 23 March 2020 onwards or consulting for their 12th week of pregnancy from 26 May 2020 onwards. Information on occupational variables and housing characteristics was self-reported. Pregnant women were tested for a current or past infection of SARS-CoV-2 using both PCR and antibodies detection (ELISA). Logistic regression models were used to analyze factors associated with SARS-CoV-2 infection, adjusting for age and country of origin. Infection by SARS-CoV-2 was not associated with educational level or occupational variables, except for where the pregnant woman was a healthcare worker (odds ratio (OR) = 2.87, 95% confidence interval (CI): 0.84–9.79). Housing with four or more rooms (OR = 2.07, 95% CI: 0.96–4.47), four or more people in the household (OR = 1.91, 95% CI: 0.89–4.14), lack of heating (OR = 2.81, 95% CI: 1.24–6.34) and less than 23 square meters per person (OR = 3.97, 95% CI: 1.43–11.1) were the housing characteristics associated with SARS-CoV-2 infection. Housing characteristics, but not occupational or educational variables, were associated with SARS-CoV-2 infection. Guidelines on the prevention of COVID-19 should reinforce household measures to prevent pregnant women from becoming infected by their relatives.

Background: Factors associated with duration of breastfeeding have been usually studied at specific times after birth. Little is known about how much time is added to breastfeeding by each associated factor. Methods: A cohort of 969 mother-child dyads was followed-up for twelve months at the Marqués de Valdecilla University Hospital, Spain, in 2018. Data on mother characteristics, pregnancy, delivery and children characteristics were obtained from medical records. Length of breastfeeding was reported by the mothers and recorded in paediatric medical record at hospital discharge and 2, 4, 6, 9 and 12 months of life. Factors associated with duration of breastfeeding were analysed via multivariate Weibull regression parameterized as accelerated time of failure. Results are presented as time ratios. Results: About four out of five children were breastfed at hospital discharge, although this proportion dropped to 65% in children born from smoker women, 70% in preterm children and 68% in neonates weighting less than 2500 g. Mother’s age was associated with longer breastfeeding, adding 2% more breastfeeding time per year (adjusted time ratio 1.02; 95% confidence interval 1.00, 1.04). Children born from mothers with university studies were breastfed 53% more time than those born from mothers with primary studies (adjusted time ratio 1.53; 95% confidence interval 1.21, 1.95); smoking in pregnancy decreased length of breastfeeding by 41% (adjusted time ratio 0.59; 95% confidence interval 0.46, 0.76). Other factors associated with longer breastfeeding were single pregnancy and newborn weight over 2500 g. Conclusions: Analysing factors associated with duration of breastfeeding as time parameters allows us to quantify the amount of time gained or lost by each factor, which could make it easier to evaluate the relevance of programmes directed to promote facilitating breastfeeding factors.

Background: Breastfeeding is associated with lower risk of infectious diseases, leading to fewer hospital admissions and pediatrician consultations. It is cost saving for the health care system, however, it is not usually estimated from actual cohorts but via simulation studies. Methods: A cohort of 970 children was followed-up for twelve months. Data on mother characteristics, pregnancy, delivery and neonate characteristics were obtained from medical records. The type of neonate feeding at discharge, 2, 4, 6, 9 and 12 months of life was reported by the mothers. Infectious diseases diagnosed in the first year of life, hospital admissions, primary care and emergency room consultations and drug treatments were obtained from neonate medical records. Health care costs were attributed using public prices and All Patients Refined–Diagnosis Related Groups (APR–DRG) classification. Results: Health care costs in the first year of life were higher in children artificially fed than in those breastfed (1339.5€, 95% confidence interval (CI): 903.0–1775.0 for artificially fed vs. 443.5€, 95% CI: 193.7–694.0 for breastfed). The breakdown of costs also shows differences in primary care consultations (295.7€ for formula fed children vs. 197.9€ for breastfed children), emergency room consultations (260.1€ for artificially fed children vs. 196.2€ for breastfed children) and hospital admissions (791.6€ for artificially fed children vs. 86.9€ for breastfed children). Conclusions: Children artificially fed brought about more health care costs related to infectious diseases than those exclusively breastfed or mixed breastfed. Excess costs were caused in hospital admissions, primary care consultations, emergency room consultations and drug consumption.