Jessica Oliveira Cecilio

Background: Secretory immunoglobulin A (IgA) is the predominant immunoglobulin in human milk and a key component of neonatal mucosal immunity. While its biological functions are well established, the impact of maternal psycho‑emotional factors on its concentration remains largely unknown. No previous review has systematically mapped this intersection. Objectives: To synthesize evidence on relationships between maternal psycho-emotional factors—depression, anxiety, stress, fatigue, and sleep disturbance—and IgA concentrations in human milk. Methods: Following the JBI framework and PRISMA-ScR guidelines, a comprehensive search was conducted across MEDLINE, Embase, Cochrane, CINAHL, PsycINFO, Scopus, and Web of Science without date restrictions. Fourteen studies met eligibility criteria. Data were extracted using a standardized form and synthesized narratively. Results: Findings were heterogeneous, with positive, negative, and null associations across psychological domains. Occasionally, anxiety was associated with lower milk IgA in early postpartum cohorts, whereas associations with depressive symptoms varied by lactation stage. Postpartum-specific stress showed the clearest inverse relationship with milk IgA, although evidence remained limited. Only one study assessed maternal fatigue, and none examined sleep disturbance. Differences in lactation stage, milk sampling timing, and laboratory methods appeared to contribute substantially to variability across studies. Conclusion: Maternal psycho-emotional factors do not exert a uniform influence on milk IgA. Instead, evidence suggests context-dependent patterns shaped by lactation stage, biological processes, and methodological factors. This review highlights an understudied area and underscores the need for standardized longitudinal studies to clarify how maternal mental health interfaces with lactational immunity.

Objectives: to analyze the effectiveness on health education to prevent nipple trauma in breastfeeding compared to other interventions. Methods: systematic literature review was carried out in January 2019, according to PRISMA recommendations. The searches were conducted in Cinahl, PubMed, Web of Science, Scopus, and in the references cited in the selected articles. The studies were assessed for quality and level of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: twelve studies were selected, all conducted at the maternities. The interventions were classified in two categories: health education on breastfeeding and the use of nipple covers. Health education on breastfeeding presents a moderate level of evidence on the prevention of nipple trauma. There is a moderate to high level of evidence on the positive effects of guaiazulene, gel or peppermint water applied in the postpartum period to prevent nipple trauma. Conclusion: health education on breastfeeding with clinical demonstration is an important strategy to prevent nipple trauma and requires more than one educational approach. The use of nipple covers requires some consideration, since they must be removed prior to breastfeeding. All interventions were conducted in the postpartum period, which points out for the necessity of clinical research to prevent nipple trauma in prenatal care.