Promotion of Exclusive Breastfeeding in Children with Sickle Cell Disease for Improved Health Outcomes

摘要 镰状细胞病（SCD）是一种遗传性红细胞疾病，主要影响非洲人， 血统. SCD的生理学标志包括慢性红细胞溶血、氧化应激、炎症、血管紧张素Ⅱ和血管紧张素Ⅱ。 损伤和终末器官损伤。这些生理后遗症导致不可预测的血管闭塞并发症， 例如疼痛和急性胸部综合征（ACS）。人类母乳含有抗氧化剂，抗炎， 免疫调节特性被证明是保护对慢性炎症条件，如 哮喘、肥胖和心血管疾病。人类母乳的持久影响一直是 在青少年和成人研究中证实，其中婴儿时期母乳喂养的个体 血液中炎症的生物标志物水平。有趣的是，母乳甚至被 被证明可以防止端粒的侵蚀-端粒是DNA的保护帽， 建立氧化应激和炎症的标志物。美国儿科学会和世界 世界卫生组织建议在出生后的前6个月进行纯母乳喂养（EBF），然后是1至2个月。 多年的母乳喂养和营养补充。然而，尽管这些建议和良好的- 建立EBF的保护性福利，2020年健康人群母乳喂养目标与当前目标之间的差距 与所有其他种族和族裔群体相比，非裔美国妇女的EBF率最高。 此外，EBF在SCD中的保护作用从未被探索过。一些研究指出， 缺乏母乳喂养的榜样和支持网络是非洲裔美国妇女获得EBF的障碍。 位于伯明翰（亚拉巴马）的一个社区组织--巧克力牛奶妈妈， 通过在线和面对面的教育和支持团体，专门解决这些障碍， 哺乳咨询服务，为低收入母亲提供免费的吸奶器租赁服务，以及家庭探访和同行探访， 辅导计划。巧克力牛奶妈妈专门针对非洲裔美国母亲，因为他们的比例较低 母乳喂养的比例。该群体在2019年实现了83%的6个月EBF率，远远超过了州政府。 和国家趋势。考虑到SCD中普遍存在的氧化应激和炎症， 对于疼痛和肺部健康状况不佳，必须测试EBF的保护作用并建立有效的EBF- 加强对高危人群的干预。本项目的目标是：1）测试协会 EBF暴露与SCD并发症之间的关系，2）测试EBF暴露与生物学之间的关系， 氧化应激和炎症的标志物，以及3）试验招募和保留20名母亲的可行性， 患有SCD的儿童参加基于社区的EBF计划（巧克力牛奶妈妈）≥6个月， 将为未来更大规模的随机对照试验提供信息。这项研究的长期目标是建立 通过推广EBF，提高SCD患者母乳喂养的保护性益处，并改善整体健康结果。

ABSTRACT Sickle cell disease (SCD) is an inherited red blood cell disorder that predominantly affects individuals of African descent. The physiologic hallmarks of SCD include chronic red blood cell hemolysis, oxidative stress, inflammation, vascular damage and end-organ damage. These physiologic sequelae lead to unpredictable vaso occlusive complications, such as pain and acute chest syndrome (ACS). Human breastmilk contains antioxidant, anti-inflammatory and immune-modulating properties proven to be protective against chronic inflammatory conditions, such as asthma, obesity and cardiovascular disease. The lasting impacts of human breastmilk have been demonstrated in adolescent and adult studies, wherein individuals that were breastfed as infants had lower levels of biological markers of inflammation in their bloodstream. Interestingly, breastmilk has even been demonstrated to be protective against the erosion of telomeres – which are the protective caps of DNA and established markers of oxidative stress and inflammation. The American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding (EBF) for the first 6 months of life, followed by 1 to 2 years of breastfeeding with nutritious supplementation. However, despite these recommendations and the well- established protective benefits of EBF, the gap between Healthy People 2020 breastfeeding goals and current rates of EBF is widest amongst African American women compared to all other racial and ethnic groups. Furthermore, the protective effects of EBF have never been explored in SCD. Several studies have noted a lack of breastfeeding role models and support networks as barriers to EBF among African American women. One community-based organization located in Birmingham (Alabama) — the Chocolate Milk Mommies —, specifically addresses these barriers through online and in-person education and support groups, certified lactation consultant services, free breast pump rentals for low-income mothers and a home visitation and peer- mentoring program. Chocolate Milk Mommies specifically targets African American mothers, given the lower rates of breastfeeding in this population. This group achieved a 6-month EBF rate of 83% in 2019, far exceeding state and national trends. Given the pervasive oxidative stress and inflammation in SCD, and the consequent risk for pain and poor lung health, it is essential to test the protective benefits of EBF and establish effective EBF- promoting interventions among this high risk population. The aims for this project are to: 1) test the association between EBF exposure and SCD complications, 2) test the association between EBF exposures and biological markers of oxidative stress and inflammation, and 3) pilot the feasibility to recruit and retain 20 mothers of children with SCD to a community-based EBF program (the Chocolate Milk Mommies) for ≥6 months, which will inform a future larger randomized controlled trial. The long-term goal for this research is to establish the protective benefits of breastfeeding in SCD and improve overall health outcomes through the promotion of EBF.