Effect of Breastfeeding Optimization on Early Vascular Development (BRAVO)

• Cardiovascular risk [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  Abdominal aortic/carotid intima media thickness, distensibility, elastic modulus; pulse wave velocity, stiffness index, blood pressure; echocardiography: ejection fraction (%), fractional shortening (%), TAPSE (cm), cardiac index (L/min/m2), LV mass (grams)
  
  
• Breastfeeding habits [ Time Frame: 1 years ] [ Designated as safety issue: No ]
  Breastfeeding practice: Y/N, night/day, frequency (time interval between breastfeeding, e.g 2 hours) Supplementary formula: frequency/day, volume per feeding Complementary feeding: Y/N, type of foods; frequency/day Employer and employee satisfaction
  
  

• Child growth [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  Body weight, height, head circumference, abdominal circumference
  
  
• Lung function [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  Resistance, compliance, time constant, FVC (liters), FEV1 (liters) measured by spirometry
  
  
• Microbiome [ Time Frame: 1 years ] [ Designated as safety issue: No ]
  Infant nasopharyngeal & oral flora, digestive tract/feces flora, maternal oropharyngeal evaluated using PCR and culture.
  
  
• Development [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  Bayley Infant Scales, IQ
  
  
• Illness [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Infection/fever, allergic symptoms, wheezing, upper/lower respiratory disease, gastrointestinal symptoms
  
  
• Inflammation [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Serum hs-CRP, Fibrinogen
  
  

Breast feeding is suggested to give many benefits for babies and there are some initial prove that it might affect their future health, including the development of cardiovascular diseases. In Indonesia, breast feeding rates are very low, while there is a strong upsurge of cardiovascular disease. In this study, we propose to randomly allocate pregnant Indonesian women who plan to give breast feeding for no more than two months, to either care as usual or to a breast feeding empowerment program lasting to 6 months post partum. At the age of one year, all randomized offspring will undergo non-invasive echographic aortic vascular measurements and cardiovascular risk profiling. Measurements for assessing children's general health status will also be performed, including growth monitoring, repeated lung function test, and microbiomic sampling.