title: Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia.
abstract: OBJECTIVE
  To investigate Candida species and Staphylococcus aureus and the development of 'nipple and breast thrush' among breastfeeding women.
  
  
  METHODS
  Prospective longitudinal cohort study.
  
  
  METHODS
  Two hospitals in Melbourne, Australia (one public, one private) with follow-up in the community.
  
  
  METHODS
  360 nulliparous women recruited at ≥36 weeks' gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks.
  
  
  METHODS
  Case definition 'nipple and breast thrush': burning nipple pain and breast pain (not related to mastitis); detection of Candida spp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection of S aureus in the mother's nipple or breast milk.
  
  
  RESULTS
  Women with the case definition of nipple/breast thrush were more likely to have Candida spp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014). S aureus was common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence that S aureus colonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates that Candida and nipple damage are independent predictors of our case definition.
authors.affiliation: Mother & Child Health Research, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Amir
authors.forename: Susan M
authors.initials: SM
authors.lastname: Donath
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Garland
authors.forename: Sepehr N
authors.initials: SN
authors.lastname: Tabrizi
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Bennett
authors.forename: Meabh
authors.initials: M
authors.lastname: Cullinane
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Payne