title: Prevalence and factors associated with cracked nipples in the first month postpartum.
abstract: To assess the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum.
  
  
  
  This was a cross-sectional study nested in a cohort of mothers living in Feira de Santana, state of Bahia, northeastern Brazil. Data from 1,243 mother-child dyads assessed both at the maternity ward and 30 days after delivery were analyzed. The association between cracked nipples as reported by mothers and their possible determinants was analyzed using Poisson regression in a model where the variables were hierarchically organized into four levels: distal (individual characteristics), distal intermediate (prenatal characteristics), proximal intermediate (delivery characteristics), and proximal (postnatal characteristics).
  
  
  
  The prevalence of cracked nipples was 32 % (95 % confidence interval [95 % CI] 29.4-34.7) in the first 30 days postpartum. The following factors showed significant association with the outcome: poor breastfeeding technique (prevalence ratio [PR] = 3.18, 95 % CI 2.72-3.72); breast engorgement (PR = 1.70, 95 % CI 1.46-1.99); birth in a maternity ward not accredited by the Baby-Friendly Hospital Initiative (PR = 1.51, 95 % CI 1.15-1.99); cesarean section (PR = 1.33, 95 % CI 1.13-1.57); use of a feeding bottle (PR = 1.29, 95 % CI 1.06-1.55); and higher maternal education level (PR = 1.23, 95 % CI 1.04-1.47).
  
  
  
  The prevalence of cracked nipples was high in our sample. Most of the factors associated with cracked nipples were related to postnatal characteristics, especially poor breastfeeding technique, which could be improved to help prevent the condition.
authors: State University of Feira de Santana, Bahia, Brazil. kjulisantos@yahoo.com.br.|Centro de Pós-Graduação em Saúde Coletiva, Mestrado Acadêmico, Avenida Transnordestina, s/n, Avenida dos Laboratórios, Módulo 6, Bairro Novo Horizonte, CEP 44036-900, Feira de Santana, BA, Brazil. kjulisantos@yahoo.com.br.
authors: Kamila Juliana da Silva
authors: KJ
authors: Santos
authors: State University of Feira de Santana, Bahia, Brazil.
authors: Géssica Silva
authors: GS
authors: Santana
authors: State University of Feira de Santana, Bahia, Brazil.
authors: Tatiana de Oliveira
authors: Tde O
authors: Vieira
authors: State University of Feira de Santana, Bahia, Brazil.
authors: Carlos Antônio de Souza Teles
authors: CA
authors: Santos
authors: Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil.
authors: Elsa Regina Justo
authors: ER
authors: Giugliani
authors: State University of Feira de Santana, Bahia, Brazil.
authors: Graciete Oliveira
authors: GO
authors: Vieira
mesh_terms: D000293:Adolescent; D000328:Adult; D001903:Bottle Feeding / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D001941:Breast Diseases / Q000453:epidemiology*; D001942:Breast Feeding / Q000379:methods; D002585:Cesarean Section / Q000706:statistics & numerical data; D002648:Child; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D007775:Lactation Disorders / Q000453:epidemiology; D008875:Middle Aged; D009558:Nipples; D049590:Postpartum Period; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
keywords: Breastfeeding; Lactation disorders; Nipple injuries