Environmental impact of infant feeding type, accessories used and maternal dietary habits: The GREEN MOTHER-I project, a cross-sectional study protocol
Authors: Cabedo-Ferreiro Rosa Maria , Liutsko Liudmila , Cos-Busquets Judit , García-Sierra Rosa , Colldeforns-Vidal Margalida , Reyes-Lacalle Azahara , Vicente-Hernández Mª Mercedes , Gómez-Masvidal Miriam , Montero-Pons Laura , Cazorla-Ortiz Gemma , Torán-Monserrat Pere , Violán Concepció , Falguera-Puig Gemma ,   The GREEN MOTHER Group, Seguranyes-Guillot Glòria , Manresa-Dominguez Josep Mª , Perez-Llusà Anna , Arias-Perianez Antonia , Gol-Gómez Roser , Alcaraz-Sanz Mª Dolores , Nebot-Rodrigo Núria , Puig-Calsina Salut , Alcaraz-Vidal Lucia , Sitjà-Begué Núria , Barluenga Perez-Cossio Ana M. , Garcia-Sanchez Miriam , Cerro-Hernandez Esther , Morote-Muñoz Cristina , Amoros-Ferrer Paula , Martinez-Mondejar Raquel , Dueñas-Herrero Natalia , Xivillé-Sole Marta , Raja-Carcaña Marina , Risques-Fernandez Núria , Vila-Corominas Anna , Prats-Oliveras Assumpta , Sancho-Esteban Susanna , Vigil-Mamani Mercedes Giselle , Barrionuevo-Ramírez Carmen , Arias-Perianez Antònia , Casquete-Perez Marta , Buitrago-Torrijos Nuria , Maldonado-Aubian Gladis Margarita , Camacho-Donézar Maria , García-Martín Inés María , Nieto-Tirado Sara , Olivas-Menendez Cristina , Rodriguez-Alvarez Maria Inmaculada , Burgos-Cubero Lucia , Gonzalo-Ortega Júlia , Porras-Paradas David , Salceda-Varea Tamara , Samsó-Julià Roser , Suñé-Socias Rita , Vidal-Testal Mª Carmen , Alós-Rodriguez Carolina , Garrido-Dominguez Montse , Miralpeix-Pomar Glòria , Fernandez-Varela Irene , Torres-Franco Ariadna , Prieto-Sanchez Gemma , Guerrero-Martinez Mercedes , Mendoza-Ariza Margarita , Fors-Andreu Meritxell , Expósito-Moreno Carolina , Martinez-Rubiño Silvia , Perez-Navarro Sara , Rodríguez-López Rocío , Garcia-Gonzalez Cristina , Cristóbal-Balbás Laura , Ribas-Tristany Aleida , Antón de Silva Raquel , Imbernon-Bustamante Elena , Estruch-Riu Anna , Borras-Reverter Ainhoa , Llobera-Sanz Alba , Amado-Barroso Paloma , Vera-Pérez Soraya , Gómez-Masvidal Miriam , Martinez-Diaz Marina , Gonzalez-Perez Saray , Pujol-Abajo Montserrat , Monllau-Ros Mireia , Sesa-Nogueras Mercè , Tamaral-Cepas Rosa , Tortola-Brocal Yolanda , Guillen-Vila Marta , Muñoz-Tamajon Laura , Garcia-Muñoz Alba , Martinez-Terron Mònica , Lobera Gutierrez de Pando Eduard , Segovia-Navarro Lorena , Bueno-López Eva , López-Ollero Antonio , de la Fuente Guirado Concepción , Tarrats-Velasco Laura , Garrido-Domingo Montserrat , Calle del Fresno Susana , Casajoana-Guerrero Meritxell , Segura-Soler Míriam , Gomez-Maldonado Meritxell , Cano-Blasco Jose 
Published: August 2024

Abstract
Introduction
Breastfeeding (BF) is the healthiest form of nutrition for babies and is recommended exclusively (EBF) for at least the first six months of life. The carbon footprint of formula feeding (FF) has been studied, but that of BF is unknown.

Aim
To identify the environmental impact of three types of infant feeding taking into account the accessories needed and the diet of postpartum women in the baby’s first month of life.

Methods
This is a multicentre, cross-sectional study conducted in the Barcelona North Metropolitan Area (Catalonia, Spain). The participating sites are primary care settings that will recruit 408 postpartum women (4–6 weeks) as per inclusion/exclusion criteria. The data will be collected through a GREEN MOTHER Survey that includes 4 dimensions: 1) socio-demographic and clinical data; 2) data on the newborn and accessories used in infant feeding; 3) general data on the mother's diet (food consumption habits), and 4) recording of 24 h of the mother’s diet. The data analysis will be performed to check the prevalence of infant feeding types at birth and month 1, as well as a comparative analysis of three types of infant feeding on environmental impact (climate change; water consumption, and scarcity).
Ethics.
This project was approved by the Research Ethics Committee of the Jordi Gol i Gurina University Institute Foundation for Primary Health Care Research (IDIAP) under code 22/101-P dated 22/02/2023.

Discussion
A second phase of the GREEN MOTHER study is planned, which will consist of an educational intervention to promote breastfeeding, nutrition and sustainability. This intervention will be based on the results obtained in Phase I. We expect that the project results – through the publication and dissemination of scientific papers and reports among relevant stakeholders (association of community midwives, healthcare and primary care attention professionals and the public) – will increase public awareness of breastfeeding and its impact on sustainability.

Trial registration
Both phases of the GREEN MOTHER study protocol were registered in ClinicalTrials.gov, NCT05729581.