Breastfeeding and health Flashcards
WHO recommended breast feeding time?
6 months
2 years after with compulsory foods
what does breast milk contain more of compared to formula
live constituents that promote health.
What is in human milk that isnt in formula
CYTOKINES IL-7 ENZYMES LACTOFERRIN IMMUNOGLOBULINS STEM CELLS
MAIN constitutes of breast milk
water is filtered
protein is more whey based
main protein in breast milk? what is it good for?
alpha lactalbumin
destruction of over 40 types of cancer cells including bladder and brain.
Protein in formula has been associated with an increased risk of?
a baby developing juvenile onset diabetes.
Primary carbohydrate in breastmilk?
lactose - 40% calories
What are fats essential for?
brain development and absorption of fat soluble vitamins, and are a major calorie source.
what fatty acids occur naturally in breast milk - what do they support?
long chain polyunsaturated fatty acids (LCPs)
- NS development , retinol development (improved eyesight),
what growth factors promote gut growth?
Epidermal, insulin and transforming factors
Necrotising Enterocolitis (NEC) is increased in?
mothers who have preterm babies
Transfer factor - lactoferrin role
absorption of iron, and in so doing reduces the amount of free iron which attracts bacteria. Lactoferrin is also bactericidal e.g. it kills E.coli bacteria. There are also transfer factors that help with the absorption of fats and vitamins.
immunoglobulins present in BM - what is the most important one and why?
IgA, IgG, IgM and IgD
IgA - a protective coating to the baby’s gut; it covers the mucosal gut surface to prevent entry of pathogenic bacteria and enteroviruses (E Coli, Salmonella, Streptococci, Staph, pneumococci, rotavirus etc.), protecting against gastroenteritis, respiratory infections
leukocytes produce what?
lysozyme, an enzyme which destroys bacteria by disrupting the cell wall.
Oligosaccharides help to protect against what conditions ?
development of the microflora
- increase good gut bacteria
- otitis media, respiratory, urine and gastrointestinal.
Role of milk lipids
damage the outer surface of certain virus types, reducing infection rate in the baby.
IL-7 is linked to what?
thymus size
- central organ in the immune system
- breastfed babies have a larger thymus
- stimulates antibody producing cells
Anti-inflammatory factors in colostrum help reduce the risk of ?
Necrotising Enterocolitis (NEC), especially in preterm babies.
What does the colostrum help cells and villi do?
gut proliferate, thereby speeding up gut maturity.
Special features of colostrum (6)
- Packed with protective factors
- Concentrated nutrition
- Strong anti-inflammatory factors
- Stimulates gut growth
- Small volumes – intentionally
- Laxative effect – to clear meconium
think of colostrum as a?
concentrated version of breastmilk.
what effect does colostrum ?
laxative effect which helps to minimise jaundice by assisting the passage of meconium (containing bilirubin).
What is a newborn baby born with
a surfeit of interstitial fluid and needs to process this in the first few days.
How do healthy term babies not become dehydrated in the first few days?
kidneys are immature. Colostrum contains all the nutrients and protective factors the baby needs without all the excess water which his system would find difficult to process
not breastfeeding increases the risk of: - in babies (7)
Gastroenteritis Respiratory infections Allergies* Obesity Type 1 and 2 diabetes SIDS NEC
not breastfeeding increases the risk of: - mother (4)
Breast cancer
Ovarian cancer
Hip fractures
Heart disease
the longer mothers breastfeed - the greater protected they are from?
breast and ovarian cancer, and hip fractures in later life
There is an association between prolonged breastfeeding and lower
postmenopausal risk for cardiovascular (CV) disease.
what crosses the gut/blood barrier to kickstart the babies endocrine system?
Tiny molecules in breastmilk such as maternal antibodies and hormones
what do metabolites allow
stimulation of enzyme release in babies, provision of signals from mother to baby about threats in the environment (allergies, potential infections) and support of growth and development.
When do babies begin to pick up their familial microbiome
as they pass through the vagina at birth and through their mother’s milk in the postnatal period and beyond
Why are the microbes in our gut important?
Generate our energy needs
Produce enzymes to digest food
Manufacture vitamins B, K and nicotinic acid
Regulate fat storage
Manufacture amino acids
Help with iron absorption
Create our individual immune system and help immune cells reproduce
Train our immune system on what is safe and what to reject
Oligosaccharides features (2)
feed healthy gut bacteria
produce an adhesive protein substance which helps seal the gaps between cells in the gut wall
What increases in the vagina during pregnancy?
lactobacilli bacteria
- baby is exposed
What is seeding?
the baby’s gut is colonised with maternal microbes.
What happens with the first breastfeed?
live constituents in breastmilk continue to develop this process of setting up immune system in babies gut - with its high levels of bifidobacteria and oligosaccharides
What provides the baby with the best tart in life?
vaginal birth, skin-to-skin contact and breastfeeding - passes microbial heritage
if a baby is born by CS they miss out on? what will this compromise?
vaginal transfer of microbes
- gut flora
Breastfeeding may result in epigenetic changes which impact on: (3)
Brain development
Baby’s immune system
Baby’s metabolic system
most critical time period for epigenome?
what can breastmilk do to the epigenome?
in utero to age three
- to turn off or on certain epigenetic changes
Leptin and breastmilk ?
babies who are breastfed have higher levels of leptin at one month of age
- regulates appetite control and food intake
What is the steps in the Broncho-mammary pathway
Pathogens inhaled - Antibodies sent to breast - incorporated into breastmilk
What is the steps in the Entero-mammary pathway?
Pathogens ingested -
Antibodies produced and sent to breasts - incorporated into breastmilk
GALT/ BALT - names
- Gut-Activated Lymphatic Tissue
- Bronchus-Activated Lymphatic Tissue
those choosing to give formula- what must they be told?
that parents be informed that first milks are the most appropriate formula for babies and sufficient for the first year of life.
formula milk does not contain any?
live constituents and so cannot boost immune systems or enhance brain development;
What are the 3 stages of lactation- describe them - what week/time is the production
Lactogenesis 1 – Breast development and colostrum production from approx. 16 weeks gestation
Lactogenesis 2 – Onset of copious milk secretion occurring between 32 and 96 hours after birth
Lactogenesis 3 – Maintenance of milk production
main step of lactogenesis 1
differentiation of alveolar epithelial cells into lactocytes that secrete colostrum from around 3-4 months of pregnancy
main step of lactogenesis 2
occurs in response to rise in prolactin and decrease in pregnancy hormones, and milk will ‘come in’ regardless of whether a woman wants to breastfeed or not.
main step of lactogenesis 3
the long term maintenance and becomes less reliant on prolactin and more on FIL.
external changes of the breast during pregnancy?
become bigger, areola and nipple may darken, Montgomery’s tubercles appear on the areola to secrete an antiseptic sebum to lubricate the area.
Montgomery’s tubercles appear on the areola to secrete what?
antiseptic sebum to lubricate the area. The sebum also secretes a scent to entice the baby to begin to search in the area for his first feed. May notice ‘marbling’ as the blood supply to the breast increases.
when may the breasts produce colostrum?
16 weeks gestation
how does the ductal system and alveolus develop?
under the influence of oestrogen, progesterone and human placental lactogen
what is inside each alveolar sac?
thousands of milk producing cells called lactocytes.
what muscle cells surround the alveolus and ductal cells and what do they do?
myoepithelial cells which help squeeze the milk down the ducts to the openings in the nipple.
What drops soon after birth?
Oestrogen and progesterone levels drop as soon as placenta delivered
what hormone levels rise after birth and how?
Prolactin and oxytocin levels rise in response to touch, smell and sight of baby
The prolactin receptor theory - what is on the cell wall of each lactocyte? how do these levels rise?
Prolactin receptors. Prolactin levels in the blood stream rise in response to touch and suckling by the baby.
How are fat globules better removed?
can adhere to the cell wall, a little like the way fat rises to the top of a milk bottle, and will be better removed by the flutter suckling a baby does towards the end of a breastfeed.
Features that prolactin is responsible for? (4)
- milk production
- Responsive to touch and stimulation
- Levels higher at night
- Frequent contact/feeds sets up long term production
Features that oxytocin is responsible for? (4)
for milk delivery
Acts on muscle cells in pulsatile action
Levels higher when baby is near
Stress can temporarily delay ‘let down’
when does plasma prolactin levels increase the most?
immediate postpartum period but rise and fall in proportion to the frequency, intensity, and duration of nipple stimulation.
Why doe prolactin levels double in the blood?
in response to suckling and peaks approximately 45 minutes after the beginning of a breastfeeding session.
what % do prolactin levels drop after the first week of birth?
50%
if non breastfeeding- reach non-preg levels after 7 days
what rhythm does prolactin follow?
circadian rhythm: levels during the night (sleep) are higher than during the day.
circulating oxytocin acts on the muscle cells to?
release milk from the lactocytes.
what can compete with a mothers oxytocin?
cortisol levels - especially if a baby is crying or distressed
Effect of stress on milk production?
- what techniques can help?
cortisol and adrenaline) causes us to tighten rather than relax our muscles and so the muscle tissue around the breast is affected and can take time to respond.
Relaxation techniques can help as well as can skin-to-skin contact, but it is best to prevent the stress by keeping baby close.
Feedback Inhibitor of Lactation (FIL) - what controls milk production within the bloodstream?
Circulating prolactin
Whey protein in the milk role in FIL?
FIL slows down synthesis by signalling to the cells to stop production.
How else is down regulation caused?
pressure within the full breast flattening and expanding the cells and the receptor sites, making it difficult for prolactin to attach to and enter the cells.
Some positive features of oxytocin (5)
- Works on our feelings and emotions
- Lowers blood pressure and improves sleep (reduces cortisol)
- Reduces stress levels by ‘taking on’ cortisol
- Reduces pain sensitivity
- Boosts our immune system
name some places where oxytocin receptors are commonly found?
mammary gland, uterus
- stomach, kidneys, blood vessels and heart, brain
what does oxytocin being a neuropeptide mean?
acts on the muscles within our body but also on our brain
a baby will be given a hat to wear if…?
If the baby has risk factors for neonatal hypoglycaemia
- supports thermoregulation
Why skin contact should be protected ? (5)
- Triggers lactation and mothering hormones
- Regulates temperature, heart rate and breathing in baby
- Colonises baby with microbes from mother, father, and their environment
- Stimulates feeding behaviour
- Reduces stress hormones in mother and baby
Catecholamine levels are?
give examples
- what happens when this level drops?
raised after birth
- adrenaline, dopamine and norepinephrine
- baby more awake and interested
One hour of skin contact can reduce stress hormone levels by?
75%
At any time skin contact can help with? (5)
- Attachment challenges
- Boosting milk supply
- Unsettled babies and mothers
- Breast refusal
- Postnatal depression or low mood
dad’s can enjoy this too!!!
