Chapter 7: Nutrition During Lactation II Flashcards
Milk-to-Plasma Drug Concentration Ratio (M/P Ratio)
The ratio of the concentration of drug in milk to the concentration of the drug in maternal plasma. Since the ratio varies over time, a time-averaged ratio provides more meaningful information that data obtained at a single time point. It is helpful in understanding the mechanisms of drug transfer and should not be viewed as a predictor of risk to the infant, as it is the concentration of the drug in milk, and not the M/P ratio, that is critical to the calculation of infant dose and assessment of risk.
Exposure Index
The average infant milk intake per kilogram body weight per day X ( the milk-to-plasma ratio divided by the rate of drug clearance) X 100. It is indicative of the amount of the drug in breast milk that the infant ingests and is expressed as a percentage of the therapeutic (or equivalent) dose for the infant.
Hyperbilirubinemia
Elevated blood levels of bilirubin, a yellow pigment that is a by-product of the breakdown of fetal hemoglobin.
Kernicterus or Bilirubin Encephalopathy
The chronic and permanent clinical sequelae that are the end result of very high untreated bilirubin levels. Excessive bilirubin in the system is deposited in the brain, causing toxicity to the basal ganglia and various brainstem nuclei.
Meconium
Dark green mucilaginous material in the intestine of the full-term fetus.
Letdown Failure
Milk not being stimulated and released. Stress may inhibit oxytocin as well as alcohol and distractions. Prolonged letdown failure will cause lactation suppression. May try reducing caffeine and/or alcohol and using relaxation techniques.
Hyperactive Letdown
When letdown is overactive, milk streams from the breast as feeding begins. Milk may also leak from the breast that the infant is not being nursed from. The milk streams quickly, and the infant may be overwhelmed by the volume. The infant may choke, cough, or gulp to keep up with the flow. When the infant gulps, the infant may take in air, develop gas pain, and the become fussy.
Engorgement
Occurs when breasts are overfilled with milk when the supply and demand process is not yet established, and the milk is abundant. Also occurs with infrequent or ineffective removal of milk from the breast because of mother-infant separation, a sleepy baby, sore nipples, or improper breastfeeding technique.
Plugged Duct
A plugged duct is a localized blockage of milk resulting from milk stasis (milk remaining in the ducts). The mother may feel a painful knot in one breast and usually does not have a fever or other signs of illness. Treatment for plugged ducts is gentle massage, warm compresses, and complete emptying of the breast.
Mastitis
An inflammation of the breast most commonly found in breastfeeding women. it can be infective or noninfective. Some women get mastitis after having cracked or sore nipples, and some get it without any noticeable problem on the surface of the breast.
Low Milk Supply
Most common reason for cessation of breastfeeding. Usually caused by the mother not breastfeeding or pumping often enough or inefficient emptying of the breast caused by a poor latch or incorrect flange size while pumping. Stress may also be a factor.
Allergic Diseases
Conditions resulting from hypersensitivity to a physical or chemical agent.
Hypersensitivity (Food Allergy)
Abnormal or exaggerated immunologic response usually immunoglobulin E (igE) mediated, to a specific food protein.
Food Intolerance
An adverse reaction involving digestion or metabolism but not the immune system.
Hormonal Maternal Benefits of Breastfeeding
Oxytocin secretion causes uterine contractions in the early postpartum phase. Causes reduces postpartum blood loss and possibly long-term anovulation.
Physical Maternal Benefits of Breastfeeding
Reduced breast and ovarian cancer risk if the mother is under the age of 35
Decreased risk of RA
Weight loss
Psychosocial Maternal Benefits of Breastfeeding
Bonding
Self-confidence
Infant Nutritional Benefits of Breastfeeding
Dynamic nature of HM
Isosmotic- HM and plasma have like ionic concentration
Digestibility
High mineral bioavailability
As food for infants, HM is a stand alone-no other method of feeding babies is as perfect
Infant Immunity Benefits of Breastfeeding
Many substances in HM offer protection against both viral and bacterial infections
Leads to fewer acute illnesses among breastfed infants
Also appears to reduce risk of some chronic illnesses that occur during childhood
Protective Factors in HM
Lactoferrin Lactobacillus Bifidus Factor Immunoglobulins Lysosomes Lymphocytes Macrophages
Lactoferrin
Iron-binding protein; reduces iron available to iron-requiring gut pathogens.
Lactobacillus Bifidus Factor
Facilitates growth of protective gut bacteria. 3 months of breastfeeding is required.
Immunoglobulins
Glycoproteins that function as antibodies. Protects the gut from bacterial invasion/colonization.
Lysosomes
Enzymes that cause breakdown of harmful bacteria cell walls.
Lymphocytes
WBC that make IgA and interferon.
Macrophages
Make complement (phagocytosis of antigens), lactoferrin, lysosome, and more.
Prolactin
Hormone from anterior pituitary that stimulates HM synthesis. Increased by suckling, sleep, and sexual arousal.
Prolactin
Role in Lactation: Alveolar development and milk secretion
Stage of Lactation: Pregnancy and breastfeeding (from the third trimester of pregnancy to weaning)
Estrogen
Role in Lactation: Ductal growth
Stage of Lactation: Mammary gland differentiation with menstruation
Progesterone
Role in Lactation: Alveolar development
Stage of Lactation: After onset of menses and during pregnancy
Human Growth Hormone
Role in Lactation: Development of terminal end buds
Stage of Lactation: Mammary gland development
Human Placental Lactogen
Role in Lactation: Alveolar development
Stage of Lactation: Pregnancy
Oxytocin
Role in Lactation: Letdown; ejection of milk from myoepithelial cells
Stage in Lactation: From the onset of milk secretion to weaning
Lactogenesis I
Begins in the 3rd trimester and lasts for the first few days postpartum; milk production begins.
Lactogenesis II
2-5 days postpartum; increased blood flow to breasts. Transition to mature milk.
Lactogenesis III
10 days postpartum; mature milk secretion.
Letdown Reflex
When milk is released from milk gland into lactiferous sinuses.
Colostrum
Liquid gold
Thick and yellow
Very high in protein/immune factors
Quantity is much lower vs. mature milk
Mature HM Components
Energy: .65 kcal/ml
Lipid: 50% of total kcals; less at start of feeding (foremilk) and more at the end (hindmilk)
DHA: needed for retinal development
Cholesterol: higher in HM than in HMS
CHO: primary CHO is lactose which increases Ca absorption
Vitamin D: not readily transferred to HM. Supplements usually recommended in exclusively breastfed infants.
Folate/B12: these are protein-bond. B12 is often lower in vegan HM
Minerals: quantity is lower vs. HMS, but bioavailability is higher
Feeding Frequency and Duration
Newborn: 10-14 times per 24 hours
10-20 minutes per breast
Frequency is less as the infant grows
Signs that Breastfeeding is Progressing Well
Infant gains weight steadily after week 1
6 wet and 3-4 soiled diapers daily after week 1
Infant is alert, bright, and responsive
Audible swallow during feedings
Maternal Energy Intake During Breastfeeding
Assumption is that it takes 500 kcals a day to produce sufficient breastmilk in the first 6 months; 400 kcals a day after that.
RDIs: TEE + 330 kcals daily in the first 6 months. TEE + 400 kcals daily in the second 6 months
Maternal Fluid Intake During Breastfeeding
2-3 L needed daily
Generally just drink to thirst
Increased fluid intake does not cause increased breastmilk production
PCM or PEM During Breastfeeding
Usually, there is a slight reduction in the quantity of milk but not the quality.
Weight Loss During Breastfeeding
Varies widely from woman to woman. Gradual weight loss is the recommendation.
Exercise During Breastfeeding
Encouraged as able. Mother’s body seems to adjust energy balance to preserve milk supply.
Vegetarians and Breastfeeding
Adequate B12 is a special concern in vegans. Supplements/fortified foods are likely indicated.
Personal Barriers to Initiating and Continuing Breastfeeding
Embarrassment Time/social constraints Lack of support from family or friends Low confidence Fear of pain
Societal Barriers to Initiating and Continuing Breastfeeding
Commercial promotion of formula
Poor societal acceptance
Early hospital discharge and/or poor follow up
Employers not always supportive and have limited maternity leave
Convenience culture
OB/GYNs do not have time to promote during prenatal care appointments
