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Nutri Sci 431 > Exam 3- Lactation > Flashcards

Exam 3- Lactation Flashcards

1
Q

Lactiferous sinus function

A

Storage of milk

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2
Q

Functional unit of breast

A

alveoli

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3
Q

Estrogen increase during puberty causes

A

duct growth and branching

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4
Q

Progesterone increase during puberty causes

A

alveoli growth

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5
Q

During pregnancy estrogen ______ and progesterone _____ causing the breasts to double in size

A

increases, increases twice as much

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6
Q

During lactation the breast increase to ___ times there adult size because of a decrease in ___ and ___ and an increase in ____ and ___.

A

estrogen and progesterone

prolactin and oxytocin

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7
Q

The first milk is called ____, first few days: 2-10 mL per feeding in first 2-3 days

A

colostrum

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8
Q

Milk in days 7-14

A

Transitional- rapid changes in composition and volume

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9
Q

Mature human milk

A

2 wks to 6 months, fully developed and supports healthy full term infants

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10
Q

Extended lactation milk

A

Beyond 6 mo, declining conc of vitamins and minerals

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11
Q

Milk is made ____in the ____

A

de novo synthesis, mammary gland

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12
Q

Lactose is made of ___ and ___ and its synthesis requires ___

A

glucose and galactose, a-lactalbumin

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13
Q

Protein comes from ____ and _____ and fats are ____ and _____ chain

A

casein and lactalbumins (amino acids)

short and medium chain

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14
Q

Nutrients are transferred (uptake) from the

A

maternal plasma

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15
Q

Nutrients from maternal plasma

A
  • long chain fatty acids
  • all vitamins and minerals
  • immunoglobulins, enzymes
  • harmful substances: drugs, alc, caffeine
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16
Q

Milk synthesis and secretion

A

most active during feeding

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17
Q

Milk release: infant suckling stimulates sensory neurons and initiates neural loop in the _____

A

hypothalamus

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18
Q

The anterior pituitary releases _____ which stimulates______

A

prolactin, milk production

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19
Q

The posterior pituitary releases ______ which stimulates

A

oxytocin, milk ejection (let-down reflex)

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20
Q

Milk ejection: Primary stimulus is ______

A

infant suckling (artificial pumping is less effective)

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21
Q

Factors affecting let down

A
  • infant: proper position, adequate latch-on

- psychological: baby crying, embarrassment (e.g., nursing in public), fatigue/stress

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22
Q

Signs of successful letdown

A
  • milk dripping
  • tingling
  • uterus contraction
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23
Q

Breastfeeding Benefits for Mom

A
  • prolactin inhibits ovulation and menstruation
  • oxytocin promotes uterine contraction, thereby reducing postpartum blood loss
  • promote postpartum weight loss & return to pre-pregnant weight
  • lower risk of breast and ovarian cancer
  • increase maternal self-confidence and maternal-infant bonding
  • convenient and cheap
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24
Q

Breastfeeding benefits to baby

A
  • nutrient content matches human infant need
  • many components of breast milk have immunologic benefits
  • reduction in acute and chronic illness
  • may help to prevent obesity later in life
  • increased IQ
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25
Q

Barriers to breastfeeding in US

A
  • Lack of knowledge
  • social norms
  • Poor family and social support
  • Embarrassment
  • Lactation problems
  • employment and child care
  • Barriers related to Health Services
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26
Q

Breastfeeding common problem: sore nipples

A

very common

  • prevention: proper position and latch-on
  • treatment: letting breasts air-dry, rubbing expressed milk
  • reducing feeding frequency doesn’t help
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27
Q

Breastfeeding common problem: engorgement

A
  • breasts overfilled with milk, difficult for infant to latch-on - common in 1st time mothers; peak time: 2-3 d postpartum
  • treatment: warm compress; express milk until breast not hard
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28
Q

Breastfeeding common problem: Plugged duct

A
  • localized blockage of milk resulting from milk stasis
  • prevention: complete emptying of breasts
  • treatment: warm compress, gentle massage
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29
Q

Breastfeeding less common problem: Low milk supply

A
  • most likely due to not breastfeeding enough (i.e., frequency & duration)
  • insufficient milk syndrome is uncommon, occurs only in 5% of women, caused by inadequate breast development
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30
Q

Breastfeeding less common problem: Flat/inverted nipples and let-down failure

A
  • seek lactation consultant’s help
31
Q

Breastfeeding less common problem: Mastitis

A
  • inflammation of the breast, accompanied by fever and pain
  • engorgement -> plugged duct -> mastitis
  • treatment: antibiotics + effective removal of milk: keep nursing (antibodies=protective)
32
Q

Alcohol consumption during breastfeeding

Effects on infant

A

best to avoid alcohol

-odor, decreased milk consumption, disrupt sleep and cognitive development

33
Q

How long does it take to clear alcohol?

A

1 drink: 2-3 hrs

2: 4-5 hrs
3: 6-8 hrs

34
Q

Caffeine consumption during breastfeeding

A

Moderate intake okay - only 1% goes into milk

35
Q

Caffeine accumulates in young infants because

A
  • ability to metabolize caffeine not fully developed until 3-4 mo
  • symptoms: wakeful, hyperactive, fussy
36
Q

Studies show that most infants can tolerate maternal consumption of caffeine up to

A

3-4 cups a day (can test by avoiding all caffeine-containing beverages for 2-3 weeks)

37
Q

Breastfeeding maintenance: Supply and demand principle

A
  • daily production is governed primarily by frequency & duration of breastfeeding (BF)
  • critical in lactogenesis stages I and II when trying to establish BF; less influential after stage III
  • pumping/expression: less efficient than nursing; wait until BF is established (after stage III)
38
Q

Breastfeeding maintenance: size of breast

A
  • determined by the amount of fat, not number of alveoli cells
  • affects storage, not total amount produced
39
Q

Breastfeeding maintenance: Breast surgery

- reduction/augmentation, implants

A

reduction: usually can’t breastfeed
implants: usually can

40
Q

When not to breastfeed

A

-Infants with galactosemia
-Maternal infections : -HIV - human T-cell lymphotropic virus - untreated active tuberculosis (TB)
Maternal medications
- many medications are safe, e.g., Tylenol
- chemotherapy or radiation
- check LactMed database
- consult with physicians

41
Q

Steps to successful breastfeeding (10 but just main)

A
  • policy
  • education
  • support
  • breastfeeding on demand (every 2-3 hours)
42
Q

DRI for lactation: Requirement for non-pregnant, non-lactating (NPNL) woman plus

A

requirement to produce breast milk

43
Q

Breast milk production: average daily amount

A
  • 0-6 mo postpartum: 780 ml/day (in exclusive breastfeeding- solids at 4-6 mo)
  • 7-12 mo postpartum: 600 ml/day
44
Q

average caloric density of breast milk:

A

20 kcal/oz or 667 kcal/liter

  • 0-6 mo: 500 kcal
  • 7-12 mo: 400 kcal
45
Q

Macronutrient content in breast milk

A
  • CHO: ~80 g/liter
  • protein: ~9 g/liter
  • fat: ~35 g /liter
46
Q

breast milk contains ___% of calories from fat and ___% of calories from protein

A

47, 5

47
Q

Energy expenditure during lactation- Major components of energy expenditure

A

BMR, PA, cals needed to make milk
BMR: little change
PA: slightly decrease in early postpartum but variable among women

48
Q

Calories needed to produce milk can be supplied by

A
  • Energy mobilized from normal, postpartum weight loss (1/3 at delivery, 1/3 0-6 mo postpartum, 1/3 >6 mo postpartum)
  • Energy intake from the diet
49
Q

Energy mobilized from postpartum weight loss

A
  • 0-6 mo postpartum: average ~5 kg = 0.8 kg/mo
  • 7-12 mo postpartum: not all women continue to lose weight and the amount of weight loss highly variable among women; so, cannot count on this for milk production
50
Q

Calories needed for milk production

A

-0-6 mo postpartum: 170 kcal can be supplied from normal weight loss, only 330 kcal need to be supplied from the diet
-7-12 mo postpartum: 400 calories from diet
Avg: 365 kcal/day

51
Q

Energy need for pregnancy compared to lactation

A

Lactation: 365
Preg: 264
*energy requirement for lactation is higher than pregnancy and lactation needs more nutrients

52
Q

Fat soluble vitamins that RDA increases in lactation

A

E and A

53
Q

T/F: Protein requirement increases for both pregnancy and lactation

A

True

54
Q

The water soluble vitamins have a higher requirement for lactation than pregnancy except for

A

Folate

55
Q

The requirement for calcium

A

never changes

56
Q

The requirement for iron increases in pregnancy and _____ in lactation

A

decreases

57
Q

Iron requirement for lactation:

A

Exclusive breastfeeding before menstruation resumes EAR = (basal need + Fe needed in milk) / (% absorption)= (0.9 mg + 0.27 ) / 18%= 6.5 mg/day
RDA = 9 mg/day
*Although Fe-deficient anemia is common in lactating women, this is primarily due to blood loss during delivery and not increased Fe requirement for breast milk production

58
Q

Why doesn’t calcium requirement change when 210 mg is needed to produce 780 ml of milk? Sources of Ca

A
  • diet, bone and renal retention
    Maintenance of calcium homeostasis:decreasing ca levels= increased absorption, ca release from bones, and increased ca retention in kidneys
59
Q

What is the primary source of Ca for milk production?

A

Ca retention

60
Q

Hypothesis in study of lactation

A

Ca supplement will decrease bone loss, greater benefit for lactating

61
Q

Hypothesis in study of weaning

A

Ca supplement augments bone gain, benefit greater for lactating women

62
Q

Purpose of?
Randomiziation
double blind
Placebo

A

decrease likely hood that results are due to something else

63
Q

Treatment in lactation study

A

2, 500mg doses a day for 6 months, adequate vita D and iron

64
Q

Treatment in weaning study

A

same as lactation but with no extra iron

65
Q

Primary outcome measure in lactation and weaning study

A

Total body bone mass and lumbar spine bone density and radius

66
Q

secondary outcome measures in lactation study

A

breast milk Ca increase?

67
Q

What methods were used to estimate participants dietary Ca intake before and during study

A

Before: food frequency questionarre over past 3 months (retrospective= bias)
During: Pill counts, 3 day food records (portion size estimate)

68
Q

How were subjects Ca intake compared to EAR and RDA

A

Most were lower than EAR

69
Q

Results for lactating study

A

Ca supplement did not significantly increase bone density of lumbar spine in lactating women but helped non lactating women increase their bone density. The supplement was of greater benefit to lactating women.

70
Q

Results for weaning study

A

Ca supplement increased bone augmentation in both lactating and non lactating groups but did not help lactating women more than non lactating

71
Q

Does Ca supplementation increase Ca content in breast milk?

A

No

72
Q

How does Ca content in breast milk change over time

A

Decreases

73
Q

A dietary Ca supplement during lactation isnt needed bc

A
  • doesnt increase intestinal Ca absorption

- doesnt prevent bone loss

74
Q

Ca needs are met by ___ during lactation

A

-mobilizing bone Ca
-decreasing urinary Ca excretion
(in preg by increased rate of absorption)

Nutri Sci 431 (8 decks)

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