Intro to lactation Flashcards by Nancy He

Breastfeeding has been described as “___ ____”

external gestation

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What is important to help the mother with successful breastfeeding?

support system (encouraging environment)

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In lactation, what hormones are decreased, and which ones increase?

decrease in progesterone and estrogen

increase in prolactin, oxytocin

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____ and ____ immediately after birth is important to start milk production

holding, sucking stimulus

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What are the roles of the 2 main hormones involved in lactation?

prolactin: stimulate PRODUCTION of milk from mammary alveolar cells
oxytocin: stimulate contraction of MYEPITHELIAL cells -> milk release

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What is also known as the “pleasure hormone?” What roles does it play after birth? (4)

mothering response
milk let-down
suppress ovulation (decrease estrogen/progesterone, increase prolactin)
help uterus shrink back to normal

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Where do oxytocin and prolactin come from?

oxytocin: from posterior pituitary
prolactin: from anterior pituitary

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Describe the hormonal cascade for milk production and release

sucking stimulus -> stimulate hypothalamus -> anterior pituitary -> produce PROLACTIN -> alveolar cells produce milk

posterior pituitary -> OXYTOCIN -> milk let-down

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What are some difficulties people may face with breastfeeding? (6)

lack of knowledge
need patience
lack of support
psychological inhibitions
PCOS - less milk production
impaired or LBW baby - cannot latch properly

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If a mother is not producing enough milk, what can be done? (2)

supplement with formula

medication to increase production

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True/False: breastfeeding can act as a form of birth control

True: as long as infant is ONLY breastfeeding, oxytocin will inhibit ovulation

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True/False: breastmilk has over 200 components, and more are being discovered.

True

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What anti-infectious agents are found in breast milk? What was this found to help prevent in infants and young children?

WBC, antibacterial/antiviral molecules

prevent respiratory infections

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Advantages of breastfeeding: (5)

nutritionally superior
always fresh, bacteriologically safe
help proper jaw/tooth development
anti-infectious agents and immune cells
reduce risk of allergies

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3 phases of milk production (types):

COLOSTRUM
TRANSITION
MATURE

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What are the different “compartments” or compound types in breast milk? (4)

macronutrients (protein/carbs/lipids)
Cells
globules/micelles
vitamins/minerals trace elements

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Where do the milk components come from? (3)

transferred from maternal plasma
synthesized by alveolar cells from plasma precursors
synthesized from other mammary cells in situ

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How does time of feeding affect the composition of mature milk (name the types)? How should breastfeeding habits account for this?

FORE MILK: early in the day especially, more lactose and water to rehydrate
HIND MILK: towards end of feeding period, more fat and calories

should empty one breast before switch to other one, to make sure infant gets hind milk (fat is important for brain)

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Transitional milk describes the shift from ____ to ____. What increases, and what decreases?

colostrum; mature milk (up to 3-4 wks)
protein decrease
lactose and fat increase

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Why is it important to stimulate maturation of the GI tract in the infant?

prevent leaky mucosal barrier and GI lining - don’t want compounds or pathogens to sneak through

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compare colostrum to mature milk (4). When is it produced?

honey like, transparent orange (more carotenoids)
more protein and minerals
less energy, fat, lactose
has more of some immunological factors
Only in first 5-7 days; small amounts produced (baby doesn’t eat much)

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The immunological properties of breast milk: (3)

direct action against pathogens
modulate immune response in infant
promote growth/mature GI tract

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True/False: immunological factors are only produced in early colostrum

False: some are higher in colostrum, but factors are produced throughout lactation

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What proteins are not degraded in the stomach and can reach the intestine intact? Describe their structure

Whey proteins

Globular, with disulfide bonds

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Are immunological factors found in alternatives to breast milk?

Formula: NO | Cow milk: lower amounts

____ proteins are resistant against acid and proteolysis. Why?

Whey proteins | contain ANTI-PROTEASES (sulfhydryl oxidase) - preserves disulfide bonds

How can processing of breast milk affect the immunological factors?

Freezing - damage WBC in breast milk, but other factors remain Fridge - up to 3 days is still good Microwave - destroys WBC (Also can create hot spots)

What is the purpose of antibodies in breast milk, and why are they important for the infant?

provide PASSIVE IMMUNITY (defense against pathogens) | infant immune system is not fully developed

The main antibodies in breast milk: (4)

IgG IgA IgM IgE

Describe the process of antibody synthesis for breastmilk:

B cells travel to mammary glands -> form plasma cells -> create antibodies

The antibodies are produced ____, except Ig___ which comes from where?

in the mammary gland; | IgG is exception, comes directly from maternal plasma

The B cells used for synthesizing antibodies in breastmilk typically come from where? Why?

Respiratory and intestinal tract | areas of HIGH EXPOSURE to pathogens (good "database" in B cells)

The antibody ____ is protective against many pathogens, and is ___% of the secretory antibodies

IgA | 90%

What are the anti-infectious agents in breast milk? (proteins) (8)

- lysozymes - lactoferrin - lactoperoxidases - lipases - interferons - B12 binding protein - fibronectin - complement proteins

An important N containing carbohydrate in breast milk was once known as the ___ ____, but now called _____.

bifidus factor | human milk oligosaccharides

What are the immune cells found in breast milk? (3)

- macrophages - neutrophils - lymphocytes

How might antibodies be beneficial for the baby's gut?

Neutralize harmful bacteria so that gut can be colonized by "good" bacteria

How does HMO benefit immunity?

promote growth of LACTOBACILLUS in lower GI tract -> produces acids that prevent pathogen growth prevent enterobacteria -> diarrhea diseases prevent necrotizing enterocolitis (dying GI tissue)

What are 2 anti-infectious factors found in breast-milk? (other)

HMO/bifidus factor | anti-staph factor

What is the role of lysozymes?

Break down bacteria cell wall (proteoglycans)

What is the role of lactoferrin? Why is it so efficient?

Bind to iron very efficiently (limits amount for siderophilic bacteria) 80% is in the "free" form (ample amounts) - able to bind very well to any iron present

list the causes of necrotizing enterocolitis: (4)

premature poor blood flow to gut health defect bacterial infection

Which of the breast milk anti-infectious proteins can give some antiviral benefits?

lipases | interferons

What is the role of lipases? How does this contribute to immunity?

break down fat | produces monoacylglycerols and free FA -> antiviral properties

Interferons will inhibit:

intracellular viral replication

What is the role of lactoperoxidases?

Kill strep and enteric bacteria

Which of the cells in breast milk are responsible for synthesis (2)? What do they produce?

Lymphocytes: IgAs and others Macrophages: complement proteins, lysozymes, lactoferrin

How do fibronectin and complement proteins aid in fighting bacteria?

Fibronectin: increase phagocytosis complement: create pores in bacteria -> destroyed

Which WBCs in breast milk are responsible for phagocytosis?

macrophages | neutrophils

Which anti-infectious agents act by reducing the nutrients available for bacteria?

Lactoferrin (iron) | B12 binding protein (B12)

Where is the main area of the baby's body that these immune factors play a role?

GI tract

Give 2 examples of prostaglandins in breast milk:

spermine | spermidine

the growth factors in breast milk: (3) | What are their roles?

cortisol/thyroxine/insulin -> stimulate gut enzymes -> mature GI tract prostaglandins -> mucus secretion & cell division polyamines -> growth factor; increase cell replication

What vitamin can help stimulate the immune system in infants?

vitamin E

What are the 2 main milk proteins? Describe them.

CASEINS: phosphoproteins in micelles with Ca, P, Mg WHEY: resistant to acid, leftover after acid precipitation of casein

Why does human milk have lower proportion of protein compared to cow or goat?

slower growth rate

How does human milk differ from bovine milk? (4)

more whey, less casein more nucleotides better balance of essential AA lower risk of allergy

Which milk protein type is better absorbed by the infant?

Whey - forms softer curd -> travel through GI and slow release of peptides Pepsin not yet mature in stomach, can't break down casein well

What is an important role of whey proteins? Which ones in particular?

bind and supply minerals lactalbumin (Ca and Zn) Lactoferrin (Fe) ``` others: xanthine oxidase (Fe and Mo) Glutathione PO (Se) Alkaline phosphatase (Zn and Mg) ```

What are the NPNs? How well are they absorbed?

non protein nitrogen: AA, peptides, N-acetyl sugars, urea, nucleotides Better digestibility

What is a major protein in cow milk that is responsible for most allergy reactions? To what extent is it in human milk?

B-lactoglobulin | NOT AT ALL in human milk

Human milk is rich in ____, which is a conditionally essential non protein amino acid. What else is it needed for? (2)

taurine bile acid conjugation act as neurotransmitter

What protein in cow milk is linked to type 1 diabetes? How could this occur?

bovine serum albumin | similar structure to site on pancreas -> antibody made for antigenic site -> body will attack own pancreas

How can cow milk formula be processed to prevent allergic reactions?

hydrolyze proteins

How does the allergic response occur?

IgE bind to food proteins -> bind to mast cells -> cytokine/IL/platelet activation -> INFLAMMATION (histamine release)

What antibody in cow milk has been linked to an excessive crying condition in infants? What is that condition?

``` IgG colic (intestinal distress, gassy) ```

In terms of amino acids, human milk is higher in ___ while lower in ___ , ____and ____. why?

rich in cysteine - cystathionase not fully developed, cannot synthesize enough low in met, phe, tyr - met: cannot convert to cys efficiently, excess levels bad for CNS - Phe and Tyr: tyr aminotransferase and PHPP oxidase not fully developed, excess bad for CNS

What are the clinical signs of a cow milk allergy?

vomit/nausea/diarrhea sneeze/wheeze/cough dermatitis headaches (crying)

Should infants who develop a cow milk allergy be given soy as an alternative?

No can also develop allergy also: phytic acid lowers nutrient absorption lower Ca, P

What antibody in breast milk can help prevent food allergies? How? (2)

IgA bind to food molecules -> prevent from going through leaky gut and causing reaction -> passed out through reticuloendothelial system promote mucus production to form protective layer in gut

What type of milk help to stimulate sealing of the gut leaky junctions?

Colostrum (early milk)

What is the syndrome that is a hypersensitivity to cow's milk? What symptoms does it cause, and why is it hard to diagnose?

Heiner's syndrome GI blood loss -> iron deficiency anemia failure to thrive similar symptoms to pulmonary disease; appears like an infection

Why should newborns never be given cow milk at all?

allergy risk | GI not yet sealed (antigens can leak through)