Lactation Flashcards
Anatomy involved in lactation
Anatomy: fat, connective tissue, lobes/lobules, ducts, lymph nodes
Ducts carry milk from alveoli to areola opening into larger ducts at nipple
Nerves, hormones, hypothalamus, pituitary gland
Milk-producing structures nearly the same in all women
Hormones involved in lactation
Regulation of breast milk production
Suckling is the trigger of these hormones to be released:
1) Oxytocin (posterior pituitary): triggers myoepithelial cells to contract and let down milk/mothering response
2) Prolactin (anterior pituitary): Prolactin causes alveoli cells to convert nutrients from blood into breastmilk
- ↓ estrogen/progesterone and ↑ prolactin suppress ovulation
suppressed let-down: embarrassment, pain, stress, anxiety, cold, smoking, excessive caffeine, meds
Breastfeeding is supply and demand oriented
Breastfeeding technique
Shallow latch consequences
Technique: Position is navel to navel, nipple in line with center of baby’s lip, eye contact, wide mouth latch (positive pressure to create flow)
Shallow latch causes pain: nipple discomfort, plugged ducts, mastitis and decreased milk supply
Barriers to breastfeeding
lack of knowledge, perceived inconvenience, difficulty establishing, returning to work, sore nipples, engorged breast, mastitis, pain, baby’s latching issues
Protective effects of breastfeeding for infant
Probiotic gut flora population - 6 months reduces risk of diarrhea by ½
Reduced necrotizing entercolitis - more mature gut lining ↓ leaky junctions
Possible risk reduction for allergies - 4-6 months breastfeeding
Breastfed infants are leaner at 3-4 months of age
Lower risk of obesity with lower plasma insulin levels (reduced adipocyte deposition)
Increases comfort, pain control (skin 2 skin)
Positive correlation with intelligence
Positive effects of breastfeeding for mother
6 month breastfeeding —> return to prepregnancy weight
Reduced risk diabetes, obesity, hypertension, CVD, hyperlipidemia, some cancers (breast cancer)
Reduced financial burden compared to formula
Increased productivity (bonded well, less disruptions)
Dietary recommendations for breastfeeding mothers
Dietary recommendations for vegan breastfeeding mothers
General: healthy diet transfers flavors to ↑ acceptance of low-sugar, low Na, or vegetable rich
- continue prenatal vitamin + vitamin D
- spicy food or garlic can cause distress in infants
Vegan: monitor EAA, omega-3s, Fe (regularly), Ca, vitamin D and B12
- Vegan diets require vitamin D + B12 supplementation
Dietary recommendations for exclusively breastfed infants
in US recommended 1mg/kg of Fe drops at 4 months of age for exclusively breastfed infants
Vitamin D supplementation 10 µg/d to exclusively breastfed infants OR mothers can also supplement with up to 100 µg/d to increase milk content
- vitamin D through sun exposure not advised - sunburnt babies!
Considerations during breastfeeding with special needs infants
Infants with poor stamina/muscle tone - difficulty removing milk or end sessions early
- limit to 30 minute sessions
- increase frequency to 2 hours
- supplement with expressed breastmilk
- use lactation consultant
Preterm infants, late preterm or small for gestational age: ↑ risk of hypoglycemia, hypothermia, hyperbilirubinemia (lacking enzymes → brain damage from build up), dehydration, weight loss, failure to thrive
- mothers should pump after feeding to stimulate increased supply
- supplement hindmilk or human-milk based fortifier
Short-term breastfeeding interruptions
express milk, store in glass/polypropylene container, refrigerate/freeze (below 4°C), heat up to 35-37° NOT in microwave (hot spots)
pump 4x per day and once overnight
PCBs/Dioxins and vitamin K consideration
Environmental contaminants - PCBs and dioxins stored in maternal fat excreted at high levels in week 1 after birth
- upregulation of enzymes for excretion of contaminants
- can interfere with vitamin K metabolism
Deficiency of vitamin K: low in breastmilk → late hemorrhagic disease in infant (low prothrombin in first week of life)
- Neonates have poor stores and require supplementation
- PCBs/anticonvulsants induce cytochrome p450 detox metabolism and excretion of vitamin K
Drug considerations
Rx Drugs: most are excreted in breastmilk - consult doctor for less excretable or short half-life
Oral contraceptives can cause gynecomastia or suppress lactation (estrogen)
Social drugs and alcohol contraindicated - can cause addiction or ↓ milk production
Antibiotics → allergic rxn, vomiting, refusal to eat
Caffeine → restlessness
Sedatives → lethargy
Smoking/alcohol ↓ milk production
Genetic disorders consideration
Phenylketonuria - Lofenalac special formula low in Phe
Galactosemia - rare autosomal recessive disorder, cannot convert galactose → UDP-galactose → galactitol (highly toxic) → severe mental retardation, cataracts and liver damage
- Must cease breastfeeding immediately
Neonatal jaundice: inhibited bilirubin conjugation by glucoronyl transferase → yellowing of skin and eyes
- treatment: light treatments
- risk factors: maternal health issues, prematurity, neonate bruising, excessive weight loss
HIV transfer - therapy to reduce viral load and regular testing → not automatic contraindication
Reduced growth of infant could be due to
Reduced growth:
1) Eczema associated with allergy to breastmilk
2) Prolonged breastfeeding without introduction of solids after 6 months
- Also Fe deficiency without Fe-rich solids introduced (not problem for formula fed)
Stages of breast milk
Lactogenesis I (production in first few days, for 5-7 days)
- Colostrum containings exclusive immune factors found nowhere else
Lactogenesis II (begins day 2-5, for day 7-3 or 4 weeks)
- Transition milk - increased concentration of lactose
Lactogenesis III (begins week 2-5)
Stabilized composition and volume
- Quantity matches amount infant will consume during first year
