Lactation and the effects on early life Flashcards
What are the WHO guidelines for breastfeeding?
- exclusive for around 6 months
- up to 2 years and beyond
(lots of misconceptions about breast milk, and lower feeding rates in UK)
What is the full duration of breastfeeding per child?
How does it differ across different countries
between 4-7 years… (i.e. why ‘milk teeth’ stay until this age!)
- but western culture norms have disrupted this
- other more remote communities and primates go for much longer (eg. mongolia)
- only 1 in 200 by age 1 are still breastfed in UK!!!!
- we should be doing it for much longer
What is tandem feeding?
feeding multiple children i.e. one older and younger child; here, milk reverts to newborn milk type
What are the functions of breast milk?
- epigenetic regulator
- prevents against non-communicable diseases
- provides innate immunity to child (has anti-microbial factors) and healthy bacteria e.g. bifido, lacto
- anti-viral properties
- metabolic programming
- brain development
alongside growth
What does human milk contain?
- vits and minerals
- nucleotides
- amino acids
- > eg tryptophan sets diurnal rhythm
- pluripotent stem cells
- enzymes
- hormones
- fats
- antimicrobial factors
- growth factors
- oligosaccharides: over 200!
What is the rhythm of lactation? i.e when are levels of breast milk higher?
diurnal (breast milk in higher quantities in the evening)
What molecules in human milk have antiviral properties?
- sIgA
- Oligosaccharides
- Lactoferrin
- Lysosyme
- vitamin A (antiviral properties)
- cytokines
- antioxidants
lots more!
Describe oligosaccharides in human milk.
how many do we have?
over 200!
Each mother has unique fingerprint influenced by genetics, seasons, environment
20 of these sugars can’t be metabolised by humans but are the metabolites for bifido and lacto bacteria!
What is the role of breast milk in the gut?
Variance in the infant gut microbiome depends almost solely on breast milk for first 14 months
Oligosaccharides provide metabolites for bifido and lacto bacteria in the gut
Describe the intestinal barrier in the fetus
Gaps = infant takes up large molecules e.g. Igs, stem cells, to pass through placenta
Dendritic cell samples environment and presents to B cells in gut wall
if non-human protein detected? junction seals to prevent it getting through BUT THIS BLUNTS IMMUNE RESPONSE! (could cause autoimmune disease)
What factors contribute to disease?
Genetic susceptibility
Environmental stressors
Infant feeding + aberrant microbiome
- implicated in
- asthma
- obesity
- T1DM (increasing incidence)
- ALL
- neurological disease (dementia?)
What is the role of breast milk in metabolic programming?
• human milk contains fatty acids (alkylglycerols) which maintain beige thermogenic adipocytes
- beige adipocytes release heat, infant thermoregulation
- if alkylglycerols are not present beige adipocytes convert to white adipocytes = fat tissue storage
- beige adipocytes persist for longer in infants who have been breast fed for longer
- infants who are formula fed from younger have a significant risk of being overweight later in life
How does breast milk affect brain development?
increased breast milk feeding associated with increased connectivity between different areas of the brain
What are the benefits of breastfeeding to maternal health?
Breastfeeding reduces risk of breast cancer
- 20% reduction in triple-negative breast cancers
Esp for those with High risk genetic mutations (e.g., BRCA1)
- 1 yr breastfeeding → risk reduction 35-40%
- 2 yr breastfeeding → risk reduction 55-60%
Reduced risk ovarian and endometrial cancer FOR ALL WOMEN
Reduced risk of postnatal depression for all women
How does breastfeeding relate to postnatal depression?
Major factor is women who want to breastfeed but can’t (over 85%)
Lack of prolactin/oxytocin released due to no breastfeeding
Only explanation for body is infant dying! hence breastfeeding grief can occur
Describe global breast feeding rates
declining
- in UK catastrophically low rates of BF at 1 year
- brazil had public health campaign to tackle low rates via human milk bank to provide alternatives to formula for women
What are the two main hormones in lactation?
explain the physiology
Prolactin
- drives milk production
- acts on lactocytes
oxytocin
- triggers myoepithelial cells to contract
- milk ejection
How often do babies breastfeed?
- typically feed at least 8-12 times per 24hrs
- at four month they have growth spurt so it increases
- cluster feeds e.g. every 5 mins
Describe newborn sleeping patterns?
what causes sleep arousal for babies?
No clear circadian rhythm at birth
50% “active sleep” ≈ REM
Active sleep (~30m) → quiet sleep (~50m) → active sleep….
Arousal easy in active sleep, can be caused by:
- Hunger
- Cold
- Discomfort
- Startle reflex
- Unfamiliar conditions: It is normal that newborns “won’t be put down”
What factors can decrease mother’s milk supply?
Supplementing with formula milk
Using a dummy in the early weeks (avoiding hunger cues)
Separating mother and baby (advocate keeping a single unit)
Trying to follow a routine
Sleep training?
What is responsive feeding?
explain physiology and what happens in real life
Concept of demand and supply
Rapid increase in prolactin & oxytocin after placenta removed
Removal of milk from breast triggers prolactin
Feeding whenever baby signals to be fed
Typically very frequently
Night feeding
What is responsive feeding associated with? (in mother and baby)
Mother:
- higher prolactin levels
- fewer breastfeeding difficulties
- increased milk supply
Baby
- lower risk of overweight
- later satiety responsiveness
- longer duration for breastfeeding
How can doctors help with breast feeding practice?
Inform mothers of resources for breastfeeding problems like:
- national breastfeeding helpline
- the breastfeeding network
Advocate for:
- responsive feeding
- sling
Unicef
Guide to supporting breastfeeding
Prescribing advice
- Remember to warn patients that leaflets may say not to breastfeed
Milk banks
What are the key barriers to breastfeeding?
in UK mainly due to attitude imprinted by society
- breastfeeding not prevalent enough in culture
- also dependent on mother’s experience
Aggressive formula milk marketing
Lost awareness of breastfeeding practice over the years; no community
