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HUNT243 > Lecture 7: Lactation and Human Milk > Flashcards

Lecture 7: Lactation and Human Milk Flashcards

1
Q

What are the functional units of mammary gland?

A

Alveoli

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2
Q

What does each alveolus have?

A

A cluster of cells (secretory cells) with a duct in the centre to secrete milk

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3
Q

How are ducts arranged?

A

Like branches of a tree with each smaller duct leading to 6-10 larger collecting ducts, leading to the nipple

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4
Q

What surrounds the secretory cells?

A

Myoepithelial cells

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5
Q

What is the role of myoepithelial cells?

A

Contract under the influence of oxytocin and cause milk to be ejected into ducts

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6
Q

The mammary gland is made up of how many lobes?

A

15-25 lobes

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7
Q

Where do lobes drain into?

A

Collection duct

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8
Q

How many lobules make up a lobe?

A

20-40 lobules

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9
Q

What is each lobule comprised of?

A

40-100 alveoli

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10
Q

What is the structure of an alveolus?

A
  • Surrounded by myoepithelial cells (contractile)
  • Contain milk-producing lactocytes
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11
Q

Where is milk squeezed out of?

A

Lactocytes in alveoli

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12
Q

Why are alveoli well vascularized?

A

So that oxytocin may reach them

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13
Q

What happens to ovaries during puberty?

A

Mature and increase in estrogen and progesterone

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14
Q

How are mammary lobular structures initiated?

A

By increased estrogen and progesterone

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15
Q

How do mammary lobular structures mature?

A
  • Ductal sustem matures
  • Nipple grows
  • Fibrous and fatty tissue increase around the duct
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16
Q

When are mammary lobular structures complete?

A

approx. 12-18 months after menarche (first period)

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17
Q

What hormones allow further preparation of the mammary gland?

A

Human Chorionic Gonadotropin (HcG) and Placental Lactogen

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18
Q

What stimulates the development of glands that will produce milk?

A

Estrogen

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19
Q

What happens to tubules and epithelial cells during pregnancy?

A

Tubules elongate and epithelial cells that line the tubules duplicate

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20
Q

What hormone stimulates the elongation of tubules and duplication of epithelial cells?

A

Progesterone

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21
Q

What is the role of prolactin during pregnancy?

A

Stimulates milk production via suckling (baby)

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22
Q

What are the two stages of prolactin levels during pregnancy?

A
  1. Breast development
  2. Inhibition of lactation
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23
Q

How is prolactin involved in breast development?

A

Stimulates the growth and development of the mammary glands

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24
Q

How is prolactin involved in the inhibition of lactation?

A

Although prolactin levels are high, high levels of estrogen and progesterone prevents actual production of milk

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25
Q

Why is the production of milk suppressed during pregnancy?

A

During last 3 mo pregnancy to allow for the body to prepare for milk production

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26
Q

What is the role of oxytocin?

A

Stimulates ejection of milk from the milk gland into ducts via suckling (baby) - ‘letdown’

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27
Q

What does the contraction of the milk ducts feel like?

A

Tingling, tightening or shooting pain - lasts about 1 minute

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28
Q

Oxytocin acts on the ?? as well as milk ducts

A

Uterus

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29
Q

How does oxytocin act on the uterus?

A

During and after delivery, causing it to contract (back to pre-pregnancy size)

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30
Q

Where is oxytocin released from?

A

Posterior pituitary

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31
Q

Where is prolactin released from?

A

Anterior pituitary

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32
Q

Milk ejection is stimulated by…

A

Oxytocin

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33
Q

Milk secretion is stimulated by?

A

Prolactin

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34
Q

How many stages of milk production are there?

A

3

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35
Q

What are the 3 stages of milk production?

A

Lactogenesis 1, 2 & 3:
1. Colostrum
2. Transitional milk
3. Mature Milk

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36
Q

When is colostrum produced?

A

Produced directly after birth and in 1st few days

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37
Q

What are the milk production levels of colostrum?

A

Low

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38
Q

What is the micronutrient make up of colostrum?

A

High levels of white blood cells, immunoglobulin A, vitamin A - immunity support

39
Q

What is the macronutrient makeup of colostrum?

A

High protein, low fat

40
Q

When is transitional milk produced?

A

After 1st couple of days (2-3 days of birth) up to approx. 10 days

41
Q

What are the milk production levels of transitional milk?

A

Increased milk production, stimulated by maternal hormones - approx. 300-400ml/day

42
Q

What is the macronutrient makeup of transitional milk?

A

Higher protein and fat than colostrum - still lower fat than mature milk

43
Q

When is mature milk produced?

A

Begins around 10 days postpartum

44
Q

What are the milk production levels of mature milk?

A

approx. 780ml/day during exclusive breastfeeding (0-6 months)

45
Q

As milk matures the amount…

A

Increases

46
Q

As milk matures, fat content…

A

Increases

47
Q

What is the colour of colostrum?

A

Thick and yellow

48
Q

Why is colostrum yellow?

A

From high concentration of carotenoids

49
Q

When should breastfeeding be initiated?

A

Within first hour of birth - just as soon as possible

50
Q

What feeding reflexes are healthy term infants born with?

A
  • Suck and swallow
  • Oral search (open mouth)
  • Rooting reflex (turn head side to side)
51
Q

What happens when suction is created by a babies mouth?

A

Causes the mothers nipple and areola to elongate and form a ‘teat’

52
Q

What are the mechanics of milk moving from the milk ducts to baby’s mouth?

A

Baby’s jaw moves tongue toward areola, compressing it and causing milk to travel out into the mouth

53
Q

What channels milk to the back of the babies oral cavity?

A

Peristaltic motions - forming groove in tongue

54
Q

What are peristaltic motions?

A

Raising anterior portion of tongue and depresses and retracts posterior portion of tongue

55
Q

What initiates the swallow reflex?

A

Receptors in back of baby’s oral cavity

56
Q

What is the key to successful breastfeeding?

A

Proper latch and positioning

57
Q

What is the typical milk production in the first month?

A

600mL

58
Q

What is the typical milk production by 4-5 months?

A

750-800mL

59
Q

What is the range per day in one infant of breastfeeding?

A

450 to 1200mL per day

60
Q

What happens to breastfeeding when a mother has twins/triplets?

A

Increases to meet demand

61
Q

When does milk production decline?

A

After 6/7 months to around 600mL

62
Q

What percent of breastmilk is water?

A

88%

63
Q

Do babies need water?

A

NO - there is plenty in milk

64
Q

What is the foremilk?

A

Start of the milk that comes out is low in fat

65
Q

What is the hindmilk?

A

End of the feed which is high in fat

66
Q

What are the second largest component of BM?

A

Lipids - provide half the energy; contain cholesterol

67
Q

What is the lipid content of BM correlated with?

A

Mothers diet, including trans fatty acid intake

68
Q

What is the protein content of mature milk?

A

Relatively low (higher protein in less mature milk)

69
Q

What are the protein classes in BM?

A

Whey, casein and non-protein nitrogen (nucleotides)

70
Q

What is most of CHO in BM made up of?

A

Lactose (which enhances calcium absorption)

71
Q

Other than lactose, what are the different types of CHO in BM?

A
  • Monosaccharides (glucose)
  • Poly and oligo (gut bacteria)
72
Q

What are HMOs?

A

Human Milk Oligosaccharides

73
Q

What are human milk oligosaccharides?

A

Complex, indigestible, medium-length CHO with lactose on one end

74
Q

How are HMOs found?

A

Free or bound to protein as glycoproteins or lipids as glycolipids

75
Q

How many oligosaccharides are there?

A

Over 150

76
Q

Are HMO’s prebiotic or probiotic?

A

Prebiotic

77
Q

How do HMO’s provide immunity to infants?

A

Stimulate growth of Bifidus bacteria (beneficial) and inhibit Escherichia Coli

78
Q

How do HMO’s prevent infection?

A

Prevent binding of pathogenic microorganisms to the surface receptors of their target cell

79
Q

What are group 1 micronutrient categories in BM?

A

Affected by maternal status - therefore can be restored

80
Q

What are group 2 micronutrient categories in BM?

A

Not affected by maternal status

81
Q

What do infant stores of group 1 micronutrients look like?

A

Infant stores are low and readily depleted, depend on adequate supply from BM

82
Q

What is the iron concentration of human milk?

A

Average 0.35mg/L - low but highly bioavailable

83
Q

Absorption of iron in BM vs formula

A

50% vs 10%

84
Q

What is lactoferrin?

A

A protein with an anti-tumour effect, and has been found to significantly inhibit the growth of some cancerous cells

85
Q

What are the benefits of lactoferrin in human milk?

A
  • Immunity/infection resistance
  • Binds to iron stores to help absorption
86
Q

What is a major determinant of anemia risk during infancy?

A

Infants reserves at birth

87
Q

What is sustained IDA associated with?

A

Irreversible and detrimental effects on intellectual and motor performance - restricts linear growth

88
Q

How much of maternal circulating vitamin D is transferred into breastmilk?

A

20-30%

89
Q

What can low vitamin D status in infants result in?

A

Rickets = soft, weakened bones

90
Q

Vitamin D in BM vs Formula

A

20-70 vs 200

91
Q

Why is it hard to increase the vitamin D content of BM?

A

Group 2 nutrient - maternal intake needs to increase a lot for BM content to increase only a small amount

92
Q

What would a dose of between 200-500 IU per day of vitamin D do for BM?

A

Basically nothing, needs to be higher to support the infant

93
Q

What is the recommendation for Vitamin D supplementation?

A

Give a supplement to baby itself until infant is mobile, or up to 12 months of age

HUNT243 (11 decks)

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