Lecture 8: Maternal Energy Needs (Lactation)

Question 1

BMR of lactating vs non-lactating women

Answer 1

Very similar - Energy cost of lactation is from the energy content of milk plus energy required to produce it

Question 2

What are the estimated energy requirements of lactation from 0-6 months?

Answer 2

2000 kJ/d above NPNL

Question 3

What is the mean milk volume per day?

Answer 3

780mL/day

Question 4

What is the energy density of BM?

Answer 4

2.8kJ/g

Question 5

What is the milk synthesis efficiency conversion (conversion of maternal dietary energy to milk energy)?

Answer 5

Conversion of 80%

Question 6

What are the estimated energy requirements adjusted for?

Answer 6

Weight loss post-partum; to account for energy mobilisation from adipose tissue stores

Question 7

What is the estimated energy requirements of lactation over 6 months postpartum?

Answer 7

1680 kJ above NPNL

Question 8

Why do energy requirements decrease after 6 months?

Answer 8

• Reduced milk production
• Reduced maternal weight loss

Question 9

What is the average weight loss per month during 0-6 months for the mother?

Answer 9

0.8kg/month

Question 10

When is the most rapid weight loss postpartum seen?

Answer 10

Between 3 and 6 months

Question 11

Why is it recommended not to use bottles initially when breastfeeding?

Answer 11

It is faster out of a bottle therefore the babies need to learn to take it from the breast before moving to bottles

Question 12

What is exclusive breastfeeding defined as?

Answer 12

No other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for 6 months of life

Question 13

What are the only things infants are allowed when exclusively breastfed?

Answer 13

ORS, Drops and Syrups (vitamins, minerals and medicines)

Question 14

What percent of babies are breastfed within 1 hour of birth globally?

Answer 14

47%

Question 15

How many babies are given fluids other than breastmilk in the first 3 days?

Answer 15

1 in 3

Question 16

What is partial breastfeeding?

Answer 16

Baby receives some BM and some infant formula or other solid food

Question 17

What are the benefits of BF for the BABY?

Answer 17

• Reduced infant morbidity and mortality
• Reduced chronic disease
• Increased cognitive function

Question 18

What forms of infant morbidity and mortality does BF reduce?

Answer 18

• GI infections
• Respiratory illnesses
• Otitis media infections
• SUDI

Question 19

What forms of chronic disease in infants does BF reduce?

Answer 19

• Allergies
• Type 2 diabetes
• Childhood obesity

Question 20

What are the benefits of BF for the MOTHER?

Answer 20

• Protects mothers health
• Helps delay a new pregnancy (lactational amenorrhea)
• Helps weight loss

Question 21

What is lactational amenorrhea?

Answer 21

temporary absence of menstrual periods (amenorrhea) due to the hormonal changes associated with breastfeeding

Question 22

What are the specific ways a mothers health is protected from BF?

Answer 22

• Reduces uterine bleeding
• Contracts uterus back
• Reduced risk of ovarian and breast cancer
• Reduced postpartum depression

Question 23

Why are EBF rates low?

Answer 23

• Marketing of substitutes
• Lack of workplace support
• Lack of antenatal care attendance
• Lack of lactation support
• Societal or cultural beliefs

Question 24

Globally, how many infants aged 0-6 months of age are EBF?

Answer 24

48%

Question 25

What is the global nutrition target for breastfeeding by 2030?

Answer 25

Increase rate of EBF in first 6 months to at least 70%

Question 26

What is BFHI?

Answer 26

Baby Friendly Hospital Initiative

Question 27

What is the Baby Friendly Hospital Initiative?

Answer 27

To ensure that all maternities, whether free standing or in a hospital, become centers of breastfeeding support

Question 28

How can a maternity facility be designated ‘baby friendly’?

Answer 28

• No free or low-cost breast milk substitutes
• No feeding bottles or teats, - Implemented ‘10 specific steps to support successful BF’

Question 29

What do baby friendly hospitals aim to do?

Answer 29

Aim to protect, promote and support EBF from birth

Question 30

What are the first 5 steps to support successful BF?

Answer 30

1. Written BF policy communicated to all staff
2. Train all staff to implement this policy
3. Inform all women of benefits
4. Help mothers initiate BF within half-hour of birth
5. Show mothers how to BF

Question 31

What are the second 5 steps (6-10) to support successful BF?

Answer 31

6. No food or drink other than BM
7. Practice rooming in
8. Encourage BF on demand
9. No artificial teats or pacifiers
10. Encourage further BF support

Question 32

How many DHB’s are meeting the BFHI standard in NZ?

Answer 32

15/20 - 75%

Question 33

What is the international code of marketing of Breast-milk substitutes?

Answer 33

Restriction of the marketing of BM substitutes - to ensure mothers are not discouraged

Question 34

What does the Marketing code of BM substitutes in NZ aim to do?

Answer 34

Creates an enviornment where:
- Mothers can make the best possible choice
- Provided with impartial information
- Free from commercial influences

Question 35

What are the general rules of BF substitute marketing?

Answer 35

• No advertisement/promotion
• No samples/gifts to mothers or healthcare professionals
• Material for health workers only to contain scientific info
• All material to support and state benefits of BF

Question 36

Why was Nestle boycotted in 1977?

Answer 36

They were pushing and promoting their own formula

Question 37

What is the recommendation for BF women and alcohol?

Answer 37

There is no safe amount

Question 38

What hormone does alcohol inhibit in BF women?

Answer 38

Oxytocin