Nutrition During Lactation Flashcards
When did breastfeeding rates start to decline?
1950s and 1960s
then dramatically in the 1970s
declined until the early 1990s
What demographic factors are associated with longer duration of breastfeeding?
higher education higher SES western region married being older white, hispanic/latino
What timeframe is considered early postpartum?
first 7 days
What is the mammary gland?
source of milk for offspring
What are alveoli?
functional unit of mammary gland - secretes milk
cluster of cells with a duct in the center
round or oblong shaped cavity in the breast
What are secretory cells?
responsible for secreting milk components into the ducts
What are myoepithelial cells?
line the alveoli
contract to cause milk to be secreted into the ducts
What is oxytocin?
hormone
letdown - eject milk from gland (acinus) into milk ducts
stimulated by sucking and nipple stimulation
causes uterus to contract, shrink and seals blood vessels
How do mammary glands develop?
during puberty
increased release of E and P from ovaries
hormones govern breast development
develops lobes, ducts and alveoli
usually complete within 12-18 months of menarche
What happens as the ductal system matures?
cells that secrete milk develop
nipple grows
nipple pigmentation changes
fibrous and fatty tissues increase around ducts
What happens during pregnancy to prepare for breastfeeding?
luteal and placental hormones
estrogen simulates dev. of glands that make milk
P allows tubules to elongate and epithelial cells to duplicate
What is lactogenesis?
production of milk
occurs in 3 stages
What is lactogenesis 1?
begins during last trimester, extends through first few days postpartum
milk begins to form
lactose and protein content of milk increases
What may impact lactogenesis 1?
premature delivery
method of delivery
other factors
What is a full milk supply?
25-35 ounces per day
What is lactogenesis 2?
2-5 days postpartum
increased blood flow to the mammary gland
onset of copious milk secretion
significant changes in composition and quantity over first 10 days
What is lactogenesis 3?
about 10 days postpartum
composition becomes stable
What is prolactin?
hormone
stimulates milk production, inhibits ovulation
sucking stimulates secretion of prolactin
also stimulated by: stress, sleep, intercourse
3rd trimester to weaning (activity inhibited during pregnancy)
What hormones are necessary for establishing and maintaining milk supply?
prolactin and oxytocin
What hormones contribute to breast development and lactation?
estrogen, progesterone, human growth hormone, human placental lactogen, prolactin, oxytocin
What are the pathways for secretion of milk components?
- made in the secretory cells
- passive diffusion through alveolar cell membranes
- from mother’s blood
What causes letdown?
suckling, sexual arousal, thinking about nursing, hearing a baby cry, etc.
What is the purpose of human milk?
nurture the infant
protect from infectious and certain chronic diseases
What can cause the composition of human milk to change?
age of infant gestation at delivery presence of infection in breast menses maternal nutritional status
What is colostrum?
first milk produced during lactogenesis 2
thick, often yellow
has a lot of immunoglobulin
How does colostrum differ from mature milk?
higher in protein, lower in fat and CHO lower in calories higher in mononuclear cells (immune) higher concentrations of Na, K, Chloride some proteins not present higher in Vitamin A (about double)
What are the components of human milk?
water, energy, protein, fat, minerals, nutrients, sugars, carbs
Which infants consume more calories?
non-breastfed
What are the PRO, CHO, FAT shares of energy in human milk?
FAT - 50% (assume 20 kcal per ounce)
PRO - 1%
CHO - 49%
How does the maternal diet effect fat composition?
diet reflects the fatty acids
if she’s losing weight, fat stores reflect the fatty acids
if her diet is low fat, but calorie sufficient, there are more medium-chain fatty acids
DHA levels increased by supplementation
reflects trans-fats
What are the benefits of DHA in breastmilk?
retinal development
associated with higher IQ scores
only found in some formulas
especially important to preterm infants
Which infants consume more cholesterol?
breastfed
early consumption appears to lower levels in later life
What impacts protein concentration?
age of infant rather than maternal intake and status
What are the values of human milk proteins?
antiviral and antimicrobial effects
might facilitate prevention of inflammation
What is casein?
the major class of pro in mature milk
keeps calcium in soluble form
facilitates calcium absorption
casein is the curd - the insoluble part
What are whey proteins?
remain soluble in water after casein is precipitated
includes milk and serum proteins, enzymes, immunoglobulins, mineral, hormone and vitamin-binding proteins
aid in digestion and protect against bacteria
What is nonprotein nitrogen?
present in milk
available for producing nonessential amino acids
some used to produce other proteins with biological roles
What is the dominant CHO in human milk?
lactose
What do oligosaccharides in human milk do?
provide calories
stimulate growth of bacteria in the gut (good)
inhibit growth of e.coli and harmful bacteria
What vitamins in human milk are not adequate for full-term infants?
K, B6, B12 can be in certain circumstances
*D is unknown
B6 most likely to be deficient
What vitamins in human milk are also not adequate for pre-term infants
E
What maternal characteristics are associated with low levels of B12 in milk?
gastric bypass surgery, vegan, hypothyroidism, latent pernicious anemia, generally malnourished
What is osmolality?
measure of the concentration of particles in solution
What role do minerals in milk play?
contribute to osmolality
content related to growth rate
mineral content decreases over first 4 months - easier for kidneys to handle
packaging makes them highly bioavailable
What are the benefits of breastfeeding for mothers?
hormonal, physical, and psychosocial
increases oxytocin - shrinks uterus, reduces blood loss
delayed ovulation
self-confidence
bonding with infant
lower risk of breast and ovarian cancer and RA (especially who nurse at younger age, for longer)
What are the nutritional benefits of breastfeeding for infants?
optimal nutrition, matches requirements for growth and development, isosmotic, doesn’t overload immature kidneys with N, PRO is in an easily digestible form, generous amounts of lipids, DHA and long-chain PUFAs, enhanced bioavailability of minerals
What are the immunological benefits of breastfeeding for infants?
protects against infections
many components of milk that confer immunological benefits
enhance the maturity of the GI tract
What components of milk confer immunological benefits?
cells, secretory immunoglobins, histocompatibility antigens, T-cell products, carrier proteins, enzymes, nonspecific factors
How do cellular components of human milk provide immunological benefits?
phagocytosis of fungi and bacteria, kill bacteria, produce complement proteins, protect GI tract
protections may extend beyond acute infection
How do immunoglobins provide immunological benefits?
block colonization of pathogens, limit number of antigens that cross mucosal barrier
protects against all sorts of diseases
How does bifidus factor provide benefits?
supports growth of lactobacillus which:
stimulated antibody production
enhances phagocytosis of antigens
What are other benefits of breastfeeding for infants?
lower infant mortality in developing countries
may reduce the risk of SIDS
fewer acute illnesses
reductions in chronic illnesses
increased cognitive ability
analgesic effects
socioeconomic benefits - decreased medical costs
Which acute and chronic diseases does breastfeeding seem to protect against?
diarrhea, GI infection, ear infection, coughing, wheezing
celiac, IBD, neuroblastoma, allergies, asthma
What increases the demand for milk?
infant weight
caloric density of milk
infant’s age
How does breast size impact milk supply?
Doesn’t effect production amount
Effects storage capacity
How can milk be expressed?
manually, hand pumps, commercial electric pumps, hospital grade electric pumps
How might breast augmentation surgery impact breastfeeding ability?
might lead to duct compression and poor milk production
How might breast reduction surgery impact breastfeeding ability?
evidence suggests they may be more likely to be unsuccessful with breastfeeding
depends on type of surgery, location and amount of tissue removed, damage to remaining tissue, incision location
What is considered the optimal duration of breastfeeding?
better for 6 months
best to breastfeed for 12 months+
When do infant reflexes for feeding develop?
suckling at adequate pace and rhythm - by 34 weeks
gag reflex by 28 weeks
oral search reflex - opening mouth wide and thrusting tongue forward
rooting reflex - response to stimulation on the lip
What is necessary for successful nursing?
presence of reflexes
appropriate positioning
adequate letdown and milk production
What changes happen to the breasts during pregnancy?
first trimester - sore nipples
enlargement of nipple and breast starts in first trimester and continues through pregnancy
third trimester - Montgomery glands become pronounced (produce oils to lubricated nipple and areola), nipples darken
What is a proper latch?
nipple in the center of the mouth, most or all of areola in the mouth, tongue lying around the lower gum line, nose close to the breast and breathing unrestricted, hear swallowing but not slurping or clicking, slow deep sucks and relaxed, nipple doesn’t move during suckling, don’t force the breast into the mouth - make sure the baby’s mouth is wide open before you bring the baby towards the breast
How can you tell that an infant is hungry?
bring their hands to their mouth
suck on their hands
move head side to side with mouth open
*shouldn’t wait until crying
Why should the infant nurse at one breast as long as they want, rather than switching?
ensure that they get both foremilk and hind milk
too much foremilk can cause diarrhea - high lactose
hind milk has higher fat content - signal satiety
How frequently should infants be fed?
10-12 feedings are normal for newborns
stomach empties in about 1.5 hours
Which vitamin supplements do breastfed infants need?
all infants get vitamin K shot at birth
rec - 400 IU supplement of D every day for the first 2 months
What newborn weight loss in the first week signals a need for evaluation?
10%
What are symptoms of a malnourished infant?
sleepy, nonresponsive, weak cry, few wet diapers, urine is concentrated, infrequent stools
What are infant causes of failure to thrive while breastfed?
poor intake - sucking, infrequent feeding, structural abnormality
low net intake - infection, malabsorption, vomiting and diarrhea
high energy requirement - CNS development, SGA, congestive heart disease
What are maternal causes of failure to thrive while breastfed?
poor production - diet, illness, fatigue
poor letdown - drugs, smoking, psychological resistance
What are common nutrition diagnoses for breastfeeding women?
altered maternal BMI (obesity, underweight, rate of weight loss) nutrient inadequacy or excess perceived or real inadequate production knowledge deficit qualify for WIC
What are the additional energy needs of breastfeeding women?
approximately 330-450 kcal per day
How does protein-calorie malnutrition impact breastfeeding?
reduces volume, but doesn’t compromise composition
What are common barriers to breastfeeding initiation?
embarrassment, time and social constraints, loss of freedom, lack of support, lack of confidence, diet and health concerns, fear of pain
What are obstacles to continuation of breastfeeding?
insufficient prenatal education, health care provider apathy and misinformation, inadequate lactation training in health care provider, disruptive hospital policies, early discharge, lack of routine follow up care, maternal employment, lack of broad societal support, portrayal of bottle-fed as the norm, sagging (unfounded), promotion of formula and free samples
What are reasons cited for stopping breastfeeding by 4 weeks?
sore nipples, inadequate supply, feeling the infant isn’t satisfied, other infant problems
When is the critical period for providing breastfeeding support?
7-10 days postpartum
How does being a working mother make breastfeeding a challenge?
lack of on-site daycare, insufficiently paid maternity leave, rigid work schedules, lack of employer knowledge
What health policies inhibit breastfeeding?
leaving the hospital before the main challenges occur - lose access to the experts
insurance usually only covers 1 lactation consultant visit
first few months requires near constant care of the infant (feed frequently and feedings can last awhile)
What might parents need to be reassured about in regards to breastfeeding?
sucking and swallowing noises
wide range of pooping that’s normal
initial goal is at least 5 wet diapers per day
how much the baby needs and that they’re getting enough (visuals of stomach size, etc.)
What are some societal challenges of breastfeeding?
not often done in public
lack of knowledge - don’t know what to expect
often not talking about it until they need to breastfeed
could do it at prenatal visits or even sooner, within schools
work related challenges
What are the parts of the Baby-Friendly Hospital Initiative?
written BF promotion policies, BF training for all health personnel, prenatal BF promotion, BF initiation w/i 30 minutes, BF counseling in maternity ward, breast milk only, rooming-in, BF on demand, no bottles or pacifiers, community-based postnatal BF support
What is the whey:casein ratio in human milk?
70:30
in cow’s milk it is 20:80
What form of Vitamin D is in human milk?
most Vitamin D2 - ergocalciferol
reflects mother’s sun exposure
What percent of breastfed infants are at risk for K deficiency?
about 5%
Which women are more likely to have B12 deficiency and therefore the breastfed infant might be at risk?
vegans, hypothyroidism, malnourished, gastric bypass, latent or pernicious anemia
