Sept12 A3-Breastfeeding Flashcards
lactation consultant def
any health prof trained in breastfeeding medicine
right way to breastfeed
exclusively breastfeed infants for first 6 months of life and then breastfeed + complementary foods up to 2 years and beyond
problem of taking meds + breastfeeding
no prob. most meds post partum are compatible with breastfeeding
- Abx
- pain meds
- etc
when to use infant formula instead of breast milk
only in some medical conditions where have to supplement the infant or maternal HIV or taking specific meds
glandular tissue of mammary glands extends where
up to axilla. so normal to have swelling there when lactate
areola def
area around the nipple
basic unit of mature glandular tissue secreting milk (milk secreting cells)
alveoli
architecture of mammary gland
- each cluster of alveoli is surrounded by myoepith cells. eject milk in lactiferous ductules
- each ductule merges into larger duct
- open into nipple pore
- 1 lobe = 1 duct
neurovasc supply of breast
- internal mammary a.
- lateral thoracic a.
- intercostal nerves
mammogenesis steps (in a woman’s life)
- 4-week old embryo: milk strk is formed from a raised area of ectoderm
- 5 weeks embryo: ectoderm depresses into underlying mesoderm forming the milk line (or ridge)
- birth: breast contains milk ducts
- puberty: estogen and GH promote formation of alveoli and ductules
- tissue grows and prolif at each menstrual cycle bc of E and P
- complete dev only at pregnancy
lactogenesis I def
-first breastmilk prod between 15-20 weeks gestation UNTIL 2 days PP
hormones involved in lactogenesis 1
- prolactin for nipple growth
- human placental lactogen for areolar growth
- estrogen (for prolif and diff of ductal system)
- progesterone for dev of lobes and alveoli
lactogenesis 2 def
- days 3 to 8 PP
- is the onset of mature milk secretion
why does the breast not secrete milk during pregnancy (secrete = production)
progesterone made by placenta inhibits prolactin
- at birth, placenta removed, P falls
- prolactin is uninhibited
main hormone involved in breast milk biosynthesis
prolactin
P falls after birth, what about estrogen?
also falls, and then stays steady
(IMP) main hormones of lactation
- prolactin
- oxytocin
(IMP) prolactin charact and fct
- prod by ant pit
- dopamine (prolactin inhibiting factor is another name) inhibits it. TSH stimulates it
- fct = initiation and maintenance of milk prod
(IMP) oxytocin charact and fct
- prod by hypothalamus and stored in post pit
- released by post pit
- released IN RESPONSE TO BEAST SENSORY STIMULATION
- fct = contraction of myoepithelial cells and ejection of milk
(IMP) what’s the milk ejection reflex
- breast suckling. stimulus for oxytocin release
- oxytocin released by post pit
- causes contraction of myoepith cells and milk ejection
breast milk secretion in lactogenesis II vs after it
- lactogenesis II = endocrine control (HP axis)
- after lactogensis II = autocrine control. supply-demand principle
(imp?) autocrine control of breastfeeding after lactogen II
- supply-demand principle: more sucking and milk removal = more milk further produced
- when the breast is full of milk, it produces feedback inhibitor of lactation to inhibit milk PRODUCTION
lactogenesis III def
day 9 PP to end of lactation and start of breast involution
when breast involution starts PP
40 days after last breastfeed (ductules become smaller and go dormant)
name of baby’s first milk + charact
colostrum
- prod in day 1-3 PP (comes just before lactogenesis II)
- differs from mature milk bc has low lactose and water, high protein, WBCs, surface IgA to coat the gut, etc.
what stims start of lactogenesis II
drop in progesterone II which causes prolactin to be uninhibited
colostrum other + effects on baby
laxative. helps them empty out meconian stool (black, green tarry) so can start having normal yellow stool
milk components
- lot of water
- fat (TGs, FFAs)
- lactose
- proteins (high whey:casein ratio, essential aa, enzymes to help digestion)
- vitamins, minerals, micronutrients
- immunomodulatory components
immunomodulatory components in mature milk
- WBCs
- antiinflam factors (PGs, cytokines)
- GFs and hormones to promote immune def in gut
- oligosacch and glycoconj to protect against parasites
- Igs, lysozymes, lactoferrin to protect against specific bacteria and parasites
(imp) short term benefits of breastfeeding + main one
- decreased morbidity and mortality
- decreased risk of infection (gastro, resp, otitis, sepsis) IS THE MAIN WAY***
- establishment of healthy infant microbiome
- decreased risk of sudden infant death syndrome
- decreased asthma, allergies and eczema (atopy)
(imp) long term benefits of breastfeeding
- decreased risk of diabetes, obesity, hypercholesterolemia
- increased dev, cognition, IQ
- less risk of childhood cancers of blood
- decreased risk of certain chronic diseases (celiac, etc.)
- decreased risk of dental carries and malocclusion
short term benefit of breastfeeding on the mom
- bonding
- less PP bleeding bc of oxytocin release
- earlier return to pre pregnancy weight
- lactational amenorrhea is 99.5% effective contraception (means breastfeed exclusively, every 4 hours, in infant <6 mo)
long term benefits to the mom from breastfeeding
decreased risk of
- breast ca
- ovarian ca
- endo ca
- CVD
prolactin importance in lactogenesis III
less imp bc now lactation and milk prod is autocrine
