Natural processes do not always function perfectly. In breastfeeding, problems are encountered in up to 80% of mother-infant dyads. Altogether, in Western societies, the difficulties reduce the ...breastfeeding rate within the first months drastically. To deal with the problems of breastfeeding efficiently requires a profound understanding of its physiology, as well as of its psychological and social determinants. This review focuses on the current knowledge of breastfeeding physiology, only touching the psychosocial factors, which are included in the promotion strategies. Subsequently, it scrutinizes definitions, incidences, prevention, and treatment of breastfeeding problems faced most frequently by nursing mothers and their consultants. Not all measures used in counseling mothers and not all treatments for the most common medical problems withstand a careful evaluation on the basis of current scientific data. However, applying proven prevention strategies will significantly improve the well being of mothers and their infants, and may contribute to an affective attitude that increases the success, frequency, and duration of breastfeeding.
Pregnancy-induced hypoaminoacidemia, ʟ-methionine (Met) included, disturbs embryogenesis and may also affect breast function. Supplementation with the dipeptideʟ-methionyl-Met (Met-Met) may improve ...lactation performance.
We compared the effects of supplemental Met or Met-Met during pregnancy on mammogenesis and lactogenesis and investigated underlying mechanisms.
In experiment 1, 9-wk-old ICR mice (n = 72, ~30 g) were divided into 3 groups. During the first 17 days of pregnancy (DP), the Control group was fed a diet with Met (8.2 g/kg) and saline was intraperitoneally injected, the Met group was fed a Met-devoid diet and 35% of the Met (92-mmoʟMet) as contained in the Control diet was intraperitoneally injected, and the Met-Met group was fed the same diet and 70-mmoʟMet plus 11-mmoʟMet-Met was intraperitoneally injected. All animals were fed the Control diet after DP17 and during lactation. Mammogenesis, lactogenesis, transcriptome at DP17, and milk performance during lactation were examined. In experiment 2, 9-wk-old ICR mice (n = 55, ~30 g) at DP0 were injected through the teat with adeno-associated virus for overexpression/inhibition of phosphoinositide-3-kinase regulatory subunit 1 (Pik3r1), divided into the Control, Met, and Met-Met groups and received the same treatment as experiment 1 to examine mammogenesis and lactogenesis at DP17.
In experiment 1, compared with the Met group, the Met-Met group showed higher (P < 0.05) mammary epithelium percentage (42%) and aS1-casein expression (84%) at DP17, milk yield (34%) and energy concentrations (8.7%) during lactation; transcriptomic analysis illustrated activated phosphatidylinositol-3 kinase (PI3K)/protein kinase B (AKT) signaling in the mammary glands of the Met-Met group (P-adj < 0.001). In experiment 2, overexpression ofPik3r1enhanced (P < 0.05) the protective effect of Met-Met over Met on mammogenesis and β-casein expression.
Met-Met is more effective than Met in promoting mammogenesis and lactogenesis mainly by activation of PI3K-AKT signaling in Met-deficient mice.
Lactation is critical to infant short-term and long-term health and protects mothers from breast cancer, ovarian cancer and type 2 diabetes mellitus. The mammary gland is a dynamic organ, regulated ...by the coordinated actions of reproductive and metabolic hormones. These hormones promote gland development from puberty onwards and induce the formation of a branched, epithelial, milk-secreting organ by the end of pregnancy. Progesterone withdrawal following placental delivery initiates lactation, which is maintained by increased pituitary secretion of prolactin and oxytocin, and stimulated by infant suckling. After weaning, local cytokine production and decreased prolactin secretion trigger large-scale mammary cell loss, leading to gland involution. Here, we review advances in the molecular endocrinology of mammary gland development and milk synthesis. We discuss the hormonal functions of the mammary gland, including parathyroid hormone-related peptide secretion that stimulates maternal calcium mobilization for milk synthesis. We also consider the hormonal composition of human milk and its associated effects on infant health and development. Finally, we highlight endocrine and metabolic diseases that cause lactation insufficiency, for example, monogenic disorders of prolactin and prolactin receptor mutations, maternal obesity and diabetes mellitus, interventions during labour and delivery, and exposure to endocrine-disrupting chemicals such as polyfluoroalkyl substances in consumer products and other oestrogenic compounds.
Background: Longer exclusive breastfeeding duration has been associated with differences in neural development, better satiety responsiveness, and decreased risk for childhood obesity. Given its ...sensitivity to diet and contribution to regulating food intake through the integration of hormonal and cognitive signals, hippocampus may play a role in these relationships. Methods: We conducted a secondary analysis of 149, 7-11-year-olds (73 males) who participated in one of five studies that assessed neural responses to food cues. Hippocampal grey matter volume (GMV) was extracted from structural scans using CAT12, weight status was assessed using age- and sex-adjusted body mass index (%BMIp85), and parents reported exclusive breastfeeding duration and satiety responsiveness (Child Eating Behavior Questionnaire). Separate path models for left and right hippocampus tested: 1) the direct effect of exclusive breastfeeding on satiety responsiveness and its indirect effect through hippocampal GMV; 2) the direct effect of hippocampal GMV on %BMIp85 and its indirect effect through satiety responsiveness. %BMIp85 was adjusted for maternal education, yearly income, and prematurity while hippocampal GMV was adjusted for total intercranial volume, age, and study from which data were extracted. Results: Longer exclusive breastfeeding duration was associated with greater bilateral hippocampal GMV. While better satiety responsiveness and greater left hippocampal GMV were both associated with lower %BMIp85, hippocampal GMV was not associated with satiety responsiveness. Conclusions: While exclusive breastfeeding duration was not directly associated with weight status in children, these results highlight the potential impact of exclusive breastfeeding on hippocampal structure. Future studies need to determine the relative impact that complimentary feeding has on regional brain development and satiety responsiveness.
Maternal caffeine crosses the placenta and mammary barriers, reaching the baby and, because his/her caffeine metabolism is immature, our hypothesis is that even a low caffeine intake (250 mg/day), ...lower than the dose limit recommended by the World Health Organization, can promote caffeine overexposure in the offspring, leading to short- and long-term changes.
Pregnant Wistar rats received intragastric caffeine (CAF) (25 mg/Kg/day) or vehicle during the gestation and lactation periods. We evaluated morphometrical, metabolic, hormonal, and behavioral parameters of male and female offspring at different ages.
Even a low caffeine intake promoted lower maternal body mass and adiposity, higher plasma cholesterol and lower plasma T3, without changes in plasma corticosterone. Female CAF offspring exhibited lower birth weight, body mass gain and food intake throughout life, and hyperinsulinemia at weaning, while male CAF offspring showed reduced food intake and lower plasma T3 at weaning. At puberty and adulthood, male CAF showed higher preference for palatable food, aversion to caffeine intake and higher locomotor activity, while female CAF only showed lower preference for high fat diet (HFD) and lower anxiety-like behavior. At adulthood, both male and female offspring showed higher plasma T3. Male CAF showed hypertestosteronemia, while female CAF showed hypoinsulinemia without effect on glucose tolerance.
A low caffeine intake during the perinatal period affects rat's offspring development, promoting sex-dependent hormonal and behavior changes. Current data suggest the need to review caffeine recommendations during the perinatal period.
Adequate nutrition is essential during the lactation period for better maternal and child health outcomes. Although food insecurity and dietary monotony (defined as less diverse diet), two important ...determinants of undernutrition, are endemic in the rural mountains of Nepal, insufficiently examined and assessed for risk factors in mothers during lactation, a life stage of high nutritional demand. This study aimed to assess the status and factors associated with food insecurity and dietary diversity among lactating mothers residing in the mountains of Nepal.
A community-based cross-sectional study was conducted in an urban municipality in the mountainous Bajhang District of far-western Nepal. The sampling frame and strategy led to 417 randomly selected lactating mothers. Household Food Insecurity Access Scale (HFIAS) and the tool "Minimum Dietary Diversity for Women" developed by the Food and Agriculture Organization were used to measure food insecurity and dietary diversity, respectively. Additional information on socio-demographics and risk factors were collected. Multivariable logistics regression assessed correlates of study outcomes.
Overall, 54% of the households were food insecure, and over half (53%) of the mothers had low dietary diversity. Food insecurity status (mild food insecurity AOR = 10.12, 95% CI = 4.21-24.34; moderate food insecurity AOR = 8.17, 95% CI = 3.24-20.59, and severe food insecurity AOR = 10.56, 95% CI = 3.92-28.43) were associated with higher odds of dietary monotony. Likewise, participants with lower dietary diversity were 8.5 times more likely to be food insecure than those with higher dietary diversity (AOR = 8.48, 95% CI = 3.76-19.14). The monthly income of the family was positively associated with food insecurity. Participants' (AOR = 3.92 95%CI = 1.76-8.71) or spouses' (AOR = 2.90, 95% CI = 1.07-7.85) unemployment was associated with higher odds of being food insecure. Likewise, owning a cultivable land (AOR = 0.49, 95% CI = 0.28-0.84) and participant's unemployment status (AOR = 5.92, 95% CI = 3.02-11.63), were significantly associated with increased odds of dietary monotony.
The observed food insecurity and poor dietary diversity among lactating mothers, the correlates associated with these outcomes, may help local stakeholders to identify local health needs and subgroups for targeted interventions. Socioeconomically disadvantaged mothers should be specifically targeted for relevant programs and policies.
Karen Wambach recently retired from a distinguished career in nursing education and breastfeeding research in the United States, practicing her craft during the formative years of the field of ...lactation consulting. Her research focused on the description of biopsychosocial influences on breastfeeding initiation and duration, as well as interventions for promoting and supporting breastfeeding among vulnerable childbearing populations, for example, adolescent mothers. Her research career trajectory mirrors the development of breastfeeding research more broadly. She began with descriptive studies and theory testing, which included the development of the Breastfeeding Experience Scale quantifying early breastfeeding problems. She then moved on to randomized clinical trials of breastfeeding education/support for adolescent mothers, and finished her funded research using a multi-behavioral, technology-based education and support intervention to promote breastfeeding, healthy lifestyle, and depression prevention in adolescent mothers. As researcher and educator in a clinical science area, she has supported evidence-based practice and translational science through her work as lead editor of many editions of the textbook Breastfeeding and Human Lactation. She is a consummate teacher, having mentored many upcoming researchers during her teaching career, and directed the undergraduate nursing honors program and PhD program at the University of Kansas School of Nursing in the United States. She also believes in serving her profession and has been an active member of American Academy of Nursing, the Midwest Nursing Research Society, the Association of Women’s Health, Obstetric, and the Neonatal Nursing and the International Lactation Consultant Association, including serving on JHL’s Editorial Review Board for many years. (This conversation was recorded on October 14, 2022 then transcribed and edited for readability. EC = Ellen Chetwynd; KW = Karen Wambach)
ABSTRACT
Background
Human milk oligosaccharides (HMOs) are complex glycans that are highly abundant in human milk. While over 150 HMOs have been identified, it is unknown how individual HMOs change ...in concentration over 24 months of lactation.
Objectives
To understand how HMO concentrations change over 24 months of lactation.
Methods
Breast milk samples were collected from participants in a longitudinal cohort study of Hispanic mother-infant pairs at 1, 6, 12, 18, and 24 months postpartum. Concentrations of 19 of the most abundant HMOs were measured using HPLC. Because the parent study is ongoing and not all participants have finished all time points yet, the sample sizes ranged per time point (n = 207 at 1 month; n = 109 at 6 months; n = 83 at 12 months; n = 59 at 18 months; and n = 28 at 24 months). Approximately 88% of participants were classified as HMO secretors—a genetic factor that affects concentrations of HMOs such as 2’fucosyllactose (2’FL) and lacto-N-fucopentaose I—while the remaining 12% were classified as nonsecretors. Mixed models were used to examine changes in HMO concentrations and relative abundances over the course of lactation.
Results
The majority of HMOs significantly decreased in concentration over the course of lactation. The exceptions were 2’FL, sialyl-lacto-N-tetraose b, and disialyl-lacto-N-tetraose, which did not change with time, and 3-fucosyllactose (3FL) and 3′-sialyllactose (3’SL), which significantly increased. The concentration of 3FL increased 10-fold, from 195 (IQR 138–415) μg/mL at 1 month to 1930 (1100–2630) μg/mL at 24 months, while 3’SL increased 2-fold, from 277 (198–377) μg/mL to 568 (448–708) μg/mL over the same time period.
Conclusions
These results indicate that HMOs do not decrease in concentration uniformly across lactation. In particular, 3FL and 3’SL increased over the course of lactation in this cohort. Future studies are required to fully understand the functions of these HMOs.
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