A prospective cohort study on lactation status and breastfeeding challenges in mothers giving birth to preterm infants

Background Mothers of preterm infants face many challenges in breastfeeding, especially regarding lactation. This study aimed to investigate the lactation status and challenges in breastfeeding faced by preterm infants’ mothers. Methods We approached 124 mothers who gave birth to preterm infants between 26 May and 31 October 2018 in a tertiary hospital in China. Lactation status and challenges in breastfeeding on day 7 postpartum, at discharge of infants, 2 weeks post-discharge, and 3 months of corrected age were collected using questionnaires. The area under the receiver operating characteristic (ROC) curve for expressed milk volume on day 7 postpartum for predicting expressed milk volume ≥ 300 mL/d at discharge was calculated. Logistic regression analyses were performed to identify factors associated with delayed lactogenesis II onset and continuation of breastfeeding at 3 months of corrected age. Results Seventy mothers were enrolled, and 51.4% had delayed lactogenesis II. Multivariate logistic regression analysis revealed that older maternal age (aOR = 1.19; 95% CI: 1.01, 1.40) and first live birth (aOR = 4.81; 95% CI 1.43, 16.18) were significant independent predictors of delayed lactogenesis II. Mothers with delayed lactogenesis II had significantly lower expressed milk volume (day 7 postpartum: 160.0 mL vs. 300.0 mL, U = 328.50, p = 0.001; at discharge: 425.0 mL vs. 612.5 mL, U = 372.00, p = 0.005), with a lower proportion of exclusive breastfeeding in their infants (at discharge: 33.3% vs. 69.8%, χ2 = 12.39, df = 1, p < 0.001; 3 months of corrected age: 17.8% vs. 52.8%, χ2 = 11.03, df = 1, p = 0.001). The ROC showed that expressed milk volume > 190 mL/d on day 7 postpartum significantly predicted expressed milk volume ≥ 300 mL/d at discharge. Insufficient human milk was the main reason for breastfeeding discontinuation at 3 months of corrected age. Twins were less likely to continue breastfeeding at 3 months of corrected age (aOR = 0.27; 95% CI 0.09, 0.86). In singleton infants, mother’s own milk ≥50% of total milk uptake at 2 weeks post-discharge (aOR = 32.66; 95% CI 3.00, 355.25) was an independent predictor of continuous breastfeeding at 3 months of corrected age. Feeding complications in infants, poor breastfeeding technique, and low milk output are the main challenges in breastfeeding. Conclusion Interventions to improve early postpartum lactation and breastfeeding techniques may increase breastfeeding adoption in mothers of preterm infants.

Effectiveness of Ayurved Siriraj Prasa-Nam-Nom Recipe on Breast Milk Volume in Early Postpartum Women: A Randomized, Double-Blind, Placebo- Controlled Trial

Objective: To explore the effectiveness of Ayurved Siriraj Prasa-Nam-Nom (ASPNN) recipe on breast milk production in early postpartum women. Methods: Fifty-four normal vaginal term delivery mothers who had inadequate milk volume were enrolled into this randomized, double-blind, placebo-controlled trial. All participants received ASPNN or placebo 1,500 mg three times/day for 3 days in the hospital and 7 days at home. Primary outcomes, including breast milk volume, %creamatocrit, and level of prolactin, were evaluated on day 1 and day 3. Satisfaction scores, adverse effects, and types of breastfeeding were also determined. Results: On day 3, milk volume was increased in both groups. The median volume of ASPNN group was 19 ml, while that of the placebo group was 30 ml. The median %creamatocrit of ASPNN and placebo group were 7.17% and 6.98%, respectively. Mean serum prolactin levels of ASPNN and placebo group were 321.76 + 114.23 ng/ml and 323.78 + 116.68 ng/ml, respectively. Although the effects were not difference from the placebo, the reduction of prolactin in ASPNN was lower. Minor adverse effects included skin rash and mild diarrhea. Exclusive breastfeeding rate on day 11 in ASPNN and placebo group were 92.6 % and 88.5%, respectively. Conclusion: Short term ASPNN supplementation produce no direct effect on breast milk volume, creamatocrit, and serum prolactin. It was safe and might help maintaining serum prolactin. A future trial with more participants and longer period should be conducted to confirm the effect of ASPNN on breast milk quantity and quality.

Prolactin Level and Breastmilk Production among Mothers of Low-Birth-Weight Infants Admitted to Level II Neonatal Intensive Care Unit

Background. Kangaroo mother care (KMC) has been proven by several studies to promote breastfeeding, but many of the studies focus on the success of exclusive breastfeeding, and less on its galactogenic effects. Objective. We aim to determine the maternal serum prolactin levels and breastmilk volume of mothers who rendered KMC to their infants. Materials and Methods. This is a randomized controlled, open-labeled, interventional study in the Neonatal Intensive Care Unit of a tertiary government hospital. Infants weighing < 2000 grams admitted in NICU Level II, together with medically stable mothers and no contraindication for breastfeeding were simultaneously enrolled. Primary outcome measures were maternal serum prolactin levels and expressed milk volume on day 3 and day 7 postpartum. Two-sample t-test was used to compare groups, and paired t-test to compare within groups. Tests were two-tailed, with a p-value of < 0.05 considered statistically significant. Trial Registration. Australia-New Zealand Clinical Trial Registry ID ACTRN12614000218695 Results. Fifty mother-infant dyads were equally allocated into KMC and control groups (p < 0.001). There was significantly larger milk volume on the third day (29.6 ± 27.8 mL vs 16.3 ± 26.1 mL; p < 0.001) and seventh post-partum day (72.4 ± 62.3 mL vs 47.3 ± 43.8 mL; p < 0.000). There were increased serum prolactin levels compatible with post-partum state. The increase was more evident in the KMC (5244 ± 2702 mIU/L, on the 3rd postpartum day versus 4969 ± 2426 mIU/L, on the 7th postpartum day, p = 0.996) compared to control group (4129 ± 2485 mIU/L on the 3rd postpartum day versus 3705 ± 2731 mIU/L on the 7th postpartum day, p = 0.301). Conclusion. We noted a significantly larger milk volume in the KMC group. There was also a greater increase in the prolactin levels in the KMC group, but this did not reach statistical significance. Further studies should be done to determine mechanism of galactogenesis through KMC.

Metoclopramide for Milk Production in Lactating Women: A Systematic Review and Meta-Analysis

Background: Breastfeeding is recognized as the optimal form of nutrition for the physical and neurological development of infants and is considered the most significant way to prevent child mortality. This study aimed to assess the effectiveness of metoclopramide for enhancing milk production in lactating women.Methods: We searched the Cochrane Central Register of Controlled Trials and MEDLINE for randomized controlled trials comparing metoclopramide with a placebo, no treatment, or other galactagogue drugs. We included breastfeeding women with term or preterm infants.Results: We retrieved 164 records from our search of the electronic databases and 20 records from other sources. Eight trials involving 342 lactating women that used metoclopramide were included in this review after assessing the eligibility criteria. The meta-analysis of these trials revealed that metoclopramide did not increase the milk volume of the intervention groups compared to that of the control groups. There was a significant increase in the serum concentrations of prolactin when the mothers were administered metoclopramide. No significant adverse events were reported.Conclusion: Metoclopramide did not improve milk production in lactating women. Therefore, we do not recommend using metoclopramide to increase milk production in lactating women.

Influence of lactation and nutrition on health of nursing woman

Lactation contributes to the recovery of the mother after pregnancy and can affect many aspects of maternal health later in life. The short-term benefits of breastfeeding are associated with faster postpartum psychological and emotional recovery. In the long term, lactation reduces the risk of breast, ovarian and endometrial cancer, as well as a number of other diseases, more if exclusive breastfeeding continues for six months or more. Inappropriate nutrition of a nursing mother is one of the most destructive factors for her health. It is also important to remember that the amount of milk depends on the frequency of breastfeeding, and there is no evidence for foods, herbs or medications to prolong lactation or increase milk volume. A varied, balanced diet, including natural and specialized foods for nursing mothers, as well as dietary supplements, sources of vitamins and minerals, can ensure that the mother is consuming enough nutrients for both herself and her baby.

A Capra Hircus Chromosome 19 Locus Linked to Milk Production Influences Mammary Conformation

Background: Economically important milk production traits including milk volume, milk fat and protein yield vary considerably across dairy goats in New Zealand. A significant portion of the variation is attributable to genetic variation. Discovery of genetic markers linked to milk production traits can be utilised to drive selection of high-performance animals.A previously reported genome wide association study across dairy goats in New Zealand identified a quantitative trait loci (QTL) located on chromosome 19. The most significantly associated single nucleotide polymorphism (SNP) marker for this locus is located at position 26,610,610 (SNP marker 19:26,610,610). This locus is associated with multiple milk production traits including fat, protein and volume. The predicted effect of selection for the beneficial haplotype would result in an average production increase of 2.2kg fat, 1.9kg protein and 73.6kg volume.An outstanding question was whether selection for the beneficial allele would co-select for any negative pleiotropic effects. An adverse relationship between milk production and udder health traits has been reported at this locus. Therefore, a genome wide association study was undertaken looking for loci associated with udder traitsResults: The QTL and production associated marker 19:26,610,610 was identified in this study to also be associated with several goat udder traits including udder depth (UD), fore udder attachment (FUA) and rear udder attachment (RUA). Our study replicates the negative relationship between production and udder traits with the high production allele at position 19:26,610,610 associated with an adverse change in UD, FUA and RUAConclusions: Our study has confirmed this negative relationship between udder traits and production traits in the NZ goat population. We have found that the frequency of the high production allele is relatively high in the NZ goat population, indicating that its effect on udder conformation is not significantly detrimental on animal health. It will however be important to monitor udder conformation as the Chromosome 19 locus is progressively implemented for marker assisted selection. It will also be of interest to determine if the gene underlying the production QTL has a direct effect on mammary gland morphology or whether the changes observed are a consequence of the increased milk volume.

Management of high cows-share-contribution of SCC to the bulk milk tank by acoustic pulse technology (APT)

A cow with mastitis has a high somatic cell count (SCC) in its milk. Cow-share-contribution of somatic cells to the bulk milk tank (BMTSCC) refers to the relative addition made by each cow’s milk to the bulk tank’s SCC. Since bulk milk is graded and priced according to the BMTSCC, high-yielding cows with mastitis are the main contributors to penalizations in milk price. The benefits of acoustic pulse technology (APT) application to tissues are well documented, including its anti-inflammatory effect and restoration of tissue function by triggering natural healing processes. An APT-based device was developed specifically for treating mastitis in dairy cows. It enables rapid and deep penetration of the acoustic pulses over a large area of the udder in a single session. A study was performed on six farms with a total of 3,900 cows. One unit of cow-share-contribution equaled the addition of 1,000 cells to each mL of the bulk milk volume above the mean BMTSCC. A total of 206 cows were selected: 103 were treated with APT and 103 served as controls. All of the cows contributed over 1.5 units to the BMTSCC at the time of treatment. Seventy-five days after APT treatment, 2 of the 103 treated cows (1.9%) were culled, compared to 19 (18.5%) of the 103 control cows, as well as infected quarter dry-off in 5 others (4.85%). Overall success was defined as a decrease of >75% in cow-share-contribution from treatment time in two of the three monthly milk recordings following treatment. Results indicated 57.3% success for the APT-treated cows vs. 14.6% for the untreated control groups. Highest share-contribution provide an additional tool for the farmer’s decision of how to control BMTSCC. Because the cow-share-contribution value is relative to herd size and BMTSCC, this study included a similar number of cows, with similar SCC and milk yield from each of the six herds.

A Comparative Review of the Cell Biology, Biochemistry, and Genetics of Lactose Synthesis

Lactose is the primary carbohydrate in the milk of most mammals and is unique in that it is only synthesized by epithelial cells in the mammary glands. Lactose is also essential for the development and nutrition of infants. Across species, the concentration of lactose in milk holds a strong positive correlation with overall milk volume. Additionally, there is a range of examples where the onset of lactose synthesis as well as the content of lactose in milk varies between species and throughout a lactation. Despite this diversity, the precursors, genes, proteins and ions that regulate lactose synthesis have not received the depth of study they likely deserve relative to the significance of this simple and abundant molecule. Through this review, our objective is to highlight the requirements for lactose synthesis at the biochemical, cellular and temporal levels through a comparative approach. This overview also serves as the prelude to a companion review describing the dietary, hormonal, molecular, and genetic factors that regulate lactose synthesis.

Rule Discovery in Milk Content towards Mastitis Diagnosis: Dealing with Farm Heterogeneity over Multiple Years through Classification Based on Associations

Subclinical mastitis, an economically challenging disease of dairy cattle, is associated with an increased use of antimicrobials which reduces milk quantity and quality. It is more common than clinical mastitis and far more difficult to detect. Recently, much attention has been paid to the development of machine-learning expert systems for early detection of subclinical mastitis from milking features. However, differences between animals within a farm as well as between farms, particularly across multiple years, are major obstacles to the generalisation of machine learning models. Here, for the first time, we integrated scaling by quartiling with classification based on associations in a multi-year study to deal with farm heterogeneity by discovery of multiple patterns towards mastitis. The data were obtained from one farm comprising Holstein Friesian cows in Ongaonga, New Zealand, using an electronic automated monitoring system. The data collection was repeated annually over 3 consecutive years. Some discovered rules, such as when the milking peak flow is low, electrical conductivity (EC) of milk is low, milk lactose is low, milk fat is high, and milk volume is low, the cow has subclinical mastitis, reached high confidence (>70%) in multiple years. On averages, over 3 years, low level of milk lactose and high value of milk EC were part of 93% and 83.8% of all subclinical mastitis detecting rules, offering a reproducible pattern of subclinical mastitis detection. The scaled year-independent combinational rules provide an easy-to-apply and cost-effective machine-learning expert system for early detection of hidden mastitis using milking parameters.