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lactation (breastfeeding)

Indications: Benefits of breast feeding: - analgesic effects on infant [1] - longer breastfeeding associated with higher adult IQ [25] - increased intelligence in children at age 3 & 7 [18] - does NOT increase intelligence in children [7] - confounder is maternal intelligence - breast feeding may reduce risk of autism in infants homozygous for a specific CD38 variant that increases risk for autism [30] - breastfeeding for >= 6 months may lower risk of childhood leukemia (RR= 0.9) [28] - breast feeding may lower cardiovascular risk in women - breast feeding may reduce risk of endometriosis [39] - 3% lower risk for each additional month of breast feeding - up to 27% lower risk for 18 monnths of breast feeding - breastfeeding may lower risk for progression to type 2 diabetes in women with gestational diabetes [31] - breastfeeding >= 6 months lowers risk for type 2 diabetes [40] - breast-feeding lowers risk for gastroenteritis, respiratory infections, otitis media, & urinary tract infections in infants [37] - breast-feeding lowers risk for diabetes mellitus, breast cancer, endometrial cancer & ovarian cancer [37] - preterm infants breast fed during the 1st month of life have better school-age neurodevelopmental outcomes [34] - have > 1 child & breast feeding > 15 months reduces risk for multiple sclerosis in mothers [38] * shorter lactation duration is associated with subclinical atherosclerosis independent of prepregnancy cardiovascular risk factors Does increase intelligence in children [18] Not well tolerated by many women [2] Does NOT prevent childhood obesity [10,17,21] Bottle-fed infants gain more weight in 1st year of life than breast-fed infants (regardless of milk-type) [14] * assessment of benefits may depend upon population studied - *breast feeding improves measures of body mass index, obesity, hyperactivity, parental attachment, vocabulary, reading, math, Wechsler Intelligence Scale, & self-reported scholastic competence, in analysis that control for known maternal, prenatal, & birth factors - *in an analysis of breast-fed vs non breast-fed siblings, all outcome measures were similar [21] Complications: - drinking alcohol while breast feeding associated with worse cognition in offspring [44] Management: recommendations: [3,6] 1) iron 27 mg/day for mom [6] - breast milk contains low levels of iron [3,6] 2) vitamin K a) all breastfed infants should receive 1.0 mg of vitamin K IM after the first feeding is completed & within the 1st 6 hours of life [3] b) oral vitamin K is not recommended (it may not provide the adequate stores of vitamin K necessary to prevent hemorrhage later in infancy) COMMENT (SSB) seems a bogus recommendation vitamin K is synthesized by GI flora & few infants die of hemorrhage 3) vitamin D - all breastfed infants should receive 200 IU of oral vitamin D drops daily beginning during the first 2 months of life (400 IU/day [36] - maternal vitamin D supplementation to breastfeeding mothers is generally preferred by most women [36] - COMMENT (SSB) sunlight can produce far more vitamin D than supplements 4) DHA: NIH panel recommends 300 mg/day of DHA [6] 5) pregnant & breast-feeding women should eat of a variety of fish two to three times a week (8-12 oz weekly) to support growth & development [22] - the fish should be low in methylmercury 6) fish oil supplementation during pregnancy & lactation reduces risk for allergic sensitization to egg at 1 year (RR=0.69) [41] 7) iodine: a) mom's requirement for iodine increases by ~100% during lactation [12] b) breast-feeding women should take 250 ug/day iodine [15] 8) CDC recommendations to improve breastfeeding support [13] 9) see safety in lactation for drug safety For preventing asthma & allergies, total duration of breast- feeding is more important than excluding other foods 1) introducing wheat, rye, oats, & barley before 5.5 months of age, fish before 9 months of age, & eggs before 11 months is associated with diminished risk of asthma, allergic rhinitis, & specific IgE sensitizatio 2) breast-feeding durations of > 9.5 months is associated with diminished risk of nonatopic asthma [16] Medications: - most drugs ok [19] - see Drugs and Lactation Database (LactMed) - infants of mothers who took psychotropic medications while breast-feeding were developmentally normal [42] - biologic immunosuppressive agents ok [43] Vaccinations: - small pox vaccine & yellow fever vaccine contraindicated - other vaccines safe [19] Notes: - online breast milk market puts infants at increased risk for exposure to pathogens [26] - online purchase breast milk often contains cow's milk [27] - breast-feeding friendly maternity wards encourage breast- feeding among adolescent moms [32] - USPSTF recommends implementing primary care interventions that support & promote breast-feeding [33,35]

Related

Lactation disorder safety in lactation

General

physiologic process

References

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  2. Journal Watch 23(14):109, 2003 Ahluwalia IB et al, J Pediatr 142:486, 2003 PMID: 12756378
  3. Journal Watch 24(2):19, 2004 Friel JK et al, J Pediatr 143:582, 2003 PMID: 14615726 Lozoff B, J Pediatr 143:554, 2003
  4. Breastfeeding and the Use of Human Milk. Pediatrics. 2005 Feb;115(2):496-506. PMID: 15687461 http://pediatrics.aappublications.org/cgi/content/abstract/115/2/496
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  6. Prescriber's Letter 13(8): 2006 DHA Supplementation During Pregnancy and Lactation Detail-Document#: 220810 (subscription needed) http://www.prescribersletter.com
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  8. Prescriber's Letter 14(4): 2007 OTC medication use while breastfeeding Detail-Document#: 230412 (subscription needed) http://www.prescribersletter.com
  9. Management of breastfeeding for pre-term infants Singapore Ministry of Health http://www.hpp.moh.gov.sg/HPP/MungoBlobs/949/91/Card%20&%20booklet%20-%20MOH%20Nursing%20CPG%20-%20Management%20of%20Breastfeeding%20for%20Pre-term%20Infants%202006.pdf
  10. Michels KB et al, A longitudinal study of infant feeding and obesity throughout life course. Int J Obes (Lond) 2007, April 24 PMID: 17452993 http://dx.doi.org/10.1038/sj.ijo.0803622
  11. Prescriber's Letter 16(6): 2009 Antibiotic and Antifungal Use During Pregnancy and Breastfeeding Detail-Document#: 250620 (subscription needed) http://www.prescribersletter.com
  12. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  13. Centers for Disease Control and Prevention Vital Signs: Hospital Practices to Support Breastfeeding - United States, 2007 and 2009 MMWR, August 5, 2011 / 60(30);1020-1025 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6030a4.htm
  14. Li R et al Risk of Bottle-feeding for Rapid Weight Gain During the First Year of Life Arch Pediatr Adolesc Med. 2012;166(5):431-436 PMID: 22566543 http://archpedi.ama-assn.org/cgi/content/short/166/5/431
  15. De Groot L et al Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab August 1, 2012 97(8):2543 PMID: 22869843 http://jcem.endojournals.org/content/97/8/2543.abstract (corresponding NGC guideline withdrawn Feb 2018) - Stagnaro-Green A Optimal Care of the Pregnant Woman with Thyroid Disease J Clin Endocrinol Metab August 1, 2012 97(8):2619 PMID: 22869845 http://jcem.endojournals.org/content/97/8/2619.full
  16. Nwaru BI et al. Timing of infant feeding in relation to childhood asthma and allergic diseases. J Allergy Clin Immunol 2013 Jan; 131:78 http://www.jacionline.org/article/S0091-6749(12)01696-X/abstract
  17. Martin RM et al Effects of Promoting Longer-term and Exclusive Breastfeeding on Adiposity and Insulin-like Growth Factor-I at Age 11.5 Years. A Randomized Trial JAMA. 2013;309(10):1005-1013 PMID: 23483175 http://jama.jamanetwork.com/article.aspx?articleid=1667089
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  19. Sachs HC and the Committee on Drugs The Transfer of Drugs and Theapeutics Into Human Breast Milk: An Update on Selected Topics: Pediatrics. August 26, 2013 PMID: 23979084 http://pediatrics.aappublications.org/content/early/2013/08/20/peds.2013-1985.full.pdf+html
  20. Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006 Apr;24(2):167-97, vi. PMID: 16677965
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  22. FDA News Release. June 10, 2014 FDA and EPA issue draft updated advice for fish consumption. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm397929.htm
  23. Centers for Disease Control and Prevention (CDC) Breast Feeding Report Card. United States 2014. http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf
  24. United States Breast Feeding Committee Healthy People 2020: Breastfeeding Objectives http://www.usbreastfeeding.org/LegislationPolicy/FederalPoliciesInitiatives/HealthyPeople2020BreastfeedingObjectives/tabid/120/Default.aspx
  25. Victora CG et al Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. The Lancet. Global Health. 2015. 3(4):e199-205 PMID: 25794674 http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2815%2970002-1/abstract
  26. Herman AO, Fairchild DG, Di Francesco L Online Breast Milk Market Puts Infants at Risk. Physician's First Watch, March 25, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  27. Keim SA et al Cow's Milk Contamination of Human Milk Purchased via the Internet. Pediatrics. April 6, 2015 PMID: 25847797 http://pediatrics.aappublications.org/content/early/2015/03/31/peds.2014-3554
  28. Amitay EL, Keinan-Boker L Breastfeeding and Childhood Leukemia Incidence. A Meta-analysis and Systematic Review. JAMA Pediatr. 2015;169(6):e151025. PMID: 26030516 http://archpedi.jamanetwork.com/article.aspx?articleid=2299705
  29. Gunderson EP et al. Lactation duration and midlife atherosclerosis. Obstet Gynecol 2015 Aug; 126:381 PMID: 26241429
  30. Krol KM et al. Genetic variation in CD38 and breastfeeding experience interact to impact infants' attention to social eye cues. Proc Natl Acad Sci U S A 2015 Sep 29; 112:E5434 PMID: 26371313 http://www.pnas.org/content/112/39/E5434?ijkey=d8ac2cb6121ef027533d2e4c602d00c60c994c34&keytype2=tf_ipsecsha
  31. Gunderson EP et al Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort. Ann Intern Med. Published online 24 November 2015 PMID: 26595611 http://annals.org/article.aspx?articleid=2471594
  32. Olaiya ), Dee DL, Sharma AJ, Smith RA, Maternity Care Practices and Breastfeeding Among Adolescent Mothers Aged 12-19 Years - United States, 2009-2011. MMWR Weekly / January 22, 2016 / 65(2);17-22 http://www.cdc.gov/mmwr/volumes/65/wr/mm6502a1.htm
  33. U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement Breastfeeding: Primary Care Interventions opportunity for public comment expires on May 23, 2016 http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement158/breastfeeding-primary-care-interventions - U.S. Preventive Services Task Force (USPSTF) Draft Evidence Review Draft Evidence Review for Breastfeeding: Primary Care Interventions opportunity for public comment expires on May 23, 2016 http://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review149/breastfeeding-primary-care-interventions
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  35. US Preventive Services Task Force Primary Care Interventions to Support Breastfeeding. US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316(16):1688-1693 PMID: 27784102 http://jamanetwork.com/journals/jama/fullarticle/2571249 - Patnode CD, Henninger ML, Senger CA et al Primary Care Interventions to Support Breastfeeding. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2016;316(16):1694-1705 PMID: 27784101 http://jamanetwork.com/journals/jama/fullarticle/2571248 - Christakis DA In Support of Breastfeeding Support in Primary Care. JAMA Pediatr. Published online October 25, 2016 PMID: 27784036 http://jamanetwork.com/journals/jamapediatrics/article-abstract/2565110
  36. Umaretiya PJ, Oberhelman SS, Cozine EW et al Maternal Preferences for Vitamin D Supplementation in Breastfed Infants. Ann Fam Med. January/February 2017 vol. 15 no. 1 68-70 PMID: 28376463 Free full text http://www.annfammed.org/content/15/1/68
  37. Barbieri RL Endometrial Cancer and Breast-Feeding: Add Another Benefit to the Inventory. NEJM Journal Watch. May 18, 2017 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Jordan SJ, Na R, Johnatty SE et al. Breastfeeding and endometrial cancer risk: An analysis from the Epidemiology of Endometrial Cancer Consortium. Obstet Gynecol 2017 Jun; 129:1059 PMID: 28486362
  38. LLanger-Gould A, Smith JB, Hellwig K et al. Breastfeeding, ovulatory years, and risk of multiple sclerosis. Neurol (Tokyo) 2017 Jul 12; PMID: 28701499 http://www.neurology.org/content/early/2017/07/07/WNL.0000000000004207
  39. Farland LV, Eliassen AH, Tamimi RM et al History of breast feeding and risk of incident endometriosis: prospective cohort study. BMJ 2017;358:j3778 PMID: 28851765 Free Article http://www.bmj.com/content/358/bmj.j3778
  40. Gunderson EP, Lewis CE, Lin Y et al Lactation Duration and Progression to Diabetes in Women Across the Childbearing Years. The 30-Year CARDIA Study. JAMA Intern Med. Published online January 16, 2018 PMID: 29340577 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2668634
  41. Garcia-Larsen V, Ierodiakonou D, Jarrold K et al Diet during pregnancy and infancy and risk of allergic or autoimmune disease: A systematic review and meta-analysis. PLOS Medicine. February 28, 2018 PMID: 29489823 http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002507
  42. Kronenfeld N et al. Chronic use of psychotropic medications in breastfeeding women: Is it safe? PLoS One 2018 May 21; 13:e0197196 PMID: 29782546 Free PMC Article http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197196
  43. Matro R, Martin CF, Wolf D et al. Exposure concentrations of infants breastfed by women receiving biologic therapies for inflammatory bowel diseases and effects of breastfeeding on infections and development. Gastroenterology 2018 May 29 PMID: 29857090
  44. Gibson L, Porter M Drinking or Smoking While Breastfeeding and Later Cognition in Children. Pediatrics. July 2018 PMID: 30061301 http://pediatrics.aappublications.org/content/early/2018/07/26/peds.2017-4266 - Jansson LM Maternal Alcohol Use During Lactation and Child Development. Pediatrics. July 2018 PMID: 30061303 http://pediatrics.aappublications.org/content/early/2018/07/26/peds.2018-1377
  45. The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. http://www.cdc.gov/breastfeeding/resources/guide.htm
  46. Drugs and Lactation Database (LactMed) http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
  47. Motherisk http://www.motherisk.org/index.jsp - The Academy of Breastfeeding Medicine http://www.bfmed.org/index.asp?menuID=139&firstlevelmenuID=139