-
1.
Topical Drugs in Nursing Mothers.
Anderson, PO
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 2018;(1):5-7
-
2.
Lactation ketoacidosis: case presentation and literature review.
Al Alawi, AM, Falhammar, H
BMJ case reports. 2018
-
-
Free full text
-
Abstract
A 35-year-old woman presented to the emergency department with a 2 days history of malaise and headache. She was breastfeeding her 5-month old infant and had recently started an altered diet based on reducing carbohydrate amount. Moreover, she had also started exercising 2 weeks prior to her illness. Initial blood tests revealed high anion gap metabolic acidosis and hypoglycaemia (pH 7.13 (normal 7.30-7.40), bicarbonate 9.4 mmol/L (normal 21.0-28.0), anion gap 22.6 mmol/L (normal 8-12), glucose 2.9 mmol/L (normal fasting 3.9-5.8) and ketones 6.4 mmol/L (normal <0.6)). The patient was treated with intravenous dextrose and showed complete resolution of ketoacidosis and hypoglycaemia within 48 hours. She was discharged home and remained well with a balanced diet. After excluding all other the causes of hypoglycaemia and ketoacidosis, the diagnosis of lactation ketoacidosis was made and it was considered triggered by altered diet, exercise and skipping meals. All 11 cases of lactation ketoacidosis which has previously been published are reviewed as well.
-
3.
High-Fructose Corn-Syrup-Sweetened Beverage Intake Increases 5-Hour Breast Milk Fructose Concentrations in Lactating Women.
Berger, PK, Fields, DA, Demerath, EW, Fujiwara, H, Goran, MI
Nutrients. 2018;(6)
Abstract
This study determined the effects of consuming a high-fructose corn syrup (HFCS)-sweetened beverage on breast milk fructose, glucose, and lactose concentrations in lactating women. At six weeks postpartum, lactating mothers (n = 41) were randomized to a crossover study to consume a commercially available HFCS-sweetened beverage or artificially sweetened control beverage. At each session, mothers pumped a complete breast milk expression every hour for six consecutive hours. The baseline fasting concentrations of breast milk fructose, glucose, and lactose were 5.0 ± 1.3 µg/mL, 0.6 ± 0.3 mg/mL, and 6.8 ± 1.6 g/dL, respectively. The changes over time in breast milk sugars were significant only for fructose (treatment × time, p < 0.01). Post hoc comparisons showed the HFCS-sweetened beverage vs. control beverage increased breast milk fructose at 120 min (8.8 ± 2.1 vs. 5.3 ± 1.9 µg/mL), 180 min (9.4 ± 1.9 vs. 5.2 ± 2.2 µg/mL), 240 min (7.8 ± 1.7 vs. 5.1 ± 1.9 µg/mL), and 300 min (6.9 ± 1.4 vs. 4.9 ± 1.9 µg/mL) (all p < 0.05). The mean incremental area under the curve for breast milk fructose was also different between treatments (14.7 ± 1.2 vs. -2.60 ± 1.2 µg/mL × 360 min, p < 0.01). There was no treatment × time interaction for breast milk glucose or lactose. Our data suggest that the consumption of an HFCS-sweetened beverage increased breast milk fructose concentrations, which remained elevated up to five hours post-consumption.
-
4.
Longer-term breastfeeding outcomes associated with domperidone use for lactation differs according to maternal weight.
Grzeskowiak, LE, Amir, LH, Smithers, LG
European journal of clinical pharmacology. 2018;(8):1071-1075
Abstract
PURPOSE To examine differences in longer-term breastfeeding outcomes among mothers of preterm infants according to domperidone exposure status, as well as examine the potential for effect modification according to maternal weight. METHODS Retrospective cohort study of 198 mothers of very preterm infants (born ≤ 30 weeks' gestation) who initiated breastfeeding and whose infants survived until hospital discharge. Data on domperidone use were obtained from hospital pharmacy records, with the primary outcome defined as continuation of breastfeeding at infant discharge from the Neonatal Unit. The relationship between domperidone exposure and breastfeeding status was investigated using multivariable regression analysis, adjusting for potential confounders. Additional pre-determined analyses were undertaken following stratification according to maternal weight to investigate the presence of effect modification. RESULTS No overall difference was observed in the proportion of mothers continuing to breastfeed at the time of infant discharge from the Neonatal Unit according to whether or not they received domperidone (aRR 0.99; 0.86-1.13). Notably, effect modification was observed according to maternal weight, with use of domperidone associated with a reduced likelihood of breastfeeding at discharge among women ≥ 70 kg (aRR 0.72; 0.54-0.97), but not among those < 70 kg (aRR 1.16; 0.92-1.46). CONCLUSIONS Despite experiencing low milk supply, longer-term breastfeeding outcomes were similar between women who did and did not use domperidone. Differences in domperidone effectiveness according to maternal weight have important implications for clinical practice given the increasing prevalence of overweight/obesity in reproductive-age women and their higher risk of low milk supply, highlighting the importance of further research in this area.
-
5.
Effects of daytime versus night-time cesarean deliveries on Stage II lactogenesis.
İlhan, G, Atmaca, FV, Çümen, A, Zebitay, AG, Güngör, ES, Karasu, AFG
The journal of obstetrics and gynaecology research. 2018;(4):717-722
Abstract
AIM: The circadian timing system has a rhythm and one of the roles of this system is the mediation of hormonal and metabolic adaptations to lactation. This study was conducted to determine whether the time to stage II lactogenesis differed in women who underwent cesarean section (CS) in the daytime (DT) or night-time (NT). METHODS This study was conducted at Süleymaniye Research and Education Hospital between June and December 2016. Two hundred and eighty-eight mothers who had a cesarean delivery and their healthy singleton neonates were included. Clinical and demographic data of the mothers and neonates, time of initiation of breastfeeding and time to stage II lactogenesis were analyzed according to DT or NT CS groups. RESULTS There were no statistically significant differences in age, gravida, parity, body mass index, week of gestation at birth, postoperative hemoglobin level, cesarean indications, anesthesia type, previous history of breastfeeding, transfusion need, Apgar scores or birth weight-height of neonates between the DT and NT CS groups. While the time of initiation of breastfeeding did not differ statistically in terms of DT or NT CS groups, the time to stage II lactogenesis was significantly longer in the NT CS group. CONCLUSIONS NT cesarean delivery is a risk factor for the delayed onset of lactogenesis. The results of this study may be useful to clinical practitioners counseling mothers who undergo NT cesarean delivery.
-
6.
Structural studies on inhibitory mechanisms of antibiotic, corticosteroid and catecholamine molecules on lactoperoxidase.
Sheikh, IA, Jiffri, EH, Ashraf, GM, Kamal, MA, Beg, MA
Life sciences. 2018;:412-419
Abstract
AIM: Lactoperoxidase (LPO) is an essential protein with broad spectrum antimicrobial activity present in mammalian milk. It imparts immunity to infants against wide range of pathogenic infections. Several in vitro studies have shown inhibition of LPO activity by pharmaceutical compounds including commonly used antibiotics such as ampicillin and gentamicin, and molecules like prednisolone, norepinephrine, etc. Prescription of such drugs to lactating mothers might have adverse health effects on infants. The aim of our study was the elucidation of the structural aspects of the inhibitory mechanism of ampicillin, gentamicin, amoxicillin, prednisolone and norepinephrine on LPO. MATERIAL AND METHODS Three dimensional structure of camel LPO (cLPO) was developed using homology modeling and used for in silico experimental studies. The Schrödinger induced fit docking along with binding affinity estimation experiments were performed. The cLPO and Ligands were prepared using Protein Preparation Wizard and Ligprep modules available in Schrodinger suite. For estimating Binding affinity Prime Molecular Mechanics with Generalized Born and Surface Area (MMGB-SA) module was used. KEY RESULTS The five drug ligands formed three to five hydrogen bonding interactions with cLPO. Amino acids Arg-231, Asp-232, Ser-370, Arg-371 and Glu-374 of cLPO were crucial for these interactions. The binding affinity values for gentamicin were highest and for norepinephrine were the lowest. SIGNIFICANCE This study concludes that the five drug molecules show potential ability to inhibit the LPO activity. Further, a very high sequence similarity of cLPO with human LPO imparts high significance to these conclusions in relation to human health especially in new born infants.
-
7.
A randomized interventional study to promote milk secretion during mother-baby separation based on the health belief model: A consort compliant.
Liu, Y, Yao, J, Liu, X, Luo, B, Zhao, X
Medicine. 2018;(42):e12921
-
-
Free full text
-
Abstract
BACKGROUND Breast milk is the most important nutrition for premature babies, but mothers of premature infants have difficulty in initiating and sustaining lactation. Breastfeeding infants who are separated with mothers have decreased morbidity. Nevertheless, such decrease is limited due to insufficient milk supply resulting from mother-baby separation during lac. OBJECTIVE To evaluate the effect of intervention methods based on the health belief model on promoting the secretion of milk among mothers who were separated with their babies. METHODS In this prospective, randomized controlled clinical trial, we enrolled 260 separation mothers between September 26, 2016 and March 7, 2017, in a 3rd-grade women and children hospital of Chengdu. The mothers all had cesarean delivery and were randomized into 2 groups: the intervention group (educated by investigators based on the health belief) and the control group (routinely educated by obstetric nurses). Data on the onset of lactation and the milk volume during 3 days postpartum were collected. The breast swelling rate within 3 days postpartum and the exclusive breastfeeding rate at 42 days postpartum were compared. The psychologic scores of separation maternal in both groups were assessed with State-Trait Anxiety Inventory at the 3rd day postpartum. RESULTS Compared with the control group, the intervention group had significantly earlier lactation time (P < .01), significantly larger milk volume (P < .01) during 24, 24 to 48, and 48 to 72 hours, and significantly lower psychologic scores (P < .01) at the 3rd-day postpartum.The onset of lactation among mothers who initiated milk expression within 1 hour after childbirth were earlier than those who initiated milk expression between 1 and 6 hours (P < .01); the milk volume within 24-hour postpartum did not differ significantly between the 2 groups (P > .05). However, the milk volume of the early-expression group (<1 hour) was significantly higher than that of the late-expression group (1-6 hours) during 24 to 48 and 48 to72 hours (P < .05).The breast swelling rate of separation mothers within 3 days postpartum in the intervention group was lower than that in the control group (P < .05). The exclusive breastfeeding rate of mothers in the intervention group was significantly higher than that in the control group (59% vs 35%; P < .01) at 42 days postpartum. CONCLUSION Nursing intervention based on the health belief model can stimulate milk secretion in mothers who were separated with their babies.
-
8.
The Role of Vitamin D in Fertility and during Pregnancy and Lactation: A Review of Clinical Data.
Pilz, S, Zittermann, A, Obeid, R, Hahn, A, Pludowski, P, Trummer, C, Lerchbaum, E, Pérez-López, FR, Karras, SN, März, W
International journal of environmental research and public health. 2018;(10)
Abstract
Vitamin D deficiency is common and there exists a huge gap between recommended dietary vitamin D intakes and the poor vitamin D supply in the general population. While vitamin D is important for musculoskeletal health, there are accumulating data suggesting that vitamin D may also be important for fertility, pregnancy outcomes and lactation. Significant changes in vitamin D metabolism during pregnancy such as increased production of the "active vitamin D hormone" calcitriol support the important role of vitamin D in this setting. Observational studies show that vitamin D deficiency is a risk marker for reduced fertility and various adverse pregnancy outcomes and is associated with a low vitamin D content of breast milk. Meta-analyses of randomized controlled trials (RCTs) document that physiological vitamin D supplementation during pregnancy is safe and improves vitamin D and calcium status, thereby protecting skeletal health. Although certain RCTs and/or meta-analyses reported some other beneficial effects, it is still not clear whether vitamin D supplementation improves fertility or decreases the risk of adverse pregnancy outcomes such as low birth weight, pre-eclampsia and neonatal mortality, or reduces wheeze/asthma in the infants. Nevertheless, vitamin D supplementation in pregnant women is frequently required to achieve a sufficient vitamin D status as recommended by nutritional vitamin D guidelines. In this review, we provide an overview of systematic reviews, meta-analyses and large trials reporting clinical data on the role of vitamin D for fertility, pregnancy and lactation.
-
9.
Does Maternal Synbiotic Supplementation Affect Conjugated Linoleic Acid Level in Breast Milk? A Randomized Placebo-Controlled Clinical Trial.
Nikniaz, L, Mahdavi, R, Ostadrahimi, A, Nikniaz, Z, Aliasgharzadeh, S
Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 2018;(1):81-84
Abstract
AIM: As conjugated linoleic acid (CLA)is a potential growth promotor in newborns, the present pilot study aimed at measuring the effect of synbiotic supplementation on breast milk CLA level. MATERIALS AND METHODS Sixty lactating mothers were randomly allocated to take either synbiotic (n = 31) or placebo (n = 29) for 30 days. Maternal anthropometric indices were measured at the onset and end of the study by standard methods and body mass index was calculated. Information on food intake was collected by using a 24 hours 24-hour recall method for 2 days and food record questionnaire for 1 day. Breast milk lipids were extracted and CLA level was quantified by gas chromatography. RESULTS No significant differences were observed in the baseline mean breast milk concentrations of Fatty acids (FAs) between the synbiotic and placebo groups (p > 0.05). The CLA content of breast milk increased significantly by 58% (from 0.19 ± 0.15 to 0.30 ± 0.22 mmol/L) in the supplemented group, whereas it decrease decreased slightly but not significantly by 14% (from 0.22 ± 0.14 to 0.19 ± 0.10 mmol/L) in the placebo group. After adjustment for covariates, the CLA content of breast milk was significantly higher in the supplemented group compared with placebo group after the intervention (p = 0.03). The ratio of total n - 6:3 increased significantly over time in both groups, but was not different among groups (p < 0.05). CONCLUSIONS This pilot study showed that supplementation of lactating women with synbiotic, resulted in increased breast milk CLA composition. Further research using different species of probiotic bacteria and analysis of maternal and infant plasma FAs would be beneficial.
-
10.
Levels of Growth Factors and IgA in the Colostrum of Women from Burundi and Italy.
Munblit, D, Abrol, P, Sheth, S, Chow, LY, Khaleva, E, Asmanov, A, Lauriola, S, Padovani, EM, Comberiati, P, Boner, AL, et al
Nutrients. 2018;(9)
Abstract
Colostrum is produced in the first days postpartum. It is a known source of immune mediators for a newborn within the first week of life. Although it is still unclear if colostrum composition varies between populations, recent data suggest differences. Hepatocyte growth factor (HGF); transforming growth factor-β (TGF-β) 1, 2, and 3; and immunoglobulin A (IgA) are key immunological components of colostrum that stimulate neonatal gastrointestinal and immune system development. We aimed to investigate the differences in the concentration between immune markers in the colostrum of mothers living in Burundi and Italy, and to identify the factors associated with differences. In this cross-sectional birth cohort study, a total of 99 colostrum samples from Burundian (n = 23) and Italian (n = 76) women were collected at 0 to 6 days postpartum. A clinical chemistry analyser was used for IgA quantification and electro-chemiluminescence, for HGF and TGFβ1-3 assessment. A univariate analysis and multivariate linear regression model were used for statistical testing. The concentrations of TGF-β2 (p = 0.01) and IgA (p < 0.01) were significantly higher in the colostrum from the women residing in Burundi than in Italy, both in a univariate analysis and upon the adjustment for confounding factors. A similar trend is seen for HGF, reaching statistical significance upon a multivariate analysis. We found a moderate to strong positive correlation between the TGF-β isoforms and IgA concentration in both countries (p < 0.01), with stronger concentration in the colostrum from Burundi. The results of this study are in support of previous data, suggesting that concentration of the immune active molecules is higher in the human milk of women residing in developing countries. However, with a small sample size, caution must be applied, as the findings require further confirmation. Future work should also be focused on other factors (e.g., lipid and microbial composition), as well as the investigation into colostrum and between populations comparison, adjusting for potential confounders.