Timing of Stage II Lactogenesis Is Predicted by Antenatal Metabolic Health in a Cohort of Primiparas

Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
Breastfeeding Medicine (Impact Factor: 1.25). 04/2011; 7(1):43-9. DOI: 10.1089/bfm.2011.0007
Source: PubMed


Time to onset of stage II lactogenesis varies widely, and delayed onset of lactogenesis (OL) is common among first-time mothers in the United States. Higher body mass index, older age, and larger infant birth weight are identified risk factors for delayed OL; all are known correlates with glucose metabolism. Our objective was to prenatally assess maternal biomarkers related to metabolic health and determine the extent to which these biomarkers predict timing of OL.
We enrolled a population-based sample of expectant primiparas attending a single prenatal clinic. We obtained a blood sample 1-hour post-glucose load from an antenatal oral glucose challenge test and assayed for the following biomarkers: serum insulin, glucose, adiponectin, leptin, C-reactive protein, interleukin-6, resistin, and tumor necrosis factor-α. Our outcome measure was timing of OL, based on maternal report at 3-5 days postpartum. We used linear regression to model OL hour.
Twenty-six of 29 (90%) agreed to screening, 18 delivered at term and initiated breastfeeding, and 16 have complete data. Median (minimum-maximum) postpartum body mass index was 27.4 (21.8-34.7) kg/m(2), and median time to OL was 64 (10-121) hours. The model, OL = 232 - 34.9(ln[ratio insulin/glucose]) - 1.4(adiponectin), explained 56% of the variation in OL hour (p = 0.005) and was not weakened by potential confounders.
Higher serum insulin secretion relative to serum glucose after a glucose challenge and higher serum adiponectin are associated with earlier onset of OL. These findings suggest that factors associated with better glucose tolerance predict earlier OL.

12 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article provides an overview of the composition of human milk, its variation, and its clinical relevance. The composition of human milk is the biological norm for infant nutrition. Human milk also contains many hundreds to thousands of distinct bioactive molecules that protect against infection and inflammation and contribute to immune maturation, organ development, and healthy microbial colonization. Some of these molecules (eg, lactoferrin) are being investigated as novel therapeutic agents. Human milk changes in composition from colostrum to late lactation, within feeds, by gestational age, diurnally, and between mothers. Feeding infants with expressed human milk is increasing.
    Pediatric Clinics of North America 02/2013; 60(1):49-74. DOI:10.1016/j.pcl.2012.10.002 · 2.12 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Aware of the important benefits of human milk, most U.S. women initiate breastfeeding but difficulties with milk supply lead some to quit earlier than intended. Yet, the contribution of maternal physiology to lactation difficulties remains poorly understood. Human milk fat globules, by enveloping cell contents during their secretion into milk, are a rich source of mammary cell RNA. Here, we pair this non-invasive mRNA source with RNA-sequencing to probe the milk fat layer transcriptome during three stages of lactation: colostral, transitional, and mature milk production. The resulting transcriptomes paint an exquisite portrait of human lactation. The resulting transcriptional profiles cluster not by postpartum day, but by milk Na:K ratio, indicating that women sampled during similar postpartum time frames could be at markedly different stages of gene expression. Each stage of lactation is characterized by a dynamic range (10(5)-fold) in transcript abundances not previously observed with microarray technology. We discovered that transcripts for isoferritins and cathepsins are strikingly abundant during colostrum production, highlighting the potential importance of these proteins for neonatal health. Two transcripts, encoding β-casein (CSN2) and α-lactalbumin (LALBA), make up 45% of the total pool of mRNA in mature lactation. Genes significantly expressed across all stages of lactation are associated with making, modifying, transporting, and packaging milk proteins. Stage-specific transcripts are associated with immune defense during the colostral stage, up-regulation of the machinery needed for milk protein synthesis during the transitional stage, and the production of lipids during mature lactation. We observed strong modulation of key genes involved in lactose synthesis and insulin signaling. In particular, protein tyrosine phosphatase, receptor type, F (PTPRF) may serve as a biomarker linking insulin resistance with insufficient milk supply. This study provides the methodology and reference data set to enable future targeted research on the physiological contributors of sub-optimal lactation in humans.
    PLoS ONE 07/2013; 8(7):e67531. DOI:10.1371/journal.pone.0067531 · 3.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract 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.
    Journal of Perinatal Medicine 09/2013; 42(1):1-10. DOI:10.1515/jpm-2013-0095 · 1.36 Impact Factor
Show more