Article

Alcohol levels in Chinese lactating mothers after consumption of alcoholic diet during postpartum “doing-the-month” ritual

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Abstract

This study examined the effects of exposure to ethanol through cultural practices by lactating mothers. Specifically, the pharmacokinetics of alcohol in Chinese lactating mothers was investigated after they consumed chicken soup flavored with sesame oil and rice wine (CSSR), a typically prescribed diet during the postpartum "doing-the-month" period. Experimental findings were employed to estimate the potential ethanol dose to neonates and determine associated health risks. Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. The target alcohol dosage was 0.3g/kg. Milk and blood samples were collected at fixed time intervals from each subject following exposure to CSSR, and alcohol levels were determined. Acute health risks to infants were estimated by comparing the potential infant dosage to an established criterion dose. Blood alcohol level peaked at 20 min after exposure to CSSR and decreased almost linearly thereafter. Alcohol in milk reached a plateau roughly at 20-40 min after exposure to CSSR and then decreased. Alcohol pharmacokinetics among subjects varied widely. The coefficients of variation in subject alcohol concentrations were 16.5-46.2% (mean, 30.0%) for blood and 32.8-57.6% (mean, 44.4%) for milk. Mean maximal alcohol concentration in blood (30.2+/-5.0 mg/dl) was achieved at 23.5+/-7.6 min and in milk (31.6+/-10.3 mg/dl) at 31.7+/-12.7 min. Potential infant doses were 3.0-58.8 mg (mean, 13.4 mg), and the predicted time required for milk alcohol level to return to zero level was 175 min. The acute health risks for infants exposed to alcohol through their mothers' milk under the current exposure scenario are low (hazard index<0.2). Nursing infants at least 3h after ingesting a diet containing alcohol would further reduce potential health risks.

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... In such cases, ethanol ingested by breast-feeding mothers is passed to nursing infants through breast milk. Chicken soup flavoured with sesame oil and rice wine (CSSR), which is consumed by Taiwanese (ethnically Chinese) mothers during the traditional Chinese 'doing-the-month' ritual, is another example of the mother-milk-infant exposure pathway (13) . 'Doing the month' is a 30 d, culturally defined postpartum period of prescribed behaviours such as eating certain foods deemed beneficial to convalescing mothers. ...
... Since the entire study was conducted over a period of several months, CSSR was prepared on three different occasions, and alcohol levels and other macronutrients were analysed after each preparation. Analysis of CSSR by GC equipped with a flame ionization detector revealed alcohol levels of 40?65 (SD 1?82) mg/ml (13) . A target alcohol dosage of 0?30 g/kg body weight was achieved by administering to each subject , 8 ml of soup per kilogram of body weight. ...
... The pharmacokinetics of alcohol in milk and blood after CSSR consumption and its implications have been described in detail elsewhere (13) . Briefly, milk alcohol peaked at 20-40 min, decreased nearly linearly thereafter, and reached zero level at approximately 175 min postconsumption. ...
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The present study examined whether ethanol exposure influences lactation parameters. Specifically, selected constituents in maternal blood and milk and the lactation performance of Chinese lactating mothers were evaluated after they had consumed chicken soup flavoured with sesame oil and rice wine (CSSR), a diet traditionally prescribed during the postpartum 'doing-the-month' ritual. Twenty-three lactating mothers were examined. Informed consent was obtained from each subject. Each subject was tested on two occasions separated by a week. The target alcohol dosage was 0.3 g/kg body weight. Milk and blood samples were collected prior to consumption of soup and at 120 and 150 min, respectively, after consumption. Levels of various constituents were measured. The time for ejection of the first milk droplet and total milk volume yielded were also measured. Consumption of CSSR influenced TAG, insulin and lactate levels in maternal blood. Likewise, consumption of the soup affected milk composition and its nutritional status, particularly total protein, TAG, fatty acid, beta-hydroxybutyrate and lactate levels. CSSR intake significantly affected TAG and lactate levels in milk. The time for the first milk droplet to be ejected was significantly longer in the CSSR group, indicating that the milk-ejecting reflex is inhibited. However, blood prolactin level increased slightly after ethanol intake. Milk yields were reduced after ingestion of CSSR although the difference was not statistically significant. Consumption of CSSR affects not only the composition of maternal blood and milk, but also lactation performance. These findings suggest that an alcoholic diet should be avoided during lactation.
... Da Silva et al. [35] measured ethanol levels in blood and breast milk by GC using the headspace technique in five lactating and five control women at different times after ingesting 0.4 g/kg of ethanol, and demonstrated that lactating women have blood ethanol levels lower than those observed in non-lactating women after ingesting the same amount of ethanol, indicating the importance of lactation for ethanol pharmacokinetics. Chien et al. [38], using GC-FID, analyzed alcohol levels in milk from lactating mothers on an alcoholic diet (chicken soup with sesame oil and rice wine). Maximal alcohol concentration in milk was 31.6 ± 10.3 mg/dl at 31.7± 12.7 min, the potential mean infant dose was 13.4 mg, and the predicted time required for the milk alcohol level to return to the zero level was 175 min. ...
... The method of Da Silva et al. [35] was quite lengthy, as it required 60 min for instrumental equilibration after the chromatographic run. Conversely, that of Chien et al. [38] was quite rapid, as the milk sample was directly injected into the GC. Another advantage of the method of Chien et al. [38] was that required only 1 μl of milk, whereas the method of da Silva et al. [35] required 10 μl. ...
... Conversely, that of Chien et al. [38] was quite rapid, as the milk sample was directly injected into the GC. Another advantage of the method of Chien et al. [38] was that required only 1 μl of milk, whereas the method of da Silva et al. [35] required 10 μl. Besides, this, the method of Chien et al. gave better precision (CV< 2.2%) than that of da Silva et al. [35] (CV<12%). ...
Article
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Most of the licit and illicit drugs consumed by the breastfeeding woman pass into the milk and can modify the production, volume and composition of the milk, as well as hypothetically have short- and long-term harmful effects on the infant. There is much confusion in the scientific community regarding this issue: should a woman breastfeed her baby while continuing to use prescription drugs and/or drugs of abuse? There are many case reports of clinically significant toxicity in breast-fed infants from some substances used by mothers (such as irritability, vomiting, sedation, respiratory depression, shock), but there are too few data on studies conducted in breastfeeding women and their infants to make a realistic risk assessment. The objective measurement of a drug and/or metabolites in maternal milk is the first step when investigating the amount of drug exctreted in milk and subsequently calculating the daily dose administered to the breast-fed infant. The present review reports the analytical methods developed to detect different drugs in the breast milk, listing the principal characteristics and validation parameters, advantages and disadvantges. Furthermore, the mechanisms of drug transfer into breast milk are discussed, the correlation between the concentration of the drug in breast milk and potential adverse outcomes on the infant are described for each drug, and suggested harm minimization strategies and approved breastfeeding recommendations are indicated. Figure
... With a low molecular weight, no protein binding, and being a strong base, alcohol diffuses in and out of breast milk depending on maternal blood alcohol levels, peaking 30-60 minutes after consumption (Giglia and Binns 2006); (D'apolito 2013). After providing 0.3mg alcohol/kg of mother's body weight, Chien et al. (Chien et al. 2005) found that alcohol in breast milk reached a peak at 20-40 min after exposure, decreasing thereafter. Because none is absorbed into fat, alcohol levels will not build up in the mother, as is the case for drugs like marijuana and cocaine. ...
... Because its elimination follows zero-order kinetics (a constant, predictable rate of elimination), pumping and dumping will not speed up the elimination of alcohol from breast milk (nor will coffee drinking or anything else except the time required for the liver to detoxify alcohol in the blood) (Koren 2002). However, the pharmacokinetics of alcohol varies greatly among lactating women, with coefficients of variation from 38-57% in breast milk (Chien et al. 2005). ...
... In folklore, alcohol has long been considered a galactagogue (Pepino and Mennella 2004); (Flores-Huerta et al. 1992a); (Schaffir and Czapla 2012) or a way to lengthen the duration of breastfeeding (Bowen and Tumback 2010) and its maternal use at bedtime was often advised to reduce fussiness and symptoms of colic or to sedate infants (Adams and Davidson 1987). In Taiwan, soup containing rice wine is traditionally prescribed for mothers during the first month postpartum (Chien et al. 2005). Myths about its benefits were disseminated by alcoholic beverage manufacturers in the past (Mennella and Beauchamp 1993). ...
Article
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Moderate alcohol use by breastfeeding women appears to be relatively common. Alcohol concentrates in breast milk at levels slightly higher than in maternal blood, peaking at 30-60 minutes after consumption. Most studies find no link with the duration of breastfeeding unless drinking is fairly heavy (>2 standard drinks/day). However, seven studies have found that moderate maternal alcohol consumption was associated with a shorter duration of exclusive breastfeeding; one found no difference and one found an increase. Alcohol affects oxytocin release, leading to reductions in breast milk consumption in the following hours. Infant alcohol exposure may increase fussiness and reduce sleep, both temporary if the mother does not continue to drink. These effects on the infant and on the breastfeeding process could be interpreted by mothers as signs of infant dissatisfaction with their breast milk, “insufficient milk,” or other commonly expressed causes for suboptimal breastfeeding patterns. Chronic alcohol consumption, even if moderate, may have a number of more serious effects, including on infant development. In the early weeks or months of life, infant toleration of alcohol is lower than it is at later stages of infancy, and the early breastfeeding process is more susceptible to disruption. Therefore, it may be wise to advise mothers to continue their abstinence from alcohol during pregnancy into the first few months of breastfeeding. Little research has been done on how often women time their drinking so as to avoid infant exposure to alcohol. Health workers and others sometimes propagate myths that alcohol, especially alcoholic beer, is beneficial to breastfeeding. Research is needed in different cultures into whether various forms of cautionary messages are likely to discourage moderate drinkers from initiating breastfeeding or to shorten its duration, and which type of messages if any actually lead to a reduction in drinking during breastfeeding.
... The traditional Chinese diet for new mothers was defined as an intake of Chinese herbal medicines (including sh¯ enghù a t¯ ang, s` ı w` u t¯ ang and Eucommia ulmoides) along with socalled warm food (such as chicken soup and sesameoil chicken) [13]. This diet is part of a traditional month-long period of customs aimed at accelerating the recovery of postpartum mothers [14]. The other Chinese herbal medicines were not examined in this study. ...
... In Taiwan, consuming certain foods and Chinese medicines is widely believed to be beneficial for convalescing mothers during the postpartum period [13, 18]. However, the impact of maternal intake of a traditional Chinese postpartum diet on infants' health has never been surveyed [14, 19]. Our results indicate that a combination of Chinese medicines with a traditional Chinese maternal diet may decrease the development of prolonged jaundice. ...
... In addition, in Taiwan it is a tradition that convalescing mothers ingest chicken soup flavored with alcohol. Chien et al. reported that the breast milk of these mothers contains significant levels of alcohol [14]. However, the impact of maternal alcohol consumption on prolonged jaundice of nursing infants is not clear. ...
Article
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Our objective was to identify the association between maternal diet with Chinese herbal medicines and prolonged jaundice of breast-fed infants. Healthy infants at 25 to 45 days of age were eligible for enrollment into this prospective study. Jaundice was defined as a transcutaneous bilirubin (TcB) value ≥ 5 mg/dL. A questionnaire survey asking feeding type, stool pattern, and maternal diet was conducted at the time of TcB measurement. A total of 1148 infants were enrolled, including 151 formula-fed, 436 combination-fed, and 561 breast-fed infants. The incidences of jaundice were 4.0% in formula-fed infants, 15.1% in combination-fed infants, and 39.8% in breast-fed infants (P < 0.001). In addition, jaundice was noted in 37.1% of preterm infants and 25.0% of term infants (P < 0.001). Furthermore, jaundice was more common in breast-fed infants whose mothers did not consume the traditional Chinese herbal medicines than in breast-fed infants whose mothers did consume such medicines (P < 0.001). In conclusion, this cohort study has identified late-preterm birth and breast feeding as the contributory factors for prolonged jaundice of apparently well infants. The data indicate that postpartum diet with Chinese herbal medicines is associated with breast milk jaundice.
... El vino, bebida mencionada por las mujeres del estudio, ha estado presente de igual manera en otras culturas (23)(24) , como hábito alimentario. Su consumo ha sido raramente cuestionado, considerado incluso como un tónico fuerte. ...
... Las sopas de caballo cansadas que se daban a los niños en Portugal confirman esta idea (4) . Sin embargo, se sabe que este repercute negativamente a corto y largo plazo en la salud de los lactantes, y reduce la producción de la leche en la madre (23) . ...
Article
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Objective: To describe the cultural beliefs and practices related to food during pregnancy and the puerperium in adult women (over 60 years old) in two different cultures by applying the Health Traditions Model. Method: A qualitative study was carried out with the participation of 16 women resident during their pregnancy / childbirth / puerperium in a rural area of Braga (Portugal), and León (Spain). The information collection technique was the semi-structured interview. A content analysis was made, following the Health Traditions Model. Results: Beliefs and dietary practices related to feeding were identified, aimed at protecting, maintaining and recovering the health of the mother / newborn, from the physical / mental / spiritual sphere (9 interrelated dimensions). Conclusion: Eating beliefs and practices in pregnancy / puerperium of older women were described, confirming the role of culture in them. 9 interrelated dimensions were considered, as well as the relevant role of family / relatives. These data can help us plan for current, participatory (family / community) maternal health actions, correct certain practices, and provide care consistent with the culture of women. This can help transform beliefs, or values and attitudes that embody a certain cultural form in nursing.
... Twelve publications concerning the pharmacokinetics of alcohol during lactation were identified [5,[33][34][35][36][37][38][39][40][41][42][43]. Alcohol passes freely into breast milk in approximately the same concentrations as in maternal blood; one study has shown marginally higher concentrations in blood [33], another in milk [34]. ...
... The highest concentration is seen after 30-60 min, and the concentration declines linearly at the same rate as in maternal blood (i.e. approximately 15-20 mg/dL/h [1]) due to dynamic equilibrium between plasma and breast milk [33][34][35]. The toxic metabolite of alcohol and acetaldehyde is apparently not excreted into milk, even at high concentrations in maternal blood [33]. ...
Article
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While the harmful effects of alcohol during pregnancy are well established, the consequences of alcohol intake during lactation have been far less examined. We reviewed available data on the prevalence of alcohol intake during lactation, the influence of alcohol on breastfeeding, the pharmacokinetics of alcohol in lactating women and nursing infants, and the effects of alcohol intake on nursing infants. A systematic search was performed in PubMed from origin to May 2013, and 41 publications were included in the review. Approximately half of all lactating women in Western countries consume alcohol while breastfeeding. Alcohol intake inhibits the milk ejection reflex, causing a temporary decrease in milk yield. The alcohol concentrations in breastmilk closely resemble those in maternal blood. The amount of alcohol presented to nursing infants through breastmilk is approximately 5-6% of the weight-adjusted maternal dose, and even in a theoretical case of binge drinking, the children would not be subjected to clinically relevant amounts of alcohol. Newborns metabolise alcohol at approximately half the rate of adults. Minute behavioural changes in infants exposed to alcohol-containing milk have been reported, but the literature is contradictory. Any long-term consequences for the children of alcohol-abusing mothers are yet unknown, but occasional drinking while breastfeeding has not been convincingly shown to adversely affect nursing infants. In conclusion, special recommendations aimed at lactating women are not warranted. Instead, lactating women should simply follow standard recommendations on alcohol consumption. This article is protected by copyright. All rights reserved.
... In Mexico, pregnant and lactating women are encouraged to drink pulque, a low-alcohol beverage made from Agave atrovirens [ 14 ] ; the "magic elixir" in Argentina [ 15 ] and Germany [ 16 ] is malt beer. Chicken soup fl avored with sesame oil and rice wine is recommended in China [ 17,18 ] . ...
... In 1895, a major US brewery produced a low-alcohol beer that was sold exclusively in drugstores and prescribed by physicians as a tonic for lactating women [ 19 ] . Even today, alcohol consumption is regarded by many authorities [ 20 ] and cultures [ 11,17,21 ] as compatible with breastfeeding and/or as imparting positive effects, such as facilitating milk letdown, rectifying milk insuf fi ciency, and calming "fussy" breastfed infants [22][23][24][25] . Our own research on women living in the Delaware Valley revealed that one-quarter of the women who were discouraged from drinking alcohol while they were pregnant were encouraged to drink by their health professionals once they began breastfeeding [ 11 ] . ...
Chapter
Breastfeeding has increased across all socioeconomic groups in the USA, with increasing recognition of the health and psychological benefits to both mother and infant [1–4]. Despite this resurgence, and the fact that alcohol is one of the most frequently consumed drugs in women of childbearing age [5, 6], little is known about the effects of alcohol on this biologically important reproductive state in women or on the growing infant. Although lactating mothers exhibit similar drinking patterns as formula-feeding mothers [7–9], recommendations about alcohol are largely based on folklore passed down through generations, and many cultures believe that alcohol is a milk-producing substance (galactagogue).
... It is very common to find that the ingredients for postpartum diets contain some alcohol since it is believed that alcohol helps the body to absorb herbal medicine. One study found women's blood and breast milk contained high levels of alcohol within one hour after they took one of the traditional postpartum foods such as chicken soup flavored with sesame oil and rice wine (Chien, et al, 2009;Chien, Liu, Huang, Hsu, & Chao, 2005). Women who adopt a diet cooked with alcohol should be advised to avoid breastfeeding and pumping breast milk within three hours after they ate the special diet (Chien, et al., 2005). ...
... One study found women's blood and breast milk contained high levels of alcohol within one hour after they took one of the traditional postpartum foods such as chicken soup flavored with sesame oil and rice wine (Chien, et al, 2009;Chien, Liu, Huang, Hsu, & Chao, 2005). Women who adopt a diet cooked with alcohol should be advised to avoid breastfeeding and pumping breast milk within three hours after they ate the special diet (Chien, et al., 2005). In addition, break milk production should be closely monitored since food mixed with sesame oil and alcohol could prohibit break milk (Chien, et al., 2009). ...
... Another common DTM practice is drinking rice wine. Depending on the amount of time that has passed between rice wine consumption and nursing, drinking rice wine or consuming foods cooked with rice wine could affect developing infants, as well as increase time needed for breastfeeding patients to lactate [26,27]. ...
Article
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To evaluate the knowledge of, participation in, attitudes towards, and experiences with “doing the month” (DTM), a traditional Chinese and Vietnamese postpartum practice, at a federally qualified health center that serves predominantly Asian immigrants. DTM practices revolve around the balance between yin and yang and include practices such as the mother remaining on bed rest for as long as possible, restricting diet to certain foods, and avoiding visitors and social activities. A cross-sectional survey in Chinese, Vietnamese, and English was developed to determine the prevalence of women who have heard of and participated in DTM. 154 respondents participated. The mean age of respondents was 40.1 years. Without prompting of what DTM was, 58 (37.7%) responded that they had heard of DTM. After an explanatory paragraph, this increased to 117 (76.6%) participants. Out of 107 patients who have children, 65 (60.7%) “did the month” after giving birth. Participation rates were highest for women who identified as Chinese or Vietnamese. Likert-type scale questions showed that respondents believed DTM was stressful but enjoyable and helpful for recovery from childbirth. In conclusion, DTM is a common practice that health providers should be aware of.
... Similar results were observed in studies that employed alternative methodological approaches (e.g., assessment of adoptees with or without prenatal alcohol exposure; Yates et al., 1998). Furthermore, cultural practices promote early contact with ethanol not only during pregnancy (Chambers et al., 2005; Morris et al., 2008) but also through milk during breastfeeding (Chien et al., 2005Chien et al., , 2008 Menella, 2001; Mennella and Beauchamp, 1993) and routine medical procedures (Croce, 1987; Fildes, 1986; Flores-Huerta et al., 1992). A full experimental analysis of the relationship between early prenatal and postnatal experience with alcohol and heightened affinity for the drug in humans is limited by the obvious ethical and legal constraints regulating experimental behavioral research in infancy, childhood and adolescence (Witt, 1994). ...
Article
The motivational effects of drugs play a key role during the transition from casual use to abuse and dependence. Ethanol reinforcement has been successfully studied through Pavlovian and operant conditioning in adult rats and mice genetically selected for their ready acceptance of ethanol. Another model for studying ethanol reinforcement is the immature (preweanling) rat, which consumes ethanol and exhibits the capacity to process tactile, odor and taste cues and transfer information between different sensorial modalities. This review describes the motivational effects of ethanol in preweanling, heterogeneous non-selected rats. Preweanlings exhibit ethanol-mediated conditioned taste avoidance and conditioned place aversion. Ethanol's appetitive effects, however, are evident when using first- and second-order conditioning and operant procedures. Ethanol also devalues the motivational representation of aversive stimuli, suggesting early negative reinforcement. It seems that preweanlings are highly sensitive not only to the aversive motivational effects of ethanol but also to its positive and negative (anti-anxiety) reinforcement potential. The review underscores the advantages of using a developing rat to evaluate alcohol's motivational effects.
... For chicken soup and sesame oil chicken, the consumption for 0-3 days was scored as 0, for 4-7 days was scored as 1, for 8-15 days was scored as 2, and consumption for more than 15 days was scored as 3. The sesame oil chicken is comprised of chicken, ginger, black sesame oil, and rice wine [21], and the chicken soup was defined as a soup cooked by boiling chicken until well cooked. No consumption of Sheng-hau-tang and Siwu-tang was scored as 0. Consumption of Sheng-hau-tang and Si-wu-tang for 1-4 days was scored as 1, for 5-10 days was scored as 2, and for more than 10 days was scored as 3. ...
Article
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Background. Traditional Chinese postpartum care is believed to help in the recovery of women after delivery. Objective. This study investigated the association of elements in dietary and herbal therapy with uterine involution. Methods. Indices of uterine involution were measured ultrasonographically in 127 postpartum women between 4-6 weeks after delivery. A self-reported retrospective questionnaire was used to query women about their frequencies of taking herbal medicines and consuming special diets during the first month after delivery. Correlation coefficients were calculated to identify the associations, then the regression models were used to identify the predictors. Result. Among the herbal medicines and diet, consumption of Eucommia ulmoides (E. ulmoides) negatively correlated with the AP diameter of the uterus and the cavity. E. ulmoides was also the only predictor of maximum AP diameter of the uterus, AP diameter of the uterus 5 cm from the fundus, and the maximum AP diameter of the cavity. Moreover, consumption of Sheng-hau-tang was significantly correlated with anteverted uterus and was a predictor of anteverted uterus. Conclusion. E. ulmoides and Sheng-hau-tang positively correlated with the degree of uterine involution after delivery, implying that both therapies might possess the pharmacological efficacy of uterine contraction in postpartum women.
... For over 1000 years, Chinese women have kept and maintained zuo yuezi (Chien et al, 2005). Many other traditions have been either forgotten or are being kept as heritage and practiced only occasionally for ceremonial purposes. ...
Article
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Modernity has caused many changes to culture and to a certain extent has contributed to the lapse of many traditional practices. However, Chinese women have continued to practice zuo yuezi all over the world. Zuo Yuezi is traditional confinement which has been practised by the Chinese for at least 1000 years. Studies have shown Chinese women all over the world are still practising the tradition. This article will explore how and why the tradition is still practised in the modern age by Malaysian Chinese women and to what extent. This article will also attempt to explain the reasons for zuo yuezi to be continually practised by Chinese women by analyzing the functionality of the tradition and other factors which could have supported its resilience.
... Women influenced by TCM, on the other hand, were encouraged to consume rice wine or certain soup cooked with the wine to increase hot humor in the body (Y. C. Chien, Liu, Huang, Hsu, & Chao, 2005;Liu, et al., 2006). ...
... Throughout the world, women have used many alternative approaches in an attempt to increase milk production such as following special diets and the use of herbal or natural substances. Mothers of different cultural and ethnic backgrounds often choose different approaches according to their tradition or experience [27][28][29][30][31][32]. Herbal medicines commonly believed to aid lactation include fenugreek (Trigonella foenum-gracum) [4,[33][34][35][36][37], blessed thistle (Cnicus benedictus) [4,13,19,38], milk thistle (Silybum marianum) [39,40], goat's rue (Galega officinalis) [4,41,42], marshmallow (Althaea officinalis) [4], fennel (Foeniculum vulgare) [4,13], torbangun (Coleus amboinicus Lour) [36], nettle (Urtica dioica) [4,13] and black seed (Nigella sativa) [43]. ...
Article
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The World Health Organization recommends breastfeeding as the normal infant feeding method and that infants being breastfed should be regarded as the control group or norm reference in all instances. There are many factors which could contribute to a new mother ceasing breastfeeding early, with the most commonly reported reason being perceived insufficient breast milk supply. The use of herbal galactagogues is increasingly common worldwide. Literature review identified a need for more research in the area of herbal galactagogue use during breastfeeding. Twenty in-depth semi-structured interviews were undertaken with breastfeeding women who used herbal galactagogues, to document use and explore their perceived effectiveness and safety of herbal galactagogues. Several indicators of breastfeeding adequacy were mentioned as participants described their experiences with the use of herbal galactagogues. Confidence and self-empowerment emerged as an over-arching theme linked to positive experiences with the use of herbal galactagogues. Despite the lack of clinical trial data on the actual increase in measured volume of breast milk production, indicators of breastfeeding adequacy boosted participants' confidence levels and resulted in psychological benefits. This study highlighted the importance of considering the potential psychological benefits of using herbal galactagogues, and how this translates into breastfeeding adequacy.
... The pharmacokinetic profiles are very similar, reaching zero at roughly the same time (Lawton, 1985). Some investigators made calculations on how long a nursing mother needs to wait after consumption of alcohol before feeding the baby (Ho et al., 2001;Chung et al., 2005). ...
... Für die Modellstruktur wurde ein Modell eines Erwachsenen sowie eines Neugeborenen und Säuglings, das bereits mehrfach von uns benutzt wurde(Abraham et al. 2005, Mielke et al. 2005, Mielke et al. 2009 Milchproduktion als kontinuierlich beschrieben wird (RAM2). Entsprechend den experimentellen Daten vonChien et al. (2005), daSilva et al. (1993),Lawton (1985),Kesäniemi (1974) wurde mit einem Verhältnis der Konzentrationen Blut/Milch von 1 gerechnet. Für die Simulation des Konzentration-Zeit-Verlaufs von Alkohol durch Gabe eines pflanzlichen Carminativums wurde eine dreimal tägliche Gabe in der angegebenen Dosierung von fünf Tropfen für das Neugeborene und zehn Tropfen für den drei Monate alten Säugling mit Applikation in das Kind simuliert. ...
Article
Some groups recommend breast pumping before alcohol consumption and feeding the milk instead of breast feeding afterwards to nursing women. We established a physiologically based kinetic model and simulated the concentration of alcohol in a breast fed neonate and a 3 month old suckling infant after the nursing mother had consumed alcohol (alternatively 0.25 L wine, 0.5 L beer, 0.1 L sparkling wine, 0.5 L "alcoholfree" beer, 0.5 L Null-Komma-null- Prozent (zero-dot-zero-percent) beer, 0.5 L juice). We also simulated the concentration in utero/fetal compartment during pregnancy assuming the identical alcohol consumption of the pregnant woman as indicated and in addition the alcohol concentration during infant's treatment of bloating using an approved herbal drug containing alcohol. Peak maternal alcohol concentration was 0.59‰ after consuming 0.25 L of wine, peak concentration was 0.0033 in the newborn, 0.0038 in the 3 months old infant (due to higher drinking volume) and 0.38 ‰ in the utero/fetal compartment. The peak concentration with herbal drug treatment was 0.015‰ in the neonate and 0.015‰ in the 3 months old infant, respectively. We discuss the results of the simulations and compare it with doses and published concentrations measured in experimentals. We conclude that for the nursing mother the recommendation "1 to 2 glasses of wine on occasion" (Agence Nationale d'Accréditation et d'Évaluation en Santé 2002) and "no excessive or daily alcohol consumption, occasional drinking without unwanted effect fort the child" (Public Health Agency of Canada, 2005) are in accordance with scientific evaluation whereas stronger restrictions are not scientifically sound.
... Another study concluded that: potential infant alcohol doses were low (3.0-58.8 mg (mean 13.4 mg)); predicted time required for milk to return to zero alcohol content was 175 min after drinking; health risks to the infant from a single dose were low; but nursing activity should be postponed for three hours after the maternal alcohol use of a dose equal to one standard drink [30]. Academy of Breastfeeding Medicine guidelines also recommend a two hour wait before resuming nursing, but state that "possible long-term effects of alcohol in maternal milk remain unknown" [31]. ...
Article
Objective: Determine any effects that maternal alcohol consumption during the breastfeeding period has on child outcomes. Methods: Population-based samples of children with fetal alcohol spectrum disorders (FASD), normally-developing children, and their mothers were analyzed for differences in child outcomes. Results: Ninety percent (90%) of mothers breastfed for an average of 19.9 months. Of mothers who drank postpartum and breastfed (MDPB), 47% breastfed for 12 months or more. In case control analyses, children of MDPB were significantly lighter, had lower verbal IQ scores, and more anomalies in comparisons controlling for prenatal alcohol exposure and final FASD diagnosis. Utilizing a stepwise logistic regression model adjusting for nine confounders of prenatal drinking and other maternal risks, MDPB were 6.4 times more likely to have a child with FASD than breastfeeding mothers who abstained from alcohol while breastfeeding. Conclusions: Alcohol use during the period of breastfeeding was found to significantly compromise a child's development.
... 방 법 [3] 3-P Calcium for pregnant women 12 [31] [3] 4-P Healthy weight gain during pregnancy 12 5-L Nutritional management for lactating women 13 [31] Healthy food choices 6-P Fruits during pregnancy 21 [31 − 33] 7-P Fish during pregnancy 9 [31,32] [34] 8-P Tips for a more nutritious diet 18 [31 − 33] 9-PL Tips for choosing processed foods 13 [35] 10-PL Tips for choosing dietary supplements 9 [31] Food safety 11-P Prevention of food-borne illness 8 12-P Foods to avoid during pregnancy 11 Favorites to avoid 13-PL Caffeine during pregnancy and lactation 11 [30] [36] 14-P Alcohol during pregnancy 13 [17,36,37] 15-L Alcohol during lactation 10 [17,37] [38] 16-PL Smoking during pregnancy and lactation 15 [17,36,37] Nutrition management in special conditions 17-P Vegetarians 14 [31,32] 18-P Women with food allergies 14 [39] 19-P Underweight women 15 [31] 20-P Obese women 14 [31,40] 21-P Multiple pregnancy 12 [31] [20] 22-P Nausea and vomiting in early pregnancy 17 [31,32] [36] 23-P Gestational diabetes 15 [18] 24-P Gestational hypertension 16 [30,31,40] [19] 25-P Hypothyroidism 16 [41] 26-P Hyperthyroidism 11 [36,41] 1) P: for pregnant women, L: for lactating women 2) Common references were [ ...
... The acute health risks for infants exposed to ethanol through their mothers' milk under the usual exposure scenario are low. The authors advised that nursing infants at least 3 hours after ingesting a diet containing alcohol would further reduce potential health risks [19]. ...
Article
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Alcohol addiction and intoxication are major health problems worldwide. Acute alcohol intoxication is well reported in adults and adolescents but less frequently reported in children of younger ages. We report three anonymized cases of pediatric ethanol exposure and illustrate the different mechanisms of intoxication. In all cases, a focused history is the key to prompt diagnosis and timely management. Physicians should be aware of this potential poison in children presented with acute confusional or encephalopathic state. In contrast, neonates with ethanol intoxication may present with nonspecific gastrointestinal symptomatology. Urgent exclusion of sepsis, electrolyte imbalance, drug intoxication, and surgical abdominal condition is critical. Using these illustrated cases, we performed a narrative literature review on issues of exposure to ethanol-containing substances and ethanol intoxication in children. In conclusion, a high level of suspicion and interrogation on ethanol or substance use are essential particularly in the lactating mother for an accurate and timely diagnosis of ethanol intoxication to be made.
... The maximum concentration is seen after 30 60 min, and the concentration decays linearly at the similar rate as in parental blood (i.e. approximately 15 20 mg/dL/h [1]) owing to dynamic equilibrium among plasma and breast milk [25][26][27]. The poisonous metabolite of alcohol and acetaldehyde is seemingly not excreted into milk, even at high concentrations in parental blood [25]. ...
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Alcohol intake has occurred in India for many centuries. While the injurious effect of alcohol during pregnancy are entrenched, the significances of alcohol consumption through lactation have been far less studied. In chemistry, the term alcohol is used as a common or generic name to entitle numerous sequences of materials. Heavy drinking during pregnancy increases the risk to offspring. Alcohol consumption by a breastfeeding mother is very harmful for the infants. Excessive intake of alcohol by the pregnant woman can lead to a premature birth. If the mother consuming alcohol can cause drowsiness, deep sleep, abnormal weight, weakness. This review gives you the detailed study about how the pregnant can get harm by the alcohol during pregnancy.
... An analysis of milk and blood samples from 23 lactating mothers consuming this diet showed that blood alcohol level peaked 20 min after soup consumption and decreased almost linearly afterwards. Milk alcohol levels plateaued at~20-40 minutes and potential infant alcohol doses varied between 3.0 to 58.8 mg (mean, 13.4 mg) and took about 175 minutes to return to zero [54]. ...
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Aims: To review the impact of prenatal alcohol exposure on the outcomes of the mother and child. Design: Narrative review. Setting: Review of literature. Participants: Mothers and infants affected by prenatal alcohol use. Measurements: Outcomes of mothers and children. Findings: Prenatal alcohol exposure is one of the most important causes of preventable cognitive impairment in the world. The developing neurological system is exquisitely sensitive to harm from alcohol and there is now also substantial evidence that alcohol-related harm can extend beyond the individual person, leading to epigenetic changes and intergenerational vulnerability and disadvantage. There is no known safe level or timing of drinking for pregnant or lactating women and binge drinking (> four drinks within 2 hours for women) is the most harmful. Alcohol-exposure increases the risk of congenital problems, including Fetal Alcohol Spectrum Disorder (FASD) and its most severe form, Fetal Alcohol Syndrome (FAS). Conclusion: The impact of FASD and FAS is enduring and life-long with no current treatment or cure. Emerging therapeutic options may mitigate the worst impact of alcohol exposure but significant knowledge gaps remain. This review discusses the history, epidemiology and clinical presentations of prenatal alcohol exposure, focusing on FASD and FAS, and the impact of evidence on future research, practice and policy directions.
... Remaining indoors may prevent adequate sun exposure and thus a vitamin D deficiency, which can further contribute to risk of depression (Strand et al., 2009). Depending on the amount of time that has passed between rice wine consumption and nursing, drinking rice wine or consuming foods cooked with rice wine could affect developing infants, as well as increase time needed for breastfeeding patients to lactate (Chien et al., 2005(Chien et al., , 2009. Being unable to shower can contribute to postpartum infections, and being unable to leave the house may contribute to postpartum depression in the mother, especially for women who delivered by Cesarean section (Liu et al., 2014). ...
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Breastfeeding's role in infant health is well recognized. Breastfeeding in the transitional developing countries is an interesting aspect in paediatric nutrition. In transitional developing countries, although nearly all post-partum women initiate breastfeeding and duration is lengthy, infant growth faltering and malnutrition are widespread. Compliance with breastfeeding recommendations in developing countries is low, and more attention should be given to increasing breastfeeding, especially exclusive breastfeeding, and to monitoring trends. Distinct social class- and country-specific patterns can be observed for breastfeeding.
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To provide useful alternatives to in vivo animal studies, in vitro assays for dose-response assessments of xenobiotic chemicals must use concentrations in media and target tissues that are within biologically-plausible limits. Determining these concentrations is a complex matter, which can be facilitated by applying physiologically-based pharmacokinetic (PBPK) models in an in vitro to in vivo extrapolation (IVIVE) paradigm. We used ethanol (EtOH), a ubiquitous chemical with defined metrics for in vivo and in vitro embryotoxicity, as a model chemical to evaluate this paradigm. A published series of life-stage PBPK models for rats was extended to mice, yielding simulations that adequately predicted in vivo blood EtOH concentrations (BECs) from oral, intraperitoneal, and intravenous routes in non-pregnant and pregnant adult mice. The models were then extrapolated to non-pregnant and pregnant humans, replicating BEC data within a factor of two. The rodent models were then used to conduct IVIVEs for rodent and whole-embryo culture embryotoxicity data (neural tube closure defects, morphological changes). A second IVIVE was conducted for exposure scenarios in pregnant women during critical windows of susceptibility for developmental toxicity, such as the first six-to-eight weeks (pre-recognition period) or mid-to-late pregnancy period, when EtOH consumption is associated with fetal alcohol spectrum disorders. Incorporation of data from human embryonic stem cell studies led to a model-supported linkage of in vitro concentrations with plausible exposure ranges for pregnant women. This effort demonstrates benefits and challenges associated with use of multi-species PBPK models to estimate in vivo tissue concentrations associated with in vitro embryotoxicity studies. Published by Oxford University Press on behalf of the Society of Toxicology 2014. This work is written by US Government employees and is in the public domain in the US.
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Children are often first exposed to ethanol during intrauterine life or during breastfeeding. In many cultures, alcohol has been considered a good galactogogue but recent investigations do not support this opinion. This review presents the latest knowledge on the influence of ethanol on neuroendocrine control of lactation, pharmacokinetics of ethanol in human milk and the potential effects of ethanol in mother’s milk on the breast-fed infant. In view of the high prevalence of alcohol consumption in our contemporary culture and the necessity to diminish the adverse consequences of alcohol consumption by breastfeeding mothers, the author presents recommendations regarding alcohol consumption during lactation and problems which arise during the formulation of such recommendations. Possible correlation between the duration of breastfeeding and alcoholism in adult life is also discussed. Do pierwszego zetknięcia się dziecka z alkoholem etylowym dochodzi często już podczas życia wewnątrzmacicznego lub w okresie karmienia piersią. W wielu kulturach alkohol był uważany za dobry środek mlekopędny, ale współczesne badania takiego działania nie potwierdzają. W niniejszym opracowaniu autor przedstawił aktualny stan wiedzy o oddziaływaniu etanolu na neurohormonalną regulację laktacji, o farmakokinetyce etanolu w mleku kobiecym i o potencjalnych następstwach oddziaływania etanolu na niemowlę karmione piersią. Wobec powszechności spożywania alkoholu w naszej kulturze i konieczności zminimalizowania niekorzystnych następstw spożywania alkoholu przez matki karmiące piersią, autor przedstawił zalecenia odnośnie spożywania alkoholu w okresie laktacji oraz problemy, które powstają przy formułowaniu takich zaleceń. Omówione zostało także zagadnienie ewentualnego związku pomiędzy czasem trwania karmienia piersią a alkoholizmem w wieku dorosłym.
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Background: Doing the month is a general term to describe traditional beliefs, rituals, and practices in relation to how a postpartum woman should behave immediately after childbirth and continues for a month. It is not clear whether the traditional practices are beneficial for women's health or well-being. Purpose: to describe the postpartum ritual of doing the month and implications for health care. Significance: Better understanding of the different cultural beliefs and practices can help health professionals provide culturally sensitive care to meet postpartum women's physical and psychological needs, as well as avoiding unnecessary conflicts. Methodology: literature review. Findings: The rational underlying doing the month is originated from the traditional Chinese medicine in theories of the somatic balance of Yin and Yang. Women are expected to rest a lot and remain confined to their homes for one month to ensure recovery from pregnancy induced imbalance and prevent future illness. The postpartum women should refrain from eating Yin foods, such as fruits, cold water, ice cream, and salad. Washing hair and bathing, and brushing teeth are prohibited to avoid the invasion of humidity and wind. Conclusions: With the globalization, health professionals have many opportunities caring for clients from diverse backgrounds. To offer better quality care and promote understanding of the beliefs and needs of postpartum women, education curricula should include the concept of traditional postpartum customs. While remaining sensitive to the needs of cultural beliefs and practices, health professionals are obligated to provide accurate medical information to achieve client's optimal health.
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To examine changes in food consumption during pregnancy and the postpartum period in women of major Asian ethnic groups. Using interviewer-administered questionnaires, we assessed changes in food consumption during pregnancy (26-28 weeks' gestation) and the postpartum period (3 weeks after delivery) as compared with the usual pre-pregnancy diet. Singapore. Pregnant women (n 1027) of Chinese, Malay and Indian ethnicity (mean age 30·4 (sd 5·2) years) who participated in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. During pregnancy, participants tended to increase their consumption of milk, fruit and vegetables and decrease their consumption of tea, coffee, soft drinks and seafood (all P < 0·001). Most participants reported adherence to traditional restrictions ('confinement') during the early postpartum period (Chinese: 94·8 %, Malay: 91·6 %, Indian: 79·6 %). During the postpartum period, participants tended to increase their consumption of fish and milk-based drinks and decrease their consumption of noodles, seafood, and chocolates and sweets (all P < 0·001). Ethnic differences in food consumption were pronounced during the postpartum period. For example, most Chinese participants (87·2 %) increased their ginger consumption during the postpartum period as compared with smaller percentages of Malays (31·8 %) and Indians (40·8 %; P for ethnic difference <0·001). Similar ethnic differences were observed for cooking wine/alcohol, herbs and spices, and herbal tea consumption. Marked changes in food consumption that reflect both modern dietary recommendations and the persistence of traditional beliefs were observed in Singaporean women during pregnancy and the postpartum period. Traditional beliefs should be considered in interventions to improve dietary intakes during these periods.
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In this study, the new methodologies of the ISO 22000:2018 and HACCP systems were fully implemented in an organization from the pre‐prepared postpartum meal industry. One of the organization’s dishes was chosen as an example dish. The Critical Control Points (CCPs) were identified as the acceptance of raw materials, cooking, and reheating steps in the preparation process. The impacts before and after applying these food safety systems to the end product were evaluated. The results indicated that the monthly average aerobic plate count and coliforms levels in the dish samples tested in 2018 and 2019 (before and after the implementation of the systems) had gradually decreased. The Chinese herbal medicinal materials were subjected to rapid testing and a periodic rotation scheme with enhanced intensity of monitoring. We found that the presence of aflatoxin residues in the Chinese herbal medicinal materials reflected the importance and necessity of rapid testing and third‐party testing in small‐ and medium‐sized food and beverage establishments. Meanwhile, following the full implementation of the systems, the quality and safety of the organization’s dishes had gradually improved, and the number of customer complaints had decreased. The customers also increased their positive feedbacks and recommendations, so as to provide more opportunities for the organization. We expect that the methodologies, principles, and models used by the organization in this study could be applied on its other dishes as well as on other similar small‐ and medium‐sized food and beverage establishments in the industry, so as to elevate their image and boost sales. This study examined the strategies, methodologies, and programs as per the ISO 22000:2018 clauses implemented by a small and medium enterprise in the pre‐prepared postpartum meal industry. Pig trotter soup with peanuts was selected as an example dish.
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The amount of alcohol ingested by a breast-fed infant is only a small fraction of that consumed by its mother, but even this small amount may have an effect on the infant. We investigated whether the ingestion of alcohol by a lactating woman altered the odor of her milk and whether exposure to a small amount of alcohol in the mother's milk had immediate effects on the behavior of the infant. Twelve lactating women and their infants were tested on two days separated by an interval of one week. On each testing day, the mother expressed a small quantity of breast milk and then drank either orange juice or orange juice containing a small quantity of ethanol (0.3 g per kilogram of body weight). Additional milk samples were obtained at fixed intervals after the ingestion of the beverage and analyzed to determine their ethanol content. The samples were also evaluated by a panel of adults to determine whether any difference in the odor of the milk was detectable after alcohol ingestion. The infants were weighed before and after nursing to assess the amount of milk they ingested, and their behavior during breast-feeding was monitored by videotape. Short-term alcohol consumption by lactating women significantly and uniformly increased the perceived intensity of the odor of their milk as assessed by the panel; this increase in the intensity of the odor peaked 30 minutes to 1 hour after the alcohol was consumed and decreased thereafter. The alteration in the odor of the milk closely paralleled the changes in the concentration of ethanol in the milk (mean range, 0 to 6.9 mmol per liter [0 to 32 mg per deciliter]). The infants sucked more frequently during the first minute of feedings after their mothers had consumed alcohol (67.0 +/- 6.5 sucks, as compared with 58.4 +/- 5.9 sucks for feedings after the consumption of the nonalcoholic beverage; P less than 0.05), but they consumed significantly less milk (120.4 +/- 9.5 ml vs. 156.4 +/- 8.2 ml, P less than 0.001) during the testing sessions in which their mothers drank the alcoholic beverage. Although the mechanisms underlying this reduction in milk intake remain to be elucidated, this study shows that short-term alcohol consumption by nursing mothers has an immediate effect on the sensory characteristics (odor) of their milk and the feeding behavior of their infants.
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In medical research data are often collected serially on subjects. The statistical analysis of such data is often inadequate in two ways: it may fail to settle clinically relevant questions and it may be statistically invalid. A commonly used method which compares groups at a series of time points, possibly with t tests, is flawed on both counts. There may, however, be a remedy, which takes the form of a two stage method that uses summary measures. In the first stage a suitable summary of the response in an individual, such as a rate of change or an area under a curve, is identified and calculated for each subject. In the second stage these summary measures are analysed by simple statistical techniques as though they were raw data. The method is statistically valid and likely to be more relevant to the study questions. If this method is borne in mind when the experiment is being planned it should promote studies with enough subjects and sufficient observations at critical times to enable useful conclusions to be drawn. Use of summary measures to analyse serial measurements, though not new, is potentially a useful and simple tool in medical research.
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This review contains a succinct overview of the nature and extent of the problem of contamination of human milk with environmental and occupational chemicals, excluding drugs. Factors influencing the levels of contaminants in breast milk are discussed. Also, data on major chemicals of concern with potential health risk(s) to the general population and risk-benefit considerations are dealt with briefly. Based on the available data on the subject, research needs have been identified and policy recommendations are suggested.
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To test the hypothesis that exposure to alcohol in breast milk affects infants' sleep and activity levels in the short term. Thirteen lactating women and their infants were tested on 2 days, separated by an interval of 1 week. On each testing day, the mother expressed 100 mL of milk, while a small, computerized movement detector called an actigraph was placed on the infant's left leg to monitor sleep and activity patterning. After the actigraph had been in place for approximately 15 minutes, the infants ingested their mother's breast milk flavored with alcohol (32 mg) on one testing day and breast milk alone on the other. The infants' behaviors were monitored for the next 3.5 hours. The infants spent significantly less time sleeping during the 3.5 hours after consuming the alcohol-flavored milk (78.2 minutes compared with 56.8 minutes after feeding alcohol in breast milk). This reduction was apparently attributable to a shortening in the longest sleeping bout (34.5 compared with 56.7 minutes for sleeping after breast milk alone) and the amount of time spent in active sleep (25.8 minutes compared with 44.2 minutes after breast milk alone); the decrease in active sleep was observed in all but 2 of the 13 infants tested. Although the mechanisms underlying the reduction in sleep remain to be elucidated, this study shows that short-term exposure to small amounts of alcohol in breast milk produces distinctive changes in the infant's sleep-wake patterning.
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The effects of maternal alcohol consumption on fetal neurologic development, growth and physical development have been widely documented. The effects of further alcohol exposure in breast milk are not understood, but generally believed not to be significant. (C) Williams & Wilkins 1990. All Rights Reserved.
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Ethanol is present in more than 700 pharmaceutical liquid preparations, ostensibly as an 'inert' solvent or diluent. Despite recent voluntary efforts by several pharmaceutical companies to replace alcohol or reduce its content, there remain on the market an excessive number of liquid medications containing alcohol in concentrations ranging from 0.3% to 68%, eg, teething preparations, decongestants, and cough medicines. The presence of ethanol in children's medication is of major toxicologic interest with respect to both acute ingestion and passive exposure that occurs during therapy with ethanol-containing products. This commentary focuses upon the toxicology in children and the determination of acceptable alcohol concentrations in children's medication.
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For many infants, human milk is the sole source of nutrients, including energy, for up to 1 year and may be a major source of calories and protein in the diet for 2 years or more. The success of lactation must be judged ultimately by its adequacy for the growth and health of the breast-fed infant. The physiological and nutritional demands of lactation on the mother are high and may last for considerably longer than those of pregnancy. Thus, the relationship between maternal nutritional status and lactation performance is a public health issue of substantial importance.
Objective: To review data on the occurrence and toxicity of the commonly reported pesticides and industrial environmental pollutant chemicals in breast milk.Data Sources: Continuous automated literature surveillance plus contact with investigators and governmental agencies.Study Selections: For data on occurrence, the most recent data from the largest data sets on the most representative donors were used. For data on toxicity, the primary report that was publicly available was used.Data Extraction: When necessary, data were reexpressed or concentrations were rescaled. The original investigator was contacted if necessary.Data Synthesis: Although pollutant chemicals are readily detected in most human milk worldwide, there is little evidence for consequent morbidity in nurslings. There have been several mass poisonings in which chemicals that were transmitted through breast milk clearly affected children who were breast-fed, and there is some evidence that prenatal exposure to background levels resulted in mild developmental delay and that lactation per se was disturbed.Conclusions: Breast-feeding is recommended despite the presence of chemical residues. The prenatal period in the child and the initiation of lactation in the mother may be sensitive periods to the toxicity of the chemicals that are considered here, and the potential for poisoning at higher levels is clear. However, in the vast majority of women, the benefits of breast-feeding appear to outweigh the risks, and those who advise women about infant nutrition should continue to support breast-feeding.Arch Pediatr Adolesc Med. 1996;150:981-990
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It was shown that 2,4,5,2',4',5'-hexachlorobiphenyl (6-CB) administered to adult female mice accumulated in their nursing offspring more rapidly than a dose administered to weanling mice when treated animals were bred at equivalent ages. This suggested that the PCB was eliminated from the maternal animal relative to its time of sequestration into storage depots. Using a model which more closely approximates conditions during human lactation, the influence of a high-fat diet and decreased litter size on this phenomenon was examined. Female ICR mice were treated with 4 mg/kg (14C)-6-CB as 13-g weanlings (dW) at 3 weeks of age or as adults (dA) at 11 weeks of age. All animals were mated at 11 weeks of age. On Day 1 of pregnancy, mice were placed on a low-fat (11.5% of the total calories) or high-fat (43.8% of total calories) diet. At parturition, litters were adjusted to either two or eight within each diet group. Elimination of maternal 6-CB was determined by assessing radioactivity in offspring carcasses on Day 15 of gestation or Day 1, 3, 5, 10, or 15 postpartum. Consumption of a high-fat diet significantly extended the t1/2 of elimination of 6-CB from mothers nursing a litter of two in the dW group (low fat = 7.3 days; high fat = 12.4 days) and in both the dW and dA groups nursing litters of eight (dW: low fat = 4.6 days; high fat = 6.8 days; and dA: low fat = 1.8 days; high fat = 3.0 days). Within diet and group, reducing litter size to two also significantly decreased the rate of elimination of 6-CB from maternal animals. 6-CB was eliminated to offspring more rapidly from the dA group when compared to the dW group regardless of diet in animals nursing litters of eight. This relationship was not observed in maternal animals nursing litters of two. In general, exposure to a high-fat diet increased the t1/2 of elimination of 6-CB from maternal animals.
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A nonlinear relationship between the total area under the blood ethanol concentration-time curve and the orally administered dose (mg/kg) of ethanol was observed in fasting subjects. A preliminary model, based on physiological considerations, was elaborated and shown, for the first time, to describe the entire time course of blood alcohol concentrations after four different doses of alcohol. The model could be refined by further experimentation.
Traditional custom in China stipulates that a woman should be confined to home for one full month of convalescence after giving birth. During this time she is expected to adhere to a broad set of extremely restrictive prescriptions and proscriptions collectively referred to as “doing the month”. This includes refraining from washing and all contact with water and wind, following a “hot” diet to remedy pregnancy-induced “hot/cold” imbalance, and observing taboos premised on belief in the polluting powers of placental blood.The specific rules and rationale are presented first from the ethnomedical folk perspective of those who do the month, are then analyzed according to the logic of classical Chinese medicine, and are finally appraised in light, of Western medical and nutritional knowledge. From the latter perspective, some of the practices are efficacious while others, which may have once been so, now appear dysfunctional. From the Chinese perspective, the practices taken together are considered efficacious for curing the body's imbalance but especially as a preventive therapy against ailments in later years. A direct bearing upon mental well-being and familial relationships is also recognized.The practices of doing the month persist in China despite socialism in the People's Republic of China and Westernization in Taiwan. This suggests that Western-type health professionals throughout the developing countries must remain cognizant and respectful of the indigenous beliefs and practices linking the events of reproduction and the health status of women.The original data upon which the study is based were gathered in interviews in Mandarin Chinese with laypersons, herbalists, and physicians in Taiwan and with physicians and laypersons from the People's Republic of China.
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Thesis (doctoral)--University of California, San Francisco, 1993. Includes bibliographical references (leaves 133-157).
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This paper reviews the literature on the incidence and duration of breast-feeding in various countries, the volume and composition of breast milk, the health and nutrition of breast-fed babies as judged by growth and morbidity, maternal nutritional requirements during lactation, and the effect of prolonged lactation on maternal health. It appears that lactation can be as well sustained by impoverished as by affluent mothers, and that even in communities where malnutrition is common the average growth of infants is satisfactory up to the age of about 3 months on a diet of breast milk alone. Breast milk appears to have specific anti-infective properties, but prolonged breast-feeding will not prevent infections among older infants reared in a poor environment. The authors believe that breast-feeding is the best form of nutrition for the young infant and deplore its decline in modern industrial societies. The recommendations of various FAO/WHO Expert Groups on nutritional intakes during lactation are summarized. The need for an increased daily energy intake of 4.2 MJ (1 000 kcal) is questioned, and an increase of 2.5 MJ (600 kcal) is suggested. Data on the effect of prolonged lactation on the health of the mother are scanty; body weight appears to be maintained even among poorly nourished mothers. The authors stress the need for well-planned and technically adequate studies of the material and psychological factors involved in breast feeding.
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Women from rural areas of the central plateau of Mexico drink during pregnancy and lactation a mild alcoholic beverage called pulque as a galactogogue. Ethanol present in milk could have a harmful effect on growth and development of breast-fed children. The purpose of this study was to quantify the ethanol consumed as pulque by eleven lactating rural women as well as its clearance rate in blood and milk. Mothers were separated in two groups depending upon the ethanol ingested in a single dose of pulque 0.21 +/- 0.08 g/kg of body weight (group A) and 0.44 +/- 0.11 g/kg (group B). Maximal concentration of ethanol was reached in milk at 60 minutes and almost equaled that in plasma. Both groups showed a similar clearance pattern regardless of the volume of pulque ingested. Clearance rates between groups were different: ethanol concentration in milk at 60 min were 8.4 +/- 3.0 mg/dL for group A and 26.2 +/- 7.0 mg/dL for group B. Two hours later ethanol levels were 3.6 +/- 3.4 mg/dL and 23.3 +/- 9.4 mg/dL respectively. Clearance rates were slower in mothers showing the highest concentration of ethanol in milk. The present data demonstrate that there is no differential elimination of ethanol in maternal blood and milk following ingestion of a moderate amount of pulque during lactation. The amount of ethanol received by infants through milk is relatively low and therefore it is unlikely to have harmful effects on them. Pulque consumption adds about 350 kcal/day to the customary dietary intake of these lactating women.
Article
Although information about the pregnancy outcome of alcoholic mothers is relatively abundant, no information is available about the effects of ethanol consumption on the infant's postnatal growth. This investigation aims to describe the physical growth of 32 infants born to mothers accustomed to drinking pulque, a mild alcoholic beverage, on a daily basis during pregnancy and lactation and to quantitate the ethanol disposed through the milk, as well as to identify cases of newborns with fetal alcohol syndrome. No full-blown cases of the syndrome were found: birth weight was similar to their non-drinking counterpart, but the relative risk of newborns to drinking mothers to have a low birth weight was 3.39. Ethanol found in milk accounted for 40 mg/day available to the infant. The postnatal growth of infants of ethanol drinkers was similar to that of controls. Further studies on their mental development are required in order to understand the extent of the effects of such a habit.
Article
It was shown that 2,4,5,2',4',5'-hexachlorobiphenyl (6-CB) administered to adult female mice accumulated in their nursing offspring more rapidly than a dose administered to weanling mice when treated animals were bred at equivalent ages. This suggested that the PCB was eliminated from the maternal animal relative to its time of sequestration into storage depots. Using a model which more closely approximates conditions during human lactation, the influence of a high-fat diet and decreased litter size on this phenomenon was examined. Female ICR mice were treated with 4 mg/kg [14C]-6-CB as 13-g weanlings (dW) at 3 weeks of age or as adults (dA) at 11 weeks of age. All animals were mated at 11 weeks of age. On Day 1 of pregnancy, mice were placed on a low-fat (11.5% of the total calories) or high-fat (43.8% of total calories) diet. At parturition, litters were adjusted to either two or eight within each diet group. Elimination of maternal 6-CB was determined by assessing radioactivity in offspring carcasses on Day 15 of gestation or Day 1, 3, 5, 10, or 15 postpartum. Consumption of a high-fat diet significantly extended the t1/2 of elimination of 6-CB from mothers nursing a litter of two in the dW group (low fat = 7.3 days; high fat = 12.4 days) and in both the dW and dA groups nursing litters of eight (dW: low fat = 4.6 days; high fat = 6.8 days; and dA: low fat = 1.8 days; high fat = 3.0 days). Within diet and group, reducing litter size to two also significantly decreased the rate of elimination of 6-CB from maternal animals. 6-CB was eliminated to offspring more rapidly from the dA group when compared to the dW group regardless of diet in animals nursing litters of eight. This relationship was not observed in maternal animals nursing litters of two. In general, exposure to a high-fat diet increased the t1/2 of elimination of 6-CB from maternal animals. Reducing litter size had a greater influence and also masked the ordered mobilization of 6-CB relative to its time of sequestration. Thus, under experimental conditions which more closely mimic the human situation, 6-CB was eliminated less rapidly in the rodent, and sequential 6-CB doses were equally available to nursing offspring.
Article
The detrimental effects of maternal drinking during pregnancy on fetal health have been documented. The consequences for infants of maternal drinking during breast-feeding are unknown, but research in animals suggests that the infant could be affected by exposure to alcohol through the mother's milk. In a study of 400 infants born to members of a health maintenance organization, we investigated the relation of the mother's use of alcohol during breast-feeding to the infant's development at one year of age. Mental development, as measured by the Bayley Mental Development Index (MDI), was unrelated to maternal drinking during breast-feeding. However, motor development, as measured by the Psychomotor Development Index (PDI), was significantly lower in infants exposed regularly to alcohol in breast milk (after alcohol exposure during gestation was controlled for), with a dose-response relation (P for linear trend, 0.006). The infants of breast-feeding mothers who had at least one drink daily had a mean PDI score of 98, whereas the infants exposed to less alcohol in breast milk had a mean PDI score of 103 (95 percent confidence interval for the difference of the two means, 1.2 to 9.8). The effect was more pronounced when mothers who supplemented breast-feeding with formula were excluded from the analysis. The association persisted even after we controlled for more than 100 potentially confounding variables, including smoking and other drug use during pregnancy and in the postpartum period. We conclude that ethanol ingested through breast milk has a slight but significant detrimental effect on motor development, but not mental development, in breast-fed infants.
Article
The authors measured polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) in maternal serum, cord blood, placenta, and serial samples of breast milk from 868 women. Almost all samples of breast milk showed detectable levels of both chemicals. Overall, values for DDE in this study are within the range of those found previously, whereas those for PCBs are somewhat higher. Possible causes of variation in levels were investigated. For DDE, older women, Black women, cigarette smokers, and women who consumed sport fish during pregnancy had higher levels; only age and race showed large effects. For PCBs, older women, women who regularly drink alcohol, and primiparae had higher levels. In addition, both chemicals showed modest variation across occupational groupings. Casual exposure to a PCB spill did not result in chemical levels different from background. In general, women have higher levels in their first lactation and in the earlier samples of a given lactation, and levels decline both with time spent breast-feeding and with number of children nursed. These striking declines are presumably a measure of exposure to the child.
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The pharmacokinetics of ethanol after typical doses are described by a 1-compartment model with concentration-dependent elimination. The volume of distribution estimated from blood concentrations is about 37 L/70kg. Protein binding of ethanol has not been reported. Elimination is principally by metabolism in the liver with small amounts excreted in the breath (0.7%), urine (0.3%), and sweat (0.1%). Metabolism occurs, principally by alcohol dehydrogenase, in the liver to acetaldehyde. Models of ethanol input and absorption are crucial to the description and understanding of the effects of ethanol dose on bioavailability. Little attention has been paid to evaluation of potential models. First-pass extraction of ethanol is predicted to be dependent on hepatic blood flow and ethanol absorption rate, with a typical extraction ratio of 0.2. The overall elimination process can be described by a capacity-limited model similar to the Michaelis-Menten model for enzyme kinetics. The maximum rate of elimination of ethanol (elimination capacity or V maxis 8.5 g/h/70kg. This would be equivalent to a blood ethanol disappearance rate of 230 mg/L/h if metabolism took place at its maximum rate. The elimination rate is half of the elimination capacity at a peripheral blood ethanol concentration (Km) of about 80 mg/L. Ethanol is readily detectable in expired air. The usual blood: expired air ratio is 2300: 1 and breath clearance at rest is 0.16 L/h. The renal clearance of ethanol is 0.06 L/h and sweat clearance is 0.02 L/h. The use of a zero-order model of ethanol elimination has been widespread although the limitations of this model have been known for a long time. Much of the published work on ethanol pharmacokinetics must be regarded with suspicion because of this assumption.
Article
The effects of polymorphism of aldehyde dehydrogenase (ALDH) and obesity (body weight/lean body mass) on the rate of ethanol elimination were studied. One hundred and forty subjects of healthy Japanese male volunteers who ingested 0.4 g/kg of ethanol were divided into two groups, i.e., a normal ALDH group with a low Km isozyme of ALDH and a deficient group. They were further divided into three groups in which the obesity increased in the order group A, B, C. Ethanol elimination (ER) and beta were significantly higher in the normal ALDH group than in the deficient group. In the normal ALDH subjects, beta of group C(0.187 mg/ml/hr) was higher than that of group B(0.155 mg/ml/hr). No difference in ER was observed among the three groups of the obesity in each ALDH group. Distribution volume of ethanol, r, estimated by Watson's method (0.65 to 0.89) was more accurate than Widmark's r(0.5 to 1.00). Ethanol elimination rate in the normal ALDH subjects was greater than that in Caucasian reported by other authors. Body weight was correlated well with liver weight in 135 autopsy materials.
Article
At fixed intervals after the ingestion of alcohol by 8 nursing mothers, sets of breast milk and blood samples were collected and their alcohol levels compared. One set of milk samples was solely hind-milk while the remainder were fore-milk samples. The results showed that alcohol appeared quickly in both fore- and hind-milk at a level equivalent to or higher than the corresponding blood samples. Elimination of alcohol from the milk was closely related to its elimination from blood and was unaffected by breast feeding. However, despite this, the large dilution of the alcohol contained in the milk by the baby's body water renders the baby's resultant blood alcohol level very low in all but the most extreme cases.
Article
In an effort to promote breast feeding, health workers are publicising the advantages of human milk. However, not all infants will benefit from being breast fed. Human milk may be unsuitable for infants with some metabolic conditions, or those whose mothers are undergoing certain drug therapies. Pooled breast milk from human milk banks is often of questionable nutritional quality, its use for sick infants requires careful consideration. The composition of breast milk is influenced by the maternal diet and environmental pollution. Occasional reports of nutritional deficiencies in breast-fed infants emphasise the unpredictability of human milk. These reports, although rare, serve as reminders that human milk is neither a perfect nor a complete food. Health workers need to be aware of the shortcomings of breast milk as well as its undoubted benefits.
Ethanol and acetaldehyde were measured in the milk and peripheral blood of lactating women at various intervals after drinking ethanol. The results of the present study support the earlier findings that ethanol reaches human milk in a similar concentration to that in the peripheral blood, decreasing together with the decreasing ethanol content of the blood. On the other hand, no acetaldehyde was found in the milk, even though considerable amounts were measured in the blood. The amount of ethanol that a suckling could receive during maternal ethanol metabolism is shown to be relatively low and unlikely to cause harmful effects when maternal use of alcohol is temporary.
Article
The concentrations of organochlorine pesticides and polychlorinated biphenyls (PCBs) in successive milk fractions collected from two mothers during the course of a feeding were constant for each of the mothers when calculated on a milk fat basis. The levels in milk from one mother collected on six nursing occasions during a 24-hr period were also constant when calculated on the basis of milk fat. When milk collected from three mothers at weekly intervals during several months was analyzed, the levels ofp,p′-DDT,p,p′-DDE and PCBs calculated on a milk fat basis fluctuated slightly in each case; a slight decrease in the concentrations ofp,p′-DDE and PCBs was observed with time. Two methods commonly used for the extraction of fat and organochlorine contaminants from milk were compared and found to give similar results. A problem in the analysis of PCBs in human milk is that the pattern of these contaminants in the milk differs from that in the commercially available mixtures used as standards. The PCB levels in nine human milk samples were calculated by comparison with three standards: Clophen® A50, Aroclor® 1254 and Aroclor® 1260. Within the analytical errors, the results were the same with Clophen A50 and Aroclor 1260, and an average of 14% higher with Aroclor 1254.
Article
The concentration-time profile of ethanol in breath air (AAC), arterial (ABAC) and venous blood (VBAC) of human volunteers was studied after four different oral doses of absolute alcohol--0.5, 0.75, 1.0, and 1.25 g/kg body weight. Seventy-eight single dose experiments were carried out in 42 subjects. In all 78 studies AAC was measured and VBAC was estimated simultaneously in blood collected from a cubital vein of 36 volunteers. Arterial blood, too, was collected from 8 subjects from a catheter in a brachial artery. All blood alcohol concentrations were analysed independently by gas chromatography (GLC) and an enzymatic (ADH) method. A one-compartment open model with first order absorption and pseudo-zero-order elimination was employed to calculate the pharmacokinetic parameters. The average values for the first order absorption rate constant (ka) ranged from 2.2 to 3.1, from 2.4 to 2.6 and from 1.0 to 1.7 h-1 for ACC, ABAC and VBAC, respectively. The pseudo-zero-order elimination rate constant (beta) was 0.17 to 0.18, 0.21 to 0.22 and 0.26 to 0.27 g X 1(-1) X h-1, respectively. During absorption ABAC tended to be higher than VBAC, peaking at a higher level (Cmax) and with a shorter time to peak (tmax) until an arterio-venous concentration equilibrium was reached, whereafter VBAC remained above ABAC. Although there was a close relationship between AAC, ABAC and VBAC during elimination, AAC closely followed the pattern of ABAC during absorption and tended to deviate from VBAC. AAC, therefore, is a much better predictor of ABAC during absorption than VBAC.
Article
In a carefully controlled drinking situation there was great individual variation in peak blood alcohol concentrations (BACS) for given doses of alcohol. Alcohol nomograms and tables based on average results from such studies could be misleading since they could frequently result in serious underestimates or overestimates of peak BACS.
Article
Chinese food therapy has endured and evolved from the beginning of Chinese civilization to the present day. Basic tenets central to food therapy such as "curing and nourishing come from the same source" and "when you eat, satisfy only seven-tenths of your hunger" have been passed down from generation to generation. Dietetic practice today must take into consideration and respect many of the ancient beliefs for maximum effectiveness with many of today's Chinese.
Article
Ethanol disposition was evaluated in 77 female and 97 male college seniors during an alcohol challenge study. All were regular drinkers who exceeded legal intoxication levels at least twice a month by history. A standard ethanol dose (females, 0.43 g/kg; males, 0.51 g/kg) was administered over 10 min, after a 4-hr fast, and breath alcohol concentrations (BrACs) were measured for 2 hr. Intersubject variability in BrACs was greatest early in the study, during ethanol absorption; the coefficient of variation decreased from 39% at 14 min to 14% at 125 min after the start of drinking. The time to peak BrAC varied from 10 to 91 min after the start of drinking (mean 39.6 min). Mean BrACs were significantly lower in females than males; mean peak BrACs were 0.054 g/210 liters in females and 0.058 g/210 liters in males (p = 0.031). The beta- and r-values for both genders were higher than those typically used in ethanol dose calculation formulas. Data are discussed to direct future research. The constants used in Widmark's formula need to be revised differentially for males and females in this population to reach specific target BrACs. Furthermore, substantial variability in absorption rates must be accounted for when assessing rising versus falling limb BrAC phenomena.
Article
1. Twelve healthy men drank 0.80 g ethanol kg-1 body weight on four occasions spread over several weeks. Ethanol was given as 96% v/v solvent which was diluted with orange juice to make a cocktail (20-25% v/v). This drink was ingested in exactly 30 min at 08.00 h after an overnight (10 h) fast. 2. Samples of venous blood were obtained at exactly timed intervals of 0, 10, 20, 30, 45, 60, 90, 120, 150, 180, 240, 300, and 360 min after the start of drinking. The concentrations of ethanol in whole blood were determined by headspace gas chromatography. 3. Summary measures were used to evaluate the concentration-time profiles of ethanol for each subject. The between-subject and within-subject components of variation for the pharmacokinetics of ethanol were derived by one-way analysis of variance (ANOVA). 4. The variation between different subjects dominated the total variance for all of the pharmacokinetic parameters studied except the rate of disappearance of ethanol from blood (ko). For this latter parameter, 42% and 58% of the total variation arose from variations between- and within-subjects respectively. These results might be important to consider when experiments on the clinical pharmacokinetics of ethanol are being planned.
Article
All chemicals that are not normal constituents of human milk should be considered undesirable contaminants. In the present review, the following substances detected in human milk are considered: persistent organochlorine pesticides; polychlorinated biphenyls (PCB); polychlorinated dibenzodioxins (PCDD) and dibenzofurans (PCDF); polybrominated compounds; polycyclic aromatic hydrocarbons (PAH); trace elements; mycotoxins; nitrate, nitrite, nitrosamines; nicotine, caffeine, ethanol; and drugs. The levels of most of these substances found in human milk were within a range that would not constitute health hazards for breast-fed infants. For many of these, there is a comfortable safety margin. This applies also to organochlorine pesticides and PCB, particularly since, as a result of their discontinued use, the levels of these compounds have clearly declined in recent years. On the other hand, the aflatoxin burden mediated through breast milk, at least in certain tropical countries, appears to pose a definite health hazard. Detailed reference are given on the contamination of human milk with PCDD/PCDF which has to be considered as a matter of concern from the viewpoint of preventive public health. Although the low PCDD/PCDF levels found in the adipose tissue of infants indicate that there is no appreciable health risk emanating from these substances for breast-fed infants, appropriate measures to reduce the current rate of their emission into the environment have to be taken.
Article
Experimental studies in rats have demonstrated that lactating females have blood ethanol levels five times lower than those observed in non-lactating rats. The purpose of the present study was to verify if this phenomenon also occurs in human beings. Five lactating (L) and five control (C) women received, after formal agreement to the experimental procedure, 0.4 g/kg of ethanol as vodka (Stolichnaya, USSR), between 9:00 and 10:15 a.m. Blood and milk samples were collected 10, 20, 40, 60, 90, 150 and 180 min after ethanol ingestion. Ethanol levels in blood and milk were measured by gas chromatography using the head space technique. Results indicated that: time to reach maximal blood levels was significantly longer in the L group (L: 48.0 +/- 10.9, C: 31.2 +/- 16.4 min, means +/- SD), area under the curve was smaller when group L was compared to group C (L: 3821.5 +/- 1240.5, C: 5154.8 +/- 1313.7 mg% x min, means +/- SD), ethanol blood levels (mg/dl) at 150 and 180 min were significantly lower in the L group (150: L, 10.5 +/- 5.6; C, 18.7 +/- 6.8; 180: L, 3.9 +/- 2.8; C, 13.2 +/- 6.4, means +/- SD). Concentration of ethanol in milk was similar to concentration in blood. These results indicate the importance of lactation for ethanol pharmacokinetics and raise questions about the pharmacokinetics of other drugs ingested by lactating women.
Article
To assess the extent and site of the first-pass metabolism of ethanol and to examine whether first-pass metabolism and disposition of ethanol are dependent on gender. After a standardized lunch, healthy subjects (six women and six men) received on two separate occasions a 60-minute intravenous infusion of ethanol (0.3 gm/kg) and concomitantly an equimolar dose of d3-ethanol/kg either orally (over 20 minutes) or intraduodenally (infused over 30 minutes). Blood levels, urinary excretion of d0- and d3-ethanol, and sedative effects were monitored for 6 hours. Disposition and first-pass metabolism of ethanol were evaluated by applying an open two-compartment model with Michaelis-Menten elimination. Comparison of the corresponding intravenous/oral versus intravenous/intraduodenal data of each individual revealed that total first-pass metabolism (gastric plus hepatic) was not pronounced in either males (9.1% +/- 4.0%; mean +/- SD) or females (8.4% +/- 3.1%) and that this first-pass metabolism was partly of gastric origin. Dose-corrected values for area under blood concentration-time curve were on average 28% higher (p < 0.0001) in the women than in the men. Mean total blood ethanol disappearance rate was higher (p < 0.001) in women (3.92 +/- 0.40 mmol/L . hr) than in men (3.19 +/- 0.48 mmol/L . hr). Renal clearance was gender-independent and negligible. A linear relationship (p < 0.001) could be found between the blood levels of ethanol and sedation index. Because the slope was steeper in women (1.04) than in men (0.42) a higher central nervous system sensitivity to the sedative effects of ethanol in women can be assumed. Under realistic life conditions (social drinking of moderate doses of ethanol after a light lunch) only a minor, gender-independent first-pass metabolism is observed that is partly of gastric origin.
Article
To explore worries of postpartum mothers who participate in Tso-Yueh-Tzu. Primiparas (N = 21) with a mean age of 30 years, a mean educational level of 15 years. Seventeen (81%) were working. The mean number of postpartum days was 14. Focus groups, each group session lasted approximately 2 hours and was audiotaped. Four themes regarding worries emerged: searching process to integrate the self into the rituals of Tso-Yueh-Tzu, understanding that the newborn's care influences evaluation of the self as a "good mother," decision-making process of the self to arrange the best baby care for a career women, and reconciling the need for self-fulfillment with the demand to be a "family-mother." Nurses can help a mother work through her worries. Although the women expressed their worries in different content, all focused on the need for "the integration of the self" while they went through Tso-Yueh-Tzu.
Article
An ethnographic approach was used to explore the cultural practices of Hong Kong Chinese women during the postpartum period. Seven multiparous women were interviewed and asked to reflect on their self-care practices within the family home during the month after the birth of their first child. Content analysis was applied to the interviews and major categories identified: good food and bad blood, poisonous sex, dirt and prohibitions, rest and appeasing the placenta god, and competing loyalties. The indication is that these Chinese mothers had attempted to follow their personally constructed interpretations of traditional customary practices, being influenced by close family members, neighbors, and historical precedent. These women further outlined a number of personal variations to traditional practices in the face of increasingly Western influences. We provide insights into the complexity of issues modern Hong Kong Chinese women face in the first postpartum month and on a more global level highlight the importance of culturally sensitive and congruent nursing practice.
Article
To examine how Chinese women experience postnatal care in a Scottish setting, their beliefs, needs and experience, and why any differences exist. The aim is to bring the knowledge forward and to improve these women's childbearing experience. a qualitative comparative approach. maternity units in Scotland. ten Chinese and ten Scottish women, ten health workers, five relatives, five Chinese women's friends, and five Scottish women's friends, plus two groups discussions of four and six Chinese discussants, and one group discussion with four Scottish mothers and a health worker. four stage semi-structured interviews with the two comparison groups of ten Chinese and ten Scottish women, and non-structured interviews/talks/discussions with ten health workers, ten women, five relatives and ten friends. zuo yuezi is a popular integrated set of postnatal practices for Chinese mothers, not only in China, but also in Scotland, in their convalescence after giving birth. This traditional postnatal behaviour is embedded in culture. It is used to facilitate the physical recovery of the mothers, to prevent chronic illness, and also to strengthen their intra-family relationships. zuo yuezi serves as a physical convalescence, a preventative measure, a social sanction to rest, a consolation, and a prompt for Chinese women to concentrate on their baby and their role of breast feeding, as well as an occasion to strengthen the intra-family tie, especially between the woman and her own mother or mother-in-law. This practice has a direct bearing upon the psychological well-being of Chinese women postnatally and in their future life. This suggests that these puerperal practices and the custom deserve the cognitive recognition of midwives, so that they can be aware of and respect the indigenous beliefs and practices that link the events of childbearing, the health status of women, and family relationships in order to provide better maternity care for this group of women.
Article
To investigate whether the relative amounts of fat, carbohydrate (CHO), or protein in a meal influence the pharmacokinetics of a small dose of ethanol. Nine healthy men received ethanol (0.30 g kg-1 body weight) on five occasions in a randomized cross-over fashion. On three occasions the dose of ethanol was consumed within 15 min of eating a standardized breakfast of similar volume and calorific value but containing different amounts of fat, CHO, and protein. On two other occasions the same dose of ethanol was ingested on an empty stomach (overnight fast) or administered by intravenous (i.v.) infusion over 30 min. The blood-ethanol profiles showed large inter and intraindividual variations, especially when ethanol was ingested after eating food. The peak blood-alcohol concentrations (BAC) were 16.6 +/- 4.0, 17.7 +/- 7.1, and 13.3 +/- 4.0 mg dl-1 (mean +/- s.d.) after fat, CHO, and protein-rich meals and 30.8 +/- 4.3 and 54.3 +/- 6.4 mg dl-1 after fasting and i.v. infusion, respectively. The corresponding areas under the concentration-time profiles (AUC) were 1767 +/ -549, 1619 +/- 760 1270 +/- 406 mg dl-1 min after fat, CHO, and protein-rich meals compared with 3210 +/- 527 and 4786 +/- 446 mg dl-1 min after fasting and i.v. infusion, respectively. The time required to eliminate ethanol from the blood was shortened by 1-2 h in the fed-state. Drinking ethanol after eating a meal, regardless of the nutritional composition, decreases the systemic availability of ethanol. Because gastric emptying is slow and more prolonged with food in the stomach, the delivery of ethanol to the duodenum and the liver will be highly variable as will the hepatic clearance of ethanol. Provided that portal venous BAC remains fairly low and ethanol metabolizing enzymes are not fully saturated then part of the dose of ethanol can be cleared by hepatic first-pass metabolism (FPM), as one consequence of Michaelis-Menten elimination kinetics.
Article
Previous animal models testing infantile reactivity to ethanol (EtOH) in maternal milk used EtOH doses that vastly exceeded levels actually encountered in a mildly or moderately intoxicated dam. The present study assessed whether 12- and 16-day-old rats are capable of detecting EtOH in milk at levels actually recorded in an intoxicated dam. Experiment 1 determined representative levels of EtOH in maternal milk as a function of maternal intragastric administration of EtOH (0.5-3.0 g/kg). Experiment 2A assessed generalization of conditioned taste aversions accrued with a high level of EtOH (6%) in either water or milk vehicles towards lower, more representative EtOH levels obtained from Experiment 1. With body weight gain as the dependent measure, conditioned aversions to milk were evident with the milk vehicle, but there was no detection of EtOH at any level at either age. Detection of the high level of EtOH (6%) in milk, however, was observed by 16 day olds within an habituation paradigm (Exp. 2b) via cardiac and behavioral (locomotion, mouthing) indexes. In Experiment 3 application of Experiment 2's more sensitive, behavioral index to assess generalization of the conditioned taste aversions revealed detection of a lower, more representative concentration of EtOH (175 mg%) in milk in 16-day-old rats. Overall the results show that the unweaned rat is capable of detecting very low concentrations of EtOH in milk and can modify their behavior accordingly. The expression of this capability is not, however, homogeneous across different response indexes. In conjunction with prior research it is clear that the infant rat's perception of EtOH in milk, including the very low levels of EtOH found in maternal milk during mild or moderate intoxication, is a relevant experience for generating new responses towards EtOH.
Article
Previous research demonstrated that breast-feeding infants consumed significantly less milk during the immediate hours after their mothers consumed an acute dose of alcohol when compared with a nonalcoholic beverage. The present study tested the hypothesis that maternal alcohol consumption decreases the amount of milk available to the infant and alters milk composition in the short term. To this aim, 22 lactating women were tested on 2 days separated by 1 week; the women reported that they drank very little during pregnancy, but significantly increased alcohol intake during lactation. Each woman drank a 0.3 g/kg dose of alcohol in orange juice on one testing day and orange juice alone on the other; the order was counterbalanced. Immediately before drinking the beverage (baseline) and 2 hr after (postconsumption), women expressed their milk by using an electric breast pump until no milk had been secreted from either breast for 5 min. Although there was no difference in the energy content of the milk, maternal alcohol consumption slightly, but significantly, reduced the amount of milk produced by the lactating mother. These findings underscore the importance of determining whether and when infants compensate for the reductions in intake experienced at the breast following maternal alcohol consumption and how such changes impact on mother-infant interaction.