Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology

Abstract

Lactation is a dynamic process that has evolved to produce a complex biological fluid that provides nutritive and nonnutritive factors to the nursing offspring. It has long been assumed that once lactation is successfully initiated, the primary factor regulating milk production is infant demand. Thus, most interventions have focused on improving breastfeeding education and early lactation support. However, in addition to infant demand, increasing evidence from studies conducted in experimental animal models, production animals, and breastfeeding women suggests that a diverse array of maternal factors may also affect milk production and composition. In this review, we provide an overview of our current understanding of the role of maternal genetics and modifiable factors, such as diet and environmental exposures, on reproductive endocrinology, lactation physiology, and the ability to successfully produce milk. To identify factors that may affect lactation in women, we highlight some information gleaned from studies in experimental animal models and production animals. Finally, we highlight the gaps in current knowledge and provide commentary on future research opportunities aimed at improving lactation outcomes in breastfeeding women to improve the health of mothers and their infants.

Breastfeeding and risk for ceasing in mothers of preterm infants—Long‐term follow‐up

“…It has been hypothesised that SES influences our health through changes in our physiology through different pathways, with mothers of lower SES experiencing poorer health, for example, obesity (Chen & Miller, 2013). Obesity in turn may result in delayed lactogenesis and/or low milk supply (Lee & Kelleher, 2016;Nommsen-Rivers, 2016). Another suggestion is that mothers with a lower SES have less intention and/or self-efficacy to breastfeed as a result of fewer internal and external resources (de Jersey, Mallan, Forster, & Daniels, 2017;Karall et al, 2015).…”

Physiology of milk secretion

“…Maternal nutrition affects both the quantity and quality of milk, which vary among countries, and lactation requires adjustments of maternal metabolism to adapt to the energetic demands of breastfeeding [90]. As the milk production is almost entirely regulated by the infant demand, the maternal metabolism can be increased up to 20% of the metabolic output of the mother.…”

“…Breastfeeding also appears to be protective against sudden infant death syndrome, the risk of diarrhea, respiratory infections, and malocclusion, but does not seem to provide a protection towards either eczema or food allergy [94,95]. Breastfeeding outcomes are also related to mother genotype, phenotype, diet, disease, and lifestyle [90].…”

Calidad fisicoquímica y microbiológica de la leche materna de madres donantes colombianas

“…Los sólidos solubles de las LH se caracterizan por la presencia de lactosa, en este caso se presenta una relación lineal positiva entre los ºBrix y los niveles de lactosa, azúcar que contribuye al metabolismo energético. Es un parámetro con reducida variabilidad que puede alcanzar niveles hasta de 1,0 g dL -1 , dependiendo de la etapa de lactancia y factores genéticos maternos 3,6,9,10 . La lactosa parece ser un nutriente específico para el primer año de vida, su metabolismo es dependiente de la enzima lactasa, la concentración de lactosa es de 6,7 a 7,8 g dL -1 y no varía en los momentos del día 13,14 .…”

“…La LH, es el alimento preferente de lactantes prematuros a causa de su composición previniendo la retinopatía grave prematura, la enterocolitis necrotizante, y la meningitis, contribuyendo al crecimiento y mejora al desarrollo de tejidos y su nivel neurológico 4,5,6 . La inducción metabólica para la generación de LH es concomitante con las fases de lactogénesis y galactopoyesis 7 .…”