Breastfeeding a small for gestational age infant, complicated by maternal gestational diabetes: a case report

Abstract

Background Small for gestational age (SGA) infants are those born small for their gestational age, with weight below the 10th percentile. Not only do SGA infants suffer growth issues after birth, they have elevated risk for the development of metabolic and cardiovascular diseases later in life. Current research has suggested that in cases of SGA infants, maternal milk and breastfeeding are not affected. Case summary The mother of an SGA infant was diagnosed with placental insufficiency and Gestational Diabetes Mellitus (GDM) during her pregnancy. The infant was born term, at 38 weeks 3 days, and SGA. The mother had a low milk supply and her milk composition differed from reference values such that the daily infant intake provided less than 50% of the required energy intake at 3 months. Conclusion In cases of SGA and/or GDM, maternal milk quality and quantity may be compromised. This requires follow-up in order to reduce the disease risk for SGA infants and the corresponding public health implications.

Sampling Procedures for Estimating the Infant Intake of Human Milk Leptin, Adiponectin, Insulin, Glucose, and Total Lipid

“…While we provide a future direction for the design of HM studies in terms of sampling and estimating infant HM component intakes, these results cannot be generalized to be used in some populations, due to the substantial differences in milk intake between infants (Figure 1), particularly in those of women with low milk supply. The results from the case study by George et al [48] highlight that there is a possibility of overestimation of intake of HM components such as total lipid, protein, and lactose concerning for infant health outcomes. Therefore, the estimation protocols presented in this study might not be an appropriate replacement for the objective HM components intake measurement.…”

“…Previous studies have emphasised the variability in HM total lipid intake (mainly due to its concentration variability throughout 24 h [12]), and the importance of more frequent sampling for accurate assessment of infant lipid intake over a 24 h period to understand its potential impact on infant growth and development [23,48,49]. George et al demonstrated that an exclusively breastfed infant who was born small-for-gestational age had slow weight gain, despite the mother having a total HM lipid concentration within the reference range [48]. This reduced weight gain was attributed to the low 24 h milk intake, such that the infant's calculated 24 h total lipid intake was below the reference range, thus contributing to low energy intake which resulted in poor infant growth.…”

Human Milk Sampling Protocols Affect Estimation of Infant Lipid Intake

“…We have previously demonstrated the impact of this finding in a case study of a breastfed infant who was small for gestational age, where the HM lipid concentrations were within normal range but the volume intake was well below average (419 mL/d). If 800 mL was assumed to be the daily intake volume, the lipid intake—and therefore the energy intake—would have been grossly overestimated for this infant (estimated 41.3 g/d vs. true 21.6 g/d) and not identified as the primary reason for the infant's poor growth ( 15 ).…”

Infant factors that impact the ecology of human milk secretion and composition—a report from “Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)” Working Group 3

“…Therefore, the postnatal catch-up growth exhibited by intrauterine growth restricted (IUGR) infants may be related to the volume of human milk intake rather than compositional differences. Yet, other studies have described lower human milk intake and lower fat and protein density in SGA infants demonstrating poor infant growth [ 205 ]. In an animal model of placental insufficiency—often an underlying cause of fetal growth restriction—mammary development appeared similar, but milk nutrient delivery, as measured by calcium transport, appeared reduced [ 206 ].…”