Nutrition During Pregnancy and Lactation Exploring New Evidence: Proceedings of a Workshop (2020) / Chapter Skim
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7 Maternal Intakes and Nutritional Status During Lactation and the Implications for Maternal and Infant Health
7 Maternal Intakes and Nutritional Status During Lactation and the Implications for Maternal and Infant Health
Pages 87-106
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From page 87... ...
In her review of current evidence on the relationship between maternal nutrient status, maternal intake, and human milk composition, Allen discussed the analysis of human milk micronutrient composition, updated 87
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From page 88... ...
. • A number of research gaps remain regarding relationships between maternal metabolic status and breast milk composition and merit further exploration (Demerath)
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From page 89... ...
For instance, human milk concentrations of folate, calcium, iron, copper, and zinc do not change with maternal supplementation. By contrast, human milk concentrations of the fat-soluble vitamins, thiamin, riboflavin, vitamin B6, vitamin B12, choline, iodine, and selenium are affected by maternal status and are the nutrients that have the most implications for public health interventions, noted Allen.
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From page 90... ...
In several countries, particularly low-income countries, breast milk vitamin B6 concentrations are below 0.13 mg/L, the value used to establish the infant AIs. One small study, conducted in lactating women from Davis, California, who were not taking supplements during lactation, found an average vitamin B6 concentrations of 0.3 mg/L.
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From page 91... ...
Across longitudinal studies iodine concentrations in breast milk are variable, but generally there is a marked decrease in iodine content during the first month of lactation. The only longitudinal study assessing the iodine content of breast milk in the United States was conducted in 31 Mexican American women and found concentrations below the values used to establish the iodine AIs for infants.
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From page 92... ...
Allen suggested the dose atters, and smaller repeated exposures during lactation, rather than a m single one-a-day supplement appear to be more effective. Despite the link with maternal dietary patterns, Allen stated that current intake is not the main influence on breast milk vitamin B12 concentrations.
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From page 93... ...
THE IMPLICATIONS OF MATERNAL WEIGHT AND METABOLIC STATUS FOR LACTATION AND BREAST MILK COMPOSITION Ellen Demerath, professor of epidemiology and community health at the University of Minnesota School of Public Health, opened her remarks by emphasizing that the weight and metabolic status of the population has significantly changed over the past 30 years. When Nutrition During Lactation was published in the early 1990s, the prevalence of obesity among adults was 11.4 percent and the prevalence of gestational diabetes was 2 percent (IOM, 1991)
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From page 94... ...
Study and HAPO Follow-Up Study provided critical insight into the influence of gestational diabetes. Compared to women who did not develop gestational diabetes, those who did had higher rates of Cesarean section, offspring who were large for gestational age, preterm infants, preeclampsia, maternal prediabetes, maternal type 2 diabetes, and offspring diabetes (Hod et al., 2019)
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From page 95... ...
. Demerath emphasized that breastfeeding has important maternal and child health benefits, as compared to formula feeding, and that changes to maternal metabolic status as a result of lactation have biological underpinnings.
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In contrast, IFPS II did not find shortened breastfeeding durations among women who self-reported they had gestational diabetes (Wallenborn et al., 2017)
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Evidence is less robust linking maternal metabolic status to breast milk micronutrient composition. Carotenoid and vitamin D concentrations have been reported to be lower in the breast milk of women with obesity ( anagos et al., 2016)
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Concentrations of ghrelin in breast milk appear to be lower among women with gestational diabetes or preexisting diabetes, but this relationship is not seen in mature breast milk (Aydin et al., 2007)
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In addition, Gunderson discussed the study designs and key findings from the Coronary Artery Risk Development in Young Adults (CARDIA) Study and SWIFT, and offered her reflections on the importance of this emerging evidence base.
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Women who had gestational diabetes are at increased risk for type 2 diabetes, with a substantial portion of conversion occurring in the first few years postpartum (Bellamy et al., 2009)
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The prospective and longitudinal measures of the antecedent metabolic risk factors are crucial for any causal inferences, because it is important to establish that women who breastfed or did not breastfeed, or who differed in lactation duration, had equivalency of maternal metabolism or obesity before lactation to address potential confounding, explained Gunderson. CARDIA Gunderson highlighted some of the key study design elements that set CARDIA apart from other epidemiological studies that have explored the relationship between lactation and long-term chronic disease risk.
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From page 102... ...
Women who had gestational diabetes were at higher risk of developing diabetes during the 30 years, but they showed a similar decrease in relative risk with longer breastfeeding duration. Based on multivariate models that accounted for numerous covariates, including preconception metabolic risk factors,2 there remained strong inverse, graded associations between lactation duration and diabetes risk.
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From page 103... ...
There were strong, graded inverse relationships for lactation measures and the 2-year and 30-year incidence of diabetes in women who did and did not have gestational diabetes. This inverse relationship was seen after controlling for antecedent biochemical and clinical risk factors prior to lactation, psychosocial factors, sociodemographic risk factors, and lifestyle behaviors.
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DISCUSSION Allen, Demerath, and Gunderson responded to audience questions. In the discussion, moderated by O'Connor, questions were raised related to lactational programming, studying breast milk composition, and factors affecting lactation success.
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From a clinical perspective, Demerath agreed that there is too much focus on weight during pregnancy and postpartum, but she noted that weight gain outside of the current guidelines could have deleterious effects on birth outcomes and child health. She suggested that each individual's context should be considered.
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From page 106... ...
Demerath added that a Canadian study reported differences with respect to the microbiome, but echoed Gunderson's sentiment that this is an area that is understudied.
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