Lecture 9 – Lactation

 Benefits of breastfeeding?
 Challenges to breast feeding today?
*All infants for the first 6 months of life need breast milk

Interesting Facts
 Composition of human milk can change over a single feeding, over a
day and according to the age of the infant
 The flavor of human milk changes –depends on moms diet
o Fetus also exposed to different flavors – amniotic fluid

Current breast-feeding rates

 2020 Goal - 82%
 Current 2015 - 79%
 1 year still breastfeeding current - 27%

#1 reason moms stop- is the worry/concern that the infant isn’t getting
enough breast milk.

Breast – Anatomy - Key Terms

Mammary gland- source of milk for the offspring. AKA breast

Alveoli- Rounded or oblong shaped cavity present in breast (contain cells that produce
milk)

Secretory cells- Cells in alveoli that are responsible for secreting milk components into
ducts.

Myoepithelial cells- Line the alveoli and can contract to cause milk to be secreted into
ducts

Lactiferous sinuses- Larger ducts for storage of milk behind the nipple

Lactogenesis- Term for human milk production. (production of milk)

 Breast Development - Stages of breast development
1) in utero
- Begins in week 6 of embryogenesis
- Continues throughout gestation
- At birth, full formed with 15 – 25 lactiferous ducts

2) Adolescence
 Ductal growth throughout adolescence due to estrogen

 Alveolar lobes (mammary glands) after 1.5 years of menstruation

Lactogenesis

Preparation During Pregnancy:

Early to mid-pregnancy
 ductular sprouting, branching and lobular formation (placental
hormones)
 Colostrum –produced by 3rd trimester
Post-partum:
 Colostrum – produced first few days
 Milk production initiated due to prolactin production, and
decreased estrogen and progesterone after delivery of the
placenta
 Stimulation by infant sucking required to maintain milk
production

Stages of Lactogenesis
 Stage I – milk begins to form, lactose and protein content increases, first
few post-partum days, suckling not required

 Stage II – 2-5 days postpartum,  blood flow to alveoli, large in milk

production, first 10 days postpartum, suckling not required

 Stage III – Maintenance of milk supply, day 10 onwards, suckling required

 Central Role of Prolactin and Oxytocin
1. *Prolactin- stimulates milk production (stimulates milk production)
 Suckling stimulates prolactin secretion
 Secreted from anterior pituitary

2. *Oxytocin (release of that milk)

 Ejects milk form the alveoli into milk ducts (let-down)
 Stimulated by suckling develops into a conditioned response
 Also acts on uterus and blood vessels
 Secreted from posterior

Secretion of Milk – Pathways

 Some components of milk made by secretory cells and secreted into

the ducts (lactose)

 Water, sodium, potassium and chloride pass through aveolar cell

membranes

 Milk fat comes from triglycerides in mom’s blood and fatty acids made
in the breast

Composition of Milk

Milk is a solution of proteins, sugars, salts and fats

 100 gram of human milk (65 cal)
 1g of protein (6% of calories)
 7.2 g of lactose (44%)
 3.6 g fat (50%) –breast milk high in fat
*remember the grams not percentages
 Composition of Milk
-Colostrum
 Thick, yellow, fluid
 Produced days 1-3 after birth
 High concentrations of white blood cells from mom (provides immune
protection)
 Fist milk secreted during the first few days postpartum

Proteins
Caseins – Main protein in mature milk, helps calcium absorption

Enzymes
 Amylase – poly saccharide digestion
 Protease - protein
 Lipases – emulsifies milkfat, breaks down triglycerides to free fatty acids
and glycerol
- Also hormones and growth factors
- Low protein content – good for immature kidneys

Water-soluble vitamins
Responsive to the content of maternal diet
 Thiamin, Riboflavin
 Niacin
 Pantothenic acid
 Biotin, Folate
 B6, B12-Vegan moms (supplementation would be useful)
 Vitamin C

Cells
Raw breast milk contains cells which
Enhance resistance to infection by:
 Anti-bacterial action
 Production of antibodies
 Secretion of antibacterial products

Cells
 T and B lymphocytes (Only found in Human Milk)
 Protect against organisms in the GI tract
 B lymphocytes produce immunoglobulins
o Block the colonization of pathogens
o Limit the # of antigens that cross the mucosal barrier

*offers protection for the infant

Carbohydrates

Predominate CHO is lactose* important

Disaccharide galactose + glucose

High concentration – 40% of energy

130 different oligosaccharides

 Some known to simulate growth of bacteria and bind harmful bacteria.
(prevent infection and diarrhea)

Lipids (Fat)
*breastmilk is a high fat substance
Average content is low
3.9 g/100 ml (4% weight but 50% of energy)
 Higher in hindmilk than foremilk (rich in lactose)

Essential Fatty Acids must be derived from maternal diet

 Can be stored, but initially derived from diet
 Stored in adipose tissue and can be secreted into breast milk.
 EFA linoleic 18:2n-6 (omega 6)
linolenic 18:3n-3 (omega 3)

Essential Fatty Acids

 Humans have the capacity to synthesize longer chain (EPA and DHA) omega 3
fatty acids when they consume the precursor (the essential fatty acid alpha-
linolenic acid.

 Dietary sources can supply DHA

DHA (Docosahexaenioic Acid) – Omega 3 Fatty Acid

 Sources of DHA – Fish
 Flaxseed oil – rich in alpha linolenic acid (precursor to DHA)
 Important for brain and retina development in the infant
 DHA Added to some formula. Fat content*