Effect of maternal nutritional status and infant supplementation during lactation on postpartum amenorrhea

Hunger, Health, and Society

Our theoretical and empirical analysis leads us to suggest some propositions that we present here by way of a summary.

1. Food aid is more nutritionally cost-effective than money aid whenever the a value of the commodity is greater than unity. This would be the case whenever the value of the commodity to the recipient exceeds its cost to the aid providing agency. We cited several reasons why this could occur, with illustrations of actual cases. 2. We do not know whether food aid is more or less cost-effective than money aid if the a value is less than unity. The marginal propensity to spend on better nutrition may be higher for food aid than for money aid. If such differences do not exist, or if they could be eliminated with nutrition education, nutritional cost-effectiveness could be enhanced by turning into cash commodities that have an a value of less than unity. 3. For foods that are found in the diets of the recipients in excess of the amounts supplied through the supplementary food aid package, the relative nutritional cost-effectiveness of commodities is always in direct proportion to their a values. 4. The precise nutritional impact of any commodity depends on the marginal propensity of the recipients to allocate additional income (conveyed through the food aid) to improving their nutritional status. If the recipients response is judged to be unsatisfactory with respect to energy (calorie) cost-effectiveness, the only possible remedy is to provide nutrition education. The cost-effectiveness of food aid in terms of protein or any other specific nutrient might also be increased by supplying a suitable commodity (such as a fortified food) that will be consumed in lieu of another commodity in the current diet. In this case, there is likely to be a trade-off of, perhaps, more protein for less energy as a consequence of selecting the commodity with the lower a value. This is sensible only if protein content is judged to be more deficient than the energy content in the recipients’ diets. 5. Selection of commodities on the basis of the or value criterion is particularly important when the intent of the programme is to improve nutrition indirectly through providing the beneficiaries with an incentive to participate in nutrition education or work programmes. 6. Substitution of the new commodity selection criteria for those currently in use in food aid programmes could bring about a large increase in nutritional cost effectiveness. Moreover, the data requirements are low and could be met at minimal cost.

Mood, Food, and Fertility: Adaptations of the Maternal Brain

Successfully rearing young places multiple demands on the mammalian female. These are met by a wide array of alterations in maternal physiology and behavior that are coordinated with the needs of the developing young, and include adaptations in neuroendocrine systems not directly involved in maternal behavior or lactation. In this article, attenuations in the behavioral and neuroendocrine responses to stressors, the alterations in metabolic pathways facilitating both increased food intake and conservation of energy, and the changes in fertility that occur postpartum are described. The mechanisms underlying these processes as well as the factors that contribute to them and the relative contributions of these stimuli at different times postpartum are also reviewed. The induction and maintenance of the adaptations observed in the postpartum maternal brain are dependent on mother-young interaction and, in most cases, on suckling stimulation and its consequences for the hormonal profile of the mother. The peptide hormone prolactin acting on receptors within the brain makes a major contribution to changes in metabolic pathways, suppression of fertility and the attenuation of the neuroendocrine response to stress during lactation. Oxytocin is also released, both into the circulation and in some hypothalamic nuclei, in response to suckling stimulation and this hormone has been implicated in the decrease in anxiety behavior seen in the early postpartum period. The relative importance of these hormones changes across lactation and it is becoming increasingly clear that many of the adaptations to motherhood reviewed here reflect the outcome of multiple influences. © 2016 American Physiological Society. Compr Physiol 6:1493-1518, 2016.

Loss of body fat and associated decrease in leptin in early lactation are related to shorter duration of postpartum anovulation in healthy US women

BACKGROUND

The mechanisms regulating postpartum anovulation (PPA) are not well understood, although poor nutritional status and "intense" breastfeeding behaviors are associated with longer durations.

OBJECTIVES

This study was designed primarily to investigate the hypothesis that higher body fat and leptin concentrations are related to shorter PPA in healthy, lactating US women. Nutrient intake, breastfeeding behaviors, prolactin, and insulin levels were also evaluated.

METHODS

Fasting serum was collected during the third trimester of pregnancy, at 2 and 4 weeks postpartum, and every 4 weeks until the occurrence of the first postpartum menses. Body composition and breastfeeding behaviors were assessed at the same times postpartum. Women (n = 13) were categorized based on initial percentage body fat and timing of first postpartum menses.

RESULTS

There were no consistent relationships between body composition, leptin, or breastfeeding behaviors and duration of PPA. However, there was an interaction (P = .005) between ovulation group and time on adiposity; earlier ovulating women had less percentage body fat in early lactation than did later ovulating women. There was also an interaction (P = .1) between ovulation group and time postpartum on leptin, such that leptin concentrations tended to be greater in later than earlier ovulating groups beginning at 12 weeks postpartum.

CONCLUSION

In summary, although baseline percentage body fat and leptin were not related to duration of PPA, fertility returned earlier in women who lost greater percentage body fat during the early postpartum period.

Maternal supplementation differentially affects the mother and newborn

Although studying the effect of supplementation on maternal health or the outcome of pregnancy was not a primary goal of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study, many important findings in these areas were produced. As part of the study, a food supplementation program was implemented. Two villages received Atole, a gruel containing protein and energy, and 2 matched villages received a refreshing, low-energy drink containing no protein. Both drinks contained micronutrients. Some women did not choose to consume the supplements and those who did consumed widely varying amounts. More volume of Fresco was consumed than Atole. The energy in the supplements improved birthweight, with no apparent additional benefit from protein or micronutrients. Researchers identified several groups of women who benefited from supplementation more than others by having babies with higher birthweights, including those with poorer current nutritional status and those who consumed high amounts of the supplement continuously from one pregnancy to the next. Results from the study provided an early indication that supplementation might increase the duration of gestation and, thus, reduce preterm birth. On the other hand, maternal supplementation did not substantially alter the duration of postpartum amenorrhea once concurrent infant supplementation was taken into account. Finally, findings from this study provided evidence of a biological trade-off between maintenance of maternal nutritional status and increasing fetal size that was responsive to both current maternal nutritional status and supplement intake but not to the mother's nutritional status earlier in life.

Maternal nutritional status is inversely associated with lactational amenorrhea in Sub-Saharan Africa: results from demographic and health surveys II and III

Breast-feeding is positively associated with the duration of postpartum amenorrhea; thus it is a major determinant of fertility in countries where effective contraceptive methods are not widely available. The objective of these analyses was to examine the association between maternal nutritional status and lactational amenorrhea (LA) among breast-feeding women. Women who were not pregnant, who were breast-feeding, who were not using hormonal contraceptives and who had a child </=2 y old at the time of survey were included in the analyses. Multivariate logistic regression was used to examine this association with the use of Demographic and Health Surveys data collected in seven Sub-Saharan African countries between 1990 and 1994. Analyses were adjusted for nine confounders, including breast-feeding behavior, child nutritional status and child age. Within-country analyses consistently showed the trend of low maternal body mass index (BMI) associated with a higher likelihood of being amenorrheic. Pooled analyses (n = 9839) were performed using two child age groups (<9 mo and 9-24 mo). The <9 mo pooled analysis showed that women with BMI < 18.5 kg/m2 (odds ratio; 95% confidence interval: 1.6; 1.2-2.3) were more likely to remain amenorrheic at the time of the survey than their "better-nourished" counterparts. The 9-24 mo pooled analysis showed that the differential probability of being amenorrheic between undernourished and "better-nourished" women increased with time postpartum, where the adjusted difference in the median duration of amenorrhea associated with maternal nutritional status among breast-feeding women was 1.4 mo. These results suggest that maternal nutritional status plays an independent role in the return of ovulation after delivery.

Correlation between subsequent lengths of postpartum amenorrhoea in a prospective study of breast-feeding women in rural Bangladesh

The relationship between subsequent lengths of lactational amenorrhoea for individual women in a prospective study of breast-feeding women in Bangladesh was studied. The data indicate that previous length of amenorrhoea has significant predictive value for the subsequent length of amenorrhoea. Information on previous experience with lactational amenorrhoea should be therefore incorporated into guidelines for the introduction of family planning during lactation.

Fertility-related changes in maternal body composition among the Au of Papua New Guinea

Evolutionary theory predicts that organisms make trade-offs between their somatic and reproductive energy budgets. Thus every round of reproduction should result in a concomitant decline in the parents' total energy reserves. Among humans this prediction was corroborated more than 25 years ago when fertility-related nutritional depletion was reported among mothers in the Highlands of New Guinea (Jelliffe and Maddocks, 1964). More recently, however, a number of studies of fertility and maternal nutritional status in both developed and developing nations have reported fertility-related increases in various indices of adiposity and lean body mass. Such findings have called the so-called "maternal depletion syndrome" into question, and have raised serious doubts as to whether the phenomenon is widely generalizable to all populations. In light of this recent controversy, data are presented here on fertility-related changes in maternal adiposity and lean body mass among the Au, a lowland forager-horticulturalist population in Papua New Guinea. While both a short-term decline in adiposity following childbirth, and a long-term fertility-related decline are seen among more traditional Au, individuals with a regular source of wage-income show only the former. There are no significant changes in lean body mass with increasing fertility in either group. The finding of significant socioeconomic variation in the capacity to withstand the stress of repeated reproduction even within this one extremely rural area of Papua New Guinea may lend insight into why previous studies have been unable to find evidence of maternal depletion. The fertility-related decline in adiposity that is reported for the more traditional Au is consistent with the predictions of evolutionary theory.

Birth-interval dynamics in rural Bangladesh and maternal weight

This article reports on the results of a study conducted in rural Bangladesh on the influence of maternal weight on the components of birth intervals, including gestation and intrauterine mortality, the duration of postpartum amenorrhea, and the duration of waiting time to conception (the menstrual interval). When biological factors (in-cluding maternal age, parity, and supplementation practices) and behavioral variables, including religion, education, and occupation, were controlled, maternal weight was found to be related to the risk of intrauterine mortality and to the probability of resuming menses in the postpartum period. The implications of these findings for policies and programs in developing countries are discussed.

Reproductive patterns and child mortality in guatemala

In this paper, we investigate the association of child mortality with maternal age, parity, birth spacing, and socioeconomic status, in a sample of Guatemalan children who were included in a public health intervention program. Our results indicate that maternal age, birth order, and the length of the previous and following birth intervals all have a significant impact on the risk of child mortality and that these associations cannot be accounted for by differences in breastfeeding, socioeconomic status, or the survival status of the previous child.

Maternal and child nutritional status: its association with the risk of pregnancy

Breastfeeding reduces the interval between births by its effect on prolonging the period of postpartum anovulation and in some cases, reducing the likelihood of conception once ovulation has occurred. Extended durations of postpartum amenorrhea (18 months and longer) are observed among many women in developing countries, while shorter durations (6 months or less) are common among women in developed countries. This differential effect has been suggested to be related to maternal nutritional status, but numerous other factors also differ. This paper reviews the literature in this area, and suggests that most studies indicate a small and demographically insignificant effect of maternal nutritional status on the period of postpartum amenorrhea. Factors associated with suckling patterns appear to be more important in determining the length of postpartum infertility. Suckling frequency and intensity which affects the hormonal stimulus preventing ovulation appear to be affected by the type of and how supplemental feeding is given to the child (use of bottles), whether suckling is on demand or scheduled, the frequency of night-time feedings (influenced by whether or not the mother sleeps with the child), whether or not pacifiers are used, and the child's nutritional and health status.