Relationship between serum prolactin, lactation and changes in maternal blood B-cell (CD19+) percents during the first 8 months post-partum

Acupoint-tuina therapy promotes lactation in postpartum women with insufficient milk production who underwent caesarean sections

Breast milk is recognized and strongly recommended by the World Health Organization (WHO) as the optimal feeding for all babies. Breastfeeding is associated with better nutritional and non-nutritional outcomes when compared to formula feeding, and has proven health benefits to both infants and their mothers. This clinical research is to examine the feasibility and efficacy of Acupoint-Tuina therapy in treating postpartum women who underwent C-sections and suffered from insufficient milk production.The patients in the control group received standard medical care, while the patients in the Tuina group received Tuina therapy during the next 48 hours in addition to standard care, given once daily for 2 days. To evaluate the efficacy of Tuina therapy, patients of both groups were assessed for surface temperature of breasts, volume of breasts, volume of breast milk production, serum PRL level, and uterus recovery at various time points.Tuina therapy significantly increased the milk production when compared to the control group, for as much as 13-fold and 10-fold of that in the control group on the third and fourth postpartum days. In addition, Tuina therapy also significantly increased the full breast enlargement and the serum PRL level change, and decreased the breast surface temperature rise. Last but not the least, Tuina therapy also accelerated the post-surgery recovery of uterus.During the early postpartum days, Tuina therapy increases the milk production and promotes other physiological changes supporting lactation for postpartum women with C-section delivery and insufficient breast milk production. The novel intervention is warranted for further investigation and validation.

Milk immunity and reproductive status among Ariaal women of northern Kenya

Abstract Background: The immune factors in human milk protect infants from infection and promote immune development. Evidence suggests that the production of milk-specific immunoproteins is energetically costly, making them a form of maternal investment in offspring health that is subject to life history trade-offs.

AIM

This research tests the relationship between measures of reproductive effort and the production of milk immunoglobulin A (IgA) among Ariaal women, a settled northern Kenyan pastoralist population that experiences nutritional and disease stress.

SUBJECTS AND METHODS

Two hundred and forty-three lactating Ariaal women participated in a questionnaire, anthropometric measurement and milk collection. Milk IgA was analysed using ELISA.

RESULTS

There was a significant U-shaped relationship between post-partum months and milk IgA, reflecting decreasing investment in the current offspring over the early post-partum period and subsequent recovery of maternal energy status near the end. There was also a significant inverse U-shaped relationship between milk IgA and parity, with high parity women showing a drop in milk IgA. In contrast, anthropometric measures of energy status were not associated with the production of milk IgA.

CONCLUSION

This research shows that patterns of reproductive investment can be demonstrated in milk IgA in the absence of measured energy changes.

Immune activation markers in peripartum women in Botswana: association with feeding strategy and maternal morbidity

Hormone levels shift the immune state in HIV-uninfected pregnant and breastfeeding women away from Th₁ responses and toward regulation to permit fetal tolerance. Limited data exist on inflammation during pregnancy or postpartum in HIV-infected women, though certain inflammatory markers are associated with adverse health outcomes among HIV-infected persons.

We measured hsCRP, D-dimer, IFN-γ, IL-6, IL-10 and TNF-α at 34 weeks gestation and six months postpartum in HIV-infected women from the Botswana Mashi PMTCT trial who were randomized to breastfeeding or formula-feeding. Differences in inflammatory markers between gestation and postpartum periods, and by randomized feeding method, were estimated using generalized estimating equations, adjusting for baseline plasma HIV-1 viral load, CD4 count, calendar time, and antiretroviral treatment status. Additionally, we studied the association between marker concentrations at six months postpartum and major adverse clinical events over the following 4.5 years, using case-cohort sampling and adjusted Cox proportional hazards models.

In 86 breastfeeding and 75 formula-feeding women, hsCRP and D-dimer decreased significantly between 34 weeks gestation and six months postpartum, while IFN-γ increased. There was no significant association between inflammatory marker change and randomized feeding method after adjusting for multiple comparisons and removing outliers. In univariate analysis, TNF-α, D-dimer, and IFN-γ concentrations at six months postpartum were significant predictors of subsequent clinical events, and TNF-α remained significant in multivariate analysis (HR = 4.16, p = 0.001).

In young HIV-infected women in Botswana inflammatory marker concentrations did not differ significantly between women who breast- vs. formula-fed. However, postpartum TNF-α level was predictive of subsequent adverse clinical event.

Visfatin is secreted into the breast milk and is correlated with weight changes of the infant after the birth

INTRODUCTION

Visfatin is a recently identified adipokine with numerous metabolic and immunoregulatory properties that has been implicated in the regulation of the white adipose tissue (WAT) and significant changes in visfatin levels were reported during pregnancy. The aim of the study was to investigate dynamics of visfatin levels in maternal serum and human breast milk during a 180-d period after the delivery.

MATERIALS AND METHODS

: Breast milk and venous blood samples were obtained from 24 healthy lactating women with uncomplicated, physiological pregnancy and appropriate-for-gestational age neonates and serum-milk sample duos were collected at the time of birth, at the 1-3, 12-14, 28-30, 88-90 and 178-180 postpartum.

RESULTS

Our study demonstrates that (1) visfatin is abundantly secreted into breast milk in humans, reaching approx. 100× higher concentrations compared to maternal serum; (2) visfatin concentrations in maternal serum show significant variations after the delivery and (3) visfatin concentration in colostrum could be used for prediction of the subsequent weight development (less/more severe weight loss during first 3 days after the birth) of the infant.

DISCUSSION

Our data suggest that visfatin could play an important role in regulation of adiposity of the infant after the birth.

Immunomodulatory effects of the intake of fermented milk with Lactobacillus casei DN114001 in lactating mothers and their children

The healthy action of probiotics is not only due to their nutritional properties and their influence on the gastrointestinal environment, but also to their action on the immune system. The aim of the present study was to determine if 6 weeks of probiotic intake would be able to modulate the immune system in women who had recently delivered and were breast-feeding. The design consisted of a randomised, controlled and double-blind nutritional intervention study with parallel groups with a sample size of 104 women. The main variable is the T helper type 1/T helper type 2 (Th1/Th2) profile determined by measuring interferon-gamma (Th1) and IL-4 (Th2) values in peripheral blood by flow cytometry. The modifications of cytokines were evaluated in maternal milk by cytometric bead array in a flow cytometer and ELISA at three stages of breast-feeding: colostrum, early milk (10 d) and mature milk (45 d). Additionally, the anthropometry and infectious and allergic episodes in the newborn were followed up throughout the first 6 months of life. After the consumption of milk fermented with Lactobacillus casei during the puerperium, we observed a nonsignificant increase in T and B lymphocytes and a significant increase in natural killer cells. A decrease in the pro-inflammatory cytokine TNF-alpha in maternal milk and fewer gastrointestinal disturbances were also observed in the breast-fed child of the mothers who consumed L. casei. The intake of milk fermented with L. casei during the lactation period modestly contributes to the modulation of the mother's immunological response after delivery and decreases the incidence of gastrointestinal episodes in the breast-fed child.

Breastfeeding and Maternal Stress Response and Health

This article reviews findings on the maternal stress and health effects of lactation. Several significant associations have emerged. Compared with not breastfeeding, breastfeeding is associated with increased parasympathetic nervous system modulation, greater vascular stress response, lower perceived stress levels, and fewer depressive symptoms. Breastfeeding exclusively is associated with an attenuated initial sympathetic cardiac nervous system response to some laboratory stressors. Bottle-feeding is associated with increased sympathetic and decreased parasympathetic cardiac control. The act of breastfeeding is associated with decreased neuroendocrine response to stressors and decreased negative mood. Finally, breastfeeding is associated with enhanced physical and mental health compared with non-breastfeeding.

Immune Status of Physically Active Women during Lactation

PURPOSE

The purpose of this study was to provide baseline data on immune status of exercising and sedentary exclusively lactating women. Dietary intake and body composition were also investigated to determine whether they related to immune function.

METHODS

Healthy, exclusively breastfeeding women with a body mass index between 20 and 30 kg x m were studied at 3 months postpartum. Participants in the exercise group (EG; N = 27) exercised aerobically at least 30 min x d, 3x wk, and women in the sedentary group (SG; N = 23) exercised once a week or less during the previous 6 wk. Immune status while at rest was determined by measuring: 1) a complete blood cell count and differential leukocyte count; 2) percentages and absolute counts of peripheral blood T cells (CD3+), cytotoxic T cells (CD3+CD8+), helper T cells (CD3+CD4+), B cells (CD19+), and natural killer cells (CD56+); 3) neutrophil bacterial killing and oxidative burst activity; and 4) in vitro mitogenic responsiveness of lymphocytes. Cardiorespiratory fitness, body composition, and dietary intake were also measured.

RESULTS

Participants in the EG had a significantly higher level of mean predicted cardiorespiratory fitness than women in the SG (39.5 +/- 1.1 vs 32.5 +/- 1.0 mL O2 x min x kg; P < 0.05); however, there were no significant differences in body composition or dietary intake. There were no significant differences in any of the indicators of immune status between groups. In addition, there were no significant relationships between body composition or dietary intake and immune status.

CONCLUSIONS

The results of this study suggest that women may exercise moderately during lactation and increase their fitness level without impairing their immune function.

The Impact of Energy Restriction and Exercise in Lactating Women

Exercise improves cardiovascular fitness, plasma lipids, and insulin response in lactating women. However, exercise alone, without caloric restriction, does not promote weight loss. Once lactation is established, over-weight women may restrict their energy intake by 500 kcal/day to promote a weight loss of 0.5 kg/week without affecting the growth of their infants. Moderate exercise does not affect maternal immune status or levels of sIgA, lactoferrin, and lysozyme in human milk. Further research is needed to determine the effect of exercise and energy restriction on maternal bone health and immune status and composition of human milk.

Hormonal and reproductive risk factors for development of systemic lupus erythematosus: results of a population-based, case-control study

OBJECTIVE

Estrogen and prolactin may accelerate the progression of murine systemic lupus erythematosus (SLE). In humans, 85% of lupus patients are women, which also suggests the importance of hormonal factors in disease pathogenesis. The purpose of this study was to examine hormonal and reproductive risk factors for lupus among women.

METHODS

This population-based, case-control study included 240 female SLE patients diagnosed between January 1, 1995 and July 31, 1999 who fulfilled the American College of Rheumatology classification criteria. Female controls (n = 321) were identified through driver's license records. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) as measures of association, adjusting for age, state, race, and education. Analyses were limited to exposures before diagnosis.

RESULTS

Breast-feeding was associated with a decreased risk of developing SLE (OR 0.6, 95% CI 0.4-0.9), with a statistically significant trend for number of babies breast-fed and total weeks of breast-feeding. There were no associations with number of pregnancies or live births. Natural menopause occurred earlier in women with subsequent development of SLE compared with controls (P < 0.001). There was little association between SLE and current use or duration of use of hormone replacement therapy or oral contraceptives, and no association with previous use of fertility drugs.

CONCLUSION

We found little evidence that estrogen- or prolactin-related exposures are associated with an increased risk of lupus. The reduced risk observed among women who had breast-fed one or more babies should be examined in other studies. Early natural menopause, rather than decreasing risk of SLE because of reduced estrogen exposure, may be a marker of susceptibility to development of SLE.

Mammary candidosis in lactating women

Though perceived to be a growing problem by lactation professionals, fungal infection of the breast (mammary candidosis) is largely unstudied. Candida albicans, a commensal organism encountered frequently in the vagina and gastrointestinal tract of humans, has been reported to be responsible for both superficial (cutaneous) and localized (ductal) infection of the mammary gland in lactating women, though the latter association is not universally accepted. Severe pain is considered to be characteristic of yeast infection of the breast and may be a cause of premature weaning among lactating mothers. Given that pain is often the complaint that prompts mothers to consult lactation professionals, it is important that healthcare providers working with lactating women be knowledgeable about this disease. In this article, current research regarding yeast infection of the breast is summarized, including morphology and pathology, diagnosis, risk factors, and common treatment options.

Maternal blood B-cell (CD19+) percentages and serum immunoglobulin concentrations correlate with breast-feeding behavior and serum prolactin concentration

PROBLEM

Lactating women recover from pregnancy-induced immunosuppression while actively secreting immunologically active agents into milk. Few clinical studies have examined changes in postpartum maternal immune status or explored mechanisms.

METHOD OF STUDY

We measured blood B-cell (CD19+) percentages and serum concentrations of immunoglobulin (Ig) G, IgM, and IgA at 1 to 2 weeks, 1 month, and 2 months postpartum in a longitudinal study of seven healthy, lactating women.

RESULTS

More frequent or extended breast-feeding sessions were correlated with lower CD19+ percentages, reduced serum IgG, and higher serum IgA and IgM concentrations. CD19+ percentages were correlated negatively with serum prolactin concentrations. Blood samples drawn before and 30 min after breast-feeding did not differ in CD19+ percentages or serum Ig concentrations.

CONCLUSIONS

These findings confirm our previous cross-sectional study showing a negative correlation between CD19+ percentages and serum prolactin. Because lactation practices are modifiable, these findings suggest that women can influence the course of lactation-associated immunologic changes.