Codonopsis lanceolata polysaccharide ameliorates high-fat diet induced-postpartum hypogalactia via stimulating prolactin receptor-mediated Jak2/Stat5 signaling

This study aims to investigate the ameliorative effect of Codonopsis lanceolata polysaccharide (PCL) on mice with hypogalatia induced by a high-fat diet (HFD) and the potential underlying mechanism. We found that oral administration of PCL demonstrated significant benefits in countering the negative effects of HFD, including weight gain, hepatic steatosis, mesenteric adipocyte hypertrophy, and abnormal glucose/lipid metabolism. In addition, PCL improved mammary gland development and enhanced lactogenesis performance. Histologically, PCL ameliorated the retardation of ductal growth, reduced mammary fat pad thickness, improved the incomplete linear encapsulation of luminal epithelium and myoepithelium, and increased the proliferation of mammary epithelial cells. Flow cytometry analysis showed that PCL mitigated the detrimental effects of HFD on mammary gland development by promoting the proliferation and differentiation of mammary epithelial cells. Mechanistic studies revealed that PCL upregulated the levels of prolactin (PRL) and its receptor (PRLR) in the mammary gland, activated JAK2/STAT5 signaling pathway, and increased the expression of p63, ERBB4, and NRG1. Overall, PCL can ameliorate HFD-induced hypogalactia by activating PRLR-mediated JAK2/STAT5 signaling. Our findings offer a methodological and theoretical foundation for investigating the functional constituents of traditional Chinese medicine in the treatment of hypogalactia.

Safety of COVID-19 Vaccination During Pregnancy and Lactation: A VigiBase Analysis

BACKGROUND

There is limited evidence on the safety of coronavirus disease 2019 (COVID-19) vaccination during pregnancy and lactation. Thus, we aimed to evaluate the association between COVID-19 vaccination during pregnancy and lactation and reporting risk of adverse pregnancy or lactation outcomes.

METHODS

Using VigiBase, we performed a disproportionality analysis with case/non case design. Cases were defined based on the Standardized MedDRA Queries (SMQs) of "pregnancy and neonatal topics" and non-cases were defined as all other adverse events. We included all reports with COVID-19 vaccines as the suspected cause. Using the full database as the comparators, reporting odds ratios (RORs) with 95% confidence intervals (CIs) were estimated by logistic regression while adjusting for maternal age. Infants' age and sex were additionally adjusted in analyzing the risk of COVID-19 vaccination during lactation.

RESULTS

We identified 10,266 and 6,474 reports with the SMQ of "pregnancy and neonatal topics" associated with COVID-19 vaccines during pregnancy and lactation, respectively. No significant RORs of adverse pregnancy outcomes associated with COVID-19 vaccines during pregnancy were observed; however, "functional lactation disorders" showed significant disproportionality during lactation with adjusted ROR of 1.48 (95% CI, 1.21-1.79). Further analysis that analyzed "functional lactation disorders" at a preferred term level, showed higher ROR in mastitis (2.76 [95% CI, 1.45-5.27]).

CONCLUSION

Overall, we did not observe a positive association between COVID-19 vaccination during pregnancy and risk of reporting adverse pregnancy outcomes. However, we found a significant disproportionate reporting association between COVID-19 vaccination during lactation and "functional lactation disorders", specifically mastitis. Continuous surveillance is warranted to confirm the safety of COVID-19 vaccine during pregnancy and lactation.

Evidence of the acupuncture points stimulation for the treatment of hypogalactia: A systematic review and meta-analysis

OBJECTIVE

To perform a literature review aimed to analyze if acupoint stimulation increases lactation quantity.

METHOD

Studies were collected from five electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with clinical trial design and observational studies, with no restriction on time of publication, in which the effect of acupoint stimulation on improving the quantity of lactation by conventional acupuncture, electroacupuncture, laser, fire needling, manual stimulation, tuina or catgut had been evaluated. Two authors independently extracted data for the characteristics and main outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis.

RESULTS

A total of 14 studies were included in the present review. Most of the included studies exhibited some concerns in the risk of bias assessment. The quality of the studies was moderate. The meta-analysis showed that manual acupoint stimulation improves the lactation quantity (SMD 95% CI = 1.63 [1.13-2.13]; p < 0.0001).

CONCLUSION

The literature suggests that manual stimulation of acupuncture points improves the amount of milk produced during lactation.

Efficacy and safety of acupuncture for postpartum hypogalactia: protocol for a systematic review and meta-analysis

INTRODUCTION

Breast milk is recognised as the best natural food for neonates, but many women experience postpartum hypogalactia (PH). Randomised trials have found that acupuncture exert therapeutic effect on women with PH. However, systematic reviews on the efficacy and safety of acupuncture are still lacking; therefore, this systematic review aims to evaluate the efficacy and safety of acupuncture for PH.

METHODS AND ANALYSIS

Six English databases (PubMed, Cochrane Library, EMBASE, EBSCO, Scopus, and Web of Science) and four Chinese databases (China National Knowledge Infrastructure, Wan-Fang, Chinese Biomedical Literature and Chinese Scientific Journal) will be systematically searched from their establishment to 1 September 2022. Randomised controlled trials of the efficacy of acupuncture for PH will be reviewed. The study selection, data extraction and research quality evaluation will be conducted independently by two reviewers. The primary outcome is the change in serum prolactin level from baseline to the end of treatment. Secondary results include milk secretion volume, total effectiveness rate, degree of mammary fullness, rate of exclusive breast feeding, and adverse events. A meta-analysis will be performed using RevMan V.5.4 statistical software. Otherwise, a descriptive analysis will be conducted. The risk of bias will be assessed using the revised Cochrane risk-of-bias tool.

ETHICS AND DISSEMINATION

This systematic review protocol does not require ethical approval because it does not include private information/data of the participants. This article will be published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42022351849.

Cardiometabolic profile of young women with hypoprolactinemia

PURPOSE

Unlike hyperprolactinemia, clinical significance of prolactin deficiency remains poorly understood. The aim of this study was to assess the cardiometabolic profile of patients with low prolactin levels.

METHODS

The study population consisted of three groups of young women. Two groups were chronically treated with cabergoline but differed in prolactin levels, which were either abnormally low (group A; n = 16) or within the reference range (group B, n = 23). Group C, serving as a control group, included 28 drug-naïve women with normal prolactin levels. The dose of cabergoline in group A was then tapered down. Glucose homeostasis markers, plasma lipids and circulating levels of hormones, uric acid, high-sensitivity C-reactive protein (hsCRP), fibrinogen and homocysteine, as well as the carotid intima-media thickness were assessed at baseline and 6 months later.

RESULTS

Compared with subjects with normal prolactin levels, women with hypoprolactinemia had higher levels of 2-h postchallenge glucose, glycated hemoglobin, triglycerides, uric acid, hsCRP and fibrinogen, lower values of HDL-cholesterol, total testosterone and free androgen index, as well as reduced insulin sensitivity. No differences in these variables were observed between groups B and C. Apart from prolactin normalization, cabergoline dose reduction reversed all laboratory disturbances reported in group A.

CONCLUSION

The obtained results suggest that hypoprolactinemia in women of reproductive age may increase cardiometabolic risk.

EARLY PROGNOSIS OF HYPOGALACTIA IN BREASTFEEDING MOTHERS: NEW OPPORTUNITIES FOR PRIMARY PREVENTION

An increase in the hypogalactia frequency diagnosis in breastfeeding mothers is one of the world-spread medical and social problems and is especially high in women with risk factors of lactation disorders. Early estimation of risk factors creates opportunities for physicians to diagnose the lactation problem that mothers face and solve it. Aim - to identify and calculate prognostic criteria for determining the risk of hypogalactia in breastfeeding mothers and strategies to help women overcome them. Twenty-two factors that cause the most significant impact on the development of hypogalactia were selected, and their frequency was determined in 208 mothers with hypogalactia (group 1) and 388 mothers with normal lactation (group 2). The sequential Wald analysis, which compares the frequencies of distribution of traits in the study groups and determines their informativeness by calculating prognostic coefficients (PK) for different risk factors and estimating the individual risk of hypogalactia was used. The elder age of the breastfeeding mother (36-40 years and elder) and its lower educational level promoted hypogalactia. Low security of the mother was associated with hypogalactia (PC -1,4). It was also found that mothers engaged in heavy physical labor suffer from hypogalactia more often than employees. Mothers' return to work, have been reported as factors that influence breastfeeding. Occupational hazards (noise, dyes, vibration, lead soldering, dust factors) and bad habits caused hypogalactia (PC -5,4). Prenatal breastfeeding education has been shown to prevent hypogalactia. A burdensome obstetric history (PC -3,9), habitual miscarriage (PC-1,4), and female genital diseases worsen the prognosis of lactation. Extragenital pathology was characterized by negative PC of hypogalactia, especially rheumatic fever, compensated heart defect (PC -3,2), chronic cardiovascular insufficiency (PC -11,4), congenital heart disease (PC -11,4), obesity (PC -4,8), diabetes mellitus (PC -5,8). The time of the first application to the breast affected the mothers' milk production. The mathematical model of the individual prognosis of lactation in mothers contributes to the early detection of hypogalactia and the corresponding correction.

Factors Associated with Perceived Insufficient Milk in the First Three Months of Breastfeeding

PURPOSE

Perceived insufficient milk is the predominant risk factor for early breastfeeding discontinuation globally. The purpose of this study was to explore the association between perceived insufficient milk in the first 3 months and infant factors, maternal factors, professional support, parenting decisions, and breastfeeding concerns. Sixty-nine mothers who had perceived insufficient milk and 301 mothers who did not were included.

STUDY DESIGN AND METHODS

A cross-sectional online survey design was used in a convenience sample of 370 U.S. mothers with a healthy singleton infant between 1 and 12 weeks who were breastfeeding directly on the breast as part of their feeding methods.

RESULTS

Using stratified multivariable logistic regression, we found that among 102 mothers of infants < 4 weeks of age, planned breastfeeding duration < 6 months (OR = 13.17; 95% CI [1.42, 122.48], p = .024), and concerns about infant crying or fussing (OR = 4.72; 95% CI [1.10, 20.00], p = .03) were associated with perceived insufficient milk. Among 256 mothers of infants 4 to 12 weeks of age, concerns about frequent feedings (OR = 4.05; 95% CI [1.95, 8.40], p = .000) and latching difficulty (OR = 2.95; 95% CI [1.33, 6.54], p = .008) were associated with perceived insufficient milk.

CLINICAL IMPLICATIONS

Association between factors and perceived insufficient milk differed based on infant age. Maternal perceptions of crying or fussing, frequent feedings, and latching difficulty need to be assessed because of its attribution to perceived insufficient milk.

[Pilot study of early breastfeeding difficulties of term newborns: incidence and risk factors]

OBJECTIVES

To identify the incidence and risk factors of breastfeeding difficulties in maternity using 3 indicators: excess neonatal weight loss in maternity (EWL>or=10%), delayed onset of lactation (DOL>or=72 h) and suboptimal infant breastfeeding behaviour (SIBB=IBFAT score<or=10).

METHODS

Descriptive and prospective survey from January 1st to March 15th of 2005. Mothers who gave birth to a healthy, single and term infant were included. Every day, the data were collected in maternity by nursing staff. Analysis of correlation by Spearman's coefficient or Fischer's test, bivariate and multivariate analysis of risk factors with logistic regression model.

RESULTS

One hundred and eighteen dyads were included. Incidence of breastfeeding difficulties indicators was variable: SIBB day 0: 33.9%, SIBB day 3: 7.6%, DOL: 50%, EWL: 6.8%. Significant correlations between DOL and EWL (correlation coefficient [cc]<0.6; P<0.0043); between SIBB on day 0 and SIBB day 3 (cc=0.289; P=0.0015); between EWL and SIBB day 3 (cc=-0.187; P=0.0418). In multiple logistic regression, significant association between SIBB day 0 and nipple type (OR=15), between DOL and lack of previous breastfeeding experience (OR=2.53), between EWL and elevated neonatal weight (OR=1.22) and use of non breastmilk fluids>60 ml (OR=2.36).

CONCLUSION

Difficulties in the breastfeeding initiation are not uncommon. Influencing factors are not always modifiable. Breastfeeding couples considered at risk should be recognized and should benefit from a special lactation guidance in maternity and from a post-discharge follow-up.

The course of acute-phase proteins and serum cortisol in mastitis metritis agalactia (MMA) of the sow and sow performance

The objective of this study was to evaluate changes in acute-phase proteins (APPs) during mastitis metritis agalactia (MMA) in sows. Sows with MMA (group one, n=15) and healthy sows (group two, n = 15) were evaluated at days 0, 5, 10, 15, and 20 postpartum. Number of total born, liveborn, stillborn, and mummified pigs did not differ significantly between the groups. Preweaning mortality was higher (P < 0.001) among MMA sows than among healthy control animals. The offspring of healthy sows had higher (P < 0.05) weaning litter weights than the off-spring of MMA sows. Mean serum alpha 1-acid glycoprotein (AGP) concentrations were higher in MMA sows on the days 1 (P < 0.05), 5 (P = 0.05), and 10 (P < 0.001) post partum. Mean serum haptoglobin (HPT) was higher in MMA sows on days 1, 5 (P < 0.001), and 10 (P < 0.05) of lactation. Cortisol serum concentrations up to day 10 post partum were higher (P < 0.001) in MMA sows than in healthy sows. AGP was negatively correlated with litter weight, indicating that activation of the cellular immune response in sows negatively affects the growth rate of suckling piglets. Correlations were found between the overall means for weight, acute-phase proteins, and serum cortisol concentration.

Caveolin-1-deficient mice show accelerated mammary gland development during pregnancy, premature lactation, and hyperactivation of the Jak-2/STAT5a signaling cascade

It is well established that mammary gland development and lactation are tightly controlled by prolactin signaling. Binding of prolactin to its cognate receptor (Prl-R) leads to activation of the Jak-2 tyrosine kinase and the recruitment/tyrosine phosphorylation of STAT5a. However, the mechanisms for attenuating the Prl-R/Jak-2/STAT5a signaling cascade are just now being elucidated. Here, we present evidence that caveolin-1 functions as a novel suppressor of cytokine signaling in the mammary gland, akin to the SOCS family of proteins. Specifically, we show that caveolin-1 expression blocks prolactin-induced activation of a STAT5a-responsive luciferase reporter in mammary epithelial cells. Furthermore, caveolin-1 expression inhibited prolactin-induced STAT5a tyrosine phosphorylation and DNA binding activity, suggesting that caveolin-1 may negatively regulate the Jak-2 tyrosine kinase. Because the caveolin-scaffolding domain bears a striking resemblance to the SOCS pseudosubstrate domain, we examined whether Jak-2 associates with caveolin-1. In accordance with this homology, we demonstrate that Jak-2 cofractionates and coimmunoprecipitates with caveolin-1. We next tested the in vivo relevance of these findings using female Cav-1 (-/-) null mice. If caveolin-1 normally functions as a suppressor of cytokine signaling in the mammary gland, then Cav-1 null mice should show premature development of the lobuloalveolar compartment because of hyperactivation of the prolactin signaling cascade via disinhibition of Jak-2. In accordance with this prediction, Cav-1 null mice show accelerated development of the lobuloalveolar compartment, premature milk production, and hyperphosphorylation of STAT5a (pY694) at its Jak-2 phosphorylation site. In addition, the Ras-p42/44 MAPK cascade is hyper-activated. Because a similar premature lactation phenotype is observed in SOCS1 (-/-) null mice, we conclude that caveolin-1 is a novel suppressor of cytokine signaling.

IMMUNOASSAY FOR HUMAN CHORIONIC "GROWTH HORMONE-PROLACTIN" IN SERUM AND URINE

Chorionic "growth hormone-prolactin" in serum and urine from pregnant women, in serum from umbilical cord, and in amniotic fluid was assayed by a sensitive immunological method dependent on the combination of rabbit antiserum to the growth hormone-prolactin with the iodine-131-labeled hormone. The hormone is detectable in serum and urine early in gestation, and with advancing pregnancy its concentration in serum continues to increase to a maximum during the last trimester. It was not found in serum within 8 hours after delivery.

[Hyperprolactinemia. Reproductive consequences]

The medical history of 9 patients interested in childbearing are studied. They all had a high prolactin level, infertility, alteration in the menstrual cycle and in the majority (8/9) breast secretion. The results obtained with the usage of Parlodel (by the oral route) complemented with ovulation induction are evaluated, as well as existing local restrictions to permit fulfilling the various diagnostic procedures, oriented to define the etiology of the above mentioned clinical entity.

Physiology of lactation and factors affecting lactation

Breast-feeding may be considered an ancient yet modern phenomenon. Despite trends toward bottle feeding in the 1950s and 1960s, the value of breast feeding is being rediscovered, because it is nutritionally ideal and now fashionable to connect pregnancy and the puerperium with being as "natural" as possible. Nursing normally begins shortly after delivery. This enhances the mother-infant relationship in terms of bonding, and it also stimulates mature milk production. The duration of the nursing period is widely variable, even within cultures. Dietary precautions should ensure adequate maternal dietary intake during breast feeding and should include avoidance of nonessential medications. With proper care and concern, nursing must be considered the ideal form of nutrition for the newborn human.

Breast-feeding patterns in rural Bangladesh

Nearly 1500 women with live births from February through September 1974 were included in this multiple phase study of breast-feeding patterns in a rural area of Banglandesh. The median duration of breast feeding was observed to be 30 months. Over 75% of the women whose most recently born children were living were breast feeding at 2 1/2 years postpartum. The major reason for discontinuing breast feeding in the 1st year was infant death, and in the 2nd year, pregnancy. Insufficient milk was given as a reason for discontinuing breast feeding by 18% of the women who stopped breast feeding for reasons other than child death; among these women almost 60% were pregnant at the time they stopped. Of the breast-feeding women who became pregnant, over 50% continued to breast feed through the 6th month of pregnancy. A sample of 200 breast-feeding women with children ages 17 to 25 months were followed longitudinally for 1 1/2 years or until the mothers conceived. A seasonal trend in suckling time was observed with women reducing suckling during the harvest season. Total suckling time was inversely associated with socioeconomic factors and with infant nutritional status. No association was found between mean suckling time and maternal nutritional status, maternal morbidity, infant morbidity, or child's sex.

Further decline of breast-feeding

In a personal survey, by structured interview, we have investigated some of the factors which led 100 healthy mothers (63 primiparae) to decide to breast-feed their healthy babies, and 100 comparable mothers (43 primiparae) to decide to bottle-feed. Past experience (either personal or that of their family and friends) was of considerable but not overriding importance, and the decisions were apparently made surprisingly early in most cases. But much more effective educational approaches are needed, perhaps starting in the schools, and concentrated in the antenatal clinic, to allow mothers to reach the right decision for themselves and their babies. The reasons for early cessation of breast-feeding were also investigated, and suggested that those mothers opting for breast-feeding need better technical information and support.

Myopathy and neuropathy associated with osteomalacia

Thirty unselected females with proven osteomalacia were evaluated clinically, electromyographically and histopathologically for muscle dysfunction. Clinical evidence of myopathy was found in all the patients except one; the electromyograms were abnormal in 25 of them, and histopathological abnormalities, although slight and nonspecific, were seen in all the 17 patients who underwent muscle biopsy. Electromyographic findings revealed a myopathic pattern as evidenced by a significant reduction in motor unit potential duration and amplitude, and an increased percentage polyphasicity as compared to the controls. There was a complete absence of denervation potentials. The histopathological abnormalities were nonspecific and slight, and consisted of fatty infiltration, interstitial fibrosis, sarcolemmal nuclear proliferation and variation in muscle fibre thickness. A statistically significant reduction in motor nerve conduction velocities of the ulnar and peroneal nerves was found. It was considered that this reduction in the velocities was due to subclinical neuropathy. Our data suggest that myopathy, neuropathy and osteomalacia in our patients are due to nutritional deficiencies of multiple vitamins.

The effects of phenothiazines on endocrine function: II. Effects in men and post-menopausal women

There is ample evidence that high doses of phenothiazines and other neuroleptics depress the pituitary-gonadal axis in experimental animals (De Wied, 1967), but the effects of these drugs on sex hormones in human subjects are still controversial (Shader and Di Mascio, 1970). Literature concerning growth hormone (GH) is even more controversial, since phenothiazines have been found to inhibit GH release in rodents (Muller et al., 1967) but to increase it in the rhesus monkey (Meyer and Knobil, 1967). In human subjects phenothiazines have been reported to depress both basal levels of GH and the response to hypoglycaemia (Sherman et al., 1971), while others have found that this response is enhanced (Schimmelbusch, Mueller and Scheps, 1971). Studies of prolactin levels are more consistent, showing raised prolactin both in experimental animals and in human subjects following administration of phenothiazines (Apostolakis et al., 1972; Hwang et al., 1971; Kleinberg et al., 1971; Sulman, 1970).