Breastfeeding

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Basics

  • Breastfeeding is the natural process of feeding human milk directly from the breast.
  • Breast milk is the preferred nutritional source and the normal and physiologic way to feed all newborns and infants.
  • Breast milk contains over 200 active components which provide nutrition, fight pathogens, promote healthy gut microbiome, and aid in maturity of immune system.
  • The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Congress of Obstetricians and Gynecologists (ACOG) recommend exclusive breastfeeding for 6 months, with continuation of breastfeeding for ≥1 year as desired by mother and infant (1)[A].

Description

  • Maternal benefits (as compared with mothers who do not breastfeed) include:
    • Rapid involution/decreased postpartum bleeding
    • Decreased risk of postpartum depression and increased bonding
    • Postpartum weight loss
    • Decreased risk of breast cancer and association of decreased risk of premenopausal and postmenopausal ovarian cancer (2), decreased risk of type 2 diabetes, hypertension, hyperlipidemia, rheumatoid arthritis, and cardiovascular disease
    • Decreased risk of prematurity
    • Increased bone density
  • Infant benefits include the following (1):
    • Ideal food: easily digestible, nutrients well absorbed, less constipation
    • Lower rates of virtually all infections via maternal antibody protection
      • Fewer respiratory and GI infections
      • Decreased risk of ear infections, bacterial meningitis, pneumonia, and sepsis
      • Decreased incidence of otitis media and necrotizing enterocolitis
    • Decreased incidence of obesity and type 1 and 2 diabetes
    • Decreased incidence of allergies, clinical asthma, and atopic dermatitis in childhood
    • Decreased risk of developing celiac disease and inflammatory bowel disease
    • Decreased risk of childhood leukemia
    • Decreased risk of sudden infant death syndrome (SIDS)
    • Enhanced neurodevelopmental performance including intelligence (3)
    • Increased attachment between mother and baby

Epidemiology

Incidence

  • According to CDC Breastfeeding Scorecard, U.S. breastfeeding rates are on the rise in 2018: any breastfeeding: 83.2%. (however, differs among different sociodemographic and culture) (4)
  • Breastfeeding at 6 months: 57.6%
  • Breastfeeding at 12 months: 35.9%
  • Exclusive breastfeeding at 3 months: 46.9%
  • Exclusive breastfeeding at 6 months: 24.9%

Etiology and Pathophysiology

  • The mechanism of milk production is based on several hormones: Prolactin triggers milk production and oxytocin releases milk based on supply and demand. Endocrine control system triggers making of colostrum at 5 months’ gestation.
  • Alveoli make milk in response to hormone prolactin. Sucking stimulates secretion of prolactin, which triggers milk production.
  • Stimulation of areola causes secretion of oxytocin. Oxytocin is responsible for let-down reflex when myoepithelial cells contract and milk is ejected into milk ducts.
  • Endocrine/metabolic: Cystic fibrosis, diabetes, galactosemia, phenylketonuria, and thyroid dysfunction may cause delayed lactation or decreased milk.

General Prevention

Most vaccinations can be given to breastfeeding mothers, including COVID-19 immunization. The CDC recommends that the diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated influenza virus (as opposed to live attenuated), measles-mumps-rubella (MMR), and inactivated polio and varicella vaccines can be given. The CDC recommends avoiding the yellow fever or smallpox vaccine in breastfeeding mothers (5).

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Basics

  • Breastfeeding is the natural process of feeding human milk directly from the breast.
  • Breast milk is the preferred nutritional source and the normal and physiologic way to feed all newborns and infants.
  • Breast milk contains over 200 active components which provide nutrition, fight pathogens, promote healthy gut microbiome, and aid in maturity of immune system.
  • The American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Congress of Obstetricians and Gynecologists (ACOG) recommend exclusive breastfeeding for 6 months, with continuation of breastfeeding for ≥1 year as desired by mother and infant (1)[A].

Description

  • Maternal benefits (as compared with mothers who do not breastfeed) include:
    • Rapid involution/decreased postpartum bleeding
    • Decreased risk of postpartum depression and increased bonding
    • Postpartum weight loss
    • Decreased risk of breast cancer and association of decreased risk of premenopausal and postmenopausal ovarian cancer (2), decreased risk of type 2 diabetes, hypertension, hyperlipidemia, rheumatoid arthritis, and cardiovascular disease
    • Decreased risk of prematurity
    • Increased bone density
  • Infant benefits include the following (1):
    • Ideal food: easily digestible, nutrients well absorbed, less constipation
    • Lower rates of virtually all infections via maternal antibody protection
      • Fewer respiratory and GI infections
      • Decreased risk of ear infections, bacterial meningitis, pneumonia, and sepsis
      • Decreased incidence of otitis media and necrotizing enterocolitis
    • Decreased incidence of obesity and type 1 and 2 diabetes
    • Decreased incidence of allergies, clinical asthma, and atopic dermatitis in childhood
    • Decreased risk of developing celiac disease and inflammatory bowel disease
    • Decreased risk of childhood leukemia
    • Decreased risk of sudden infant death syndrome (SIDS)
    • Enhanced neurodevelopmental performance including intelligence (3)
    • Increased attachment between mother and baby

Epidemiology

Incidence

  • According to CDC Breastfeeding Scorecard, U.S. breastfeeding rates are on the rise in 2018: any breastfeeding: 83.2%. (however, differs among different sociodemographic and culture) (4)
  • Breastfeeding at 6 months: 57.6%
  • Breastfeeding at 12 months: 35.9%
  • Exclusive breastfeeding at 3 months: 46.9%
  • Exclusive breastfeeding at 6 months: 24.9%

Etiology and Pathophysiology

  • The mechanism of milk production is based on several hormones: Prolactin triggers milk production and oxytocin releases milk based on supply and demand. Endocrine control system triggers making of colostrum at 5 months’ gestation.
  • Alveoli make milk in response to hormone prolactin. Sucking stimulates secretion of prolactin, which triggers milk production.
  • Stimulation of areola causes secretion of oxytocin. Oxytocin is responsible for let-down reflex when myoepithelial cells contract and milk is ejected into milk ducts.
  • Endocrine/metabolic: Cystic fibrosis, diabetes, galactosemia, phenylketonuria, and thyroid dysfunction may cause delayed lactation or decreased milk.

General Prevention

Most vaccinations can be given to breastfeeding mothers, including COVID-19 immunization. The CDC recommends that the diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated influenza virus (as opposed to live attenuated), measles-mumps-rubella (MMR), and inactivated polio and varicella vaccines can be given. The CDC recommends avoiding the yellow fever or smallpox vaccine in breastfeeding mothers (5).

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