Lactation physiokinetics-using advances in technology for a fresh perspective on human milk transfer.

Introduction: Though the nature of breastfeeding is critical, scant information is available on how the action of the milk transfer from mother to infant is regulated in humans, where the points of dysfunction are, and what can be done to optimize breastfeeding outcomes. While better therapeutic strategies are needed, before they can be devised, a basic scientific understanding of the biomechanical mechanisms that regulate human milk transfer from breast to stomach must first be identified, defined, and understood. Methods: Combining systems biology and systems medicine into a conceptual framework, using engineering design principles, this work investigates the use of biosensors to characterize human milk flow from the breast to the infant's stomach to identify points of regulation. This exploratory study used this framework to characterize Maternal/Infant Lactation physioKinetics (MILK) utilizing a Biosensor ARray (BAR) as a data collection method. Results: Participants tolerated the MILKBAR well during data collection. Changes in breast turgor and temperature were significant and related to the volume of milk transferred from the breast. The total milk volume transferred was evaluated in relation to contact force, oral pressure, and jaw movement. Contact force was correlated with milk flow. Oral pressure appears to be a redundant measure and reflective of jaw movements. Discussion: Nipple and breast turgor, jaw movement, and swallowing were associated with the mass of milk transferred to the infant's stomach. More investigation is needed to better quantify the mass of milk transferred in relation to each variable and understand how each variable regulates milk transfer.

A Scoping Review of Neonatal Opioid Withdrawal and the Infant Gut Microbiome: Does Human Milk Optimize Infant Outcomes?

BACKGROUND: While a growing body of literature has established the role of human milk as a mechanism of protection in the formation of the infant gut microbiome, it remains unclear the extent to which this association exists for infants with neonatal opioid withdrawal syndrome. PURPOSE: The purpose of this scoping review was to describe the current state of the literature regarding the influence of human milk on infant gut microbiota in infants with neonatal opioid withdrawal syndrome. DATA SOURCES: CINAHL, PubMed, and Scopus databases were searched for original studies published from January 2009 through February 2022. Additionally, unpublished studies across relevant trial registries, conference proceedings, websites, and organizations were reviewed for possible inclusion. A total of 1610 articles met selection criteria through database and register searches and 20 through manual reference searches. STUDY SELECTION: Inclusion criteria were primary research studies, written in English, published between 2009 and 2022, including a sample of infants with neonatal opioid withdrawal syndrome/neonatal abstinence syndrome, and focusing on the relationship between the receipt of human milk and the infant gut microbiome. DATA EXTRACTION: Two authors independently conducted title/abstract and full-text review until there was consensus of study selection. RESULTS: No studies satisfied the inclusion criteria, which resulted in an empty review. IMPLICATIONS FOR PRACTICE AND RESEARCH: Findings from this study document the paucity of data exploring the associations between human milk, the infant gut microbiome, and subsequent neonatal opioid withdrawal syndrome. Further, these results highlight the timely importance of prioritizing this area of scientific inquiry.

Hypertensive Disorders of Pregnancy in a Military Hospital Birth Cohort.

Background: Hypertensive disorders of pregnancy (HDP) are risk factors for maternal and fetal complications with long-term sequelae for mother and children. HDP are not clearly understood; however, there appears to be a relationship with maternal weight gain. The effects of maternal weight gain and pregnancy outcomes, including HDP, are understudied. Few studies have assessed maternal weight gain in service-connected women and its effects on HDP. This study aimed to evaluate the relationship between blood pressure and birth outcomes in women who delivered their infants at a military hospital. Methods: This birth cohort study included all patients admitted to a military hospital for delivery over a 12-month period. Data were analyzed for hypertensive disorders, maternal weight gain, delivery type, infant maturity, and infant weight at delivery. Results: Of the 1,018 participants, 186 were diagnosed with HDP with no statistical difference observed for maternal age. The hypertensive group had higher mean weight gain. More patients in the hypertension group delivered at term with lower mean birth weight. The rate of small-for-gestational age infants was higher in the HDP group (p < 0.001). Discussion: The rate of HDP in this cohort of military members and dependents was 18.3%, which was similar to the 19% rate reported for a southern US hospital, but higher than in other regions of the United States. This evidence indicates that HDP are increasing, and maternal/infant morbidity was affected by hypertension in this study.

Considerations for lactation with Ehlers-Danlos syndrome: a narrative review.

BACKGROUND: Ehlers-Danlos syndrome (EDS) is a rare genetic connective tissue condition that is poorly understood in relation to lactation. As diagnostic methods improve, prevalence has increased. EDS, a disorder that impacts connective tissue, is characterized by skin extensibility, joint hypermobility, and fragile tissue which can affect every organ and body system leading to complications during pregnancy, delivery, and the postpartum period. Traits of this disease can cause mild to severe physiologic and functional obstacles during lactation. Unfortunately, there is little clinical evidence and minimal guidance for lactation management, and providers may feel uncomfortable and hesitant to address these concerns with patients due to a lack of readily available resources on the subject and inexperience with such patients. This narrative review describes and discusses the types of EDS, identifying symptoms, considerations, and precautions for care providers to implement during lactation and breastfeeding. METHODS: An electronic search of relevant citations was conducted using the databases Cochrane, PubMed, and Google Scholar from 1 January 2000 to 1 November 2021. Search terms used were Ehlers-Danlos syndrome, Hypermobility Syndrome, breastfeeding, lactation, breastmilk expression, breastmilk collection, human milk expression, human milk collection, and infant feeding. The search of these databases yielded zero results. As no research articles on EDS were directly related to lactation, this narrative review includes articles found that related to the health of mothers relevant to maternal function during lactation. DISCUSSION: For the healthcare provider, identifying characteristics of EDS can improve the management of lactation challenges. Mothers may experience generalized symptoms from gastrointestinal distress to fatigue or chronic pain, while they also may suffer from more specific joint complaints and injuries, such as dislocations / subluxations, or skin fragility. Such obstacles can generate impediments to breastfeeding and create unique challenges for breastfeeding mothers with EDS. Unfortunately, new mothers with these symptoms may have them overlooked or not addressed, impacting a mother's ability to meet her breastfeeding intentions. While there are some published research manuscripts on EDS and pregnancy, there is a lack of information regarding breastfeeding and lactation. Additional research is needed to help guide EDS mothers to achieve their breastfeeding intentions.

Physical Analysis of the Breast After Direct Breastfeeding Compared with Hand or Pump Expression: A Randomized Clinical Trial.

Background: Expressing human milk using commercially available pumps has increased. Most women use mechanical means to transfer their milk at some point during lactation. Yet, there is very little quantification of any breast tissue changes that occur when using mechanical devices to facilitate milk transfer. Objective: Women comfortable with breastfeeding were recruited to participate in a study to measure physical changes of the breast with a variety of human milk transfer modalities under close observation. Materials and Methods: Direct breastfeeding with their infant, hand expression, and mechanical milk transfer using two commonly available breast pumps were utilized over four milk transfer sessions with each participant. Each participant directly breastfed on the first milk transfer session and the remaining modalities were randomized. Measurements were taken before and after each modality using digital calipers. Participants completed a modified pain scale after each observation. Measurements taken after breastfeeding were used as the control for data interpretation for each participant. After a 20-minute rest period, breast tissue was again examined, and tissue appearance was recorded. Within-subject modality differences were calculated, and paired analysis mean difference and standard error of the mean are presented. Results: Fifty eligible women were approached with 92% participating. The "before" measurements were not significant for all the modalities. The "after" measurements were significantly different at p < 0.003 for breast pumps but not for breastfeeding or hand expressing. Many participants indicated pain with pumping. Conclusion: Mechanical pump use correlated with significantly increased length and diameter of the nipple compared with the post-breastfeeding and hand expressing dimensions. Pump use correlated with significant pain scores and resulted in localized inflammatory changes. Understanding how pumps affect breast tissue is helpful in improving experiences with breast pumps and may improve breastfeeding outcomes. Additional research is needed to better understand ramifications of long-term use of breast pumps.

Preventive Health Application to Increase Breastfeeding.

Background: Mother-infant dyads are not meeting recommended breastfeeding goals. There is lack of consensus regarding any program's ability to increase breastfeeding duration to meet the recommended guidelines, and effective strategies are needed moving forward to help families meet those goals. Primary prevention utilizing consistent visits with lactation professionals with a group of new mothers may efficiently address this care gap. Methods: Mother-infant dyads attending a newborn care clinic for 6 weeks received feeding assessment and standard-of-care guidance from an Internationally Board-Certified Lactation Consultant (IBCLC). Regression analysis was completed with outcome variables "exclusive direct breastfeeding" (EDB) and "any breastfeeding" (AB) at 6 weeks postpartum (PP) and odds ratios were calculated. Results: The number and timing of IBCLC visits was correlated with EDB at 6 weeks PP. Maternal/infant dyads seen at day 3 had 2.5 times higher odds of EDB at 6 weeks than those not receiving IBCLC standard-of-care feeding assessment. Dyads seen at days 3 and 14 had 3.4 times higher odds of EDB than those with less follow-up. Bottle use correlated with decreased odds of AB at 6 weeks PP; similarly, dyads seen only at day 14 PP had decreased odds of EDB. When looking at timing of the first involvement, dyads seen at 3 days had higher odds of EDB than dyads first seen at day 14 PP. Conclusions: This primary prevention strategy of early minimal intervention using an IBCLC increased the odds of EDB and AB at 6 weeks PP. These data support the conclusion that early feeding assessment the first 2 weeks PP with an IBCLC may increase breastfeeding at 6 weeks PP.

Decreasing retinol and α-tocopherol concentrations in human milk and infant formula using varied bottle systems.

Expressing human milk has become a more common alternative for mothers, as the average work demand has increased. As more mothers must work, bottle feeding trends are increasingly common. The handling and storage of human milk introduce the risk of degradation to expressed human milk and infant formula. In following a 20-minute simulated feeding, Vitamin C has been found to degrade. Vitamin C acts as an anti-oxidant and is responsible for shielding other nutrients from oxidation, such as retinol and alpha-tocopherol. By analyzing a 20-minute simulated feeding, retinol and alpha-tocopherol each displayed decreases over time significantly different than that of the Control, which was milk not exposed to bottle feeding. In human milk, retinol showed as high as a 9.5% decrease compared to the Control. Similar trends were seen with the infant formula samples. The correlation between degradation and bottle feeding systems was dependent upon the formation of bubbles in the milk as the milk was removed from the bottle. The analysis indicated a decrease of up to 12%, as seen in retinol, and 35%, as seen in alpha-tocopherol. These decreases in retinol and alpha-tocopherol should be considered when using a bottle feeding system to deliver either human milk or formula to an infant. More research is necessary to determine the effect of this decrease on the nutritional status of infants, particularly premature infants, who are at higher risk for nutrient deficiencies.

Glycoprotein expression in human milk during lactation.

While milk proteins have been studied for decades, strikingly little effort has been applied to determining how the post-translational modifications (PTMs) of these proteins may change during the course of lactation. PTMs, particularly glycosylation, can greatly influence protein structure, function, and stability and can particularly influence the gut where their degradation products are potentially bioactive. In this work, previously undiscovered temporal variations in both expression and glycosylation of the glycoproteome of human milk are observed. Lactoferrin, one of the most abundant glycoproteins in human milk, is shown to be dynamically glycosylated during the first 10 days of lactation. Variations in expression or glycosylation levels are also demonstrated for several other abundant whey proteins, including tenascin, bile salt-stimulated lipase, xanthine dehydrogenase, and mannose receptor.

Comparative analysis of ascorbic acid in human milk and infant formula using varied milk delivery systems.

BACKGROUND: The expression of human milk for later use is on the rise. Bottle systems are used to deliver the expressed milk. Research has shown that storage of both human milk and artificial baby milk, or infant formula, leads to a loss of ascorbic acid (commonly called Vitamin C). As milk is removed from the bottle during feeding and replaced by ambient air, it is unknown if loss of ascorbic acid occurs during the course of a feeding. The purpose of this study is to investigate the effect of the milk delivery system on levels of ascorbic acid in human milk and infant formula. The objectives are to 1) determine changes in ascorbic acid concentration during a 20 minute "feed," 2) determine if there is a difference in ascorbic acid concentration between delivery systems, and 3) evaluate if any differences are of clinical importance. METHODS: Commonly available bottles were used for comparison of bottle delivery systems. Mature human milk was standardized to 42 mg/L of ascorbic acid. Infant formula with iron and infant formula with docosahexanoic acid were used for the formula samples. Each sample was analyzed for ascorbic acid concentration at baseline (0), 5, 10, 15, and 20 minutes. Each collection of samples was completed in triplicate. Samples were analyzed for ascorbic acid using normal-phase high performance liquid chromatography. RESULTS: Ascorbic acid concentration declined in all bottle systems during testing, Differences between the bottle systems were noted. Ascorbic acid concentrations declined to less than 40% of recommended daily intake for infants in 4 of the bottles systems at the 20 minute sampling. CONCLUSION: The bottle systems used in this study had measurable decreases in the mean concentration of ascorbic acid. More research is needed to determine if the observed decreases are related to lower plasma ascorbic acid concentration in infants exclusively bottle fed. The decrease of ascorbic acid concentration observed in both human milk and infant formula using varied milk delivery systems may be of clinical importance. For infants who rely solely on bottle feeds there may be increased risk of deficiency. Bottle shape, size, and venting should be considered.

Daily variations in oligosaccharides of human milk determined by microfluidic chips and mass spectrometry.

Human milk is a complex biological fluid that provides not only primary nourishment for infants but also protection against pathogens and influences their metabolic, immunologic, and even cognitive development. The presence of oligosaccharides in remarkable abundance in human milk has been associated to provide diverse biological functions including directing the development of an infant's intestinal microflora and immune system. Recent advances in analytical tools offer invaluable insights in understanding the specific functions and health benefits these biomolecules impart to infants. Oligosaccharides in human milk samples obtained from five different individual donors over the course of a 3 month lactation period were isolated and analyzed using HPLC-Chip/TOF-MS technology. The levels and compositions of oligosaccharides in human milk were investigated from five individual donors. Comparison of HPLC-Chip/TOF-MS oligosaccharides profiles revealed heterogeneity among multiple individuals with no significant variations at different stages of lactation within individual donors.