Urinary Silicon Excretion in Relation to Lactation and Bone Mineral Density - a Longitudinal Study Post-partum.

Silicon (Si) may be a mineral beneficial for bone health. Pregnancy and lactation have major impacts on maternal bone metabolism as bone minerals, including calcium (Ca), are required for growth of the foetus and for milk production. Like urinary Ca excretion, Si excretion has been reported to be high in pregnant women, but there are no data post-partum and during lactation. The aim of the present study was to investigate the urinary excretion of Si (U-Si), from the third trimester of pregnancy until 18 months post-partum, and in relation to the length of lactation, to determine if changes in U-Si are associated with changes in areal bone mineral density (aBMD). This longitudinal study included 81 pregnant women, of whom 56 completed the study. Spot urine samples were collected at the third trimester and at 0.5, 4, 12, and 18 months post-partum and were analysed for Si and Ca by ICP-OES. The aBMD was measured post-partum at lumbar spine and femoral neck by dual-energy x-ray absorptiometry. Women lactating for 4-8.9 and ≥ 9 months had significantly higher U-Si at 4 months post-partum, compared with the third trimester. No significant longitudinal differences in U-Si were found after correcting for creatinine. Changes in U-Si and in aBMD were not correlated, except at the lumbar spine from 0.5 to 12 months post-partum in the women lactating for 4-8.9 months. Taken together, our results suggest that there is a possibility that U-Si increases post-partum in women lactating for 4 months or longer, although it is not related to changes in aBMD.

Risk analysis and seroprevalence of bovine ephemeral fever virus in Punjab, Pakistan.

Bovine ephemeral fever (BEF) is a vector-borne viral disease caused by the RNA virus which belongs to the genus Ephemerovirus and the family Rhabdoviridae. To evaluate the effect of the risk factors like the breed of cattle and buffaloes, age, sex, lactation, housing and region on the bovine ephemeral fever virus (BEFV) prevalence, ELISA and virus neutralisation (VN) tests (n = 600) were performed for the BEFV prevalence. The seroprevalence in cattle was 45.6% and 42% by ELISA and VN, respectively (P = 0.001). The breed-wise seropositive ratio was (55-64%) in cattle and (22.5-18.3%) in buffaloes by VN and ELISA. The sex-wise prevalence was (40-49.4%) in females and (35.8-46%) in males by VN and ELISA in cattle and a similar prevalence was reported in buffaloes. The age-wise prevalence in bovines by ELISA was 5.33, 22.66 and 17.66% in the age group < 1 year, 1-3 years and > 3 years, respectively. The disease prevalence was higher in the age group of 1-3 years. The prevalence was higher during the 3rd lactation in bovines. The region-wise prevalence was higher in the 07 districts while lower (18-21%) in Rawalpindi District by VN and ELISA, respectively (P = 0.001). Commercial dairy farms of cattle showed a higher disease prevalence (52% and 44%) than non-commercial farms (38% and 36%) by ELISA and VN, respectively (P = 0.227). Exotic cows showed higher disease prevalence (76.67% and 70%) by ELISA and VN. The mortality in bovines was 5% (7.7% and 2.3%) in the cattle and buffaloes. The case fatality of BEFV in bovines was 12.25%. There was a significant effect of the risk factors like the breed, age, sex, lactation, housing and region on the BEFV prevalence. This is the first comprehensive study of BEFV in Pakistan.

Analysis of a Pharmacy Developed, Outpatient Lactation Consultant Initiated Domperidone Programme.

BACKGROUND: Domperidone is a commonly prescribed galactagogue used off-label for lactation insufficiency. Prescriber unfamiliarity or safety concerns can lead to therapeutic delay and potential early breastfeeding discontinuation. To facilitate access, the study site pharmacy department developed a Structured Administration and Supply Arrangement (SASA) for International Board-Certified Lactation Consultants (IBCLC) to screen and initiate domperidone using a checklist. MATERIAL: To validate a domperidone screening tool via analysis of its use and compliance, together with a staff satisfaction survey. METHODS: Records were extracted from the REDCap® database for women with documented domperidone supply between 06/05/2022 and 27/01/2023 and reviewed with medical records. A staff survey was distributed assessing compliance and attitudes towards the SASA. RESULTS: Records of supply revealed that 34% (17/50) of patients were referred to a physician, revealing a discrepancy between database documentation and checklists, as no referrals were documented. Overall staff satisfaction with the SASA was rated 4.6 out of 5. 77.7% (7/9) felt confident counselling and supplying domperidone with the SASA in place. 88.9% (8/9) felt confident using the checklist to identify the appropriateness of therapy and referral to a physician. CONCLUSIONS: The system in place allows the IBCLCs to initiate and supply domperidone in a timely manner to breastfeeding mothers with lactation insufficiency. The support tools, including domperidone SASA, REDCap® documentation database and the checklist domperidone as a Galactagogue Checklist, can be greatly appreciated by the LCs. Continued discussion with IBCLCs to refine and improve the SASA and associated education package will result in more consistent compliance.

A case of phyllodes tumor with rapid growth during pregnancy and lactation period: a case report.

BACKGROUND: The age of onset of the phyllodes tumor is generally in the late 40 s, and diagnosis and treatment during pregnancy and lactation are rare. We herein present a case of a phyllodes tumor that rapidly increased in size during the pregnancy and lactation period. CASE PRESENTATION: A 39-year-old woman was referred to our hospital with a mass in the right breast that increased in size during the pregnancy and lactation period. On ultrasound (5 week postpartum), a well-defined lobulated mass with internal septations and fluid retention was observed. Magnetic resonance imaging of the breast at 8 week postpartum revealed a 70-mm-sized smooth-margin mass with multilocular cystic components. Marked proliferation of stromal cells with high cell density was observed in a biopsy specimen taken at the previous hospital. We diagnosed the mass as a phyllodes tumor of borderline malignancy and excised it at 13 week postpartum. The excised tumor was 85 mm in diameter and its interior was filled with a milk-like substance. Histologically, there was only a mild increase in stromal cell density but fibrosis with associated degeneration was prominent. The final diagnosis was benign phyllodes tumor with degeneration. CONCLUSIONS: We report a case of a phyllodes tumor that rapidly increased in size during pregnancy and the lactation period. The accumulation of a milk-like substance was thought to be responsible for the rapid growth of the tumor.

Deletion of FNDC5/irisin modifies murine osteocyte function in a sex-specific manner.

Irisin, released from exercised muscle, has been shown to have beneficial effects on numerous tissues but its effects on bone are unclear. We found significant sex and genotype differences in bone from wildtype (WT) mice compared to mice lacking Fndc5 (knockout [KO]), with and without calcium deficiency. Despite their bone being indistinguishable from WT females, KO female mice were partially protected from osteocytic osteolysis and osteoclastic bone resorption when allowed to lactate or when placed on a low-calcium diet. Male KO mice have more but weaker bone compared to WT males, and when challenged with a low-calcium diet lost more bone than WT males. To begin to understand responsible molecular mechanisms, osteocyte transcriptomics was performed. Osteocytes from WT females had greater expression of genes associated with osteocytic osteolysis and osteoclastic bone resorption compared to WT males which had greater expression of genes associated with steroid and fatty acid metabolism. Few differences were observed between female KO and WT osteocytes, but with a low-calcium diet, the KO females had lower expression of genes responsible for osteocytic osteolysis and osteoclastic resorption than the WT females. Male KO osteocytes had lower expression of genes associated with steroid and fatty acid metabolism, but higher expression of genes associated with bone resorption compared to male WT. In conclusion, irisin plays a critical role in the development of the male but not the female skeleton and protects male but not female bone from calcium deficiency. We propose irisin ensures the survival of offspring by targeting the osteocyte to provide calcium in lactating females, a novel function for this myokine.

Breast problems and associated factors among lactating women in Northeast Ethiopia, 2022.

Breastfeeding is the cornerstone of child and maternal health. However, maternal breast problems during breastfeeding have been frequently reported as one of the reasons for early discontinuation of breastfeeding. Despite the importance of having knowledge on breast problems magnitude and its associated factors in the clinical practices and designing effective interventions, there is limited data on this topic. Therefore, this study aimed to assess the prevalence and associated factors of breast problem among postnatal lactating women in Legambo district, south wollo zone, North East Ethiopia, in 2022. A community-based cross sectional study was conducted among 610 lactating mothers in Legambo district. Multi-stage sampling was employed to select study participants. Interviewer administered, WHO B-R-E-A-S-T-Feeding, observational checklist and maternal self-reported breast problem questionnaires were used to collect the data. Epi-Data version 3.1 was used for data entry and export to SPSS version 25.0 for analysis. Descriptive statistics and bi-variable and multivariable analysis was carried out. On the multivariable logistic regression, variables with p-value < 0.5 were considered as they had statistically significant association with breast problem. The overall prevalence of breast problems among postnatal lactating women was 54.3% (95%, CI 49.3-59.3%). Primipara (AOR = 5.09; 95% CI 3.40-7.62), preterm infant (AOR = 2.12; 95% CI 1.22-3.66), home delivery (AOR = 3.67; 95% CI 1.62-8.30), ineffective breastfeeding techniques (AOR = 2.45; 95%CI 1.61-3.74), caesarean section delivery (AOR = 2.05;95%CI :1.15-3.64) and mixed type of feeding (AOR = 1.97:95%CI 1.34-2.89) were factors showed significant association. The prevalence of breast problems was 54.3%. Relevant factors related to an increase risks are being primipara, cesarean section delivery, home delivery, preterm birth, ineffective breastfeeding techniques and mixed type of feeding.

Pregnancy and lactation-associated osteoporosis as a major type of premenopausal osteoporosis: a retrospective cohort study based on real-world data.

BACKGROUND: Pregnancy and lactation-associated osteoporosis (PLO), as well as premenopausal osteoporosis, might be a predictor of future fracture. This study aimed to describe the clinical features of PLO as a subtype of premenopausal osteoporosis and to evaluate medical interventions for it. METHODS: From an administrative claims database including 4,224,246 people in Japan, we classified women for whom the date of childbirth had been defined and who had suffered low-trauma fracture between the ages of 18-47 years as the premenopausal osteoporosis group. A fracture site for which the odds ratio for fractures occurring between 5 months before and 12 months after childbirth (around childbirth) was greater than 1 was considered the PLO site. We classified patients with a fracture at the PLO site around childbirth as the PLO group. The control group consisted of 500 women without fragility fractures. We investigated some drugs and diseases to explore fracture-causing factors, as well as medical interventions such as osteoporosis diagnosis, bone densitometry, anti-osteoporosis pharmacotherapy, and lactation inhibitors. RESULTS: In total, 231 parous women were classified into the premenopausal osteoporosis group. The most common fracture was vertebral fracture and was likely to occur around childbirth, followed by distal radius and sacral fractures, which were rare around childbirth. Considering vertebral, pelvic, and proximal femoral fractures as PLO sites, 56 women with 57 PLO fractures were classified into the PLO group. The incidence of PLO was estimated at 460 per million deliveries. Ovulation disorder and high maternal age were associated with the development of PLO. Vertebral fracture was the most common PLO fracture. It was mainly diagnosed a few months, and possibly up to 1 year, postpartum. PLO patients with vertebral fractures underwent more medical interventions than did those with other fractures, but they were still inadequate. CONCLUSIONS: PLO with vertebral fracture was one of the major types of premenopausal osteoporosis. The prevalence of PLO is considered to be higher than previously thought, indicating the presence of potentially overlooked patients. More timely interventions for PLO might lead to the improved management of latent patients with premenopausal osteoporosis and reduce future fracture risk.

The Effect of Maternal Overweight/Obesity on Serum and Breastmilk Leptin, and Its Associations with Body Composition, Cardiometabolic Health Indices, and Maternal Diet: The BLOOM Study.

In overweight and obese patients, elevated serum and breastmilk leptin concentrations are observed, with serum leptin also being likely affected by the diet. We analyzed serum and breastmilk leptin in normal weight (NW) and overweight/obese (OW/OB) mothers, and evaluated its associations with (1) maternal anthropometric parameters; (2) markers of cardiometabolic health; and (3) the maternal diet. The BLOOM (Breastmilk and the Link to Overweight/Obesity and Maternal diet) study was conducted among 40 women (n = 20 OW/OB; n = 20, NW) who were exclusively or predominantly breastfeeding for 15.5 ± 1.2 (OW/OB group (0.99)) weeks. We collected 24 h breastmilk and fasting blood samples for leptin analysis by ELISA. Maternal dietary habits were evaluated using a 3-day dietary record and food frequency questionnaire, which were used to calculate the Polish-adapted Mediterranean Diet score. Maternal anthropometric measurements and DEXA scans were performed, and anthropometric and cardiometabolic indices were calculated. The OW mothers had 1.4 times higher serum levels, while OB mothers had 4.5 and 6.2 higher serum and breastmilk leptin levels, respectively, in comparison to the NW mothers. The FM% was correlated with serum and breastmilk leptin levels (r = 0.878, r = 0.638). Serum leptin was associated with markers of cardiometabolic health such as AIP, CMI, and VAI in the NW mothers, and with LAP in the OW/OB mothers. Higher energy, fructose intake and adherence to the Mediterranean diet were associated with serum leptin in the NW mothers (ß = 0.323, 0.039-0.608; ß = 0.318, 0.065-0.572; ß = 0.279, 0.031-0.528); meanwhile, higher adherence to the Mediterranean diet could protect against elevated breastmilk leptin concentrations in OW/OB mothers (ß = -0.444, -0.839--0.050), even after adjustment for FM%. Our results suggest a potential association between maternal serum leptin concentrations and cardiometabolic health. In addition, we confirm the importance of healthy dietary patterns in the improvement of breastmilk composition.

Combined Metabolomics and Biochemical Analyses of Serum and Milk Revealed Parity-Related Metabolic Differences in Sanhe Dairy Cattle.

The production performance of dairy cattle is closely related to their metabolic state. This study aims to provide a comprehensive understanding of the production performance and metabolic features of Sanhe dairy cattle across different parities, with a specific focus on evaluating variations in milk traits and metabolites in both milk and serum. Sanhe dairy cattle from parities 1 to 4 (S1, n = 10; S2, n = 9; S3, n = 10; and S4, n = 10) at mid-lactation were maintained under the same feeding and management conditions. The milk traits, hydrolyzed milk amino acid levels, serum biochemical parameters, and serum free amino acid levels of the Sanhe dairy cattle were determined. Multiparous Sanhe dairy cattle (S2, S3, and S4) had a greater milk protein content, lower milk lactose content, and lower solids-not-fat content than primiparous Sanhe dairy cattle (S1). Moreover, S1 had a higher ratio of essential to total amino acids (EAAs/TAAs) in both the serum and milk. The serum biochemical results showed the lower glucose and total protein levels in S1 cattle were associated with milk quality. Furthermore, ultra-high-resolution high-performance liquid chromatography with tandem MS analysis (UPLC-MS/MS) identified 86 and 105 differential metabolites in the serum and milk, respectively, and these were mainly involved in amino acid, carbohydrate, and lipid metabolism. S1 and S2/S3/S4 had significantly different metabolic patterns in the serum and milk, and more vitamin B-related metabolites were significantly higher identified in S1 than in multiparous cattle. Among 36 shared differential metabolites in the serum and milk, 10 and 7 metabolites were significantly and strongly correlated with differential physiological indices, respectively. The differential metabolites identified were enriched in key metabolic pathways, illustrating the metabolic characteristics of the serum and milk from Sanhe dairy cattle of different parities. L-phenylalanine, dehydroepiandrosterone, and linoleic acid in the milk and N-acetylornithine in the serum could be used as potential marker metabolites to distinguish between Sanhe dairy cattle with parities of 1-4. In addition, a metabolic map of the serum and milk from the three aspects of carbohydrates, amino acids, and lipids was created for the further analysis and exploration of their relationships. These results reveal significant variations in milk traits and metabolites across different parities of Sanhe dairy cattle, highlighting the influence of parity on the metabolic profiles and production performance. Tailored nutritional strategies based on parity-specific metabolic profiles are recommended to optimize milk production and quality in Sanhe cattle.

Computational model captures cardiac growth in hypertensive pregnancies and in the postpartum period.

Heart growth in the pregnant patient helps maintain cardiovascular function while supporting the growing fetus. However, in some cases, the cardiovascular demand of pregnancy can trigger life-threatening conditions, including hypertensive disorders of pregnancy and peripartum cardiomyopathy. The mechanisms that control heart growth throughout pregnancy are unclear, and treating these diseases remains elusive. We previously developed a computational model that accounts for hormonal and hemodynamic interactions throughout pregnancy and demonstrated its ability to capture realistic cardiac growth in normal rat pregnancy. In this study, we evaluated whether this model could capture heart growth beyond normal pregnancy. After further validation of our normal pregnancy predictions, we tested our model predictions of three rat studies of hypertensive pregnancies. Next, we simulated the postpartum period and examined the impact of lactation on cardiac growth in rats. We demonstrate that our multiscale model can capture cardiac growth associated with new-onset hypertension during pregnancy and lactation status in the postpartum period. We conclude by elaborating on the potential clinical utility of our model in the future.

Characterizing sow feed intake during lactation to explain litter and subsequent farrowing performance.

Variation in feed intake results in nearly 20% of sows consuming less than the recommended lysine (Lys) intake for lactating sows. The Lys requirement for lactating sows is based on litter size and piglet average daily gain which influences milk production. Litter size continues to increase every year causing the need for routine reevaluation of nutrient requirements. If dietary inclusion levels are not continuously adjusted this can lead to inadequate daily Lys and energy intake and may negatively impact sow body condition and litter performance. The objective was to characterize the average daily feed intake (ADFI) of sows and define feed intake patterns and their effects on sow body weight, farrowing performance, litter performance, and subsequent farrowing performance. ADFI during lactation was recorded for 4,248 sows from 7 independent research studies. Data collection occurred from November 2021 through November 2023 at a commercial breed-to-wean facility in western Illinois. Each sow was categorized as: consistently low intake (< 5.5 kg/d) throughout the lactation (LLL); low intakes (< 5 kg/d) in the first week, then gradually increased throughout the rest of the lactation period (LHH); gradual increase in intake throughout lactation with no drop and a peak intake after day 10 of lactation (gradual); rapid increase in intake with no drop and the peak intake met before day 10 (rapid); a major drop in feed intake (> 1.6 kg decrease for ≥ 2 d) any time during lactation (MAJOR); minor drop (≤ 1.6 kg for ≥ 2 d; MINOR). Sows were also separated into low (quartile 1; ≤ 25%), average (quartile 2 through 3), or high feed intake (quartile 4; ≥ 75%) by parity (P1, P2, P3+). Sows in the LLL category were younger in parity, had the greatest preweaned mortality, weaned the lightest average pigs, and experienced the greatest loss in body weight percentage compared with sows in all other feed intake categories. Furthermore, sows in the LLL and LHH categories had one fewer subsequent pig born compared with sows in the other four categories. These data support historical findings that feed intake patterns directly contribute to current litter farrowing performance. Lactation intake patterns also influence subsequent farrowing performance. Identifying under-consuming sows that are likely Lys and energy deficient allows producers opportunities to promote consistent, adequate daily intakes to these groups and mitigate negative impacts on sow and litter performance.

This study investigated different sow feed intake patterns during lactation and average daily feed intakes within parity on current and subsequent farrowing and litter performance. Findings revealed sows that have consistently low intake throughout the lactation period have a significant reduction in average pig wean weight, a greater percentage of pre-wean mortality, and take an additional day or longer to return to estrus compared with sows that have average or above feed intake throughout the lactation period. Specifically, older parity sows were heavier, had greater feed intake, nursed heavier litters, and had litters with less preweaned mortality compared with younger parity sows. The average pig weaned weight and subsequent total pigs born improved as intake increased within parity. Prewean mortality decreased as feed intake increased within parity. These findings highlight the importance of ensuring sows are not only eating enough, but that they are consuming more than average when possible, to continually improve current and subsequent farrowing and litter performance. This study provides important information that will allow producers to target specific under-consuming sows and then promote consistent and high daily lactation intakes. Targeting these potentially nutrient-restricted sows may help reduce negative impacts on sow and litter performance.

Breastfeeding patterns in one-year-old children was not affected by a breastfeeding support intervention.

BACKGROUND: Breastfeeding patterns in 12-month-old children play a central role in the mother-infant dyad, but studies describing the patterns are scarce. AIM: To investigate breastfeeding patterns in 12-month-old infants before and after a breastfeeding support programme. STUDY DESIGN: A baseline/intervention design as part of a larger implementation project aiming to revive the Ten Steps to Successful Breastfeeding programme. SUBJECTS: During a 24-h period, 28 mothers from a baseline group and 24 mothers from an intervention group recorded all breastfeeding sessions on a pen and paper form. RESULTS: The median (range) frequency of breastfeeding sessions was 6 (1-22) in the baseline group and 7 (1-20) times per 24 h in the intervention group. No significant difference was observed in frequencies between the two groups. The majority of children (57 % in the baseline group and 62 % in the intervention group) exhibited a pattern classified as partial breastfeeding, engaging in breastfeeding 6 or more times per 24 h throughout a substantial part of the day. A second pattern was classified as token breastfeeding, with few breastfeeding sessions, suggesting that breastfeeding occurred primarily for comfort. CONCLUSION: This study illuminates the breastfeeding behaviours of 12-month-old children and can serve to normalise frequent breastfeeding patterns, potentially aiding mothers who wish to continue breastfeeding beyond infancy. The findings indicate no difference between the groups, suggesting that the implemented intervention did not influence maternal breastfeeding practices at one year of age. This underscores the potential necessity for prolonged support for parents throughout the breastfeeding period. ISRCTN registry: doi.org/10.1186/ISRCTN91972905.

Comparison of nonlinear functions to describe lactation curves for cumulative milk production in buffalo.

The aim of this study was to examine the suitability of different growth functions (linear, sinusoidal, Gompertz, Schumacher and Richards) to fit cumulative milk production data from buffalo cows. Cumulative milk production at each day in milk was calculated from two published datasets reporting (i) fortnightly test-day milk yield records of the first lactation of Murrah buffalo that had calved during 1977-2012 and (ii) the first lactation records of Jaffarabadi buffalo collected from history-cum-pedigree registers for each quinquennium between 1991 and 2010. Each function was fitted to the lactation curves using nonlinear regression procedures. The Richards and sinusoidal equations provided the smallest root mean square error values, Akaike's and Bayesian information criteria and, therefore, the best fit for the cumulative lactation curves for milk yield. The Richards equation appeared to provide the most accurate estimate of the cumulative milk production at peak milk yield. Sinusoidal and flexible classical growth functions are appropriate to describe cumulative milk production curves and estimate lactation traits in buffalo.

Zinc supplementation initiated prior to or during pregnancy modestly impacted maternal status and high prevalence of hypozincemia in pregnancy and lactation: the Women First Preconception Maternal Nutrition Trial.

BACKGROUND: Data regarding effects of small quantity-lipid-based nutrient supplements (SQ-LNS) on maternal serum zinc concentrations (SZC) in pregnancy and lactation are limited. OBJECTIVES: Evaluate the effect of preconception vs prenatal zinc supplementation (vs control) on maternal SZC and hypozincemia during pregnancy and early lactation in women in low resource settings, and to assess associations with birth anthropometry. METHODS: From ∼100 women/arm at each of 3 sites (Guatemala, India, Pakistan) of the Women First Preconception Nutrition trial, we compared SZC at 12- and 34-weeks gestation (n=651 and 838, respectively) and 3-months postpartum (n=742) in women randomized to daily SQ-LNS containing 15 mg zinc from ≥3 months prior to conception (preconception, Arm 1), from ∼12 weeks gestation through delivery (early pregnancy, Arm 2) or not at all (control, Arm 3). Birth anthropometry was examined for newborns with ultrasound-determined gestational age. Statistical analyses were performed separately for each time point. RESULTS: At 12-weeks gestation and 3-months postpartum, no statistical differences in mean SZC were observed among arms. At 34-weeks, mean SZC for Arms 1 and 2 were significantly higher than Arm 3 (50.3, 50.8, 47.8 µg/dL respectively; P=0.005). Results were not impacted by correction for inflammation or albumin concentrations. Prevalence of hypozincemia at 12-weeks (<56 µg/dL) was 23% in Guatemala, 26% in India, and 65% in Pakistan; at 34 weeks (<50 µg/dL) 36% in Guatemala, 48% in India, and 74% in Pakistan; and at 3-months postpartum (<66 µg/dL) 79% in Guatemala, 91% in India, and 92% in Pakistan. Maternal hypozincemia at 34-weeks was associated with lower birth length-for-age Z-scores (all sites P=0.013, Pakistan P=0.008) and weight-for-age Z-scores (all sites P=0.017, Pakistan P=0.022). CONCLUSIONS: Despite daily zinc supplementation for ≥7 months, high rates of maternal hypozincemia were observed. The association of hypozincemia with impaired fetal growth suggests widespread zinc deficiency in these settings. CLINICAL TRIAL REGISTRATION: The study protocol is registered at ClinicalTrials.gov #NCT01883193 at https://clinicaltrials.gov/ct2/show/NCT01883193?term=01883193&rank=1 and the protocol is available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000057/.

Ayurvedic Herbal Medicines: A Literature Review of Their Applications in Female Reproductive Health.

Ayurveda, an ancient holistic and personalized healing system originating from the Indian subcontinent, has been gaining increasing attention as a complementary and alternative medical practice for treating various health conditions, including those related to women's reproductive well-being. This comprehensive literature review examines a wide array of experimental and clinical studies exploring the diverse facets of Ayurvedic interventions in addressing issues such as menstrual irregularities, polycystic ovary syndrome (PCOS), infertility, and menopausal symptoms. The paper specifically focuses on discussing the available data regarding the efficacy of Tulsi (Ocimum tenuiflorum), ashwagandha (Withania somnifera), ginger (Zingiber officinale), cardamom (Elettaria cardamomum), turmeric (Curcuma longa), and Shatavari (Asparagus racemosus), which have traditionally been used in Ayurvedic medicine for centuries. The synthesis of literature not only highlights the potential benefits of these Ayurvedic interventions, but also critically assesses the methodological rigor of existing studies, identifying research gaps, and proposing directions for future investigations. While acknowledging the need for further rigorous research and clinical trials, the review emphasizes the benefits of collaborative and integrative healthcare. This review aims to serve as a valuable resource for healthcare practitioners, researchers, and individuals seeking holistic and natural alternatives for female reproductive health management.

Pumps: A Possible Tool to Promote More Equitable Lactation Outcomes.

Pregnant individuals and infants in the US are experiencing rising morbidity and mortality rates. Breastfeeding is a cost-effective intervention associated with a lower risk of health conditions driving dyadic morbidity and mortality, including cardiometabolic disease and sudden infant death. Pregnant individuals and infants from racial/ethnic subgroups facing the highest risk of mortality also have the lowest breastfeeding rates, likely reflective of generational socioeconomic marginalization and its impact on health outcomes. Promoting breastfeeding among groups with the lowest rates could improve the health of dyads with the greatest health risk and facilitate more equitable, person-centered lactation outcomes. Multiple barriers to lactation initiation and duration exist for families who have been socioeconomically marginalized by health and public systems. These include the lack of paid parental leave, increased access to subsidized human milk substitutes, and reduced access to professional and lay breastfeeding expertise. Breast pumps have the potential to mitigate these barriers, making breastfeeding more accessible to all interested dyads. In 2012, The Patient Protection and Affordable Care Act (ACA) greatly expanded access to pumps through the preventative services mandate, with a single pump now available to most US families. Despite their near ubiquitous use among lactating individuals, little research has been conducted on how and when to use pumps appropriately to optimize breastfeeding outcomes. There is a timely and critical need for policy, scholarship, and education around pump use given their widespread provision and potential to promote equity for those families facing the greatest barriers to achieving their personal breastfeeding goals.

Carbohydrate restriction during lactation: A systematic review.

The quality of a mother's diet is important to ensure child growth and development and keep women healthy. This systematic review aimed to identify the outcomes of a carbohydrate-restricted diet during lactation. PubMed, EMBASE, Scopus, Web of Science, and LILACS were searched for studies published between 2012 and 2023; 16 studies were selected, all of them case reports or care series. The carbohydrate restriction described in the papers mainly was ketogenic, low-carb, low-carbohydrate and high-fat, and modified ketogenic diets. The main goal of women undertaking these diets was weight loss, with therapeutic purposes (monitored and supervised by health professionals) in only 2 cases: (1) ketogenic diet therapy for treatment of seizures in the infant and (2) to reduce symptoms of mother's gastroesophageal reflux. Most articles reported that lactating women were hospitalized, experiencing symptoms such as vomiting, muscle weakness, nausea, abdominal pain, general malaise, and fatigue. However, articles did not mention poor outcomes for the infants. Most of the studies in this review were published in the past 3 years, indicating a possible increase in cases of women practicing carbohydrate restriction during lactation for weight loss caused by body dissatisfaction. In conclusion, carbohydrate restriction during lactation may be harmful to the lactating woman and contribute to the state of lactational ketoacidosis, but infant outcomes are mainly a change in feeding patterns. Thus, education on food and nutrition is necessary for this population.

Effects of a Person's Lactation History on Later-Life Development of Alzheimer's Disease: An Integrative Review.

Objective: The purpose of this integrative review is to assess the existing evidence regarding the effects of a person's lactation history on later-life development of Alzheimer's disease. Methods: The authors searched the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Excerpta Medica dataBASE, and performed backward reference searches using search terms such as, "Alzheimer's disease, dementia," and "breastfeeding, lactation." Authors selected relevant records through the application of inclusion and exclusion criteria and reading the titles, abstracts, or records in full. Results: In total, 400 articles were identified, and 10 articles meeting inclusion criteria were analyzed. Authors extracted data following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and scored levels of evidence according to Melnyk and Fineout-Overholt. Data were organized according to themes of breastfeeding duration, ever having breastfed, and indirect effects of breastfeeding. Conclusions: Breastfeeding may have neuroprotective effects for the lactating person and reduce the risk of later-life development of Alzheimer's disease. However, future research is necessary to determine the generalizability of this association.

Corrigendum: Structural and functional changes of bioactive proteins in donor human milk treated by vat-pasteurization, retort sterilization, ultra-high-temperature sterilization, freeze-thawing and homogenization.

[This corrects the article DOI: 10.3389/fnut.2022.926814.].

Sex differences and sex-specific regulation of motivated behavior by Melanin-concentrating hormone: a short review.

Recent preclinical research exploring how neuropeptide transmitter systems regulate motivated behavior reveal the increasing importance of sex as a critical biological variable. Neuropeptide systems and their central circuits both contribute to sex differences in a range of motivated behaviors and regulate sex-specific behaviors. In this short review, we explore the current research of how sex as a biological variable influences several distinct motivated behaviors that are modulated by the melanin-concentrating hormone (MCH) neuropeptide system. First, we review how MCH regulates feeding behavior within the context of energy homeostasis differently between male and female rodents. Then, we focus on MCH's role in lactation as a sex-specific process within the context of energy homeostasis. Next, we discuss the sex-specific effects of MCH on maternal behavior. Finally, we summarize the role of MCH in drug-motivated behaviors. While these topics are traditionally investigated from different scientific perspectives, in this short review we discuss how these behaviors share commonalities within the larger context of motivated behaviors, and that sex differences discovered in one area of research may impact our understanding in another. Overall, our review highlights the need for further research into how sex differences in energy regulation associated with reproduction and parental care contribute to regulating motivated behaviors.