Barriers to receiving adequate prenatal care

One hundred eleven postpartum patients who received varying amounts of prenatal care (no care, inadequate care, intermediate care, and adequate care) were assessed for demographic, medical and sociocultural factors by interview and review of the medical chart. Six sociocultural factors identified by stepwise multiple regression contributed to 49% of the variance for amount of prenatal care: amount of insurance, attitudes toward health professionals, delays in suspecting pregnancy, delay in telling others about the pregnancy, perception of the importance of prenatal care, and initial attitudes about being pregnant. Results are discussed in terms of developing outreach programs altered to the patient's needs and life-styles.     

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.     

Exposure to mother's pregnancy and lactation in infancy is associated with sexual attraction to pregnancy and lactation in adulthood

IntroductionSeveral theories, including psychodynamic theories, sexual imprinting and early conditioning have been formulated to explain sexual development. Empirical data, however, remain insufficient for a thorough evaluation of these theories.AimIn this study, we test the hypothesis that a critical period exists for the acquisition of sexual preferences, as suggested by empirical findings in birds and mammals (sexual imprinting).MethodsAn Internet questionnaire was used.Main Outcome MeasuresWe gather data from individuals with a sexual preference for pregnant and/or lactating women, under the hypothesis that pregnancy or lactation may become sexually attractive in adulthood following an exposure to pregnant or lactating women in infancy.ResultsWe find that these preferences are more common in older siblings, i.e., in individuals who have been exposed to more maternal pregnancy and lactation. This result is independent of respondent and sibling sex. In addition, only maternal pregnancies and lactations experienced between 1.5 and 5 years of age are associated with the preferences.ConclusionsWe discuss our findings in relation to theories of sexual development and to earlier reports of birth order effects on sexual behavior. We suggest that this age range may constitute a sensitive period for the acquisition of sexual preferences. Enquist M, Aronsson H, Ghirlanda S, Jansson L, and Jannini EA. Exposure to mother's pregnancy and lactation in infancy is associated with sexual attraction to pregnancy and lactation in adulthood.     

Use of parenteral nutrition to maintain adequate nutritional status in hyperemesis gravidarum

A retrospective study was performed to demonstrate that safe parenteral nutrition (PN) support can be given during pregnancy. There has been some hesitation to use PN during pregnancy partly due to the unknown consequences of the lipid emulsions in the PN solution. Twenty-three women received PN including lipid daily but at varying stages of pregnancy. The regimen was based on individual calculated requirements plus 300 kcal for pregnancy. Approximately 50% of the nonprotein calories were provided by lipid. At delivery, no gross abnormalities of the placenta were seen. The majority of the women (52%) received PN during the first trimester of pregnancy. The mean duration of PN therapy was 2.7 weeks (SE +/- 0.4) with a range of 0.5 to 7.5 weeks, and the mean weight gain on PN therapy was 2.4 lb (SE +/- 0.5). The majority of the women (84%) were able to gain appropriate weight to maintain the pregnancy. Although there was a 20% incidence of prematurity and a 30% incidence of low birthweight, this was not significantly different from the control group of women matched for age and parity. It was concluded that PN can provide a safe means of maintaining adequate maternal nutrition and continued fetal growth during a period when oral intake is severely curtailed. The nutrition regimen should include lipid and should be customized to meet the specific needs of each individual.     

Endocrinology of lactation

The endocrine control of lactation is one of the most complex physiologic mechanisms of human parturition. Mammogenesis, lactogenesis, galactopoiesis, and galactokinesis are all essential to assure proper lactation. Prolactin is the key hormone of lactation and seems to be the single most important galactopoietic hormone. Oxytocin, serotonin, opioids, histamine, substance P, and arginine-leucine modulate prolactin release by means of an autocrine/paracrine mechanism, whereas estrogen and progesterone hormones can act at the hypothalamic and adenohypophysial levels. Human placental lactogen and growth factors play an essential role to assure successful lactation during pregnancy. Oxytocin is the most powerful galactokinetic hormone.     

Contraception and lactation

The benefits of breastfeeding for both the infant and the mother are undisputed. Longer intervals between births decrease fetal/infant and maternal complications. Lactation is an effective contraceptive for the first 6 months postpartum only if women breastfeed exclusively and at regular intervals, including nighttime. Because a high percentage of women in the United States supplement breastfeeding, it is important for these women to choose a method of contraception to prevent unintended pregnancies. Both the method of contraception and the timing of the initiation of contraceptives are important decisions that a clinician must help the breastfeeding woman make. Ideally, the chosen method of contraception should not interfere with lactation. This article reviews the research on the effect of contraceptives, including hormonal contraceptives, on lactation.     

Pregnancy and lactation in relation to breast cancer risk.

In the past, numerous efforts have been made to define risk and protective factors of breast cancer. Among these, pregnancy and lactation have been extensively discussed in connection with breast cancer. Unfortunately, many of the reports on the protective effects of pregnancy and lactation are equivocal; caution needs to be exercised when interpreting the results of a single publication. Development of breast cancer is often preceded by the occurrence of preneoplastic mammary lesions, which may be the result of long-term exposure to estrogens and prolactin. Since endogenous estrogen levels regulate pituitary prolactin secretion to some extent, it has been postulated that a hormonal imbalance exists in early mammary carcinogenesis. Exogenous estrogens directly increase pituitary prolactin secretion. During gestation, greatly increased levels of endogenous sex steroids efficiently stimulate pituitary prolactin secretion; during lactation, the stimulus of suckling is responsible for hyperprolactinemia. However, most studies did not reveal a cause-effect relationship between prolactin levels and enhanced risk of breast cancer. At present, the role of pregnancy and lactation in the development and prognosis of breast cancer is not determined.