Breastfeeding Multiples: It Can Be Done

The recognition of the benefits of breastfeeding and the perils of formula feeding makes it incumbent upon the nursing profession to become knowledgeable in the realm of evidence-based care for all breastfeeding women. This is even more apparent with the rise in the number of multiple births and the potential subsequent sequelae that frequently arises from multiple gestations, that is, preterm births. Breastfeeding organizations such as La Leche League promote and support breastfeeding for women with multiple births. The aim of this article is to address those issues that hinder a mother's desire to breastfeed her twins, triplets, or even quadruplets. The numerous benefits of breastfeeding are elucidated together with guidelines for the health care professional to use in assisting the breastfeeding mother.     

Adaptive modulation of behavioural profiles by social stress during early phases of life and adolescence

The development of individual behavioural profiles can be powerfully influenced by stressful social experiences. Using a comparative approach, we focus on the role of social stressors for the modulation of behavioural profile during early phases of life and adolescence. For gregarious species, the stability of the social environment in which the pregnant and lactating female lives is of major importance for foetal brain development and the behavioural profile of the offspring in later life. Social instability during these critical periods of development generally brings about a behavioural and neuroendocrine masculinisation in daughters and a less pronounced expression of male-typical traits in sons. Moreover, when mothers live in a socially threatening world during this time, anxiety-like behaviour of their offspring often is elevated in adulthood. These effects of the social environment are likely to be mediated by maternal hormones and/or maternal behaviour. In addition, they can be modulated significantly by offspring genotype. We favour the hypothesis that the behavioural effects of social stress during this phase of life are not necessarily “pathological” (nonadaptive) consequences or constraints of adverse social conditions. Rather, mothers could be adjusting the offspring to their environment in an adaptive way. Adolescence is another period in which behavioural development is particularly susceptible to social influences. There is some evidence that stressful social events experienced at this time alter and canalize behaviour in an adaptive fashion, so that earlier influences on behavioural profile development can be complemented and readjusted, if necessary, to meet current environmental conditions. In terms of underlying neuroendocrine mechanism, a central role for the interaction of testosterone and stress hormones is suggested. In summary, the modulation of behavioural profiles by social stress from the prenatal phase through adolescence appears to represent an effective mechanism for repeated and rapid adaptation.     

哺乳期疤痕子宫人工流产手术方法及风险分析

目的:关于哺乳期疤痕子宫人流手术方法及风险分析。方法:对100例早孕患者中哺乳期疤痕子宫患者与正常早孕患者行人流手术风险对比。结果:哺乳期疤痕子宫组中手术并发症,出血量等显著多于正常组。结论:减少剖宫产率、产后计生宣教的落实,以及术前准备完善、术中规范操作,能有效地减少人流手术风险的发生。     

Infants of mothers with persistent nipple pain exert strong sucking vacuums

AIM: The objective of this study was to determine whether infants of mothers experiencing persistent nipple pain exerted very strong intraoral vacuums during a breastfeed. METHODS: Thirty mothers experiencing persistent pain during breastfeeding (Pain group; infants aged 49.4 +/- 35.5 days) were compared to 30 successfully breastfeeding mothers (Control group; infants aged 55.0 +/- 22.7 days). Infant intraoral vacuums were measured via a small milk-filled tube taped alongside the nipple and connected to a pressure transducer. Milk intake was measured using the test weigh method. RESULTS: Infants in the Pain group applied significantly stronger baseline (-90.8 +/- 54.5 vs. -56.4 +/- 31.4 mmHg, p = 0.004), peak (-214.3 +/- 60.5 vs. 163.2 +/- 62.4 mmHg, p = 0.002) and pause vacuums (-104.8 +/- 67.9 vs. -45.8 +/- 30.3 mmHg, p < 0.001). Despite similar active sucking times (377.5 +/- 175.2 vs. 349.4 +/- 184.0 sec, p = 0.554) the mean milk intake was significantly lower for infants of mothers with nipple pain (41.6 +/- 31.3 vs. 70.7 +/- 30.7 g, p = 0.001). CONCLUSION: Infants of breastfeeding mothers experiencing persistent nipple pain applied significantly higher vacuum to the breast during breastfeeding despite assistance with positioning and attachment from a lactation consultant. Further investigation into the cause of the abnormally high vacuums is essential to develop successful interventions for these mother-infant dyads.     

哺乳期瘢痕子宫早孕流产方式的临床研究

目的 探讨哺乳期瘢痕子宫早孕流产方式的选择及注意事项.方法 回顾性分析312例非意愿妊娠要求流产的哺乳期瘢痕子宫患者的临床资料,按其流产方式分为人工流产组(92例)、药物流产组(98例)和米索前列醇联合吸宫术组(联合组,122例),对三组患者的流产效果、手术时间、术中出血、术后阴道流血时间、术后感染及药物不良反应等进行比较.结果 人工流产组和联合组完全流产率[97.8%(90/92)和99.2%(121/122)]明显高于药物流产组[77.6%(76/98)],术后阴道流血时间[(5.9±1.1)、(5.6±1.2)d]均明显低于药物流产组[(12.4±1.8)d],且术后感染及药物不良反应发生率低,与药物流产组比较差异均有统计学意义(P＜0.05).联合组与人工流产组比较,手术时间短、术中出血量少、Ⅲ级疼痛发生率低(P＜0.05).结论 米索前列醇联合吸宫术终止哺乳期瘢痕子宫早孕简化了流产手术步骤,出血少,对母婴影响较小,是一种理想的流产方式.     

Progestogen-only contraceptive use among breastfeeding women: a systematic review

Background

The use of progestogen-only contraceptives by breastfeeding women raises theoretical concerns regarding possible adverse effects on breastfeeding success, and infant health or growth. This review was conducted to determine from the literature whether use of progestogen-only contraceptives by breastfeeding women leads to adverse effects on lactation, or infant growth or health when compared to nonuse.

Study Design

We searched the Medline, Popline, Cochrane and LILACS databases for all articles published from database inception through May 2009. Studies were included if they investigated the use of progestogen-only methods in breastfeeding women and reported on clinical outcomes in either women or their infants. Standard data abstraction templates were used to systematically assess and summarize. Summary odds ratios were not calculated, given the heterogeneity of interventions, results and non-quantifiable outcomes reported.

Results

We identified 43 articles for this review. Overall, five randomized trials and 38 observational studies demonstrated no adverse effects of various progestogen-only methods of contraception on multiple measures of breastfeeding performance through 12 months in women using these methods in the postpartum period. Many of these studies also demonstrated no adverse effects of progestogen-only methods on infant growth, health or development from 6 months to 6 years of age. Additional studies demonstrated no effects on infant immunoglobulins or sex hormones of exposed male infants. A single study of a desogestrel pill reported two cases of gynecomastia in exposed infants.

Conclusions

Evidence suggests that progestogen-only methods of contraception do not adversely affect breastfeeding performance when used during lactation. Evidence that progestogen-only contraception does not adversely affect infant growth, health, or development when used by breastfeeding women is consistent but methodologically limited.     

Maternal intake of cashew nuts accelerates reflex maturation and facilitates memory in the offspring

Essential fatty acids, being indispensable during the stages of pregnancy, lactation and infancy influence the transmission of nerve impulses and brain function, and cashew nuts are a good source of these fatty acids. The objective of this study was to evaluate the effects of cashew nut consumption on reflex development, memory and profile of fatty acids of rat offspring treated during pregnancy and lactation. The animals were divided into three groups: Control (CONT), treated with 7% lipid derived from soybean oil; Normolipidic (NL) treated with 7% lipids derived from cashew nuts; and Hyperlipidic (HL) treated with 20% lipids derived from cashew nuts. Reflex ontogeny, Open-field habituation test and the Object Recognition Test (ORT) were assessed. The profile of fatty acids in the brain was carried out when the animals were zero, 21 and 60 days old. Accelerated reflex maturation was observed in animals treated with cashew nuts (p < 0.05). NL presented better memory in the Open-field habituation test; the NL and HL showed improvement of short-term memory in the ORT, but long term damage in HL (p < 0.05). The results of the lipid profile of the brain at the end of the experiment showed an increase in levels of saturated fatty acids and less Docosahexaenoic acid (DHA) in animals of the HL. The data showed that maternal consumption of cashew nuts can accelerate reflex maturation and facilitate memory in offspring when offered in adequate quantities.     

Bone metabolism during pregnancy

During pregnancy, mineral concentrations, of calcium and phosphorus in particular, are maintained at a high level in fetal blood so that the developing skeleton may accrete adequate mineral content. The placenta actively transports minerals for this purpose. Maternal intestinal absorption increases in order to meet the fetal demand for calcium, which is only partly dependent on calcitriol. Mineral regulation is essentially dependent on parathyroid hormone (PTH) and PTH-related protein (PTHrP). The calcium-sensing receptor (CaSR) regulates PTH and PTHrP production. If calcium intake is insufficient, the maternal skeleton will undergo resorption due to PTHrP. After birth, a switch from fetal to neonatal homeostasis occurs through increase in PTH and calcitriol, and developmental adaptation of the kidneys and intestines with bone turnover contributing additional mineral to the circulation. Calcium absorption becomes progressively active and dependent on calcitriol. The postnatal skeleton can transiently present with osteoposis but adequate mineral diet usually allows full restoration. Cases of primary osteoporosis must be identified. Loss of trabecular mineral content occurs during lactation in order to provide calcium to the newborn. This programmed bone loss is dependent on a “brain-breast-bone” circuit. The physiological bone resorption during reproduction does not normally cause fractures or persistent osteoporosis. Women who experience fracture are likely to have other causes of bone loss.     

Estradiol and progesterone modulation of angiotensin II receptors in the arcuate nucleus of ovariectomized and lactating rats

The expression of angiotensin II (Ang II) receptors in the brain is modulated by estradiol and progesterone. Considering that Ang II plays a critical role in controlling prolactin secretion and that neurons in the arcuate nucleus (ARC) are the main regulator of this function, the present study aimed to evaluate ARC Ang II receptor binding in 2 experimental models with different estradiol and progesterone plasma levels. Animals were divided into 4 groups: ovariectomy (OVX) plus oil vehicle, OVX plus estradiol and progesterone replacement, lactating rats on day 7 postpartum, and lactating rats on day 20. Animals were killed by decapitation, and the brains were removed. Ang II receptors were quantified by autoradiography in ARC. Trunk blood samples were collected, and plasma estradiol and progesterone were measured by radioimmunoassay. Treatment of OVX rats with estradiol and progesterone increased Ang II receptor binding when compared to OVX vehicle-treated animals. Plasma estradiol (r = +0.77) and progesterone (r = +0.87) were highly correlated with Ang II receptors in ovariectomized animals. Lactating rats (day 20) showed a significant decrease in Ang II receptor binding and plasma progesterone when compared to lactating rats (day 7), however, no difference was seen in plasma estradiol. Plasma levels of progesterone (r = +0.81), but not estradiol (r = +0.32), were highly correlated with Ang II receptors in lactating rats. In conclusion, present results show that ARC Ang II receptors decreases on day 20 of lactation compared to day 7 and are highly correlated with plasma progesterone, indicating a pivotal role for progesterone in this regulation.