Early Milk Production Compromised in Overweight/Obese Mothers
By Megan Rauscher
NEW YORK (Reuters Health) May 03 - The prolactin response to suckling,
which is responsible for stimulating milk production early in lactation, is
diminished in the first postpartum week in new mothers who are overweight
or obese.
This finding provides a biological basis for why overweight and obese women
often give up on breastfeeding earlier than do normal-weight women, two
researchers from New York suggest in the May issue of Pediatrics.
"Our study shows that heavier women need even more support to be successful
breastfeeders," Dr. Kathleen M. Rasmussen from Cornell University in Ithaca
told Reuters Health. "In practical terms, this means encouraging heavier
women to seek help from lactation counselors and scheduling early follow-up
appointments in the first days and weeks after birth."
Previously, Dr. Rasmussen and colleagues observed that being overweight or
obese negatively affects lactational performance. While overweight and
obese women are as likely as normal-weight women to initiate breastfeeding,
they are less likely continue. (see Reuters Health report January 2, 1998)
"In our other research, psychosocial characteristics such as self-efficacy
for breastfeeding in heavier women did not seem to explain their short
duration of breastfeeding," Dr. Rasmussen said.
"We proposed in our study that the normal increase in prolactin
concentration in response to infant feeding might be affected by obesity,"
she said.
Dr. Rasmussen and Dr. Chris L. Kjolhede from Bassett Healthcare Research
Institute in Cooperstown, measured serum prolactin and progesterone
concentrations before and 30 minutes after the beginning of a suckling
episode at 48 hours and 7 days after delivery.
In unadjusted analysis, women who were overweight or obese (BMI >26) before
conception had a lower prolactin response to suckling than normal-weight
women at 48 hours but not 7 days postpartum. In multivariate analysis,
overweight/obesity, primiparity, and birth weight correlated negatively
with the 48-hour prolactin response to suckling.
In further analyses adjusting for time since delivery and the duration of
the suckling episode, "only overweight/obesity remained a significant
negative predictor" of prolactin response to suckling at day 7 postpartum.
This diminished prolactin response to suckling "would be expected" to
compromise the ability of overweight/obese women to produce milk, and may
contribute to early cessation of breastfeeding, the researchers suggest.
It is "important" to note, Dr. Rasmussen said, that "heavier women can be
successful breastfeeders, but they need more support than normal-weight
women."
In this study, concentrations of progesterone were not markedly different
between overweight and normal-weight women, a finding that does not support
the hypothesis that higher progesterone concentrations in overweight/obese
women might delay lactogenesis, the team notes.
Pediatrics 2004;113:e465-e471.
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