PEDIATRICS Vol. 113 No. 5 May 2004, pp. e405-e411


Mothers' and Clinicians' Perspectives on Breastfeeding Counseling During
Routine Preventive Visits
Background. Recent national statistics indicate that, despite increases in
the proportion of mothers who initiate breastfeeding, the proportion that
continue to breastfeed their infants through 6 months of age remains below the
Healthy People 2010 goal of 50%. National professional organizations recommend that
clinicians routinely counsel mothers about the benefits of breastfeeding.
Little is known, however, about the counseling provided during these visits and
how mothers and their clinicians perceive breastfeeding counseling.
http://pediatrics.aappublications.org/cgi/content/abstract/113/5/e405?etoc

PEDIATRICS Vol. 113 No. 5 May 2004, pp. e435-e439

Breastfeeding and the Risk of Postneonatal Death in the United States
Objective. Breastfed infants in the United States have lower rates of
morbidity, especially from infectious disease, but there are few contemporary studies
in the developed world of the effect of breastfeeding on postneonatal
mortality. We evaluated the effect of breastfeeding on postneonatal mortality in
United States using 1988 National Maternal and Infant Health Survey (NMIHS) data.
http://pediatrics.aappublications.org/cgi/content/abstract/113/5/e435?etoc

PEDIATRICS Vol. 113 No. 5 May 2004, pp. e465-e471

Prepregnant Overweight and Obesity Diminish the Prolactin Response to
Suckling in the First Week Postpartum

Objective. The population subgroups with the highest proportion of overweight
and obese women often are characterized by the lowest rates of initiation and
shortest durations of breastfeeding. We previously documented that these 2
population-level trends may be related. In a population of white women who lived
in a rural area, we observed that prepregnant overweight and obesity were
associated with failure to initiate and also to sustain lactation. The means by
which being overweight or obese negatively affect lactational performance is
unknown and likely to be multifactorial in origin, including the simple
mechanical difficulties of latching on and proper positioning of the infant. In
addition, we have shown that prepregnant body mass index (BMI) is negatively
associated with the timing of lactogenesis II, the onset of copious milk secretion.
Although the effects of obesity on the prolactin response to infant suckling
have never been studied, we postulated that maternal obesity could compromise
this important response. We proposed that this might occur because obesity
alters the 24-hour spontaneous release of prolactin and also because prolactin
secretion is blunted in response to various stimuli among obese subjects. The fall
in progesterone concentration that occurs immediately postpartum is the
trigger for the onset of copious milk secretion, but maintenance of prolactin and
cortisol concentrations is necessary for this trigger to be effective. Adipose
tissue concentrates progesterone. We proposed that this additional source of
progesterone would lead to consistently higher progesterone concentrations
among obese compared with normal-weight women. This, in turn, would lead to a
delay in reaching the appropriate concentration to trigger the onset of
lactogenesis II. We tested the hypotheses that a reduced prolactin response to suckling
and higher-than-normal progesterone concentration in the first week after
delivery might be among the means by which maternal overweight could compromise
early lactation.
http://pediatrics.aappublications.org/cgi/content/abstract/113/5/e465?etoc

Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Nurturing Family Lactation and Parenting Services

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