Hello, my name is Sarah Graves and I am a junior nursing student at the
University of North Dakota.  I have recently joined this listserv
because of my interest in the importance of breast-feeding and ways to
promote it.  The topic that I found interesting while doing research was
the correlation between maternal obesity and poor breast-feeding and
lactation outcomes.  I thought this is an important issue because
breast-feeding has so many benefits.  For example, infants who were
breast-fed show better growth patterns and have a reduced risk of being
overweight later in life (Baker, Michaelsen, Rasmussen, & Sorensen,
2004).  I read about many studies that were done concerning
this matter and they seemed to all come to about the same conclusions.

    One study conducted by Li, Jewell, and Grummer-Strawn, (2003),
compared prepregnancy obesity or excessive weight gain during pregnancy
to a decrease in initiation and maintenance of breast-feeding.  They
found that women who were obese before pregnancy were less likely to
breast-feed than women who were of normal weight before pregnancy.  They
also found those women who had prepregnancy obesity and did breast-feed,
did so for an average of two weeks less than the women of normal
weights.

    A possible explanation for this low rate of successful
breast-feeding in obese mothers is that they may be experiencing delayed
onset of lactogenesis II.  The initiation of lactogenesis mostly relies
on an increase in prolactin secretion and a fall in the progesterone
levels which should occur after delivery.  Obese mothers may have an
elevated amount of progesterone compared to normal weight mothers due to
excess adipose tissue; therefore causing a delayed fall in progesterone
and lactogenesis (Hilson, Rasmussen, & Kjohede, 2004).  A study
conducted by Hilson, Rasmussen, and Kjolhede, (2004), compared the
onset of lactogenesis II in women with a prepregnant BMI of >26.1 to
women with a prepregnant BMI of <26.  They found that there was a
correlation between a later onset of lactogenesis in women with a
prepregnant BMI of >26.1.

    My questions are:  What factors do you think cause obese mothers to
breast-feed for shorter amounts of time than normal weight mothers?  Is
there any medical intervention to quicken the onset of lactogenesis in
obese mothers to help promote breast-feeding?  And finally, how often do
you personally see obese mothers have problems such as those mentioned
during breast-feeding?  Thank you so much for your time and your
responses are very much appreciated!

Sarah Graves, SN
University of North Dakota

References:

Baker, J., Michaelsen, K., Rasmussen, K., & Sorensen, T.  (2004).
    Maternal prepregnant body mass index, duration of breastfeeding, and
    timing of complementary food introduction are associated with infant
    weight gain.  American Journal of Clinical Nutrition, 80, 1579-1588.

Hilson, J., Rasmussen, K., & Kjolhede, C.  (2004).  High prepregnant BMI
    is associated with poor lactation outcomes among white, rural women
    independent of psychosocial and demographic correlates.  Journal of
    Human Lactation, 20(1), 18-29.

Li, R., Jewell, S., & Grummer-Strawn, L.  (2003).  Maternal obesity and
    breast-feeding practices.  American Journal of Clinical Nutrition, 77,
    931-936.

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