Pregnancy, lactation and hormones | Open Access Government

Here, Dr. Fiona MacRae, women’s health and hormone specialist at the Marion Gluck Clinic, gives her expert opinion on pregnancy, breastfeeding and hormones.

Breastfeeding is the most natural way to nourish a newborn during the first months of life. “Breast is best” is the mantra, but best for whom? Does the evidence support the pro-breastfeeding movement? And if so, why does the UK have one of the lowest rates in Europe?

A source of nutrition for newborns

Breast milk is undoubtedly the optimal source of nutrition for newborn babies. It is recommended that breastmilk be used exclusively up to six months of age, followed by free breastfeeding up to 12 months and beyond. This is supported by several professional and medical organisations, including the World Health Organization (WHO), the Royal College of Pediatric and Child Health (RCPCH) and Public Health England (PHE).

In addition to the ideal balance of macronutrients, minerals and water, breast milk has anti-inflammatory, antibiotic and immunomodulatory properties that protect the developing infant against infections, including gastroenteritis and diarrhea; the life-threatening gastrointestinal infection necrotizing enterocolitis; middle ear infections and urinary tract infections resulting in reduced hospital admissions for all causes of sepsis.

Breastfed babies are less likely to suffer from sudden infant death syndrome, asthma, allergies and dental malocclusion.

Breast milk is rich in digestive enzymes such as protease, which aid infant digestion, as well as growth factors, gut mediators and amino acids to stimulate gastrointestinal function and the development of the gut microbiome. Additionally, close skin-to-skin contact is thought to have neurobehavioral benefits and even analgesic effects, reducing stress and crying, especially in response to pain.

There are several appealing benefits for new moms and evidence-based health benefits. The initiation of breastfeeding is associated with an increase in oxytocin, one of whose functions is to contract the uterus and thus reduce postpartum bleeding. Breastfeeding provides contraceptive benefit due to ongoing elevated circulating prolactin, which inhibits gonadotropin release and ovulation. It is also essential for weight loss after pregnancy. More calories are burned in breast milk production while elevated circulating oxytocin stimulates fat burning.

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Breastfeeding promotes the mobilization and metabolism of visceral fat, thereby reducing the incidence of type 2 diabetes. In addition, lactation improves glucose tolerance and insulin sensitivity. It is proven to reduce the production and release of cortisol, the stress hormone. Stress reduction continues throughout the breastfeeding period. Oxytocin also strengthens the bond between mother and baby, triggering positive emotions. There are also long-term benefits for breastfeeding mothers; evidence supports reduced risk of breast, ovarian and endometrial cancer.

While breastfeeding, it is essential to ensure a healthy and balanced diet consisting of lean proteins, fatty fish, complex carbohydrates and plenty of fruits and vegetables. Adequate dairy intake provides essential nutrients such as calcium. Milk can be fortified with vitamin D, and some groups recommend that breastfed babies get more vitamin D. Mothers on restrictive diets, such as a vegan diet, may need to take vitamin B supplements while breastfeeding . Overall calorie intake may need to be increased. Attention to maternal nutrition is essential for mother and baby during breastfeeding.

From an economic point of view, in addition to the obvious financial savings for breastfeeding mothers, it is estimated that breastfeeding could benefit the NHS by reducing GP consultations and hospital admissions, not to mention the savings resulting from reducing the use of antibiotics.

To what extent do women in the UK breastfeed?

In the UK, nearly three-quarters of women choose to breastfeed when their child is born; however, about 40% stop breastfeeding within six to eight weeks. A survey commissioned by PHE revealed a variety of reasons, including mothers’ concerns that babies were not getting the right nutrients or that they might be underfeeding or overfeeding their babies. Pressure from helpful parents may cause new mothers to supplement breastfeeding with formula, but this only undermines milk supply, which is triggered by the suckling.

There are also societal attitudes that can increase discomfort when breastfeeding in public. 63% of women surveyed by PHE said they would feel embarrassed breastfeeding in front of strangers. Breastfeeding prevalence is particularly low among young mothers from lower socioeconomic groups. Clearly, given the benefits described, this disparity will lead to increased health inequalities, and this is a concern of PHE.

Key messages for healthcare professionals

The RCPCH presents key messages for healthcare professionals stating that “all child healthcare professionals have a responsibility to be aware of specialist advice and local services to support breastfeeding, in order to guide mothers effectively”. (1) Interestingly, the promotion of infant formula and the provision of free samples of formula to new mothers are now banned by the WHO. Of course, some mothers cannot or choose not to breastfeed, and this should be respected, but because of the health and wealth benefits, breastfeeding is actively encouraged and supported by the medical profession. This often requires ongoing encouragement and reassurance for new moms. Babies are intelligent little beings and are quite capable of meeting their own needs, given a nurturing and supportive environment. As we have seen, many mothers choose to breastfeed at first and then drift to formula. This is where the timely support of a friendly health visitor could make all the difference.

There may also be a place for hormonal support. It is estimated that up to one in seven new mothers suffer from postpartum depression (PPD) due to a drop in progesterone. Breastfeeding mothers have a lower incidence of PPD, and PPD is associated with a decreased incidence of breastfeeding. Progesterone is a feel-good hormone and transdermal application in some women offers a safe and natural approach to PPD, leaving mothers happier and better able to take care of their babies, including successful breastfeeding.

1. https://www.rcpch.ac.uk/resources/breastfeeding-uk-position-statement#key-messages-for-health-professionals

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