Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on breast-milk output

Article Abstract:

People living on the Indonesian island of Madura are mildly undernourished when compared to similar populations of developed countries. Mothers on Madura were enrolled in a program of dietary supplementation during the last trimester of pregnancy and the period that their babies were breast-fed (lactation). Babies who were born to mothers who had given birth previously (multiparous mothers) and had received dietary supplementation during pregnancy were matched with control babies (matched for age, birth month, sex and location). Twins and babies of low birth weight were excluded from the study. Mothers and babies included in the study were measured at eight week intervals beginning from either two weeks or six weeks after birth. Measurement of lactation volume were made by measuring the baby's weight before and after nursing; the increase in weight being the amount of milk consumed. The activities of the mothers were also recorded during periods of observation at the same time that the breast-milk output measurements were being made. The activity patterns during the first seven months of lactation were light to moderate; nearly 50 percent of time was spent sleeping or resting. The short-term dietary supplementation that the mothers received during pregnancy had no effect on the volume of milk produced and there was no difference in any measured parameter between the experimental group (supplemented) and the nonsupplemented control group of women and babies. Breast-feeding frequency was the most important factor in determining breast-milk output from the mother. Those babies who were exclusively breast-fed received more milk than babies who received other foods (force feeding is a common and traditional practice in this area). The authors comment that lactating women who are not severely undernourished produce almost equal amounts of breast milk as women who are well nourished; for this reason no difference was seen in milk production between the mothers who did and did not receive supplements in their diet. It is also noted that the weights of the babies were influenced by the amount of breast milk produced and by their age. This research establishes the importance of breast feeding young infants in developing countries.

Measurement, Food and nutrition, Infants

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Milk composition and volume during the onset of lactation in a diabetic mother

Article Abstract:

Little research has been published concerning breast-feeding by diabetic mothers. One study found that the breast milk intake of infants with insulin-dependent diabetic mothers was lower than that of infants with non-diabetic mothers. Another study reported that nutrient concentrations in breast milk of diabetic women were within normal ranges, with the exception of glucose and sodium. A case study was performed with one insulin-dependent diabetic mother which measured milk volume and milk composition the first week after the baby's birth. The subject delivered by cesarean section at 37 weeks gestation and was unable to breast-feed initially because her infant was in intensive care. In order to initiate milk production, she used a breast pump five to seven times daily, from day three to day seven postpartum. By day five postpartum, her milk volume was within the range reported for a reference population of healthy women; However, it should be noted that the diabetic subject's milk was pumped, but the reference subjects that were used for comparison breast-fed their infants directly. Pumped milk volumes do not reflect the natural interaction of supply and demand that occurs during nursing. Thus, pumped milk volumes are not relevant in evaluating the nutrition of infants of diabetics. By day five postpartum, the subject's milk composition was normal for sodium, potassium, chloride, lactose, protein, calcium, magnesium and citrate. Milk fat content was slightly below normal and cholesterol content was at only 20 percent of normal levels. Analysis of fatty acid composition suggested that fatty acid synthesis in the mammary gland of this diabetic woman was impaired. The results indicate that maternal diabetes may alter mammary gland lipid metabolism in ways that affect breast milk composition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Complications and side effects, Physiological aspects, Diabetes, Diabetes mellitus, Diabetes in pregnancy, Gestational diabetes, Milk production

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Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry

Article Abstract:

In undernourished populations, nutritional supplementation of pregnant women has been reported to increase the average infant birth weight. However, the magnitude of this effect varies and in many cases is lower than expected. In addition, it is not clear whether prenatal supplementation is beneficial to the mother. The effect of prenatal energy supplementation was determined in a controlled, randomized study in Madura, East Java. Women between the 26th and 28th of gestation were given supplements of 465 kilocalories per day (HE group) or 52 kilocalories per day (LE group). There were 266 women in each group. Supplement intake varied between the two groups. Therefore, testing was done by dividing the two groups into six subcategories based on the amount of supplement consumed (HE groups one to three and LE groups one to three, corresponding to less than 45, 45 to 89, and 90 or more packets of supplement consumed). There were no significant differences among the six subcategories in third-trimester weight gain, skinfold thickness, four-week postpartum weight, or body mass index. The results indicate that, in this population, energy supplementation did not sufficiently improve maternal nutrition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Nutrition, Pregnancy, Diet therapy, Malnutrition, Malnutrition in pregnancy

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