Pregnancy, Breastfeeding and Hormones | Open Access Government

Here Dr Fiona MacRae, Women’s Health & Hormone Specialist at The Marion Gluck Clinic, provides an expert view on pregnancy, breastfeeding and hormones

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

A source of nutrition for newborn babies

Breast milk is undoubtedly the optimal source of nutrition for newborn babies. It is recommended to use exclusively breast milk up to six months of age, followed by free breastfeeding for 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 baby from infections, including gastroenteritis and diarrhea; the potentially fatal gastrointestinal infection necrotizing enterocolitis; middle ear infections and urinary tract infections resulting in reduced hospitalizations for all causes of sepsis.

Breastfed babies are less likely to experience sudden infant death, asthma, allergies and dental abnormalities.

Breast milk is rich in digestive enzymes such as protease, which aids baby’s digestion, as well as growth factors, intestinal mediators and amino acids to boost gastrointestinal function and the development of the gut microbiome. In addition, 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 attractive benefits for new mothers and proven health benefits. Initiation of breastfeeding is associated with a rise in oxytocin, one function of which is to contract the uterus and thus reduce postpartum bleeding. Breastfeeding provides a contraceptive advantage because of the sustained high circulating prolactin, which inhibits gonadotropin release and ovulation. It is also key to weight loss after pregnancy. More calories are burned in the production of breast milk, while high circulating oxytocin stimulates fat burning.

© Thien Woei Jiing

Breastfeeding stimulates the mobilization and metabolism of visceral fat, reducing the incidence of type 2 diabetes. In addition, breastfeeding improves glucose tolerance and insulin sensitivity. There is some evidence that it reduces the production and release of the stress hormone cortisol. The reduction in stress continues throughout the breastfeeding period. Oxytocin also improves the bond between mother and baby, generating 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 vital to ensure a healthy, balanced diet of lean protein, 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 receive extra vitamin D. Mothers on a restrictive diet, such as a vegan diet, may need to take vitamin B supplements while breastfeeding. Overall calorie intake may need to be increased. Attention to the mother’s nutrition is essential for both mother and baby during breastfeeding.

From an economic perspective, it is estimated that, apart from the obvious financial savings for breastfeeding mothers, breastfeeding could benefit the NHS by reducing GPs and hospital admissions, not to mention the savings from reduced antibiotic use.

To what extent do women in the UK breastfeed?

In the UK, almost three quarters of women choose to breastfeed when their child is born; however, about 40% stop breastfeeding within six to eight weeks. A PHE-commissioned study revealed several reasons, including mothers’ concerns that babies aren’t getting the right nutrients or that they may be underfeeding or overfeeding their babies. Pressure from helpful family members may encourage new mothers to supplement breastfeeding with formula, but this only serves to undermine the milk supply caused by suckling.

There are also societal attitudes that can increase the discomfort of breastfeeding in public. 63% of women surveyed by PGO said they would be embarrassed to breastfeed in front of strangers. The prevalence of breastfeeding is particularly low among young mothers from lower socio-economic groups. It is clear that, given the benefits described, this disparity will lead to an increase in health inequalities, and this is a concern for PHE.

Key messages for health professionals

RCPCH outlines key messages for health professionals stating that “all child health professionals have a responsibility to be aware of specialist advice and local services to support breastfeeding, in order to effectively educate mothers”. (1) Interestingly, the promotion of infant formula and the provision of free formula samples to new mothers has now been banned by the WHO. Of course, some mothers are unable or unwilling to breastfeed, and this should be respected, but due to health and welfare benefits, breastfeeding is actively encouraged and supported by the medical profession. This often requires constant encouragement and reassurance from young mothers. Babies are smart little creatures and are quite capable of satisfying their own needs given a conducive and supportive environment. As we have seen, many mothers choose to breastfeed initially, but then switch to bottle feeding. It is here that timely support from a sympathetic health visitor can make all the difference.

There may also be room for hormonal support. It is estimated that as many as one in seven new mothers experience postpartum depression (PPD) due to falling progesterone. Breastfeeding mothers have a lower incidence of PPD and PPD is associated with a reduced incidence of breastfeeding. Progesterone is a feel-good hormone and transdermal application in selected women provides a safe and natural approach to PPD, leaving mothers happier and better able to care for 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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Pregnancy, Breastfeeding and Hormones | Open Access Government

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