Restricted accessResearch articleFirst published online 2022-02
Prepregnancy Body Mass Index Is Associated with Time-Dependent Changes in Secretory Activation Measures During the First 7 Days Postpartum in Breast Pump-dependent Mothers of Premature Infants
Little is known about the biology of secretory activation (SA) in overweight and obese (OW/OB) mothers who are breast pump dependent with a premature infant in the neonatal intensive care unit.
Objective:
To compare time-dependent changes in daily pumped milk volume, maternal milk sodium (Na) concentration, and Na-to-potassium (K) ratios (Na:K) in the first 14 days postpartum in breast pump-dependent mothers with prepregnancy body mass index (BMI) <27 and BMI ≥27 kg/m2.
Design/Methods:
This secondary analysis for 39 subjects, 44% (n = 17) with prepregnancy BMI <27 and 56% (n = 22) with BMI ≥27, included transformed data of outcome measures, chi-square, t-tests, and growth curve models.
Results:
For days 1–7, daily pumped milk volume increased significantly more rapidly for mothers with BMI <27 (65.82 mL/d) versus BMI ≥27 (33.08 mL/d), but the daily rate of change in pumped milk volume during days 8–14 was not statistically different. Daily milk Na concentration decreased significantly faster in BMI <27 (−3.93 mM/d) versus BMI ≥27 (−2.00 mM/day) during days 1–7, but was not significantly different for days 8–14. No statistical differences were noted for Na:K ratio for either time period.
Conclusion:
These data add biologic evidence to previous research, suggesting delayed or impaired SA in OW/OB mothers, and suggest that the window of opportunity for research and clinical interventions is days 1–7 postpartum in this population.
Get full access to this article
View all access options for this article.
References
1.
ChangYS, GlariaAA, DavieP, et al.Breastfeeding experiences and support for women who are overweight or obese: A mixed-methods systematic review. Matern Child Nutr, 2020; 16:e12865.
2.
MartinH, Thevenet-MorrisonK, DozierA. Maternal pre-pregnancy body mass index, gestational weight gain and breastfeeding outcomes: A cross-sectional analysis. BMC Pregnancy Childbirth, 2020; 20:1–10.
3.
DriscollAK, GregoryECV. Increases in prepregnancy obesity: United states, 2016–2019. NCHS Data Brief, 2020; 392:1–8.
HauffLE, DemerathEW. Poor positioning, decreased prolactin levels, and low milk output associated with early cessation of exclusive breastfeeding in obese women. FASEB J 2012;26:368.2.
6.
PostonL, CaleyachettyR, CnattingiusS, et al.Preconceptional and maternal obesity: Epidemiology and health consequences. Lancet Diabetes Endocrinol, 2016; 4:1025–1036.
7.
SnowdenJM, MissionJF, MarshallNE, et al.The impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects. Obesity, 2016; 24:1590–1597.
8.
LynchTA, MalsheA, ColihanS, et al.Impact of maternal obesity on perinatal outcomes in preterm prelabor rupture of membranes ≥34 weeks. Am J Perinatol, 2020; 37:467–474.
9.
LoveladyCA. Is maternal obesity a cause of poor lactation performance. Nutr Rev, 2005; 63:352–355.
10.
StuebeAM, HortonBJ, ChetwyndE, et al.Prevalence and risk factors for early, undesired weaning attributed to lactation dysfunction. J Womens Health, 2014; 23:404–412.
11.
MarshallNE, LallandeLF, SchedinPJ, et al.Exclusive breastfeeding rates at 6 weeks postpartum as a function of preconception body mass index are not impacted by postpartum obstetrical practices or routines. Breastfeed Med, 2020; 15:458.
12.
Medina PoelinizC, EngstromJL, HobanR, et al.Measures of secretory activation for research and practice: An integrative review. Breastfeed Med, 2020; 15:191–212.
13.
Nommsen-RiversAL. Does insulin explain the relation between maternal obesity and poor lactation outcomes? an overview of the literature. Adv Nutr, 2016; 7:407–414.
14.
O'SullivanEJ, PerrineCG, RasmussenKM. Early breastfeeding problems mediate the negative association between maternal obesity and exclusive breastfeeding at 1 and 2 months postpartum. J Nutr, 2015; 145:2369–2378.
15.
ChapmanDJ, MorelK, Bermúdez-MillánA, et al.Breastfeeding education and support trial for overweight and obese women: A randomized trial. Pediatrics, 2013; 131:e162–e170.
16.
HobanR, BiggerHR, PatelAL, et al.Goals for human milk feeding in mothers of very low birth weight infants: How do goals change and are they achieved during the NICU hospitalization?. Breastfeed Med, 2015; 10:35–311.
17.
MeierPP, PatelAL, BiggerHR, et al.Supporting breastfeeding in the neonatal intensive care unit: Rush mother's milk club as a case study of evidence-based care. Pediatr Clin North Am, 2013; 60:209–226.
18.
ChantryCJ, DeweyKG, PeersonJM, et al. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr 2014;164:1339–1345.e5.
19.
GarnerCD, McKenzieSA, DevineCM, et al.Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: Discoveries from a longitudinal, qualitative study. Matern Child Nutr, 2017; 13:e12344.
20.
ClaessonIM, LarssonL, SteenL, et al.“You just need to leave the room when you breastfeed” breastfeeding experiences among obese women in Sweden–A qualitative study. BMC Pregnancy Childbirth, 2018; 18:1–10.
21.
MassovL. Clinically overweight and obese mothers and low rates of breastfeeding: Exploring women's perspectives. J N Z Coll Midwives, 2015; 51:23–29.
22.
Nommsen-RiversLA, DolanLM, HuangB. Timing of stage II lactogenesis is predicted by antenatal metabolic health in a cohort of primiparas. Breastfeed Med, 2012; 7:43–49.
23.
MarchiJ, BergM, DenckerA, et al.Risks associated with obesity in pregnancy, for the mother and baby: A systematic review of reviews. Obes Rev, 2015; 16:621–638.
24.
RobinsonDT, JosefsonJ, Van HornL. Considerations for preterm human milk feedings when caring for mothers who are overweight or obese. Adv Neonatal Care, 2019; 19:361–370.
25.
HobanR, PatelAL, Medina PoelinizC, et al.Human milk biomarkers of secretory activation in breast pump-dependent mothers of premature infants. Breastfeed Med, 2018; 13:352–360.
26.
ParkerLA, SullivanS, CachoN, et al.Indicators of secretory activation in mothers of preterm very low birth weight infants. J Hum Lact, 2021; 37:581–592.
27.
ParkerLA, KruegerC, SullivanS, et al.Demographic, social, and personal factors associated with lactation cessation by 6 weeks in mothers of very low birth weight infants. J Hum Lact, 2021; 37:511–520.
28.
HillPD, AldagJC, DemirtasH, et al.Association of serum prolactin and oxytocin with milk production in mothers of preterm and term infants. Biol Res Nurs, 2009; 10:340–349.
29.
GreeneMM, RossmanB, PatraK, et al.Depression, anxiety, and perinatal-specific posttraumatic distress in mothers of very low birth weight infants in the neonatal intensive care unit. J Dev Behav Pediatr, 2015; 36:362–370.
30.
HobanR, Medina PoelinizC, SomersetE, et al.Mother's own milk biomarkers predict coming to volume in pump-dependent mothers of preterm infants. J Pediatr, 2021; 228:44–52.
31.
NevilleMC, KellerR, SeacatJ, et al.Studies in human lactation: Milk volumes in lactating women during the onset of lactation and full lactation. Am J Clin Nutr, 1988; 48:1375–1386.
32.
McManamanJL, NevilleMC. Mammary physiology and milk secretion. Adv Drug Deliv Rev, 2003; 55:629–641.
33.
NevilleMC. Anatomy and physiology of lactation. Pediatr Clin North Am, 2001; 48:13–32.
34.
Esquerra-ZwiersA, VroomA, GeddesD, et al.Use of a portable point-of-care instrumentation to measure human milk sodium and potassium concentrations. Breastfeed Med, 2022; 17:46–51.
35.
DanknerR, ShanikM, RothJ, et al.Sex and ethnic-origin specific BMI cut points improve prediction of 40-year mortality: The Israel GOH study. Diabetes Metabol Res Rev, 2015; 31:530–536.
36.
FlegalKM, KitBK, OrpanaH, et al.Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis. JAMA, 2013; 309:71–82.
37.
Breastmilk ecology: Genesis of infant nutrition (BEGIN) meeting series, working group 1: Maternal inputs. Available at https://videocast.nih.gov/watch=40150 (accessed January15, 2021). NIH Streaming, United States; 2021.
HilsonJA, RasmussenKM, KjolhedeCL. Maternal obesity and breast-feeding success in a rural population of white women. Am J Clin Nutr, 1997; 66:1371–1378.
40.
RasmussenKM, KjolhedeCL. Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum. Pediatrics, 2004; 113:e465–e471.
41.
RutishauserHEI, CarlinJB. Body mass index and duration of breast feeding: A survival analysis during the first six months of life. J Epidemiol Commun Health (1979), 1992; 46:559–565.
42.
HilsonJA, RasmussenKM, KjolhedeCL. High prepregnant body mass index is associated with poor lactation outcomes among white, rural women independent of psychosocial and demographic correlates. J Hum Lact, 2004; 20:18–29.
43.
ChapmanDJ, Perez-EscamillaR. Identification of risk factors for delayed onset of lactation. J Am Diet Assoc, 1999; 99:450–454.
44.
WooJG, McMahonRJ, Nommsen-RiversAL, et al.Maternal pre-pregnancy BMI independently predicts breastfeeding duration among successfully breastfeeding mothers. Obesity, 2010; 18(S2):S188.
45.
Nommsen-RiversLA, ChantryCJ, PeersonJM, et al.Delayed onset of lactogenesis among first-time mothers is related to maternal obesity and factors associated with ineffective breastfeeding. Am J Clin Nutr, 2010; 92:574–584.
46.
RasmussenKM, DieterichCM, ZelekST, et al.Interventions to increase the duration of breastfeeding in obese mothers: The Bassett improving breastfeeding study. Breastfeed Med, 2011; 6:69–75.
47.
CarlsenEM, KyhnaebA, RenaultKM, et al.Telephone-based support prolongs breastfeeding duration in obese women: A randomized trial. Am J Clin Nutr, 2013; 98:1226–1232.
48.
MeierPP, JohnsonTJ, PatelAL, et al.Evidence-based methods that promote human milk feeding of preterm infants: An expert review. Clin Perinatol, 2017; 44:1.
49.
JegierBJ, JohnsonTJ, EngstromJL, et al.The institutional cost of acquiring 100 mL of human milk for very low birth weight infants in the neonatal intensive care unit. J Hum Lact, 2013; 29:390–399.
50.
JohnsonTJ, PatelAL, BiggerHR, et al.Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants. Neonatology, 2015; 107:271–276.
51.
PatelAL, JohnsonTJ, MeierPP, et al.Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units. Pediatr Res, 2020; 89:1–9.
52.
HillPD, JohnsonTS. Assessment of breastfeeding and infant growth. J Midwifery Womens Health, 2007; 52:571–578.
53.
LaiCT, GardnerH, GeddesD. Comparison of inductively coupled plasma optical emission spectrometry with an ion-selective electrode to determine sodium and potassium levels in human milk. Nutrients, 2018; 10:1218.
54.
SingerJD, WillettJB. Applied Longitudinal Data Analysis: Modeling Changed and Event Occurrence. Oxford, UK: Oxford University Press, 2003.
55.
DurlakJA. How to select, calculate, and interpret effect sizes. J Pediatr Psychol, 2009; 34:917–928.
56.
TurcksinR, BelS, GaljaarS, et al.Maternal obesity and breastfeeding intention, initiation, intensity and duration: A systematic review. Matern Child Nutr, 2014; 10:166–183.
57.
PreustingI, BrumleyJ, OdiboL, et al.Obesity as a predictor of delayed lactogenesis II. J Hum Lact, 2017; 33:684–691.
58.
MeierPP, EngstromJL, JanesJE et al. Breast pump suction patterns that mimic the human infant during breastfeeding: Greater milk output in less time spent pumping for breast pump-dependent mothers with premature infants. J Perinatol, 2012; 32:103–110.
59.
HumenickSS, HillPD, ThompsonHJ, et al.Breast-milk sodium as a predictor of breastfeeding patterns. Can J Nurs Res, 1998; 30:67–81.
60.
KairLR, ColaizyTT. Obese mothers have lower odds of experiencing pro-breastfeeding hospital practices than mothers of normal weight: CDC pregnancy risk assessment monitoring system (PRAMS), 2004–2008. Matern Child Health J, 2016; 20:593–601.
61.
SwansonV, KeelyA, DenisonFC. Does body image influence the relationship between body weight and breastfeeding maintenance in new mothers?. Br J Health Psychol, 2017; 22:557–576.
62.
NevilleMC, WebbP, RamanathanP, et al.The insulin receptor plays an important role in secretory differentiation in the mammary gland. Am J Physiol Endocrinol Metab, 2013; 305:1103–1114.
63.
LeeS, KelleherSL. Biological underpinnings of breastfeeding challenges: The role of genetics, diet, and environment on lactation physiology. Am J Physiol Endocrinol Metab, 2016; 311:E405–E422.
64.
SabenJL, AbrahamA, BodeL, et al.Third-trimester glucose homeostasis in healthy women is differentially associated with human milk oligosaccharide composition at 2 months postpartum by secretor phenotype. Nutrients, 2020; 12:1–15.
65.
KeelyA, LawtonJ, SwansonV, et al.Barriers to breast-feeding in obese women: A qualitative exploration. Midwifery, 2015; 31:532–539.
66.
ÁlvarezD, MuñozY, OrtizM, et al.Impact of maternal obesity on the metabolism and bioavailability of polyunsaturated fatty acids during pregnancy and breastfeeding. Nutrients, 2020; 13:19.
67.
KairLR, NickelNC, JonesK, et al.Hospital breastfeeding support and exclusive breastfeeding by maternal prepregnancy body mass index. Matern Child Nutr, 2019; 15:e12783.
68.
MeierPP, EngstromJL, HurstNM, et al.A comparison of the efficiency, efficacy, comfort, and convenience of two hospital-grade electric breast pumps for mothers of very low birthweight infants. Breastfeed Med, 2008; 3:141–150.
69.
MeierPP, PatelAL, HobanR, et al.Which breast pump for which mother: An evidence-based approach to individualizing breast pump technology. J Perinatol, 2016; 36:493–499.
70.
MeierPP, JohnsonTJ, PatelAL, et al.Evidence-based methods that promote human milk feeding of preterm infants. Clin Perinatol, 2016; 44:1–22.
71.
HobanR, McLeanL, SullivanS. Proactive lactation care is associated with improved outcomes in a referral NICU. J Hum Lact, 2021; 890334421993467.
72.
PangW, HartmannPP. Initiation of human lactation: Secretory differentiation and secretory activation. J Mammary Gland Biol Neoplasia, 2007; 12:211–221.
73.
MokE, MultonC, PiguelL, et al.Decreased full breastfeeding, altered practices, perceptions, and infant weight change of prepregnant obese women: A need for extra support. Pediatrics, 2008; 121:e1319–e1324.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
