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Abstract

Chinese

Background:

While prior studies have established associations between specific factors and delayed onset of Lactogenesis II, critical gaps remain in understanding how the timing of lactogenesis initiation dynamically affects macronutrient levels within 72 hours postpartum, and whether modifiable factors alter these relationships.

Research Aims:

To validate known risk factors for delayed lactogenesis in a Chinese population; characterize time-specific macronutrient changes; and evaluate how modifiable factors (e.g., gestational diabetes mellitus) influence human milk composition.

Methods:

In this prospective cohort study, 360 participants were interviewed during the first 24 hours postpartum in China. At 24-hour intervals, the onset of lactogenesis was determined based on maternal perception. The participants were divided into delayed onset of lactogenesis and onset of lactogenesis groups. Human milk samples were collected at 24, 48, and 72 hours postpartum, and their macronutrient content (lactose, fat, and protein) was determined using a human milk analyzer.

Results:

Approximately 23.6% (n = 85) of participants experienced delayed lactogenesis, which was significantly associated with gestational diabetes mellitus, Cesarean delivery, and pre-pregnancy body mass index ≥ 25.0 kg/m² (odds ratio [95% confidence interval] = 2.32 [1.20, 4.50], 2.02 [1.20, 3.41], and 2.75 [1.23, 6.18], respectively).

Lactose concentration was significantly lower in the delayed onset of lactogenesis group at 24 hours: Wald χ²(1) = 23.71, p < 0.001, and 48 hours: Wald χ²(1) = 8.26, p = 0.04, as well as in those with gestational diabetes at 24 hours postpartum: Wald χ²(1) = 9.60, p = 0.002.

Conclusion:

Beyond confirming known risk factors for delayed lactogenesis in China, our identification of time-dependent lactose deficiency highlights the need for lactose concentration monitoring within the first 48 hours postpartum.

Keywords

breastfeeding China human milk lactation lactogenesis macronutrients prospective studies risk factors

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References

American Diabetes Association. (2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37(Suppl. 1), S81–S90. https://doi.org/10.2337/dc14-S081

Arthur

P. G.

Smith

Hartmann

P. E.

(1989). Milk lactose, citrate, and glucose as markers of lactogenesis in normal and diabetic women. Journal of Pediatric Gastroenterology and Nutrition, 9(4), 488–496. https://doi.org/10.1097/00005176-198911000-00016

Association of Women’s Health, Obstetric and Neonatal Nurses. (2021). Breastfeeding and the use of human milk. Nursing for Women’s Health, 25(5), e4–e8. https://doi.org/10.1016/j.nwh.2021.06.005

Azulay Chertok

I. R.

Haile

Z. T.

Shuisong

Kennedy

(2020). Differences in human milk lactose and citrate concentrations based on gestational diabetes status. Breastfeeding Medicine, 15(12), 798–802. https://doi.org/10.1089/bfm.2020.0051

Chapman

D. J.

Pérez-Escamilla

(2000). Maternal perception of the onset of lactation is a valid, public health indicator of lactogenesis stage II. Journal of Nutrition, 130(12), 2972–2980. https://doi.org/10.1093/jn/130.12.2972

Chengdu Municipal Statistics Bureau. (2024). Bulletin on principal population data of Chengdu Municipality (2023). https://cdstats.chengdu.gov.cn/cdstjj/c154780/sjtj.shtml

Chengdu Women’s and Children’s Central Hospital. (2023). Hospital profile. Chengdu Women’s and Children’s Central Hospital. https://www.wcch.cn/introduce/

Cohen

J. E.

(1988). Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Inc. https://books.google.com/books/about/Statistical_Power_Analysis_for_the_Behavio.html?id=rEe0BwAAQBAJ

Cox

J. L.

Holden

J. M.

Sagovsky

(1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry: The Journal of Mental Science, 150(6), 782–786. https://doi.org/10.1192/bjp.150.6.782

10.

Faul

Erdfelder

Lang

A. G.

Buchner

(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146

11.

Hartmann

Cregan

(2001). Lactogenesis and the effects of insulin-dependent diabetes mellitus and prematurity. The Journal of Nutrition, 131(11), 3016S–3020S. https://doi.org/10.1093/jn/131.11.3016S

12.

Jiang

Duan

Y. F.

Pang

X. H.

Wang

Zhao

L. Y.

Yin

Yang

Z. Y.

(2016). Prevalence of delayed milk delivery in Chinese lactating mothers and its influencing factors in 2013. Chinese Journal of Preventive Medicine, 50(12), 1061–1066. https://doi.org/10.3760/cma.j.issn.0253-9624.2016.12.008

13.

Khan

Hepworth

A. R.

Prime

D. K.

Lai

C. T.

Trengove

N. J.

Hartmann

P. E.

(2013). Variation in fat, lactose, and protein composition in breast milk over 24 hours: Associations with infant feeding patterns. Journal of Human Lactation, 29(1), 81–89. https://doi.org/10.1177/0890334412448841

14.

Kulski

J. K.

Smith

Hartmann

P. E.

(1981). Normal and caesarian section delivery and the initiation of lactation in women. Australian Journal of Experimental Biology and Medical Science, 59(4), 405–412. https://doi.org/10.1038/icb.1981.34

15.

Kung

W. Y.

Yue

S. F.

S. T.

(2019). Effect of intravenous analgesia with dizocin on changes in breast milk nutrient composition after cesarean section. Shanxi Medical Journal, 48(20), 2459–2462. https://doi.org/10.3969/j.issn.0253-9926.2019.20.001

16.

Lau

Wang

Yin

Chan

K. S.

Guo

(2010). Validation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale in Chengdu mothers. International Journal of Nursing Studies, 47(9), 1139–1151. https://doi.org/10.1016/j.ijnurstu.2010.02.005

17.

Lawrence

R. A.

(2022). Physiology of lactation. In Lawrence

R. A.

Lawrence

R. M.

(Eds.), Breastfeeding (9th ed., pp. 58–92). Elsevier. https://www.sciencedirect.com/science/article/pii/B9780323680134000031

18.

Wupuer

Hou

(2024). Factors influencing delayed onset of lactogenesis: A scoping review. International Journal of General Medicine, 17, 2311–2326. https://doi.org/10.2147/IJGM.S452108

19.

Matias

S. L.

Dewey

K. G.

Quesenberry

C. P.

Gunderson

E. P.

(2014). Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. American Journal of Clinical Nutrition, 99(1), 115–121. https://doi.org/10.3945/ajcn.113.073049

20.

Mauri

P. A.

Contini

N. N.

Giliberti

Barretta

Consonni

Negri

Di Benedetto

(2015). Intrapartum epidural analgesia and onset of lactation: A prospective study in an Italian birth centre. Maternal and Child Health Journal, 19(3), 511–518. https://doi.org/10.1007/s10995-014-1532-x

21.

Medina Poeliniz

Engstrom

J. L.

Hoban

Patel

A. L.

Meier

(2020). Measures of secretory activation for research and practice: An integrative review. Breastfeeding Medicine, 15(4), 191–212. https://doi.org/10.1089/bfm.2019.0247

22.

Mullen

A. J.

O’Connor

D. L.

Hanley

A. J.

Piedimonte

Wallace

Ley

S. H.

(2022). Associations of metabolic and obstetric risk parameters with timing of lactogenesis II. Nutrients, 14(4), 876. https://doi.org/10.3390/nu14040876

23.

Neville

M. C.

Webb

Ramanathan

Mannino

M. P.

Pecorini

Monks

Anderson

S. M.

MacLean

(2013). The insulin receptor plays an important role in secretory differentiation in the mammary gland. American Journal of Physiology. Endocrinology and Metabolism, 305(9), E1103–E1114. https://doi.org/10.1152/ajpendo.00337.2013

24.

Oliva-Pérez

Oliver-Roig

(2022). Relationship of delayed lactogenesis II to maternal perception of insufficient milk: A longitudinal study. Enfermeria Clinica (English Edition), 32(6), 413–422. https://doi.org/10.1016/j.enfcle.2022.07.005

25.

Pang

W. W.

Hartmann

P. E.

(2007). Initiation of human lactation: Secretory differentiation and secretory activation. Journal of Mammary Gland Biology and Neoplasia, 12(4), 211–221. https://doi.org/10.1007/s10911-007-9054-4

26.

Permyakov

E. A.

(2020). α-Lactalbumin, Amazing calcium-binding protein. Biomolecules, 10(9), Article 1210. https://doi.org/10.3390/biom10091210

27.

Rasmussen

K. M.

Yaktine

A. L.

, the U.S. Institute of Medicine, the U.S. National Research Council, & the Committee to Reexamine IOM Pregnancy Weight Guidelines (Eds.). (2009). Weight gain during pregnancy: Reexamining the guidelines. National Academies Press. https://doi.org/10.17226/12584

28.

Ren

Zhang

Wang

Xia

(2022). Role of perinatal biological factors in delayed lactogenesis II among women with pre-pregnancy overweight and obesity. Biological Research for Nursing, 24(4), 459–471. https://doi.org/10.1177/10998004221097085

29.

Rosenberg

Mangel

Mandel

Marom

Lubetzky

(2021). Tandem breastfeeding and human milk macronutrients: A prospective observational study. Journal of Human Lactation, 37(4), 723–729. https://doi.org/10.1177/08903344211003827

30.

Tie

W. J.

Gardner

Lai

C. T.

Hepworth

A. R.

Al-Tamimi

Paech

M. J.

Hartmann

P. E.

Geddes

D. T.

(2017). Changes in milk composition associated with pethidine-PCEA usage after Caesarean section. Maternal & Child Nutrition, 13(2), Article e12275. https://doi.org/10.1111/mcn.12275

31.

Truchet

Honvo-Houéto

(2017). Physiology of milk secretion. Best Practice & Research Clinical Endocrinology & Metabolism, 31(4), 367–384. https://doi.org/10.1016/j.beem.2017.10.008

32.

Vehling

Chan

McGavock

Becker

A. B.

Subbarao

Moraes

T. J.

Mandhane

P. J.

Turvey

S. E.

Lefebvre

D. L.

Sears

M. R.

Azad

M. B.

(2018). Exclusive breastfeeding in hospital predicts longer breastfeeding duration in Canada: Implications for health equity. Birth, 45(4), 440–449. https://doi.org/10.1111/birt.12345

33.

World Health Organization. (2023). WHO acceleration plan to stop obesity. https://www.who.int/initiatives/stop-obesity

34.

World Health Organization. (2024). Global nutrition targets 2025: Breastfeeding policy brief. https://www.who.int/publications/i/item/WHO-NMH-NHD-14.7

35.

Zhang

Y. H.

Wang

K. L.

Shi

Wang

C. P.

(2021). Comparison of breast milk macronutrients between Han and Hui lactating mothers in Lanzhou based on propensity score distribution ratio. Chinese Journal of Child Health, 29(7), 794–797. https://doi.org/10.11852/zgetbjzz2020-1459

36.

Zhang

Y. Y.

Zhou

Wang

(2022). Effects of pre-pregnancy body mass index, pregnancy weight gain and early feeding behavior on the timing of initiation of maternal lactation II: A prospective study. Chinese Journal of Perinatal Medicine, 25(7), 504–512. https://doi.org/10.3760/cma.j.cn113903-20220301-00192

Changes in Human Milk Macronutrients and Risk Factors for Delayed Lactogenesis: A Prospective Cohort Study

Abstract

Background:

Research Aims:

Methods:

Results:

Conclusion:

Keywords

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References