Poor metabolic health parameters linked to low breast milk production
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Women with severely low breast milk production have higher BMI, blood pressure and plasma lipid levels compared with those with normal milk production, according to a study published in Breastfeeding Medicine.
“This study breaks new ground by demonstrating women with severely low milk supply, despite frequent and thorough breastfeeding or pumping, are significantly more likely to exhibit worse metabolic health across a spectrum of clinical measures,” Laurie A. Nommsen-Rivers, PhD, RD, IBCLC, associate professor and the Ruth Rosevear Endowed Chair of Maternal and Child Nutrition in the College of Allied Health Sciences at University of Cincinnati, told Healio. “For example, affected women are more likely to exhibit higher blood pressure, insulin resistance, elevated plasma triglycerides, a history of gestational diabetes, and have class 2 or higher obesity. This was a small case-control study; however, our careful management of breastfeeding practices and measurement of milk production enabled us to confirm that their struggles were not attributable to ‘not breastfeeding enough.’”
Nommsen-Rivers and colleagues analyzed data from women screened for a low milk supply randomized controlled trial from February 2015 to June 2016. Mothers who were aged 20 years or older and 1 to 8 weeks postpartum with a healthy singleton infant born at 37 weeks of gestation or later were included. Participants completed at-home infant test-weighting to measure milk output. Eighteen women with severely low milk output of less than 300 mL per 24 hours were matched with a nested cohort of 12 women who had moderately low to normal milk output of more than 300 mL per 24 hours. The severely low milk output group was also compared with an external control group of exclusively breastfeeding mothers with infant weight velocity of more than 20 g per day from March to June 2018. All participants visited the Cincinnati Children’s Schubert Research Clinic within 1 week of completing test weighing. BP and fasting blood samples were collected, and participants provided demographics, medical history and breastfeeding history via interviews. Researchers analyzed variables associated with metabolic health, including BMI, waist circumference, BP, fasting plasma glucose, insulin, C-peptide and lipids, serum prolactin, gestational diabetes diagnosis during pregnancy and polycystic ovary syndrome.
Low milk production linked to worse metabolic health
Maximum measured milk output ranged from 30 mL to 281 mL per 24 hours in the low milk group compared with a range of 372 mL to 801 mL per 24 hours in the nested cohort. The average exclusively breastfeeding infant consumes about 750 mL per 24 hours. Mothers in all groups had similar demographics except for the low milk output group having a lower percentage of college graduates (67%) than the nested control group (100%) and the external control group (92%; P = .05).
The low milk output group had higher BMI, waist circumference, C-peptide, insulin resistance, triglycerides, systolic BP, diastolic BP and metabolic syndrome risk z score compared with both control groups. The prevalence of gestational diabetes was higher among those with low milk output (39%) compared with those with normal milk output (0%) and external controls (8%; P = .02). No differences were observed between the control groups.
More research needed on metabolically driven low milk output
“Our findings reinforce the importance of considering the lactating parent and their infant as a dyad, where both contribute to the establishment of an abundant milk supply,” Nommsen-Rivers said. “For example, when considering the risk of excess weight loss in an exclusively breastfeeding newborn infant, it is important for the health care provider to go beyond the usual checklist of ensuring the baby is latching well at the breast, feeding frequently, et cetera, and to consider maternal metabolic risk factors present before delivery, such as gestational diabetes and class 2 or higher obesity.”
Nommsen-Rivers said more research is still needed on low milk supply, with no targeted pharmacological treatments currently endorsed by the Academy of Breastfeeding Medicine and no validated clinical indicators available to standardize screening for metabolically driven low milk supply.
“Much research needs to be done, spanning from basic science discoveries of underlying mechanisms and potential treatments, large prospective cohort studies toward establishing norms for clinical measures of healthy lactation, randomized clinical trials on potential treatments, and patient-centered outcomes research on optimizing infant feeding and lactation management in these situations, not to mention the entire realm of health communication research needed to balance public health messages on the importance of breastfeeding with provider education regarding the very real struggles of women with persistent low milk supply,” Nommsen-Rivers said.
For more information:
Laurie A. Nommsen-Rivers, PhD, RD, IBCLC, can be reached at nommsele@ucmail.uc.edu.
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