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Proceedings of the
58th Annual Convention of the
American Association of
Equine Practitioners
- AAEP -
December 1-5, 2012
Anaheim, CA, USA

Next Meeting :

Dec. 7-11, 2013 - Nashville, Tennessee, USA

Reprinted in the IVIS website with the permission of the AAEP

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HOW TO MANAGE THE SUBFERTILE MARE

Agalactia, Dysgalactia, and Nutrition of the

Postpartum Mare

Peter R. Morresey, BVSc, MACVSc, Diplomate ACT, ACVIM (Large Animal)

Successful initiation and continuation of lactation in the postpartum mare depends on normal
hormonal activity and a lack of any inhibitory influences on the mare. Impediments to adequate
lactation include underlying systemic disease of the mare, pathology of the mammary gland,
malnutrition, and diminished neonatal vigor reducing normal suckling activity. Author’s ad-
dress: Rood and Riddle Equine Hospital, PO Box 12070, Lexington, KY 40580; e-mail: pmorresey@
roodandriddle.com. © 2012 AAEP.

1. Introduction progressively larger ducts that converge into cis-

Lactation places considerable nutritional and phys-
iological demands on the mare. The nursing mare
must provide sufficient milk to allow the foal to
achieve approximately 45% of its mature weight at
weaning.1 At the same time, to maintain a yearly
foaling interval, the mare must be sufficiently recov-
ered from the demands of gestation to allow rebreed-
ing within the first month of lactation if so desired.
Numerous management decisions and medical con-
ditions can lead to either complete failure of lacta-
tion or insufficient milk production to meet the
needs of the growing foal.
2. Anatomy, Physiology, and Endocrinology of
Lactation
The equine mammary gland is composed of four
separate functional gland units, two on either side of
the inguinal midline. Each pair (collateral) is
served by a single teat; however, each of these has
two teat canals and cisterns, with separate duct and
alveolar systems for each gland unit. Secretory ep-
ithelial cells line the alveoli, with myoepithelial cells
encasing the alveoli. The alveoli empty milk into
terns above the teats. Groups of alveoli cluster to-
gether to form lobules. In turn, these cluster
together to form lobes, which is collectively known
as a lobuloalveolar construct.
The mammary gland undergoes a cycle of growth
and differentiation of tissue after every mating that
results in a pregnancy. Growth of the mammary
gland tissue continues to some degree into the lac-
tation phase, with this being followed by a period of
involution. In most species, growth of the lobuloal-
veolar tissue is stimulated by high levels of both
estrogen and progesterone during pregnancy, with
the latter inhibiting milk production.2
The mare differs from other species in that circu-
lating progesterone levels are relatively low during
the third trimester of gestation. Progesterone en-
tering the maternal circulation from the fetoplacen-
tal unit is metabolized to the 5␣-pregnanes.3,4 The
most bioactive metabolite is thought to be 5␣-
pregnane-3,20-dione, which is found in high concen-
tration and has demonstrable affinity for the
progesterone receptor.5 Estrogens are represented
by the inactive equilin and equilenin during late

NOTES

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Published in IVIS with the permission of the AAEP
pregnancy, with estradiol 17-␤ rising before
6
parturition.7,8
The trigger for initiation of lactation is thought to
be the progestagen decrease and prolactin increase
at the end of lactation. Prolactin has a major role
in the initiation of lactation in the mare. Levels
suddenly increase in the last days of gestation and
peak at parturition,9 remaining elevated for up to 3
months postpartum.10 Prolactin is not required for
the continuation of lactation once established,11
even though suckling raises maternal prolactin con-
centrations.12 Prolactin receptors are present in
mammary tissue and increase in number during
gestation and after parturition.
Lactation in the mare peaks 30 to 60 days post-
partum. During this time, average daily produc-
tion of 15 L per day in Thoroughbred mares and 12
to 13 L per day in Quarter Horse mares is
achieved.13,14 Therefore, daily consumption by the
foal is in the range of 21% to 25% of body weight on
average over this period.15
As the demand for milk by the foal decreases, the
mammary gland undergoes a progressive involu-
tion. Weaning occurs at relatively high milk pro-
duction, causing increased intramammary pressure
due to accumulation of milk. This increased pres-
sure along with suspected inhibitors in the milk
further decreases production. Secretory tissue is
subsequently replaced with connective and adipose
tissue.2
3. Composition of Milk
Synthesis of milk within the mammary gland of the
mare is similar to that in ruminants.16 Compo-
nents are sourced from body reserves, feed materi-
als, and de novo synthesis within the mammary
gland epithelium. Throughout lactation, a slow de-
cline occurs in energy, total solids, protein, ash,
and minerals; however, lactose concentrations
increase.17
Lactose is derived from glucose absorbed from the
small intestine. Fatty acids are produced from ac-
etate and 3-hydroxybutryrate sourced from carbohy-
drate digestion in the large intestine. Unsaturated
C18 fatty acid is supplied either directly from the
diet or from body reserves.18 Protein in milk is
derived from the highly synthetic cells of the mam-
mary epithelium. Most research has centered on
the effects on the foal after variations in mare pro-
tein intake; however, research in mares has found
that an increase in dietary crude protein up to 14%
of the diet increased milk production.19
Compared with human and bovine milk, mare
milk is of lower fat and hence energy content. Mare
milk and human milk have a similar sugar content,
whole protein, and electrolyte content, in contrast to
the increased electrolyte content of cow’s milk, mak-
ing that a less suitable replacement for mare milk.16
Antimicrobial defense in mare’s milk seems to be
due mainly to the presence of lysozyme (as in human
milk) and, to a lesser degree, to lactoferrin, which is
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HOW TO MANAGE THE SUBFERTILE MARE
preponderant in human milk.20,21 A dynamic state
of immunity exists during the prepartum and the
immediate postpartum periods. Prepartum, colos-
tral immunoglobulin accumulates in preparation for
transfer of immunity to the neonatal foal. The
mammary gland does not produce immunoglobulin
G but instead concentrates it from the vascular sup-
ply. Lysozyme remains elevated in milk well after
parturition, remaining active in the foal intestine
and providing protection after cessation of macro-
molecule absorption. This elevated level of ly-
sozyme may also protect the mammary gland
against infection.22
4. Disturbances of Lactation and Differential
Diagnoses
The failure to produce colostrum or milk is known as
agalactia. This is a separate condition from lack of
milk letdown by some inexperienced primiparous
mares or that caused by painful mammary glands.
Dysgalactia is defined as poor or inadequate milk
production, this being essentially a partial failure in
lactation initiation or its continuation. Devitaliza-
tion of the mare due to a systemic medical condition
or during a period of postsurgical convalescence may
be responsible for diminuation or cessation of
lactation.
5. Fescue Toxicosis
The most common cause in the United States is
ingestion of fescue pasture contaminated with the
endophyte Neotyphodium coenophialum.23 This
compound is a dopamine agonist which antagonizes
the action of prolactin during initiation of lactation.
Placental edema and prolonged gestation also
result.
6. Concurrent Disease Process
Whereas milk production is a potent driver of met-
abolic requirements, it is subservient to survival of
the mare. In the absence of other precipitating fac-
tors, systemic disease of the mare should be ruled
out in cases of agalactia or decreased milk produc-
tion. Also, diminished suckling activity by the foal,
failure to fully let down by the mare, or incomplete
manual milking (where the foal is unable to suckle
the mare, such as with hospitalization) can lead to
rapid diminution of milk production due to incom-
plete clearance of the mammary secretions, thereby
raising pressure within the mammary gland, which
is deleterious to further production.
7. Malnutrition
The energy requirements for lactation are high.
Lactose is sourced from glucose provided in the diet,
with fatty acids produced from acetate and butyrate
of large intestinal origin. Adipose tissue will be
mobilized during times of limited intake with the
potential to decrease mare body condition. Protein
is similarly harvested from tissue stores.
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HOW TO MANAGE THE SUBFERTILE MARE
8. Mastitis
Infection and inflammation of the mammary gland
of the mare is uncommon. Most common at wean-
ing, this condition may occur during lactation if the
foal does not regularly and sufficiently suckle the
mare during periods of high production. Tail
swishing, ground stomping, regional swelling, and
pain, as well as curdled milk, are common signs of
mastitis. In addition, the mare may be reluctant to
move, and fever may be present.24 Causative or-
ganisms have been reported to include Streptococcus
equi subspecies zooepidemicus, which was the most
common isolate, and a wide range of both Gram-
positive and Gram-negative aerobic organisms.24,25
Both systemic and local antimicrobial therapy, anti-
inflammatories, and regular milking have been
recommended and are common treatments.25 Fi-
brosis of untreated tissue decreases secretory mam-
mary mass and therefore decreases future milk
production.
9. Mammary Pathology
Reported neoplasia of the mammary gland is rare.
Invasion of mammary tissue with carcinoma,26 ad-
enoma,27 ductal adenocarcinoma,28 fibrous histiocy-
toma,29 and lymphoma30 have been reported. The
most common presenting clinical sign in one re-
view24 was enlargement of the affected gland; other
findings reported were increased firmness of the
gland, heat, pain, purulent or hemorrhagic mam-
mary secretion, ventral abdominal edema, ipsilat-
eral hind limb lameness, and a serous mammary
gland discharge.
10. Endocrinopathy
Diminished circulating T4 and T3 concentrations
have been obtained during investigation of a variety
of conditions in horses.31 Because of this, hypothy-
roidism is deduced as the cause of poor performance,
weight loss, infertility, laminitis, anhydrosis, and
lactation failure. In the absence of thyroid stimu-
lation testing demonstrating abnormal responses or
overt pathology of the gland, there is no confirma-
tion possible for this diagnosis.31 The euthyroid
sick syndrome is well recognized in human medi-
cine, whereby clinical signs attributable to another
disease process are ascribed to the thyroid gland as
suppression of circulating T4 levels, not thyroid
function itself, is occurring.32
11. Management
Key to the successful management of lactation fail-
ure is to diagnose and manage any underlying med-
ical cause of physiological stress to the mare. In
the absence of systemic disease, causes specific to
the neurohormonal lactation axis must be sought
and addressed.
In situations in which access to the endophyte
Neotyphodium coenophialum is suspected to have
occurred, avoidance of further grazing of those areas
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may lead to resolution of the diminished mammary
development and resultant agalactia.
Domperidone is the most commonly used lacto-
genic agent due to its ability to stimulate prolactin
secretion in situations of dopaminergic inhibition
such as with fescue toxicosis. This medication will
also be administered in situations in which systemic
health of the mare or lack of appropriate suckling by
the foal is thought responsible. Reserpine is also in
common usage, with the added benefit of behavioral
modification. Reports of metoclopramide and
sulpiride usage also exist.33–35
The use of pergolide (a dopamine agonist and
therefore a prolactin antagonist) is not without risk
of causing lactation failure in treated mares. Al-
though many mares initiate lactation without diffi-
culty while on this treatment, it is the author’s
preference to remove this treatment in the last 30
days of gestation if the health of the mare is not
endangered. Once lactation has been established
postpartum, pergolide treatment can resume.
12. Nutritional Requirements of Lactation
In addition to the endocrine and medical reasons for
lactation failure, provision of inadequate nutrition
should not be overlooked. Total energy and protein
requirements are composed of maintenance and lac-
tation needs. Maintenance is estimated from body
weight, with lactation requirements calculated from
milk production and composition at all stages of
lactation, factoring in diet composition, feed intake,
conversion efficiency, and current body reserves.
Therefore, a primary deficiency may result when
insufficient calories and nutrients are offered for
mare maintenance and lactational demand, or a sec-
ondary deficiency when consumption and utilization
of nutrition is diminished or uncompensated catab-
olism is occurring due to underlying disease. The
energy cost and nutrient requirement of milk
production therefore exceeds available substrate
intake.
13. Requirements for the Pregnant Mare
Daily energy requirements for a 200- to 600-kg mare
are calculated as follows36:
DE ⫽ 共maintenance兲 ⫹ 共pregnancy requirements兲
DE ⫽ 共1.4 ⫹ 0.03BW兲 ⫹ 共maintenance ⫻ F兲
where DE ⫽ digestible energy (MJ); BW ⫽ body
weight (kg); and F ⫽ 1.11 (9 months); 1.13 (10
months); 1.2 (11 months).
Daily protein requirements for a 200- to 600-kg
mare are calculated as follows36:
gCP/d ⫽ 共maintenance兲 ⫹ 共pregnancy兲
gCP/d ⫽ 共10 g CP/MJDE兲 ⫹ 共11 g CP/MJDE兲
where CP ⫽ crude protein and MJDE ⫽ MJ of di-
gestible energy.
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14. How Much of Common Feed Materials Is That?
As a percentage of body weight, dry matter intake in
the last trimester for the pregnant mare ranges from
1.5% to 2% of body weight.36 Of this, 35% to 40% is
suggested to be derived from concentrate. In the
final stages of gestation, voluntary intake of preg-
nant mares compared with nonpregnant controls
decreased on average 20% due to the increase in
fetal size making the quality of the forage offered
important to allow mares to meet their needs.37
Intake depends on forage quality. In a study of
light breed mares fed ad libitum, daily intake of hay
was 11% higher in the high-quality versus the low-
quality group.36 Although energy requirements
were met in both groups, protein was only sufficient
in the high-quality group.
With respect to the lactating mare, little is known
regarding dietary protein intake and its effect on
milk protein. Protein content of milk decreases
throughout lactation, also as the energy content of
the ration increases milk volume increases, leading
to dilutional effects on proteins.38 In one study,
foals of mares fed the minimum recommended (Na-
tional Research Council, 1989) total daily protein
were significantly decreased in size at weaning com-
pared with those of mares fed 160% of minimum.39
Protein intake is not dependent solely on the
amount of crude protein in the diet but the overall
quality of the protein offered. Also, mares are able
to use body reserves to maintain milk production
and composition when fed a diet deficient in pro-
tein.40 Protein content of milk was found to be
consistent and to predictably decline during lacta-
tion.17 The feeding of soybean meal to lactating
mares positively affected the growth of their foals in
early life; however, the decline in protein content of
the milk throughout lactation was not affected.41
Milk production has been documented to vary
from 1.9% to 3.9% of body weight throughout lacta-
tion in several studies.40 Using this range of pro-
duction, calculation of protein requirements for
lactation can be achieved as follows:
CP requirement ⫽ BW ⫻ 1.44 g CP/kg BW/d
plus milk production (kg/d) ⫻ 50 g CP/kg milk.
This equates to, for a 500-kg mare:
500 ⫻ 1.44 ⫽ 720 g/d
and assuming 3.2% BW of milk (16 kg) in early
lactation:
16 ⫻ 50 ⫽ 800 g/d.
Total daily requirement in early lactation is there-
fore 1520 g/d.
It is therefore a straightforward calculation to
determine the amount of feed material needed daily
to provide this amount. Crude protein from all
sources (grass, hay, concentrate) should be consid-
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HOW TO MANAGE THE SUBFERTILE MARE
ered when calculating the amount of concentrate
feed required:
For example, daily amount of concentrate feed
required that provides 16% CP (assume 40% of ra-
tion) ⫽ 100/16 ⫻ 0.4 ⫻ 1520 g (calculated above) ⫽
3.8 kg.
15. Induction of Lactation
Lactation may be induced by hormonal methods in
nonparous mares. Protocols have been reviewed in
the literature.42,43 A combination of exogenous
hormones and repeated mammary stimulation by
milking is required. Two avenues are taken to es-
tablish lactation in conjunction with repeated mam-
mary stimulation. As detailed by Steiner,44 the
first involves the use of serial estrogen and proges-
terone supplementation, with a dopamine antago-
nist (prolactin agonist) added. An alternative
program involves the use of a lighting program and
a dopamine antagonist as relayed by Lyman.45
16. Summary
Lactation is the result of a complex interplay be-
tween specialized anatomy and endocrinology
driven by the reproductive necessities of the equine.
The mammary gland develops in response to each
pregnancy and involutes when no longer required.
Milk production is tailored to the requirements of
the foal but is affected by the systemic health of the
mare, nutritional status, and exogenous prolactin
inhibitors.
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HOW TO MANAGE THE SUBFERTILE MARE
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