Maternal nutrition and breastfeeding

lecturar : dr khadra Aymoy mohamed

 Breast feeding
Breastfeeding, or nursing, is the process by which human
breast milk is fed to a child.milk may be from the breast, or may
be expressed by hand or pumped and fed to the infant. The
World Health Organization (WHO) recommends that
breastfeeding begin within the first hour of a baby's life and
continue as often and as much as the baby wants. Health
organizations, including the WHO, recommend breastfeeding
exclusively for six months.
This means that no other foods or drinks, other than vitamin D,
are typically given. WHO recommends exclusive breastfeeding
for the first 6 months of life, followed by continued
breastfeeding with appropriate complementary foods for up to 2
years and beyond.Of the 135 million babies born every year, only
42% are breastfed within the first hour of life, only 38% of
mothers practice exclusive breastfeeding during the first six
months, and 58% of mothers continue breastfeeding up to the
age of two years
 Breastfeeding physiology

Breast development starts in puberty with the growth of

ducts, fat cells, and connective tissue. The ultimate size of the
breasts is determined by the number of fat cells. The size of
the breast is not related to a mother's breastfeeding
capability or the volume of milk she will produce. The process
of milk production, termed lactogenesis,
The process of milk production, occurs in 3 stages.

1: first stage takes place during pregnancy, allowing for

the development of the breast and production of
colostrum, the thick, early form of milk that is low in
volume, but rich in nutrition

2:The birth of the baby and the placenta triggers the

onset of the second stage of milk production, triggering
the milk to come in over the next several days.

3:The third stage of milk production occurs gradually over

several weeks
Lactogenesis I and other changes in pregnancy

1: Lactogenesis I Changes in pregnancy,

starting around 16 weeks gestational age,
prepare the breast for lactation. These
changes, collectively known as Lactogenesis I,
are directed by hormones produced by the
placenta and the brain, namely estrogen,
progesterone, prolactin,
 estrogen, progesterone, prolactin,

1:estrogen,

a} Development of stromal tissues of breast

B} Growth of an extensive ductile system
C} Deposition of fat in the ductile system
2: progesterone

A: stumulation the formation of te milk

gland
B: blocks the prolactin receptors in the
breast, thus inhibiting milk from
"coming in" during pregnancy
3: Prolactin
While prolactin is the predominant
hormone in milk production
Lactogenesis II

The third stage of labor describes the period between the birth
of the baby and the delivery of the placenta, which normally
lasts less than 30 minutes.The delivery of the placenta causes an
abrupt drop off of placental hormones.This drop, specifically in
progesterone, allows prolactin to work effectively at its receptors
in the breast, leading to an array of changes over the next
several days that allow the milk to "come in"; these changes are
known collectively as Lactogenesis II.
Many other physiologic changes occur under the control of
progesterone and estrogen. These changes include, but are not
limited to, dilation of blood vessels, increased blood flow to the
uterus, increased availability of glucose (which subsequently is
passed through the placenta to the fetus), and increased skin
pigmentation, which results in darkening of the nipples and
areola, formation of the linea nigra, and onset of melasma
of pregnancy.
4: Oxytocin
dual activity
Oxytocin, which signals the smooth muscle of the uterus to
contract during pregnancy, labor, birth and following delivery, is
also involved in the process of breastfeeding.Oxytocin also
contracts the smooth muscle layer of band-like cells surrounding
the milk ducts and alveoli to s the newly produced milk through
the duct system and out through the nipple.This process is
known as the milk ejection reflex, or let-down. Because of
oxytocin's dual activity at the breast and the uterus,
breastfeeding mothers may also experience uterine cramping at
the time of breastfeeding, for the first several days to weeks.
Lactogenesis III

Prolactin and oxytocin are vital for establishing milk supply

initially, however, once the milk supply is well established, the
volume and content of the milk produced is controlled locally.[9]:
18–21 [21]
Although prolactin levels are higher on average among
breastfeeding mothers,
 Nutritional content

The pattern of intended nutrient content in breast milk is

relatively consistent. Breastmilk is made from nutrients in the
mother's bloodstream and bodily stores. It has an optimal
balance of fat, sugar, water, and protein that is needed for a
baby's age appropriate growth and development

The first type of milk produced is called colostrum contains

A}antibodies to protect the newborn against disease and

infection, and immune and growth factors and other bioactives
that help to activate a newborn's immune system,
B} Colostrum also has a mild laxative effect,
encouraging the passing of a baby's first stool,
which is called meconium.[8] This clears excess
bilirubin, a waste-product of dead red blood
cells which is produced in large quantities at
birth due to blood volume reduction from the
infant's body and which also helps prevent
jaundice.
 Bioactive components in colostrum

Newborns have very immature and small digestive systems, and

colostrum delivers its bioactives in a very concentrated low-
volume form. Colostrum is known to contain immune cells (as
lymphocytes)and many antibodies such as IgA, IgG, and IgM.
These are some of the components of the adaptive immune
system. Other immune components of colostrum include the
major components of the innate immune system, such as
lactoferrin, lysozyme, lactoperoxidase,complement, and proline
-rich polypeptides (PRP).A number of cytokines (small
messenger peptides that control the functioning of the immune
system) are found in colostrum as well,including
interleukins, tumor necrosis factor,chemokines, and others.
Thanks for your Attention