149. Lactation: Physiology, Nutrition

You are here: Home / 149. Lactation: Physiology, Nutrition

 

149. Lactation: Physiology, Nutrition

 

 

CATEGORY: Diet Nutrition Supplementation – 500 Courses

COURSE NUMBER: 149

FEES: 555/- INR only

CERTIFICATE VALIDITY: Lifetime

CERTIFICATES DELIVERY: In 48 hours

BOOKS/ MANUALS: Pages

Syllabus

I. Introduction
1. An Introduction to Lactation and Breast-Feeding
Margaret C. Neville and Marianne R. Neifert
Evolution and Lactation . . . . . . . . . . . . . . . . . . . . . 3
Historical Perspectives on Milk Secretion. . . . . . . . . . . . . . . . . . . . . . 5
Historical Perspectives on the Hormonal Control of Lactation. . . . .. . . . . . . 7
Placenta versus Ovary in Mammary Development . . . . . . . . . . . . . . . . . 8
A Role for the Pituitary Gland …………………… 8
The Hypothesis of Meites and Turner. . . . . . . . . . . . . . . . . . . . . . . 9
Multiple Hormonal Control…. .. ……………. .. …… 10
The Role of the Placenta. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Historical Perspectives on Breast-Feeding. . . . . . . .. . . . . . . . . . . . . 12
Historical Alternatives to Breast-Feeding. . . . . . . .. . . . . . . . . . . 12
The Decline of Breast-Feeding. .. .. .. . . . . . . . .. . . . . . . . . . . . . . . 13
Third-World Issues in Breast-Feeding. . . . . . . . .. . . . . . . . .. . . 15
References . . . . . . . . . . . . . . . . . . . . 18

II. The Scientific Basis of Lactation

2. Anatomy of the Breast
Stanley F. Gould
Anatomical Features of the Breast………………………………………. 23
Surface Anatomy, Supporting Structures, and General Relationships. . . . .. .. . . . . 23
The Nipple and Areola. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 24
Vessels and Nerves. . .. . .. . .. . . … . . . . . . . . . . . . . . . . .. . 25
Lymphatic Drainage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Content,
Embryologit:td Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Normal Development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Anomalous Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Structure of the Mammary Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
General Features………………………………………………….. 27
Inactive or Resting Stage. . . . . . . . . . . . . . . . . . 30
Proliferative or Active Phase .. . . . . . . . . . . . . . . . . . . . . . . . . . 34
Lactation or Secretory Phase. . . . . . . . . . . . . . .. .. . . . . . 37
Regression. Involution. or Atrophy. . . . . . . . . . . . . . . . . . . . . . . . . 44
Summary………………………………………………………….. 47
Refereru:es ………………………………………………………… 47
3. The Mechanisms of Milk Secretion
Margaret C. Neville,Jonathan C. Allen, and Christopher Watters
Introduction and Overview. . . . .. .. . . . . . .. . .. … . . .. .. .. .. .. . . . .. . .. .. . . . . . .. .. 49
Cellular Mechanisms for Milk Synthesis and Secretion. . . . . . . . . . . . . . . . . . . . . . . . . 51
Changes in Milk Composition at Parturition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
The Secretion of Cells into Colostrum and Milk…………………………. 57
Suckling and the Ejection of Milk from the Breast ………………………. 58
Mammary Blood Flow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Protein Syntheris, Processing, and Secretion in the Mammary Gland. . . . . . . . . . . . . . . . 59
Properties of Milk Proteins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Protein Precursors-The Transport of Amino Acids into Mammary Alveolar
Cells……………………………………………………………. 62
Synthesis and Processing of Milk-Specific Proteins. . .. .. .. .. . .. . .. .. .. . . . .. .. . . 62
Regulation of Milk Protein Synthesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Immunoglobulin Secretion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
The Syntheris of Mille Sugars. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Glucose Utilization in the Mammary Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Lactose Synthesis. . .. . . . .. . . . .. . . . . . .. .. .. .. . . . .. .. .. .. . .. . . . .. .. .. .. .. . . . .. 69
Regulation of Lactose Synthesis. . .. . . .. .. .. … . . . . .. .. .. . .. .. .. . .. .. . . . .. .. .. 71
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Secretion of Cakium, Phosphate, and Citrate into Mille ……………………… 72
The Role of the Golgi Secretory Vesicles in Calcium Secretion……………… 73
Possible Regulatory Activities of Calcium in the Mammary Gland.. .. .. .. .. . .. .. 74
The Secretion of Mille Lipid . … ‘. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
The Composition of Milk Fat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
Fatty Acid Synthesis in the Mammary Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Lipoprotein Lipase and the Extraction of Lipids from Plasma. . . .. . … .. .. .. .. . 81
Triglyceride Synthesis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Cholestrol Secretion into Milk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Phospholipids ……………………………………………………. 83
Milk Lipases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Conclusions ……………………………………………………… 84
The Secretion of Monovalent Ions and Water into Mille. . . . .. … .. .. .. .. .. .. …. .. . 84
Transcellular Ion Transport . . . … . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Paracellular Ion Transport. . .. .. .. .. . . .. . . . .. … . .. … .. .. .. .. . . .. .. .. .. .. .. 87
Conclusions ……………………………………………………… 88
Trace Element Secretion into Mille. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Iron……………………………………………………………. 88
Zinc……………………………………………………………. 89

Contents xi
Iodine………………………………………………………….. 89
Selenium ……………………………………………………….. 90
Sulfur………………………………………………………….. 90
Cobalt ……………………………………… , … .. . .. . . . . . .. . . . .. . . 91
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Milk Secretion-Questions for the Future. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
References ………………………………………………………… 92
4. Regulation of Mammary Development and Lactation
Margaret C. NeviUe
Stages in the Development of Mammary FUllction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Mammogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Lactogenesis …………………………………………………….. 108
Lactation ……………………………………………………….. 113
Involution ………………………………………………………. liS
Prolactin Secretion through the Life Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Milk Ejection and Oxytocin .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
Oxytocin Synthesis and Release. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Interaction of Oxytocin with Myoepithelial Cells ………………….. , . .. .. . 123
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Lactation and Postpartum Infertility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Relation between Duration of Postpartum Amenorrhea and Breast-Feeding.. … 125
Reproductive Hormone Levels during Lactation …. ‘” .. … .. .. .. . . .. …. .. .. 126
The Mechanism of Postpartum Amenorrhea.. …. . ….. .. . .. .. .. …. .. .. .. … 129
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Interactions between Food Intake and Lactation………………………..131
A Forward Look…………………………..132
References ………………………………………………………… 133
5. CeUular and Molecular Aspects of the Hormonal Control of
Mammary Function
Margaret C. NeviUe and SaUy E. Berga
Lactogenic Hormones……………………………….141
Regulation of Prolactin Synthesis and Release…………………………142
Cellular Actions of Prolactin………………………………144
Placental Lactogen…………………………..149
Conclusion…………………………………..150
The Role of Steroid Hormones in the Control of Mammary Function…………………….. 151
Estrogens ……………………………………………………….. 151
Progesterone…………………………..154
Glucocorticoids…………………… 157
The Role of Insulin in Mammary Function………………………….160
The Role of Insulin in Mammary Growth………………………..160
The Role of Insulin in Lactogenesis and Lactation………………………161
Effects of Insulin on Lipid Synthesis………………………..161
Conclusion………………………………162
Thyroid Hormones…………………………162
Prostaglandins…………………..163
Cyclic AMP…………………….164

6. In Vitro Model Systems for the Study of Hormonal Control of
Mammary Gland Growth and Differentiation
Janice E. Errick and Tamiko Kano-Sueoka
Introduction …………………………… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Whole Gland Culture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Explant Cultures…………. ………………………………………. … 183
Primary Culture . ……………………. , ……… ” .. . . . . .. . . . . . .. .. . .. . . . . 186
CeU Culture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
General Conclusions……………………………………… ………….. 194
References ………………………………………………………… 194

111. The Nutritional and Immunologic Significance of Mammary Secretions
7. Nutritional Aspects of Human Lactation
Clare E. Casey and K. Michael Hambidge
Introduction ……. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Technical Difficulties in the Measurement of Milk yield……………………… 199
Composition of Human Milk…………….. …………………….. …….. 201
Gross Composition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
,Protein …………………………………………………………. 202
Fat…………………………………………………………….. 204
Lactose …………………………………………………………. 205
Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Minerals ………………………………………………………… 206
Trace Elements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Nutritional Requirements for Lactation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Recommended Daily Allowances……………………………………… 209
Energy …………………………………………………………. 210
Protein …………………………………………………………. 212
Calcium ………………………………………………………… 213
Iron………………… ………………… ………………………. 214
Vitamins……………… ………………………………………… 215
Maternal Nutrition and Lactation Performance . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . .. . 216
Volume…………………………………………………………. 216
Composition …………………………………………………….. 219
Incidence and Duration of Lactation …………………………………. 225
Influence of Lactation on Maternal Nutritional Status. . . . . . .. . . . . . .. . . . . . .. . . . 226
Other Maternal Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . •. . . . . . . . . . . . 228
Human Milk in Infant Nutrition……….. ………………………………. 230
Growth…………………………………………………………. 230
Biochemical Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Dietary Supplementation……………………………………………. 236
Premature Infants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Conclusions ……………………………………………………….. 238
References ………………………………………………………… 239

8. The Immunology of Breast Milk
Anthony R. Hayward
Introduction.. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . 249
Antibodies ………………………………………………………. 249
Cellular Aspects of the Specific Immune Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Phagocytes and Complement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
The Secretory Immune System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
ImmunologicaUy Active Constituents of Breast Milk . ………. ” . . . . .. . . . . . . . . . . . . 257
Nonspecific Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Cells in Milk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Functional Responses of Breast Milk Lymphocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Immunologic Consequences of Breast-Feeding for the Baby. . . . . . . . . . . . . . . . . . . . . . . . . 261
Protection from Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Protection from Allergic Reactions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
Breast-Feeding and Immunization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Conclusions ……………………………………………………….. 266
References ………………………………………………………… 266

IV. Medical Management of Breast-Feeding

9. Routine Management of Breast-Feeding
Marianne R. Neifert
Introduction.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . 273
Prenatal Period… ………………………………………………… .. 274
Role of the Health Professional in Breast-Feeding Education. . . . .. . . . . . . . . . . . . . 274
Prenatal Examination………………… … ………………….. ….. … 275
Management Plans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Nipple Preparation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Support Groups. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
Intrapartum Period …………………………………………………. 279
Hospital Policies .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Initiation of Nursing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Common Early Problems …………………….. . . . . . . . . . . . . . . . . . . . . . . . . . 283
The Normal Co”rse of Lactation…………………………………. …….. 287
First Two Weeks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Two Weeks …………………………………………………….. ” 288
Two Months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Four Months … . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
Six Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
Nine Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Twelve Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Late Nursing… ………. …………………………………………. 296
Nursing through Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Conclusion ………………………………………………………… 297
References ………………………………………………………… 298

10. Infant Problems in Breast-Feeding
Marianne R. Neifert

The Premature or Sick Newborn …….. ‘…………………………………. 304
Advantages of Human Milk in Feeding Preterm Infants………………….. 304
Initiating Breast-Feeding in the Premature Infant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Methods of Expressing Milk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Maintaining the Milk Supply. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308
Surveillance and Storage of Milk …………………………………….. 309
Transition to the Breast. . . . .. .. .. . . .. .. .. .. .. .. .. . .. . .. ….. . . .. . .. . .. .. .. . 311
Follow-Up ………………………………………………………. 312
F aUure to Thrive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Etiologies of Lactation Failure-Maternal Factors……………………….. 313
Etiologies of Lactation Failure-Infant Factors………………………….. 316
Evaluation of Failure to Thrive. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Assessment and Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Cleft Lip and Palate .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Nursing Infants with Cleft Lip ………………………………………. 324
Nursing Infants with Cleft Palate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Multiple Births. . . . . . . . .. . . .. . .. .. . . . . .. . . .. .. . . .. .. .. .. . . . .. . .. .. .. .. .. . . .. .. 325
Breast Milk Jaundice. . .. . … . . .. .. .. . . .. .. .. .. .. .. .. .. .. .. . .. .. . .. .. .. .. .. . . .. 326
Phenylketonuria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
Hoapitalization of the Infant or Mother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Conclusion ………………………………………………………… 328
References ………………………………………………………… 328
11. Maternal Problems in Lactation
James A. McGregor and Marianne R. Neifert
Lactation and Infectious Disease……………………………………… 333
Mastitis …………………………………………………………. 334
Painful Nipples and Candida albicans ………………………………….. 337
Tuberculosis …………………………………………………….. 338
Herpes Viruses . . . ………………………………….. . . 338
Rotaviruses ……………………………………………………… 340
Hepatitis B Virus …………………………………………………. 340
Chronic Maternal Illness ……………………………………………… 342
Psychiatric Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Diabetes Mellitus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Cystic Fibrosis ……………………………………………………. 343
Mammoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Relactation and Induced Lactation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
Conclusion ………………………………………………………… 346
References ………………………………………………………… 346
12. Psychological Implications of Breast-Feeding for the Mother
Robin Dee Post and Rhoda Singer
Breast or Bottle’ The Decision-Making Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Psychodynamic Factors in the Decison Not to Breast-Feed………………………………..349

The Influence of Significant Others ……………………………… . . . . . 351
The Time for Decision . . . . . . . . . . . . .. .. .. . . . . . .. . . . .. . .. .. . .. . . . . . . . . . . . . . . . 352
Attihules aM Personality Charaeteristics of Breast· and Bottle.Feeding Mothers ….. 353
Mother-Infant Attach_t: The Importance of the Earl, Po,tpartum Period for the
Mother-Infant Bond aM the Establishment of Laetation …………………… 354
Psychological and Hormonal Interaetion in Breast·Feeding . .. .. . .. . . . . .. . . . .. . . . . . 355
Psychological Factors in Milk Secretion. . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . 355
Postpartum Blues…………………………. ……………………… 357
Sexuality of Breast·Feeding Women….. ……………………….. …. … 357
Support Systems for Nursing WOfM1I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
Breast.Feeding and Family Life. .. . . . . . . . . . . . .. .. . . .. .. . .. . . . . . . . . . . . .. .. . . . 359
Medical Support Systems for the Expectant and New Mother . . . . . . . . . . . . . . . . . . 359
La Leche League International……………………………………….. 360
Psychological Considerations in Weaning aM Exteruled Nursing……………………………..361
Conclusions ……………………………………………………….. 362
References ………………………………………………………… 363
13. Drugs, Toxins, and Environmental Agents in Breast Milk
Robert G. Peterson and Watson A. Bowes,jr.
Introduction ………………………………………………………. . 367
Drug Distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
Propertie’ of Sub,tance, That Affect Their Distribution into Milk. . .. .. . . . . . . .. . .. . 372
Quantitative Delivery of Pharmacologic Agent. to the Newborn. … .. . . . . . . . . . . . . . . . 375
Oral Drug Absorption by the Infant………………………….. ……… 375
Recognizing Drug Toxicity in the Infant. . . . . . . .. . . . . .. . . . . . . . . . . . . .. . . . . . . . . 376
Idiosyncratic and Allergic Drug Reactions……………………………… 377
Selective Drug Toxicity in Infants……………………………………. 378
Neonatal Drug Accumulation……………………………………….. 379
Potential for Masking Medical Conditions……………………………… 379
Over·the-Counter Medications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380
Environmental Agents in Breast Milk ……………………………………. 381
Summary of Quantitative Considerations . .. . . . . . .. . . . . . . .. . . . . . .. .. . . . . . . . . . . . . . 382
Review of Pharmaeologic Classes of Drugs in Breast Milk. . . . . . . . . . . . . . . . . . . . . . . . . 383
Antimicrobial Drugs. . .. . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . 383
Analgesics and Psychotherapeutic Drugs ………………………………. 385
Methylxanthenes …………………………………………………. 386
Cardiovascular and Diuretic Agents. . . .. . . . .. . . . .. . . .. .. . . . . . . . .. . . . . . . . . . . . . 387
Rubella Vaccination……………………………………………….. 388
Antithyroid Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Anticoagulants ……………………………………………… 388
Anticonvulsants ………………………………………………….. 389
Radio·Pharmaceuticals for Diagnostic Procedures. . . . . . . .. .. . . . . . . . . . . . . . . . . .. 389
Recreational Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390
Insecticide, aM Polychlorinated Biphen,ls (PCB,) in Breast Milk ………………………..390
Summary of Clinical Considerations………………………………. …….. 391
Drug. That Affect Laetation …………………………………………… 393
Introduction …………………………………………………….. 393
Drugs That Inhibit Lactation.. .. .. . . . . . . .. . . . .. . . . . . .. . .. . . . . . . . . . .. .. . . . . . . 393
Drugs That Enhance Lactation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
Summary ……………………………………………………….. 397
Reference, ………………………………………………………… 398

14. Lactation and Contraception
James A. McGregor
Methodoligic Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
The Effects of Lactation on Fertility. . . . . . . .. .. . . . . . . . .. .. . . . . .. .. .. .. . . . . . .. .. . . 406
Endocrine Basis of Lactational Amenorrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
Conception and Lactation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
Summary ……………………………………………………….. 408
Contraception during Lactation . ………………………………… 409
Abstinence ……………………………………….. 409
Barrier Methods………………………………………………….. 410
Rhythm or Natural Family Planning………………………………… 410
Postpartum Sterilization ……………………………………………. 411
Intrauterine Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
Steroid Contraceptives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
Summary of Contraceptive Usage in Lactation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
References ………………………………………………………… 418
15. Pregnancy, Lactation, and Breast Cancer
Mary B. Mockus and Kathryn B. Horwitz
Introduction. .. . . . . . . . . . . . .. . . . .. . .. .. .. . . . . . . . .. . . . . . .. .. . .. .. .. …. .. .. . . . . 423
Epidemiology………………………………………………………. 423
Steroid Hormones and Breast Cancer……………………………………. 426
Viruses and Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429
Pregnancy, Lactation, and Breast Cancer: The Clinical Picture. .. . .. . . . . . . . .. .. . . . 430
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
References ………………………………………………………… 434
Index ……………………………………. 441

……………………………………………………………………………………………………………………………………………………………………………………………………………………

 

Medifit  Courses Demo Certificate 

48 hours delivery

| International acceptance | Medical based | Job oriented | Lifetime validity | Most economical |

 

555 INR Demo Certificate – 2 months duration

Demo Certificate – 6 months duration

48 hours delivery after fees payment

48 hours delivery after fees payment

 

Medifit 48 hours Delivery

  Get your Certificates delivered by online mode in 48 hours after Fees payment. We try to deliver certificates in 24 hours, but the committed delivery hours are 48. Its,

Pay Today &
get Tomorrow

procedure, only by Medifit.

LIFETIME VALIDITY

Medifit issues Lifetime validity certificates for all Online Courses provided. No need to renew the certificates every 2 or 3 years. All Courses Certificates of Medifit are having Lifetime Validity. No need to renew these certificates every 2 or 3 years.

 

What makes the certificates of Medifit to get it recognized Internationally?

Vast number of students applying for Job in international market of Fitness through Medifits Online Courses Certificates. And most importantly, the Medical standards maintained, helps to acquire jobs internationally. This gives very strong International acceptance to Certificates of Medifit Courses.

 

ABOUT MEDIFIT ACADEMY CERTIFICATION COURSE:

Medifit Education Online Academy is an innovative, digital and engaging education platform that delivers fast track accredited courses and skills development courses instantly online, with no time limits, enabling individuals to study anywhere and anytime. We are proud to offer international standard courses that have helped our students build their careers across the globe.

HOW DO MEDIFIT ONLINE CERTIFICATE COURSES HELP?

Short term Professional Courses International Standards courses Opens Global opportunities Career defining Courses Skill Development Programmes Knowledge in short span Learn at your own pace Certification of Completion Immediate Earning Opportunities Positive Social Impact Optimistic Psychological Benefits Improved Standard of Living Study from anywhere & anytime Very Economical Fees

[/cmsms_text][/cmsms_column][/cmsms_row]