Breastfeeding: History and Evolution

Lactancia Materna: History and Evolution

• In 1955, the Protein Advisory Group (GAP) was created within the UN to advise the WHO, UNICEF, and FAO on nutritional programs
• An international WHO/UNICEF meeting on infant feeding in 1979 resulted in a resolution to develop the International Code of Marketing of Breast-milk Substitutes
• The International Code was approved at the 34th World Health Assembly in 1981 (WHA 34.22)
• The WHO and UNICEF issued a joint statement in 1989 urging governments to protect, promote, and support breastfeeding
• The Innocenti Declaration was made in Florence in 1990 as a global commitment to promote breastfeeding during the 1990s
• The World Alliance of Breastfeeding Action (WABA) was established in 1991 to organize World Breastfeeding Week (August 1-7)
• The WHO established in 1994 that exclusive breastfeeding is optimal for the first 6 months of life per Resolution 47.5
• The Global Strategy for Infant and Young Child Feeding (EMALNP) was approved in 2002
• The Strategic Plan for the Protection, Promotion and Support of Breastfeeding was presented in the EU in Dublin in 2004

Lactancia Materna: Physiology

• Milk production starts in the 5th month of pregnancy, increasing after birth due to the baby's suckling
• This is mediated by lactogen release or "milk let-down"
• Prolactin, from the anterior pituitary, stimulates milk production and is regulated by dopamine, which is an inhibitory factor
• Oxytocin, from the posterior pituitary, induces milk ejection; it is inhibited by stress or adrenaline
• Medications like reserpine and phenothiazines inhibit prolactin
• Certain diseases, such as hypothyroidism, or hormones such as progesterone, can alter milk synthesis
• Exclusive breastfeeding has a contraceptive effect, inhibiting ovulation in 5-15% of cases, but is not a reliable sole method

Lactancia Materna: Types

• Exclusive breastfeeding: Only breast milk, including expressed milk
• Predominant breastfeeding: Breast milk is the main food source, supplemented by water or infusions
• Complete breastfeeding: Includes both exclusive and predominant breastfeeding
• Complementary feeding: Breast milk supplemented by solids or liquids
• Bottle feeding: Liquid or semi-solid foods given via bottle
• Multiple/deferred/tandem/induced/mercenary/solidarity/relactation: Variations according to context such as milk from another mother or remuneration

Lactancia Materna: Composition

• The stages of breast milk include:
  • Colostrum: Produced 2-5 days postpartum, high in proteins, sodium, potassium, chloride, IgA, and lysozyme, but low in carbohydrates, fats, and vitamins
  • Transitional Milk: Produced from days 5-10, containing more phosphorus and representing a transition from colostrum
  • Mature Milk: Produced from day 10 onward, higher in fat, lactose, and fat-soluble vitamins and contains 85-90% water, 0.9% protein, 2.7-4.5% fat, and 6-7.6% carbohydrates
• Breast milk variations:
  • Premature infant milk: High in protein, sodium, and chloride but low in calcium and phosphorus compared to term milk
  • Term infant milk: Higher in carbohydrates
  • Different times of day: Higher fat content in the morning

Lactancia Materna: Differences between Human and Cow's Milk

• Proteins: Human milk has 80% alpha-lactalbumin, while cow's milk has 80% beta-lactoglobulin, which is allergenic
• Fats: Human milk has a higher amount of fat and is easily digested due to lipase, while cow's milk has lower digestibility
• Vitamins: Human milk has less vitamin K and D but better absorption, while cow's milk has more vitamin K and D but lower absorption
• Immunological Factors: Human milk is rich in secretory IgA, lactoferrin, and lysozyme, whereas cow's milk lacks these
• Enzymes/Hormones: Human milk contains prostaglandins E and F for intestinal motility and is less active compared to cow's milk

Lactancia Materna: Advantages

• Breastfeeding helps prevent infections, reducing the occurence of gastroenteritis, necrotizing enterocolitis, meningitis, botulism, and sudden death
• It provides immunological benefits by offering IgA to protect digestive/respiratory systems
• Breastfeeding offers nutritional and economic advantages like it saves on formula costs and reduces malnutrition risk
• It also provides psychological/developmental benefits such as enhancing mother-child bonding and reducing risk of obesity, diabetes, and asthma
• For the mother, breastfeeding reduces risks of breast/ovarian cancer, osteoporosis, and anemia

Lactancia Materna: Disadvantages of Not Breastfeeding

• Mothers who don't breastfeed have a higher risk of postpartum hemorrhage, anemia, cancer, and osteoporosis
• Not breastfeeding can cause elevated formula costs, medication expenses, and medical consultation fees for families
• It can also cause decreased productivity in the work place

Lactancia Materna: Contraindications

• Absolute contraindications include galactosemia, active breast cancer, herpes or syphilis on the nipple, and the use of radiopharmaceuticals or antithyroid medications
• Temporary contraindications include varicella, active tuberculosis, CMV, and neonatal hyperbilirubinemia

Lactancia Materna: Medication & Substance Effects

• Reserpine inhibits milk production by blocking dopamine
• Alcohol causes somnolence and weak suckling
• Caffeine causes irritability and sleep disorders
• Nicotine reduces prolactin, causes colic, and can cause tachycardia
• Metoclopramide increases prolactin

Lactancia Materna: Factors that help with Transfer

• Liposolubility
• Low molecular weight, less than 200 kDa
• Low ionization

Lactancia Materna: WHO/UNICEF Hospital Recommendations

• Hospitals should have written breastfeeding promotion policies
• Initiate breastfeeding in the first postpartum hour
• Keep mother and baby together in the same room 24 hours a day
• Avoid pacifiers and bottles
• Train staff and educate pregnant women

Lactancia Materna: Nutritional Recommendations for Infants

• Iron should be supplemented starting at 3-4 months due to depleted reserves.
• Zinc at 2 mg/day from breast milk and hepatic reserves
• Vitamin D at 300 IU/day for rickets prevention
• Vitamin K at 0.5-1 mg IM as a single dose.
• Vitamin C at 35-60 mg/day in premature infants to prevent tyrosinemia.

Lactancia Materna: Feeding Techniques

• Position the baby in a semi-seated position, with their head higher than their body
• Each breast should be fed for 15-20 minutes and the total feeding time should be a maximum of 40 minutes
• Feed the baby every 2-3 hours
• Effective signs of a feeding include a 30 g/day increase in weight after 15 days