week 6 (async)- breastfeeding and women

Question 1

cycle of malnutrition in women

Answer 1

1. undernourished mothers give birth to undernourished kids
   - LBW, intrauterine growth restriction, long term cognitive and physical impacts
2. undernourised babies end up stunted or wasted at a young age,may experience ricketts and difficulties learning in school
3. stunting and wasting in early childhood lead to delayed periods and narrow pelvises
4. hidden hunger leaves potential mothers with micronutrient deficiencies, leading to many complications with pregnancy and birth
   * start of the intergenerational cycle
5. socioeconomic factors such as lack of education and health care, poverty and low social status all contribute to this cycle of malnutrition

Question 2

WHO breasfeeding guidelines

Answer 2

• exclusive breastfeeding for the first 6 months, at which point complimentary feeding with iron-rich foods should be initiated and continue for 2 years
• breastfeeding should begin within an hour of birth and should be on demand (watch for hunger cues)
• bottles and pacifiers should be avoided early in life, as they may lead to nipple confusion

1-6-24 model

Question 3

how many women actually breastfeed?

Answer 3

42% exclusively BF for first 6 months, althoygh 96% of women are physiologically capable

Question 3

risks associated with each feeding stage

Answer 3

1. exclusive BF for 6 months
   - lack of exclusive/continued BF, marketing of breastmilk substitutes
2. complimentary feeding from 6 months to 2 years
   - lack of dietary diversity, low feeding frequency, eating ultra-processed foods or drinking sugar-sweetened beverages
3. regular foods: 3-4 years
   - inadequate diets, marketing of unhealthy foods, lack of physical activity

Question 4

benefits and challenges of complementary feeding

Answer 4

• infants require comlpementary feeding at 6 months, as breastmilk alone can no longer meet their energy and nutrient requirements
• foods may be introduced too early/too late, may not be nutritionally adequate foods, may be unsafe (foodborne illness)

Question 5

why are breastfeeding recommendations made?

Answer 5

1. reduces risk of infant mortality
2. reducing risk of postpartum hemorrhage
3. increased birth spacing
4. reduces risk of breast and ovarian cancer in mom

Question 6

how does BF decrease risk of infant mortality?

Answer 6

• non-BF infants (0-5M) in developing countries are 14.4 times more likely to die
• non-BF infants (6-23M) in developing countries are 2 times more likely to die
• diarrhea and pneumonia are more severe in non-BF children

Question 7

how does BF decrease hemorrhage risk?

Answer 7

• if mother BF shortly after birth, it stimulates a hormone cascade that leads to uterine contraction
• this is important as placental retention can lead to hemorrhage, and uterine contraction helps expel the placenta

Question 8

how does BF increase birth spacing?

Answer 8

• exclusive breastfeeding can lead to lactational amenorrhea, where women don’t get their period
• can give a women 98% protection against pregnancy during this time (MUST BE EXCLUSIVE BF)
• an interval of 24M between birth and the next conception reduces risk of negative outcomes for mother and child

Question 9

breastmilk composition

Answer 9

• very high in fat and carbs (energy-rich), low in protein
• sufficient amunts of vitamins, except vitamin D and vitamin K
• low in iron, but high bioavailability
• contains immunoglobulins, WBCs, lysozyme and lactoferrin
• other bioactive factors include lipase, growth factors and laxative factors

Question 9

how does BM composition change over time?

Answer 9

a) colostrum (2-3 days post-delivery)
b) transitional milk (until 2 weeks old)
c) mature milk (from 2 weeks to 6M)
d) extended lactation (beyond 6M)

Question 10

colostrum

Answer 10

• very nutritious, laxative effect, rich in antibodies and growth factors
• infants only consume 1tsp in a feeding
• some cultures see it as immature, dirty milk and so they’ll provide prelacteal feeds until their milk transitions

Question 11

how does breastmilk composition change within a feed?

Answer 11

• foremilk occurs at the beginning of a feed, quite watery
• hindmilk occurs at the end of a feed
• hindmilk contains more vitamin A and fat (energy), so a breat should be completely drained before switching

Question 11

factors that affect a woman’s ability to BF

Answer 11

1. opportunity to feed right away
2. supportive sociocultural context
3. direct information and support

Question 11

how common are prelacteal feeds?

Answer 11

43% of infants are given something other than breatmilk within first 3 days of life

Question 12

what are myths about BF during crises and how have BF rates changes in countries experiencing humanitarian emergencies?

Answer 12

• a common myth is that mothers under stress cannot nurse, however BF becomes increasingly important in times of crises when there are a lack of health services/sanitation
• countries experiencing humanitarian crises had some of the highest increases in BF rates

Question 13

vertical transmission of HIV

Answer 13

• occurs when a women transmits HIV to their child through pregnancy, labour or BF
• there is a 5-10% chance that a child will become infected during pregnancy, and a 10-20% chance that an infant will become infected during labour or BF (without ART)
• if the mother is on ART, the transmission risk is reduced to 1%

Question 13

BF recommendations for HIV+ women

Answer 13

• if a safe alternative is available (formula, donor milk), they should use that
• if not, the mother should BF exclusively for 6M and take ART
• as soon as the infant is able to consume enough food and fluids, stop BF