Lactation

I. Introduction.- 1. An Introduction to Lactation and Breast-Feeding.- Evolution and Lactation.- Historical Perspectives on Milk Secretion.- Historical Perspectives on the Hormonal Control of Lactation.- Placenta versus Ovary in Mammary Development.- A Role for the Pituitary Gland.- The Hypothesis of Meites and Turner.- Multiple Hormonal Control.- The Role of the Placenta.- Historical Perspectives on Breast-Feeding.- Historical Alternatives to Breast-Feeding.- The Decline of Breast-Feeding.- Third-World Issues in Breast-Feeding.- References.- II. The Scientific Basis of Lactation.- 2. Anatomy of the Breast.- Anatomical Features of the Breast.- Surface Anatomy, Supporting Structures, and General Relationships.- The Nipple and Areola.- Vessels and Nerves.- Lymphatic Drainage.- Embryological Development.- Normal Development.- Anomalous Development.- Structure of the Mammary Gland.- General Features.- Inactive or Resting Stage.- Proliferative or Active Phase.- Lactation or Secretory Phase.- Regression, Involution, or Atrophy.- Summary.- References.- 3. The Mechanisms of Milk Secretion.- and Overview.- Cellular Mechanisms for Milk Synthesis and Secretion.- Changes in Milk Composition at Parturition.- The Secretion of Cells into Colostrum and Milk.- Suckling and the Ejection of Milk from the Breast.- Mammary Blood Flow.- Protein Synthesis, Processing, and Secretion in the Mammary Gland.- Properties of Milk Proteins.- Protein Precursors—The Transport of Amino Acids into Mammary Alveolar Cells.- Synthesis and Processing of Milk-Specific Proteins.- Regulation of Milk Protein Synthesis.- Immunoglobulin Secretion.- Conclusion.- The Synthesis of Milk Sugars.- Glucose Utilization in the Mammary Gland.- Lactose Synthesis.- Regulation of Lactose Synthesis.- Conclusion.- Secretion of Calcium, Phosphate, and Citrate into Milk.- The Role of the Golgi Secretory Vesicles in Calcium Secretion.- Possible Regulatory Activities of Calcium in the Mammary Gland.- The Secretion of Milk Lipid.- The Composition of Milk Fat.- Fatty Acid Synthesis in the Mammary Gland.- Lipoprotein Lipase and the Extraction of Lipids from Plasma.- Triglyceride Synthesis.- Cholestrol Secretion into Milk.- Phospholipids.- Milk Lipases.- Conclusions.- The Secretion of Monovalent Ions and Water into Milk.- Transcellular Ion Transport.- Paracellular Ion Transport.- Conclusions.- Trace Element Secretion into Milk.- Iron.- Zinc.- Iodine.- Selenium.- Sulfur.- Cobalt.- Conclusion.- Milk Secretion—Questions for the Future.- References.- 4. Regulation of Mammary Development and Lactation.- Stages in the Development of Mammary Function.- Mammogenesis.- Lactogenesis.- Lactation.- Involution.- Prolactin Secretion through the Life Cycle.- Milk Ejection and Oxytocin.- Oxytocin Synthesis and Release.- Interaction of Oxytocin with Myoepithelial Cells.- Conclusion.- Lactation and Postpartum Infertility.- Relation between Duration of Postpartum Amenorrhea and Breast-Feeding.- Reproductive Hormone Levels during Lactation.- The Mechanism of Postpartum Amenorrhea.- Conclusion.- Interactions between Food Intake and Lactation.- A Forward Look.- References.- 5. Cellular and Molecular Aspects of the Hormonal Control of Mammary Function.- Lactogenic Hormones.- Regulation of Prolactin Synthesis and Release.- Cellular Actions of Prolactin.- Placental Lactogen.- Conclusion.- The Role of Steroid Hormones in the Control of Mammary Function.- Estrogens.- Progesterone.- Glucocorticoids.- The Role of Insulin in Mammary Function.- The Role of Insulin in Mammary Growth.- The Role of Insulin in Lactogenesis and Lactation.- Effects of Insulin on Lipid Synthesis.- Conclusion.- Thyroid Hormones.- Prostaglandins.- Cyclic AMP.- Conclusion.- References.- 6. In Vitro Model Systems for the Study of Hormonal Control of Mammary Gland Growth and Differentiation.- Whole Gland Culture.- Explant Cultures.- Primary Culture.- Cell Culture.- General Conclusions.- References.- III. The Nutritional and Immunologic Significance of Mammary Secretions.- 7. Nutritional Aspects of Human Lactation.- Technical Difficulties in the Measurement of Milk Yield.- Composition of Human Milk.- Gross Composition.- Protein.- Fat.- Lactose.- Vitamins.- Minerals.- Trace Elements.- Nutritional Requirements for Lactation.- Recommended Daily Allowances.- Energy.- Protein.- Calcium.- Iron.- Vitamins.- Maternal Nutrition and Lactation Performance.- Volume.- Composition.- Incidence and Duration of Lactation.- Influence of Lactation on Maternal Nutritional Status.- Other Maternal Factors.- Human Milk in Infant Nutrition.- Growth.- Biochemical Considerations.- Dietary Supplementation.- Premature Infants.- Conclusions.- References.- 8. The Immunology of Breast Milk.- Antibodies.- Cellular Aspects of the Specific Immune Response.- Phagocytes and Complement.- The Secretory Immune System.- Immunologically Active Constituents of Breast Milk.- Nonspecific Factors.- Cells in Milk.- Functional Responses of Breast Milk Lymphocytes.- Immunologic Consequences of Breast-Feeding for the Baby.- Protection from Infection.- Protection from Allergic Reactions.- Breast-Feeding and Immunization.- Conclusions.- References.- IV. Medical Management of Breast-Feeding.- 9. Routine Management of Breast-Feeding.- Prenatal Period.- Role of the Health Professional in Breast-Feeding Education.- Prenatal Examination.- Management Plans.- Nipple Preparation.- Support Groups.- Intrapartum Period.- Hospital Policies.- Initiation of Nursing.- Common Early Problems.- The Normal Course of Lactation.- First Two Weeks.- Two Weeks.- Two Months.- Four Months.- Six Months.- Nine Months.- Twelve Months.- Late Nursing.- Nursing through Pregnancy.- Conclusion.- References.- 10. Infant Problems in Breast-Feeding.- The Premature or Sick Newborn.- Advantages of Human Milk in Feeding Preterm Infants.- Initiating Breast-Feeding in the Premature Infant.- Methods of Expressing Milk.- Maintaining the Milk Supply.- Surveillance and Storage of Milk.- Transition to the Breast.- Follow-Up.- Failure to Thrive.- Definition.- Etiologies of Lactation Failure—Maternal Factors.- Etiologies of Lactation Failure—Infant Factors.- Evaluation of Failure to Thrive.- Assessment and Plan.- Conclusion.- Cleft Lip and Palate.- Nursing Infants with Cleft Lip.- Nursing Infants with Cleft Palate.- Multiple Births.- Breast Milk Jaundice.- Phenylketonuria.- Hospitalization of the Infant or Mother.- Conclusion.- References.- 11. Maternal Problems in Lactation.- Lactation and Infectious Disease.- Mastitis.- Painful Nipples and Candida albicans.- Tuberculosis.- Herpes Viruses.- Rotaviruses.- Hepatitis B Virus.- Chronic Maternal Illness.- Psychiatric Illness.- Diabetes Mellitus.- Cystic Fibrosis.- Mammoplasty.- Relactation and Induced Lactation.- Conclusion.- References.- 12. Psychological Implications of Breast-Feeding for the Mother.- Breast or Bottled? The Decision-Making Process.- Psychodynamic Factors in the Decison Not to Breast-Feed.- The Influence of Significant Others.- The Time for Decision.- Attitudes and Personality Characteristics of Breast- and Bottle-Feeding Mothers.- Mother-Infant Attachment: The Importance of the Early Postpartum Period for the Mother-Infant Bond and the Establishment of Lactation.- Psychological and Hormonal Interaction in Breast-Feeding.- Psychological Factors in Milk Secretion.- Postpartum Blues.- Sexuality of Breast-Feeding Women.- Support Systems for Nursing Women.- Breast-Feeding and Family Life.- Medical Support Systems for the Expectant and New Mother.- La Leche League International.- Psychological Considerations in Weaning and Extended Nursing.- Conclusions.- References.- 13. Drugs, Toxins, and Environmental Agents in Breast Milk.- Drug Distribution.- Properties of Substances That Affect Their Distribution into Milk.- Quantitative Delivery of Pharmacologic Agents to the Newborn.- Oral Drug Absorption by the Infant.- Recognizing Drug Toxicity in the Infant.- Idiosyncratic and Allergic Drug Reactions.- Selective Drug Toxicity in Infants.- Neonatal Drug Accumulation.- Potential for Masking Medical Conditions.- Over-the-counter Medications.- Environmental Agents in Breast Milk.- Summary of Quantitative Considerations.- Review of Pharmacologic Classes of Drugs in Breast Milk.- Antimicrobial Drugs.- Analgesics and Psychotherapeutic Drugs.- Methylxanthenes.- Cardiovascular and Diuretic Agents.- Rubella Vaccination.- Antithyroid Drugs.- Anticoagulants.- Anticonvulsants.- Radio-Pharmaceuticals for Diagnostic Procedures.- Recreational Drugs.- Insecticides and Polychlorinated Biphenyls (PCBs) in Breast Milk.- Summary of Clinical Considerations.- Drugs That Affect Lactation.- Drugs That Inhibit Lactation.- Drugs That Enhance Lactation.- Summary.- References.- 14. Lactation and Contraception.- Methodoligic Concerns.- The Effects of Lactation on Fertility.- Endocrine Basis of Lactational Amenorrhea.- Conception and Lactation.- Summary.- Contraception during Lactation.- Abstinence.- Barrier Methods.- Rhythm or Natural Family Planning.- Postpartum Sterilization.- Intrauterine Devices.- Steroid Contraceptives.- Summary of Contraceptive Usage in Lactation.- References.- 15. Pregnancy, Lactation, and Breast Cancer.- Epidemiology.- Steroid Hormones and Breast Cancer.- Viruses and Breast Cancer.- Pregnancy, Lactation, and Breast Cancer: The Clinical Picture.- Summary.- References.