Perceptions of Mothers with Preterm Babies towards Donor Breast Milk at Women and Newborn Hospital,Lusaka Zambia

Breast milk offers essential nutrients crucial for the development of the preterm immune system, thus reducing the incidence of infection and mortality often associated with prematurity. In the absence of breast milk, the preferred option is donated breast milk, the best alternative for hospitalized neonates whose mothers have insufficient breast milk or are unavailable. In Zambia, donor breast milk is unavailable. Instead, the protocol recommends the administration of formula milk. However, the use of formula milk in preterm babies is associated with an increased risk of necrotizing enterocolitis and sepsis. Zambia needs to establish a donor milk bank, hence the need to understand the perception of mothers towards donated breast milk. A qualitative descriptive case study utilized 10 focus group discussions with in-depth interviews, purposively selected using a variation strategy. Data was thematically analysed. Participants demonstrated potential acceptance to donor breast milk utilization, as more nutritional compared to formula despite lack of awareness. Concerns related to safety, quality, fear of disease transmission and discomfort feeding from a different bloodline were identified as hinderance to possible utilisation. These perceptions underscore the importance of educational initiatives aimed at dispelling myths and misconceptions surrounding donor breast milk and establishing donor breast milk programs. Therefore, the study recommends educational initiatives tailored to raise awareness to mothers about donor breast milk.

Application of Hazard Vulnerability Analysis Based on Kaiser Model in Neonatal Breast Milk Management

Objective:To analyze the existing risks in breast milk management at the neonatal department and provide corresponding countermeasures.Methods:22 risk events were identified in 7 risk links in the process of bottle-feeding of breast milk.Hazard Vulnerability Analysis based on the Kaiser model was applied to investigate and evaluate the risk events.Results:High-risk events include breast milk quality inspection,hand hygiene during collection,disinfection of collectors,cold chain management,hand hygiene during the reception,breast milk closed-loop management,and post-collection disposal.Root cause analysis of high-risk events was conducted and breast milk management strategies outside the hospital and within the neonatal department were proposed.Conclusion:Hazard Vulnerability Analysis based on the Kaiser model can identify and assess neonatal breast milk management risks effectively,which helps improve the management of neonatal breast milk.It is conducive to the safe development and promotion of bottle feeding of breast milk for neonates,ensuring the quality of medical services and the safety of children.

Breast Milk:Its Role in Early Development of the Immune System and Long-Term Health

Breast milk is the best source of nutrition that provides the energy and nutrients needed for the ideal growth and development of newborns and infants. Besides, breast milk includes various bioactive compounds, which protects infants against infectious agents and antigens and contributes to immune maturation, organ development and microbial colonization. Breast milk is dynamic;the composition of the nutrients and the content of immunological active compounds may change in each stage of lactation. During the early stages of lactation, biological and immunological active compounds provide additional support to the development of the neonatal immune system. After these stages, the composition of breast milk continues to provide appropriate energy and nutrients according to the infant needs, in order to protect neonatal immune system and maintain the development and growth of infants. Immunological maturation during the fetal life and the first months of life is provided by immunoglobulins in breast milk, which are among the most important immune protective factors and transferred to infants through breastfeeding. Due to their biological characteristics, Secretory Immunoglobulin A (SIgA) antibodies are the most important antibodies in breast milk, which provide the first defense against the antigens in the intestines of infants. In addition to antibodies, enzymes, including active leukocytes, cytokines, oligosaccharides, lactoferrin, lysozyme and lactoperoxidase, as well as biological and immunological factors, such as hormones, growth factors, bioactive peptides, nucleotides and fatty acids are transferred to infants through breastfeeding. There is now a growing body of evidence suggesting that breastfeeding protects infants against many infections such as gastrointestinal system and respiratory tract infections, strengthens immune system and provides protective effects against allergic and autoimmune diseases in later life.

Breast Milk Lead and Cadmium Levels in Suburban Areas of Nanjing,China

Objective To evaluate levels of lead(Pb) and cadmium(Cd) in the breast milk in the second postpartum month,to investigate the relationship between Pb/Cd levels in breast milk and some sociodemographic parameters,and to explore whether these levels affect the infants' physical status or the mothers' psychological status(postpartum depression).Methods A cross-sectional study was conducted between November 2009 and December 2010.Altogether 170 healthy mothers were enrolled from Nanjing Maternity and Child Health Care Hospital.The inclusion criteria were:voluntary to participate in this study,healthy,with no chronic disease,breastfeeding in the second postpartum month,living in a suburban but not non-industrial area of Nanjing,and not occupationally exposed to toxic metals.All the mothers completed a questionnaire and were evaluated based on the Edinburgh Postpartum Depression Scale(EPDS) to identify the risk of postpartum depression.Pb and Cd levels in breast milk were determined by inductively coupled plasma mass spectroscopy.The infants of these mothers were examined for their z scores of weight for age,length for age,head circumference for age,and body mass index for age.Results The median breast milk levels of Pb and Cd were 40.6 μg/L and 0.67 μg/L,respectively.In 164(96.5%) of the 170 samples,Pb levels were higher than the limit reported by the World Health Organization(> 5 μg/L).Breast milk Cd level was > 1 μg/L in 54(31.8%) mothers.The mothers with a history of anemia had a higher breast milk Pb level than those without a history of anemia(41.1 μg/L vs.37.9 μg/L,P = 0.050).The median breast milk Cd level in those who were active and passive smokers during pregnancy was significantly higher than that in non-smokers(0.88 μg/L vs.0.00 μg/L,P = 0.025).The breast milk Cd level in the mothers not taking iron and vitamin supplements for 2 months postpartum was higher than in those taking the supplements(iron supplement:0.74 μg/L vs.0.00 μg/L,P = 0.025;vitamin supplement:0.78 μg/L vs.0.00 μg/L,P = 0.005).Breast milk Cd level at the second postpartum month was negatively correlated with the z scores of head circumference(r = 0.248,P = 0.042) and weight for age at birth(r = 0.241,P = 0.024) in girls.No correlation was found between the breast milk Pb/Cd levels and the EPDS scores.Conclusion Considering the high levels of Pb and Cd in breast milk in this study,breast milk monitoring programs are necessary.

Genetic Variants in the ELOVL5 but not ELOVL2 Gene Associated with Polyunsaturated Fatty Acids in Han Chinese Breast Milk

The present study was designed to examine the contributions of the fatty acid elongase （ELOVL） gene polymorphisms to the levels of polyunsaturated fatty acids （PUFAs） in breast milk. Two hundred and nine healthy Han Chinese mothers were included in the study. Carriers of minor alleles of SNPs （rs2397142 and rs9357760） in ELOVL5 were associated with higher levels of linoleic acid （LA）, dihomo-γ-linolenic acid （DGLA）, arachidonic acid （AA）, docosatetraenoic acid （DTA）, docosahexenoic acid （DHA）, while in rs209512 of ELOVL5 the carriers of minor alleles had lower levels of DTA compared to major homozygote alleles （P ranged from 0.004-0.046）, and genetically explained variability ranged from 3.2% for eicosapentaenoic acid （EPA） to 6.0% for LA. Our findings demonstrated that common variation in ELOVL5 gene encoding rate-limiting enzymes in the metabolism of PUFAs contribute to the PUFAs in breast milk.

Identification of Lactobacillus and Bifidobacterium 16S rRNA Gene in Breast Milk of Some Healthy Women in Kinshasa (DR Congo)

Breast milk is important for infant health. Some of its benefits are due to the presence of a specific population of bacteria in the microflora. However, the microbiome of breast milk is influenced by many parameters such as maternal diet, breastfeeding and geographic location. Culture and non-culture methods have been used in studies of this bacterial population worldwide. But in the DR Congo, there was no study reporting the use of culture-independent techniques to characterize the bacterial diversity of human milk. The aim of this study was to identify the bacterial 16S rRNA gene from two genera Lactobacillus and Bifidobacterium. The 16S rRNA gene was also identified from four species: Lactobacillus reuteri, Lactobacillus rhamnosus, Bifidobacterium longum and Bifidobacterium lactis. This analytical cross-sectional study was conducted in Kinshasa. Breast milk from some healthy women was collected from February 2 to 28, 2018. A culture-independent protocol using the classical polymerase chain reaction (PCR) was used to identify the bacterial 16S rRNA gene. The 68 samples of breast milk were collected in a sterile condition. The bacteria-specific ribosomal gene 16S rRNA was detected in 91.18% of Lactobacillus and 32.35% of Bifidobacterium at genus level. At of species level, only Lactobacillus reuteri 16S rRNA gene was identified in 89.71%. The 16S rRNA gene from the other species could not be amplified. There was also an association between educational level and the presence of Bifidobacterium and Lactobacillus 16S rRNA genes in the breast milk (p = 0.008*, p Conclusion: This study demonstrates the presence of the bacterial 16S rRNA gene from Lactobacillus and Bifidobacterium in breast milk at the genus and Lactobacillus reuteri at species level. A further study on the diet, use of antibiotics during pregnancy and lactation practice will provide a better understanding of the microflora of breast milk.

Determination of the Fatty Acid Profile of Breast Milk from Nursing Mothers in Bungoma County, Kenya

The fatty acid profile in breast milk of nursing mothers who participated in a Cohort for Vitamin A (COVA) study at the fourth and ninth month of lactation was investigated. Breast milk samples were collected by manual expression and stored at - 20°C until analysis. The fat was extracted from the milk and methylated using the American Oil Chemists’ Society (AOCS) Official Methods with modifications. The separation, identification and quantification of the fatty acid methyl esters was performed by gas chromatography coupled with mass spectrometry (GC-MS). Fat contents of human milk increased significantly between the fourth and ninth month of lactation 0.38 and 1.21 mg·mL-1 respectively;P 0.05) than the average percent of the total unsaturated FAs (48.93%). Similarly, at the 9th month the percentage average of the total saturated fatty acids (15.18%) was significantly lower (P < 0.05) than the average percent of the total unsaturated FAs (31.05%). The results obtained in this study demonstrated that the fat content in breast milk significantly increased in the 9th compared to the 4th month of lactation. The fatty profile was also significantly different with the omega 6 being the dominant at the 9th month compared with the omega - 9 being dominant at the 4th month of lactation.

Identification and characterization of resistance and pathogenicity of Enterococcus spp.in samples of donor breast milk

BACKGROUND Breast milk is the primary source of nutrition for newborns.Hospitalized babies frequently need nutritional support from Human Milk Banks.As bacterial species of the genus Enterococcus are part of the microbiota of healthy donors,they may contaminate samples of pumped breast milk.AIM To identify and characterize the bacterial virulence and resistance in samples isolated from the nipple-areolar region,hands,and breast milk aliquots from donors at the Human Milk Bank of Municipal Hospital EsauMatos in the city of Vitória da Conquista,Bahia State,Brazil.METHODS The personal hygiene and sanitation of donors were analyzed with the aim of identifying possible reasons for contamination of pumped milk.Cutaneous samples as well as aliquots of unpasteurized and pasteurized milk from 30 participants were obtained.Each Enterococcus spp.isolate underwent a disk diffusion susceptibility test and molecular biology techniques to determine resistance and virulence genes.RESULTS Enterococcus spp.were identified in 30%of donors(n=9),and 11 specimens were isolated.Resistance to tetracycline was highly prevalent,being detectable in 63%of the isolates(n=7)and followed by intermediate sensitivity to ciprofloxacin,observed in 27%of the specimens(n=3).The efaA gene was found in 63%(n=7)of the isolates,while the ace gene was detected in 27%(n=3).CONCLUSION This study illustrates the importance of microbiological monitoring by Human Milk Banks and the need for alternatives to prevent the presence of Enterococcus spp.in hospital settings.

Comparison Effectiveness Breast Milk and Dry Sterile Gauze to Treatment Umbilical Cord

Infection of the umbilical cord has been the cause of illness and death constantly in different countries. Each year 500,000 infants die from neonatal tetanus and 460,000 infants die from bacterial infections. One way that is currently being developed is the use breast milk. Various kinds of content of nutrients and substances that exist in breast milk may reduce the risk of incidence of the infection so that the baby can avoid the incidence of umbilical cord infection. This type of research is quasy experiments with static group comparison. The research data are obtained by researchers using observation sheet, then the data are tabulated. Results of the observation of the time required in the treatment of breast milk and umbilical cord using dry Sterile gauze then compare and conclusions draw an average release time of each media. From the results, the average time of the release of the umbilical cord using breast milk is for 127.41 hours and the average time of the release of the umbilical cord using dry Sterile gauze is for 157.38 hours. From the results of correlation Mann Whitney test with significance level α = 0.05 is obtained significance value (p) of 0.00. It takes a more active research and in a greater scope to conduct more studies in the use of breast milk to use for umbilicard cord of the baby. That requires the active participation of various stakeholders to provide support in implementing it.

Maternal Body Composition and Its Relationship to Infant Breast Milk Intake in Rural Pakistan

Some women in rural Pakistan are chronically undernourished, and consequently underweight. Concerns have been expressed that the degree of undernourishment might be sufficiently severe to affect lactation performance. We have obtained data on maternal body composition and infant breast milk intake using stable isotope methods in a group of thirty three mother and infant pairs at approximately six months of age. The maternal body mass index ranged from 16.6 to 29.1 kg·m-2. In this population we found that exclusive breast-feeding tended to be associated with lower maternal body fat, and that there was no evidence for compromised lactational performance due to malnourishment. Finally we note that when our data is combined with that from other studies there may be a generalised negative correlation between breast milk intake and maternal body fat.

Microbiological safety of expressed breast milk for preterm admitted to neonatal unit in China

Objective To determine the degrees and types of bacterial contamination in home-expressed mother's milk for preterm admitted to neonatal unit in China. Methods The present paper was a descriptive study enrolled a total of 75 human breast milk samples from February 2nd to March 1st 2015. The primary outcome was microbiological features of breast milk samples collected at home. A sample of more than 104 colony-forming units/mL is considered as the significantly bacterial contaminated breast milk. Results Among the milk samples obtained from the mothers of 75 neonatal babies,69. 3% had substantial bacterial growth. This high contamination rate could be due to the Chinese tradition of avoiding bathing for one month after childbirth.Conclusion Un-processed breast milk expressed by mothers in home was not safe for high risk preterm babies. Health care needs to pay attention to the risk of that in China. Good hygienic practice and strict process control for breast expression,including collection,transportation and storage should be developed for Chinese mothers of hospitalized preterm infants.

Impact of Breast Milk Biochemistry on Neonatal Jaundice: Insights from a Cross-Sectional Study in Jos, Nigeria

Background: Exclusive breastfeeding is globally promoted as a preventive health measure. However, an increasing incidence of jaundice among exclusively breastfed neonates has been observed. In Jos, Nigeria, anecdotal evidence suggests a rise in jaundice cases among breastfed infants during their first week of life. This study investigates the relationship between neonatal jaundice and the biochemical composition of maternal breast milk in Jos, Nigeria. Objective: To evaluate the role of maternal milk protein status and other milk constituents in the development of neonatal jaundice among exclusively breastfed full-term infants. Methods: This cross-sectional study involved 152 participants, comprising of 76 neonates (38 jaundiced and 38 healthy controls) and their corresponding 76 mothers at Jos University Teaching Hospital. Biochemical analyses were conducted on maternal breast milk (albumin, proteins, casein, fat, lactose, enzymes) and infant serum (bilirubin, albumin, proteins, enzymes). Statistical analysis was performed using Mann-Whitney tests with significance set at p ≤ 0.05. Results: Maternal breast milk from mothers of jaundiced infants showed significantly lower protein (0.73 ± 0.07 g/100ml), albumin (0.62 ± 0.04 g/100ml), and casein (1.6 ± 0.12 g/100ml) levels compared to controls (p Conclusion: The study highlights a potential link between lower maternal milk protein levels and the occurrence of neonatal jaundice. Interventions aimed at enhancing maternal nutrition and promoting more frequent breastfeeding may mitigate the risk. Further research should explore additional maternal and neonatal factors contributing to this condition.

Breast Milk Application as a Natural Method for Umbilical Cord Care:A Community-Label 3-Arm Pilot Clinical Trial

Objective: To compare the effects of human breast milk with those of chlorhexidine and the dry method on umbilical cord separation in Ethiopia.Methods: This open-label 3-arm nonrandomized pilot clinical trial was conducted among 45 neonates(15 in each arm)with more than 630 home visits.After a standard cord cut,human breast milk,chlorhexidine,or nothing was applied once per day for 7 days.The primary outcome was the duration of cord separation,while the secondary outcomes were umbilical cord infection,neonatal fever,jaundice,feeding and breathing difficulty,and persistent crying.Results: There were statistically significant differences in the time-to-cord separation between the human breast milk group and the chlorhexidine(P<0.001)and dry alone(P=0.038)groups.Compared to those of chlorhexidine,the rates of cord separation among human breast milk and the dry-alone group were 16.02,with 95%confidence intervals(3.81,37.43;P<0.001)and 3.15(0.99,10.00;P=0.052),respectively.One(6.7%)cord site infection was observed in the dry-alone groups only.Conclusion: This community-label study indicated that human breast milk application significantly shortened the length of umbilical cord separation time compared to chlorhexidine and dry methods.A large-scale randomized controlled trial is needed to confirm these results.

Mineral compositions in breast milk of healthy Chinese lactating women in urban areas and its associated factors

Background Optimal mineral intakes are important for infant growth and development. However, data on mineral compositions of breast milk in Chinese women are scarce, and most were acquired before 1990. The objectives of this study were three-fold： （1） to investigate the mineral compositions of Chinese healthy mothers＇ breast milk in different lactation stages; （2） to explore correlations among mineral concentrations in breast milk; and （3） to explore the associated factors affecting mineral compositions in breast milk. Methods The inductively coupled plasma mass spectrometry （ICP-MS） was used to analyze mineral concentrations in breast-milk of 444 healthy lactating women from three cities in China. A questionnaire was used to survey socio- demographic characteristics and pregnancy history. Food intakes by lactating women were measured using both food frequency questionnaire and one cycle of 24-hour dietary recall. Results Mineral compositions of breast milk varied in different regions. Concentrations of most minerals were higher in the first one or two months of lactation, and then decreased with time, except for magnesium and iron. Inter-mineral correlations existed among several minerals. The calcium-to-phosphorus ratio was above 2：1 in each lactation stage. Women with caesarean section had higher concentration of iodine in the transitional milk （349.9 pg/kg） compared to women with natural delivery （237.5 pg/kg, P〈0.001）. Dietary mineral intakes, supplements, food intake frequencies in the recent 6 months, maternal age and maternal BMI did not show significant correlations with concentrations of milk minerals （all P 〉0.05）. Conclusions Milk minerals decreased with time, and changed most rapidly in the first one or two months of lactation. Caesarean section might affect the iodine level in transitional milk. Chin Med J 2014;127 （14）： 2643-2648

Outsourcing Breast Milk

我们对于母乳喂养对小宝宝带来的好处耳熟能详。可是由于心理压力或身体疾病而产奶不理想等原因,不少母亲担心自己的宝宝不能随时品尝到营养口味俱佳的母乳,于是替代式喂养方式卷土重来,是天使,还是恶魔?尽管多方争执不断,但美国的一些公司已经开始尝试向市场投放母乳产品,并且前景看好。相信在不久的将来,任何人只要跑到便利店就可以购买到经过消毒的母乳产品。

Glucose and Insulin Levels are Increased in Obese and Overweight Mothers’ Breast-Milk

Objective: To analyze the relationships between mothers’ pre-pregnancy body mass index (BMI) and levels of glucose and insulin in breast-milk. Methods: Participants were 32 breast-feeding mothers who were assigned to either normal weight (group 1: n = 21, BMI between 18.5 and 24.9 kg/m2) or overweight/obese (group 2: n = 11, BMI ≥ 25 kg/m2) based on their pre-pregnancy BMI. Breast-milk samples were collected at six weeks postpartum. Glucose and insulin concentrations were measured in the breast-milk samples. To control for any extreme dietary influences on breast-milk glucose concentrations, mothers completed 24-hour food recalls. Results: Mean milk-glucose values of groups 1 and 2 were 32.6 ± 21.8 mg/dL and 51.9 ± 20.5 mg/dL respectively. Milk-borne insulin values were 4.5 ± 7.6 μIU/mL and 30.1 ± 56.3 μ IU/mL, respectively. Independent-samples t tests found that glucose levels of group 2 were greater than those of group 1, t(30) = 2.43, p = 0.02;and milk-borne insulin was greater in group 2 than in group 1, t(30) = 2.075, p = 0.05. Mothers’ pre-pregnancy BMI was found correlated with both breast-milk glucose (r = 0.483, p = 0.005) and insulin (r = 0.565, p = 0.001). Conclusion: This study found that in comparison with normal weight mothers, over-weight/ obese mothers have higher concentrations of glucose and insulin in their breast-milk. Further studies are needed to explain the underlying mechanisms, and possible consequences of infant exposure to higher levels of glucose and insulin in breast-milk.

母乳功能组分对哺乳期幼鼠免疫和学习记忆能力的影响

以婴幼儿配方乳粉为对照组,分别研究依据中国人乳比例混合的母乳低聚糖、来源于中国人乳的益生菌及乳脂肪球膜等3种母乳功能组分(FCs)对哺乳期Sprague Dawley幼鼠免疫能力的影响,并探究其对幼鼠学习记忆能力的改善作用。结果表明,与对照组相比,FCs均能使哺乳期幼鼠体质量稳定增长,其中,添加来源于中国人乳的益生菌(动物双歧杆菌M8和植物乳杆菌12)的婴配粉使幼鼠体质量高于其余3组;FCs均能显著提高哺乳期幼鼠血清中免疫球蛋白G、免疫球蛋白M、免疫球蛋白A、肿瘤坏死因子-α等免疫因子含量(P<0.05),并显著降低血清中白细胞介素-10、白细胞介素-4含量(P<0.05),其中,混合母乳低聚糖对幼鼠免疫能力改善作用显著高于其他3组(P<0.05);FCs还显著降低幼鼠在水迷宫中的平台潜伏期时间(P<0.05),其中,益生菌组幼鼠潜伏期时间显著低于其余3组(P<0.05);混合母乳低聚糖和乳脂肪球膜还显著提高了哺乳期幼鼠粪便中短链脂肪酸(Short chain fatty acid,SCFAs)含量(P<0.05),而混合母乳低聚糖组幼鼠粪便中总SCFAs含量显著高于其余3组(P<0.05);3种母乳功能组分,特别是按中国人乳比例混合的母乳低聚糖和来源于中国人乳的益生菌均有利于提高哺乳期幼鼠的体质量和增强其学习记忆能力,并可能通过提高肠道中SCFAs含量来增强其免疫。文章为开发适合中国婴幼儿的配方乳粉提供理论依据。

The level of bile salt-stimulated lipase in the milk of Chinese women and its association with maternal BMI

This study aimed to investigate the bile salt-stimulated lipase(BSSL) concentration in the milk of Chinese women and its correlation with maternal body mass index(BMI), gestational diabetes mellitus(GDM) and gestational hypertensive disorder(GHD). The BSSL levels in the milk samples were measured by enzyme-linked immunosorbent assay(ELISA). BSSL level in colostrum milk of mothers with full-term infants was positively correlated with pregnancy week and negatively correlated with maternal pre-pregnancy BMI and BMI late in pregnancy. Moreover, the BSSL concentration in mature milk was positively correlated with BMI gain during pregnancy. The BSSL concentration in colostrum milk was lower in GDM mothers than in normal mothers. The BSSL helps infants digest fat in early life and its level was associated with lactation. The changes in BSSL characteristics with maternal BMI and GDM in this study may have clinical implications regarding the effects of pregnancy weight and metabolism on the nutrition and health of the offspring.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

Pharmacological role of efflux transporters: Clinical implications for medication use during breastfeeding

The World Health Organisation recommends exclusive breastfeeding for the first six months of an infant’s life and in combination with solid food thereafter. This recommendation was introduced based on research showing numerous health benefits of breastfeeding for both the mother and the infant. However, there is always concern regarding the transfer of medications from mother to their breastfed baby via milk. Pharma-cokinetic properties of a drug are usually used to pre-dict its transferability into breast milk. Although most drugs are compatible with breastfeeding, cases of toxic drug exposure have been reported. This is thought to be due to active transport mechanisms whereby effux transporter proteins expressed in the epithelial cells of the mammary gland actively secrete drugs into milk. An example of such effux transporters including the breast cancer resistance protein which is strongly induced during lactation and this could result in contamination of milk with the substrates of this transporter which may place the suckling infant at risk of toxicity. Furthermore, there is little known about the substrate specifcity of most effux transporters as we have highlighted in this review. There also exists some degree of contradiction between in vivo and in vitro studies which makes it difficult to conclusively predict outcomes and drug-drug interactions.