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Does Breastmilk Neutralize HIV?

Written by Diana Cassar-Uhl, IBCLC

Photo by DFID – UK Department for International Development via Flickr

As an IBCLC, I’m always thrilled when a new study comes out and affirms what I already know about human milk – that it’s amazing and we’re constantly learning something new about it.

Last summer, one of the first classes I took toward my Master of Public Health was Introduction to Epidemiology. Because it was online, class discussions were held to a strict standard – our professor required us to back up any claims with peer-reviewed evidence.  No matter what the topic was, I did my best to bring it around to breastfeeding, often to the chagrin of the other rising students of public health, who learned quickly just how much they didn’t know about breastfeeding. Naturally, no class about epidemiology (according to Merriam-Webster: the study of the incidence, distribution, and control of diseases in a population) would be complete without discussions of HIV, but the topic of HIV and breastfeeding wasn’t one I ever needed more than an elementary understanding about, given the population I serve as an IBCLC.

A classmate remarked that while breastfeeding might be the best thing to do for most mothers in most parts of the world, in nations where the prevalence of HIV is high, only those mothers with access to highly-active anti-retroviral therapy (HAART) were advised to breastfeed. She had worked with a population that was not advised to breastfeed their babies, and was frustrated by the fact that access to uncontaminated water (both for mixing formula and for cleaning feeding vessels) was nearly as difficult as access to the HAART drugs – making minimization of all risk impossible for these babies born to HIV+ mothers. I had read that, for HIV+ mothers, exclusive breastfeeding, rather than mixed feeding (breastfeeding plus formula) was the safest way to feed her infant, perhaps due to the protective effect of SIgA and other human milk components on the infant’s gut (shown by reduced incidence of transmission in the exclusively breastfed groups in studies cited below). However, a newly-released study offers another explanation, one that adds to the “wow factor” of human milk: antibodies in the milk of HIV-infected mothers actually help neutralize HIV itself.

The study by Friedman, et al. at Duke University in North Carolina, U.S.A. is part of ongoing efforts to develop a vaccine against HIV. Researchers isolated an immunological component of colostrum of HIV+ mothers – HIV-specific B-cells, and noted that they neutralized the virus.

The World Health Organization states:

Mothers known to be HIV-infected (and whose infants are HIV uninfected or of unknown HIV status) should exclusively breastfeed their infants for the first 6 months of life, introducing appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life.

Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided (WHO, 2010.)

In many developing nations, the criteria “nutritionally adequate and safe” are not possible to meet; therefore, exclusive breastfeeding remains the most protective method of feeding an infant, even one with an HIV-infected mother; the risk of illness or death from causes related to the replacement feeding methods are significant in these areas of the world. Guidance from the Centers for Disease Control (CDC) in the United States mirrors this, but presumes the availability of replacement feeding that is acceptable, feasible, affordable, sustainable, and safe.

While it could be part of the explanation for why the vast majority (over 90% in some studies) of exclusively-breastfed infants of HIV+ mothers do not contract the virus, the discovery of HIV-specific B-cells in the colostrum of HIV-infected mothers is not yet the “green light” for exclusive breastfeeding for all; however, it offers promise toward understanding and hopefully, gaining the upper hand on HIV transmission rates not just for babies, for entire at-risk populations.

Friedman, J., Alam, S. M., Shen, X., Xia, S. M., Stewart, S., Anasti, K., Pollara, J., et al. (2012). Isolation of HIV-1-neutralizing mucosal monoclonal antibodies from human colostrum.

World Health Organization. (2010). Guidelines on HIV and Infant Feeding.

U. S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2010). Breastfeeding, Human Immunodeficiency Virus (HIV), and Acquired Immunodeficiency Syndrome (AIDS).

Diana Cassar-Uhl, IBCLC and La Leche League Leader, enjoys writing to share breastfeeding information with mothers and those who support them.  In addition to her frequent contributions to La Leche League International’s publication Breastfeeding Today, Diana blogs about normalizing breastfeeding in American culture at http://DianaIBCLC.com and has been a guest blogger at Best for Babes and The Leaky Boob.  Diana can be found lecturing at breastfeeding education events around the United States.  She is pursuing a Master of Public Health, and upon graduation hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition.  Mother to three breastfed children, Diana recently retired after serving as a clarinetist on active military (Army) duty in the West Point Band since 1995.

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How can we best support mothers to reach their breastfeeding goals?

Written by Jennie Bever Babendure, PhD, IBCLC

Photo via laurabl @ Flickr

Despite the recent media attention on toddler breastfeeding, a majority of women in the US and many other countries struggle to reach even 6 months of breastfeeding. To help mothers reach their breastfeeding goals, researchers have long created and studied support interventions. On May 16th, a review and meta-analysis was released by the Cochrane Collaboration looking at breastfeeding support interventions at the highest tier of evidence, randomized and quasi-randomized controlled trials. The study, “Support for healthy breastfeeding mothers with healthy term babies” focused on the effectiveness of 52 postnatal support interventions from 21 countries between 1979 and 2011 looking at primary outcomes of breastfeeding duration and exclusivity in healthy full term babies born to healthy mothers. 1

While some of their findings came as no surprise, others are very telling for the future of our efforts to increase breastfeeding duration and exclusivity all over the world.

What we might have expected:

1. Taken as a whole, support interventions reduced the number of women who stopped breastfeeding before 6 months and reduced the number of women who were no longer breastfeeding exclusively at 4-6 weeks and at 6 months.

2. Face to face support was more effective than telephone support

What we might not expect:

3. Support interventions were more effective in populations in which breastfeeding initiation was high.

Support is more effective when women are already motivated to breastfeed.

4. Lay support was more or as effective as professional support in reducing breastfeeding
cessation.

As the most common reason mothers cite for stopping breastfeeding is the perception of not enough milk, encouragement and education from a peer counselor, community health worker, or other lay supporter can be exactly what a mother needs to reach her goals.

Most significantly, the study found that:

5. Interventions in which mothers had to ask for support, travel a distance to access
support, and in which only one interaction was provided were NOT effective at increasing
breastfeeding duration and exclusivity.

The review goes on to conclude that “Support that is only offered if women seek help is unlikely to be effective. This indicates that women should be offered predictable, scheduled, ongoing visits.” For most countries, providing this type of proactive support to all mothers would require systematic change. Most of the reviewed studies provided support by home visits or telephone calls to mothers soon after birth and continuing for many weeks postpartum. Home visits by lactation consultants, nurses, midwives, and peer counselors have demonstrated positive results, as has an intervention to incorporate lactation consultations into the regular pediatric office visits. For a more in-depth discussion of the need for proactive support, see my most recent post at www.breastfeedingscience.com.

Based on the above findings it is clear that if we are to create systematic, sustainable impacts on how mothers feed their children, we need to think about how ongoing proactive support for breastfeeding mothers can best tie into our existing culture. Given the recent movement towards sustainability and health, our community has an opportunity to put forth a unified front and effect change to ensure that routine lactation support is as normal as a pediatric check-up.

The 203 page study is freely accessible in its entirety here.

1. Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 2012; 5.

Editor’s Note:  Please take the opportunity to read Jennie’s companion post to this one on her blog. In it, she highlights how formula companies have figured out how to make their product available to mothers in the ways mentioned above and makes suggestions for ways that lactation professionals could change their thinking on such matters.

Jennie Bever Babendure, PhD, IBCLC

I am a mother of 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates.

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Job Security and IBCLC Advocacy

Written by Liz Brooks, JD, IBCLC, FILCA

I read a post on a list recently, from a USA-based IBCLC, concerned about a large birth facility that contemplates cutting IBCLC services because administrators perceive lactation services as costly “extras.”  Her concerns are very real. IBCLCs are under threat of losing their jobs in a tough economy, in a culture that perceives
bottle-feeding rather than breastfeeding BF as “normal.”

IBCLCs do not need to be lactivists, or to have “clout,” to be advocates.
All it takes is a little energy to make a stab at telling administrators how wrong their thinking is.  Will you “win?”  Maybe not.  But remaining silent will surely not change the mind-set at the institution, either.

The GOOD news is the IBCLC does NOT have to go and “think up” any of the advocacy
materials to share with decision-makers. Much of it has already been done,
and nearly all of it is free.  Thus, I suggest:

(1)  Run, do not walk, to the USLCA website, to download and read ALL the
incredible IBCLC  advocacy materials that are there all day, everyday. There
are swanky-looking, FREE, evidence-based hand-outs about hospital staffing,
the IBCLC credential, etc.  The website is newly-redesigned and quite
elegant.

(2)  Run, do not walk, to the U.S. Surgeon General’s Call to Action to Support Breastfeeding, to download and read the FREE evidence-based report by the nation’s most important public health official on the importance of having *everyone* support
breastfeeding mothers …. starting with the facilities where they birth.

(3) Run, do not walk, to the ILCA website to download the FREE Position
Paper on the Role and Impact of the IBCLC:

(4)  Run, do not walk, to the FREE “Speak Up” campaign materials written by
the Joint Commission on the topic of breastfeeding.  Does your facility
really want to be seen as doing the precise opposite of what the Joint
Commission has declared is a vital patient right … to speak up for and get qualified lactation care?

(5)  Run, do not walk, to the Centers for Disease Control website, to review
their FREE materials on the nationwide effort for hospitals to attain
Baby-Friendly status, in order to meet national public health objectives.
Does your facility really want to be seen as doing the precise opposite of
what the CDC has declared is critical to providing healthcare that improves public health?

(6)  For a quick-and-easy evidence-based document (8 pages text; 4 pages
citations), about five dollars will buy you The Risks of Not Breastfeeding,
from ILCA:

(7)  For a huge evidence-based document on maternal and child health
outcomes of breastfeeding, download the FREE 415-page “mother of them all”
by Ip, et al. and Agency for Healthcare Screen Sharing Research and Quality (AHRQ) “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries.”  Or, download just the first 11 pages (the Executive Summary)

(8)  Report back to Lactation Matters and report on how things went … to energize, empower and embolden other IBCLCs facing the same crisis.

Liz Brooks, JD, IBCLC, FILCA, has been one of the leading car accident lawyers (since 1983), private practice lactation consultant (since 1997), and leader in her professional association (since 2005.)  As an IBCLC, Liz has worked in private practice (offering home visits); a hospital setting (offering prenatal education, “rounding” on breastfeeding mothers and babies in the full-term and Level III NICU nurseries, and providing in-service education to nurses, doctors and midwives); and a non-profit, community-based breastfeeding clinic (which provides IBCLC service to mothers on a sliding fee scale).

Liz has been on the Board of Directors of the International Lactation Consultant Association (ILCA: Secretary 2005-11; will be President 2012-14); she is the United States Lactation Consultant Association Alternate to the United States Breastfeeding Committee (USBC) (since 2011); she remains active in her local ILCA chapter PRO-LC. Liz was designated Fellow of the International Lactation Consultant Association (FILCA) in 2008, the inaugural year for the program.

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