Archive | Research

Can A Cow Jump Over the Moon (or Produce Human Milk)?

By Maryanne Perrin, MBA

Photo by law_keven via Flickr Creative Commons

“Hey diddle diddle,
The cat and the fiddle,
The cow jumped over the moon.”

How many of us have lulled little ones to sleep with the lines from this old English nursery rhyme? Today’s news headlines claim cows are performing another impressive trick –producing human milk – thanks to the wonders of genetic engineering. And while cow tricks are amusing in nursery rhymes, in the field of infant nutrition they deserve a lot more scrutiny. So let’s take a closer look at the claims of human-milk-producing cows.

What’s Been Engineered Into Cows’ Milk

In recent years, scientists in China have genetically modified cows to produce human lysozymes, an antimicrobial protein (1) that disrupts the cell wall of gram-positive bacteria. They’ve also created a cow that produces human lactoferrin, another important antimicrobial protein (1) that destabilizes the cell wall of both gram-positive and gram-negative bacteria. A 2011 study out of The Netherlands found that the lysozyme content of human milk was 3,000 times greater than that of bovine milk, and that the lactoferrin content was 75 times greater (2). Clearly the greater concentrations of these antibacterial proteins in human milk are important for infants, given the immature nature of their gastrointestinal tract. But does adding a genetically engineered human protein to cow milk provide the same immunological benefits to humans (many more studies will be needed to establish safety and efficacy) and are there other important human milk compounds missing from engineered cows’ milk?

What’s Still Missing?

We’ve learned a lot over the past few decades about the make-up of human milk (and there’s still more to be discovered and understood!). Two of the most obvious areas where human milk and bovine milk differ in their nutrient make-up are in proteins and carbohydrates.

Proteins: Both the quantity and nature of proteins differ between human and bovine milk. For example, human milk has substantially less total-protein and casein-protein than cows’ milk, while it has significantly higher concentration of several proteins associated with the development of the mucosal immune system. The Netherland study showed that of the 268 proteins identified in human milk, 121 of these proteins (45%) were not found in cow milk (2).  Notable differences include the high concentration of immunoglobulin A, a human milk protein customized to bind pathogens found in the mother’s (and thus the baby’s) environment, and CD14, a protein involved in detecting gram-negative bacteria and activating the innate immune system.

Carbohydrates: Human milk has a higher concentration and more diverse portfolio of oligosaccharides, (a short chain of sugar molecules) than cow milk (3). Human Milk Oligosaccharides (HMOs) pass through an infant’s gut undigested, and serve as a prebiotic for the development of a healthy gut microflora. They also appear to act as a very shape specific “lock and key” to bind pathogens. While much research remains to be done in this field, recent studies have shown HMOs to be protective against NEC in an animal model, and to be associated with a reduced transmission of HIV.

Today’s scientific advances will allow us to continue to identify health-promoting compounds in human milk and then manufacture them using various biotechnologies. But “human milk” cannot be created by bolstering cow milk with one or two important proteins, as evidenced by the hundreds of unique proteins and hundreds of unique and changing oligosaccharides in human milk (not to mention living cells and bacteria) that work collectively to support an infant’s immature immune system. Re-engineering all of that into a single cow is a mighty big challenge – probably even bigger than jumping over the moon!

Written by Maryanne Perrin, MBA, Graduate student in Nutrition Science, and ILCA volunteer

References

1. Hanson, L.A. (2005). Human milk: Its components and their immunobiologic functions. In J. Mestecky, M. Lamm et al (Eds.), Mucosal Immunology 3rd Edition ( 1795-1827). Oxford: Elsevier Academic Press.

2. Hettinga K, van Valenberg H, de Vries S, Boeren S, van Hooijdonk T, et al. (2011) The
Host Defense Proteome of Human and Bovine Milk. PLoS ONE6(4): e19433. Doi:10.1371/
journal.pone.0019433.

3. Mehra R, Kelly P. Milk oligosaccharides: Structural and technological aspects. International Dairy Journal. 2006; 16(11): 1334-1340.

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FREE Access to the Journal of Human Lactation during August in celebration of World Breastfeeding Week

The Journal of Human Lactation (JHL) is the premier quarterly, peer-reviewed journal publishing original research, commentaries relating to human lactation and breastfeeding behavior, case reports relevant to the practicing lactation consultant and other health professionals who assist lactating mothers or their breastfeeding infants, debate on research methods for breastfeeding and lactation studies, and discussions of the business aspects of lactation consulting.

In celebration of World Breastfeeding Week, JHL is offering free access to a number of their most-read articles through August 31, 2012. While ILCA members receive and have access to JHL as a member benefit, the availability of the free articles is especially beneficial for our colleagues from other disciplines.  Please share widely these resources to pediatricians, obstetricians, midwives, nurses, educators, researchers and general public.

Free articles from JHL (through August 31, 2012) include:

Human Colostrum and Breast Milk Contain High Levels of TNF-Related Apoptosis-Inducing Ligand (TRAIL) by Riccardo Davanzo, Giorgio Zauli, Lorenzo Monasta, Liza Vecchi Brumatti, Maria Valentina Abate, Giovanna Ventura, Erika Rimondi, Paola Secchiero, and Sergio Demarini

Maternal Request for In-hospital Supplementation of Healthy Breastfed Infants among Low-income Women by Katie DaMota, Jennifer Bañuelos, Jennifer Goldbronn, Luz Elvia Vera-Beccera, and M. Jane Heinig

Expansion of the Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations for Three Guiding Principles by Kerstin Hedberg Nyqvist, Anna-Pia Häggkvist, Mette Ness Hansen, Elisabeth Kylberg, Annemi Lyng Frandsen, Ragnhild Maastrup, Aino Ezeonodo, Leena Hannula, Katja Koskinen, and Laura N. Haiek

Milk and Social Media: Online Communities and the International Code of Marketing of Breast-milk Substitutes by Sheryl W. Abrahams

Development of a Postnatal Educational Program for Breastfeeding Mothers in Community Settings: Intervention Mapping as a Useful Guide by Hanne Kronborg and Gerjo Kok

Barriers, Facilitators, and Recommendations Related to Implementing the Baby-Friendly Initiative (BFI): An Integrative Review by Sonia Semenic, Janet E. Childerhose, Julie Lauzière, and Danielle Groleau

Breastfeeding at NICU Discharge: A Multicenter Italian Study by Riccardo Davanzo, Lorenzo Monasta, Luca Ronfani, Pierpaolo Brovedani, and Sergio Demarini

A Model Infant Feeding Policy for Baby-Friendly Designation in the USA by Lori Feldman-Winter, Diane Procaccini, and Anne Merewood

What are your favorite JHL articles from the past year?  How have they impacted your practice?

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Breastmilk and Breast Cancer Research {A Follow-Up}

Photo by honey-bee via Flickr Creative Commons

Recently, we ran a series (Part 1 and Part 2) on the work of Dr. Kathleen Arcaro, using breast milk to help determine breast cancer risk.  The response to the posts was overwhelming with both posts together being read by over 3,600 people. We are confident that, with the help and encouragement of IBCLCs, women all over the country can be involved in this exciting research.

Dr. Arcaro is now looking for a new set of breastmilk samples:  those from women who either currently have or have previously had breast cancer.  These samples can be either fresh or frozen.

If you know of a mother who fits this profile, please have them contact Beth at (413) 545-0813 or email her.  If not, please help by spreading the word however you like – Facebook, Twitter, etc.

Thank you!

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Increasing breastfeeding duration: One Sling at a Time!

Written by Jennie Bever Babendure, PhD, IBCLC

Author Jennie Bever Babendure with her little one

By now, most of us in the lactation field have heard of Kangaroo Mother Care (KMC). Maybe you’ve even been lucky enough to hear Nils Bergman speak passionately about the work he’s done using KMC, and its benefits for premature infant thermal regulation and brain development. Most importantly for those of us in the lactation world, the skin-to skin contact (SSC) used in KMC is associated with increased breastfeeding duration. Despite all the attention SSC and KMC have received, no one has yet looked at the impact on breastfeeding of mother/infant body contact beyond the first hours after birth in term infants.

A recent article in Acta Paediatrica by Continisio, Continisio, Filosa and Tagliamonte, set out to remedy this by designing an intervention to increase mother/infant body contact in the first month of life. 100 Italian mothers were given information on breastfeeding as well as a cloth baby carrier. They were shown how to put their (clothed) infants into the carrier and asked to wear the baby in the carrier as often as possible, and for at least 1 hour per day during the baby’s first month. Control mothers were given information on breastfeeding only.

What they found surprised even me, a sling-wearing, card-carrying member of the babywearing fan club.

Photo by hugabub via Flickr Creative Commons

Mothers in the intervention group were 1.8 times more likely to still be breastfeeding at 2 months and 2.9 times more likely to still be breastfeeding at 5 months and breastfed their babies significantly more often (times per day/ night) at 1 and 2 months. Mothers in the intervention were also more likely to be exclusively breastfeeding at 2 and 5 months. In addition, the majority of the mothers who used the baby carrier felt it was useful for breastfeeding as well as bonding, understanding of baby needs, and getting things done.

Wow!

For me, these results are staggering. The intervention is simple, requires minimal skill to administer, and mothers and babies are not only getting the health advantages of longer and more exclusive breastfeeding, they’re also getting more bonding time and getting things done! It is for this last reason, I would imagine, that women the world over have chosen to carry their babies in cloth carriers for thousands of years. They, like many mothers who use cloth carriers these days, likely could have told us that babywearing makes breastfeeding easier. Thanks to this study, we now know that it also helps mothers breastfeed longer and more exclusively.

This study provides solid evidence that increased mother/baby contact through the use of a baby carrier can increase breastfeeding duration and exclusivity. Although this study was done with only one type of carrier, I would guess that most carriers that allow mothers to wear their new babies close to their chests (as in KMC) would be of similar benefit.

One of my favorite resources for all things babywearing is www.thebabywearer.com. They have reviews, forums, and information on buying, making, and using baby carriers of all kinds. Be sure to check out the resources on their homepage on safe positioning. Like any type of baby gear, baby carriers must be used properly, and it’s important to check to make sure that any baby carrier you use has not been recalled.

I’m not sure I would have made it through the first few months without a baby carrier. In fact as I finish this post, my son is snuggled against my chest in a carrier while we sway back and forth to Neil Diamond.

Have you or the mothers you work with used a baby carrier? Have you found it to make breastfeeding easier?

Pisacane A, Continisio P, Continisio GI, Filosa C, Tagliamonte V. Use of baby carriers to increase breastfeeding duration among term-infants: the effects of an educational intervention in Italy. Acta Paediatrica 2012:epub ahead of print.

Jennie Bever Babendure, PhD, IBCLC: I am mom to 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. For more research news and commentary, check out my blog at www.breastfeedingscience.com.

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What Do Undergraduates Think about Breastfeeding?

Written by Robin Kaplan, M.Ed., IBCLC

Photo by j.o.h.n. walker via Flickr

It is well known that in the United States, breastfeeding rates are somewhat discouraging. With only 35% of babies exclusively breastfeeding at 3 months and 44.3% receiving any breast milk at all at 6 months, as a nation we are not meeting the standards set forth by the American Academy of Pediatrics nor the World Health Organization. As we continue to look at ways in which we can increase our breastfeeding rates, one suggestion has been to examine the breastfeeding education taught to nonpregnant youth.

An article in the upcoming issue of the Journal of Human Lactation explores this issue. Kavanaugh, et al. surveyed 248 nonpregnant undergraduate youth at a large research university in Tennessee to determine their breastfeeding knowledge, attitudes, prior exposure, and breastfeeding intent (For subscribers to The Journal of Human Lactation, you can read the full text of the paper here).

The most significant findings from the study were:

  • Over 90% of the participants agreed that breastfeeding should be started soon after birth and that breast milk and formula were not the same. However, only about 50% of the participants knew that breastfeeding can reduce a mother’s risk of cancer and that formula-fed infants are ill more often than breastfed babies.
  • While a majority of the participants believed that breastfeeding was cheaper and healthier than formula, an astounding number felt that breastfeeding in public was embarrassing and unacceptable (71% female, 47.7% male) as well as inconvenient and painful (47.8 female, 33.8% male).
  • Those who had been breastfed as infants scored significantly higher on breastfeeding knowledge and positive attitude towards breastfeeding than those who were unsure or had not been breastfed.
  • The majority of the participants (80%) intended to breastfeed/support a partner to breastfeed in the future.

So where do we go from here? How do we change the attitudes of children, adolescents, and young nonpregnant adults about breastfeeding?

  • This research study is limited in its generalization due to the sample of the participants, therefore we need more wide spread, longitudinal studies of adolescents and young adults’ breastfeeding knowledge and attitudes.
  • We need better support and legislation to protect breastfeeding in public. If breastfeeding in public becomes the norm, as it is in MANY other countries, it should decrease the perception that it is embarrassing, unacceptable, and inconvenient. It’s time we start seeing more of this:

    Photo via blondebutbright.blogspot.com

    and less of this:

    Photo by Kate Gulbranson (@hygeiakate)

  • Additional curriculum, like the one pioneered in NY State, that promotes breastfeeding as the norm, in human development and nutrition classes for children, adolescents and college students. The bulk of the content could focus on the benefits of breastfeeding (for both mother and baby), the hazards of formula, and the superior nutritional components of breast milk.
  • A recommendation, per the authors (which I personally think is brilliant), it also to educate our youth about appropriate infant development and behavior. The authors concluded that if our youth understood how often an infant/toddler needed to breastfeed and that covering with a blanket was not always feasible (especially with an older infant who wants to see the world around him/her), that they might stop viewing a breastfeeding mother as being immodest when breastfeeding in public. Also, since an infant typically breastfeeds every few hours, it is irrational to expect this mother to stay at home for every feeding.

What recommendations would you add to this list? How does your community make breastfeeding the norm?

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of the International Lactation Consultant Association’s (ILCA) blog, Lactation Matters, and a regular contributor to ILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show, which launches on July 2, 2012, and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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What can breastmilk tell us about breast cancer risk? (Part 2)

Written by Tanya Lieberman, IBCLC

Yesterday, we looked at the work Dr. Kathleen Arcaro has been doing using breast milk samples to help determine breast cancer risk.  Today, we see how we, as lactation consultants, can be involved in helping our clients and any other breastfeeding mothers we encounter, especially those who are African American, be a part of this exciting research.

Photo via Indiana Black Breastfeeding Coalition

One thing was bothering Dr. Arcaro about the hundreds of breastmilk samples she had collected and analyzed – they were overwhelmingly from Caucasian women. She knew that African American women have a different pattern of breast cancer than white women. The rates of breast cancer in premenopausal black women are higher than in white women, and breast cancer in young women is generally more aggressive, leading to a higher mortality. Her goal is to develop an accurate model for breast cancer risk for all women, not just certain populations who traditionally participate in cancer research. To ensure her findings applicable to all women, she began working to recruit African American women to donate breastmilk samples.

While several funders told her that it would be impossible to collect large numbers of breastmilk samples from African American women, Dr. Arcaro found an enthusiastic partner in the Avon Foundation for Women, which is providing funding for the collection and analysis of milk samples from 200 African American women around the country. A few months into this project, she and her study team are well on their way to collecting these samples. African American women have expressed great enthusiasm for this project – the lab received expressions of interest from over 60 women in just the first 48 hours after recruitment began!

Another key part of this project is to recruit African American women (who don’t need to be lactating or any particular age) to sign up for the Love/Avon Army of Women – a project aiming to recruit one million women to sign up to participate in breast cancer research. Dr. Arcaro’s biopsy study benefited tremendously from participation in the Army of Women, making recruitment of women to donate milk fast, inexpensive and efficient. But having African American women well represented in the Army of Women is key, for her research and many others’. So Dr. Arcaro hopes you’ll help increase the number of African American women registered (and be sure to select “breast milk study” in the drop down menu to help us track our impact).

Dr. Arcaro’s lab is one of the few in the world which is consistently investigating the secrets breastmilk holds for our understanding of breast cancer. You can learn more about Dr. Arcaro’s work, and see if you or mothers you know might qualify for one of her studies, at the website of the UMass Breastmilk Lab, and follow the lab on Facebook.

Tanya Lieberman, IBCLC is a lactation consultant who has worked in pediatric and hospital outpatient settings. She writes the Motherwear Breastfeeding Blog, for the Best for Babes Foundation, for Motherlove Herbal Company blog, among other websites. She is co-author of Spanish for Breastfeeding Support (Hale Publishing, 2009). She has been a member of several Dr. Kathleen Arcaro’s study teams, working to recruit mothers to donate milk samples. Before becoming a lactation consultant she was senior education policy staff in the California legislature. She lives in Massachusetts with her husband and two children.

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What can breastmilk tell us about breast cancer risk? (Part 1)

Written by Tanya Lieberman, IBCLC

This is Part 1 of a 2-part series on the research of Dr. Kathleen Arcaro.  Please check back tomorrow about specific information about how to help your clients become involved in this research.

To the many wonders of breastmilk, add another possible one: Clues to your breast cancer risk.

Are you at high risk for breast cancer? Despite years of breast cancer research,it’s very hard to know. You may have heard that family history puts you at greater risk, but the startling fact is that 8 out of 9 women diagnosed with breast cancer have no close female relative with a history of the disease. Women with “the breast cancer gene” (BRCA) know they’re at higher risk, but they account for only a small number of new cases.

Enter Dr. Kathleen Arcaro of the University of Massachusetts, Amherst. An environmental toxicologist by training, Dr. Arcaro had been studying pollutants in breastmilk for years before she became curious about what breastmilk could tell us about breast cancer risk.

Breast cells are key in breast cancer research, but are notoriously hard to get. You can get a limited number through biopsy or extracting nipple aspirate (ouch!), but neither of these methods sound like much fun to most women. They also have limitations: breast biopsies only yield cells in a very small area of a breast, and nipple aspirate produces very few cells for analysis.

It’s been clear for some time, though, that ductal breast cells naturally slough off into breastmilk. The cells in breastmilk of course come from all ductal areas of the breast, and they’re plentiful – an average of 30,000 per milliliter.

Dr. Kathleen Arcaro

Until very recently the presence of these cells in milk was only an interesting footnote in the literature. But with the advent of DNA analysis, the breast cells in breastmilk suddenly became an extremely valuable resource. Scientists could now extract DNA from these cells and look for patterns of “methylation:” the presence of methyl groups that attach to key parts of our DNA which are thought to regulate its functioning in important ways.

For example, some parts of our DNA are known as “tumor suppressor genes.” As the name implies, these genes tell our cells to stop the growth of tumors – a key way our bodies protect us from cancer.

But if a methyl group attaches to this gene, it can essentially turn it off – kind of like you would a light switch. This leaves us more vulnerable to the growth of tumors. In a cancer prone area of our bodies like the breast, their function is critical.

Taken collectively, these alterations to our DNA are known as our “epigenome,” (yes, you have one) and they have an even bigger influence over our health trajectories than the DNA we were born with. Factors like diet, smoking, exposure to toxins, stress, and exercise all contribute to the functioning of our DNA and our health.

So, how do you get this breastmilk and the elusive cells it contains? Funders and researchers told Dr. Arcaro that getting large numbers of breastmilk samples wouldn’t be worth the effort. Too costly, too time consuming, and too hard to find willing mothers.

Undeterred, Dr. Arcaro began looking for milk. Spreading the word through lactation consultants and La Leche League leaders (and occasionally stopping a mother on the street), she found willing participants. She started driving from mother’s house to mother’s house, occasionally sitting on the floor at a “pumping party” at a pediatrician’s office or a La Leche League meeting. Far from finding it difficult to recruit moms, she found mothers enthusiastic to donate their milk in the name of breast cancer research. Many viewed their milk donation as a way of fighting the disease which had taken the health and sometimes lives of friends and family members.

In 2009, Dr. Arcaro received a federal grant to investigate whether breastmilk could reveal patterns in breast cancer risk, by studying women who had or were planning to have a breast biopsy. These women were at a higher risk (though still relatively small) of developing breast cancer. Would their DNA methylation show it?

Dr. Arcaro indeed found that certain patterns of methylation are correlated with a higher risk of breast cancer. She has since published two papers demonstrating this, and there are more to come.

Two things make this finding important: One is the hope that one day women might be able to get a personalized breast cancer risk profile and not just learn how to get bigger breasts. The second possibility is that once the “target” methylation is revealed by this research, new treatments may actually be able to reverse it. Amazingly, some of the first generation chemotherapy drugs are in fact “anti methylating” agents – drugs which can actually remove methyl groups from your DNA, allowing your DNA to function properly in the fight against cancer. Dr. Arcaro would even like to see if some dietary changes might actually reduce methylation, which she could measure in milk.

Check back tomorrow for Part 2 of this series on the work of Dr. Kathleen Arcaro where we will discuss what she discovered about the mothers who were donating their milk and what is being done to specifically address the needs of high risk groups.

Tanya Lieberman, IBCLC is a lactation consultant who has worked in pediatric and hospital outpatient settings. She writes the Motherwear Breastfeeding Blog, for the Best for Babes Foundation, for Motherlove Herbal Company blog, among other websites. She is co-author of Spanish for Breastfeeding Support (Hale Publishing, 2009). She has been a member of several Dr. Kathleen Arcaro’s study teams, working to recruit mothers to donate milk samples. Before becoming a lactation consultant she was senior education policy staff in the California legislature. She lives in Massachusetts with her husband and two children.

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Journal of Human Lactation Launches New Podcast Feature!

Written by Karen Wambach

In the first of a new regular feature, The Journal of Human Lactation and Sage Publications has just launched its FIRST PODCAST entitled “On the TRAIL of cancer fighting cells in human milk: The latest research” . These podcasts will feature the author of a JHL paper in a 10-15 minute interview and will be available from the JHL website. The goal is to have at least 1 podcast per JHL issue.

In the current podcast, Editor-in-Chief Anne Merewood PhD, MPH, IBCLC, interviews Italian researchers Riccardo Davanzo MD PhD, and Giorgio Zauli MD PhD, about their paper “Human Colostrum and Breast Milk Contain High Levels of TNF-Related Apoptosis-Inducing Ligand (TRAIL)”, published online in the Journal of Human Lactation. The researchers, in a first-time effort to measure TRAIL in human milk, took samples of colostrum and mature breast milk from new mothers. Researchers then obtained samples of blood from healthy women, and various ready-to-feed infant formulas. The colostrum, mature breast milk, blood and formula were then all tested to measure their level of TRAIL. The researchers found that colostrum and breast milk contained 400- and 100-fold, respectively, higher levels of TRAIL than blood. No TRAIL was detected in the formula.

In the podcast, the authors discuss the implications of their findings with regard to the cancer prevention properties of human milk, and areas of ongoing and future research. High levels of TRAIL protein in breast milk might contribute to anticancer activity.

For subscribers to the journal, read the full study here: “Human Colostrum and Breast Milk Contain High Levels of TNF-related Apoptosis-Inducing Ligand (TRAIL)” by Riccardo Davanzo, MD, PhD; Giorgio Zauli, MD, PhD;Lorenzo Monasta, MSc, DSc; Liza Vecchi Brumatti, MSc; Maria Valentina Abate, MD;Giovanna Ventura, MD; Erika Rimondi, MSc, PhD; Paola Secchiero, MSc, PhD; and Sergio Demarini, MD. Journal of Human Lactation

Karen Wambach is the Director of Research and Special Projects for ILCA. Karen received her nursing degrees from the University of Minnesota in 1982 (BSN), and her MS (1989) and PhD in Nursing (1993) from the University of Arizona. A nurse educator, researcher, and IBCLC, Karen is Associate Professor at the University of Kansas. She has been active in ILCA at the local, regional, and international levels as a presenter, regional conference planner, and member and chair of the ILCA Research Committee. She is a member of the Missouri and Kansas Breastfeeding Coalitions and involved in evaluation of the Kansas Breastfeeding Coalition’s Business Case for Breastfeeding project. A recipient of NIH funding for a randomized clinical trial; her program of research has evolved over the years and now focuses on promotion and support of breastfeeding in vulnerable populations including adolescent mothers and ethnic minorities.

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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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