NEW YORK (Reuters Health) - First-time moms who are older than 30, overweight or have breastfeeding difficulties on their newborn's first day may have increased odds of delayed lactogenesis, a new study suggests.
With delayed lactogenesis - that is, when the shift from colostrum to full breast milk does not happen within 72 hours -- some infants may become dehydrated and lose weight, and some mothers, worried and frustrated, may give up on breastfeeding.
But new moms with a delay in full milk production should not be discouraged, said Dr. Laurie A. Nommsen-Rivers of Cincinnati Children's Hospital Medical Center in Ohio, the lead researcher on the new study.
Instead, she said, they should call their pediatrician or a "lactation consultant."
With some support, Dr. Nommsen-Rivers said, mothers with delayed breast-milk production will "do just fine." She noted that 98% of new mothers have their milk come in within a week.
For the current study, published online June 23rd in the American Journal of Clinical Nutrition, Dr. Nommsen-Rivers and her colleagues looked at the factors associated with delayed lactation among 431 first-time mothers who gave birth at one California medical center.
Overall, the study found, 44% took longer than 72 hours to have their milk come in -- which was assessed by asking the study participants whether their breasts felt "noticeably fuller" three days after giving birth.
Women who were overweight or obese were more likely than thinner women to have a delay; 45% and 54%, respectively, compared with 31% of normal-weight women. Age also appeared to be a factor, as 58% of women age 30 and older had a delay in their breast milk coming in, versus 39% of younger women.
In addition, mothers who said they had "breastfed well" at least twice during the first 24 hours of their newborn's life were less likely to have a delay in their milk coming in: 39% to 43% of these women had a delay, compared with 65% of mothers who reported only one or no instance of breastfeeding "well" in the first 24 hours.
Another factor related to delayed milk production was nipple soreness. Women who had more than mild soreness in the first few days after giving birth were less likely to have a delay than other women.
That soreness, the researchers note, may be an indicator of more-effective early breastfeeding, which would encourage full milk production.
It is not clear why relatively older age and heavier weight in the mother would be associated with a higher risk of delayed lactation, according to Dr. Nommsen-Rivers.
But both, she and her colleagues note, are related to greater odds of carbohydrate intolerance during pregnancy. Problems in sugar metabolism could be a factor in the higher risk of delays in full breast-milk production, they speculate.
Whatever the underlying mechanisms for the findings, Dr. Nommsen-Rivers said that the bottom line for women is to seek help for any early breastfeeding difficulties.
She suggests that during pregnancy, women try to see a provider who has an affiliation with a lactation consultant. A home visit from the consultant in the first couple days after a woman gives birth can help identify and address any breastfeeding difficulties.
To help support early breastfeeding success, the American Academy of Pediatrics recommends that women ask to have their newborn placed in skin-to-skin contact with them immediately after birth so that they can breastfeed.
Frequent feedings in the early days are also important, Dr. Nommsen-Rivers said. It is often recommended that women breastfeed every two hours, but she suggested that new moms try to breastfeed whenever their newborn "shows an interest," with cues such as "smacking" his or her lips.
The rate of delayed milk production in this study - 44% -- is significant, according to Dr. Nommsen-Rivers. Past studies have shown that compared with U.S. women, those in less-developed nations, such as Peru and Guatemala, tend to have their milk come in more quickly.
Pinning down the reasons for that difference -- including the facets of modern maternity care that may be involved -- will be important, Dr. Nommsen-Rivers said.
SOURCE: http://link.reuters.com/hyr79m
Am J Clin Nutr 2010.