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\"What happens to pregnant women when the largest country in the world implements a global health policy aimed at reorganizing hospitals and re- training health care workers to promote breastfeeding? Since 1992, the Chinese government has led the world in reorganizing more than 7,000 hospitals into \"Baby- Friendly\" hospitals. The initiative's goal, overseen by UNICEF and the World Health Organization, is to promote the practice of breastfeeding by reorganizing hospital routines, spaces, and knowledge in maternity wards and obstetrics clinics. At the same time, China's hospitals in the mid- 1990s operated as sites where the effects of economic reform and capitalism increasingly blurred the boundaries between state imperatives to produce healthy future citizens and the flexibility accorded individuals through their participation in an emerging consumer culture. Formulas for Motherhood follows a group of women over eighteen months as they visited a Beijing Baby- Friendly Hospital over the course of their pregnancies and throughout their postpartum recoveries. The book shows how the space of the hospital operates as a microcosm of the larger social, political, and economic forces that urban Chinese women navigate in the process of becoming a mother. Relations between biomedical practices, heightened expectations of femininity and sexuality demanded by a consumer culture, alongside international and national agendas to promote maternal and child health, reveal new agents of maternal governance emerging at the very moment China's economy heats up. This ethnography provides insight into how women's creative pragmatism in a rapidly changing society leads to their views and decisions about motherhood\"-- Provided by publisher.

Despite recommendations from the World Health Organization and the American Academy of Pediatrics to exclusively breastfeed infants for their first 6 months of life, 75% of women do not meet exclusive breastfeeding guidelines, and 60% do not meet their own breastfeeding goals. Numerous observational studies have linked maternal psychological distress (eg, perceived stress, anxiety, and depression) with nonoptimal breastfeeding outcomes, such as decreased proportion and duration of exclusive breastfeeding. The physiological mechanisms underlying these associations, however, remain unclear. For this narrative review, we evaluated the evidence of relationships between maternal psychological distress and lactation and breastfeeding outcomes in pregnancy and post partum and the possible physiological mechanisms that facilitate these relationships. We searched PubMed using the following terms: stress, anxiety, depression, breastfeeding, and lactation. Additional search by hand was conducted to ensure a thorough review of the literature. Among the studies examined, methods used to assess maternal psychological distress were not uniform, with some studies examining perceived distress via a variety of validated tools and others measuring biological measures of distress, such as cortisol. Evidence supports a role for psychological distress in multiple breastfeeding outcomes, including delayed secretory activation and decreased duration of exclusive breastfeeding. One physiological mechanism proposed to explain these relationships is that psychological distress may impair the release of oxytocin, a hormone that plays a critical role in milk ejection during lactation. Continued impairment of milk ejection may lead to decreased milk production because of incomplete emptying of the breast during each feed. Maternal distress may also yield elevated levels of serum cortisol and decreased insulin sensitivity, which are associated with decreased milk production. The relationship between psychological distress and breastfeeding is likely to be bidirectional, however, in that breastfeeding appears to reduce maternal distress, again possibly via effects on the pleasure or reward pathway and calming effects of oxytocin on the mother. This finding suggests that interventions to support lactation and breastfeeding goals in women who score high on measures of psychological distress would be beneficial for both maternal and infant well-being. Evidence to date suggests that maternal psychological distress may impair lactation and breastfeeding outcomes, but stronger study designs and rigorous assessment methods are needed. A better understanding of the physiological mechanisms leading to impaired lactation may assist in the development of early interventions for mothers experiencing distress. In addition, stress-reducing programs and policies should be investigated for their potential to improve breastfeeding outcomes.

\"After drawing its first breath, every newborn mammal turns his or her complete attention to obtaining milk. This primal act was once thought to stem from a basic fact: milk provides the initial source of calories and nutrients for all mammalian young. But it turns out that milk is a much more complicated biochemical cocktail and provides benefits beyond nutrition. In this fascinating book, biologists Michael L. Power and Jay Schulkin reveal this liquid's evolutionary history and show how its ingredients have changed over many millions of years to become a potent elixir. Power and Schulkin walk readers through the early origins of the mammary gland and describe the incredible diversification of milk among the various mammalian lineages. After revealing the roots of lactation, the authors describe the substances that naturally occur in milk and discuss their biological functions. They reveal that mothers pass along numerous biochemical signals to their babies through milk. The authors explain how milk boosts an infant's immune system, affects an infant's metabolism and physiology, and helps inoculate and feed the baby's gut microbiome. Throughout the book, the authors weave in stories from studies of other species, explaining how comparative research sheds light on human lactation. The authors then turn their attention to the fascinating topic of cross-species milk consumption--something only practiced by certain humans who evolved an ability to retain lactase synthesis into adulthood. The first book to discuss milk from a comparative and evolutionary perspective, Power and Schulkin's masterpiece reveals the rich biological story of the common thread that connects all mammals\"-- Provided by publisher.

Adequate nutrition is essential during the lactation period for better maternal and child health outcomes. Although food insecurity and dietary monotony (defined as less diverse diet), two important determinants of undernutrition, are endemic in the rural mountains of Nepal, insufficiently examined and assessed for risk factors in mothers during lactation, a life stage of high nutritional demand. This study aimed to assess the status and factors associated with food insecurity and dietary diversity among lactating mothers residing in the mountains of Nepal. A community-based cross-sectional study was conducted in an urban municipality in the mountainous Bajhang District of far-western Nepal. The sampling frame and strategy led to 417 randomly selected lactating mothers. Household Food Insecurity Access Scale (HFIAS) and the tool \"Minimum Dietary Diversity for Women\" developed by the Food and Agriculture Organization were used to measure food insecurity and dietary diversity, respectively. Additional information on socio-demographics and risk factors were collected. Multivariable logistics regression assessed correlates of study outcomes. Overall, 54% of the households were food insecure, and over half (53%) of the mothers had low dietary diversity. Food insecurity status (mild food insecurity AOR = 10.12, 95% CI = 4.21-24.34; moderate food insecurity AOR = 8.17, 95% CI = 3.24-20.59, and severe food insecurity AOR = 10.56, 95% CI = 3.92-28.43) were associated with higher odds of dietary monotony. Likewise, participants with lower dietary diversity were 8.5 times more likely to be food insecure than those with higher dietary diversity (AOR = 8.48, 95% CI = 3.76-19.14). The monthly income of the family was positively associated with food insecurity. Participants' (AOR = 3.92 95%CI = 1.76-8.71) or spouses' (AOR = 2.90, 95% CI = 1.07-7.85) unemployment was associated with higher odds of being food insecure. Likewise, owning a cultivable land (AOR = 0.49, 95% CI = 0.28-0.84) and participant's unemployment status (AOR = 5.92, 95% CI = 3.02-11.63), were significantly associated with increased odds of dietary monotony. The observed food insecurity and poor dietary diversity among lactating mothers, the correlates associated with these outcomes, may help local stakeholders to identify local health needs and subgroups for targeted interventions. Socioeconomically disadvantaged mothers should be specifically targeted for relevant programs and policies.

Background: Lactoferrin (Lf) is a multifunctional protein and one of the most abundant proteins in human milk. Various factors may affect its concentration in human milk, such as stage of lactation, ethnicity, and diet. Objectives: The objectives of the present study were to examine the dynamic change in milk Lf throughout the course of lactation and explore factors associated with milk Lf concentrations in various Chinese populations. Methods: This investigation was a part of a large cross-sectional study conducted in 11 provinces/autonomous regions/municipalities (Beijing, Gansu, Guangdong, Guangxi, Heilongjiang, Inner Mongolia, Shandong, Shanghai, Xinjiang, Yunnan, and Zhejiang) across China between 2011 and 2013. Lactating women (n = 6481) within 0–330 days postpartum were recruited in the original study. A sub-sample of 824 women was randomly selected, and milk Lf concentrations were determined by UPLC/MS. Results: The Lf concentration in milk from women delivering at term was 3.16 g/L, 1.73 g/L and 0.90 g/L for colostrum, transitional milk, and mature milk, respectively. Lf concentrations differed significantly between stages of lactation (colostrum vs. transitional milk, colostrum vs. mature milk, transitional milk vs. mature milk, all p < 0.001). Maternal BMI, age, mode of delivery, parturition, protein intake, and serum albumin concentration were not correlated with milk Lf concentration. However, milk Lf concentrations varied among different geographical regions (Guangdong (1.91 g/L) vs. Heilongjiang (1.44 g/L), p = 0.037; Guangdong (1.91 g/L) vs. Gansu (1.43 g/L), p = 0.041) and ethnicities (Dai (1.80 g/L) vs. Tibetan (0.99 g/L), p = 0.007; Han (1.62 g/L) vs. Tibetan (0.99 g/L), p = 0.002) in China. Conclusions: The concentration of Lf in human milk changes dynamically throughout lactation. Few maternal characteristics affect the milk Lf concentration, but it varies across different geographical regions and ethnicities in China.

This study explored the status of postpartum lactation in caesarean section mothers and identified the factors that influence lactation insufficiency. A total of 265 mothers who delivered via cesarean section between November 2021 and November 2022 were followed for six months. Lactation efficiency was measured by collecting daily milk output using a breast pump from postpartum days 1 to 10; insufficient lactation was defined as a total daily milk volume <500 mL on day 10. Lactation typically began between 25 and 48 hours postpartum (45.1%), with a delayed onset of lactogenesis incidence of 19.6% and an overall lactation insufficiency rate of 48.3%. Multivariate logistic regression analysis identified advanced maternal age (>35 years), excessive weight gain during pregnancy (≥5.6 kg/m²), high postpartum pain scores (≥4), gestational diabetes mellitus, and postpartum depression as significant risk factors for insufficient lactation. In contrast, early skin-to-skin contact and suckling significantly reduced the risk. Furthermore, infants in the exclusive breastfeeding group showed significantly better nutritional outcomes, as measured by the Kaup index, compared to partially or non-breastfed infants. These findings underscore the need for targeted clinical interventions during the perinatal period, including effective pain management, mental health support, and promotion of early breastfeeding, to enhance lactation outcomes among cesarean section mothers. Cette étude a exploré la situation de l'allaitement post-partum chez les mères ayant accouché par césarienne et a identifié les facteurs influençant l'insuffisance lactée. Un total de 265 mères ayant accouché par césarienne entre novembre 2021 et janvier 2022 ont été suivies pendant six mois. L'efficacité de l'allaitement a été mesurée en collectant la quantité quotidienne de lait produite à l'aide d'un tire-lait du premier au dixième jour post-partum ; l'insuffisance lactée a été définie par un volume de lait quotidien total <500 mL au dixième jour. L'allaitement a généralement commencé entre 25 et 48 heures après l'accouchement (45,1 %), avec une incidence de retard de la lactogenèse de 19,6 % et un taux global d'insuffisance lactée de 48,3 %. L'analyse de régression logistique multivariée a identifié l'âge maternel avancé (>35 ans), un gain de poids excessif pendant la grossesse (≥5,6 kg/m²), des scores élevés de douleur post-partum (≥4), le diabète gestationnel et la dépression post-partum comme des facteurs de risque significatifs pour une lactation insuffisante. En revanche, le contact peau-à-peau précoce et l'allaitement au sein ont significativement réduit ce risque. De plus, les nourrissons du groupe d'allaitement exclusif ont montré de meilleurs résultats nutritionnels, mesurés par l'indice de Kaup, par rapport aux nourrissons partiellement ou non allaités. Ces résultats soulignent la nécessité d'interventions cliniques ciblées pendant la période périnatale, comprenant une gestion efficace de la douleur, un soutien en santé mentale et la promotion de l'allaitement précoce, afin d'améliorer les résultats de l'allaitement chez les mères ayant accouché par césarienne.

Background Breastfeeding has many benefits for mothers and infants. Lactogenesis II is one of the key steps in the implementation of breastfeeding. If lactogenesis II occurs more than 72 h after delivery, it is termed delayed onset of lactation (DOL). DOL is associated with decreased milk production, shortened breastfeeding time, and pathological neonatal weight loss. A comprehensive summary of the incidence and factors influencing DOL is needed to provide a basis for improving breastfeeding practices and health outcomes. Methods Studies on the incidence and factors influencing DOL were retrieved from 13 Chinese and English databases (PubMed, Embase, Web of Science, Cochrane Library, CINAHL, etc.) from database inception to August 2023. Two researchers independently conducted the study screening, data extraction and quality evaluation. Stata 16.0 SE software was used for data analysis, and sensitivity analysis and publication bias tests were also performed. The qualitative description method was used to analyse studies that could not be combined quantitatively. Results A total of 35 studies involving 19,176 parturients, including 4,922 who had DOL, were included. The mean Newcastle‒Ottawa scale score of the included studies was ≥ 6, indicating that the quality was relatively high. Finally, the incidence of DOL was 30%, and 13 factors influencing DOL with robust results and no publication bias were obtained: prepregnancy body mass index (overweight or obesity), gestational diabetes, gestational hypertension, thyroid disease during pregnancy, serum albumin levels (< 35 g/L), parity, (unscheduled) caesarean section, caesarean section history, daily sleep duration, gestational age, birth weight (< 2.5 kg), breastfeeding guidance and daily breastfeeding frequency. However, there were still six influencing factors with undetermined associations: age, gestational weight gain, birth weight (≥ 4 kg), anxiety, time of first breastfeeding session (maternal separation) and breast massage or treatment. Conclusions The incidence of DOL is high. Clinicians should pay attention to parturients at high risk of DOL and formulate targeted prevention strategies according to the influencing factors to reduce the occurrence of DOL and promote better maternal and infant outcomes. Trial registration PROSPERO (ID: CRD42023458786), September 10, 2023.

One impediment to breastfeeding is the lack of information on the use of many drugs during lactation, especially newer ones. The principles of drug passage into breastmilk are well established, but have often not been optimally applied prospectively. Commonly used preclinical rodent models for determining drug excretion into milk are very unreliable because of marked differences in milk composition and transporters compared to those of humans. Measurement of drug concentrations in humans remains the gold standard, but computer modeling is promising. New FDA labeling requirements present an opportunity to apply modeling to preclinical drug development in place of conventional animal testing for drug excretion into breastmilk, which should improve the use of medications in nursing mothers.

Background Preeclampsia is a multi-system, hypertensive disorder of pregnancy that increases a woman’s risk of later-life cardiovascular disease. Breastfeeding may counteract the negative cardiovascular sequela associated with preeclampsia; however, women who develop preeclampsia may be at-risk for suboptimal breastfeeding rates. In this case series, we present three cases of late-onset preeclampsia and one case of severe gestational hypertension that illustrate a potential association between hypertensive disorders of pregnancy and suboptimal breastfeeding outcomes, including delayed onset of lactogenesis II and in-hospital formula supplementation. Case presentation All cases were drawn from an ongoing pilot randomized controlled trial investigating the impact of antenatal milk expression versus an education control on breastfeeding outcomes. All study participants were healthy nulliparous women recruited at 34–36 6/7 gestational weeks from a hospital-based midwife practice. The variability in clinical presentation among the four cases suggests that any effect of hypertensive disorders on breastfeeding outcomes is likely multifactorial in nature, and may include both primary (e.g., preeclampsia disease course itself) and secondary (e.g., magnesium sulfate therapy, delayed at-breast feeding due to maternal-infant separation) etiologies. We further describe the use of antenatal milk expression (AME), or milk expression and storage beginning around 37 weeks of gestation, as a potential intervention to mitigate suboptimal breastfeeding outcomes in women at risk for preeclampsia and other hypertensive disorders of pregnancy. Conclusions Additional research is needed to address incidence, etiology, and interventions, including AME, for breastfeeding issues among a larger sample of women who develop hypertensive disorders of pregnancy.

High-lactation cows exhibit advantages in milk yield and quality compared to low-lactation cows; however, the underlying mechanisms remain unclear. Based on the demand for high-quality milk sources in the food industry, this study used single-cell sequencing technology (scRNA-seq) on the 10 × Chromium platform to analyze the milk cells of 10 Holstein cows (5 in the high-lactation group and 5 in the low-lactation group). The seven cell types included two types of epithelial cells (epithelial and secretory epithelial cells) and five types of immune cells (neutrophils, T cells, macrophages, B cells, and dendritic cells). Further sub-clustering analysis identified three epithelial cell types and nine T-cell subsets, and their differentiation paths were depicted through pseudo temporal analysis. Inter-group comparisons revealed differential genes and signaling pathways that affect lactation performance, such as lactation-related pathways (prolactin, protein export, thermogenesis) and immune-related pathways (Toll-like receptor, cytokine-receptor interaction, and NF-κB). In addition, this study elucidated the complex signaling relationships between epithelial and immune cells, especially the impact of CyPA, ICAM, and SELL signaling pathways on lactation. Moreover, additional analyses of macrophage and neutrophil subpopulations further revealed their interactions with epithelial cells, providing complementary insights into immune regulation during lactation.This study enriches the knowledge of cow lactation biology and provides a reference for the food industry to screen high-quality milk sources and optimize dairy processing technology.