A mother with a height of 1 meter and 6 meters, weighed 75 kg before pregnancy, had a full-term birth, and the baby weighed 3900g. 3 days after giving birth, the main complaint is still no milk, ask whether this is related to their obesity (current weight 84 kg)?
To answer Mom's questions, we need to understand the following questions.
1. Definition of obesity
Obesity is a chronic metabolic disease caused by genetic and environmental factors, because the body's energy intake is greater than the body's energy consumption, so that excess energy is stored in the form of fat, resulting in excessive total body fat content and /or local content increase and abnormal distribution, causing a certain impact on health.
2. How do I determine if I'm obese by BMI?
BMI (Body Mass Index), or body mass index, is a commonly used international standard to measure the degree of fat and thin body and whether it is healthy. The formula is: BMI = weight (kg) ÷ height (m).
For example, the previous mother calculated BMI = 75 ÷ 1.60 = 29.30 according to her pre-pregnancy weight. Our Asian adults have a BMI of 28 for obesity. In contrast, this mother is obese.
3. What are the effects of obesity on breastfeeding?
(1) Effect on lactation:
The concentration of leptin, cortisol and milk protein in the milk of obese mothers is relatively high.
Cortisol is one of the most important glucocorticoids in the body, and it works synergistically with prolactin in the mammary glands, and high levels of cortisol cause delay in lactation.
The concentration of leptin in the milk of obese mothers is 3 times higher than that in the milk of normal-weight mothers, which can protect breastfed babies from the risk of being overweight.
Obese mothers may develop insulin resistance, decreased sensitivity of the mammary glands to insulin, interference with insulin binding to receptors on lactation cells, affecting the synthesis of fatty proteins in lactation cells, and eventually leading to insufficient breast milk.
A California study reported that the rate of insufficient breast milk in people with a BMI below 25 was 31.4 percent, and the rate of insufficient breast milk for people with a BMI of more than 29 was 53.8 percent.
(2) Effects on the breastfeeding process:
Obese mothers before pregnancy may have factors such as insufficient breastfeeding confidence, limited information resources, and unfavorable environmental impact, and their willingness to breastfeed may not be strong.
When obese mothers are feeding, it may be difficult to put the baby in the nursing position because of the large breasts, and the large breasts are prone to flat nipples, making it difficult for the baby to effectively contain.
In the absence of effective support and guidance, moms may not be able to adopt the correct breastfeeding posture, leading to a range of common breastfeeding problems such as sore nipples.
When the baby sucks, the prolactin secretion response of obese mothers will be relatively weak, which can also lead to delayed lactation initiation and insufficient breast milk.
The results of a large sample of studies in the United States, Norway, Denmark and other countries found that there was a correlation between the duration of breastfeeding and the BMI index, that is, the higher the BMI index, the shorter the duration of breastfeeding.
(3) Effect on the baby:
Immune-specific alterations in the milk of obese mothers may affect the child's genetic metabolism and epigenetic processes, affecting the baby's future brain development and cardiovascular system health.
(4) The influence of confounding factors:
Studies have shown that if the mother is older than 30 years old, obese, and the baby's birth weight is more than 3600 grams, the three factors are mixed, 76% of the mothers will have delayed lactation.
According to the above knowledge points, we can tell the mother: she may be because of obesity caused by delayed lactation. At the same time, we need to assess her breastfeeding willingness, breast nipples, feeding position, infant inclusion, etc., and give her effective feeding guidance to promote breastfeeding success. At the same time, it is recommended that she go to the nutrition clinic as soon as possible for consultation to improve her body mass index.
Author: Tingting Sun International Certified Lactation Consultant
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Resources
[1] Chinese Nutrition Science Encyclopedia: All 2 volumes / Yang Yuexin, Ge Keyou, editors--Beijing: People's Medical Publishing House, 2019
[2] Kugananthan S., Gridneva Z., Lai C.T., Hepworth A.R., Mark P.J., Kakulas F., Geddes D.T. Associations between Maternal Body Composition and Appetite Hormones and Macronutrients in Human Milk. [3] Houseknecht K.L., McGuire M.K., Portocarrero C.P., McGuire M.A., Beerman K. Leptin is present in human milk and is related to maternal plasma leptin concentration and adiposity. [4] Pundir S., Gridneva Z., Pillai A., Thorstensen E.B., Wall C.R., Geddes D.T., Cameron-Smith D. Human Milk Glucocorticoid Levels Are Associated with Infant Adiposity and Head Circumference over the First Year of Life.