LCP and yoga instructor partner to open milk depot


For a brief moment, Donna Ellis, RN, MSN, CLC, IBCLC  thought, “Oh dear, what have I gotten myself into?”

In the fall of 2018, Ellis attended a La Leche League conference where she met a doula and yoga instructor with a toddler attached in a sling. Ellis recently moved to Maine after many years working and living in Germany, and she was taking every opportunity to increase awareness of banked donor milk in her new community.

Ellis eventually began attending the instructor’s adaptive yoga practice.

“As I began taking classes, this instructor and I realized how much we enjoyed one another and shared similar interests,” Ellis begins. “I provided breastfeeding information to one of her prenatal yoga classes and attended the LLL group that met at the studio.” 

Later in the fall, Ellis attended a Maine State Breastfeeding Coalition presentation by Cynthia Cohen from the Mother’s Milk Bank Northeast who’d reported on the role and the need for milk depots. At that time Maine had only two depots, both a distance from the Southern Maine communities where Ellis lived. 

Ellis became excited about the prospect of setting up a milk depot in her community, the yoga studio seemed a good community location. The instructor was delighted and also thought it was a good fit.  

The process began. Ellis registered as a volunteer with the milk bank and gained basic education on the process for receiving and shipping frozen donor milk.

Setting up the milk depot would require a deep freezer, a roughly one to two thousand dollar piece of equipment, which is either purchased or donated by the community. This seemed to be the major hurdle. Ellis started to wonder what she’d gotten herself into. After only a few emails to local appliance businesses though, a local business man quickly volunteered to anonymously donate a new freezer.

Ellis says she was surprised and pleased! 

The milk bank then provided online HIPAA training for Ellis and the yoga instructor. They also provided a temperature monitoring device for the freezer which sets off an alarm if the temperature becomes too high. 

The milk depot officially opened on May 30, 2019 with press coverage, a ceremonial ribbon cutting and cake. The event was attended by several representatives of the Mother’s Milk Bank Northeast and Maine families who had donated their milk.

Ellis explains that the original space was tucked into an old mill that at one time produced fabric. It had old wood floors and wide open space. Just inside the entrance was a lounge area with comfortable chairs and a small kitchen and toys for children to play. Partly because parking was a challenge though, the studio/depot recently moved to a new location just down the street with plenty of parking, ramps that accommodate strollers and a quiet environment. 

So far, Ellis reports that only two mothers have donated to the milk depot, as a result of frequent travel, the unexpected move of the yoga studio and many individuals choose to donate directly to the milk bank with the convenience of FedEx’s milk shipping services.  

“The donation of human milk is an amazing gift making a major difference in the lives of families reaching beyond today into the future,” Ellis says. “Those who provide their milk are quiet heroes.” 

She points out some important things about donor human milk:

  • Donor milk contains bioactive components, hormones, and enzymes that optimize infant growth and development.
  • It is species specific working best with the newborn’s immature gut, liver, kidneys and immune system. 
  • It is just the right mix of nutrients – not only for the newborn and preterm infant, but to nourish the microbes composing the gut microbiome.
  • It has immune properties – Secretory IgA.  Infants don’t have any Secretory IgA so the first bits of colostrum from the mother or expressed milk provide a protective coating, keeping nasty bacteria from causing infections like NEC – a severe bowel condition that targets preterm infants and other serious illnesses and infections.

Once milk is collected and sent to the milk bank, safety is guaranteed through the history and serology of donors, bacteriology of the milk and subsequent heat treatment destroying HIV, Herpes, CMV and other viruses. Still, Ellis reports, around 90 percent of the beneficial components remain. And while the cost of donor human milk might look expensive at first glance, coming in around four to six dollars per ounce, when we consider it’s a medication, it’s truly cost effective. 

There was a recent public hearing in Maine regarding access to donor milk. A Maine State Breastfeeding Coalition member who works with the Maine State Legislature attended and indicated that LD 1938 (donor breast milk reimbursement in MaineCare) passed unanimously through the HHS Committee. Amendments were made, so the HHS Committee will have another opportunity to review the language. Once that is accomplished the bill should go to the house floor for a vote. 

In the summer of 2019, Connecticut passed a law requiring Medicaid coverage of donor human milk under certain circumstances. A New Jersey law went into effect in January 2019 requiring all health insurers in the state to cover donated human breast milk for infants under certain circumstances as well. Ellis believes these milestones will serve as inspiration for what is to come in Maine. 
If you’re interested in setting up a milk depot in your area, visit the Human Milk Banking Association of North America (HMBANA)  website here. Ellis encourages us to share information about the incredible gift of milk donation whenever possible. Mothers’ Milk Bank Northeast has incredible donation stories on their blog including those of bereaved parents.

Getting off to a good start

Photo by Ksenia Makagonova on Unsplash

If you’re a mother living in Colorado, chances are you’ve breastfed your baby. Statistically, Colorado fares well compared to U.S. national average breastfeeding rates. 

Jodi Heiser RN, CLC, ANLC, IBCLC and Bonnie Garcia RN, CLC, ANLC, IBCLC, lactation specialists working in a private pediatric practice in the Denver metro area, attribute this phenomenon to Colorado being a “pro-health” state in general. 

“People are very active here,” they begin in an email interview.  “We spend a lot of time outside, hiking, biking or just being outside.  This is probably due to the fact that 300 out of the 365 days a year are sunny.”

“This healthy lifestyle also supports healthy eating,” they go on. “Since the healthiest meal for babies is breastfeeding, most families plan and want to breastfeed their children.” 

Nearly fifty percent of Colorado parents give birth in a Baby-Friendly facility too, according to the latest CDC Breastfeeding Report Card

“This gives us a bit of an advantage as breastfeeding is considered the standard for feeding newborns,” Heiser and Garcia comment. “[Dyads] are given support and a good foundation for being successful at breastfeeding.” 

Although Colorado parents are often off to a great start, Heiser and Garcia notice that their feeding situations tend to become more challenging once they’ve left the hospital. 

Short hospital stays mean that mothers’ milk may not have yet transitioned from colostrum, and feeding and latching challenges might start to arise in the first few days at home. 

“That’s where we feel our pediatric practice can be a unique place to provide support,” the duo writes. 

Heiser and Garcia provide care all week at three offices located throughout Denver. They’re also available by phone to field breastfeeding questions and triage lactation issues. 

Cultivating a breastfeeding-friendly culture comes easy to the team in the pediatric care setting. They’re able to fulfill the American Academy of Pediatrics’ recommendation for a newborn feeding assessment be done at day 3 to 4 of life by a qualified lactation professional. 

“The wonderful thing about providing lactation care in the pediatric setting is that it is all a part of the continuum of care that the mom and baby are already receiving,” they write. “If a mom is having breastfeeding issues, we can provide assistance right there at her pediatrician’s office… It eliminates her having to find another resource…” 

Heiser and Garcia find success in each family and are inspired by parents’ resilience. 

“What I love best about what Bonnie and I get to do is that we are able to build relationships with these moms and their children,” Hesier shares. “We watch the children grow, we watch siblings be born, we get the blessing of helping them feel good about feeding their babies. It really is a long term relationship we have been able to develop with our families over the years.” 

She recalls “Sarah’s” story, a mother in their practice with her first child “Charlie”, at the time three days old. 

Sarah struggled with low milk production and severe nipple pain and no confidence that she would be successful at breastfeeding her child, Heiser remembers.  The provider wanted to start formula supplementation because Charlie was down 12 percent from birth weight.

“I felt Sarah’s milk was coming in and that helping Sarah correct Charlie’s latch would minimize nipple pain and help him be more effective at breast,” Heiser continues.

The provider agreed to wait one more day. Sarah triple-fed for the next 24 hours and Charlie bounced up 2 oz the next day. 

Sarah went on to successfully and confidently breastfeed Charlie until she became pregnant with her daughter “Valerie”. 

For at least two to three years, Heiser and Garcia have been working to implement  newborn feeding assessments as part of routine care and getting insurance to pay for the service.

“We have felt strongly that this should not be a service available only to only those who can afford to pay out of pocket for this service,” Garcia states.

“We are finally, in the past year, seeing successful insurance reimbursement rates which has allowed us to offer this service to any new mom and baby that would benefit from a feeding assessment,” she goes on. “It is more and more becoming just a natural part of their postpartum/neonatal care and insurance companies are (for the most part) paying for this service.” 

The team has also recently created “Baby Bistro”, a monthly get together for new parents. 

“We want it to be a place where there is peer support and relationship bonding between mothers,” they write. 

In addition, Heiser and Garcia plan to speak briefly about a breastfeeding topic at the Baby Bistro and offer a Q&A session as well as the chance to set up a feeding assessment for more challenging feeding concerns.  

For more information about the team’s work, visit them here

Nutrition During Pregnancy and Lactation: Exploring New Evidence Day 2

Last week,  Cindy Turner-Maffei, MA, ALC, IBCLC shared a summary of what she learned at the Nutrition During Pregnancy and Lactation: Exploring New Evidence – A Workshop through her tweets. This week, she shares Day 2.

NASEM has made the videos from the workshop available here.

Cindy Turner-Maffei, MA, ALC, IBCLC at the academy.

 

————

Guest post by Cindy Turner-Maffei, MA, ALC, IBCLC

Dr. Thorlton

On January 30, 2020, the presentations on the impact of Nutrition during Pregnancy & Lactation continued at the National Academy of Sciences in Washington DC began with Janet Thorlton of University of Illinois-Chicago College of Nursing with an update on the impact of caffeine in this time frame:

  • Genetic variance determines whether we’re slow (SCM) or fast (FCM) caffeine metabolizers. If exposed to high doses of caffeine, SCMs may have increased risk of preterm birth, and FCMs of smaller babies.

Kjersti Aagaard of Baylor College of Medicine reported on the impact of maternal diet on the developing infant microbiome:

  • The diversity of vaginal microbes decreases in pregnancy. The neonate’s early biome looks very different than that of the vagina. 
  • The neonate’s microbiome may reflect the amount of fat in the mother’s diet. High fat diet (>35% of calories as fat) is more correlated with infant dysbiosis* than with maternal obesity. (This difference persists—it seems irreversible with dietary changes later.) [*dysbiosis=imbalance in the microbiome—a less than desirable microbial community]
  • We should stop focusing on treating obesity in pregnancy/lactation and focus instead on supporting dietary change. Within days of changing the diet (less added sugar and fat and more fiber), the mother’s metabolic markers and those in her milk change for the better. 
  • Similarly, “we must come to value nutrition over weight.” 
  • Encourage nutrient quality: “fresh from the source produce” is best. Address equity issues in access to fresh produce.
  • Today’s research does not show that giving probiotics in pregnancy protects mother or infant.
  • Fun fact: Did you know that “there are Pseudomonas species that can exist solely on caffeine”???!!!

    Dr. Aagaard

Michael Goran of Children’s Hospital of Los Angeles and the University of Southern California on fructose and oligosaccharides in breastmilk and the effects on infant body composition and cognitive outcomes:

  • Children who were BF >12 m were less likely to be obese at 4 y, even when regularly fed sugar sweetened beverages (SSB). Does human milk offers some protection against effects of SSB?
  • Maternal diet alters the type of human milk oligosaccharides (HMO) in milk. HMOs are also found in amniotic fluid by mid pregnancy. Is this part of how the baby comes to tolerate (and not attack) commensal microbes?

 

Dr. Allen

Lindsay Allen of U.S. Department of Agriculture on maternal micronutrient status and intake and their effect on milk composition:

  • Maternal status and intake has no effect on calcium, folate, iron, zinc and copper content of human milk
  • Many other micronutrients are lower in milk when status/intake is low.
  • Research is needed to determine specific micronutrient needs in these time frames.

Ellen Demerath of University of Minnesota on the implications of maternal weight and metabolic status for lactation and breastmilk composition:

  • Why are BF rates and duration shorter in obese folks? It’s complicated! There are biological, social, and emotional contributors. 
  • Some intriguing new insights, e.g., leptin is thought to suppress oxytocin, thus potentially decreasing milk release. Leptin levels are higher in obesity.
  • Those with higher pre-pregnancy BMI have more leptin and insulin in their milk. 
  • There may be even higher insulin in their milk when they have female infants. 
  • In diabetic individuals, insulin and glucose are higher in colostrum, but this normalizes in mature milk.
  • Focus on helping new moms improve nutrition and get more sleep, and work for paid parental leave, instead of focusing on weight loss. The diseases BF protects against are crucial to women’s health. Paid leave and more support would both increase BF success and thereby public health.

Lunch break Day 2, needed a brain expansion, appealed to this guy for some help. -CTM

Erica Gunderson of Kaiser Permanente Northern California on lactation and the future risk of cardiometabolic diseases in women: 

  • Pregnancy and lactation are a metabolic continuum. Pregnancy requires adaptations that would be considered pathological in any other state (e.g. suppressed immunity, inflammation)
  • Complicated pregnancy, preterm birth, and preexisting conditions such as hypertension and diabetes increase risk for metabolic disease in the future. Lactation may reset maternal metabolism (higher HDL levels, lower blood glucose and insulin, etc.)
  • BF is associated with 7% risk hypertension overall over maternal lifetime. More protection (12% reduction) for BF >12 mo. 
  • Cardiovascular mortality risk also decreases with increased BF duration. But most studies do not explore preexisting conditions that impact risk.
  • Ongoing SWIFT study is following ~1,000 women with gestational diabetes (GDM) for10 years, watching for conversion to Type 2 Diabetes (T2DM). So far, longer duration of BF is showing 50% reduction in risk of T2DM. Similar to findings of CARDIA study.

Drs. Goran, Aagaard & Myatt

Leslie Myatt of Oregon Health & Sciences University spoke on the role of the placenta in delivering nutrients and in developmental programming of the fetus:

  • The placenta’s metabolic activity is ~5X greater than the fetus’s! It’s not a passive portal. 
  • The placenta consumes about 1/3 of energy transferred from mother to make peptides and grow—it’s called a “selfish organ” for this reason.
  • The placenta adapts to nutrient shortages.
  • At term, its’ surface area is the size of a parking spot
  • The placenta functions differently for male vs female fetuses, supporting sexual dimorphism.

Angela Odoms-Young launched the final session examining community solutions to improve nutrition access and equity in pregnancy and lactation.

Rafael Peréz-Escamilla on systems changes for improving maternal nutrition during pregnancy/lactation:

  • Social justice issues and inequities in access to and quality of lactation care are profound. 
  • The breastfeeding gear model identifies key partners for creating equity and systems change. 
    • [CTM Note: Check out the breastfeeding gear model here.]

      The Gear Model

Kate Keenan of University of Chicago on using nutrition science to reduce perinatal health disparities:

  • “Poverty=Stress=Health Disparities.” 
  • A pilot RCT of DHA supplementation of black pregnant women of low income status found a reduction in perceived stress among mothers, and higher birthweight and APGAR scores in their babies.

Barbara Laraia of University of California, Berkeley on food insecurity and stress as common challenges to optimal nutrition during pregnancy:

  • Her recent study provided mindfulness training and support, finding decreased stress, but no effect on % with high gestational weight gain (GWG). Some women had low GWG and lower scores on oral glucose tolerance tests. 
  • San Francisco is giving $40/month in additional vouchers for vegetables to WIC participants in pregnancy through 3 mo. postpartum. Preliminary data shows reduction in preterm birth and high utilization of the vouchers.

Darlena Birch of the National WIC Association (NWA) on the role of WIC in supports nutrition during pregnancy and lactation:

  • NWA is employing a health equity framework to address disparities in care experienced by WIC participants. 
  • WIC’s BF Peer Counseling program is a powerful tool in closing gaps in communities of color.

Patsy Brannon of Cornell University tackled the unenviable task of summarizing the entire two days of the meeting in 20 minutes:

Planning Committee chair Anna Siega-Riz of University of Massachusetts at Amherst graciously closed the workshop.

My reflections:

As I left the meeting, my brain felt incredibly full. I felt such gratitude to the Committee, the Planning Committee, the truly amazing presenters and the National Academy of Science for a fabulous crash course on the state of nutrition knowledge regarding pregnancy and lactation.

On my way home, I jotted this note synthesizing a few overarching threads:

Changemakers are prone to singling out and manipulating individual entities (nutrients, people, etc.) rather than examining the complex webs they inhabit. A needed shift is to understand the webs (systems) first.

Nutrition During Pregnancy and Lactation: Exploring New Evidence

Guest post by Cindy Turner-Maffei, MA, ALC, IBCLC

Cindy Turner-Maffei, MA, ALC, IBCLC at the academy.

Did you know that the Dietary Guidelines for America (DGA), now 40 years old, have never included guidance for nutrition during pregnancy, lactation, infancy or for children under age 2? Worrisome when you think about the lifelong impact of nutrition in these crucial formative time frames.

Congress mandated that the next edition of the DGA, due later this year, provide nutrition guidance for pregnancy, lactation, and through age 2 years.

At the end of January, I had the great honor and pleasure of attending Nutrition During Pregnancy and Lactation: Exploring New Evidence – A Workshop, a 2-day workshop at the National Academy of Sciences (NASEM) in Washington, DC.  The National Academies of Health and Medicine sponsored this workshop to “explore the current state of the science on nutrients, dietary patterns, nutritional supplements, and other nutrition-based topics relevant to pregnancy and lactation. The workshop topics will include discussion of equity in access to nutritional care for women of childbearing age.” The last in-depth compilation of knowledge about this crucial topic was published by the Institute of Medicine (now the National Academy of Medicine) in 1990!

Conference opening slide.

Backstory of this workshop: In developing the 2020 DGA, the 2020 Dietary Guidelines Advisory Committee (DGAC) has developed a list of questions about nutrition needs in this crucial timeframe, and has begun an evidence review. A new Ad Hoc Committee led by Dr. Kathryn Dewey was identified to explore the infancy questions. This January meeting is the DGAC bringing together  top notch researchers who could share cutting-edge information about the research to inform their knowledge on those questions. Attending 2 days of concise and information dense presentations beginning at 8 am and running through 5 pm, was kind of like sitting in on a high-level nutrition briefing, in a similar vein to the intense briefings I was sure were going on right across the street at the Department of State. It was definitely nutrition science brain gym for me!

In order to summarize my learning, and share that knowledge with all of you, I live-tweeted the event. Below are my tweets in chronological order. Next week we will share a summary of Day 2. NASEM has made the videos of the Nutrition during Pregnancy & Lactation available here.

January 29, 2020

Anna Maria Siega-Riz updated us about changes among new parents since the 1990 IOM reports on nutrition in pregnancy and lactation: birthing folk today are older, heavier, less likely to smoke, more likely to birth surgically, and more likely to be diabetic.

Alison Steiber of the Academy of Nutrition & Dietetics (AND) shared that AND has launched a study examining how dietitians work with breastfeeding families.

Maria Makrides of SAHMRI Women and Kids at South Australian Health and Medical Research Institute reported on research about docosahexaenoic acid (DHA – an omega-3 fatty acid) supplementation during pregnancy, finding no significant decrease in postpartum depression, and no impact on cognition in children. 

  • On the 2018 Cochrane review of impact of DHA supplementation in pregnancy, she states:  “preterm birth < 37 weeks and early preterm birth < 34 weeks were reduced in women receiving omega-3 (Ω-3) long-chain polyunsaturated fatty acids (LCPUFA).” However, the DOMInO trial does not support this finding. 
  • Paraphrasing Makrides: “Women who start pregnancy with low omega-3 levels are at risk of preterm birth; that risk is reduced by supplementation with Ω-.. We found no benefits related to preterm birth for supplementation of pregnant folk who are Ω-3 replete*.” (*replete refers to having adequate stores in the body)
  • “Our research also concluded that DHA supplementation in pregnancy does not significantly decrease risk of allergies and asthma in children at hereditary risk.”
  • Consumption of 8 to 12 ounces of wild caught fatty fish weekly should maintain appropriate Ω-3 levels. Farmed fish is less ideal. 
    • {CTM note: check out safe dietary Ω-3 sources for pregnancy consumption here and here.)

 

Dr. Elango

Rajavel Elango of University of British Columbia on protein needs in pregnancy and lactation: 

  • “Protein needs were developed based on the needs of males. DRIs (Dietary Reference Intates) for pregnancy are based on males.” (?!?)
  • Our research in British Columbia suggests that protein needs in pregnancy are higher than the DRIs.
  • When protein intake is too high (>25% of kcal), the risks for high weight gain and fetal death increase
  • While pregnancy increases protein needs, not all amino acid are needed at the same level. Some individuals following plant-based diets may need help on how to balance protein and amino acid needs. We need more research on vegan and vegetarian diets in pregnancy.
  • In a well-nourished mother, variety of plant-based foods is probably fine (some dairy is a good addition, as it includes many needed amino acids). In a poorly nourished woman, assessing and meeting protein and amino acid intake is more crucial.
  • My lab has not evaluated how body type (overweight, underweight, obesity) impacts protein needs. Our work is with women of normal weight.

 

Leanne Redman of Pennington Biomedical Research Center on carbohydrates and energy requirements in pregnancy and lactation: 

  • In pregnancy, carbohydrate need increases 35% to fuel the fetal brain. 
  • In lactation, carbohydrates need doubles over non-pregnancy need, as glucose is used to make lactose. 
  • All carbs are not the same. Surveys of pregnant North Americans suggest intake of carbs is too high and fiber too low.
  • The National Institutes of Health (NIH) recommends decreasing added sugars (<10% of daily calories) and increasing fiber (28 g/d) in pregnancy.

 

Yvonne Lamers of University of British Columbia on folate and Vitamin B-12 in pregnancy and lactation:

  • The neural tube closes at 3 weeks gestation, before many know they are pregnant. WHO recommends 400 micrograms daily starting preconceptually through 12 weeks gestation. Women with previous child with neural tube defects need more.  
  • 20% of American women do not have sufficient folate in their red blood cells. Insufficient blood levels of folate are higher in African-American women (~35%).
  • In an era of food fortification, are folate supplements still required for pregnant women? YES! For all women, as it is needed early in pregnancy, before many know they are pregnant.
  • Response from Lamers to a later question about folate supplementation for those with the MTHFR genetic variant: The original concern about this arose in Europe where there is no universal FA fortification and lower folate status. Due to universal folate fortification, we are folate replete in No. America. Thus no difference in folate status between these genotypes and risk of neural tube defects. Theoretically there should be no difference between 5methyltetrahydrofolate and other folate sources, but research is needed to assure us that it is absorbed in the same manner as other folate sources. 
  • In pregnancy, fetal development requires adequate vitamin B12 levels.

 

Marie Caudill of Cornell University on the benefits of choline for mothers and infants:

  • There is a high demand for the essential nutrient choline in pregnancy, to meet fetal needs: Choline, a methyl-donor, is necessary for epigenetic expression and for many metabolic reactions in the body; it plays multiple roles including developing myelin sheaths around nerves, increasing speed of message transmission. 
  • Higher choline intake increases DHA status in women of childbearing age. “This suggests increasing choline in pregnancy may be a way to increase DHA supply to the developing fetus.”
  • Those with higher pregnancy choline intake were less likely to have babies with neural tube defects. Increased choline intake may also ease baby’s response to stress as measured by infant cortisol level.
  • Higher maternal choline intake decreases preeclampsia risk and improves lifelong cognitive functioning in offspring (at least in baby rats). Rodent studies also show protection against Alzheimers, fetal alcohol syndrome, autism, and others.
  • Higher maternal choline intake improves infant information processing speed + other cognitive performance measures.
  • The amount of choline in cow’s milk based formula is similar to human milk (HM), but lower in soy-based formula. The form of choline in formula is different than HM. Absorption is likely best from HM. Current AI (adequate intake recommendation)  for choline is likely too low.
  • Only 8% of women achieve the recommended intake of 550 mg of choline daily. Best sources are animal source foods, which poses a challenge for those on plant-based diets. Most prenatal vitamins do not contain choline. Human milk has15x more choline than maternal blood; thus, need in lactation is great too.
  • Choline-rich foods include egg yolks, beef, chicken, fish at about 100 mg/3 oz serving. Best plant sources are legumes and cruciferous vegs, which provide 3~0 mg/serving. Overweight women and those with fatty liver disease likely need more.
    • CTM Note: Information about choline requirements and food sources may be found here.

 

Kimberly O’Brien of Cornell University on iron (Fe) requirements in pregnancy and lactation:

  • US recommendations on pregnancy need is based on 400 women in Finland, UK and Sweden (ethnicities not reported). Dosage of iron provided was 7X the U.S. RDA.
  • Fe-deficiency highest in African Americans

 

Corrine Hanson of University of Nebraska Medical Center on nutritional antioxidants during pregnancy and lactation: 

  • Levels of antioxidant nutrients (vitamins C and E, selenium, and β-carotenoids) are lowest among those living in food deserts. 
  • These nutrients fight oxidative stress, helping the body recover.
  • Take home message: we need to increase population access to fruits, vegetables, nuts and seeds.
  • Calcium(Ca)  is also a population challenge in pregnancy and lactation. However, a Cochrane review found no clear benefits of Ca supplementation.
  • Activated vitamin D has a half-life of 4 hours. Therefore, regular input of D is important. Yet studies on the impact of D supplementation have inconsistent outcomes. 
  • 20% of North American women are vitamin D deficient (<20ng/ml).
  • Response from Hanson to a later general question about nutrient supplementation: Nutrients are not benign. They are powerful bioactive chemicals. Giving replete individuals more of a specific nutrients does not usually result in good outcomes. The individual’s circumstances need to be taken into account.

 

Elizabeth Pearce of Boston University School of Medicine on iodine (I) needs in pregnancy and lactation:

  • Iodine levels in the population are decreasing, according to NHANES (the National Health and Nutrition Examination Survey). 
  • The most critical period for adequate iodine intake is the 1st trimester of pregnancy
  • The longest list of negative impacts of iodine deficiency accrues to the fetus, including cognitive deficiencies, increased risk of stillbirth, cretinism, etc.
  • Iodized salt has decreased I-deficiency worldwide. UK research shows lower maternal I levels in pregnancy correlate to lower child IQ, even for those with the mildest level of deficiency. 
  • Vegans and vegetarians are at greater risk for I-deficiency. 
  • Prenatal supplementation of 150 mcg/d is recommended. However, current research does not demonstrate that supplementation is effective.
  • There are potential risks of excess iodine consumption. For example, an estimated 10% of pregnant women have thyroid autoimmunity. Hypothetically, a big dose of iodine could trigger hypothyroidism in the susceptible woman and also in her child.
  • CTM: Interesting question from a participant: Could the decrease in iodine status be related to concerns about sodium intake and the use of non-iodized salt products (e.g. sea salt, artisanal salt products)?

 

Dr. Bailey

Regan Bailey of Purdue University on dietary supplement use during pregnancy and lactation:

  • Who takes supplements in preg/lact? 77% of pregnant women. Older women (35-44) are the most likely to do so. By ethnicity: most likely among Non-Hispanic (NH) Whites, followed by Hispanic/Mexican Americans and then NH Blacks.
  • Many prenatal vitamins (PNV) do not contain any choline. 
  • There is a lot of variability among PNVs. 
  • Many pregnant women do not consume enough of several nutrients, and almost all are at risk of excess sodium intake and insufficient iron and folate intake.

 

Dr. Borgelt

Laura Borgelt of University of Colorado Anschutz Medical Campus on prenatal supplement formulations:

  • Prescription vs. over-the-counter PNVs: Rx version have higher doses of Fe and folic acid. Non-Rx versions tend to contain choline and extra ingredients (e.g. botanicals).
  • Research has found that both Rx and non-Rx PNVs may have more or less of ingredients than are listed on the label. 
  • If looking for a safer PNV, look for PMVM Quality Assurance (QA) designations on the label, such as: USP, NSF, Consumer Labs. These QA seals don’t address health outcomes, but that the contents are what the label states + there are no known safety issues. 
  • Guidelines needed for safe lead levels, avoiding other potentially toxic ingredients, etc.
  • Diet is the safest source of nutrients.

CTM Note: Check out the NIH Prenatal Multivitamin + Mineral (PMVM) Calculator – your tax dollars at work! 

‘Breastfeeding As An Act Of Resistance For The Black Mother’ guest post

By Nichelle Clark, Certified Breastfeeding Specialist

Originally published January 31, 2020 on SonShine & Rainbows Lactation

Black History Month in the breastfeeding community is normally littered with posts and articles about the dark history of African American Breastfeeding in this country. I firmly believe that in order to understand where you are going, you must first understand where you have been. However, Black Mothers in today’s society face a very different dilemma: actually being Black History.

We’ll start with the sordid history of Black breastfeeding women in America. Beaten and broken, then used as wet nurses for the children of slave owners. The children of these wet nurses were fed condensed or cows milk, that was prepared in filthy conditions. This history has cultivated a stigma and bias against what infant feeding should look like in African American families.

However, this has not deterred the rise of Millennial and Gen X parents in the Black Community. The Center for Disease Control Report Card, published in 2019, showed that only 74 percent of African American mothers had initiated any breastfeeding. By 6 months, the percentage of mothers exclusively breastfeeding drops to 27.1 percent. These numbers are up from previous years, at 69.4 and 17.2 percent respectively. According to the the American Academy of Pediatrics, breastfeeding protects against type 1 and 2 diabetes, as well as the likelihood of childhood obesity. The CDC lists diabetes as the number 6 killer of Black Men and the number 4 of Black Women (over all ages). Of African Americans aged 20 and over, 28.4 percent of men and 17.6 percent of women have been found to be obese. In our community, breastfeeding can truly be life or death. While it doesn’t preclude African Americans from these diseases, the advantage against them is something we most desperately need.

So, how is breastfeeding an act of resistance for the Black Mother? We must first define resistance. While not the most commonly used definition, resistance, in this case, is defined as “the ability not to be affected by something, especially adversely”.  And for Black Mothers in America, this is most certainly an act of resistance. Because of the traumas our ancestors faced, the majority of us simply did not grow up seeing mothers breastfeed. There weren’t many breastfeeding classes or clinics (this is still an issue in our community) and there was little familial support. I meet Black Mothers daily who still don’t know there’s an entire profession dedicated to assisting parents in mapping and meeting their breastfeeding goals. Even if we remove all these obstacles, a study by Chapman University found that African American mothers are more likely to be offered formula in the hospital than any other demographic. The “whys” are still being researched, but those of us belonging to the African American community know exactly why: There’s this social construct that Black Women just don’t breastfeed. But….. why? Because after years of being forced to nurse children against our wills while ours were fed dirty formula concoctions and died, African American mothers did not pass the practice down to their children. Couple that with diminished resources in our communities and lactation care providers that don’t understand our cultural history and social makeup, you can see why becoming Black History is a dilemma.

Black Breastfeeding Mothers are making history. We are educating ourselves and slowly changing what a Black breastfeeding mom looks like. Sometimes, we are outright defying our support systems and significant others. Make no mistake; all the reasons for NOT breastfeeding and the trauma in our communities still exist. Lack of Black IBCLCs still exist. Lack of resources and evidence based support still exists. Defiant child care providers still exist. Many mothers find solace in online support groups, where like minded parents understand the difficulties of healing these traumas in our own families. Again, therein lies the dilemma. We’re in this unique position of changing our history, while navigating the uncharted waters of not only breastfeeding, but motherhood and womanhood ourselves. While it is not fair to ask this of Black Women, it is something we gladly take on. Because our history is only part of the story. We are writing the next chapter.

We ARE Black History.

A special thanks to fellow Black Breastfeeding Mama, Yolanda Williams of the Parenting Decolonized Podcast.

Want to hear our conversation on the topic? Listen here!