Tag: epigentics

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Breastfeeding is an opportunity to learn.

–This post is part of our 10-year anniversary series “Breastfeeding is…”—

Breastfeeding is an opportunity to learn. Although breastfeeding is an ancient practice, there is still so much to learn about the lactating breast, breast function and the process of breastfeeding, especially as our modern lives continue to change.

Many current textbook depictions of the anatomy of the lactating breast are largely based on research conducted over 150 years ago, Donna T. Geddess points out in The anatomy of the lactating breast: Latest research and clinical implications.

“…Few studies have actively investigated the anatomy of the lactating breast despite the obvious importance a clear understanding of the lactating mammary gland has to both mother and infant,” Geddess writes. “Perhaps this lack of information is a part of the greater reason why many women continue to experience breastfeeding problems.”

Katherine Lee writes in Katie Hinde Championing the Fun Side of Science Through Virtual Animal Games, Thunderdome Style about Hinde’s hope to change the perception about breastmilk and quotes her saying “‘Still to this day, there is no integration between breastfeeding and milk composition and volume,’ noted Hinde. ‘In Pubmed, there are more articles about tomatoes than human breast milk.’ When they listed the human microbiome project, they didn’t include breastmilk…”

This week we present several  recent (in the last 5 years) publications that are helping to shape our understanding of infant feeding. We have also included studies that relate specifically to pregnancy as pregnancy, birth and breastfeeding are all part of a continuum.

It is important to note that research published in medical journals is not the only way to capture and develop an understanding of infant feeding experiences. For instance, Camie Jae Goldhammer,  MSW, LICSW, IBCLC, (Sisseton-Wahpeton), founder of  Hummingbird Indigenous Doula Services says that their program is proudly not rooted in “evidence”; instead, it’s a community designed program. Anecdotal evidence and indigenous knowledge and wisdom should be honored. Moreover, as with any research, we must always consider how the research is funded, who is or is not being represented, and how the research is presented. For more on equity in science, check out Increasing equity in data science and the work being done at the Urban Indian Health Institute.

 

Lactation duration and stroke risk 

In February 2022, Ziyang Ren, MD, et al released Lactation Duration and the Risk of Subtypes of Stroke Among Parous Postmenopausal Women From the China Kadoorie Biobank.

Stroke is a growing global health problem. It is the third leading cause of disability adjusted–life years (DALYs) worldwide and the first leading cause of DALYs in China, Ren, et al point out. Stroke  imposes a financial burden on patients, families, and society. The cohort study found that lactation duration significantly lowers the risk of stroke.

Up until now, most research has focused on the association between lactation and cardiovascular diseases (CVDs), but this piece lays out the association between lactation and stroke subtypes.

Specifically, the study found that parous postmenopausal women with lifetime lactation duration of at least 7 months had lower risks of ischemic stroke and intracerebral hemorrhage (ICH) compared with women who never lactated. For subarachnoid hemorrhage (SAH) though, such associations were found only in participants with lifetime lactation duration of longer than 24 months. In addition, the authors found that those with an average lactation duration per child or lactation duration for the first child of at least 7 months were less likely to develop stroke and its subtypes.

 

Marijuana exposure in utero 

Birth Outcomes of Neonates Exposed to Marijuana in Utero: A Systematic Review and Meta-analysis by Greg Marchand, et al, the largest meta-analyses on prenatal cannabis use to date, the authors  found significant increases in seven adverse neonatal outcomes among women who were exposed to marijuana during pregnancy versus those who were not exposed during pregnancy.

Photo by Solen Feyissa on Unsplash

The systematic review and meta-analysis demonstrated higher rates of low birth weight (<2500 g) and small for gestational age (<fifth percentile), lower mean birth weight, preterm delivery (<37 weeks’ gestation), higher rate of admission to the neonatal intensive care unit, poorer Apgar scores at 1 minute, and smaller head circumference in those exposed to marijuana.

The prevalence of marijuana use during pregnancy is significant, and many people cite the belief that marijuana use is relatively safe during

pregnancy. This work may help to raise awareness and be used to educate patients about adverse outcomes with the hope of improving neonatal health.

With increased marijuana legalization in mind, Kara R. Skelton, PhD and  Sara E. Benjamin-Neelon, PhD, JD, MPH in Reexamining Risks of Prenatal Cannabis Use—Mounting Evidence and a Call to Action urge states that have legalized and commercialized cannabis to retroactively prioritize protection of neonatal health.

More on cannabis during the perinatal period here.

 

Childhood obesity 

The authors of Childhood Obesity and Breastfeeding Rates in Pennsylvania Counties-Spatial Analysis of the Lactation Support Landscape examined the relationship between childhood obesity and breastfeeding rates in Pennsylvania (PA) counties, the relationship between geographic access to professional lactation support providers  (LSPs) in PA counties and breastfeeding rates, and  the relationship between geographic access to professional LSPs and childhood obesity in PA counties. They found a significant, inverse relationship between breastfeeding rates and childhood obesity prevalence at the county level and a significant, inverse relationship between the number of CLCs and the number of all professional LSPs and childhood obesity rates at the county level. Thus,  the authors conclude, the availability of breastfeeding support is significantly related to breastfeeding rates and inversely related to childhood obesity rates across Pennsylvania.

 

Measuring optimal skin-to-skin practice 

The authors of Mapping, Measuring, and Analyzing the Process of Skin-to-Skin Contact and Early Breastfeeding in the First Hour After Birth show how process mapping of optimal skin-to-skin practice in the first hour after birth using the algorithm, HCP-S2S-IA, produced an accurate and useful measurement, illuminating how work is conducted and providing patterns for analysis and opportunities for improvement with targeted interventions.

More specifically, the algorithm provides a tool to help reduce delays or decrease interruptions during skin-to-skin contact (SSC). The authors note, “Not suckling in the first hour after birth places newborns at higher risk for neonatal morbidities and mortality. Examining patterns and developing strategies for change optimizes patient outcomes.”

 

Acknowledging the social determinants of health

Pregnancy and the origins of illness (2022) by Anne Drapkin Lyerly begins by acknowledging that the COVID-19 pandemic has induced a collective trauma that is expected to be felt for generations after the virus is contained. The study of epigenetics has shown that children gestated or born during times of great tragedy, carry a genetically coded and inherited imprint of their mother’s experience with lifelong consequences to their health.

Recognizing the “maternal-fetal interface” as the “nexus of inter-generational trauma” raises the question of how we should think about this implication of maternal bodies, especially in light of the current pandemic.

The author explores the growing field of developmental origins of health and disease (DOHaD) and its use of epigenetics. Thinking about the tools of history, philosophy, and gender studies of science, the author advises we proceed with caution as we consider maternal effect science which raises several concerns that can impact practice and the well-being of mothers and consequently their children.

Namely,  there may be a tendency to ascribe blame on pregnant people for the health outcomes of their offspring that are well beyond their control. This approach doesn’t adequately weigh the effects of paternal, postanal, and other social and environmental factors that also influence the long-term health of children.

Analyzing epigenetics can eventually contribute to the erasure of the mother as a person, and further, characterizing the maternal body as an environment may excuse women from being appropriately considered in public health policies, clinical care and health research.

The author considers DOHaD research a corrective approach to near-sighted fetal origins science and urges that we expand our understanding of the gestational environment from not simply the womb, but to the broader environment in which a person gestates, marking the importance of acknowledging the social determinants of health. To best direct our efforts during the current pandemic, the author suggests shifting the focus off of maternal behavior and choices and instead focus on limiting the harm of climate change, racism, and other structural inequities.

 

Can’t get enough? 

Check out the Breastfeeding Medicine Podcat’s episode Review of a Potpourri of Research Topics with co Hosts Anne Eglash MD, IBCLC and Karen Bodnar MD, IBCLC. You can find a full list of their podcast episodes here.

Subscribe to SPLASH! Milk Science Update

Check out The International Society for Research in Human Milk and Lactation

 

——–

As part of our celebration, we are giving away an online learning module with contact hours each week. Here’s how to enter into the drawings:

Email info@ourmilkyway.org with your name and “OMW is 10” in the subject line.

This week, in the body of the email, tell us: What fascinates you about breastfeeding and/or what do you wonder about breastfeeding?

Subsequent weeks will have a different prompt in the blog post.

We will conduct a new drawing each week over the 10-week period.  Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.

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Musings on unity beyond National Breastfeeding Month

This year’s National Breastfeeding Month (NBM) celebration has come to an end, but our momentum as maternal child health advocates– striving for equitable care for all– powers on. 

The 2020 NBM theme, Many Voices United, called on us to come together to identify and implement the policy and system changes that are needed to ensure that all families have the support and resources they need in order to feed their babies healthily. 

Photo by Tim Mossholder on Unsplash
Colorful Hands 1 of 3 / George Fox students Annabelle Wombacher, Jared Mar, Sierra Ratcliff and Benjamin Cahoon collaborated on the mural. / Article: https://www.orartswatch.org/painting-the-town-in-newberg/

Achieving this shared goal requires daily self-work and individual introspection so that our collective can be as effective as ever. No matter how socially-conscious, open-minded, anti-racist, (insert adjective), we think we may be, we still have learned biases and prejudices that require near constant attention. Much like I remind my children to brush their teeth every morning and every night, as a white, binary woman, I must remind myself to examine my biases and my privilege daily.  

With NBM’s theme of unity in mind, this Upworthy video features an art installation that demonstrates our society’s interconnectedness. With a piece of string, the installation shows an intricate, densely-woven web created by individuals wrapping thread around 32 poles with identifiers arranged in a circle. 

“You can see that even though we all have different experiences and we all identify in different ways…We are really one,” the project’s creator says in the video. 

The sentiment and the product are truly beautiful and fascinating. While appreciating the beauty of unity, it’s important to keep our critical thinking and progressive attitude sharp, refraining from slipping into too comfortable a space where change cannot happen.  

Recently, I’ve seen a few statements on unity circulating social media that I’d like to embrace with a “Yes!” Instead, I find myself reacting, “Yes! But…” 

My worry is that these well-intentioned mantras we live by– much like some might argue certain microaggressions are well-intentioned– are also dismissive. 

  1. We all bleed the same blood. 
  1. Children are not born racist.
  1. I will teach my child to love your child. Period. 

Let’s break those down starting with “We all bleed the same blood.”  Some things to consider:

First, Ashley May for The Thirbly writes,

“Black breasts do not exist separate from Black bodies and the situated existence we navigate in this world nor the racialized experience of motherhood. Racism and classism intertwine to act as a containment, working to make some of us feel as if we are walking in quicksand. Add to this the complexities of new motherhood and the needs of the postpartum body and now we have a cocktail for failure. Literal milk plugs. So, although her precious body may be able to produce milk, her situation prevents her and her baby from receiving it. Even the intention to breastfeed cannot save the milk of the mother who cannot find time for pump breaks as she works the night shift as a security guard. Or, perhaps she cannot figure out why pumping is not working, but she doesn’t have the time to seek the educational or financial resources to help her problem solve.” (underline added by OMW) 

Racism affects People of Color (POC) at a cellular level. Studies show that the experience of racial discrimination accelerates the shortening of telomeres (the repetitive sequences of DNA at the ends of chromosomes that protect the cell) and ultimately contributes to an increase in people’s risks of developing diseases. 

It’s epigenetics; the environments POC of are growing in affect their biology.  

Children are not born racist, but white children are born into a racist society that they will benefit from. 

From the very beginning, white children have a better chance of survival than Children of Color; African Americans have 2.3 times the infant mortality rate as non-Hispanic whites. 

What’s more, Black children are three times more likely to die when cared for by white doctors, while the mortality rate for white babies is largely unaffected by the doctor’s race, a recent study found. 

White children are born into being part of the problem and just the same, can be part of equitable solutions. 

I will teach my child to love your child. Period. 

Love is action, and even if it’s easier said than done, there are so many ways to teach our children about race, inequities and injustice. Afterall, “If Black children are ‘old enough’ to experience racism then white children are ‘old enough’ to learn about it.” – Blair Amadeus Imani

  • Be careful what you say. As a young girl on my way to ballet class one day, my mom, while locking the car doors,  pointed out the barred doors and boarded windows in the neighborhood we rolled through. 

“That’s how you know this is not a safe neighborhood,” my mom warned me. 

No questions asked, I noted the building facades, and then I noted the Black people. Because there wasn’t any further conversation, I made the connection that Black people must be “not safe” and ultimately, that there must be something wrong with Black people if they’re confined to neighborhoods “like this.” 

Imagine the impact we could make if we showed our children that there is nothing inherently wrong with Black people that ending racism can’t solve.

As a nation we are apathetic, made apparent by a recent poll. The survey shows that only 30 percent of white people have taken concrete action to better understand racial issues after George Floyd’s killing. 

The poll also shows that White Americans are also the least likely to support the Black Lives Matter movement, with 47 percent expressing support.

Is it because we don’t claim it as our problem? Is it because we misunderstand the problem? Is it because it’s easier to point fingers at others than ourselves? 

I’d like to leave you with this video of writer Kimberly Jones where she provides a brief history of the American economy told through an analogy using the board game Monopoly. I urge you to watch it, and then watch it again, and again, and again. 

There is no time for complacency within these truly abhorrent systems. When we start to lose sight of that, envision the tangle of yarn from the aforementioned unity art installation and remember that vastly different experiences are networked together.

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