Mammary Glands and Lactation

Nulligravida
Define lactation
Structure of Mammary Gland
Functions of Mammary Gland
Breastfeeding Timeline
First 6 months – only breast milk
Until 2 years old – breast milk + complementary foods

Hormonal Control

 TRH and PRH stimulate secretion of prolactin from anterior pituitary gland.
 Dopamine/PIH (prolactin inhibitory hormone) normally inhibits prolactin secretion.
 Suckling reflex stimulates hypothalamus to secrete TRH and PRH and to inhibit PIH which
results in stimulation of lactotrophs of anterior pituitary to secrete prolactin.

NB: Dopamine normally acts on D2 receptors in lactotrophs.

Prolactin

Secretory Levels:
Secretion increases gradually during pregnancy and remains elevated 2-3 months post-partum with
surges seen during suckling and breast emptying.

Functions:
It inhibits FSH and LH and makes ovaries nonresponsive to their hormonal stimulation in order to
prevent conception.

Hyperprolactinaemia (causes):
1) Excess production from AP – pituitary adenoma
2) Reduced inhibition – PIH blocked from getting to AP by mass lesions in pituitary stalk.
3) Hormonal conditions – pregnancy, hypothyroidism, oestrogen therapy.
4) Drugs – antipsychotic drugs and opiates.
5) Excess suckling.
Excess prolactin common cause of infertility and galactorrhoea (inappropriate lactation).

Brest changes during & after pregnancy

1) Mammogenesis (ductal formation)
 Prolactin  cellular differentiation to increase lactogenic capacity
 Insulin  multiplication of epithelial cells
 Oestrogen  duct formation
 Progesterone  alveolar formation

2) Lactogenesis
 Lactogenesis 1 (mid-pregnancy to 30 hrs after birth)
Progesterone from placenta  inhibits milk production
 Lactogenesis 2 (30-40 hrs after birth)
Placenta delivered  Decreased progesterone and high already high prolactin 
high milk production.
 Lactogenesis 3 (2 to 3 months postpartum onwards)
Autocrine lactation stimulated & maintained by suckling.
 3) Galactogenesis
 Neurosensory reflex
 Afferent stimuli from suckling reach posterior pituitary causing oxytocin release
 Oxytocin causes contraction of myoepithelial cells
 Cortical inputs
e.g. thinking of baby or hearing baby cry

Biosynthesis of Lactose (Slide 19)

LACTOSE BIOSYNTHESIS
• Lactose: glucose + galactose

• 2 glucoses required for each lactose molecule synthesized:

• One glucose converted to UDP-glucose, then UDP-galactose
• Second unmodified glucose

• Lactose synthase enzyme activity is composed of:

Ø catalytic component = galactosyltransferase (GT)
Ø regulatory = a-lactalbumin (a-LA)
Ø a-LA specificity modulator - found only in lactating gland
Ø expression is upregulated in response to prolactin and surpressed by
progesterone during pregnancy

Comparison of Breast Milk, Bovine Milk & Formula

Components of Breast Milk
• Carbohydrate
– Lactose (a disaccharide unique to milk)
– Oligosaccharides
• Milk fat (mainly in form of triglyceride)
• Proteins
– casein
– whey proteins
• lactoferrin
• secretory immunoglobulin A (sIgA)  mucosal immunity (since babies prone
to mucosal infections)
• a-lactalbumin and others
• Minerals: sodium, potassium, chloride, calcium, magnesium
• Other components: enzymes, vitamins, trace elements, growth factors

Human milk has more lactose but less protein and less ionic constituents than cow or goat milk.
Components of Human Milk Not Found in Formula

Components not found in formula

• Lactoferrin protein (for intestinal health)
• Anti-infectious oligosaccharides & glycoconjugates
• Growth factors
• Long-chain polyunsatursated fatty acids (LCPUFA) - Docosahexaenoic acid (DHA, omega-3)
and arachidonic acid (AA, omega-6)
• Fat-digesting enzyme, lipase

State the current WHO breast feeding recommendations for infants and outline the
aim of the International Code of Marketing of Breast-milk Substitutes

• The Code seeks to:

• promote and protect breastfeeding
• control marketing practices used to sell products for artificial feeding
• give health workers the responsibility to encourage and protect breastfeeding
Describe the evidence-based benefits of breastfeeding for both infant and mother
• Improved gastrointestinal function, digestion, and absorption of nutrients
• Improved cognitive and visual development
• Improved host defense with reduced rates of infection (e.g. sepsis, necrotizing enterocolitis,
and urinary tract infection)
• Enhanced maternal psychological well-being and maternal-infant bonding; improve birth
spacing
• Research ongoing: microbiome, epigenetics, stem cells, etc.

Colustrum
• First liquid produced, yellow and thicker
• Very high in concentrated nutrition
 low in fat, high in proteins & carbohydrates, very easy to digest
• High concentration of antibodies, especially IgA, helps protect the lungs, throat, and
intestines
• Laxative effect, which helps pass first bowel movements (prevents newborn jaundice)
• Within a few days after delivery - transitional milk
• After ~1/2 weeks mature milk produced

Weaning
• Weaning: reduction of breast milk and/or formula to replace it with more solid food
• after first six months (WHO)
• formula-fed, between 4-6 months of age
• Continue to breastfeed in combination with suitably nutritious and safe complementary
foods until 2yrs
• Breast/formula milk should be used for drinking until 12 months, after which cow’s milk (full
fat) can be introduced as a drink