LACTATION AND
HUMAN MILK
Lilly Chang, MD MS PGY-6
Growth of Mammary Glands
Embryology
¨ 6th week of gestation: Mammary glands begin to
develop as solid growths of epidermis called
mammary ridges
¨ Under the influence of estrogen from placenta,
mammary ridges canalize to form ducts
¨ At birth, mammary glands of males and females
are identical, composed of ~15-20 rudimentary
lactiferous ducts
Development of Breasts:
Puberty
¨ Under the influence of estrogen from developing
follicle & corpus luteum each month)
¨ Enlargement occurs due to deposition of fat &
connective tissue
¨ Nipple becomes enlarged and pigmented
¨ Further growth & branching of lactiferous ducts
Development of Breasts: Pregnancy
¨ More intense growth and branching of lactiferous
ducts (under high levels of estrogen from corpus luteum &
placenta)
¨ GH, glucocorticoids, prolactin, insulin all influence
growth
¨ Final development of mammary glands occurs under
the influence of progesterone, which (in concert with
hormones mentioned above) cause alveoli to bud
from the ends of the lactiferous ducts
¨ Each alveolus is lined by milk secreting cells
Milk Production
(during pregnancy)
¨ Prolactin, secreted by anterior pituitary gland,
stimulates milk production
¨ During pregnancy, prolactin levels increase 20 fold but
action of prolactin inhibited by high estrogen &
progesterone levels
¨ Human chorionic somatomammotropin ( i.e. placental
lactogen) plays role in lactogenesis
¨ Towards end of pregnancy, breasts are fully developed
but milk production is suppressed except for small
amount of colostrum (same concentration of proteins
and lactose as regular milk but hardly any fat)
Milk Production
(after birth)
¨ After birth, estrogen and progesterone levels drop
and milk is produced in 1-7 days
¨ Milk production requires: secretion of hormones
involved in protein, glucose & calcium regulation
(GH, cortisol, insulin, PTH)
¨ PRL levels return to normal within a few weeks.
Each time an infant feeds, neurohumoral reflex
leads to burst of prolactin secretion
Milk Ejection
¨ Alveolar milk accumulates in
the lactiferous sinuses
(enlargements of ducts near
opening of nipple)
¨ Suckling hypothalamus
release of oxytocin from post.
pituitary.
¨ Oxytocin contraction of
myoepithelial cells around the
ducts.
¨ Negative maternal emotions
(frustration, anger, anxiety)
can inhibit oxytocin secretion
& suppress milk ejection
reflex
Contraindications
¨ HTLV-1 and HTLV-2 ¨ Maternal HIV
¨ HSV with lesion on the ¤ US: not recommended
breast ¤ UNICEF: When
replacement feeding is
¨ Active tuberculosis acceptable, feasible,
¨ Medications that affordable, sustainable
contraindicate and safe, avoidance of
all breastfeeding is
breastfeeding recommended; otherwise,
¨ Newborn with exclusive breastfeeding
galactosemia is recommended during
the first months of life.
Colostrum
¨ It is the first stage of breast milk that is produced
after birth and lasts for several days
¨ It has a yellowish to cream colored thick
appearance
¨ It is high in protein (antibodies), vitamins (especially
fat soluble vitamins), minerals
¨ Major protein is whey (80:20 whey:casein)
¨ Very low in fat compared to mature breast milk
Mature Milk
¨ Contains higher levels of fat, lactose, and vitamins
(more water-soluble vitamins)
¨ Larger percentage is water
¨ More protein is casein (55:45 whey:casein)
¨ Multiple carbohydrates including lactose and human
milk oligosaccarides
¨ Two types milk: foremilk and hindmilk
¤ Foremilk has more lactose and less fat
Preterm breast milk
¨ Contains more protein, sodium, chloride
¨ Protein amount still below amount supplied by
placenta
¨ Less lactose
Immunologic Components
¨ Immunoglobulins - Human milk contains all of the
different antibodies (M, A, D, G, E), but secretory
immunoglobulin A (sIgA) is the most abundant
¨ Lactoferrin - which binds to iron, thus making it
unavailable to pathogenic bacteria
¨ Lysozyme - which enhances sIgA bactericidal activity
against gram-negative organisms
¨ Mucins - adhere to bacteria and viruses and help
eliminate them from the body
¨ Leukocytes - with the transition from colostrum to mature
milk, the percentage of macrophages increases from
40-60% of the cells to 80-90%
Donor Milk
¨ Milk from 3-5 donor
mothers is thawed,
transferred to glass flasks,
and mixed
¨ Milk samples are cultured
during the pasteurization
process then frozen at -
4°F and stored
¨ Culture-positive milk is
discarded
¨ Milk is shipped frozen
overnight to hospitals and
individuals
Donor Milk
¨ Pasteurization impacts immunological properties
¨ Lymphocytes, alkaline phosphatase, cytokines, some
growth factors, lipoprotein and some lipases are
destroyed
¨ Decreased lactoferrin and lysozyme
¨ Some immunoglobulins are preserved such as IgA
and IgG but IgM mostly destroyed
Nutritional Composition
¨ Human milk has more
long chain fatty acid
¨ DHA added to formula
