1.3 Effects of Breastfeeding alternatives

Key Points - Case Study A
Joanne, aged 32, a regular patient, comes to see you when she is 12 weeks pregnant with her first baby. She has just returned from a trip around Australia and her pregnancy was confirmed by a doctor in the town they were in at the time. She has copies of her baseline blood tests with her and all are normal.
Would you discuss breastfeeding at this visit?
- Topic 1.1: Discussing breastfeeding
- It is important that doctors discuss infant feeding decisions and breastfeeding with women early in a pregnancy rather than waiting until the third trimester or after the baby is born.
What information would you give?
- Topic 1.2: What information to give
- When discussing infant feeding with mothers it is important to note that alternatives to breastfeeding have many undesirable outcomes.
Why do breastfeeding alternatives have different effects?
- Topic 1.3: Effects of Breastfeeding alternatives
- These effects are due in part to the presence in breast milk of substances and systems that act against infections and inflammation.
Why do breastfeeding alternatives have different effects?
These effects are due in part to the presence in breastmilk of substances and systems that act against infections and inflammation or stimulate the growth of 'normal' bacterial colonization.
Secretory IgA (SIgA) | Secretory IgA is manufactured in the breast and acts against pathogens to which the mother has been exposed. Stimulated lymphocytes migrate from Peyer’s patches in the mothers gut and similar lymphoid tissue in the bronchial tree to the breast and produce SIgA in reaction to the pathogens present in the infant's environment (entero-mammary and broncho-mammary pathways). 1 2 It also neutralises viruses and bacterial toxins. Other antibodies (IgG, IgM and IgE) are also present in breast milk. 3 |
Leukocytes | Similar to SIgA, leukocyte numbers are highest in colostrum, and fall to approximately 10 4 – 2x10 5 in mature milk. 2 The majority of cells are macrophages (85%) and small lymphocytes and play a role in protecting the breastfed infant and the breast by destroying pathogens by phagocytosis. 4 Macrophages and lymphocytes in breastmilk produce other active agents (SIgA, lactoferrin, complement, prostaglandins). They are also able to enter the infant’s circulation. 3 |
Lactoferrin | Lactoferrin is an iron-binding glycoprotein that has a bactericidal effect on gram +ve and -ve bacteria as well having antiviral and antifungal capacity. 5 6 |
Carbohydrates | Oligosaccharides, glycoproteins and glycolipids in particular promote the growth of non-pathogenic bacteria, such as bifidobacteria, in the infant’s gut (prebiotic effect) 7 as well as preventing the attachment of bacteria and other pathogens to the epithelial lining of the gut and other mucosal surfaces. 8 |
Fatty Acids | Fatty acids affect certain bacteria, viruses and parasites. They also enhance the development of the nervous system. 4 It is hypothesised that the fatty acid composition of breastmilk is responsible for the differences in cognitive development between those breastfed and those formula-fed, 9 and may also impact on the development of allergic disease. 4 |
Probiotic bacterial growth. | Probiotic bacteria (eg. Lactobacillus bifidus ) flourish in breastfed infants due to substances found in breastmilk, such as bifidus factor and oligosaccharides. 10 8 These organisms cause the low pH of the breastfed infant's colon, inhibiting the growth of pathogenic bacteria. |
Lysozyme, α lactalbumin, complement, cytokines, growth factor, nucleotides | Lysozyme, α lactalbumin, complement, cytokines, growth factor, nucleotides present in breastmilk have all been shown to have an active role against pathogens. 4 3,10 |
Notes
- # Newburg DS et al. (2007) Protection of the neonate by the innate immune system of developing gut and of human milk.
- # Xanthou M et al. (1995) Human milk and intestinal host defense in newborns: an update
- # Hanson LA (2007) The role of breastfeeding in the defense of the infant
- # Hanson L (2004) Immunology of Human Milk: How breastfeeding protects babies
- # Harmsen MC et al. (1995) Antiviral effects of plasma and milk proteins: lactoferrin shows potent activity against both human immunodeficiency virus and human cytomegalovirus replication in vitro.
- # Jenssen H et al. (2009) Antimicrobial properties of lactoferrin.
- # Coppa GV et al. (2004) The first prebiotics in humans: human milk oligosaccharides.
- # Newburg DS (1996) Oligosaccharides and glycoconjugates in human milk: their role in host defense.
- # Caspi A et al. (2007) Moderation of breastfeeding effects on the IQ by genetic variation in fatty acid metabolism
- # Lawrence RM et al. (2007) Human breast milk: current concepts of immunology and infectious diseases.