To produce milk, four secretory processes are synchronized in the alveolar cell of the mature, functional mammary gland: (1) exocytosis, (2) fat synthesis and secretion, (3) secretion of ions and water, and (4) transcytosis of immunoglubulins and other substances from the interstitial space. Milk is synthesized continuously into the alveolar lumen, where it is stored until milk removal from the breast is initiated. Prolactin mediates the central nervous system regulation of milk secretion, but its influence is modified greatly by local factors that depend on milk removal from the breast. Oxytocin mediates milk let-down by stimulating the contraction of myoepithelial cells that surround the alveoli and ducts. Lactogenesis includes all the processes necessary to go from the undifferentiated mammary gland in the early pregnant animal to full lactation sometime after parturition. The most important factors in initiation of lactogenesis stage II appear to be progesterone withdrawal. The metabolic demands of breastfeeding require an increase in maternal metabolism. Postpartum suppression of fertility is thought to be the result of an alteration in pulsatile gonadotropin releasing hormone secretion from the hypothalamus. Women who wish to ensure against pregnancy during lactation usually are advised to use other contraceptive means.
Animals ; Breast ; Breast Feeding ; Central Nervous System ; Contracts ; Dietary Sucrose ; Exocytosis ; Female ; Fertility ; Gonadotropin-Releasing Hormone ; Humans ; Hypothalamus ; Ions ; Lactation ; Mammary Glands, Human ; Milk ; Milk Ejection ; Oxytocin ; Parturition ; Postpartum Period ; Pregnancy ; Progesterone ; Prolactin ; Secretory Pathway ; Transcytosis ; Water

The aim of this study is to evaluate pituitary-ovarian function at different postpartum periods during the lactational amenorrhea in order to understand the mechanism by which puerperal lactation is associated with a protracted period of amenorrhea and natural infertility. Ninety four lactating women and 119 lactating women with menstruation, aged between 21 and 38 years, volunteered for this study. The pituitary was relatively insensitive to LH-RH during the first 3 weeks following delivery. The recovery of FSH responsiveness to LH-RH occurred earlier than that of LH. Normal FSH response resumed in the 2nd week while the LH response, although not normal, started at the 3rd week postpartum. Pituitary responsiveness after the 5th week postpartum was similar to that occurring in normally menstruating women, except that FSH response was exagerated. Serum prolactin levels were elevated above 160 ng/ml until the 5th week postpartum and decreased to 84.2 ng/ml in the 6th week postpartum. It appears that at least one reason for anovulation during the first four weeks following delivery is the relative insensitivity of the pituitary to hypothalamic stimulation. Prolactin does not seem to modulate pituitary responsiveness to LH-RH. In order to clarify hormonal profiles during the lactational amenorrhea beyond the 5th week puerperium, serum levels of LH, FSH, prolactin, estradiol and progesterone were determined during different postpartum periods. Serum FSH and LH levels during 1-10 months postpartum were similar to basal levels seen during the normal menstrual cycle. Serum estradiol concentrations throughout 1-10 months postpartum, however, were significantly decreased as compared with the levels during the follicular phase of the normal menstrual cycle. Serum prolactin levels were elevated throughout 1-10 months postpartum in lactating amenorrhic women but decreased as the postpartum period lengthened. As compared with lactating amenorrhic women, lactating women with resumed menstruation showed a decrease in prolactin levels from 89.20 ng/ml to 51.39 ng/ml at 1-3 months, from 75.08 ng/ml to 49.99 ng/ml at 4-6 months, and from 54.73 ng/ml to 28.74ng/ml at 7-10 months postpartum. These results suggest that the apparent anovulation seen beyond 5th week postpartum during lactation was not due to pituitary insensitivity to LH-RH. Rather, prolactindependent mechanism interfering with cyclic activity may be operative during long term lactation.
Amenorrhea/etiology* ; Female ; Gonadorelin/pharmacology ; Gonadotropins, Pituitary/secretion ; Human ; Lactation* ; Ovary/physiology* ; Pituitary Gland/physiology* ; Pregnancy ; Prolactin/physiology ; Puerperium*

No abstract available.
Bone Density* ; Female ; Lactation* ; Postpartum Period*

To elucidate the changes in bone turnover during pregnancy and puerperium, we measured serially the levels of serum osteocalcin and urine deoxypyridinoline (Dpy) as markers of bone formation and bone resorption, respectively, in 22 healthy women with normal pregnancy. Nineteen non-pregnant women served as control. The Dpy levels increased significantly at 16 weeks of pregnancy and remained elevated thereafter. The levels of osteocalcin, however, were significantly decreased at 16 weeks of pregnancy and elevated later at 6 weeks postpartum. Bone turnover ratio (Dpy/osteocalcin) continued to rise during pregnancy, but returned to control levels 6 weeks after delivery. Dpy levels and bone turnover ratio during puerperium tended to be higher in 17 breast-feeding women than those of 5 exclusive bottle-feeders. In conclusion, bone resorption begins to increase from the second trimester of pregnancy and calcium release from bone tissue might play a major role in calcium homeostasis during the whole period of pregnancy as well as during lactation.
Adult ; Amino Acids/urine ; Analysis of Variance ; Biological Markers* ; Bone Resorption/physiopathology* ; Calcium/metabolism ; Female ; Human ; Lactation/physiology ; Osteocalcin/blood ; Osteoporosis/physiopathology* ; Pregnancy ; Pregnancy Complications/physiopathology* ; Puerperium/physiology*

OBJECTIVE: To observe the effect of electroacupuncture at Shaoze (SI 1) on breast milk volume and nutrient composition in postpartum hypogalactia. METHODS: A total of 62 women with postpartum hypogalactia were randomized into an observation group (31 cases, 3 cases dropped off) and a control group (31 cases, 3 cases dropped off). Electroacupuncture was exerted at Shaoze (SI 1) in the observation group and at Shangyang (LI 1) in the control group, 10 Hz in frequency, 30 min each time, once a day. The treatment for 5 times as one course and 3 courses of treatment were required totally. Separately, before treatment and at the end of 1 course and 3 courses of treatment, the breast milk volume was measured and the composition was analyzed. The breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density were observed in the two groups. After treatment, the clinical effect was compared between the two groups. RESULTS: In the observation group, after 1 course of treatment, the breast milk volume and the values of lactose and protein in the breast milk were increased as compared with those before treatment, the breast milk energy and density were increased as compared with those before treatment (all <0.05). After 3 courses of treatment, the breast milk volume and the values of nutrient composition (lactose, fat and protein) were improved as compared with those before treatment, and the breast milk energy and density were increased obviously as compared with those before treatment in the observation group (all <0.05). In the control group, after 1 course and 3 courses of treatment, only breast milk volume was increased obviously as compared with that before treatment (both <0.05). After 1 course of treatment, the nutrient composition (lactose and protein), breast milk energy and density in the observation group were higher than those in the control group (all <0.05). After 3 courses of treatment, the levels of breast milk volume, nutrient composition (lactose, fat and protein), breast milk energy and density in the observation group were all higher than those in the control group (all <0.05). The effective rate was 92.9% (26/28) in the observation group, which was higher than 17.9% (5/28) in the control group (<0.05). CONCLUSION Electroacupuncture at Shaozhe (SI 1) increases breast milk volume in patients with postpartum hypogalactia and promotes the production of the nutrient composition in breast milk, as well as the breast milk energy and density.
Acupuncture Points ; Electroacupuncture ; Female ; Humans ; Lactation ; Lactation Disorders ; therapy ; Milk, Human ; Postpartum Period

PURPOSE: This study was done to identify the effects of self-breast pumping on breastfeeding rates and, the degree of breast milk fullness among primiparous women giving birth by cesarean section. METHODS: The study design was a non-synchronized posttest control group experiment with repeated measures. The participants were 60 women, 31 in the experimental group who used a manual pump 5 times a day after exclusive breastfeeding and 29 in the control group who breastfed exclusively with no other interventions. RESULTS: While self-breast pumping did not improve breastfeeding rates or the degree of breast milk fullness at any of the time points studied, breastfeeding rates continued to remain high till 12 weeks postpartum in both groups. Conclusion: Although some modifications in research methods will be required to identify the effects of breast pumping and exclusive breastfeeding, both these approaches can be used as interventions to improve breastfeeding rates and breast milk quantity.
Breast Feeding ; Breast Milk Expression ; Cesarean Section ; Female ; Humans ; Lactation ; Milk, Human ; Parturition ; Postpartum Period ; Pregnancy

Although the pregnancy period has typically been viewed as a time of emotional well-being, recent data do not substantiate this optimistic view for women with prior histories of depression. This paper will review the natural history of depression in pregnancy. The potential risks to the mother and the fetus when the psychiatric illness goes untreated will be reviewed. Also to be discussed are: the potential teratogenicity of each class of psychotropic medication, the treatment dilemmas, the possible alternatives when prescribing psychotropic medications and the decision-making guidelines regarding the discontinuation of medications. The risk of major depression in the postpartum period in the overall population and the likelihood of recurrence will be reviewed, and prophylactic strategies will be covered also.
Depression ; Female ; Fetus ; Humans ; Lactation* ; Mothers ; Natural History ; Postpartum Period ; Pregnancy* ; Recurrence

OBJECTIVETo explore an effective method for puerperant to lactate.

METHODSOne hundred and seven cases that were about to giving a birth in our hospital were randomly divided into an observation group (52 cases) and a control group (55 cases). Based on the routine hospital care, the patients in the observation group received auricular point sticking with vaccaria seed at Endocrine (CO18), Mammary Gland, etc. after 1 hour of childbirth, which was pressed 3 times daily, for 1-2 min each time. In the control group, routine hospital care was given, which didn't include auricular point sticking. The lactation volume, starting time of lactation and serum prolactin (PRL) were observed after 5 days of treatment.

RESULTSCompared with the control group, lactation volume in the observation group was more superior (P < 0.01). Rate I of lactation volume in the observation group was 51.9% (27/52), which was obviously higher than 27.3% (15/55) in the control group (P < 0 01). The starting time of lactation in the observation group was obviously earlier than that in the control group (P < 0 05). The content of PRL was apparently improved after one or two days of childbirth (both P < 0.05), and significantly increased after 5 days (P < 0.01).

CONCLUSIONThe auricular point sticking is a better method to promote lactation for puerperant, which could be beneficial to increasing the success rate of breastfeeding.

Acupuncture, Ear ; Adult ; Female ; Humans ; Lactation ; Milk, Human ; secretion ; Postpartum Period ; physiology ; Young Adult

In this paper, the TCM typing of postpartum hypolactation is introduced and the manipulation and duration of Tuina treatment for postpartum hypolactation are summarized, and the effectiveness index used in Tuina treatment is proposed. It is held that the Tuina therapy will be widely used for treatment of the postpartum hypolactation, and the convenient and effective Tuina manipulation will promote the development of postpartum nursing and will be used in gynecology department and enlarge the therapeutic range of the Tuina therapy.
Biomedical Research ; methods ; trends ; Female ; Humans ; Lactation Disorders ; therapy ; Medicine, Chinese Traditional ; methods ; trends ; Postpartum Period

Pregnancy- and lactation associated osteoporosis is a rare condition. However, it may cause fragility fracture with severe pain. A 29-year-old woman had first delivery without any complications and she was breast-feeding her baby. In a postpartum one month, she had a severe back pain and it has gotten worse. She was diagnosed with multiple recent compression fractures in thoracic spines and treated with brace immobilization and bisphosphonate therapy. We report this rare case of pregnancy- and lactation associated osteoporosis with multiple vertebral compression fractures.
Adult ; Back Pain ; Braces ; Female ; Fractures, Compression ; Humans ; Immobilization ; Lactation ; Osteoporosis ; Postpartum Period ; Pregnancy ; Spine