Lactation Complicated by Overweight and Obesity: Supporting the Mother and Newborn

Cecilia Jevitt, CNM, PhD; Ivonne Hernandez, MS, RN, IBLC; Maureen Groër, RN, PhD

Disclosures

J Midwifery Womens Health. 2007;52(6):606-613. 

In This Article

Abstract and Introduction

Abstract

Research shows that mothers who are obese (with a BMI > 30) are less likely to initiate lactation, have delayed lactogenesis II, and are prone to early cessation of breastfeeding. Black women, with the highest rates of American obesity, have the lowest rates and shortest duration of breastfeeding compared to Hispanic and white women. Women who are overweight and obese have lowered prolactin responses to suckling. Women who are obese are at risk for prolonged labors, excessive labor stress, and cesarean birth, all of which delay lactogenesis II. Lactation has a small but significant role in preventing future obesity in the mother and child. Midwifery management of obesity-related lactation problems begins with education about optimal prenatal weight gain and regular weight assessment to avoid excessive gain. Support of physiologic birth processes to avoid stress, prolonged labor, and surgical birth and limit maternal-newborn separation enhances the onset of lactogenesis II. Massage or pumping may soften and extend the obese nipple for easier latch. Infants of lactating women with prior bariatric surgery are at risk for B12 deficiency and require regular nutrition and growth assessment. Five hundred calorie per day restriction paired with aerobic exercise for intentional postpartum weight loss does not affect milk quality or infant growth.

Introduction

Obesity related perinatal morbidity does not end with birth but continues to affect the maternal-infant dyad. Mothers who are obese are less likely to initiate lactation, have delayed lactogenesis II, and are prone to early cessation of breastfeeding. Obesity rates are highest among black women (49.6%), who have the lowest rate of breastfeeding initiation (45.3%) and breastfeeding continuation to 3 months (33.7%). White women and Mexican Hispanic women have lower rates of obesity (31% and 38.9%, respectively), have higher rates of breastfeeding initiation (68.7% and 76%), and are more likely to be breastfeeding at 3 months postpartum (48.7% and 54.3%).[1] However, a survey of lactation counseling practices for mothers who are obese showed that only 29% of 80 clinicians believed that women who are obese were less successful with breastfeeding than mothers who are normal weight.[2] In a second survey of 31 lactation consultants, 23% asked for a definition of obesity.[2]

This article reviews the prevalence of lactation problems related to overweight and obesity (as defined in a 1990 Institute of Medicine [IOM] report on nutrition in pregnancy)[3] and excess prenatal weight gain. Current understandings of obesity related hormones and their effect on lactation, and the relationship of lactation to future maternal and infant obesity are also discussed. Finally, this article describes evidence-based techniques for clinicians to reduce the lactational impact of overweight, obesity, and excessive weight gain during the prenatal and intrapartum periods, as well as methods for supporting lactation in women who are obese.

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