Virtually nursing-in? Try nipple-soothing peppermint

If you plan to do some extra breastfeeding today as part of the great virtual breast fest, here's a tip from a recent study on preventing and soothing those nipple cracks that might arise.

Researchers studied whether peppermint gel, lanolin gel, or a neutral ointment were better for soothing the nipple pain and cracking that are often associated with first-time breastfeeding. They enrolled 216 women into the study and randomly gave them one of the 3 gels. They did not tell the women which gel they received, but they did tell them to use the gel daily for the first two weeks of breastfeeding. They found the peppermint gel was much more effective than either lanolin or a neutral ointment in reducing the rate of nipple and areola (the area around the nipple) cracks and pain.

Sore nipples are a common reason some women fail to continue breastfeeding in the early days of trying. However, breastfeeding is so beneficial to moms and babies that women's health researchers will take time to figure out how to keep mom comfortable while she and her infant learn to feed.

Now if we could only figure out how to keep the general public feeling comfortable when they see a mom breastfeeding....

Pregnancy weight gain - one size doesn't fit all

Most women know about the traditional weight gain recommendations for pregnancy: 25-35 pounds if you're normal weight (body mass index = 20-25), up to 10 pounds more if you started the pregnancy underweight (BMI <> 25). However, a new study published this week in Obstetrics & Gynecology suggests that these guidelines may be out of date, at least as far as obese women are concerned.

Investigators analyzed data from more than 120,000 obese women in Missouri to see how the weight they gained during pregnancy affected three outcomes: blood pressure, rate of cesarean sections, and the infant's birth weight. They found that 23% of obese women gained less than 15 pounds, 31% gained the recommended 15-25 pounds, and nearly 50% gained more than 25 pounds. The women who gained less weight during pregnancy had the best outcomes, including less pregnancy-induced high blood pressure and normal weight babies.

The researchers also calculated optimal ranges of weight gain during pregnancy based on pre-pregnancy BMI. Women with BMIs of 30-34.9 had the best outcomes when they gained between 10 and 25 pounds. These same women were more likely to have low birth-weight babies when they lost weight, but they had fewer other complications like high blood pressure and C-section deliveries. Women with a BMI of 35-39.9 did best when they gained less than 9 pounds. For women with a BMI of 40 or higher, losing up to 9 pounds produced the best outcomes.

As you can see, this study's findings contradict the current guidelines, which were established in 1990 when obesity wasn't so common. However the current guidelines may be no more. The Institute of Medicine plans to reevaluate its recommendations for weight gain during pregnancy to reflect more recent evidence about pregnancy and birth outcomes.

What does this mean for you? If you are obese and pregnant, or planning to become pregnant, talk to your doctor or midwife about the best weight gain - or weight loss - strategy. And remember, no matter what weight you are, it's important to eat a nutritious and well-rounded diet while pregnant and postpartum.

In your face(book): Calling all breastfeeding moms

As noted in the description of this site, my purpose is to relay research findings in a way that is more accessible to women who are not researchers themselves. However, occasionally something comes to my attention that is not research per se, but supports what research shows is a positive health behavior.

Today that something is breastfeeding - or more specifically, a breastfeeding event sponsored by the League of Maternal Justice. As I have discussed before, breastfeeding is healthy for babies AND moms for a variety of reasons. These mothers have united to support not only the act of breastfeeding, but the right to breastfeed undisturbed in a public venue, and the right to not be censored on a social media site for showing yourself breastfeeding.

So if you are (or have been) a breastfeeding mother, you can participate in this event on October 10th at 10AM. Check out the website for more details.

Maybe breastfeeding isn't better

After all my ranting about breastfeeding yesterday, I see an article in Pediatrics today that caused me pause. Apparently, women who smoke and breastfeed are lacing their milk with nicotine, and it's having a negative effect.

Researchers in Pennsylvania studied 15 mother-infant pairs to better understand how nicotine affects infants in the short-term. Moms were asked to breastfeed their babies on two separate occasions. On one occasion, the moms dressed in disposable lab coats and gloves and entered a 700 square foot stainless steel chamber to smoke without their babies present. Then they removed their protective garb, washed their hands, provided a sample of breast milk, and breastfed their babies upon demand. The babies were then placed in a crib or on a carpeted floor to sleep. On the second occasion, the moms did not smoke before breastfeeding their babies and putting them down for a nap. On both occasions, researchers monitored the babies' sleep patterns and movement.

The first relevant finding in this study was that both nicotine and cotinine (a metabolite of nicotine) were present in the mothers' breast milk. The researchers estimated the infants received 4.3 times the amount of nicotine when moms smoked before breastfeeding, compared to when they did not.

The second relevant finding is that infants who fed after their mothers' smoked slept 36.7% less than when their mothers did not smoke beforehand. Further, there was a direct and negative relationship between nicotine exposure and sleep: the more nicotine the infants were exposed to, the less they slept. This is not wholly surprising - after all, nicotine is a stimulant.

The researchers suggest that although nicotine has been removed from the list of drugs contraindicated during lactation, nursing mothers who smoke still should consider the negative effects of nicotine on their infants. Since nicotine is not stored in breast milk, they suggest these mothers time their breastfeeding and avoid nursing 30 to 60 minutes after smoking, when nicotine levels peak. They also caution there may be other chemicals transferred in breast milk that we don't know about, and these unknown compounds may have negative health consequences.

What's the moral of this story? Quit if you smoke - it's better for you and your baby. If you don't quit, at least avoid nursing when nicotine levels are highest. You'll transfer less nicotine to your baby, and you both may get more sleep. And that's something everyone in the household can benefit from.

Breastfeeding is better for babies AND moms - so why is it discouraged?

As if it weren't enough that Applebee's in Lexington pushed a mom out of their restaurant for breastfeeding her baby in a back corner booth. (So much for that Kentucky law that states breastfeeding in public is legal. Of course, why we need laws for this I'm unclear, but that's for another post).

Now the federal government has toned down its ads to promote breastfeeding. You read correctly, toned down its ads, even though media relations experts advised them against softening the ads, because they wouldn't increase breastfeeding. I mean, why would the federal government want to increase breastfeeding rates? Who cares about the study published this year by the Agency for Healthcare Research and Quality (yes, an agency of the federal government) that showed breastfeeding contributes to good infant AND maternal health? According to this AHRQ study, children who are breastfed get fewer ear and respiratory infections, GI illnesses, and skin rashes. They're also less likely to have asthma, obesity, type 1 and 2 diabetes, and childhood leukemia, and less likely to die from sudden infant death syndrome (SIDS).

As for moms - women who breastfed were less likely to have type 2 diabetes, breast cancer, and ovarian cancer. Conversely, women who stopped breastfeeding early (before 6 months) or never breastfed at all were more likely to have postpartum depression.

So why are we spending money on an ad campaign for breastfeeding that will essentially have no effect on a mother's decision to breastfeed? Talk to your neighborhood pharmaceutical company - apparently it was the infant formula/pharmaceutical lobby that got the Department of Health and Human Services to tone down its ads, because they need to keep those revenues up. And not just in infancy mind you. They want to make sure kids keep needing their prescriptions well into childhood to take care of the asthma, ear infections, and diabetes they develop.

Are we really making health policy based on an industry that does better when people are unhealthy? I say nurse-in at Applebee's today - big PHRMA tomorrow.