Can Genetic Analysis of Breast Milk Help Identify Ways to Improve a Newborn’s Diet?

PRESS RELEASE FROM BREASTFEEDING MEDICINE Contact: Vicki Cohn Mary Ann Liebert, Inc., publishers (914) 740-2100, ext. 2156 vcohn@liebertpub.com ShareThis

Can Genetic Analysis of Breast Milk Help Identify Ways to Improve a Newborn’s Diet? New Rochelle, NY, June 4, 2013—The composition of breast milk varies from mother to mother, and genetic factors may affect the levels of protective components in breast milk that could influence a newborn’s outcomes. The potential to perform genomic studies on breast milk samples is explored in a Review article in Breastfeeding Medicine, the Official Journal of the Academy of Breastfeeding Medicine, published by Mary Ann Liebert, Inc., publishers. The article is available free on the Breastfeeding Medicine website. Kelley Baumgartel and Yvette Conley, University of Pittsburgh, PA, reviewed the scientific literature to determine whether breast milk is an appropriate source for genetic material—DNA and RNA—to perform gene expression and epigenetic studies. In the article “The Utility of Breast Milk for Genetic or Genomic Studies: A Systematic Review,” the authors describe the potential value of the genetic information obtained from breast milk, which can be collected easily and noninvasively. It could lead to a better understanding of the variability in breast milk and to strategies for optimizing the neonatal diet through fortification of donor breast milk, supplementation of the mother’s diet, or maternal lifestyle changes that would affect breast milk composition. “The great majority of mothers produces milk that matches the needs of her infant amazingly well,” says Associate Editor David S. Newburg, PhD, Professor, Department of Biology, Boston College, Chestnut Hill, MA. “But for those few infants with exceptional needs, such as premature infants, or for mothers with uncommon mutations whose milk lacks the full complement of beneficial components, genetic and genomic analysis would both identify the mismatch and provide the information to produce a personalized complementary fortifier or supplement.” About the Journal Breastfeeding Medicine, the Official Journal of the Academy of Breastfeeding Medicine, is an authoritative, peer-reviewed journal published bimonthly in print and online. In 2014 the Journal will be publishing 10 issues per year. The Journal publishes original scientific papers, reviews, and case studies on a broad spectrum of topics in lactation medicine. It presents evidence-based research advances and explores the immediate and long-term outcomes of breastfeeding, including the epidemiologic, physiologic, and psychological benefits of breastfeeding. Tables of content and a sample issue may be viewed on the Breastfeeding Medicine website. About the Publisher Mary Ann Liebert, Inc., publishers is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Journal of Women’s Health, Childhood Obesity, and Pediatric Allergy, Immunology, and Pulmonology. Its biotechnology trade magazine, Genetic Engineering & Biotechnology News (GEN) was the first in its field and is today the industry’s most widely read publication worldwide. A complete list of the firm’s 70 journals, books, and newsmagazines is available on the Mary Ann Liebert, Inc., publishers website.

The President’s Corner

It Takes a Village and Beyond to Support Breastfeeding

To cite this article:
Arthur I. Eidelman. Breastfeeding Medicine. April 2013, 8(2): 243-244. doi:10.1089/bfm.2013.9993.

Published in Volume: 8 Issue 2: April 10, 2013

Arthur I. Eidelman

—Arthur I. Eidelman, MD, FABM, FAAP

President, Academy of Breastfeeding Medicine

If there is anything that is a measure of the Academy of Breastfeeding Medicine’s (ABM’s) relevance and importance, it is its series of Clinical Protocols in general and the publication in this issue of Breastfeeding Medicine of its latest protocol,¹ entitled “Breastfeeding-Friendly Physician’s Office,” in particular. To remind those who have forgotten and to inform those not in the know, these protocols have been formally accepted for distribution by the National Guideline Clearinghouse (www.guideline.gov) of the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services under its mandate to provide a “public resource for evidence based clinical practice guidelines.” No less a testimony to the quality of these protocols and their acceptance as a standard has been the pronouncement in the most recent Policy Statement on “Breastfeeding and the Use of Human Milk”² by the Section of Breastfeeding of the American Academy of Pediatrics that “evidence-based protocols from organizations such as the Academy of Breastfeeding Medicine provide detailed clinical guidance for management of specific issues,” and thus there is no need for the American Academy of Pediatrics to duplicate clinical management protocols.

So what is so special regarding the latest ABM protocol, which on the surface seems to discuss a relatively mundane issue of creating a practice environment that is supportive of breastfeeding, but does not address a clinical issue that might help the physician in the management of a specific maternal–infant dyad? From my perspective it is just this focus that makes this a most important and, I would venture to say, almost revolutionary document.

For one, it acknowledges that from a public health point of view the major problem in our breastfeeding programs is not the breastfeeding initiation rate but rather the precipitous drop in the breastfeeding rates after discharge from the hospital, the all too short duration of any breastfeeding, let alone the rate of exclusively feeding human milk. (As a reminder, in the United States the averaged initiation rates are over 75%, whereas the “any” breastfeeding rate at 6 months is 44%, and the rate for exclusivity of breastfeeding is 33% at 3 months and only 14% at 6 months, with even lower rates for minority mothers, particularly those of color.)

The “success” of the initiation rates reflects hospital-based public health policies that are best exemplified by the incorporation of the World Health Organization/UNICEF 10 Steps into hospital routines, the Baby-Friendly Initiative, and the decision of the Joint Commission to include the exclusive breastfeeding rate as a Perinatal Core Measure in their assessment of hospital performance and quality. As such, it has become increasingly clear that it is just such successful public health population-based, system-oriented approaches that need to be formulated and standardized for the post-hospital period if we wish to extend the success on initiation beyond the immediate postpartum period into the critical months of early infancy and beyond.

Thus, the evidence-based recommendations that are detailed in this latest ABM protocol are not just welcome but are a major conceptual contribution that will, it is hoped, facilitate the refocusing our efforts and the direction for the investment of resources that will result in maximum public health benefit. As I have mentioned previously, we need to go beyond the management of the individual maternal–infant dyad and create supportive, culturally sensitive, total environments for the support of breastfeeding. That this environment must be “total” and not just a reflection of the individual caretaker’s knowledge or skills is emphasized by the detailed outline in the Protocol of what is necessary to truly become a Breastfeeding-Friendly office.

Most important is the need for the office environment to implement the World Health Organization’s International Code for Marketing of Breast-milk Substitutes regarding use of noncommercial educational material and limiting the visibility of human milk substitutes so as to demonstrate breastfeeding support. In addition, the entire medical, nursing, technical, and administrative staff of the office need be properly trained in their appropriate roles so as to provide a uniform supportive environment. Furthermore, the physician and his or her team must link with other community-based programs while serving as a public advocate for breastfeeding. To paraphrase the well-used dictum “it takes a village to raise a child,”³ and, no less so, it has become increasingly clear that it takes more than the individual health practitioner working in a vacuum to succeed in increasing our breastfeeding rates.

No less important is the fact that this protocol truly reflects the international mission of the ABM. Not only do the recommendations avoid the trap of being too United States–centric, on the contrary, they reflect the reality of the varied healthcare systems and practices that exist worldwide, be it in the length of the postpartum stay in the hospital, the roles of the non-physician provider, patterns of financial compensation and insurance payments for breastfeeding support services, role of family physician versus pediatrician, etc. One need just peruse the reference list to note that this document¹ will truly serve the international audience of ABM.

Thus, the ABM Protocol Committee should be thanked and congratulated for producing this vitally needed document and refocusing our energies for the greater good.

References

1. Grawey AE, Marinelli KA, Holmes AV, Academy of Breastfeeding Medicine. ABM clinical protocol #14: Breastfeeding-friendly physician’s office: Optimizing care for infants and children, revised 2013. Breastfeed Med 2013;8:237–242.

2. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012;129:e827–e841.

3. Lawrence RA. Breastfeeding: It takes a village. Breastfeed Med 2013;8:1–2.