Breastfeeding

BF: Dietary Factors, Breast Milk and Infant Outcomes (2008)

Effect of Dietary Factors on Breast Milk and Infant Health Outcomes

• Intervention
  In pregnant or breastfeeding women, what are the effects of maternal diet or dietary supplements of omega-3 fatty acids on the breast milk composition and infant health outcomes?

  • Conclusion

    Consistent results from RCTs have shown that omega-3 fatty acid supplementation (fish oil, cod liver oil or DHA-rich oil) to pregnant women or breastfeeding mothers can increase omega-3 fatty acid levels in both breast milk and infants' plasma phospholipids. There is a dose-response relationship between doses of DHA supplementation and breast milk DHA levels, but the saturation dose remains unclear. Currently there is no study directly examining the dose-response relationship for other types of omega-3 fatty acid supplementation.

    There are positive changes in breast milk omega-3 fatty acid compositions; however, the long-term effects on infant health outcomes are not always clear.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What are the effects of maternal diet or dietary supplements of omega-3 fatty acids on the breast milk composition and infant health outcomes?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Dunstan JA, Roper J, Mitoulas L, Hartmann PE, Simmer K and Prescott Sl. The effect of supplementation with fish oil during pregnancy on breast milk immunoglobulin A, soluble CD14, cytokine levels and fatty acid composition. Clin Exp Allergy 2004; 34:1,237-1,242.  
      • Dunstan JA, Mitoulas LR, Dixon G, Doherty DA, Hartmann PE, Simmer K, Prescott SL. The effects of fish oil supplementation in pregnancy of breast milk fatty acid composition over the course of lactation: A randomized controlled trial. Pediatric Research 20007; 62 (6): 689-694.
      • Gibson, RA , Neumann, MA, and Makrides, M. Effect of increasing breast milk docosahexaenoic acid (DHA) on plasma and erythrocyte phospholipid fatty acids and neural indices of exclusively breast fed infants. European Journal of Clinical Nutrition 1997; 51: 578-584.
      • Helland IB, Saugstad OD, Smith L, Saarem K, Solvoll K, Ganes T, Drevon CA.  Similar effects on infants of n-3 and n-6 fatty acids supplementation to pregnant and lactating women. Pediatrics 2001; 108: e82. 
      • Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very-long chain n-3 fatty acids during pregnancy and lactation augments children's IQ at four years of age. Pediatrics 2003; 111: e39-44. 
      • Helland IB, Saugstad OD, Saarem K, Van Houwelingen AC, Nylander G, Drevon CA. Supplementation of n-3 fatty acids during pregnancy and lactation reduces maternal plasma lipid levels and provides DHA to the infants. J of Maternal-Fetal and Neonatal Medicine. July 2006; 19 (7): 397-406.
      • Jensen CJ, Voight RG, Prager  TC, Zou YL, Fraley JK, Rozelle JC, Turich MR, Llorente AM, Anderson RE, Heird WC. Effects of maternal docosahexaunoic acid intake on visual function and neurodevelopment in breast-fed term infants. Am J Clin Nutr. 2005; 82: 125-132.
      • Jensen CL, Maude M, Anderson EA, Heird WC. Effect of docosahexaenoic acid supplementation of lactating women on the fatty acid composition of breast milk lipids and maternal and infant plasma phospholipids. Am J Clin Nutr. 2000; 71 (suppl); 292S-299S.
      • Lauritzen L, Hope C, Straarup EM, Michaelsen KF. Maternal fish oil supplementation in lactation and growth during the first 2.5 years of life. 2005; Pediatr Res. 58 (2): 235-242.
      • Lauritzen L, Jørgensen MH, Mikkelsen TB, Skovgaard M, Straarup EM, Olsen SF, Høy CE, Michaelsen KF. Maternal fish oil supplementation in lactation: effect on visual acuity and n−3 fatty acid content of infant erythrocytes. Lipids. 2004; 39 (3): 195-206.
      • Makrides M, Neumann MA, Gibson RA. Effect of maternal docosahexaenoic acid (DHA) supplementation on breast milk composition. European Journal of Clinical Nutr. 1996; 50: 352-357.
      • Smit EN, Koopmann M, Boersma ER, Musklet FAJ. Effect of supplementation of arachidonic acid (AA) or a combination of AA plus docosahexaenic acid on breastmilk fatty acid composition. Prostaglandins, Leukotrienes and Essential Fatty Acids 2000; 62 (6): 335-340.
  • Evidence Summary: What are the effects of maternal dietary supplements of omega-3 fatty acids on visual and cognitive development of their children? A Systematic Review
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Eilander A, Hundscheid DC, Osendarp SJ, Transler C, Zock PL. Effects of n-3 long chain polyunsaturated fatty acid supplementation on visual and cognitive development throughout childhood: A review of human studies. Prostaglandins, Leukotrienes and Essential Fatty Acids 2007; 76: 189-203.
  • Search Plan and Results: BF: EPA and DHA 2008
     
  Which dietary factors would affect breast milk production (or breast milk supply, established lactation) in healthy adult lactating women?

  • Conclusion

    Current available evidence shows no significant effects or relationships between any of the following dietary factors and breast milk production in healthy adult lactating women (mean±SD BMI ranged from 21.4±0.9 to 25.2±4.2): short periods (less than 10 weeks) of reduced calorie intake (25% to 35% energy deficit), increased or decreased fluid intake (±25% to 50%), increased protein intake (1.5grams per kg per day), three types of nutrition supplement (i.e., Coleus amboinicus soup, fenugreek seeds capsules; sugar-coated Moloco+B₁₂ tablets) and calcium intake.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Which dietary factors would affect breast milk production (or breast milk supply, established lactation)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Barbosa L, Butte NF, Villalpando S, Wong WW, Smith EO. Maternal energy balance and lactation performance of Mesoamerindians as a function of body mass index.  Am J Clin Nutr. 1997; 66: 575-583. 
      •  Damanik R, Wahlqvist M, Wattanapenpaiboon N. Lactagogue Effects of Torbangun, a Bataknese Traditional Cuisine. Asia Pacific Journal of Clinical Nutrition. 2006; 15(2): 267-274.
      • Dusdieker LB, Hemingway DL, Stumbo PJ.  Is milk production impaired by dieting during lactation?  AJCN. 1994; 59: 833-840.
      • Dusdieker LB, Stumbo PJ, Booth BM, Wilmoth RN. Prolonged Maternal Fluid Supplementation in Breast-Feeding. Pediatrics.1990; 86: 737-740.
      • Laskey MA, Prentice A, Hanratty LA, Jarjou LM, Dibba B, Beavan SR, Cole TJ.  Bone changes after 3 mo of lactation: influence of calcium intake, breast-milk output, and vitamin-D receptor genotype.  Am J Clin Nutr. 1998; 67: 685-692. 
      • McCrory MA, Nommsen-Rivers LA, Mole PA, Lonnerdal B, Dewey KG.  Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. American Journal of Clinical Nutrition 1999; 69: 959-967. 
      • Morse JM, Ewing G, Gamble D, Donahue P.  The effect of maternal fluid intake on breast milk supply:  a pilot study.  Canadian Journal of Public Health. 1992 May-Jun; 83(3): 213-216. 
      • Motil KJ, Montandon CM, Hachey DL, Boutton TW, Klein PD, Garza C.  Relationships among lactation performance, maternal diet, and body protein metabolism in humans. Eur J Clin Nutr. 1989; 43: 681-691. 
      • Motil KJ, Thotathuchery M, Bahar A, Montandon CM.  Marginal dietary protein restriction reduced nonprotein nitrogen, but not protein nitrogen, components of human milk. J Am Coll Nutr. 1995; 14 (2): 184-191. 
      • Okamura T, Takeuchi T, Nishi O, Yaginuma T, Kawana T.  Effects of low-caloric diet in puerperium on prolactin, TSH, estradiol and milk secretion.  Acta Obst Gynaec Jpn. 1987; 39(11): 2059-2055. 
      • Strode MA, Dewey KG, Lonnerdal B. Effects of short-term caloric restriction on lactational performance of well-nourished women. Acta Paediatr Scand. 1986; 75: 222-229.
  • Search Plan and Results: Dietary factors and milk supply 2008