Recent articles on Breastfeeding

Via Ingenta (and I should point out that there are invariably a number of
interesting-sounding articles with no summary provided)...

Strategies for preventing wheezing and asthma in small children
Allergy, August 2003, vol. 58, no. 8, pp. 742-747(6)
Wickman M.; Melén E.; Berglind N.; Lennart Nordvall S.; Almqvist C.; Kull I.;
Svartengren M.; Pershagen G.

Design: Prospective birth cohort study (BAMSE). Questionnaires on heredity
and environmental factors were answered when the child was 2 months, and
detailed questionnaires on symptoms at 1 and 2 years of age.

Participants: 4089 children, born during 1994*1996.

Setting: Child Health Centres in central and north-western parts of
Stockholm, Sweden.

Main outcome measures: Wheezing and asthma up to the age of 2.

Results: The effects of preventive guidelines regarding breastfeeding,
maternal tobacco smoke and home dampness on wheezing and asthma were assessed
in multiple logistic regression models. The cumulative incidence of recurrent
wheezing at 2 years of age was 12.6% and of asthma 6.8% among those with a
lifestyle in agreement with all guidelines and 24.1 and 17.9%, respectively,
in families exposed to at least two of the three risk factors. Among children
with no heredity, family lifestyle according to the guidelines gave a twofold
reduction of asthma (5.3 vs. 10.5%), while the group with heredity had a
threefold reduction (9.1 vs. 27.3%). The attributable fraction for asthma
associated with the guidelines was 23% in total and 33% among those with
heredity.

Conclusion: In this observational study, family lifestyle according to
preventive guidelines is associated with an important reduction of recurrent
wheezing and asthma at 2 years of age, especially among children with allergic
heredity. A follow-up will determine whether there still a risk reduction of
both symptoms and disease.



Pseudoephedrine: effects on milk production in women and estimation of infant
exposure via breastmilk
British Journal of Clinical Pharmacology, July 2003, vol. 56, no. 1, pp.
18-24(7)
Aljazaf K.; Hale T.W.; Ilett K.F.; Hartmann P.E.; Mitoulas L.R.; Kristensen
J.H.; Hackett L.P.

(Yes, THAT Hale. The rest are Western Australian.)

Aims: To assess the effects of pseudoephedrine on breast blood flow,
temperature and milk production, and to estimate the likely infant dose during
breastfeeding.

Methods: Eight lactating women (mean age 35 years and weight 69 kg)
participated in a single-blind randomized crossover study of 60 mg
pseudoephedrine hydrochloride vs placebo. Breast blood flow and surface
temperature were measured from 0 to 4 h following the dose, and change in
plasma prolactin was measured as the difference between predose and 1 h
postdose concentrations. Milk production was measured for 24 h following
placebo and pseudoephedrine. Infant dose of pseudoephedrine for a 60-mg dose
administered four times daily to the mother was quantified as the product of
average steady-state drug concentration in milk and an estimated milk
production rate of 0.15 l kg-1 day-1 and expressed relative to the maternal
weight-adjusted dose.

Results: There were no physiologically significant changes in breast blood
flow or temperature between the placebo and pseudoephedrine periods. The mean
change in plasma prolactin was slightly (13.5%), but not significantly lower
(t = 1.245, P = 0.253) after pseudoephedrine (1775 mU l-1) compared with
placebo (2014 mU l-1). However, the mean milk volume was reduced by 24% from
784 ml day-1 in the placebo period to 623 ml day-1 in the pseudoephedrine
period (difference between means 161 ml day-1 (95% CI: 63, 259 ml day-1); t =
3.9, P = 0.006). Assuming maternal intake of 60 mg pseudoephedrine
hydrochloride four times daily, the estimated infant dose of pseudoephedrine
was 4.3% (95% CI, 3.2, 5.4%) of the weight-adjusted maternal dose.

Conclusions: A single dose of pseudoephedrine significantly reduced milk
production. This effect was not attributable to changes in blood flow, but
depression of prolactin secretion may be a contributing factor. At the maximum
recommended pseudoephedrine doses, the calculated infant dose delivered via
milk was 10% of the maternal dose, and is unlikely to affect the infant
adversely. The ability of pseudoephedrine to suppress lactation suggests a
novel use for the drug.

--
Chookie -- Sydney, Australia
(Replace "foulspambegone" with "optushome" to reply)

"...children should continue to be breastfed... for up to two years of age
or beyond." -- Innocenti Declaration, Florence, 1 August 1990