EFFECT OF MATERNAL DIETARY SUPPLEMENTATION ON LACTATIONAL AMENORRHEA AND NUTRITIONAL STATUS OF THEIR INFANTS

Abstract

Effects of maternal nutritional status and maternal dietary supplementation, on the growth of suckling infants, breast-feeding patterns. Prolactin concentration, return of menstruation and ovulation were studied in 162 marginally malnourished mother- infant pairs. Subjects were randomised into two study groups. One group of 8 mothers received 40g Australian high protein, high-energy biscuits and served as supplemented subjects. The second group of 79 mothers did not receive any nutritional supplement and served as controls. The subjects were followed up monthly until their second menstruation. Anthropometric measurements, information on breast feeding patterns and infant's breast milk intake were recorded at each visit. In addition, blood samples (5mls) were obtained at least one and a half hours before a breast feeding episode and thirty minutes after the commencement of a breast feeding episode for prolactin estimation. Aliquots of the blood sample were used for haemoglobin and albumin estimations. The subjects were visited at home at least three times week to collect early morning urine samples for pregnandiol-3-alpha glucuronide and estrone-3-glucuronide determinations and to ensure compliance with dietary supplements. There were no significant differences in the frequency of daytime and night time breast feeding, and mean duration of breast feeding episodes in the two groups of mothers through-out the follow up period (P>0.05). A similar growth pattern was recorded for infants of the two groups of mothers. Significant differences were observed in some anthropometric measurements between the two groups of mothers, within six months or commencement of supplementation. Body mass index increased from 20.2 to 21 at the end of the sixth month in the supplemented subjects and it was reduced from 20.5 to 20.2 in the control subjects. The increase in Body mass index of the supplemented mothers was not significant (p>0.05). There was no significant difference between milk output and daily energy expenditure of both groups. The overall prevalence of breast-feeding was high (98-69%) in the first 4 months of life but it reduced to less than 50% by the 7 month. Most of the mothers gave -water to their babies in addition to breast milk. None of the infants was wet nursed or showed preference for the left breast. Only 2% of infants of the supplemented mothers and 3% of infants of the control mothers showed preference for the right breast. There were no significant differences between the basal and suckling-induced Prolactin concentrations in the two groups of mothers studied, thus showing a supplementation of the mothers' dirt had no effect on the concentration of the blood Prolactin levels. There was no significant difference between the duration of lactational amenorrhoea of the two groups of mothers. Prolactin concentration and suckling induced Prolactin concentrations declined in parallel to suckling activity with time postpartum. The return of fertility (ovarian cyclic activity) postpartum was monitored by the onset of follicular development and ovulation in the first and second menstruation in the two group of mothers. The urinary concentration of pregnanediol-3. alpha glucuronide and Estrone-3- glucuconide was used to determine the level of ovarian cyclic activity. The result showed that even when menstruation has occurred, there were still a lot of irregularities in the follicular development and ovulation of the lactating women. The results of this study indicate that dietary supplementation of the marginally malnourished mother did not affect the growth of the infants, breast-feeding patterns and the duration of lactational amenorrhoea of the mothers.