Correlation between Maternal Nutrition and breastmilk volume

Dear Noella, although malnutrition may affect the quality of milk, studies show that the amount of breast milk produced depends mainly on how often and how effectively the baby sucks on the breast. If a mother temporarily produces less milk than the infant needs, the infant responds by suckling more vigorously, more frequently, or longer at each feeding. This stimulates greater milk production.

Also, two randomized intervention trials, in Burma and Guatemala, have so far been conducted to answer this question. In both studies, food supplementation of malnourished lactating mothers resulted in a small increase in infant milk intake. In another study in Indonesia, maternal supplementation during pregnancy improved infant growth rates, possibly by increasing breast milk production. Therefore, although maternal malnutrition is not considered an important constraint to breastfeeding for most mothers, giving additional food to malnourished mothers during pregnancy and/or lactation may help increase milk production and will certainly improve their own nutritional status and provide additional energy to care for themselves and their families

In conclusion, if any, the correlation between maternal nutrition and BM production is not significant.The studies above were highly critiqued and considered flawed in methodology. However, there is need to refer to more current studies since the above were conducted over 5 years ago.

Dear Samuel,

Your response to Noella's question is very useful and highly relevant.

Could you kindly give the reference of the studies in Burma and Guatemala you refer to ? Were they published ? I could find them on Medline.

I assume the study in Indonesia you refer to is this one :

van Steenbergen WM, Kusin JA, Kardjati S, de With C. Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on breast-milk output. Am J Clin Nutr. 1989 Aug;50(2):274-9.

Breast-milk output was measured in women who during the last trimester of pregnancy consumed a high- or low-energy supplement (53 and 55 women, respectively). Infant and mother pairs were enrolled at 2 or 6 wk postpartum. Test weighings were done four times at 8-wk intervals. Mean breast-milk output ranged from 682 to 744 g/d in the age period of 2 wk to 7 mo. There was no difference in milk output between the two experimental groups. In all cohorts, breast-feeding frequency influenced milk output positively. Only at age 18-22 wk did the mothers' prepregnancy or 4-wk postpartum body mass index play an additional role. The results confirm that breast-milk output of mildly undernourished women is comparable with that of well-nourished women. Short-term energy supplementation during pregnancy did not increase breast-milk output, probably because the sample studied was not at nutritional risk.

Full article available at: http://www.ajcn.org/cgi/reprint/50/2/274

This study by the way did not find any difference in breast milk output and supplementation during last trimester of pregnancy.

Another relevant study is this one from the Gambia published in different papers:

Prentice AM, Roberts SB, Prentice A, Paul AA, Watkinson M, Watkinson AA, Whitehead RG. Dietary supplementation of lactating Gambian women. I. Effect on breast-milk volume and quality. Hum Nutr Clin Nutr. 1983 Jan;37(1):53-64.

In order to test whether lactational capacity can be improved by dietary interventions, a nutritionally balanced supplement was provided under carefully controlled conditions to 130 nursing mothers in Keneba, The Gambia over 12 months. Maternal mean energy intake (+/- s.e.) increased from 1568 +/- 15 kcal/d (6.56 +/- 0.06 MJ/d) to 2291 +/- 14 kcal/d (9.59 +/- 0.06 MJ/d). Protein intake was in excess of the WHO/FAO recommended intake after supplementation and serious deficits of riboflavin, vitamin A, vitamin C and calcium were rectified. The supplement had no effect on breast-milk volume, compared with retrospective controls, at any stage of lactation or in any season of the year. There was no selective effect on women with poor milk outputs. The average milk protein concentration was slightly improved over the entire period of lactation (+ 6.6 per cent, P less than 0.01), but the total energy content was unchanged since an increase in breast-milk fat concentration (+ 7.9 per cent, n.s.) was offset by a decrease in the milk lactose concentration (- 7.6 per cent, P less than 0.01). Breast milk vitamin content was improved for those vitamins for which the supplement provided a significant proportion of the recommended dietary intake.

Prentice AM, Whitehead RG, Roberts SB, Paul AA, Watkinson M, Prentice A, Watkinson AA. Dietary supplementation of Gambian nursing mothers and lactational performance.
Lancet. 1980 Oct 25;2(8200):886-8.

A dietary supplement, resulting in a mean net increase in energy intake of over 700 kcal/day, was supplied to all nursing mothers in a West African village for 12 months. The supplement produced a slight initial improvement in maternal body weight and subcutaneous fat stores but did not increase breast-milk output or fat content.

So to answer Noella's question, there is no solid evidence so far that maternal supplementation does increase breast milk volume. Breast milk production indeed seems related mainly to the child's demand. Maternal supplementation during lactation may have other benefits however, including mother's well being in food insecure situations.

As far as I am aware, no such correlation has been found. It is thought that maternal metabolism changes during lactation to ensure that sufficient macro and micro nutrients are available to both the infant and the child. Most 'low supply' is actually insufficient intake caused by infrequent feeding (perhaps because mother is separated from her child for a period of the day pursuing income generating activities; perhaps due to inappropriate supplementation) or poor milk transfer (perhaps due to illness or oral anomaly such as tongue tie in the child; perhaps due to poor positioning at the breast).
That said, clinical experience suggests that providing mothers who are in food insecure situations with supplementary rations helps them to feel better - less fatigued, less cranky and more confident in their milk supply (so less likely to offer their babies breastmilk substitutes which present a very real risk of infection, even in the most affluent societies)*
Cheers
Nina
*Paricio Talayero et al PEDIATRICS 2007 & Quigley et al ARCH DIS CHILD 2009