For a long time, it was believed that problems with lactation arose mainly due to incorrect feeding technique or insufficient breast stimulation. But new research shows: in 10-20% of women, a lack of breast milk may be associated with biological characteristics of the body that mothers can barely influence.
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Statistics show that about a quarter of mothers in developed countries stop breastfeeding shortly after starting, and the main reason is an acute lack of milk. While earlier medicine claimed that real physiological insufficiency occurred in only 5% of cases, modern studies in the USA and Australia show significantly more alarming figures: from 10% to 20%.
At the same time, many women, even following all recommendations, face the fact that their baby is not gaining weight well – this is the main sign of insufficient nutrition.
The key role of lactocytes
The key to understanding this problem, as The Economist writes, lies in the microscopic cells of the mammary glands – lactocytes, which actively multiply during pregnancy, and after childbirth begin to produce milk.
Previously, their study required complex and painful tissue biopsies, but a scientific breakthrough in 2010 allowed researchers to use breast milk itself as a "liquid biopsy."
It turned out that milk contains microRNA molecules that store all information about the mother's cell function. It was through these studies that scientists began to understand why the lactation mechanism fails in some women even before the baby is born.
In some women, there are simply too few lactocytes. In others, the cells are present but work inefficiently and produce little milk. Problems can arise even during pregnancy. Some lactocytes multiply, forming new cells, while others accumulate copies of their DNA to increase milk production. But these cells can be damaged by random mutations.
A complex genetic mechanism and enzymes, such as WEE1, are responsible for the milk production process. In studies on mice, scientists found that in the absence of this enzyme, the cell repair system works worse. As a result, the number of functional lactocytes decreases, and along with it, milk production falls. Perhaps a similar mechanism exists in humans.
Other researchers are studying the role of the placenta. It produces many hormones that prepare the breasts for lactation. Scientists are investigating whether damage to the placenta – for example, through infections – can affect future milk production. If the connection is confirmed, doctors will be able to predict the risk of lactation problems even during childbirth.
Other causes
But even with a sufficient number of cells, they may not work efficiently. Lactation is a very energy-intensive process that requires a continuous supply of nutrients.
Researchers have found that genetic mutations that prevent the transportation of zinc or other minerals from the blood to breast tissues can paralyze the function of lactocytes.
But genetics is not the main explanation. Scientists believe that chronic inflammation may play a more significant role. It is often found in obesity, diabetes, and autoimmune diseases.
In 2022, researchers discovered that in chronic inflammation, fatty acids are less effectively delivered to the mammary glands. In addition, inflammatory molecules can hinder the formation of carbohydrates – another important component of breast milk.
Therefore, in women with obesity, diabetes, autoimmune diseases, or preeclampsia (a placental disorder that occurs in approximately 4% of pregnant women and can damage various body systems), the risk of lactation problems may be significantly higher. According to some studies, in certain groups, such difficulties can occur in almost half of mothers.
There are other factors that have been less studied so far. For example, several studies have found a link between insufficient lactation and widely spaced breasts. Often, such women have less glandular tissue and, consequently, fewer lactocytes.
There are also suggestions that obesity in childhood can affect the development of mammary glands already in adolescence.
All these factors combine into a single picture, which shows: low lactation is more often a medical problem than a result of "incorrect behavior" by the mother.
New diagnostic methods are gradually appearing. Australian researchers have already created handheld sensors that can determine the sodium level in breast milk. An elevated level may indicate impaired lactocyte function or other problems, such as mastitis.
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