Letter to the Editor: World Breastfeeding Week

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Dear Editor,

Due to World Breastfeeding Week, it is planned to support and encourage breastfeeding and to protect breastfeeding women between August 1 and 7, 2015. World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organizations endeavoring to highlight the significance of breast-milk and to   make breastfeeding widespread. WABA has announced its goals for 2015. The most important two goals are to support women being able to breastfeed in workplace and to encourage governments to establish laws protecting mothers.
Since 2001, World Health Organization has been recommending exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.[1] Most of the mothers want to breastfeed for a long time for the purposes of feeding their babies, protecting them against infections and having the emotional satisfaction of breastfeeding. Turkish Population and Health Survey 2013 showed that 33.9% of 20–23-month-old babies were breastfed and the mean lactation period for all children born within three years before 2013 was 16.7 months.[2] According to the data of the same survey, 18% of the deliveries in Turkey occurred less than 24 months after the previous delivery.[2] According to these data, we should observe a considerable amount of pregnant women in the clinics who have a child below 2-year-old they are breastfeeding. It is very critical to inform mother for the continuation or discontinuation of lactation when a breastfeeding woman gets pregnant. In Turkey, women tend to discontinue lactation when they get pregnant. Atar Güler et al. found that 26 of 102 pregnant women, whose pregnancy interval (the period between previous delivery and the onset of following pregnancy) is less than 24 months, discontinued lactation due to the pregnancy.[3] At this point, gynecologists and obstetricians may support the discontinuation of lactation due to the concern that lactation during pregnancy may have risks for fetus and/or mother. However, the studies show that miscarriage[4–6] and preterm labor[4,7] risks do not increase in pregnancies during lactation. In cases where pregnancy coincides with lactation, it is unclear if continuation of lactation causes the fetal growth to slow down. When birth weights of babies delivered by women continuing lactation during pregnancy were compared with those delivered by women discontinued lactation during pregnancy, a study carried out on 505 pregnant women found no statistically significant difference[8,9] while another study carried out on 61 pregnant women found statistically significant difference.[7] No guide has been found in the literature showing the daily needs of lactating pregnant women for calories, protein, vitamin and mineral. On the other hand, it should be taken into account that energy, protein, vitamin, mineral and water needs of both pregnant and lactating women increase. Although the data in the literature indicates that lactating during pregnancy is safe, current studies cannot prove that lactation during pregnancy is either harmful or useful for mother/fetus/baby. Today, where there are many efforts to make breastfeeding widespread and to extend lactation period, it is possible that we come across mothers more frequently who prefer to continue lactation during pregnancy. Therefore, gynecologists and obstetricians should have up-to-date knowledge about the outcomes of lactation in cases where pregnancy and lactation coincide.

References

1. WHO. The optimal duration of exclusive breastfeeding, report of an expert consultation. Geneva: WHO; 2001.
2. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü. Türkiye Nüfus ve Sağlık Araştırması 2013. Ankara: Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Türkiye Cumhuriyeti Kalkınma Bakanlığı, Türkiye Cumhuriyeti Sağlık Bakanlığı; 2014.
3. Atar Güler S, Gürel H. Gebelik aralığına etki eden faktörler. Perinatoloji Dergisi 1996;4:126–8.
4. Ayrim A, Gunduz S, Akcal B, Kafali H. Breastfeeding throughout pregnancy in Turkish women. Breastfeed Med 2014;9: 157–60. [PubMed] [CrossRef] 
5. Ishii H. Does breastfeeding induce spontaneous abortion? J Obstet Gynaecol Res 2009;35:864–8. [PubMed] [CrossRef] 
6. Vitzthum VJ, Thornburg J, Spielvogel H. Seasonal modulation of reproductive effort during early pregnancy in humans. Am J Hum Biol 2009;21:548–58. [PubMed] [CrossRef] 
7. Sengul O, Sivaslioglu AA, Kokanali MK, Ustuner I, Avsar AF. The outcomes of the pregnancies of lactating women. Turk J Med Sci 2013;43:251–4.
8. Merchant K, Martorell R, Haas J. Maternal and fetal responses to the stresses of lactation concurrent with pregnancy and of short recuperative intervals. Am J Clin Nutr 1990;52:280–8. [PubMed] 
9. Merchant K, Martorell R, Haas JD. Consequences for maternal nutrition of reproductive stres across consecutive pregnancies. Am J Clin Nutr 1990;52:616–20. [PubMed]