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Colostrum Part 3: Remember the Gaps
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Colostrum Part 3: Remember the Gaps

May 9, 2022

Barbara L. Philipp, MD
May 9
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Hi everyone. To our new folks, I hope you are getting the hang of how the Lactation College works. I post topics for the Lactation College on Substack (Basic Option - free) on Mondays, Wednesdays and Fridays. If you subscribe (which means providing your email) - then - every post will go to your email box. On Thursdays I post interesting research articles. We call this the Advanced Option. There is a fee for the Research Thursday articles. I don’t have a funder anymore so this is a way to keep the free option going.

This is the third post on Colostrum. The next one (on May 11) will be a Test Your Knowledge post where I will post questions like you might see on the IBCLC certification exam on the topic we just discussed. The answers will be at the bottom of the post. Thus, the goal is that by May 11 you will have a depth of knowledge into Colostrum and why it is, truly, liquid gold.

Colostrum Part 3: Remember the Gaps

My family had a wonderful trip to London years ago and, to this day, I still remember hearing the phrase - Mind the Gap - when we went to the London Underground. This was a warning to be careful about the gaps between the platform and the Tube (the subway train).

For this class we’ll stay in that spirit with - Remember the Gaps.

During pregnancy and during the early days after birth, gaps exist between the lactocytes, the cells lining the alveolar sacs in the breasts. These loose junctions allow fluid and other solutes to flow more easily between the milk space and the other parts of the mammary gland (for example: capillaries and interstitial tissue).

These gaps play a major role in making colostrum the special fluid that it is. The gaps tightening up contributes to the process of transitioning from colostrum to more mature milk.

Here is the sequence of events.

  • The placenta produces the hormone, progesterone. Progesterone blocks the action of another hormone, prolactin, on the lactocyte.

  • Following birth, the delivery of the placenta leads to a rapid drop in progesterone. Prolactin levels, however, remain high.

  • Prolactin receptors in the lactocytes are then unopposed and, under the influence of prolactin, components in the lactocytes get to work making a variety of products including lactose.

  • Along with the withdrawal of progesterone, the influence of glucocorticoids also causes the intercellular gaps to tighten up.

  • Lactose made in the lactocyte is secreted into the milk compartment. The increased concentration of lactose draws water into the milk. The mother feels a sense of fullness in her breasts.

From Breastfeeding and Human Lactation (Reference 1), “The time at which mothers report that their milk comes in is highly variable and ranges from 38-98 hours after birth, with an average of 50-59 hours.”

The process described above is under endocrine control (hormonal control) compared to milk production later on that is under autocrine control (local control). More on that later.

Now it should be clear why retained placental fragments can lead to insufficient milk production. Those placental fragments continue to produce progesterone which blocks the action of prolactin on the lactocytes.

And this should help us remember that the concentration of lactose in colostrum is lower than in more mature milk.

When in London, Mind the Gap.

On the test, Remember the Gaps.

References

1. Wambach K and Spencer B. Breastfeeding and Human Lactation, 6th edition. Jones & Bartlett Learning. 2021

2. Hale & Hartmann’s Textbook of Human Lactation, 1st Edition. Edited by Thomas W. Hale and Peter E. Hartmann. Springer Publishing Company. 2017

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Calostro 3: Recuerda las brechas
Mi familia tuvo un viaje maravilloso a Londres hace años y hasta el día de hoy todavía recuerdo haber escuchado la frase - Mind the Gap - cuando fuimos al metro de Londres. Esta fue una advertencia para tener cuidado con los espacios entre la plataforma y el metro (el tren subterráneo).
Para esta clase nos mantendremos en ese espíritu con - Remember the Gaps.
Durante el embarazo y durante los primeros días después del nacimiento, existen espacios entre los lactocitos, las células que recubren los sacos alveolares de las mamas. Estas uniones sueltas permiten que el líquido y otros solutos fluyan más fácilmente entre el espacio lácteo y las otras partes de la glándula mamaria (por ejemplo: capilares y tejido intersticial).
Estas brechas juegan un papel importante en hacer que el calostro sea el fluido especial que es. El endurecimiento de las brechas contribuye al proceso de transición del calostro a una leche más madura. 
Aquí está la secuencia de eventos.
La placenta produce la hormona progesterona. La progesterona bloquea la acción de otra hormona, la prolactina, sobre el lactocito. Después del nacimiento, el parto de la placenta conduce a una rápida caída de la progesterona. Los niveles de prolactina, sin embargo, siguen siendo altos. Los receptores de prolactina en los lactocitos no tienen oposición y, bajo la influencia de la prolactina, los componentes de los lactocitos se ponen a trabajar para producir una variedad de productos, incluida la lactosa. Junto con la abstinencia de progesterona, la influencia de los glucocorticoides también hace que las brechas intercelulares se estrechen. La lactosa producida en el lactocito se secreta en el compartimento de la leche. La mayor concentración de lactosa atrae agua a la leche. La madre siente una sensación de plenitud en sus senos.

De Lactancia materna y la lactancia humana, "El momento en el que las madres informan que sale su leche es muy variable y varía entre 38 y 98 horas después del nacimiento, con un promedio de 50 a 59 horas".

El proceso descrito anteriormente está bajo control endocrino (control hormonal) en comparación con la producción de leche posterior que está bajo control autocrino (control local). Más sobre eso más tarde.

Ahora debería quedar claro por qué los fragmentos de placenta retenidos pueden conducir a una producción de leche insuficiente. Esos fragmentos de placenta continúan produciendo progesterona que bloquea la acción de la prolactina sobre los lactocitos.

Y esto debería ayudarnos a recordar que la concentración de lactosa en el calostro es menor que en la leche más madura.

Cuando estés en Londres, Mind the Gap.

En la prueba, recuerda las brechas.

Referencias

1. Wambach K y Spencer B. Lactancia materna y la lactancia humana, 6ª edición. Jones y Bartlett Learning. 2021

2. Libro de texto de lactancia humana de Hale & Hartmann, 1ª edición. Editado por Thomas W. Hale y Peter E. Hartmann. Springer Publishing Company. 2017

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Юлія Голубовська
May 9

I am very grateful and truly impressed, Barbara. I just read this post (it is the first one for me from The Lactation College). It was amazing....everything is nicely done (easy for understanding, professional, short). I am Ukrainian, English is not my native language, alhtough I was able to understand all material. Thank you so very much for your precious work.

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