Mohd Shukri, NHB; (2016) Mother-infant signalling during breastfeeding and infant growth: an investigation of physiological, psychological and anthropological aspects of infant feeding. Doctoral thesis , UCL (University College London).

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Abstract

Lactation is a dynamic process involving complex physiological signalling and behavioural negotiation between mother and the infant. Challenging behaviour amongst breastfed infants has been associated with higher milk cortisol, demonstrating maternal potential to shape infant behaviour by the transmission of bioactive factors in milk. Maternal psychological state is also recognised to be influential, largely affecting milk production. Thus increased stress can disrupt milk flow, whilst milk ejection can be improved by relaxation therapy; previously shown in mothers of pre-term infants. However, these mother-infant factors are inter-related, making it difficult to define cause and effect using an observational study design. Therefore, I aimed to investigate biological and anthropological aspects of mother-infant signalling during breastfeeding using an experimental approach. Maternal psychological state was manipulated using relaxation therapy in mothers breastfeeding their full-term infant to test the primary hypothesis that the intervention would reduce maternal stress, favourably affect breast milk composition and positively influence infant behaviour and growth; and the secondary hypotheses that milk composition (including hormones) and infant characteristics (temperament, appetite, gender) would associate with infant growth. Pregnant women, recruited from antenatal clinics in Malaysia, were randomised postnatally into control (no treatment) and intervention (audio relaxation recording) groups. Home visits were performed at 2-3, 6-8 and 12-14 weeks to assess infant anthropometry, maternal stress and infant behaviour, and to collect fore- and hindmilk samples for composition including cortisol, ghrelin and leptin. The relaxation therapy was effective in reducing maternal stress during lactation, favourably affecting breast milk composition and positively influencing infant sleeping behaviour and growth. Infant temperament, appetite and breast milk hormones were also found to be associated with infant growth. Overall, this thesis presents results based on the primary and secondary hypotheses, explores potential pathways for intervention effects, and discusses the findings from a biological and anthropological perspective.

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