Physiological basis of longitudinal changes in human milk yield and composition.

Currently in Western Australia more than 85% of women are breast-feeding after discharge from the hospital. Breast milk is the only fluid consumed by 64% of infants at 6 months of age, and 25% of infants are still breast-fed at 12 months of age. Therefore, many Western Australian mothers have optimized the art of breast-feeding and thereby provide an ideal population for studies of the physiological, pathological, and pharmacological factors affecting lactation. Reports from other countries conclude that the maximum milk yield of well-nourished women is 700-900 ml/24 h. Our studies have found the average milk yield of mothers breast-feeding single infants was in excess of 1100 ml/24 h for the first 6 months of lactation. Furthermore, mothers breast-feeding twins produced in excess of 2100 ml/24 h over this period, which demonstrates that the potential milk yield for mothers is much higher than 700-900 ml/24 h. Substantial alterations in the composition of breast milk occur at the initiation of lactation and after the cessation of suckling. During established lactation it is generally believed that there is only a slight variation in the composition of the milk. However, intensive studies have revealed acute changes in the concentrations of lactose, glucose, sodium, potassium, and chloride 5-6 days before and 6-7 days after ovulation. These findings suggest that unknown hormonal events associated with the reproductive cycle in women also influence breast milk composition.