title: Validity and public health implications of maternal perception of the onset of lactation: an international analytical overview.
abstract: The main objective of this analytical overview is to assess the validity of maternal perception of the onset of lactation (OL) as an indicator of lactogenesis stage II (LS-II). Prospective studies that assessed OL and/or LS-II [based on test-weighing milk volume (MV) and/or breast milk biomarkers (BMB)] were identified. OL is a clearly defined and easily identified event across cultures, with the overwhelming majority of women being able to report when they experience it. Mean OL ranges from 50 to 73 h postpartum across studies and from 1 to 148 h postpartum within studies. The wide range detected within samples is fully consistent with the wide within sample LS-II variability as determined by BMB or MV. Studies have identified similar risk factors for delayed LS-II, such as labor and delivery stress, primiparity and insulin-dependent diabetes mellitus, regardless of marker used (i.e., OL, MV or BMB). The correlation between OL and MV (r = -0.60) is of similar magnitude to that between OL and BMB (r = 0.50) and that between BMB and MV (r = 0.47-0.69). In conclusion, OL is a valid clinical indicator of LS-II. This has public health relevance because studies have identified delayed OL (i.e., >72 h postpartum) as a risk factor for shorter breastfeeding duration and for greater infant weight loss by d 3 postpartum. Multidisciplinary studies are needed to standardize the definition of OL and to confirm its validity in different sociocultural contexts.
authors.affiliation: Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269-4017, USA. rperez@canr.uconn.edu
authors.forename: R
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.forename: D J
authors.initials: DJ
authors.lastname: Chapman
mesh_terms: D001942:Breast Feeding; D005260:Female; D006801:Humans; D007774:Lactation / Q000523:psychology*; D010298:Parity; D049590:Postpartum Period; D011634:Public Health; D015203:Reproducibility of Results