226 Obstetrics and Gynecology Board Review •••
❍ In which infant illness is breastfeeding contraindicated?
Galactosemia.
❍ Why is galactosemia an absolute contraindication to breastfeeding?
Galactosemia is an inborn error of metabolism. Infants with this disorder are unable to utilize galactose, a
component of the lactose sugar in human milk. Accumulation of galactose may lead to failure to thrive, liver
dysfunction, cataracts, and mental retardation.
❍ What is the definition of tandem nursing?
The nursing of two children of differing ages during the same time frame. This can be siblings (ie, a newborn
and an older child) or could be adoptive nursing of an infant while nursing a biologic toddler. Of importance
is that if both children are biologic, the newborn must be nursed first at any feeding time, as the milk produced
will revert to colostrum just after delivery. Colostrum should be given to the newborn first to assure adequate
nutrition and hydration. It is presumed that the older child receives most of its nutrition elsewhere and does not
rely on the breast.
❍ Can a pregnant patient nurse her infant or toddler?
Yes. In an uncomplicated pregnancy, a woman may continue nursing. However, her milk supply may decrease.
❍ Can an adoptive mother nurse her infant?
Yes. If the mother has had a prior term pregnancy and lactated with that delivery, her success rate is highest.
The breast of a woman who has never been pregnant can be primed with oral estrogen, and then given TRH to
stimulate prolactin. If there is then mechanical stimulation and/or suckling, the breast will produce milk. The
quantity in the latter circumstance may not be sufficient for total nutrition. The infant should be supplemented
with formula.
❍ Your patient planned to breastfeed but delivers at 28 weeks. How do you counsel her?
Encourage her to use an electric pump and take the milk to the NICU. This milk is rich in immunologic value. It
is a way for the mother to be actively involved in her infant’s care. Most insurance companies will reimburse for the
pump rental. She should pump every 3 hours during the day and once at night to maintain a good supply.
❍ Should a baby with a cleft lip and/or palate be breastfed?
Yes. It can actually be easier. The large surface area of the breast can help occlude the defect. In very large defects
special devices may be needed.
❍ A 26-year-old patient is being treated during pregnancy for a microadenoma of the pituitary. She has had no
tumor enlargement and no symptoms. She would like to breastfeed. How do you advise her?
There is no contraindication to breastfeeding, but in some situations she may have a low milk supply. This is most
common after surgery or prior radiation.
❍ Are the iron levels in breast milk affected in women who are anemic?
No. They produce milk with normal iron levels.