Institute Activities and Advances
Several NICHD organizational units (OUs) support and conduct research on breastfeeding and breast milk. Many of these efforts overlap and require trans-NICHD and trans-NIH collaboration. The following is only a summary of some of these efforts.
Pediatric Growth and Nutrition Branch (PGNB) research on breastfeeding is part of a larger research program on nutrition that uses a systems approach to incorporate biological, environmental, and other critical components as integral to public health. This program also explores nutritional variables, including those specific to breastfeeding, in both domestic and international contexts. Some of the PGNB projects related to breastfeeding include:
- Improving knowledge of maternal-fetal and newborn nutrition, particularly for preterm infants, low-birth-weight (LBW) infants, and infants in resource-poor areas;
- Elucidating the nutritional and bioactive components of breast milk, such as iron, and how these influence the duration of exclusive breastfeeding and the timing of introduction of supplemental or complementary foods;
- Understanding the role of breast milk and its components in gastrointestinal immunity, prevention of respiratory disease, and prevention and treatment of infections and inflammation;
- Identifying biomarkers for exposure, status, and function of vitamin D, zinc, and other nutrients and micronutrients and defining the long-term impacts of nutritional deficiency during infancy;
- Exploring the nutritional needs of women with HIV/AIDS and how best to safely wean their infants to minimize exposure to the disease while still providing optimal nutrition, especially in resource-poor areas; and
- Contributing scientific expertise to the World Health Organization (WHO), the United Nations World Food Programme, the President's Emergency Plan for AIDS Relief (PEPFAR), the NIH Office of AIDS Research, and other groups' guidelines and best practice recommendations on infant feeding and nutrition.
The Institute's Pregnancy and Perinatology Branch (PPB) supports basic and clinical studies aimed at understanding the etiology, pathophysiology, therapy, and follow-up of health during the perinatal and neonatal periods, as well as research on in utero conditions and their influence on health outcomes. Among the PPB's projects within this context related to breastfeeding are:
- Studies on the optimal timing of breastfeeding initiation, especially in resource-poor countries, and the effects on infant health outcomes, including infant mortality;
- Research on the effects of breastfeeding on brain development, specifically development of the medullary raphe of the brainstem and the serotonin systems, and its mechanisms for reducing the risk for sudden infant death syndrome (SIDS);
- Investigations of how breast milk improves neurodevelopmental and other outcomes for neonates, including extremely LBW (ELBW) infants and preterm infants; and
- Research on breast milk and its effects on severity of and treatment for certain newborn diseases, such as necrotizing enterocolitis, retinopathy of prematurity, and jaundice.
The Maternal and Pediatric Infectious Disease Branch conducts and supports research on breast milk and breastfeeding within the context of HIV/AIDS infection and transmission. This research includes not only studies of the prevention of mother-to-child transmission (MTCT) of HIV/AIDS through a combination of limited duration of breastfeeding and medication interventions, but also the biological mechanisms by which MTCT occurs via breast milk. Additional studies examine the conditions that enhance or reduce the chance of transmission through breast milk, such as viral load and the number of mammary cells infected with HIV. Branch studies also aim to provide evidence about the best practices for breastfeeding, formula feeding, weaning, and supplementation for populations affected by HIV/AIDS. This research is conducted both domestically and abroad and includes partnerships and collaborations with other NIH Institutes and Offices, the WHO, PEPFAR, and other agencies and organizations in the U.S. and elsewhere.
The NICHD Population Dynamics Branch supports research on breastfeeding within the context of its social and societal impacts. Some of these studies aim to understand the home and socioeconomic factors that influence breastfeeding decisions, while other efforts aim to quantify the effects of workplace and public policies on breastfeeding and breastfeeding duration. This work also examines the range of breastfeeding impacts on communities and societies, from its influence on community connectedness to current and future economic health.
Researchers in the NICHD Division of Epidemiology, Statistics, and Prevention Research (DESPR) also conduct research on breastfeeding and breast milk. These studies include (but are not limited to) the effects of maternal nutrition and malnutrition on breast milk composition and subsequent effects on fetal and infant nutrition. Additional research examines the factors that influence breastfeeding decisions, particularly among those in at-risk groups, including African American mothers who live in low-income areas, as well as the long-term effects of breastfeeding on chronic diseases, such as obesity.
Through its Obstetric and Pediatric Pharmacology and Therapeutics Branch (OPPTB) , the NICHD also studies the effects of certain drugs on pregnancy and neonatal outcomes. Among the studies supported by the OPPTB are those that examine whether certain medications are transmitted via breast milk and their effects on infant development.
Other Activities and Advances
As explained above, NICHD OUs collaborate with each other, with NIH Institutes and Centers, and with other governmental and non-governmental organizations in the United States and worldwide. Some of these partnership and activities are described below.
- The NICHD PPB collaborated with the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration to conduct the Infant Feeding Practices II (IFPII) Survey aimed at examining infant feeding practices, including breastfeeding, among a large cohort of women and the impacts of these practices on infant health.
- The Neonatal Research Network (NRN), supported through the PPB, investigates the safety and efficacy of treatment and management strategies for newborn infants. The NRN has led several of the PPB's efforts on breastfeeding and neurodevelopmental outcomes for ELBW infants and on nutritional management of preterm, LBW, and ELBW infants.
- The Biomarkers of Nutrition for Development (BOND) project, led by the PGNB, aims to develop a unified approach to examine the scientific basis for choosing appropriate biomarkers for assessing the function and effect of diet and nutrition on health and disease in individuals and populations and for supporting the development and evaluation of evidence-based programs and policies to improve diet and nutrition as a way to improve health. Although the project does not focus specifically on breastfeeding or breast milk, these factors play a critical role in improving nutrition, especially in resource-poor areas of the world.
- The NICHD also participated in activities related to the Surgeon General's Call to Action on breastfeeding. To learn more about the Call to Action and the Breastfeeding Initiative, visit http://www.surgeongeneral.gov/initiatives/breastfeeding/index.html.