Chatterton R T, Hill P D, Aldag J C, Hodges K R, Belknap S M, Zinaman M J
Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois 60611, USA.
J Clin Endocrinol Metab. 2000 Oct;85(10):3661-8. doi: 10.1210/jcem.85.10.6912.
Responses of oxytocin and PRL to mechanical breast pumping and the influence of physiological indicators of stress were measured at 2, 4, and 6 weeks postpartum to determine potential causes of inadequate milk production in 18 women with prematurely delivered, nonnursing (<1500 g) infants. Median milk production was similar to that reported in breastfeeding mothers, but a third of mothers were producing less than half as much by week 6. Plasma oxytocin was similar to that previously reported for breastfeeding mothers. The oxytocin area under the curve (AUC) for breast-pumping sessions (70 min) was correlated at each occasion (r = 0.37, 0.58, and 0.55, respectively) with milk yield. Unlike reports of PRL levels in breast-feeding women, PRL AUC declined between weeks 2 and 6 weeks postpartum (P = 0.03); significant increases in plasma PRL occurred in response to pumping at 2 and 4 weeks, but not at 6 weeks. Salivary amylase, a measure of alpha-adrenergic activity, was highly negatively correlated on each occasion with PRL AUC (r = -0.58, -0.68, and -0.86, respectively), but not with oxytocin. Salivary cortisol was negatively correlated to a lesser degree. We hypothesize that deficiencies in preterm lactation are mediated in part upon stress-induced suppression of PRL secretion through an adrenergic mechanism.
在产后2周、4周和6周时，测量了18名早产、非母乳喂养（<1500g）婴儿的母亲的催产素和催乳素对机械吸乳的反应以及应激生理指标的影响，以确定乳汁分泌不足的潜在原因。乳汁分泌量中位数与母乳喂养母亲的报告相似，但三分之一的母亲到第6周时分泌量不到一半。血浆催产素与先前报道的母乳喂养母亲的水平相似。每次吸乳过程（70分钟）中催产素曲线下面积（AUC）与乳汁产量相关（r分别为0.37、0.58和0.55）。与母乳喂养女性催乳素水平的报告不同，产后2周至6周期间催乳素AUC下降（P = 0.03）；产后2周和4周时，吸乳后血浆催乳素显著升高，但6周时未升高。唾液淀粉酶是一种α-肾上腺素能活性指标，每次均与催乳素AUC高度负相关（r分别为-0.58、-0.68和-0.86），但与催产素无关。唾液皮质醇的负相关性较小。我们假设早产泌乳不足部分是由应激通过肾上腺素能机制抑制催乳素分泌介导的。
