Pierre Delvoye

The influence of the frequency of nursing and of previous lactation experience on serum prolactin in lactating mothers

Serum prolactin levels were measured for 97 women from Zaire for 22 months postpartum. These 97 women were divided into 3 groups according to how frequently they breast-fed their children. These results were compared with the prolactin levels of 25 nonlactating, nonpregnant women. The prolactin levels increased with the frequency of breast-feeding. The postpartum decrease in serum prolactin is quicker among women who breast-feed less frequently; the serum prolactin levels returned to normal ranges within 6 months postpartum among women who breast-fed their children 1-3 times/day. No correlation could be found between previous breast-feeding or the parity of women and prolactin levels during subsequent pregnancies.

Serum prolactin, gonadotropins, and estradiol in menstruating and amenorrheic mothers during two years' lactation.

Serum prolactin, LH, FSH, and estradiol were measured in single blood samples collected from 465 nursing mothers in Central Africa (Kivu, Zaïre) during the first 2 postpartum years. Lactating mothers were hyperprolactinemic during 15 to 18 postpartum months. Both serum prolactin and FSH were higher in amenorrheic than in menstruating nursing mothers; the difference was more apparent during the first than during the second year. Mean serum LH and estradiol were significantly higher in menstruating then in amenorrheic nursing mothers during the second postpartum year but not during the first. There was a significant association of hyperprolactinemia with amenorrhea. Furthermore, postpartum, the incidence of amenorrhea declined parallel to that of hyperprolactinemia.

Epidemiology of pregnancies with unknown last menstrual period.

A group of women with unknown last menstrual period was studied representing 16% of a total of 22 404 pregnant women recorded using a common perinatal form. Unknown menstrual period is associated with high rates of low birth weight and with low socioeconomic and sociodemographic status. Such characteristics are also associated with a high rate of preterm deliveries. Thus any possible bias introduced in studies of prematurity by ignoring the group of women with unknown last menstrual period should be carefully checked.

Hyperprolactinaemia during prolonged lactation: evidence for anovulatory cycles and inadequate corpus luteum.

Serum progesterone and prolactin were measured in single blood samples collected from 176 mothers during a lactation period of 2 years and from fifty‐six non‐lactating, non‐pregnant and regularly menstruating women from the Kivu region (Zaire). On the basis of serum progesterone levels, evidence of corpus luteum activity was obtained in 61% of non‐lactating women; but only 20% of non‐amenorrhoeic lactating mothers. This suggests an increased incidence of anovulatory cycles and/or cycles with short luteal phases among nursing mothers. The incidence of corpus luteum activity was 8% in amenorrhoeic lactating mothers. In this 8% recurrence of ovulation preceded return of menstruation. Mean serum progesterone was significantly higher and serum prolactin significantly lower in the non‐lactating women than in the nursing mothers. This suggests that although ovulation occurs, corpus luteum activity is inadequate in hyperprolactinaemic nursing mothers.

Models of preconception care implementation in selected countries.

Globally, maternal and child health faces diverse challenges depending on the status of the development of the country. Some countries have introduced or explored preconception care for various reasons. Falling birth rates and increasing knowledge about risk factors for adverse pregnancy outcomes led to the introduction of preconception care in Hong Kong in 1998, and South Korea in 2004. In Hong Kong, comprehensive preconception care including laboratory tests are provided to over 4000 women each year at a cost of

TIME‐COURSE OF PHYSIOLOGICAL HYPERPROLACTINAEMIA DURING TWO YEARS LACTATION

75 per person. In Korea, about 60% of the women served have known medical risk history, and the challenge is to expand the program capacity to all women who plan pregnancy, and conducting social marketing. Belgium has established an ad hoc-committee to develop a comprehensive social marketing and professional training strategy for pilot testing preconception care models in the French speaking part of Belgium, an area that represents 5 million people and 50,000 births per year using prenatal care and pediatric clinics, gynecological departments, and the genetic centers. In China, Guangxi province piloted preconceptional HIV testing and counseling among couples who sought the then mandatory premarital medical examination as a component of the three-pronged approach to reduce mother to child transmission of HIV. HIV testing rates among couples increased from 38% to 62% over one year period. In October 2003, China changed the legal requirement of premarital medical examination from mandatory to “voluntary.” This change was interpreted by most women that the premarital health examination was “unnecessary” and overall premarital health examination rates dropped. Social marketing efforts piloted in 2004 indicated that 95% of women were willing to pay up to RMB 100 (US

Serum Prolactin Levels During the Menstrual Cycle

12) for preconception health care services. These case studies illustrate programmatic feasibility of preconception care services to address maternal and child health and other public health challenges in developed and emerging economies.

Prolactin studies in normal subjects.

SUMMARY. In Central Africa, mothers on nursing for 2 years are hyperprolactinaemic during the first 15–18 post‐partum months; serum prolactin levels are some three times higher than in non‐pregnant and non‐lactating women.