The Relationship Between the Onset of Lactogenesis II And Mother's Anthropometric Indices Following Delivery

Document Type : Original Article


1 Lecturer, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

2 M.Sc. in Student, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate Professor of Nutrition in Public Health, Shahid Beheshti University, Tehran, Iran

4 Associate Professor of Biostatic, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Delayed onset of lactogenesis II is one of the reasons of poor lactation outcomes. Recently,obesity in mother is implicated in delayed onset of lactogenesis II. Therefore, this study was performed to assess the relationship between the onset of lactogenesis II and antropometric indices at 14±1 days following child birth.
Methods: This descriptive and analytic research was conducted in Shahid Rajaee hospital of Tonekabon City and Imam Sajjad hospital of Ramsar City. The samples were 103 parturient women who were enrolled by purposive sampling. According to mothers' report of latogenesis II,they were put into two groups,with lactogenesis II within 72 hours and beyond,respectively. Then anthropometric indices of mothers were registered on 14th day after delivery.Data gathering was done by interview, observation forms and file. Analysis of data was performed by student t-test, Chi square, Mann-Whitney, Fischer's exact test, Pearson correlation, and Multivariate-Logistic regression.
Results: Pearson coefficient test showed a direct meaningful relationship between anthropometric measurements at 14 days following child birth onset of lactogenesis II. There were relationship between onset of lactogenesis II and mid arm circumference (r=0.248, P= 0.012), skin fold thickness (r=0.233, P=0.018), Calf circumference (r=0.387, P< 0.001), body mass index (r=0.378, P<0.001). By using logistic regression, results of study revealed the role of BMI is more significant in delayed onset of lactogenesis II (P= 0.006), and R.O.C curve defined that mothers with BMI ≥ 29 are at risk for late onset of lactogenesis II (P< 0.001).
Conclusion: All of the antropometric indices have direct and meaningful relation with onset of lactogenesis II, but Body Mass Index has more significant role in comparison to other factors.


1. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O’Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics 2005 Feb; 115 (2):496­506.
2. World  Breastfeeding Week Starts Aug. 1 in the Americas. Available at:
3. Dewey KG , Nommsen­Rivers LA, Heling MJ, Cohen RJ. Risk factors for suboptimal infant breestfeeding 
behavior, delayed onset of lactation, and exess neonatal weight loss.Pediateric 2003 Sep;112 (3 Pt 1):607­ 19.
4. Guyton  AC, Hall JE.  Textbook  of medical physiology. 11Th  ed. Philadelphia: Elsevier Saunders;
5. Lawrance, RA. Breastfeeding guide  for the medical profession . 5th ed. St Louis:Mosby;2001:65­7,233­65.
6. Hilson  JA, Rasmussen  KM,  Kjothede  Cl. High  prepregnant body mass  index  is  associated with  poor
lactation outcomes among white, rural women independent of psychosocial and demographic correlates. J 
Hum Lact 2004 Feb;20(1):18­29
7. Hruschka DJ, Sellen DW, Stein AD, Martorell R. Delayed onset of lactation and risk of ending full breastfeeding
early in rural Guatemalal. J Nutr 2003 Aug;133(8):2592­9.
8. Chapman DJ, Perez­Escamilla R. Identification  of risk factors for delayed  onset of lactation. J Am Diet
Assoc 1999 Apr;99(4):450­4.
9. Li R, Jewell S, Grummer­Strawn L. Maternal obesity and breast­feeding practices. Am J Clin Nutr 2003 
Apr;77 (4): 931­6 
10. Kugyelka JG, Rasmussen KM, Frongillo EA. Maternal obesity is negatively associated with breast feeding  success among Hispanic but not Black women. J Nutr 2004. Jul;134(7):1746­53.
11. Nishida C, Mucavela P. Monitoring the rapidly emerging public health problem of overweight & obesity:
the WHO Global Database on Body Mass Index. J SCN News 2005;( 29):5­12.
12. SantosJL,AlbalaC,leraL,GaricaC,ArroyoP,PerezF,etal ‘Anthropometric measurements in the Elderly 
population of Santiago,Chile’.Nutr 2004;20(5)452­457 
13. Maurice E, Shils JA, Balado D. Modern nutrition in health and disease. 9th ed. New York: Wolters Klawer Company;2002:790, 906 –9,1396­7.
14. Peckenpaugh  NJ,  Poleman CM. Nutrition  essential and  diet therapy. 8th  ed. Philadelphia: Saunders;1999:443 
15. Grander M, Anderson SL, Deyoung S. Foundation and clinical Application of nutrition. 2nd ed. St Louis: Mosby;2000:440­5.
16. Hornby ST, Nunes QM,  Hillmam TE, Stanga  Z, Neal KR, Rowlands BJ, et al. Relationships between  structural and functional measures of nutritional status in normally nourished population. Clin Nutr 2005