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Chapter: Medical Physiology: Pregnancy and Lactation

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Initiation of Lactation-Function of Prolactin

Initiation of Lactation-Function of Prolactin
Although estrogen and progesterone are essential for the physical development of the breasts during pregnancy, a specific effect of both these hormones is to inhibit the actual secretion of milk.

Initiation of Lactation-Function of Prolactin

Although estrogen and progesterone are essential for the physical development of the breasts during pregnancy, a specific effect of both these hormones is to inhibit the actual secretion of milk. Conversely, the hormone prolactin has exactly the opposite effect on milk secretion—promoting it. This hormone is secreted by the mother’s anterior pituitary gland, and its concentration in her blood rises steadily from the fifth week of pregnancy until birth of the baby, at which time it has risen to 10 to 20 times the normal nonpregnant level. This high level of prolactin at the end of pregnancy is shown in Figure 82–11.


In addition, the placenta secretes large quantities of human chorionic somatomammotropin, which proba-bly has lactogenic properties, thus supporting the pro-lactin from the mother’s pituitary during pregnancy. Even so, because of the suppressive effects of estrogen and progesterone, no more than a few milliliters of fluid are secreted each day until after the baby is born. The fluid secreted during the last few days before and the first few days after parturition is called colostrum; it contains essentially the same concentrations of pro-teins and lactose as milk, but it has almost no fat, and its maximum rate of production is about 1/100 the subsequent rate of milk production.

Immediately after the baby is born, the sudden loss of both estrogen and progesterone secretion from the placenta allows the lactogenic effect of prolactin from the mother’s pituitary gland to assume its natural milk-promoting role, and over the next 1 to 7 days, the breasts begin to secrete copious quantities of milk instead of colostrum. This secretion of milk requires an adequate background secretion of most of the mother’s other hormones as well, but most important are growth hormone, cortisol, parathyroid hormone, and insulin. These hormones are necessary to provide the amino acids, fatty acids, glucose, and calcium required for milk formation.


After birth of the baby, the basal level of prolactin secretion returns to the nonpregnant level over the next few weeks, as shown in Figure 82–11. However, each time the mother nurses her baby, nervous signals from the nipples to the hypothalamus cause a 10- to 20-fold surge in prolactin secretion that lasts for about 1 hour, which is also shown in Figure 82–11. This prolactin acts on the mother’s breasts to keep the mammary glands secreting milk into the alveoli for the subsequent nursing periods. If this prolactin surge is absent or blocked as a result of hypothalamic or pitu-itary damage or if nursing does not continue, the breasts lose their ability to produce milk within 1 week or so. However, milk production can continue for several years if the child continues to suckle, although the rate of milk formation normally decreases consid-erably after 7 to 9 months.

Hypothalamic Control of Prolactin Secretion. The hypothal-amus plays an essential role in controlling prolactin secretion, as it does for almost all the other anterior pituitary hormones. However, this control is different in one aspect: The hypothalamus mainly stimulates production of all the other hormones, but it mainly inhibits prolactin production. Consequently, damageto the hypothalamus or blockage of the hypothalamic-hypophysial portal system often increases prolactin secretion while it depresses secretion of the other anterior pituitary hormones.

Therefore, it is believed that anterior pituitary secre-tion of prolactin is controlled either entirely or almost entirely by an inhibitory factor formed in the hypo-thalamus and transported through the hypothalamic-hypophysial portal system to the anterior pituitary gland. This factor is called prolactin inhibitoryhormone. It is almost certainly the same as the cate-cholamine dopamine, which is known to be secreted by the arcuate nuclei of the hypothalamus and can decrease prolactin secretion as much as 10-fold.

Suppression of the Female Ovarian Cycles in Nursing Mothers for Many Months After Delivery. In most nursing mothers,the ovarian cycle (and ovulation) does not resume until a few weeks after cessation of nursing.The reason seems to be that the same nervous signals from the breasts to the hypothalamus that cause prolactin secretion during suckling—either because of the nervous signals themselves or because of a subsequent effect of increased prolactin—inhibit secretion of gonadotropin-releasing hormone by the hypothala-mus. This, in turn, suppresses formation of the pituitary gonadotropic hormones—luteinizing hormone and follicle-stimulating hormone. However, after several months of lactation, in some mothers, especially in those who nurse their babies only some of the time, the pituitary begins to secrete sufficient gonadotropic hormones to reinstate the monthly sexual cycle, even though nursing continues.



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