Increasing the Supply of Donor Milk: The Impact of Lactation-Duration Based Exclusion Criteria and Internet Milk Sharing.

摘要

Pasteurized human donor milk is an important functional first food for the preterm infant who does not have access to their mother's own milk, significantly improving health outcomes and lowering health care costs. Despite a renaissance in donor milk banking in North America that has resulted in the opening of 5 new milk banks since 2012, the demand for donor milk currently outpaces supply. This dissertation uses quantitative and qualitative methods to research potential solutions for expanding the supply of pasteurized donor milk available through the Human Milk Banking Association of North America (HMBANA).;In study 1, the composition of human milk was examined longitudinally during the second year of lactation to evaluate the current guideline that prohibits milk donation beyond one year postpartum. Nineteen mothers provided monthly milk samples (N=131) from eleven months postpartum (the control) until 17 months postpartum. Milk samples were analyzed for macronutrients, minerals, and bioactive proteins. There was no evidence of a change in the lactose, total fat, iron, and potassium content of the milk over the study period. Total protein, lactoferrin, lysozyme, immunoglobulin A (IgA), and sodium increased over time, and there was a gradual decrease in zinc and calcium (P < 0.05). Milk samples beyond one year postpartum were also compared to pooled milk samples (N=33) provided by two HMBANA milk banks. In this analysis, late lactation samples contained significantly more total protein, lactoferrin, lysozyme, and IgA, and significantly less zinc, calcium, and iron than milk bank samples (P < 0.05). There was no evidence of a difference in total fat, lactose, potassium, and sodium. These findings suggest that human milk beyond one year postpartum provides stable or increasing concentrations of macronutrients and bioactive factors, and may require mineral fortification to meet the unique needs of the preterm infant.;In study 2, an observational approach was used to describe the nature of online milk sharing communities that facilitate the direct exchange of unpasteurized human milk between milk seekers and donors. The purpose of this study was to quantify the different segments of the human milk market in the United States. Three months of data were extracted from nine public Facebook pages that facilitate the exchange of human milk. The number of participants, interactions and comments were analyzed. We observed 954 individuals participating in milk sharing, with 532 of the participants (55.8%) offering milk and 413 participants (43.3%) seeking milk. The top reasons participants requested milk was "Lactation Problems" (69.4%). Nearly half of the donors were offering 100 ounces or more. This is the minimum donation volume to be eligible to donate to many HMBANA milk banks, suggesting that donors who participate in online milk sharing communities may also be a potential pool of donors for non-profit milk banks. Additionally, the study raises questions about the root of lactation problems that are prompting mothers to seek milk.;In study 3, in-depth telephone interviews were conducted with 27 women who had shared milk with a peer, but not with a milk bank. A Grounded Theory approach was used to analyze content and develop a preliminary theoretical model that describes the process of becoming a peer-to-peer milk donor. Our findings suggest that an unexpected surplus of expressed milk prompts donation. Information about donation options comes predominantly from social circles, not from health care providers. Donors are concerned about milk bank costs, convenience of donation, and community impact. Insights from this model can be used to develop strategies to address the public health call for increasing the availability of pasteurized donor milk including developing prenatal promotion and screening programs to increase the number of milk bank donors.;Funding Sources: North Carolina State University CALS Dean's Enrichment Grant; American Society of Nutrition's Gerber Foundation Predoctoral Fellowship Award; United States Department of Agriculture Kannapolis Scholars Training Grant; Mothers' Milk Bank, San Jose, California; Mothers' Milk Bank, Denver, Colorado; Mothers' Milk Bank Northeast, Newton Upper Falls, Massachusetts.