Mastitis Prevention Strategies

Editor(s): María Eugenia Flores-Quijano.

Mastitis Prevention Strategies 

María Eugenia Flores-Quijano 

Key Messages 
  • Mastitis prevention strategies include general recommendations to protect the women’s immune system and milk microbiota
  • Breastfeeding counselling on ade­quate lactation practices and the cor­rect breastfeeding technique are of crucial importance to promote fre­quent and effective milk extraction and reduce any risk associated with mastitis
  • Counselling must also include infor­mation on breast care and mastitis sign recognition in order for women to seek professional help on time when needed 
Clinical mastitis is often a cause of breastfeeding cessation, but other ear­lier or more subtle manifestations such as pain when feeding and perceived re­duced milk flow are also causes for early weaning and breastfeeding termi­nation [1], therefore mastitis preven­tion is an important measure to pro­mote continued and successful breastfeeding. 

Previous studies have documented risk factors for mastitis, which need to be considered in order to put forward adequate preventive measures. Some of these factors fit into a non-modifi­able category, placing women with these characteristics in a high-risk group that needs extra attention and support [2]. However, most of the fac­tors associated with the occurrence of mastitis are modifiable. Some of them may directly alter the microbiota, such as the irrational use of antibiotic ther­apy associated with Caesarean deliv­ery or recurrent throat infections [3], unnecessary antifungal medications and nipple ointments [2], or even the use of not properly sterilized breast pumps that could be the source of pathogenic bacteria [2]. Other factors induce changes in the maternal immu­nological system that may predispose for mastitis. For instance, in women living in underprivileged communities in Africa, reduced plasma levels of some micronutrients including vitamin A, zinc, and antioxidants, such as vita­min E and selenium, have been asso­ciated with subclinical mastitis [4, 5]. Also, psychological stress and fatigue have consistently been associated with this condition [6]. 

Additionally to the above-men­tioned factors, breastfeeding practices and techniques that women choose, as well as factors that hinder appropri­ate ones such as milk oversupply, the separation of the mother from the baby, or factors that may hurt the breast or nipple such as the use of a tight bra, the presence of tongue or lip tie in the baby, and the improper use of breast-pumps create conditions or a breastfeeding environment that may cause blocked ducts, engorgement (build-up of milk in the breast), and in­crease the risk for mastitis [7]. Some inadequate practices that lead to infre­quent and incomplete milk removal are [8]: scheduled feedings, purposely short duration of feeding, missed feedings, early introduction of formula milk or food (mixed feeding), and pac­ifier use. An incorrect breastfeeding technique may not only cause nipple damage, but also prevent optimal milk drainage from the breast. At the same time, it has been hypothesized that nipple cracks and nipple injuries may not only provide a point of entry for microorganisms, but could also be early clinical signs of mastitis [3]. 

In terms of mastitis prevention, there are some general recommen­dations that protect women’s im­mune system and their milk microbi­ota, these may include: strategies that improve or maintain an adequate nutrition status; provide guidance on how to cope with stress and fatigue [9]; promote the rational use of anti­biotics during pregnancy, parturition, and postpartum, and limit the unnec­essary use of breast ointments during lactation. Additionally, the use of se­lected probiotics has recently been proposed as a novel preventive inter­vention especially for the high-risk group of women [10]. 
Nevertheless, a crucial interven­tion to prevent mastitis, even in the more susceptible women, is to pro­mote the best conditions for breast­feeding and provide pertinent coun-selling on important matters such as: (I) adequate breastfeeding practices, (II) the correct technique to comfort­ably sit or lie and place the baby to the breast, (III) how to take care of the breasts, and (IV) very importantly, information on how to recognize early signs of mastitis, so affected patients get proper treatment if needed. 

Adequate practices and correct techniques that may help prevent mastitis
 Initiate breastfeeding very soon after
birth (no longer than 24 hours)
• Exclusive breastfeeding
• Free demand, not scheduled feedings
• Let baby fnish suckling and extracting
milk from one breast before changing
to the other one
• Delay the use of pacifer
Woman's position:
• Teach correct and comfortable
positions to sit or lie for breastfeeding

Baby's position
• Head and body are aligned
• Face facing the chest, nose
opposite the nipple
• Whole body facing the mother

Position of the mouth on the breast
(correct latch):

• Way in which the woman takes
and presents the breast
• Recommendation: hand forms a “C”
• Stimulate the search refex and to
open mouth widely
• It is not necessary to place a fnger
near the nose 


References 
  1. González de Cosío T, Escobar-Zaragoza L, González-Castell LD, Rivera-Dommarco JÁ: Prácticas de alimentación infantil y deteri­oro de la lactancia materna en México. Salud Pública Mex 2013;55(Suppl(2)):S170–S179.
  2. Fernández L, Mediano P, García R, Rodríguez JM, Marín M: Risk factors pre­dicting infectious lactational mastitis: decision tree approach versus logistic re­gression analysis. Matern Child Health J 2016;20:1895–1903.
  3. Mediano P, Fernández L, Rodríguez JM, Marín M: Case-control study of risk factors for infectious mastitis in Spanish breast­feeding women. BMC Pregnancy Childbirth 2014;14:195.
  4. Tomkins A: Nutrition and maternal morbidity and mortality. Br J Nutr 2001;85 Suppl 2:S93–S99.
  5. Semba RD, Neville MC: Breast-feeding, mastitis, and HIV transmission: nutritional implications. Nutr Rev 1999;57:146–153.
  6. Wöckel A, Beggel A, Rücke M, Abou-Dakn M, Arck P: Predictors of inflammatory breast diseases during lactation – results of a cohort study. Am J Reprod Immunol 2009;63:28–37.
  7. Berens PD: Breast pain: engorgement, nipple pain, and mastitis. Clin Obstet Gynecol 2015;58:902–914.
  8. Amir LH; Academy of Breastfeeding Medicine Protocol Committee: ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeed Med 2014;9:239–243.
  9. Tang L, Lee AH, Qiu L, Binns CW: Mastitis in Chinese breastfeeding mothers: a prospective cohort study. Breastfeed Med 2014;9:35–38.
  10. Fernández L, Arroyo R, Espinosa I, Marín M, Jiménez E, Rodríguez JM: Probiotics for human lactational mastitis. Benef Microbes 2014;5:169–183.