At The Injury Clinic, we recognise that there are many changes that occur in a woman’s body, not only while they are pregnant, but also during the postpartum period. Nearly all (96%) of women in Australia start breastfeeding when their child is born, and the World Health Organisation recommends breastfeeding (alongside suitable foods) until the child is 2 years old. In Australia, we know:

At around 4 months, 69% of babies are receiving some breastmilk
By 12 months 28% of children continue to receive breastmilk
5% of children continue to receive breastmilk up to 2 years of age.

While there is a lot of research still being conducted on what exactly is in breastmilk, we know it includes:

Factors that help protect against infection and inflammation, which helps the child develop their immune system and a healthy gut microbiome.
Macro- and micronutrients that are necessary to ensure growth and development of a child and their vital organs.
- Breast milk contains protein, fat and carbohydrates. The composition of these macronutrients vary between women.
- Breastmilk also contains a wide range of micronutrients, including (but not limited to) calcium, iron, vitamin B12, Vitamin D and iodine.

As breastmilk is full of a range of nutrients, breastfeeding mothers need to be sure they maintain adequate nutrition throughout the course of their breastfeeding journey. Breastfeeding is a period of high energy and has critical nutrient demands, which can make women vulnerable from a nutritional standpoint. The nutrients found in the breastmilk are either made in the milk making cells of the breast, are sourced from the mother’s diet or are from maternal stores.

If a breastfeeding mothers diet isn’t sufficient to meet her nutritional needs, research has demonstrated that she can still produce sufficient, high quality breast milk. In these cases, it may mean that the mothers own stores of nutrients (i.e. calcium) are being reabsorbed into the bloodstream and used in the breastmilk.

Breastfeeding Induced Transient Osteopenia

It is recognised that breastfeeding women can experience breastfeeding induced transient osteopenia. This is where a woman’s bone mineral density reduces secondary to calcium reabsorption, which occurs while breastfeeding to ensure their child receives adequate calcium via breastmilk. We also know that in the third trimester of pregnancy, the baby will receive 75% of the calcium that it needs while in utero. Once the child is born, he/she will continue to need up to 400mg of calcium daily, which is obtained from breastmilk (if a mother is breastfeeding).

This can lead to an average rate of 1-3% loss of bone mineral density per month during lactation. Over time, this can lead to significantly reduced bone mineral density, and we can see the development of transient osteopenia. Most research then indicates that bone mineral density recovers and improves within 6-12months post cessation of breastfeeding.

What does this mean for me?

For the majority of women, even if they are breastfeeding, their bone mineral density will recover without any awareness or knowledge that there was a reduction. This reduction in bone mineral density is certainly not a reason to avoid breastfeeding, or to wean your baby early. It does, however, mean:

Women should be mindful of their diet, and ensure their caloric intake is sufficient to meet both their breastfeeding and general life requirements. It is thought an additional 300-500kcal should be consumed daily while breastfeeding.
Consideration should be given to ensuring adequate micronutrients are consumed within a balanced diet.
- When discussing bone mineral density, calcium and vitamin D are essential for strong and healthy bones.
- It is also important to monitor levels of other vital micronutrients and discuss any concerns you may have regarding these with your GP or a dietitian.
When returning to exercise, it is important that any return to high impact exercise (including running) should be done gradually and with the guidance of your physio.

Bone mineral density and injury risk factors

It is widely accepted that reduced bone mineral density can increase the risk of bone stress injuries. This is important to consider for breast feeding mothers who are wanting to return to exercise, particularly those wanting to get back to running and other high impact activities. In a study of elite postpartum runners, 50% sustained injuries in their return. Of these, 29% sustained bone stress injuries. While this is not a reason to avoid running, it does indicate that these types of injuries can be relatively common in the postpartum running community.

What can be done to reduce the risk of a bone stress injury while breastfeeding?

If your goal is to return to high impact exercise, there are several things that can be done to help reduce the risk of bone stress injury. It is important to note, these things may help reduce the risk, but will not remove all risk completely. These things include (but are not limited to):

Consulting with a physiotherapist to ensure:
- You have adequate strength and stability to support the demands of your activity (ie. running).
- You have adapted to any biomechanical changes that occurred during pregnancy and are transferring load well through your body.
- You manage your exercise loading appropriately.
Consider consulting with a dietitian to ensure you are meeting the nutritional demands of breastfeeding as well as your chosen activity.
Ensure you are wearing appropriate support clothing and footwear.
- This may include purchasing new shoes to accommodate any changes that occurred to your feet during pregnancy.
- Ensuring you have a well fitted sports bra with adequate support. Poorly supported breasts can lead to a change in biomechanics which can lead to a change in injury profile.

It is important to note, it is safe to return to high impact exercise while breastfeeding, but there are a few additional factors that should be considered to reduce the risk of injury during this time.

SUMMARY

In summary, the nutritional demands of breastfeeding on a mother are significant. These demands should be considered, particularly by women who plan a return to high impact exercise while breastfeeding. It is important to consider consulting with a dietitian and a physiotherapist to reduce as much risk as possible. For more information, please click here to book an appointment online, or call 5229 3911 to book an appointment with o...

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