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Agalactia, Dysgalactia, and Nutrition of the Postpartum Mare

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Agalactia, Dysgalactia, and Nutrition of the Postpartum Mare HOW TO MANAGE THE SUBFERTILE MARE Agalactia, Dysgalactia, and Nutrition of the Postpartum Mare Peter R. Morresey, BVSc, MACVSc, Diplomate ACT, ACVIM (Large Animal) Successful initiation and continuation of lactation in the postpartum mare depends on normal hormonal activity and a lack of any inhibitory influences on the mare. Impediments to adequate lactation include underlying systemic disease of the mare, pathology of the mammary gland, malnutrition, and diminished neonatal vigor reducing normal suckling activity. Author’s ad- dress: Rood and Riddle Equine Hospital, PO Box 12070, Lexington, KY 40580; e-mail: pmorresey@ roodandriddle.com. © 2012 AAEP. 1. Introduction progressively larger ducts that converge into cis- Lactation places considerable nutritional and phys- terns above the teats. Groups of alveoli cluster to- iological demands on the mare. The nursing mare gether to form lobules. In turn, these cluster must provide sufficient milk to allow the foal to together to form lobes, which is collectively known achieve approximately 45% of its mature weight at as a lobuloalveolar construct. weaning.1 At the same time, to maintain a yearly The mammary gland undergoes a cycle of growth foaling interval, the mare must be sufficiently recov- and differentiation of tissue after every mating that ered from the demands of gestation to allow rebreed- results in a pregnancy. Growth of the mammary ing within the first month of lactation if so desired. gland tissue continues to some degree into the lac- Numerous management decisions and medical con- tation phase, with this being followed by a period of ditions can lead to either complete failure of lacta- involution. In most species, growth of the lobuloal- tion or insufficient milk production to meet the veolar tissue is stimulated by high levels of both needs of the growing foal. estrogen and progesterone during pregnancy, with the latter inhibiting milk production.2 2. Anatomy, Physiology, and Endocrinology of The mare differs from other species in that circu- Lactation lating progesterone levels are relatively low during The equine mammary gland is composed of four the third trimester of gestation. Progesterone en- separate functional gland units, two on either side of tering the maternal circulation from the fetoplacen- the inguinal midline. Each pair (collateral) is tal unit is metabolized to the 5␣-pregnanes.3,4 The served by a single teat; however, each of these has most bioactive metabolite is thought to be 5␣- two teat canals and cisterns, with separate duct and pregnane-3,20-dione, which is found in high concen- alveolar systems for each gland unit. Secretory ep- tration and has demonstrable affinity for the ithelial cells line the alveoli, with myoepithelial cells progesterone receptor.5 Estrogens are represented encasing the alveoli. The alveoli empty milk into by the inactive equilin and equilenin during late NOTES 370 2012 ր Vol. 58 ր AAEP PROCEEDINGS Orig. Op. OPERATOR: Session PROOF: PE’s: AA’s: COMMENTS ARTNO: 1st disk, 2nd beb spencers 10 3285 HOW TO MANAGE THE SUBFERTILE MARE pregnancy,6 with estradiol 17-␤ rising before preponderant in human milk.20,21 A dynamic state parturition.7,8 of immunity exists during the prepartum and the The trigger for initiation of lactation is thought to immediate postpartum periods. Prepartum, colos- be the progestagen decrease and prolactin increase tral immunoglobulin accumulates in preparation for at the end of lactation. Prolactin has a major role transfer of immunity to the neonatal foal. The in the initiation of lactation in the mare. Levels mammary gland does not produce immunoglobulin suddenly increase in the last days of gestation and G but instead concentrates it from the vascular sup- peak at parturition,9 remaining elevated for up to 3 ply. Lysozyme remains elevated in milk well after months postpartum.10 Prolactin is not required for parturition, remaining active in the foal intestine the continuation of lactation once established,11 and providing protection after cessation of macro- even though suckling raises maternal prolactin con- molecule absorption. This elevated level of ly- centrations.12 Prolactin receptors are present in sozyme may also protect the mammary gland mammary tissue and increase in number during against infection.22 gestation and after parturition. Lactation in the mare peaks 30 to 60 days post- 4. Disturbances of Lactation and Differential partum. During this time, average daily produc- Diagnoses tion of 15 L per day in Thoroughbred mares and 12 The failure to produce colostrum or milk is known as to 13 L per day in Quarter Horse mares is agalactia. This is a separate condition from lack of 13,14 achieved. Therefore, daily consumption by the milk letdown by some inexperienced primiparous foal is in the range of 21% to 25% of body weight on mares or that caused by painful mammary glands. 15 average over this period. Dysgalactia is defined as poor or inadequate milk As the demand for milk by the foal decreases, the production, this being essentially a partial failure in mammary gland undergoes a progressive involu- lactation initiation or its continuation. Devitaliza- tion. Weaning occurs at relatively high milk pro- tion of the mare due to a systemic medical condition duction, causing increased intramammary pressure or during a period of postsurgical convalescence may due to accumulation of milk. This increased pres- be responsible for diminuation or cessation of sure along with suspected inhibitors in the milk lactation. further decreases production. Secretory tissue is subsequently replaced with connective and adipose 5. Fescue Toxicosis tissue.2 The most common cause in the United States is 3. Composition of Milk ingestion of fescue pasture contaminated with the endophyte Neotyphodium coenophialum.23 This Synthesis of milk within the mammary gland of the compound is a dopamine agonist which antagonizes mare is similar to that in ruminants.16 Compo- the action of prolactin during initiation of lactation. nents are sourced from body reserves, feed materi- Placental edema and prolonged gestation also als, and de novo synthesis within the mammary result. gland epithelium. Throughout lactation, a slow de- cline occurs in energy, total solids, protein, ash, 6. Concurrent Disease Process and minerals; however, lactose concentrations increase.17 Whereas milk production is a potent driver of met- Lactose is derived from glucose absorbed from the abolic requirements, it is subservient to survival of small intestine. Fatty acids are produced from ac- the mare. In the absence of other precipitating fac- etate and 3-hydroxybutryrate sourced from carbohy- tors, systemic disease of the mare should be ruled drate digestion in the large intestine. Unsaturated out in cases of agalactia or decreased milk produc- C18 fatty acid is supplied either directly from the tion. Also, diminished suckling activity by the foal, diet or from body reserves.18 Protein in milk is failure to fully let down by the mare, or incomplete derived from the highly synthetic cells of the mam- manual milking (where the foal is unable to suckle mary epithelium. Most research has centered on the mare, such as with hospitalization) can lead to the effects on the foal after variations in mare pro- rapid diminution of milk production due to incom- tein intake; however, research in mares has found plete clearance of the mammary secretions, thereby that an increase in dietary crude protein up to 14% raising pressure within the mammary gland, which of the diet increased milk production.19 is deleterious to further production. Compared with human and bovine milk, mare milk is of lower fat and hence energy content. Mare 7. Malnutrition milk and human milk have a similar sugar content, The energy requirements for lactation are high. whole protein, and electrolyte content, in contrast to Lactose is sourced from glucose provided in the diet, the increased electrolyte content of cow’s milk, mak- with fatty acids produced from acetate and butyrate ing that a less suitable replacement for mare milk.16 of large intestinal origin. Adipose tissue will be Antimicrobial defense in mare’s milk seems to be mobilized during times of limited intake with the due mainly to the presence of lysozyme (as in human potential to decrease mare body condition. Protein milk) and, to a lesser degree, to lactoferrin, which is is similarly harvested from tissue stores. AAEP PROCEEDINGS ր Vol. 58 ր 2012 371 Orig. Op. OPERATOR: Session PROOF: PE’s: AA’s: COMMENTS ARTNO: 1st disk, 2nd beb spencers 10 3285 HOW TO MANAGE THE SUBFERTILE MARE 8. Mastitis may lead to resolution of the diminished mammary Infection and inflammation of the mammary gland development and resultant agalactia. of the mare is uncommon. Most common at wean- Domperidone is the most commonly used lacto- ing, this condition may occur during lactation if the genic agent due to its ability to stimulate prolactin foal does not regularly and sufficiently suckle the secretion in situations of dopaminergic inhibition mare during periods of high production. Tail such as with fescue toxicosis. This medication will swishing, ground stomping, regional swelling, and also be administered in situations in which systemic pain, as well as curdled milk, are common signs of health of the mare or lack of appropriate suckling by mastitis. In addition, the mare may be reluctant to the foal is thought responsible. Reserpine is also in move, and fever may be present.24 Causative or- common usage, with the added benefit of behavioral ganisms have been reported to include Streptococcus modification. Reports of metoclopramide and 33–35 equi subspecies zooepidemicus, which was the most sulpiride usage also exist. common isolate, and a wide range of both Gram- The use of pergolide (a dopamine agonist and positive and Gram-negative aerobic organisms.24,25 therefore a prolactin antagonist) is not without risk Both systemic and local antimicrobial therapy, anti- of causing lactation failure in treated mares.
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