GRADUATE AND POSTDOCTORAL STUDIES
Abstract
MCGILL UNIVERSITY
Three studies were designed to explore: (i) cultural determinants
of optimal breastfeeding practices among Indigenous Mam-Mayan
women in the Western Highlands of Guatemala, (ii) the relationship
between subclinical mastitis and impaired infant anthropometric
indicators and (iii) the role of infection, inflammation, hygiene and
lactation practices in underscoring the complex relationship between
subclinical mastitis and infant growth.
FINAL ORAL EXAMINATION
FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
OF
HILARY WREN
SCHOOL OF DIETETICS & HUMAN NUTRITION
SUBCLINICAL MASTITIS AND INFANT GROWTH IN THE
WESTERN HIGHLANDS OF GUATEMALA
Friday February 19th, 2016
1:45pm
CINE Board Room
McGill University, Macdonald Campus
COMMITTEE:
Dr. A. Biswas (Pro-Dean) (Natural Resource Sciences)
Dr. L. Wykes (Departmental Chair) (School of Dietetics & Human Nutrition)
Dr. K. Koski (Supervisor) (School of Dietetics & Human Nutrition)
Dr. M. Scott (Co-Supervisor) (Institute of Parasitology)
Dr. K. Gray-Donald (Internal Examiner) (School of Dietetics & Human Nutrition)
Dr. H. Monardes (External Member) (Animal Science Department)
Dr. Josephine Nalbantoglu, Dean of Graduate and Postdoctoral Studies
Members of the Faculty and Graduate Students
are invited to attend
Manuscript 1 explored whether cultural influences were
associated with achievement of the World Health Organization infant
feeding recommendations and if these cultural practices served as
moderators of the relationship between breastfeeding practices and
infant weight-for-age (WAZ). Mothers who delivered at the traditional
midwife’s house and those that did not believe in the transmission of
susto (fright) through breast milk were more likely to initiate
breastfeeding within 1 hour postpartum. Higher breastfeeding frequency
was observed among mothers who spent more time in the temascal
(sauna). Initiating breastfeeding within 1 hour postpartum was the sole
infant feeding practice positively associated with exclusive breastfeeding
and infant WAZ. This work highlighted that health practitioners need to
understand how local cultural practices influence early initiation of
breastfeeding to promote adequate infant weight.
Manuscript 2 compared mothers with SCM (breast milk Na/K
ratio >0.6) and without SCM for selected factors and practices and
evaluated if SCM increased the likelihood of infant stunting (LAZ<2SD), underweight (WAZ<-2SD) and microcephaly (HCZ<-2SD) in a
cross sectional study. Older maternal age, higher parity, higher
breastfeeding frequency, and increased hours of maternal daily walking
characterized mothers with SCM. In a multiple logistic regression, the
presence of maternal stool Entamoeba coli increased the odds of infant
microcephaly. Importantly, SCM increased the likelihood of infant
stunting, underweight and microcephaly. Given the demonstrated
associations between SCM and anthropometric indicators of poor infant
growth, improving maternal breast health may be required to improve
infant growth.
Manuscript 3 explored the prevalence and determinants of SCM
at 0-6 wks (early) and 4-6 mo (established) in a longitudinal cohort of
mothers and investigated the contribution of infection, inflammation,
mammary gland permeability, and growth factors present in milk to
infant WAZ, LAZ, and HCZ at both stages of lactation. Prevalence of
SCM (Na/K ratio >0.6) differed between early and established stages of
lactation demonstrating that SCM did not persist. Determinants of SCM
at 0-6 wks were lack of home faucet and parity and at 4-6 mo were lack
of home faucet, lower feeding frequency, and higher early milk Na/K
ratio. In early lactation, increased mammary gland permeability and
maternal stool B.hominis impaired anthropometric measurements WAZ
and HCZ whereas leukocytes in urine and the pro-inflammatory
cytokine IL-6 in milk were associated with increased LAZ and HCZ,
respectively. In established lactation, maternal stool E.coli impaired
WAZ and LAZ, milk EGF was negatively associated with LAZ and
HCZ whereas milk pro-inflammatory cytokines TNF-α and IL-6 were
associated with increased WAZ and HCZ. This study suggests that
breast milk is a pathway through which non-genetic transmission of
growth faltering is passed although an inflammatory response in the
mammary gland may provide a measure of protection to the infant.
Taken together, these studies re-enforce the promotion of
optimal breastfeeding practices among Indigenous Mam-Mayan mothers
and endorse cultural practices during lactation but caution health
practitioners not to underestimate subclinical mastitis and the importance
of breast milk as a vehicle for transmission of poor growth.
CURRICULUM VITAE
UNIVERSITY EDUCATION
2011- present
Doctor of Philosophy (PhD)
School of Dietetics and Human Nutrition
McGill University
2007-2009
Masters of Public Health (MPH)
Department of Health Sciences,
Lakehead University
2002-2006
Honors Bachelor of Health Science (BHSc)
Minor in Religious Studies
School of Health Studies
The University of Western Ontario
SELECTED PEER REVIEWED PUBLICATIONS
Wren HM, Solomons NW, Scott ME, & Koski KG. (2015). Subclinical
mastitis is associated with poorer infant anthropometric indicators among
indigenous Mam-Mayan mothers in the Western Highlands of Guatemala.
Submitted to The Journal of Human Lactation.
Chomat AM, Solomons NW, Koski KG, Pedersen D, Wren HM, Vossenaar M,
Scott ME. (2015). Quantitative methodologies reveal a diversity of nutrition,
infection/illness and psychosocial stressors during pregnancy and lactation in
rural Mam-Mayan mother-infant dyads from the Western Highlands of
Guatemala. Food and Nutrition Bulletin, 1-26.
Wren HM, Solomons NW, Chomat AM, Scott ME, & Koski KG. (2015).
Cultural determinants of optimal breastfeeding practices among indigenous
Mam-Mayan women in the Western Highlands of Guatemala. The Journal of
Human Lactation, 31(1): 172-184.
Wren HM & Chambers L. (2011). Breastfeeding in Cambodia: Mother
knowledge, attitudes and practices. World Health & Population, 13(1), 17-29.
SELECTED PUBLISHED CONFERENCE ABSTRACTS
Subclinical mastitis is associated with higher breastfeeding frequency and
poorer infant anthropometric indicators among indigenous Mam-Mayan
mothers in the Western Highlands of Guatemala. Hilary Wren, Noel W.
Solomons, Marilyn E. Scott, Kristine G. Koski. Canadian Conference on Global
Health. Montreal, 2015. (168).Poster.
Factors associated with subclinical mastitis (SCM) among Indigenous mothers
in the Western Highlands of Guatemala. Hilary Wren, Noel W. Solomons,
Marilyn E. Scott, Kristine G. Koski. FASEB J. Boston, 2015. (580.3). Poster.
Milk mineral and cytokine concentrations differ in Guatemalan mothers with
subclinical mastitis (SCM) by stage of lactation. Chen Li, Hilary Wren, Noel
W. Solomons, Marilyn E. Scott, Kristine G. Koski. FASEB J. Boston, 2015.
(582.3). Poster.
CURRENT PROFESSIONAL AFFILIATIONS
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International Society for Research in Human Milk and Lactation
(ISRHML)
Canadian Society for International Health (CSIH)
American Society of Nutrition (ASN)
Canadian Public Health Association (CPHA)
SELECTED EMPLOYMENT
Comparison of breast milk sodium-potassium (Na/K) ratio, pro-inflammatory
cytokines, and somatic cell count (SCC) as potential biomarkers of subclinical
mastitis (SCM). Hilary Wren, Chen Li, Noel W. Solomons, Anne Marie
Chomat, Marilyn E. Scott, Kristine G. Koski. FASEB J. San Diego, 2014.
(623.21). Poster.
Comparison of mineral content in breast milk between early and late lactation
among Indigenous women from the Western Highlands of Guatemala. Chen Li,
Hilary Wren, Ran Xu, Noel W. Solomons, Anne Marie Chomat, Marilyn E.
Scott, Kristine G. Koski. FASEB J. San Diego, 2014. (623.11). Poster.
2009 – 2010
Public Health Planner
Communicable Disease, Dental & Sexuality
Resources Department
Region of Waterloo Public Health (ROWPH);
Information Program and Planning Team
Waterloo, ON
2008 - 2010
Research Assistant
Department of Social, Prevention & Health Policy
Centre for Addition and Mental Health (CAMH)
Social & Community Prevention Research
Toronto, ON
2006- 2008
Medical Record Coordinator
MEDCAN Health Management Inc.
Toronto, ON
SELECTED HONORS AND AWARDS
2016
2016
2016
2015
2015
2014
2014
2013
2013
2013
2012
2012
2011
2011
2011
2010
American Society of Nutrition (ASN): Clinical
Emerging Leader Award Oral Competition
American Society of Nutrition (ASN): Emerging
Leaders in Nutrition Science Poster Competition.
The International Society for Research in Human
Milk and Lactation (ISRHML) Trainee Award.
Funded in part by Bill & Melinda Gates Foundation.
Institute of Parasitology/Centre for Host and Parasite
Interactions Bridge Funds, McGill University
Graduate Excellence Award in Dietetics and
Human Nutrition
Catherine Freeman Fellowship in Human Nutrition
Christine Gagnon Memorial Scholarship
Graduate Excellence Award in Dietetics and Human
Nutrition
Catherine Freeman Fellowship in Human Nutrition
Graduate Research Mobility Travel Award
Graduate Excellence Award in Dietetics and Human
Nutrition
Graduate Research Enhancement and Travel Award
Catherine Freeman Fellowship in Human Nutrition
McGill University Graduate Excellence Award
McGill University Graduate Travel Award
McGill University Provost Graduate
Entrance Scholarship
SELECTED VOLUNTEER EXPERIENCE
2016
Syrian Refugee Sponsorship Group
Guelph, Ontario
2014
Social Equity & Diversity Education Office:
Calendar Project
McGill University, Montreal
2003
World University Service of Canada (WUSC):
Canada World Youth
Costa Rica
LANGUAGE SKILLS
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Spanish (basic oral)
French (basic oral)
American Sign Language (intermediate)