The role of antenatal oestrogen in post-partum human lactogenesis: evidence from oestrogen-deficient pregnancies.

Five women with severe ante-partum oestrogen deficiency (in four due to placental steroid sulphatase deficiency and in one due to an unknown cause) had low concentrations of PRL in peripheral plasma at delivery and in the puerperium. These women were unable to establish lactogenesis as assessed from plasma alpha-lactalbumin concentrations on day 4 post-partum. It is concluded that ante-partum oestrogen is required both to ensure adequate PRL secretion and to permit lactogenesis in breast tissue in response to PRL. A review of patients' records in another nine cases of placental steroid sulphatase deficiency indicates that failure to establish breast feeding is a common feature.