Breast Milk Concentrations Research Articles

Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants.

Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth—particularly brain development—that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification—including targeted and adjusted fortification—show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.

The Role of Iodine for Thyroid Function in Lactating Women and Infants.

Iodine is a micronutrient needed for the production of thyroid hormones, which regulate metabolism, growth, and development. Iodine deficiency or excess may alter the thyroid hormone synthesis. The potential effects on infant development depend on the degree, timing, and duration of exposure. The iodine requirement is particularly high during infancy because of elevated thyroid hormone turnover. Breastfed infants rely on iodine provided by human milk, but the iodine concentration in breast milk is determined by the maternal iodine intake. Diets in many countries cannot provide sufficient iodine, and deficiency is prevented by iodine fortification of salt. However, the coverage of iodized salt varies between countries. Epidemiological data suggest large differences in the iodine intake in lactating women, infants, and toddlers worldwide, ranging from deficient to excessive intake. In this review, we provide an overview of the current knowledge and recent advances in the understanding of iodine nutrition and its association with thyroid function in lactating women, infants, and toddlers. We discuss risk factors for iodine malnutrition and the impact of targeted intervention strategies on these vulnerable population groups. We highlight the importance of appropriate definitions of optimal iodine nutrition and the need for more data assessing the risk of mild iodine deficiency for thyroid disorders during the first 2 years in life.

Assessment and Factors Influencing Protein Content of Human Breast Milk at Various Stages of Lactation in Yobe State Nigeria

Aims: Aim: Protein in breast milk has diverse functions which gives short and long term benefits. This means human milk must adequately supply the nutritional needs of infants especially during the period of exclusive breast feeding as mandated for lactating mothers. The study assessed quantity of proteins in lactating stages of mother’s breast milk and the factors that influence its availability in Yobe State, Nigeria.
 Study Design: Quantitative experimental and descriptive survey methods were adopted for the study. Quantitative experimental design was used for the analysis of breast milk samples collected while descriptive survey method was used to derive primary and secondary data to determine factors influencing protein in breast milk.
 Place and Duration of Study: The collection of the samples was done in three stages of lactation from October to December (2019) in Yobe State, Nigeria.
 Methodology: Primiparous women residing in Nguru (n= 49/town) were recruited base on agreement with the hospitals prior to their delivery. Breast milk samples were collected at three stages of lactation; colostrums (1-2 days), transition (12 day) and mature (30 day) for protein analysis. Descriptive survey through structured questionnaire was adopted to derive primary data which was used to determine nutrition during pregnancy and factors influencing breast milk composition.
 Results: The mean proteins are 3.88%, 1.79% and 1.23% for colostrum, transition and mature milk respectively. It showed that breast milk is a dynamic fluid with changes in its protein content over the course of lactation and varies within and between nutrition and between mothers. Those with low, normal and high BMI accounted for 6.1%, 81.6% and 12.2% respectively. Based on WHO standard, 82% of the women has normal BMI during pregnancy which translate good nutrition.
 Conclusion: The nutrition of the pregnant women influenced breast milk proteins. Age, ethnicity, religion and parity have no significant effect on protein quantity in breast milk. Increased education stratification and income levels contribute positively to proteins in lactation stages.

Acrylamide Content in Breast Milk: The Evaluation of the Impact of Breastfeeding Women's Diet and the Estimation of the Exposure of Breastfed Infants to Acrylamide in Breast Milk.

Acrylamide in food is formed by the Maillard reaction. Numerous studies have shown that acrylamide is a neurotoxic and carcinogenic compound. The aim of this study was to determine the level of acrylamide in breast milk at different lactation stages and to evaluate the impact of breastfeeding women’s diet on the content of this compound in breast milk. The acrylamide level in breast milk samples was determined by LC–MS/MS. Breastfeeding women’s diet was evaluated based on the 24 h dietary recall. The median acrylamide level in colostrum (n = 47) was significantly (p < 0.0005) lower than in the mature milk (n = 26)—0.05 µg/L and 0.14 µg/L, respectively. The estimated breastfeeding women’s acrylamide intake from the hospital diet was significantly (p < 0.0001) lower than that from the home diet. We found positive—although modest and borderline significant—correlation between acrylamide intake by breastfeeding women from the hospital diet µg/day) and acrylamide level in the colostrum (µg/L). Acrylamide has been detected in human milk samples, and a positive correlation between dietary acrylamide intake by breastfeeding women and its content in breast milk was observed, which suggests that the concentration can be reduced. Breastfeeding women should avoid foods that may be a source of acrylamide in their diet.

Docosahexaenoic acid-rich algae oil supplementation on breast milk fatty acid profile of mothers who delivered prematurely: a randomized clinical trial

Preterm infants are deficient in long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), a fatty acid (FA) associated with an increase in bronchopulmonary dysplasia (BPD). In two previous randomized control trials, DHA supplementation did not reduce the risk of BPD. We examined the breast milk FA profile, collected 14 days after birth, of mothers who delivered before 29 weeks of gestation and who were supplemented with DHA-rich algae oil or a placebo within 72 h after birth as part of the MOBYDIck trial. Milk FA were analyzed by gas chromatography. The total amount of FA (mg/mL) was similar in both groups but the supplementation increased DHA (expressed as % of total FA, mean ± SD, treatment vs placebo, 0.95 ± 0.44% vs 0.34 ± 0.20%; P < 0.0001), n-6 docosapentaenoic acid (DPA) (0.275 ± 0.14% vs 0.04 ± 0.04%; P < 0.0001) and eicosapentaenoic acid (0.08 ± 0.08% vs 0.07 ± 0.07%; P < 0.0001) while decreasing n-3 DPA (0.16 ± 0.05% vs 0.17 ± 0.06%; P < 0.05). Supplementation changed the ratio of DHA to arachidonic acid (1.76 ± 1.55% vs 0.60 ± 0.31%; P < 0.0001) and n-6 to n-3 FA (0.21 ± 0.06% vs 0.17 ± 0.04%; P < 0.0001). DHA-rich algae supplementation successfully increased the DHA content of breast milk but also included secondary changes that are closely involved with inflammation and may contribute to changing clinical outcomes.

Pharmacokinetic study of clarithromycin in human breast milk by UPLC–MS/MS

This study aimed to develop a validated UPLC-MS/MS method for pharmacokinetic analysis of clarithromycin in human breast milk. For sample preparation, proteins precipitated with methanol and azithromycin were used as internal standards. Clarithromycin and azithromycin detection was achieved using electrospray ionization in positive mode. The chromatographic separation time was 5 min. The lower limit of quantification was 50 ng/mL. The calibration curve of clarithromycin was 50–4000 ng/mL, with a correlation coefficient> 0.99. The method was successfully applied to determine clarithromycin levels in breast milk obtained from a lactating mother after oral administration of a single tablet containing 500 mg of clarithromycin. The maximum human breast milk concentration (Cmax) was 3660 ng/mL, the time to reach the maximum concentration (tmax) was 2.5 h, and the area under curve (AUC0–24) was 18450 ng h/mL. The present study provides a novel UPLC–MS/MS method for pharmacokinetic analysis of clarithromycin in breast milk.

Determination of Dabigatran Concentration in Human Plasma and Breast Milk.

Venous thromboembolism (VTE) is an important cause of death following childbirth. Dabigatran etexilate can be a useful prophylaxis in susceptible women during the postpartum period. However, it is not clear whether dabigatran is excreted into breast milk in amounts which can be harmful to the suckling baby. We have developed an accurate, sensitive, and specific assay for the quantitation of dabigatran in both human plasma and breast milk. This is particularly useful for the determination of the extent by which dabigatran is secreted into breast milk in relation to its systemic availability. Dabigatran was enriched from both matrices using solid-phase extraction prior to separation on a C8-RPLC column and detection using SRM on a QqTrap mass spectrometer. The assay was validated for specificity, sensitivity, linearity, precision, accuracy, and stability of the analyte in human plasma and breast milk. The lower limit of detection for dabigatran was 20 pg/ml in plasma and 75 pg/ml in breast milk. This assay will aid future studies for the measurement of dabigatran concentrations in human breast milk to help determine if dabigatran etexilate can safely be administered to breast-feeding women.

Egyptian Mother’s Breast Milk: Protein and Lipid Content in Correlation with Growth of Their Newborns

Abstract Background Infant growth is a big concern among the community, mothers and the pediatricians, this study focused on what can affect newborns growth in Egyptian community. Objective Primary objective to detect the relationships between protein and lipid content of the breast milk of Egyptian women with their infant’s growth. Secondary objective is to correlate protein and lipid content in the mother’s milk and their diet. Patients and Methods This is a cohort study done on 30 infant in Ain Shams University for a period of six months.history was taken by questionnaire about infant’s Gestational age. parity. Dietetic history of infant (breast fed, frequency of feeds),Mother’s age, education, address, body weight, height, BMI and maternal illness. Mother’s dietetic history by 24 hour recall.breast milk samples was collected by hand expression between 4 and 8 weeks of lactation, kept frozen at20 °C. Triglyceride (fat) concentrations were measured in homogenized HM samples using H-Nuclear magnetic resonance (NMR) spectra. For protein, total nitrogen was measured by the Dumas method. Results The growth rate range of infants under study was (18gm/day _ 28gm/day). Protein content of mother’s milk lowest value was 0.7gm, and highest value was 1.9gm. Lipid content of mother’s milk lowest value was 3.1gm, and highest value was 5.6gm. Lactose content of mother’s milk lowest value was 5.9gm, and highest value was 7.4gm.Caloric content of maternal diet lowest value was 1013kcal/day and highest value was 2818kcal/day. the protein of breast milk has a direct positive effect on Infant’s growthrate(r = 0.735,p=0.000)weight(r = 0.689,p=0.000)and z score(r = 0.573, p = 0.001).lipid content of breast milk has a positive effect on Infant’s growthrate(r = 0.677,p=0.000)weight(r = 0.742,p=0.000)and zscore(r = 0.592,p=0.001). Protein of maternal diet has an impact on the protein content of her breast milk(r = 0.719,p=0.000)and lipid content of breast milk(r = 0.712, p = 0.000).lipid of maternal diet has no effect on lipid content of breast milk(r = 0.127,p=0.52)and protein of breast milk (r = 0.118,p=0.536).caloric intake of mothers has positive effect on protein of breast milk(r = 0.599,p=0.000),and lipid of breast milk(r = 0.496,p=0.005). Conclusion Protein content of breast milk of mothers positively affects growth rate weight and height of their infants. (P value 0.000, 0.001,0.005 respectively). As protein content of breast milk exceeds 1.1gm/dl infant kept same or higher weight/height centile and z score. As lipid content of breast milk exceeds 4mg/dl infant kept same or higher weight/height centile and z score. Protein content of breast milk is positively affected by protein in maternal diet(r = 0.747,P 0.000) and her total caloric intake(r = 0.519,p 0.005).lipid content of breast milk is positively affected by protein content of maternal diet (r = 0.719,P 0.000)and her total caloric intake(r = 0.496,p 0.005).

Energy content of milk from nursing mothers of premature infants and its relationship with caloric intake and maternal sociodemographic characteristics/ Conteúdo energético do leite de nutrizes de lactentes prematuros e sua relação com a ingestão calórica e com características sociodemográficas maternas

Aim: To evaluate the energy content of milk of nursing mothers of premature infants and identify whether there is association with caloric intake and maternal sociodemographic variables. Methods: analytical, cross-sectional study with milk donated by 18 nursing mothers of premature infants admitted to the Neonatal Intensive Care Unit of the National Institute of Woman, Child and Adolescent Health - IFF/Fiocruz. The energy content of breast milk was evaluated by crematocrit, by the human milk bank. To assess maternal food consumption, the Food Frequency Questionnaire was used and sociodemographic data were obtained from interviews with the nursing mothers. Data were evaluated using the SPSS 22.0 software.Results: It was found that 89% of the milk collected was normocaloric, with an average energy content of 597.2 ± 79.1 kcal/L and that most of the milk expressed was colostrum. The average caloric intake of the nursing mothers was 2554 ± 413.1 kcal/day and the consumption of polyunsaturated fats, which corresponded to 3.5% of the total energy intake, was below the recommendation. There was no association between the energy content of human milk and the studied variables, but there was a tendency for nursing mothers living outside the city of Rio de Janeiro to have a higher caloric content in milk (p = 0.06).Conclusion: The human milk samples were normocaloric, maternal food consumption was inadequate for polyunsaturated fats and there was no association of sociodemographic variables or maternal caloric intake with the energy content of human milk.

Impact of maternal nutrition during early pregnancy and diet during lactation on lactoferrin in mature breast milk

ObjectiveLactoferrin supplementation is a promising strategy to prevent infections in neonates. Exploring whether maternal nutritional status in early pregnancy and maternal diet during lactation are associated with lactoferrin concentrations in mature human milk can provide early warning and allow timely adjustment. MethodsIn this follow-up cohort study, 206 participants were recruited at Peking University People's Hospital from June 2018 to June 2019. The levels of albumin and thyroid-stimulating hormones (TSH) were determined as nutritional indicators during early pregnancy. Information on maternal diet during lactation was collected with a semiquantitative food frequency questionnaire, and the lactoferrin concentrations in breast milk were examined at around 42 d postpartum. ResultsThe median level (interquartile range) of lactoferrin in breast milk was 2844.2 (2568.1, 3103.1) μg/mL. Overall, 5.5% of participants had lower albumin (<40 g/L), and 21.6% had elevated TSH (>2.5 mIU/L), respectively. The concentration of lactoferrin was higher (216.8 [13.4, 420.2] μg/mL) in women with lower albumin levels than in those with normal levels, and elevated TSH had no effect. A 1 g increase in egg intake led to a 0.3 (0.0, 0.6) μg/mL increase in lactoferrin concentration. Lactoferrin levels were also affected by intake of energy, protein, cholesterol, and vitamin A. ConclusionsWomen with lower albumin levels in early pregnancy had higher levels of lactoferrin in mature breast milk. TSH was not related to lactoferrin levels. Intake of energy, protein, cholesterol, and vitamin A may have contributed to lactoferrin concentrations in milk, and egg intake was positively associated with lactoferrin.

MAKING PREGNANCY A MISSED OPPORTUNITY FOR TREATMENT OF TUBERCULOSIS INFECTION : A SYSTEMATIC REVIEW

Background : Eleven million Americans, representing 4% of the U.S. general population, are estimated to have latent tuberculosis infection (LTBI). In countries with low TB incidence, immigrant from higher incidence countries form the major pool of infected individuals. To understand the prevalence, screening and management of TBI in pregnancy. Methods : A systematic review of 4 databases (Embase, Embase Classic, Medline, Cochrane Library) covering articles published from January 1st 2010 to April 30th 2018. Articles in English with relevant information on prevalence, screening strategies and treatment of TBI during pregnancy were eligible for inclusion. Results : Of 193 titles initially identified, 108 abstracts were eligible for review. Of these, 86 articles qualified for full text review and 22 were retained: 3 cohort studies, 2 case-control studies, and 17 cross-sectional studies. In the USA, the estimated prevalence of TBI ranged from 14 to 48% in women tested, and tuberculin skin test (TST) positivity was associated with ethnicity. The proportion of women who attended follow-up visits after positive tuberculin tests varied from 14 to 69%, while 5 to 42% of those who attended follow-up visits completed a minimum of 6 months of isoniazid treatment. One study raised the possibility of an association of pregnancy/post-partum state with INH hepatitis (risk ratio 2,5, 95% CI 0.8–8.2) and fatal hepatotoxicity (rate ratio 4.0, 95% CI 0.2–258). One study deemed INH safe during breastfeeding based on peak concentrations in plasma and breast milk after INH administration. Conclusion : Pregnancy is an opportunity to screen for TBI. Interferongamma release assays are likely comparable to tuberculin skin tests and may be used during pregnancy. Efforts should be made to improve adherence with follow-up and treatment post-partum. Further data are needed with respect to safety and feasibility of antepartum INH therapy, and with respect to alternative treatment regimens.

Influence of Breastfeeding Factors on Polyamine Content in Human Milk.

The polyamine content of human breast milk, which is the first exogenous source of polyamines for the newborn, can be affected by several factors associated with the mother, the infant, or breastfeeding itself. The aim of this study was to evaluate the influence of different breastfeeding factors on the polyamines found in human milk. For this study, a cohort of 83 mothers was considered for up to 4 months, and a subgroup of 33 mothers were followed during the first six months of breastfeeding. Two breast milk samples were collected at each sampling point (foremilk and hindmilk) and the polyamine content was determined by UHPLC-FL. Polyamine levels varied considerably between the mothers and tended to decrease over time. Putrescine was the minor polyamine, whereas spermidine and spermine contents were very similar. The concentrations of the three polyamines were significantly higher in hindmilk than foremilk (p < 0.001). Spermidine and spermine levels decreased significantly through the lactation progress (p < 0.05). Finally, slightly higher levels of polyamines were observed in the milk of mothers providing partial, rather than full, breastfeeding, although the differences were not significant. The polyamine content in human milk was found to change during a single feed (foremilk versus hindmilk) and as lactation progressed, mainly in response to the specific circumstances of the newborn.

Drug and Neurofilament Levels in Serum and Breastmilk of Women With Multiple Sclerosis Exposed to Natalizumab During Pregnancy and Lactation.

ObjectiveTo determine the transfer of the monoclonal antibody natalizumab into breastmilk and to evaluate drug and serum neurofilament light chain ((s)NfL) levels in natalizumab exposed pregnancies and lactation periods.MethodsEleven women with relapsing remitting multiple sclerosis treated with natalizumab during pregnancy and lactation were included in this study. Breastmilk samples were collected up to 302 days after delivery and analyzed for natalizumab concentration and NfL. Additionally, maternal drug levels and sNfL were determined preconceptually, in each trimester, at delivery and postpartum. Clinical and radiological disease activity was systemically assessed across pregnancy and postpartum period.ResultsThe mean average natalizumab concentration in breast milk was low at 0.06 µg/ml [standard deviation (SD) 0.05] in the eight patients who provided serial breastmilk samples with an estimated mean absolute infant dose of 0.007 mg/kg/d (SD 0.005). The relative infant dose (RID), a metric comparing the infant with maternal drug exposure was low as well with a mean of 0.04% (SD=0.03). Most patients had a maximum concentration in breast milk at one to eight days after infusion. Pregnancy was associated with a non-significant decline of the median natalizumab serum concentration. All patients exposed to natalizumab prior (n=10) and during pregnancy (n=11) kept free of disease activity during gestation. While pregnancy was associated with low sNfL levels in patients treated with natalizumab prior and during pregnancy, the postpartum period was linked to a transient sNfL increase in some patients without any evidence of clinical or radiological disease activity. NfL was detectable in the majority of breastmilk samples with a median concentration of 1.7 pg/ml (range 0.004-18.1).ConclusionWe determined transfer of natalizumab into breastmilk with an RID far below the threshold of concern of 10%. Studies including childhood development assessment are needed in order to gain safety data about natalizumab-exposed breastfeeding. SNfL assessment might be a useful adjunct to monitor silent disease activity and therapeutic response during pregnancy and postpartum period. However, further investigations regarding transient postpartum sNfL increases are required to determine its association to parturition per se or to a silent disease activity in people with multiple sclerosis.

Systematic Review : Immunoglobulin Concentration in Breast Milk as a Body Defense against Sars-Cov-2

The largest cases of pneumonia occurred in Wuhan City, Hubei Province of China in December 2019, which resembles SARS-CoV as a cause of SARS (Severe Acute Respiratory Syndrome) virus infection. The number of cases reaches 3.2 million people worldwide, and among them are breastfeeding mothers. Although virus transmission occurs through direct contact with infected patients, the number of infants or young children who were infected with COVID-19 during breastfeeding was only 10%. There is no scientific evidence for vertical transmission from mother to her baby during pregnancy and breastfeeding. The content of immunoglobulin A (IgA), immunoglobulin M (IgM), and immunoglobulin G (IgG) has a positive impact on the infant’s body. The objective of the study was to determine the immunoglobulin concentration in breast milk against SARS CoV2. The method used a systematic review approach with the design of Preferred Reporting Items For Systematic Reviews &amp; Meta-Analyses (PRISMA). The result showed laboratory clinical trials, the IgA, IgG, and IgM responses showed good results in the spread of the coronavirus into the baby's body. IgA reactivity has a higher concentration than other cells. In conclusion, Covid-19 pandemic made the public worried about their health, including breastfeeding mothers. The role of health workers is needed to provide information related to breastfeeding exclusively to their babies so that they will receive protection against virus entered their bodies. Suggestion: It is necessary to develop studies regarding the typical responses that come up from IgA, IgM, IgG and are able to protect infants from Covid-19 and vertical transmission between mother and her baby during pregnancy to breastfeeding.

The Frequency of Antenatal Care with The Risk of Failure to Breastfeeding for Infants Aged 3-6 Months

Antenatal care during pregnancy has an influence on fetal growth and a mother's readiness to prepare for labor and breastfeeding. Failure to provide exclusive breastfeeding can have a potential death impact on children, because exclusive breastfeeding is the basis for children's survival and children's health because of the irreplaceable nutritional content of breast milk for children's growth and development. This study aimed to determine the correlation between ANC frequency and the risk of breastfeeding failure to infants aged 3-6 months. The study method used Analytical Study with the Case Control approach. The sample in this study was 20 mothers who had babies aged 3 months and were divided into 2 groups, namely the case group and the control group with purposive sampling technique. In this study, cases and controls were not matched. The data analysis used the Fisher Extact test and the odds ratio of case exposure was indicated by a value of ρ &lt;0.05 and an OR value&gt; 1 to determine the amount of risk that occurred in the variable. The results showed that there was no correlation between ANC frequency and failure to administer breast milk for infants aged 3-6 months. The frequency of ANC that was incomplete could have a risk of failure of breastfeeding in infants aged 3-6 months by 2.333 times compared to mothers with the frequency of complete ANC. It is hoped that this study can be continued by paying attention to confounding factors and seeing the correlation between variables.

Optimization of the micronutrients sufficiency of feeding women and children on exclusively breastfeeding by enriching of the woman diet

A significant part of pregnant and lactating women have a lack of several micronutrients at once (vitamin D, group B, iodine, iron, etc.). The secretion of vitamins A, E, D, C, B1, B2, B6, B12, iodine and selenium into breast milk decreases with their insufficient consumption and insufficient provision of the nursing mother. The content of folates, calcium, magnesium, phosphorus in breast milk is maintained even if they are insufficient in the mother, however, enriching the diet with them during breastfeeding, improving the status of the mother, prevents the depletion of reserves in her body. The iron and zinc content in breast milk is determined by the mothers status during pregnancy. The intake of vitamin-mineral supplements or food products enriched with micronutrients during the pregravid period, during pregnancy and lactation leads to an improvement in the provision of a woman and her child by increasing the content of vitamins, iodine and selenium in breast milk. The use of vitamin-mineral supplements is an effective way not only to eliminate multiple micronutrient deficiencies in the diet and improve the status of a lactating woman, but also to optimize the vitamin composition of breast milk and the provision of an exclusively breastfed baby.

Influence of Vitamin D3 Levels and T Cell-Related Cytokines in Human Milk on Coronavirus Disease 2019 Infection in Lactating Women.

Background: Vitamin D deficiency was associated with an increased risk of coronavirus disease 2019 (COVID-19) infection. Vitamin D deficient mothers are more likely to have infants with vitamin D deficiency, affecting their immunity and protection against infection. This study aimed at comparing the concentrations of vitamin D3 and T cell-related cytokines in milk between mothers with confirmed COVID-19 polymerase chain reaction (PCR) test, mothers with viral infections suggestive of COVID-19, and mothers without infection. Materials and Methods: Concentrations of vitamin D3 and T cell-related cytokines in milk samples were determined by ELISA from 10 mothers who had a positive COVID-19 PCR test, 10 mothers with viral symptoms suggestive of COVID-19, and 20 mothers without infection. Results: Vitamin D3 concentration in human milk was higher in women without infection than in women with viral symptoms or COVID-19 PCR. Interleukin-2 level in milk was higher in the no-infection group than the COVID-19 PCR group but it did not differ with the viral symptoms group. Vitamin D3 did not correlate with any cytokines in human milk. Prenatal vitamin intake did not affect the vitamin D3 in human milk. The percentage of milk from mothers with <20 ng/mL of vitamin D3 was 50% in the COVID-19 PCR group, 60% in the viral symptoms group, and 5% in the no-infection group. Conclusions: Vitamin D3 level in breast milk may influence maternal immunity against COVID-19 infection. A larger study is needed to evaluate the relationship between vitamin D3 concentration in breast milk, maternal immune response, and the incidence of COVID-19 infection in lactating mothers.

Trace element levels in mature breast milk of recently lactating Japanese women.

Many trace elements are essential for infant growth and development during early life. Their concentrations in breast milk vary depending on social and economic factors. Nonetheless, the present available values in Japan were derived from lactating mothers approximately 15 years ago. Healthy mothers who gave birth to a single infant after 37weeks of gestation at Teikyo University Hospital were recruited between July 2016 and December 2017. They were encouraged to collect breast milk samples and a self-administered food frequency questionnaire at 1 and 3months postpartum. Anthropometric data for the mothers and their infants were also collected. Overall, 79 subjects were analyzed after excluding subjects with inadequate data in the food frequency questionnaire, insufficient breast milk samples, and medication that could affect dietary intakes. Trace element concentrations were determined by inductively coupled plasma mass spectrometry, and their correlation with several factors were investigated. Trace element concentrations were widely distributed as previously reported. Median concentrations of Cr, Mn, Fe, Cu, Zn, Se, and Mo were 0.8, 0.8, 98, 50, 272, 2.2, and 0.7µg/dL at 1month postpartum and 0.6, 0.7, 55, 33, 177, 2.1, and 0.7µg/dL at 3months postpartum, respectively. There were no correlations between trace element concentrations and either mothers' intakes or infants' growth. In contrast, there were significant correlations between several trace elements and macronutrients in addition to inter-element correlations among almost all trace elements. Trace element concentrations in mature breast milk were determined from recently lactating mothers in Japan.

Osteopontin Levels in Human Milk Are Related to Maternal Nutrition and Infant Health and Growth

Background: Osteopontin (OPN) is a glycosylated phosphoprotein found in human tissues and body fluids. OPN in breast milk is thought to play a major role in growth and immune system development in early infancy. Here, we investigated maternal factors that may affect concentrations of OPN in breast milk, and the possible associated consequences for the health of neonates. Methods: General characteristics, health status, dietary patterns, and anthropometric measurements of 85 mothers and their babies were recorded antenatally and during postnatal follow-up. Results: The mean concentration of OPN in breast milk was 137.1 ± 56.8 mg/L. Maternal factors including smoking, BMI, birth route, pregnancy weight gain, and energy intake during lactation were associated with OPN levels (p < 0.05). Significant correlations were determined between body weight, length, and head circumference, respectively, and OPN levels after one (r = 0.442, p = < 0.001; r = −0.284, p = < 0.001; r = −0.392, p = < 0.001) and three months (r = 0.501, p = < 0.001; r = −0.450, p = < 0.001; r = −0.498, p = < 0.001) of lactation. A negative relation between fever-related infant hospitalizations from 0–3 months and breast milk OPN levels (r = −0.599, p < 0.001) was identified. Conclusions: OPN concentrations in breast milk differ depending on maternal factors, and these differences can affect the growth and immune system functions of infants. OPN supplementation in infant formula feed may have benefits and should be further investigated.

Plasma and Breast Milk Pharmacokinetics of Tenofovir Disoproxil Fumarate in Nursing Mother with Chronic Hepatitis B-Infant Pairs.

Tenofovir use is associated with lower risk of mother-to-infant transmission of the virus, and discontinuation of the treatment is not safe. However, the safety of the drug during pregnancy and breastfeeding is not clear. In this study, we aimed to determine the tenofovir concentration in plasma of mother-infant pairs along with breast milk in chronic hepatitis B patients during the lactation period. A total of 11 mother-infant pairs were enrolled in the study. All the mothers received tenofovir disoproxil fumarate (TDF) 245 mg/day for at least 1 month because of chronic hepatitis B infection. Maternal blood, breast milk, and infant blood samples were obtained concomitantly. Tenofovir concentrations were determined by liquid chromatography-tandem mass spectrometry. The median concentrations of tenofovir in maternal plasma and breast milk samples were 88.44 (interquartile range [IQR], 62.47 to 116.17) ng/ml and 6.69 (IQR, 4.88 to 7.03) ng/ml, respectively. Tenofovir concentrations were undetectable (<4 ng/ml) in all of the infant plasma samples. The ratio of tenofovir concentration in breast milk to that in maternal plasma was 0.07. Tenofovir disoproxil fumarate passes through the breast milk in a small amount. Infants had no detectable tenofovir level in their plasma. Our study suggests that tenofovir disoproxil fumarate treatment is safe during the breastfeeding period in chronic hepatitis B patients.