Breast Milk Concentrations Research Articles

Sleep duration of lactating mothers and its relationship with feeding pattern, milk macronutrients and related serum factors: A combined longitudinal cohort and cross-sectional study.

ObjectiveInsufficient sleep is common in postpartum mothers. The main objectives of this study are to explore the sleep duration among Chinese lactating mothers and preliminarily investigate the relationship between sleep duration and feeding pattern. The secondary objectives are to investigate the relationships between sleep duration and milk macronutrients and between maternal-related indicators, including melatonin (MT), growth hormone (GH), ghrelin (GHRL), glucagon-like peptide-1 (GLP-1), prolactin (PRL), and cholecystokinin (CCK).MethodsThe present study comprises a longitudinal and a cross-sectional cohort from December 2019 to December 2021. Postpartum lactating women living in Shanghai were recruited through online and offline recruitment. The subjects were included in the longitudinal cohort or cross-sectional study based on their lactation period at the time of recruitment. The longitudinal cohort included a total of 115 mothers. Human milk and feeding pattern were measured and collected at 2–4 months and 5–7 months postpartum. At four predetermined follow-up time points, data on sleep duration was collected (at the time of recruitment, 2–4 months postpartum, 5–7 months postpartum, and 12–17 months postpartum). The cross-sectional study included 35 lactating mothers (2–12 months postpartum) who reported their sleep duration and provided blood samples. Mid-infrared spectroscopy (MIRS) method was used to analyze the macronutrients of breast milk, while MT, GH, GHRL, GLP-1, PRL, and CCK in maternal blood were determined by ELISA.ResultsThe maternal sleep duration before pregnancy was 8.14 ± 1.18 h/d (n = 115), 7.27 ± 1.31 h/d (n = 113) for 2–4 months postpartum, 7.02 ± 1.05 h/d (n = 105) for 5–7 months postpartum, and 7.45 ± 1.05 h/d (n = 115) for 12–17 months postpartum. The incidence of insufficient sleep (<7 h/d) before pregnancy (12.17%) was significantly less than at any follow-up time after delivery (vs. 2–4 months postpartum, χ2 = 10.101, p = 0.001; vs. 5–7 months postpartum, χ2 = 15.281, p < 0.0001; vs. 12–17 months postpartum, χ2 = 6.426, p = 0.011). The percentage of insufficient maternal sleep was highest at 5–7 months postpartum (34.29%). No significant difference was found between the incidence of insufficient sleep at 5–7 months postpartum, 2–4 months postpartum (29.20%, χ2 = 0.650, p = 0.420), and 12–17 months postpartum (25.22%, χ2 = 2.168, p = 0.141). At 2–4 months postpartum, the frequency of formula feeding per day is related to reduced maternal sleep duration (Standardization coefficient β = −0.265, p = 0.005, Adjusted R2 = 0.061). At 2–4 months and 5–7 months postpartum, the relationship between macronutrients in breast milk and the mother's sleep duration was insignificant (all p > 0.05). Other than the positive correlation found between maternal GHRL and sleep duration (r = 0.3661, p = 0.0305), no significant relationship was observed between sleep duration and other indexes (all p > 0.05).ConclusionsPostpartum mothers generally sleep less, but there is no correlation between insufficient sleep and the macronutrient content of breast milk. Formula feeding may be related to the mother's sleep loss, while breastfeeding (especially direct breastfeeding) may be related to increased maternal sleep duration. The findings suggest that sleep duration is related to maternal serum GHRL. More high-quality studies are needed to clarify the mechanism of these findings and provide a solid theoretical basis and support references for breastfeeding.

The Content of Breast Milk and the Challenges Experienced by Breastfeeding Mothers during the COVID-19 pandemic: A Systematic Review

Introduction: Every postpartum mother is recommended to breastfeed her baby because breast milk is the main need of newborns. The COVID-19 pandemic has had an impact on life in various aspects, including on the breastfeeding mothers, especially if they suffer from COVID-19 infection. Aim: The study aims to provide comprehensive evidence regarding potential virus transmission and antibody transfer through breastmilk and the experiences of mothers related to breastfeeding during the COVID-19 pandemic. Methods: A systematic review was conducted following the PRISMA guidelines. The search strategy involved the use of keywords related to COVID-19 and breastfeeding in PubMed and Science Direct databases. Articles were selected according to inclusion and exclusion criteria. Results: Breastfeeding has been recommended to be continued during the pandemic due to the benefits associated with it and the absence of sufficient evidence for transmission of COVID-19 infection through breast milk. During the lockdown period, there was a change in breastfeeding patterns, although most mothers believed that breastfeeding should be continued. Anxiety and lack of support affected breastfeeding practices. Breastfeeding mothers reported a dilemmatic situation. They felt protected because of the lockdown policy but also struggled to get support from their social environment. The impact varied in terms of stopping breastfeeding practice altogether, breastfeeding irregularly, and even giving formula milk. Conclusion: Adherence to health protocols can reduce the risk of transmission of COVID-19 infection through breastfeeding from mother to baby. Support from the family and the environment is needed to ensure the continuity of breastfeeding practice.

The Relationship of Adolescent Motherhood to the Macronutrient Content of Breast Milk.

Objective: Breast milk is the best nutrient for newborns due to its rich dietary content, immunological factors, ease of accessibility, and affordability. Given the fact that adolescent birth rate in Turkey is high, this study examines the effects of adolescent motherhood with regard to macronutrient contents in breast milk. Study Design: We collected colostrum samples from mothers staying at our hospital. Gestational ages were ≥37 weeks. Demographic characteristics of the patients were registered. The MIRIS (Mid-Infrared Human Milk Analyzer) device was operated to analyze breast milk, adopting a spectroscopy method for measurements. Protein, fat, carbohydrate, and energy levels of the hindmilk samples were measured; thus, study groups were compared. Results: The study included 224 mothers, of whom 49 were adolescents and 125 were adults. Maternal weight and maternal body mass index, weight gain during pregnancy, mode of delivery and gestational age, as well as birth weight and gender of the infants were similar. As breast milk contents were compared, we found out that fat content levels in the colostrum of adolescent mothers were significantly higher, with respect to the other group. Protein and carbohydrate levels were lower in adolescents, even if they were not statistically significant. There was no difference between the groups in terms of energy levels. Conclusion: Adolescent motherhood may have negative influences on infant welfare. However, in terms of breast milk content quality, adult mothers are not superior to adolescents.

Interaction between maternal dietary fat intake, breast milk omega-3 fatty acids and infant growth during the first year of life.

Long chain fatty acids (LCFA) of human milk (HM) might be associated with different patterns of weight gain in infancy. This study aims to examine the interaction between maternal dietary fat intake, breast milk content of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) with infant growth during the first year of life. This longitudinal study was conducted among 215 Iranian mother-infant pairs. The infants were followed up from birth to 12 months of age. Trained healthcare providers measured infant anthropometrics including weight, length and head circumference at birth, 2, 4, 6 and 12 months of age. Breast hind milk samples were collected in the morning through hand expression between 6 and 12 weeks postpartum. Maternal dietary intake was assessed using a 3-day dietary record. Linear mixed effects models were performed to determine the interaction between maternal dietary fat intake, the breast milk content of EPA and DHA with infant growth. Further adjustments were applied for potential confounders. Mean and standard deviation (SD) of maternal age and body mass index were 29.70 (5.24) years and 24.47 (4.42)kg/m2 , respectively. Mean (SD) of infant birth weight was 3177.50 (413.20)g, and 50% were boys. An inverse interaction existed between maternal dietary fat intake and breast milk EPA with infant 4-month weight (β: -366.2, P-value: 0.01). We found a significant association of maternal dietary fat intake and infant 6-month weight (β: 22.5, P-value: 0.04). An inverse interaction was documented between maternal dietary fat intake and breast milk DHA with infant weight at 12-month of age (β: -95.3, P-value: 0.02). We found a significant association between maternal dietary fat intake and infant length at 12-month (β: 0.06, P-value: 0.02). We found an inverse interaction between maternal dietary fat intake and breast milk omega-3 fatty acids with infant weight at 4 and 12 months of age. Although longer follow-up of growth indices is recommended, these findings suggest functional relevance of HM composition to infant growth.

The Effect of Zinc Administration in Short Adolescent Mothers who Breastfeed on Zinc Level, Insulin-1 Growth Factors, and Infant Growth

BACKGROUND: Zinc is an important nutrient for humans at all stages of life, whose needs increase during pregnancy and lactation. Zinc concentrations in breast milk are considered adequate for the first 6 months of life, despite an increase in the volume of milk consumed, zinc in breast milk is likely to be sufficient if there is no diet. weaning (9). Zinc levels in breast milk cannot compensate for the increased zinc requirements of the premature neonate due to higher than normal zinc requirements, small liver size with reduced zinc stores and a shortened digestive system.&#x0D; AIM:This study aims to measure serum zinc levels, IGF-1, and growth of infants aged 6 months in short adolescent mothers who are breastfeeding and have been intervened with zinc supplementation.&#x0D; MATERIAL AND METHOD: This study is a quantitative study using a quasi-experimental design, and a pretest-posttest approach with a control group. The sampling technique used purposive sampling with inclusion criteria, namely: infants from breastfeeding mothers aged &lt;19 years, history of SEZ, maternal height &lt;150 cm, so that the total sample size was 60 respondents (30 control samples and 30 intervention samples). Analysis of the data collected in the study was processed analytically with the Independent Sample T-Test and Paired T-Test tests.&#x0D; RESULT: From this study, it was found that the Paired Sample T Test results obtained p value &lt; 0.001 indicating that there was a difference before and after the intervention, so it can be concluded that there was an effect of giving zinc supplementation on serum zinc and IGF-1 levels of infants in the intervention group. And through the Independent T test, the value of p = 0.001 &lt; = 0.05. This shows that there is an effect of zinc supplementation on serum zinc and IGF-1 levels in infants. While the results of the Z-Score test for body weight and Z-Score values for body length obtained p &lt;0.001. This illustrates that there is a difference between the intervention group and the control group, so it can be concluded that there is an effect of zinc supplementation on the growth of infants aged 6 months.&#x0D; CONCLUSSION: There was a significant difference between before and after the intervention in the two groups, so that zinc supplementation was effective in influencing serum zinc levels, IGF-1 and infant growth.

Irisin concentration in infant formulas and breast milk.

Irisin is a newly discovered myokine with antiobesity properties. The delivery of irisin with the breast milk or formula is an emerging concept that myokine present at human milk influences postnatal energy balance and developmental parameters. The aim of the study was to evaluate irisin concentration in breast milk of mothers with term and preterm babies and in infant formulas. A total of 49 lactating mothers were enrolled in the study: 31 mothers of very low birth weight preterm infants and 18 mothers of term infants. Milk samples were collected twice: during the first week after delivery and after 4 weeks of delivery. Irisin concentration was determined using ELISA kits both in human milk and in samples of 14 different infant formulas. There were no differences in milk irisin levels between preterm and full-term milk samples during both the 1st and the 4th week after delivery. There were also no differences in irisin concentration between transitional milk and mature milk in both tested groups. Irisin concentrations in preterm and full-term milk were significantly higher than in formulas for 30 days period after delivery. A significant increase of irisin concentration in natural milk 4 weeks postdelivery in comparison to 1st week after delivery was observed (mean difference 0.362 µg/mL; P=0.0063). This study provides evidence that irisin is present in infant formulas, although in less amount than in human milk. Further research is needed to assess, if children fed with infant formulas may disadvantage from lower irisin supply.

Use of Compartmental Modeling and Datasets for Theoretical Lactating Women to Determine Conditions under Which Vitamin A–Specific Activity in Breast Milk Provides Accurate Estimates of Vitamin A Total Body Stores by Retinol Isotope Dilution

Vitamin A concentrations in breast milk are related to maternal vitamin A intake and status. Our objective was to identify conditions under which vitamin A specific activity in breast milk (SAm) could be used instead of retinol specific activity in plasma (SAp) to predict vitamin A total body stores (TBS) by retinol isotope dilution (RID). We used 12 previously-studied theoretical lactating women with assigned values for TBS (219-1348μmol) and retinol kinetic parameters; we assumed subjects ingested a dose of stable isotope-labeled vitamin A. We expanded a 9-compartment steady state tracer model to include a parallel model for tracee (unlabeled retinol) and then adapted that model so vitamin A intake entered the system in 3 meals each day. Using compartmental analysis, we first simulated SAm and SAp after an overnight fast (as in actual RID experiments) and then with vitamin A intake also restricted in sequential meals on the day before sampling for RID. After an overnight fast, SAm at day 21 postdosing was lower than SAp. However, if vitamin A intake was also restricted in 1, 2, or 3 meals before sampling, SAm/SAp (mean±SD) was 0.92±0.042, 0.96±0.016, or 0.99±0.004, respectively; results for days 14 and 28 were similar. When either SAp or SAm was used to predict TBS by RID on day 21 after 1-d restriction, predictions for all subjects were within 25% of assigned TBS. Results indicate that, for theoretical lactating women with a wide range of vitamin A status, SAm will accurately predict TBS by RID at 2-4 wk postdosing if vitamin A intake is restricted for 1 d before sampling. If confirmed in community settings, results suggest that vitamin A status in lactating women can be determined without collecting blood.

Ustekinumab during pregnancy and lactation: drug levels in maternal serum, cord blood, breast milk, and infant serum

BackgroundPatients with ulcerative colitis (UC) may be concerned about medication safety during preconception, pregnancy, and lactation, and they should be closely followed up to ensure that UC activity is controlled during the perinatal period. Reported information on the safety of ustekinumab during pregnancy and lactation is limited. In this case report, we examined the safety of ustekinumab in a fetus and breastfed infant with reference to drug concentrations in maternal serum, cord blood, breast milk, and infant serum.Case presentationA 36-year-old female who developed hematochezia and was diagnosed with ulcerative colitis at age 24 was pregnant with her first child. During pregnancy she was treated with subcutaneous bimonthly ustekinumab, at a dose of 90 mg, until 29 weeks of gestation. Her ulcerative colitis symptoms remained in remission. At 38 weeks of gestation she underwent cesarean section and delivered a healthy female infant weighing 3043 g and with no congenital malformations. The infant received routine vaccinations with no adverse events. Ustekinumab treatment was resumed at 7 weeks postpartum.The ustekinumab concentration in maternal serum at 12 days after injection (30.7 weeks of gestation) was 7968.5 ng/mL, and it decreased to 106.1 ng/mL at 114 days after the last dose. In cord blood, the ustekinumab concentration was 1131.2 ng/mL at 65 days after the last dose; this was 2.5 times higher than that in the maternal serum, which was consistent with a previous report. Ustekinumab was detected in infant serum collected at 71 days after the last maternal dose (299.0 ng/mL), with rapid elimination from the infant’s body. In breast milk, the maximum ustekinumab concentrations were 13.6 ng/mL at 9 days after the last maternal dose, respectively. The ratio of the calculated areas under the time-concentration curves of ustekinumab in breast milk and maternal serum was 0.0008 (257.1/327632.7), which was comparable with a previous human study.ConclusionThe placental transfer and breast milk secretion of ustekinumab in our case were comparable with previous reports. Use of ustekinumab during pregnancy and lactation was feasible in this case. Further research is needed to clarify the safety of ustekinumab during pregnancy and lactation.

DYNAMICS OF SIgA CONTENT IN BREAST MILK WHEN RISK FACTORS AND LACTATIONAL CHARACTERISTICS ARE CONSIDERED

The leading role associated with an anti-infective action of breast milk belongs to secretory IgA (SIgA). Therefore, the determination of the level of SIgA in colostrum and milk of mothers with different lactation levels and mothers at risk at different levels and duration of lactation has a practical interest.&#x0D; Aim. The research aims at studying the dynamics of SIgA content in breast milk, taking into account risk factors and features of lactation.&#x0D; Material and Methods. The content of SIgA in colostrum and breast milk of 372 mothers with full lactation and 208 with hypogalactia, of which 72 with early and 146 with late hypogalactia at different times of lactation (1-8 days and 1-3 months) was determined. The SIgA content was also studied in mothers; 65 with preeclampsia, including 12 with early hypogalactia, 24 with late hypogalactia, 23 with full lactation, and 44 with anemia of pregnancy, including 12 with early hypogalactia, 19 with late hypogalactia and 13 with full lactation. The determination of SIgA content in colostrum and milk was performed using the method of simple radial immunodiffusion in a gel by G. Mancini et al.&#x0D; Results and Discussion. The SIgA concentration in colostrum and breast milk decreased during the secretion process. In early hypogalactia, the content of SIgA did not differ significantly from the level of SIgA in colostrum and breast milk with full lactation in the early neonatal period and at 1-3 months of secretion. In the late hypogalactia, SIgA content did not differ significantly from its level in the control group. Due to the lower amount of milk received by the mother's child with hypogalactia, the supply of children with SIgA is insufficient, and the deficit is higher the sooner the hypogalactia develops. Similar changes in the dynamics of SIgA content have been found in mothers with preeclampsia and at different levels of lactation. The exception was the content of SIgA in colostrum and milk of mothers with anemia of pregnancy and early hypogalactia, which in the first five days of lactation was lower than in mothers with full lactation.&#x0D; Conclusion. The SIgA concentration in colostrum and breast milk decreases during the secretion process. The level of lactation does not affect the dynamics of SIgA content, except for the SIgA content in colostrum and breast milk of mothers with anemia of pregnancy and hypogalactia in the early stages of secretion. Despite the absence of a significant difference in SIgA levels in mothers with different levels of lactation due to less colostrum and milk received by children with early and late hypogalactia, the supply of SIgA is insufficient, and the cumulative deficit is higher the faster the hypogalactia develops.

800IU versus 400IU per day of vitamin D3 in term breastfed infants: a randomized controlled trial from an LMIC.

This open-label, block-randomized controlled trial compared the effect of 800IU/day and 400IU/day of oral vitamin D3 supplementation in reducing vitamin D insufficiency (VDI) among healthy-term breastfed infants at 14weeks of postnatal age. All eligible infants were randomized to receive either 800 or 400IU/day of oral vitamin D3 (starting within the first week until 14weeks). The primary outcome was the proportion of infants with VDI (25-OH-D < 20ng/ml) at 14weeks. Secondary outcomes were vitamin D deficiency (VDD, < 12ng/ml), severe VDD (< 5ng/ml), anthropometry, biochemical or clinical rickets, and any adverse events related to vitamin D toxicity (VDT). Among 102 enrolled infants, the distribution of baseline variables (including cord 25-OH-D levels; 13.0 versus 14.2ng/ml) was similar in both groups. On intention-to-treat analysis, the proportions of infants with VDI at 14weeks were significantly lower in the 800IU group compared to those in the 400IU group [24% versus 55%; RR 0.44; 95% CI: 0.25-0.76]. The proportions of infants with elevated parathormone (6% versus 26.5%; p = 0.012) and severe VDD (0% versus 12.2%; p = 0.033) were significantly lower in the 800IU group. Clinical rickets developed in three (6.2%) infants in the 400IU group. No infant developed VDT. Conclusions: Daily oral supplementation with 800IU of vitamin D3 resulted in an almost 50% reduction in the proportion of infants with VDI and prevented the occurrence of severe VDD at 14weeks of age compared to 400IU with no evidence of vitamin D toxicity. Trial Registration: Clinical Trial Registry of India (CTRI/2019/02/017374). What is Known: •Breastfeeding is the ideal source of nutrition for healthy-term breastfed infants; however,vitamin D content of breastmilk is suboptimal. •AAP recommends daily oral supplementation of 400 IU of vitamin D to all healthy-term breastfed infants; however, trials from high-income countries support insufficiency of this dose in maintaining serum 25-OH-D levels >20 ng/ml with no such information from low-middle-income countries. What is New: •800 IU/day of oral vitamin D3 supplementation among term breastfed infants significantly reduces vitamin D insufficiency at 14 weeks' age as compared to the recommended dose of 400 IU/day. •This higher supplemental dose is safe with no evidence of vitamin D toxicity.

β-Carotene Attenuates Apoptosis and Autophagy via PI3K/AKT/mTOR Signaling Pathway in Necrotizing Enterocolitis Model Cells IEC-6.

Background Necrotizing enterocolitis (NEC) is a devastating disease affecting the gastrointestinal tract in the newborn period. In recent years, the role of apoptosis and autophagy in intestinal mucosal barrier dysfunction has come into prominence in research regarding the pathogenesis of NEC. β-Carotene is a well-known vitamin A precursor, and its content in breast milk is relatively high, especially in the colostrum. In the present study, we investigated the protective effect of β-carotene on necrotizing enterocolitis model cells IEC-6 induced by lipopolysaccharide (LPS). Methods CCK-8 assay was performed to evaluate cell viability. The Annexin V-FITC/PI method was used to detect apoptosis. Western blotting was utilized to measure the expression levels of proteins. Immunofluorescence analysis was used to assess the autophagy of IEC-6 cells. Results Our findings indicated that β-carotene inhibited the apoptosis of IEC-6 cells by downregulating cleaved caspase-3 levels and Bax levels and upregulating Bcl-2 levels, reducing cell autophagy via downregulating LC3II/I ratio and upregulating p62 levels. In addition, the expression of p-PI3K, p-AKT, and p-mTOR was upregulated after β-carotene treatment. Interestingly, these changes induced by β-carotene were partially reversed by rapamycin and voxtalisib. Conclusion In conclusion, our findings indicated that β-carotene can attenuate apoptosis and autophagy of IEC-6 cells induced by LPS via activating the PI3K/AKT/mTOR signaling pathway. Therefore, β-carotene may be a promising drug used in the clinical treatment of NEC.

Cow’s Milk Antigens Content in Human Milk: A Scoping Review

The functionality of breast milk in terms of immunity is well-known. Despite this, a significant proportion of breastfed infants exhibit sensitization to different potentially allergenic proteins and clinical reactivity (including anaphylaxis) early in life and before the introduction of complementary feeding for the first time. The potential induction of early oral tolerance to overcome early allergic sensitization through exposure to allergens in breast milk also remains controversial and not yet well-established. The objective of this scoping review is to provide a critical appraisal of knowledge about the content of cow’s milk antigens in human milk. The amount of dietary derived milk antigens found in human milk and the analytical methodologies used to detect and quantify these antigens, the allergic status of the mother, the stage of lactation, the time of sampling (before or after ingestion of food), and the impact of human milk allergen on the infant were the outcomes that were assessed. Allergy risk was explored in all reviewed studies and could help to better elucidate its role in the context of allergic disease development. According to the included literature, we can conclude that there are mainly fragments derived from bovine proteins in human milk, and the presence of potentially allergenic molecules is greater in the milk of mothers with an allergic tendency. A clear relationship between maternal diet and allergen content in breast milk could not be firmly concluded though. Also, infants receiving milk from human milk banks, where donor milk is pasteurized for preservation, may be subject to greater risk of allergy development, especially for β-lactoglobulin.

Comparative study of phospholipid content in breast milk of mothers at preterm and term babies

Phospholipids play important roles in cell membrane integrity, neural and brain development, and inflammatory responses. Phospholipids are also important for the growth of infants and the neurological development and the neurological disorders.The aim of the present study was to determine and compare phospholipid content in breast milk of mothers at preterm and term babies.The present study was a hospital- based comparative and analytical study. The study was conducted over a period of 1 year on 60 samples. The study group comprised a total 60 individuals in which breast milk of mothers of preterm babies comprised of 30 individuals and breast milk of mothers of term babies comprised of 30 individuals. The phospholipid content were qualitatively analyzed by the Thin Layer Chromatography and quantitatively analyzed by the method of Connerty.The results of the present study show that, the Mean±SD of the total phospholipid content (mg/dl) in breast milk of mothers of preterm babies was 84.44±10.45 mg/dl and the Mean±SD of the total phospholipid content (mg/dl) in breast milk of mothers of term babies was 45.1±7.15 mg/dl. The results of the present study indicate that the difference between the preterm and term babies was found to be significant statistically (p=&amp;#60;0.0001). The present study concluded that phospholipids content was significantly higher in breast milk of mothers in preterm babies as compared to term babies. Difference in composition of individual phospholipid may contribute to difference in rf values of individual phospholipids in breast milk of mothers of term and preterm babies.

Bedaquiline exposure in pregnancy and breastfeeding in women with rifampicin-resistant tuberculosis.

AimsWe aimed to explore the effect of pregnancy on bedaquiline pharmacokinetics (PK) and describe bedaquiline exposure in the breast milk of mothers treated for rifampicin‐resistant tuberculosis (TB), where there are no human data available.MethodsWe performed a longitudinal PK study in pregnant women treated for rifampicin‐resistant TB to explore the effect of pregnancy on bedaquiline exposure. Pharmacokinetic sampling was performed at 4 time‐points over 6 hours in the third trimester, and again at approximately 6 weeks postpartum. We obtained serial breast milk samples from breastfeeding mothers, and a single plasma sample taken from breastfed and nonbreastfed infants to assess bedaquiline exposure. We used liquid chromatography–tandem mass spectrometry to perform the breast milk and plasma bedaquiline assays, and population PK modelling to interpret the bedaquiline concentrations.ResultsWe recruited 13 women, 6 of whom completed the ante‐ and postpartum PK sampling. All participants were HIV‐positive on antiretroviral therapy. We observed lower ante‐ and postpartum bedaquiline exposures than reported in nonpregnant controls. Bedaquiline concentrations in breast milk were higher than maternal plasma (milk to maternal plasma ratio: 14:1). A single random plasma bedaquiline and M2 concentration was available in 4 infants (median age: 6.5 wk): concentrations in the 1 breastfed infant were similar to maternal plasma concentrations; concentrations in the 3 nonbreastfed infants were detectable but lower than maternal plasma concentrations.ConclusionWe report low exposure of bedaquiline in pregnant women treated for rifampicin‐resistant TB. Bedaquiline significantly accumulates in breast milk; breastfed infants receive mg/kg doses of bedaquiline equivalent to maternal doses.

Increased Breastfeeding Proportion Is Associated with Improved Gross Motor Skills at 3-5 Years of Age: A Pilot Study.

Breastmilk provides key nutrients and bio-active factors that contribute to infant neurodevelopment. Optimizing maternal nutrition could provide further benefit to psychomotor outcomes. Our observational cohort pilot study aims to determine if breastfeeding extent and breastmilk nutrients correlate with psychomotor outcomes at school age. The breastfeeding proportion at 3 months of age and neurodevelopmental outcomes at 3–5 years of age were recorded for 33 typically developing newborns born after uncomplicated pregnancies. The association between categorical breastfeeding proportion and neurodevelopmental outcome scores was determined for the cohort using a Spearman correlation with and without the inclusion of parental factors. Vitamin E and carotenoid levels were determined in breastmilk samples from 14 of the mothers. After the inclusion of parental education and income as covariates, motor skill scores positively correlated with breastmilk contents of α-tocopherol (Spearman coefficient 0.88, p-value = 0.02), translutein (0.98, p-value = 0.0007), total lutein (0.92, p-value = 0.01), and zeaxanthin (0.93, p-value = 0.0068). Problem solving skills negatively correlated with the levels of the RSR enantiomer of α-tocopherol (−0.86, p-value = 0.03). Overall, higher exposure to breastfeeding was associated with improved gross motor and problem-solving skills at 3–5 years of age. The potential of α-tocopherol, lutein, and zeaxanthin intake to provide neurodevelopmental benefit is worthy of further investigation.

Breast milk from healthy women has higher anti-Candida properties than women with vaginal infections during pregnancy.

The aim of this study was to investigate the different immunological and antimicrobial properties of breast milk from women with (W) or without (WO) vaginal yeast infections during pregnancy in 85 lactating women (W, n = 43; WO, n = 42). Concentrations of IL-10, IgA, IgM, IgG, EGF, and TGF-α were similar in both groups. However, breast milk of women aged below 31years old from the W-group showed higher concentration of EGF than the WO-group (p = 0.031). Breast milk from WO-group exhibited higher anti-Candida properties than W-group, both via growth inhibition and aggregation of yeast cells (p < 0.001). Correlation analysis showed that breast milk concentration of TGF-α positively correlated with concentrations of IL-10 (p = 0.001) and IgA (p = 0.021) in the W-group. Data from our present study shows that although breast milk from women with vaginal infections during pregnancy may not sufficiently hinder Candida growth, other immuno-modulatory bioactives may substitute for such a protective effect.

Effects of Maternal Exclusion Diet for Infants Suspected Food Allergy on Fatty Acid Composition in Breast Milk

Background: Levels of fatty acid (FA) in breast milk (BM) may vary depending on the maternal diet. This study aimed to explore FA composition in BM of lactating women following dietary restrictions due to infant allergic conditions. Materials and Methods: Thai lactating mothers of term infants who were on exclusion diets were recruited. Mature BM was collected before and after a period (at least 2 weeks) of dietary restriction. FA in BM was analyzed by gas chromatography-mass spectrometry. Results: Fifty lactating women 33.7 ± 3.6 years of age were enrolled. Thirty-three percent of the lactating mothers restricted more than eight food items. Most common dietary restriction were cow's milk (88%) and eggs (74%). After the period of dietary exclusion, total polyunsaturated FA showed no significant change, while saturated FA (SFA) declined, and monounsaturated FA (MUFA) increased. A decrease in fat intake was associated with an increase in arachidonic acid (ARA) and docosahexaenoic acid (DHA) content in BM (r = -0.37, r = -0.36; p < 0.05). However, a rise in ARA, eicosapentaenoic acid (EPA), and DHA intake was associated with an increase in linoleic acid and EPA in BM, respectively (r = 0.38, r = 0.55 and r = 0.41; p < 0.05). Infant weight-for-age z-score did not significantly change after the period of maternal dietary exclusion. Conclusion: Maternal exclusion diet resulted in lower SFA and higher MUFA composition in BM. Further study should explore the long-term outcomes of maternal dietary restriction on infant and child health.

M015 Establishing and verifying a very rapid inductively coupled plasma-mass spectrometry method to determine iodine concentrations in amniotic fluid, breast milk and cerebrospinal fluid

M015 Establishing and verifying a very rapid inductively coupled plasma-mass spectrometry method to determine iodine concentrations in amniotic fluid, breast milk and cerebrospinal fluid

The role of exclusive breastfeeding on sIgA and lactoferrin levels in toddlers suffering from Acute Respiratory Infection: A cross-sectional study

Secretion of Immunoglobulin A (sIgA) and lactoferrin is a nutrient content in breast milk that can increase immunity in preventing infectious diseases such as Acute Respiratory Infection (ARI). This research aims to determine the role of exclusive breastfeeding (EBF) on sIgA and Lactoferrin levels in toddlers suffering from ARI. A cross-sectional study was conducted on 124 toddlers under five from January–July 2021. Toddlers were selected using a purposive technique sampling from three Community Health Centers in Central Jakarta. Data were analyzed using t-test and ANOVA. The history of immunization, EBF, and frequency of ARI was significantly associated with levels of sIgA and lactoferrin. Parity only correlated with sIgA but not with lactoferrin levels. Maternal and toddlers' age, gender, and nutritional status were not significantly related to sIgA and lactoferrin levels. There is a significant (p-value <0.001) difference in the mean protein sIgA and lactoferrin levels in toddlers who were given EBF with ARI frequency <2 times and toddlers who were given EBF with ARI frequency ≥2 times. Toddlers who were exclusively breastfed with ARI frequency <2 times had higher levels of sIgA and lactoferrin (188901.77 pg/ml and 262.32 ng/ml, respectively) compared to infants given EBF with ARI frequency ≥2 times (136683.47 pg/ml and 181.49 ng/ml, respectively). History of immunization was also significantly (p-value <0.05) associated with levels of sIgA and lactoferrin in infants with ARI. The content of sIgA and lactoferrin in breast milk and immunization can increase the body's immune system in toddlers suffering from ARI.

Adverse effects of dioxins on cognitive ability and motor performance of 5-year-old children residing in a hotspot of dioxin contamination originating from Agent Orange in Vietnam: A prospective cohort study

Bien Hoa airbase is the most dioxin-polluted hotspot in Vietnam. In 2012, a birth cohort living around Bien Hoa airbase was recruited for assessment of physical and neurological development. In the present study, neurodevelopment scores at 5 years of age were assessed by the Kaufman Assessment Battery for Children, Second Edition and the Movement Assessment Battery for Children, Second Edition for 185 children in Bien Hoa and 104 children in Ha Dong (unexposed control group) to clarify the effects of dioxin. 2,3,7,8-tetrachlorodibenzo-p-dioxin concentrations in breast milk of women in Bien Hoa were approximately three times higher than those of women in Ha Dong (2.33 vs. 0.69 pg/g fat, p < 0.001). In general, neurodevelopment scores were lower in Bien Hoa children than in Ha Dong children. In boys, scores differed for number recall (12.6 vs. 14.0, p = 0.036), triangles (10.7 vs. 12.4, p = 0.005), manual dexterity (8.3 vs. 9.7, p = 0.037), balance (7.4 vs. 10.3, p < 0.001), and total movement scores (8.0 vs. 10.1, p = 0.003). After adjusting for covariates, linear regression analysis indicated that the scores of the triangles, balance, and total movement tests were inversely associated with levels of 2,3,7,8-tetrachlorodibenzo-p-dioxin and of toxic equivalency of polychlorinated dibenzodioxins and polychlorinated dibenzofurans. In girls, scores differed for the triangles test (11.0 vs. 12.6, p = 0.005), hand movement test (9.6 vs. 11.3, p = 0.003), and balance test (9.1 vs. 10.7, p = 0.050); toxic equivalency of polychlorinated dibenzofurans was inversely associated with hand movement and balance scores. Overall, perinatal dioxin exposure appears to have a long-term impact on neurodevelopment.