Breast-feeding exposure of infants to cadmium, lead, and mercury: a public health viewpoint.

Division of Toxicology, Agency for Toxic Substances and Disease Registry, U.S. Department of Health and Human Services, Atlanta, Georgia 30333, USA.
Toxicology and Industrial Health (Impact Factor: 1.56). 07/1997; 13(4):495-517. DOI: 10.1177/074823379701300403
Source: PubMed

ABSTRACT The purpose of this report is to provide an overview of the public health implications of exposure via breast milk to cadmium, lead, and mercury for nursing infants and to provide health-based guidance. Daily intakes were calculated and compared with guidance values used for public health assessments at hazardous waste sites. Cadmium, lead, and mercury under normal conditions are found in breast milk at concentration ranges of < 1 microgram/L, 2-5 micrograms/L, and 1.4-1.7 micrograms/L, respectively. Women exposed environmentally or occupationally can have higher levels in their breast milk. Concentrations of about 5 micrograms/L (cadmium), 20 micrograms/L (lead), and 3.5 micrograms/L (mercury) appear to be adequate screening levels. Many factors affect both the distribution of cadmium, lead, and mercury in breast milk and the health consequences to an infant. It is not clear what additional impact low-level exposure via breast milk may have on an infant born with a body burden to one of these metals. There is sufficient evidence to make the case that contaminated breast milk is a source of potential risk to infants in certain populations. Prevention strategies that include behavior modification and proper nutrition should be communicated to women at risk. Identification and elimination of exposure pathways and a critical analysis of the benefits of breast feeding versus heavy metal exposure are needed on a site-specific or individual basis. Research is required to better understand the impact of low-level exposure to heavy metals via breast milk. Breastfeeding should be encouraged under most circumstances.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Human milk is a potential source of lead exposure. Yet, lactational transfer of lead from maternal blood into breast milk and its contribution to infant lead burden remains poorly understood. We explored the dose-response relationships between maternal blood, plasma, and breast milk to better understand lactational transfer of lead from blood and plasma into milk and, ultimately, to the breastfeeding infant. We measured lead in 81 maternal blood, plasma, and breast milk samples at 1-month postpartum and in 60 infant blood samples at 3 months of age. Milk-to-plasma (M/P) lead ratios were calculated. Multivariate linear, piecewise, and generalized additive models were used to examine dose-response relationships between blood, plasma, and milk lead levels. Maternal lead levels (mean ± SD) were: blood: 7.7 ± 4.0 µg/dL; plasma: 0.1 ± 0.1 µg/L; milk: 0.8 ± 0.7 µg/L. Average M/P lead ratio was 7.7 (range 0.6 - 39.8) with 97% of the ratios being greater than 1. The dose-response relationship between plasma lead and M/P ratio was nonlinear (EDF = 6.5, p-value = 0.0006) with M/P ratio decreasing by 16.6 and 0.6 per 0.1 µg/L of plasma lead, respectively, below and above 0.1 µg/L plasma lead. Infant blood lead (3.4 ± 2.2 µg/dL) increased by 1.8 µg/dL per 1 µg/L milk lead (p-value < 0.0001, R(2) = 0.3). The M/P ratio for lead in humans is substantially higher than previously reported and transfer of lead from plasma to milk may be higher at lower levels of plasma lead. Breast milk is an important determinant of lead burden among breastfeeding infants.
    Environmental Health Perspectives 11/2013; · 7.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT:   Fertility among human beings appear to be on the decline in many Western countries, and part of the explanation may be decreasing male fecundity. A hypothesis has been put forward that decreasing semen quality may be associated with a testicular dysgenesis syndrome (TDS), a spectrum of disorders originating in early foetal life. TDS comprises various aspects of impaired gonadal development and function, including testicular cancer. A growing body of evidence, including animal models and research in human beings, points to lifestyle factors and endocrine disrupters as risk factors for TDS. We present our view of the emerging role of Leydig cell dysfunction with subsequent decreased testosterone levels in the pathogenesis of TDS.
    Basic & Clinical Pharmacology & Toxicology 01/2008; 102(2):155 - 161. · 2.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk in the second postpartum month, to investigate the relationship between Pb/Cd levels in breast milk and some sociodemographic pa-rameters, and to explore whether these levels affect the infants' physical status or the mothers' psychological status (postpartum depression). Methods A cross-sectional study was conducted between November 2009 and December 2010. Altogether 170 healthy mothers were enrolled from Nanjing Maternity and Child Health Care Hospital. The inclusion criteria were: voluntary to participate in this study, healthy, with no chronic disease, breastfeeding in the second postpartum month, living in a suburban but not non-industrial area of Nanjing, and not occupationally exposed to toxic metals. All the mothers completed a questionnaire and were evaluated based on the Edinburgh Postpartum Depression Scale (EPDS) to identify the risk of postpartum depression. Pb and Cd levels in breast milk were determined by inductively coupled plasma mass spectroscopy. The infants of these mothers were examined for their z scores of weight for age, length for age, head circumference for age, and body mass index for age. Results The median breast milk levels of Pb and Cd were 40.6 μg/L and 0.67 μg/L, respectively. In 164 (96.5%) of the 170 samples, Pb levels were higher than the limit reported by the World Health Organization (> 5 μg/L). Breast milk Cd level was > 1 μg/L in 54 (31.8%) mothers. The mothers with a history of anemia had a higher breast milk Pb level than those without a history of anemia (41.1 μg/L vs. 37.9 μg/L, P = 0.050). The median breast milk Cd level in those who were active and passive smokers during pregnancy was significantly higher than that in non-smokers (0.88 μg/L vs. 0.00 μg/L, P = 0.025). The breast milk Cd level in the mothers not taking iron and vitamin supplements for 2 months postpartum was higher than in those taking the supplements (iron supplement: 0.74 μg/L vs. 0.00 μg/L, P = 0.025; vitamin supplement: 0.78 μg/L vs. 0.00 μg/L, P = 0.005). Breast milk Cd level at the second postpartum month was negatively correlated with the z scores of head circumference (r = - 0.248, P = 0.042) and weight for age at birth (r =- 0.241, P = 0.024) in girls. No correlation was found between the breast milk Pb/Cd levels and the EPDS scores. Conclusion Considering the high levels of Pb and Cd in breast milk in this study, breast milk monitoring programs are necessary.
    Chinese Medical Sciences Journal 03/2013; 28(1):7-15.