Breast-feeding exposure of infants to cadmium, lead, and mercury: a public health viewpoint.
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.
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ABSTRACT: Measurement of lead in breast milk is an important public health consideration and can be technically quite challenging. The reliable and accurate determination of trace lead in human breast milk is difficult for several reasons including: potential for contamination during sample collection, storage, and analysis; complexities related to the high fat content of human milk; and poor analytic sensitivity at low concentrations. Breast milk lead levels from previous published studies should therefore be reviewed with caution. Due to the difficulty in identifying a method that would successfully digest samples with 100% efficiency, we evaluated three different digestion procedures including: (1) dry ashing in a muffle furnace, (2) microwave oven digestion, and (3) digestion in high pressure asher. High temperature, high pressure asher digestion was selected as the procedure of choice for the breast milk samples. Trace lead analysis was performed using isotope dilution (ID) inductively coupled plasma mass spectrometry (ICP-MS). Measured lead concentrations in breast milk samples (n = 200) from Mexico ranged from 0.2 to 6.7 ng ml(-1). The precision for these measurements ranged from 0.27-7.8% RSD. Use of strict contamination control techniques and of a very powerful digestion procedure, along with an ID-ICP-MS method for lead determination, enables us to measure trace lead levels as low as 0.2 ng ml(-1) in milk (instrument detection limit = 0.01 ng ml(-1)).Analytical methods 01/2013; 5(7):1676-1681. · 1.86 Impact Factor
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ABSTRACT: Human milk is considered to be the best nutrition for all infants because it provides the optimal source of nutritional, immunological, developmental, psychological, economic, practical, and environmental benefits in both the short and long terms. To the best of our knowledge, few studies in Taiwan have examined the toxicants level of breast milk and associated factors. The research was carried out over a 6-month period. Forty-five healthy lactating women, who delivered full-term newborns at our maternity ward, were recruited, and all participants had been living in coastal urban areas of mid-Taiwan for at least 3 years. One hundred and eighty human milk samples were collected on four occasions, which were classified into four lactation stages as follows: colostrums, transitional milk, early mature milk, and mature milk. We found that lead, cadmium, aluminium, and arsenic concentrations were the highest in colostrums: 13.22 ± 3.58 ng/mL, 1.37 ± 0.94 ng/mL, 56.45 ± 22.77 ng/mL, and 1.50 ± 1.50 ng/mL, respectively. The results of lead, cadmium, aluminium, and arsenic determination in human milk samples demonstrated a trend of decline of microelement concentrations with advancing stages of lactation. We found that the infants of smoking mothers were exposed to more cadmium than infants of nonsmoking mothers (p < 0.05). According to our findings, frequent routine sampling of breast milk is worthwhile. Prevention strategies including behavior modification and proper nutrition should be educated to women who are at high risk of toxicant exposure. In summary, breastfeeding is still generally encouraged and recommended.Pediatrics & Neonatology 11/2013; · 0.93 Impact Factor
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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