Mercury, lead and cadmium in human milk in relation to diet, lifestyle habits and sociodemographic variables in Madrid (Spain)

Lactational Exposure of Human Infants to Metal (loid)s: A Comparison of Industrial and Urban Inhabitants in North of the Persian Gulf

In this study, postnatal metal (loid)s (MLs) exposure was compared between the petrochemical and gas area of Asaluyeh (PGA) and urban area of Kaki (UA) in Bushehr province, Iran. Two hundred human breast milk (BM) samples from the industrial and urban areas were analyzed for MLs using Inductivity Coupled Plasma-Optical Emission Spectrometry (ICP-OES). Boron (B), copper (Cu), iron (Fe), and nickel (Ni) were found at the highest levels in both study areas. Adjusted multiple linear regression models revealed that the mean concentration of total MLs in BM samples collected from the PGA was statistically significantly greater than that of the UA (655.85 vs. 338.17 µg/L). Also, the mean concentrations of all detected MLs in BM samples collected from the PGA were statistically significantly higher than those collected from the UA. The hazard index (HI) of combined MLs in the PGA and UA illustrated non-cancer risk for infants. Lead (Pb) and chromium (Cr) in the PGA and Cr in the UA showed the risk of cancer. So it can be concluded that nursing infants from an industrial area are most at risk for MLs exposure during entire lactation course than those from an urban area.

Essential and non-essential element concentrations in human milk samples and the assessment of infants' exposure

As the data concerning element concentrations in human milk (HM) samples and their intake by infants are lacking in Poland, the present study aimed to explore this issue. The material consisted of HM samples obtained from 30 exclusively breastfeeding mothers during 4-6 weeks postpartum. Additionally, to identify the factors that may potentially affect HM composition, information regarding maternal data (anthropometry, body composition, and diet) was also collected. Maternal diet was assessed with two methods-a food frequency questionnaire and 3-day dietary records. In total, 18 essential and non-essential elements were determined. For the elements analysis, we used inductively coupled plasma quadrupole mass spectrometry. Most of the elements (n = 11, 61%) were detected in all HM samples. In all HM samples tin concentration was higher (5.67 ± 2.39 μg/L) than the usual range reported by the World Health Organization (~ 1.0 μg/L). HM cadmium content was positively associated with maternal salty snacks intake (r = 0.502, p = 0.005), arsenic with whole-grain products intake (r = 0.37, p = 0.043), and mercury concentration with fruits and seeds/nuts consumption (r = 0.424, p = 0.042 and r = 0.378, p = 0.039, respectively). Higher HM lead concentration was predicted by maternal age (95% CI [0.94-0.97]), intake of fish (95% CI [1.01-1.03]), and vegetables (95% CI [1.02-1.06]). The highest infants' intake was observed for copper (35.24 ± 12.48) and the lowest for arsenic (0.076 ± 0.102). Infants' exposure to lead was associated with maternal frequency consumption of canned fish (p = 0.0045). There is a need to perform further research on this topic to maximize the benefits of breastfeeding by minimizing maternal and infant exposure to potentially toxic elements.

Effects of food-borne docosahexaenoic acid supplementation on bone lead mobilisation, mitochondrial function and serum metabolomics in pre-pregnancy lead-exposed lactating rats

Large bone lead (Pb) resulting from high environmental exposure during childhood is an important source of endogenous Pb during pregnancy and lactation. Docosahexaenoic acid (DHA) attenuates Pb toxicity, however, the effect of DHA on bone Pb mobilisation during lactation has not been investigated. We aimed to study the effects of DHA supplementation during pregnancy and lactation on bone Pb mobilisation during lactation and its potential mechanisms. Weaning female rats were randomly divided into control (0.05% sodium acetate) and Pb-exposed (0.05% Pb acetate) groups, after a 4-week exposure by ad libitum drinking and a subsequent 4-week washout period, all female rats were mated with healthy males until pregnancy. Then exposed rats were randomly divided into Pb and Pb + DHA groups, and the latter was given a 0.14% DHA diet, while the remaining groups were given normal feed until the end of lactation. Pb and calcium levels, bone microarchitecture, bone turnover markers, mitochondrial function and serum metabolomics were analyzed. The results showed that higher blood and bone Pb levels were observed in the Pb group compared to the control, and there was a significant negative correlation between blood and bone Pb. Also, Pb increased trabecular bone loss along with slightly elevated serum C-telopeptide of type I collagen (CTX-I) levels. However, DHA reduced CTX-I levels and improved trabecular bone microarchitecture. Metabolomics showed that Pb affected mitochondrial function, which was further demonstrated in bone tissue by significant reductions in ATP levels, Na+-K+-ATPase, Ca2+-Mg2+-ATPase and CAT activities, and elevated levels of MDA, IL-1β and IL-18. However, these alterations were partially mitigated by DHA. In conclusion, DHA supplementation during pregnancy and lactation improved bone Pb mobilisation and mitochondrial dysfunction in lactating rats induced by pre-pregnancy Pb exposure, providing potential means of mitigating bone Pb mobilisation levels during lactation, but the mechanism still needs further study.

Nutrition paves the way to environmental toxicants and influences fetal development during pregnancy

Nutrition plays a major role in the healthy pregnancy and development of the fetus. In addition, nutrition can expose humans to a wide range of potentially hazardous environmental constituents, such as organic pollutants and heavy metals from marine or agricultural food products while processing, producing, and packaging. Humans constantly face these constituents through air, water, soil, food, and domestic products. During pregnancy, the rate of cellular division and differentiation is higher; exposure to any of these environmental toxicants can lead to developmental defects as they cross the placental barrier and, in some cases, can harm the successive generation too, as some contaminants can act on the reproductive cells of the fetus (Diethylstilbestrol). Pregnant women are considered a vulnerable population to food contaminant exposure and require a proper dietary chart and conscious food choices. Food is a source of both essential nutrients and environmental toxicants. Here, we have researched the possible toxicants of the food industry and their influence on the fetus's in-utero development, along with the importance of dietary interventions and the need to balance a healthy diet to overcome the harms. The cumulative exposure to environmental toxicants can influence the mother's prenatal environment and affect the fetus's development.

Human health risk assessment of potentially toxic elements in the breast milk consumed by infants in Western Iran

This study aimed to assess the human health risk of some toxic metals/metalloids [lead (Pb), mercury (Hg), cadmium (Cd), nickel (Ni), chromium (Cr), and arsenic (As)] on infants via consumption of the breast milk of women living in urban areas of Kermanshah city, west of Iran. After collecting milk samples, the carcinogenic and non-carcinogenic risk assessment as well as uncertainty analysis of toxic metal levels were carried out. The order of concentration of heavy metals/metalloids in the breast milk samples was Cr (41.07 ± 23.19) > Ni (19.25 ± 11.81) > Pb (11.5 ± 4.48) > As (1.96 ± 2.04) > Cd (.72 ± 0.42) > Hg (0.31 ± 0.26). The results revealed that the levels of Cr and Pb in the breast milk samples were exceeded the World Health Organization (WHO) tolerable daily intake. In the breast milk samples a high levels of one of the trace elements As, Cd, Cr, Pb, and Ni were observed (over 73%) and in 40% of them the levels of Cr, Pb, Cd, As, and Ni were all above WHO tolerable daily intake. Moreover, the As-related point assessment of target risk factor (THQ) was higher than the allowable limit only for 1-month-old male neonates and 2-month-old female neonates (THQ > 1). In addition, Cr-related THQ scores were higher at all age and gender groups (THQ > 1). In conclusion, our findings suggest a potential risk of some metals for infants via the consumption of mothers' breast milk.

The impact of the 2019/2020 Australian landscape fires on infant feeding and contaminants in breast milk in women with asthma

BACKGROUND

The 2019/2020 Australian landscape fires (bushfires) resulted in prolonged extreme air pollution; little is known about the effects on breastfeeding women and their infants. This study aimed to examine the impact of prolonged landscape fires on infant feeding methods and assess the concentration of polycyclic aromatic hydrocarbons (PAHs) and elements in breast milk samples.

METHODS

From May - December 2020, women with asthma, who were feeding their infants during the fires, were recruited from an existing cohort. Data on infant feeding and maternal concern during the fires were retrospectively collected. Breast milk samples were collected from a sample of women during the fire period and compared with samples collected outside of the fire period for levels of 16 PAHs (gas chromatography coupled with mass spectrometry), and 20 elements (inductively coupled plasma-mass spectrometry).

RESULTS

One-hundred-and-two women who were feeding infants completed the survey, and 77 provided 92 breast milk samples. Two women reported concern about the impact of fire events on their infant feeding method, while four reported the events influenced their decision. PAHs were detected in 34% of samples collected during, versus no samples collected outside, the fire period (cross-sectional analysis); specifically, fluoranthene (median concentration 0.015 mg/kg) and pyrene (median concentration 0.008 mg/kg) were detected. Women whose samples contained fluoranthene and pyrene were exposed to higher levels of fire-related fine particulate matter and more fire days, versus women whose samples had no detectable fluoranthene and pyrene. Calcium, potassium, magnesium, sodium, sulphur, and copper were detected in all samples. No samples contained chromium, lead, nickel, barium, or aluminium. No statistically significant difference was observed in the concentration of elements between samples collected during the fire period versus outside the fire period.

CONCLUSIONS

Few women had concerns about the impact of fire events on infant feeding. Detection of fluoranthene and pyrene in breast milk samples was more likely during the 2019/2020 Australian fire period; however, levels detected were much lower than levels expected to be related to adverse health outcomes.

Evaluation of some toxic metals in breast milk samples with dietary and sociodemographic characteristics: a case study of Kermanshah, Western Iran

This study aimed to investigate the concentration of some toxic metals (gold (Au), cadmium (Cd), chromium (Cr), mercury (Hg), nickel (Ni), lead (Pb), tin (Sn), and vanadium (V)) and arsenic (As) in breast milk based on demographic characteristics and the diet of mothers. In this cross-sectional study, 100 lactating mothers from Kermanshah, Western Iran, were included. The mean age of the participants was 29.5 (ranging from 16 to 43 years) with a mean BMI of 26.9 (± 3.81) kg (range: 17.0-39.1). The results of the pairwise correlation coefficient of trace elements illustrated that correlation was mostly positive and weak to moderate. A few exceptions of strong correlations were Cr-Ni (r = 0.82), Au-As (r = 0.64), Cr-V (r = 0.64), and Ni-V (r = 0.58). Moreover, results indicated that BMI (p = 0.008), cooking oil (0.042), and potato intake (p = 0.010) affected the trace element levels significantly. The concentrations of V (p = 0.044), Sn (p = 0.036), Au (p < 0.001), and As (p < 0.001) in the breast milk of women was affected by the BMI. The results of univariate linear regression analysis showed that the concentration of Pb in the milk of mothers who use cosmetics was significant (p < 0.05). Since the lifestyle of lactating women, such as cosmetics usage can impact the content of some elements in breast milk, they should be educated in this part.

Dietary Exposure to Toxic Elements and the Health of Young Children: Methodological Considerations and Data Needs

Concerns have been raised regarding toxic-element (arsenic, cadmium, lead, and mercury) contamination of commercially available infant foods around the world. Young children are vulnerable to the effects of toxic elements, based on higher absorption levels and potentially poorer detoxification capacities. Toxic-element exposures in early life exact high societal costs, but it is unclear how much dietary exposure to these elements contributes to adverse health outcomes. Well-designed epidemiological studies conducted in different geographical and socioeconomic contexts need to estimate dietary toxicant exposure in young children and to determine whether causal links exist between toxicants in children's diets and health outcomes. This commentary outlines the methodological considerations and data needs to advance such research.

Impact of industrial effluents on the environment and human health and their remediation using MOFs-based hybrid membrane filtration techniques

The hazardous risk posed by industrial effluent discharge into the ecosystem has raised a plethora of environmental issues, public health, and safety concerns. The effluents from industries such as tanning, leather, petrochemicals, pharmaceuticals, and textiles are create significant stress on the aquatic ecosystem, which induces significant toxicity, involved in endocrine disruptions, and inhibits reproductive functions. Therefore, this review presented an overall abridgment of the effects of these effluents and their ability to synergize with modern pollutants such as pharmaceuticals, cosmetic chemicals, nanoparticles, and heavy metals. We further emphasize the metal organic framework (MOF) based membrane filtration approach for remediation of industrial effluents in comparison to the traditional remediation process. The MOF based-hybrid membrane filters provide higher reusability, better adsorption, and superior removal rates through the implication of nanotechnology, while the traditional remediation process offers poorer filtration rates and stability.

The concentration and health risk of potentially toxic elements (PTEs) in the breast milk of mothers: a systematic review and meta-analysis

AIM

Breast milk is the best source of nutrition for a newborn during the first six months of his or her life. However there is a possibility that breast milk may contain pollutants such as metals. The current meta-analytic study assessed the concentration of potentially toxic elements (PTEs), including lead (Pb), cadmium (Cd), arsenic (As), Iron (Fe), Zinc (Zn), copper (Cu), and nickel (Ni), in mothers' milk.

METHOD

The literature studies regarding the concentrations of PTEs in the breast milk of mothers were collected from international databases such as PubMed, Scopus, Web of Science, and Embase. Afterward, the Total Target Hazard Quotient (TTHQ) by Monte Carlo Simulation (MCS) model was used to assess the non-carcinogenic risk.

RESULTS AND DISCUSSION

According to 42 of the 836 retrieved articles, the PTE concentrations in mother's milk were as follows: Cu (1.84 mg/kg) > Zn (1.80 mg/kg) > Fe (1.03 mg/kg) > Ni (0.60 mg/kg) > Pb (0.10 mg/kg) > As (0.15 mg/kg) ≈ Cd (0.15 mg/kg). Based on the containment type, the highest concentrations of As (2.80 mg/kg), Cd (0.07 mg/kg), and Pb (2.68 mg/kg) were related to Western Pacific Region (WPRO), European Region (EURO), and WPRO, respectively. In addition, for trace elements, Eastern Mediterranean Region (EMRO) was the region with the highest concentrations of Cu (3.56 mg/kg), Fe (2.78 mg/kg), Ni (3.13 mg/kg), and Zn (5.58 mg/kg) were related to Lastly, the non-carcinogenic risk assessment of the PTEs in breast milk indicated different risk patterns in various countries, and the calculated TTHQ level in infants was below 1.

CONCLUSION

Overall, human breast milk was generally safe for infants to consume and poses no risks to their health.

Lead, mercury, and cadmium levels in breast milk and infant hair in the late period of lactation in Ankara, Turkey

Lead (Pb), mercury (Hg), and cadmium (Cd) have known harmful effects on children's well-being. The object of this study was to measure the levels of heavy metals (Pb, Hg, and Cd) in breast milk and infant hair, connected environmental factors, and the impact on infant growth and development at 8 months. Seventy-four breast milk samples and 46 infant hair samples were analyzed. Cd, Pb, and Hg were detected in 99%, 91%, and 87% of breast milk samples, respectively. Cd levels were higher in the hair of infants in extended families, living in older houses and when there was a maternal history of anemia and postpartum anemia. Hg levels in breast milk were higher in Denver II suspicious/abnormal infants than in Denver II normal infants. Further biomonitoring studies and preventive measures should be conducted to minimize exposure to toxic metals in early childhood period.

Contamination of breast milk with lead, mercury, arsenic, and cadmium in Iran: a systematic review and meta-analysis

Breast milk is a complete food for the development of the newborn, but it can also be an important route for environmental pollutants transmission to the infants. This study was aimed to evaluate the status of heavy metals including lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As) in the breast milk of Iranian mothers. The international databases including Scopus, PubMed, Web of Science and the Persian electronic databases including Scientific Information Database, IranMedex and Magiran were examined to find relevant articles published until July 2021. A total of 23 studies examined the levels of toxic metals in Iranian breast milk samples. According to the findings, the pooled average concentrations (µg/L) of Pb, Cd, Hg and As were 25.61, 2.40, 1.29 and 1.16, respectively. The concentration of Hg and Pb in colostrum milk was more than twice of mature milk. The Hg mean concentration in the breast milk of mothers with at least one amalgam-filled tooth was approximately three times that of mothers without amalgam-filled teeth. Risk assessment analysis indicated that the intake of Pb and Hg by infants through breastfeeding can be considered a health concern in Iran. It seems necessary to reduce the Pb exposure of pregnant and lactating women in Iran. However, more extensive studies are needed to clarify the toxic metals' exposure status of infants through breast milk in other parts of the country.

Correlation between As, Cd, Hg, Pb and Sn concentration in human milk and breastfeeding mothers' food consumption: a systematic review and infants' health risk assessment

Mothers' food and water consumption appear to be determining factors for infants' potentially toxic elements exposure through human milk. Therefore, this systematic review aimed to assess correlations between As, Cd, Hg, Pb and/or Sn concentration in human milk and breastfeeding mothers' food consumption, with later infants' health risk assessment. Estimated Daily Intakes of such elements by infants were also calculated and compared with reference values (RfD or BMDL01). Among 5.663 identified studies, 23 papers remained for analysis. Potentially toxic elements concentration in human milk presented positive correlation with seafood (As, Hg), fresh vegetables (Hg, Cd), cereals (Hg, Cd), cheese, rice, potatoes, private and well-water supply (Pb), wild meat (Pb, Cd) and milk, dairy products, dried fruits and oilseeds (Cd) mothers' consumption. Red meat, caffeinated drinks, and dairy products consume presented negative correlations (Pb). No correlations were found for Sn. Infants from three studies presented high Hg exposition through human milk (> 0. 1 μg/kg PC-1 day-1), as well as observed for Pb in one study (> 0. 5 μg/kg PC-1 day-1). Potentially toxic elements can damage infants' health when they are present in mothers' diet due to the infants' high vulnerability. Therefore, these results raise important issues for public health.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2056869 .

Concentrations and determinants of lead, mercury, cadmium, and arsenic in pooled donor breast milk in Spain

AIM

To measure concentrations of lead (Pb), mercury (Hg), cadmium (Cd), and arsenic (As) in longitudinally collected donor breast milk samples and to determine associated factors.

METHODS

Pb, Hg, Cd, and As concentrations were measured in 242 pooled breast milk samples from 83 donors to a Human Milk Bank in Spain, in 2015-2018, determining their association with the donors' sociodemographic profile, dietary and lifestyle habits, and post-partum time, among other factors, and with the nutritional characteristics of samples. Mixed-effect linear regression was used to identify predictors of Hg and As concentrations in breast milk and mixed-effect logistic regression to identify predictors of the presence of Pb and Cd.

RESULTS

As was the element most frequently detected in milk samples (97.1%), followed by Hg (81.2%), Pb (50.6%), and Cd (38.0%). Their median breast milk concentrations were 1.49 μg/L, 0.26 μg/L, 0.14 μg/L, and <0.04 μg/L, respectively. Concentrations of As were higher in breast milk from primiparous donors, while Hg was higher in donors with a greater intake of fatty fish and meat and lower in samples collected after a longer post-partum time and with higher lactose content. Detection of Pb was higher among multiparous donors, those gaining weight since before pregnancy, and ex-smokers and was lower in samples collected more recently and from donors with greater intake of red meat and eggs. Cd detection was higher for donors with university education and those with greater intake of fried and canned food and more frequent use of hand cream and was lower for donors with greater bread intake.

CONCLUSIONS

These findings reveal relatively high As concentrations, moderate Hg concentrations, and low Pb and Cd concentrations in pooled donor breast milk. Several factors including post-partum time, parity, smoking habit, and the intake of certain food items were associated with the metal content of milk samples.

Monitoring of urinary arsenic (As) and lead (Pb) among a sample of pregnant Iranian women

PURPOSE

Heavy metals, as significant toxic environmental contaminants, can cause serious adverse health outcomes on the human body even in trace concentrations. There is limited evidence on heavy metal concentrations existing in the body fluids of pregnant women. This study aims to evaluate the urinary levels of arsenic (As) and lead (Pb), as two main toxic heavy metals, among pregnant women and their lifestyle determinants.

METHODS

The study was performed in 2019-2020 in Isfahan, Iran. A number of 140 urine samples of pregnant women who were in their first pregnancy trimester were examined. Inductively coupled plasma optical emission spectrometry (ICP-OES) was applied to analyze the urinary concentrations of As and Pb. Socio-demographic data including age, pre-pregnancy body mass index (BMI), education status, and family income, as well as the use of cleaning products (cosmetic and household cleaning products), and lifestyle habits (food intake, smoking, and physical activity) were collected using a validated questionnaire.

RESULTS

The mean concentration of As and Pb were 8.14 ± 10.8 and 9.6 ± 7.1 μg/g creatinine, respectively. The mean urinary concentration of Pb indicated significant differences in the levels of cosmetic usage, second-hand smoking exposure, and the use of Copper, Aluminum, Teflon, Steel, and Enameled utensils for cooking (p-value < 0.05). Furthermore, the mean of urinary Pb concentrations at high levels of physical activity and scratched utensils using was significantly different from the other categories (p-value = 0.02). No significant differences were found between As and Pb concentration with other socio-demographic factors.

CONCLUSION

The lifestyle determinants and cosmetic products use are important predictors of urinary heavy metals in pregnant women, rather than sociodemographic characteristics. Additional research is necessary to determine long-term adverse birth outcomes of exposure to these heavy metals.

Levels of mercury in Moroccan breast milk and the affecting factors: CONTAMILK study

This study aims to evaluate the level of mercury in the breast milk of Moroccan mothers and its association with several maternal parameters and habits, and to estimate the daily intake of the newborns. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the concentrations of mercury in 70 colostrum samples. Indeed, a structured questionnaire was administrated during milk collection to report data concerning the maternal socioeconomic and anthropometric parameters, as well as dietary habits and smoking habits in the family, etc. The median of mercury in breast milk was 3,56 μg/L (range 1.64-124 μg/L) and exceeded normal levels of 1.7 μg/l, suggested by the World health organization in 99% of milk samples. Significant associations were found between mercury levels and the occurrence of previous miscarriages, anemia before pregnancy and vitamin & mineral supplementation during pregnancy, as well the frequency of consumption of cereals and the use of lipstick. The estimated daily intake was higher than the tolerable daily intake of the World health organization and the European food safety authority in 30% of newborns. These results need to be confirmed by multicenter studies to investigate the levels of mercury in the breast milk of the Moroccan population.

Lead (Pb) and neurodevelopment: A review on exposure and biomarkers of effect (BDNF, HDL) and susceptibility

Lead (Pb) is a ubiquitous environmental pollutant and a potent toxic compound. Humans are exposed to Pb through inhalation, ingestion, and skin contact via food, water, tobacco smoke, air, dust, and soil. Pb accumulates in bones, brain, liver and kidney. Fetal exposure occurs via transplacental transmission. The most critical health effects are developmental neurotoxicity in infants and cardiovascular effects and nephrotoxicity in adults. Pb exposure has been steadily decreasing over the past decades, but there are few recent exposure data from the general European population; moreover, no safe Pb limit has been set. Sensitive biomarkers of exposure, effect and susceptibility, that reliably and timely indicate Pb-associated toxicity are required to assess human exposure-health relationships in a situation of low to moderate exposure. Therefore, a systematic literature review based on PubMed entries published before July 2019 that addressed Pb exposure and biomarkers of effect and susceptibility, neurodevelopmental toxicity, epigenetic modifications, and transcriptomics was conducted. Finally included were 58 original papers on Pb exposure and 17 studies on biomarkers. The biomarkers that are linked to Pb exposure and neurodevelopment were grouped into effect biomarkers (serum brain-derived neurotrophic factor (BDNF) and serum/saliva cortisol), susceptibility markers (epigenetic markers and gene sequence variants) and other biomarkers (serum high-density lipoprotein (HDL), maternal iron (Fe) and calcium (Ca) status). Serum BDNF and plasma HDL are potential candidates to be further validated as effect markers for routine use in HBM studies of Pb, complemented by markers of Fe and Ca status to also address nutritional interactions related to neurodevelopmental disorders. For several markers, a causal relationship with Pb-induced neurodevelopmental toxicity is likely. Results on BDNF are discussed in relation to Adverse Outcome Pathway (AOP) 13 ("Chronic binding of antagonist to N-methyl-D-aspartate receptors (NMDARs) during brain development induces impairment of learning and memory abilities") of the AOP-Wiki. Further studies are needed to validate sensitive, reliable, and timely effect biomarkers, especially for low to moderate Pb exposure scenarios.

Health Risk Assessments of Selected Trace Elements and Factors Associated with Their Levels in Human Breast Milk from Pretoria, South Africa

While breast milk is the recommended food for infants up to at least six months, exogenously derived compounds such as trace elements have been widely reported in human milk which may make it become toxic or a source of pollutants to the infants. Numerous short- and long-term health effects have been associated with high body-burdens of trace elements, which are amplified in infants. The current study determined the levels and possible contributing factors of six trace elements in breast milk of nursing mothers from a local hospital in Pretoria. Extraction of trace elements employed a digestion technique using perchloric and nitric acid in a ratio of 1:3, while Inductively Coupled Plasma-Membrane Spectrophotometry was used to identify and quantify their levels in breast milk. Concentrations of Cr and Mn were the highest in breast milk, with values ranging from 0.30 to 5.72 µg/L and 0.23 to 5.13 µg/L, respectively. Levels of Co, As, Pb and Cd ranged from Collapse

Key Words

• arsenic
• breast milk and passive smoking
• chromium
• manganese

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MESH Headings

• Environmental Pollutants
• Female
• Humans
• Milk, Human/chemistry
• Risk Assessment
• South Africa
• Trace Elements/analysis

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Grants Collapse

Affiliation(s)

Joshua O. Olowoyo Department of Biology, Sefako Makgatho Health Sciences University, P.O Box 139, Pretoria 0204, South Africa; (L.R.M.); (P.M.M.)
Linda R. Macheka
Phiona M. Mametja

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Heavy Metals and Trace Elements in Human Breast Milk from Industrial/Mining and Agricultural Zones of Southeastern Spain

Human breast milk is the most complete foodstuff for infants but can also be a potential source of exposure to toxic chemicals. The aim of this study was to assess the levels of metal pollution in the breast milk of women living in agricultural and industrial/mining areas of the Region of Murcia (Spain) that are well known for their cases of environmental pollution. Human milk samples were collected from 50 mothers and inorganic contaminants were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). The mean or maximum concentrations of the different inorganic elements analyzed in breast milk, with the exception of manganese, exceeded the maximum limits established by the WHO and could constitute a high risk for pregnant mothers and their children. The breast milk of women living in the industrial/mining zone presented the highest levels of aluminum, zinc, arsenic, lead, mercury and nickel. On the contrary, the highest concentrations of manganese, chromium and iron were determined in the milk of women living in the agricultural zone. These results suggested and confirmed different profiles of environmental contamination of these areas.

Lead concentrations in breast milk of Moroccan nursing mothers and associated factors of exposure: CONTAMILK STUDY

The aim of CONTAMILK study was to estimate levels of contamination of breast milk (BM) of Moroccan nursing mothers by some xenobiotics including, lead (Pb), to identify associated factors of exposure and to determine the daily intake of newborns. Lead concentrations were determined in 70 samples of colostrum by ICPMS and a structured questionnaire was filled during milk collection to report participants' data. The median lead concentration was 908 μg/L (range 1.38-515,39 μg/L) and in 79 % of samples, levels were higher than the normal range reported by the World Health Organization (WHO) in BM (2-5 μg/L). Indeed, preterm delivery, frequency of use of cosmetic powders and lipsticks were significantly associated with the level of lead in BM. The estimated daily intake was greater than the tolerable daily intake (TDI) of the European food safety authority (0.5 μg/kg/day) for 39 babies and 6 babies according to the WHO (3.6 μg/kg/day).

Toxic metals in human milk in relation to tobacco smoke exposure

Several reports confirm the deleterious effects of tobacco smoking and exposure to second-hand smoke (SHS) resulting in changes in the composition of breast milk. The aim of our study was to compare the levels of selected essential, as well as, toxic metals found in colostrum (collected at day 1 ± 2 post-birth) and mature milk (1 month ± 7 days post-birth) of nonsmoking women (n = 52) compared to those found in women who smoke tobacco (n = 51) and women exposed to second-hand smoke during pregnancy and lactation (n = 47). Women's non-smoking or smoking status was determined by their responses to a questionnaire, including questions about others who may smoke in the home environment, and confirmed by measurement of cotinine in the blood serum by high performance liquid chromatography with diode array detector (HPLC-DAD). Inductively coupled plasma mass spectrometry (ICP-MS) and flame atomic absorption spectroscopy (F-AAS) techniques were used to determine the metal concentrations in colostrum and mature milk previously digested by a microwave mineralizer. We confirmed that exposure to tobacco smoke increases concentrations of heavy metals (cadmium and lead) in colostrum and mature milk. These increased concentrations of heavy metals may disturb the action of bioactive substances necessary for the optimal growth and development of newborns and infants. These findings support the need for increased concern and information to lactating women about preventing their exposure to cigarette smoking and SHS due to the adverse effects of tobacco smoke on breast milk with added risks to their infants.

Relationship between particulate matter exposure and female breast cancer incidence and mortality: a systematic review and meta-analysis

OBJECTIVES

The associations of PM with the risk and prognosis of breast cancer have not been determined. This systematic review aimed to provide an updated understanding of the relationship between PM exposure level and breast cancer incidence and mortality.

METHODS

Articles from Web of Science and PubMed databases were methodically inspected until March 8, 2020. In final, 15 studies were kept for analysis, which provided necessary information to estimate the impact of PM on breast cancer risk and prognosis. These studies were combined for quantitative analyses to evaluate the effect of per 10 μg /m³ increment exposure of PM_2.5 (< 2.5 μm in aerodynamic diameter) and PM₁₀ (< 10 μm in aerodynamic diameter) using random-effects model.

RESULTS

PM_2.5 exposure was associated with increased breast cancer mortality (relative risk [RR] = 1.09; 95% confidence interval [CI]: 1.02, 1.16; P_Q-test = 0.158). No association of PM_2.5 (1.02; 0.97, 1.18; 0.308) and PM₁₀ (1.03; 0.98, 1.09; 0.009) with the increase incidence of breast cancer was observed. Stratified analysis suggested that PM_2.5 was associated with the increase mortality of breast cancer (1.10; 1.03, 1.17; 0.529) in subgroup of developed country. PM₁₀ was associated with breast cancer incidence based on studies published after 2017 (1.08; 1.00, 1.15; 0.157) and European studies (1.15; 1.06, 1.25; 0.502).

CONCLUSIONS

Our study indicated that PM_2.5 exposure was related to breast cancer mortality. Further researches in this field are needed to validate the conclusion.

Essential and toxic elements in human milk concentrate with human milk lyophilizate: A preclinical study

Concentrated human milk (HM-concentrate) can be obtained from the simple and inexpensive method of donated breast milk direct lyophilization. A previous study reported that HM-concentrate contains the adequate amount of main macro- and micronutrients for use as a nutritional resource for preterm infants with very low birth weight admitted to neonatal intensive care units. However, further details need to be elucidated about HM-concentrate composition, particularly its content of essential and potentially toxic trace elements. Therefore, this study aimed to determine the concentration of essential and toxic elements in human milk considered baseline (HM-baseline) and HM-concentrate, as well as to quantify changes in concentration of these elements after the HM concentration process. The concentration of Aluminum, Arsenic, Cadmium, Chromium, Iron, Mercury, Manganese, Nickel, Lead, Selenium, Tin, and Thallium was analyzed by inductively coupled plasma-mass spectrometry (ICP-MS). Moreover, Bayesian linear mixed effect models were applied to estimate the mean difference between HM-baseline and HM-concentrate samples. After comparison (HM-concentrate versus HM-baseline), a significant increase in concentration was observed only for Manganese (0.80 μg/L; 95% CrI [0.16; 1.43]) and Selenium (6.74 μg/L; 95% CrI [4.66; 8.86]), while Lead concentration (-6.13 μg/L; 95% CrI [-8.63; -3.61]) decreased. This study provides latest and reliable information about HM composition. After milk concentration by lyophilization, there was a significant increase only in the essential elements Manganese and Selenium. The essential micronutrient content in HM-concentrate was similar or higher than that in preterm mothers' milk, which suggests it is viable for nutritional support of preterm infants. In addition, the low concentrations of potentially toxic elements in HM-concentrate indicates that it is safe for consumption by premature newborns.

Cadmium Contamination in Breast Milk of Moroccan Lactating Women and the Associated Factors: CONTAMILK Study

The objectives of this study were to assess levels of contamination of breast milk (BM) by cadmium (Cd) among lactating mothers from Rabat, Morocco, and to investigate its association with several maternal habits, parameters, and factors. In addition, to estimate the daily intake of the newborns. Cd concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS) in 70 human milk samples collected between the 2nd and 5th day postpartum. Accuracy of the analysis was checked by various methods including the use of reference material. A structured questionnaire was filled during the collection of milk reporting data concerning anthropometric, sociodemographic parameters, dietary and cosmetic habits, etc. The median (range) of Cd in human milk was 0.49 μg/L (range 0.013-95.19 μg/L) respectively. In 21 (30%) of 70 samples, Cd levels were higher than the normal reported by the World Health Organization (WHO) in BM (< 1 μg/L). Indeed, several factors affect significantly Cd levels in BM of the mothers such as low maternal education level, preterm delivery, cesarean delivery, and area of residence. Also, the frequency of consumption of milk and dairy products as well dried fruits and wheat bread and the frequency of use of cosmetic powders. However, the daily intake of cadmium by the newborns was lower than tolerable daily intake of the WHO for 97% of them. Our results revealed low cadmium concentrations in human milk samples from Moroccan lactating mothers living in Rabat, also the association of some factors with the levels of contamination found in this population.

The mercury level in hair and breast milk of lactating mothers in Iran: a systematic review and meta-analysis

Exposure to mercury is one of the major global health concerns due to its stability, bioaccumulation and high toxicity. Therefore, the present study was conducted to assess the mean mercury level in hair and breast milk (BM) of Iranian lactating mothers (ILMs) through meta-analysis technique. We conducted a systematic literature search in online electronic databases included main domestic databases (SID, Magiran, Iran medex, Medlib and ISC) and international databases (Embase, Scopus and PubMed) for studies published between 2000 up 2018. Each process of research and evaluation of articles based on inclusion and exclusion criteria is done by two researchers, individually. From10 studies entered to meta-analysis process including 556 ILM, the mean hair mercury level (HML) and mean milk mercury level (MML) was estimated to be 0.15 μg/g (95 CI: 0.11-0.19, I2: 47.6%, P: 0.028) and 0.51 μg/l (95 CI: 0.28-0.74, I2: 1.9%, P: 0.421), respectively. In this meta-analysis, the mean HML and mean MML were estimated to be lower than the standard of World Health Organization (WHO). Although the mean mercury level in hair and BM of ILMs was lower than the WHO standard, but due to toxicity and serious concern of health, management and Periodic monitor are recommended in different cities of the country for evaluate the mercury levels in hair and BM of ILMs and to estimate the infant's exposure.

Systematic Review of the Literature of Factors Affecting the Exposure and the Levels of Lead in Human Breast Milk

Human milk may sometimes contain chemical contaminants, which could have adverse effects on neonates or nursing infants. Lead (Pb) is of considerable interest due to its toxicity and occurrence. Furthermore, it has been suggested that human milk is a significant potential source of lead exposure to nursing infants. A systematic literature search in PubMed, Science Direct, and Google Scholar databases was performed to identify relevant studies, published in English until 2017, that investigated and explored common factors affecting the level of lead in human milk among lactating women around the world. Forty-nine papers were rated and explored the effect of one or several factors on the level of lead in human milk from 28 countries and carried out over a wide time frame from 1983 to 2017 and through Europe, Asia, America, and Africa, reviewing more than 5,000 subjects. Place of residence, maternal age, stage of lactation, smoking habits, maternal dietary intakes, and parity were the mostly assessed factors among the studies and considered as the main factors affecting Pb levels in BM. Other factors were not studied well enough and considered minor because few surveys evaluated their impacts. However, the literature findings are very controversial.

Protective Effect of Breastfeeding on the Adverse Health Effects Induced by Air Pollution: Current Evidence and Possible Mechanisms

Air pollution is a major social, economic, and health problem around the world. Children are particularly susceptible to the negative effects of air pollution due to their immaturity and excessive growth and development. The aims of this narrative review were to: (1) summarize evidence about the protective effects of breastfeeding on the adverse health effects of air pollution exposure, (2) define and describe the potential mechanisms underlying the protective effects of breastfeeding, and (3) examine the potential effects of air pollution on breastmilk composition and lactation. A literature search was conducted using electronic databases. Existing evidence suggests that breastfeeding has a protective effect on adverse outcomes of indoor and outdoor air pollution exposure in respiratory (infections, lung function, asthma symptoms) and immune (allergic, nervous and cardiovascular) systems, as well as under-five mortality in both developing and developed countries. However, some studies reported no protective effect of breastfeeding or even negative effects of breastfeeding for under-five mortality. Several possible mechanisms of the breastfeeding protective effect were proposed, including the beneficial influence of breastfeeding on immune, respiratory, and nervous systems, which are related to the immunomodulatory, anti-inflammatory, anti-oxidant, and neuroprotective properties of breastmilk. Breastmilk components responsible for its protective effect against air pollutants exposure may be long chain polyunsaturated fatty acids (LC PUFA), antioxidant vitamins, carotenoids, flavonoids, immunoglobins, and cytokines, some of which have concentrations that are diet-dependent. However, maternal exposure to air pollution is related to increased breastmilk concentrations of pollutants (e.g., Polycyclic aromatic hydrocarbons (PAHs) or heavy metals in particulate matter (PM)). Nonetheless, environmental studies have confirmed that breastmilk’s protective effects outweigh its potential health risk to the infant. Mothers should be encouraged and supported to breastfeed their infants due to its unique health benefits, as well as its limited ecological footprint, which is associated with decreased waste production and the emission of pollutants.

A prophylactic multi-strain probiotic treatment to reduce the absorption of toxic elements: In-vitro study and biomonitoring of breast milk and infant stools

Potential exposure to toxic elements initially occurs during gestation and after birth via breast milk, which is the principal source of nutrients for infants during the first months of life. In this study, we evaluated whether maternal oral supplementation with a multi-strain probiotic product can protect infants from exposure to arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) via breast milk. In-vitro studies of the bacterial strains present in this probiotic product showed a high bacterial tolerance for As, Cd, Hg, and Pb, and good binding capacity for Cd, Hg, and Pb (72%, 81%, and 64%, respectively) within 1 h of contact. We evaluated concentrations (5 mg L^-1 for Cd and Pb, and 2 mg L^-1 for Hg) that largely exceeded the provisional tolerable weekly intake of these toxic elements via food or water applicable for human consumption. Changes in the levels of these elements in breast milk and newborn stools were evaluated in the control (orally supplemented with placebo) and experimental (orally supplemented with probiotic) groups at birth (t0), 15 days (t15), and 30 days (t30) after delivery. Elemental analysis of breast milk did not show significant differences between the control and experimental groups at different stages of lactation; however, stool samples obtained from newborns of mothers supplemented with the probiotic product showed that Cd levels were significantly reduced (by 26%) at t15 compared with the levels of the controls. Our data did not show an association between concentration of toxic elements in breast milk and that in newborn stools. Indeed, the concentration of Cd, Hg, and Pb in breast milk decreased during the lactation period, whereas the levels of these elements in newborn stools were stable over time. Although our in-vitro data indicate that the consortium of these probiotic strains can absorb toxic compounds, this study was limited by its small sample size and potential uncontrolled confounding effects, such as maternal diet and lifestyle. Therefore, we could not confirm whether prophylactic use of this probiotic product can reduce the absorption of toxic elements. The risk assessment in the studied population evidenced a margin of exposure (MOE) of 1, or between 1 and 10 for Pb, and lower than 50 for As. This poses a potential risk for breastfed infants, indicating that interventions aimed to avoid breastfeeding-related health risks remain a major challenge in public health.

Predictors of toxic metal exposures among US women of reproductive age

BACKGROUND

Arsenic, cadmium, lead, and mercury are ubiquitous toxicants that may be especially harmful to unborn children. We therefore sought to identify temporal trends and predictors of toxic metal biomarkers among US women of reproductive age, including those who were pregnant and/or breastfeeding.

METHODS

Interviews and examinations were performed among a representative sample of women, aged 20-44 years, as part of the 2003-2014 National Health and Nutrition Examination Surveys. A range of sociodemographic, lifestyle, and dietary factors were evaluated as predictors of urinary inorganic arsenic, urinary cadmium, blood mercury, and blood lead concentrations.

RESULTS

Levels of all four toxic metal biomarkers declined during the study period. Older age, racial/ethnic minorities, and a birthplace outside of the US were independently associated with higher toxic metal concentrations. Associations were similar for women who were pregnant or breastfeeding and those who were not.

CONCLUSION

US women of reproductive age were exposed to lower levels of toxic metals in 2013-2014 compared to 2003-2004. However, because the long-term health effects of early life exposures are unclear, public health efforts to address toxic metals should pay particular attention to older, nonwhite, and foreign-born women if they are pregnant or planning to become pregnant.

Concentration of mercury, cadmium, and lead in breast milk from Norwegian mothers: Association with dietary habits, amalgam and other factors

Mercury (Hg), cadmium (Cd), and lead (Pb) are of great concern for food safety and infants are especially sensitive to exposure to the maternal body burden. We quantified these elements in breast milk from Norwegian mothers and determined their association with dietary habits, maternal amalgam fillings, and smoking. Breast milk (n = 300) from the Norwegian Human Milk Study (HUMIS) was analyzed using triple quadrupole inductively coupled plasma mass spectrometry, after an acidic decomposition using microwave technique. We used multiple linear regression to examine predictors of Hg and Cd in breast milk, and logistic regression to test predictors of Pb above the quantification limit. The median breast milk concentrations (minimum - maximum) were 0.20 μg Hg/kg (<0.058-0.89), 0.057 μg Cd/kg (0.017-1.2), and <0.67 μg Pb/kg (<0.2-7.5). Cadmium showed no significant relation with any exposure variable investigated. Lead was associated with intake of liver and kidneys from game. For Hg concentration in breast milk, number of amalgam fillings and high fish consumption were significant predictors (p < 0.001). We detected a significant association (p < 0.01) between Hg in breast milk and maternal consumption of Atlantic halibut, lean fish, mussels and scallops and lifetime consumption of crab. Seafood intake alone explained 10% of variance, while together with amalgam explained 46% of variance in Hg concentration in breast milk. Our findings emphasize the importance of following consumer advice with respect to fish and seafood and points to amalgam as an important source for Hg exposure.

The impact of environmental pollution on the quality of mother's milk

Breastfeeding is a gold standard of neonate nutrition because human milk contains a lot of essential compounds crucial for proper development of a child. However, milk is also a biofluid which can contain environmental pollution, which can have effects on immune system and consequently on the various body organs. Polychlorinated biphenyls are organic pollutants which have been detected in human milk. They have lipophilic properties, so they can penetrate to fatty milk and ultimately to neonate digestive track. Another problem of interest is the presence in milk of heavy metals-arsenic, lead, cadmium, and mercury-as these compounds can lead to disorders in production of cytokines, which are important immunomodulators. The toxicants cause stimulation or suppression of this compounds. This can lead to health problems in children as allergy, disorders in the endocrine system, end even neurodevelopment delay and disorder. Consequently, correlations between pollutants and bioactive components in milk should be investigated. This article provides an overview of environmental pollutants found in human milk as well as of the consequences of cytokine disorder correlated with presence of heavy metals. Graphical abstract.

Total, organic, and inorganic mercury in human breast milk: levels and maternal factors of exposure, systematic literature review, 1976-2017

This systematic review summarizes the finding of 58 studies from 33 countries, which assessed mercury concentrations in breast milk and the factors related to the level of contamination. We performed a literature search in Pubmed, Science Direct, and Google Scholar databases for studies published between 1976 and 2017 that are monitoring and measuring mercury in human breast milk and investigating the associated factors. Then, we extracted more information about the aim of the study, the country, samples size, time of lactation, mercury concentration, and other data. Most of the studies used mature milk or colostrum for analysis and in about 60% of them, the concentrations exceed significantly the limit set by the World Health Organization (WHO) of 1.7 µg/l; In addition, many factors and parameters were related to the level of mercury contamination in breast milk. Periodic monitoring surveys are recommended in each country to evaluate the level of mercury in milk of lactating women and to estimate the level of exposure of newborns.

Environmental Chemical Contaminants in Food: Review of a Global Problem

Contamination by chemicals from the environment is a major global food safety issue, posing a serious threat to human health. These chemicals belong to many groups, including metals/metalloids, polycyclic aromatic hydrocarbons (PAHs), persistent organic pollutants (POPs), perfluorinated compounds (PFCs), pharmaceutical and personal care products (PPCPs), radioactive elements, electronic waste, plastics, and nanoparticles. Some of these occur naturally in the environment, whilst others are produced from anthropogenic sources. They may contaminate our food-crops, livestock, and seafood-and drinking water and exert adverse effects on our health. It is important to perform assessments of the associated potential risks. Monitoring contamination levels, enactment of control measures including remediation, and consideration of sociopolitical implications are vital to provide safer food globally.

The Safety Assessment of Toxic Metals in Commonly Used Pharmaceutical Herbal Products and Traditional Herbs for Infants in Jordanian Market

The objective of this study was to assess the levels of contamination by toxic metals (Pb, Al, Ni, Cd and As) that may be present in 25 infant pharmaceutical herbal products and 15 traditional herbs in Jordan. Both products and medicinal herbs are currently prescribed by paediatricians. They are available as over-the-counter medicines and are sold the in herbal market, ensuring easy accessibility for parents. Inductively coupled plasma-optical emission spectroscopy (ICP-OES), with limit of detections (LODs) of 0.10, 1.00, 0.20, 0.15 and 2.00 mg.kg^-1 for Pb, Al, Ni, Cd and As respectively, was employed to measure the levels of toxic metals in the samples. Pb, Al and Ni were detected in 88, 76 and 4% of the analysed samples of pharmaceutical herbal products and in 93, 87 and 13% of the analysed samples of traditional herbs, respectively. Neither Cd or As were detected in all analysed samples. The data obtained were subsequently compared by referral to the acceptable limits of toxic heavy metals according to World Health Organisation (WHO) standards. Largely, the results showed acceptable toxic metal levels in the finished pharmaceutical products and the traditional medicinal herbs for infants. One exception to this was Persian Thyme (Satureja thymbra) with Pb content of 41.18 mg.kg^-1. Also, the daily intake of detected metals through pharmaceutical herbal products was found to be lower than the daily tolerable intake limit set by the regulatory bodies, except of 8% of products that exceeded the tolerable daily intake of Pb set by US FDA, as compared to traditional medicinal herbs, where the tolerable daily intake for Pb, Al and Ni were exceeded in 40, 60 and 8% of the analysed herbs, respectively. The results obtained revealed that the excessive use of medicinal plants as alternative medicine should be used with caution keeping in mind the safety factor in infants.

Mercury, Lead, Cadmium, and Barium Levels in Human Breast Milk and Factors Affecting Their Concentrations in Hamadan, Iran

Breast milk is considered the best source of nutrition for all infants. However, exposure of newborns to toxic metals is of special interest due to their potential harmful effects. Thus, the primary aims of this study were to determine the concentration of toxic heavy metals including lead, mercury, cadmium, and barium in breast milk samples from Hamadan, Iran, in relation to some sociodemographic variables. A total of 100 breast milk samples were collected and their heavy metal contents were measured by inductively coupled plasma mass spectroscopy (ICP-MS). The median breast milk concentrations of Pb, Hg, and Ba were 41.9, 2.8, and 1.95 μg/L, respectively. Cd levels were < 1 μg/L in all samples. The Pb level in 94% of the samples was higher than the recommended Pb limit of < 5 μg/L in breast milk suggested by World Health Organization (WHO). Hg levels in 54% of the breast milk samples were higher than the normal mean concentration (1.7 μg/L) suggested by WHO. We found no correlation between Hg levels in breast milk and sociodemographic factors. Ba levels in all the breast milk samples were lower than the WHO's proposed health-based drinking water guideline (0.7 mg/L). Considering the results of the present study and the vulnerability of infants, along with the well-known toxicity of these metals, further studies are warranted to identify the main sources of exposure that contribute their concentration in breast milk, establish harmless intake values of toxic metals in breast milk, and develop preventive measures.

Breast milk contamination with lead and cadmium and its related factors in Kerman, Iran

BACKGROUND

Heavy metals may be carcinogenic and have serious health effects in humans. In this study, levels of lead (Pb) and cadmium (Cd) in human milk samples from Kerman, Iran were evaluated.

METHODS

One-hundred breast milk samples were collected from mothers visiting 20 maternal and child care centers. Demographic, diet and smoking data was collected for each mother. Samples were analyzed by Graphite Furnace Atomic Absorption Spectrometry. Statistical analysis was done in Minitab15, through non-parametric methods, Spearman's correlation and chi-square.

RESULTS

The mean ± sd of Pb and Cd was 53.6 ± 64.9 and 8.01 ± 15.5 μg/L respectively. The median (25-75 percentiles) of Pb and Cd was 34.00 (4.00-81.75) and 5.00 (4.00-7.00) μg/L; 6 and 17% of infants were receiving higher than recommended levels of lead and cadmium respectively. Mothers who took fat off their meat before eating and mothers who had a vaginal delivery had higher levels of Cd than others (p value = 0.04, 0.002). Non-primiparous mothers and those who consumed more yogurt had higher levels of Pb (p value = 0.011, 0.025).

CONCLUSION

Lead and cadmium contamination was considerable among mothers' in Kerman, Iran. There is a need for decreasing the current levels in food, air, water and other consumer products such as cosmetics.

Multiple low-level exposures: Hg interactions with co-occurring neurotoxic substances in early life

All chemical forms of Hg can affect neurodevelopment; however, low levels of organic Hg (methylmercury-MeHg and ethylmercury-EtHg in Thimerosal-containing vaccines, hereafter 'TCV') exposures during early life (pregnancy and lactation) co-occur with other environmental neurotoxic substances. These neurotoxicants may act in parallel, synergistically, or antagonistically to Hg. Nevertheless, the risks of neurotoxicity associated with multiple neuro-toxicants depend on type, time, combinations of exposure, and environmental and/or genetic-associated factors. Neurological developmental disorders, delays in cognition and behavioral outcomes associated with multiple exposures (which include Hg) may show transient or lasting outcomes depending on constitutional and/or environmental factors that can interact to neutralize, aggravate or attenuate these effects; often these studies are challenging to interpret. During pregnancy and lactation, fish-MeHg exposure is frequently confounded with the opposing effects of neuroactive nutrients (in fish) that lead to positive, negative, or no effects on neurobehavioral tests. In infancy, exposures to acute binary mixtures (TCV- EtHg and Al-adjuvants in infant immunizations) are associated with increased risks of tics and other developmental disorders. Despite the certitude that promulgates single environmental neurotoxicants, empirical comparisons of combined exposures indicate that Hg-related outcome is uneven. Hg in combination with other neurotoxic mixtures may elevate risks of neurotoxicity, but these risks arise in circumstances that are not yet predictable. Therefore, to achieve the goals of the Minamata treaty and to safeguard the health of children, low levels of mercury exposure (in any chemical form) needs to be further reduced whether the source is environmental (air- and food-borne) or iatrogenic (pediatric TCVs).

Environmental Chemicals in Breast Milk and Formula: Exposure and Risk Assessment Implications

BACKGROUND

Human health risk assessment methods have advanced in recent years to more accurately estimate risks associated with exposure during childhood. However, predicting risks related to infant exposures to environmental chemicals in breast milk and formula remains challenging.

OBJECTIVES

Our goal was to compile available information on infant exposures to environmental chemicals in breast milk and formula, describe methods to characterize infant exposure and potential for health risk in the context of a risk assessment, and identify research needed to improve risk analyses based on this type of exposure and health risk information.

METHODS

We reviewed recent literature on levels of environmental chemicals in breast milk and formula, with a focus on data from the United States. We then selected three example publications that quantified infant exposure using breast milk or formula chemical concentrations and estimated breast milk or formula intake. The potential for health risk from these dietary exposures was then characterized by comparison with available health risk benchmarks. We identified areas of this approach in need of improvement to better characterize the potential for infant health risk from this critical exposure pathway.

DISCUSSION

Measurements of chemicals in breast milk and formula are integral to the evaluation of risk from early life dietary exposures to environmental chemicals. Risk assessments may also be informed by research investigating the impact of chemical exposure on developmental processes known to be active, and subject to disruption, during infancy, and by analysis of exposure-response data specific to the infant life stage. Critical data gaps exist in all of these areas.

CONCLUSIONS

Better-designed studies are needed to characterize infant exposures to environmental chemicals in breast milk and infant formula as well as to improve risk assessments of chemicals found in both foods. https://doi.org/10.1289/EHP1953.

Optimization and validation of a fast digestion method for the determination of major and trace elements in breast milk by ICP-MS

Breast milk guarantees all the nutrients required by infants during their first few months of life and remains the most important food source for their health and growth. However, the mother may transfer potentially toxic chemicals to the suckling infant through breastfeeding. The aim of this study was to optimize and validate a fast method for the determination of a total content of 34 elements (Al, As, B, Ba, Be, Bi, Ca, Cd, Co, Cr, Cs, Cu, Fe, K, Li, Mg, Mn, Mo, Na, Ni, P, Pb, Rb, Sb, Se, Si, Sn, Sr, Te, Ti, Tl, U, V, and Zn) in liquid and lyophilized breast milk. The samples were subjected to HNO₃:H₂O₂ (2:1) digestion in an open vessel heated in a water bath (WBD; 80 °C) and subsequently analysed by quadrupole inductively coupled plasma mass spectrometry equipped with a collision-reaction interface. The performance of the proposed method was evaluated in terms of selectivity, detection and quantification limits, linearity, accuracy, and robustness by using standard reference materials and filed samples of breast milk. Compared to microwave-assisted acid digestion, the proposed open vessel digestion allows a significant reduction in treatment time and sample manipulation, while maintaining a similar analytical performance. Masses of 0.5 g of breast milk were efficiently digested with the WBD treatment allowing a residual carbon content lower than 60 mg L^-1 and a residual acidity lower than 0.87 mol L^-1 in final digested samples. Thus, it shows great potential for application to routine analysis. The method provides satisfactory detection limits and good performance (trueness and recovery percentages 80-111%; coefficient of variation <10%; and relative repeatability <15%) and allows a high sample throughput for multi-elemental determination in human biomonitoring studies.

Metalloproteomics Approach to Analyze Mercury in Breast Milk and Hair Samples of Lactating Women in Communities of the Amazon Basin, Brazil

Mercury is a potentially toxic element that is present in the environment of the Brazilian Amazon and is responsible for adverse health effects in humans. This study sought to assess possible protein biomarkers of mercury exposure in breast milk samples from lactating women in the Madeira and Negro Rivers in the Brazilian Amazon. The mercury content of hair samples of lactating women was determined, and the proteome of breast milk samples was obtained using two-dimensional electrophoresis after protein precipitation with acetone. Mercury measurements of protein spots obtained via protein fractionation were performed by graphite furnace atomic absorption spectrometry (GFAAS), and it was observed that mercury is linked to proteins with molecular masses in the range of 14-26 kDa. The total mercury concentration was also determined by GFAAS in unprocessed milk, lyophilized milk, and protein pellets, with the purpose of determining the mercury mass balance in relation to the concentration of this element in milk and pellets. Approximately 85 to 97% of mercury present in the lyophilized milk from samples of lactating women of the Madeira River is bound in the protein fraction. From lactating women of the Negro River, approximately 49% of the total mercury is bound in the protein fraction, and a difference of 51% is bound in the lipid fraction.

Exposure to lead and mercury through breastfeeding during the first month of life: A CHECK cohort study

Mercury and lead are naturally occurring toxicants and are responsible for various health issues including neurobehavioral and developmental disorders. Because of crucial synchronized developmental processes occurring at the early stage of life, infancy and childhood are considered as among the most susceptible windows to the exposure to these metals. Breastmilk is often the only source of nutrition during the first months of life. As breastmilk can be contaminated with these metals, breastfeeding may serve as a significant route of heavy metal exposure among infants. In order to understand current levels of exposure to mercury and lead through breastfeeding, and their associated risks, a total of 157 lactating mothers were recruited from Children's Health and Environmental Chemicals of Korea (CHECK) cohort, and breastmilk samples were collected at 15 and 30days after delivery (n=207). Mercury was detected from 100% of breastmilk with a median concentration of 0.59μg/L, and lead was detected in 77% of the samples with a median at 4.71μg/L. Higher concentrations of lead were found in the 30- day breastmilk than in the 15-day. Up to 45% of the breastmilk samples exceeded the normal range of the breastmilk lead suggested by WHO. Based on Monte Carlo simulation, about 71% of 15days old infants and 56% of 30days old infants were estimated at risk due to lead exposure through breastfeeding. Considering vulnerability of infants and well-known neurological toxicity of these metals, further studies to identify major exposure sources that contribute the lead concentration in breastmilk and health implication of early life stage exposure to lead among the breastfed infants are warranted.

Lead, cadmium and arsenic in human milk and their socio-demographic and lifestyle determinants in Lebanon

INTRODUCTION

Exposure of newborns to toxic metals is of special interest due to their reported contamination in breast milk and potential harm. The aim of this study was to assess the occurrence and factors associated with lead, cadmium and arsenic contamination in breast milk collected from lactating mothers in Lebanon.

METHODS

A total of 74 breast milk samples were collected from primaparas according to guidelines set by the World Health Organization. A survey was administered to determine the demographic and anthropometric characteristics of participating lactating mothers. Dietary habits were assessed using a semi-quantitative food frequency questionnaire. The milk samples were analyzed for the presence of arsenic, cadmium and lead using microwave-assisted digestion and atomic absorption spectrophotometry.

RESULTS

Arsenic contamination was found in 63.51% of breast milk samples (mean 2.36 ± 1.95 μg/L) whereas cadmium and lead were detected in 40.54% and 67.61% of samples respectively (means 0.87 ± 1.18 μg/L and 18.18 ± 13.31 μg/L). Regression analysis indicated that arsenic contamination was associated with cereal and fish intake (p = 0.013 and p = 0.042 respectively). Residence near cultivation activities (p = 0.008), smoking status before pregnancy (p = 0.046), potato consumption (p = 0.046) and education level (p = 0.041) were associated with lead contamination. Cadmium contamination was significantly associated with random smoke exposure (p = 0.002).

CONCLUSION

Our study is the first in Lebanon to report toxic metal contamination in breast milk. Although estimated weekly infant intake of these metals from breast milk was found to be lower than the limit set by international guidelines, our results highlight the need for developing strategies to protect infants from exposure to these hazardous substances.

Rare-earth elements in human colostrum milk

Rare-earth elements (REEs) are used in a growing number of applications, and their release to environment has increased over the decades. Knowledge of REEs in human milk and factors that could possibly influence their concentration is scarce. This study evaluated the concentrations of 16 REEs (Ce, Eu, Er, Gd, La, Nd, Pr, Sc, Sm, Dy, Ho, Lu, Tb, Tm, Y, and Yb) in human colostrum milk collected from Polish women (n = 100) with the ICP-OES technique. The concentrations (mean ± SD) of Pr (41.9 ± 13.2 μg L^-1), Nd (11.0 ± 4.0 μg L^-1), La (7.1 ± 5.2 μg L^-1), and Er (2.2 ± 0.8 μg L^-1) were found above detection limits. The total mean ± SD concentration of detected REEs was 60.9 ± 17.8 μg L^-1. Current smokers displayed significantly increased Nd concentrations compared to women who had never smoked. No other associations between REEs in colostrum milk and age, diet in pregnancy (food supplement use and frequency of fish, meat, and vegetable consumption) or place of living (urban/rural) were found. This study adds to general understanding of the occurrence and turnover of REEs in women and human fluids.

Assessment of cadmium levels in human breast milk and the affecting factors: A systematic review, 1971-2014

BACKGROUND

This is a first systematic review summarizing 43 years of research from 36 countries for the assessment of cadmium in breast milk, a suitable matrix in human biomonitoring.

OBJECTIVES

To report from the published literature the levels of cadmium in breast milk, and the affecting factors causing increase in cadmium concentrations. In addition, to gather several quantitative data that might be useful to evaluate the international degrees of maternal and infant exposure.

METHODS

We reviewed the literature published between 1971 and 2014, available on Pubmed, Science Direct, and Google Scholar, reporting quantitative data about cadmium levels in human breast milk. Information about the aim of the study, name of the country, period of collection of samples, size of samples, sampling method, time of lactation, mother's age, area of residence, cadmium concentration, and other data were extracted.

RESULTS

Sixty-seven studies were selected and included in this systematic review. Some concentrations greatly exceed the limit set by the World Health Organization (WHO); however, about 50% of the studies had less than 1 µg/L cadmium concentration (recommended by the WHO); as well as many factors have shown their implication in breast milk contamination.

CONCLUSIONS

Breast milk is a pathway of maternal excretion of cadmium. It is also a biological indicator of the degree of environmental pollution and cadmium exposure of the lactating woman and the nourished infant. Therefore, preventive measures and continuous monitoring are necessary.

Cross-sectional assessment of infants' exposure to toxic metals through breast milk in a prospective cohort study of mining communities in Ghana

Background

Although breastfeeding of infants is recommended globally, the fact that maternal toxic metal stores are mobilised into breast milk implies infants, whose mothers live and work in mining communities, are at risk of multiple exposure to mining related toxic metals, such as Lead (Pb), Mercury (Hg), Cadmium (Cd) and Arsenic (As), through breast milk intake, in addition to in utero exposure.

Method

A total of 114 mother-baby pairs, recruited from two community hospitals servicing mining communities in two different regions in Ghana (57 each), were involved in this study. When the babies were 3 months old, the amount of breast milk intake, concentrations of selected toxic metals in the breast milk and therefore the amount of toxic metals exposure through breast milk were determined. The study also, determined the amount of these toxic metals in the hair and urine of each mother-baby pair at 3 months postpartum.

Results

Based on the amounts of milk intake and non-milk oral intakes (geometric mean of 0.701 (95% CL 0.59–0.81) Kg/day and median of 0.22 Kg/day respectively), 90% of the babies were determined to have been exclusively breastfed. The amounts of most of the toxic metals in breast milk were higher than the WHO set limits and for 46.4%, 33.3% and 4.4% of the babies, their intake of As, Hg and Pb respectively were above the WHO provisional tolerable daily intake (PTDI) values.

Conclusion

An appreciable proportion of babies living within the communities served by the Mangoasi Community Hospital in the Obuasi Municipality of the Ashanti Region and the Dompime Health Centre in the Tarkwa Municipality of the Western Region were exposed to Hg, As and Pb through breast milk in excess of what they should and these may have health implication for the infants and therefore calls for interventions.

Blood cadmium concentrations and environmental exposure sources in newcomer South and East Asian women in the Greater Toronto Area, Canada

BACKGROUND

Immigrant women are often identified as being particularly vulnerable to environmental exposures and health effects. The availability of biomonitoring data on newcomers is limited, thus, presenting a challenge to public health practitioners in the identification of priorities for intervention.

OBJECTIVES

In fulfillment of data needs, the purpose of this study was to characterize blood concentrations of cadmium (Cd) among newcomer women of reproductive age (19-45 years of age) living in the Greater Toronto Area (GTA), Canada and to assess potential sources of environmental exposures.

METHODS

A community-based model, engaging peer researchers from the communities of interest, was used for recruitment and follow-up purposes. Blood samples were taken from a total of 211 newcomer women from South and East Asia, representing primary, regional origins of immigrants to the GTA, and environmental exposure sources were assessed via telephone survey. Metal concentrations were measured in blood samples (diluted with 0.5% (v/v) ammonium hydroxide and 0.1% (v/v) octylphenol ethoxylate) using a quadrupole ICP-MS. Survey questions addressed a wide range of environmental exposure sources, including dietary and smoking patterns and use of nutritional supplements, herbal products and cosmetics.

RESULTS

A geometric mean (GM) blood Cd concentration of 0.39µg/L (SD:±2.07µg/L) was determined for study participants (min/max: <0.045µg/L (LOD)/2.36µg/L). Several variables including low educational attainment (Relative Ratio (RR) (adjusted)=1.50; 95% CI 1.17-1.91), milk consumption (RR (adjusted)=0.86; 95% CI 0.76-0.97), and use of zinc supplements (RR (adjusted)=0.76; 95% CI 0.64-0.95) were observed to be significantly associated with blood Cd concentrations in the adjusted regression model. The variable domains socioeconomic status (R²_adj=0.11) and country of origin (R²_adj=0.236) were the strongest predictors of blood Cd.

CONCLUSION

Blood Cd concentrations fell below those generally considered to be of human health concern. However, negative health effects cannot be entirely excluded, especially for those that fall in the upper percentile range of the distribution, given the mounting evidence for negative health outcomes at low environmental exposure concentrations.