The Psychological Experience of Nursing Mothers upon Learning of a Toxic Substance in Their Breast Milk

Smoking during pregnancy, stigma and secrets: Visual methods exploration in the UK

BACKGROUND

Moral judgements are commonly directed towards mothers through reference to health behaviour in pregnancy, and working-class mothers are particularly subject to this moral gaze.

AIM

To gain an in-depth understanding of the health issues affecting 10 low income pregnant women from deprived areas of south Wales, UK.

METHODS

Participants completed visual activities (timelines, collaging or thought bubbles and dyad sandboxing) prior to each interview. Participants' visual representations were used in place of a topic guide, to direct the interview. Guided by feminist principles, 28 interviews were completed with 10 women. Data were analysed thematically.

FINDINGS

Smoking was discussed at length during interviews, and this paper focuses on this issue alone. Five of the participants had smoked during pregnancy. Negative reactions were directed towards pregnant women who smoked in public, resulting in maternal smoking being undertaken in private. Participants also reported awkward relationships with midwives and other health professionals, including receipt of public health advice in a judgemental tone.

DISCUSSION

Smoking during pregnancy is a particularly demonised and stigmatised activity. This stigma is not always related to the level of risk to the foetus, and instead can be seen as a moral judgement about women. We urgently need to move from individualised neo-liberal discourses about the failure of individual smokers, to a more socio-ecological view which avoids victim blaming.

CONCLUSION

Stigma from friends, family, strangers and health professionals may lead to hidden smoking. This is a barrier to women obtaining evidence based stop smoking support.

Measuring personal chemical exposures through biomonitoring: the experiences of research participants

Using a technique called human biomonitoring, scientists can now measure hundreds of environmental chemicals and/or their metabolites in human body fluids and tissues. In this article, I examine the experiences of 28 women who participated in two different types of biomonitoring studies and received personal exposure results. I show that although the women's experiences of biomonitoring differed and were shaped by the contexts in which biomonitoring occurred, there were also remarkable similarities across contexts. Most notably, through the receipt of personal biomonitoring data, all of the women came to view themselves as partially, if not entirely, responsible for their chemical exposures (past, present, and future). These are novel findings, which suggest that as scientists increasingly measure individuals' exposures to environmental chemicals found in common consumer products and food, the distinctions between environmental and lifestyle risks are being blurred; that is, environmental risks are increasingly experienced as lifestyle risks.

Participant experiences in a breastmilk biomonitoring study: a qualitative assessment

BACKGROUND

Biomonitoring studies can provide information about individual and population-wide exposure. However they must be designed in a way that protects the rights and welfare of participants. This descriptive qualitative study was conducted as a follow-up to a breastmilk biomonitoring study. The primary objectives were to assess participants' experiences in the study, including the report-back of individual body burden results, and to determine if participation in the study negatively affected breastfeeding rates or duration.

METHODS

Participants of the Greater Boston PBDE Breastmilk Biomonitoring Study were contacted and asked about their experiences in the study: the impact of study recruitment materials on attitudes towards breastfeeding; if participants had wanted individual biomonitoring results; if the protocol by which individual results were distributed met participants' needs; and the impact of individual results on attitudes towards breastfeeding.

RESULTS

No participants reported reducing the duration of breastfeeding because of the biomonitoring study, but some responses suggested that breastmilk biomonitoring studies have the potential to raise anxieties about breastfeeding. Almost all participants wished to obtain individual results. Although several reported some concern about individual body burden, none reported reducing the duration of breastfeeding because of biomonitoring results. The study literature and report-back method were found to mitigate potential negative impacts.

CONCLUSION

Biomonitoring study design, including clear communication about the benefits of breastfeeding and the manner in which individual results are distributed, can prevent negative impacts of biomonitoring on breastfeeding. Adoption of more specific standards for biomonitoring studies and continued study of risk communication issues related to biomonitoring will help protect participants from harm.

Reporting individual test results of environmental chemicals in breastmilk: potential for premature weaning

OBJECTIVE

Environmental chemicals are readily measured in human milk. Although it is imperative to conduct studies on frequency of detection and effects of exposures to environmental chemicals in human milk, the potential impact of reporting individual test results to lactating women is poorly understood. The purpose of this study was to determine if mothers want to know if chemicals are in their breastmilk and if knowing the results would alter their breastfeeding practices.

METHODS

We surveyed 381 mothers who were participating in a longitudinal birth cohort about whether they wanted to receive individual test results for environmental chemicals in their milk and whether they would alter their breastfeeding patterns if they were told that their milk contained "low" or "high" levels of phthalates.

RESULTS

Among the women who breastfed, 68% said that they wanted to know if there were chemicals in their breastmilk. Of breastfeeding women, 78% and 93% of mothers reported that they would either discontinue breastfeeding sooner than intended or pump and discard their milk if they were told they had "low" or "high" levels of phthalates in their milk, respectively. African American women were significantly more likely than Caucasian women to report that they would immediately wean if told of phthalates in their milk.

CONCLUSIONS

Concern about environmental chemicals in breastmilk may lead to early termination of breastfeeding. Chemical manufacturers and researchers should recognize the potential implications of isolating and reporting environmental chemicals in breastmilk.

Reporting needs for studies of environmental chemicals in human milk

Studies of environmental chemicals in human milk have been carried out in many countries, but few have been conducted in the United States. These studies are useful for monitoring population trends in exposure to chemicals, for research into the determinants of environmental chemicals in milk and relationships between the levels found and the health status of the women and their infants, and for risk assessment. This article provides practical advice on data and information reporting for such studies. Participation in these studies comes at a difficult time for the breast-feeding mothers, so it is important that the mothers support the study and its goals. A key goal of any study of environmental chemicals in human milk must be to ensure that the breast-feeding process is not disrupted by unwarranted concerns about harm to the infant from chemicals in human milk. Therefore, it is essential that reporting of information be a two-way process. Information needs to be supplied to participating mothers before, during, and after their participation in the study. Information supplied before participation is necessary to satisfy the ethical requirement for informed consent; information supplied during participation includes advice on expressing, collecting, and storing milk samples, and how to avoid sample contamination; and information supplied to each participant at the end of the study includes a report of their individual results and a summary of study results and outcomes generally. The key instrument for obtaining data from the participants is the study questionnaire. This needs to be prepared in accordance with principles of good questionnaire development, and preferably should be interviewer administered. The questionnaire content will vary according to the objectives of the study. Although studies of environmental chemicals in human milk are logistically complex and demanding, they are practicable and, with careful planning and execution, yield important data.

Influence of lysine on cimetidine uptake and on excretion of cimetidine by the rat mammary gland

Cimetidine is actively transported into human and rat milk. However, the transporters involved have not been characterized. It is possible that xenobiotics may be actively transported into milk by an amino acid transport system. The objective of these studies was to determine the influence of lysine on the uptake of cimetidine into rat mammary explants (study 1), and on the excretion of cimetidine into rat milk (study 2). In study 1, excised lactating rat mammary epithelial tissue fragments were exposed to 3H-cimetidine and 14C-lysine in the presence of 10 microM, 1 mM, or 1 M cold lysine, and the uptake of 3H-cimetidine and 14C-lysine were measured by liquid scintillation counting after 5 or 20 minutes of incubation. After 5 minutes of incubation, 1 M lysine inhibited 3H-cimetidine uptake by 47.7% (SD +/- 6.5%), compared with 10 microM lysine (P < 0.05), and 14C-lysine uptake was also inhibited by 54.1% (SD +/- 6.4%) (P < 0.05). Similar results were seen after 20 minutes of incubation. In a randomized crossover study (study 2), 6 lactating female rats were infused to steady state with cimetidine (0.5mg/h) in the presence or absence of lysine (360mg/h). Cimetidine concentrations in serum and milk were determined by high-performance liquid chromatography. Cimetidine systemic clearance (28.6+/-15.0mL/kg/min vs. 38.9+/-3.9 mL/kg/min, mean +/- SD) and milk to serum cimetidine ratio (M/S) (28.0+/-16.1 vs. 28.9+/-6.7), respectively, were not significantly altered by the presence or absence of lysine. Although 1 M lysine inhibited uptake of cimetidine in rat mammary explants, the concentrations of lysine used in this study, which approached toxicity in vivo, produced no significant effects on cimetidine transport into milk or the systemic clearance of cimetidine.

Active transport of nitrofurantoin into human milk

STUDY OBJECTIVE

To determine the extent to which nitrofurantoin is transferred into human milk.

DESIGN

Prospective, single-dose pharmacokinetic study.

SETTING

University-affiliated clinical research center.

PATIENTS

Four healthy lactating women 8-26 weeks postpartum.

INTERVENTION

All subjects received a single, oral, 100-mg dose of nitrofurantoin macrocrystals with food. Serial serum and milk samples were obtained and analyzed by high-performance liquid chromatography.

MEASUREMENTS AND MAIN RESULTS

Milk pH, milk fat partitioning, and protein binding in serum and milk were determined. Predicted milk:serum ratio (M:S) was compared with the observed M:S. Nitrofurantoin M:S predicted was 0.28+/-0.05, whereas M:S observed was 6.21+/-2.71. Average milk concentration was 1.3 mg/L, and estimated suckling infant dosage was 0.2 mg/kg/day or 6% of maternal dose (mg/kg).

CONCLUSIONS

Nitrofurantoin is actively transported into human milk, achieving concentrations in milk greatly exceeding those in serum. Concern is warranted for suckling infants younger than 1 month old, or for infants with a high frequency of glucose-6-phosphate dehydrogenase deficiency or sensitivity to nitrofurantoin.