Breast Milk Lead Levels in 3 Major Regions of the West Bank of Palestine

Breastmilk cadmium levels and estimated infant exposure: a multicenter study of associated factors in a resource-limited country

BACKGROUND

Despite the undisputed benefits of breastfeeding, infants might become exposed to xenobiotics that could be excreted into breast milk following maternal exposure. This study was conducted to assess breastmilk cadmium levels among lactating women in Palestine, a resource-limited country. Estimated daily intake (EDI) of cadmium via breastmilk was also calculated and predictors of high breastmilk cadmium levels and high infant exposure via breastmilk were identified.

METHODS

This multicenter study was conducted using a descriptive-analytical design. The lactating women were recruited from different maternity and public health clinics in all regions of Palestine. Demographic variables and exposure to sources of cadmium were collected in an interviewer-administered questionnaire. Foremilk samples (about 5 mL) were collected in polyethylene tubes using the hand-expression technique. The breast milk samples were collected in the period between December 2020 and March 2021. A pre-validated method using inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify breastmilk cadmium levels. EDI values were calculated from the quantified breastmilk cadmium levels.

RESULTS

Breastmilk samples were obtained from 256 lactating women. The mean breastmilk cadmium level was 0.34 (SD: 0.33) μg / L and the mean EDI of cadmium via breastmilk was 0.059 (SD: 0.058) µg / kg per body weight / day. Breastmilk cadmium levels were quantified in 92.6% of the breastmilk samples. Of the breastmilk samples, 13 (5.1%) had cadmium levels above those reported as "normal" by the World Health Organization (WHO). Multiple linear regression showed that higher breastmilk cadmium levels and higher EDI were predicted by being a smoker, living in a refugee camp, living close to an industrial area, living close to disposal of wastes, living close to paint shops, living in a house with peeling / chipping paint, frequent use of cosmetics, frequent use of hair dyes, and not using vitamins.

CONCLUSION

The breastmilk cadmium levels and infant exposure were predicted by maternal exposure to sources of cadmium. The findings reported in this study are valuable to antenatal and postnatal healthcare service providers. More studies are needed to plan and implement measures to reduce breastmilk cadmium levels and infants' exposure to cadmium via breastmilk.

Analysis of the nutritional status in the Palestinian territory: a review study

Background

Food insecurity, occupation, and poverty contribute to the poor nutritional status of Palestine. This review study aimed to analyze the nutritional status in the Palestinian Territory by analyzing published data from 2011 to 2023.

Method

Searching for relevant publications yielded 67 studies. Based on reviewing these studies, five major themes were identified: low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency.

Results

Based on the review of these studies, five major themes were identified, namely, low birth weight, breastfeeding, obesity and overweight, protein-energy malnutrition, and micronutrient deficiency. Based on the literature, the prevalence rate of exclusive breastfeeding was 24.4% in the Gaza Strip, compared to a national rate of 39.9% in 2020. Smoking, anemia in mothers, diet during pregnancy, and indoor pollution were associated with low birth weight. One-fifth of the boys and girls were stunted by 2 years of age in the Gaza Strip, and girls were more stunted than boys. The prevalence rates of underweight, overweight, and obesity among school children in the West Bank were 7.3%, 14.5%, and 15.7%, respectively. Age, gender, and living area were significant predictors of being overweight among school children. The prevalence rates of overweight and obesity among adults in Palestine were 57.8% and 26.8%, respectively. Obesity is associated with a family history, chronic diseases, and low physical activity among adults. Exclusive breastfeeding was below the WHO recommendations, while significant rates of obesity and overweight were found among children and adults. Iron-deficiency anemia (IDA) among pregnant women and children remains a challenging public health issue, while other micronutrient deficiencies are high among children.

Conclusion

This review emphasizes the need for multi-sectoral interventions to address malnutrition and nutritional shifts. It identifies gaps and addresses nutrition-related issues in the Palestinian Territory, which can serve as a basis for guiding United Nations agencies and governments in formulating evidence-based policies and strategies for prioritizing nutritional interventions to meet sustainable development goals.

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.

Predictors of Breast Milk Zinc Levels Among Breastfeeding Women in Palestine: a Cross-Sectional Study

Zinc is one of the most important essential micronutrients that is needed for the normal growth, development, and maintaining the health of human beings. Previous studies showed that zinc deficiency was highly prevalent among pregnant and lactating women. This cross-sectional study was conducted to determine breast milk zinc levels among breastfeeding women in Palestine and to identify the predictors of breast milk zinc levels. Breast milk samples were obtained from breastfeeding women who visited maternity and primary healthcare centers. Zinc levels were determined using inductively coupled plasma mass spectrometry. Breast milk zinc levels were determined in 390 breast milk samples. The mean breast milk zinc level in all samples was 0.15 ± 0.09 mg per 100 mL. Breast milk zinc levels declined with postpartum time from 0.22 ± 0.011 at ≤ 1 month postpartum to 0.09 ± 0.009 mg per 100 mL at > 9 months postpartum (p-value < 0.001). Multiple linear regression showed that high breast milk zinc levels were predicted by younger maternal age, postpartum time, being employed, frequent consumption of multivitamins/minerals, and practicing exclusive breastfeeding. In conclusion, the breast milk zinc levels quantified among breastfeeding women in Palestine were comparable to those previously reported among non-malnourished women elsewhere. The findings of this study are informative to pediatricians, gynecologists, nurses/midwives, breastfeeding advisors/counselors, nutritionists, and policymakers who might be interested in designing and implementing interventions to improve breast milk zinc levels.

Salivary Lead Levels among Workers in Different Industrial Areas in the West Bank of Palestine: a Cross-Sectional Study

Saliva is a biofluid that can easily be obtained and used for biomonitoring lead levels in occupationally and environmentally exposed individuals. The aims of this study were to determine salivary lead levels among workers in different industrial areas in the West Bank of Palestine and investigate the association between sociodemographic and occupational characteristics of the workers and their salivary lead levels. Salivary samples were obtained from workers in different industrial areas in metal-free polyethylene tubes. The samples were analyzed for their lead contents using a pre-validated inductively coupled plasma-mass spectrometric method. A total of 97 salivary samples were analyzed. The median salivary lead level was 1.84 μg/dL an IQR of 5.04 μg/dL. Salivary lead levels were significantly higher in workers who were 40 years and older (p value = 0.031), had 3 children or more (p value = 0.048), worked in repair workshops (p value = 0.012), worked in industrial areas for 20 years or more (p value = 0.048), did not consume fruits on regular basis (p value = 0.031), and smoked for 30 years or more (p value = 0.013). Multiple linear regression showed that smoking of 30 years old or more was a significant (p value < 0.001) predictor of higher salivary lead levels. Salivary lead levels among workers from different industrial areas of the West Bank were comparable to those occupationally exposed to lead in more industrialized and urbanized areas of the world. Smoking was a predictor of higher salivary lead levels.

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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Breast milk to blood lead ratios among women from the West Bank of Palestine: a cross-sectional study of associated factors

Background

Infants fed contaminated breast milk are at an increased risk of exposure to lead. Breast milk to blood (M/B) ratios have not been investigated among women in Palestine. The aim of this study was to assess blood, breast milk, and M/B lead ratios in samples collected from Palestinian breastfeeding women. Associations between sociodemographic characteristics with breast milk lead levels and M/B lead ratios were also investigated.

Methods

This study was conducted in a cross-sectional design in the period between October 2017 and April 2018. Breastfeeding women visiting maternity care centers in different regions of the West Bank of Palestine were recruited to the study by the nurses in the maternity care centers. Sociodemographic characteristics, venous blood, and breast milk samples were collected from each participant. Lead concentrations were analyzed using a validated inductively coupled plasma-mass spectrometric method. Mann–Whitney U test, Pearson’s Chi-square, Fisher’s exact, and Spearman’s correlations were used to analyze the data. Odds ratios (OR) were computed using a multivariate logistic regression model.

Results

Matching blood and milk samples were collected from 80 women. Lead concentrations in 11 (13.8%) of the breast milk samples were above the World Health Organization’s recommended levels. Breast milk lead levels were more likely to be ≥5 μg/L in breastfeeding women who lived in urban areas (aOR 4.96; 95% CI 1.10, 22.38) compared to those who lived in rural areas. Breast milk to blood lead ratios were more likely to be ≥25% in breastfeeding women who lived in urban areas (aOR 7.06; 95% CI 1.68, 29.77), used eye kohl (aOR 14.29; 95% CI 1.32, 155.06), and used hair dye (aOR 5.33; 95% CI 1.58, 18.00) compared to those who lived in rural areas, did not use eye kohl, and did not use hair dye, respectively.

Conclusions

Higher M/B lead ratios were predicted by living in urban areas, using eye kohl, and using hair dye. Decision makers in health authorities should address sources of exposure to lead in urban areas. Cosmetics containing lead should be assessed and regulated for lead content.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00410-3.

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).

Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students

BACKGROUND

Co-existence of depression and anxiety can be associated with severe detrimental consequences to the physical, mental and social wellbeing of the affected populations. This study was conducted to determine prevalence of depressive and anxiety symptoms among Palestinian medical students and to investigate associations between sociodemographic factors of the students with depressive and anxiety symptoms.

METHODS

This study was conducted in a cross-sectional observational design using a questionnaire in the period between September 2018 and April 2019 in a major university in the West Bank of Palestine. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) and anxiety symptoms were assessed using the Beck Anxiety Inventory (BAI). The questionnaire also collected the sociodemographic characteristics of the students. Reliability of the questionnaire was tested using the test re-test method. A total of 425 medical students were invited to participate in the study.

RESULTS

Of those invited, 286 students completed the questionnaire, giving a response rate of 67.3%. More than half (56.6%) of the students had minimal depression, 20.3% had mild depression, 14.0% had moderate depression, 9.1% had severe depression, 23.4% had no anxiety, 29.7% had mild to moderate anxiety, 25.5% had moderate to severe anxiety, and 21.3% had severe anxiety. Multiple linear regression analysis showed that academic stage (p-value < 0.01), Grade Point Average (p-value < 0.01), mental health status (p-value < 0.001), ever attempted suicide (p-value < 0.05), and religious commitment (p-value < 0.01) were predictors of BDI-II scores. Multiple linear regression analysis showed that academic stage (p-value < 0.05) and mental health status (p-value < 0.001) were predictors of BAI scores.

CONCLUSIONS

Depressive and anxiety symptoms were prevalent among Palestinian medical students in a major university in the West Bank of Palestine. Interventions might be designed to improve self-rated mental health of medical students in their academic years, ameliorate study conditions, and provision of counseling services to improve spirituality might be effective in reducing symptoms of depression and anxiety among medical students in Palestine. Future studies are still needed to investigate if these interventions could be useful in reducing depressive and anxiety symptoms among Palestinian medical students.

Sub-chronic treatment with high doses of ascorbic acid reduces lead levels in hen eggs intentionally exposed to a concentrated source of lead: a pilot study

Background

Hen eggs contaminated with lead can be harmful to the health of children and adults. The objective of this pilot study was to investigate if sub-chronic treatment with ascorbic acid can reduce lead levels in the different parts of hen eggs after intentionally exposing the laying hens to a concentrated source of lead.

Methods

Clinically normal mixed-breed egg laying hens (n = 18) were used in this pilot study. Hens were exposed to a concentrated source of lead (200 mg/kg_{body weight}/day lead acetate) for 1 week. Subsequently, egg laying hens were either treated with sub-chronic doses of ascorbic acid (500 mg/kg_{body weight}/day) or left untreated for 4 weeks. Lead levels were assessed in egg-shell, egg-albumen, and egg-yolk samples using a graphite furnace atomic absorption spectrophotometer.

Results

Lead levels increased significantly (p-value < 0.01) from baseline in egg-yolk, egg-albumen, and egg-shell samples following 1 week exposure to lead acetate. Sub-chronic treatment of egg laying hens with high doses of ascorbic acid could bring statistically significant reduction (p-value < 0.01) in lead levels in egg-yolk, egg-albumen, and egg-shell samples after intentional exposure to a concentrated source of lead.

Conclusions

Findings of this pilot study showed that sub-chronic treatment of egg laying hens with ascorbic acid can reduce lead levels in different egg parts after intentional exposure to a concentrated source of lead. Supplementing feedstuffs and water with sources of ascorbic acid could be beneficial in reducing lead levels in hen egg tissues following environmental exposure. Further studies are still required to investigate if ascorbic acid can reduce lead levels in other chicken tissues.

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.

Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: A case of driver with breakthrough seizures

OBJECTIVE

The present study was conducted among pharmacy students to use an 8-step systematic approach to facilitate discussions, deliberations, and decision-making on what to do when facing a dilemma of a patient with epilepsy who drives while having breakthrough seizures.

METHODS

A hypothetical case was developed using the 12-tips for developing dilemma case-based assessments in health education. A mixed method was used in this study. A serial group discussions based on the nominal group technique (NGT) method were applied. A thorough review of the literature and interviews with key experts in the domain (n = 12) were conducted to obtain pertinent data to inform discussions, deliberations, and decision-making. The analytic hierarchy process (AHP) was used to pairwise compare countervailing arguments and alternative courses of action.

RESULTS

In this study, 3 nominal groups were held, and for each 3, discussion rounds were conducted. A total of 27 panelists took part in the nominal groups. Compared with other alternative courses of action, significantly higher weight scores (p-value < 0.001) were given to the course action, "the pharmacist could counsel/educate the patient on the dangers/risks of driving while experiencing breakthrough seizures, inform the patient to refrain from driving in this period, and make a shared decision with the patient to refrain from driving in this period and inform the state authorities".

CONCLUSION

This study demonstrates that the 8-step approach when combined with the AHP can be a handy method in facilitating decision-making while addressing and resolving ethical/legal/professional dilemmas in daily healthcare practice.

Merits, features, and desiderata to be considered when developing electronic health records with embedded clinical decision support systems in Palestinian hospitals: a consensus study

BACKGROUND

Electronic health records (EHRs) with embedded clinical decision support systems (CDSSs) have the potential to improve healthcare delivery. This study was conducted to explore merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs.

METHODS

A mixed-method combining the Delphi technique and Analytic Hierarchy Process was used. Potentially important items were collected after a thorough search of the literature and from interviews with key contact experts (n = 19). Opinions and views of the 76 panelists on the use of EHRs were also explored. Iterative Delphi rounds were conducted to achieve consensus on 122 potentially important items by a panel of 76 participants. Items on which consensus was achieved were ranked in the order of their importance using the Analytic Hierarchy Process.

RESULTS

Of the 122 potentially important items presented to the panelists in the Delphi rounds, consensus was achieved on 110 (90.2%) items. Of these, 16 (14.5%) items were related to the demographic characteristics of the patient, 16 (14.5%) were related to prescribing medications, 16 (14.5%) were related to checking prescriptions and alerts, 14 (12.7%) items were related to the patient's identity, 13 (11.8%) items were related to patient assessment, 12 (10.9%) items were related to the quality of alerts, 11 (10%) items were related to admission and discharge of the patient, 9 (8.2%) items were general features, and 3 (2.7%) items were related to diseases and making diagnosis.

CONCLUSIONS

In this study, merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs were explored. Considering items on which consensus was achieved might promote congruence and safe use of EHRs. Further studies are still needed to determine if these recommendations can improve patient safety and outcomes in Palestinian hospitals.

Selenium status in lactating mothers-infants and its potential protective role against the neurotoxicity of methylmercury, lead, manganese, and DDT

A total of 206 lactating mothers and their infants (3-12 months) were included in this study to evaluate postnatal exposure to neurotoxic pollutants such as methylmercury (MeHg), lead (Pb), manganese (Mn), dichlorodiphenyltrichloroethane (DDT) and its metabolites [dichlorodiphenyldichloroethane (DDD), and dichlorodiphenyldichloroethylene (DDE)] and their association with delayed neurological development and to explore the protective role of selenium (Se) against chemical neurotoxicity. Neurodevelopmental performance was evaluated using Denver Developmental Screening Test II and Parents' Evaluation of Developmental Status (PEDS). Multivariate log-binomial regression modeling was applied for both single and multiple exposures to chemicals using a principal component analysis that generated six principal components. Both mothers and their infants had been exposed to metals and DDT metabolites, with some exceeding the accepted permissible limits. The geometric means of MeHg, Pb, Mn, DDD, DDE and DDT levels in breast milk were 1.333, 45.327, 15.576, 0.069, 0.542 and 1.08 μg/l, respectively. A single-exposure model identified a high risk of reduced PEDS performance significantly associated with DDD in breast milk [relative risk (RR) = 1.484; 95% confidence interval (95%CI) = 1.091-2.019] and marginally significantly associated with Pb in the mothers' blood (RR = 2.164; 95%CI = 0.87-5.382). We did not find a protective role of Se in neurodevelopment due to its high levels in the mothers. Models of multi-chemical exposure indicated that Mn in blood and breast milk, Se in blood and Pb in the mothers' urine were marginally significantly associated with a high risk of reduced PEDS performance (RR = 0.424; 95%CI = 0.176-1.022). The use of multi-chemical exposure approach in early life risk assessments is important because it indicates real-world exposure. Our results were not conclusive because the sample size was small, so future studies examining the implications to health of the impact of prenatal/postnatal exposure to a mixture of chemicals in the Saudi population are merited.

Development of key performance indicators to capture in measuring the impact of pharmacists in caring for patients with epilepsy in primary healthcare: A Delphi consensual study

OBJECTIVE

This study was conducted to develop and achieve formal consensus on a core set of key performance indicators (KPIs) that can be captured in measuring the impact of pharmacists in caring for patients with epilepsy (PWE) visiting epilepsy clinics as outpatients in primary healthcare practice.

METHODS

In this study, a comprehensive literature search and review was conducted to extract candidate KPIs. Interviews with key contacts (6 pharmacists, 2 neurologists, 3 nurses, and 3 PWE) were also conducted to supplement the inventory set of KPI candidates. A three-round Delphi technique was followed among a panel of 40 members to achieve formal consensus on a core list of KPIs. Consensual KPIs were ranked by the ratings of the panelists.

RESULTS

The final consensual core set contained 8 KPIs in the thematic activity areas of pharmaceutical care, medication reconciliation and best possible medication history, patient education/counseling, interprofessional patient care, competence, and performance efficiency/patient satisfaction. The KPIs related to therapy problems identified and resolved by pharmacist and provision of proactive comprehensive direct patient care by a pharmacist received significantly higher (p-value: 0.0001) scores compared to the KPI related to complaints about pharmacists received.

CONCLUSION

Eight consensual KPIs to capture in measuring the impact of pharmacists in caring for PWE visiting epilepsy clinics as outpatients in primary healthcare practice were developed using the Delphi technique. If successfully adopted, implemented, captured, and analyzed, these consensual KPIs might help advance pharmaceutical care of PWE in primary healthcare practice.

Exposure to heavy metals released to the environment through breastfeeding: A probabilistic risk estimation

Toxic heavy metals released into the environment through various anthropogenic activities, raising concerns over their potential adverse effects on human health and the environment. Biological monitoring studies are of great value in toxicological research for estimation of such health effects. The aim of this study was to evaluate the concentrations of lead (Pb), arsenic (As), and chromium (Cr) in the breast milk of urban mothers in Hamadan city, Iran and the accompanying health risk to infants. A total of 100 lactating mothers were recruited from public health care centers in Hamadan city and breast milk samples were collected at 2, 6, 8, and 12 months postpartum. Inductively coupled plasma mass spectroscopy (ICP-MS) has been used to measure target heavy metal concentrations. The median breast milk concentrations of Pb, As, and Cr were 41.90, 0.50, and 3.95 μg/L, respectively. The highest levels of Pb were observed after two months of delivery (with the mean of 96.69 μg/L and median of 45.70 μg/L). Up to 94% of the breast milk samples exceeded the WHO limit suggested for lead contamination of breast milk (<5 μg/L). The breast milk As and Cr contents were above the limit of detection (LOD) in 19% and 76% of samples, respectively. Unacceptable non-cancer health risk levels or hazard quotient (HQ) were found for Pb and As in 61% and 10% of the samples, respectively. Nevertheless, HQ from Cr was <1.0 for 100% of breastfeeding infants. Finally, our results indicated that there may be a potential risk of toxic metals, especially lead, for infants in Hamadan via the consumption of mothers' breast milk.

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.

Blood zinc levels in nursing women from different regions of the West Bank of Palestine

Pregnant and nursing women are at higher risk of zinc deficiency which can have detrimental consequences on health. We assessed blood zinc levels in 72 nursing women from the West Bank of Palestine and investigated the association between sociodemographic variables and blood zinc levels. Blood samples were analyzed for their zinc contents using graphite furnace atomic absorption spectrophotometry. Blood and data collection were performed between July and December 2016. The median blood zinc level was 4.53 mg/L (interquartile range of 0.38 mg/L). In unadjusted analyses, blood zinc levels were higher in nursing women who lived in cities (p-value <.001), had higher household income (p-value <.001), whose husbands had a white collar job (p-value <.05), were nonsmokers (p-value <.05), did not use hair dyes (p-value <.05), and consumed energy beverages (p-value <.001). Multiple linear analysis showed that living in cities and consuming energy beverages remained significantly associated with higher blood zinc levels (p-value <.05). Blood zinc levels were in the range previously reported for similar non-malnourished populations. Nursing women living in cities and those consuming energy beverages tended to have higher blood zinc levels. Urbanized lifestyle might have enhanced blood zinc levels in nursing women.

Concentrations of trace elements in human milk: Comparisons among women in Argentina, Namibia, Poland, and the United States

Human milk contains essential micronutrients for growth and development during early life. Environmental pollutants, such as potentially toxic metals, can also be transferred to the infant through human milk. These elements have been well-studied, but changing diets and environments and advances in laboratory technology require re-examining these elements in a variety of settings. The aim of this study was to characterize the concentrations of essential and toxic metals in human milk from four diverse populations. Human milk samples (n = 70) were collected in Argentina (n = 21), Namibia (n = 6), Poland (n = 23), and the United States (n = 20) using a standardized mid-feed collection procedure. Milk concentrations of calcium, zinc, iron, copper, manganese, lead, arsenic, and cadmium were determined using inductively coupled plasma mass spectrometry (ICP-MS). We used standard multiple linear regression models to evaluate differences among populations, while including infant age, infant sex, and maternal parity status (multiparous or primiparous) as covariates. Concentrations of all elements, except zinc, varied across populations after controlling for infant age, infant sex, and maternal parity. Calcium and magnesium showed more differences across populations than iron or copper. There were no significant differences among population in zinc concentrations. Mean concentrations of lead, but not arsenic, were low compared to recently published values from other populations. The concentrations of trace elements in human milk are variable among populations. Limitations due to small sample sizes and environmental contamination of some samples prevent us from drawing robust conclusions about the causes of these differences.

Arsenic, lead, mercury and cadmium: Toxicity, levels in breast milk and the risks for breastfed infants

Metals are ubiquitous in nature, being found in all environmental compartments, and have a variety of applications in human activities. Metals are transferred by maternal blood to the fetus via the placenta, and exposure continues throughout life. For the general population, exposure comes mainly from water and food consumption, including breast milk. In this paper, we reviewed studies on the toxicity of arsenic, lead, mercury and cadmium, the toxic metals of most concern to human health, focusing on the potential risks to newborns and infants. A total of 75 studies published since 2000 reporting the levels of these metals in breast milk were reviewed. Lead was the metal most investigated in breast milk (43 studies), and for which the highest levels were reported (up to 1515µg/L). Arsenic was the least investigated (18 studies), with higher levels reported for breast milk (up to 149µg/L) collected in regions with high arsenic concentrations in water (>10µg/L). Data from 34 studies on mercury showed that levels in breast milk were generally higher in populations with high fish consumption, where it may be present mainly as MeHg. Cadmium levels in breast milk were the lowest, with means <2µg/L in most of the 29 studies reviewed. Results of risk assessments indicated that the intake of arsenic, lead and mercury by infants through breastfeeding can be considered a health concern in most regions of the world. Although the potential risks to infants are mostly outweighed by the benefits of breast milk consumption, it is essential that contaminants be continuously monitored, especially in the most critical regions, and that measures be implemented by health authorities to reduce exposure of newborns and infants to these metals, and thus avoid unnecessary health risks.