A Mother with Green Breastmilk Due to Multivitamin and Mineral Intake: A Case Report

Abstract

It is a globally accepted fact that breastfeeding reduces infant mortality and morbidity, optimizes infant growth, is superior to other forms of nutrition for infants, and has economic advantages for the family and the country. This case study reports a new mother who stopped breastfeeding her baby because her breastmilk was green. When her second child was born, her milk came in green, and a consultation was requested from pediatrics and infectious diseases. A physical examination and laboratory tests revealed that the abnormal color of her breastmilk was related to multivitamin intake. The patient was advised to continue breastfeeding despite the odd color. Although clinical specialists know that the color of breastmilk can change with the ingestion of certain medications and foods, mothers are usually unaware and may unnecessarily terminate breastfeeding.

Introduction

In the history of infant feeding, it has become clear that the single most important nutrient for infants is breastmilk.¹ The milk excreted in the first 5 postnatal days is called colostrum. During postnatal days 5–15, it is known as transition milk. In days 15–20, the breastmilk is referred to as mature milk. Research regarding the composition of breastmilk has shown it to be rich with carbohydrates at the beginning and rich with fat toward the end^2,3 of a breastfeeding session.

Case Presentation

On the second day (24 hours) postpartum, a consultation was requested for a 36-year-old mother because her breastmilk came in with a deep green color (Fig. 1). The mother stated that she had had a similar experience with her firstborn and that she had not breastfed that child for the first month, only breastfeeding when the color of her breastmilk had returned to normal. The infectious disease consultation included an etiological examination (hemogram, C-reactive protein, and breastmilk culture). Breastfeeding was suspended for 3 days pending the test results, but the mother was encouraged to pump her breastmilk during this time to maintain production. The blood cell count and C-reactive protein test results were normal. The culture test of the breastmilk was negative on postpartum day 5 (Fig. 2). The mother was encouraged to resume breastfeeding. The mother took the same type of multivitamin during both pregnancies (content of the multivitamin is described in Table 1). Multivitamin tablets are reddish-brown in color. The mother stopped taking these vitamins when the baby was born. The color of her breastmilk slowly faded to normal, although it took 3 weeks (Fig. 3) to fully fade. During the mother's first pregnancy, she had taken the same vitamin type and had experienced the same change in breastmilk color. The first time, it took a month for the milk to return to a normal color.

FIG. 1.

The color of the milk is dark green (after 24 hours).

FIG. 2.

The color of the milk is still green (after 5 days).

FIG. 3.

The color of the milk is normal (after 3 weeks).

Table 1.

Multivitamin Active Ingredients per Tablet

Nutritional information	Average per tablet	% RDA
Vitamin D (400 IU)	10 μg	200
Vitamin E (natural source)	4 mg	33
Vitamin C	70 mg	88
Vitamin B1 (thiamine)	3 mg	273
Vitamin B2 (riboflavin)	2 mg	143
Vitamin B3 (niacin)	20 mg	125
Vitamin B6	10 mg	714
Folic acid	400 μg	200
Vitamin B12	6 μg	240
Natural mixed carotenoids	2 mg	—
Vitamin K	70 μg	93
Iron	17 mg	121
Selenium	30 μg	55
Magnesium	150 mg	40
Zinc	15 mg	150
Iodine	140 μg	93
Pantothenic acid	6 mg	100
Biotin	150 μg	300
Copper	1,000 μg	100

RDA, recommended dietary allowance.

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

A literature search for other cases of green breastmilk had sparse results. This case study may build awareness, encourage hesitant mothers to continue breastfeeding, and add to what is already known about the composition of breastmilk.

Discussion

Despite the semipermeable character of the milk–blood barrier, molecules of medications and vitamins taken by the mother may be found in breastmilk,⁴ sometimes changing its color and composition (Table 2). Breastmilk composition varies depending on gestational age and stage of lactation, but the food, medication, and other chemical substances ingested by the mother may affect the nature and color of breastmilk,⁹ and riboflavin, protein, and β-carotene levels play a key role in whitening the milk.¹⁰ One study found that 6–7 hours after a propofol infusion, excreted milk turns green and then returns to normal within 24 hours.⁶ “Green breast milk is described after iron intake. Also, low casein and lactose content might cause green breast milk.”⁷ There are also articles reporting black breastmilk excretion due to oral minocycline therapy.⁵ In another case, it was reported that pink breastmilk is caused by the bacterium Serratia.⁸

Table 2.

Summary of Breastmilk Color Changes and Causes

Color of breastmilk	Causes
Black	Minocycline⁵
Green	Propofol⁶
	Iron⁷
	Low casein and lactose content⁷
Pink	Serratia bacterium⁸

In this case, the mother was not given any medications during delivery, and her physical examination and laboratory test results were normal. We concluded that the green breastmilk excretion was due to long-term multivitamin and mineral intake, probably due to the iron content in the vitamins taken, although this cannot be determined for certain.

Conclusion

It is important to bear in mind that breastmilk can take on different colors because of food and medication intake. Therefore, it is crucial that mothers are made aware of this possibility to avoid unnecessary termination of breastfeeding.

Footnotes

Disclosure Statement

H.Y. designed the study and drafted the manuscript. M.D. participated in the design of the study. Z.Y. performed microbiological laboratory testing. A.R.T. helped to draft the manuscript. A.G. performed biochemical laboratory testing. The authors have no competing interests.

References

Kramer

, Chalmers

, Hodnett

et al. Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. JAMA, 2001; 285:413–420.

Carias

, Velasquez

, Cioccia

et al. The effect of lactation time on the macronutrient and mineral composition of milk from Venezuelan women. Arch Latinoam Nutr, 1997; 47:110–117.

Udosen

, Ebong

. Milk macronutrient levels during the first month of term and preterm Nigerian mothers. Trop Geogr Med, 1992; 44:256–259.

Pharmacokinetics of the Mammary Gland. www.exopol.com. 2011 October .

Hunt

, Salisbury

, Grace

et al. Black breast milk due to minocycline therapy. Br J Dermatol, 1996; 134:943–944.

Birkholz

, Eckardt

, Renner

et al. Green breast milk after propofol administration. Anesthesiology, 2009; 111:1168–1169.

Slivka

, Eisenfeld

, Worthley

. Green breast milk. Conn Med, 1993; 57:763–764.

Faro

, Katz

, Berens

, Ross

. Premature termination of nursing secondary to Serratia marcescens breast pump contamination. Obstet Gynecol, 2011; 117:485–486.

Madsen

, Rasmussen

, Nielsen

et al. Physical properties of mammary secretions in relation to chemical changes during transition from colostrum to milk. J Dairy Res, 2004; 71:263–272.

10.

Solah

, Staines

, Honda

, Limley

. Measurement of milk color and composition: Effect of dietary intervention on Western Australian Holstein-Friesian cow's milk quality. J Food Sci, 2007; 72:S560–S565.