Abstract
The unique components of breast milk are still being “discovered.” Beyond the well-described and studied classical nutritional components of specific proteins, fats, and carbohydrates, nowadays the focus is on the elements that contribute to the well-being of the infant and the process of disease prevention and long-term health benefits for the growing child and adult. The elements include prebiotic and probiotic elements, 1 stem cells and microRNA, and the end results are being documented almost daily.2–5
This month's issue Breastfeeding Medicine addresses two related and relevant questions. Given all the advantageous components in human milk the question is, what should we avoid so as to not to interfere with the value of feeding human milk, and what if anything is needed to supplement the milk.
In this context, we must congratulate the Protocol Committee of the Academy of Breastfeeding Medicine for preparing a most comprehensive guideline of how to balance the desire to have mothers continue to provide their infants with their own milk in an era of expanding availability of an array of procedures and tests that are being utilized in the diagnosis and management of an increasing number of clinical entities.
Entitled “Radiology and Nuclear Medicine Studies in Lactating Women” the Protocol details the variety of radioisotopes that are in use today, focusing primarily on their potential transfer and ultimate concentration in breast milk. The bottom line of the committee's recommendations regarding the safety of common imaging and nuclear medicine procedures that might be performed on mothers who wish to continue to nurse their infants, is that in the vast majority of circumstances one does not require interruption of breastfeeding, although certain exceptions as noted do exist. Given its update detail I suspect that this protocol will serve as the ultimate “bible” for clinicians facing these management dilemmas.
This issue of Breastfeeding Medicine also features a pilot study of Short and colleagues that assessed “breastfeeding knowledge, attitudes, and perceptions of individuals who work in perinatal opioid use disorder treatment settings.” They documented that although the personnel had adequate theoretical knowledge of the advantages of feeding mother's own milk, in practice breastfeeding was neither encouraged nor supported. This “low priority” of the staff apparently reflected their concern (1) of the possible transfer to the infant of medications (such as methadone) through the breast milk and (2) their beliefs that formula is better than breastfeeding. Of particular concern was the lack of knowledge by the staff of the literature that supports breastfeeding as an integral part of health management of the opioid-dependent mothers.6,7 Clearly, we have work to here, given the opioid epidemic that is ravaging the United States.
This month's LactMed Update column is guest written by Dr. Sauberan (who is responsible for the National Library of Medicine Toxnet LactMed information regarding maternal vitamin ingestion). In this issue of Breastfeeding Medicine, he addresses the issue of maternal vitamins supplementation, particularly regarding the ingestion of mega vitamin doses and their potential effect on breast milk. Again the bottom line was generally supportive of continued breastfeeding reflecting the conclusion that there is little evidence of any infant harm from mother's ingestion of vitamin megadoses. The exception is extremely high doses of pyridoxine that might suppress milk production and a maternal vitamin D mega dose of 6,000 IU/day in situations where the infant might be heavily exposed to sun.
Given these results and conclusion, one can correctly proclaim that old adage “that if it is not broken don't fix it” is most relevant for this subject. Nature's perfection in producing this idealized source of sustenance for the infant should be, as much as possible, left alone. It is clear that in most cases the advantages of breastfeeding far outweigh almost all theoretical concerns, especially, given the lack of any evidence-based data to the contrary and, no less so, from the lack of understanding of too many of the basic physiology of lactation.