Abstract
This month's issue of Breastfeeding Medicine highlights a seemingly “minor” finding of lowered protein and fat content in the colostrum milk of Syrian refugee mothers as compared with the content of the colostrum of the local Turkish mothers. As studied by Ozmen et al., the differences in macronutrient content was reflected also in the lower energy content of the refugee mother's milk, especially in the colostrum samples of the first postpartum day, that is, 59/(kcal·dL) as compared with 71/(kcal·dL). The clinical implications of these data are that the lower protein content most likely reflects primarily diminished amounts of immunoprotective proteins, whereas the lower fat content clearly deprives the infants of a major energy source.
This documentation of a statistical difference no doubt should raise concern when one remembers that health status of populations who acutely become refugees, secondary to civil strife and worse, has been documented to be poor, both in comparison with its prerefugee status and compared with the status of a comparable native population of the host country.1,2 Ozmen's report that from day 1 the infants are potentially being deprived of the full potential benefits of mother's milk just reinforces one concern as to long-term health status of these infants.
The magnitude of this problem can only be fully appreciated when one realizes that the United Nations reported that at the end of April 2020, there were >5.5 million refugees from Syria with Turkey having received >3.5 million, Lebanon nearly a million, and Jordan >600,00 refugees. The challenge to address this potential social economic and health crisis situation is clearly both at the local level, and hopefully aided and sustained by appropriate collective international financial and professional support.4,5
Ozmen did not delineate what are underlying processes in the Syrian refugee population that could account for these differences in macronutrient concentration. Their data did not show any association with prepregnancy BMI. There was a statistical difference in maternal weight gain during pregnancy, although it was only ∼1 kg and thus of questionable clinical significance. Birth weight of the infants was similar in both populations, discounting any evidence of a gross effect of prenatal maternal nutrition on fetal growth.
What role heightened combined prenatal and postnatal maternal anxiety or stress played in specifically effecting macronutrient content is unknown, but this is a subject that currently is under study in a variety of other studies.6,7 Surely, given the real world status of the refugee population in the various physical settings in Turkey and elsewhere, the effect of chronic stress is a variable that needs to be urgently studied. Similarly, studies that focus on low-cost techniques that can potentially relive and or mitigate chronic stress are welcome. 8
Bottom line is that the humanitarian crisis that has resulted from the years long civil strife in Syria has created a public health emergency that potentially affects the mother–infant dyad both in the short and in the long term as to their growth, development, and well-being.