A shocking hazard in breastfeeding: Perfluoroalkane acids, a POPs binding to human milk
Biomonitoring for polychlorinated dibenzodioxins and dibenzofurans (PCDD/PCDF) and polychlorinated biphenyls (PCB), to name two groups of the lipophilic organic pollutants has long traditions and was continued with the global monitoring plan (GMP) under the Stockholm Convention on Persistent Organic Pollutants. The aim of the GMP is to apply one framework for sampling and analysis of so-called core matrices to detect temporal and spatial changes of POP concentrations. Due to inherent persistence and bioaccumulation of chlorinated POPs, the biomonitoring samples should be collected from primiparae, i.e., mothers having their first child, only. This requirement could reduce the influences of individual factors from the donor mother and the chemical. Protocols to harmonize the identification, collection, and chemical analysis of the POPs in human milk had been developed and were updated periodically to incorporate newly listed POPs including the brominated flame retardants and perfluoroalkane substances (PFAS).
Perfluorooctane sulfonic acid (PFOS), its salts and perfluorooctane sulfonyl fluoride (PFOSF) was listed in 2009, amended in 2019, perfluorooctanoic acid (PFOA), its salts and PFOA-related compounds was listed in 2019. They have different physical and chemical properties than the initial chlorinated POPs and the later added polybrominated POPs (polybrominated diphenyl ether, hexabromocyclododecane, hexabromobiphenyl). They bind preferentially to proteins in the plasma. Nevertheless, human milk remained the preferred matrix in the GMP and an aliquot from the national samples collected for the analysis of brominated/chlorinated POPs was recommended to be used for the analysis of the fluorinated POPs. Perfluoroalkane substances (PFAS) are a group of persistent substances that is suspected to cause several negative health effects including reduced birth weight, late puberty and lowered semen quality. In humans, often levels of perfluorocarboxylic acids (PFCA) and perfluorosulfonic acids (PFSA) but also fluorotelomer compounds or replacements such as ammonium 4,8-dioxa-3H-perfluorononanoate, the ammonium salt of hexafluoropropylene oxide dimer acid (HFPO-DA) fluoride or 6:2 chlorinated polyfluorinated ether sulfonate are monitored at global level. Other PFAS, like perfluorohexanesulfonic acid (PFHxS) and perfluorononanoic acid (PFNA), had quite high detection frequencies but at lower concentrations.
Biomonitoring data using human milk are less than for blood, serum or plasma but have been reported from primiparae and multiparae. Most human milk studies found that concentrations for all PFAA analyzed were much lower than those in human blood. In all studies, PFOS and PFOA had the highest detection frequencies with variable results of recent researches.
With expanding the previous publication containing the data for PFOS, PFOA, and PFHxS from 44 human milk samples, the researchers from Örebro University of Sweden and Instituto Nacional de Controle de Qualidade em Saúde of Brazil have added other PFCA and PFSA which are not included in the list of recommended POPs in the GMP guidance document. The results from historic stored samples from Brazil were also presented and discussed. This study entitled “Perfluoroalkane acids in human milk under the global monitoring plan of the Stockholm Convention on Persistent Organic Pollutants (2008–2019)” is published online in Frontiers of Environmental Science & Engineering in 2022.
In 101 samples consisting of 86 national pools and 15 pools from States in Brazil obtained between 2008 and 2019, PFHxS was detected in 17% of the national pools and none in Brazil. PFOA and PFOS had a detection frequency of 100% and 92%, respectively. Other perfluoroalkane substances (PFAS) had either low detection frequencies and median values of zero (carboxylic acids C4–C11; except PFOA) or could not be quantified in any sample (sulfonic acids, C4–C10, and long-chain carboxylic acids, C12–C14). Correlation between PFOA and PFOS was moderately (r = 0.58). Whereas median values were almost identical (18.9 pg/g f.w. for PFOS; 18.6 pg/g f.w. for PFOA), PFOS showed larger ranges (< 6.2 pg/g f.w.–212 pg/g f.w.) than PFOA (< 6.2 pg/g f.w.–63.4 pg/g f.w.). It was shown that wealthier countries had higher PFOA concentrations than poorer countries. No difference in concentrations was found for samples collected in countries having or not having ratified the Stockholm Convention amendments to list PFOS or PFOA. The goal to achieve 50% decrease in concentrations within ten years was met by Antigua and Barbuda, Kenya, and Nigeria for PFOS and by Antigua and Barbuda for PFOA. In a few cases, increases were observed; one country for PFOS, four countries for PFOA.
With this study, no spatial and temporal trends could be established mainly due to uneven representation of countries from the UN regions and relatively short time periods between the measurements. Compared with PFOS, PFOA was more difficult to achieve the Stockholm Convention goal of 50% reduction in ten years. Although some impact from geographic location (UN region) and lifestyle factors (income) were found, none of these seems to be a good indicator for PFOS and PFOA body burden. Since there are no health-based values for PFOS and PFOA in human milk, present assessments remain limited to high quality analytical measurements and the interpretation of these results is limited to the assessment of geographic patterns. It is highly recommended to develop “safe” concentrations for PFOS and PFOA in human milk to support breastfeeding without risk as was done for PCDD/PCDF, PCB, and DDT.
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JOURNAL
Frontiers of Environmental Science & Engineering
METHOD OF RESEARCH
Experimental study
ARTICLE TITLE
Perfluoroalkane acids in human milk under the global monitoring plan of the Stockholm Convention on Persistent Organic Pollutants (2008–2019)
UC San Diego launches new Human Milk Institute
Combining current programs into single entity, researchers, physicians and educators hope to create a global hub for understanding and accelerating knowledge and application of human milk
Business AnnouncementIMAGE: THE UC HEALTH MILK BANK, OPERATED BY UC SAN DIEGO HEALTH, OPENED IN 2020, ONE OF ONLY 31 NONPROFIT MILK BANKS IN NORTH AMERICA AND ONLY THE SECOND IN CALIFORNIA. LEVERAGING RESEARCH AND CLINICAL RESOURCES, IT SEEKS TO PROVIDE SAFE, HIGH-QUALITY DONOR MILK TO THE NEEDIEST INFANTS AND COMMUNITIES. view more
CREDIT: ERIK JEPSEN
Building upon a long and robust history, the University of California San Diego has launched a new Human Milk Institute (HMI) to accelerate research into the nature, biology and therapeutic potential of human milk to prevent or treat both infant and adult diseases. The new institute is believed to be the first of its kind worldwide.
“Physicians and scientists at UC San Diego and elsewhere have been doing this work for a while, but largely isolated in their respective fields of interest,” said Lars Bode, PhD, professor of pediatrics at UC San Diego School of Medicine and the HMI’s founding director.
“With the novel, comprehensive approach of the Human Milk Institute at UC San Diego, we have an opportunity to learn, coordinate and interact in a single, go-to place, and be able to speak with one voice. Research can inform clinical care, clinical care can inform research and both can help educate.”
The new institute harmonizes efforts across multiple, ongoing enterprises and programs at UC San Diego related to human milk and lactation, including:
- In research, the Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Researcher Excellence or MOMI CORE focuses on better understanding how the components of human milk can be leveraged to treat or prevent infant and adult diseases. Funded by the National Institute of Child Health and Human Development, the Maternal and Pediatric Precision in Therapeutics and Center of Excellence in Therapeutics takes a human milk-centered approach to investigate the role of maternal and pediatric therapeutics at intersections of the mother-milk-infant ‘triad’ and aggregates and disseminates knowledge, tools and expertise in maternal and pediatric therapeutics to the larger research, regulatory and drug development communities.
- In clinical care, the University of California Health Milk Bank, operated by UC San Diego Health, opened in 2020, one of only 31 nonprofit milk banks in North America. It leverages research and clinical resources to improve the quality and safety of donor milk. The UC Health Milk Bank seeks to address disparities in donor milk provision to the most vulnerable infants, and to promote voluntary milk donations to meet those needs. The Supporting Premature Infant Nutrition program at UC San Diego Health is a multi-disciplinary approach that engages medical staff and families to improve premature infant outcomes by enhancing human milk provision and nutritional management in clinical settings. The follow-up Premature Infant Nutrition Clinic provides continuing nutritional support to infants and their families during the critical transition from hospital to home.
- In education, the Center for Better Beginnings, part of the Department of Pediatrics at UC San Diego Health, combines multiple maternal and infant programs to identify, prevent and treat birth defects, and includes the Mommy’s Milk Human Milk Research Biorepository. The Lactation and Perinatal Education Program at UC San Diego Extended Studies offers clinical lactation education to professionals at all levels.
- In community health, the Center for Community Health at Altman Clinical and Translational Research Institute seeks to improve lactation accommodation equity through its Lactation Supportive Environments projects and the San Diego County Childhood Obesity Initiative.
“The goal is to exponentially increase expertise and the pace of progress by convening great minds and converging programs,” said UC San Diego Chancellor Pradeep K. Khosla. “This collaborative approach will generate synergies that jumpstart further discovery and innovation.
“There is a long history of human milk research and advocacy at UC San Diego. Our scientists in health sciences and physicians at UC San Diego Health have been thought leaders on this topic for decades. With the HMI, we’re thinking ahead to what can be done next and what needs to happen next to improve the lifelong health of all people through human milk.”
As an interdisciplinary institute with a strong clinical and community component, the HMI will also focus on effective communication within and across groups, said Bode, allowing for easy-to-understand, actionable information that increases community’s engagement in research and outreach programs.
“Pediatricians are regularly asked about human milk by patients and new parents. In the past, we haven’t always been able to provide answers with evidence-based data,” said Gabriel Haddad, MD, chair of the Department of Pediatrics at UC San Diego School of Medicine. “With the continuing work of the HMI, we can confidently provide guidance based on science, much of it discovered at UC San Diego.”
All of these efforts, said Bode, will help direct national and global recommendations and policies regarding human milk and improved health care.
“With our ongoing research and published results, we continue to educate families and our community on the invaluable benefits of human milk,” said Christina Chambers, PhD, MPH, professor of pediatrics at UC San Diego School of Medicine, director of Mommy’s Milk Human Milk Research Biorepository and co-director of the Center for Better Beginnings.
“From the research lab to the neonatal intensive care unit, the HMI will bring us together in unprecedented ways to support our monumental efforts in discovering how human milk can help people of all ages.”
Bode, Chambers and Lisa Stellwagen, MD, a pediatrician at UC San Diego Health and executive director of the UC Health Milk Bank, are co-directors of HMI.
In recent years, experts at UC San Diego and UC San Diego Health have published key research findings regarding human milk. For example, a study in 2018 found that the composition of complex sugars in breast milk might prevent future food allergies. In 2020, during the height of the COVID-19 pandemic, UC San Diego scientists reported that the causative SARS-CoV-2 virus did not appear to be transmitted through breastfeeding from mother to infant. UC San Diego researchers are currently investigating whether medications taken by breastfeeding women affect their milk or infants.
“We will work to answer critical and life-saving questions, such as ‘Can components of human milk be developed into natural therapies or serve as non-invasive diagnostics?’” said Bode. “The answers could prevent diseases like necrotizing enterocolitis, a deadly gastrointestinal disease that primarily affects premature babies. Our findings could also help reduce the risk of heart attack and stroke in adults.
“We envision a future where human milk is the first and critical foundation for human life and equitable access to better health for the global community. Today, we are laying the foundation for achieving this vision by establishing a world-class institute and creating a sustainable model for ongoing research that will not only promote health, growth and development, but save lives.”
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