Protecting human milk from persistent toxic chemical contaminants
- 20055
APHA policies #7403, #7922, #8022, #8126, #8226 and #2001141-6 promote breastfeeding as the healthiest food for infants and acknowledge that breastfeeding provides nutritional and immunologic benefits for the infant and enhances the emotional bond between mother and child. The American Academy of Pediatrics notes: Human milk is species-specific, and all substitute feeding preparations differ markedly from it, making human milk uniquely superior for infant feeding.7 Research clearly shows that breastfed babies have lower rates of diarrhea, upper and lower respiratory tract infections and urinary infections than do formula-fed infants.7 Breastfeeding enhances intellectual development, 8, 9 lowers the risk of asthma, 10,11,12 obesity,13,14 certain cancers 15 and diabetes,16,17 and may lower the risk of sudden infant death syndrome.18
This policy affirms the continued importance of human milk and breastfeeding while acknowledging that human milk is also the top of the human food chain and reflects maternal exposure to an array of persistent toxic chemical contaminants, including dioxins/furans, PCBs (polychlorinated biphenyls), PBDE (polybrominated diphenyl ethers) flame retardants and chlorinated organic pesticides.19 Noting that these chemical contaminants are currently found in human milk from women around the world and specifically in the United States,19,20 this policy urges proactive steps to protect human milk from further contamination by reducing the sources of this contamination in the environment, citing especially APHA policy #200011 encouraging precautionary action to prevent potential harm to reproductive health, infants, and children, even if some cause and effect relationships have not been established with scientific certainty.21
Although research suggests that prenatal exposures to persistent toxic chemicals have greater impacts on children's health than exposures through breastfeeding, 22,23 some researchers have found evidence that the presence of persistent toxic chemicals in human milk may compromise some of its benefits.24,25 In general, breastfed infants continue to be exposed to persistent toxic chemicals, as they were in utero. Levels of organochlorine chemicals in the bodies of breastfed babies in Germany were 10-20 times higher than formula-fed babies.26,27 Adjusted for body weight, breastfed infants ingest 50 times more dioxins and PCBs (polychlorinated biphenyls) than their parents.26 One study estimated a breastfed infant's exposure to dioxin-like compounds during the first year of life at 242 pg TEQ/kg-day, adjusted for body weight, compared with the average adult exposure at 1 pg TEQ/kg-day.28 Researchers in Norway found 2-3 times more PBDEs in the serum of 0-4-year-olds compared with all age groups.29 PBDE levels in U.S. women's human milk are typically 10-100 times higher than levels in European women.30,31 Organochlorine pesticides are also commonly found in human milk.32
Because certain chemical contaminants persist in human tissues for many years, early exposure contributes to lifetime body burden. Dutch researchers estimate that between 12-14 percent of adult body burden of these chemicals comes from human milk.33 These chemicals also persist in the environment. For example, PCBs were banned in the United States in 1979 and DDT in 1972, yet PCBs and DDE, a metabolite of DDT are commonly found in human milk even today.19,20 However, declining levels illustrate the effectiveness of the bans. Action to reduce other persistent toxic chemicals should occur as quickly as possible, in order to reduce levels of these chemicals in human milk in the future. An example of one such action is the Stockholm Convention on Persistent Organic Pollutants, an international treaty on elimination of certain persistent global pollutants, which the U.S. signed in 2001, but has not yet ratified.
Progress in reducing human milk contamination can only be measured if routine bio- monitoring occurs. Sweden has had a national human milk-monitoring program for over 30 years, which has enabled the tracking of contaminant levels over time, including documenting decreases and emerging problem chemicals such as PBDE flame retardants. The United States has no national human milk monitoring program.19,34 A human milk monitoring program in the United States would enable uniform tracking of contaminant levels across the country to more easily identify trends and emerging contaminants34 and support pollution prevention to protect human milk from chemical contamination in order to promote the optimum health and well-being of infants.
In light of the widespread presence of chemical contaminants in human milk and considering the significant contribution of human milk and breastfeeding to infant health and life-long health:
Therefore, The American Public Health Association urges:
1. State, federal and international actions to prevent persistent toxic chemicals from polluting the environment and human milk, including but not limited to the Stockholm Convention on Persistent Organic Pollutants.
2. The U.S. government to fully implement and ratify the Stockholm Convention on Persistent Organic Pollutants in a manner fully consistent with the intent and spirit of this international treaty.
3. The U.S. Environmental Protection Agency to incorporate breastfeeding as one route of exposure in conducting risk assessments on individual chemicals commonly found in breast milk.
4. The U.S. Congress to grant funding to the U.S. Centers for Disease Control and Prevention to develop a national human milk monitoring program and appropriate risk communication strategies, so that persistent toxic chemicals accumulating in breast milk can be identified and steps taken to immediately reduce chemical contamination so as to prevent the exposure of fetuses and newborn infants to those chemicals, but in ways that do not discourage breastfeeding.
References:
1. American Public Health Association Policy # 7403, Breastfeeding.
2. American Public Health Association Policy # 7922, Infant Feeding Advertising.
3. American Public Health Association Policy # 8022, Infant Feeding in the United States.
4. American Public Health Association Policy # 8126, Nestle Boycott.
5. American Public Health Association Policy # 8226, Breastfeeding.
6. American Public Health Association Policy # 200114, APHA Supports the Health and Human Services Blueprint for Action on Breastfeeding.
7. Gartner LM, Eidelman AI, Morton J, et al (American Academy of Pediatrics). 2005. Breastfeeding and the use of human milk. Pediatrics. 115(2): 496-506.
8. Anderson JW, Johnstone BM, Remley DT. 1999. Breast-feeding and cognitive development : a meta-analysis, Am J Clin Nutr. 70 : 525-35.
9. Horwood LJ, Darlow BA, Mogridge N. 2001. Breast milk feeding and cognitive ability at 7-8 years. Arch Dis Child Fetal Neonatal Ed. 84(1): F23-7.
10. Oddy WH, Holt PG, Sly PD et al, 1999. Association between breast-feeding and asthma in 6-year-old children: findings of a prospective birth cohort study. BMJ.319(7213): 815-19.
11. Oddy WH, Peat JK, de Klerk NH. 2002. Maternal asthma, infant feeding, and the risk of asthma in childhood. J Allergy Clin Immunol. 110(1): 65-7.
12. Chulada PC, Arbes SJ Jr, Dunson D, Zeldin DC. 2003. Breast-feeding and the prevalence of asthma and wheeze in children: analyses from the Third National Health and Nutrition Examination Survey, 1988-1994. J Allergy Clin Immunol. 111(2): 328-36.
13. Von Kries R, Koletzko B, Sauerwald T et al, 1999. Breast-feeding and obesity: cross sectional study. BMJ .319(7203): 147-50.
14. Armstrong J, Reilly J. 2002. Breastfeeding and lowering the risk of childhood obesity. Lancet. 359(9322): 2003-4.
15. Davis MK, 1998. Review of the evidence for an association between infant feeding and childhood cancer, Int J Cancer Suppl. 11: 29-33.
16. Virtanen SM, Rasanen L, Aro A et al, 1991. Infant feeding in Finnish children less than 7 yr of age with newly diagnosed IDDM. Childhood diabetes in Finland study group. Diabetes Care. 14(5): 415-17.
17. Gerstein HC. 1994. Cow's milk exposure and type I diabetes mellitus. A critical overview of the clinical literature. Diabetes Care. 17(1): 13-19.
18. McVea KL, Turner PD, Peppler DK. 2000. The role of breastfeeding in sudden infant death syndrome. J Hum Lact. 6(1): 13-20.
19. LaKind JS, Berlin CM, Naiman DQ. 2001. Infant exposure to chemicals in breast milk in the United States: What we need to learn from a breast milk monitoring program. EHP 109(1): 75-88.
20. Sonawane BR. 1995. Chemical contaminants in human milk: an overview. Environ Health Perspect. 103 Suppl 6: 197-205.
21. American Public Health Association Policy # 200011, The Precautionary Principle and Children's Health.
22. Jacobson JL & Jacobson SW, 2002. Association of prenatal exposure to an environmental contaminant with intellectual function in childhood. J Toxicol Clin Toxicol. 40(4): 467-75
23. Koopman-Esseboom C, Weisglas-Kuperus N, de Ridder MA et al, 1996. Effects of polychlorinated biphenyl/dioxin exposure and feeding type on infants' mental and psychomotor development, Pediatrics. 97(5): 700-6.
24. Weisglas-Kuperus N, Patandin S, Berbers G et al, 2000. Immunologic Effects of background exposure to polychlorinated biphenyls and dioxins in Dutch preschool children. EHP. 108(12): 1203-07.
25. Patandin S, Dagnelie PC, Mulder P et al, 1999. Dietary exposure to polychlorinated biphenyl and dioxins from infancy until adulthood: A comparison between breast-feeding, toddler, and long-term exposure. EHP. 107(1): 45-51.
26. Papke O, 1998. PCDD/PCDF: Human background data for Germany, a ten year experience, Environ Health Perspect 106(suppl. 2): 723-31.
27. Beck H, Dross A, Mathar W. 1994. PCDD and PCDF exposures and levels in humans in Germany, Environ Health Perspect. 102 (suppl.1): 173-85.
28. Lorber M, Phillips L, 2002. Infant exposure to dioxin-like compounds in human milk, EHP. 110(6): A325-32.
29. Thomsen C, Lundanes E, Becher G. 2002. Brominated flame retardants in archived serum samples from Norway : a study on temporal trends and the role of age. Envir Sci & Technol. 6(7) : 1414-18.
30. Schecter A, Pavuk M, Papke O et al. 2003. Polybrominated diphenyl ethers (PBDEs) in U.S. mother's milk. Environ Health Perspect. 111(14): 1723-1729.
31. Mazdai A, Dodder NG, Abernathy MP et al. 2003. Polybrominated diphenyl ethers in maternal and fetal blood samples, Environ Health Perspect. 111(9): 1249-1252.
32. Pohl HR, Tylenda CA, 2000. Breast-feeding exposure of infants to selected pesticides: a public health viewpoint, Toxicol Ind Health. 16(2): 65-77.
33. Patandin S, Lanting CI, Mulder PG et al, 1999. Effects of environmental exposure to PCBs and dioxins on cognitive abilities of Dutch children at 42 months of age. J of Pediatrics.134(1): 33-41.
34. Hooper K, She J. 2003. Lessons from the polybrominated diphenyl ethers (PBDEs): precautionary principle, primary prevention, and the value of community-based body-burden monitoring using breast milk. Environ Health Perspect. 111(1): 109-14.
This policy affirms the continued importance of human milk and breastfeeding while acknowledging that human milk is also the top of the human food chain and reflects maternal exposure to an array of persistent toxic chemical contaminants, including dioxins/furans, PCBs (polychlorinated biphenyls), PBDE (polybrominated diphenyl ethers) flame retardants and chlorinated organic pesticides.19 Noting that these chemical contaminants are currently found in human milk from women around the world and specifically in the United States,19,20 this policy urges proactive steps to protect human milk from further contamination by reducing the sources of this contamination in the environment, citing especially APHA policy #200011 encouraging precautionary action to prevent potential harm to reproductive health, infants, and children, even if some cause and effect relationships have not been established with scientific certainty.21
Although research suggests that prenatal exposures to persistent toxic chemicals have greater impacts on children's health than exposures through breastfeeding, 22,23 some researchers have found evidence that the presence of persistent toxic chemicals in human milk may compromise some of its benefits.24,25 In general, breastfed infants continue to be exposed to persistent toxic chemicals, as they were in utero. Levels of organochlorine chemicals in the bodies of breastfed babies in Germany were 10-20 times higher than formula-fed babies.26,27 Adjusted for body weight, breastfed infants ingest 50 times more dioxins and PCBs (polychlorinated biphenyls) than their parents.26 One study estimated a breastfed infant's exposure to dioxin-like compounds during the first year of life at 242 pg TEQ/kg-day, adjusted for body weight, compared with the average adult exposure at 1 pg TEQ/kg-day.28 Researchers in Norway found 2-3 times more PBDEs in the serum of 0-4-year-olds compared with all age groups.29 PBDE levels in U.S. women's human milk are typically 10-100 times higher than levels in European women.30,31 Organochlorine pesticides are also commonly found in human milk.32
Because certain chemical contaminants persist in human tissues for many years, early exposure contributes to lifetime body burden. Dutch researchers estimate that between 12-14 percent of adult body burden of these chemicals comes from human milk.33 These chemicals also persist in the environment. For example, PCBs were banned in the United States in 1979 and DDT in 1972, yet PCBs and DDE, a metabolite of DDT are commonly found in human milk even today.19,20 However, declining levels illustrate the effectiveness of the bans. Action to reduce other persistent toxic chemicals should occur as quickly as possible, in order to reduce levels of these chemicals in human milk in the future. An example of one such action is the Stockholm Convention on Persistent Organic Pollutants, an international treaty on elimination of certain persistent global pollutants, which the U.S. signed in 2001, but has not yet ratified.
Progress in reducing human milk contamination can only be measured if routine bio- monitoring occurs. Sweden has had a national human milk-monitoring program for over 30 years, which has enabled the tracking of contaminant levels over time, including documenting decreases and emerging problem chemicals such as PBDE flame retardants. The United States has no national human milk monitoring program.19,34 A human milk monitoring program in the United States would enable uniform tracking of contaminant levels across the country to more easily identify trends and emerging contaminants34 and support pollution prevention to protect human milk from chemical contamination in order to promote the optimum health and well-being of infants.
In light of the widespread presence of chemical contaminants in human milk and considering the significant contribution of human milk and breastfeeding to infant health and life-long health:
Therefore, The American Public Health Association urges:
1. State, federal and international actions to prevent persistent toxic chemicals from polluting the environment and human milk, including but not limited to the Stockholm Convention on Persistent Organic Pollutants.
2. The U.S. government to fully implement and ratify the Stockholm Convention on Persistent Organic Pollutants in a manner fully consistent with the intent and spirit of this international treaty.
3. The U.S. Environmental Protection Agency to incorporate breastfeeding as one route of exposure in conducting risk assessments on individual chemicals commonly found in breast milk.
4. The U.S. Congress to grant funding to the U.S. Centers for Disease Control and Prevention to develop a national human milk monitoring program and appropriate risk communication strategies, so that persistent toxic chemicals accumulating in breast milk can be identified and steps taken to immediately reduce chemical contamination so as to prevent the exposure of fetuses and newborn infants to those chemicals, but in ways that do not discourage breastfeeding.
References:
1. American Public Health Association Policy # 7403, Breastfeeding.
2. American Public Health Association Policy # 7922, Infant Feeding Advertising.
3. American Public Health Association Policy # 8022, Infant Feeding in the United States.
4. American Public Health Association Policy # 8126, Nestle Boycott.
5. American Public Health Association Policy # 8226, Breastfeeding.
6. American Public Health Association Policy # 200114, APHA Supports the Health and Human Services Blueprint for Action on Breastfeeding.
7. Gartner LM, Eidelman AI, Morton J, et al (American Academy of Pediatrics). 2005. Breastfeeding and the use of human milk. Pediatrics. 115(2): 496-506.
8. Anderson JW, Johnstone BM, Remley DT. 1999. Breast-feeding and cognitive development : a meta-analysis, Am J Clin Nutr. 70 : 525-35.
9. Horwood LJ, Darlow BA, Mogridge N. 2001. Breast milk feeding and cognitive ability at 7-8 years. Arch Dis Child Fetal Neonatal Ed. 84(1): F23-7.
10. Oddy WH, Holt PG, Sly PD et al, 1999. Association between breast-feeding and asthma in 6-year-old children: findings of a prospective birth cohort study. BMJ.319(7213): 815-19.
11. Oddy WH, Peat JK, de Klerk NH. 2002. Maternal asthma, infant feeding, and the risk of asthma in childhood. J Allergy Clin Immunol. 110(1): 65-7.
12. Chulada PC, Arbes SJ Jr, Dunson D, Zeldin DC. 2003. Breast-feeding and the prevalence of asthma and wheeze in children: analyses from the Third National Health and Nutrition Examination Survey, 1988-1994. J Allergy Clin Immunol. 111(2): 328-36.
13. Von Kries R, Koletzko B, Sauerwald T et al, 1999. Breast-feeding and obesity: cross sectional study. BMJ .319(7203): 147-50.
14. Armstrong J, Reilly J. 2002. Breastfeeding and lowering the risk of childhood obesity. Lancet. 359(9322): 2003-4.
15. Davis MK, 1998. Review of the evidence for an association between infant feeding and childhood cancer, Int J Cancer Suppl. 11: 29-33.
16. Virtanen SM, Rasanen L, Aro A et al, 1991. Infant feeding in Finnish children less than 7 yr of age with newly diagnosed IDDM. Childhood diabetes in Finland study group. Diabetes Care. 14(5): 415-17.
17. Gerstein HC. 1994. Cow's milk exposure and type I diabetes mellitus. A critical overview of the clinical literature. Diabetes Care. 17(1): 13-19.
18. McVea KL, Turner PD, Peppler DK. 2000. The role of breastfeeding in sudden infant death syndrome. J Hum Lact. 6(1): 13-20.
19. LaKind JS, Berlin CM, Naiman DQ. 2001. Infant exposure to chemicals in breast milk in the United States: What we need to learn from a breast milk monitoring program. EHP 109(1): 75-88.
20. Sonawane BR. 1995. Chemical contaminants in human milk: an overview. Environ Health Perspect. 103 Suppl 6: 197-205.
21. American Public Health Association Policy # 200011, The Precautionary Principle and Children's Health.
22. Jacobson JL & Jacobson SW, 2002. Association of prenatal exposure to an environmental contaminant with intellectual function in childhood. J Toxicol Clin Toxicol. 40(4): 467-75
23. Koopman-Esseboom C, Weisglas-Kuperus N, de Ridder MA et al, 1996. Effects of polychlorinated biphenyl/dioxin exposure and feeding type on infants' mental and psychomotor development, Pediatrics. 97(5): 700-6.
24. Weisglas-Kuperus N, Patandin S, Berbers G et al, 2000. Immunologic Effects of background exposure to polychlorinated biphenyls and dioxins in Dutch preschool children. EHP. 108(12): 1203-07.
25. Patandin S, Dagnelie PC, Mulder P et al, 1999. Dietary exposure to polychlorinated biphenyl and dioxins from infancy until adulthood: A comparison between breast-feeding, toddler, and long-term exposure. EHP. 107(1): 45-51.
26. Papke O, 1998. PCDD/PCDF: Human background data for Germany, a ten year experience, Environ Health Perspect 106(suppl. 2): 723-31.
27. Beck H, Dross A, Mathar W. 1994. PCDD and PCDF exposures and levels in humans in Germany, Environ Health Perspect. 102 (suppl.1): 173-85.
28. Lorber M, Phillips L, 2002. Infant exposure to dioxin-like compounds in human milk, EHP. 110(6): A325-32.
29. Thomsen C, Lundanes E, Becher G. 2002. Brominated flame retardants in archived serum samples from Norway : a study on temporal trends and the role of age. Envir Sci & Technol. 6(7) : 1414-18.
30. Schecter A, Pavuk M, Papke O et al. 2003. Polybrominated diphenyl ethers (PBDEs) in U.S. mother's milk. Environ Health Perspect. 111(14): 1723-1729.
31. Mazdai A, Dodder NG, Abernathy MP et al. 2003. Polybrominated diphenyl ethers in maternal and fetal blood samples, Environ Health Perspect. 111(9): 1249-1252.
32. Pohl HR, Tylenda CA, 2000. Breast-feeding exposure of infants to selected pesticides: a public health viewpoint, Toxicol Ind Health. 16(2): 65-77.
33. Patandin S, Lanting CI, Mulder PG et al, 1999. Effects of environmental exposure to PCBs and dioxins on cognitive abilities of Dutch children at 42 months of age. J of Pediatrics.134(1): 33-41.
34. Hooper K, She J. 2003. Lessons from the polybrominated diphenyl ethers (PBDEs): precautionary principle, primary prevention, and the value of community-based body-burden monitoring using breast milk. Environ Health Perspect. 111(1): 109-14.
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