by Anne Eglash MD, IBCLC, FABM
How does the maternal diet affect the make-up of a mother’s breastmilk? Mothers often wonder if their diets are sufficient to provide all necessary nutrients in their breastmilk. In addition, many mothers ask whether they should alter their diets or take supplements to improve their breastmilk quality.
Authors of a recent article in Breastfeeding Medicine Journal recently reviewed the published literature on the impact of maternal dietary nutrients and the addition of supplements on the make-up of breastmilk.
What do you believe are true statements about maternal diet and/or supplements on the quality of breastmilk? Choose 1 or more:
- Short term fasting (such as 1 day) will decrease the fat and protein in breastmilk.
- Milk fat provides 50% of the energy in breastmilk, and the types of fats that mothers eat influences the types of fat in breastmilk.
- Maternal calcium supplementation will increase the calcium level in breastmilk.
- A mother with a low blood vitamin B12 level will have plenty of B12 in her breastmilk.
- Maternal iron supplementation will increase the iron in her breastmilk.
- Maternal vitamin D supplementation will increase the vitamin D level in breastmilk.
- Taking vitamin C increases the vitamin C level in breastmilk.
See the Answer
The correct answers are B, F, G
Macro- and Micronutrients of Human Milk Composition: Are They Related to Maternal Diet? A Comprehensive Systematic Review
Keikha M, Bahreynian M, Saleki M, Kelishadi R
BACKGROUND:
This study aims at systematically reviewing the observational and interventional studies on the association of maternal macro- and micronutrient intake with breast milk content.
METHODS:
We systematically searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till October 2016 with the following search strategy: (“human milk” OR “breast milk” OR “breast milk composition” OR “human breast milk composition” OR “composition breastmilk” OR “mother milk” OR “human breast milk”) AND (“maternal diet” OR “maternal nutrition”). We also searched Google scholar for increasing the sensitivity of our search. The search was not limited to title and abstract due to the possibility that the desired outcome might have been considered a secondary aim. We excluded conference papers, editorials, letters, commentary, short survey, and notes. The search was refined to English language, and we did not consider any time limitation. To increase the sensitivity and to select more studies, the reference list of the published studies was checked as well.
RESULTS:
This review included 59 observational and 43 interventional studies on maternal diet related to breast milk composition. Different studies determined the associations and effects of some maternal dietary intake of micro and macronutrients and its reflection in human milk.
CONCLUSION:
Maternal dietary intake, particularly fatty acids, and some micronutrients, including fat soluble vitamins, vitamin B1, and vitamin C, was related to their content in breast milk composition.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
There is a lack of literature on the effect of maternal diet on breastmilk composition. For example, we know that the fats in a breastfeeding mother’s diet influences the fatty acids in her breastmilk but we don’t know what that means for infant health or breast health. For example, are certain fats in addition to fish oil important for infant growth and development? Do certain fats in mom’s diet influence her risk of milk plugs?
Given that the maternal diet influences the makeup of breastmilk for some but not all nutrients, we should be encouraging nutrient supplementation in any nursing woman who is at risk of vitamin deficiency, such as women who have had a gastric bypass, women on certain medications that block nutrient absorption (ie proton pump inhibitors, metformin), vegans (at risk for low B12), or women on various restrictive diets.
Until we know more, it is reasonable for breastfeeding women to take a multivitamin to ensure a proper balance of vitamins, unless she has a well-balanced diet without underlying health problems. In addition, a breastfeeding mother who is not eating 8-12 oz of fish a week should be encouraged to take a DHA supplement each day, such as fish oil.
Becky Hill
Dr Eglash,
Could you comment on the amount of DHA that should be encouraged. The supplements are so varied and often difficult to evaluate? Are there parameters that you can recommend?
MilkMob
It appears that women need approximately 250mg-300mg of DHA daily to achieve sufficient DHA in their breastmilk for their babies. This can be accomplished by eating 8-12 oz of fish every week, according to the FDA, or taking a daily DHA supplement.
Source: Koletzo, B Clin Perinatol 44 (2017) 85-93
Rosa
For a fasting mother (during Ramadan) in some countries it’s a 19hr fast (no water no food). How does that affect the micronutrient composition in breastmilk and how does it affect the baby?
MilkMob
I am not sure that this has been studied. I would assume that fasting throughout the day would not have a negative impact on the micronutrients in breastmilk, as long as nutrient intake is sufficient when eating is allowed.
rlessen
Actually a study (Zimmerman D, Journal of Human Lactation, 2009) of lactating women after a 25 hour fast (no food or water) showed that there are changes to milk composition. Compared to baseline following the fast levels of sodium, calcium and protein were elevated, lactose and potassium were decreased and potassium and triglycerides were unchanged. These changes might be related to maternal dehydration and reduced production but these weren’t measured.