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Grand Rounds

Does Low-Level Prenatal Passive Tobacco Exposure Decrease Breastfeeding Duration?

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BACKGROUND AND PURPOSE: 

  • Environmental contaminants, including tobacco smoke, lead and phthalates, are transferred from mothers to infants transplacentally and via breast milk 
  • Most studies have evaluated impact of toxins on breast feeding by focusing on exposure via breast milk 
  • Few studies have focused on low-level exposures to toxins in the prenatal period  
  • Rosen–Carole et al. (Maternal and Child Health Journal, 2017) assessed the impact of low prenatal exposure to common toxins (tobacco smoke, lead, and phthalates) on breastfeeding exclusivity and duration 

METHODS: 

  • Prospective cohort study 
  • Health Outcomes and Measures of the Environment (HOME) Study (2003-2006) 
  • Serum and urine samples were collected at approximately 16 (range 10-23) and 26 (range 19-35) weeks gestation and at delivery  
  • Women were included who lived in a home built in 1978 or before, when lead-based paints were frequently used  
  • Maternal infant feeding interviews were conducted eight times through 30 months postpartum, beginning 4 weeks post partum   
  • Tobacco smoke  
    • Passive smoke exposure defined as serum cotinine levels of 0.015-3.0 μg/mL)  
    • Active smokers defined as serum cotinine concentrations >3.0 μg/mL 
  • Cotinine, lead, and phthalates measured at the CDC Division of Laboratory Sciences  
  • Primary outcomes were duration of any and exclusive breastfeeding 

RESULTS: 

  • Samples were collected from 373 women; 302 breastfed their infants  
  • As serum cotinine concentrations increased, duration of any breastfeeding decreased 
    • 29.9 weeks unexposed vs. 24.9 weeks with passive exposure (p = 0.04) 
  • Duration of any breastfeeding was not significantly different between active smokers and the unexposed group but there was a linear trend for increasing cotinine levels (p = 0.03 for linear trend) 
    • Only 12% of women were active smokers and ‘n’ may be too small to detect difference  
  • There was no difference in duration for exclusive breastfeeding  
  • Prenatal levels of blood lead and urinary phthalate metabolites were not significantly associated with duration of any or exclusive breastfeeding 
  • More women in passively and actively exposed groups did not feel they had breastfed for as long as intended compared with unexposed women 
    • 21% felt they did not meet their goals because of return to work while 49% felt their breast milk was insufficient or reported growth failure for their infants 

CONCLUSION: 

  • Researchers acknowledge study limitations, including potential lack of generalizability as the HOME cohort generally had lower rates of exclusive breastfeeding and briefer breastfeeding compared to national cohorts 
  • This study does not address biologic explanation but other researchers have suggested toxic impact on development of mammary glands during pregnancy or disruption of hormonal signaling  
  • Hypothesis supported by at least one animal study  
  • Passive exposure to tobacco smoke during pregnancy was associated with shortened duration of any breastfeeding even after adjusting for confounders 

Learn More – Primary Sources:  

Low-Level Prenatal Toxin Exposures and Breastfeeding Duration: A Prospective Cohort Study

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