SYMPOSIUM

Impact of Maternal Nutritional Status on Human

Milk Quality and Infant Outcomes: An Update
on Key Nutrients1,2
Donna J. Chapman3* and Laurie Nommsen-Rivers4
3

Yale School of Public Health, New Haven, CT; and 4Cincinnati Childrens Hospital, Cincinnati, OH

Published as a supplement to Advances in Nutrition. Presented as part of the symposium

entitled Impact of Maternal Status on Breast Milk Quality and Infant Outcomes: An Update
on Key Nutrients, given at the Experimental Biology 2011 meeting, April 12, 2011, in
Washington, DC. The symposium was sponsored by the American Society for Nutrition and
supported by an unrestricted educational grant from Medela. The symposium was chaired
by Laurie Nommsen-Rivers and Donna J. Chapman. Guest Editors for this symposium
publication were Donna J. Chapman and Shelley McGuire. Guest Editor disclosure: Donna J.
Chapman received travel support and compensation for editorial services provided for this
symposium from the International Society for Research on Human Milk and Lactation.
Shelley McGuire had no conflicts to disclose.
2
Author disclosures: D.J. Chapman and L. Nommsen-Rivers, no conflicts of interest.
* To whom correspondence should be addressed: donna.chapman@yale.edu.

2012 American Society for Nutrition. Adv. Nutr. 3: 351352, 2012; doi:10.3945/an.111.001123.

are at greater risk of vitamin B-12 deciency compared

with those consuming larger amounts of meat. Furthermore, current public health recommendations advise pregnant and lactating women to limit their consumption of
seafood with high methylmercury levels (16) and for all individuals to minimize sun exposure, practices that may
compromise the levels of (n-3) fatty acids (17) and vitamin
D (18) in human milk, respectively. These contemporary issues highlight the need to better understand the impact of
maternal dietary intake on human milk nutrient levels and
the resultant infant functional outcomes. For some nutrients, the answers to these relationships are relatively well established; however, important knowledge gaps remain in
our understanding of these relationships for select nutrients.
Our expert panel was invited to address the current evidence
and summarize emerging research with regard to human
milk quality, focusing on the B vitamins, vitamin D, and docosahexaenoic acid (DHA).
Dr. Lindsay Allen (19) presents a global overview of B vitamin levels in human milk, how these levels are inuenced
by maternal diet and supplementation patterns, and the B
vitamin status of infants breast-fed by mothers with inadequate B vitamin intake.
Drs. Adekunle Dawodu and Reginald Tsang (20) provide an overview of the interplay between the vitamin D
status of the mother, her milk, and her infant in a contemporary, cross-national context. Their paper also highlights
intriguing recent research evaluating maternal vitamin D
supplementation as a means to improve the vitamin D status of infants in settings with very low maternal vitamin D
levels.
Dr. Christina Valentine (21) presents a critical review of
the literature addressing the relationship between maternal
DHA intake and DHA levels in human milk, including the
donor milk supply in the United States and the potential impact of human milk DHA content on functional outcomes
in the preterm infant.
Although each of these authors has focused on addressing
suboptimal human milk levels of select nutrients, these
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The profound importance of human milk in optimizing

neonatal health and improving child survival is becoming
increasingly more apparent, both domestically (15) and internationally (6). Human milk is recommended as the sole
source of nutrition for the first 6 mo of life (710) and is
an important food source for the first 1 (7) to 2 y (11).
Therefore, promoting and protecting human milk nutrient
quality are of great public health concern. Until recently, it
was widely believed that nutritional deficiencies in breastfed infants were relatively rare. Routine supplementation
of breast-fed infants is not recommended in the United
States, with the exception of vitamin K in the newly delivered neonate (12) andsince 2005vitamin D supplementation throughout infancy (13). However, WHO expert
consultation on the optimal duration of exclusive breastfeeding (10) did acknowledge that data are insufficient to exclude the possibility of micronutrient deficiencies in some
infants exclusively breastfed for 6 mo.
Thus, there has been a renewed effort to better understand the relationship between maternal micronutrient status and human milk quality, particularly in regions of the
world where diet quality is poor (14). However, even for
women in resource-rich settings, modern trends in diet
and lifestyle may compromise human milk nutrient levels.
For example, it was previously believed that only strict
vegans were at risk of vitamin B-12 deciency. However, recent studies have revealed that even lacto-ovo vegetarians
and individuals who consume low amounts of meat (15)

Acknowledgments
The authors have read and approved the nal manuscript.

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symposium proceedings should not be interpreted as reasons to disregard current recommendations to provide human milk as the sole source of nutrition for the rst 6 mo
of life. On the contrary, all 4 authors acknowledge the vitally
important nutritional and immunological advantages of exclusive breastfeeding. In the instances in which human milk
nutrient levels have been shown to be suboptimal, each author
has highlighted emerging research on interventions designed
to address the problem, primarily by improving maternal intake. It would be misguided to solve the problem of a nutrient deficiency in human milk by recommending human milk
substitutes because this ignores the importance of exclusive
breastfeeding in maximizing protection from infectious disease and improving child survival. By tackling the issue of human milk quality for select nutrients, this symposium provides
a road map for future research focused on protecting and promoting human milk quality. Clearly, more research is needed
to determine the safety and effectiveness of approaches used to
address this challenging public health issue.