Lower protein, fat levels in breastmilk exposed to antidepressant, anti-inflammatory drugs
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Key takeaways:
- Breastmilk samples from mothers exposed to antidepressants and anti-inflammatory drugs had lower protein, fat and energy levels.
- Mean macronutrient levels were still within normal range in all exposure groups.
Mothers taking antidepressants or anti-inflammatory medications had lower protein and fat levels in breastmilk, which may cause health risks for infants, but researchers noted that more studies are needed to confirm the findings.
“While these findings do not support any change to breastfeeding recommendations or increased follow-up for exposed, healthy full-term infants, the maternal medications and milk macronutrient content could be considered as a contributing factor for poor growth, especially in vulnerable infants such as infants born preterm or small for gestational age,” Essi Whaites Heinonen, MD, PhD, neonatologist in the department of clinical science, intervention and technology in the division of pediatrics at Karolinska Institutet in Sweden, told Healio.
Heinonen and colleagues conducted a cross-sectional study, published in JAMA Network Open, using 384 samples collected from breastfeeding mothers (mean age, 33.5 years) in the U.S. and Canada between October 2014 and January 2024. All mothers participated in the Mommy’s Milk Human Milk Research Biorepository at the University of California, San Diego. Researchers compared macronutrient levels in breastmilk samples from mothers treated with long-term medications with samples from untreated healthy and disease-matched controls.
Overall, 64 samples were from healthy controls, 141 were from disease-matched controls, 63 were exposed to SSRIs, 63 to monoclonal antibodies, 33 to systemic steroids and 20 to other anti-inflammatory medications.
Primary outcome was levels of protein, fat, carbohydrate and total energy in breastmilk samples.
Per 100 mL of breastmilk, mean protein levels were 15% to 21% lower in samples collected from mothers exposed to SSRIs (0.92 g), monoclonal antibodies (0.85 g), steroids (0.88 g) and other anti-inflammatory medications (0.85 g) compared with samples from healthy mothers (1.08 g). However, after adjusting for infant and maternal age, parity, maternal BMI, infant sex, exclusive breastfeeding, feeding frequency, collection time, maternal cannabis use and occupation, the difference was significant only for SSRIs (P = .04) and steroids (P = .03).
In addition, per 100 mL of breastmilk, mean fat and total energy were 10% to 22% lower in samples collected from mothers exposed to other anti-inflammatory medications (3.4 g and 69.56 kcal) compared with healthy (3.85 g and 77.16 kcal) and disease-matched (4.38 g and 80.6 kcal) controls. However, after adjustments, the difference was only significant for fat levels compared with disease-matched controls (P = .01).
The researchers noted that all mean macronutrient levels were within the reference range; however, individual samples had “concerningly low levels” of the different macronutrients and the implications for the breastfed infant are so far unclear.“To understand whether any of these changes may be caused by the medication itself or some coexisting factor, future studies are needed on the potential effects of maternal diet and disease severity on the macronutrient composition of human milk,” Whaites Heinonen said.
For more information:
Essi Whaites Heinonen, MD, PhD, can be reached at essi.heinonen@ki.se.