Abstract Objective: To review data on the occurrence and toxicity of the commonly reported pesticides and industrial environmental pollutant chemicals in breast milk. Data Sources: Continuous automated literature surveillance plus contact with investigators and governmental agencies. Study Selections: For data on occurrence, the most recent data from the largest data sets on the most representative donors were used. For data on toxicity, the primary report that was publicly available was used. Data Extraction: When necessary, data were reexpressed or concentrations were rescaled. The original investigator was contacted if necessary.Data Synthesis: Although pollutant chemicals are readily detected in most human milk worldwide, there is little evidence for consequent morbidity in nurslings. There have been several mass poisonings in which chemicals that were transmitted through breast milk clearly affected children who were breast-fed, and there is some evidence that prenatal exposure to background levels resulted in mild developmental delay and that lactation per se was disturbed. Conclusions: Breast-feeding is recommended despite the presence of chemical residues. The prenatal period in the child and the initiation of lactation in the mother may be sensitive periods to the toxicity of the chemicals that are considered here, and the potential for poisoning at higher levels is clear. However, in the vast majority of women, the benefits of breast-feeding appear to outweigh the risks, and those who advise women about infant nutrition should continue to support breast-feeding.Arch Pediatr Adolesc Med. 1996;150:981-990 References 1. Industry Activities Section, Center for Food Safety and Nutrition, Food and Drug Administration. Action Levels for Poisonous or Deleterious Substances in Human Food and Animal Feed . Washington, DC: Food and Drug Administration; 1992, 1994 (Changes in Action Levels). 2. Trotter WJ, Dickerson R. Pesticide residues in composited milk collected through the U.S. Pasteurized Milk Network . J Assoc Off Anal Chem . 1993:76:1220-1225. 3. Jensen AA. Chemical contaminants in human milk . Residue Rev . 1983;89:1-128. 4. Savage EP, Keefe TJ, Tessari JD, et al. National study of chlorinated hydrocarbon insecticide residues in human milk, USA, I: geographic distribution of dieldrin, heptachlor, heptachlor epoxide, chlordane, oxychlordane, and Mirex . Am J Epidemiol . 1981;113:413-422. 5. Savage EP, Keefe TJ, Wheeler HW, Tessari JD, Aaronson MJ. Second National Study to Determine Levels of Chlorinated Hydrocarbon Insecticides and Polychlorinated Biphenyls in Human Milk . Fort Collins, Colo: Epidemiologic Pesticides Studies Center, Colorado State University; 1984. 6. Jensen AA. Polychlorobiphenyls (PCBs), polychlorodibenzo-p-dioxins (PCDDs) and polychlorodibenzofurans (PCDFs) in human milk, blood and adipose tissue . Sci Total Environ . 1987;64:259-293.Crossref 7. Environmental Protection Agency. DDT: a Review of Scientific and Economic Aspects of the Decision to Ban Its Use as a Pesticide . Washington, DC: US Environmental Protection Agency; 1975. 8. Kupfer D, Bulger WH. Estrogenic properties of DDT and its analogues . In: McLachlan J, ed. Estrogens in the Environment . New York, NY: Elsevier Science Inc; 1980:239. 9. International Programme on Chemical Safety, World Health Organization. Polychlorinated Biphenyls and Terphenyls . 2nd ed. Geneva, Switzerland: World Health Organization; 1993:140. 10. Radcliffe DA. Decrease in eggshell weight in certain birds of prey . Nature . 1967;215:208-210.Crossref 11. Kutz FW, Wood PH, Bottimore DP. Organochlorine pesticides and polychlorinated biphenyls in human adipose tissue . Rev Environ Contam Toxicol . 1991; 120:1-82. 12. Environmental Protection Agency. Chlordane/heptachlor termitocides: notification of cancellation and amendment of existing stocks determination . Federal Register . (April 8) , 1988;53:11798-11805. 13. Courtney KD. Hexachlorobenzene (HCB): a review . Environ Res . 1979:20: 225-266.Crossref 14. Anonymous. Report of a new chemical hazard . New Scientist . 1966;32:612. 15. Kay K. Polybrominated biphenyls (PBB) environmental contamination in Michigan, 1973-1976 . Environ Res . 1977;13:74-93.Crossref 16. Masuda Y. The Yusho rice oil poisoning incident . In: Schecter A, ed. Dioxins and Health . New York, NY: Plenum Publishing Corp; 1994:633. 17. Hsu CC, Yu MLM, Chen YCJ, Guo YLL, Rogan WJ. The Yu-cheng rice oil poisoning incident . In: Schecter A, ed. Dioxins and Health . New York, NY: Plenum Publishing Corp; 1994:661. 18. Dewailly E, Nantel A, Weber JP, Meyer F. High levels of PCBs in breast milk of Inuit women from Arctic Quebec . Bull Environ Contam Toxicol . 1989;43: 641-646.Crossref 19. Fiore BJ, Anderson HA, Hanrahan LP, Olson LJ, Sonzogni WC. Sport fish consumption and body burden levels of chlorinated hydrocarbons: a study of Wisconsin anglers . Arch Environ Health . 1989;44:82-88.Crossref 20. Jacobson SW, Jacobson JL, Schwartz PM, Fein GG. Intrauterine exposure of human newborns to PCBs: measures of exposure . In: D'ltri FM, Kamrin M, eds. PCBs: Human and Environmental Hazards . Newton, Mass: Butterworth-Heinemann; 1983:311. 21. Schwartz PM, Jacobson SW, Fein G, Jacobson JL, Price HA. Lake Michigan fish consumption as a source of polychlorinated biphenyls in human cord serum, maternal serum, and milk . Am J Public Health . 1983;73:293-296.Crossref 22. Niessen KH, Ramolla J, Binder M, Brügmann G, Hofmann U. Chlorinated hydrocarbons in adipose tissue of infants and toddlers: inventory and studies on their association with intake of mothers' milk . Eur J Pediatr . 1984;142: 238-243.Crossref 23. Jacobson JL, Humphrey HEB, Jacobson SW, Schantz SL, Mullin MD, Welch R. Determinants of polychlorinated biphenyls (PCBs), polybrominated biphenyls (PBBs) and dichlorodiphenyl trichlorethane (DDT) levels in the sera of young children . Am J Public Health . 1989;79:1401-1404.Crossref 24. Yakushiji T, Watanabe I, Kuwabara K, et al. Postnatal transfer of PCBs from exposed mothers to their babies: influence of breast-feeding . Arch Environ Health . 1984;39:368-375.Crossref 25. Kuwabara K, Yakushiji T, Watanabe I, et al. Relationship between breast feeding and PCB residues in blood of the children whose mothers were occupationally exposed to PCBs . Int Arch Occup Environ Health . 1978;41:189-197.Crossref 26. Food and Drug Administration. Polychlorinated biphenyls (PCBs): reduction of tolerances . Federal Register . (June 29) , 1979;44:38330-38340. 27. International Programme on Chemical Safety, World Health Organization, Summary of Toxicological Evaluations Performed by the Joint FAO/WHO Meeting on Pesticide Residues (JMPR) . Geneva, Switzerland: United Nations Environment Programme, the International Labour Organisation, and the World Health Organization; 1993. 28. Rogan WJ, Gladen BC, McKinney JD, et al. Polychlorinated biphenyls (PCBs) and dichlorodiphenyl dichloroethene (DDE) in human milk: effects of maternal factors and previous lactation . Am J Public Health . 1986;76:172-177.Crossref 29. World Health Organization. Summary Report: Consultation on Tolerable Daily Intake From Food of PCDDs and PCDFs . Bilthoven, the Netherlands: Regional Office for Europe, World Health Organization; 1991. 30. Schecter A, Fürst P, Fürst C, et al. Chlorinated dioxins and dibenzofurans in human tissue from general populations: a selective review . Environ Health Perspect . 1994;102( (suppl 1) ):159-171.Crossref 31. Safe S. Polychlorinated biphenyls (PCBs), dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs), and related compounds: environmental and mechanistic considerations which support the development of toxic equivalency factors (TEFs) . Crit Rev Toxicol . 1990;21:51-88.Crossref 32. Ahlborg UG, Hanberg A, Kenne K. Nord, 26: Risk Assessment of Polychlorinated Biphenyls (PCBs) . Stockholm, Sweden: Nordic Council of Ministers; 1992. 33. Barnes D, Alford-Stevens A, Birnbaum L, Kutz FW, Wood W, Patton D. Toxicity equivalency factors for PCBs . Qual Assur Good Pract Regulation Law . 1991;1:70-81. 34. Seegal RF, Bush B, Shain W. Lightly chlorinated ortho-substituted PCB congeners decrease dopamine in nonhuman primate brain and in tissue culture . Toxicol Appl Pharmacol . 1990;106:136-144.Crossref 35. Poland A, Glover E, Bradfield CA. Characterization of polyclonal antibodies to the Ah receptor prepared by immunization with a synthetic peptide hapten . Mol Pharmacol . 1991;39:20-26. 36. Stone R. Dioxin receptor knocked out . Science . 1995;268:638-639.Crossref 37. Kuratsune M. Yusho, with reference to Yu-Cheng . In: Kimbrough RD, Jensen AA, eds. Topics in Environmental Health . 2nd fully revised ed. Amsterdam, the Netherlands: Elsevier Science Publishers; 1989;4:381. 38. Funatsu I, Yamashita F, Ito Y, et al. Polychlorbiphenyls (PCB)—induced fetopathy, I: clinical observation . Kurume Med J . 1972;19:43-51.Crossref 39. Harada M. Intrauterine poisoning: clinical and epidemiological studies of the problem . Bull Inst Const Med Kumamato Univ . 1976;25:1-60. 40. Hsu S-T, Ma C-I, Hsu S-K, et al. Discovery and epidemiology of PCB poisoning in Taiwan: a four-year follow-up . Environ Health Perspect . 1985;59: 5-10.Crossref 41. Chen Y-CJ, Guo Y-L, Hsu C-C, Rogan WJ. Cognitive development of Yu-Cheng ('oil disease') children prenatally exposed to heat-degraded PCBs . JAMA . 1992;268:3213-3218.Crossref 42. Masuda Y, Kuroki H, Haraguchi K, Nagayama J. PCDFs and related compounds in humans from Yusho and Yu-Cheng incidents . Chemosphere . 1986; 15:1621-1628.Crossref 43. Rogan WJ, Gladen BC, Hung K-L, et al. Congenital poisoning by polychlorinated biphenyls and their contaminants in Taiwan . Science . 1988;241:334-336.Crossref 44. Chen Y-CJ, Yu M-LM, Rogan WJ, Gladen BC, Hsu C-C. A six-year follow-up of behavior and activity disorders in the Taiwan Yu-Cheng children . Am J Public Health . 1994;84:415-421.Crossref 45. Yu M-L, Hsu C-C, Gladen BC, Rogan WJ. In utero PCB/PCDF exposure: relation of developmental delay to dysmorphology and dose . Neurotoxicol Teratol . 1991;13:195-202.Crossref 46. Mastroiacovo P, Spagnolo A, Marni E, Meazza L, Bertollini R, Segni G. Birth defects in the Seveso area after TCDD contamination . JAMA . 1988;259:1668-1672.Crossref 47. Reggiani G. Medical survey techniques in the Seveso TCDD exposure . J Appl Toxicol . 1981;1:323-331.Crossref 48. Mocarelli P, Needham LL, Morocchi A, et al. Serum concentrations of 2,3,7,8-tetrachlorodibenzo-p-dioxin and test results from selected residents of Seveso , Italy. J Toxicol Environ Health . 1991;32:357-366.Crossref 49. Erickson JD, Mulinare J, McClain PW, et al. Vietnam veterans' risks for fathering babies with birth defects . JAMA . 1984;252:903-912.Crossref 50. Wolfe WH, Michalek JE, Miner JC, et al. Paternal serum dioxin and reproductive outcomes among veterans of Operation Ranch Hand . Epidemiology . 1995;6:17-22.Crossref 51. Baughman RW. Tetrachlorodibenzo-p-dioxins in the Environment: High-Resolution Mass Spectrometry at the Picogram Level. Cambridge, Mass: Harvard University; 1974. Thesis. 52. Schecter A, Dai LC, Thuy LTB, et al. Agent Orange and the Vietnamese: the persistence of elevated dioxin levels in human tissues . Am J Public Health . 1995;85:516-522.Crossref 53. Huisman M, Koopman-Esseboom C, Fidler V, et al. Perinatal exposure to polychlorinated biphenyls and dioxins and its effect on neonatal neurological development . Early Hum Dev . 1995;41:111-127.Crossref 54. Jacobson JL, Jacobson SW, Fein GG, Schwartz PM, Dowler JK. Prenatal exposure to an environmental toxin: a test of the multiple effects model . Dev Psychol . 1984;20:523-532.Crossref 55. Rogan WJ, Gladen BC, McKinney JD, et al. Neonatal effects of transplacental exposure to PCBs and DDE . J Pediatr . 1986;109:335-341.Crossref 56. Gladen BC, Rogan WJ, Hardy P, Thullen J, Tingelstad J, Tully M. Development after exposure to polychlorinated biphenyls and dichlorodiphenyl dichloroethene transplacentally and through human milk . J Pediatr . 1988;113: 991-995.Crossref 57. Rogan WJ, Gladen BC. PCBs, DDE, and child development at 18 and 24 months . Ann Epidemiol . 1991;1:407-413.Crossref 58. Jacobson SW, Fein GG, Jacobson JL, Schwartz PM, Dowler JK. The effect of intrauterine PCB exposure on visual recognition memory . Child Dev . 1985; 56:853-860.Crossref 59. Jacobson JL, Jacobson SW, Humphrey HEB. Effects of in utero exposure to polychlorinated biphenyls and related contaminants on cognitive functioning in young children . J Pediatr . 1990:11:6:38-45.Crossref 60. Gladen BC, Rogan WJ. Effects of perinatal polychlorinated biphenyls and dichlorodiphenyl dichloroethene on later development . J Pediatr . 1991;119:58-63.Crossref 61. Jacobson JL, Jacobson SW, Humphrey HEB. Effects of exposure to PCBs and related compounds on growth and activity in children . Neurotoxicol Teratol . 1990;12:319-326.Crossref 62. Rogan WJ, Gladen BC. Neurotoxicology of PCBs and related compounds . Neurotoxicology . 1992;13:27-36. 63. Rogan WJ, Gladen BC, McKinney JD, et al. Polychlorinated (PCBs) and dichlorodiphenyl dichloroethene (DDE) in human milk: effects on growth, morbidity, and duration of lactation . Am J Public Health . 1987;77:1294-1297.Crossref 64. Gladen BC, Rogan WJ. DDE and shortened duration of lactation in a northern Mexican town . Am J Public Health . 1995;85:504-508.Crossref 65. Brilliant LB, Wilcox K, VanAmburg G, et al. Breast milk monitoring to measure Michigan's contamination with polybrominated biphenyls . Lancet . 1978; 2:8091-8095. 66. Barr M. Pediatric aspects of the Michigan polybrominated biphenyl contamination . Environ Res . 1980;21:255-274.Crossref 67. Weil WB, Spencer M, Benjamin D, Seagull E. The effect of polybrominated biphenyl on infants and young children . J Pediatr . 1981;98:47-51.Crossref 68. Seagull EW. Development abilities of children exposed to polybrominated biphenyls (PBB) . Am J Public Health . 1983;73:281-285.Crossref 69. Smith RJ. Hawaiian milk contamination creates alarm . Science . 1982;217: 137-140.Crossref 70. Casarett LJ, Fryer GC, Yanger WL, Klemmer HW. Organochlorine pesticide residue in human tissue—Hawaii . Arch Environ Health . 1968;17:306-311.Crossref 71. Takahashi W, Saidin D, Takei G, Wong L. Organochlorine pesticide residues in human milk in Hawaii, 1979-1980 . Bull Environ Contam Toxicol . 1981;27: 506-511.Crossref 72. Pesticide Hazard Assessment Project. Hepatochlor Epoxide in Mother's Milk, Oahu, August 1981-November 1982 . Manoa, Hawaii: University of Hawaii at Manoa; 1983. 73. Stehr-Green PA, Wohlleb JC, Royce W, Head SL. An evaluation of serum pesticide residue levels and liver function in persons exposed to dairy products contaminated with heptachlor . JAMA . 1988;259:374-377.Crossref 74. Mattison DR, Wohleb J, To T, et al. Pesticide concentrations in Arkansas breast milk . J Ark Med Soc . 1992;88:553-557. 75. Livingston JM, Jones CR. Living area contamination by chlordane used for termite treatment . Bull Environ Contam Toxicol . 1981;27:406-411.Crossref 76. Lillie TH. Chlordane in Air Force Housing . San Antonio, Tex: USAF Occupational and Environmental Health Laboratory, Brooks Air Force Base; 1981. 77. Taguchi S, Yakushiji T. Influence of termite treatment in the home on the chlordane concentration in human milk . Arch Environ Contam Toxicol . 1988; 17:65-71.Crossref 78. Peters HA, Jonson SAM, Cam S, Oral S, Muftu Y, Ergene R. Hexachlorobenzene-induced porphyria: effect of chelation on the disease, porphyrin and metal metabolism . Am J Med Sci . 1966;251:314-322.Crossref 79. Cripps DJ, Peters HA, Gocmen A, Dogramaci I. Porphyria turcica due to hexachlorobenzene: a 20- to 30-year follow-up study on 204 patients . Br J Dermatol . 1984;111:413-422.Crossref 80. Cripps DJ, Gocmen A, Peters HA. Porphyria turcica: twenty years after hexachlorobenzene intoxication . Arch Dermatol . 1980;116:46-50.Crossref 81. Anderson LM, van Havere K, Budinger JM. Effects of polychlorinated biphenyls on lung and liver tumors initiated in suckling mice by N-nitrosodimethylamine . J Natl Cancer Inst . 1983;71:157-163. 82. Anderson LM, Ward JM, Fox SD, Isaaq HJ, Riggs CW. Effects of a single dose of polychlorinated biphenyls to infant mice on N-nitrosodimethylamine—initiated lung and liver tumors . Int J Cancer . 1986;38:109-116.Crossref 83. National Toxicology Program. NTP Technical Report on the Perinatal Toxicity and Carcinogenicity Studies of Ethylene Thiourea (CAS No. 96-45-7) in F/344 Rats and B6C3F1 Mice (Feed Studies) . Research Triangle Park, NC: US Dept of Health and Human Services, National Institutes of Health; 1992. 84. Smith AH. Infant exposure assessment for breast milk dioxins and furans derived from waste incineration emissions . Risk Anal . 1987;7:347-353.Crossref 85. Rogan WJ, Blanton PJ, Portier CJ, Stallard E. Should the presence of carcinogens in breast milk discourage breast feeding? Regul Toxicol Pharmacol . 1991;13:228-240.Crossref 86. Hoover S, Zeise L, Krowech G. Exposure to environmental contaminants through breast milk . In: Garner BJ, ed. Advances in Risk Analysis: the Analysis, Communication, and Perception of Risk . New York, NY: Plenum Publishing Corp; 1991;9:257. 87. Kelsey JL, Horn-Ross PL. Breast cancer: magnitude of the problem and descriptive epidemiology . Epidemiol Rev . 1993;15:7-16. 88. Mussalo-Rauhamaa H, Häsänen E, Pyysalo H, Antervo K, Kauppilla R, Pantzar P. Occurrence of betahexachlorocyclohexane in breast cancer patients . Cancer . 1990;66:2124-2128.Crossref 89. Falck F, Ricci A, Wolff MS, Godbold J, Deckers P. Pesticides and polychlorinated biphenyl residues in human breast lipids and their relation to breast cancer . Arch Environ Health . 1992;47:143-146. 90. Wolff MS, Toniolo PG, Lee EW, Rivera M, Dubin N. Blood levels of organochlorine residues and risk of breast cancer . J Natl Cancer Inst . 1993:85:648-652.Crossref 91. Krieger N, Wolff MS, Hiatt RA, Rivera M, Vogelman J, Orentreich N. Breast cancer and serum organochlorines: a prospective study among white, black, and Asian women . J Natl Cancer Inst . 1994;86:589-599.Crossref 92. Unger M, Kiaer H, Blichert-Toft M, Olsen J, Clausen J. Organochlorine compounds in human breast fat from deceased with and without breast cancer and in a biopsy material from newly diagnosed patients undergoing breast surgery . Environ Res . 1984;34:24-28.Crossref 93. Dewailly E, Dodin S, Verreault R, et al. High organochlorine body burden in women with estrogen-positive breast cancer . J Natl Cancer Inst . 1994;86: 232-234.Crossref 94. Wasserman M, Nogueira DP, Tomatis L, et al. Organochlorine compounds in neoplastic and adjacent apparently normal breast tissue . Bull Environ Contam Toxicol . 1976;4:478-484.Crossref 95. Key T, Reeves G. Organochlorines in the environment and breast cancer . BMJ . 1994;308:1520-1521.Crossref 96. Boylan JJ, Egle JL, Guzelian PS. Cholestyramine: use as a new therapeutic approach for chlordecone (Kepone) poisoning . Science . 1978;199:893-895.Crossref 97. Hong CS, Xiao J, Casey AC, Bush B, Fitzgerald EF, Hwang SA. mono-ortho-and non-ortho-substituted polychlorinated biphenyls in human milk from Mohawk and control women: effects of maternal factors and previous lactation . Arch Environ Contam Toxicol . 1994;27:431-437.Crossref 98. McCullar M, Brenner V, Adams RH, Focht DD. Construction of a novel polychlorinated biphenyl-degrading bacterium: utilization of 3,4′-dichlorobiphenyl by Pseudomonas acidovorans M3GY . Appl Environ Microbiol . 1994;60:3833-3839. 99. Tilson HA, Jacobson JL, Rogan WJ. Polychlorinated biphenyls and the developing nervous system: cross-species comparisons . Neurotoxicol Teratol . 1990;12:239-248.Crossref 100. Lilienthal H, Winneke G. Sensitive periods for behavioral toxicity of polychlorinated biphenyls: determination by cross-fostering in rats . Fundam Appl Toxicol . 1991;17:368-375.Crossref 101. Reigart JR, Etzel RA, Goldman LR, Hendrick JG, Mofenson HC, Simon PR. PCBs in breast milk . Pediatrics . 1994;94:122-124. 102. Grandjean P, Tarkowski S, Kimbrough R, Yrjänheikki E, Rantanen JH, eds. Environmental Health, 29: Assessment of Health Risks in Infants Associated With Exposure to PCBs, PCDDs, and PCDFs in Breast Milk . Copenhagen, Denmark: Regional Office for Europe, World Health Organization; 1988.
Archives of Pediatrics & Adolescent Medicine – American Medical Association
Published: Sep 1, 1996