A recent study published in JAMA Network Open explores how maternal use of antidepressant and anti-inflammatory medications may impact the macronutrient composition of human milk. The study sheds light on the potential effects of long-term medication use on milk’s protein and fat levels, which are crucial for infant development.
Background
Breastfeeding offers numerous health benefits for both mothers and infants, with the World Health Organization recommending exclusive breastfeeding for the first six months. Human milk contains essential macronutrients—carbohydrates, fats, and proteins—that support infant growth. However, these levels can fluctuate due to various factors, such as feeding frequency, infant age, maternal body mass index (BMI), and diet.
Over 70% of breastfeeding mothers take some form of medication, yet the effects of these medications on milk composition have not been fully understood. This study seeks to clarify how medications might influence macronutrient levels in human milk.
Study Overview
The research team, led by scientists from the University of California, San Diego, collected data on maternal medication use and milk samples from October 2014 to January 2024. Milk samples were gathered from mothers with singleton infants between two weeks and 12 months postpartum. In total, 3,366 samples met the inclusion criteria, with 310 from mothers on long-term medication and 3,056 from untreated mothers.
The medicated mothers were categorized into four groups based on their medication use: selective serotonin reuptake inhibitors (SSRIs), monoclonal antibodies (MABs), systemic corticosteroids, and other anti-inflammatory drugs (ADs). Samples from mothers using multiple medications were excluded. Additionally, untreated mothers with inflammatory or mood disorders served as disease-matched controls (DMCs), while healthy controls were matched by infant age and sex.
Milk macronutrients—including carbohydrates, fats, proteins, and total energy content—were measured using near-infrared spectroscopy. Statistical analysis accounted for various factors such as maternal age, infant age, BMI, breastfeeding exclusivity, feeding frequency, and maternal cannabis use.
Key Findings
The study analyzed 384 milk samples, with the majority from mothers treated with SSRIs (63), MABs (63), systemic corticosteroids (33), and other ADs (20). Control groups included 141 samples from DMCs and 64 from healthy, unmedicated mothers.
The cohort had a mix of racial and ethnic backgrounds: 7.0% Asian, 12.5% non-Hispanic Black, 12.5% Hispanic, 75.8% non-Hispanic White, and 2.9% from other racial or ethnic groups. The study found that the average maternal age was 33.5 years, while infants had an average age of 6.6 months.
Mothers on SSRIs had a significantly higher BMI (29.9) compared to other groups, and cannabis use was less common among mothers taking antidepressants. No significant differences were found between groups in terms of infant age, breastfeeding exclusivity, or socioeconomic factors.
Macronutrient Analysis
The analysis revealed that carbohydrate levels in milk remained consistent across all groups, showing no significant differences. However, protein content was notably lower in all exposed groups compared to healthy mothers, with reductions ranging from 15% to 21%. After adjusting for various factors, significant differences in protein levels persisted in the SSRI and steroid groups.
Fat and energy content were 10% to 22% lower in milk samples from mothers treated with other ADs compared to DMC and healthy controls. When adjusted for other variables, significant differences in fat content remained only when compared to DMCs.
Conclusions
This study is the first to investigate the impact of long-term maternal medication use on the macronutrient composition of human milk. While carbohydrate levels remained unchanged, both protein and fat levels were significantly affected in medicated mothers, with some milk samples showing notably lower macronutrient content.
While the average values fell within reference ranges, these variations could be particularly concerning for preterm or ill infants, who may face growth or health risks if nutrient deficits are not detected. The study also notes that maternal diet, nutrient reserves, and disease severity could influence milk composition, highlighting potential confounding factors that were not fully measured.
Overall, the findings underscore the need for further research to better understand the clinical implications of these changes, especially for vulnerable infants. The study suggests that healthcare providers may need to consider the potential effects of maternal medications on milk composition when advising breastfeeding mothers, particularly those with infants at higher risk for nutritional deficits.
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