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

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Abstract

Introduction Maternal exposure to tobacco smoke is associated with shortened breastfeeding duration, but few studies have examined the effects on breastfeeding outcomes of low level exposures to other toxic chemicals. Moreover, it is unclear if passive smoking is associated with duration of breastfeeding. Our objective was therefore to examine the effect of low-level prenatal exposures to common environmental toxins (tobacco smoke, lead, and phthalates) on breastfeeding exclusivity and duration. Methods We conducted an analysis of data from the Health Outcomes and Measures of the Environment (HOME) Study. Serum and urine samples were collected at approximately 16 and 26 weeks gestation and at delivery from 373 women; 302 breastfed their infants. Maternal infant feeding interviews were conducted a maximum of eight times through 30 months postpartum. The main predictor variables for this study were gestational exposures to tobacco smoke (measured by serum cotinine), lead, and phthalates. Passive smoke exposure was defined as cotinine levels of 0.015–3.0 μg/mL. Primary outcomes were duration of any and exclusive breastfeeding. Results Serum cotinine concentrations were negatively associated with the duration of any breastfeeding (29.9 weeks unexposed vs. 24.9 weeks with passive exposure, p = 0.04; and 22.4 weeks with active exposure, p = 0.12; p = 0.03 for linear trend), but not duration of exclusive breastfeeding. Prenatal levels of blood lead and urinary phthalate metabolites were not significantly associated with duration of any or exclusive breastfeeding. Conclusions Passive exposure to tobacco smoke during pregnancy was associated with shortened duration of any breastfeeding.

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Acknowledgements

Dr. Lanphear has served as an expert witness and a consultant to the California Attorney General’s Office for the plaintiffs in a public nuisance case related to childhood lead poisoning, but he has not personally received any compensation for these services. Dr. Lanphear has also served as a paid consultant on a US Environmental Protection Agency research study related to childhood lead poisoning. None of these activities are directly related to the present study.

Funding

This work was supported by grants from the National Institute of Environmental Health Sciences (NIEHS; P01 ES11261, R01 ES014575). We acknowledge the technical assistance of the Centers for Disease Control and Prevention for laboratory measurements: AM Calafat (phthalate metabolites), R Jones and KC Caldwell (lead), and JT Bernert (cotinine).

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Authors and Affiliations

  1. University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, BOX 777, Rochester, NY, 14642, USA

    Casey B. Rosen-Carole, Peggy Auinger & Cynthia R. Howard

  2. Connecticut Children’s Medical Center, Hartford, CT, USA

    Elizabeth A. Brownell

  3. Simon Fraser University, Vancouver, BC, Canada

    Bruce P. Lanphear

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  1. Casey B. Rosen-Carole
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  2. Peggy Auinger
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Correspondence to Casey B. Rosen-Carole.

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Rosen-Carole, C.B., Auinger, P., Howard, C.R. et al. Low-Level Prenatal Toxin Exposures and Breastfeeding Duration: A Prospective Cohort Study. Matern Child Health J 21, 2245–2255 (2017). https://doi.org/10.1007/s10995-017-2346-4

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