1. 74% of breast milk samples purchased from US milk sharing websites were contaminated with gram-negative bacteria or had >104 colony-forming units/mL of aerobic bacteria while 21% weere cytomegalovirus positive.
2. Only one half of samples purchased arrived within two days; each additional transit day was associated with an increased total bacteria count.
Study Rundown: Human breast milk is widely regarded to be optimal nutrition for infants and has both short and longterm medical and neurodevelopmental advantages. Some mothers are unable to breastfeed their children, however, and in recent years online marketplaces have been established that facilitate the sale of human milk to meet this need. The Food and Drug Administration (FDA) and the American Academy of Pediatrics (AAP) discourages the informal distribution or commoditization of unpasteurized human milk because, unlike human milk distributed by the Human Milk Banking Association of North America (HMBANA), these informal channels distribute unpasteurized milk from unscreened donors. This study addressed the potential infectious disease risks associated with breast milk samples purchased over the Internet by comparing 102 samples purchased from an online marketplace to 20 unpasteurized control samples. 74% were colonized with bacteria including gram negative bacteria, Staphylococcus, and Streptococcus species. Purchased milk had a higher mean total bacterial concentration than control samples obtained from HMBANA. In addition, although no samples were positive for HIV, 21% of samples were positive for cytomegalovirus (CMV) by PCR. Only one half of samples arrived via mail within two days, with 12% arriving after three to six days of transit, and bacterial counts were found to be significantly associated with increased shipment time. This study demonstrates that breast milk purchased via classified milk sharing websites may contain significant amounts of pathogenic bacteria and viruses and suggests that regulation of human breast milk exchange in order prevent infant illness would be beneficial.
Relevant Reading: Breastfeeding and the use of human milk, AAP Policy Statement
In-Depth [cross-sectional analysis]: During a three-month period in 2012, individuals advertising the sale of breast milk on two major internet classified sites facilitating human breast milk purchase were contacted via email with a request to buy milk. Of 495 initial inquiries, only 102 samples of milk shipments were received and analyzed. Approximately 50% of samples arrived within 2 days while 12% arrived 3-6 days after shipment. Of the shipments received, 19% included no cooling agent, 62% used dry ice, and 20% used freezer ice or gel packs to maintain low temperatures during transit. Milk samples were analyzed for bacterial contamination and compared to control samples of unpasteurized human breast milk from the HMBANA. Significantly more internet samples were found to be contaminated with gram negative bacteria, when compared to control samples (72% v. 35%; p < 0.003). In addition, signficantly more internet samples were contaminated with Staphylococcus species (63% v. 25%; p < 0.002). A higher, though not statistically significant number of internet samples were CMV DNA positive when compared to control samples (21% v. 5%; p = 0.12). No milk samples were HIV-RNA positive.
By Emilia Hermann and Leah H. Carr
Reviewed by William V. Raszka, MD
More from this author:AAP urges bottle feeding over breastfeeding in mothers with HIV, Pediatric influenza burden remains high despite new vaccination recommendations, Cow’s milk consumption linked to increased vitamin D and decreased iron stores in early childhood
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