by Donna Walls, RN, BSN, IBCLC, ANLC
There seems be a growing trend toward analyzing the content of a mother’s milk, mostly focusing on preemie or vulnerable infants. Most analyses offer to determine levels of the major components of milk, specifically the concentration of fat, carbohydrate, protein, solids and energy in human milk. In December of 2018 the Food and Drug Administration approved the first “milk analyzer” marketed as a tool to manage the nutritional needs of infants at risk for growth failure. This approval was for a “prescription device intended for use by trained health care personnel at clinical laboratories.” Analysis is now also being offered to the general public a well as to professionals and parents of at-risk newborns and infants. The concept is that a mother’s milk may be deficient in macro or micro nutrients and that by supplying the mother with nutritional supplements the breastmilk can be restored to optimal levels of nutrients. Many breastfeeding advocates are concerned about not only how these tests are used but also the message being sent to breastfeeding mothers. We know breastmilk is dynamic and changing and, for example, the fat content can vary from day to day or during the same feeding. When a single milk sample is obtained it may not actually be representative of the mother’s milk the infant would receive over a period of time, hours or days. We previously believed that foremilk (milk consumed early in the feeding} was low in fat and hindmilk (milk consumed later in the feeding) was high in fat. Research showed us that this concept was not true in all mothers. Some very efficient infants with a correct latch tend to consume higher amounts of fat early in the feed. These findings called into question the idea that all feedings begin with low fat and end with high fat milk. We now also recognize the diurnal changes in milk showing varying levels of fat and other components at different times of the day. If obtaining a single sample early in the morning the conclusion of the milk analysis might be that her milk is low in fat and if the single sample was obtained later in the day it may show a very different amount of fat, leading to the possibility of making an incorrect conclusion. This might call into question any specific conclusions or recommendations based on a single sample. There is also recognition of variations in human milk according to geography. Studies have shown varying levels of micronutrients in different regions of the world as well as different areas of the same country, e.g. rural south USA compared to the rural northwest. This type of variation also occurs in native soils and foods. The next logical questions are if these variations are “normal” and are they clinically significant. Does a minor difference in a micronutrient or trace element affect the health of the infant? Some studies looking at supplementation of the nursing mother with specific essential fatty acids may have slightly changed the levels in her breastmilk but showed no clinical benefits in the child’s cognitive development or vision. Further research is needed to determine if maternal supplementation with nutritional supplements does in fact change her milk content and does that contribute to improved health of the infant. There seems to be little or no plan for further research on the efficacy of maternal supplementation and clinical infant outcomes. Without significant safety and efficacy studies there are some concerns about not having standards for the supplementation practices. On a personal note, I am concerned about the messaging of generalized milk analysis. Women are too often given the clear message that their breasts are not quite right, that their nipples need to be perfect to successfully breastfeed. Now the message seems to be that they need to “analyze” their milk, to see if the milk that has sustained humans for millennia is now unsuitable to nourish our offspring. When studying human milk and, even more, the capability of women’s bodies to respond physically and emotionally to their infants I am in awe of the miraculous event we are privileged to be a part of as mothers and care providers. I hope we are cautious before we dive into this movement of milk analysis and fully understand all the implications and results of the practices before we blindly continue down this path.
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