Environmental chemicals in human milk: a review of levels, infant exposures and health, and guidance for future research.

The aim of this review is to introduce the reader to various science and policy aspects of the topic of environmental chemicals in human milk. Although information on environmental chemicals in human milk has been available since the 1950s, it is only relatively recently that public awareness of the issue has grown. This review on environmental chemicals in human milk provides a resource summarizing what is currently known about levels and trends of environmental chemicals in human milk, potential infant exposures, and benefits of breast-feeding relative to the risks of exposures to environmental chemicals. The term "environmental chemicals," as it pertains to human milk, refers to many classes of exogenous chemicals that may be detected in human milk. For example, pharmaceutical agents and alcohol are environmental chemicals that have been found in human milk. Other chemicals, such as heavy metals and volatile organic compounds, have also been detected in human milk. Most research on environmental chemicals in human milk has concentrated on persistent, bioaccumulative, and toxic (PBT) chemicals. In this review, a description of human milk is provided, including a brief review of endogenous substances in human milk. Determinants of levels of PBTs are discussed, as are models that have been developed to predict levels of PBTs in human milk and associated body burdens in breast-feeding infants. Methodologies for human milk sampling and analysis, and concepts for consideration in interpretation and communication of study results, as developed by the Technical Workshop on Human Milk Surveillance and Research for Environmental Chemicals in the United States are described. Studies which have compared the health risks and benefits associated with breast-feeding and formula-feeding are discussed.