Because certain substances and toxins get into breast milk and thus burden the baby, there are contraindications to breastfeeding. It is also the case with serious diseases, autoimmune diseases, and certain infections (these should always be discussed with the gynecologist).

Infectious diseases

Most infectious diseases are not transmitted through breast milk, but within the skin and mucous membranes or by the respiratory tract. For some viral diseases, however, it is not advisable to breastfeed, as it can not be excluded the transmission through breast milk.  There are different types of hepatitis viruses and the resulting variances in liver diseases.

The experts nowadays mostly assess the risk of transmission of most forms of hepatitis from breastfeeding to infants as rather harmless; only for the too little researched hepatitis G form breastfeeding is generally discouraged.

In most cases, the hepatitis virus is transmitted from mother to child in the womb or at birth. Besides, not all hepatitis viruses are found in breast milk. But with the forms of hepatitis that can be transmitted via blood, care must also be taken at breastfeeding when the nipple is injured; as with HIV, the uninfected infant could become infected.

If the mother is diagnosed with hepatitis infection, the infants should be treated or immunized. For this, the women must contact the specialized immunologists and gynecologists.

Babies from HIV-positive women who are not yet HIV-infected have a risk of being infected through breast milk. Even effective, maternal antiretroviral therapy does not definitively prevent the transmission to the Baby. Mothers should not breastfeed their children. Transmission through tears in the nipple (blood) during breastfeeding is also conceivable.

HTL viruses are retroviruses (like HIV). Breastfeeding increases the child's risk of infection. Therefore, HTLV-1 positive mothers should not breastfeed their children.

The uncomplicated, postnatally acquired toxoplasmosis or listeriosis requires surveillance, but no therapy.

Towards the end of pregnancy, the risk of transmission of toxoplasmosis is greater at around 80%, but infection in infants is only weak, or they are not infected at all. A listeriosis infection no longer has the same risk after birth as it has during pregnancy. A newly acquired toxoplasmosis or listeriosis infection during breastfeeding, therefore, also requires monitoring, but usually no therapy

Breast milk does not transmit diseases such as toxoplasmosis and listeriosis. After birth, women can eat raw meat, raw milk products, and cheese with rind again. Nevertheless, attention should be paid to the hygienic measures to avoid infections (especially salmonellosis). See the previous newsletter.

Medications

Breast milk from mothers who take certain medications is not suitable (see University Clinic Charite´ Internet https://www.embryotox.de/ ).

For example:

• certain hormones, 
• certain antibiotics, 
• aminoglycosides, 
• immunosuppressants, 
• cytostatics and radioactive substances,
• thyrostatics, 
• ergotamine preparations

Drugs / Toxins / Pollutants

Breastfeeding should not be done even when exposed to various “toxins”.

Drugs: like cocaine, cannabis, heroin, amphetamines, speed, etc. But also, if too much nicotine and/or alcohol is consumed.

Just like pregnant women, breastfeeding mothers should absolutely not smoke, or drink very little or no alcohol.

If there is an increased heavy metal load(that can be examined in blood serum), breastfeeding should not take place depending on the findings.

Smoking not only provides a lot of long-term carcinogenic toxins but also heavy metals such as lead and cadmium, which can acutely disrupt the mineral balance and may have further disadvantages.

Breast milk pollutants Benefit-Risk assessment The breast milk of women in most countries of the world (especially in "industrialized countries") contains traces of alcohol, nicotine, or medicinal substances when consuming or using these. Also, traces of toxic heavy metals, dioxins, pesticides (glyphosate, etc.), PCB or PFAs(polychlorinated biphenyls /perfluorinated alkylate substances)and other pollutants are often measured for example - or in food, in plastics- as in some food packaging, paints, in products such as textiles, clothing, in air pollution, and other sources. Such environmental pollutants are distributed everywhere via air and rain or in contact with the dermal skin or mucosal skin.   Since these pollutants can accumulate in the mother's fat tissue and thus also get into breast milk, the question exists for a long time whether contaminated breast milk is more of a risk or is still of great benefit. The harmful effects of various pollutants and the total of such substances acting together have not been investigated in fetuses and infants. In general, the pollutants should be reduced or avoided as far as possible. The specialist societies continue to see the benefits of breastfeeding predominating; in general, it is stated that the advantages outweigh the disadvantages.   Breast milk provides very important messenger substances of the immune defense (immunoglobulins) and also influences metabolic processes in the long term, which can even reduce later risk of some diseases ("Early Nutrition Programming" - Metabolic and Health Programming); Breast milk also seems to have a positive influence on factors against later overweight development. The highest pollutant burden, that breastfed children are exposed to, are alcohol and nicotine or other drugs when the mother is exposed to them. When smoking, passive smoking is enough to be exposed to hazardous pollutants significantly. It is a risk for the breastfeeding mother and the baby - even more, when the infant or child is exposed already to the smallest amounts of smoke in the air itself.

 

Coffee - Caffein 

With Breastfeeding up to 2 or 3 small cups of coffee are harmless. According to the centers for Disease Control and Prevention (CDC), breastfeeding women can usually enjoy up to 2-3 small cups (a´125ml) of unsweetened coffee throughout the day; but, because even only small amounts can pass into breast milk, less might be better.

During pregnancy, women should be more careful since caffeine passes the placenta, and then effects on the fetus, which is very sensitive to it. Pregnant women should better drink only one cup of coffee (125 ml) per day if it is not decaffeinated. Decaffeinated is safer for the fetus. Further, pregnant women have a significantly slower metabolism and thus degradation time of caffeine. In adults, about half of the caffeine in the blood is broken down after 5 hours (metabolic half-life).

Newborn jaundice

For breastfeeding is also important to watch if the baby develops newborn jaundice. Breast milk can slow physiological bilirubin reduction. The baby is then placed under a UV lamp (supports bilirubin breakdown). Breastfeeding pause is only recommended for more extreme bilirubin levels (however, the milk should be pumped out of the breast to stimulate further milk production).

This jaundice is normal to a certain extent because of the hemoglobin changes in newborns, and bilirubin is checked separately in the event of abnormalities. Direct bilirubin should also be checked to rule out biliary congestion due to liver disease.

Infant Formula  Milk - Substitute milk

Baby cow´s-milk-based infant formula adapted to breast milk

If it is impossible to breastfeed or mother produce insufficient breast milk, the baby should get infant formula milk.  

Martin, Camilia R. et al.  Review of Infant Feeding: Key Features of Breast Milk and Infant Formula:[Nutrients2016,8, 279; doi:10.3390/nu8050279 https://dash.harvard.edu/handle/1/27320186 ]

In the article “Review of Infant Feeding: Key Features of Breast Milk and Infant Formula”, Martin Camila and other authors reviewed the nutritional information of breast milk and infant formulas for better understanding of the importance of breastfeeding and the uses of infant formula from birth to 12 months of age when a substitute form of nutrition is required.

Mothers’ own milk is the best source of nutrition for nearly all infants. Beyond somatic growth, breast milk as a biologic fluid has a variety of other benefits, including modulation of postnatal intestinal function, immune ontogeny, and brain development. Although breastfeeding is highly recommended, breastfeeding may not always be possible, suitable, or solely adequate.

Infant formula is an industrially produced substitute for infant consumption. Infant formula attempts to mimic the nutritional composition of breast milk as closely as possible and is based on cow’s milk or soymilk. Several alternatives to cow’s milk-based formula also exist.

The recently updated FDA (Food and Drug Administration) rule on current Good Manufacturing Practices for infant formula, requires, among other things, that formulas satisfy the quality factors of normal physical growth and a sufficient biological quality of protein component (adequate amounts of protein in a form that can be used by infants). Infant formula is only for the health of infants without unusual medical or dietary problems. The manufacturing process is highly regulated and monitored to meet national and international quality criteria.

 

Additional information about infant formula milk Contrary to breast milk, cow's milk consists of 80% casein and 20% whey protein. Therefore, the casein and whey must be separated for the formula replacement milk for bottle feeding in cow's milk, and the ratio between casein and whey must be reversed. Only lactose should be included as the carbohydrate. As substitutes, the replacement milk contains iron, vitamin D, and polyunsaturated fatty acids (e.g. Omega 3 FA) and some extra amino acids, which are lower in cow's milk than in breast milk. The milk powder for baby bottle nutrition is usually adapted to the growth conditions or requirements (breast milk also changes over the course of the months). There are the following milk formulas(baby milk food) for the different age groups:

"Pre" - Formula for newborn feeding or for adding to the breastfeeding if necessary. Pre-milk is suitable for the entire first year of life; it is less filling than starchy milk, and the baby can drink as much of it as he likes (weight checks are advised).

"1" - Formula to be given after breast milk or pre-formula are also suitable for the entire 1st year of life but should not be given exclusively at the beginning - pre-formula is better there. In addition to lactose, they contain other carbohydrates (maltodextrin and starch forms); it is therefore somewhat thicker and more filling. More caution is needed here regarding overfeeding. Feeding should only take place in the rhythm of meals and not at the child's convenience (not ad libitum).

"2" formula is only possible from the 7th month of life. However, it is not absolutely necessary. It is also possible after breast milk or after starting to eat food. It should not be given in the first 4 months because they are less adapted to breast milk. It contains higher doses of iron.

"3" formula is possible after a "2" formula - only possible from the 10th month of life and is also not suitable in the first 4 months -has higher energy content and is more filling.

Cow's milk protein intolerance or allergy

If the baby has a cow's milk protein intolerance or allergy, partial or extensive hydrolyzed formula baby food (hypoallergenic food - H.A. formula) should be fed. This also consists predominantly of casein and whey, but not of cow's milk (sometimes soy protein is also included).

The H.A. formula consists of hydrolyzed (pre-digested) proteins that do not induce IgE immune reactions. Such H.A. infant formula is also available as "Pre", "1" and "2" infant formula. Like the other Formula bottle foods, they are intended for the appropriate age. The “2” formula - only from the 7th month.

This is also recommended for allergy prevention if there is an allergic disposition of the parents (a general allergy problem - not necessarily against cow's milk).

Mothers avoiding the cow's milk during pregnancy or breastfeeding does not reduce the child's risk of allergy. For prevention, if necessary (history of allergies to parents), exclusive breast milk feeding with the addition of H.A. formula food is recommended.

Breastfeeding is recommended for at least 4, better 6 months; and the feeding of foods with unhydrolyzed proteins should be avoided. Only hypoallergenic baby food should be given during the first 6 months if necessary. With a high familial allergy disposition, the complementary foods should better be fed from the 5th month of life and contain food that does not have a higher allergen potential (not cow's milk- or egg-protein; or maybe also not fish- or soy- protein).

Breast milk feeding is the best way

United Nations >> international resolution to promote breastfeeding

Harvard T.H. Chan School of Public Health’s Ana Langer

“Breastfeeding has been recognized for decades as the best way to feed infants, with evidence consistently demonstrating its health, psychological, and financial benefits. Breast milk and the experience of breastfeeding protect babies against malnutrition and infections, represent a unique mother-baby bonding opportunity, promote psychological wellbeing for both mothers and babies, and contribute to children’s cognitive development. Breastfeeding also protects the longer-term health of the child by reducing his or her risk of obesity and related conditions, such as diabetes and hypertension, and protects* women against ovarian and breast cancer. Furthermore, breast milk does not require any special preparation, does not expose the baby to contaminated water, and does not involve any direct financial cost.”

* Note: “protects” means in this regard, it reduces the risks and the incidence of ovarian and breast cancer.