Factors associated with longitudinal changes in B-vitamin and choline concentrations of human milk

Authors: BATALHA, MONICA - Universidade Federal Do Rio De Janeiro; FERREIRA, ANA - Universidade Federal Do Rio De Janeiro; FREITAS-COSTA, NATHALIA - Universidade Federal Do Rio De Janeiro; FIGUEIREDO, AMANDA - Universidade Federal Do Rio De Janeiro; CARRILHO, THAIS - Universidade Federal Do Rio De Janeiro; Shahab-Ferdows, Setti; HAMPEL, DANIELA - University Of California, Davis; Allen, Lindsay - A; PEREZ-ESCAMILLA, RAFAEL - Yale School Of Medicine; KAC, GILBERTO - Universidade Federal Do Rio De Janeiro

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/17/2021
Publication Date: 6/10/2021
Citation: Batalha, M.A., Ferreira, A.L., Freitas-Costa, N.C., Figueiredo, A.C., Carrilho, T.R., Shahab-Ferdows, S., Hampel, D., Allen, L.H., Perez-Escamilla, R., Kac, G. 2021. Factors associated with longitudinal changes in B-vitamin and choline concentrations of human milk. American Journal of Clinical Nutrition. 114(4):1560-1573. https://doi.org/10.1093/ajcn/nqab191.
DOI: https://doi.org/10.1093/ajcn/nqab191

Interpretive Summary: Little is known about how maternal factors and concentration of B-vitamins and choline in human milk shortly after birth affect concentrations of these milk micronutrients later in lactation. Therefore, we examined the relationships of maternal nutritional status and milk B-vitamins and choline concentrations. Human milk from 100 women was collected at three-time points: 2-8d (TP1), 28-50d (TP2) and 88-119d postpartum (TP3) for the measurement of B-vitamins and choline. Maternal diet during pregnancy and lactation was captured by Food Frequency Questionnaire. The results were used to examine changes of B-vitamins and choline concentrations in milk over time in relation to maternal factors (pre-pregnancy BMI, maternal dietary intake and use of supplements, parity, gestational age at delivery, and mode of delivery) and the early postpartum concentrations of these micronutrients. We found that women with higher early postpartum milk concentrations of B3, B5, B6, B12, and choline had lower concentrations of these vitamins during lactation compared to women with lower early postpartum concentrations. Women who were overweight before pregnancy revealed increasing milk B12 concentration over time, while decreasing B12 was observed among women with inadequate B12-intake during pregnancy. Women with insufficient B3-intake during lactation experienced an increase in the concentration in milk over time. Gestational age at birth >40 weeks was associated with a higher choline concentration in lactation. Thus, changes in B-vitamins and choline concentrations in human milk over time are affected by early concentrations of these micronutrients in milk, maternal pre-pregnancy BMI, dietary intake, and gestational age at delivery. More research is needed for a better understanding mechanism behind these relationships and how they translate to infant outcomes.

Technical Abstract: Background: There is a lack of evidence about how maternal factors and concentration of B-vitamins and choline in human milk early in lactation could modify the time trajectories of these vitamins during lactation. Objective: We evaluated associations of maternal nutritional status and B-vitamins and choline concentrations, and how early postpartum milk vitamin concentrations and maternal factors modify vitamin time trajectories during lactation. Methods: Human milk samples from 100 women studied in a prospective birth cohort were collected at three-time points: 2-8d (TP1), 28-50d (TP2) and 88-119d postpartum (TP3). Maternal dietary intake during pregnancy and lactation were assessed by food frequency questionnaire (FFQ). Longitudinal linear mixed-effects models with interaction terms were used to evaluate changes of B-vitamins and choline concentrations in milk over time based on maternal factors (pre-pregnancy BMI, maternal dietary intake and use of supplements, parity, gestational age at delivery, and mode of delivery) and the early postpartum concentrations of these micronutrients. Results: Women with higher early postpartum milk concentrations of B3, B5, B6, B12, and choline experienced a greater decrease in their concentrations during lactation compared to women with lower concentrations. Women who were overweight pre-pregnancy experienced an increase in milk B12 concentration over time. Contrarily, a decrease in B12 concentration was observed among women with inadequate B12-intake during pregnancy. Women with insufficient B3-intake during lactation experienced an increase in the concentration in milk over time. Gestational age at birth >40 weeks was associated with a higher choline concentration in lactation. Conclusions: Changes in B-vitamins and choline concentrations in human milk over time may be modified by the early concentrations of these micronutrients in milk, maternal pre-pregnancy BMI, dietary intake, and gestational age at delivery. More research is needed for a better understanding mechanism behind these relationships and how they translate to infant outcomes.