title: Tobacco Metabolites and Caffeine in Human Milk Purchased via the Internet.
abstract: BACKGROUND
  Chemicals inhaled or ingested by mothers can be present in their milk. Our objective was to determine levels of nicotine, cotinine, and caffeine in human milk purchased via the Internet.
  
  
  METHODS
  We purchased human milk (n=102) via the Internet and abstracted seller advertisements for information volunteered about tobacco and caffeine use. Nicotine, cotinine, and caffeine levels in the milk were quantified by mass spectrometry according to published protocols.
  
  
  RESULTS
  No sellers indicated smoking in their advertisement. Many of the milk samples (58%) had detectable nicotine or cotinine; four (4%) of the samples had nicotine or cotinine levels high enough to indicate active smoking. Twelve (12%) sellers said in their advertisements that they specifically limit (4%) or avoid (8%) caffeine entirely. Five (5%) of the samples had caffeine levels consistent with consuming at least 1 cup of coffee 2 hours prior to milk expression. Detectable amounts of caffeine were found in almost all of the samples (97%).
  
  
  CONCLUSIONS
  In 102 milk samples, we detected evidence of active smoking, secondhand smoke exposure, and almost ubiquitous caffeine consumption. Buyers of human milk on the Internet should be aware that advertisements do not always include accurate information as to what substances may be present. Sellers may misrepresent their health behaviors or be unaware of lifestyle factors that can lead to exposure to nicotine and caffeine.
authors.affiliation: 1 Cincinnati Children's Center for Breastfeeding Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
authors.forename: Sheela R
authors.initials: SR
authors.lastname: Geraghty
authors.affiliation: 2 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital Medical Center , Columbus, Ohio.
authors.forename: Kelly
authors.initials: K
authors.lastname: McNamara
authors.affiliation: 3 Department of Microbial Infection and Immunity, College of Medicine, The Ohio State University , Columbus, Ohio.|4 Department of Microbiology, College of Arts and Sciences, The Ohio State University , Columbus, Ohio.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Kwiek
authors.affiliation: 5 Department of Pediatrics, College of Medicine, The Ohio State University , Columbus, Ohio.|6 Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital Medical Center , Columbus, Ohio.
authors.forename: Lynette
authors.initials: L
authors.lastname: Rogers
authors.affiliation: 5 Department of Pediatrics, College of Medicine, The Ohio State University , Columbus, Ohio.|6 Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital Medical Center , Columbus, Ohio.|7 Division of Epidemiology, College of Public Health, The Ohio State University , Columbus, Ohio.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Klebanoff
authors.affiliation: 6 Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital Medical Center , Columbus, Ohio.
authors.forename: Molly
authors.initials: M
authors.lastname: Augustine
authors.affiliation: 2 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital Medical Center , Columbus, Ohio.|5 Department of Pediatrics, College of Medicine, The Ohio State University , Columbus, Ohio.|7 Division of Epidemiology, College of Public Health, The Ohio State University , Columbus, Ohio.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Keim
mesh_terms: D000328:Adult; D002110:Caffeine / Q000378:metabolism; D003132:Commerce; D003367:Cotinine / Q000378:metabolism; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D020407:Internet; D008297:Male; D013058:Mass Spectrometry; D017784:Milk Banks; D008895:Milk, Human / Q000737:chemistry*; D009538:Nicotine / Q000378:metabolism; D012907:Smoking; D014028:Tobacco Smoke Pollution; D014342:Truth Disclosure; D014026:Nicotiana
chemical_list: D014028:Tobacco Smoke Pollution; D002110:Caffeine; D009538:Nicotine; D003367:Cotinine