title: Assessment of cadmium levels in human breast milk and the affecting factors: A systematic review, 1971-2014.
abstract: BACKGROUND
  This is a first systematic review summarizing 43 years of research from 36 countries for the assessment of cadmium in breast milk, a suitable matrix in human biomonitoring.
  
  
  OBJECTIVE
  To report from the published literature the levels of cadmium in breast milk, and the affecting factors causing increase in cadmium concentrations. In addition, to gather several quantitative data that might be useful to evaluate the international degrees of maternal and infant exposure.
  
  
  METHODS
  We reviewed the literature published between 1971 and 2014, available on Pubmed, Science Direct, and Google Scholar, reporting quantitative data about cadmium levels in human breast milk. Information about the aim of the study, name of the country, period of collection of samples, size of samples, sampling method, time of lactation, mother's age, area of residence, cadmium concentration, and other data were extracted.
  
  
  RESULTS
  Sixty-seven studies were selected and included in this systematic review. Some concentrations greatly exceed the limit set by the World Health Organization (WHO); however, about 50% of the studies had less than 1 µg/L cadmium concentration (recommended by the WHO); as well as many factors have shown their implication in breast milk contamination.
  
  
  CONCLUSIONS
  Breast milk is a pathway of maternal excretion of cadmium. It is also a biological indicator of the degree of environmental pollution and cadmium exposure of the lactating woman and the nourished infant. Therefore, preventive measures and continuous monitoring are necessary.
authors.affiliation: a Unit of Training and Research in Nutrition and Food Sciences, Faculty of Medicine and Pharmacy, Mohammed V University , Rabat , Morocco.|b Center of Doctoral Studies in Life Sciences and Health CEDoc-SVS, Faculty of Medicine and Pharmacy, Mohammed V University , Rabat , Morocco.
authors.forename: Abha
authors.initials: A
authors.lastname: Cherkani-Hassani
authors.affiliation: c Faculty of Medicine and Pharmacy, Mohammed V University , Rabat , Morocco.
authors.forename: Imane
authors.initials: I
authors.lastname: Ghanname
authors.affiliation: a Unit of Training and Research in Nutrition and Food Sciences, Faculty of Medicine and Pharmacy, Mohammed V University , Rabat , Morocco.|d Department of Pediatric Hepatology , Gastroenterology and Nutrition -- P III, Rabat Children's Hospital , Rabat , Morocco.
authors.forename: Nezha
authors.initials: N
authors.lastname: Mouane
mesh_terms: D002104:Cadmium / Q000032:analysis*; D004787:Environmental Pollution / Q000032:analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008895:Milk, Human / Q000737:chemistry*; D011247:Pregnancy
chemical_list: D002104:Cadmium
keywords: Cadmium; affecting factors; breast milk