title: Persistent Environmental Toxicants in Breast Milk and Rapid Infant Growth.
abstract: Many environmental toxicants are passed to infants in utero and through breast milk. Exposure to toxicants during the perinatal period can alter growth patterns, impairing growth or increasing obesity risk. Previous studies have focused on only a few toxicants at a time, which may confound results. We investigated levels of 26 toxicants in breast milk and their associations with rapid infant growth, a risk factor for later obesity.
  
  
  
  We used data from the Norwegian HUMIS study, a multi-center cohort of 2,606 mothers and newborns enrolled between 2002 and 2008. Milk samples collected 1 month after delivery from a subset of 789 women oversampled by overweight were analyzed for toxicants including polychlorinated biphenyls (PCBs), heavy metals, and pesticides. Growth was defined as change in weight-for-age z-score between 0 and 6 months among the HUMIS population, and rapid growth was defined as change in z-score above 0.67. We used a Bayesian variable selection method to determine the exposures that most explained variation in the outcome. Identified toxicants were included in logistic and linear regression models to estimate associations with growth, adjusting for maternal age, smoking, education, pre-pregnancy body mass index (BMI), gestational weight gain, parity, child sex, cumulative breastfeeding, birth weight, gestational age, and preterm status.
  
  
  
  Of 789 infants, 19.2% displayed rapid growth. The median maternal age was 29.6 years, and the median pre-pregnancy BMI was 24.0 kg/m2, with 45.3% of mothers overweight or obese. Rapid growers were more likely to be firstborn. Hexachlorobenzene, β-hexachlorocyclohexane (β-HCH), and PCB-74 were identified in the variable selection method. An interquartile range (IQR) increase in β-HCH exposure was associated with a lower odds of rapid growth (OR 0.63, 95% CI 0.42-0.94). Newborns exposed to high levels of β-HCH showed reduced infant growth (β = -0.03, 95% CI -0.05 to -0.01 for IQR increase in breast milk concentration). No other significant associations were found.
  
  
  
  Our results suggest that early life β-HCH exposure may be linked to slowed growth. Further research is warranted on the potential mechanism behind this association and the longer-term metabolic effects of perinatal β-HCH exposure.
authors.affiliation: Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Rachel
authors.initials: R
authors.lastname: Criswell
authors.forename: Virissa
authors.initials: V
authors.lastname: Lenters
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Mandal
authors.forename: Hein
authors.initials: H
authors.lastname: Stigum
authors.forename: Nina
authors.initials: N
authors.lastname: Iszatt
authors.forename: Merete
authors.initials: M
authors.lastname: Eggesbø
mesh_terms: D000328:Adult; D001499:Bayes Theorem; D001724:Birth Weight; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006128:Growth / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D018811:Maternal Exposure / Q000009:adverse effects*; D019216:Metals, Heavy / Q000032:analysis / Q000633:toxicity; D008895:Milk, Human / Q000737:chemistry*; D009664:Norway; D009765:Obesity / Q000503:physiopathology; D010575:Pesticides / Q000032:analysis / Q000633:toxicity; D011078:Polychlorinated Biphenyls / Q000032:analysis / Q000633:toxicity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced / Q000503:physiopathology*
chemical_list: D019216:Metals, Heavy; D010575:Pesticides; D011078:Polychlorinated Biphenyls
keywords: Breast milk; Environmental toxicants; Infant growth; Obesity; β-Hexachlorocyclohexane