Quantifying Breast Milk Retinol Inadequacy and the Impact on Neonatal Outcomes in a Midwestern United States Population of Postpartum Women
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College, Institute, or Department
Child Health Research Institute
Dr. Anderson Berry and Dr. Thoene
Background: Low serum antioxidant concentrations at birth can lead to oxidative stress, bronchopulmonary dysplasia, retinopathy, and necrotizing colitis in infants. Specifically, low retinol (Vitamin A1) levels can cause night blindness and impaired immune system function. Retinol inadequacy is a well-documented nutritional issue in developing countries. According to World Health Organization survey data, low Vitamin A serum levels (less than 300 mcg/L) impact approximately one third of pre-school aged children and more than 15% of pregnant woman in at-risk populations. However, there is a lack of understanding about the prevalence of breast milk retinol inadequacy in developed countries. For vitamin A deficiency to constitute a moderate public health problem by WHO biochemical standards, population retinol must reach between 10-25% for breast milk inadequacy or 10-20% for maternal serum deficiency. Objective: The purpose of this study is to quantify the prevalence of breast milk retinol adequacy (greater than 300 mcg/L), insufficiency (between 200 – 300 mcg/L) and deficiency (less than 200 mcg/L) in a Midwestern United States population of postpartum women. A secondary aim is to identify the relationship amongst breast milk retinol concentrations and birth outcomes. Experimental Design: An IRB approved study enrolled 24 infant-mother pairs. Data analysis was performed on subjects with breast milk nutrient analyses available. Descriptive statistics were run for all variables, including maternal retinol activity equivalents. Spearman correlation coefficients were used to assess the relationship between maternal blood retinol and breast milk retinol, cord blood retinol and breast milk retinol, and breast milk retinol and birth outcomes. Median corrected gestational age statistics and breast milk retinol levels were compared amongst maternal serum retinol groups. Results: In our population of postpartum mothers, only 56% of participants had breast milk retinol adequacy, with 36.4% of participants achieving maternal serum retinol adequacy. Retinol category results are summed up in Table 1. Median maternal retinol activity equivalents was 1740 mcg/L (range=651mcg/L - 3436mcg/L). There was no significant correlation between maternal serum retinol level and breast milk retinol levels (R=0.24, p=0.915). Additionally, there was no significant correlation between maternal retinol activity equivalents and maternal serum retinol level (R=.008, p=0.973) or breast milk retinol level (R=-.192, p=0.381). There was a significant negative correlation between breast milk retinol level and the number of oxygen therapy days during infant admission (R=-0.483, p=0.017).
Conclusion: Based on these results, breast milk and maternal serum retinol inadequacies may constitute a serious and moderate public health problem, respectively, for postpartum mothers in the Midwestern United States. These results suggest that breast milk retinol adequacy promotes healthy lung development in neonates. Further, breast milk retinol levels may be independent of maternal serum retinol levels and maternal retinol activity equivalents. Limitations of this study include a small sample size of mothers whose preterm skewed infants were all admitted to the NICU. Future studies should focus on replicating these results with a larger heterogenous sample size.
Retinol, Vitamin A, Deficiency, Breast Milk, Serum
Wickman, Julia; Zetterman, Allison; Wegner, Lauren; Hattery, Jaden; Slotkowski, Rebecca; VanOrmer, Matthew; Thoene, Melissa; Thompson, Maranda; Hanson, Corrine; and Anderson-Berry, Ann, "Quantifying Breast Milk Retinol Inadequacy and the Impact on Neonatal Outcomes in a Midwestern United States Population of Postpartum Women" (2020). Posters: 2020 Summer Undergraduate Research Program. 21.