The US Food and Drug Administration recommends against feeding infants human milk from unscreened donors, but sharing milk via the Internet is growing in popularity. Recipient infants risk the possibility of consuming contaminated or adulterated milk. Our objective was to test milk advertised for sale online as human milk to verify its human origin and to rule out contamination with cow’s milk.
We anonymously purchased 102 samples advertised as human milk online. DNA was extracted from 200 μL of each sample. The presence of human or bovine mitochondrial DNA was assessed with a species-specific real-time polymerase chain reaction assay targeting the nicotinamide adenine dinucleotide (NADH) dehydrogenase subunit 5 gene. Four laboratory-created mixtures representing various dilutions of human milk with fluid cow’s milk or reconstituted infant formula were compared with the Internet samples to semiquantitate the extent of contamination with cow’s milk.
All Internet samples amplified human DNA. After 2 rounds of testing, 11 samples also contained bovine DNA. Ten of these samples had a level of bovine DNA consistent with human milk mixed with at least 10% fluid cow’s milk.
Ten Internet samples had bovine DNA concentrations high enough to rule out minor contamination, suggesting a cow’s milk product was added. Cow’s milk can be problematic for infants with allergy or intolerance. Because buyers cannot verify the composition of milk they purchase, all should be aware that it might be adulterated with cow’s milk. Pediatricians should be aware of the online market for human milk and the potential risks.
Comments
Lack of Safety of Human Milk Obtained Online HIghlights Need for Comprehensive Lactation Training for Physicians
We commend the authors for their insightful work investigating the cows milk contamination of donated human milk obtained from the internet market.1 Parents continue to seek alternatives to formula when they are unable to provide human milk for their children. This may be a reflection that patients have heard the message that human milk has multiple benefits over formula. Despite many parents' good intentions, this article demonstrates that infants are vulnerable to unsafe sources of human milk if it is not obtained from a human milk bank that screens voluntary donors and pasteurizes human milk.1 We agree with the authors' conclusions that pediatricians should be aware of the risks of obtaining human milk from internet sites as well as provide education to parents about safe sources of donated human milk.1
However, it is important to acknowledge that many residency programs, including pediatrics, do not prepare physicians for this conversation. Recent and past evidence shows that many pediatricians emerge into practice feeling unprepared to assist patients with basic breastfeeding issues and therefore many physicians do not address breastfeeding with their patients at all, and far fewer are aware of the trend of selling human milk online. Physicians are unprepared because a large proportion of training programs provide only minimal education about lactation.2,3 Osband et al2 reported an average of just 9 hours of lactation training during 3 years of pediatric residency even though formal resident lactation curricula are freely available and have been shown to improve physician confidence and patient breastfeeding rates.4,5 In our recent study of 104 pediatric, family medicine, and obstetrics residents in our medical center, 60 residents reported that they did not feel confident in their abilities to manage common breastfeeding complications. We believe this study highlights important safety information for parents and also sheds light on the critical need for an all-encompassing human milk education in primary care residency programs.
1) Keim, SA, Kulkarni, MM, McNamara, K, Geraghty, SH, Billock, RM, Ronau, R, Hogan, JS, Kwiek, JJ. Cow's milk contamination of human milk purchased via the Internet. Pediatrics. 2015; 135(5) 2) Osband YB, Altman, RL, Patrick, PA, Edwards, KS. Breastfeeding education and support services offered to pediatric residents in the US. Academic Pediatrics. 2011; 11(10):7579 3) Freed, GL, Clark, SJ, Sorenson, J, Lohr, JA, Cefalo, R, Curtis,P. National assessment of physicians' breast-feeding knowledge, attitudes, training, and experience. JAMA. 1995; 273(6):472-476 4) Feldman-Winter, L. Barone, L, Milcarek, B. Hunter, K, Meek, J, Morton, J, Wlliams, T, Naylor, A, Lawrence, RA. Residency curriculum improves breastfeeding care. Pediatrics. 2010; 126(20):289-297 5) Holmes, AV, McLeod, AY, Thesing, C, Kramer, S, Howard, CR. Physician breastfeeding education leads to practice changes and improved clinical outcomes. Breastfeeding Medicine. 2012; 7(6):403-408
Conflict of Interest:
None declared