Nutritional composition of human milk and its association with maternal and perinatal factors

Marano, Daniele; Melo, Raquel Ximenes; Silva, Danielle Aparecida da; Vilarim, Marina Machado; Moreira, Maria Elisabeth Lopes

doi:10.1590/1984-0462/2024/42/2023001

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Revista Paulista de Pediatria

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ORIGINAL ARTICLE • Rev. paul. pediatr. 42 • 2024 • https://doi.org/10.1590/1984-0462/2024/42/2023001 copy

Nutritional composition of human milk and its association with maternal and perinatal factors

Composição nutricional do leite humano e sua associação com fatores maternos e perinatais

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

The objective of this study was to evaluate the influence of maternal and perinatal factors on the nutritional composition of human milk.

Methods:

A cross-sectional study was conducted between November 2018 and January 2020, with 181 donors selected in Tertiary Health Units of the Unified Health System — from one collection station and five Human Milk Banks. Data were collected through a standardized questionnaire. To be fit to be a donor in a Human Milk Banks and produce mature milk were the eligibility criteria to participate in the study. We excluded milk samples with Dornic acidity above 8° D. The dependent variables were the macronutrients of human milk (i.e., carbohydrates, proteins, lipids, and total energy), that were analyzed using spectroscopy with the Miris Human Milk Analyzer™. The maternal and perinatal factors were the independent variables.

Results:

Women with pre-gestational obesity and gestational weight gain above the recommendation showed a lower protein concentration compared to eutrophic women (median=0.8, interquartile range (IQR): 0.7–0.9 vs. median=0.8, and IQR: 0.8–1.0) and those with adequate gestational weight gain (median=0.8, IQR: 0.7–0.9 vs. median=0.9, and IQR: 0.8–1.0), respectively. The other analyzed factors (i.e., maternal habits, comorbidities, and perinatal factors) were not associated with the nutritional composition of human milk.

Conclusions:

The assessment of factors associated with the nutritional composition of human milk is extremely important to assist postpartum care. Pre-gestational obesity and inadequate gestational weight gain were the only factors statistically associated with the nutritional composition of human milk as they impacted its protein content.

Keywords:
Human milk; Postpartum; Perinatal; Maternal; Maternity; Newborn

	Average	Median	Percentiles 25–75	SD
Lipids (g/100 mL)	2.7	2.5	1.6–3.5	1.5
Carbohydrates (g/100 mL)	7.4	7.7	7.2–7.9	1.0
Proteins (g/100 mL)	0.9	0.8	0.8–1.0	0.3
Calories (kcal/100 mL)	59.2	57.0	49.5–67.0	14.3

		Average (SD)	n	%
Maternal age (years)		33.1±5.1	–	–
Schooling	High school incomplete	–	3	1.7
	High school complete	–	26	14.4
	University incomplete	–	8	4.4
	University complete	–	144	79.6
Skin color	White	–	116	64.1
	Interracial	–	47	26
	Black	–	13	7.2
	Yellow	–	5	2.8
Marital status	Single	–	14	7.7
	Married	–	123	68
	Stable union	–	43	23.8
	Divorced	–	1	0.6
Prenatal care service	Public	–	27	14.9
Prenatal care service	Private	–	154	85.1
Alcohol during pregnancy	Yes	–	26	14.4
Smoking during pregnancy	No	–	177	97.8
Drug consumption during pregnancy	No	–	180	99.4
Alcohol whilst breastfeeding	No	–	160	88.4
Smoking whilst breastfeeding	No	–	180	99.4
Pre-gestational hypertension	No	–	178	98.3
Hypertension during pregnancy	No	–	168	92.8
Diabetes mellitus pre-gestational	No	–	181	100
Diabetes mellitus during pregnancy	No	–	175	96.7
Pre-gestational nutritional status (WHO¹⁶16. World Health Organization [homepage on the Internet]. A healthy lifestyle – WHO recommendations [cited 2023 July 26]. Geneva: WHO; 2010. Available from: https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations https://www.who.int/europe/news-room/fac... )	Low weight	–	10	5.5
	Adequate	–	108	59.7
	Overweight	–	46	25.4
	Obese	–	17	9.4
Gestational weight gain (IOM¹⁵15. Institute of Medicine, National Research Council, Committee to Reexamine IOM Pregnancy Weight Guidelines, Rasmussen KM, Yaktine AL. Weight gain during pregnancy: reexamining the guidelines. Washington: National Academies Press; 2009. https://doi.org/10.17226/12584 https://doi.org/10.17226/12584... )	Low	–	55	30.4
	Adequate	–	59	32.6
	Above	–	67	37
Sex	Female	–	98	54.1
Sex	Male	–	83	45.9
Type of delivery	Normal	–	76	41.9
	Cesarean	–	102	56.4
	Forceps	–	3	1.7
Birth weight (g)	–	3254.8±501.0	–	–
Gestational age (weeks)	–	39.1±1.4	–	–

		n	Lipids	p-value	Carbohydrates	p-value	Proteins	p-value	Calories	p-value
		n	Median (percentiles 25–75)	p-value	Median (percentiles 25–75)	p-value	Median (percentiles 25–75)	p-value	Median (percentiles 25–75)	p-value
Alcohol during pregnancy	No	155	2.4 (1.6–3.4)	0.862	7.7 (7.1–7.9)	0.842	0.8 (0.8–1.0)	0.730	57.0 (50.0–66.0)	0.762
Alcohol during pregnancy	Yes	26	2.7 (1.3–3.6)	0.862	7.8 (7.2–7.8)	0.842	0.8 (0.8–1.0)	0.730	58.5 (48.0–69.0)	0.762
Alcohol during breastfeeding	No	160	2.5 (1.6–3.5)	0.969	7.7 (7.1–7.9)	0.533	0.8 (0.8–1.0)	0.379	57.0 (50.0–66.5)	0.950
Alcohol during breastfeeding	Yes	21	2.6 (1.3–3.4)	0.969	7.8 (7.3–7.9)	0.533	0.8 (0.8–0.9)	0.379	59.0 (49.0–67.0)	0.950
Smoking during pregnancy	No	177	2.5 (1.6–3.4)	0.284	7.7 (7.2–7.9)	0.739	0.8 (0.8–1.0)	0.563	57.0 (50.0–67.0)	0.453
Smoking during pregnancy	Yes	4	3.4 (2.4–5.4)	0.284	7.2 (6.4–8.8)	0.739	0.9 (0.8–2.6)	0.563	61.0 (54.5–96.0)	0.453
Smoking during breastfeeding	No	180	2.5 (1.6–3.4)	–	7.7 (7.2–7.9)	–	0.8 (0.8–1.0)	–	57.0 (49.5–66.5)	–
Smoking during breastfeeding	Yes	1	7.4	–	9.7	–	4.1	–	130.0	–
Pre-gestational hypertension	No	178	2.5 (1.6–3.5)	0.998	7.7 (7.2–7.9)	0.475	0.8 (0.8–1.0)	0.722	57.0 (49.0–67.0)	0.907
Pre-gestational hypertension	Yes	3	2.5 (2.2–2.8)	0.998	7.9 (7.0–8.1)	0.475	0.8 (0.7–1.0)	0.722	59.0 (52.0–64.0)	0.907
Hypertension during pregnancy	No	168	2.5 (1.6–3.5)	0.663	7.7 (7.2–7.9)	0.648	0.8 (0.8–1.0)	0.981	57.0 (50.0–67.0)	0.703
Hypertension during pregnancy	Yes	13	2.5 (1.7–3.0)	0.663	7.6 (7.2–8.0)	0.648	0.8 (0.8–1.0)	0.981	59.0 (49.0–65.0)	0.703
Pre-gestational diabetes mellitus	No	181	2.5 (1.6–3.4)	–	7.7 (7.2–7.9)	–	0.8 (0.8–1.0)	–	57.0 (50.0–67.0)	–
Pre-gestational diabetes mellitus	Yes	0	–	–	–	–	–	–	–	–
Diabetes mellitus during pregnancy	No	175	2.5 (1.6–3.5)	0.622	7.7 (7.1–7.9)	0.805	0.8 (0.8–1.0)	0.779	57.0 (49.0–67.0)	0.692
Diabetes mellitus during pregnancy	Yes	6	3.1 (1.7–3.3)	0.622	7.7 (7.2–7.9)	0.805	0.9 (0.8–0.9)	0.779	62.0 (51.0–66.0)	0.692
Gestational age (weeks)	≥37	172	2.5 (1.6–3.5)	0.371	7.7 (7.2–7.9)	0.593	0.8 (0.8–1.0)	0.398	57.0 (49.5–67.0)	0.396
	34–36.9	8	2.9 (1.9–3.7)		7.6 (7.2–7.7)		1.0 (0.7–1.0)		60.5 (53.5–65.5)
	<34	1	1.1		7.4		0.7		44.0
Sex of the newborn	Female	98	2.5 (1.6–3.4)	0.606	7.7 (7.1–7.9)	0.858	0.8 (0.8–1.0)	0.996	56.5 (49.0–67.0)	0.521
Sex of the newborn	Male	83	2.5 (1.6–3.7)	0.606	7.7 (7.2–7.9)	0.858	0.8 (0.8–0.9)	0.996	58.0 (51.0–68.0)	0.521

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[1] *Corresponding author. E-mail: danielemarano@yahoo.com.br (D. Marano)