Vegan/vegetarian diet and human milk donation: An EMBA survey across European milk banks.

The nutritional adequacy of human milk (HM) from vegan/vegetarian mothers has been a matter of debate, and a variety of recommendations regarding the eligibility of these mothers as human milk donors exists. According to the latest evidence, HM from vegans/vegetarians is similar in its composition to that from omnivores, however, some differences may be observed regarding vitamin B12 and omega-3 fatty acids concentrations. Maternal supplementation of these compounds has been proven effective in increasing their HM concentration. With this survey, we aimed to explore the practices currently in use in European human milk banks (HMBs) regarding potential donors following vegan/vegetarian diets. The online survey was distributed to European HMBs between January and July 2022. A total of 188 HMBs were contacted, and 118 replied (response rate 63%). Vegan and vegetarian mothers were recommended supplements of vitamin B12 to be accepted as donors in 27% and 26% of HMBs, respectively. Additional omega-3 fatty acid supplementation was required in 8% HMBs. In the remaining HMBs, these mothers were either systematically excluded or included regardless of supplementation. The dosage of the recommended supplements was extremely variable. Fifty-one percent of HMBs were following recommendations to guide their practice, national or local recommendations mainly. Great variability in European HMBs practices towards potential donors following vegan/vegetarian diets exists. Some of these practices can result in loss of donors and/or in potential nutritional deficiencies. Standardised evidence-based recommendations on this issue and their implementation in daily HMB practice are needed.

Impact of gestational diabetes and other maternal factors on neonatal body composition in the first week of life: a case-control study.

OBJECTIVES: Newborns of diabetic mothers are at increased risk of abnormal nutritional status at birth, thus developing metabolic disorders. The aim of this study was to evaluate the anthropometric measurements and body composition of newborns born to mothers with gestational diabetes in comparison to newborns born to mothers with normal glucose tolerance in pregnancy, in the first week of their life. Maternal factors affecting the gestational period were also evaluated. MATERIAL AND METHODS: The study included 70 participants: neonates born to mothers with gestational diabetes (GDM) and neonates born to healthy mothers (non-GDM). A set of statistical methods (e.g., ANOVA, Kruskal-Wallis test, Chi-square test, regression, cluster analysis) was used to compare data between the study groups and to find their association with maternal factors. RESULTS: Our approach resulted in statistically significant classification (p < 0.05) by maternal history of hypothyroidism, weight gain during pregnancy and diagnosis of GDM. Newborns of mothers diagnosed with both GDM and hypothyroidism had lower birth weight and fat mass than newborns of mothers without GDM nor hypothyroidism (p < 0.05), however this finding might be associated with high incidence of excessive gestational weight gain among healthy mothers. No differences in body composition were found between the study groups on account of maternal GDM only (p > 0.05). CONCLUSIONS: Thus, well-controlled gestational diabetes mellitus as an individual factor does not significantly affect neonatal anthropometric measurements and body composition.

The link between knowledge of the maternal diet and breastfeeding practices in mothers and health workers in Poland.

BACKGROUND: There are multiple misconceptions concerning the breastfeeding mother's diet and its adverse impact on breast milk composition and the breastfed child's health, which might lead to breastfeeding cessation. Although prophylactic maternal dietary restrictions are not recommended, mothers all over the world are often recommended to avoid certain foods, due to cultural beliefs, social pressure and even outdated or ambiguous medical recommendations. In Poland, there is no systematic approach to breastfeeding education in the form of nationwide educational programs for particular social groups. It was estimated that in 2017 only 3-4% of Polish infants were exclusively breastfed at 6 months of age. The aim of this study was to recognize the scale of common dietary misconceptions among lactating mothers in Poland and to compare knowledge and opinions between medical staff and mothers who have ever breastfed a child. In addition, the paper is an attempt to identify factors contributing to the still current practice of recommending prophylactic dietary restrictions to breastfeeding mothers by medical staff. METHODS: The study was conducted in Poland, in January - February 2019. The study used a diagnostic poll method and was conducted mainly in an electronic form. A total of 1159 completed questionnaires data were analyzed: 35.1% completed by medical staff and 64.9% by mothers in non-medical professions. Statistical calculations were conducted with Chi-square test, logistic regression and U Mann Whitney test (level of significance set at 0.05). RESULTS: The respondents presented a good level of knowledge and predominantly assessed the questioned statements correctly. Duration of breastfeeding was found to be the main factor determining respondents' knowledge (p <  0.05). Concerning medical staff, the parity (p <  0.001) and applying an elimination diet when themselves breastfeeding (p <  0.001) had a significant impact on recommendation of prophylactic dietetic restrictions to the lactating women. CONCLUSIONS: Regardless of a resonably good level of knowledge on maternal nutrition in the lactation period, both breastfeeding mothers and medical staff are still convinced of the beneficial effect of preventive dietary restrictions, which affects further lactational counselling and lactational performance.

Vegan or vegetarian diet and breast milk composition - a systematic review.

It is known that nutritional composition of breast milk is, to a certain extent, related to maternal diet. The question of nutritional adequacy of mothers' milk is often raised whenever a vegetarian or vegan diet during the lactation process is concerned. For this reason, in some countries, the recruitment of vegan lactating women as milk donors is excluded by milk banks. The purpose of this systematic review is to summarize existing knowledge on variability of specific nutrients in breastmilk of mothers adhering to a plant-based diet. The databases, including MEDLINE (Pubmed) and Scopus, were used to identify relevant publications. Data extraction and analysis were conducted following a PRISMA protocol. Thirteen publications concerning the impact of dietary pattern and levels of animal-origin food intake on breast milk composition were included. The systematic review has shown that all non-vegetarian, vegetarian and vegan mothers produce breast milk of comparable nutritional value. Several differences are primarily attributed to fatty acids and some micro-components, primarily vitamin B12. Regardless of dietary choices, nourishment and adequate nutrition have a significant impact on human milk composition - on the basis of the current evidence, vegetarian and vegan mothers are capable of producing nutritionally valuable milk for their infants, as far as the appropriate supplementation compensating for breastfeeding mother's nutritional requirements is provided. Dietary choices should not be a permanent exclusion criterion for donor candidates in human milk banks.

Foods to Avoid While Breastfeeding? Experiences and Opinions of Polish Mothers and Healthcare Providers.

Popular beliefs regarding a mother's diet during lactation have a significant impact on breastfeeding practices among mothers, as well on breastfeeding counseling among healthcare providers worldwide. The objective of this study was to assess mothers' and medical professionals' knowledge and opinions on the "lactating mother's diet". An electronic survey, prepared in Polish, was administered to healthcare providers, as well as mothers who have breastfed a child. The chi-square test, logistic regression, and Mann Whitney U test were used for statistical calculations. Out of a total of 1180 responses received, 1159 were analyzed, and 21 were excluded because they did not meet the inclusion criteria. The survey was completed by 407 (35%) medical healthcare providers and 752 (65%) lactating mothers in non-medical professions. In total, the study included 1074 mothers who have breastfed a child, and 29.14% of them reported that they eliminated certain foods from their diet when breastfeeding. There was no statistically significant difference in the responses received from mothers and medical staff providing maternal care (for each of 17 products, e.g., steak tartare, sushi, legumes, dairy products, p > 0.05 by the Mann-Whitney test). However, a logistic regression revealed some significant correlations with other variables (e.g., duration of lactation). The respondents revealed an appropriate level of knowledge on nutrition during lactation and the majority of participants neither adhered to nor recommended a prophylactic elimination diet. Among other evaluated factors, the experience of following an elimination diet affected respondents' knowledge of nutrition during breastfeeding. Both mothers and healthcare providers require good nutritional education.

Non-nutritional "paramedical" usage of human milk - knowledge and opinion of breastfeeding mothers in Poland.

OBJECTIVES: The objective of this study is to understand knowledge, attitudes and practices of non-nutritional breast milk use among lactating women in respect of skin diseases and other frequent ailments. MATERIAL AND METHODS: The study, in the form of a questionnaire, spread on social media, was targeted at breastfeeding women. The questionnaire consisted of questions regarding the knowledge of non-nutritional usage of human milk, its use in practice, subjective opinion on the observed results and inclination towards future use. Chi-square tests and c-Pearson coefficients were used for statistical calculations. RESULTS: A total of 1187 responses were acted upon. In the study group, 879 women claimed to have knowledge of non-nutritional use of human milk in respect of skin and most common ailments, whilst 688 of them claimed to use at least one usage. The most frequently, breast milk was used for: care of cracked nipples, care of healthy skin, treatment of diaper dermatitis and treatment of neonatal acne. A correlation between duration of breastfeeding (p < 0.05) and gestational age (p < 0.05) and practical use of non-nutritional human milk was found. CONCLUSIONS: The study showed a great enthusiasm of mothers in respect of using breast milk for non-nutritional purposes, including the treatment of skin diseases and other common ailments. However, given the scant studies determining possible concerns surrounding these methods, there is a requirement for parental education with emphasis on the need for prompt medical examination and pertinent treatment.

Non-Nutritional Use of Human Milk Part 1: A Survey of the Use of Breast Milk as a Therapy for Mucosal Infections of Various Types in Poland.

The use of home remedies for the treatment of moderately severe ailments is a common practice in the Polish population. Currently, the topic of the potential non-nutritional properties of human milk is attracting the attention of breastfeeding mothers. This study was aimed at understanding lactating women's knowledge, attitudes, and practices of non-nutritional breast milk on mucous membranes. The study was conducted among lactating women, who filled out a questionnaire consisting of questions about their knowledge and experiences with non-nutritional use of human milk. Statistical calculations were conducted with chi-square test and c-Pearson coefficient. A total of 1187 women were acted on, whereby 768 of respondents claimed to have knowledge of the non-nutritional use of human milk on mucous membranes, whilst 404 of them claimed that they had used at least one method. Among the most frequently used methods were the treatment of rhinorrhea, lacrimal canaliculi obstruction, and conjunctivitis. A correlation between length of breastfeeding (p < 0.001) and knowledge of non-nutritional human milk usage in prophylaxis and treatment of mucous membrane inflammation was found. Breastfeeding duration (p < 0.001) and parity (p < 0.005) were correlated with the application of those methods in practice. Due to a high propensity to testing those methods, parents' education in the field of possible risks and importance of medical consultations is necessary.

[Vegetarian diet in pregnancy and lactation - safety and rules of balancing meal plan in the aspect of optimal fetal and infant development]. / Dieta wegetarianska w ciazy i okresie laktacji ­ bezpieczenstwo i zasady bilansowania jadlospisu w aspekcie optymalnego rozwoju plodu i noworodka.

Pregnancy is a period of intense fetal development, as well as maternal physiological adaptation. During this period a varied diet is particularly important, as intake of macronutrients and micronutrients directly affects pregnancy outcome and the quality of breast milk. The dietary recommendations for pregnant women are indeed very similar to those for other adults, but with a few remarkable exceptions. Therefore, it is important to evaluate, monitor, and, when appropriate, make changes to improve maternal nutrition both before and during pregnancy and lactation, while respecting patients' choices. Growing interest of vegetarian diets needs to be included, as pregnant women may present with unique nutrient deficiencies. However, evidencebased reviews showed that "vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes". This statements is supported by worldwide nutrition specialists, though, the risk and consequences of nutrient deficiencies is emphasized. The nutritional adequacy of a vegetarian diet must be judged individually, not on the basis of what it is called, but on the type, amount, variety and bioavaliability of nutrients that are consumed. Special consideration is required for proteins, calcium, iron, zinc, vitamin B12 and omega-3 fatty acids. Moreover, following advices regarding micronutrients supplementation is essential. This article provides guidelines for counseling vegetarian patients in prenatal and postnatal care.

Umbilical cord blood NGAL concentration as an early marker of perinatal asphyxia in neonates.

INTRODUCTION: Recent reports have revealed increased concentration of neutrophil gelatinase-associated lipocalin (NGAL) in cardiovascular diseases and after episodes of hypoxia. We hypothesized that elevated plasma NGAL levels could be a result of vascular endothelial injury due to perinatal asphyxia. MATERIALS AND METHODS: Ninety-three newborns with a gestational age > or = 37 weeks, of which 32 newborns were asphyxiated (study group), and 61 were healthy children (control group), were enrolled in the study Serum NGAL, lactate and creatinine concentrations, acid-base balance, neutrophil and white blood cell count were measured in the umbilical cord blood. RESULTS: Asphyxiated newborns had a significantly lower pH value (7.0 vs. 7.3, p < 0.001), lower HCO3 (15.8 mmol/L vs. 23.2 mmol/L; p < 0.001) and higher lactate concentrations (7.5 mmol/L vs. 2.3 mmol/L; p < 0.001), as compared to controls. Neutrophil count (10.3 x 109/L vs. 6.5 x 109/L; p = 0.02) and NGAL concentration (122.5 ng/mL vs. 24.3 ng/ mL p < 0.001) were elevated in asphyxiated newborns as compared to healthy children. CONCLUSIONS: The measurement of NGAL in the umbilical blood can be a valuable biomarker of perinatal asphyxia in neonates.