The Impact of Maternal Chronic Inflammatory Conditions on Breast Milk Composition: Possible Influence on Offspring Metabolic Programming

Abstract

Breastfeeding is the best way to provide newborns with crucial nutrients and produce a unique bond between mother and child. Breast milk is rich in nutritious and non-nutritive bioactive components, such as immune cells, cytokines, chemokines, immunoglobulins, hormones, fatty acids, and other constituents. Maternal effects during gestation and lactation can alter these components, influencing offspring outcomes. Chronic inflammatory maternal conditions, such as obesity, diabetes, and hypertension, impact breast milk composition. Breast milk from obese mothers exhibits changes in fat content, cytokine levels, and hormonal concentrations, potentially affecting infant growth and health. Similarly, diabetes alters the composition of breast milk, impacting immune factors and metabolic markers. Other pro-inflammatory conditions, such as dyslipidemia and metabolic syndrome, have been barely studied. Thus, maternal obesity, diabetes, and altered tension parameters have been described as modifying the composition of breast milk in its macronutrients and other important biomolecules, likely affecting the offspring’s weight. This review emphasizes the impact of chronic inflammatory conditions on breast milk composition and its potential implications for offspring development through the revision of full-access original articles.

1. Introduction

Breastfeeding provides essential nutrients and fosters a unique bond in the dyad [1]. Breast milk is rich in bioactive components, including immune cells, hormones, and fatty acids, which support infant growth and development [2,3,4,5,6,7]. However, maternal health conditions, such as obesity, diabetes, and hypertension, are described to modify the composition of breast milk [8,9,10,11,12,13]. These chronic inflammatory states alter levels of macronutrients, cytokines, and hormones, impacting offspring’s weight [14,15,16]. This article examines the effects of maternal inflammatory conditions on breast milk composition and explores their implications for child development.

2. Methodology

In this review, we aimed to show that metabolic diseases such as obesity, diabetes, hypertension, dyslipidemia, and metabolic syndrome, which have joint systemic inflammation, can impact women during gestation and continue during lactation, affecting breast milk quality and composition. In addition, this review briefly describes the scarce existing information regarding the effects of these alterations on the offspring later in life. For this, we performed a comprehensive literature review using Science Direct, PubMed, and Medline (https://www.ncbi.nlm.nih.gov/pubmed) search for articles published up to December 2024. For this purpose, the search was performed using the following mesh terms and combinations of words was done to search: (“breast milk” OR “breastmilk” OR “breastfeeding” OR “lactation” OR “lactation programming” OR “maternal milk” OR “human milk” OR breast milk composition) AND (“chronic inflammation” OR “obesity” OR “overweight” OR “diabetes” OR “diabetes mellitus type 2” OR “ type 1 diabetes” OR “insulin resistance” OR “preeclampsia” OR “hypertension” OR “hypertensive syndrome” OR “hypercholesterolemia” OR “dyslipidemia” OR “maternal dyslipidemia” OR “maternal inflammation” OR “metabolic syndrome” OR “MetS” OR “epigenetics” OR “fetal programming”) AND (“postpartum” OR “puerperium” OR “immunity” OR “immune system” OR “immune cells” OR “macronutrients” OR “offspring”). We selected studies in humans published as full-length articles. The electronic search was integrated by manually searching the reference lists of the selected publications and reviews on the issue to identify any other relevant publications.

Inclusion and exclusion criteria studies were included if they provided quantitative information on the relationship between previously mentioned variables and if the articles were written in English idiom.

3. Breastfeeding, Breast Milk Composition, the Impact of Geographic Regions, and Maternal Dietary Habits on Breast Milk Composition

Breastfeeding is essential to the neonatal and infant periods [1]. It is widely known as the best way to provide newborns with crucial nutrients and produce a unique bond between mother and child [1,17]. Compared with alternative formulas, maternal milk is considered the preferred source of nutrition for newborns [17]. In this regard, the World Health Organization (WHO) recommends exclusively breastfeeding for the first six months of an infant’s life to receive the optimal benefits of breast milk [18]. Under normal conditions, breastfeeding is associated with a lower incidence of globally significant infectious diseases like diarrhea and pneumonia and a decreased prevalence of critical chronic diseases, such as obesity and diabetes [19].

Breast milk is a complex biological fluid secreted by alveolar epithelial cells from the mammary gland, which provides all the necessary nutrient requirements for neonatal growth and maturation [20]. Its composition is rich in nutritional and non-nutritional bioactive components, including enzymes, hormones, and immune factors such as chemokines, cytokines, immunoglobulins, and immune cells [2]. Breast milk contains irreplaceable components essential for optimal postnatal development, unlike most infant formulas, which lack bioactive and immune factors [21].

Breast milk composition is dynamic and may vary in response to the infant’s nutritional needs depending on the nursing stage, maternal diet, and many other environmental factors [2,3,4,5,6,7]. This ability to modify its composition according to the environment suggests that it can also change in maternal pathological states, especially those that alter the balance in the immune response, favoring inflammation in chronic conditions [22]. Research in human and animal models indicates that maternal exposures can alter specific bioactive components in breast milk, influencing offspring outcomes [2]. Thus, recent studies have pointed out that breast milk is a biological nutrient system [23] that can be disturbed under certain maternal pro-inflammatory conditions, being conditionally perfect [24]. In this regard, breast milk accomplishes its basic nurturing function and, at the same time, executes a second and important action, which is infant oral programming through the transmission of factors that modify some epigenetic mechanisms that can contribute to the epigenetic programming in the nursling [25].

In normal conditions, breast milk is made up of about 87–88% water and solid components, including about 7% carbohydrates, 1% proteins, and 3.8% fat [26]. Among the constituents of breast milk, the fat fraction provides 44% of the total energy intake in infants [27]. It is secreted in small droplets that contain lipids (milk fat globule), which are a source of essential fatty acids (FAs) that are crucial for the neurological and immune development of a child [28,29,30]. Most of them are saturated FAs and monounsaturated FAs, followed in quantity by omega-3 (n-3) or omega-6 (n-6) polyunsaturated FAs (PUFAs) [21,31]. n-3 PUFAs decrease the production of inflammatory cytokines, while n-6 increase intestinal inflammatory responses and oxidative stress [32]. The ideal n-6:n-3 PUFA ratio should range between 1:1 to 5:1 to maintain a healthy balance and prevent chronic diseases [33]. An increased ratio is associated with pro-inflammatory effects [26]. Breast milk is rich in immune cells, which migrate to the breast via the lymphatic vessels and systemic circulation, playing a crucial role in developing the infant’s immune system [34,35]. Breast milk leukocytes are principally composed of neutrophils (40–65%), followed by macrophages (35–55%) and lymphocytes T and B (5–10%) [34,36,37,38]. These immune cells produce and release cytokines, such as interleukin 1β (IL-1β), IL-6, IL-10, IL-13, tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), transforming growth factor beta (TGF-β), among others [34,39]. Some of these, like IL-6 and TNF-α, have pro-inflammatory properties and, under normal conditions, offer beneficial effects in the defense against gastrointestinal and respiratory diseases [34,40,41]. Meanwhile, IL-10 and TGF-β have anti-inflammatory effects, promoting B cell differentiation and playing a regulatory role in the neonatal gastrointestinal tract [34,40,41,42]. The abundance of leukocytes and cytokines in breast milk is highly dynamic, changing throughout lactation and being influenced by the maternal and infant health status [34,41,43,44].

Maternal dietary habits play a crucial role in determining the composition of breast milk, influencing various bioactive components. Notably, the concentrations of fat, fatty acids, and water-soluble vitamins, such as vitamins A, C, B6, and B12, can vary in human milk due to maternal nutrition [45,46,47,48]. Among these bioactive components, lipids are likely the most affected by maternal diet. Studies have shown that a maternal high-fat and high-lipid diet can increase milk fat content by approximately 12–25% compared to a low-fat diet [49,50,51,52]. Ward et al. determine the acute effect of increased sugar (150.4 g sugar/day) and fat (129.7 g fat/day) consumption on breast milk lipids, finding that triglycerides significantly increased in both diets, with a greater response to the higher sugar intake compared to the control diet (mean difference of 3.05 g/dL ± 0.39 and 13.8 g/dL ± 0.39, respectively; p < 0.001) [53]. Breast milk cholesterol concentration increased only with the high-sugar diet (0.07 g/dL ± 0.005 vs. 0.04 g/dL, p < 0.005) [53]. These intervention studies provide evidence that maternal diet can impact total milk lipids.

Breast milk fatty acids are derived from endogenous synthesis in the mammary gland and uptake from maternal plasma, with both processes being influenced by maternal nutrition [45]. Dietary fatty acids are rapidly transferred into milk, and the composition of human milk fat can change to reflect the dietary fat profile [49]. In this regard, Kim et al. found positive correlations between dietary intake of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), n-3 fatty acids, n-6 fatty acids, saturated fatty acids (SFA), and PUFAs and their concentrations in the breast milk of South Korean mothers [54]. Similar correlations were observed in lactating women in China, where the maternal dietary fatty acid composition was positively associated with SFA, PUFA, and DHA concentrations (p < 0.001) and negatively with monounsaturated fatty acids (MUFA) (p > 0.05) in breast milk [55]. High-fat diets can increase omega-6 fatty acids in breast milk, which may exacerbate inflammatory responses [54,56,57,58]. Conversely, a diet supplemented with omega-3 fatty acids can enhance DHA and EPA concentrations in breast milk, potentially mitigating the risks associated with chronic inflammation [59,60,61,62].

The link between maternal diet and chronic inflammatory conditions is well-established. Poor dietary choices can lead to metabolic dysregulation, contributing to conditions such as obesity, diabetes, and hypercholesterolemia, which not only affects maternal health but also alters the bioactive components of breast milk [63,64,65,66,67]. Therefore, addressing maternal dietary habits is essential, particularly in the context of chronic inflammatory conditions. A balanced, nutrient-rich diet can help mitigate some of the negative effects these conditions have on breast milk composition, thereby supporting better health outcomes for both mother and infant. Incorporating dietary counseling into postpartum care could enhance the bioactive profile of breast milk, promoting its role as a critical component in the early-life prevention of inflammation-related diseases.

Breast milk composition varies dynamically across different ethnicities and geographic regions [68]. Meta-regression analyses indicate that the study region significantly contributes to the variation in lipid profiles [68]. Kumar et al. investigated the influence of geographical location on breast milk lipid composition, focusing on Europe (Spain and Finland), Africa (South Africa), and Asia (China) [69]. The study found significant differences in total PUFAs (p < 0.001), n-6 PUFAs (p < 0.001), n-3 PUFAs (p = 0.003), and SFA (p < 0.001) across countries. Chinese women were observed to have the highest levels of n-6 PUFAs (25.6%) and lower levels of SFA (34.7%) compared to other regions. Additionally, Chinese and Finnish samples exhibited relatively higher levels of n-3 PUFAs [69]. Western countries tend to have higher concentrations of MUFAs and omega-9 (18:1n-9) but lower levels of PUFAs, including 18:2n-6, 20:4n-6, 18:3n-3, 20:5n-3, 22:6n-3, and total n-6 PUFA in human milk compared to non-Western countries (p < 0.001) [68]. In contrast, no significant regional difference was detected for SFA (p = 0.799) and most other subtypes of fatty acids [68]. Yuhas et al. compared the fatty acid contents of human milk across nine countries (Australia, Canada, Chile, China, Japan, Mexico, Philippines, the United Kingdom, and the United States), finding that the proportion of saturated fatty acids was relatively constant among these countries, except the Philippines, where levels of lauric and myristic acids were elevated [68,70]. Arachidonic acid (ARA) concentrations range from 0.36% in the United Kingdom to 0.49% in China, and DHA levels range from 0.17% to 0.99%, with the highest levels in Japanese milk and the lowest levels in Canadian and U.S. simples, highlighting the variability in human milk fatty acid content across regions [68,70]. These variations are not only attributed to geographic and dietary factors but also to lactation stages, time of day, and sample collection year [68]. Understanding these differences is crucial for nutritional interventions and guidelines to optimize infant health globally.

Unlike lipids, the variation in miRNA composition across different geographic regions and populations has not been extensively studied. While such regional differences have been documented in other biofluids, such as blood and saliva, similar research on breast milk remains limited. Given the critical role of miRNAs in regulating immune and metabolic processes in infants, understanding their regional variation could provide valuable insights into how environmental, dietary, and genetic factors influence breast milk composition. Investigating these variations is essential to identify potential disparities in the health benefits of breast milk, which could inform the development of targeted nutritional interventions to optimize infant health across diverse populations.

In this review, we highlight the effects of maternal pathologies characterized by chronic inflammation on breast milk composition and the implications of this on offspring’s development later in life. Understanding the influence of maternal health status on breast milk components is crucial for developing nutritional strategies that optimize the benefits derived from breastfeeding.

4. Chronic Inflammation

Inflammation is a biological response of the immune system that can be triggered by various factors, including pathogens, damaged cells, and toxic compounds [71]. During inflammation, immune cells are recruited from circulation, infiltrate the tissue, differentiate, and produce inflammatory mediators as cytokines to achieve healing and restore the tissue’s homeostasis [72]. Acute inflammation can be triggered in minutes to hours and lasts hours to days [73]. On the other hand, chronic inflammation continues to acute inflammation when the tissue injury or infection cannot be resolved. Chronic inflammation recruits monocytes; however, it also usually involves the recruitment and activation of adaptive immune cells such as lymphocytes [74,75]. Interestingly, chronic inflammatory conditions are not caused by traditional triggers but are mainly caused by tissue malfunction [76]. The inflammation that characterizes most chronic diseases suggests a central role of the adaptive and innate immune system in the risk and pathogenesis of these conditions [77].

The newborn’s immune system is influenced by maternal immunity transferred via the placenta and breast milk [78]. Breast milk contains components that can modulate the immune system of infants by providing protection and facilitating development, tolerance, and an appropriate inflammatory response [32,35]. Researchers indicate that chronic inflammatory diseases in adulthood seem to be associated with early prenatal and postnatal malnutrition [77,79]. Inflammation early in life may lead to adverse neurodevelopmental outcomes, highlighting the importance of mitigating inflammation during the newborn period [32]. It is essential to understand the influence of the environment on the development of immune and metabolic programming to identify critical factors that modulate maternal and offspring health.

5. Chronic Inflammatory Conditions in the Mother, Their Impact on Breast Milk Composition, and Possible Role in Nursling Programming

5.1. Obesity

According to the WHO, obesity has emerged as a global epidemic, affecting over 650 million people worldwide [80]. The standard measure for identifying obesity is a body mass index (BMI) of 30 kg/m² or higher [81]. This can be complemented by measuring waist circumference (88 cm or higher for females) to assess visceral adiposity and predict disease risk [82]. Obesity is characterized by low-grade chronic inflammation that causes multiple metabolic diseases, such as diabetes, hypertension, and dyslipidemia, among others [83].

The prevalence of obesity in women of childbearing age has been persistently increasing for the past three decades [84,85]. In 2014, the global estimation of pregnant women with obesity reached 14.6 million, and approximately one-third of these women remain obese in the postpartum period when lactation occurs [85,86]. Maternal obesity may lead to gestational diabetes mellitus (GDM), hypertension, preeclampsia, complications during delivery, and difficult breastfeeding [87]. In addition to the health concerns for mothers with obesity, children born to obese mothers are 3–5 times more susceptible to developing obesity later in life [88]. These data indicate that obesity is a persistent concern during the postpartum period and may have potential implications for maternal and infant health later in life.

Maternal obesity is related to excess adipose mass, which affects hormonal and some vitamin [89] regulation and alters breast milk’s immunological and bioactive factors [89,90]. In this regard, breast milk of obese mothers contains higher levels of total fat, glucose, lactoferrin, C-reactive protein (CRP), and hormones such as insulin, leptin, ghrelin, adiponectin, and obestatin [8,9,10,11,12,13]. These alterations in breast milk could have implications for the infant’s metabolic development and weight regulation, e.g., they could influence the infant’s feeding behavior. Additionally, obesity has an impact on immunoglobulin (Ig) concentration, showing elevated levels of soluble IgA in colostrum (the first form of milk) [91]. In contrast, the concentrations of IgG and IgM remained unaffected by maternal BMI [91]. This suggests that certain components of the immune protection provided by breast milk, particularly those related to the transfer of immunity against pathogens, remain stable regardless of maternal obesity. Breast milk of obese mothers shows an increased ratio of pro-inflammatory omega-6 to omega-3 polyunsaturated fatty acids (PUFAs), which may influence the offspring’s cardiometabolic status and neurodevelopmental outcomes [11,12]. These changes in the profile of breast milk fatty acids are associated with alterations in insulin, CRP, leptin, adiponectin, ghrelin, interleukin (IL)-6, and tumor necrosis factor-alpha (TNF-α) [11,90]. These alterations may influence the composition of bioactive compounds delivered to the infant. However, the direct impact of these changes on neonatal health and development has not yet been thoroughly studied.

The cytokine levels in breast milk of obese mothers show conflicting results. While some studies report changes in their concentration, others do not [12,13,92,93]. This discrepancy might be due to the heterogeneous groups in these studies. However, lower levels of breast milk transforming growth factor-beta 2 (TGF-β2) and IL-6 are related to higher BMI, which may impact the maturation of the offspring’s immune system [44,94]. Some of these cytokines are derived from immune cells of the mammary gland or breast milk, while others might be transferred from maternal circulation [39]. A cross-sectional study reported phenotypic alterations of leukocyte subpopulations, such as decreased B lymphocyte fraction, between peripheral blood and colostrum from women with obesity [95]. However, there is limited information about the phenotype or status of these immune cells and, therefore, the origin of breast milk inflammation in obese mothers. Research in mice and humans with obesity demonstrates that the adipocytes, which also secrete pro-inflammatory mediators, are dysfunctional and hypertrophied, leading to tissue inflammation [96]. However, further studies are needed to explore the contribution of adipocytes in breast milk alterations in obese mothers (Figure 1).

Due to the permeability of the young infant gut, these altered immunological and bioactive compounds in breast milk may induce systemic effects by entering the offspring’s circulation [93]. Most studies have shown that pre- and postnatal nutritional excess interact with each other to exert additive effects on programming [97]. To disclose the specific role of breastfeeding, some studies have employed a cross-fostering murine model to compare the differences in pups from obese and lean dams during lactation, showing the importance of the lactation period to the later metabolic alterations in the offspring [14,98]. In mice, a maternal high-fat diet-induced redistribution of fatty acyl residues in the dam’s circulation, which was associated with increased levels of omega-6 PUFAs in both milk and the pup nursing neonate circulation [99]. High amounts of omega-6 PUFAs have been related to modifications in the eicosanoids cascade and disturbances in the immune system [99]. This may have harmful programming effects on the offspring, predisposing them to inflammatory-related conditions, such as obesity, diabetes, and hypertension, among others in mice models [14,15,16].

Clinical studies reported that elevated levels of leptin and omega-6 to omega-3 PUFAs in the human breast milk of obese mothers are associated with excessive weight gain in infants, which may lead to the development of metabolic and inflammatory conditions later in life [14,91,100,101,102,103]. Breast milk from obese mothers also has higher adiponectin levels, indicating a possible role in attenuating inflammatory processes [8]. Little is known about the impact of immune cells and cytokines in breast milk from obese mothers on offspring health; however, they are essential for immune system development and regulation of inflammatory processes in newborns [40]. These findings suggest the impact of maternal obesity and inflammation on breast milk composition, with potential implications for infant growth and development later in life, highlighting the critical need for future research to improve maternal breast milk quality (Figure 1).

5.2. Diabetes

Diabetes mellitus (DM) is a metabolic disease that results in elevated blood glucose levels [104]. The main subtypes of DM are Type 1 (T1DM) and Type 2 (T2DM), which classically result from defective insulin secretion (T1DM) and/or action (T2DM) [104,105]. DM in mothers may be pregestational (PGDM), consisting of T1DM and T2DM, or appear during pregnancy, known as gestational diabetes mellitus (GDM) [106]. According to the International Diabetes Federation, GDM affects approximately 14% of pregnancies worldwide, representing 20 million births annually [107]. Approximately 14.9 million women have PGDM, representing 1–2% of all pregnancies [108]. GDM and PGDM increase the risk of various complications, including preeclampsia, cardiovascular disease, and obesity [109]. These factors contribute to an increased susceptibility to the development of T2DM in both the mother and the infant [109].

Some studies suggest that the composition of breast milk from women with DM may exhibit variations compared to non-diabetic women. Colostrum of GDM mothers had a higher content of carbohydrates and energy content [110,111]. Meanwhile, calorie, fat, and protein composition were not altered [110,111]. Colostrum of GDM women had different levels of cytokines and chemokines, with increased concentrations of IL-15, IL-6, and interferon-gamma (IFN-γ) and reduced levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), causing altered immune composition [112]. GDM also alters the concentration of human milk hormones, increasing insulin levels and decreasing levels of ghrelin and adiponectin; however, these relationships are limited to the early lactation stage [106,113]. Breast milk composition of GDM women also has increased lactoferrin levels [114]. Glucose was higher, and long-chain PUFAs were lower in the breast milk of PGDM women, which may result from altered fatty acid metabolism [115,116]. PGDM women have altered the mammary gland’s lipid metabolism and increased glucose and sodium levels in mature milk [117], which could affect the infant’s electrolyte balance and energy metabolism. The implications of these changes on infant health require further investigation, but they suggest that maternal DM could potentially affect the infant’s metabolic and immune programming. Also, early neonatal intake of breast milk from diabetic mothers was associated with a higher body weight in early childhood, increasing the risk of becoming overweight later in life [118] (Figure 1). The precise impacts of these alterations on the infant’s long-term health are not fully elucidated. Further research is necessary to discern how maternal diabetes may affect the composition of breast milk and whether these changes have significant consequences for the child’s development and health.

5.3. Hypercholesterolemia

Hypercholesterolemia is a lipid metabolism disorder characterized by elevated cholesterol levels in the blood, mainly low-density lipoprotein cholesterol (LDL-C), strongly associated with cardiovascular disease [119]. According to the WHO, approximately 39% of adults worldwide have elevated cholesterol levels, with a relatively higher prevalence among women (40%) compared to men (37%) [120]. As described in other pathologies reviewed earlier, breastfeeding is a protective factor to prevent this lipidic alteration in the dyad. Specifically, breastfeeding for more than two years decreases the 16% probability of having LDL-related disorders among women aged 30–39 years compared to women who did not breastfeed [121]. For breastfed adults, it is also described that it may have benefits related to reduced risk of developing atherosclerosis [122]. Breastfeeding for over three months is associated with improved maternal cholesterol profiles at one year postpartum [123,124]. Lactation functions as a physiological pathway for the excretion of triglycerides and cholesterol, which helps reduce maternal serum concentrations during this period [125,126]. However, these lipid levels may return to baseline after lactation ends [125,126]. This lipid-lowering effect postpartum mediated by lactation may contribute to a reduced risk of developing cardiovascular diseases later in life in women who breastfed. Therefore, breastfeeding not only benefits the infant but may also have significant protective effects on maternal cardiovascular health by improving lipid metabolism and reducing the likelihood of persistent dyslipidemia.

Maternal dyslipidemia in pregnancy is associated with adverse pregnancy outcomes for both mother and fetus, including preeclampsia and an increased risk of gestational diabetes [127]. Previous studies have shown that the prevalence of postpartum lipid alteration ranges from 38.5% to 52%, depending on the observation period after delivery [128,129,130]. Regardless, when dyslipidemia or hypercholesterolemia occurs during breastfeeding or the postpartum period, these disorders have not been articulated as clinically significant problems. As such, lipids are not determined during this period as public health policy. Even though several articles mention this alteration as a significant problem during gestation with important consequences for the dyad regarding their cardiovascular health [131,132,133,134,135], to our knowledge, there are no studies that have researched the development of hypercholesterolemia during puerperium or postpartum period as such, the impact on maternal and infant cardiovascular health, or the possible impact of this lipidic disorder in breast milk composition or quality that these women produce.

All the available information described in the literature are observational reports regarding the variation of lipids before pregnancy (total cholesterol 160–210 mg/dL), during the first trimester of pregnancy (total cholesterol 167–198 mg/dL), second trimester (total cholesterol 200–279 mg/dL), third trimester (total cholesterol 239–317 mg/dL), at delivery (total cholesterol 240–312 mg/dL), and as time goes by in the postpartum period, lipid levels normalize in normal gestation [132,136,137,138,139,140]. However, there is another group that, according to the literature, shows hypercholesterolemia during pregnancy and the postpartum period. Variations in maternal lipids levels have also been reported due to physiologic changes in the menstrual cycle [141], specific maternal pathologies [128,142,143,144,145,146,147,148,149,150,151] such as depression [143,147,152], alterations in glucose metabolism [145,146,148,151], and tension alterations [145,149,150]. In addition, lipids during postpartum also were evaluated under dietary and exercise interventions [153,154], weight loss or retention [153,155,156,157,158,159], parity [160,161], lactation versus no lactating [123,162], type of lactation [163], extension of lactation [126,164,165], among others, all of them are summarized in the following table sorted by year of publication (Table 1).

Interestingly, what it is relevant to highlight from these studies is that women who had lipid levels higher than 300 mg/dL during the third trimester of gestation remained with their lipid levels high for a more extended period during the postpartum period, in comparison to those women who during the third trimester of pregnancy had their lipid levels lower to 300 mg/dL [132]. Additionally, it was observed, related to parity [136,137,160], that multiparous women presented higher lipid levels than nulliparous women [160]. Worryingly, these women presented lower levels of HDL cholesterol and higher levels of LDL cholesterol during the postpartum period [139], suggesting that pregnancy increases their vascular risk, likely sensitive to diet consumption. Even though the authors observed this alteration during the postpartum period, this evidence was not subject to further analysis.

Most studies centered on lipid levels during the postpartum period mention that lipid concentration decreases to “normal levels”, i.e., to 200 mg/dL in a year [136,137,140]. Jimenez et al., 1988 described that the first 40 days postpartum decrease unesterified cholesterol levels [138], which is relevant since free cholesterol in circulation is biologically active and has cytotoxic effects [171]. However, this study did not consider whether women were breastfeeding and how these lipid levels might be affected by this parameter. In this respect, TC and TG levels decrease during the postpartum period, although TC and TG from breastfeeding women decrease their levels faster than those who do not breastfeed [172]. However, no studies mention maternal lipidic alterations, such as hypercholesterolemia, that could be present during the lactation period as a pathology or that this lipid change could be a physiological response to lactation demands (Figure 1). In addition to this information gap, there are currently no studies regarding breast milk composition from these women with altered lipids during lactation.

In this concern, it is well described that breast milk lipids change with the lactation stage [173]. At the same time, considering the first 16–21 weeks postpartum, total breast milk lipids increase with the length of lactation. The changes include increased TG levels [174,175], a decrease in breast milk cholesterol levels [175,176,177], and so do free cholesterol levels [173]. On the other hand, women who exclusively breastfeed their infants excrete large amounts of cholesterol into their breast milk [178], which likely significantly decreases the serum cholesterol concentration in these women [178]. However, since lipids are not measured during gestation or postpartum if a nursing mother has increased the lipid levels, she might transfer them to her infant, likely impacting the offspring’s cardiovascular health early in life.

Thus, there is a significant gap in information regarding the impact of dyslipidemia or hypercholesterolemia in women during the postpartum period and among those who breastfeed on their cardiovascular health, their infant, and breast milk composition.

5.4. Hypertension

Hypertension, defined as persistently elevated blood pressure, is a significant risk factor for cardiovascular disease and affects approximately 1.28 billion adults worldwide, according to the WHO [179]. Globally, the prevalence of hypertension is slightly higher in men (24%) than in women (20%), though women are particularly vulnerable during pregnancy due to conditions like preeclampsia (PE) [179,180]. Hypertension affects about 5–10% of pregnancies and can lead to severe complications, including PE, preterm birth, and an increased risk of cardiovascular disease later in life for both mother and child [181,182]. Furthermore, studies indicate that 39% of women experience persistent hypertension at three months postpartum [183,184]. These statistics highlight the critical need for effective monitoring and management of blood pressure during and after pregnancy to reduce long-term health risks for women and their offspring.

It is well described that lactation between 1 and 6 months or higher is a protective risk factor for hypertension postpartum [185]. It is associated with a beneficial effect on maternal blood pressure that persists for decades, suggesting a protective association of lactation with maternal cardiovascular risk [186]. Unfortunately, though this protective effect was present in women who developed gestational hypertension, it was not among those who developed PE [187].

Among the women who developed hypertension during gestation, there was a delayed initiation of breast milk expression [188], significantly higher odds of reporting insufficient milk supply [189], increased odds of non-exclusive breastfeeding at four months postpartum [189,190] close to six weeks less than 12 months postpartum [189] Thus, they showed a shorter duration of lactation [190].

Regarding the nutritional composition of colostrum and mature breast milk from hypertensive women, they presented higher levels of total protein [191], higher amounts of lipids, calories [191,192], and carbohydrates in comparison to normotensive women [192]. Breast milk of mothers who had systemic arterial hypertension during pregnancy presented lower levels of fat and calories than women who did not have this condition [193]. On the other hand, in breast milk from women with PE, macronutrient composition did not present differences with respect to normotensive women during the lactation period [194].

Regarding breast milk metabolites in PE women compared to the control group at 6 months postpartum, low levels of glycerophosphocholine and citrate were described, both related to inflammatory responses and oxidative stress [195,196] and impaired energy metabolism [195,196].

Other compound concentrations, such as docosahexaenoic acid (DHA), were significantly increased in breast milk despite lower maternal plasma DHA concentrations in PE women [197], likely suggesting a local mammary gland regulation. Neurotrophins present in breast milk, such as milk nerve growth factor (NGF) and milk brain-derived neurotrophic factor (BDNF) levels, were lower at 1.5 months (10.5%) in the PE group as compared to the normotensive group [198], possibly causing the reported impaired growth parameters of children born to PE mothers.

As shown here, breast milk from mothers with hypertensive disorders presents alterations in some of its components (Figure 1). However, the impact of this dysregulation on the offspring has been neglected, evidencing a significant opportunity for further study.

5.5. Metabolic Syndrome

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities, including hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia, that significantly increase the risk of developing diabetes and cardiovascular disease [199]. According to global estimates, MetS affects approximately 20–25% of the adult population, with women having a significantly higher risk of prevalence compared to men [200,201]. During pregnancy, maternal MetS can increase the risk of gestational diabetes, preeclampsia, and adverse neonatal outcomes, including preterm birth and fetal overgrowth [202,203,204,205]. The prevalence of MetS at three years postpartum is 20% [206]. This highlights the importance of addressing metabolic risk factors early in pregnancy and continuing management into the postpartum period to improve long-term maternal and child health outcomes.

A meta-analysis conducted four years ago mentions that although most of the included studies revealed beneficial associations between lactation and maternal MetS development- the pooled effect among them was non-conclusive [207]. Notwithstanding, breastfeeding duration, among other factors, can predict MetS in lactating women [208,209].

The duration of breastfeeding was negatively associated with the risk of MetS incidence in women (hazard ratio (HR) 0.98, 95% CI 0.98–0.99). In particular, a one-month increase in breastfeeding duration reduced the risk of MetS by 2% [210].

This comparison was also made for women who presented or did not have GDM. The HR of MetS between GDM and non-GDM women demonstrated significantly reduced MetS incidence with a longer duration of exclusive BF (HR 0.93, 95% CI 0.88–0.98) [210]. Also, the impact of maternal obesity and obesogenic diets during lactation is the development of metabolic syndrome in adulthood [211].

Currently, there is no information on metabolic syndrome (MetS) and its impact on breast milk composition or quality, nor regarding the impact on the offspring’s health (Figure 1). Thus, the lack of studies in this field is an opportunity to understand if there is any alteration in the biofluid and infants.

6. Epigenetic Programming Effects of Breast Milk Extracellular Vesicles on Infant Metabolic and Immunological Development

Breast milk extracellular vesicles (EVs) play a crucial role in the epigenetic programming of infants by influencing gene expression and developmental pathways, including immunity, neural development, and metabolic regulation [212]. These vesicles are secreted by the mammary gland epithelium and act as molecular carriers, delivering bioactive components such as microRNAs (miRNAs), long non-coding RNAs (lncRNAs), small interfering RNAs (siRNAs), proteins, and lipids [213,214,215,216]. EVs survive the infant’s gastrointestinal environment and are absorbed by tissues, enabling cell-to-cell communication through systemic circulation and facilitating the epigenetic programming that modulates cellular functions critical for infant growth and long-term health [217,218,219]. For this reason, they are considered important signaling molecules between mother and child [215,220].

Human milk contains more than 1400 distinct miRNAs and is considered one of the biological fluids with the highest miRNA concentrations [213,220,221]. Many of these miRNAs are encapsulated within exosomes, which protect them from degradation and ensure their stability and biological activity [220]. Evidence suggests that miRNA concentrations vary throughout lactation, reflecting the dynamic nature of breast milk’s molecular profile and its adaptation to the infant’s changing nutritional and developmental needs [222,223,224,225].

Maternal conditions such as diabetes mellitus, overweight or obesity, and the diet that she consumes are known to trigger epigenetic changes in offspring and can significantly influence the miRNA composition of human milk [220]. In this regard, Mirza et al. investigated the differences in expression of human breast milk miRNAs between mothers with type 1 diabetes and healthy controls [226]. They reported nine differentially expressed miRNAs, six were upregulated: hsa-miR-4497, hsa-miR-1246, hsa-miR-133a-3p, hsa-miR-3178, hsa-miR-1290, and hsa-miR-320d, while the remaining three were downregulated: hsa-miR-518e-3p, hsa-miR-629-3p, hsa-miR-200c-5p [226]. Functional analysis revealed that these upregulated miRNAs are involved in key pathways such as FoxO signaling, immune modulation, and inflammation regulation [226]. Notably, hsa-miR-4497 and hsa-miR-3178 increased macrophage TNF-α production, suggesting their potential role in influencing immune responses in infants of mothers with type 1 diabetes [226].

Shah et al. found that immune-related miRNAs such as miR-148a, miR-30b, and miR-let-7a are found in lower concentrations in breast milk from mothers with gestational diabetes and overweight/obesity, suggesting a direct impact of maternal health on milk composition [227,228]. These miRNAs, critical for regulating metabolic and adipogenic pathways, were linked to changes in infant growth and body composition, with miRNA-148a negatively associated with infant weight and fat mass and miRNA-30b positively associated with these measures [227,228]. miR-148a is the precursor of miR-148a-3p, the most abundant miRNA in breast milk, known for its neuroprotective and neuroproliferative effects [229]. Consequently, a reduction in miR-148a may increase the risk of childhood obesity and negatively impact the neurological development of children of obese mothers [229]. These findings suggest that altered milk miRNA profiles may influence offspring’s metabolic programming, potentially increasing the risk of adiposity and metabolic diseases later in life. Similarly, women who consumed a high-fat diet showed increased miR-67 and miR-27 concentrations in milk fat globule, while animal models fed with an obesogenic diet exhibited higher concentrations of miR-222 and reduced miR-200 and miR-26, likely modulating infant metabolism to meet dietary patterns [230]. Thus, breast milk EVs are vital mediators of epigenetic regulation, linking maternal conditions, lifestyle, and diet to infant development, with long-term implications for reducing the risk of immune and metabolic disorders.

7. Projections

Breastfeeding is considered the gold standard for infant nutrition during the first months of life. The composition of breast milk has evolved to provide optimal nutrition, immune protection, and regulation of growth, development, and metabolism for infants. It is well-established that breastfeeding improves the quality of life for both mother and child. However, it’s crucial to consider that not all breast milk has the same quality. A significant contributing factor is the mother’s health status, which is often left aside. Chronic inflammatory maternal diseases can alter the composition of breast milk, potentially impacting the health of the nursling with long-term consequences. Therefore, more research is needed to understand how different maternal pathologies affect breast milk components and their potential implications for the offspring later in life. Despite these considerations, it is essential to mention that breastfeeding is consistently recommended over formula. An important aspect of this review is raising mothers’ awareness about the impact of their health status, which they can positively change through a healthier lifestyle.

Competing interests

Conflicts of InterestThe authors declare no conflicts of interest.

References

1. Kalarikkal S., Pfleghaar J.. Breastfeeding. StatPearls. 2024 PubMed
2. Eisha S., Joarder I., Wijenayake S., McGowan P.O.. Non-Nutritive Bioactive Components in Maternal Milk and Offspring Development: A Scoping Review. J. Dev. Orig. Health Dis.. 2022 doi:10.1017/S2040174422000149 PubMed
3. Andreas N.J., Kampmann B., Mehring Le-Doare K.. Human Breast Milk: A Review on Its Composition and Bioactivity. Early Hum. Dev.. 2015 doi:10.1016/j.earlhumdev.2015.08.013 PubMed
4. Monaco M.H., Kim J., Donovan S.M.. Human Milk: Composition and Nutritional Value. Encyclopedia of Food and Health. 2016
5. Fields D.A., Schneider C.R., Pavela G.. A Narrative Review of the Associations between Six Bioactive Components in Breast Milk and Infant Adiposity. Obesity. 2016 doi:10.1002/oby.21519 PubMed
6. Skibiel A.L., Hood W.R.. Milk Matters: Offspring Survival in Columbian Ground Squirrels Is Affected by Nutrient Composition of Mother’s Milk. Front. Ecol. Evol.. 2015 doi:10.3389/fevo.2015.00111
7. Kim S.Y., Yi D.Y.. Components of Human Breast Milk: From Macronutrient to Microbiome and MicroRNA. Clin. Exp. Pediatr.. 2020 doi:10.3345/cep.2020.00059 PubMed
8. Ahuja S., Boylan M., Hart S.L., Román-Shriver C., Spallholz J.E., Pence B.C. et al. Glucose and Insulin Levels Are Increased in Obese and Overweight Mothers’ Breast-Milk. Food Nutr. Sci.. 2011 doi:10.4236/fns.2011.23027
9. Newburg D.S., Woo J.G., Morrow A.L.. Characteristics and Potential Functions of Human Milk Adiponectin. J. Pediatr.. 2010 doi:10.1016/j.jpeds.2009.11.020 PubMed
10. Houghton M.R., Gracey M., Burke V., Bottrell C., Spargo R.M.. Breast Milk Lactoferrin Levels in Relation to Maternal Nutritional Status. J. Pediatr. Gastroenterol. Nutr.. 1985 doi:10.1097/00005176-198504000-00013 PubMed
11. Panagos P.G., Vishwanathan R., Penfield-Cyr A., Matthan N.R., Shivappa N., Wirth M.D. et al. Breastmilk from Obese Mothers Has Pro-Inflammatory Properties and Decreased Neuroprotective Factors. J. Perinatol.. 2016 doi:10.1038/jp.2015.199 PubMed
12. Enstad S., Cheema S., Thomas R., Fichorova R.N., Martin C.R., O’Tierney-Ginn P. et al. The Impact of Maternal Obesity and Breast Milk Inflammation on Developmental Programming of Infant Growth. Eur. J. Clin. Nutr.. 2021 doi:10.1038/s41430-020-00720-5 PubMed
13. Whitaker K.M., Marino R.C., Haapala J.L., Foster L., Smith K.D., Teague A.M. et al. Associations of Maternal Weight Status Before, During, and After Pregnancy with Inflammatory Markers in Breast Milk. Obesity. 2017 doi:10.1002/oby.22025 PubMed
14. Gorski J.N., Dunn-Meynell A.A., Hartman T.G., Levin B.E.. Postnatal Environment Overrides Genetic and Prenatal Factors Influencing Offspring Obesity and Insulin Resistance. Am. J. Physiol. Regul. Integr. Comp. Physiol.. 2006 doi:10.1152/ajpregu.00138.2006 PubMed
15. Oben J.A., Mouralidarane A., Samuelsson A.M., Matthews P.J., Morgan M.L., Mckee C. et al. Maternal Obesity during Pregnancy and Lactation Programs the Development of Offspring Non-Alcoholic Fatty Liver Disease in Mice. J. Hepatol.. 2010 doi:10.1016/j.jhep.2009.12.042 PubMed
16. Du Y., Yang M., Lee S., Behrendt C.L., Hooper L.V., Saghatelian A. et al. Maternal Western Diet Causes Inflammatory Milk and TLR2/4-Dependent Neonatal Toxicity. Genes Dev.. 2012 doi:10.1101/gad.191031.112 PubMed
17. Martin C.R., Ling P.R., Blackburn G.L.. Review of Infant Feeding: Key Features of Breast Milk and Infant Formula. Nutrients. 2016 doi:10.3390/nu8050279 PubMed
18. Breastfeeding
19. Hossain S., Mihrshahi S.. Exclusive Breastfeeding and Childhood Morbidity: A Narrative Review. Int. J. Environ. Res. Public Health. 2022 doi:10.3390/ijerph192214804 PubMed
20. Russo J., Russo I.H.. Hormonal Control of Breast Development. Endocrinol. Adult Pediatr.. 2015 doi:10.1016/B978-0-323-18907-1.00128-1
21. Sorrentino E., Sarkadi L.S., Zhang M., Muránszky G., Vass R.A., Matsyura O. et al. Fatty Acid Composition of Milk from Mothers with Normal Weight, Obesity, or Gestational Diabetes. Life. 2022 doi:10.3390/life12071093 PubMed
22. Zurutuza J.I., Gonzalez S., Calderón A.L., Caba M., Ramos F.R., Zurutuza J.I. et al. Changes in the Immunology of Breast Milk from Obese or Overweight Women: A Brief Review. Cureus. 2024 doi:10.7759/cureus.52207 PubMed
23. Christian P., Smith E.R., Lee S.E., Vargas A.J., Bremer A.A., Raiten D.J.. The Need to Study Human Milk as a Biological System. Am. J. Clin. Nutr.. 2021 doi:10.1093/ajcn/nqab075 PubMed
24. Erick M.. Breast Milk Is Conditionally Perfect. Med. Hypotheses. 2018 doi:10.1016/j.mehy.2017.12.020 PubMed
25. Ozkan H., Tuzun F., Taheri S., Korhan P., Akokay P., Yılmaz O. et al. Epigenetic Programming Through Breast Milk and Its Impact on Milk-Siblings Mating. Front. Genet.. 2020 doi:10.3389/fgene.2020.569232 PubMed
26. Kim S.Y., Yi D.Y.. Analysis of the Human Breast Milk Microbiome and Bacterial Extracellular Vesicles in Healthy Mothers. Exp. Mol. Med.. 2020 doi:10.1038/s12276-020-0470-5 PubMed
27. Koletzko B.. Human Milk Lipids. Ann. Nutr. Metab.. 2017 doi:10.1159/000452819 PubMed
28. Demmelmair H., Koletzko B.. Lipids in Human Milk. Best. Pract. Res. Clin. Endocrinol. Metab.. 2018 doi:10.1016/j.beem.2017.11.002 PubMed
29. Martinat M., Rossitto M., Di Miceli M., Layé S.. Perinatal Dietary Polyunsaturated Fatty Acids in Brain Development, Role in Neurodevelopmental Disorders. Nutrients. 2021 doi:10.3390/nu13041185 PubMed
30. Gibson R.A., Makrides M.. Long-Chain Polyunsaturated Fatty Acids in Breast Milk: Are They Essential?. Adv. Exp. Med. Biol.. 2001 doi:10.1007/978-1-4615-1371-1_46 PubMed
31. German J.B., Dillard C.J.. Composition, Structure and Absorption of Milk Lipids: A Source of Energy, Fat-Soluble Nutrients and Bioactive Molecules. Crit. Rev. Food Sci. Nutr.. 2006 doi:10.1080/10408690590957098 PubMed
32. Thai J.D., Gregory K.E.. Bioactive Factors in Human Breast Milk Attenuate Intestinal Inflammation during Early Life. Nutrients. 2020 doi:10.3390/nu12020581 PubMed
33. Gonzalez-Becerra K., Barron-Cabrera E., Muñoz-Valle J.F., Torres-Castillo N., Rivera-Valdes J.J., Rodriguez-Echevarria R. et al. A Balanced Dietary Ratio of N-6:N-3 Polyunsaturated Fatty Acids Exerts an Effect on Total Fatty Acid Profile in RBCs and Inflammatory Markers in Subjects with Obesity. Healthcare. 2023 doi:10.3390/healthcare11162333 PubMed
34. Hassiotou F., Geddes D.T.. Immune Cell-Mediated Protection of the Mammary Gland and the Infant during Breastfeeding. Adv. Nutr.. 2015 doi:10.3945/an.114.007377 PubMed
35. Lewis E.D., Richard C., Larsen B.M., Field C.J.. The Importance of Human Milk for Immunity in Preterm Infants. Clin. Perinatol.. 2017 doi:10.1016/j.clp.2016.11.008 PubMed
36. Cabinian A., Sinsimer D., Tang M., Zumba O., Mehta H., Toma A. et al. Transfer of Maternal Immune Cells by Breastfeeding: Maternal Cytotoxic T Lymphocytes Present in Breast Milk Localize in the Peyer’s Patches of the Nursed Infant. PLoS ONE. 2016 doi:10.1371/journal.pone.0156762 PubMed
37. Witkowska-Zimny M., Kaminska-El-Hassan E.. Cells of Human Breast Milk. Cell Mol. Biol. Lett.. 2017 doi:10.1186/s11658-017-0042-4 PubMed
38. Trend S., De Jong E., Lloyd M.L., Kok C.H., Richmond P., Doherty D.A. et al. Leukocyte Populations in Human Preterm and Term Breast Milk Identified by Multicolour Flow Cytometry. PLoS ONE. 2015 doi:10.1371/journal.pone.0135580 PubMed
39. Dawod B., Marshall J.S.. Cytokines and Soluble Receptors in Breast Milk as Enhancers of Oral Tolerance Development. Front. Immunol.. 2019 doi:10.3389/fimmu.2019.00016 PubMed
40. Kielbasa A., Gadzala-Kopciuch R., Buszewski B.. Cytokines-Biogenesis and Their Role in Human Breast Milk and Determination. Int. J. Mol. Sci.. 2021 doi:10.3390/ijms22126238 PubMed
41. Kverka M., Burianova J., Lodinova-Zadnikova R., Kocourkova I., Cinova J., Tuckova L. et al. Cytokine Profiling in Human Colostrum and Milk by Protein Array. Clin. Chem.. 2007 doi:10.1373/clinchem.2006.077107 PubMed
42. Bardanzellu F., Peroni D.G., Fanos V.. Human Breast Milk: Bioactive Components, from Stem Cells to Health Outcomes. Curr. Nutr. Rep.. 2020 doi:10.1007/s13668-020-00303-7 PubMed
43. Camacho-Morales A., Caba M., García-Juárez M., Caba-Flores M.D., Viveros-Contreras R., Martínez-Valenzuela C.. Breastfeeding Contributes to Physiological Immune Programming in the Newborn. Front. Pediatr.. 2021 doi:10.3389/fped.2021.744104 PubMed
44. Bermejo-Haro M.Y., Camacho-Pacheco R.T., Brito-Pérez Y., Mancilla-Herrera I.. The Hormonal Physiology of Immune Components in Breast Milk and Their Impact on the Infant Immune Response. Mol. Cell Endocrinol.. 2023 doi:10.1016/j.mce.2023.111956 PubMed
45. Innis S.M.. Impact of Maternal Diet on Human Milk Composition and Neurological Development of Infants. Am. J. Clin. Nutr.. 2014 doi:10.3945/ajcn.113.072595 PubMed
46. Lönnerdal B.. Effects of Maternal Dietary Intake on Human Milk Composition. J. Nutr.. 1986 doi:10.1093/jn/116.4.499 PubMed
47. Bravi F., Wiens F., Decarli A., Dal Pont A., Agostoni C., Ferraroni M.. Impact of Maternal Nutrition on Breast-Milk Composition: A Systematic Review. Am. J. Clin. Nutr.. 2016 doi:10.3945/ajcn.115.120881 PubMed
48. Petersohn I., Hellinga A.H., van Lee L., Keukens N., Bont L., Hettinga K.A. et al. Maternal Diet and Human Milk Composition: An Updated Systematic Review. Front. Nutr.. 2024 doi:10.3389/fnut.2023.1320560 PubMed
49. Insull W., Hirsch J., James T., Ahrens E.H.. The fatty acids of human milk. II. Alterations produced by manipulation of caloric balance and exchange of dietary fats. J. Clin. Investig.. 1959 doi:10.1172/JCI103819 PubMed
50. Karmarkar M.G., Rajalakshmf R., Ramakrishnan C.V.. Studies on Human Lactation. Acta Paediatr.. 1963 doi:10.1111/j.1651-2227.1963.tb03806.x PubMed
51. Park Y., McGuire M.K., Behr R., McGuire M.A., Evans M.A., Shultz T.D.. High-fat Dairy Product Consumption Increases Δ9 c’ 11 t −18:2 (Rumenic Acid) and Total Lipid Concentrations of Human Milk. Lipids. 1999 doi:10.1007/s11745-999-0396-2 PubMed
52. Mohammad M.A., Sunehag A.L., Haymond M.W.. Effect of Dietary Macronutrient Composition under Moderate Hypocaloric Intake on Maternal Adaptation during Lactation. Am. J. Clin. Nutr.. 2009 doi:10.3945/ajcn.2008.26877 PubMed
53. Ward E., Yang N., Muhlhausler B.S., Leghi G.E., Netting M.J., Elmes M.J. et al. Acute Changes to Breast Milk Composition Following Consumption of High-fat and High-sugar Meals. Matern. Child. Nutr.. 2021 doi:10.1111/mcn.13168 PubMed
54. Kim H., Kang S., Jung B.-M., Yi H., Jung J.A., Chang N.. Breast Milk Fatty Acid Composition and Fatty Acid Intake of Lactating Mothers in South Korea. Br. J. Nutr.. 2017 doi:10.1017/S0007114517000253 PubMed
55. Liu Y., Liu X., Wang L.. The Investigation of Fatty Acid Composition of Breast Milk and Its Relationship with Dietary Fatty Acid Intake in 5 Regions of China. Medicine. 2019 doi:10.1097/MD.0000000000015855 PubMed
56. Patterson E., Wall R., Fitzgerald G.F., Ross R.P., Stanton C.. Health Implications of High Dietary Omega-6 Polyunsaturated Fatty Acids. J. Nutr. Metab.. 2012 doi:10.1155/2012/539426 PubMed
57. Aumeistere L., Ciproviča I., Zavadska D., Andersons J., Volkovs V., Ceļmalniece K.. Impact of Maternal Diet on Human Milk Composition Among Lactating Women in Latvia. Medicina. 2019 doi:10.3390/medicina55050173 PubMed
58. Armand M., Bernard J.Y., Forhan A., Heude B., Charles M.-A., Annesi-Maesano I. et al. Maternal Nutritional Determinants of Colostrum Fatty Acids in the EDEN Mother-Child Cohort. Clin. Nutr.. 2018 doi:10.1016/j.clnu.2017.10.007 PubMed
59. Mazurier E., Rigourd V., Perez P., Buffin R., Couedelo L., Vaysse C. et al. Effects of Maternal Supplementation with Omega-3 Precursors on Human Milk Composition. J. Human. Lact.. 2017 doi:10.1177/0890334417691946 PubMed
60. Puca D., Estay P., Valenzuela C., Muñoz Y.. Effect of Omega-3 Supplementation during Pregnancy and Lactation on the Fatty Acid Composition of Breast Milk in the First Months of Life: A Narrative Review. Nutr. Hosp.. 2021 doi:10.20960/nh.03486 PubMed
61. Ay E., Büyükuslu N., Batırel S., İlktaç H.Y., Garipağaoğlu M.. The Effects of Maternal Omega-3 Fatty Acid Supplementation on Breast Milk Fatty Acid Composition. Acta Pharm. Sci.. 2018 doi:10.23893/1307-2080.APS.05609
62. Bortolozo E.A.F.Q., Sauer E., Santos M.D.S., Baggio S.R., Santos Junior G.D., Farago P.V. et al. Supplementation with the Omega-3 Docosahexaenoic Acid: Influence on the Lipid Composition and Fatty Acid Profile of Human Milk. Rev. Nutr.. 2013 doi:10.1590/S1415-52732013000100003
63. Schwab U., Reynolds A.N., Sallinen T., Rivellese A.A., Risérus U.. Dietary Fat Intakes and Cardiovascular Disease Risk in Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Eur. J. Nutr.. 2021 doi:10.1007/s00394-021-02507-1 PubMed
64. Xiao Y.-L., Gong Y., Qi Y.-J., Shao Z.-M., Jiang Y.-Z.. Effects of Dietary Intervention on Human Diseases: Molecular Mechanisms and Therapeutic Potential. Signal Transduct. Target. Ther.. 2024 doi:10.1038/s41392-024-01771-x PubMed
65. Clemente-Suárez V.J., Beltrán-Velasco A.I., Redondo-Flórez L., Martín-Rodríguez A., Tornero-Aguilera J.F.. Global Impacts of Western Diet and Its Effects on Metabolism and Health: A Narrative Review. Nutrients. 2023 doi:10.3390/nu15122749 PubMed
66. Kumar Verma M., Tripathi M., Kumar Singh B.. Dietary Determinants of Metabolic Syndrome: Focus on the Obesity and Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Metabolic Syndrome—Lifestyle and Biological Risk Factors. 2024
67. Monda A., de Stefano M.I., Villano I., Allocca S., Casillo M., Messina A. et al. Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review. Foods. 2024 doi:10.3390/foods13162627 PubMed
68. Zhang Z., Wang Y., Yang X., Cheng Y., Zhang H., Xu X. et al. Human Milk Lipid Profiles around the World: A Systematic Review and Meta-Analysis. Adv. Nutr.. 2022 doi:10.1093/advances/nmac097 PubMed
69. Kumar H., du Toit E., Kulkarni A., Aakko J., Linderborg K.M., Zhang Y. et al. Distinct Patterns in Human Milk Microbiota and Fatty Acid Profiles Across Specific Geographic Locations. Front. Microbiol.. 2016 doi:10.3389/fmicb.2016.01619 PubMed
70. Yuhas R., Pramuk K., Lien E.L.. Human Milk Fatty Acid Composition from Nine Countries Varies Most in DHA. Lipids. 2006 doi:10.1007/s11745-006-5040-7 PubMed
71. Chen L., Deng H., Cui H., Fang J., Zuo Z., Deng J. et al. Inflammatory Responses and Inflammation-Associated Diseases in Organs. Oncotarget. 2018 doi:10.18632/oncotarget.23208 PubMed
72. Soliman A.M., Barreda D.R.. Acute Inflammation in Tissue Healing. Int. J. Mol. Sci.. 2022 doi:10.3390/ijms24010641 PubMed
73. Stone W., Basit H., Zubair M., Burns B.. Pathology, Inflammation. StatPearls. 2024 PubMed
74. Rust C., Malan-Muller S., van den Heuvel L.L., Tonge D., Seedat S., Pretorius E. et al. Platelets Bridging the Gap between Gut Dysbiosis and Neuroinflammation in Stress-Linked Disorders: A Narrative Review. J. Neuroimmunol.. 2023 doi:10.1016/j.jneuroim.2023.578155 PubMed
75. Austermann J., Roth J., Barczyk-Kahlert K.. The Good and the Bad: Monocytes’ and Macrophages’ Diverse Functions in Inflammation. Cells. 2022 doi:10.3390/cells11121979 PubMed
76. Furman D., Campisi J., Verdin E., Carrera-Bastos P., Targ S., Franceschi C. et al. Chronic Inflammation in the Etiology of Disease across the Life Span. Nat. Med.. 2019 doi:10.1038/s41591-019-0675-0 PubMed
77. Prescott S.L.. Early Nutrition as a Major Determinant of ‘Immune Health’: Implications for Allergy, Obesity and Other Noncommunicable Diseases. 2016 doi:10.1159/000439477 PubMed
78. Cinicola B., Conti M.G., Terrin G., Sgrulletti M., Elfeky R., Carsetti R. et al. The Protective Role of Maternal Immunization in Early Life. Front. Pediatr.. 2021 doi:10.3389/fped.2021.638871 PubMed
79. Savino F., Liguori S.A.. Update on Breast Milk Hormones: Leptin, Ghrelin and Adiponectin. Clin. Nutr.. 2008 doi:10.1016/j.clnu.2007.06.006 PubMed
80. Obesity and Overweight
81. Frankenfield D.C., Rowe W.A., Cooney R.N., Smith J.S., Becker D.. Limits of Body Mass Index to Detect Obesity and Predict Body Composition. Nutrition. 2001 doi:10.1016/S0899-9007(00)00471-8 PubMed
82. Seagle H.M., Wyatt H.R., Hill J.O.. Obesity: Overview of Treatments and Interventions. Nutrition in the Prevention and Treatment of Disease. 2013 doi:10.1016/B978-0-12-391884-0.00024-X
83. Hildebrandt X., Ibrahim M., Peltzer N.. Cell Death and Inflammation during Obesity: “Know My Methods, WAT(Son)”. Cell Death Differ.. 2023 doi:10.1038/s41418-022-01062-4 PubMed
84. Poston L., Caleyachetty R., Cnattingius S., Corvalán C., Uauy R., Herring S. et al. Preconceptional and Maternal Obesity: Epidemiology and Health Consequences. Lancet Diabetes Endocrinol.. 2016 doi:10.1016/S2213-8587(16)30217-0 PubMed
85. Chen C., Xu X., Yan Y.. Estimated Global Overweight and Obesity Burden in Pregnant Women Based on Panel Data Model. PLoS ONE. 2018 doi:10.1371/journal.pone.0202183 PubMed
86. Spencer L., Rollo M., Hauck Y., MacDonald-Wicks L., Wood L., Hutchesson M. et al. The Effect of Weight Management Interventions That Include a Diet Component on Weight-Related Outcomes in Pregnant and Postpartum Women: A Systematic Review Protocol. JBI Database Syst. Rev. Implement. Rep.. 2015 doi:10.11124/jbisrir-2015-1812 PubMed
87. Catalano P.M., Shankar K.. State of the Art Review: Obesity and Pregnancy: Mechanisms of Short Term and Long Term Adverse Consequences for Mother and Child. BMJ. 2017 doi:10.1136/bmj.j1 PubMed
88. Catalano P.M., Farrell K., Thomas A., Huston-Presley L., Mencin P., de Mouzon S.H. et al. Perinatal Risk Factors for Childhood Obesity and Metabolic Dysregulation. Am. J. Clin. Nutr.. 2009 doi:10.3945/ajcn.2008.27416 PubMed
89. Sen S., Penfield-Cyr A., Hollis B.W., Wagner C.L.. Maternal Obesity, 25(OH)D Concentration and Bone Density in Breastfeeding Dyads. J. Pediatr.. 2017 doi:10.1016/j.jpeds.2017.04.024 PubMed
90. Álvarez D., Muñoz Y., Ortiz M., Maliqueo M., Chouinard-Watkins R., Valenzuela R.. Impact of Maternal Obesity on the Metabolism and Bioavailability of Polyunsaturated Fatty Acids during Pregnancy and Breastfeeding. Nutrients. 2020 doi:10.3390/nu13010019 PubMed
91. Fujimori M., França E.L., Fiorin V., Morais T.C., Honorio-França A.C., de Abreu L.C.. Changes in the Biochemical and Immunological Components of Serum and Colostrum of Overweight and Obese Mothers. BMC Pregnancy Childbirth. 2015 doi:10.1186/s12884-015-0574-4 PubMed
92. Fujimori M., França E.L., Morais T.C., Fiorin V., de Abreu L.C., Honório-França A.C.. Cytokine and Adipokine Are Biofactors Can Act in Blood and Colostrum of Obese Mothers. BioFactors. 2017 doi:10.1002/biof.1339 PubMed
93. Young B.E., Patinkin Z.W., Pyle L., de la Houssaye B., Davidson B.S., Geraghty S. et al. Markers of Oxidative Stress in Human Milk Do Not Differ by Maternal BMI But Are Related to Infant Growth Trajectories. Matern. Child Health J.. 2017 doi:10.1007/s10995-016-2243-2 PubMed
94. Collado M.C., Laitinen K., Salminen S., Isolauri E.. Maternal Weight and Excessive Weight Gain during Pregnancy Modify the Immunomodulatory Potential of Breast Milk. Pediatr. Res.. 2012 doi:10.1038/pr.2012.42 PubMed
95. Piñeiro-Salvador R., Vazquez-Garza E., Cruz-Cardenas J.A., Licona-Cassani C., García-Rivas G., Moreno-Vásquez J. et al. A Cross-Sectional Study Evidences Regulations of Leukocytes in the Colostrum of Mothers with Obesity. BMC Med.. 2022 doi:10.1186/s12916-022-02575-y PubMed
96. Colleluori G., Perugini J., Barbatelli G., Cinti S.. Mammary Gland Adipocytes in Lactation Cycle, Obesity and Breast Cancer. Rev. Endocr. Metab. Disord.. 2021 doi:10.1007/s11154-021-09633-5 PubMed
97. Denizli M., Capitano M.L., Kua K.L.. Maternal Obesity and the Impact of Associated Early-Life Inflammation on Long-Term Health of Offspring. Front. Cell Infect. Microbiol.. 2022 doi:10.3389/fcimb.2022.940937 PubMed
98. Amaro A., Baptista F.I., Matafome P.. Programming of Future Generations during Breastfeeding: The Intricate Relation between Metabolic and Neurodevelopment Disorders. Life Sci.. 2022 doi:10.1016/j.lfs.2022.120526 PubMed
99. Suarez-Trujillo A., Huff K., Ramires Ferreira C., Paschoal Sobreira T.J., Buhman K.K., Casey T.. High-Fat-Diet Induced Obesity Increases the Proportion of Linoleic Acyl Residues in Dam Serum and Milk and in Suckling Neonate Circulation. Biol. Reprod.. 2020 doi:10.1093/biolre/ioaa103 PubMed
100. Wijenayake S., Martz J., Lapp H.E., Storm J.A., Champagne F.A., Kentner A.C.. The Contributions of Parental Lactation on Offspring Development: It’s Not Udder Nonsense!. Horm. Behav.. 2023 doi:10.1016/j.yhbeh.2023.105375 PubMed
101. Howie G.J., Sloboda D.M., Kamal T., Vickers M.H.. Maternal Nutritional History Predicts Obesity in Adult Offspring Independent of Postnatal Diet. J. Physiol.. 2009 doi:10.1113/jphysiol.2008.163477 PubMed
102. Brunner S., Schmid D., Zang K., Much D., Knoeferl B., Kratzsch J. et al. Breast Milk Leptin and Adiponectin in Relation to Infant Body Composition up to 2 Years. Pediatr. Obes.. 2015 doi:10.1111/j.2047-6310.2014.222.x PubMed
103. Grunewald M., Hellmuth C., Demmelmair H., Koletzko B.. Excessive Weight Gain during Full Breast-Feeding. Ann. Nutr. Metab.. 2014 doi:10.1159/000365033 PubMed
104. Sapra A., Bhandari P.. Diabetes. StatPearls. 2023
105. Patel N., Hameed A., Banerjee A.. Pre-Existing Type I and Type II Diabetes in Pregnancy. Obstet. Gynaecol. Reprod. Med.. 2014 doi:10.1016/j.ogrm.2014.03.002
106. Peila C., Gazzolo D., Bertino E., Cresi F., Coscia A.. Influence of Diabetes during Pregnancy on Human Milk Composition. Nutrients. 2020 doi:10.3390/nu12010185 PubMed
107. Wang H., Li N., Chivese T., Werfalli M., Sun H., Yuen L. et al. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria. Diabetes Res. Clin. Pract.. 2022 doi:10.1016/j.diabres.2021.109050 PubMed
108. Mellitus G.D.. ACOG Practice Bulletin No. 201: Pregestational Diabetes Mellitus. Obstet. Gynecol.. 2018 doi:10.1097/AOG.0000000000002960 PubMed
109. Modzelewski R., Stefanowicz-Rutkowska M.M., Matuszewski W., Bandurska-Stankiewicz E.M.. Gestational Diabetes Mellitus—Recent Literature Review. J. Clin. Med.. 2022 doi:10.3390/jcm11195736 PubMed
110. Korkut S., Köse Çetinkaya A., Işık Ş., Özel Ş., Gökay N., Şahin A. et al. Macronutrient Composition of Colostrum in Mothers with Gestational Diabetes Mellitus. Breastfeed. Med.. 2022 doi:10.1089/bfm.2021.0209 PubMed
111. Dritsakou K., Liosis G., Valsami G., Polychronopoulos E., Skouroliakou M.. The Impact of Maternal- and Neonatal-Associated Factors on Human Milk’s Macronutrients and Energy. J. Matern. Fetal Neonatal Med.. 2017 doi:10.1080/14767058.2016.1212329 PubMed
112. Avellar A.C.D.S., Oliveira M.N., Caixeta F., Souza R.C.V.E., Teixeira A., Faria A.M.C. et al. Gestational Diabetes Mellitus Changes Human Colostrum Immune Composition. Front. Immunol.. 2022 doi:10.3389/fimmu.2022.910807 PubMed
113. Suwaydi M.A., Zhou X., Perrella S.L., Wlodek M.E., Lai C.T., Gridneva Z. et al. The Impact of Gestational Diabetes Mellitus on Human Milk Metabolic Hormones: A Systematic Review. Nutrients. 2022 doi:10.3390/nu14173620 PubMed
114. Smilowitz J.T., Totten S.M., Huang J., Grapov D., Durham H.A., Lammi-Keefe C.J. et al. Human Milk Secretory Immunoglobulin a and Lactoferrin N-Glycans Are Altered in Women with Gestational Diabetes Mellitus. J. Nutr.. 2013 doi:10.3945/JN.113.180695 PubMed
115. Jackson M., Lammi-Keefe C., Jensen R., Couch S., Ferris A.. Total Lipid and Fatty Acid Composition of Milk from Women with and without Insulin-Dependent Diabetes Mellitus. Am. J. Clin. Nutr.. 1994 doi:10.1093/ajcn/60.3.353 PubMed
116. Butte N.F., Garza C., Burr R., Goldman A.S., Kennedy K., Kitzmiller J.L.. Milk Composition of Insulin-Dependent Diabetic Women. J. Pediatr. Gastroenterol. Nutr.. 1987 doi:10.1097/00005176-198711000-00020 PubMed
117. Elbeltagi R., Al-Beltagi M., Saeed N.K., Bediwy A.S.. Cardiometabolic Effects of Breastfeeding on Infants of Diabetic Mothers. World J. Diabetes. 2023 doi:10.4239/wjd.v14.i5.617 PubMed
118. Plagemann A., Harder T., Franke K., Kohlhoff R.. Long-Term Impact of Neonatal Breast-Feeding on Body Weight and Glucose Tolerance in Children of Diabetic Mothers. Diabetes Care. 2002 doi:10.2337/diacare.25.1.16 PubMed
119. Ibrahim M., Asuka E., Jialal I.. Hypercholesterolemia. 2023 PubMed
120. The Global Health Observatory
121. Cho S., Han E.. Association of Breastfeeding Duration with Dyslipidemia in Women Aged over 20 Years: Korea National Health and Nutrition Examination Survey 2010–2014. J. Clin. Lipidol.. 2018 doi:10.1016/j.jacl.2018.01.009 PubMed
122. Martin R.M., Ebrahim S., Griffin M., Smith G.D., Nicolaides A.N., Georgiou N. et al. Breastfeeding and Atherosclerosis: Intima-Media Thickness and Plaques at 65-Year Follow-up of the Boyd Orr Cohort. Arterioscler. Thromb. Vasc. Biol.. 2005 doi:10.1161/01.ATV.0000170129.20609.49 PubMed
123. Gunderson E.P., Lewis C.E., Wei G.S., Whitmer R.A., Quesenberry C.P., Sidney S.. Lactation and Changes in Maternal Metabolic Risk Factors. Obstet. Gynecol.. 2007 doi:10.1097/01.AOG.0000252831.06695.03 PubMed
124. Magnus M.C., Wallace M.K., Demirci J.R., Catov J.M., Schmella M.J., Fraser A.. Breastfeeding and Later-Life Cardiometabolic Health in Women with and Without Hypertensive Disorders of Pregnancy. J. Am. Heart Assoc.. 2023 doi:10.1161/JAHA.122.026696 PubMed
125. Perrine C.G., Nelson J.M., Corbelli J., Scanlon K.S.. Lactation and Maternal Cardio-Metabolic Health. Annu. Rev. Nutr.. 2016 doi:10.1146/annurev-nutr-071715-051213 PubMed
126. Kallio M.J.T., Siimes M.A., Perheentupa J., Salmenperä L., Miettinen T.A.. Serum Cholesterol and Lipoprotein Concentrations in Mothers during and after Prolonged Exclusive Lactation. Metabolism. 1992 doi:10.1016/0026-0495(92)90103-H PubMed
127. Wild R., Kenneth F.. Effect of Pregnancy on Lipid Metabolism and Lipoprotein Levels. Endotext. 2023
128. O’Higgins A.C., O’Dwyer V., O’Connor C., Daly S.F., Kinsley B.T., Turner M.J.. Postpartum Dyslipidaemia in Women Diagnosed with Gestational Diabetes Mellitus. Ir. J. Med. Sci.. 2017 doi:10.1007/s11845-016-1474-y PubMed
129. Pei L., Xiao H., Lai F., Li Z., Li Z., Yue S. et al. Early Postpartum Dyslipidemia and Its Potential Predictors during Pregnancy in Women with a History of Gestational Diabetes Mellitus. Lipids Health Dis.. 2020 doi:10.1186/s12944-020-01398-1 PubMed
130. Chodick G., Tenne Y., Barer Y., Shalev V., Elchalal U.. Gestational Diabetes and Long-Term Risk for Dyslipidemia: A Population-Based Historical Cohort Study. BMJ Open Diabetes Res. Care. 2020 doi:10.1136/bmjdrc-2019-000870 PubMed
131. Leiva A., de Medina C.D., Guzmán-Gutierrez E., Pardo F., Sobrevia L.. Maternal Hypercholesterolemia in Gestational Diabetes and the Association with Placental Endothelial Dysfunction. Gestational Diabetes—Causes, Diagnosis and Treatment. 2013
132. Montes A., Walden C.E., Knopp R.H., Cheung M., Chapman M.B., Albers J.J.. Physiologic and Supraphysiologic Increases in Lipoprotein Lipids and Apoproteins in Late Pregnancy and Postpartum. Possible Markers for the Diagnosis of “Prelipemia”. Arteriosclerosis. 1984 doi:10.1161/01.ATV.4.4.407 PubMed
133. Liguori A., D’Armiento F.P., Palagiano A., Palinski W., Napoli C.. Maternal C-Reactive Protein and Developmental Programming of Atherosclerosis. Am. J. Obstet. Gynecol.. 2008 doi:10.1016/j.ajog.2007.11.027 PubMed
134. Napoli C., D’Armiento F.P., Mancini F.P., Postiglione A., Witztum J.L., Palumbo G. et al. Fatty Streak Formation Occurs in Human Fetal Aortas and Is Greatly Enhanced Maternal, Hypercholesterolemia. J. Clin. Investig.. 1997 doi:10.1172/JCI119813 PubMed
135. Napoli C., Witztum J.L., De Nigris F., Palumbo G., D’Armiento F.P., Palinski W.. Intracranial Arteries of Human Fetuses Are More Resistant to Hypercholesterolemia-Induced Fatty Streak Formation than Extracranial Arteries. Circulation. 1999 doi:10.1161/01.CIR.99.15.2003 PubMed
136. Potter J.M., Nestel P.J.. The Hyperlipidemia of Pregnancy in Normal and Complicated Pregnancies. Am. J. Obstet. Gynecol.. 1979 doi:10.1016/0002-9378(79)90469-1 PubMed
137. Stiphout W.A.H.J.V., Hofman A., Bruijn A.M.D.. Serum Lipids in Young Women before, during, and after Pregnancy. Am. J. Epidemiol.. 1987 doi:10.1093/oxfordjournals.aje.a114729 PubMed
138. Jimenez D.M., Pocovi M., Ramon-Cajal J., Romero M.A., Martinez H., Grande F.. Longitudinal Study of Plasma Lipids and Lipoprotein Cholesterol in Normal Pregnancy and Puerperium. Gynecol. Obstet. Investig.. 1988 doi:10.1159/000293765 PubMed
139. Loke D.F.M., Viegas O.A.C., Kek L.P., Rauff M., Thai A.C., Ratnam S.S.. Lipid Profiles during and after Normal Pregnancy. Gynecol. Obstet. Investig.. 1991 doi:10.1159/000293016 PubMed
140. An-Na C., Man-Li Y., Jeng-Hsiu H., Pesus C., Shin-Kuo S., Heung-Tat N.. Alterations of Serum Lipid Levels and Their Biological Relevances during and after Pregnancy. Life Sci.. 1995 doi:10.1016/0024-3205(95)00230-4 PubMed
141. Desoye G., Schweditsch M.O., Pfeiffer K.P., Zechner R., Kostner G.M.. Correlation of Hormones with Lipid and Lipoprotein Levels during Normal Pregnancy and Postpartum. J. Clin. Endocrinol. Metab.. 1987 doi:10.1210/jcem-64-4-704 PubMed
142. Koukkou E., Watts G.F., Lowy C.. Serum Lipid, Lipoprotein and Apolipoprotein Changes in Gestational Diabetes Mellitus: A Cross-Sectional and Prospective Study. J. Clin. Pathol.. 1996 doi:10.1136/jcp.49.8.634 PubMed
143. Van Dam R.M., Schuit A.J., Schouten E.G., Vader H.L., Pop V.J.M.. Serum Cholesterol Decline and Depression in the Postpartum Period. J. Psychosom. Res.. 1999 doi:10.1016/S0022-3999(98)00100-7 PubMed
144. Troisi A., Moles A., Panepuccia L., Lo Russo D., Palla G., Scucchi S.. Serum Cholesterol Levels and Mood Symptoms in the Postpartum Period. Psychiatry Res.. 2002 doi:10.1016/S0165-1781(02)00020-3 PubMed
145. Wiznitzer A., Mayer A., Novack V., Sheiner E., Gilutz H., Malhotra A. et al. Association of Lipid Levels During Gestation With Preeclampsia and Gestational Diabetes Mellitus: A Population-Based Study. Am. J. Obstet. Gynecol.. 2009 doi:10.1016/j.ajog.2009.05.032 PubMed
146. Retnakaran R., Qi Y., Connelly P.W., Sermer M., Hanley A.J., Zinman B.. The Graded Relationship between Glucose Tolerance Status in Pregnancy and Postpartum Levels of Low-Density-Lipoprotein Cholesterol and Apolipoprotein B in Young Women: Implications for Future Cardiovascular Risk. J. Clin. Endocrinol. Metab.. 2010 doi:10.1210/jc.2010-0361 PubMed
147. Prairie B.A., Wisniewski S.R., Luther J.F., Sit D., Wisner K.L.. Postpartum Lipid Levels in Women with Major Depression. J. Womens Health. 2012 doi:10.1089/jwh.2011.3256 PubMed
148. Nouhjah S., Shahbazian H., Jahanfar S., Shahbazian N., Jahanshahi A., Cheraghian B. et al. Early Postpartum Lipid Profile in Women with and without Gestational Diabetes Mellitus: Results of a Prospective Cohort Study. Iran. Red. Crescent Med. J.. 2017 doi:10.5812/ircmj.13097
149. Wen C., Metcalfe A., Anderson T.J., Johnson J.A., Sigal R.J., Nerenberg K.A.. Measurement of Lipid Profiles in the Early Postpartum Period after Hypertensive Disorders of Pregnancy. J. Clin. Lipidol.. 2019 doi:10.1016/j.jacl.2019.10.002 PubMed
150. Mendieta-Zerón H.. Dyslipidemia Is a Persistent Problem in Puerperium with or Without Preeclampsia PubMed
151. Lin C.-H., Wen S.-F., Wu Y.-H., Huang Y.-Y., Huang M.-J.. The Postpartum Metabolic Outcome of Women with Previous Gestational Diabetes Mellitus. Change Gung Med. J.. 2005 PubMed
152. Troisi A., Croce Nanni R.. Normal Cholesterol Levels in the Immediate Postpartum Period: A Risk Factor for Depressive and Anxiety Symptoms?. Psychiatry Res.. 2018 doi:10.1016/j.psychres.2018.08.099 PubMed
153. Lim S., Harrison C., Callander E., Walker R., Teede H., Moran L.. Addressing Obesity in Preconception, Pregnancy, and Postpartum: A Review of the Literature. Curr. Obes. Rep.. 2022 doi:10.1007/s13679-022-00485-x PubMed
154. Kyle E.M., Miller H.B., Schueler J., Clinton M., Alexander B.M., Hart A.M. et al. Changes in Bone Mineral Density and Serum Lipids across the First Postpartum Year: Effect of Aerobic Fitness and Physical Activity. Nutrients. 2022 doi:10.3390/nu14030703 PubMed
155. Mizuno O., Toriumi T., Tsutsumi N.. The Influence of Weight Changes in Pregnancy and Postpartum on Serum Total Cholesterol or Triglyceride. Acta Obstet. Gynaecol. Jpn.. 1984 PubMed
156. Puhkala J., Luoto R., Ahotupa M., Raitanen J., Vasankari T.. Postpartum Weight Retention Is Associated with Elevated Ratio of Oxidized LDL Lipids to HDL-Cholesterol. Lipids. 2013 doi:10.1007/s11745-013-3852-9 PubMed
157. Wahabi H.A., Fayed A.A., Tharkar S., Esmaeil S.A., Bakhsh H.. Postpartum Weight Retention and Cardiometabolic Risk among Saudi Women: A Follow-Up Study of RAHMA Subcohort. Biomed. Res. Int.. 2019 doi:10.1155/2019/2957429 PubMed
158. Zhang H., Wu L., Wu X., Chen Y., Tian F.Y., Yin A. et al. Maternal BMI Changes from the Prepregnancy to Postpartum Period Are Associated with Postpartum Cardiometabolic Risk Factors: A Longitudinal Study. Arch. Gynecol. Obstet.. 2023 doi:10.1007/s00404-023-07154-x PubMed
159. Hong D.K., Cho H.Y., Kim J.Y., Park H.J., Cha D.H., Shim S.S. et al. Intrapartum Factors Affecting Abnormal Lipid Profiles in Early Postpartum Period. J. Pers. Med.. 2023 doi:10.3390/jpm13030444 PubMed
160. Deslypere J.P., Van Trappen Y., Thiery M.. Influence of Parity on Plasma Lipid Levels. Eur. J. Obstet. Gynecoioa Reprod. Biol.. 1990 doi:10.1016/0028-2243(90)90135-N PubMed
161. Gaillard R., Rurangirwa A.A., Williams M.A., Hofman A., MacKenbach J.P., Franco O.H. et al. Maternal Parity, Fetal and Childhood Growth, and Cardiometabolic Risk Factors. Hypertension. 2014 doi:10.1161/HYPERTENSIONAHA.114.03492 PubMed
162. Knopp R.H., Walden C.E., Wahl P.W., Bergelin R., Chapman M., Irvine S. et al. Effect of Postpartum Lactation on Lipoprotein Lipids and Apoproteins. J. Clin. Endocrinol. Metab.. 1985 doi:10.1210/jcem-60-3-542 PubMed
163. Schwarz E.B., Brown J.S., Creasman J.M., Stuebe A., McClure C.K., Van Den Eeden S.K. et al. Lactation and Maternal Risk of Type 2 Diabetes: A Population-Based Study. Am. J. Med.. 2010 doi:10.1016/j.amjmed.2010.03.016 PubMed
164. Tørris C., Thune I., Emaus A., Finstad S.E., Bye A., Furberg A.S. et al. Duration of Lactation, Maternal Metabolic Profile, and Body Composition in the Norwegian EBBA I-Study. Breastfeed. Med.. 2013 doi:10.1089/bfm.2012.0048 PubMed
165. Niu Z., Naya C.H., Reynaga L., Toledo-Corral C.M., Johnson M., Yang T. et al. Association of Breastfeeding Duration with 12-Month Postpartum Blood Lipids in a Predominately Lower-Income Hispanic Pregnancy Cohort in Los Angeles. Int. J. Environ. Res. Public Health. 2022 doi:10.3390/ijerph19053008 PubMed
166. Rymer J., Constable S., Lumb P., Crook M.. Serum Lipoprotein (A) and Apolipoproteins during Pregnancy and Postpartum in Normal Women. J. Obstet. Gynaecol.. 2002 doi:10.1080/01443610220130517 PubMed
167. Lim S., Liang X., Hill B., Teede H., Moran L.J., O’Reilly S.. A Systematic Review and Meta-Analysis of Intervention Characteristics in Postpartum Weight Management Using the TIDieR Framework: A Summary of Evidence to Inform Implementation. Obes. Rev.. 2019 doi:10.1111/obr.12846 PubMed
168. Shalowitz M.U., Schetter C.D., Hillemeier M.M., Chinchilli V.M., Adam E.K., Hobel C.J. et al. Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity and Poverty Status. Am. J. Perinatol.. 2019 doi:10.1055/s-0038-1675618 PubMed
169. Yang Z., Jiang R., Li H., Wang J., Duan Y., Pang X. et al. Human Milk Cholesterol Is Associated with Lactation Stage and Maternal Plasma Cholesterol in Chinese Populations. Pediatr. Res.. 2021 doi:10.1038/s41390-021-01440-7 PubMed
170. Tinius R.A., Yoho K., Blankenship M.M., Maples J.M.. Postpartum Metabolism: How Does It Change from Pregnancy and What Are the Potential Implications?. Int. J. Womens Health. 2021 doi:10.2147/IJWH.S314469 PubMed
171. Bagheri B., Alikhani A., Mokhtari H., Rasouli M.. The Ratio of Unesterified/Esterified Cholesterol Is the Major Determinant of Atherogenicity of Lipoprotein Fractions. Med. Arch.. 2018 doi:10.5455/medarh.2018.72.103-107 PubMed
172. Qureshi I.A.. Hyperlipidaemia During Normal Pregnancy, Parturition and Lactation PubMed
173. Clark R.M., Ferris A.M., Fey M., Brown P.B., Hundrieser K.E., Jensen R.G.. Changes in the Lipids of Human Milk from 2 to 16 Weeks Postpartum. J. Pediatr. Gastron. Nutr.. 1982 doi:10.1097/00005176-198201030-00006 PubMed
174. Hromadnikova I., Dvorakova L., Kotlabova K., Krofta L.. The Prediction of Gestational Hypertension, Preeclampsia and Fetal Growth Restriction via the First Trimester Screening of Plasma Exosomal C19MC MicroRNAs. Int. J. Mol. Sci.. 2019 doi:10.3390/ijms20122972 PubMed
175. Jensen R.G.. Lipids in Human Milk. Lipids. 1999 doi:10.1007/s11745-999-0477-2 PubMed
176. Hromadová M., Ponec J., Macková M.. Cholesterol and Triacylglycerols in Human Breast Milk before and after Nursing. Endocr. Regul.. 1991 PubMed
177. Donda K., Maheshwari A.. Human Milk Lipids Induce Important Metabolic and Epigenetic Changes in Neonates. Clin. Perinatol.. 2022 doi:10.1016/j.clp.2022.02.006 PubMed
178. Kallio M.J.T., Siimes M.A., Perheentupa J., Salmenpera L., Miettinen T.A.. Cholesterol and Its Precursors in Human Milk during Prolonged Exclusive Breast-Feeding. Am. J. Clin. Nutr.. 1989 doi:10.1093/ajcn/50.4.782 PubMed
179. Hypertension
180. Xavier I.M., Simões A.C.Z., Oliveira R.D., Barros Y.E., Sarmento A.C.A., Medeiros K.S.D. et al. Maternal-Fetal Outcomes of Women with Hypertensive Disorders of Pregnancy. Rev. Assoc. Med. Bras.. 2023 doi:10.1590/1806-9282.20230060 PubMed
181. Yang Q.. Literature Overview of Association Between Preeclampsia and Cardiovascular Risk. Anatol. J. Cardiol.. 2023 doi:10.14744/AnatolJCardiol.2023.2865 PubMed
182. Agrawal A., Wenger N.K.. Hypertension During Pregnancy. Curr. Hypertens. Rep.. 2020 doi:10.1007/s11906-020-01070-0 PubMed
183. Lugobe H.M., Kayondo M., Mceniery C.M., Catov J.M., Wilkinson I.B., Wylie B.J. et al. Persistent Hypertension at 3 Months Postpartum among Women with Hypertensive Disorders of Pregnancy at a Tertiary Hospital in Southwestern Uganda. AJOG Glob. Rep.. 2023 doi:10.1016/j.xagr.2023.100163 PubMed
184. Ishaku S.M., Jamilu T., Innocent A.P., Gbenga K.A., Lamaran D., Lawal O. et al. Persistent Hypertension Up to One Year Postpartum among Women with Hypertensive Disorders in Pregnancy in a Low-Resource Setting: A Prospective Cohort Study. Glob. Heart. 2021 doi:10.5334/gh.854 PubMed
185. Zhang B.Z., Zhang H.Y., Liu H.H., Li H.J., Wang J.S.. Breastfeeding and Maternal Hypertension and Diabetes: A Population-Based Cross-Sectional Study. Breastfeed. Med.. 2015 doi:10.1089/bfm.2014.0116 PubMed
186. Bonifacino E., Schwartz E.B., Jun H., Wessel C.B., Corbelli J.A.. Effect of Lactation on Maternal Hypertension: A Systematic Review. Breastfeed. Med.. 2018 doi:10.1089/bfm.2018.0108 PubMed
187. Countouris M.E., Schwarz E.B., Rossiter B.C., Althouse A.D., Berlacher K.L., Jeyabalan A. et al. Effects of Lactation on Postpartum Blood Pressure among Women with Gestational Hypertension and Preeclampsia. Am. J. Obstet. Gynecol.. 2016 doi:10.1016/j.ajog.2016.02.046 PubMed
188. Murase M., Nommsen-Rivers L., Morrow A.L., Hatsuno M., Mizuno K., Taki M. et al. Predictors of Low Milk Volume among Mothers Who Delivered Preterm. J. Hum. Lact.. 2014 doi:10.1177/0890334414543951 PubMed
189. Horsley K., Chaput K., Da Costa D., Nguyen T.V., Dayan N., Tomfohr-Madsen L. et al. Hypertensive Disorders of Pregnancy and Breastfeeding Practices: A Secondary Analysis of Data from the All Our Families Cohort. Acta Obstet. Gynecol. Scand.. 2022 doi:10.1111/aogs.14378 PubMed
190. Strapasson M.R., Ferreira C.F., Ramos J.G.L.. Feeding Practices in the First 6 months after Delivery: Effects of Gestational Hypertension. Pregnancy Hypertens.. 2018 doi:10.1016/j.preghy.2018.07.002 PubMed
191. Amaral Y., Marano D., Oliveira E., Moreira M.E.. Impact of Pre-Pregnancy Excessive Body Weight on the Composition of Polyunsaturated Fatty Acids in Breast Milk: A Systematic Review. Int. J. Food Sci. Nutr.. 2020 doi:10.1080/09637486.2019.1646713 PubMed
192. Sokołowska E.M., Jassem-Bobowicz J.M., Drążkowska I., Świąder Z., Domżalska-Popadiuk I.. Gestational Hypertension and Human Breast Milk Composition in Correlation with the Assessment of Fetal Growth-A Pilot Study. Nutrients. 2023 doi:10.3390/nu15102404 PubMed
193. Moreira M.E.L., Lucena S.L., De Magalhães P.S.C., Rocha A.D., Costa A.C.C., Soares F.V.M.. Macronutrients of mothers’ milk of very low birth weight infants: Analysis according to gestational age and maternal variables. Rev. Paul. Pediatr.. 2021 doi:10.1590/1984-0462/2021/39/2019097 PubMed
194. Beser E., Kose Cetinkaya A., Kucukoglu Keser M., Okman E., Sari F.N., Alyamac Dizdar E.. Evaluation of Breast Milk Macronutrient Content in Preeclamptic Mothers. Breastfeed. Med.. 2022 doi:10.1089/bfm.2021.0249 PubMed
195. Dangat K., Upadhyay D., Kilari A., Sharma U., Kemse N., Mehendale S. et al. Altered Breast Milk Components in Preeclampsia; An in-Vitro Proton NMR Spectroscopy Study. Clin. Chim. Acta. 2016 doi:10.1016/j.cca.2016.10.015 PubMed
196. Bardanzellu F., Puddu M., Peroni D.G., Fanos V.. The Human Breast Milk Metabolome in Overweight and Obese Mothers. Front. Immunol.. 2020 doi:10.3389/fimmu.2020.01533 PubMed
197. Dangat K.D., Mehendale S.S., Yadav H.R., Kilari A.S., Kulkarni A.V., Taralekar V.S. et al. Long-Chain Polyunsaturated Fatty Acid Composition of Breast Milk in Pre-Eclamptic Mothers. Neonatology. 2010 doi:10.1159/000252971 PubMed
198. Dangat K., Kilari A., Mehendale S., Lalwani S., Joshi S.. Preeclampsia Alters Milk Neurotrophins and Long Chain Polyunsaturated Fatty Acids. Int. J. Devl. Neurosci.. 2014 doi:10.1016/j.ijdevneu.2013.12.007 PubMed
199. Rochlani Y., Pothineni N.V., Kovelamudi S., Mehta J.L.. Metabolic Syndrome: Pathophysiology, Management, and Modulation by Natural Compounds. Ther. Adv. Cardiovasc. Dis.. 2017 doi:10.1177/1753944717711379 PubMed
200. Alberti K.G.M.M., Zimmet P., Shaw J.. Metabolic Syndrome—A New World-wide Definition. A Consensus Statement from the International Diabetes Federation. Diabet. Med.. 2006 doi:10.1111/j.1464-5491.2006.01858.x PubMed
201. Zeng K., Wang S., Zhang L., Zhang Y., Ma J.. Gender Differences in Prevalence and Associated Factors of Metabolic Syndrome in First-Treatment and Drug-Naïve Schizophrenia Patients. Ann. Gen. Psychiatry. 2023 doi:10.1186/s12991-023-00455-0 PubMed
202. Jayasinghe I.U., Agampodi T.C., Dissanayake A.K., Agampodi S.B.. Early Pregnancy Metabolic Syndrome and Risk for Adverse Pregnancy Outcomes: Findings from Rajarata Pregnancy Cohort (RaPCo) in Sri Lanka. BMC Pregnancy Childbirth. 2023 doi:10.1186/s12884-023-05548-y PubMed
203. Grieger J.A., Bianco-Miotto T., Grzeskowiak L.E., Leemaqz S.Y., Poston L., McCowan L.M. et al. Metabolic Syndrome in Pregnancy and Risk for Adverse Pregnancy Outcomes: A Prospective Cohort of Nulliparous Women. PLoS Med.. 2018 doi:10.1371/journal.pmed.1002710 PubMed
204. Alonso-Ventura V., Li Y., Pasupuleti V., Roman Y.M., Hernandez A.V., Pérez-López F.R.. Effects of Preeclampsia and Eclampsia on Maternal Metabolic and Biochemical Outcomes in Later Life: A Systematic Review and Meta-Analysis. Metabolism. 2020 doi:10.1016/j.metabol.2019.154012 PubMed
205. Vernini J.M., Nicolosi B.F., Arantes M.A., Costa R.A., Magalhães C.G., Corrente J.E. et al. Metabolic Syndrome Markers and Risk of Hyperglycemia in Pregnancy: A Cross-Sectional Cohort Study. Sci. Rep.. 2020 doi:10.1038/s41598-020-78099-3 PubMed
206. Bodnar L.M., Jin Q., Naimi A.I., Simhan H.N., Catov J.M., Parisi S.M. et al. Periconceptional Dietary Quality and Metabolic Syndrome at 3 Years Postpartum. J. Am. Heart Assoc.. 2024 doi:10.1161/JAHA.124.035555 PubMed
207. Tørris C., Bjørnnes A.K.. Duration of Lactation and Maternal Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis. Nutrients. 2020 doi:10.3390/nu12092718 PubMed
208. Matsunaga T., Kadomatsu Y., Tsukamoto M., Kubo Y., Okada R., Nagayoshi M. et al. Associations of Breastfeeding History with Metabolic Syndrome and Cardiovascular Risk Factors in Community-Dwelling Parous Women: The Japan Multi-Institutional Collaborative Cohort Study. PLoS ONE. 2022 doi:10.1371/journal.pone.0262252 PubMed
209. Lee J.S., Choi E.S., Lee H., Son S., Lee K.S., Ahn K.H.. Machine Learning Analysis for the Association between Breast Feeding and Metabolic Syndrome in Women. Sci. Rep.. 2024 doi:10.1038/s41598-024-53137-6 PubMed
210. Farahmand M., Rahmati M., Azizi F., Ramezani Tehrani F.. Lactation Duration and Lifetime Progression to Metabolic Syndrome in Women According to Their History of Gestational Diabetes: A Prospective Longitudinal Community-Based Cohort Study. J. Transl. Med.. 2023 doi:10.1186/s12967-023-04005-w PubMed
211. Picó C., Reis F., Egas C., Mathias P., Matafome P.. Lactation as a Programming Window for Metabolic Syndrome. Eur. J. Clin. Investig.. 2021 doi:10.1111/eci.13482 PubMed
212. Zempleni J., Aguilar-Lozano A., Sadri M., Sukreet S., Manca S., Wu D. et al. Biological Activities of Extracellular Vesicles and Their Cargos from Bovine and Human Milk in Humans and Implications for Infants. J. Nutr.. 2017 doi:10.3945/jn.116.238949 PubMed
213. Carrillo-Lozano E., Sebastián-Valles F., Knott-Torcal C.. Circulating MicroRNAs in Breast Milk and Their Potential Impact on the Infant. Nutrients. 2020 doi:10.3390/nu12103066 PubMed
214. Chutipongtanate S., Morrow A.L., Newburg D.S.. Human Milk Extracellular Vesicles: A Biological System with Clinical Implications. Cells. 2022 doi:10.3390/cells11152345 PubMed
215. Melnik B.C., Stremmel W., Weiskirchen R., John S.M., Schmitz G.. Exosome-Derived MicroRNAs of Human Milk and Their Effects on Infant Health and Development. Biomolecules. 2021 doi:10.3390/biom11060851 PubMed
216. Karlsson O., Rodosthenous R.S., Jara C., Brennan K.J., Wright R.O., Baccarelli A.A. et al. Detection of Long Non-Coding RNAs in Human Breastmilk Extracellular Vesicles: Implications for Early Child Development. Epigenetics. 2016 doi:10.1080/15592294.2016.1216285 PubMed
217. Kahn S., Liao Y., Du X., Xu W., Li J., Lönnerdal B.. Exosomal MicroRNAs in Milk from Mothers Delivering Preterm Infants Survive In Vitro Digestion and Are Taken Up by Human Intestinal Cells. Mol. Nutr. Food Res.. 2018 doi:10.1002/mnfr.201701050 PubMed
218. Shandilya S., Rani P., Onteru S.K., Singh D.. Small Interfering RNA in Milk Exosomes Is Resistant to Digestion and Crosses the Intestinal Barrier In Vitro. J. Agric. Food Chem.. 2017 doi:10.1021/acs.jafc.7b03123 PubMed
219. Liao Y., Du X., Li J., Lönnerdal B.. Human Milk Exosomes and Their MicroRNAs Survive Digestion in Vitro and Are Taken up by Human Intestinal Cells. Mol. Nutr. Food Res.. 2017 doi:10.1002/mnfr.201700082 PubMed
220. Gialeli G., Panagopoulou O., Liosis G., Siahanidou T.. Potential Epigenetic Effects of Human Milk on Infants’ Neurodevelopment. Nutrients. 2023 doi:10.3390/nu15163614 PubMed
221. Alsaweed M., Hartmann P., Geddes D., Kakulas F.. MicroRNAs in Breastmilk and the Lactating Breast: Potential Immunoprotectors and Developmental Regulators for the Infant and the Mother. Int. J. Environ. Res. Public Health. 2015 doi:10.3390/ijerph121113981 PubMed
222. Kupsco A., Prada D., Valvi D., Hu L., Petersen M.S., Coull B. et al. Human Milk Extracellular Vesicle MiRNA Expression and Associations with Maternal Characteristics in a Population-Based Cohort from the Faroe Islands. Sci. Rep.. 2021 doi:10.1038/s41598-021-84809-2 PubMed
223. Alsaweed M., Lai C.T., Hartmann P.E., Geddes D.T., Kakulas F.. Human Milk Cells and Lipids Conserve Numerous Known and Novel MiRNAs, Some of Which Are Differentially Expressed during Lactation. PLoS ONE. 2016 doi:10.1371/journal.pone.0152610 PubMed
224. Xi Y., Jiang X., Li R., Chen M., Song W., Li X.. The Levels of Human Milk MicroRNAs and Their Association with Maternal Weight Characteristics. Eur. J. Clin. Nutr.. 2016 doi:10.1038/ejcn.2015.168 PubMed
225. Hatmal M.M., Al-Hatamleh M.A.I., Olaimat A.N., Alshaer W., Hasan H., Albakri K.A. et al. Immunomodulatory Properties of Human Breast Milk: MicroRNA Contents and Potential Epigenetic Effects. Biomedicines. 2022 doi:10.3390/biomedicines10061219 PubMed
226. Mirza A.H., Kaur S., Nielsen L.B., Størling J., Yarani R., Roursgaard M. et al. Breast Milk-Derived Extracellular Vesicles Enriched in Exosomes from Mothers With Type 1 Diabetes Contain Aberrant Levels of MicroRNAs. Front. Immunol.. 2019 doi:10.3389/fimmu.2019.02543 PubMed
227. Shah K.B., Fields D.A., Pezant N.P., Kharoud H.K., Gulati S., Jacobs K. et al. Gestational Diabetes Mellitus Is Associated with Altered Abundance of Exosomal MicroRNAs in Human Milk. Clin. Ther.. 2022 doi:10.1016/j.clinthera.2022.01.005 PubMed
228. Shah K.B., Chernausek S.D., Garman L.D., Pezant N.P., Plows J.F., Kharoud H.K. et al. Human Milk Exosomal MicroRNA: Associations with Maternal Overweight/Obesity and Infant Body Composition at 1 Month of Life. Nutrients. 2021 doi:10.3390/nu13041091 PubMed
229. Słyk-Gulewska P., Kondracka A., Kwaśniewska A.. MicroRNA as a New Bioactive Component in Breast Milk. Noncoding RNA Res.. 2023 doi:10.1016/j.ncrna.2023.06.003 PubMed
230. Munch E.M., Harris R.A., Mohammad M., Benham A.L., Pejerrey S.M., Showalter L. et al. Transcriptome Profiling of MicroRNA by Next-Gen Deep Sequencing Reveals Known and Novel MiRNA Species in the Lipid Fraction of Human Breast Milk. PLoS ONE. 2013 doi:10.1371/journal.pone.0050564 PubMed