Contaminant Composition of Human Milk in the US: A Systematic Review
Bibliographic record
Abstract
Objectives:The US Food and Drug Administration aims to reduce contaminant exposure from foods, especially for infants and children.Dietary exposure to contaminants during pregnancy and lactation may impact contaminant levels in human milk (HM), potentially impacting fetal and child development.Therefore, we conducted a systematic review to describe arsenic, cadmium, lead, mercury, and per-and polyfluoroalkyl substances (PFAS) concentrations in HM in the US and document available evidence from other countries.Methods: The protocol was informed by a technical expert panel.The search strategy was developed by two evidence synthesis information specialists.CAB Abstracts, CENTRAL, CINAHL, Embase, and MEDLINE were searched for peerreviewed articles in English through October 18, 2024.Studies describing arsenic, cadmium, lead, mercury and PFAS concentrations in HM from countries rated 'high' or 'very high' on the Human Development Index (HDI) were included.Articles were independently screened at title/abstract and full text level by two reviewers.Data were synthesized narratively from US studies; data from other included countries were documented in evidence maps.Sample collection and analytic methods were reviewed by technical experts.ROBINS-E and GRADE were used to assess risk of bias and certainty of evidence, respectively.Results: From 8967 records identified, 322 articles described contaminants in HM, including 14 studies (3 prospective cohorts, 11 cross-sectional) with 870 participants from the US (arsenic n2, cadmium n2, lead n8, mercury n2, PFAS n4).Studies had some concerns or high risk of bias, largely due to selection bias and missing data.With moderate certainty, PFOA concentration in HM ranged from undetected to 36.1 pg/mL and PFOS ranged from undetected to 106 pg/mL in the US.The evidence for heavy metals, PFNA, or PFHxS in HM in the US was inconclusive due to small and unrepresentative samples, concerns about analytic methods, and outdated data.Conclusions: PFOA and PFOS were detected in HM in the US, but evidence about heavy metals was inconclusive.Future systematic reviews of evidence identified from other high to very high HDI countries could help address knowledge gaps and reduce contaminant exposure for pregnant and lactating individuals.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".