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Try out PMC Labs and tell us what you think. Learn More. Colostrum is the first ingested sole nutritional source for the newborn infant. The vitamin profile of colostrum depends on the maternal vitamin status, which in turn is influenced by diet and lifestyle. Yet, the relationship between maternal vitamin status and colostrum vitamin composition has not been systematically reviewed. This review was conducted with the aim to generate a comprehensive overview on the relationship between maternal serum plasma vitamin concentration and corresponding colostrum composition.

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Three electronic databases, Embase OvidMedline Ovidand Cochrane, were systematically searched based on predefined inclusion and exclusion criteria. Finally, a total of 11 eligible publications were included that examined the vitamins A, C, D, E, and K in both biological fluids. Maternal vitamin A, D, E, and K blood levels were unrelated to colostrum content of the respective vitamins, and serum vitamin A was inversely correlated with colostrum vitamin E.

Colostrum versus maternal serum vitamins were higher for vitamins A, C, and K, lower for vitamin D, and divergent were reported for vitamin E levels. Colostrum appears typically enriched in vitamin A, C, and K compared to maternal serum, possibly indicative of active mammary gland transport mechanisms. Exclusive breast feeding is recognised as the normative standard of infant feeding for the first six months of life, with continued breastfeeding for one to two years of life, or longer [ 12 ]. Human milk uniquely fits the human infant requirement, containing both nutritive and non-nutritive bioactive factors that promote survival and healthy development [ 3 ].

This biological fluid produced by the mammary glands has a rather complex composition, containing macronutrients fats, carbohydrates, proteinsmicronutrients vitamins and mineralsprotective factors e. Its composition is subject to dynamic changes within one feeding, with time of the day, over the lactation period, and between mothers and populations. In addition, it is influenced by maternal genetic and environmental factors, such as infection status [ 4 ] and maternal lifestyle, including dietary habits [ 56 ].

Human milk composition changes as lactation progresses, and based on the composition, the lactation period is divided into three different stages: Colostrum, transitional- Adult ladies im or more 37 Grafton 37 mature milk. Colostrum is the first fluid produced by the mother after delivery, and is distinct in appearance, composition, and volume. The first days postpartum, colostrum appears typically thick with a yellow hue and is produced in low quantities. Colostrum is rich in developmental factors, such as epidermal growth factor, as well as immunologic components, such as secretory IgA, lactoferrin, leukocytes [ 789 ].

In addition, it contains high amounts of protein, vitamin A, vitamin B12, and vitamin K [ 10 ], and low levels of lactose. As tight junction closure occurs in the mammary epithelium, a decline in sodium-potassium ratio and an incline in lactose concentration takes place, indicating secretory activation and transitional milk production. Transitional milk shares some of the characteristics of colostrum, but stands for a period of increased milk production that supports nutritional and developmental requirements of the rapidly growing infant from five days to two weeks postpartum.

After the first two weeks, the milk is considered largely mature. By four to six weeks postpartum, the fully mature stage is reached, after which the human milk composition remains relatively constant with only subtle changes occurring over the course of lactation.

Human milk nutritional components come from three sources: Maternal diet, maternal stores, and lactocyte nutrient production. Fats, oligosaccharides, and proteins compose the major digestible energy components of human milk. The mean macronutrient composition of mature, term milk is estimated to be approximately 0.

InNommsen et al. Vitamins and essential minerals and trace elements, together termed as micronutrients, are present in human milk with varying concentrations throughout lactation, ideally suiting the infant. Vitamins are defined as organic dietary compounds required by the human body in relatively small, yet essential quantities, for healthy growth, development and to sustain life. They are a group of compounds with functions ranging from essential cofactors for numerous enzymes to key regulators of gene expression and to antioxidant function.

They are important for metabolic processes, mineral homeostasis and bone development, vision, cognitive function, cardiovascular health, and immunity [ 151617 ]. A lack of vitamins in overt symptoms of deficiency related to these processes. Vitamins vary in polarity, which determines their way of transport through the body. The lipid-soluble vitamins A, D, E, and K require carrier proteins or lipoprotein vesicles for transport via the blood, whereas water soluble vitamins, such as thiamin B1riboflavin B2niacin B3pyridoxine B6cobalamin B12folate, biotin, panthothenic acid, and ascorbic acid vitamin Ceither circulate in blood freely or are bound to a carrier protein, with vitamin B6 and B12 as two examples.

The gestational period is nutritionally critical for maternal, foetal, and infant health. During these nine months, the mother provides the nutritional needs of the foetus and prepares for lactation by building up nutrient stores. In the subsequent exclusive breastfeeding period, lactating mothers are vulnerable to vitamin deficiency as the newborn feeds on her stores through milk ingestion. Accordingly, the dietary reference intakes DRIs of multiple vitamins are higher for lactating women, as set by the Food and Nutrition Board of the Institute of Medicine Table 1.

Adequate intake AI of vitamins in the first six months of life is calculated based on average intake values via maternal milk Table 1. For healthy infants receiving human milk, the Adequate Intake AI of a vitamin represents the mean intake. As vitamins are derived from the diet, the maternal dietary pattern is decisive for her vitamin status. The bioavailability of ingested vitamins in the organism is affected by several aspects, including physiological factors, such as nutritional status, amount of fat in the diet, food matrix, and interactions with other nutrients [ 19202122 ].

Newborns therefore depend on vitamin-rich early breast milk to replenish to replenish vitamin stores, and vitamin-sufficient later milk to maintain vitamin sufficiency. The maternal vitamin status is of crucial importance to sufficiently provide her newborn infant with vitamins, and micronutrient deficiency remains a critical health concern among pregnant and lactating women.

Considering that colostrum is the sole nutritive source for the infant in this period, it is key Adult ladies im or more 37 Grafton 37 understand the relation between the maternal vitamin status and the colostrum vitamin profile. This information would allow for nutritional optimisation in the maternal-infant dyad. We focused on healthy women and term infants in order to identify baseline data.

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No systematic review exists on the relationship between maternal serum plasma vitamin composition and human milk colostrum vitamin content. Available reviews have only investigated the impact of maternal status on serum levels of single vitamins. The amount of scientific articles assessing both maternal vitamin status and colostrum vitamin composition in healthy mothers of term infants is expected to be limited, since the vast majority of studies pertain to malnourished, vitamin-deficient populations, non-simultaneous blood and milk collection, and infant health outcomes.

Our systematic approach therefore fills a gap in the current knowledge. The databases Embase Ovid;Medline Ovid;and Cochrane Central Register of Controlled Trials were searched up to 11 October to identify studies examining the micronutrient composition of maternal plasma and breast milk.

In addition, the search was limited to the English language and term delivery. Search terms were adjusted according to the different databases using appropriate terms and truncation marks. Studies in humans published as full-length articles were selected.

To identify any other relevant publications, the electronic search was expanded by searching the reference lists of the selected publications. The aim of this project was to identify baseline data on the natural maternal micronutrient status and respective composition of human breast milk. Therefore, publications were excluded if they focused on participants that were confounded by known adverse conditions. These comprised mothers at higher risk of nutritional or metabolic disorders or with major chronic diseases e.

Case-control studies were excluded from the review because they represent extreme cases, rather than the natural range of a population. Secondary articles, review articles, editorials, as well as conference proceedings without published full text articles, were excluded. When multiple publications considered the same study population and outcome, we included only the most complete publication.

Insufficient information on the health status of the study population was regarded a limitation of the publication. Due to the confined time frame of the current project, the review output was further restricted to vitamin composition in colostrum first five days of lactationwherever blood plasma or serum samples were also analysed for vitamins.

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Publications that only reported levels of pro-vitamins without quantifying the active vitamin itself were excluded. Furthermore, studies were included only when maternal plasma and colostrum samples were reportedly obtained at the same time point. Prospective and retrospective studies randomised controlled trials, randomised controlled clinical trials, cohort studies, longitudinal studies were included if they investigated healthy lactating mothers of singleton infants. An overview of the inclusion and exclusion criteria is provided in the Table 2.

Predefined and restricted screening criteria. Along the lines of these inclusion and exclusion measures, titles, abstracts, and full texts were screened for eligibility. Using Covidence software, two investigators independently reviewed titles, abstracts, and full-text articles and assessed all potential studies that were identified as a result of the search strategy and were selected based on inclusion and exclusion criteria.

were then compared, and disagreements were resolved through discussion and consensus, or by consultation with a third investigator. The systematic review strategy was executed up to the point of quality assessment. Thereafter, the resulting articles were assessed and summarised in detail for this review. Information on study de, geographical area, description of participants sample size, age of mothers, maternal and infant characteristicsblood and colostrum sample collection of samples, characteristics of collection and storagevitamin composition of blood and colostrum, and quantitative estimates on the relation between maternal vitamin status and colostrum was extracted from each publication.

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Reported on mixed populations regarding general, maternal, and newborn characteristics that did not comply with our inclusion criteria were denoted as limitations of the respective study Table 3. Characteristics of publications on the relationship between maternal vitamin state and colostrum vitamin composition. The publication selection procedure is depicted in Figure 1. The initial search yielded records, of which were duplicates.

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The remaining articles were evaluated based on their title and abstracts, excluding anotherbecause of being out of scope. The remaining full texts were assessed for eligibility. Of these, papers were removed that did not satisfy inclusion criteria, and only 11 articles remained eligible. Full texts of three articles that were found eligible based on their title and abstract were not available through the University of Auckland or Wageningen University libraries, and were therefore not incorporated in this review.

Of all texts, one was excluded based on non-English language. No additional articles were obtained from the reference lists of the included articles. Hence, 11 articles were considered in the present review, of which six were cross-sectional studies [ 414243444547 ], four described randomised controlled clinical trials [ 36383940 ], and one was a quasi-experimental intervention study conducted in a convenience sample without control group [ 48 ]. Coinciding collection of colostrum and blood were baseline measurements for all randomised controlled trials and the quasi-experimental study, thus data on lost to follow up were not extracted for the current review.

One study was published inand the other 10 were published after Dimenstein as corresponding author. In total, mothers were considered, and all studies included women of reproductive age, between 14—41 years. Publication selection procedure. The flow chart depicts systematic steps of title, abstract and full-text screening as independently conducted by two authors. In eight studies, colostrum was obtained by manual expression [ 3639414243444748 ]; in two studies, a manual breast pump was used [ 4540 ]; and in one publication, no information on expression method was given [ 38 ].

Blood sample collection was done by venipuncture in five studies [ 3639434448 ]; one article stated blood samples concerned venous blood [ 40 ], and in five publications no information on blood collection method was given [ 3841424547 ]. In the majority of the studies, colostrum and blood samples were obtained at one time point between the first and fifth postpartum day, except for one study collecting colostrum samples over 1—3 days postpartum in order to establish a colostrum pool [ 42 ], and for three publications, the postpartum day was not mentioned [ 364348 ].

In eight studies, samples were collected after an overnight fast [ 3638394142434448 ]; whereas in the remaining three studies, the prandial state of participants was not specified [ 404547 ]. With regards to the vitamins assessed, six publications examined vitamin A [ 38Adult ladies im or more 37 Grafton 3742434448 ], five examined vitamin E [ 3638394142 ], and vitamin C [ 47 ], D [ 45 ], and K [ 40 ] were examined by single articles. The majority of articles reported concentrations of a single vitamin [ 36394344454748 ], two publications reported both vitamin A and E levels [ 4142 ], and one article described both vitamin K and E content in colostrum and plasma [ 40 ].

Six studies used external standards to quantify vitamin A and E [ 363841424348 ], and two studies used internal standards for vitamin A [ 44 ] and vitamins K and E [ 40 ]. In the publication by Ahmed et al.

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The correlation between maternal serum and colostrum vitamin levels as tested through linear regression analysis was reported by seven articles [ 39404142444548 ], and the remaining articles did not report this relationship through a statistical method [ 36384347 ]. Ahmed et al. Serum vitamin C levels were within the normal range of 0.

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Cancela et al. Maternal serum and colostrum vitamin D levels were individually analysed and reported for one mother that received vitamin D supplementation after postnatal day seven. Thijssen et al. Baseline menaquinone-4 colostrum levels were higher 3. Menaquinone-4 was only detected in 10 of the total 31 plasma samples of participants. No correlation was found between plasma and milk levels of vitamin K. The reported colostrum and plasma distribution values, given as colostrum:plasma ratio, did not correspond to the indicated mean concentrations in both biological fluids in the article.

The same study included vitamin E measurements for comparison reasons, but did not examine the interaction between plasma vitamin K and colostrum vitamin E, or vice versa. The major circulating form of vitamin K is phylloquinone, and serum values in healthy adults ranging from 0.

Similarly, Garcia et al. De Lira et al. Melo et al. Contacting correspondent author R. Dimenstein did not clarify this issue. Clemente et al. Grilo et al. Figure 2 provides an overview of the reported vitamin E values in serum and colostrum. Differences in mean vitamin E concentrations between colostrum and serum showed no overlap in standard deviations for two of three groups of the study by Clemente et al.

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Maternal Circulating Vitamin Status and Colostrum Vitamin Composition in Healthy Lactating Women—A Systematic Approach