| BackgroundBreastfeeding is beneficial to maternal and infants’ health,which has become a consensus.The composition of breast milk is complex,and trace elements it contains are very important to promote the growth and development of infants.The content of trace elements in breast milk is in dynamic change,which is affected by many factors such as maternal pathological state,etc.Gestational diabetes mellitus(GDM)is a common clinical complication of pregnancy,and its incidence is increasing year by year.GDM seriously harms maternal and infants’ health and has become an important public health problem.Previous studies have indicated that trace elements deficiency during pregnancy might lead to increased risk of pregnancy complications such as GDM.However,at present less studies are available on the effect of GDM on the contents of trace elements in maternal milk.ObjectiveThe contents of trace elements in the breast milk of GDM and healthy puerperae were detected and comparatively analyzed.Furthermore,the impacts of maternal dietary intakes and other potential factors on the contents of trace elements in the breast milk were analyzed.This study aimed to make clear the differences in the contents of trace elements in the breast milk of GDM and healthy puerperae,and to elucidate the factors affecting the levels of trace elements in milk.Accomlishment of this study will add new content for researches of breast milk components and also provide scientific basis for promoting rational breastfeeding for offsprings of GDM puerperae.MethodsGDM and healthy puerperae were recruited as survey objects in Nanfang Hospital of Southern Medical University.A questionnaire cosisting of maternal basic situation,deliver conditions,infant basic situation etc.were used to survey on each puerpera.Samples of breast milk(colostrum,transitional milk and mature milk)were collected and meanwhile the dietary intakes of the continuous three days before the day of milk samples collection were completed by using a 24 h dietary recall questionnaire.The concentrations of 14 trace elements in breast milk were quantitatively determined by using an Inductively Coupled Plasma Mass Spectrometry.The Wilcoxon test and Kruskal-Wallis multi-sample rank sum test were used to analyze the differences in trace elements concentration between groups by SPSS 22.0.The Spearman rank correlation analysis and multiple linear regression were used to analyze the influencing factors on the concentrations of trace elements in breast milk.Results1.Finally,70 GDM puerperae and 70 healthy puerperae were recruited as subjects.A total of 224 milk samples were collected,which included 115 milk samples from GDM puerperae and 109 milk samples from healthy puerperae.Based on the stage of lactation,a total of 83 colostrum samples,52 transitional milk samples and 89 mature milk samples were collected.2.The contents of Cd and Pb in GDM maternal milk were significantly higher than those in healthy maternal milk(P<0.05).There were no significantly statistical differences in the contents of Cr,Mn,Fe,Co,Ni,Cu,Zn,As,Se,Sr,Mo and Ba in GDM and healthy maternal milk(P>0.05).3.The contents of Cu,Zn and Mo in colostrum and transition milk of GDM puerperae were significantly higher than those in mature milk(P<0.05).The content of Se in colostrum of GDM puerperae was significantly higher than that in mature milk(P<0.05).The contents of Cu and Zn in colostrum and transition milk of healthy puerperae were significantly higher than those in mature milk(P<0.05).The contents of Co and Se in colostrum of healthy puerperae were significantly higher than those in mature milk(P<0.05).The contents of Sr and Mo in colostrum of healthy puerperae were significantly higher than those in transition milk and mature milk(P<0.05).4.The influential factors of trace elements content in breast milk were as follows:(1)The content of Fe in breast milk was changed with circadian rhythm(P<0.01),and was positively correlated with Zn intake(P<0.01).The content of Fe in breast milk was significantly higher in puerperae who took Fe supplements during pregnancy than that in those who did not(P<0.001).(2)The content of Cu in breast milk was negatively correlated with body weight before pregnancy(P<0.001).(3)The content of Zn in breast milk was positively correlated with the intakes of Zn and fruits(P<0.01),and was negatively correlated with the intakes of Vit E and vegetables(P<0.05).The content of Zn in breast milk of puerperae who used folic acid supplements during pregnancy was significantly higher than that of those who did not(P<0.001).(4)The content of Se in breast milk was changed with circadian rhythm(P<0.001),and was negatively correlated with the intakes of fruits(P<0.05).(5)The content of Cr in breast milk was positively correlated with seafood intake(P<0.05),and was negatively correlated with the neonatal weight(P<0.05),and was changed with circadian rhythm(P<0.05).The content of Cr in breast milk was significantly lower in puerperae who took DHA supplements during pregnancy than that in those who did not(P<0.05).(6)The content of Co in breastmilk was positively correlated with niacin intake(P<0.001),and was negatively correlated with weight gain during pregnancy and Vit E intake(P<0.05).The content of Co in milk of puerperae who used Fe supplements during pregnancy was higher than that of those who did not(P<0.01).(7)The content of Mn in breast milk was positively correlated with poultry meat intake(P<0.05),and was negatively correlated with Vit E intake(P<0.01).The content of Mn in milk of puerperae who used Fe supplements during pregnancy was higher than that of those who did not(P<0.01).The content of Mn in milk of puerperae who used multivitamin supplement during pregnancy was lower than that of those who did not(P<0.01).The content of Mn in milk of primiparas was higher than that of multiparas(P<0.01).(8)The content of Ni in milk was positively correlated with niacin intake(P<0.01).(9)The content of As in milk was positively correlated with poultry intake(P<0.01),and was negatively correlated with the intake of carbohydrates and Vit E(P<0.05).The content of As in milk of primiparas was higher than that of multiparas(P<0.05).(10)The content of Sr in milk was positively correlated with weight gain during pregnancy(P<0.01),and was negatively correlated with the intake of Mg and Fe(P<0.05).The content of Sr in milk of vaginal delivery puerperae was higher than that of cesarean section(P<0.01).(11)The content of Cd in milk was positively correlated with protein intake(P<0.05),and was negatively correlated with maternal height and carbohydrate intake(P<0.05).The content of Cd in milk of puerperae who did not use DHA and multivitamin supplement during pregnancy was higher than that of those who did(P<0.05).(12)The content of Ba in milk of puerperae who took DHA supplement during pregnancy was higher than that of those who did not(P<0.001).(13)The content of Pb in milk was positively correlated with poultry intake(P<0.05),and was negatively correlated with Vit E intake(P<0.01).The content of Pb in milk of puerperae who did not use multivitamin supplement during pregnancy was higher than that of those who did(P<0.01).Conclusion1.There are differences in the contents of Cd and Pb in breast milk between GDM and healthy puerperae,but there are no differences in the contents of Cr,Mn,Fe,Co,Ni,Cu,Zn,As,Se,Sr,Mo and Ba.The contents of trace elements in milk of GDM and healthy puerperae vary at different lactation stages.2.The contents of trace elements in breast milk are affected by lactation stages,circadian rhythm,maternal diet,use of nutritional supplements during pregnancy,weight gain during pregnancy,maternal weight before pregnancy,maternal height,neonatal weight,parturition or mode of delivery.However,the influencing factors of different contents of trace elements are different. |
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