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IAEA Research Project Confirms WHO Recommendation on Benefits of Exclusive Breastfeeding by HIV-positive Mothers

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Isotopic techniques help track breastfeeding practices. (Photo: S. Henriques/IAEA)

The results of an IAEA coordinated research project (CRP) on breastfeeding have confirmed how a series of breastfeeding recommendations by the World Health Organization (WHO) are beneficial to children's health. According to these recommendations, infants should be breastfed exclusively for the first six months of life, even when the mother is HIV-positive. Exclusive breastfeeding is observed with only 40% of infants globally.

The CRP, using isotopic techniques, confirmed that neither human milk production nor the health of babies of infected mothers are affected by HIV-infection – and so it is safe for mothers to breastfeed.

Breastfeeding practices in low- and middle-income countries first became a concern to the WHO in the early 2000s, when the recommendation was for HIV-infected mothers to stop breastfeeding abruptly. This resulted in a sharp increase in child mortality due to the lack of hygienic and safe environment to prepare infant foods and, in most cases, inability to afford nutritious foods. In 2010, the recommendation was revised to say that mothers should exclusively breastfeed for the first six months of life, in concert with anti-retroviral therapy to combat HIV. This prevents the disease from progressing in the mother and minimises the risk of transmitting HIV to the infant via human milk. The most recent revision to the recommendations in 2016 integrated breastfeeding and anti-retroviral guidelines into one. There has been no systematic evaluation on how this evolution of recommendations over the last 15 years has impacted child and maternal health. 

“These are useful results, providing new evidence to show that if mothers adhere to the recommendations, their children consume adequate amounts of human milk and those who are exclusively breastfed consistently for six months gain more fat-free mass at one year of age, indicating healthy growth. There were also no adverse effects on the mother’s body composition,” said Victor Owino, an IAEA nutrition specialist. “The results align well with the Sustainable Development Goal 2 target of achieving at least a 50% rate of exclusive breastfeeding by 2025. The IAEA is committed to building capacity in partner countries in this important area to enable effective tracking of the target.”

Isotopic techinques

Isotopic techniques are used to measure human milk intake, which, in combination with other data, can tell researchers the effectiveness of various policies on encouraging breastfeeding. The CRP addressed questions of whether or not infants fed exclusively with human milk for six months grow better, how much milk they consume and whether the quantity of human milk production adversely affects the mother’s own body composition, especially if the mother is HIV-positive.  When asked by health professionals, mothers may report that they are exclusively breastfeeding when they are not. The CRP confirmed that the exclusive breastfeeding rates are actually much lower than reported, by at least 40%.

“The results of this study show that if we want to determine how much nutrients children derive from human milk and we base it on recall information, then we are probably overestimating what the children are consuming,” said Owino. “The best way forward is to routinely confirm information using accurate stable isotope techniques. Such accurate data, if available for a larger population, can help inform the formulation of recommendations for nutrient intake for children, which so far are based on extrapolated adult data from developed countries.”

The research project used deuterium oxide, a stable isotope of hydrogen, which occurs naturally in the human body and in drinking water in small amounts. The mother is given a dose of deuterium, which shows up in her body water. As she breastfeeds the infant, that deuterium is passed to the infant. Analysis, using mass or infrared spectroscopy, of deuterium concentration in saliva or urine samples collected from both mother and infant over a two-week period indicates the level of deuterium transfer from the mother to the infant, thus revealing whether the infant was breastfed exclusively and how much milk was consumed. This is the most non-invasive, accurate, sensitive and objective way to determine breastfeeding practices.  Other concerns, including whether or not the HIV status of a nursing mother will affect her ability to breastfeed her child, were also addressed.

Participating countries in the CRP included Burkina Faso, India, Jamaica, Kenya, South Africa, Sri Lanka and Thailand with expert support from Australia, the United Kingdom and the United States. Results from the project will be further discussed during the upcoming International Symposium on Understanding the Double Burden of Malnutrition for Effective Interventions, to take place 10-13 December 2018.

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