Warn mothers against buying, donating breast milk via Internet
- Copyright © 2014 by the American Academy of Pediatrics
Human milk-sharing via the Internet is increasingly popular, but both the Academy and the Food and Drug Administration strongly discourage this practice because of the risk of pathogen transmission.
Many online milk-sharing communities exist to connect mothers with an abundant supply of non-pasteurized donor milk to those seeking milk for their child. A study over a three-month period in 2013 quantified the prevalence of this practice, noting 954 individuals participating in milk-sharing on nine different Facebook pages that facilitate the exchange of milk (Perrin M, et al. Breastfeed Med. 2014;9:128-134OpenUrlPubMed).
Among the Facebook sites are Human Milk for Human Babies (http://hm4hb.net/) and Eats on Feets (www.eatsonfeets.org/). They exist in 47 of 50 states and have large fan bases. On sites such as these, mothers requested milk mostly because of “lactation problems” or “child health problems,” according to the study. A minority of mothers wanted milk for an adopted or foster child.
Donor mothers offered their milk, stating attributes such as “certified,” “fresh frozen” and “no drug use” lifestyle, including medications or supplements. Some donor mothers advertised their milk using terms such as “safest” or best “quality.” Moreover, some mothers obtained milk from multiple donors.
Pediatricians need to be aware of this recent trend in casual milk-sharing because of the remarkable infectious risks associated with this practice.
Recently, investigators from several academic institutions in Ohio published a study showing high rates of pathogenic bacterial contamination found in human milk purchased via the Internet (Keim SA, et al. Pediatrics. 2013;132:e1227-e1235OpenUrl). Compared to milk donated to a local human milk bank, the Internet-acquired samples had much higher colony counts of gram-negative coliforms and Staphylococcus species. In addition, 21% of purchased samples were cytomegalovirus (CMV) DNA-positive, compared to 5% of the milk bank samples.
All Internet-acquired human milk samples were expressed outside the clinical setting and handled and stored in the home. Purchased Internet-acquired milk samples often arrived completely thawed or warm.
The majority of the Internet-acquired milk samples showed high overall bacterial growth and frequent contamination, reflecting poor collection, storage and/or shipping practices. The rates of bacterial isolation of Salmonella sp, coliforms (lactose-fermenting gram-negative bacteria), other gram-negative bacteria, Streptococcus and Staphylococcus species ranged from 3% to 75% of purchased milk samples. These samples had contamination rates predicted by time in transit and the age of the milk. Information that Internet milk-sellers conveyed in their advertisements about their health and behaviors were poor indicators of milk quality.
In contrast, human milk donated to and dispensed by human milk banks in the United States is pasteurized to eradicate all harmful bacteria and viruses, including CMV, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). In addition, U.S. human milk banks screen all of their milk donors with serological testing for HBV and HIV.
Rates of bacterial isolation from milk bank samples (prior to pasteurization) are much lower than those acquired via the Internet. This is most likely because milk bank donor mothers are instructed on hygienic milk collection and storage techniques, as well as optimal shipping procedures, such as overnight shipping on dry ice.
When advocating for breastfeeding and feeding human milk to babies, pediatricians need to explain to mothers the hazards of acquiring donor milk via the Internet. They should strongly advise against the practice and instead instruct interested mothers to seek donor milk or donate their excess milk only in conjunction with established U.S. human milk banks (see resource).
The Human Milk Banking Association of North America, https://www.hmbana.org, lists contact information for member milk banks. It also describes procedures and practices used to screen donors and collect, store, pasteurize and transport donor milk — all at no cost to donor mothers.
Dr. Landers is a member of the AAP Section on Breastfeeding.