Arsenic, lead, mercury and cadmium: Toxicity, levels in breast milk and the risks for breastfed infants

Metals are ubiquitous in nature, being found in all environmental compartments, and have a variety of applications in human activities. Metals are transferred by maternal blood to the fetus via the placenta, and exposure continues throughout life. For the general population, exposure comes mainly from water and food consumption, including breast milk. In this paper, we reviewed studies on the toxicity of arsenic, lead, mercury and cadmium, the toxic metals of most concern to human health, focusing on the potential risks to newborns and infants. A total of 75 studies published since 2000 reporting the levels of these metals in breast milk were reviewed. Lead was the metal most investigated in breast milk (43 studies), and for which the highest levels were reported (up to 1515 µg/L). Arsenic was the least investigated (18 studies), with higher levels reported for breast milk (up to 149 µg/L) collected in regions with high arsenic concentrations in water (>10 µg/L). Data from 34 studies on mercury showed that levels in breast milk were generally higher in populations with high fish consumption, where it may be present mainly as MeHg. Cadmium levels in breast milk were the lowest, with means <2 µg/L in most of the 29 studies reviewed. Results of risk assessments indicated that the intake of arsenic, lead and mercury by infants through breastfeeding can be considered a health concern in most regions of the world. Although the potential risks to infants are mostly outweighed by the benefits of breast milk consumption, it is essential that contaminants be continuously monitored, especially in the most critical regions, and that measures be implemented by health authorities to reduce exposure of newborns and infants to these metals, and thus avoid unnecessary health risks. - Highlights: • Review of 75 studies that analyzed arsenic, lead, mercury and/or cadmium levels. • Higher levels of arsenic found in India; of mercury found in Brazil. • Lead was the most detected in the studies; cadmium levels were the lowest. • Risk for breastfed babies cannot be excluded for arsenic, lead and mercury. • Risks are unavoidable, and outweighed by the benefits of breastfeeding.