Cloostermans Lucas, Allegaert Karel, Smits Anne, Van Neste Martje
Faculty of Medicine, KU Leuven, 3000 Leuven, Belgium.
Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium.
Nutrients. 2024 Dec 5;16(23):4205. doi: 10.3390/nu16234205.
Global health organizations recommend breastfeeding, but maternal pharmacotherapy can disrupt this due to safety concerns. Physiologically based pharmacokinetic (PBPK) models predict medication transfer through breastfeeding, relying on validated milk intake volume data. However, the literature is mainly focused on different measurement methods, or such intake data have been collected without systematic review. This systematic review therefore aims to gather data on human milk intake volume derived using the (dose-to-the-mother) deuterium oxide dilution method, allowing for comparison with the literature. Additionally, it aims to explore the effects of maternal conditions on milk intake volume. PubMed, Embase, Web of science, Cochrane library, Scopus and CINAHL were searched for studies on the dilution method and breastfeeding in healthy infants. Risk of bias was assessed using the Newcastle-Ottawa scale (NOS) and the Risk of Bias 2 (RoB2) tool. Data on mean human milk intake volume were extracted and synthesized (mL/day and mL/kg/day) throughout infancy. Sixty studies (34 countries) reported on the milk intake volume of 5502 infants. This intake was best described by logarithmic regression y(mL/kg/day) = 149.4002 - 0.2268 × x - 0.1365 × log(x) (x = postnatal age, days). Maternal conditions showed no significant influence on human milk intake, except for maternal smoking (reduction). This function corresponds with previous research, particularly for infants aged between 1.5 and 12 months. The limited availability of early infancy data underscores the need for additional data for future PBPK modeling to enhance informed healthcare decisions and improve outcomes for mothers and infants.
全球卫生组织推荐母乳喂养，但出于安全考虑，母亲药物治疗可能会干扰这一过程。基于生理的药代动力学（PBPK）模型通过母乳喂养预测药物转移，这依赖于经过验证的乳汁摄入量数据。然而，文献主要集中在不同的测量方法上，或者此类摄入量数据的收集没有经过系统评价。因此，本系统评价旨在收集使用（给母亲的剂量）氧化氘稀释法得出的人乳摄入量数据，以便与文献进行比较。此外，它旨在探讨母亲状况对乳汁摄入量的影响。在PubMed、Embase、科学网、考克兰图书馆、Scopus和CINAHL中检索了关于健康婴儿稀释法和母乳喂养的研究。使用纽卡斯尔-渥太华量表（NOS）和偏倚风险2（RoB2）工具评估偏倚风险。提取并综合了整个婴儿期平均人乳摄入量的数据（毫升/天和毫升/千克/天）。60项研究（来自34个国家）报告了5502名婴儿的乳汁摄入量。这种摄入量最好用对数回归y（毫升/千克/天）=149.4002 - 0.2268×x - 0.1365×log（x）（x = 出生后天数）来描述。除了母亲吸烟（摄入量减少）外，母亲状况对人乳摄入量没有显著影响。该函数与先前的研究一致，特别是对于1.5至12个月大的婴儿。婴儿早期数据的有限可用性凸显了未来PBPK建模需要更多数据，以加强明智的医疗保健决策并改善母婴结局。
