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Britta Fängström,¹ Sophie Moore,² Barbro Nermell,¹ Linda Kuenstl,³ Walter Goessler,³ Margaretha Grandér,¹ Iqbal Kabir,⁴ Brita Palm,¹ Shams El Arifeen,⁴ and Marie Vahter¹

¹Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; ²MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, The Gambia; ³Institut für Chemie, Analytische Chemie, Karl-Franzens-Universität, Graz, Austria; ⁴International Center for Diarrhoeal Disease Research, Bangladesh

Abstract
Background: Chronic arsenic exposure causes a wide range of health effects, but little is known about critical windows of exposure. Arsenic readily crosses the placenta, but the few available data on postnatal exposure to arsenic via breast milk are not conclusive.

Aim: Our goal was to assess the arsenic exposure through breast milk in Bangladeshi infants, living in an area with high prevalence of arsenic-rich tube-well water.

Methods: We analyzed metabolites of inorganic arsenic in breast milk and infant urine at 3 months of age and compared them with detailed information on breast-feeding practices and maternal arsenic exposure, as measured by concentrations in blood, urine, and saliva.

Results: Arsenic concentrations in breast-milk samples were low (median, 1 µg/kg ; range, 0.25–19 µg/kg) , despite high arsenic exposures via drinking water (10–1,100 µg/L in urine and 2–40 µg/L in red blood cells) . Accordingly, the arsenic concentrations in urine of infants whose mothers reported exclusive breast-feeding were low (median, 1.1 µg/L ; range, 0.3–29 µg/L) , whereas concentrations for those whose mothers reported partial breast-feeding ranged from 0.4 to 1,520 µg/L (median 1.9 µg/L) . The major part of arsenic in milk was inorganic. Still, the infants had a high fraction (median, 87%) of the dimethylated arsenic metabolite in urine. Arsenic in breast milk was associated with arsenic in maternal blood, urine, and saliva.

Conclusion: Very little arsenic is excreted in breast milk, even in women with high exposure from drinking water. Thus, exclusive breast-feeding protects the infant from exposure to arsenic.

Key words: arsenic, blood, breast milk, drinking water, infants, saliva, urine. Environ Health Perspect 116:963–969 (2008) . doi:10.1289/ehp.11094 available via http://dx.doi.org/ [Online 6 March 2008]

Address correspondence to M. Vahter, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden. Telephone: 46 8 524 87540. Fax: 46 8 336981. E-mail: marie.vahter@ki.se

The MINIMat study was supported by UNICEF, the Department for International Development, the Swedish International Development Agency (Sida) , the United States Agency for International Development, and the Child Health and Nutrition Initiative. The study to validate infant feeding practices was supported by the U.K. Medical Research Council, and the arsenic study by Sida, the European Union Sixth Framework Programme (FOOD-CT-2006-016253) , The Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, and Karolinska Institutet.

The authors declare they have no competing financial interests.

Received 21 November 2007 ; accepted 5 March 2008.

Correction

In Table 4, the p-value is 0.001, not 0.5 as in the manuscript originally published online, and has been corrected here.