Aflatoxin M1 in breast milk: is it an etiological factor in prolonged breast milk jaundice?

Background: it is known that aflatoxin M1 can be transmitted to newborns through breast milk and may cause serious health problems. We aimed to determine whether the presence of aflatoxin M1 in breast milk has a role in the etiology of prolonged breast milk jaundice in newborn. Methods: forty-one mothers of infants with prolonged breast milk jaundice and 38 age-matched mothers of healthy infants participated in the study. Aflatoxin M1 concentrations in breast milk were measured using a competitive ELISA method with Ridascreen commercial kits. Results: the median age was 37 days in the study group and 40 days in controls. No significant differences were observed between the groups in terms of sex, height or weight. Median aflatoxin M1 levels were significantly higher in the study group than in controls (6.2 vs 1.27 ng/l, p = 0.001). Although mean aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels were higher in the study group, these differences were not statistically significant. None of the breast milk samples exceeded toxic limit of 50 ng/l. Furthermore, no significant correlations were identified between aflatoxin M1 concentrations and total bilirubin, direct bilirubin or indirect bilirubin values (p > 0.05). Conclusıons: our study data indicate that breast milk aflatoxin M1 concentrations were elevated in infants with prolonged breast milk jaundice compared to controls but remained within safe limits. The lack of association with bilirubin levels implies a limited clinical role for aflatoxin M1 in jaundice pathogenesis. Nonetheless, continued monitoring and larger studies are warranted to assess the long-term effects of early-life aflatoxin M1 exposure.