Which factors may contribute to breast milk jaundice?

Updated: Dec 07, 2017
  • Author: Prashant G Deshpande, MD; Chief Editor: Muhammad Aslam, MD  more...
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Answer

Breast milk jaundice is a common cause of indirect hyperbilirubinemia. The etiology of breast milk jaundice is not clearly understood, but a combination of genetic and environmental factors may play a role. [5] The following factors may contribute:

  • An unusual metabolite of progesterone (pregnane-3-alpha 20 beta-diol), a substance in the breast milk that inhibits uridine diphosphoglucuronic acid (UDPGA) glucuronyl transferase [5]

  • Increased concentrations of nonesterified free fatty acids that inhibit hepatic glucuronyl transferase [5]

  • Increased enterohepatic circulation of bilirubin due to (1) increased content of beta glucuronidase activity in breast milk and, therefore, the intestines of the breastfed neonate and (2) delayed establishment of enteric flora in breastfed infants [6]

  • Defects in uridine diphosphate-glucuronyl transferase (UGT1A1) activity in infants who are homozygous or heterozygous for variants of the Gilbert syndrome promoter and coding region polymorphism [7]

  • Reduced hepatic uptake of unconjugated bilirubin due to a mutation in the solute carrier organic anion transporter protein SLCO1B1

  • Increased levels of inflammatory cytokines in human milk, especially interleukin (IL)-1 beta and IL-6,  in individuals with breast milk jaundice; these are known to be cholestatic and reduce the uptake, metabolism, and excretion of bilirubin [8]


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