Individualized support for breastfeeding in a case of elevated blood lead levels: A case report

Lead is a known toxicant that affects all tissues in the body, most notably the brains of developing children. However, there are limited data on the dynamics of lead transfer via breastmilk and its short-term and long-term consequences. Much of the available data come from areas of the world where numerous sources of lead complicate our understanding of the effects of lead exposure via breast milk. We present trends in blood lead levels in a breastfeeding dyad, where the only source of lead exposure identified was prior to pregnancy, without other known ongoing lead exposures for the lactating parent or infant. In this case, all lead exposure in the infant was presumed to come from in utero transmission and breastfeeding; and infant blood lead levels varied significantly with initiation and interruption of breastfeeding. This case is discussed in the context of current models for predicting transfer of lead in breastmilk and highlights pathophysiologic considerations for understanding lead transfer in the breastfeeding dyad. [Display omitted] •Many factors impact the transfer of lead via breast milk.•Lactating parent blood lead level helps predict changes in infant blood lead level.•Existing models can guide decision-making on timing of breastfeeding initiation.•Strategic pauses in breastfeeding can alleviate lead transfer in high-risk cases.