There’s no denying that breast milk is the gold standard for human nutrition.  In pre-term babies particularly, breast milk has been associated with improved growth and cognitive development, as well as a reduced risk of serious bowel infections and sepsis.

In cases where the mother is unable to breastfeed, what is the next best option to ensure a healthy gut microbiome in the child that will have far-reaching effects on their overall health?

In the last few years, I’ve noticed an increasing number of expectant first-time Mums asking for baby formula recommendations so they can stock up “just in case”.  Whilst I completely understand the drive to prepare for all eventualities when you’re having your first baby, it saddens me to think that women don’t realise there’s an intermediate option – donor human breast milk.

A study just published in the Frontiers of Microbiology journal compared the gut microbiota of 69 preterm infants in NICU fed either their mother’s own milk (MOM), pasteurised donor human milk (DHM) or formula, to understand the differences in resulting gut microbiota and the potential biological implications.

Faecal samples were collected and the microbiota composition was analysed through rRNA sequencing.  After controlling for other factors, the diversity of gut microbiota increased over time and was constantly higher in infants fed MOM relative to infants with other feeding types. The microbial profile of formula-fed infants was distinct from those observed in MOM and DHM, suggesting that DHM favors an intestinal microbiome more similar to MOM despite the differences between MOM and DHM.  DHM has a slightly different composition to MOM relative to the age of the child as women donating milk tend to be feeding older babies and differences in nutritional intake amongst donors can vary, which is offset somewhat by milk pooling – combining milk from several donors. Pasteurization of DHM also causes changes to the microbial balance, enzymes & proteins in the milk. In general though, only minor differences were observed in the functional profiles between MOM and DHM, suggesting the potential effect of DHM in mimicking the microbiome functionality of own maternal milk feeding.

In conclusion, DHM favors an intestinal microbiome more similar to MOM than Formula despite the differences between MOM and DHM. This may have potential beneficial long-term effects on intestinal functionality, immune system, and metabolic activities.

This would be of particular importance to infants born by Caesarian section who would not receive the same exposure to the mother’s vaginal microbiome as those born naturally.  In some cases, seeding takes place, where a gauze that’s been placed in the mother’s vagina is wiped over the baby & around their mouth to simulate the transfer of bacteria that occurs in vaginal birth to prime the infant’s immune system.

More research needs to be done to understand the long-term implications of feeding type, but that raises ethical issues around feeding one group an option known to be inferior.

Some people find it difficult to access sufficient donor milk as not all locations have milk banks and preference is given to babies most at risk.  It is worth exploring community donor schemes such as Eats on Feets or Human Milk 4 Human Babies.  These groups connect donors & recipients, but do not handle the milk or involve themselves in the arrangements.  The milk is unlikely to be pasteurised, although that means less damaged by heat, but it is up to you to screen the donors to ensure you feel safe with the milk they provide.

Mother’s own milk will always be the optimal choice, with the interaction between the microbiomes of the mother-child dyad informing the mother’s body of what the baby needs at any given moment to adapt to the environment they live in.  It is so important for the mother to have support around her that allows the time, space, hydration & nutrition she needs for proper lactation.  If there are issues feeding, seek the advice of a midwife or lactation consultant & have the baby checked for tongue &/or lip ties.

The next-best option is human donor milk, then milk from other species as a last resort.  I want to clarify that I am not saying that to judge or berate anyone for the way they feed their baby, but with human health declining & chronic illness rising, I think it is important to give consideration to the evidence available to maximize the health of our children and reverse the disease trends.  After all, the contents of our bowels that could get us out of this crap!

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