Determinants of human milk lactoferrin concentrations in rural Bangladesh

Lactoferrin is an iron-binding glycoprotein in human milk (HM) that reduces the risk of neonatal sepsis. Data from low- and middle-income countries regarding the determinants of HM lactoferrin concentration is limited. Our objectives were to assess how HM lactoferrin concentrations change over time and identify factors associated with lactoferrin concentration. From a pregnancy cohort in Sylhet, Bangladesh, we enrolled 99 women to join the lactation sub-cohort and provide HM samples at a median of 50 (T1) and 146 (T2) days postpartum. We measured HM lactoferrin concentrations with meso-scale discovery and examined associations with predictors including indices of maternal nutritional status [body mass index (BMI), mid-upper arm circumference (MUAC), hemoglobin], depression scores, infant gestational age, and birthweight-for-gestational age z-score. HM lactoferrin concentration increased by 21% from T1 to T2. Higher gestational age at birth was associated with lower HM lactoferrin concentration at T1. Higher maternal MUAC was associated with higher HM lactoferrin concentration at T2. In rural Bangladeshi women, HM lactoferrin concentration increased during the postpartum period. Higher lactoferrin was associated with earlier gestational age at delivery and better maternal nutritional status. Interventions to improve maternal nutritional status might also increase HM lactoferrin concentration and ultimately, benefit child outcomes.