Summary of Use during Lactation

Lecithin is a mixture of choline, choline esters, fatty acids, glycerol, glycolipids, triglycerides, phosphoric acid, and phospholipids, such as phosphatidylcholine that are normal components of human milk. Supplemental lecithin has been recommended as a treatment for plugged milk ducts,[1-3] and as an additive to human milk that is given to preterm infants via pumping through plastic tubing in order to prevent fat loss.[4] No scientifically valid clinical studies exist on the safety and efficacy of high-dose lecithin supplementation in nursing mothers or infants. Most nursing mothers do not have adequate choline intake and mothers of very preterm infants may have reduced levels of choline in milk.[5,6] Supplementation with one component of lecithin, phosphatidylcholine, increases choline, but not phosphatidylcholine concentrations in breastmilk and supplementation with choline increases choline metabolites, but not choline in breastmilk. A meta-analysis found that higher maternal choline intake was likely to be associated with better child neurocognition and neurodevelopment.[7] Lecithin is usually well tolerated and is considered to be "generally recognized as safe" (GRAS) by the U.S. Food and Drug Administration.

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

No published information was found as of the revision date on milk levels of lecithin components following maternal supplementation. However, lecithin components are normally found in breastmilk as reported below.

Maternal Levels. A study of human milk from mothers of preterm (n = 17) and fullterm (n = 16) infants found several lecithin components, such as choline, phosphocholine, and phosphatidylcholine. Choline levels in fullterm milk were higher (116 micromoles/L) than in preterm milk (98 micromoles/L). Choline ester concentrations were not different between the two types of milk. Phosphatidylcholine choline levels were slightly higher (90 micromoles/L) than in fullterm milk (82 micromoles/L), but the difference was not statistically significant.[8]

Longitudinal analysis of human milk samples from 8 mothers found that choline levels increased from 110 micromoles/L during days 2 to 6 postpartum to 210 micromoles/L during days 7 to 22. Phosphatidylcholine increased from 70 micromoles/L to 100 micromoles/L over the same time periods.[9]

Nursing women collected breastmilk by manual expression prior to the midday feeding of their infant. One hundred fifty-three milk samples were analyzed for free choline and choline-containing compounds. Colostrum samples (n = 21) from 21 women contained an average of 676 micromoles/L of total choline. Mature breastmilk from 37 women who were 12 to 180 days postpartum contained significantly higher levels of total choline than colostrum, averaging from 1349 to 1595 micromoles/L of total choline.[10]

A study of 103 pregnant women measured the choline content of their milk through 45 days postpartum. Participants were given a daily supplement of 5400 mg of phosphatidylcholine (PhosChol brand) equal to 750 mg of choline (n = 48) or a placebo (n = 48). The daily dosage was divided equally between morning and evening. At 45 days postpartum, breastmilk choline concentrations were statistically different at 83 micromoles/L in the placebo group and 106 micromoles/L in the supplemented group. Phosphatidylcholine concentrations were not statistically different at 107 micromoles/L in the placebo group and 113 micromoles/L in the supplemented group.[11]

Lactating women were given either 480 or 930 mg of choline daily. Both doses increased the breastmilk content of the choline metabolites, phosphocholine, glycerophosphocholine, glycine and trimethylamine oxide.[12]

Water-soluble forms of choline were measured in the breastmilk of Canadian (n = 301) and Cambodian (n = 67) mothers. Mean concentrations were free choline, 151 micromoles/L; phosphocholine 540 micromoles/L; glycerophosphocholine 411 micromoles/L and the sum of water-soluble forms of choline 1102 micromoles/L. Values did not differ between the 2 countries.[13]

A longitudinal study in China measured the changes in choline, phosphocholine, glycerophosphocholine, phosphatidylcholine, and sphingomyelin in a group of mothers up to 400 days postpartum. Statistically significant changes were found in the concentrations of each of these components over time.[14]

Thirty-three mothers of very low birthweight infants donated milk samples twice weekly during a randomized, controlled study. Average milk content of various components were as follows: free choline 17.2 mg/L, glycerophosphocholine 65.4 mg/L, phosphocholine 67.1 mg/L, betaine 0.6 mg/L, phosphatidylcholine 20.1 mg/L, lyso-phosphatidylcholine 2 mg/L, and sphingomyelin 4.8 mg/L.[5]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Scott CR. Lecithin: It isn't just for plugged milk ducts and mastitis anymore. Midwifery Today Int Midwife Winter 2005;76:26-7. [PubMed: 16419666]

2.

McGuire E. Case study: White spot and lecithin. Breastfeed Rev 2015;23:23-5. [PubMed: 25906494]

3.

Lawrence RA, Lawrence RM, Noble L, et al. Breastfeeding: A guide for the medical profession, 9th ed. Philadelphia. Elsevier. 2022.

4.

Chan MM, Nohara M, Chan BR, et al. Lecithin decreases human milk fat loss during enteral pumping. J Pediatr Gastroenterol Nutr 2003;36:613-5. [PubMed: 12717084]

5.

Minarski M, Maas C, Heinrich C, et al. Choline and betaine levels in plasma mirror choline intake in very preterm infants. Nutrients 2023;15:4758. [PMC free article: PMC10675502] [PubMed: 38004152]

6.

Obeid R, Schön C, Derbyshire E, et al. A narrative review on maternal choline intake and liver function of the fetus and the infant; implications for research, policy, and practice. Nutrients 2024;16. [PMC free article: PMC10820518] [PubMed: 38257153]

7.

Obeid R, Derbyshire E, Schön C. Association between maternal choline, foetal brain development and child neurocognition; systematic review and meta-analysis of human studies. Adv Nutr 2022;13:2445-57. [PMC free article: PMC9776654] [PubMed: 36041182]

8.

Holmes-McNary MQ, Chen WL, Mar MH, et al. Choline and choline esters in human and rat milk and in infant formulas. Am J Clin Nutr 1996;64:572-6. [PubMed: 8839502]

9.

Holmes HC, Snodgrass GJ, Iles RA. Changes in the choline content of human breast milk in the first 3 weeks after birth. Eur J Pediatr 2000;159:198-204. [PubMed: 10664235]

10.

Ilcol YO, Ozbek R, Hamurtekin E, Ulus IH. Choline status in newborns, infants, children, breast-feeding women, breast-fed infants and human breast milk. J Nutr Biochem 2005;16:489-99. [PubMed: 16043031]

11.

Fischer LM, da Costa KA, Galanko J, et al. Choline intake and genetic polymorphisms influence choline metabolite concentrations in human breast milk and plasma. Am J Clin Nutr 2010;92:336-46. [PMC free article: PMC2904035] [PubMed: 20534746]

12.

Davenport C, Yan J, Taesuwan S, et al. Choline intakes exceeding recommendations during human lactation improve breast milk choline content by increasing PEMT pathway metabolites. J Nutr Biochem 2015;26:903-11. [PubMed: 26025328]

13.

Wiedeman AM, Whitfield KC, March KM, et al. Concentrations of water-soluble forms of choline in human milk from lactating women in Canada and Cambodia. Nutrients 2018;10:E381. [PMC free article: PMC5872799] [PubMed: 29558412]

14.

Wu T, Lan QY, Tian F, et al. Longitudinal changes in choline concentration and associated factors in human breast milk. Clin Nutr 2023;42:1647-56. [PubMed: 37515842]

Substance Name

Lecithin

CAS Registry Number

8002-43-5

Drug Class

Breast Feeding

Lactation

Milk, Human

Complementary Therapies

Food

Phospholipids