Green Breast Milk Following Ingestion of Blue-Green Algae: A Case Report
Breast milk is an excellent nutritional source for newborns, and a change in its color can be alarming to both mother and physician, and may prevent breastfeeding. Different colors of breast milk have been reported such as blood-stained, blue, and bluish-green. We present the ﬁrst case of green breast milk caused by maternal ingestion of blue-green algae pills immediately before and after delivery. The score on the Naranjo Adverse Drug Reaction Probability Scale was 5, indicating a probable adverse drug reaction. Laboratory analysis yielded no other abnormalities in the milk. The mother stopped taking the supplement, and the milk returned to its normal appearance 3 days later. This report should alert physicians to include supplement intake as part of the anamnesis for new mothers who present with breast milk changes.
Breast milk is an excellent source of nutrition for newborns. It has well-recognized beneﬁts for optimal growth and development and reduces the risk of infection in early life.1 In addition, the act of breastfeeding induces mother–child bonding, which has important implications for the child’s healthy psychological development. Therefore, a change in the appearance of the breast milk may be alarming to both the mother and health care professionals. Cases of blood-stained, blue, bluish-green, and green breast milk have been described in the literature.2–6 We present the ﬁrst case of green breast milk caused by ingestion of blue-green algae in the days before and after delivery.
A healthy 38-year-oldwoman,gravida3, para 2,gave birth to healthy twins at 35 weeks’ gestation. Birth weights were 1,813 and 1,920g. Two older children were completely normal and had been breastfed until age 4 months.
On the second day after the present delivery, the mother expressed 30mL of dark green breast milk (Fig. 1). The babies were taken off breast milk and given formula feeds. On questioning, the mother revealed that 3 days before giving birth she had replaced her regular iron supplements with capsules containing a blue-green algae complex (blue-green algae, chlorella, and spirulina; Ambrosia-SupHerb Ltd., Israel), 750mg once daily, on the advice of her family. She had continued to take the pills up to the day after the birth of the twins.
The mother was instructed to immediately stop ingesting the pills. The score on the Naranjo Adverse Drug Reaction Probability Scale was 5, indicating a probable adverse drug reaction, and samples of the breast milk were sent for culture and cytological examination. No cancerous cells or other abnormalities were found on cytological study, and the culture was negative. As we did not perform a challenge with an additional dose of the algae, we could not measure blood levels.
The greenish tint of the milk faded gradually for the next 3 days. By the fourth day, the milk returned to its normal creamy-white appearance, and the mother resumed breast- feeding.There was no further change in the color of the breast milk.
FIG. 1. Breastmilk with dark green color. The ﬁrst two bottles depict the greenish tint of the milk gradually disappearing. The last bottle shows the normal creamy-white appearance of the milk.
Informed consent was obtained from the mother for publication of this case report and the images of the milk.
初乳的颜色是黄到黄橙色。成熟的母乳最初为蓝白色（前乳），然后变为乳白色（后乳）。母乳颜色的变化归因于食物中的色素、药物或草药的摄入1。有研究报告称，在0.1%的病例中，母乳可能含有血性分泌物，使其变红或变粉，通常在2-5天后消失 2。 Silva等描述了一个病例，其中从乳头流出的血使牛奶变成了铁锈色3。
The color of colostrum is yellow to yellow-orange. Mature human breast milk is initially bluish white (foremilk) and then changes to creamy white (hindmilk). Changes in the color of breast milk have been attributed to the consumption of pigments in food and intake of medications or herbal remedies.1 A studyfromour department reported that in 0.1% of cases, the breast milk may contain a bloody discharge, turning it red or pink, which usually clears after 2–5 days.2 Silva et al described a case in which a bloody discharge from the nipple gave the milk the color of a rusty pipe.3
Our search of the medical literature yielded very few reports of green breast milk. In one case presented by Yazgan et al, the green color of the milk was related to the ingestion of multivitamins and minerals, and it took 3 weeks for the color to normalize. 4 Others described a case of green milk that was attributed to infusion of propofol along with other drugs during anesthesia on the basis of previous studies showing that a metabolite of propofol can turn patients’ urine green.5 Di Comite et al described a pregnant woman diagnosed with heterozygous beta-thalassemia who produced green breast milk for days after treatment with ferritin. 6 On laboratory analysis, the milk was found to contain bivalent iron.
In this case, we assumed a possible relationship between the change in color of the mother’s breast milk and her consumption of 750mg/day of blue-green algae from 3 days before the birth of twins until 1 day after. It took 3 days for the milk to return to its normal color after the supplement was stopped.
This is the ﬁrst report of blue-green algae causing a change in the color of breast milk. This case is important as both mothers and medical staff may ﬁnd a color change of the breast milk alarming, and it can postpone the start of breastfeeding. The underlying cause should ﬁrst be sought by careful and comprehensive history taking. Physicians should be alert to the need to include questions on supplement intake when women present with breast milk changes. In the event of doubt, samples of the milk should be sent for culture and cytological examination. Patients should also be followed up for several days after stopping the supplement to conﬁrm the diagnosis and ensure that the breast milk has returned to normal before breastfeeding is resumed. Although there was no apparent harm to the infants in this case, we suggest that women should probably avoid taking nutritional supplements in the perinatal period to prevent unnecessary distress.