Nesibe Yildiz : 0000-0001-5728-5527

Adnan Yilmaz : 0000-0003-4842-1173


Background: Breast milk is a natural food that contains all the fluids, energy, and nutrients necessary for the optimum growth and development of newborns. Smoking is a public health problem that has harmful effects on the mother and baby. This study aimed to examine the association of exposure to smoking with total oxidant status (TOS) and total antioxidant status (TAS) in breast milk.

Methods: Healthy mothers without any health problems during their pregnancy and lactation periods were selected as subjects. Eighty-eight milk samples (44 in the smoking group and 44 in the nonsmoking group) were examined. TOS and TAS were analyzed using Rel Assay commercial kits.

Results: TAS level was significantly lower in the smoking group than in the nonsmoking group (p < 0.05). TOS level was higher in the smoking group than in the nonsmoking group, although the difference was not statistically significant (p > 0.05). Oxidative stress index (OSI) was significantly higher in the smoking group than in the nonsmoking group (p < 0.05).

Conclusions: Exposure to smoking was associated with low TAS and high OSI in breast milk.


  1. Ares Segura S, Arena Ansótegui J, Díaz-Gómez NM, en representación del Comité de Lactancia Materna de la Asociación Española de Pediatría. The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements? An Pediatr (Barc). 2016;84:347.e1–7.
  2. Lyons KE, Ryan CA, Dempsey EM, Ross RP, Stanton C. Breast milk, a source of beneficial microbes and associated benefits for ınfant health. Nutrients. 2020;12:1039.
  3. Kulski JK, Hartmann PE. Changes in human milk composition during the initiation of lactation. Aust J Exp Biol Med Sci. 1981;59:101–14.
  4. Sundekilde UK, Downey E, O'Mahony JA, O'Shea CA, Ryan CA, Kelly AL, et al. The effect of gestational and lactational age on the human milk metabolome. Nutrients. 2016;8:304.
  5. Kodama M, Kaneko M, Aida M, Inoue F, Nakayama T, Akimoto H. Free radical chemistry of cigarette smoke and its implication in human cancer. Anticancer Res. 1997;17:433–7.
  6. Carnevale R, Cammisotto V, Pagano F, Nocella C. Effects of smoking on oxidative stress and vascular function. In Rajer M. Ed. Smoking Prevention and Cessation. IntechOpen, 2018, p. 25–47.
  7. Wu S, Zhu W, Thompson P, Hannun YA. Evaluating intrinsic and non-intrinsic cancer risk factors. Nat Commun. 2018;9:3490.
  8. Duncan MS, Freiberg MS, Greevy RA Jr, Kundu S, Vasan RS, Tindle HA. Association of smoking cessation with subsequent risk of cardiovascular disease. JAMA. 2019;322:642–50.
  9. Zhang Y, He J, He B, Huang R, Li M. Effect of tobacco on periodontal disease and oral cancer. Tob Induc Dis. 2019;17:40.
  10. Zong D, Liu X, Li J, Ouyang R, Chen P. The role of cigarette smoke-induced epigenetic alterations in inflammation. Epigenetics Chromatin. 2019;12:65.
  11. Liu Y, Li H, Wang J, Xue Q, Yang X, Kang Y, et al. Association of cigarette smoking with cerebrospinal fluid biomarkers of neurodegeneration, neuroinflammation, and oxidation. JAMA Netw Open. 2020;3:e2018777.
  12. Thomas T, Chandan JS, Li VSW, Lai CY, Tang W, Bhala N, et al. Global smoking trends in inflammatory bowel disease: A systematic review of inception cohorts. PLoS One. 2019;14:e0221961.
  13. Hikichi M, Mizumura K, Maruoka S, Gon Y. Pathogenesis of chronic obstructive pulmonary disease (COPD) induced by cigarette smoke. J Thorac Dis. 2019;11:S2129–40.
  14. Lee PN, Forey BA, Thornton AJ, Coombs KJ. The relationship of cigarette smoking in Japan to lung cancer, COPD, ischemic heart disease and stroke: A systematic review. F1000Res. 2018;7:204.
  15. Karademirci M, Kutlu R, Kilinc I. Relationship between smoking and total antioxidant status, total oxidant status, oxidative stress index, vit C, vit E. Clin Respir J. 2018;12:2006–12.
  16. Napierala M, Mazela J, Merritt TA, Florek E. Tobacco smoking and breastfeeding: Effect on the lactation process, breast milk composition and infant development. A critical review. Environ Res. 2016;151:321–38.
  17. Erel O. A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation. Clin Biochem. 2004;37:277–85.
  18. Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005;38:1103–11.
  19. Harma M, Harma M, Kocyigit A, Erel O. Increased DNA damage in patients with complete hydatidiform mole. Mutat Res. 2005;583:49–54.
  20. Zagierski M, Szlagatys-Sidorkiewicz A, Jankowska A, Krzykowski G, Korzon M, Kaminska B. Maternal smoking decreases antioxidative status of human breast milk. J Perinatol. 2012;32:593–7.
  21. Szlagatys-Sidorkiewicz A, Zagierski M, Renke J, Korzon M. Total antioxidative status in colostrum. The influence of maternal smoking. Med Wieku Rozwoj. 2005;9:621–8.
  22. Ortega RM, López-Sobaler AM, Martínez RM, Andrés P, Quintas ME. Influence of smoking on vitamin E status during the third trimester of pregnancy and on breast-milk tocopherol concentrations in Spanish women. Am J Clin Nutr. 1998;68:662–7.
  23. Bolisetty S, Naidoo D, Lui K, Koh TH, Watson D, Montgomery R, et al. Postnatal changes in maternal and neonatal plasma antioxidant vitamins and the influence of smoking. Arch Dis Child Fetal Neonatal Ed. 2002;86:F36–40.
  24. Orhon FS, Ulukol B, Kahya D, Cengiz B, Başkan S, Tezcan S. The influence of maternal smoking on maternal and newborn oxidant and antioxidant status. Eur J Pediatr. 2009;168:975–81.
  25. Yildiz N, Yilmaz A, Iskender H, Dokumacioglu E. Association between cigarette smoking and breast milk levels of nesfatin-1, ırisin, and oxidative stress markers. Makara J Health Res. 2021;25:195–9.
  26. Mahmood IH, Abdullah KS, Othman SH. The total antioxidant status in cigarette smoking individuals. Med J Basrah Univ. 2007;25:45–50.
  27. Zhou JF, Yan XF, Guo FZ, Sun NY, Qian ZJ, Ding DY. Effects of cigarette smoking and smoking cessation on plasma constituents and enzyme activities related to oxidative stress. Biomed Environ Sci. 2000;13:44–55.
  28. Napierala M, Merritt TA, Miechowicz I, Mielnik K, Mazela J, Florek E. The effect of maternal tobacco smoking and second-hand tobacco smoke exposure on human milk oxidant-antioxidant status. Environ Res. 2019;170:110–21.
  29. Ermis B, Yildirim A, Ors R, Tastekin A, Ozkan B, Akcay F. Influence of smoking on serum and milk malondialdehyde, superoxide dismutase, glutathione peroxidase, and antioxidant potential levels in mothers at the postpartum seventh day. Biol Trace Elem Res. 2005;105:27–36.
  30. Anderson R, Theron AJ, Richards GA, Myer MS, van Rensburg AJ. Passive smoking by humans sensitizes circulating neutrophils. Am Rev Respir Dis. 1991;144:570–4.
  31. Nagamma T, Baxi J, Singh PP. Status of oxidative stress and antioxidant levels in smokers with breast cancer from western Nepal. Asian Pac J Cancer Prev. 2014;15:9467–70.
  32. Aslan R, Kutlu R, Civi S, Tasyurek E. The correlation of the total antioxidant status (TAS), total oxidant status (TOS) and paraoxonase activity (PON1) with smoking. Clin Biochem. 2014;47:393–7.

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