Occurrence and levels of mycotoxins and their metabolites in human breast milk associated to dietary habits and other factors: A systematic literature review, 1984–2015

•63 worldwide studies were reviewed to report quantitative data on the occurrence of mycotoxins in breast milk.•The concentrations of AFM1 and OTA exceed in many countries the maximum limit required by the international organizations.•Many factors have showed its implication in AFM1 & OTA breast milk contamination.•Systematic monitoring programs are required to control the presence and the levels of mycotoxins in maternal milk.

BackgroundMany studies around the world reported the occurrence of many mycotoxins and their metabolites in human breast milk. However the contamination by aflatoxin M1 and ochratoxin A were the most investigated by several countries.Scope and approachTo scrutinize all papers reporting quantitative data on the prevalence and the levels of mycotoxins and their metabolites in breast milk, also the circumstances of exposure.A systematic literature search in Pubmed, Science direct and Google scholar databases were performed to identify relevant studies, published in English from 1984 through May 2015.Key findings and conclusion63 studies met the inclusion criteria and assessed the occurrence of 29 mycotoxins & their metabolites in breast milk, regarding 7194 subjects of 31 countries. The maternal dietary habits, the socio demographic status of the mother, the seasonal variations and the sensitivity of the analytical method were the factors related to the high concentrations of AFM1 and OTA in breast milk.Studies where contamination exceeds maximum limits and exhibit real risk of public health were highlighted.