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Andjelkovic et al. J Environ Expo Assess 2024;3:23 https://dx.doi.org/10.20517/jeea.2024.22 Page 3 of 20

The World Health Organization (WHO) and various governmental authorities strongly advocate for
[1]
breastfeeding due to its numerous health benefits for infants . However, it is also recognized that human
milk can contain contaminants, particularly POPs. These include PCBs, dichlorodiphenyltrichloroethane
and its metabolites (DDTs), chlordane compounds (CHLs), and hexachlorobenzene (HCB). Due to the high
toxicity of POPs, there is significant concern about the risks these chemicals pose to infants through
breastfeeding. Therefore, obtaining realistic data on POP exposure in infants via breastfeeding is essential
for developing and enforcing future regulations on these pollutants. Under the Global Monitoring Plan for
POPs within the Stockholm Convention framework, the WHO conducted surveys to track POP levels in
human breast milk. The main objectives of these surveys were to identify global variations in POP
contamination in human milk and to establish baseline data for countries lacking prior information. This
baseline facilitated the subsequent assessments of the success of measures aimed at reducing POP exposure.

The initial WHO surveys, conducted between 1987 and 1989 and again from 1992 to 1993, primarily
examined PCBs, polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs),
focusing mainly on regions in Europe and North America. From 2000 to 2019, the WHO, in partnership
with the United Nations Environment Programme (UNEP), executed five global studies assessing the levels
of POPs in human milk. The most recent study in this series was conducted from 2016 to 2019, with
financial support from the Global Environment Facility (GEF) as part of projects under the POPs Global
[13]
Monitoring Plan . Participants included 82 countries from all United Nations regions, with representatives
from both the Eastern European Group (EEG) and the Western European and Others Group (WEOG).
Among these, 50 countries contributed data in multiple studies.

Belgium, holding the highest participation rate among WEOG countries (n = 6), contributed to two early
global harmonized human milk studies conducted before 2000, when only 19 countries participated. From
2000 to 2019, Belgium continued its involvement through four WHO-coordinated surveys on POPs in
[14]
human milk within WEOG . For each WHO survey, a national pooled sample was analyzed. In the first
two surveys, Belgian national samples were composed of fewer individual samples and were not fully
regionally representative, consisting of three pooled samples from rural, urban, and industrial areas. In 2001
(third survey), two pooled samples were collected from residents of Liège. In contrast, the fourth survey in
2006 featured a Belgian pooled sample comprised of 178 individual samples distributed proportionally by
province. Furthermore, the sixth survey included a larger number of individual samples and covered all
three Belgian regions , with sample sizes corresponding to the population of each province. Similarly, in
[15]
the survey conducted in 2014, a Belgian pooled sample was analyzed. Although the maternal characteristics
influencing POP concentrations in the breast milk of primiparous mothers in Belgium have already been
[16]
published , the specific results of the measured POPs have not yet been published. In 2024, Serreau et al.
conducted a scoping review, collecting articles (1995-2023) that reported on pollutant levels in breast
milk . Although this review provided a comprehensive overview of contaminants in human milk, data
[17]
from Belgium were not considered. Therefore, the findings from 2014 still provide valuable insight into the
dynamics of POPs and deserve special mention in scientific reviews.

In particular, the study comprised the analyses of 206 milk samples from mothers living in the three Belgian
regions (Flanders, Wallonia, and the Brussels Capital Region). All samples were analyzed for the following
POPs: hexachlorocyclohexane group [α-hexachlorocyclohexane isomer (HCH), β-HCH, γ-HCH], HCB,
DDT group (o,p’-DDD, p,p’-DDD, o,p’-DDE, p,p’-DDE, o,p’-DDT, p,p’-DDT), chlordane-group
(oxychlordane, trans-nonachlor, cis-chlordane, and trans-chlordane) PBDEs, pentachlorobenzene (PeCB),
and hexabromobiphenyl (BB-153). Pooled samples were also prepared at the provincial level for the analysis
of hexachlorobutadiene, heptachlor, chlordecone, dieldrin, and hexabromocyclododecanes (HBCDs). In a