{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T11:36:58Z","timestamp":1792237018955,"version":"4.4.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T00:00:00Z","timestamp":1719878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>While breastfeeding is recommended, knowledge regarding medicine transfer to human milk and its safety for nursing infants is limited. Only one paper has previously described dimethyl fumarate (DMF) transfer during breastfeeding in two patients at 5 and 6\u2009months postpartum, respectively. The current case report describes maternal pharmacokinetic data of monomethyl fumarate (MMF), the active metabolite of DMF, and infant exposure estimations of MMF at 3\u2009months postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 32-year-old Caucasian woman started DMF therapy (120\u2009mg, 2x\/day) for multiple sclerosis at 3\u2009months postpartum, after weaning her infant from breastfeeding. On day 99 after birth, the patient collected four milk samples over 24\u2009h after 6\u2009days of treatment at the initial dose. Additionally, a single maternal blood sample was collected to calculate the milk-to-plasma (M\/P) ratio. The samples were analyzed using liquid chromatography coupled with the mass spectrometry method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A wide range of measured steady-state concentrations of MMF (5.5-83.5 ng\/mL) was observed in human milk samples. Estimated daily infant dosage values for MMF, calculated with 150 and 200\u2009mL\/kg\/day human milk intake, were 5.76 and 7.68\u2009\u03bcg\/kg\/day, and the relative infant doses were 0.16 and 0.22%. The observed mean M\/P ratio was 0.059, similar to the M\/P ratio predicted using the empirical Koshimichi model (0.06).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Combining this case report with the two previously described cases, the estimated infant exposure is low, albeit with relevant intra- and inter-patient variabilities. Research should further focus on infant exposure and safety.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1393752","type":"journal-article","created":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T13:44:03Z","timestamp":1719927843000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Very low monomethyl fumarate exposure via human milk: a case report\u2014a contribution from the ConcePTION project"],"prefix":"10.3389","volume":"12","author":[{"given":"Martje","family":"Van Neste","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Nauwelaerts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ceulemans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikte","family":"Cuppers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter","family":"Annaert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Smits","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Allegaert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"104068","DOI":"10.1016\/j.lpm.2021.104068","article-title":"Update on treatment in multiple sclerosis","volume":"50","author":"Callegari","year":"2021","journal-title":"Presse Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1264842","DOI":"10.3389\/fphar.2023.1264842","article-title":"Novel potential pharmacological applications of dimethyl fumarate\u2014an overview and update","volume":"14","author":"Bresciani","year":"2023","journal-title":"Front Pharmacol"},{"key":"ref3","year":"2023"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1056\/NEJMoa1114287","article-title":"Placebo-controlled phase 3 study of oral BG-12 for relapsing multiple sclerosis","volume":"367","author":"Gold","year":"2012","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s11095-017-2287-z","article-title":"Drugs in lactation","volume":"35","author":"Anderson","year":"2018","journal-title":"Pharm Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/6527458","article-title":"Management of multiple sclerosis in the breastfeeding mother","volume":"2016","author":"Almas","year":"2016","journal-title":"Mult Scler Int"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"217","DOI":"10.2165\/00003088-198814040-00003","article-title":"Drugs in human milk. 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