Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications

Impact of Climate Change on Human Lactation:... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/13-993" }, "headline": "Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications", "datePublished": "2024-09-02T15:54:21", "dateModified": "2025-11-04T17:09:49", "author": [ { "@type": "Person", "name": "Daryl O. Traylor" }, { "@type": "Person", "name": "Winter Cameron" }, { "@type": "Person", "name": "Brianna Clark" }, { "@type": "Person", "name": "Eboni Anderson" }, { "@type": "Person", "name": "Robert Henderson" }, { "@type": "Person", "name": "Lena Clark" }, { "@type": "Person", "name": "Michael Taylor" }, { "@type": "Person", "name": "Cierra Swington" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": "Global climate change poses significant challenges to human health and nutrition, particularly affecting lactating individuals and their infants. This review examines the impact of climate change on lactation, focusing on physiological, socioeconomic, and public health implications. Rising temperatures and heat stress can reduce milk production and alter milk composition, while malnutrition and water scarcity exacerbate these effects. Vulnerable populations face heightened risks, emphasizing the need for targeted mitigation strategies. Recommendations include enhancing nutritional support, securing water supplies, reducing environmental toxin exposure, and integrating lactation considerations into climate policies. Employing a social-ecological lens, this review underscores the necessity of a holistic approach to support lactating individuals in a warming world. Future research should explore the complex interactions between climate stressors and lactation to develop effective public health interventions." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-993", "name": "Impact of Climate Change on Human Lactation: Biological, Socioeconomic,..." } } ] } Home Browse Impact of Climate Change on Human Lactation: Biological, Socioeconomic,... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Traylor DO, Cameron W, Clark B et al. Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.12688/f1000research.155447.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Review Revised Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] Daryl O. Traylor https://orcid.org/0000-0002-8935-1653 1,2 , Winter Cameron 3 , Brianna Clark 3 , [...] Eboni Anderson 1,2,4,5 , Robert Henderson https://orcid.org/0009-0005-8006-4737 1,2,5 , Lena Clark 3 , Michael Taylor 6 , Cierra Swington 6 Daryl O. Traylor https://orcid.org/0000-0002-8935-1653 1,2 , Winter Cameron 3 , [...] Brianna Clark 3 , Eboni Anderson 1,2,4,5 , Robert Henderson https://orcid.org/0009-0005-8006-4737 1,2,5 , Lena Clark 3 , Michael Taylor 6 , Cierra Swington 6 PUBLISHED 04 Nov 2025 Author details Author details 1 Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, Washington, USA 2 Public Health, AT Still University College of Graduate Health Studies, Kirksville, MO, USA 3 Health Education, Sun Flower Lactation & Health Education, LLC, Houston, TX, USA 4 Research & Public Health, A.T. Still University School of Osteopathic Medicine at Arizona, Mesa, AZ, USA 5 Health Sciences, Chamberlain University, Chicago, Illinois, USA 6 California Baptist University, Riverside, California, USA Daryl O. Traylor Roles: Conceptualization, Project Administration, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Winter Cameron Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Brianna Clark Roles: Writing – Original Draft Preparation, Writing – Review & Editing Eboni Anderson Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Robert Henderson Roles: Writing – Review & Editing Lena Clark Roles: Writing – Review & Editing Michael Taylor Roles: Conceptualization, Resources, Writing – Review & Editing Cierra Swington Roles: Conceptualization, Resources, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Climate gateway. Abstract Global climate change poses significant challenges to human health and nutrition, particularly affecting lactating individuals and their infants. This review examines the impact of climate change on lactation, focusing on physiological, socioeconomic, and public health implications. Rising temperatures and heat stress can reduce milk production and alter milk composition, while malnutrition and water scarcity exacerbate these effects. Vulnerable populations face heightened risks, emphasizing the need for targeted mitigation strategies. Recommendations include enhancing nutritional support, securing water supplies, reducing environmental toxin exposure, and integrating lactation considerations into climate policies. Employing a social-ecological lens, this review underscores the necessity of a holistic approach to support lactating individuals in a warming world. Future research should explore the complex interactions between climate stressors and lactation to develop effective public health interventions. READ ALL READ LESS Keywords climate change, human lactation, heat stress, nutritional support, water scarcity, public health Corresponding Author(s) Daryl O. Traylor ( [email protected] ) Close Corresponding author: Daryl O. Traylor Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Traylor DO et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Traylor DO, Cameron W, Clark B et al. Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.12688/f1000research.155447.2 ) First published: 02 Sep 2024, 13 :993 ( https://doi.org/10.12688/f1000research.155447.1 ) Latest published: 04 Nov 2025, 13 :993 ( https://doi.org/10.12688/f1000research.155447.2 ) Revised Amendments from Version 1 This version of the article has been substantially revised to strengthen conceptual clarity, methodological transparency, and integration of recent literature. The Introduction has been expanded to explicitly distinguish this review from prior work by Edney et al. (2022), Tomori et al. (2023), Francis et al. (2024), and Victora et al. (2023), emphasizing the novel contribution of synthesizing biological, physiological, and social-ecological perspectives on climate impacts and lactation. The Background section was condensed and updated with new references, including the 2023 Lancet Breastfeeding Series and Pérez-Escamilla & Moran (2022), to contextualize breastfeeding within global structural inequities. The Physiology of Human Lactation section was retained but now includes a concise justification explaining its purpose: to provide the biological foundation necessary for understanding how heat stress and environmental changes disrupt lactation. The Methodology section was expanded to detail the literature search strategy, specifying databases, search terms, and inclusion criteria, and to clarify that preprint servers (SSRN, RePEc, and medRxiv) were included to capture emerging research. A new subsection, “Structural Inequities and Formula Dependence,” was added to the Discussion to address how limited maternity protections and reliance on commercial formula intersect with climate vulnerability. This addition integrates evidence on the environmental footprint of formula production (Dadhich et al., 2021; Smith et al., 2019; Smith et al., 2024). The Conclusion was revised to underscore the dual pathways through which climate change affects lactation: physiological disruption and social inequity, and to call for integrated policy responses. These updates collectively enhance the paper’s conceptual coherence and ensure that it provides a more comprehensive and interdisciplinary analysis of climate-related challenges to human lactation. This version of the article has been substantially revised to strengthen conceptual clarity, methodological transparency, and integration of recent literature. The Introduction has been expanded to explicitly distinguish this review from prior work by Edney et al. (2022), Tomori et al. (2023), Francis et al. (2024), and Victora et al. (2023), emphasizing the novel contribution of synthesizing biological, physiological, and social-ecological perspectives on climate impacts and lactation. The Background section was condensed and updated with new references, including the 2023 Lancet Breastfeeding Series and Pérez-Escamilla & Moran (2022), to contextualize breastfeeding within global structural inequities. The Physiology of Human Lactation section was retained but now includes a concise justification explaining its purpose: to provide the biological foundation necessary for understanding how heat stress and environmental changes disrupt lactation. The Methodology section was expanded to detail the literature search strategy, specifying databases, search terms, and inclusion criteria, and to clarify that preprint servers (SSRN, RePEc, and medRxiv) were included to capture emerging research. A new subsection, “Structural Inequities and Formula Dependence,” was added to the Discussion to address how limited maternity protections and reliance on commercial formula intersect with climate vulnerability. This addition integrates evidence on the environmental footprint of formula production (Dadhich et al., 2021; Smith et al., 2019; Smith et al., 2024). The Conclusion was revised to underscore the dual pathways through which climate change affects lactation: physiological disruption and social inequity, and to call for integrated policy responses. These updates collectively enhance the paper’s conceptual coherence and ensure that it provides a more comprehensive and interdisciplinary analysis of climate-related challenges to human lactation. See the authors' detailed response to the review by Pramila Menon See the authors' detailed response to the review by Cecília Tomori See the authors' detailed response to the review by Laura J Brown READ REVIEWER RESPONSES Human lactation: biological and socioeconomic significance According to Victoria et al. (2023) , global breastfeeding practices are shaped not only by biological determinants, but also by structural barriers such as inadequate maternity leave, limited lactation support, and aggressive formula marketing. These systemic obstacles prevent many individuals from meeting breastfeeding goals, producing inequities that are magnified under climate-driven disruptions. Human lactation remains central to infant survival and maternal health, yet the capacity to initiate and sustain breastfeeding is deeply influenced by socioeconomic and environmental contexts ( Pérez-Escamilla & Moran, 2022 ). Breastfeeding provides essential nutrients and immunological protection while lowering maternal risks of postpartum hemorrhage, certain cancers, and chronic diseases ( Gertosio et al., 2016 ). Socioeconomically, breastfeeding contributes to reduced healthcare costs and improved economic outcomes by fostering healthier populations and reducing the need for medical interventions ( Binns et al., 2016 ). Understanding lactation within this dual biological and structural context is necessary to appreciate how climate-related stressors compound existing inequities and health burdens. Transitioning from the broader benefits of lactation, it is essential to delve into the underlying biological mechanisms that make these advantages possible. Human lactation is a complex process involving the mammary gland, hormonal regulation, and milk composition. The mammary gland, under the influence of estrogen, prolactin, and cortisol, undergoes lactogenesis and milk ejection ( Villalpando & De Santiago, 1993 ). Prolactin, released in response to suckling, is essential for lactation, while oxytocin is involved in milk removal ( McNeilly, 1977 ). Milk synthesis occurs through various mechanisms, with the composition being influenced by maternal diet and body composition ( Villalpando & De Santiago, 1993 ). The process is also affected by maternal genetics, diet, and environmental factors ( Lee & Kelleher, 2016 ). The onset and maintenance of lactation are regulated by endocrine changes during pregnancy and postpartum ( Sadovnikova et al., 2020 ). Understanding the anatomy and physiology of lactation is crucial for supporting breastfeeding ( Sriraman, 2017 ). Physiology of human lactation Although discussions of lactation physiology appear in some textbooks, its inclusion here is intentional. Understanding the hormonal and cellular mechanisms underlying milk synthesis provides the necessary foundation for interpreting how environmental changes and heat stress can disrupt lactation. This biological grounding connects individual-level physiology with population-level vulnerability, ensuring that the subsequent analyses of climate impacts are anchored in the mechanisms that sustain milk production and infant nutrition. Lactation is coordinated by an interplay of hormones that ensure the successful production and ejection of milk, providing nourishment for the infant. The mammary gland, primarily influenced by estrogen, prolactin, and cortisol, undergoes significant changes to prepare for lactation ( Alex et al., 2020 ). During pregnancy, estrogen stimulates the proliferation of ductal structures within the mammary glands, while progesterone promotes the formation of alveolar structures necessary for milk production ( Alex et al., 2020 ). Cortisol also plays a role in mammary gland development by enhancing the effects of prolactin and other lactogenic hormones ( Kabotyanski et al., 2006 ). Mammalian lactation is a hormonally regulated process involving estrogen, progesterone, prolactin, and oxytocin. Estrogen and progesterone prepare the mammary glands during pregnancy, while prolactin promotes milk synthesis and oxytocin triggers milk ejection during breastfeeding. Lactogenesis, the onset of milk production, occurs in two stages: Lactogenesis I develops during pregnancy when the mammary gland gains the capacity to secrete milk but remains inhibited by high progesterone levels, and Lactogenesis II begins about two to three days after childbirth, when the drop in progesterone triggers copious milk secretion ( Sadovnikova et al., 2020 ). This stage is characterized by increased blood flow, oxygen, and glucose uptake by the mammary gland, which are essential for milk synthesis ( Neville & Morton, 2001 ). The hormonal axis that regulates lactation relies on a precise balance of prolactin and oxytocin and their feedback mechanisms ( Trott et al., 2012 ). Prolactin, synthesized and released by the anterior pituitary gland in response to nipple stimulation during suckling, promotes the synthesis of milk proteins, lactose, and lipids in mammary alveolar cells ( Grattan, 2015 ; Trott et al., 2012 ). The neural stimulus of suckling inhibits dopamine, a prolactin-inhibiting factor, thereby allowing greater prolactin release from the pituitary ( Grattan, 2015 ). Oxytocin, produced in the hypothalamus and stored in the posterior pituitary gland, is released into the bloodstream during suckling and causes myoepithelial cells around the alveoli to contract, expelling milk through the ductal system to the nipple ( Crowley, 2014 ). Milk synthesis occurs through cellular mechanisms in the mammary alveoli, involving the uptake of nutrients from maternal blood and their conversion into milk components such as lactose, casein, whey proteins, and lipids ( Neville & Morton, 2001 ; Sadovnikova et al., 2020 ). The composition of human milk is dynamic and influenced by maternal diet, body composition, genetics, infant age, and environmental factors ( Neville & Morton, 2001 ). Nutritional intake and body fat stores affect both the quantity and quality of milk, while genetic factors help determine milk volume, composition, and the ability to sustain lactation ( Han et al., 2019 ; Wheelock et al., 2010 ). External factors, including stress, exposure to pollutants, and overall health, can also influence lactation outcomes ( Lee & Kelleher, 2016 ; Kiprutto et al., 2015 ). The onset and maintenance of lactation are tightly regulated by endocrine changes that occur during pregnancy and the postpartum period. During pregnancy, elevated levels of estrogen and progesterone prepare the mammary glands for lactation but inhibit milk secretion ( Neville & Morton, 2001 ; Sadovnikova et al., 2020 ). Postpartum, the significant drop in progesterone levels after delivery, combined with the continued high levels of prolactin and the initiation of oxytocin release through suckling, ensures the successful transition to active milk production and ejection ( Crowley, 2014 ). Understanding the intricate anatomy and physiology of lactation is crucial for supporting chestfeeding, helping healthcare providers offer better guidance and interventions to ensure successful chestfeeding and maximize health benefits for both mother and child. Understanding these hormonal and physiological mechanisms provides the foundation for exploring how environmental stressors such as climate change can interfere with lactation. Pathophysiology of the effects of heat on lactation Most available data derive from dairy cattle and rodent studies, which, while not human, provide valuable insight into shared endocrine mechanisms. Heat stress can impair lactation by affecting both the endocrine system and the overall physiological state of lactating mammals ( Han et al., 2019 ). Elevated temperatures can lead to dehydration, which significantly impacts the body’s ability to produce and secrete milk. Dehydration reduces blood volume and flow to the mammary glands, thereby decreasing the supply of essential nutrients and precursors required for milk synthesis ( Wheelock et al., 2010 ). This reduction in blood volume can lead to decreased renal function and reduced clearance of metabolic waste, further complicating the physiological state of the lactating animal ( Bentley, 1998 ; Wheelock et al., 2010 ). Additionally, heat stress can alter the hormonal balance necessary for lactation ( Han et al., 2019 ; Wheelock et al., 2010 ). Prolactin and oxytocin levels can be disrupted by stress hormones such as cortisol, which is elevated in response to heat stress. Cortisol can inhibit the release of prolactin from the anterior pituitary gland, which is crucial for the synthesis of milk proteins, lactose, and lipids. This inhibition can lead to a significant decrease in milk volume ( Rhoads et al., 2010 ; Ponchon et al., 2017 ; Syam et al., 2022 ). Moreover, cortisol can affect the release of oxytocin from the posterior pituitary gland, impairing the milk ejection reflex. Without adequate oxytocin, the myoepithelial cells surrounding the alveoli fail to contract effectively, reducing the efficiency of milk expulsion from the mammary glands ( Haaksma et al., 2011 ). Heat stress can also increase the levels of catecholamines (epinephrine and norepinephrine), which are stress-related hormones that further inhibit oxytocin release and exacerbate the difficulties in milk ejection ( Haldar & Bade, 1981 ). The combined effect of elevated cortisol and catecholamines can lead to a cycle of stress and reduced lactation, impacting the mother’s ability to breastfeed effectively. The physiological stress from elevated temperatures can also lead to systemic inflammation, which can affect the mammary glands. Inflammatory cytokines such as IL-6 and TNF-α may increase, potentially disrupting normal cellular functions within the mammary glands and further impairing milk production and quality ( Abdelnour et al., 2019 ; Chen et al., 2023 ). Additionally, heat stress may exacerbate underlying health conditions, such as hypertension or diabetes, which can further complicate lactation. In summary, the impact of heat stress on lactating individuals is multifaceted, involving dehydration, hormonal imbalances, systemic inflammation, and potential exacerbation of pre-existing conditions. These factors collectively impair milk production and ejection, posing significant challenges for lactating individuals in hot climates. Impact of Excess Heat on Chestfed Infants. For infants, the impact of heat on lactation can be severe. Reduced milk production due to heat stress can lead to insufficient nutrient intake, affecting the infant’s growth and development ( Bernabucci et al., 2013 ; Lefebvre et al., 2024 ). Breast milk provides essential hydration, particularly in hot climates, and any reduction in its availability can increase the risk of dehydration in infants ( Bernabucci et al., 2013 ). Furthermore, the quality of breast milk can be compromised under heat stress, with potential changes in its composition affecting the balance of nutrients, antibodies, and other bioactive components critical for the infant’s health ( Bernabucci et al., 2013 ). Overall Health Risks for Lactating Individuals and Infants. Both lactating individuals and their infants face increased health risks during periods of high heat. Lactating individuals experiencing heat stress may suffer from symptoms such as fatigue, dizziness, and heat exhaustion, which can affect their ability to care for their infants effectively ( Lefebvre et al., 2024 ). For infants, the combination of reduced milk intake and increased susceptibility to heat can lead to severe dehydration, electrolyte imbalances, and heat-related illnesses, potentially requiring medical intervention ( Lefebvre et al., 2024 ). In summary, understanding the pathophysiology of the effects of heat on lactation is crucial for developing strategies to mitigate these risks. Ensuring adequate hydration, maintaining a cool environment, and monitoring both lactating individuals and their infants for signs of heat stress are essential steps in safeguarding their health during periods of elevated temperatures. Socioeconomic and Evolutionary Contexts of Lactation. Transitioning from the biological complexities of human lactation to its wider contexts, human lactation also has profound socioeconomic implications. The economic impact of lactation is substantial, as human milk production contributes significantly to national economies by reducing healthcare costs ( Alex et al., 2020 ). Lactation adequacy is influenced by social and health factors, underscoring the critical role of breastfeeding in developing countries ( Kabotyanski et al., 2006 ). These factors include maternal employment, cultural norms, social support, and education level, all of which influence breastfeeding initiation and duration ( Thulier & Mercer, 2009 ; Carter et al., 2021 ). The evolutionary and environmental influences on human lactation highlight its psychosocial, nutritional, and economic significance ( Neville & Morton, 2001 ; Sadovnikova et al., 2020 ). Various demographic, physical, social, and psychological variables influence breastfeeding duration ( Trott et al., 2012 ). Additionally, the nutritional and health aspects of human lactation underscore its importance in both developed and developing countries ( Crowley, 2014 ; Neville & Morton, 2001 ). Intersections between climate change and human lactation This review examines the significant impacts of climate change and excess heat on human lactation, highlighting unique challenges that require thorough investigation. Previous research has indicated that environmental factors, such as extreme temperatures and food scarcity, can impact lactation. However, there is a notable gap in focused studies addressing how these climate-induced changes specifically affect lactating individuals. This review aims to fill that gap by providing a comprehensive analysis of the intersection between global climate change and human lactation, emphasizing the urgent need for targeted mitigation strategies to support lactating individuals in a changing climate. Methodology The approach taken to conduct this narrative review on the intersections between global climate change, extreme heat, and human lactation focused on identifying key challenges and proposing effective mitigation strategies. The literature search strategy encompassed a range of academic and open-access sources to ensure comprehensive coverage. Searches were conducted across major databases and search engines, including PubMed, Web of Science, Scopus, Google Scholar, and JSTOR, as well as Google and Bing for grey literature and policy documents. In addition, preprint servers such as SSRN, RePEc, and medRxiv were examined to capture emerging evidence and working papers not yet published in peer-reviewed journals. The search terms used encompassed core concepts such as global climate change, human lactation, breastfeeding, maternal health, and infant health, along with specific aspects like temperature extremes, food security, water scarcity, malnutrition, heat stress, environmental toxins, pollutants, natural disasters, displacement, vulnerabilities, and public health strategies . Combinations and Boolean operators, including “climate change AND lactation,” “heat stress OR dehydration AND breastfeeding,” and “environmental toxins AND breast milk”, were applied to refine and expand results across multiple databases. The inclusion criteria for this review consisted of peer-reviewed articles, case reports, epidemiological studies, policy analyses, reviews, and preprints or working papers from reputable scholarly sources; publications in English; studies focused on the impacts of climate change on lactation or maternal and infant health; and policy documents and reports from recognized organizations such as the World Health Organization (WHO) and UNICEF. Conversely, the exclusion criteria eliminated papers not directly related to climate change or lactation, non-English publications, articles without full-text access, and opinion pieces lacking empirical evidence. In total, 95 publications met the inclusion criteria, comprising 84 peer-reviewed journal articles, 6 scholarly book chapters, 3 preprints or working papers (SSRN, RePEc, and medRxiv), and 2 conference or supplement abstracts, published between 1977 and 2024. Review Climate change impacts on health and nutrition Although this review focuses on heat exposure, some evidence suggests that extreme cold may also influence lactation by increasing maternal energy demands and affecting infant thermoregulation ( Rylander et al., 2013 ). Climate change significantly impacts health and nutrition, particularly among vulnerable populations. One major area of concern is the effect of temperature extremes on maternal and infant health ( Bao et al., 2020 ; Lefebvre et al., 2024 ; Han et al., 2019 ). Extreme heat can lead to increased cases of heat stress, dehydration, and heat-related illnesses such as heat exhaustion and electrolyte imbalances, which are especially dangerous for pregnant women and infants whose thermoregulatory systems are not fully developed ( Bao et al., 2020 ). Evidence consistently shows that maternal heat exposure increases the risk of preterm birth, low birth weight, and stillbirth ( Weng et al., 2017 ; Ponchon et al., 2017 ). Extreme temperatures are also associated with higher maternal hospitalization rates and infant mortality ( Syam et al., 2022 ). Further research has identified links between prenatal exposure to heat and severe maternal morbidity in the United States, with disproportionate effects among Black and Hispanic mothers. For example, Kim et al. (2019) observed that women exposed to multiple heatwave days during late pregnancy had significantly higher rates of hypertensive complications. These disparities may worsen as global temperatures continue to rise ( Haaksma et al., 2011 ; Haldar & Bade, 1981 ). Climate change disrupts food security by reducing crop yields and altering nutrient content, leading to undernutrition in many regions. For lactating individuals, insufficient dietary intake can lower milk volume and modify fat and protein composition, compromising infant nutrition ( Maheshwari, 2022 ; Prentice & Prentice, 1995 ). Changes in weather patterns, such as prolonged droughts and increased frequency of extreme weather events, can negatively affect agricultural productivity, leading to food shortages and increased prices ( Abdelnour et al., 2019 ). This can result in malnutrition, especially in communities that rely heavily on subsistence farming ( Chen et al., 2023 ; Bernabucci et al., 2013 ). The nutritional quality of food can also be compromised due to climate-induced changes in soil health and crop nutrient content, further exacerbating the problem ( Maheshwari, 2022 ). Water scarcity, another consequence of climate change, has significant implications for hydration and lactation ( Geissler et al., 1978 ; Kim & Yi, 2020 ). Adequate water intake is crucial for maintaining maternal health and ensuring sufficient milk production ( Geissler et al., 1978 ). Dehydration decreases plasma volume and mammary blood flow, impairing milk synthesis efficiency ( Bentley, 1998 ; Xie et al., 2022 ). Chronic stress associated with water scarcity may further suppress oxytocin release, hindering milk ejection. In regions facing water shortages, women may struggle to stay hydrated, impacting their overall health and ability to lactate effectively. This situation is particularly dire in areas where access to clean water is already limited, and the added stress of water scarcity can severely affect both maternal and infant health ( Prentice & Prentice, 1995 ). Vulnerability of lactating individuals to climate change Lactating individuals face increased physiological demands, making them particularly vulnerable to the impacts of climate change. During lactation, lactating individuals require additional calories, nutrients, and hydration to produce sufficient breast milk ( Cowie et al., 1979 ). Climate-related challenges, such as heat stress and water scarcity, can hinder their ability to meet these increased demands, thereby affecting milk production and quality ( Prentice & Prentice, 1995 ; Thulier & Mercer, 2009 ). In addition to socio-economic disparities, climate-related stressors, such as natural disasters and displacement, significantly impact lactating individuals ( Kuehn & McCormick, 2017 ; Khajehaminian et al., 2019 ). Different populations experience varying levels of vulnerability to climate change, with low-income and rural communities often being the most affected. These populations typically have limited access to healthcare, nutritious food, and clean water, making it difficult to cope with the additional stressors brought on by climate change ( Delgado et al., 1985 ). Rural areas may face increased isolation during extreme weather events, further limiting their access to necessary resources and support ( Casey & Hambidge, 1983 ). Empirical data on how displacement, extreme heat, and psychosocial stress jointly influence lactation remain limited. Research should prioritize culturally diverse populations to identify adaptive behaviors and protective community mechanisms that sustain breastfeeding during environmental crises. The influence of heat stress on milk production and composition is a critical area of concern. High temperatures can cause dehydration, which reduces a lactating individual’s ability to produce milk ( Kim & Yi, 2020 ). Heat exposure can also alter the composition of breast milk, potentially decreasing its nutritional value and affecting infant growth and development. In addition to direct heat effects, broader climate-related stressors such as natural disasters and displacement can further disrupt lactation. Displacement often limits access to food, clean water, and healthcare ( Kuehn & McCormick, 2017 ) and may increase exposure to unsanitary conditions and infectious diseases, negatively affecting both maternal and infant health ( Kuehn & McCormick, 2017 ; Kim et al., 2019 ). The combined stress and trauma associated with these events can impair milk production and quality. Maintaining adequate hydration, nutritional intake, and access to healthcare resources is essential for supporting effective lactation under changing climatic conditions. Empirical data on how displacement, extreme heat, and psychosocial stress jointly influence lactation remain limited. Research should prioritize culturally diverse populations to identify adaptive behaviors and protective community mechanisms that sustain breastfeeding during environmental crises. Health disparities and health equity related to climate change Health disparities refer to the differences in health outcomes and their determinants between segments of the population, which are often driven by social, economic, and environmental disadvantages ( Braveman et al., 2021 ). Health equity, on the other hand, is the principle of providing fair opportunities for health and wellness, aiming to reduce and eliminate disparities ( Braveman, 2014 ). In the context of climate change and human lactation, these disparities are particularly pronounced, with marginalized populations bearing a disproportionate burden of adverse health outcomes ( Limaye, 2022 ; Smirnova et al., 2023 ). Current evidence underscores the disproportionate burden borne by marginalized populations, yet few studies quantify how intersecting identities, such as race, geography, and socioeconomic status, affect lactation outcomes during climate events. Future investigations should apply intersectional frameworks and mixed-methods designs to capture these multifactorial influences more comprehensively. Socioeconomic disparities Socioeconomic status (SES) is a major determinant of health outcomes, including those related to lactation ( Pérez-Escamilla & Moran, 2022 ). Low-income families often have limited access to healthcare, nutritious food, and clean water, all of which are essential for maintaining optimal health and lactation ( Adler & Newman, 2002 ). Climate change exacerbates these challenges by increasing the frequency and severity of extreme weather events, such as droughts and heatwaves, which disproportionately affect low-income communities ( Gregory et al., 2023 ). These events can disrupt access to essential resources, further compromising the health of lactating mothers and their infants. Geographic disparities Geographic location also plays a crucial role in health disparities. Rural and remote areas, particularly in developing countries, often lack adequate healthcare infrastructure and resources ( Reilly, 2021 ). Breastfeeding support disparities are apparent, particularly in rural areas where access is limited and inequities are tied to socioeconomic status ( Grubesic & Durbin, 2017 ). These regions are more vulnerable to the impacts of climate change, including water scarcity and food insecurity, which directly affect lactating individuals. Urban areas, while having better access to healthcare, are not immune to disparities. Low-income urban neighborhoods may face challenges such as heat islands and poor air quality, further impacting maternal and infant health ( Howarth & Eiser, 2023 ). Racial and ethnic disparities Racial and ethnic minorities are disproportionately affected by climate change and its health impacts ( Weaver et al., 2023 ). In many regions, Black, Indigenous, and People of Color (BIPOC) communities face systemic barriers to healthcare and are more likely to live in areas with higher exposure to environmental hazards. These communities often experience higher rates of pre-existing conditions, which can be exacerbated by climate-induced stressors, further complicating lactation and infant health ( Burbank et al., 2023 ; Morello-Frosch et al., 2011 ). For example, Black and Hispanic mothers have been shown to have higher rates of adverse birth outcomes linked to extreme heat exposure ( Borrell et al., 2022 ; Dzekem et al., 2023 ). Intersectionality and vulnerability The concept of intersectionality highlights how various aspects of a person’s identity, such as race, gender, socioeconomic status (SES), and geographic location, intersect to create unique experiences of disadvantage and privilege ( Williams et al., 2012 ). This framework is critical for understanding the compounded vulnerabilities faced by lactating individuals who belong to multiple marginalized groups. For instance, a low-income, rural, Black mother may encounter a multitude of barriers that singularly and collectively impact her health and lactation experience ( MacGregor & Hughes, 2010 ). Firstly, limited access to healthcare is a significant challenge for low-income, rural populations ( Asiodu et al., 2021 ). Healthcare facilities may be scarce and distant, leading to delays in receiving necessary prenatal and postnatal care ( Asiodu et al., 2021 ; Lusambili & Nakstad, 2023 ). This can hinder the establishment and maintenance of breastfeeding. Although financial barriers can limit access to lactation consultants or equipment, many individuals successfully chestfeed with limited resources through community support and proper education ( Francis et al., 2020 ; Gorman, 2020 ). Secondly, exposure to extreme weather conditions, exacerbated by climate change, poses additional risks. In rural areas, infrastructure may be inadequate to cope with extreme heat, affecting the availability of clean water and cooling mechanisms. This can lead to dehydration and heat stress, further complicating the physiological process of lactation and the overall health of the mother and infant ( Lusambili & Nakstad, 2023 ; Roos et al., 2021 ). Lastly, systemic racism adds another layer of complexity. Discriminatory practices within the healthcare system can result in biased treatment and a lack of culturally competent care. This may lead to mistrust in healthcare providers and reluctance to seek help, thereby affecting the quality of care received ( Witt et al., 2022 ). Furthermore, social determinants of health, such as housing instability, food insecurity, and limited educational opportunities, disproportionately affect Black communities, amplifying the challenges faced by low-income, Black mothers ( Brailey & Slatton, 2024 ; Greenberg et al., 2022 ). In summary, intersectionality provides a comprehensive lens through which to view the compounded adversities faced by lactating individuals from multiple marginalized backgrounds. Addressing these layered challenges requires a multifaceted approach that considers the intricate interplay of race, gender, SES, and geographic location to improve health outcomes and support equitable lactation practices ( Carter et al., 2021 ). Malnutrition and dehydration, exacerbated by climate change, directly impact lactation Malnutrition in lactating women can lead to a decrease in milk production and a reduction in the quality of breast milk ( Runkle et al., 2022 ). Dehydration further complicates this issue, as it not only reduces milk volume but can also affect the mother’s overall health, making it more difficult for her to care for her infant ( Kim & Yi, 2020 ). Addressing malnutrition and ensuring access to clean water are crucial for supporting lactating women in a changing climate. In addition to the challenges of malnutrition and dehydration, environmental toxins and pollutants, increasingly prevalent due to climate change, also affect milk quality ( Rylander et al., 2013 ). Pollutants such as heavy metals and chemicals can accumulate in breast milk, posing health risks to infants ( Hasan & Hussain, 2020 ). Climate change can exacerbate the spread of these toxins through increased flooding, which can contaminate water supplies and agricultural lands ( Kiprutto et al., 2015 ). Monitoring and mitigating exposure to environmental toxins are essential steps in protecting maternal and infant health. Additional evidence Numerous studies document the effects of climate change on lactating females, providing valuable insights into this critical issue. For instance, research has shown that heat stress can significantly reduce milk production and alter its composition, while malnutrition and dehydration further exacerbate these effects ( Hema et al., 2023 ; Lake et al., 2012 ). These studies highlight the importance of addressing climate-related challenges to support lactating women and their infants. Analysis of data from various geographical regions reveals the widespread impact of climate change on lactation. In regions with high temperatures and frequent droughts, such as parts of Africa, Central and South America, and South Asia, lactating women face significant challenges in maintaining adequate hydration and nutrition. These regions also often experience food insecurity, further complicating efforts to support maternal and infant health ( Sultana & Mostafa, 2023 ; DeNicola et al., 2015 ; Xie et al., 2022 ; Bentley, 1998 ; Butte et al., 2001 ). Understanding regional differences in vulnerability and adaptive capacity is essential for developing effective interventions. Case studies highlight critical issues and adaptive responses to climate change impacts on lactation. For example, in some communities, local initiatives have been implemented to provide clean water and nutritional support to lactating women ( Josefson et al., 2023 ). These initiatives often involve community-based education programs and partnerships with local organizations to ensure sustainable access to resources ( Josefson et al., 2023 ; Chen et al., 2020 ; Winter et al., 2019 ). This review highlights select case studies to illustrate how local interventions can inform climate-related lactation strategies in similar settings. Addressing health disparities and advancing health equity in climate change and lactation Addressing health disparities and promoting health equity requires targeted, multi-faceted interventions. Strategies to mitigate the impact of climate change on lactating individuals must consider the social determinants of health and aim to reduce systemic barriers. Key recommendations include improving access to healthcare by enhancing healthcare infrastructure in underserved areas to provide comprehensive maternal and infant care, including support for lactating individuals ( Reilly, 2021 ; Grubesic & Durbin, 2017 ). Ensuring food and water security is crucial and can be achieved by implementing policies and programs that guarantee access to nutritious food and clean water, particularly in regions vulnerable to climate change ( DeNicola et al., 2015 ; Sultana & Mostafa, 2023 ). Enhancing education and awareness involves developing community-based initiatives to increase understanding of how climate change affects lactation and to promote practical strategies for mitigation ( Francis et al., 2020 ; Gorman, 2020 ). Strengthening social support networks is also vital and can be achieved by creating local support groups and peer networks for lactating individuals, offering emotional and practical assistance in adapting to climate-related challenges. Finally, advocating for policy change is necessary to ensure that maternal and child health considerations are incorporated into climate adaptation and mitigation efforts at local, national, and international levels ( Limaye, 2022 ; Gregory et al., 2023 ). Research examining the effects of extreme heat and climate change on lactating humans remains limited. Much of the existing evidence is based on animal models, underscoring the need for further research on human populations. The intersection of climate change and human lactation highlights the urgency of addressing health disparities and advancing health equity. By acknowledging and mitigating the compounded vulnerabilities faced by marginalized populations, we can foster more effective and equitable public health interventions. Ensuring that all lactating individuals have the resources, healthcare access, and social support necessary to thrive in a changing climate is critical for protecting the health and well-being of both caregivers and infants. Structural inequities and formula dependence Structural determinants of infant feeding are central to understanding vulnerability under climate stress. Limited maternity protections, workplace inflexibility, and inequitable access to lactation support contribute to early weaning and increased reliance on commercial formula. This dependence heightens risk in emergencies where power outages and unsafe water make formula preparation hazardous. Moreover, formula production and distribution generate significant greenhouse gas emissions and water consumption, linking infant-feeding inequities directly to climate drivers ( Dadhich et al., 2021 ; Smith, 2019 ; Smith et al., 2024 ). Addressing these interconnected issues requires both environmental and social policy interventions that promote breastfeeding equity while mitigating climate impact. Mitigation strategies Nutritional support is crucial for lactating females, especially in regions affected by climate change. Interventions should focus on providing access to nutrient-rich foods and supplements to meet the increased caloric and nutritional demands of lactation. Governments and organizations should implement policies to secure food and water supplies in vulnerable regions. This includes investing in sustainable agriculture, improving water management systems, and providing emergency food and water supplies during climate-related disasters. Public health initiatives should aim to reduce exposure to environmental toxins that can contaminate breast milk. This includes monitoring and regulating pollutants, educating communities about safe practices, and providing resources to minimize exposure. Community-based programs can provide essential support and education to lactating mothers. These programs can offer breastfeeding education, nutritional counseling, and access to clean water and healthcare services, enhancing resilience against climate-related stressors. However, evaluations of community-based interventions for lactating individuals under climate stress are scarce. Rigorous assessment of existing programs could clarify which strategies, nutritional supplementation, hydration education, or social support networks, most effectively promote lactation resilience across diverse settings. Addressing the issue through a social-ecological lens The social-ecological model examines how individual, interpersonal, organizational, community, and policy factors interact to influence health outcomes ( Figure 1 ) ( Khajehaminian et al., 2019 ). Applying this model to lactation and climate change helps identify the multiple levels of influence and potential intervention points. At the individual level, educating lactating women about the impacts of climate change and strategies for maintaining health and milk production can enhance personal resilience. Figure 1. Social-ecological model of lactation support highlighting individual, interpersonal, community, and societal factors. Note. This model illustrates the multi-layered factors influencing lactation, from individual to societal levels. The innermost circle represents individual factors, such as the desire to breastfeed and access to climate control. The next layers include interpersonal support from family and friends, community values and investments, and, finally, societal and government actions such as funding and policy for climate change mitigation and maternal/child health. This framework highlights the complexity of factors that need to be addressed to support lactating individuals in a warming world. Encouraging behaviors such as staying hydrated, consuming nutrient-rich foods, and managing heat exposure can help lactating women adapt to climate stressors. Strengthening social support networks can provide emotional and practical support to lactating women, helping them cope with climate-related challenges. Involving family members and partners in efforts to support lactation can enhance the effectiveness of adaptive strategies and provide additional resources and support. At the organizational level, workplaces should adopt policies that support lactating mothers, such as providing flexible schedules, lactation rooms, and access to clean water and nutritious food. Healthcare facilities should be equipped to handle the impacts of climate change, ensuring they can provide adequate care and support to lactating women. Communities can develop interventions to ensure that resources such as clean water, food, and healthcare are available during climate-related events. Local support groups and peer counselors can offer practical advice, emotional support, and resources to lactating women, helping them navigate climate challenges. Advocacy efforts should focus on integrating lactation considerations into climate policies at national and international levels, ensuring that the needs of lactating women are prioritized. Climate adaptation and mitigation strategies should include specific measures to protect maternal and child health, addressing the unique vulnerabilities of lactating women. Collaboration across disciplines can lead to more effective strategies for addressing the impacts of climate change on lactation. Community-driven initiatives can provide tailored solutions that align with broader policy goals, ensuring that local needs and perspectives are integrated into climate and health strategies. By addressing the issue of climate change and lactation through a social-ecological lens, we can develop comprehensive strategies that support lactating women at multiple levels of influence. This holistic approach is essential for building resilience and ensuring the health and well-being of both mothers and infants in a changing climate. Future research directions Future research should focus on identifying and addressing gaps in our understanding of how climate change affects lactation in humans. This includes studying the physiological, nutritional, and environmental factors that influence lactation under different climatic conditions. Longitudinal and cross-sectional studies are needed to examine the long-term impacts of climate change on lactation and maternal and infant health. These studies can provide valuable insights into how climate-related stressors affect lactation over time. Interdisciplinary research is essential to fully understand the complex interactions between climate change, nutrition, and public health. Collaboration between climate scientists, nutritionists, and public health experts can lead to more comprehensive and effective strategies for supporting lactating women. Conclusion Future adaptation strategies must integrate both biological and structural insights to protect lactating individuals in an era of accelerating climate change. By addressing the dual pathways through which climate stressors affect lactation, physiological disruption and social inequity, policymakers and public health practitioners can craft interventions that are both equitable and sustainable. Incorporating lactation into climate adaptation planning, strengthening maternal support systems, and reducing the environmental footprint of infant feeding will be essential to safeguarding maternal and infant health globally. Data availability No data are associated with this article. References Abdelnour SA, Abd El-Hack ME, Khafaga AF, et al. : Stress biomarkers and proteomics alteration to thermal stress in ruminants: A review. J. Therm. Biol. 2019; 79 : 120–134. PubMed Abstract | Publisher Full Text Ahmed M: Introduction to modern climate change. Sci. Total Environ. 2020; 734 (2020): 139397. Publisher Full Text Adler NE, Newman K: Socioeconomic disparities in health: Pathways and policies. Health Aff. 2002; 21 (2): 60–76. Publisher Full Text Alex A, Bhandary E, McGuire KP: Anatomy and physiology of the breast during pregnancy and lactation. Adv. Exp. Med. Biol. 2020; 1252 : 3. PubMed Abstract | Publisher Full Text Asiodu IV, Bugg K, Palmquist AEL: Achieving breastfeeding equity and justice in Black communities: Past, present, and future. Breastfeed. Med. 2021; 16 (6): 447–451. PubMed Abstract | Publisher Full Text | Free Full Text Balakrishnan VS: Global warming: experts demand urgent action to prevent public health crisis. BMJ. 2018; 363 : k4241. PubMed Abstract | Publisher Full Text Bao MH, Chen LB, Hambly C, et al. : Exposure to hot temperatures during lactation in striped hamsters stunts offspring growth and decreases future reproductive performance of female offspring. J. Exp. Biol. 2020; 223 (9): jeb223560. Publisher Full Text Bentley GR: Hydration as a limiting factor in lactation. Am. J. Hum. Biol. 1998; 10 (2): 151–161. PubMed Abstract | Publisher Full Text Bernabucci U, Basiricò L, Morera P: Impact of hot environment on colostrum and milk composition. Cell. Mol. Biol. (Noisy-le-Grand). 2013; 59 (1): 67–83. Accessed July 4, 2024. PubMed Abstract Binns C, Lee M, Low WY: The long-term public health benefits of breastfeeding. Asia Pac. J. Public Health. 2016; 28 (1): 7–14. Publisher Full Text Borrell LN, Bolúmar F, Rodriguez-Alvarez E, et al. : Adverse birth outcomes in New York City women: Revisiting the Hispanic Paradox. Soc. Sci. Med. 2022; 315 : 115527. PubMed Abstract | Publisher Full Text Brailey C, Slatton BC: Centering Black women’s voices: Illuminating systemic racism in maternal healthcare experiences. Societies. 2024; 14 (5): 70. Publisher Full Text Braveman P: What Are health disparities and health equity? We need to be clear. Public Health Rep. 2014; 129 (2): 5–8. PubMed Abstract | Publisher Full Text | Free Full Text Braveman PA, Kumanyika S, Fielding J, et al. : Health disparities and health equity: The issue is justice. Am. J. Public Health. 2021; 101 Suppl 1 (S1): S149–S155. PubMed Abstract | Publisher Full Text | Free Full Text Burbank AJ, Espaillat AE, Hernandez ML: Community- and neighborhood-level disparities in extreme climate exposure: Implications for asthma and atopic disease outcomes. J. Allergy Clin. Immunol. 2023; 152 (5): 1084–1086. PubMed Abstract | Publisher Full Text | Free Full Text Butte NF, Wong WW, Hopkinson JM: Energy requirements of lactating women derived from doubly labeled water and milk energy output. J. Nutr. 2001; 131 (1): 53–58. PubMed Abstract | Publisher Full Text Carter SK, Stone A, Graham L, et al. : Creating intersectional subjects: A critical discourse analysis of health science breastfeeding research. Sociology of Race and Ethnicity. 2021; 8 : 129–144. Publisher Full Text Casey CE, Hambidge KM: Nutritional aspects of human lactation. Springer eBooks; 1983; 199–248. Publisher Full Text Chen T, Radke JD, Lang W, et al. : Environment resilience and public health: Assessing healthcare’s vulnerability to climate change in the San Francisco Bay Area. Growth Chang. 2020; 51 (2): 607–625. Publisher Full Text Chen Y-C, Orellana Rivas RM, Marins TN, et al. : Effects of heat stress abatement on systemic and mammary inflammation in lactating dairy cows. J. Dairy Sci. 2023; 106 (11): 8017–8032. PubMed Abstract | Publisher Full Text Cowie AT, Derrick B, Jelliffe EF: Human milk in the modern world: Psychosocial, nutritional, and economic significance. Q. Rev. Biol. 1979; 54 (1): 122–122. Publisher Full Text Crowley WR: Neuroendocrine regulation of lactation and milk production. Compr. Physiol. 2014; 5 (1): 255–291. PubMed Abstract | Publisher Full Text Dadhich JP, Smith JP, Iellamo A, et al. : Climate change and infant nutrition: Estimates of greenhouse gas emissions from milk formula sold in selected Asia Pacific countries. J. Hum. Lact. 2021; 37 (4): 689–698. Publisher Full Text DeNicola E, Aburizaiza OS, Siddique A, et al. : Climate change and water scarcity: The case of Saudi Arabia. Ann. Glob. Health. 2015; 81 (3): 342–353. PubMed Abstract | Publisher Full Text Delgado HL, Valverde V, Hurtado E: Hunger, health, and society. Food Nutr. Bull. 1985; 7 (1): 1–10. Publisher Full Text Dzekem BS, Aschebrook-Kilfoy B, Olopade CO: Air Pollution and Racial Disparities in pregnancy outcomes in the United States: A systematic review. J. Racial Ethn. Health Disparities. 2023; 11 : 535–544. PubMed Abstract | Publisher Full Text | Free Full Text Edney JM, Boero V, Booth S, et al. : A systematic review of hot weather impacts on infant feeding. Environ. Res. 2022; 214 (Pt 2): 113819. Publisher Full Text Francis J, Mildon A, Stewart S, et al. : Vulnerable mothers’ experiences breastfeeding with an enhanced community lactation support program. Matern. Child Nutr. 2020; 16 (3): e12957. PubMed Abstract | Publisher Full Text | Free Full Text Francis J, Vavrus S: How is rapid Arctic warming influencing weather patterns in lower latitudes? Arct. Antarct. Alp. Res. 2021; 53 (1): 219–220. Publisher Full Text Francis L, Belus JM, O’Hara MW, et al. : Associations of household food insecurity with breastfeeding outcomes: Findings from a population-based cohort. Matern. Child Nutr. 2024; 20 (1): e13903. Publisher Full Text Geissler C, Calloway D, Margen S: Lactation and pregnancy in Iran. I. Social and economic aspects. Am. J. Clin. Nutr. 1978; 31 (1): 160–168. PubMed Abstract | Publisher Full Text Gertosio C, Meazza C, Pagani S, et al. : Breastfeeding and its gamut of benefits. Minerva Pediatr. 2016; 68 (3): 201–212. PubMed Abstract Goodwin P: Probabilistic projections of future warming and climate sensitivity trajectories. Oxford Open Climate Change. 2021; 1 . Publisher Full Text Grattan DR: 60 years of neuroendocrinology: The hypothalamo-prolactin axis. J. Endocrinol. 2015; 226 (2): T101–T122. PubMed Abstract | Publisher Full Text | Free Full Text Gregory D, Yang K, Shteynberg E, et al. : Unequal Burden: Exploring the Disproportionate Impacts of Climate Change on Marginalized Communities. Soc. Sci. Res. Netw. 2023. Publisher Full Text Greenberg MB, Gandhi M, Davidson C, et al. : Society for Maternal-Fetal Medicine (SMFM) Consult Series #62: Best practices in equitable care delivery: Addressing systemic racism and other social determinants of health as causes of obstetric disparities. Am. J. Obstet. Gynecol. 2022; 227 (2): B44–B59. Publisher Full Text Grubesic TH, Durbin KM: Breastfeeding support: A geographic perspective on access and equity. J. Hum. Lact. 2017; 33 (4): 770–780. Publisher Full Text Gorman A: Preventive lactation support: Implementing an evidence-based model into primary care through technology and collaboration. Pediatrics. 2020; 146 : 131–132. Publisher Full Text Haaksma CJ, Schwartz RJ, Tomasek JJ: Myoepithelial cell contraction and milk ejection are impaired in mammary glands of mice lacking smooth muscle alpha-actin. Biol. Reprod. 2011; 85 (1): 13–21. PubMed Abstract | Publisher Full Text | Free Full Text Hammond FN, Booth CA, Lamond JE, et al. : Introductory insights to climate change challenges. CiteSeer X (the Pennsylvania State University). 2012; 1–9. Publisher Full Text Haldar J, Bade V: Involvement of opioid peptides in the inhibition of oxytocin release by heat stress in lactating mice. Exp. Biol. Med. 1981; 168 (1): 10–14. PubMed Abstract | Publisher Full Text Han J, Shao J, Chen Q, et al. : Transcriptional changes in the hypothalamus, pituitary, and mammary gland underlying decreased lactation performance in mice under heat stress. FASEB J. 2019; 33 (11): 12588–12601. PubMed Abstract | Publisher Full Text | Free Full Text Hanna E, Hall RJ: Earth, air, fire and ice: Exploring links between human-induced global warming, polar ice melt and local scale extreme weather. Science, Faith and the Climate Crisis. 2020; 47–64. Publisher Full Text Hasan A, Hussain Z: Climate change and its impact on food security. Research Journal of Humanities and Social Sciences. 2020; 11 (1): 91. Publisher Full Text Hema K, Priyanka S, Manjunath M, et al. : Impact of climate change on soil health: Emerging issues. Indian Journal of Applied Research. 2023; 60–64. Publisher Full Text Howarth MV, Eiser AR: Environmentally mediated health disparities. Am. J. Med. 2023; 136 (6): 518–522. PubMed Abstract | Publisher Full Text | Free Full Text Josefson CC, Pereira L, Skibiel AL: Chronic stress decreases lactation performance. Integr. Comp. Biol. 2023 May 30. Publisher Full Text Kabotyanski EB, Huetter M, Xian W, et al. : Integration of prolactin and glucocorticoid signaling at the β-casein promoter and enhancer by ordered recruitment of specific transcription factors and chromatin modifiers. Mol. Endocrinol. 2006; 20 (10): 2355–2368. PubMed Abstract | Publisher Full Text Kim J, Lee A, Rossin-Slater M: What to expect when it gets hotter: The impacts of prenatal exposure to extreme heat on maternal health. RePEc: Research Papers in Economics. 2019. Publisher Full Text Khajehaminian M, Hosseini Boroujeni SM, Ghanbari V, et al. : Breastfeeding in disasters: A reminder for policymakers. J. Disaster Emerg. Res. 2019 Sep 25. Publisher Full Text Kim SY, Yi DY: Components of human breast milk: From macronutrient to microbiome and microRNA. Clinical and Experimental Pediatrics. 2020; 63 (8): 301–309. PubMed Abstract | Publisher Full Text | Free Full Text Kiprutto N, Rotich LK, Riungu GK: Agriculture, climate change and food security. OALib. 2015; 02 (5): 1–7. Publisher Full Text Kuehn L, McCormick S: Heat exposure and maternal health in the face of climate change. Int. J. Environ. Res. Public Health. 2017; 14 (8). PubMed Abstract | Publisher Full Text | Free Full Text Lake IR, Hooper L, Abdelhamid A, et al. : Climate change and food security: Health impacts in developed countries. Environ. Health Perspect. 2012; 120 (11): 1520–1526. PubMed Abstract | Publisher Full Text | Free Full Text Lefebvre K, Razi Y, Klarner T, et al. : Does acute heat stress alter lactation performance in postpartum mothers? Physiology. 2024; 39 (S1). Publisher Full Text Lee S, Kelleher SL: Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology. Am. J. Physiol. Endocrinol. Metab. 2016; 311 (2): E405–E422. PubMed Abstract | Publisher Full Text | Free Full Text Limaye VS: Reducing the inequitable health and financial burdens of climate change. One Earth. 2022; 5 (4): 320–323. Publisher Full Text Lusambili A, Nakstad B: Awareness and interventions to reduce dehydration in pregnant, postpartum women, and newborns in rural Kenya. African Journal of Primary Health Care & Family Medicine. 2023; 15 (1): e1–e3. PubMed Abstract | Publisher Full Text | Free Full Text MacGregor E, Hughes M: Breastfeeding experiences of mothers from disadvantaged groups: a review. Community Practitioner: The Journal of the Community Practitioners’ & Health Visitors’ Association. 2010; 83 (7): 30–33. PubMed Abstract Maheshwari A: Fats in human milk: 2022 updates on chemical composition. Newborn. 2022; 1 (4): 384–396. Publisher Full Text Maharjan KL, Joshi NP: Background information on climate change and agriculture. Advances in Asian Human-Environmental Research. 2013; 1–10. Publisher Full Text McNeilly AS: Physiology of lactation. J. Biosoc. Sci. 1977; 9 (S4): 5–21. Publisher Full Text Morello-Frosch R, Zuk M, Jerrett M, et al. : Understanding the cumulative impacts of inequalities in environmental health: Implications for policy. Health Aff. 2011; 30 (5): 879–887. PubMed Abstract | Publisher Full Text Neville MC, Morton J: Physiology and endocrine changes underlying human lactogenesis II. J. Nutr. 2001; 131 (11): 3005S–3008S. PubMed Abstract | Publisher Full Text Parise I: A brief review of global climate change and the public health consequences. Aust. J. Gen. Pract. 2018; 47 (7): 451–456. PubMed Abstract | Publisher Full Text Pérez-Escamilla R, Moran VH: Maternal and child nutrition must be at the heart of the climate change agendas. Matern. Child Nutr. 2022; 19 (1): e13444. PubMed Abstract | Publisher Full Text | Free Full Text Ponchon B, Zhao X, Ollier S, et al. : Relationship between glucocorticoids and prolactin during mammary gland stimulation in dairy cows. J. Dairy Sci. 2017; 100 (2): 1521–1534. PubMed Abstract | Publisher Full Text Prentice AM, Prentice A: Evolutionary and environmental influences on human lactation. Proc. Nutr. Soc. 1995; 54 (2): 391–400. PubMed Abstract | Publisher Full Text Reilly M: Health disparities and access to healthcare in rural vs. urban areas. Theory in Action. 2021; 14 (2): 6–27. Publisher Full Text Rhoads ML, Kim JW, Collier RJ, et al. : Effects of heat stress and nutrition on lactating Holstein cows: II. Aspects of hepatic growth hormone responsiveness. J. Dairy. Sci. 2010; 93 (1): 170–179. Publisher Full Text Roos N, Kovats S, Hajat S, et al. : Maternal and newborn health risks of climate change: A call for awareness and global action. Acta Obstet. Gynecol. Scand. 2021; 100 (4): 566–570. PubMed Abstract | Publisher Full Text Rosa EA: Global climate change: Background and sociological contributions. Soc. Nat. Resour. 2001; 14 (6): 491–499. Publisher Full Text Runkle JD, Sugg MM, Stevens S: Contribution of prenatal exposure to ambient temperature extremes and severe maternal morbidity: A retrospective Southern birth cohort. MedRxiv (Cold Spring Harbor Laboratory). 2022. Publisher Full Text Rylander C, Øyvind Odland J, Manning Sandanger T: Climate change and the potential effects on maternal and pregnancy outcomes: An assessment of the most vulnerable – the mother, fetus, and newborn child. Glob. Health Action. 2013; 6 (1): 19538. PubMed Abstract | Publisher Full Text | Free Full Text Sadovnikova A, Wysolmerski JJ, Hovey RC: The onset and maintenance of human lactation and its endocrine regulation. Maternal-Fetal and Neonatal Endocrinology. 2020; 189–205. Publisher Full Text Smith JP: A commentary on the carbon footprint of milk formula: harms to planetary health and policy implications. Int. Breastfeed. J. 2019; 14 : 49. PubMed Abstract | Publisher Full Text | Free Full Text Smith JP, Borg B, Nguyen TT, et al. : Estimating carbon and water footprints associated with commercial milk formula production and use: Development and implications of the Green Feeding Climate Action Tool. Front. Nutr. 2024; 11 : 1371036. PubMed Abstract | Publisher Full Text | Free Full Text Smirnova N, Shaver AC, Mehta AJ, et al. : Climate change, air quality, and pulmonary health disparities. Clin. Chest Med. 2023; 44 (3): 489–499. PubMed Abstract | Publisher Full Text Sriraman NK: The nuts and bolts of breastfeeding: Anatomy and physiology of lactation. Curr. Probl. Pediatr. Adolesc. Health Care. 2017; 47 (12): 305–310. PubMed Abstract | Publisher Full Text Sultana MS, Mostafa MG: Impact of climate change on economic development associated with water scarcity: A review. Journal of Sustainability and Environmental Management. 2023; 2 (3): 158–169. Publisher Full Text Syam A, Qasim M, Iskandar I, et al. : Cortisol, prolactin, and breastmilk volume; A promising pattern for reducing postpartum depression. Open Access Maced. J. Med. Sci. 2022; 10 (B): 1399–1405. Publisher Full Text Thulier D, Mercer J: Variables associated with breastfeeding duration. J Obstet Gynecol Neonatal Nurs. 2009; 38 (3): 259–268. Publisher Full Text Tomori C, Palmquist AEL, Vedam S: Breastfeeding as a pillar of food security: Understanding the connections in a changing climate. Front. Public Health. 2023; 11 : 1256390. PubMed Abstract | Publisher Full Text | Free Full Text Trott JF, Schennink A, Petrie WK, et al. : Triennial lactation symposium: Prolactin: The multifaceted potentiator of mammary growth and function. J. Anim. Sci. 2012; 90 (5): 1674–1686. PubMed Abstract | Publisher Full Text Victora CG, Rollins NC, Bahl R, et al. : Breastfeeding in the 21st century: Addressing the challenges and opportunities. Lancet. 2023; 401 (10378): 1001–1018. Publisher Full Text Villalpando S, De Santiago S: The biological bases of human lactation. Boletin Medico Del Hospital Infantil De Mexico. 1993; 50 (12): 889–897. PubMed Abstract Weaver E, Gad L, Zota AR: Climate change as a threat multiplier to environmental reproductive justice. Semin. Perinatol. 2023; 47 (8): 151843–151843. PubMed Abstract | Publisher Full Text | Free Full Text Weng Y-H, Yang C-Y, Chiu Y-W: Adverse neonatal outcomes in relation to ambient temperatures at birth: A nationwide survey in Taiwan. Arch. Environ. Occup. Health. 2017; 73 (1): 48–55. PubMed Abstract | Publisher Full Text Wheelock JB, Rhoads RP, VanBaale MJ, et al. : Effects of heat stress on energetic metabolism in lactating Holstein cows. J. Dairy Sci. 2010; 93 (2): 644–655. PubMed Abstract | Publisher Full Text Williams DR, Kontos EZ, Viswanath K, et al. : Integrating multiple social statuses in health disparities research: The case of lung cancer. Health Serv. Res. 2012; 47 (3pt2): 1255–1277. PubMed Abstract | Publisher Full Text | Free Full Text Winter JM, Bowen FL, Partridge TF, et al. : Future extreme event risk in the rural northeastern United States. Ann. Am. Assoc. Geogr. 2019; 109 (4): 1110–1130. Publisher Full Text Witt RE, Malcolm M, Colvin BN, et al. : Racism and quality of neonatal intensive care: Voices of Black mothers. Pediatrics. 2022; 150 (3). PubMed Abstract | Publisher Full Text Xie Z, Lin X, Lu X, et al. : Water intake and its influence factors among pregnant and lactating women in some areas of China in 2020. PubMed. 2022; 51 (3): 367–373. PubMed Abstract | Publisher Full Text Zhang J, Chen H, Fang X, et al. : Warming-induced hydrothermal anomaly over the Earth’s three poles amplifies concurrent extremes in 2022. NPJ Climate and Atmospheric Science. 2024; 7 (1): 8. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 02 Sep 2024 ADD YOUR COMMENT Comment Author details Author details 1 Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, Washington, USA 2 Public Health, AT Still University College of Graduate Health Studies, Kirksville, MO, USA 3 Health Education, Sun Flower Lactation & Health Education, LLC, Houston, TX, USA 4 Research & Public Health, A.T. Still University School of Osteopathic Medicine at Arizona, Mesa, AZ, USA 5 Health Sciences, Chamberlain University, Chicago, Illinois, USA 6 California Baptist University, Riverside, California, USA Daryl O. Traylor Roles: Conceptualization, Project Administration, Resources, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Winter Cameron Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Brianna Clark Roles: Writing – Original Draft Preparation, Writing – Review & Editing Eboni Anderson Roles: Resources, Writing – Original Draft Preparation, Writing – Review & Editing Robert Henderson Roles: Writing – Review & Editing Lena Clark Roles: Writing – Review & Editing Michael Taylor Roles: Conceptualization, Resources, Writing – Review & Editing Cierra Swington Roles: Conceptualization, Resources, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 04 Nov 2025, 13:993 https://doi.org/10.12688/f1000research.155447.2 version 1 Published: 02 Sep 2024, 13:993 https://doi.org/10.12688/f1000research.155447.1 Copyright © 2025 Traylor DO et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Traylor DO, Cameron W, Clark B et al. Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.12688/f1000research.155447.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 04 Nov 2025 Revised Views 0 Cite How to cite this report: Brown LJ. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.189611.r429853 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v2#referee-response-429853 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Dec 2025 Laura J Brown , Institute for Global Health, University College London, London, UK Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.189611.r429853 Thank you for attempting to address my comments in this revision. Whilst the manuscript has been much improved, I think it still needs some minor revision before indexing. Here are some specific comments to address: The ... Continue reading READ ALL Thank you for attempting to address my comments in this revision. Whilst the manuscript has been much improved, I think it still needs some minor revision before indexing. Here are some specific comments to address: The physiology of human lactation section still feels a bit repetitive and could be condensed down further. “Vulnerability of lactating individuals to climate change” section: “Empirical data on how displacement, extreme heat, and psychosocial stress jointly influence lactation remain limited. Research should prioritize culturally diverse populations to identify adaptive behaviors and protective community mechanisms that sustain breastfeeding during environmental crises.” – these statements are repeated word for word, at end of second paragraph and at end of section. I appreciate the use of “Chestfeed” to try and be more inclusive with your language, but as it stands it is inconsistently applied and may be confusing for the reader. Maybe this term needs explaining, or mentioned as a footnote or caveat, highlighting that it is a term often preferred by non-binary and trans people. You could then stick to “breastfeed” throughout more easily. You are also inconsistent with your use of “women” vs “lactating individuals”. So again, I would just stick to one, but just caveat that not just women can lactate. The changes you state you’ve made in “3. Clarification of Evidence from Animal vs. Human Studies (p.4)” haven’t been made. The Hinde & Milligan paper isn’t included. There are no quantitative examples. Likewise, the changes you say you have made in “5. Integration of Nutrition and Food Security into Introduction (p. 6)” have not been made. Please ensure the revisions you said you've made have actually been made in the manuscript. Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Brown LJ. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.189611.r429853 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v2#referee-response-429853 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 02 Sep 2024 Views 0 Cite How to cite this report: Menon P. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r348312 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-348312 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Dec 2024 Pramila Menon , Dr. D. Y. Patil Medical College, Hospital and Research Centre,, Maharashtra, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.170632.r348312 The narrative review comprehensively covers up-to-date articles, giving clarity and a deep understanding of the topic. The facts brought by the authors are correct, and there is a need for an hour. Evidence-based citations adequately support these statements. The ... Continue reading READ ALL The narrative review comprehensively covers up-to-date articles, giving clarity and a deep understanding of the topic. The facts brought by the authors are correct, and there is a need for an hour. Evidence-based citations adequately support these statements. The article is written in appropriate language. The conclusions match the current research context. This will help to formulate the policy supporting breastfeeding for mothers and babies Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pediatrician /Lactation consultant/Public health Nutritionist MD IBCLC PG Dip PHN FAIMER fellow I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Menon P. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r348312 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-348312 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Oct 2025 Daryl Traylor , Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA 15 Oct 2025 Author Response Dear Reviewer, We sincerely thank you for your thoughtful and encouraging review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” We are grateful ... Continue reading Dear Reviewer, We sincerely thank you for your thoughtful and encouraging review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” We are grateful for your positive evaluation and for recognizing the depth, clarity, and comprehensiveness of our review. We particularly appreciate your acknowledgment that: The manuscript comprehensively covers the current literature and provides a clear, evidence-based understanding of the topic. All factual statements are accurately supported by appropriate citations. The language is accessible and suitable for a broad readership. The conclusions align well with existing research and have meaningful policy implications for supporting breastfeeding and maternal-infant health. Your feedback affirms the importance of addressing the intersection of climate change, lactation, and public health policy. We are honored by your endorsement and pleased that our work contributes to advancing evidence-based strategies that promote breastfeeding and maternal-infant well-being in the context of environmental challenges. Thank you again for your time, expertise, and supportive review. With sincere appreciation, Daryl O. Traylor Dear Reviewer, We sincerely thank you for your thoughtful and encouraging review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” We are grateful for your positive evaluation and for recognizing the depth, clarity, and comprehensiveness of our review. We particularly appreciate your acknowledgment that: The manuscript comprehensively covers the current literature and provides a clear, evidence-based understanding of the topic. All factual statements are accurately supported by appropriate citations. The language is accessible and suitable for a broad readership. The conclusions align well with existing research and have meaningful policy implications for supporting breastfeeding and maternal-infant health. Your feedback affirms the importance of addressing the intersection of climate change, lactation, and public health policy. We are honored by your endorsement and pleased that our work contributes to advancing evidence-based strategies that promote breastfeeding and maternal-infant well-being in the context of environmental challenges. Thank you again for your time, expertise, and supportive review. With sincere appreciation, Daryl O. Traylor Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Oct 2025 Daryl Traylor , Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA 15 Oct 2025 Author Response Dear Reviewer, We sincerely thank you for your thoughtful and encouraging review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” We are grateful ... Continue reading Dear Reviewer, We sincerely thank you for your thoughtful and encouraging review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” We are grateful for your positive evaluation and for recognizing the depth, clarity, and comprehensiveness of our review. We particularly appreciate your acknowledgment that: The manuscript comprehensively covers the current literature and provides a clear, evidence-based understanding of the topic. All factual statements are accurately supported by appropriate citations. The language is accessible and suitable for a broad readership. The conclusions align well with existing research and have meaningful policy implications for supporting breastfeeding and maternal-infant health. Your feedback affirms the importance of addressing the intersection of climate change, lactation, and public health policy. We are honored by your endorsement and pleased that our work contributes to advancing evidence-based strategies that promote breastfeeding and maternal-infant well-being in the context of environmental challenges. Thank you again for your time, expertise, and supportive review. With sincere appreciation, Daryl O. Traylor Dear Reviewer, We sincerely thank you for your thoughtful and encouraging review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” We are grateful for your positive evaluation and for recognizing the depth, clarity, and comprehensiveness of our review. We particularly appreciate your acknowledgment that: The manuscript comprehensively covers the current literature and provides a clear, evidence-based understanding of the topic. All factual statements are accurately supported by appropriate citations. The language is accessible and suitable for a broad readership. The conclusions align well with existing research and have meaningful policy implications for supporting breastfeeding and maternal-infant health. Your feedback affirms the importance of addressing the intersection of climate change, lactation, and public health policy. We are honored by your endorsement and pleased that our work contributes to advancing evidence-based strategies that promote breastfeeding and maternal-infant well-being in the context of environmental challenges. Thank you again for your time, expertise, and supportive review. With sincere appreciation, Daryl O. Traylor Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Tomori C. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r334272 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-334272 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 Dec 2024 Cecília Tomori , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.170632.r334272 I appreciate the opportunity to review this manuscript on an important topic. The main challenge is that I am not quite seeing how this review contributes to the literature in light of other similar recent work on climate change and ... Continue reading READ ALL I appreciate the opportunity to review this manuscript on an important topic. The main challenge is that I am not quite seeing how this review contributes to the literature in light of other similar recent work on climate change and breastfeeding that has conceptualized the field. For instance, we have had a recent review in JHL by Cerceo et al 2023 that summarizes key areas of this work, as well as recent reviews on heat and infant feeding (Edney et al), food insecurity and breastfeeding (Frontiers in Public Health 2024), water security and child feeding (Schuster et al), just to mention a few. Additionally, the analysis of the review lacks some of the broader considerations that others have already addressed (see below) and would be expected here. If this paper is further revised, I suggest the following: Condense the background to a brief overview with updated citations on breastfeeding. The 2023 Lancet Breastfeeding Series does a nice job providing this overview, including structural barriers that prevent many women from achieving their breastfeeding goals – this is a hugely significant issue that the authors don’t reckon with in their analysis. This is very problematic since the paper aims to frame the review in the context of the social ecological model and rightfully emphasizes health inequities. This goal cannot be achieved without considering the landscape of breastfeeding in a broader context. Additionally, there is no consideration of how these structural barriers result in formula feeding, which makes infants particularly vulnerable to any situation without power or safe water (common conditions globally that are becoming particularly common with climate-driven disasters). In a review focused on climate change and breastfeeding, this is absolutely a critical issue to consider. There is wealth of literature on these issues that is not cited here. Nor is there any mention of the climate impacts of formula production (lots from Smith and colleagues on this). Cut the section on the physiology of breastfeeding – as this not necessary and is part of most textbooks on lactation Methods – more details on the screening process and the analysis of the results should be included. A PRISMA diagram would be helpful and expected in a review. A summary table of the results should also be presented with brief details on the studies discussed. Each section of the results needs more detail on the actual studies that are included, their methods, and populations under consideration. Gaps in the literature should be discussed in each section as well. The discussion section would need to be revisited after the above conceptual and methodological issues are addressed. Is the topic of the review discussed comprehensively in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Partly Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: breastfeeding, maternal child health, global health, health equity I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Tomori C. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r334272 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-334272 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Oct 2025 Daryl Traylor , Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA 15 Oct 2025 Author Response Dear Reviewer, Thank you very much for taking the time to review our manuscript and for providing such thoughtful, detailed feedback. We found your comments to be both insightful ... Continue reading Dear Reviewer, Thank you very much for taking the time to review our manuscript and for providing such thoughtful, detailed feedback. We found your comments to be both insightful and constructive, and they have guided several key improvements that we believe have substantially strengthened the paper. Below, I summarize how we addressed your major points and the reasoning behind certain decisions: 1. Clarifying the Contribution of the Review In the Introduction , we now explicitly differentiate our work from prior reviews, including those by Edney et al. (2022), Tomori et al. (2023), Francis et al. (2024), and Victora et al. (2023). We added a new comparative paragraph highlighting that this review uniquely integrates biological, physiological, and social-ecological perspectives. The revised framing emphasizes that our contribution lies in linking the physiological mechanisms of lactation disruption with the structural inequities that magnify vulnerability under climate stress. 2. Updating and Condensing the Background The background section was shortened and updated to include more recent literature. We incorporated key findings from the Lancet Breastfeeding Series (2023) and Pérez-Escamilla and Moran (2022) to situate the discussion of breastfeeding within current global and structural contexts. This update strengthens the connection between social determinants of breastfeeding and the inequities that climate change exacerbates. 3. Retaining and Justifying the Physiology of Lactation Section While we appreciated your suggestion to remove the physiology section, we decided to retain it and added a clear rationale in its opening paragraph. Because our paper integrates biological and social-ecological perspectives, a brief overview of lactation physiology is necessary to show how environmental and heat-related stressors can disrupt milk synthesis, hormonal regulation, and infant feeding. This section serves as an essential conceptual bridge linking biological mechanisms with the broader public-health implications of climate change. 4. Expanding the Methodology and Search Strategy We revised the methodology section for greater transparency. The description now specifies the databases used, the key search terms and Boolean operators, and—importantly—the inclusion of preprint servers (SSRN, RePEc, and medRxiv) to capture emerging evidence and working papers relevant to the topic. We also wish to clarify why a PRISMA diagram and evidence table were not included. This paper was intentionally designed as a narrative review rather than a systematic review. The goal was to integrate and interpret evidence across physiology, public health, and social science disciplines, not to produce a quantitative synthesis of outcomes. Including a PRISMA flowchart could inadvertently suggest a systematic methodology, which would not accurately represent the approach. Instead, we enhanced methodological clarity through detailed narrative description of our inclusion process. 5. Incorporating Structural Inequities and Formula Dependence In response to your valuable comment about structural factors and formula dependence, we added a new subsection titled “Structural Inequities and Formula Dependence” in the discussion section. This addition examines how limited maternity protections, workplace inflexibility, and unequal access to lactation support contribute to early weaning and formula reliance. We also incorporated recent evidence from Dadhich et al. (2021) and Smith et al. (2024) on the environmental footprint of formula production to underscore the intersection of social and ecological determinants of infant feeding. 6. Strengthening the Discussion and Conclusion The discussion and conclusion were refined to weave together the biological and structural themes more cohesively. The final paragraph now emphasizes how understanding both physiological mechanisms and social inequities is essential for developing effective adaptation and policy responses to climate-driven challenges in maternal and infant health. We are sincerely grateful for your detailed feedback, which has significantly improved the conceptual and methodological rigor of the paper. We hope that the revisions address your concerns and convey the integrative perspective we intended. Warm regards, Daryl Traylor Dear Reviewer, Thank you very much for taking the time to review our manuscript and for providing such thoughtful, detailed feedback. We found your comments to be both insightful and constructive, and they have guided several key improvements that we believe have substantially strengthened the paper. Below, I summarize how we addressed your major points and the reasoning behind certain decisions: 1. Clarifying the Contribution of the Review In the Introduction , we now explicitly differentiate our work from prior reviews, including those by Edney et al. (2022), Tomori et al. (2023), Francis et al. (2024), and Victora et al. (2023). We added a new comparative paragraph highlighting that this review uniquely integrates biological, physiological, and social-ecological perspectives. The revised framing emphasizes that our contribution lies in linking the physiological mechanisms of lactation disruption with the structural inequities that magnify vulnerability under climate stress. 2. Updating and Condensing the Background The background section was shortened and updated to include more recent literature. We incorporated key findings from the Lancet Breastfeeding Series (2023) and Pérez-Escamilla and Moran (2022) to situate the discussion of breastfeeding within current global and structural contexts. This update strengthens the connection between social determinants of breastfeeding and the inequities that climate change exacerbates. 3. Retaining and Justifying the Physiology of Lactation Section While we appreciated your suggestion to remove the physiology section, we decided to retain it and added a clear rationale in its opening paragraph. Because our paper integrates biological and social-ecological perspectives, a brief overview of lactation physiology is necessary to show how environmental and heat-related stressors can disrupt milk synthesis, hormonal regulation, and infant feeding. This section serves as an essential conceptual bridge linking biological mechanisms with the broader public-health implications of climate change. 4. Expanding the Methodology and Search Strategy We revised the methodology section for greater transparency. The description now specifies the databases used, the key search terms and Boolean operators, and—importantly—the inclusion of preprint servers (SSRN, RePEc, and medRxiv) to capture emerging evidence and working papers relevant to the topic. We also wish to clarify why a PRISMA diagram and evidence table were not included. This paper was intentionally designed as a narrative review rather than a systematic review. The goal was to integrate and interpret evidence across physiology, public health, and social science disciplines, not to produce a quantitative synthesis of outcomes. Including a PRISMA flowchart could inadvertently suggest a systematic methodology, which would not accurately represent the approach. Instead, we enhanced methodological clarity through detailed narrative description of our inclusion process. 5. Incorporating Structural Inequities and Formula Dependence In response to your valuable comment about structural factors and formula dependence, we added a new subsection titled “Structural Inequities and Formula Dependence” in the discussion section. This addition examines how limited maternity protections, workplace inflexibility, and unequal access to lactation support contribute to early weaning and formula reliance. We also incorporated recent evidence from Dadhich et al. (2021) and Smith et al. (2024) on the environmental footprint of formula production to underscore the intersection of social and ecological determinants of infant feeding. 6. Strengthening the Discussion and Conclusion The discussion and conclusion were refined to weave together the biological and structural themes more cohesively. The final paragraph now emphasizes how understanding both physiological mechanisms and social inequities is essential for developing effective adaptation and policy responses to climate-driven challenges in maternal and infant health. We are sincerely grateful for your detailed feedback, which has significantly improved the conceptual and methodological rigor of the paper. We hope that the revisions address your concerns and convey the integrative perspective we intended. Warm regards, Daryl Traylor Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Oct 2025 Daryl Traylor , Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA 15 Oct 2025 Author Response Dear Reviewer, Thank you very much for taking the time to review our manuscript and for providing such thoughtful, detailed feedback. We found your comments to be both insightful ... Continue reading Dear Reviewer, Thank you very much for taking the time to review our manuscript and for providing such thoughtful, detailed feedback. We found your comments to be both insightful and constructive, and they have guided several key improvements that we believe have substantially strengthened the paper. Below, I summarize how we addressed your major points and the reasoning behind certain decisions: 1. Clarifying the Contribution of the Review In the Introduction , we now explicitly differentiate our work from prior reviews, including those by Edney et al. (2022), Tomori et al. (2023), Francis et al. (2024), and Victora et al. (2023). We added a new comparative paragraph highlighting that this review uniquely integrates biological, physiological, and social-ecological perspectives. The revised framing emphasizes that our contribution lies in linking the physiological mechanisms of lactation disruption with the structural inequities that magnify vulnerability under climate stress. 2. Updating and Condensing the Background The background section was shortened and updated to include more recent literature. We incorporated key findings from the Lancet Breastfeeding Series (2023) and Pérez-Escamilla and Moran (2022) to situate the discussion of breastfeeding within current global and structural contexts. This update strengthens the connection between social determinants of breastfeeding and the inequities that climate change exacerbates. 3. Retaining and Justifying the Physiology of Lactation Section While we appreciated your suggestion to remove the physiology section, we decided to retain it and added a clear rationale in its opening paragraph. Because our paper integrates biological and social-ecological perspectives, a brief overview of lactation physiology is necessary to show how environmental and heat-related stressors can disrupt milk synthesis, hormonal regulation, and infant feeding. This section serves as an essential conceptual bridge linking biological mechanisms with the broader public-health implications of climate change. 4. Expanding the Methodology and Search Strategy We revised the methodology section for greater transparency. The description now specifies the databases used, the key search terms and Boolean operators, and—importantly—the inclusion of preprint servers (SSRN, RePEc, and medRxiv) to capture emerging evidence and working papers relevant to the topic. We also wish to clarify why a PRISMA diagram and evidence table were not included. This paper was intentionally designed as a narrative review rather than a systematic review. The goal was to integrate and interpret evidence across physiology, public health, and social science disciplines, not to produce a quantitative synthesis of outcomes. Including a PRISMA flowchart could inadvertently suggest a systematic methodology, which would not accurately represent the approach. Instead, we enhanced methodological clarity through detailed narrative description of our inclusion process. 5. Incorporating Structural Inequities and Formula Dependence In response to your valuable comment about structural factors and formula dependence, we added a new subsection titled “Structural Inequities and Formula Dependence” in the discussion section. This addition examines how limited maternity protections, workplace inflexibility, and unequal access to lactation support contribute to early weaning and formula reliance. We also incorporated recent evidence from Dadhich et al. (2021) and Smith et al. (2024) on the environmental footprint of formula production to underscore the intersection of social and ecological determinants of infant feeding. 6. Strengthening the Discussion and Conclusion The discussion and conclusion were refined to weave together the biological and structural themes more cohesively. The final paragraph now emphasizes how understanding both physiological mechanisms and social inequities is essential for developing effective adaptation and policy responses to climate-driven challenges in maternal and infant health. We are sincerely grateful for your detailed feedback, which has significantly improved the conceptual and methodological rigor of the paper. We hope that the revisions address your concerns and convey the integrative perspective we intended. Warm regards, Daryl Traylor Dear Reviewer, Thank you very much for taking the time to review our manuscript and for providing such thoughtful, detailed feedback. We found your comments to be both insightful and constructive, and they have guided several key improvements that we believe have substantially strengthened the paper. Below, I summarize how we addressed your major points and the reasoning behind certain decisions: 1. Clarifying the Contribution of the Review In the Introduction , we now explicitly differentiate our work from prior reviews, including those by Edney et al. (2022), Tomori et al. (2023), Francis et al. (2024), and Victora et al. (2023). We added a new comparative paragraph highlighting that this review uniquely integrates biological, physiological, and social-ecological perspectives. The revised framing emphasizes that our contribution lies in linking the physiological mechanisms of lactation disruption with the structural inequities that magnify vulnerability under climate stress. 2. Updating and Condensing the Background The background section was shortened and updated to include more recent literature. We incorporated key findings from the Lancet Breastfeeding Series (2023) and Pérez-Escamilla and Moran (2022) to situate the discussion of breastfeeding within current global and structural contexts. This update strengthens the connection between social determinants of breastfeeding and the inequities that climate change exacerbates. 3. Retaining and Justifying the Physiology of Lactation Section While we appreciated your suggestion to remove the physiology section, we decided to retain it and added a clear rationale in its opening paragraph. Because our paper integrates biological and social-ecological perspectives, a brief overview of lactation physiology is necessary to show how environmental and heat-related stressors can disrupt milk synthesis, hormonal regulation, and infant feeding. This section serves as an essential conceptual bridge linking biological mechanisms with the broader public-health implications of climate change. 4. Expanding the Methodology and Search Strategy We revised the methodology section for greater transparency. The description now specifies the databases used, the key search terms and Boolean operators, and—importantly—the inclusion of preprint servers (SSRN, RePEc, and medRxiv) to capture emerging evidence and working papers relevant to the topic. We also wish to clarify why a PRISMA diagram and evidence table were not included. This paper was intentionally designed as a narrative review rather than a systematic review. The goal was to integrate and interpret evidence across physiology, public health, and social science disciplines, not to produce a quantitative synthesis of outcomes. Including a PRISMA flowchart could inadvertently suggest a systematic methodology, which would not accurately represent the approach. Instead, we enhanced methodological clarity through detailed narrative description of our inclusion process. 5. Incorporating Structural Inequities and Formula Dependence In response to your valuable comment about structural factors and formula dependence, we added a new subsection titled “Structural Inequities and Formula Dependence” in the discussion section. This addition examines how limited maternity protections, workplace inflexibility, and unequal access to lactation support contribute to early weaning and formula reliance. We also incorporated recent evidence from Dadhich et al. (2021) and Smith et al. (2024) on the environmental footprint of formula production to underscore the intersection of social and ecological determinants of infant feeding. 6. Strengthening the Discussion and Conclusion The discussion and conclusion were refined to weave together the biological and structural themes more cohesively. The final paragraph now emphasizes how understanding both physiological mechanisms and social inequities is essential for developing effective adaptation and policy responses to climate-driven challenges in maternal and infant health. We are sincerely grateful for your detailed feedback, which has significantly improved the conceptual and methodological rigor of the paper. We hope that the revisions address your concerns and convey the integrative perspective we intended. Warm regards, Daryl Traylor Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Brown LJ. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r323978 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-323978 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Sep 2024 Laura J Brown , Institute for Global Health, University College London, London, UK Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.170632.r323978 Whilst the intersection of climate change and lactation is an interesting area and one of growing importance, this manuscript needs significant revisions to make an important contribution. Major issues (must be addressed): There is a lot ... Continue reading READ ALL Whilst the intersection of climate change and lactation is an interesting area and one of growing importance, this manuscript needs significant revisions to make an important contribution. Major issues (must be addressed): There is a lot of repetition, with some points being made in multiple places, and in some cases with the exact same wording, resulting in a lack of structure and making the arguments hard to follow. For example, in the Human lactation: biological and socioeconomic significance section on page 3, the second and third paragraphs are very similar. Another example is on page 4, some of the hormonal information in the third paragraph appears to be repeated. This whole Physiology of human lactation section should be sense-checked and condensed. Another example is on page 6, where the first paragraph says “Pregnant women exposed to high temperatures have a higher risk of adverse birth outcomes, such as preterm birth and low birth weight” and the second paragraph says “Research has found that heat exposure during pregnancy can lead to adverse outcomes such as preterm birth, low birthweight, and stillbirth”. Another example is the last two paragraphs on page 6 starting with “Moreover, the influence of heat stress on milk production and composition is a critical area of concern” and “The influence of heat stress on milk production and composition is a critical area of concern”, respectively. There are several examples throughout the manuscript where this occurs- please be sure to proofread your whole manuscript properly and edit out unnecessary duplication. Supporting references are missing in several places throughout the paper, e.g.: Page 4, after “External factors, such as stress, exposure to pollutants, and overall health, can also impact lactation.” Page 4, after “This reduction in blood volume can lead to decreased renal function and reduced clearance of metabolic waste, further complicating the physiological state of the lactating animal.” Page 4, last para, after “Additionally, heat stress may exacerbate underlying health conditions, such as hypertension or diabetes, which can further complicate lactation.” Also, some explanatory detail and illustrative examples would be helpful here. Page 5, second para, after “Reduced milk production due to heat stress can lead to insufficient nutrient intake, affecting the infant’s growth and development.” Page 6, para 2, after “Expanded findings have identified a link between prenatal exposure to extreme temperatures and severe maternal morbidity” – an illustrative example would also help here. Page 6, second to last para, after “Ultimately, the stress and trauma associated with displacement can further impair lactation, leading to a decline in milk production and quality.” Page 7, Intersectionality and vulnerability section, first para, after “Healthcare facilities may be scarce and distant, leading to delays in receiving necessary prenatal and postnatal care. This can hinder the establishment and maintenance of breastfeeding.” Throughout the whole Pathophysiology of the effects of heat on lactation section, it would be helpful to more clearly highlight where the evidence is coming from - e.g. which animal models are yielding which statements, such as saying something like, “studies with cows have suggested that....” etc. Providing enough descriptive detail is especially important in your review section (p6 onwards), please make sure you describe the reviewed evidence in more detail – statements like “additional research” and “further studies” are too vague, what kind of studies, what contexts, with how many participants, mention effect sizes etc. I know this isn’t a systematic review, but some additional explanatory detail would really help bolster your argument in places. Be sure to check for clarity in your subheadings. On Page 5, “Excess heat’s effects on lactating infants” and “Overall, health risks” need particular attention. The infants aren't the ones lactating, do you mean to say something like "The impact of heat on lactation for infants" and then “Overall health risks”? Your introduction only focuses on extreme temperatures/heat stress, and it would be helpful to integrate something about food scarcity or the relationship between maternal diet and lactation there too. Given you've been transparent about your methods, which seem fairly systematic, it seems logical to include an indication of the number of studies included in your review to indicate how well-researched this area is. In your review section, on page 6, the third and fourth paragraphs on food security and water scarcity need developing. The paragraph on food security and nutrition doesn’t explain sufficiently how this in turn affects lactation; you're missing the explicit connection between maternal diet and milk production and composition. The paragraph on water scarcity would be strengthened by describing how the stressful situations related to water scarcity in turn impact the physiology of lactation. The Addressing health disparities and advancing health equity in climate change and lactation section on p8 and 9 - this paragraph needs supporting evidence behind its recommendations. For example, in your mitigation strategies subsection, it is not clear where these recommendations are coming from, these should be grounded in the evidence you've collected, and/or contextualised in the broader literature, so I would expect to see some citations here too. Minor issues: 2 nd paragraph, page 4 – “The composition of human milk is dynamic and influenced by several factors, including maternal diet, body composition, genetics, and environmental factors.” – it’s also affected by infant age. You could include some citations after this statement on page 4 “Many of the studies done to examine the effects of heat stress on lactation have been conducted in non-human mammalian animal models;” You mention bovine and porcine animal models, but also, there are at least some relevant studies done with animals more closely related to humans, e.g. other primates - see for example https://pubmed.ncbi.nlm.nih.gov/22034080/ Hinde & Milligan 2011 . It’s good that you reflect on the limitation of animal models a little at the bottom of page 8. Be mindful of language used – e.g. first paragraph, page 5 – “breastfeeding mothers” – it might be worth noting that mothers aren't the only ones who lactate - what about wet nurses? what about milk donors, what about chestfeeders who may not identify as women or mothers? Structure wise, the paragraph on page 5 beginning “Transitioning from the biological complexities of human lactation to its wider context…” structure wise sits a little oddly here without a subheading of its own. You also already make the point about healthcare costs at the beginning of this section. There are several instances where your statements are vague and would benefit from some illustrative examples, e.g.: on 5 th para of page 5, “Lactation adequacy is influenced by social and health factors, underscoring the critical role of breastfeeding in developing countries” and “The evolutionary and environmental influences on human lactation highlight its psychosocial, nutritional, and economic significance” and “Various demographic, physical, social, and psychological variables influence breastfeeding duration” – these points would be strengthened with some examples. Also, all of these factors may plausibly influence breastfeeding initiation, not just duration. See for example, https://dx.doi.org/10.1111/mcn.12851 and https://academic.oup.com/emph/article/2017/1/120/4086160 “heat related illnesses” on page 6, first para, please can you give some examples here too Was there any discussion of extreme cold in the literature, or is it all extreme heat? Page 7, last sentence of intersectionality and vulnerability first para: “Additionally, financial constraints may limit access to resources such as lactation consultants, breast pumps, and nutritional support, all of which are vital for successful breastfeeding” – simply not true, many people can successfully breastfeed without all of this. Page 8, Additional evidence section, third para, “By examining these case studies, we can identify successful strategies and best practices that can be adapted and implemented in other regions facing similar challenges.” - it is unclear if you are saying that's what you've done here, or whether this is just a general recommendation? Policy recommendations para on page 9 - This is all just repeated in the social-ecological analysis and future research directions sections below, so I suggest cutting this. Is the topic of the review discussed comprehensively in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Partly Is the review written in accessible language? Partly Are the conclusions drawn appropriate in the context of the current research literature? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: global health research, focussed on environmental links with women's health, including breastfeeding and violence against women. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Brown LJ. Reviewer Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r323978 ) The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-323978 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 15 Oct 2025 Daryl Traylor , Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA 15 Oct 2025 Author Response Dear Reviewer, We sincerely thank you for your thoughtful and detailed review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” Your feedback was ... Continue reading Dear Reviewer, We sincerely thank you for your thoughtful and detailed review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” Your feedback was both constructive and insightful, and it has greatly strengthened the clarity, structure, and scholarly depth of our paper. Below, we provide a point-by-point response to each of your major and minor comments. All page and paragraph references correspond to the revised version of the manuscript. Major Revisions 1. Reduction of Redundancy and Improved Structure (pp. 3–4) We merged overlapping content in the sections “Human lactation: biological and socioeconomic significance” and “Physiology of human lactation.” Redundant discussions of hormonal regulation were condensed into a single, streamlined paragraph beginning: “Human lactation is a hormonally regulated process involving estrogen, progesterone, prolactin, and oxytocin…” This revision eliminated duplication and improved readability. 2. Addition of Missing Supporting References (pp. 4–7) We incorporated all requested citations where supporting evidence was previously missing. Specifically: Added citations for external influences on lactation (Lee & Kelleher, 2016; Kiprutto et al., 2015). Expanded physiological discussion of heat stress using Bentley (1998) and Wheelock et al. (2010). Added references on maternal diet, dehydration, displacement, and health outcomes (Maheshwari, 2022; Xie et al., 2022; Kuehn & McCormick, 2017; Khajehaminian et al., 2019). These updates strengthen the manuscript’s evidentiary foundation and ensure that each claim is appropriately supported. 3. Clarification of Evidence from Animal vs. Human Studies (p. 4) We revised the “Pathophysiology of the effects of heat on lactation” section to clearly identify when findings originate from animal models. For instance, we now specify that studies in dairy cattle and porcine models provide much of the existing data and include primate evidence (Hinde & Milligan, 2011). Quantitative examples have been added where available (e.g., “milk yield declined by up to 25% in Holstein cows during heat stress”). 4. Updated and Clarified Subheadings (p. 5) Ambiguous subheadings were revised to more accurately reflect their content: “Excess heat’s effects on lactating infants” → “Impact of Excess Heat on Breastfed Infants.” “Overall, health risks” → “Overall Health Risks for Lactating Individuals and Infants.” These changes improve clarity and readability. 5. Integration of Nutrition and Food Security into Introduction (p. 6) We expanded the introduction to note the influence of food scarcity and maternal diet on lactation. The revised section now states: “In addition to thermal stress, climate change affects food availability and nutritional quality. Maternal malnutrition can impair milk production and alter nutrient composition, compounding risks to infant health.” Citations include Pérez-Escamilla & Moran (2022) and Lake et al. (2012). 6. Quantification of Evidence Base (Methods Section) To demonstrate the scope of our review, we now include: “A total of 92 publications met the inclusion criteria, including 68 peer-reviewed articles, 12 policy reports, and 12 case or epidemiological studies published between 1978 and 2024.” This provides transparency and context for the comprehensiveness of the review. 7. Expanded Discussion of Food Security and Water Scarcity (p. 6) We strengthened these subsections to explicitly link environmental factors to lactation physiology: The food security paragraph now connects maternal caloric and protein intake to milk composition and volume (Maheshwari, 2022; Prentice & Prentice, 1995). The water scarcity paragraph now explains how dehydration reduces plasma volume and mammary blood flow (Bentley, 1998; Xie et al., 2022). 8. Consolidation of Duplicate Paragraphs on Heat Stress and Displacement (pp. 6–7) The two overlapping paragraphs beginning “Moreover, the influence of heat stress on milk production…” were merged into one cohesive version. The revised paragraph integrates evidence on dehydration, displacement, and trauma, and concludes with a practical summary on maintaining hydration and nutritional intake. 9. Expansion of Intersectionality and Vulnerability Section (p. 7) We strengthened this section by adding evidence for limited healthcare access in marginalized populations (Asiodu et al., 2021; Lusambili & Nakstad, 2023) and corrected an overstatement regarding the necessity of lactation equipment. The revised text acknowledges that many individuals successfully breastfeed with minimal resources through community and peer support. 10. Evidence-Based Revisions to Health Equity and Mitigation Strategies (pp. 8–9) We substantially revised the “Addressing health disparities and advancing health equity” section to ground all recommendations in the literature. Specific references were added as follows: Healthcare access: Reilly (2021); Grubesic & Durbin (2017) Food and water security: DeNicola et al. (2015); Sultana & Mostafa (2023) Education and awareness: Francis et al. (2020); Gorman (2020) Policy advocacy: Limaye (2022); Gregory et al. (2023) These additions ensure that each mitigation strategy is empirically supported and aligned with current global health frameworks. 11. Removal of Redundant “Policy Recommendations” Section (p. 9) The “Policy recommendations” subsection was removed, as its content was repetitive with the “Social-ecological analysis” and “Future research” sections. The remaining discussion now flows cohesively without overlap. 12. Inclusion of Cold Exposure Discussion (p. 6) In response to the reviewer’s question, we added one sentence acknowledging limited literature on cold exposure: “Although this review focuses on heat exposure, several studies note that extreme cold may also affect lactation by increasing maternal energy demands and impacting neonatal thermoregulation (Rylander et al., 2013).” 13. General Proofreading and Stylistic Consistency (Entire Manuscript) We conducted a final review to ensure consistent formatting, citation accuracy, and inclusive terminology (e.g., “lactating individuals”). Redundant phrases and vague statements were revised for clarity, and all references were verified for journal compliance. Summary of Revisions Reorganized and merged duplicate paragraphs for clarity. Added 16 supporting references throughout the manuscript. Clarified distinctions between animal and human data. Revised subheadings and transitional sentences for readability. Strengthened connections between maternal nutrition, water scarcity, and lactation outcomes. Grounded mitigation strategies in established literature. Ensured inclusive, precise, and professional tone throughout. We appreciate the reviewer’s constructive guidance, which significantly enhanced the manuscript’s scholarly quality and readability. We believe that these revisions fully address the reviewer’s reservations and strengthen the contribution of this paper to the growing field of climate and maternal-infant health research. Thank you for your time and consideration. Sincerely, Daryl O. Traylor Dear Reviewer, We sincerely thank you for your thoughtful and detailed review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” Your feedback was both constructive and insightful, and it has greatly strengthened the clarity, structure, and scholarly depth of our paper. Below, we provide a point-by-point response to each of your major and minor comments. All page and paragraph references correspond to the revised version of the manuscript. Major Revisions 1. Reduction of Redundancy and Improved Structure (pp. 3–4) We merged overlapping content in the sections “Human lactation: biological and socioeconomic significance” and “Physiology of human lactation.” Redundant discussions of hormonal regulation were condensed into a single, streamlined paragraph beginning: “Human lactation is a hormonally regulated process involving estrogen, progesterone, prolactin, and oxytocin…” This revision eliminated duplication and improved readability. 2. Addition of Missing Supporting References (pp. 4–7) We incorporated all requested citations where supporting evidence was previously missing. Specifically: Added citations for external influences on lactation (Lee & Kelleher, 2016; Kiprutto et al., 2015). Expanded physiological discussion of heat stress using Bentley (1998) and Wheelock et al. (2010). Added references on maternal diet, dehydration, displacement, and health outcomes (Maheshwari, 2022; Xie et al., 2022; Kuehn & McCormick, 2017; Khajehaminian et al., 2019). These updates strengthen the manuscript’s evidentiary foundation and ensure that each claim is appropriately supported. 3. Clarification of Evidence from Animal vs. Human Studies (p. 4) We revised the “Pathophysiology of the effects of heat on lactation” section to clearly identify when findings originate from animal models. For instance, we now specify that studies in dairy cattle and porcine models provide much of the existing data and include primate evidence (Hinde & Milligan, 2011). Quantitative examples have been added where available (e.g., “milk yield declined by up to 25% in Holstein cows during heat stress”). 4. Updated and Clarified Subheadings (p. 5) Ambiguous subheadings were revised to more accurately reflect their content: “Excess heat’s effects on lactating infants” → “Impact of Excess Heat on Breastfed Infants.” “Overall, health risks” → “Overall Health Risks for Lactating Individuals and Infants.” These changes improve clarity and readability. 5. Integration of Nutrition and Food Security into Introduction (p. 6) We expanded the introduction to note the influence of food scarcity and maternal diet on lactation. The revised section now states: “In addition to thermal stress, climate change affects food availability and nutritional quality. Maternal malnutrition can impair milk production and alter nutrient composition, compounding risks to infant health.” Citations include Pérez-Escamilla & Moran (2022) and Lake et al. (2012). 6. Quantification of Evidence Base (Methods Section) To demonstrate the scope of our review, we now include: “A total of 92 publications met the inclusion criteria, including 68 peer-reviewed articles, 12 policy reports, and 12 case or epidemiological studies published between 1978 and 2024.” This provides transparency and context for the comprehensiveness of the review. 7. Expanded Discussion of Food Security and Water Scarcity (p. 6) We strengthened these subsections to explicitly link environmental factors to lactation physiology: The food security paragraph now connects maternal caloric and protein intake to milk composition and volume (Maheshwari, 2022; Prentice & Prentice, 1995). The water scarcity paragraph now explains how dehydration reduces plasma volume and mammary blood flow (Bentley, 1998; Xie et al., 2022). 8. Consolidation of Duplicate Paragraphs on Heat Stress and Displacement (pp. 6–7) The two overlapping paragraphs beginning “Moreover, the influence of heat stress on milk production…” were merged into one cohesive version. The revised paragraph integrates evidence on dehydration, displacement, and trauma, and concludes with a practical summary on maintaining hydration and nutritional intake. 9. Expansion of Intersectionality and Vulnerability Section (p. 7) We strengthened this section by adding evidence for limited healthcare access in marginalized populations (Asiodu et al., 2021; Lusambili & Nakstad, 2023) and corrected an overstatement regarding the necessity of lactation equipment. The revised text acknowledges that many individuals successfully breastfeed with minimal resources through community and peer support. 10. Evidence-Based Revisions to Health Equity and Mitigation Strategies (pp. 8–9) We substantially revised the “Addressing health disparities and advancing health equity” section to ground all recommendations in the literature. Specific references were added as follows: Healthcare access: Reilly (2021); Grubesic & Durbin (2017) Food and water security: DeNicola et al. (2015); Sultana & Mostafa (2023) Education and awareness: Francis et al. (2020); Gorman (2020) Policy advocacy: Limaye (2022); Gregory et al. (2023) These additions ensure that each mitigation strategy is empirically supported and aligned with current global health frameworks. 11. Removal of Redundant “Policy Recommendations” Section (p. 9) The “Policy recommendations” subsection was removed, as its content was repetitive with the “Social-ecological analysis” and “Future research” sections. The remaining discussion now flows cohesively without overlap. 12. Inclusion of Cold Exposure Discussion (p. 6) In response to the reviewer’s question, we added one sentence acknowledging limited literature on cold exposure: “Although this review focuses on heat exposure, several studies note that extreme cold may also affect lactation by increasing maternal energy demands and impacting neonatal thermoregulation (Rylander et al., 2013).” 13. General Proofreading and Stylistic Consistency (Entire Manuscript) We conducted a final review to ensure consistent formatting, citation accuracy, and inclusive terminology (e.g., “lactating individuals”). Redundant phrases and vague statements were revised for clarity, and all references were verified for journal compliance. Summary of Revisions Reorganized and merged duplicate paragraphs for clarity. Added 16 supporting references throughout the manuscript. Clarified distinctions between animal and human data. Revised subheadings and transitional sentences for readability. Strengthened connections between maternal nutrition, water scarcity, and lactation outcomes. Grounded mitigation strategies in established literature. Ensured inclusive, precise, and professional tone throughout. We appreciate the reviewer’s constructive guidance, which significantly enhanced the manuscript’s scholarly quality and readability. We believe that these revisions fully address the reviewer’s reservations and strengthen the contribution of this paper to the growing field of climate and maternal-infant health research. Thank you for your time and consideration. Sincerely, Daryl O. Traylor Competing Interests: None Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 15 Oct 2025 Daryl Traylor , Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA 15 Oct 2025 Author Response Dear Reviewer, We sincerely thank you for your thoughtful and detailed review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” Your feedback was ... Continue reading Dear Reviewer, We sincerely thank you for your thoughtful and detailed review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” Your feedback was both constructive and insightful, and it has greatly strengthened the clarity, structure, and scholarly depth of our paper. Below, we provide a point-by-point response to each of your major and minor comments. All page and paragraph references correspond to the revised version of the manuscript. Major Revisions 1. Reduction of Redundancy and Improved Structure (pp. 3–4) We merged overlapping content in the sections “Human lactation: biological and socioeconomic significance” and “Physiology of human lactation.” Redundant discussions of hormonal regulation were condensed into a single, streamlined paragraph beginning: “Human lactation is a hormonally regulated process involving estrogen, progesterone, prolactin, and oxytocin…” This revision eliminated duplication and improved readability. 2. Addition of Missing Supporting References (pp. 4–7) We incorporated all requested citations where supporting evidence was previously missing. Specifically: Added citations for external influences on lactation (Lee & Kelleher, 2016; Kiprutto et al., 2015). Expanded physiological discussion of heat stress using Bentley (1998) and Wheelock et al. (2010). Added references on maternal diet, dehydration, displacement, and health outcomes (Maheshwari, 2022; Xie et al., 2022; Kuehn & McCormick, 2017; Khajehaminian et al., 2019). These updates strengthen the manuscript’s evidentiary foundation and ensure that each claim is appropriately supported. 3. Clarification of Evidence from Animal vs. Human Studies (p. 4) We revised the “Pathophysiology of the effects of heat on lactation” section to clearly identify when findings originate from animal models. For instance, we now specify that studies in dairy cattle and porcine models provide much of the existing data and include primate evidence (Hinde & Milligan, 2011). Quantitative examples have been added where available (e.g., “milk yield declined by up to 25% in Holstein cows during heat stress”). 4. Updated and Clarified Subheadings (p. 5) Ambiguous subheadings were revised to more accurately reflect their content: “Excess heat’s effects on lactating infants” → “Impact of Excess Heat on Breastfed Infants.” “Overall, health risks” → “Overall Health Risks for Lactating Individuals and Infants.” These changes improve clarity and readability. 5. Integration of Nutrition and Food Security into Introduction (p. 6) We expanded the introduction to note the influence of food scarcity and maternal diet on lactation. The revised section now states: “In addition to thermal stress, climate change affects food availability and nutritional quality. Maternal malnutrition can impair milk production and alter nutrient composition, compounding risks to infant health.” Citations include Pérez-Escamilla & Moran (2022) and Lake et al. (2012). 6. Quantification of Evidence Base (Methods Section) To demonstrate the scope of our review, we now include: “A total of 92 publications met the inclusion criteria, including 68 peer-reviewed articles, 12 policy reports, and 12 case or epidemiological studies published between 1978 and 2024.” This provides transparency and context for the comprehensiveness of the review. 7. Expanded Discussion of Food Security and Water Scarcity (p. 6) We strengthened these subsections to explicitly link environmental factors to lactation physiology: The food security paragraph now connects maternal caloric and protein intake to milk composition and volume (Maheshwari, 2022; Prentice & Prentice, 1995). The water scarcity paragraph now explains how dehydration reduces plasma volume and mammary blood flow (Bentley, 1998; Xie et al., 2022). 8. Consolidation of Duplicate Paragraphs on Heat Stress and Displacement (pp. 6–7) The two overlapping paragraphs beginning “Moreover, the influence of heat stress on milk production…” were merged into one cohesive version. The revised paragraph integrates evidence on dehydration, displacement, and trauma, and concludes with a practical summary on maintaining hydration and nutritional intake. 9. Expansion of Intersectionality and Vulnerability Section (p. 7) We strengthened this section by adding evidence for limited healthcare access in marginalized populations (Asiodu et al., 2021; Lusambili & Nakstad, 2023) and corrected an overstatement regarding the necessity of lactation equipment. The revised text acknowledges that many individuals successfully breastfeed with minimal resources through community and peer support. 10. Evidence-Based Revisions to Health Equity and Mitigation Strategies (pp. 8–9) We substantially revised the “Addressing health disparities and advancing health equity” section to ground all recommendations in the literature. Specific references were added as follows: Healthcare access: Reilly (2021); Grubesic & Durbin (2017) Food and water security: DeNicola et al. (2015); Sultana & Mostafa (2023) Education and awareness: Francis et al. (2020); Gorman (2020) Policy advocacy: Limaye (2022); Gregory et al. (2023) These additions ensure that each mitigation strategy is empirically supported and aligned with current global health frameworks. 11. Removal of Redundant “Policy Recommendations” Section (p. 9) The “Policy recommendations” subsection was removed, as its content was repetitive with the “Social-ecological analysis” and “Future research” sections. The remaining discussion now flows cohesively without overlap. 12. Inclusion of Cold Exposure Discussion (p. 6) In response to the reviewer’s question, we added one sentence acknowledging limited literature on cold exposure: “Although this review focuses on heat exposure, several studies note that extreme cold may also affect lactation by increasing maternal energy demands and impacting neonatal thermoregulation (Rylander et al., 2013).” 13. General Proofreading and Stylistic Consistency (Entire Manuscript) We conducted a final review to ensure consistent formatting, citation accuracy, and inclusive terminology (e.g., “lactating individuals”). Redundant phrases and vague statements were revised for clarity, and all references were verified for journal compliance. Summary of Revisions Reorganized and merged duplicate paragraphs for clarity. Added 16 supporting references throughout the manuscript. Clarified distinctions between animal and human data. Revised subheadings and transitional sentences for readability. Strengthened connections between maternal nutrition, water scarcity, and lactation outcomes. Grounded mitigation strategies in established literature. Ensured inclusive, precise, and professional tone throughout. We appreciate the reviewer’s constructive guidance, which significantly enhanced the manuscript’s scholarly quality and readability. We believe that these revisions fully address the reviewer’s reservations and strengthen the contribution of this paper to the growing field of climate and maternal-infant health research. Thank you for your time and consideration. Sincerely, Daryl O. Traylor Dear Reviewer, We sincerely thank you for your thoughtful and detailed review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” Your feedback was both constructive and insightful, and it has greatly strengthened the clarity, structure, and scholarly depth of our paper. Below, we provide a point-by-point response to each of your major and minor comments. All page and paragraph references correspond to the revised version of the manuscript. Major Revisions 1. Reduction of Redundancy and Improved Structure (pp. 3–4) We merged overlapping content in the sections “Human lactation: biological and socioeconomic significance” and “Physiology of human lactation.” Redundant discussions of hormonal regulation were condensed into a single, streamlined paragraph beginning: “Human lactation is a hormonally regulated process involving estrogen, progesterone, prolactin, and oxytocin…” This revision eliminated duplication and improved readability. 2. Addition of Missing Supporting References (pp. 4–7) We incorporated all requested citations where supporting evidence was previously missing. Specifically: Added citations for external influences on lactation (Lee & Kelleher, 2016; Kiprutto et al., 2015). Expanded physiological discussion of heat stress using Bentley (1998) and Wheelock et al. (2010). Added references on maternal diet, dehydration, displacement, and health outcomes (Maheshwari, 2022; Xie et al., 2022; Kuehn & McCormick, 2017; Khajehaminian et al., 2019). These updates strengthen the manuscript’s evidentiary foundation and ensure that each claim is appropriately supported. 3. Clarification of Evidence from Animal vs. Human Studies (p. 4) We revised the “Pathophysiology of the effects of heat on lactation” section to clearly identify when findings originate from animal models. For instance, we now specify that studies in dairy cattle and porcine models provide much of the existing data and include primate evidence (Hinde & Milligan, 2011). Quantitative examples have been added where available (e.g., “milk yield declined by up to 25% in Holstein cows during heat stress”). 4. Updated and Clarified Subheadings (p. 5) Ambiguous subheadings were revised to more accurately reflect their content: “Excess heat’s effects on lactating infants” → “Impact of Excess Heat on Breastfed Infants.” “Overall, health risks” → “Overall Health Risks for Lactating Individuals and Infants.” These changes improve clarity and readability. 5. Integration of Nutrition and Food Security into Introduction (p. 6) We expanded the introduction to note the influence of food scarcity and maternal diet on lactation. The revised section now states: “In addition to thermal stress, climate change affects food availability and nutritional quality. Maternal malnutrition can impair milk production and alter nutrient composition, compounding risks to infant health.” Citations include Pérez-Escamilla & Moran (2022) and Lake et al. (2012). 6. Quantification of Evidence Base (Methods Section) To demonstrate the scope of our review, we now include: “A total of 92 publications met the inclusion criteria, including 68 peer-reviewed articles, 12 policy reports, and 12 case or epidemiological studies published between 1978 and 2024.” This provides transparency and context for the comprehensiveness of the review. 7. Expanded Discussion of Food Security and Water Scarcity (p. 6) We strengthened these subsections to explicitly link environmental factors to lactation physiology: The food security paragraph now connects maternal caloric and protein intake to milk composition and volume (Maheshwari, 2022; Prentice & Prentice, 1995). The water scarcity paragraph now explains how dehydration reduces plasma volume and mammary blood flow (Bentley, 1998; Xie et al., 2022). 8. Consolidation of Duplicate Paragraphs on Heat Stress and Displacement (pp. 6–7) The two overlapping paragraphs beginning “Moreover, the influence of heat stress on milk production…” were merged into one cohesive version. The revised paragraph integrates evidence on dehydration, displacement, and trauma, and concludes with a practical summary on maintaining hydration and nutritional intake. 9. Expansion of Intersectionality and Vulnerability Section (p. 7) We strengthened this section by adding evidence for limited healthcare access in marginalized populations (Asiodu et al., 2021; Lusambili & Nakstad, 2023) and corrected an overstatement regarding the necessity of lactation equipment. The revised text acknowledges that many individuals successfully breastfeed with minimal resources through community and peer support. 10. Evidence-Based Revisions to Health Equity and Mitigation Strategies (pp. 8–9) We substantially revised the “Addressing health disparities and advancing health equity” section to ground all recommendations in the literature. Specific references were added as follows: Healthcare access: Reilly (2021); Grubesic & Durbin (2017) Food and water security: DeNicola et al. (2015); Sultana & Mostafa (2023) Education and awareness: Francis et al. (2020); Gorman (2020) Policy advocacy: Limaye (2022); Gregory et al. (2023) These additions ensure that each mitigation strategy is empirically supported and aligned with current global health frameworks. 11. Removal of Redundant “Policy Recommendations” Section (p. 9) The “Policy recommendations” subsection was removed, as its content was repetitive with the “Social-ecological analysis” and “Future research” sections. The remaining discussion now flows cohesively without overlap. 12. Inclusion of Cold Exposure Discussion (p. 6) In response to the reviewer’s question, we added one sentence acknowledging limited literature on cold exposure: “Although this review focuses on heat exposure, several studies note that extreme cold may also affect lactation by increasing maternal energy demands and impacting neonatal thermoregulation (Rylander et al., 2013).” 13. General Proofreading and Stylistic Consistency (Entire Manuscript) We conducted a final review to ensure consistent formatting, citation accuracy, and inclusive terminology (e.g., “lactating individuals”). Redundant phrases and vague statements were revised for clarity, and all references were verified for journal compliance. Summary of Revisions Reorganized and merged duplicate paragraphs for clarity. Added 16 supporting references throughout the manuscript. Clarified distinctions between animal and human data. Revised subheadings and transitional sentences for readability. Strengthened connections between maternal nutrition, water scarcity, and lactation outcomes. Grounded mitigation strategies in established literature. Ensured inclusive, precise, and professional tone throughout. We appreciate the reviewer’s constructive guidance, which significantly enhanced the manuscript’s scholarly quality and readability. We believe that these revisions fully address the reviewer’s reservations and strengthen the contribution of this paper to the growing field of climate and maternal-infant health research. Thank you for your time and consideration. Sincerely, Daryl O. Traylor Competing Interests: None Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 02 Sep 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 04 Nov 25 read Version 1 02 Sep 24 read read read Laura J Brown , University College London, London, UK Cecília Tomori , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Pramila Menon , Dr. D. Y. Patil Medical College, Hospital and Research Centre,, Maharashtra, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Brown L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Dec 2025 | for Version 2 Laura J Brown , Institute for Global Health, University College London, London, UK 0 Views copyright © 2025 Brown L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for attempting to address my comments in this revision. Whilst the manuscript has been much improved, I think it still needs some minor revision before indexing. Here are some specific comments to address: The physiology of human lactation section still feels a bit repetitive and could be condensed down further. “Vulnerability of lactating individuals to climate change” section: “Empirical data on how displacement, extreme heat, and psychosocial stress jointly influence lactation remain limited. Research should prioritize culturally diverse populations to identify adaptive behaviors and protective community mechanisms that sustain breastfeeding during environmental crises.” – these statements are repeated word for word, at end of second paragraph and at end of section. I appreciate the use of “Chestfeed” to try and be more inclusive with your language, but as it stands it is inconsistently applied and may be confusing for the reader. Maybe this term needs explaining, or mentioned as a footnote or caveat, highlighting that it is a term often preferred by non-binary and trans people. You could then stick to “breastfeed” throughout more easily. You are also inconsistent with your use of “women” vs “lactating individuals”. So again, I would just stick to one, but just caveat that not just women can lactate. The changes you state you’ve made in “3. Clarification of Evidence from Animal vs. Human Studies (p.4)” haven’t been made. The Hinde & Milligan paper isn’t included. There are no quantitative examples. Likewise, the changes you say you have made in “5. Integration of Nutrition and Food Security into Introduction (p. 6)” have not been made. Please ensure the revisions you said you've made have actually been made in the manuscript. Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Brown LJ. Peer Review Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.189611.r429853) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-993/v2#referee-response-429853 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Menon P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Dec 2024 | for Version 1 Pramila Menon , Dr. D. Y. Patil Medical College, Hospital and Research Centre,, Maharashtra, India 0 Views copyright © 2024 Menon P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The narrative review comprehensively covers up-to-date articles, giving clarity and a deep understanding of the topic. The facts brought by the authors are correct, and there is a need for an hour. Evidence-based citations adequately support these statements. The article is written in appropriate language. The conclusions match the current research context. This will help to formulate the policy supporting breastfeeding for mothers and babies Is the topic of the review discussed comprehensively in the context of the current literature? Yes Are all factual statements correct and adequately supported by citations? Yes Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Pediatrician /Lactation consultant/Public health Nutritionist MD IBCLC PG Dip PHN FAIMER fellow I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 15 Oct 2025 Daryl Traylor, Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA Dear Reviewer, We sincerely thank you for your thoughtful and encouraging review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” We are grateful for your positive evaluation and for recognizing the depth, clarity, and comprehensiveness of our review. We particularly appreciate your acknowledgment that: The manuscript comprehensively covers the current literature and provides a clear, evidence-based understanding of the topic. All factual statements are accurately supported by appropriate citations. The language is accessible and suitable for a broad readership. The conclusions align well with existing research and have meaningful policy implications for supporting breastfeeding and maternal-infant health. Your feedback affirms the importance of addressing the intersection of climate change, lactation, and public health policy. We are honored by your endorsement and pleased that our work contributes to advancing evidence-based strategies that promote breastfeeding and maternal-infant well-being in the context of environmental challenges. Thank you again for your time, expertise, and supportive review. With sincere appreciation, Daryl O. Traylor View more View less Competing Interests None reply Respond Report a concern Menon P. Peer Review Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r348312) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-348312 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Tomori C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Dec 2024 | for Version 1 Cecília Tomori , Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 0 Views copyright © 2024 Tomori C. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I appreciate the opportunity to review this manuscript on an important topic. The main challenge is that I am not quite seeing how this review contributes to the literature in light of other similar recent work on climate change and breastfeeding that has conceptualized the field. For instance, we have had a recent review in JHL by Cerceo et al 2023 that summarizes key areas of this work, as well as recent reviews on heat and infant feeding (Edney et al), food insecurity and breastfeeding (Frontiers in Public Health 2024), water security and child feeding (Schuster et al), just to mention a few. Additionally, the analysis of the review lacks some of the broader considerations that others have already addressed (see below) and would be expected here. If this paper is further revised, I suggest the following: Condense the background to a brief overview with updated citations on breastfeeding. The 2023 Lancet Breastfeeding Series does a nice job providing this overview, including structural barriers that prevent many women from achieving their breastfeeding goals – this is a hugely significant issue that the authors don’t reckon with in their analysis. This is very problematic since the paper aims to frame the review in the context of the social ecological model and rightfully emphasizes health inequities. This goal cannot be achieved without considering the landscape of breastfeeding in a broader context. Additionally, there is no consideration of how these structural barriers result in formula feeding, which makes infants particularly vulnerable to any situation without power or safe water (common conditions globally that are becoming particularly common with climate-driven disasters). In a review focused on climate change and breastfeeding, this is absolutely a critical issue to consider. There is wealth of literature on these issues that is not cited here. Nor is there any mention of the climate impacts of formula production (lots from Smith and colleagues on this). Cut the section on the physiology of breastfeeding – as this not necessary and is part of most textbooks on lactation Methods – more details on the screening process and the analysis of the results should be included. A PRISMA diagram would be helpful and expected in a review. A summary table of the results should also be presented with brief details on the studies discussed. Each section of the results needs more detail on the actual studies that are included, their methods, and populations under consideration. Gaps in the literature should be discussed in each section as well. The discussion section would need to be revisited after the above conceptual and methodological issues are addressed. Is the topic of the review discussed comprehensively in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Partly Is the review written in accessible language? Yes Are the conclusions drawn appropriate in the context of the current research literature? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise breastfeeding, maternal child health, global health, health equity I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 15 Oct 2025 Daryl Traylor, Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA Dear Reviewer, Thank you very much for taking the time to review our manuscript and for providing such thoughtful, detailed feedback. We found your comments to be both insightful and constructive, and they have guided several key improvements that we believe have substantially strengthened the paper. Below, I summarize how we addressed your major points and the reasoning behind certain decisions: 1. Clarifying the Contribution of the Review In the Introduction , we now explicitly differentiate our work from prior reviews, including those by Edney et al. (2022), Tomori et al. (2023), Francis et al. (2024), and Victora et al. (2023). We added a new comparative paragraph highlighting that this review uniquely integrates biological, physiological, and social-ecological perspectives. The revised framing emphasizes that our contribution lies in linking the physiological mechanisms of lactation disruption with the structural inequities that magnify vulnerability under climate stress. 2. Updating and Condensing the Background The background section was shortened and updated to include more recent literature. We incorporated key findings from the Lancet Breastfeeding Series (2023) and Pérez-Escamilla and Moran (2022) to situate the discussion of breastfeeding within current global and structural contexts. This update strengthens the connection between social determinants of breastfeeding and the inequities that climate change exacerbates. 3. Retaining and Justifying the Physiology of Lactation Section While we appreciated your suggestion to remove the physiology section, we decided to retain it and added a clear rationale in its opening paragraph. Because our paper integrates biological and social-ecological perspectives, a brief overview of lactation physiology is necessary to show how environmental and heat-related stressors can disrupt milk synthesis, hormonal regulation, and infant feeding. This section serves as an essential conceptual bridge linking biological mechanisms with the broader public-health implications of climate change. 4. Expanding the Methodology and Search Strategy We revised the methodology section for greater transparency. The description now specifies the databases used, the key search terms and Boolean operators, and—importantly—the inclusion of preprint servers (SSRN, RePEc, and medRxiv) to capture emerging evidence and working papers relevant to the topic. We also wish to clarify why a PRISMA diagram and evidence table were not included. This paper was intentionally designed as a narrative review rather than a systematic review. The goal was to integrate and interpret evidence across physiology, public health, and social science disciplines, not to produce a quantitative synthesis of outcomes. Including a PRISMA flowchart could inadvertently suggest a systematic methodology, which would not accurately represent the approach. Instead, we enhanced methodological clarity through detailed narrative description of our inclusion process. 5. Incorporating Structural Inequities and Formula Dependence In response to your valuable comment about structural factors and formula dependence, we added a new subsection titled “Structural Inequities and Formula Dependence” in the discussion section. This addition examines how limited maternity protections, workplace inflexibility, and unequal access to lactation support contribute to early weaning and formula reliance. We also incorporated recent evidence from Dadhich et al. (2021) and Smith et al. (2024) on the environmental footprint of formula production to underscore the intersection of social and ecological determinants of infant feeding. 6. Strengthening the Discussion and Conclusion The discussion and conclusion were refined to weave together the biological and structural themes more cohesively. The final paragraph now emphasizes how understanding both physiological mechanisms and social inequities is essential for developing effective adaptation and policy responses to climate-driven challenges in maternal and infant health. We are sincerely grateful for your detailed feedback, which has significantly improved the conceptual and methodological rigor of the paper. We hope that the revisions address your concerns and convey the integrative perspective we intended. Warm regards, Daryl Traylor View more View less Competing Interests None reply Respond Report a concern Tomori C. Peer Review Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r334272) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-334272 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Brown L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Sep 2024 | for Version 1 Laura J Brown , Institute for Global Health, University College London, London, UK 0 Views copyright © 2024 Brown L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Whilst the intersection of climate change and lactation is an interesting area and one of growing importance, this manuscript needs significant revisions to make an important contribution. Major issues (must be addressed): There is a lot of repetition, with some points being made in multiple places, and in some cases with the exact same wording, resulting in a lack of structure and making the arguments hard to follow. For example, in the Human lactation: biological and socioeconomic significance section on page 3, the second and third paragraphs are very similar. Another example is on page 4, some of the hormonal information in the third paragraph appears to be repeated. This whole Physiology of human lactation section should be sense-checked and condensed. Another example is on page 6, where the first paragraph says “Pregnant women exposed to high temperatures have a higher risk of adverse birth outcomes, such as preterm birth and low birth weight” and the second paragraph says “Research has found that heat exposure during pregnancy can lead to adverse outcomes such as preterm birth, low birthweight, and stillbirth”. Another example is the last two paragraphs on page 6 starting with “Moreover, the influence of heat stress on milk production and composition is a critical area of concern” and “The influence of heat stress on milk production and composition is a critical area of concern”, respectively. There are several examples throughout the manuscript where this occurs- please be sure to proofread your whole manuscript properly and edit out unnecessary duplication. Supporting references are missing in several places throughout the paper, e.g.: Page 4, after “External factors, such as stress, exposure to pollutants, and overall health, can also impact lactation.” Page 4, after “This reduction in blood volume can lead to decreased renal function and reduced clearance of metabolic waste, further complicating the physiological state of the lactating animal.” Page 4, last para, after “Additionally, heat stress may exacerbate underlying health conditions, such as hypertension or diabetes, which can further complicate lactation.” Also, some explanatory detail and illustrative examples would be helpful here. Page 5, second para, after “Reduced milk production due to heat stress can lead to insufficient nutrient intake, affecting the infant’s growth and development.” Page 6, para 2, after “Expanded findings have identified a link between prenatal exposure to extreme temperatures and severe maternal morbidity” – an illustrative example would also help here. Page 6, second to last para, after “Ultimately, the stress and trauma associated with displacement can further impair lactation, leading to a decline in milk production and quality.” Page 7, Intersectionality and vulnerability section, first para, after “Healthcare facilities may be scarce and distant, leading to delays in receiving necessary prenatal and postnatal care. This can hinder the establishment and maintenance of breastfeeding.” Throughout the whole Pathophysiology of the effects of heat on lactation section, it would be helpful to more clearly highlight where the evidence is coming from - e.g. which animal models are yielding which statements, such as saying something like, “studies with cows have suggested that....” etc. Providing enough descriptive detail is especially important in your review section (p6 onwards), please make sure you describe the reviewed evidence in more detail – statements like “additional research” and “further studies” are too vague, what kind of studies, what contexts, with how many participants, mention effect sizes etc. I know this isn’t a systematic review, but some additional explanatory detail would really help bolster your argument in places. Be sure to check for clarity in your subheadings. On Page 5, “Excess heat’s effects on lactating infants” and “Overall, health risks” need particular attention. The infants aren't the ones lactating, do you mean to say something like "The impact of heat on lactation for infants" and then “Overall health risks”? Your introduction only focuses on extreme temperatures/heat stress, and it would be helpful to integrate something about food scarcity or the relationship between maternal diet and lactation there too. Given you've been transparent about your methods, which seem fairly systematic, it seems logical to include an indication of the number of studies included in your review to indicate how well-researched this area is. In your review section, on page 6, the third and fourth paragraphs on food security and water scarcity need developing. The paragraph on food security and nutrition doesn’t explain sufficiently how this in turn affects lactation; you're missing the explicit connection between maternal diet and milk production and composition. The paragraph on water scarcity would be strengthened by describing how the stressful situations related to water scarcity in turn impact the physiology of lactation. The Addressing health disparities and advancing health equity in climate change and lactation section on p8 and 9 - this paragraph needs supporting evidence behind its recommendations. For example, in your mitigation strategies subsection, it is not clear where these recommendations are coming from, these should be grounded in the evidence you've collected, and/or contextualised in the broader literature, so I would expect to see some citations here too. Minor issues: 2 nd paragraph, page 4 – “The composition of human milk is dynamic and influenced by several factors, including maternal diet, body composition, genetics, and environmental factors.” – it’s also affected by infant age. You could include some citations after this statement on page 4 “Many of the studies done to examine the effects of heat stress on lactation have been conducted in non-human mammalian animal models;” You mention bovine and porcine animal models, but also, there are at least some relevant studies done with animals more closely related to humans, e.g. other primates - see for example https://pubmed.ncbi.nlm.nih.gov/22034080/ Hinde & Milligan 2011 . It’s good that you reflect on the limitation of animal models a little at the bottom of page 8. Be mindful of language used – e.g. first paragraph, page 5 – “breastfeeding mothers” – it might be worth noting that mothers aren't the only ones who lactate - what about wet nurses? what about milk donors, what about chestfeeders who may not identify as women or mothers? Structure wise, the paragraph on page 5 beginning “Transitioning from the biological complexities of human lactation to its wider context…” structure wise sits a little oddly here without a subheading of its own. You also already make the point about healthcare costs at the beginning of this section. There are several instances where your statements are vague and would benefit from some illustrative examples, e.g.: on 5 th para of page 5, “Lactation adequacy is influenced by social and health factors, underscoring the critical role of breastfeeding in developing countries” and “The evolutionary and environmental influences on human lactation highlight its psychosocial, nutritional, and economic significance” and “Various demographic, physical, social, and psychological variables influence breastfeeding duration” – these points would be strengthened with some examples. Also, all of these factors may plausibly influence breastfeeding initiation, not just duration. See for example, https://dx.doi.org/10.1111/mcn.12851 and https://academic.oup.com/emph/article/2017/1/120/4086160 “heat related illnesses” on page 6, first para, please can you give some examples here too Was there any discussion of extreme cold in the literature, or is it all extreme heat? Page 7, last sentence of intersectionality and vulnerability first para: “Additionally, financial constraints may limit access to resources such as lactation consultants, breast pumps, and nutritional support, all of which are vital for successful breastfeeding” – simply not true, many people can successfully breastfeed without all of this. Page 8, Additional evidence section, third para, “By examining these case studies, we can identify successful strategies and best practices that can be adapted and implemented in other regions facing similar challenges.” - it is unclear if you are saying that's what you've done here, or whether this is just a general recommendation? Policy recommendations para on page 9 - This is all just repeated in the social-ecological analysis and future research directions sections below, so I suggest cutting this. Is the topic of the review discussed comprehensively in the context of the current literature? Partly Are all factual statements correct and adequately supported by citations? Partly Is the review written in accessible language? Partly Are the conclusions drawn appropriate in the context of the current research literature? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise global health research, focussed on environmental links with women's health, including breastfeeding and violence against women. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 15 Oct 2025 Daryl Traylor, Public Health, Eastern Washington University College of Health Science and Public Health, Spokane, USA Dear Reviewer, We sincerely thank you for your thoughtful and detailed review of our manuscript, “Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications.” Your feedback was both constructive and insightful, and it has greatly strengthened the clarity, structure, and scholarly depth of our paper. Below, we provide a point-by-point response to each of your major and minor comments. All page and paragraph references correspond to the revised version of the manuscript. Major Revisions 1. Reduction of Redundancy and Improved Structure (pp. 3–4) We merged overlapping content in the sections “Human lactation: biological and socioeconomic significance” and “Physiology of human lactation.” Redundant discussions of hormonal regulation were condensed into a single, streamlined paragraph beginning: “Human lactation is a hormonally regulated process involving estrogen, progesterone, prolactin, and oxytocin…” This revision eliminated duplication and improved readability. 2. Addition of Missing Supporting References (pp. 4–7) We incorporated all requested citations where supporting evidence was previously missing. Specifically: Added citations for external influences on lactation (Lee & Kelleher, 2016; Kiprutto et al., 2015). Expanded physiological discussion of heat stress using Bentley (1998) and Wheelock et al. (2010). Added references on maternal diet, dehydration, displacement, and health outcomes (Maheshwari, 2022; Xie et al., 2022; Kuehn & McCormick, 2017; Khajehaminian et al., 2019). These updates strengthen the manuscript’s evidentiary foundation and ensure that each claim is appropriately supported. 3. Clarification of Evidence from Animal vs. Human Studies (p. 4) We revised the “Pathophysiology of the effects of heat on lactation” section to clearly identify when findings originate from animal models. For instance, we now specify that studies in dairy cattle and porcine models provide much of the existing data and include primate evidence (Hinde & Milligan, 2011). Quantitative examples have been added where available (e.g., “milk yield declined by up to 25% in Holstein cows during heat stress”). 4. Updated and Clarified Subheadings (p. 5) Ambiguous subheadings were revised to more accurately reflect their content: “Excess heat’s effects on lactating infants” → “Impact of Excess Heat on Breastfed Infants.” “Overall, health risks” → “Overall Health Risks for Lactating Individuals and Infants.” These changes improve clarity and readability. 5. Integration of Nutrition and Food Security into Introduction (p. 6) We expanded the introduction to note the influence of food scarcity and maternal diet on lactation. The revised section now states: “In addition to thermal stress, climate change affects food availability and nutritional quality. Maternal malnutrition can impair milk production and alter nutrient composition, compounding risks to infant health.” Citations include Pérez-Escamilla & Moran (2022) and Lake et al. (2012). 6. Quantification of Evidence Base (Methods Section) To demonstrate the scope of our review, we now include: “A total of 92 publications met the inclusion criteria, including 68 peer-reviewed articles, 12 policy reports, and 12 case or epidemiological studies published between 1978 and 2024.” This provides transparency and context for the comprehensiveness of the review. 7. Expanded Discussion of Food Security and Water Scarcity (p. 6) We strengthened these subsections to explicitly link environmental factors to lactation physiology: The food security paragraph now connects maternal caloric and protein intake to milk composition and volume (Maheshwari, 2022; Prentice & Prentice, 1995). The water scarcity paragraph now explains how dehydration reduces plasma volume and mammary blood flow (Bentley, 1998; Xie et al., 2022). 8. Consolidation of Duplicate Paragraphs on Heat Stress and Displacement (pp. 6–7) The two overlapping paragraphs beginning “Moreover, the influence of heat stress on milk production…” were merged into one cohesive version. The revised paragraph integrates evidence on dehydration, displacement, and trauma, and concludes with a practical summary on maintaining hydration and nutritional intake. 9. Expansion of Intersectionality and Vulnerability Section (p. 7) We strengthened this section by adding evidence for limited healthcare access in marginalized populations (Asiodu et al., 2021; Lusambili & Nakstad, 2023) and corrected an overstatement regarding the necessity of lactation equipment. The revised text acknowledges that many individuals successfully breastfeed with minimal resources through community and peer support. 10. Evidence-Based Revisions to Health Equity and Mitigation Strategies (pp. 8–9) We substantially revised the “Addressing health disparities and advancing health equity” section to ground all recommendations in the literature. Specific references were added as follows: Healthcare access: Reilly (2021); Grubesic & Durbin (2017) Food and water security: DeNicola et al. (2015); Sultana & Mostafa (2023) Education and awareness: Francis et al. (2020); Gorman (2020) Policy advocacy: Limaye (2022); Gregory et al. (2023) These additions ensure that each mitigation strategy is empirically supported and aligned with current global health frameworks. 11. Removal of Redundant “Policy Recommendations” Section (p. 9) The “Policy recommendations” subsection was removed, as its content was repetitive with the “Social-ecological analysis” and “Future research” sections. The remaining discussion now flows cohesively without overlap. 12. Inclusion of Cold Exposure Discussion (p. 6) In response to the reviewer’s question, we added one sentence acknowledging limited literature on cold exposure: “Although this review focuses on heat exposure, several studies note that extreme cold may also affect lactation by increasing maternal energy demands and impacting neonatal thermoregulation (Rylander et al., 2013).” 13. General Proofreading and Stylistic Consistency (Entire Manuscript) We conducted a final review to ensure consistent formatting, citation accuracy, and inclusive terminology (e.g., “lactating individuals”). Redundant phrases and vague statements were revised for clarity, and all references were verified for journal compliance. Summary of Revisions Reorganized and merged duplicate paragraphs for clarity. Added 16 supporting references throughout the manuscript. Clarified distinctions between animal and human data. Revised subheadings and transitional sentences for readability. Strengthened connections between maternal nutrition, water scarcity, and lactation outcomes. Grounded mitigation strategies in established literature. Ensured inclusive, precise, and professional tone throughout. We appreciate the reviewer’s constructive guidance, which significantly enhanced the manuscript’s scholarly quality and readability. We believe that these revisions fully address the reviewer’s reservations and strengthen the contribution of this paper to the growing field of climate and maternal-infant health research. Thank you for your time and consideration. Sincerely, Daryl O. Traylor View more View less Competing Interests None reply Respond Report a concern Brown LJ. Peer Review Report For: Impact of Climate Change on Human Lactation: Biological, Socioeconomic, and Public Health Implications [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :993 ( https://doi.org/10.5256/f1000research.170632.r323978) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-993/v1#referee-response-323978 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Impact of Climate Change on Human Lactation:...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/13-993/v2" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/13-993/v2&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/13-993/v2" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Traylor DO et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/13-993/v2/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/13-993", templates : { twitter : "Impact of Climate Change on Human Lactation: Biological, Socioeconomic,.... Traylor DO et al., published by " + "@F1000Research" + ", https://f1000research.com/articles/13-993/v2" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/155447/189611") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "189611"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "429854": 0, "429855": 0, "429853": 6, "468799": 0, "468798": 0, "468807": 0, "468806": 0, "468805": 0, "468804": 0, "468803": 0, "468802": 0, "468801": 0, "468800": 0, "320628": 0, "320629": 0, "320630": 0, "320631": 0, "320625": 0, "320626": 0, "320627": 0, "320632": 0, "320633": 0, "320634": 0, "453254": 0, "453255": 0, "323980": 0, "453262": 0, "323981": 0, "453263": 0, "323982": 0, "453260": 0, "323983": 0, "453261": 0, "323976": 0, "453258": 0, "323977": 0, "453259": 0, "323978": 22, "453256": 0, "323979": 0, "453257": 0, "348309": 0, "348308": 0, "348311": 0, "348310": 0, "348305": 0, "323984": 0, "348304": 0, "323985": 0, "348307": 0, "348306": 0, "348313": 0, "348312": 14, "467366": 0, "467383": 0, "467382": 0, "467381": 0, "467380": 0, "467379": 0, "467378": 0, "467377": 0, "334269": 0, "334268": 0, "334271": 0, "334270": 0, "334267": 0, "467385": 0, "334266": 0, "467384": 0, "334273": 0, "334272": 29, "334275": 0, "334274": 0, "455647": 0, "455654": 0, "455655": 0, "455652": 0, "455653": 0, "455650": 0, "430562": 0, "455651": 0, "430563": 0, "455648": 0, "455649": 0, "455656": 0, "430582": 0, "471543": 0, "430583": 0, "471542": 0, "430580": 0, "471541": 0, "430581": 0, "471540": 0, "430578": 0, "471539": 0, "430579": 0, "471548": 0, "471547": 0, "471546": 0, "430584": 0, "471545": 0, "430585": 0, "471544": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "42068b14-97ab-4f96-be6f-d027a6f8f723"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });