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Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries
Evidence Reports/Technology Assessments, No. 153
Investigators: Stanley Ip, MD, Project Leader, Mei Chung, MPH, Gowri Raman, MD, Priscilla Chew, MPH, Nombulelo Magula, MD, Deirdre DeVine, MLitt, Project Manager, Thomas Trikalinos, MD, PhD, and Joseph Lau, MD, Principal Investigator.
Structured Abstract
Objectives:
We reviewed the evidence on the effects of breastfeeding on short- and long-term infant and maternal health outcomes in developed countries.
Data Sources:
We searched MEDLINE®, CINAHL, and the Cochrane Library in November of 2005. Supplemental searches on selected outcomes were conducted through May of 2006. We also identified additional studies in bibliographies of selected reviews and by suggestions from technical experts.
Review Methods:
We included systematic reviews/meta-analyses, randomized and non-randomized comparative trials, prospective cohort, and case-control studies on the effects of breastfeeding and relevant outcomes published in the English language. Included studies must have a comparative arm of formula feeding or different durations of breastfeeding. Only studies conducted in developed countries were included in the updates of previous systematic reviews. The studies were graded for methodological quality.
Results:
We screened over 9,000 abstracts. Forty-three primary studies on infant health outcomes, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies were included in this review. We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. There was no relationship between breastfeeding in term infants and cognitive performance. The relationship between breastfeeding and cardiovascular diseases was unclear. Similarly, it was also unclear concerning the relationship between breastfeeding and infant mortality in developed countries. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression. There was no relationship between a history of lactation and the risk of osteoporosis. The effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear.
Conclusions:
A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings. Also, there is a wide range of quality of the body of evidence across different health outcomes. For future studies, clear subject selection criteria and definition of “exclusive breastfeeding”, reliable collection of feeding data, controlling for important confounders including child-specific factors, and blinded assessment of the outcome measures will help. Sibling analysis provides a method to control for hereditary and household factors that are important in certain outcomes. In addition, cluster randomized controlled studies on the effectiveness of various breastfeeding promotion interventions will provide further opportunity to investigate any disparity in health outcomes as a result of the intervention.
Contents
- Addendum (5-15-2009)
- Preface
- Acknowledgments
- Executive Summary
- 1. Introduction
- 2. Methods
- Overview
- Key Questions Addressed in This Report
- Definitions of Breastfeeding in This Report
- Literature Search Strategy
- Study Selection
- Meta-Analysis
- Grading of Studies Analyzed in This Evidence Report
- Grading of Systematic Reviews/Meta-Analyses
- Grading of Individual Primary Studies in Updates and New Reviews
- Reporting of the Evidence
- 3. Results
- Overview
- Literature Search Results
- Organization of Results
- Part I. Term Infant Outcomes Relationship between Acute Otitis Media and Breastfeeding
- Relationship between Atopic Dermatitis and Breastfeeding
- Relationship between Gastrointestinal Infections and Breastfeeding
- Relationship of Hospitalization Secondary to Lower Respiratory Tract Diseases in Infancy and Breastfeeding
- Relationship between Asthma and Breastfeeding
- Relationship between Cognitive Development and Breastfeeding in Term Infants
- Relationship between Obesity and Breastfeeding
- Relationship between the Risk of Cardiovascular Diseases and Breastfeeding
- Cholesterols
- Blood Pressure
- Cardiovascular Disease Mortality
- Relationship between Type 1 Diabetes and Breastfeeding
- Relationship between Type 2 Diabetes and Breastfeeding
- Relationship between Childhood Leukemia and Breastfeeding
- Relationship between Infant Mortality and Breastfeeding
- Relationship between Sudden Infant Death Syndrome (SIDS) and Breastfeeding
- Part II. Preterm Infant Outcomes Relationship between Necrotizing Enterocolitis and Breast Milk Feeding in Preterm Infants
- Relationship between Cognitive Development and Breast Milk Feeding in Preterm Infants
- Part III. Maternal Outcomes Relationship between Return to Pre-Pregnancy Weight or Postpartum Weight Change and Breastfeeding
- Relationship between Maternal Type 2 Diabetes and Breastfeeding
- Relationship between Osteoporosis and Breastfeeding
- Relation between Postpartum Depression and Breastfeeding
- Relationship between Maternal Breast Cancer and Ovarian Cancer and Breastfeeding
- Breast Cancer
- Ovarian Cancer
- Other Research
- 4. Discussion
- List of Acronyms and Abbreviations
- Appendixes
- References and Included Studies
- Bibliography
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0022. Prepared by: Tufts-New England Medical Center Evidence-Based Practice Center, Boston, Massachusetts.
Suggested citation:
Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No. 153 (Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022). AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality. April 2007.
This report is based on research conducted by the Tufts-New England Medical Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0022). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, or stock options, expert testimony, grants, or patents received or pending, or royalties) that conflict with material presented in this report.
- 1
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- Review A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries.[Breastfeed Med. 2009]Review A summary of the Agency for Healthcare Research and Quality's evidence report on breastfeeding in developed countries.Ip S, Chung M, Raman G, Trikalinos TA, Lau J. Breastfeed Med. 2009 Oct; 4 Suppl 1:S17-30.
- Review The optimal duration of exclusive breastfeeding: a systematic review.[Adv Exp Med Biol. 2004]Review The optimal duration of exclusive breastfeeding: a systematic review.Kramer MS, Kakuma R. Adv Exp Med Biol. 2004; 554:63-77.
- Review Optimal duration of exclusive breastfeeding.[Cochrane Database Syst Rev. 2002]Review Optimal duration of exclusive breastfeeding.Kramer MS, Kakuma R. Cochrane Database Syst Rev. 2002; (1):CD003517.
- Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusion.[Int J Evid Based Healthc. 2005]Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusion.Callaghan A, Kendall G, Lock C, Mahony A, Payne J, Verrier L. Int J Evid Based Healthc. 2005 Jul; 3(6):147-67.
- Review Optimal duration of exclusive breastfeeding.[Cochrane Database Syst Rev. 2012]Review Optimal duration of exclusive breastfeeding.Kramer MS, Kakuma R. Cochrane Database Syst Rev. 2012 Aug 15; 2012(8):CD003517. Epub 2012 Aug 15.
- Breastfeeding and Maternal and Infant Health Outcomes in Developed CountriesBreastfeeding and Maternal and Infant Health Outcomes in Developed Countries
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