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Most recent update: March 2001 by Ginna
Wall, MN, IBCLC
I.
Effects on the
Infant
A. Infection
1.
Diarrhea
An episode of diarrhea was significantly less likely to last
for six or more days if an infant was breastfed for three or more months. Baker D et al. "Inequality in infant morbidity: causes and consequences in
England in the 1990s." J Epidemiol
Community Health 1998 Jul;52(7):451-8 The risk of developing diarrhea increases as the amount of
breast milk an infant receives decreases.
When compared with exclusively breastfed infants, infants who were
exclusively formula-fed had an 80% increase in their risk of developing
diarrhea. Scariati PD et al. "A longitudinal analysis of infant
morbidity and the extent of breastfeeding in the United States." Pediatrics 1997 Jun;99(6):E5 The type of milk consumed before start of diarrhea episode
was strongly associated with dehydration.
Compared with infants exclusively breastfed, bottle-fed infants were at
higher risk (odds ratio for cow's milk = 6.0, for formula milk = 6.9). Compared with those still breastfeeding,
children who stopped in the previous two months were more likely to develop
dehydrating diarrhea. Fuchs SC et
al. "Case-control study of risk of
dehydrating diarrhoea in infants in vulnerable period after full weaning. BMJ 1996 Aug 17;313(7054):391-4 In the first year of life the incidence of diarrheal illness
among breastfed infants was half that of formula-fed infants. Dewey KG et al. "Differences in morbidity between breast-fed and formula-fed
infants." J Pediatr 1995 May;126(5
Pt 1):696-702 Children less than 12 months of age had a lower incidence of
acute diarrheal disease during the months they were being breastfed than
children that were fed with formula during the same period. Lerman,Y. et al.
"Epidemiology of acute diarrheal diseases in children in a high standard
of living settlement in Israel". Pediatr Infect Dis J 1994; 13(2);116-22. Strictly formula-fed children had an incidence of diarrhea
over three times that of strictly breast-fed infants and twice that of
breast-fed and supplementally fed children.
Long KZ et al. Proportional
hazards analysis of diarrhea due to enterotoxigenic Escherichia coli and
breastfeeding in a cohort of urban Mexican children. Am J Epidemiol. 1994 Jan 15;139(2):193-205. In this study of 500 Brazilian infants < or = 12 months
old with diarrhea and 500 age-matched controls, breast-feeding infants < 6
months old (OR, 0.3) and boiling household drinking water (OR, 0.4) were protective. Breast-feeding was protective against
enteropathogenic Escherichia coli infections (OR, 0.1). Blake PA, et al. "Pathogen-specific risk factors and protective factors for
acute diarrheal disease in urban Brazilian infants." J Infect Dis 1993 Mar;167(3):627-32 The addition to the breast-milk diet of even water, teas,
and other nonnutritive liquids doubled or tripled the likelihood of
diarrhea. Supplementation of
breast-feeding with additional nutritive foods or liquids further increased
significantly the risk of diarrhea.
Popkin BM et al.
"Breast-feeding and diarrheal morbidity." Pediatrics 1990 Dec;86(6):874-82 2.
Haemophilus Influenza
The protective effects of human milk against otitis media
may be due in part to inhibition of nasopharyngeal colonization with H.
influenzae by specific secretory IgA antibody.
Harabuchi Y et al. "Human
milk secretory IgA antibody to nontypeable Haemophilus influenzae: possible
protective effects against nasopharyngeal colonization. J Pediatr 1994 Feb;124(2):193-8 The adjusted odds ratio for exposure to breastfeeding was
0.5. Arnold C, et al. "Day care attendance and other risk
factors for invasive Haemophilus influenzae type b disease." Am J Epidemiol 1993 Sep 1;138(5):333-40 Invasive Haemophilus influenzae type b (Hib) disease
occurred at a mean age of 8.7 months.
Breastfeeding was significantly less common among cases than controls
(odds ratio = 0.53). Petersen GM. "Effects of age, breast feeding, and
household structure on Haemophilus influenzae type b disease risk and antibody
acquisition in Alaskan Eskimos. Am J
Epidemiol 1991 Nov 15;134(10):1212-21 In a population-based case-control study of risk factors for
primary invasion of haemophilus influenza, type B disease, breastfeeding was
protective of infants less than 6 months of age. Cochi, S.L. "Primary Invasive Haemophilus Influenza Type B
Disease, A Population Based Assessment of Risk Factors". Journal of
Pediatrics 1986 Jun;108(6):887-96. 3.
Meningitis in Preterm
Infants
The incidence of any infection and sepsis/meningitis are
significantly reduced in human milk-fed VLBW infants compared with exclusively
formula-fed VLBW infants. Hylander MA
et al. "Human milk feedings and
infection among very low birth weight infants." Pediatrics 1998 Sep;102(3):E38 4.
Necrotizing
Enterocolitis
The benefits of improved health (less sepsis and necrotizing
enterocolitis) associated with the feeding of fortified human milk outweighed
the slower rate of growth observed in this study of 108 preterm infants. Infants fed human milk were discharged an
average of 15 days earlier than infants preterm formula. Schanler RJ, et al. "Feeding strategies for premature
infants: beneficial outcomes of feeding fortified human milk versus preterm
formula." Pediatrics 1999 Jun;103(6
Pt 1):1150-7 Although no specific intervention for NEC treatment exists,
preventive therapy using either enteral IgA supplementation, breast milk
feeding, antibiotic prophylaxis, or exogenous steroid administration have
reduced the incidence of this overwhelming disease in small randomized
trials. Caplan MS, et al. "Necrotizing enterocolitis: a review of
pathogenetic mechanisms and implications for prevention."(review) Pediatr Pathol 1993 May-Jun;13(3):357-69 Based on both laboratory and clinical studies, human milk
feeding appears to have protective effects against development of necrotizing
enterocolitis. Buescher ES. "Host
defense mechanisms of human milk and their relations to enteric infections and
necrotizing enterocolitis."(review)
Clin Perinatol 1994 Jun;21(2):247-62 Among babies born at more than 30 weeks gestation, confirmed
necrotizing enterocolitis was rare in those whose diet included breast milk; it
was 20 times more common in those fed formula only. Lucas, A., Cole, T.J.,
"Breast Milk and Neonatal Necrotizing Enteral Colitis". Lancet 1990;
336:1519-23 5.
Otitis Media (Middle
Ear Infection)
The risk of developing an ear infection increases as the
amount of breast milk an infant receives decreases. When compared with exclusively breastfed infants, infants who
were exclusively formula-fed had a 70% increase in their risk of developing an
ear infection. Scariati PD et al. "A longitudinal analysis of infant
morbidity and the extent of breastfeeding in the United States." Pediatrics 1997 Jun;99(6):E5 In infants who were breast fed until at least 12 months of
age, the percentage of any otitis media was 19% lower, and of prolonged
episodes (> 10 days) was 80% lower than formula-fed infants. The mean duration of episodes of otitis
media was longer in formula-fed than breastfed infants (8.8 vs 5.9 days,
respectively). Dewey KG et al. "Differences in morbidity between
breast-fed and formula-fed infants."
J Pediatr 1995 May;126(5 Pt 1):696-702 Infants exclusively
breast-fed for 4 or more months had half the number of acute otitis media
episodes as did those not breastfed at all, and 40% less than those infants
whose diets were supplemented with other foods prior to 4 months. The recurrent
otitis media rate in infants exclusively breast-fed for 6 months or more was
10% and was 20.5% in those infants who breast-fed for less than 4 months. Duncan B et al. "Exclusive breast-feeding for at least 4 months protects
against otitis media." Pediatrics
1993 May;91(5):867-72 Short duration of breastfeeding involved another significant
risk of recurrent respiratory infections and otitis media. Alho, O., "Risk
Factors for Recurrent Acute Otitis Media and Respiratory Infection in
Infancy". INT J PED OTORHINOLARYNGOLOGY 1990; 19:151-61 Significantly increased risk for acute otitis media as well
as prolonged duration of middle ear effusion were associated with male gender,
sibling history of ear infection and not being breast fed. Teele, D.W.,
Epidemiology of Otitis Media During the First Seven Years of Life in Greater
Boston: A prospective, Cohort Study". J of INFEC DIS.1989. (See
also: Duffy 1997, Aniansson 1994,
Harabushi 1994, Paradise 1994, Sassen 1994, Owen 1993, Gulick 1986, Saarinen
1982) 6.
Pneumococcal Disease
Among children 2 to 59 months, invasive pneumococcal disease
was strongly associated with underlying disease and with day care attendance in
the previous 3 months. Among 2- to
11-month-olds, current breastfeeding was associated with a decreased likelihood
of invasive pneumococcal disease.
Levine OS et al. "Risk
factors for invasive pneumococcal disease in children: a population-based
case-control study in North America."
Pediatrics 1999 Mar;103(3):E28 7.
Respiratory Infections
(general)
Infants who were not being breast fed were 17 times more
likely than those being breast fed exclusively to be admitted to hospital for
pneumonia. Cesar JA et al. "Impact of breast feeding on admission
for pneumonia during postneonatal period in Brazil: nested case-control
study. BMJ 1999 May 15;318(7194):1316-1320
In a cohort of 1,202 healthy infants, born in Albuquerque,
New Mexico, the daily occurrences of respiratory symptoms and breastfeeding
status were reported by the mothers every 2 weeks during the first 6 months of
life. After adjustment for potential
confounding factors, full breastfeeding was associated with a reduction in
lower respiratory illness risk (odds ratio=0.81) and significantly reduced the
duration of respiratory illness.
Cushing AH, et al.
"Breastfeeding reduces risk of respiratory illness in
infants." Am J Epidemiol 1998 May
1;147(9):863-70 Children who were not fed human milk had a 1.8-fold
increased risk of respiratory disease at each level of exposure to passive
cigarette smoke, in comparison with children who were fed human milk for at
least 1 month. Jin C, Rossignol
AM. "Effects of passive smoking on
respiratory illness from birth to age eighteen months, in Shanghai, People's
Republic of China. J Pediatr 1993
Oct;123(4):553-8 The authors presented results found in infants with two or
more episodes of acute chronic bronchitis. They found that approximately twice
as many bottle-fed infants presented with the problem as those who were
breastfed. deDuran, C.M. "Cytologic Diagnosis of Milk Micro Aspiration".
IMM ALLERGY PRACTICE 1991; xiii (10);402-5 Odds of respiratory illness with maternal smoking were 7
times higher among children who were never breastfed then among those who were
breastfed. Woodward A et al. "Acute Respiratory Illness in Adelaide
Children: BreastFeeding Modifies the Effect of Passive Smoking". J Epidemiol Community Health 1990
Sep;44(3):224-30 8.
Respiratory Syncytical
Virus (RSV)
Breastfeeding was associated with a lower incidence of RSV
infection during the first year of life. Holberg,C.J., "Risk Factors for
RSV Associated Lower Respiratory Illnesses in the First Year of Life". AM
J Epidemiol 1991; 133 (135-51) 9.
Sepsis in Preterm
Infants
The incidence of any infection and sepsis/meningitis are
significantly reduced in human milk-fed VLBW infants compared with exclusively
formula-fed VLBW infants. Hylander MA
et al. "Human milk feedings and
infection among very low birth weight infants." Pediatrics 1998 Sep;102(3):E38 10. Urinary Tract Infections (UTI)
Breastfed infants have a relative risk of developing a UTI
of 0.38 compared to formula-fed infants.
Pisacane A et al.
"Breast-feeding and urinary tract infection." J Pediatr 1992 Jan;120(1):87-9 The oligosaccharide content of breast-milk and urine from
nursing mothers is very similar, and the pattern of oligosaccharides excreted
by infants is also strongly correlated with
that of breastmilk. The
oligosaccharides cause inhibition of bacterial adhesion, suggesting that
breastfeeding may have a preventive effect on urinary tract infection in both
mother and infant. Coppa GV et al. "Preliminary study of breastfeeding and
bacterial adhesion to uroepithelial cells." Lancet 1990 Mar 10;335(8689):569-71 B. Childhood Illnesses
1.
Autoimmune Thyroid
Disease
Feeding practices in infancy may affect the development of
various autoimmune diseases later in life.
Thyroid alterations are among the most frequently encountered autoimmune
conditions in children. A detailed
history of feeding practices was obtained in 59 children with autoimmune
thyroid disease, their 76 healthy siblings, and 54 healthy nonrelated control
children. The frequency of feedings
with soy-based milk formulas in early life was significantly higher in children
with autoimmune thyroid disease (prevalence 31%) as compared with their siblings
(prevalence 12%), and healthy nonrelated control children (prevalence
13%). Fort P, et al. Breast and soy-formula feedings in early
infancy and the prevalence of autoimmune thyroid disease in children. J Am Coll Nutr. 1990 Apr;9(2):164-7. 2.
Cryptorchidism
(Undescended Testicle)
This case-controlled study showed a significant association
of cryptorchidism and lack of breastfeeding. Mori, M. "Maternal and other
factors of cryptorchidism: a case-control study in Japan" Kurume Med J,
1992:39:53-60 3.
Gastroesophageal Reflex
Breastfed neonates demonstrate gastroesophageal reflux
episodes of significantly shorter duration than formula fed neonates. Heacock,
H.J., "Influence of Breast vs. Formula Milk in Physiologic
Gastroesophageal Reflux in Health Newborn Infants". J. Pediatr
Gastroenterol Nutr, 1992 January; 14(1): 41-6 4.
General Morbidity
The
association between breastfeeding dose and illnesses in the first 6 months of
life was analyzed for 7092 infants.
Breastfeeding dose (ratio of breast-feedings to other feedings) was
categorized as "full," "most," "equal,"
"less," or "no" breastfeeding. Compared with no breastfeeding, full breast-feeding infants had
lower odds ratios of diarrhea, cough or wheeze, and vomiting and lower mean
ratios of illness months and sick baby medical visits. "Most"
breastfeeding infants had lower odds ratios of diarrhea and cough or wheeze,
and "equal" breast-feeding infants had lower odds ratios of cough or
wheeze. "Full," "most," and "equal" breastfeeding
infants without siblings had lower odds ratios of ear infections and certain
other illnesses, but those with siblings did not. "Less" breastfeeding infants had no reduced odds ratios
of illness. Findings did not vary by income.
Raisler J et al.
"Breast-feeding and infant illness: a dose-response
relationship? J Public Health 1999
Jan;89(1):25-30 The
incidence of any infection and sepsis/meningitis are significantly reduced in
human milk-fed VLBW infants compared with exclusively formula-fed VLBW
infants. Hylander MA et al. "Human milk feedings and infection among
very low birth weight infants."
Pediatrics 1998 Sep;102(3):E38 During the
first 6 months of life, breastfeeding has a protective effect of against
respiratory illnesses, gastrointestinal illnesses, and on all illnesses. Beaudry M et al. "Relation between infant feeding and infections during the
first six months of life." J
Pediatr 1995 Feb;126(2):191-7 Jones EG
et al. "Relationship between
infant feeding and exclusion rate from child care because of illness." J Am Diet Assoc 1993 Jul;93(7):809-11 There is
an inverse relationship to breastfeeding and morbidity. This was most prominent
in the first year of life, but it was also present in the first three years.
Van Den Bogaard, C. "Relationship Between Breast Feeding in Early
Childhood and Morbidity in a General Population". Fan Med, 1991;
23:510-515 5. Immunologic Development
Review
article: Protection against infections
has been well evidenced during lactation against, e.g., acute and prolonged
diarrhea, respiratory tract infections, otitis media, urinary tract infection,
neonatal septicemia, and necrotizing enterocolitis. There is also interesting evidence for an enhanced protection
remaining for years after lactation against diarrhea, respiratory tract infections,
otitis media, Haemophilus influenzae type b infections, and wheezing
illness. In several instances the
protection seems to improve with the duration of breastfeeding. A few factors in milk like anti-antibodies
(anti-idiotypic antibodies) and T and B lymphocytes have in some experimental
models been able to transfer priming of the breastfed offspring. This together with transfer of numerous
cytokines and growth factors via milk may add to an active stimulation of the
infant's immune system. Such an
enhanced function could also explain why breastfeeding may protect against
immunologic diseases like celiac disease and possibly allergy. Suggestions of protection against autoimmune
diseases and tumors have also been published.
Hanson LA. "Breastfeeding
provides passive and likely long-lasting active immunity. Ann Allergy Asthma Immunol 1998
Dec;81(6):523-33; quiz 533-4, 537 Secretory
IgA concentration increased more rapidly during the first 6 months after birth
in infants exclusively breastfed than in those exclusively bottle fed. Fitzsimmons SP, et al. "Immunoglobulin A subclasses in
infants' saliva and in saliva and milk from their mothers." J Pediatr 1994 Apr;124(4):566-73 Enhanced
fecal SIgA in breastfed infants is not caused solely by the presence of IgA in
breast milk; it represents a stimulatory effect of breast milk on the
gastrointestinal humoral immunologic development. Koutras, A.K., "Fecal
Secretory Immunoglobulin A in Breast Milk vs. Formula Feeding in Early Infancy".
J Ped Gastro Nutr, 1989. 6. Infant Survival
There is
association between breastfeeding up to 6 months of age and survival of infants
throughout the first year of life. The
younger the infant and the longer the breastfeeding, the greater the estimated
benefits in terms of death averted.
Habicht, J.P., "Does Breast Feeding Really Save Lives, or Are
Apparent Benefits due to Biases?" Am J Epidemiology, 1986 7. Inguinal Hernia
Human milk contains gonadotropin releasing hormone, which
may affect the maturation of neonatal testicular function. This case-control study showed breastfed
infants had a significant dose response reduction in inguinal hernia. Pisacane, A. "Breast-feeding and inguinal
hernia" Journal of Pediatrics 1995:Vol 127, No. 1, pp 109-111 8.
Pyloric Stenosis
Infants with pyloric stenosis were less likely to have been
breastfed during the first week of life.
Pisacane A, et al. Breast
feeding and hypertrophic pyloric stenosis: population based case-control
study. BMJ. 1996 Mar
23;312(7033):745-6. 9.
SIDS
Sixty-three infants who died suddenly and unexpectedly were
classified into 3 groups: SIDS (19 cases), borderline SIDS (30 cases) and
non-SIDS (14 cases). Non-SIDS cases
received more breastfeeding, the parents hardly smoked during pregnancy and
after birth, a firm mattress had been used, and more often signs of illness had
been reported by the parents, compared with the SIDS and borderline SIDS
cases. L'Hoir MP et al. "Sudden unexpected death in infancy:
epidemiologically determined risk factors related to pathological
classification." Acta Paediatr
1998 Dec;87(12):1279-87 Not breastfeeding at discharge from an obstetric hospital at
any stage of the infant's life was associated with an increased risk of SIDS.
Mitchell, A. "Results from the First Year of The New Zealand Count Death
Study". N.Z. Med A, 1991; 104:71-76 A study indicated that breastfeeding was protective against
SIDS, consistent with an effect mediated through the prevention of
gastrointestinal and/or respiratory disease. Hoffman, H.J., "Risk Factors
for SIDS: Results of the National Institute of Child Health and Human
Development SIDS Cooperative Epidemiologic Study". Ann NY ACAD Sci, 1988. 10. Toddler Health
Mothers of 67 infants were questioned about the types and
duration of illness episodes requiring medical care between 16 and 30 months of
age. Breastfeeding was noted to
decrease the number of infant illnesses and indirectly improve toddler health.
Gulick, E.E. "The Effects of Breastfeeding on the Toddler Health."
Pediatric Nursing, 1986 Jan-Feb;12(1):51-4. 11. Wheezing
Infants who were breastfed for three or more months were
significantly less likely to have three or more episodes of wheezing in the
first six months after birth. Baker D
et al. "Inequality in infant
morbidity: causes and consequences in England in the 1990s." J Epidemiol Community Health 1998
Jul;52(7):451-8 Children who had ever been breast fed had a lower incidence
of wheeze than those who had not (59% and 74% respectively). The effect
persisted to age 7 years in the non-atopics only, the risk of wheeze being
halved in the breast fed children. Burr
ML, et al. "Infant feeding,
wheezing, and allergy: a prospective study." Arch Dis Child 1993 Jun;68(6):724-8 Within the group who had had early wheezing, infants who had
been breastfed for at least one month subsequently had less severe
wheezing. Porro E, et al. "Early wheezing and breast
feeding." J Asthma 1993;30(1):23-8
Breastfeeding seems to protect against wheezing respiratory
tract illnesses in the first 4 months of life, particularly when other risk
factors are present. Wright, A.L.,
"Breastfeeding and lower respiratory Tract Illnesses in the First Year of
Life". British Medical Journal, 1989. C. Allergies
1.
Allergies in general
2187 children were followed to age 6 years to study the
association between duration of exclusive breast feeding and asthma or
atopy. After adjustment for
confounders, the introduction of milk other than breastmilk before 4 months of
age was a significant risk factor for all asthma and atopy related outcomes in
children aged 6 years. A significant
reduction in the risk of childhood asthma at age 6 years occurs if exclusive
breast feeding is continued for at least the 4 months after birth. Oddy WH et al.
"Association between breast feeding and asthma in 6 year old
children: findings of a prospective birth cohort study." BMJ 1999 Sep 25;319(7213):815-9 A birth cohort was followed-up to age 4 years. By age 4 years, 27% of the children had
symptoms of allergic disease. Family
history of atopy was the single most important risk factor for atopy in
children. Sibling atopy was a stronger
predictor of clinical disease than maternal or paternal atopy. Formula-feeding before 3 months of age
predisposed to asthma at age 4 years (OR: 1.8). Tariq SM, et al. The
prevalence of and risk factors for atopy in early childhood: a whole population
birth cohort study. J Allergy Clin
Immunol. 1998 May;101(5):587-93. The factors most important in the pathogenesis of allergic
symptoms were: (i) formula implementation
begun in the first week of life; (ii) early weaning (< 4 months); (iii)
feeding beef (< 6 months); (iv) early introduction of cow's milk (< 6
months); and (v) parental smoking in the presence of the babies and early day
care admission (< 2 years of life). All the preventive measures used in this
study (exclusive breastfeeding and/or hydrolyzed milk feeding, delayed and
selective introduction of solid foods, and environmental advice) were effective
at the third year of follow-up, greatly reducing allergic manifestations in
high atopic risk babies in comparison with those not receiving these
interventions Marini A et al.
"Effects of a dietary and environmental prevention programme on the
incidence of allergic symptoms in high atopic risk infants: three years'
follow-up. Acta Paediatr Suppl 1996
May;414:1-21 Breastfeeding, even for short periods was clearly associated
with lower incidence of wheezing, prolonged colds, diarrhea, and vomiting. Merrett, T.G., "Infant Feeding &
Allergy: 12 Month Prospective Study of 500 Babies Born into Allergic
Families". American Allergies, 1988. 2.
Asthma
Introducing milk other than breast milk to infants younger
than 4 months old increases the risk of asthma and atopy (a predisposition to
certain allergies). The investigators
followed 2,187 children from before birth through their 6th birthday. Children who were fed milk other than breast
milk before 4 months of age experienced higher rates of all indicators of
asthma and allergy. Such children were
25% more likely to be diagnosed with allergy and 30% more likely to have a
positive skin test for allergies than were children who received only breast
milk during their early months. The
total duration of exclusive breastfeeding was less important, though longer breastfeeding
was associated with less asthma and allergy.
The researchers also found increased risks of asthma and atopy among
boys, infants born prematurely, and children living in households where smoking
took place. Oddy W et al. British Medical Journal Sep
1999;319:815-819. 3.
Eczema
Prospective randomized double-blind study of high-risk
infants with a family history of atopy followed until 5 years of age showed a
significant lowering in the incidence of atopic disease in the breast-fed and
the whey hydrolysate groups, compared with the conventional cow's milk
group. Soy formula was not
effective. The occurrence of both
eczema and asthma was lowest in the breast-fed and whey hydrolysate groups and
was comparable in the cow's milk and soy groups. Chandra RK.
"Five-year follow-up of high-risk infants with family history of
allergy who were exclusively breast-fed or fed partial whey hydrolysate, soy,
and conventional cow's milk formulas."
J Pediatr Gastroenterol Nutr 1997 Apr; 24(4):380-8 Eczema was less common and milder in babies who were breast
fed (22%) and whose mothers were on a restricted diet (48%). In infants fed casein hydrolysate, soymilk
or cows milk, 21%, 63%, and 70% respectively, developed atopic eczema. Chandra R.K., "Influence of Maternal
Diet During Lactation and the Use of Formula Feed and Development of Atopic
Eczema in the High Risk Infants". Br Med J. 1989 D. Development and Intelligence
1.
Cognitive Development
96 healthy
term infants, aged between 10 and 14 months were assessed using the Bayley
Scales of Infant Development. Duration
of breast-feeding significantly predicted mental development scores for boys,
but not for girls. Duration of breast-feeding did not predict psychomotor
development scores. Paine BJ, Makrides M, Gibson RA. “Duration of breast-feeding and Bayley's Mental Developmental
Index at 1 year of age.” J Paediatr Child Health 1999
Feb;35(1):82-5. Increasing
duration of breastfeeding was associated with consistent and statistically
significant increases in 1) intelligence quotient assessed at ages 8 and 9
years; 2) reading comprehension, mathematical ability, and scholastic ability
assessed during the period from 10 to 13 years; 3) teacher ratings of reading
and mathematics assessed at 8 and 12 years; and 4) higher levels of attainment
in school leaving examinations.
Breastfeeding is associated with small but detectable increases in child
cognitive ability and educational achievement. These effects are 1) pervasive,
being reflected in a range of measures including standardized tests, teacher
ratings, and academic outcomes in high school; and 2) relatively long-lived,
extending throughout childhood into young adulthood. . Horwood LJ, Fergusson DM. "Breastfeeding and later cognitive and
academic outcomes." Pediatrics
1998 Jan;101(1):E9 Supplementary
regression analysis examining the strength of relationship between duration of
breastfeeding and cognitive development show small but significant relationship
between duration of breastfeeding and scores on the mental development index of
the Bayley Scales at 1 and 2 years.
Morrow-Tlucak, M. "Breast Feeding and Cognitive Development During
the First 2 years of Life. "Soc Sci Med, 1988, 26(6):635-9. In 771 low
birth weight infants, babies whose mothers chose to provide breast milk had an
8 point advantage in mean Bayley's mental developmental index over infants of
mother choosing not to do so. Morley, R., "Mothers Choice to provide
Breast Milk and Developmental Outcome". Arch Dis Child, 1988 2. Gastrointestinal and Immune Development
This
article summarizes the published data on the intestinal microflora in breastfed
infants published during the last 15 y.
Acetic acid is found in higher concentrations in breastfed than in
formula-fed infants. Degradation of
mucin starts later in breastfed than in formula-fed infants. The conversion of cholesterol to coprostanol
is also delayed by breastfeeding.
Orrhage K and Nord CE.
"Factors controlling the bacterial colonization of the intestine in
breastfed infants." Acta Paediatr
Suppl 1999 Aug;88(430):47-57 Nucleotides
(NT) and their related metabolic products play key roles in many biological
processes. Most dietary NT are rapidly
metabolized and excreted. However, some
are incorporated into tissues, particularly at younger ages. Under conditions of limited NT intake, rapid
growth or certain disease states, dietary NT may spare the cost of de novo NT
synthesis and optimize the function of rapidly dividing tissues such as those
of the gastrointestinal and immune systems.
Animals fed NT-supplemented versus non-NT supplemented diets have
enhanced gastrointestinal growth and maturation, and improved recovery
following small and large bowel injury.
Indices of humoral and cellular immunity are enhanced, and survival
rates are higher following infection with pathogens. Infants receive NT in
human milk, where they are present as nucleic acids, nucleosides, nucleotides
and related metabolic products. The NT
content of human milk is significantly higher than most cow's milk-based infant
formulae. Dietary NT are reported to
enhance the gastrointestinal and immune systems of formula-fed infants. Infants fed NT-supplemented versus
non-supplemented formula have a lower incidence of diarrhea, higher antibody
titers following Haemophilus influenzae type b vaccination and higher natural
killer cell activity. These data suggest that human milk NT may contribute to
the superior clinical performance of the breastfed infant. Carver JD.
"Dietary nucleotides: effects on the immune and gastrointestinal
systems." Acta Paediatr Suppl 1999
Aug;88(430):83-8 3. Hormones
Hormones, growth factors, cytokines and even whole
cells are present in breast milk and act to establish biochemical and
immunological communication between mother and child. In addition, milk nutrients such as nucleotides, glutamine and
lactoferrin have been shown to influence gastrointestinal development and host
defense. Bernt KM and Walker WA. "Human milk as a carrier of biochemical
messages." Acta Paediatr Suppl
1999 Aug;88(430):27-41. Human milk as well as the milk of several mammalian
species contains a group of biologically active substances that directly
influence the newborn's metabolism and promote growth and differentiation of
organs and target tissues. The
biological significance of hormones and growth factors in milk is an area of
active research. Murphy MS. "Growth factors and the
gastrointestinal tract." Nutrition
1998 Oct;14(10):771-4 Erythropoietin stimulates production of red blood
cells and is used in the treatment of anemia of prematurity. Human milk contains considerable amounts of
erythropoietin which resist degradation after exposure to gastric juices at
physiologic pH levels. Kling PJ et
al. "Human milk as a potential
enteral source of erythropoietin."
Pediatr Res 1998 Feb;43(2):216-21 Prolactin may be important for lung maturation and
surfactant synthesis, and may play a role in the growth of the gut and
intestinal absorption of fluid and ions.
In a study of 280 infants weighing less that 1850 grams at birth, higher
plasma prolactin levels were associated with fewer days on ventilator, faster
transition to full enteral feedings, and greater gain in length. Lucas A et al. "Plasma prolactin and clinical outcome in preterm
infants." Archives of Disease in Childhood, 1990, 65:977-983. 4.
IQ
A review
of 20 published studies on the effects of breastfeeding on infant IQ found that
breastfed babies' IQs may be 3 to 5 points higher than those of formula-fed
babies. The longer a baby is
breast-fed, the greater the benefits to his or her IQ. These benefits were seen from age 6 months
through 15 years. Anderson JW et
al. American Journal of Clinical
Nutrition, Oct 1999, 70. School-age
phenylketonuric children who had, as infants, been breastfed 20-40 days prior
to dietary intervention scored significantly better (IQ advantage of 14.0
points, p = 0.01) than children who had been formula fed. A 12.9 point advantage persisted also after
adjusting for social and maternal education status. Riva E et al. "Early
breastfeeding is linked to higher intelligence quotient scores in dietary
treated phenylketonuric children. Acta
Paediatr 1996 Jan;85(1):56-8 Children
who had consumed mother's milk by tube in early weeks of life had a
significantly higher IQ at 7.5 to 8 years, than those who received no maternal
milk, even after adjustment for differences between groups and mothers'
educational and social class. Lucas,
A., "Breast Milk and Subsequent Intelligence Quotient in Children Born
Preterm". Lancet 1992;339:261-62 5.
Psychomotor and Social
Development
Infants (4 to 6 months old) looked at a mobile significantly
longer when tested after breastfeeding.
This finding suggests that breastfeeding has a substantial effect on
infants' attentiveness to and interaction with their environment. Gerrish CJ and Mennella JA. "Short-term influence of breastfeeding
on the infants' interaction with the environment. Dev Psychobiol 2000 Jan;36(1):40-48. Motor skills and early language development were evaluated
in 1656 8-month-olds. The proportion of
infants who mastered the specific milestones increased consistently with
increasing duration of breastfeeding. The relative risk for the highest versus
the lowest breastfeeding category was 1.3 for crawling, 1.2 for pincer grip and
1.5 for polysyllable babbling. Little
change was found after adjustment for confounding factors. In conclusion, data support the hypothesis
that breastfeeding benefits neurodevelopment. Vestergaard M et al. Duration of breastfeeding and developmental
milestones during the latter half of infancy.
Acta Paediatr 1999 Dec;88(12):1327-32 Children breastfed for 9 months or more present
significantly less suspected developmental delay (25.5%, measured by the Denver
II test) than those breast fed for less than 1 month (42.4%). Barros FC.
"Breast feeding, pacifier use and infant development at 12 months
of age: a birth cohort study in Brazil." Paediatr Perinat Epidemiol 1997
Oct;11(4):441-50 A prospective study of measured psychomotor development
between 18 and 29 months using the Bayley scales. Lower results on the Index of Mental Development were associated
with bottle-fed infants. Temboury MC et
al. "Influence of breast-feeding
on the infant's intellectual development." J Pediatr Gastroenterol Nutr 1994 Jan;18(1):32-6 The psychomotor and social development of breastfed babies
clearly differs from that of bottle-fed ones and leads at the age of 12 months
to significant advantages of the psychomotor and social capabilities.
Baumgartner, C., "Psychomotor and Social Development of Breast Fed and
Bottle Fed babies During their First year of Life". Acta Paediatrica
Hungarica, 1984 25(4):409-17. 6.
Thymus development
At 10 months the thymic index was significantly higher in
those still being breast-fed compared to infants who had stopped breast-feeding
between 8 and 10 months of age. In
infants still breast-fed at 10 months there was a significant correlation
between the number of breast-feeds per day and their thymic index. Hasselbalch H et al, "Breast-feeding
influences thymic size in late infancy."
Eur J Pediatr 1999 Dec;158(12):964-7 Forty-seven healthy infants were examined as neonates and
re-examined at 4 months of age.
Thirty-seven of the infants were also re-examined at 8, 10, and 12
months of age. The thymus size was measured.
Infants exclusively breast-fed during the first 4 months of their lives
had a larger thymic index at 10 months than formula-fed infants. Infants with fever episodes from 10 to 12
months had a smaller thymic index at 12 months. The thymus size in healthy infants increases from birth to 4 and
8 months of age and then decreases.
Hasselbalch H et al. Thymus size
evaluated by sonography. A longitudinal study on infants during the first year
of life. Acta Radiol 1997 Mar;38(2):222-7 At 4 months the geometric mean thymic index was 38.3 in
exclusively breastfed infants (n = 21), 27.3 in partially breastfed infants (n
= 13) and 18.3 in formula fed infants (n = 13). This finding was independent of weight, length, sex and previous
or current illness. There was no significant difference in mean thymic index at
birth between the three feeding groups and mean thymic index had increased in
all three groups from birth to 4 months.
Conclusion: the thymus is
considerably larger in breastfed than in formula-fed infants at the age of 4
months. The cause of this difference is unknown but human milk contains many
immune modulating factors that might cause this effect. Hasselbalch H et al. Decreased thymus size in formula-fed infants
compared with breastfed infants. Acta
Paediatr 1996 Sep;85(9):1029-32 E. Physiologic Response During Feedings
Preterm infants demonstrated a higher oxygen saturation and
a higher temperature during breastfeeding than during bottle feeding, and were
less likely to desaturate to <90% oxygen during breastfeeding. Blaymore Bier
JA et al. "Breastfeeding infants
who were extremely low birth weight.
Pediatrics 1997 Dec;100(6):E3 In infants with congenital heart disease, oxygen saturations
during breastfeeding were higher on average and less variable than during
bottle feedings, indicating that there is less cardiorespiratory stress with
breastfeeding. Marino BL et al. "Oxygen saturations during breast and
bottle feedings in infants with congenital heart disease." J Pediatr Nurs 1995 Dec;10(6):360-4 Supine bottle feeding has a significant effect on middle-ear
pressure dynamics, probably caused by the aspiration of milk into the ear. Tully SB et al. "Abnormal tympanography after supine bottle
feeding." J Pediatr 1995
Jun;126(6):S105-11 F. Long Term Effects
1.
Appendicitis
Pisacane A, et al.
Breast feeding and acute appendicitis. BMJ. 1995 Apr 1;310(6983):836-7. 2.
Bone mass
In this study of 330 8-year-old children from Southern
Tasmania, those who were breastfed had higher bone mineral density at the
femoral neck, lumbar spine and total body compared with those who were
bottle-fed. This association remained
significant after adjustment for size, lifestyle factors and socioeconomic
factors. Breastfeeding for less than 3
months was not associated with increased bone mass at any site. Jones G, Riley M, Dwyer T. Breastfeeding in early life and bone mass in
prepubertal children: a longitudinal study.
Osteoporos Int 2000;11(2):146-52 3.
Cancer
a)
Breast Cancer in
Adulthood
Having been breastfed as an infant has been associated with
a 20-35% reduction in risk of premenopausal breast cancer in four of six
studies evaluating this factor.
Potischman-N; Troisi-R.
"In-utero and early life exposures in relation to risk of breast cancer." Cancer-Causes-And-Control. 1999; 10 (6):
561-573 Women who were breastfed as infants, even if only for a
short time, showed an approximate 25% lower risk of developing premenopausal or
postmenopausal breast cancer, compared to women who were bottle-fed as an
infant. Freudenheim, J. "Exposure to breast milk in infancy and the risk
of breast cancer." Epidemiology 1994 5:324-331 b)
Childhood Cancer
In a case-controlled study of 593 cases of cancer in Moscow
children 0 to 14 years of age, the positive trend of increased risk of cancer
with decreasing duration of breastfeeding was significant for all cancer
combined. Smulevich VB, Solionova LG, Belyakova SV. “Parental occupation and other factors and cancer risk in
children: I. Study methodology and non-occupational factors.” Int
J Cancer 1999 Dec
10;83(6):712-7. Children who are artificially fed or breastfed for only 6
months or less, are at an increased risk of developing cancer before age 15.
The risk of artificially-fed children was 1-8 times that of long-term breastfed
children, and the risk for short term feeders was 1-9 times that of long term
breast feeders. Davis, M.K. "Infant Feeding and Childhood Cancer."
Lancet 1988 13;2(8607):365-8. c)
Hodgkin's Disease
This review of 9 published case-control studies suggests
that children who are never breast-fed or are breast-fed short-term have a
higher risk than those breast-fed for > 6 months of developing Hodgkin's
disease, but not non-Hodgkin's lymphoma or acute lymphoblastic leukemia. Davis MK.
"Review of the evidence for an association between infant feeding
and childhood cancer." Int J
Cancer Suppl 1998;11:29-33 A statistically significant protective effect against
Hodgkin's disease among children who are breastfed at least 8 months compared
with children who were breastfed no more than 2 months. Schwartzbaum, J. "An Exploratory Study
of Environmental and Medical Factors Potentially Related to Childhood
Cancer." Medical & Pediatric Oncology, 1991; 19 (2):115-21. d)
Leukemia and Lymphoma
This case-controlled study of 117 Bedouin Arab children
showed that breastfeeding for less than six months was associated with an odds
ratio of 2.79 for contracting a lymphoid malignancy compared with children
breastfed longer than six months.
European Journal of Cancer2001 January;37:234-238. A total of 1744 children with acute lymphoblastic leukemia
(ALL) and 1879 matched control subjects, aged 1-14 years, and 456 children with
acute myeloid leukemia (AML) and 539 matched control subjects, aged 1-17 years,
were studied. Ever having breast-fed
was found to be associated with a 21% reduction in risk of childhood acute
leukemias. The inverse associations
were stronger with longer duration of breast-feeding. Shu XO etal, "Breast-feeding and risk of childhood acute leukemia. J Natl Cancer Inst 1999 Oct
20;91(20):1765-72 In interviews with the mothers of 2,200 children affected by
either acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), the
infant-feeding history of each of these children was compared with that of over
2,400 healthy controls. The
investigators found that a history of breastfeeding was associated with a
reduction in risk of childhood acute leukemias. Babies who are breast-fed for as little as one month have a 20%
lower risk of childhood leukemia than bottle-fed babies, and babies breast-fed
for more than 6 months have an even lower risk -- 30% less. Robison L et al. Journal of the National Cancer Institute 1999;91:1765-1772. 4.
Cardiovascular Disease,
Cholesterol Concentration
Exclusive breast feeding seems to have a protective effect
against some risk factors for cardiovascular disease in later life. In this study of 625 adults aged 48-53
years, those who were bottle fed had a higher mean plasma glucose concentration
after a standard oral glucose tolerance test than those who were exclusively
breast fed. They also had a higher
plasma low density lipoprotein (LDL) cholesterol concentration, a lower high
density lipoprotein (HDL) cholesterol concentration, and a higher LDL/ HDL
ratio. Systolic blood pressure and body
mass index were not affected by the method of infant feeding. Ravelli-ACJ et al. "Infant feeding and adult glucose tolerance, lipid profile,
blood pressure, and obesity."
Archives-Of-Disease-In-Childhood. MAR 2000; 82 (3) : 248-252. After adjustment for age, height, and sibship, and taking
into account current diet and parental hypercholesterolemia, cholesterol
concentration was lower in boys who had been breast fed This study provides evidence that diet in
infancy may have longstanding effect on lipid metabolism. Plancoulaine-S et al. "Infant-feeding patterns are related to
blood cholesterol concentration in prepubertal children aged 5-11y. European Journal of Clinical Nutrition. Feb
2000; 54 (2) : 114-119. Age of weaning and method of infant feeding may influence
adult serum low density lipoprotein cholesterol concentrations and mortality
from ischemic heart disease. Fall CH et
al. "Relation of infant feeding to
adult serum cholesterol concentration and death from ischaemic heart
disease." BMJ 1992 Mar
28;304(6830):801-5 5.
Celiac Disease
Celiac
disease is characterized by lethargy, megoblastic anemia, malabsorption, and GI
symptoms caused by allergy to gluten.
Prolonged breastfeeding, at least until the 6th month, and gluten
introduction started at least at the 5th month of life, significantly delay the
onset of the disease. Gluten introduction should be done progressively and
under breast feeding protection. Introduction of gluten 2 months before weaning
has a protective effect. Bouguerra F et al.
[Breast feeding effect relative to age of onset of celiac disease]. Arch
Pediatr 1998 Jun;5(6):621-6 Children
formula-fed from birth, or breast-fed for less than 30 days, were found to have
a relative risk of developing symptoms of celiac disease four times higher than
children breast-fed for more than 30 days.
Auricchio S et al. "Does
breast feeding protect against the development of clinical symptoms of celiac
disease in children?" J Pediatr
Gastroenterol Nutr 1983;2(3):428-33 6. Dental Health
In this study of 260 children ages 3-5, the authors
concluded that breastfeeding for more than 40 days may act preventively and
inhibit the development of nursing caries in children. Oulis CJ et al. “Feeding practices of Greek children with and without nursing
caries.” Pediatr Dent 1999 Nov-Dec;21(7):409-16 This study estimated the prevalence of early childhood
caries and related behavioral risk factors in a population of low-income,
Mexican-American children in Stockton, California. Data was collected on 220 children ages six years or less using a
parent-completed questionnaire and clinical dental examinations. Mean age at weaning from breast-or
bottle-feeding and patterns of bottle use during sleep did not differ significantly
between children with caries and those without. Ramos-Gomez-FJ et al.
"Assessment of early childhood caries and dietary habits in a
population of migrant Hispanic children in Stockton, California." Journal-Of-Dentistry-For-Children 1999; 66
(6): 395-403, 366 This in-vivo and in-vitro study showed that human breast
milk is not cariogenic. Erickson PR,
Mazhari E. "Investigation of the
role of human breast milk in caries development." Pediatr Dent 1999 Mar-Apr;21(2):86-90 Children who were either never breast-fed or only until 3
months exhibited a significantly higher caries prevalence than those breast-fed
for a longer time. Mattos-Graner RO et
al. "Association between caries
prevalence and clinical, microbiological and dietary variables in 1.0 to
2.5-year-old Brazilian children. Caries
Res 1998;32(5):319-23 A strong association was found between exclusive
bottle-feeding and anteroposterior malocclusion. Davis DW, Bell PA.
"Infant feeding practices and occlusal outcomes: a longitudinal study." J Can Dent Assoc 1991 Jul;57(7):593-4 Among breastfed infants, the longer the duration of nursing
the lower the incidence of malocclusion. Labbok, M.H. "Does Breast Feeding
Protect against Malocclusion? An Analysis of the 1981 Child Health Supplement
to the National Health Interview Survey". American Journal of Preventive
Medicine, 1987. 7.
Diabetes Mellitus
A population-based case-control study of 196 children with
type 1 diabetes and 325 age- and sex-matched control subjects found a
significantly raised risk for illnesses in the neonatal period (OR 1.61), the
majority of which were infections and respiratory difficulties. Exclusive
breast feeding as the initial feeding method was significantly protective (OR
0.65). McKinney et al. “Perinatal and neonatal determinants of
childhood type 1 diabetes. A case-control study in Yorkshire, U.K.” Diabetes
Care 1999 Jun;22(6):928-32 Diabetes is less common among breast-fed children (6.9 and
30.1% among offspring of nondiabetic and diabetic women, respectively) than
among bottle-fed children (11.9 and 43.6%, respectively). Pettitt DJ, Knowler WC. "Long-term effects of the intrauterine
environment, birth weight, and breast-feeding in Pima Indians." Diabetes Care 1998 Aug;21 Suppl 2:B138-41 Children who developed IDDM in New South Wales, Australia,
were compared to healthy children of the same sex and age. Those who were
exclusively breastfed during their first three months of life had a 34% lower
risk of developing diabetes than those who were not breastfed. Children given cow's-milk-based formula in
their first three months were 52% more likely to develop IDDM than those not
given cow's milk formula. Diabetes Care 1994;17:1381-1389, 1488-1490. 8.
Haemophilus Influenzae
Meningitis
A strong negative correlation between breastfeeding and
incidence of Haemophilus influenzae infection 5 to 10 years later. Silfverdal SA et al. "Protective effect of breastfeeding: an
ecologic study of Haemophilus influenzae meningitis and breastfeeding in a
Swedish population." Int J
Epidemiol 1999 Feb;28(1):152-6 9.
Inflammatory Bowel
Disease (Crohn's Disease, Ulcerative Colitis)
Twenty-six cases of Crohn's disease and 29 cases of
ulcerative colitis were matched for gender and social class with controls. There was a trend that those with Crohn's
disease were more likely not to have been breast-fed (OR 0.4). The prevalence of inflammatory bowel disease
was 5.12/1000 by the age of 43 years.
Thompson-NP; Montgomery-SM; Wadsworth-MEJ; Pounder-RE;
Wakefield-AJ. "Early determinants
of inflammatory bowel disease: use of two national longitudinal birth
cohorts. European Journal of
Gastroenterology and Hepatology. Jan
2000; 12 (1):25-30 Lack of breastfeeding in infancy was associated with an
increased risk of ulcerative colitis (chronic inflammatory disorder of the
colon) and Crohn's disease (chronic inflammatory disorder affecting any part of
the gut, aggravated by food intolerance).
Corrao G et al. "Risk of
inflammatory bowel disease attributable to smoking, oral contraception and
breastfeeding in Italy: a nationwide case-control study." Int J Epidemiol 1998 Jun;27(3):397-404 Lack of breastfeeding was a risk factor associated with
later development of Crohn's disease. Koletzko, S., "Role of Infant
Feeding Practices in Development of Crohn's Disease in Childhood". Br Med
J, 1989 10. Juvenile Rheumatoid Arthritis (JRA)
Children who have had JRA, especially pauciarticular JRA,
are less likely to have been breastfed than controls, suggesting that breast
feeding may have a protective effect on the development of JRA. Lower odds ratio were noted for increased
durations of breast feeding. Mason T et
al. "Breast feeding and the
development of juvenile rheumatoid arthritis." J Rheumatol 1995 Jun;22(6):1166-70 11. Multiple Sclerosis
Although thought to be multifactorial in origin, and without
a clearly defined etiology, lack of breastfeeding does appear to be associated
with an increased incidence of multiple sclerosis. Dick, G. "The Etiology
of Multiple Sclerosis." Proc Roy Soc Med 1976;69:611-5 Pisacane A, et al.
Breast feeding and multiple sclerosis. BMJ 1994 May 28;308(6941):1411-2. 12. Obesity
A German study of 9357 children aged 5-6 years of age found
that infants fed only breastmilk until 3-5 months were more than a third less
likely to be obese than infants fed formula from the start. Infants breastfed exclusively for 6-12
months were 43% less likely to be obese.
Breastfeeding beyond 12 months was better still, giving infants a 72%
lower chance of becoming obese children.
After adjusting for potential confounding factors, breastfeeding
remained a significant protective factor against the development of
obesity. von Kries, R. "Breast feeding and obesity: cross
sectional study." BMJ 1999; 319:
147-150.
13. Parent-child relationships
Children who were breast fed for a longer duration were more
likely, at age 15-18 years, to report higher levels of parental attachment and
tended to perceive their mothers as being more caring and less overprotective
towards them compared with bottle-fed children. After adjustment for maternal and perinatal factors, the duration
of breastfeeding remained significantly associated with adolescent perceptions
of maternal care, with increasing duration of breast feeding being associated
with higher levels of perceived maternal care during childhood. Fergusson DM, Woodward LJ. "Breast feeding and later psychosocial
adjustment." Paediatr Perinat
Epidemiol 1999 Apr;13(2):144-57 14. Tonsillitis
Pisacane
A, et al. Breast feeding and
tonsillectomy. BMJ. 1996 Mar
23;312(7033):746-7. 15. Transplant recipients
A history of breastfeeding was associated with dramatic
improvements in graft function rates after sibling donor as well as maternal
donor transplantation. Kois WE et
al. Influence of breast feeding on
subsequent reactivity to a related renal allograft. J Surg Res. 1984 Aug;37(2):89-93. The posttransplant course of 55 patients who had received a
primary maternal-donor transplant was studied.
A history of breast feeding was associated with a more favorable
posttransplant course as measured by the percentage of patients who had no
rejection episodes during the first posttransplant year. The one-year graft function rate for
breast-fed recipients was 82%; this was statistically significantly better than
the 57% measured for non-breast-fed recipients. Campbell DA et al. Breast
feeding and maternal-donor renal allografts.
Transplantation 1984 Apr;37(4):340-4. 16. Vaccine Response
The antibody levels of immunized infants were significantly
higher in the breastfed than the formula-fed group. These findings are strong evidence that breastfeeding enhances
the active humoral immune response in the first year of life. Papst, H.F. , Spady, D.W. "Effect of
Breast Feeding on Antibody Response to Conjugate Vaccine". Lancet, 1990 The breastfed group had significantly higher antibody levels
than two formula-fed groups together.
Breastfed infants thus showed better serum and secretory responses to
perioral and parenteral vaccines than the formula fed, whether with a
conventional or low-protein content.
Van-Coric, M. "Antibody Responses to Parental & Oral Vaccines
Where Impaired by Conventional and Low-Protein Formulas as Compared to Breast
Feeding". Acta Paediatr Scand 1990; 79: 1137-42 II. Maternal Effects
A. Cancer
1.
Breast Cancer
Women who breastfed a child for more than 24 months had a
54% reduced risk of developing breast cancer compared with women who breastfed
for no more than 6 months. Women who breastfed for at least 73 months over the
course of their lives had a much lower risk of breast cancer. Also confirmed
that the later age of menarche and first pregnancy at a younger age lowers
breast cancer risk. Women who went through menopause later and those with a
family history of breast cancer were at increased risk. Zeng T et al. Long-term Breastfeeding Lowers
Mother's Breast Cancer Risk. Am J Epidemiol 2001; 152:1129-1135. This study compared rates of breast cancer between 751
mothers who had breastfed at least once and 743 mothers who had not. Breastfeeding reduced the risk of breast
cancer by 20% in women age 20 to 49 years and by 30% in women ages 50 to 74
years. Moreover, breastfeeding seemed to protect against breast cancer regardless
of the number of children breastfed, mother's age at first and last lactation,
and menstrual history. R. Millikan et
al. International Journal of
Epidemiology 1999; 28:396-402. This study investigated the relationship between
reproductive events during adolescence and subsequent breast cancer risk. in
862 case patients and 790 controls in the Carolina Breast Cancer Study. Miscarriage, induced abortion, and full-term
pregnancy before 20 years of age were not associated with breast cancer. Among premenopausal women, breast-feeding
before 20 years of age was inversely associated with disease. Oral
contraceptive use before 18 years of age was positively associated with disease
risk among African American women only.
Marcus PM, Baird DD, Millikan RC, Moorman PG, Qaqish B, Newman B. Adolescent reproductive events and
subsequent breast cancer risk. Am J Public Health 1999 Aug;89(8):1244-7 If women who do not breastfeed or who breastfed for less
than 3 months were to do so for 4 to 12 months, breast cancer among parous
premenopausal women could be reduce by 11%.
If all women with children lactated for 24 months or longer, the
incidence might be reduced by nearly 25%.
Newcomb, P. et al. "Lactation and reduced risk of premenopausal
breast cancer." N Engl J Med 1994;
330(2):81-87. After controlling for age at first full term pregnancy and
other potentially compounding factors, parity and duration of breast feeding
also had a strong influence on the risk of breast cancer. Compared with parous women who never
breastfed, women who had breastfed for 25 months or more had a lower relative
risk. Layde, P.M., "The Independent Associations of Parity Age at First
full Term Pregnancy, and Duration of Breast Feeding with the Risk of Breast
Cancer." Journal of Clinical Epidemiol, 1989. Among both premenopausal and postmenopausal women, risk of
breast cancer decreases with increasing duration of lifetime lactation
experience although the effect was consistently stronger for premenopausal
women. McTieman, A., Evidence of
Protective Effect of Lactation on Risk of Breast Cancer in Young Women."
American Journal of Epidemiology, 1986 2. Endometrial Cancer
Lactation
provides a hypoestrogenic effect with less stimulation of the endometrial
lining. This event may offer a
protective effect from endometrial cancer.
Petterson B, et al. "Menstruation span- a time limited risk factor
for endometrial carcinoma". Acta Obstet Gyneocol Scand 1986;65:247-55 3. Esophageal Cancer
Breastfeeding was associated with reduced risk of
subsequently developing this cancer (OR = 0.41) and there was a significant
dose-response effect. Cheng-KK et
al. "A case-control study of
oesophageal adenocarcinoma in women: a preventable disease." British-Journal-Of-Cancer. Jul 2000; 83 (1)
: 127-132 4.
Ovarian Cancer
Cases
20-69 years of age with a recent diagnosis of epithelial ovarian cancer (767)
were compared with community controls (1367).
A number of reproductive and contraceptive factors that suppress
ovulation, including gravidity, breastfeeding, and oral contraception, reduced
the risk of ovarian cancer.
Environmental factors and medical conditions that increased risk
included talc use, endometriosis, ovarian cysts, and hyperthyroidism. Gynecologic surgery including hysterectomy
and tubal ligation were protective.
Ness-RB et al. "Factors
related to inflammation of the ovarian epithelium and risk of ovarian
cancer." Epidemiology-. Mar 2000; 11 (2) : 111-117 Breastfeeding
seems to be somewhat protective against ovarian cancer, but only before
menopause. Siskind V et al. "Breastfeeding, menopause, and
epithelial ovarian cancer. Epidemiology 1997 Mar;8(2):188-91 Decreased
risks of epithelial ovarian cancer in black women were associated with parity
of four or higher, breast-feeding for 6 months or longer, and use of oral
contraceptives for 6 years or longer.
John EM et al.
"Characteristics relating to ovarian cancer risk: collaborative
analysis of seven U.S. case-control studies. Epithelial ovarian cancer in black
women. J Natl Cancer Inst 1993 Jan
20;85(2):142-7 A marked
reduction in risk was associated with ever having breast fed. Gwinn ML et al. "Pregnancy, breast feeding, and oral contraceptives and the
risk of epithelial ovarian cancer. J
Clin Epidemiol 1990;43(6):559-68 Breastfeeding
should be added to the list of factors that decrease ovulatory age and thereby
decrease the risk of ovarian cancer.
Schneider, A.P. "Risk Factor for Ovarian Cancer. "New England
Journal of Medicine, 1987 5. Thyroid Cancer
Individually matched case-control study (292 pairs) of
female thyroid cancer patients found that risk increased with number of
pregnancies in women using lactation suppressants and decreased with duration
of breastfeeding. Mack WJ et al,
"Reproductive and hormonal risk factors for thyroid cancer in Los Angeles
County females." Cancer Epidemiol
Biomarkers Prev 1999 Nov;8(11):991-7 6.
Uterine Cancer
A protective effect against uterine cancer was found for
women who breastfeed. Brock, K.E.,
"Sexual, Reproductive, and Contraceptive Risk Factors for
Carcinoma-in-Situ of the Uterine Cervix in Sidney. "Medical Journal of
Australia, 1989. B. Emotional Health
Significant changes occur in women's personality during
pregnancy and lactation. The trend is
toward a lifestyle interpreted as more relaxed and tolerant to monotony. In this study of 161 women during pregnancy
and 3-6 months after delivery, women who had breastfed for at least 8 weeks
differed significantly from those who had not. They had lower scores on the
Somatic Anxiety, Muscular Tension, Monotony Avoidance, Suspicion, Social
Desirability and the Impulsiveness scale and higher scores on the Socialization
scale. Sjogren-B et al. "Changes
in personality pattern during the first pregnancy and lactation." Journal-Of-Psychosomatic-Obstetrics-And-Gynecology.
Mar 2000; 21 (1):31-38. Personality profiles reflecting anxiety and social
interaction showed that anxiety was inversely related with basal levels of
oxytocin and prolactin in the cesarean section mothers, whereas the pulsatility
of oxytocin was related to social desirability in both groups. Social desirability and oxytocin pulsativity
were also correlated with the amount of milk transferred from the mother to the
baby. The correlations indicate that
central oxytocin may be involved in behavioral adaptations to the maternal
role. Nissen E, Gustavsson P, Widstrom
AM, Uvnas-Moberg K. "Oxytocin,
prolactin, milk production and their relationship with personality traits in
women after vaginal delivery or Cesarean section." J Psychosom Obstet Gynaecol 1998
Mar;19(1):49-58 In both male and female rats, oxytocin exerts potent
physiological antistress effects. If daily oxytocin injections are repeated
over a 5-day period, blood pressure is decreased by 10-20 mmHg, the withdrawal
latency to heat stimuli is prolonged, cortisol levels are decreased and insulin
and cholecystokinin levels are increased.
These effects last from 1 to several weeks after the last injection. After repeated oxytocin treatment weight
gain may be promoted and the healing rate of wounds increased. Oxytocin released in response to social
stimuli may be part of a neuroendocrine substrate which underlies the benefits
of positive social experiences.
Uvnas-Moberg K. "Oxytocin
may mediate the benefits of positive social interaction and
emotions."
Psychoneuroendocrinology 1998 Nov;23(8):819-35 At one month postpartum, women who breast fed their infants
had scores indicating less anxiety and more mutuality than the women bottle
feeding their infants. Virden, S.F., "The Relationship Between Infant
Feeding Method and Maternal Role Adjustment." Journal of Nurse Midwives,
1988 Jan-Feb;33(1):31-5. C. Fertility
During
lactation, menses before 6 months are mostly anovulatory, and fertility remains
low. The lactational amenorrhea method
is based on three simultaneous conditions: (1) the baby is under 6 months; (2)
the mother is still amenorrheic; and (3) she practices exclusive or
quasi-exclusive breastfeeding on demand, day and night. Experiments with LAM
extended to 9-12 months are ongoing.
The lactational amenorrhea method is at least 98% effective. Vekemans M.
"Postpartum contraception: the lactational amenorrhea
method." Eur J Contracept Reprod
Health Care 1997 Jun;2(2):105-11 D. Insulin Requirements
Breastfeeding decreased insulin requirements in diabetic
women. Reduction in insulin dose
postpartum was significantly greater in those who were breastfeeding than those
who were bottle feeding. Davies, H.A.,
"Insulin Requirements of Diabetic Women who Breast Feed." British
Medical Journal, 1989 May 20;298(6684):1357-8. E. Osteoporosis
The odds ratio that a woman with osteoporosis did not
breastfeed her baby was 4 times higher than for a control woman. Blaauw, R. et al. "Risk factors for
development of osteoporosis in a South African population." SAMJ 1994;
84:328-32. Whether or not women had ever breastfed, total duration of
breastfeeding and duration of breastfeeding per child were not associated with
reduced bone mineral, but breastfeeding for more than 8 months was associated
with greater bone mineral at some sites.
Melton L et al. "Influence
of breastfeeding and other reproductive factors on bone mass later in
life." Osteoporos Int 1993
Mar;3(2):76-83 F. Postpartum Weight Loss
Mothers who breastfed exclusively or partially had
significantly larger reductions in hip circumference and were less above their
prepregnancy weights at 1 month postpartum than mothers who fed formula
exclusively. Kramer, F.,
"Breastfeeding reduces maternal lower body fat." J Am Diet Assoc 1993;93(4):429-33 G. Urinary Tract Infections
The oligosaccharide content of breast-milk and urine from
nursing mothers is very similar, and the pattern of oligosaccharides excreted
by infants is also strongly correlated with
that of breastmilk. The oligosaccharides
cause inhibition of bacterial adhesion, suggesting that breastfeeding may have
a preventive effect on urinary tract infection in both mother and infant. Coppa GV et al. "Preliminary study of breastfeeding and bacterial adhesion
to uroepithelial cells." Lancet
1990 Mar 10;335(8689):569-71 III. Societal Effects
A. Child Abuse
Encouraging
early mother-infant contact with suckling and rooming-in may provide a simple,
low-cost method for reducing infant abandonment. The mean infant abandonment rate decreased from 50.3 per 10,000
births in the first 6 years to 27.8 per 10,000 births in the next 6 years
following implementation of the Baby-Friendly Hospital Initiative at a Russian
hospital. Lvoff-NM et al. Effect of the baby-friendly initiative on
infant abandonment in a Russian hospital.
Archives-Of-Pediatrics-And-Adolescent-Medicine. MAY 2000;
154(5):474-477. A
retrospective review of 800 pregnancies at one family practice revealed an
association between lack of breastfeeding and physical and sexual abuse of the
mother and/or her children. This
anecdotal association has not been previously reported, is worth further study
using more rigorous methods. Acheson,
L., "Family Violence and Breast-feeding" Arch Fam Med July 1995; Vol
4,pp 650-652. B. Child Spacing
Retrospective and prospective data show that: (a) a short
preceding birth interval is detrimental for child survival in the first 4
months of life; (b) full and partial breast-feeding have direct protective
effects on child survival in the first 4-6 months of life, with the effects of
the former stronger than those of the latter; (c) early subsequent conception
significantly increases mortality risks in the first 16 months of life of the
index child. These findings are robust to various controls, e.g. study design,
data defects, child's health conditions at/around birth, postnatal maternal and
child recurrent illnesses, patterns of utilization of health care services, and
immunization status of the child. Kuate
D. "Effects of infant feeding
practices and birth spacing on infant and child survival: a reassessment from
retrospective and prospective data."
J Biosoc Sci 1997 Jul;29(3):303-26 Sufficient birth spacing helps with the survival of the
older sibling and the new infant.
Prolonged lactation helps to promote the spacing of children. Thapa, S., "Breastfeeding, birth
spacing and their effects on child survival." Nature 1988;335:679-82 C. Environment
There is less use of natural resources (glass, plastic,
metal, and paper used in bottles, bags, nipples, and formula cans) and also
less waste for landfills. D. Financial Cost to Government and Families
1.
Food Expense
The cost to supply artificial baby milk (ABM) to one child
is between $1,160 and $3,915 per year depending on the brand. Even mothers on WIC need to buy
approximately 200 cans of concentrate to feed her infant in the first
year. Breastfeeding Support
Consultants, Information on Infant Feeding Costs, April 1998 (based on Illinois and North Carolina
suburban supermarket prices). 2.
Medical Expenses
In the first year of life, after adjusting for confounders,
there were 2033 excess office visits, 212 excess days of hospitalization, and
609 excess prescriptions for these three illnesses per 1000 never-breastfed
infants compared with 1000 infants exclusively breastfed for at least 3 months.
These additional health care services cost the managed care health system
between $331 and $475 per never-breastfed infant during the first year of
life. Ball TM, Wright AL. "Health care costs of formula-feeding
in the first year of life."
Pediatrics 1999 Apr;103(4 Pt 2):870-6 Compared with formula-feeding, breast-feeding each infant
enrolled in WIC saved $478 in WIC costs and Medicaid expenditures during the
first 6 months of the infant's life.
Montgomery DL, Splett PL.
"Economic benefit of breast-feeding infants enrolled in
WIC." J Am Diet Assoc 1997
Apr;97(4):379-85 If women breast-fed each child for at least 6 months, the
total projected savings over a 7.5-year period ranges from $3,442 to $6,096 per
family. This translates into an
estimated yearly savings of between $459 and $808 per family. Savings were calculated based on estimates
of the resulting decrease in infant morbidity, maternal fertility, and formula
purchases. Tuttle CR, Dewey KG. "Potential cost savings for Medi-Cal,
AFDC, food stamps, and WIC programs associated with increasing breast-feeding
among low-income Hmong women in California.
J Am Diet Assoc 1996 Sep;96(9):885-90 A pre-publication study by the Wisconsin State Breastfeeding
Coalition estimated the following health care savings in Wisconsin if
Breastfeeding rates were at 75% at discharge-50% at six months: $4,645,250/yr Acute Otitis Media $437,120/yr Bronchitis $6,699,600/yr Gastroenteritis $262,440/yr Allergies $758,934/yr Asthma $578,500/yr Type I Diabetes (birth - 18 yrs) $17,070,000/yr Breast Cancer $30,984,432/yr TOTAL HEALTH COST SAVINGS E. Vaccine Effectiveness
Breastfed infants showed a better serum and secretory
responses to oral and parenteral vaccines than the formula-fed, whether with a
conventional or low protein content. Han-Zoric, M., "Antibody responses to
parenteral and oral vaccines are impaired by conventional and low protein
formulas as compared to breastfeeding." Acta Paediatr Scand 1990; 79:1137-42
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