Acta Paediatrica has published a special issue on the impact of breastfeeding on maternal and child health.

This supplement to Acta Paediatrica (coordinated by the World Health Organisation and funded by the Gates Foundation) presents a series of meta-analyses and systematic literature reviews examining a variety of health effects potentially related to breastfeeding. Each of the studies is summarised below.

The results overall confirm the substantial health benefits of breastfeeding: it protects against a spectrum of adverse health outcomes for children, and breastfeeding mothers also benefit from having breastfed. The papers in this supplement additionally demonstrate that many of the benefits of breastfeeding are experienced well beyond the period that breastfeeding is stopped.

The findings demonstrate that mechanisms by which breastfeeding affect health are extremely varied, and this variation implies that different metrics of breastfeeding behaviour must be utilised to truly understand the relationships of interest.

Also evidenced is the fact that breastfeeding practices are responsive to interventions delivered in health systems, communities and homes, with the largest effects achieved when interventions are delivered in combination. The Baby Friendly Initiative and its standards around care and infant feeding, are demonstrated to be highly effective in improving breastfeeding rates (see Sinha et al, 2015).

These multiple benefits of breastfeeding demonstrate the contribution and relevance of breastfeeding as a global public health issue, for low- and high-income populations alike.

Sankar, M. J. et al (2015). Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 3–13

This study synthesised the evidence for effects of optimal breastfeeding on all-cause and infection-related mortality in infants and children aged 0–23 months. The authors found higher rates of mortality among infants never breastfed compared to those exclusively breastfed in the first six months of life and receiving continued breastfeeding beyond.

Horta, B. L. et al (2015). Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 14-19.

This study systematically reviewed evidence of the association between breastfeeding and performance in intelligence tests. It was found that breastfeeding is related to improved performance in intelligence tests.

E.R.J Giugliani et al (2015). Effect of breastfeeding promotion interventions on child growth: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 20-29.

This review aimed to update a previous systematic review and meta-analyses about the effect of breastfeeding promotion interventions on child growth.
The authors found that breastfeeding promotion interventions were not associated with significant changes in weight or length, but led to a modest, albeit significant, reduction in body mass index/weight-for-height z scores.

Horta, B.L. et al (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 30-37.

This study systematically reviewed the evidence on the associations between breastfeeding and overweight/obesity, blood pressure, total cholesterol and type 2 diabetes.
It was found that breastfeeding decreased the odds of type 2 diabetes and based on high-quality studies, decreased by 13% the odds of overweight/obesity. No associations were found for total cholesterol or blood pressure.

Lodge, C.J. et al (2015) Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 38-53.

This study systematically reviewed the association between breastfeeding and childhood allergic disease.
The authors found some evidence that breastfeeding is protective for asthma (5–18 years). There is weaker evidence for a protective effect for eczema ≤2 years and allergic rhinitis ≤5 years of age, with greater protection for asthma and eczema in low-income countries.

Glazer-Peres, K. et al (2015). Effect of breastfeeding on malocclusions: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 54-61.

This systematic review found that breastfeeding decreases the risk of malocclusions.

Tham, R. et al (2015). Breastfeeding and the risk of dental caries: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 62-84.

This meta-analysis found that breastfeeding in infancy may protect against dental caries. The authors called for further research in order to understand the increased risk of caries in children breastfed after 12 months.

Bowatte, G. et al (2015). Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 85-95.

This systematic review and meta-analysis found evidence that breastfeeding protects against acute otitis media (AOM) until 2 years of age, with protection greater for exclusive breastfeeding and breastfeeding of longer duration. Exclusive breastfeeding during the first 6 months was associated with around a 43% reduction in ever having AOM in the first 2 years of life. After 2 years of age, the authors found no evidence that breastfeeding protects against AOM; however, they point out that there were few studies and the evidence quality was low.

Chowdhury, R. et al (2015). Breastfeeding and maternal health outcomes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 96-113.

This review supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma, and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea. There is evidence that breastfeeding reduces the risk of type 2 diabetes. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not evident.

Sinha, B. et al (2015). Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 114-134.

This study provided comprehensive evidence of the effect of interventions on early initiation, exclusive, continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above.

Results indicated that intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding rates, were seen when counselling or education were provided concurrently in home and community, health systems and community, health systems and home settings, respectively. Baby Friendly Hospital support at health system was the most effective intervention to improve rates of any breastfeeding.

The authors concluded that in order to promote breastfeeding, interventions should be delivered in a combination of settings by involving health systems, home and family and the community environment concurrently.

 

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