Maternal Health Research: Miscellaneous

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A range of studies looking at breastfeeding and maternal health is covered in this section.

History of breastfeeding and risk of incident endometriosis: prospective cohort study

This study found that the duration of total and exclusive breastfeeding was significantly associated with decreased risk of endometriosis. Among women who reported a lifetime total length of breastfeeding of less than one month, there were 453 endometriosis cases/100 000 person years compared with 184 cases/100 000 person years in women who reported a lifetime total of ≥36 months of breastfeeding. For every additional three months of total breastfeeding per pregnancy, women experienced an 8% lower risk of endometriosis and a 14% lower risk for every additional three months of exclusive breastfeeding per pregnancy. Women who breastfed for ≥36 months in total across their reproductive lifetime had a 40% reduced risk of endometriosis compared with women who never breastfed. The association with total breast feeding and exclusive breastfeeding on endometriosis was partially influenced by postpartum amenorrhea, which was prolonged by breastfeeding.

Farland, LV, et al (2017). History of breast feeding and risk of incident endometriosis: prospective cohort study, The British Medical Journal, https://doi.org/10.1136/bmj.j3778

Mammary candidiasis: A medical condition without scientific evidence?

This study examined the belief that yeasts (particularly Candida spp.) play an important role as an agent of nipple and breast pain. Results showed that the role played by yeasts in breast and nipple pain is, if any, marginal. In contrast, the results strongly support that coagulase-negative staphylococci and streptococci (mainly from the mitis and salivarius groups) are the agents responsible for such cases. The authors suggest that the term “mammary candidiasis” or “nipple thrush” should be avoided when referring to such conditions and be replaced by “subacute mastitis”.

Jiménez, E, et al (2017), Mammary candidiasis: A medical condition without scientific evidence? PLOS one, https://doi.org/10.1371/journal.pone.0181071

Breastfeeding, ovulatory years, and risk of multiple sclerosis (MS)

This study found that mothers who breastfed for 15 months or more over one or more pregnancies had a lower risk of developing MS or its precursor, clinically isolated syndrome (CIS). The authors observed that this was consistent with the other known maternal health benefits of breastfeeding and with their previous observation that women with MS who breastfeed exclusively are at lower risk of postpartum relapses.

Langer-Gould, A (2017), Breastfeeding, ovulatory years, and risk of multiple sclerosis. Neurology, doi: ​doi.​org/​10.​1212/​WNL.​0000000000004207

Breastfeeding and endometrial cancer risk: an analysis from the epidemiology of endometrial cancer consortium

This Australian study used pooled data of 17 studies to investigate the association between breastfeeding and the risk of endometrial cancer. The study found that breastfeeding was associated with a reduction in risk of endometrial cancer and that the longer the average duration of breastfeeding per child the greater the reduction in risk. The authors concluded that reducing endometrial cancer risk can be added to the list of maternal benefits associated with breastfeeding and that promotion, support, and facilitation of breastfeeding contributes to the prevention of this increasingly common cancer.

Jordan, S et al (2017) Breastfeeding and Endometrial Cancer Risk: An Analysis From the Epidemiology of Endometrial Cancer Consortium. Obstetrics & Gynecology doi: 10.1097/AOG.0000000000002057

Exclusive breastfeeding effect on postpartum multiple sclerosis relapses

Women with multiple sclerosis (MS) experience an elevated risk of relapse after giving birth. This study aimed to determine the effect of exclusive breastfeeding on postpartum risk of MS relapse and to investigate the effect of introducing supplemental feedings on that risk. The findings of this study suggest that exclusive breastfeeding is a modestly effective MS treatment. The authors suggest that women with MS who breastfeed exclusively should be supported to do so.

Hellwig, K. et al (2015). Exclusive Breastfeeding and the Effect on Postpartum Multiple Sclerosis Relapses. JAMA Neurology, doi:10.1001/jamaneurol.2015.1806

Mothers’ experience of bottle feeding

A systematic review of the literature into mothers’ experience of bottle feeding, published today in the Archives of Disease in Childhood, highlights a number of issues relating to care of mothers who do not breastfeed, including: inadequate information received on how to prepare bottle feeds correctly, feelings of guilt and failure experienced by mothers who do not breastfeed and perceived pressure to breastfeed.

Lakshman, R., Ogilvie, D. & Ong, K.K. (2009) Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies. Archives of Disease in childhood, 94(8).

Note

The Baby Friendly Initiative standards recommend that all mothers have a one-to-one discussion on infant feeding with a health professional as a routine part of their antenatal care, to help them make a fully informed choice regarding feeding method.

The only restriction is on group demonstrations on how to prepare bottle feeds, as such demonstrations in antenatal classes undermine breastfeeding and are an ineffective and inadequate way of teaching. There is no other restriction on any information as long as it is free from advertising and accurate. In the postnatal period it is strongly recommended that bottle feeding mothers are shown how to prepare a feed correctly before being discharged from hospital. In the community, staff are encouraged to have a full discussion with bottle feeding mothers to ensure full understanding of how to bottle feed correctly and Unicef UK provide an audit tool to help with this process. Staff are also encouraged to ensure that all mothers, regardless of feeding method, have a period of skin-to-skin contact with their babies after delivery to help facilitate bonding and that all mothers room-in with their babies so that they gain confidence in feeding and caring for them. Our long experience of working with the UK health services indicates that, far from reducing care for bottle feeding mothers, improvement in practice for breastfeeding also improves care for bottle feeding mothers. Conversely, poor practice for breastfeeding almost invariably means poor practice for bottle feeding too.

Evidence has repeatedly shown that not breastfeeding has important implications for infant and maternal health and to deny this information for fear of causing guilt is to deny parents the right to make informed decisions. It is the way the information is imparted which is key and for health professionals to do this appropriately they require adequate training, which is why staff education is such an important element of the Baby Friendly standards.