further effects of breastfeeding

Question 1

systematic review on breastfeeding: issues with breastfeeding research

Answer 1

Bernado & Cesar 2013:

firstly discuss methodological issues- randomised control trials would provide the best evidence on a
causal association between an exposure – such as breastfeeding – and a health or developmental
outcome. Randomization increases the likelihood that results will not be affected by confounding. However it would be unethical to not provide an infant with breastmilk.

other issues- most research done on high income countries, In high-income settings, breastfeeding mothers are more likely to be health-conscious, and, therefore, also more likely to promote healthy habits to their infants, including prevention of obesity,
promotion of physical activity and intellectual stimulation.
self report bias-

Did randomised control on breastfeeding counselling: The proportion of infants exclusively breastfed at 3 and 6 months was substantially
higher among infants from the intervention group. Kramer et al., 2001

issue with obesity- confounding variables and . A small-study effect (publication bias) is an
important issue, tending to overestimate the benefits of breastfeeding. Among studies with ≥ 1500
participants the protective effect of breastfeeding was relatively modest. Again SES, In England, a developed country setting, breastfeeding was protective against
overweight, but in Brazil, where breastfeeding does not show a clear social gradient, no such effect
was evident. y. By the same token, we
observed that studies with tighter control of confounding (socioeconomic factors, birth weight or
gestational age, and parental anthropometry) reported smaller benefits of breastfeeding.

ALso observed effects on type 2 diabetes, IQ, and cholesterol- but all have the same issues as above- he meta-analyses of overweight/obesity, blood pressure, diabetes and intelligence suggest that
benefits are larger for children and adolescents, and smallest among adults, suggesting a gradual
dilution of the effect with time.

Question 2

other risks of not breastfeeding

Answer 2

Sudden Infant Death Syndrome
* Leading cause of death amongst 0-12 month olds
* 2007: Meta-analysis of 6 studies: BF infants had lower
risk of experiencing SIDS than never BF infants.
* 2011: Meta-analysis: infants who were BF any amount for
at least two months had sig less risk than never BF infants
(Hauck et al., 2001)

ADHD: Ptacek & Kuzelova (2013)
* 200 mothers (100 ADHD, 100 non-ADHD)
* ADHD children BF sig shorter time (avg = 2.5
mth) than non ADHD children (avg = 7.8 mth)
* BUT – behavioural differences in children may
influence mothers’ behaviour and result in shorter
BF duration. e.g. mother did not breastfeed because behaviour meant it was difficult to

Question 3

health benefits for mother of breastfeeding

Answer 3

post natal depression:Early cessation or absence of BF
related to PND (Ip et al., 2009)
➢direction of effect?
* Prolonged feeding associated with less PND
– protective effect?
* Evidence related to lactation itself
* Countries where exclusive BF is norm, peaks at 9
months post-birth
* Countries where formula is norm, peaks at 3 months
post-birth (Labbok, 2001)

Osteoporosis – stronger bones, reduction is risk of hip
fractures in later life (Cumming & Klineberg, 1993)
* Diabetes – never breastfed had 1.7x higher chance of
developing Type II diabetes than those who had BF for >
2 yr over lifetime (Stuebe et al., 2005)
* Cardiovascular disease – 10-20% greater risk in those
who have never BF compared to BF for 13-24 mths
(Schwarz et al., 2009)
* Breast and ovarian cancers - reduced risk as BF
suppresses ovulation and limits estrogen which is
implicated in cell differentiation, mutations, and fuelling
growth. Meta-analysis of 23 studies concluded a protective effect of BF,
regardless of duration (Bernier et al., 2000)

Question 4

economic costs

Answer 4

Ball & Bennet 2001-
highlighted how we should encourage breastfeeding to reduce goverment costs. effects of not breastfeeding cost healthcare lots of money

Children who were breastfed during infancy suffer less recurrent wheezing, have a higher IQ, and develop insulin-dependent diabetes mellitus less frequently than those who are fed formula.
Also, fewer breastfeeding mothers develop ovarian cancer and bone demineralization than do women who do not breastfeed their infants.
Because the diagnosis and treatment of these illnesses result in medical care use, health care expenditures likely would be reduced with successful breastfeeding promotion.