Breast feeding 1

Health outcomes differ substantially for mothers and infants who formula feed compared with those who breastfeed, even in developed countries such as the United States. A recent meta-analysis by the Agency for Healthcare Research and Quality reviewed this evidence in detail.

• For infants, not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia, as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS).
• Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC).
• For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and the metabolic syndrome.

These findings suggest that infant feeding is an important modifiable risk factor for disease for both mothers and infants. 

The American College of Obstetricians and Gynecologists (ACOG) therefore recommends 6 months of exclusive breastfeeding for all infants.The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) similarly recommend exclusive breastfeeding for the first 6 months of life, continuing at least through the infant’s first birthday, and as long thereafter as is mutually desired. The World Health Organization (WHO) recommends at least 2 years of breastfeeding for all infants.

In the United States, breastfeeding durations fall far short of these guidelines.In 2005, 74.2% of US infants were breastfed at least once after delivery, but only 31.5% were exclusively breastfed at age 3 months, and just 11.9% were exclusively breastfed at age 6 months.

 These rates show considerable regional variation, with the highest rates in the Pacific Northwest and the lowest rates in the Southeast. Although some of this variation reflects cultural differences, recent data suggest that variations in hospital practices account for a considerable proportion of disparities in breastfeeding duration.

 This suggests that improvements in the quality of antenatal and perinatal support for breastfeeding could have a substantial impact on the health of mothers and infants.

This article reviews the health risks of not breastfeeding, for infants and for mothers, as well as the obstetrician’s role in counseling women regarding infant feeding and ensuring an optimal start for breastfeeding at birth.

Continue 10.10.2017