Over the past 3 decades, an increasing number of studies and reviews have examined the relationship of breastfeeding and childhood obesity. The authors of Agency for Healthcare Research and Quality’s (AHRQ) Evidence Report on Breastfeeding meta-analysis concluded that children who were breastfed for at least 3 months were less likely to be obese than those never breastfed, taking into account multiple confounding factors.1 The duration of breastfeeding was found to be inversely related to the risk of being overweight; each month of breastfeeding being associated with a 4% reduction in risk. A WHO meta-analysis from 2007 also concluded that longer breastfeeding (typically durations of 3 to 9 months), in comparison to no breastfeeding, was associated with lower rates of obesity.2 The Framingham Offspring study noted a relationship of breastfeeding and a lower BMI in adults.3 A sibling difference model study showed that the breastfed siblings weighed 13 pounds less than formula fed siblings at a mean age of 14 and were less likely to reach BMI obesity threshold.4 Based upon these studies, the promotion of breastfeeding to prevent obesity has been recommended by the CDC, the Institute of Medicine, and the Surgeon General.
However, there are, however, other important studies that failed to find a relationship. The PROBIT study, the only randomized trial of breastfeeding in term infants, randomized an intervention to promote increased duration and exclusivity of breastfeeding in Belarus and found no significant differences in BMI, percent body fat, and obesity between the experimental and control group children at 11.5 years of age.5 The “discordant sibling study” looked at data obtained from the National Longitudinal Survey of Youth study and found that breastfeeding was not associated with significant improvements in childhood obesity when siblings who were fed differently during infancy, one breastfed, the other bottle fed, were compared.6
So how are we to interpret these conflicting studies? My opinion has been that, as the etiology of obesity is multifactorial, breastfeeding can play an important role in its prevention, but is unlikely to entirely prevent it. The limitation of most of these studies is that they look at breastfeeding alone. Future studies need to focus on the role of multiple modifiable factors on these conditions.7 Read the rest of this entry »
The long awaited protocol revision on Contraception and Breastfeeding by Drs. Pamela Berens and Miriam Labbok is out. This revision on a crucial topic has useful information for those counseling mothers regarding contraceptive choices. One to two times a month I encounter a mother in my consultative breastfeeding practice who has been placed on some type of hormonal contraceptive and now she is struggling to make milk. In this revision there are a few new tables and a section describing in depth the individual contraceptives choices, summarizing the evidence and the associated studies. The bottom line remains: “Until more extensive well designed research exists , it would be prudent to consider hormonal contraceptive methods as potentially having some risk of decreasing the mother’s milk supply.” Options such as Lactational Amenorrhea Methods (LAM) and Natural Family Planning (NFP) and emergency contraception are discussed and associated management issues are also addressed. As with all ABM protocols, this protocol benefitted from formal feedback from our expert board members and reviewers, ensuring that it not only has practical information but also has an international approach. Share it with your colleagues and leave a copy at a work station!
Maya Bunik, MD , MSPH, is Co-Chair of the ABM Protocol Committee and a Fellow of the Academy of Breastfeeding Medicine. She is an Associate Professor of Pediatrics at University of Colorado, Children’s Hospital Colorado. She sees patients in both primary care and breastfeeding consultation and has published a book Breastfeeding Telephone Triage and Advice.
Blog posts reflect the opinions of individual authors, not ABM as a whole.
ABM, as a worldwide organization dedicated to the promotion, protection and support of breastfeeding, has been involved in promoting breastfeeding at the UN for the past 10 years. ABM became a Non-Governmental Organization (NGO) in consultative status with the UN Economic and Social Council (ECOSOC) and is a member of the NGO Committee on UNICEF. As it is impossible to accomplish anything at the UN without collaboration, we partner with ILCA, WABA and CGBI as members of the “UN Breastfeeding Advocacy Team” known as “UNBAT”, to raise breastfeeding awareness at the UN and UNICEF.
This has been a busy year for advocacy. UNICEF drafted a Breastfeeding Advocacy Strategy in March which was improved with our input. We look forward to working with UNICEF in refining the advocacy strategy and developing an implementation plan over the next year. ABM representatives participated in events celebrating the 25th Anniversary of the Convention on the Rights of the Child which frames good health, including breastfeeding, as a fundamental right, in November in New York.
We are currently collaborating with our partners to include breastfeeding in the post-2015 Sustainable Development Goals (SDGs) which will be finalized by December, 2015 to replace the Millennium Development Goals which are expiring. Getting breastfeeding promotion into the post-2015 agenda is extremely important. We worked with our UNBAT partners and the Health NGO Group to request that breastfeeding be included as one of the “critical health-related issues to achieve sustainable development.”
ABM and its partners have applied to sponsor a “parallel event” at the annual Commission on the Status of Women in New York in March to raise the profile of breastfeeding as an important measure which improves the health of women and children.
We are encouraged by the increasing attention to breastfeeding at the UN and UNICEF and feel that there will be more opportunities to promote breastfeeding as part of the post-2015 Sustainable Development agenda, through the UNICEF Advocacy Strategy, during the CSW events and through ongoing collaboration with other health and nutrition groups. If any ABM members want to assist in this important work, please contact us.
Susan Vierczhalek, MD, FABM is ABM representative to the UN, Associate Professor of Clinical Pediatrics at New York University School of Medicine, medical Director of the Bellevue Hospital Newborn Service and Breastfeeding Program, Chair of the NY State Breastfeeding Coalition, Medical Director of the New York Milk Bank.
Larry Noble, MD, FABM, IBCLC is ABM representative to the UN with Susan, a neonatologist and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai in New York City and a Board member of ABM.
I am looking forward to being part of an expert panel on cultural issues with breastfeeding at next week’s ABM meeting. I plan to talk aboutpostpartum customs, special foods, importance of elders and fathers, galactogogues and other beliefs as they relate to breastfeeding in Latinas. I will also describe some examples from Central and South American countries of why not all Latinas are alike.
I will share published work on the practice of combination feeding—why los dos…and suggest some strategies for avoiding unnecessary supplementation. I also have some interesting observations from my recent field work with home visitors in rural Guatemala. Other topics will be the assumptions for some Latinas in the US that breastfeeding for 3 months is enough, nursing babies too long can make them weak or ill-mannered. I continue to see in my clinical work and research that self-efficacy and prenatal intent is so important for exclusivity. Happy to hear any ideas you have on this topic. Hope to see you in Cleveland next week.
Maya Bunik, MD, MSPH is an Associate Professor of Pediatrics at University of Colorado, Children’s Hospital Colorado. She sees patients in both primary care and breastfeeding consultation and has published a book Breastfeeding Telephone Triage and Advice. She is a Fellow of the Academy of Breastfeeding Medicine and serves as the Protocol Committee Co-Chair.
She is a featured speaker at the ABM 19th International Meeting, November 13-16, 2014.
Blog posts reflect the opinions of individual authors, not ABM as a whole.
When I was a surgical resident, I donated 150 ounces of breastmilk to a woman I’d never met, a woman who had undergone a bilateral mastectomy for cancer. It was an easy decision – I had more than I could use, she had none that she could provide. This experience became a major one in my decision to specialize in breast surgery. The dichotomy of breasts fascinated me. Breasts are highly sexualized, yet the source of comfort and food to babies. Breasts can make life-sustaining milk, and they can develop a cancer in up to 1 in 8 women that can be life-threatening. It is no wonder that society’s relationship with breasts and breastfeeding is complicated.
I have had many patients (too many) in my practice who were young and pre-childbearing, or even pregnant or breastfeeding at the time of diagnosis. Most experience the same terror that Ms. Wax-Thibodeux felt. Many choose bilateral mastectomies, prioritizing their health and a minimization of future risk. I also care for young women with benign breast disease, that still require surgical biopsies. I do discuss the potential impact of any surgery on breastfeeding. For a lot of women, this is a side effect they hadn’t even considered. It often does not ultimately change their mind about their own most appropriate surgical choice, but there can be a pause. A moment where they consider what that means, when they reconcile themselves to that consequence, when they have the moment to grieve. Unfortunately, I suspect that not all of my colleagues do this. I wasn’t ever trained to discuss it. We spent more time, significantly more time, discussing the cosmetic changes of the breasts than any functional changes (including, unfortunately, changes in sensation that may affect sexual enjoyment.) So, for women whose world has been rocked by a cancer diagnosis at a young age, who are terrified about their survival, there is probably not the opportunity to mourn the loss of breastfeeding, until that moment comes when they hold their babies in their arms. Read the rest of this entry »
Both families and physicians are anxious about the potential impact of the Ebola virus for mothers and infants.
The CDC has recently issued guidelines for field and partner organizations regarding how to advise breastfeeding women with probably or confirmed Ebola infection:
“When safe alternatives to breastfeeding and infant care exist, mothers with probable or confirmed Ebola virus disease should not have close contact with their infants (including breastfeeding).
In resource-limited settings, non-breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease.”
The Ebola virus has been detected in the milk of infected women. For mothers who recover from Ebola, it is not known when it is safe to resume breastfeeding. The CDC recommends waiting to resume breastfeeding until milk can be shown to be Ebola-free in laboratory testing.
As the Ebola outbreak continues to evolve, the Academy of Breastfeeding Medicine recommends consulting CDC guidance on how to minimize risk for infants of affected mothers.
The recently published article by Josephson and colleagues confirms that serious infections due to postnatally acquired CMV in very low birth weight infants are a real concern. The study documented that properly screened (CMV seronegative) and filtered blood and blood components effectively blocks transmission of CMV from these previously documented sources and in turn confirmed that the primary source of transmission is maternal milk from seropositive mothers. Of the infants who were exposed to mother’s breast milk that was positive for CMV, 15 % developed serologic evidence of CMV disease and less than 3% developed significant clinical disease, including NEC, with a mortality of 60% (3/5).
Of importance to note was the fact that the study was performed primarily by a team of hematologists and transfusion experts and unfortunately lack any details as to the clinical course of the infected infants — there were no data on birth weight or gestational age data, no indication as to quantity of milk ingested, when breastfeeding was initiated, the percentage of raw milk ingested versus frozen thawed milk, post natal age of onset if disease, bowel biopsy or post mortem findings. Furthermore not all the mothers had their milk tested for presence of CMV. Thus, these significant methodological limitations preclude accurate mathematical calculations as to actual risk of feeding human milk to the VLBW infant. Furthermore, the absence of any basic clinical data precludes identifying who are the truly high-risk infants. Read the rest of this entry »