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      Breastfeeding and maternal health outcomes: a systematic review and meta-analysis

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          Abstract

          Aim

          To evaluate the effect of breastfeeding on long-term (breast carcinoma, ovarian carcinoma, osteoporosis and type 2 diabetes mellitus) and short-term (lactational amenorrhoea, postpartum depression, postpartum weight change) maternal health outcomes.

          Methods

          A systematic literature search was conducted in PubMed, Cochrane Library and CABI databases. Outcome estimates of odds ratios or relative risks or standardised mean differences were pooled. In cases of heterogeneity, subgroup analysis and meta-regression were explored.

          Results

          Breastfeeding >12 months was associated with reduced risk of breast and ovarian carcinoma by 26% and 37%, respectively. No conclusive evidence of an association between breastfeeding and bone mineral density was found. Breastfeeding was associated with 32% lower risk of type 2 diabetes. Exclusive breastfeeding and predominant breastfeeding were associated with longer duration of amenorrhoea. Shorter duration of breastfeeding was associated with higher risk of postpartum depression. Evidence suggesting an association of breastfeeding with postpartum weight change was lacking.

          Conclusion

          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.

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          Most cited references225

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          Hormonal carcinogenesis.

          Brian Henderson, Heather Spencer Feigelson (2000)
          Hormone-related cancers, namely breast, endometrium, ovary, prostate, testis, thyroid and osteosarcoma, share a unique mechanism of carcinogenesis. Endogenous and exogenous hormones drive cell proliferation, and thus the opportunity for the accumulation of random genetic errors. The emergence of a malignant phenotype depends on a series of somatic mutations that occur during cell division, but the specific genes involved in progression of hormone-related cancers are currently unknown. In this review, the epidemiology of endometrial cancer and breast cancer are used to illustrate the paradigms of hormonal carcinogenesis. Then, new strategies for early detection and prevention of hormonal carcinogenesis are discussed. This includes developing polygenic models of cancer predisposition and the further development of safe and effective chemopreventives that block target sequence activity. We developed polygenic models for breast and prostate cancer after hypothesizing that functionally relevant sequence variants in genes involved in steroid hormone metabolism and transport would act together, and also interact with well-known hormonally related risk factors, to define a high-risk profile for cancer. A combination of genes each with minor variation in expressed activity could provide a degree of separation of risk that would be clinically useful as they could yield a large cumulative difference after several decades. The genes included in the breast cancer model are the 17beta-hydroxysteroid dehydrogenase 1 (HSD17B1) gene, the cytochrome P459c17alpha (CYP17) gene, the aromatase (CYP19) gene, and the estrogen receptor alpha (ER) gene. The prostate cancer model includes the androgen receptor gene (AR), steroid 5alpha-reductase type II (SRD5A2), CYP17 and the 3beta hydroxysteroid dehydrogenase (HSD3B2) gene. We present data from our multi-ethnic cohort to support these models.
          Article 0 comments Cited 170 times – based on 0 reviews     Review now
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            Breastfeeding and depression: a systematic review of the literature.

            Cláudia Castro Dias, Barbara Figueiredo (2015)
            Research has separately indicated associations between pregnancy depression and breastfeeding, breastfeeding and postpartum depression, and pregnancy and postpartum depression. This paper aimed to provide a systematic literature review on breastfeeding and depression, considering both pregnancy and postpartum depression.
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              Etiology of hormone receptor-defined breast cancer: a systematic review of the literature.

              Jennifer H Fergenbaum, Michelle Althuis, Louise Brinton … (2004)
              Breast cancers classified by estrogen receptor (ER) and/or progesterone receptor (PR) expression have different clinical, pathologic, and molecular features. We examined existing evidence from the epidemiologic literature as to whether breast cancers stratified by hormone receptor status are also etiologically distinct diseases. Despite limited statistical power and nonstandardized receptor assays, in aggregate, the critically evaluated studies (n = 31) suggest that the etiology of hormone receptor-defined breast cancers may be heterogeneous. Reproduction-related exposures tended to be associated with increased risk of ER-positive but not ER-negative tumors. Nulliparity and delayed childbearing were more consistently associated with increased cancer risk for ER-positive than ER-negative tumors, and early menarche was more consistently associated with ER-positive/PR-positive than ER-negative/PR-negative tumors. Postmenopausal obesity was also more consistently associated with increased risk of hormone receptor-positive than hormone receptor-negative tumors, possibly reflecting increased estrogen synthesis in adipose stores and greater bioavailability. Published data are insufficient to suggest that exogenous estrogen use (oral contraceptives or hormone replacement therapy) increase risk of hormone-sensitive tumors. Risks associated with breast-feeding, alcohol consumption, cigarette smoking, family history of breast cancer, or premenopausal obesity did not differ by receptor status. Large population-based studies of determinants of hormone receptor-defined breast cancers defined using state-of-the-art quantitative immunostaining methods are needed to clarify the role of ER/PR expression in breast cancer etiology.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acta Paediatr
                Journal ID (iso-abbrev): Acta Paediatr
                Journal ID (publisher-id): apa
                Title: Acta Paediatrica (Oslo, Norway : 1992)
                Publisher: Blackwell Publishing Ltd (Oxford, UK )
                ISSN (Print): 0803-5253
                ISSN (Electronic): 1651-2227
                Publication date (Print): December 2015
                Publication date (Electronic): 04 November 2015
                Volume: 104
                Issue: Suppl 467
                Pages: 96-113
                Affiliations
                [1 ]Centre for Health Research and Development, Society for Applied Studies New Delhi, India
                [2 ]Newborn Health Knowledge Centre, ICMR Centre for Advanced Research in Newborn Health, Department of Paediatrics, All India Institute of Medical Sciences New Delhi, India
                [3 ]Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization Geneva, Switzerland
                [4 ]Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen Bergen, Norway
                Author notes
                Dr Ranadip Chowdhury, Scientist, Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi-110016, India. Tel: +91 011 46043751- 55 | Fax: +91 011 46043756 | Email: ranadip.chowdhury@ 123456sas.org.in
                Article
                DOI: 10.1111/apa.13102
                PMC ID: 4670483
                PubMed ID: 26172878
                SO-VID: 11c1d4b3-eb9a-4cdf-87da-c73a9389cfbe
                Copyright © Copyright © 2015 Foundation Acta Pædiatrica
                License:

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 May 2015
                Date revision received : 16 June 2015
                Date accepted : 18 June 2015
                Categories
                Subject: Impact of Breastfeeding on Maternal and Child Health. This Supplement was Coordinated by the World Health Organization With Financial Support From the Bill & Melinda Gates Foundation
                Subject: Review Article

                ScienceOpen disciplines: Pediatrics
                Keywords: breastfeeding,long and short term,maternal health,meta-analysis
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: breastfeeding, long and short term, maternal health, meta-analysis

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