Association of Maternal Lactation With Diabetes and Hypertension: A Systematic Review and Meta-analysis | Breastfeeding | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Women and breastfeeding
    Frederick Rivara, MD, MPH | University of Washington
    I always worry when studies like this provide more evidence for the beneficial effects of breastfeeding. This study examined the protective effects on mothers for breast-feeding for more than 12 months. My worries are that it might make mothers who are unable to breastfeed or do not choose to breastfeed for whatever reason feel worse, and that somehow their decision was "wrong."
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Original Investigation
    Obstetrics and Gynecology
    October 16, 2019

    Association of Maternal Lactation With Diabetes and Hypertension: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
    • 2Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
    • 3Department of Internal Medicine, Cleveland Clinic–Fairview Hospital, Cleveland, Ohio
    • 4Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
    • 5Dow Medical College, Karachi, Pakistan
    • 6Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio
    • 7Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
    • 8AdvantageCare Physicians, Brooklyn, New York
    JAMA Netw Open. 2019;2(10):e1913401. doi:10.1001/jamanetworkopen.2019.13401
    Key Points español 中文 (chinese)

    Question  Is breastfeeding associated with lower risk of maternal diabetes or hypertension?

    Findings  This meta-analysis of 6 studies including more than 200 000 participants found that breastfeeding was associated with a relative risk reduction of 30% for diabetes and 13% for hypertension in the mothers studied.

    Meaning  These findings suggest that breastfeeding is associated with long-term cardiovascular health benefits for women.


    Importance  Lactation has been shown to be associated with lower rates of diabetes and hypertension in mothers. However, the strength of association has varied between studies, and sample sizes are relatively small.

    Objective  To conduct a systematic review and meta-analysis to determine whether lactation is associated with a lower risk of diabetes and hypertension.

    Data Sources  Ovid MEDLINE, Ovid Embase, Cochrane CENTRAL, and CINAHL databases were searched from inception to July 2018 with manual search of the references.

    Study Selection  Studies of adult women that specified duration of breastfeeding for at least 12 months, evaluated primary hypertension and diabetes as outcomes, were full-text articles in English, and reported statistical outcomes as odds ratios were included.

    Data Extraction and Synthesis  Study characteristics were independently extracted using a standard spreadsheet template and the data were pooled using the random-effects model. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline for reporting was followed.

    Main Outcomes and Measures  Diabetes and hypertension.

    Results  The search yielded 1558 articles, from which a total of 6 studies met inclusion criteria for association between breastfeeding and diabetes and/or hypertension. The 4 studies included in the meta-analysis for the association between lactation and diabetes had a total of 206 204 participants, and the 5 studies included in the meta-analysis for the association between lactation and hypertension had a total of 255 271 participants. Breastfeeding for more than 12 months was associated with a relative risk reduction of 30% for diabetes (pooled odds ratio, 0.70 [95% CI, 0.62-0.78]; P < .001) and a relative risk reduction of 13% for hypertension (pooled odds ratio, 0.87 [95% CI, 0.78-0.97]; P = .01).

    Conclusions and Relevance  This study suggests that education about the benefits of breastfeeding for prevention of diabetes and hypertension in women is a low-risk intervention that can be easily included in daily practice and may have a positive impact on cardiovascular outcomes in mothers.