Associations of breastfeeding with maternal and child health outcomes : umbrella review

Abstract

Background: Breastfeeding (BF) has been reported to be beneficial for both mothers and their offspring, but the evidence for these associations has not been systematically evaluated. Objectives: This umbrella review aims to assess the credibility of existing evidence regarding the associations between BF and health outcomes in mothers and offspring. Methods: For each health outcome, evidence levels were determined using reanalyzed random-effects estimates, between-study heterogeneity, 95% predictive intervals, publication bias, small-study effects, and excess significance bias. Methodological quality was assessed by A Measurement Tool to Assess Systematic Reviews 2, and evidence credibility was graded with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: Overall, 192 meta-analyses from 62 articles were included. Among maternal outcomes, 3 meta-analyses (3/65, 4.6%) were considered to provide convincing evidence that BF reduced risks of ovarian cancer [odds ratio (OR) range: 0.70–0.78] and hypertension (OR range: 0.89–0.93). For short-term offspring outcomes, 5 meta-analyses (5/114, 4.4%) were considered to provide convincing evidence that exclusive BF or ever BF was associated with lower risks of sudden infant death syndrome [OR: 0.63; 95% confidence interval (CI): 0.54, 0.73] and allergic rhinitis (OR: 0.61; 95% CI: 0.54, 0.70), alongside improved physical fitness (standing long jump, standardized mean differences: 0.20–0.27). Early BF initiation (<1 h after birth) reduced neonatal mortality risk by 56% (OR: 0.44; 95% CI: 0.33, 0.61). Regarding long-term offspring outcomes, 2 meta-analyses (2/13, 15.4%) were considered to offer highly suggestive and suggestive evidence, respectively, suggesting the inverse associations of ever BF on overweight/obesity and type 2 diabetes mellitus in adulthood. After GRADE credibility assessment, only 4 of 192 meta-analyses were classified as moderate-quality evidence. Conclusions: Our findings support the benefits of BF for mothers and their offspring, underscoring the importance of promoting BF practices to improve maternal and child health outcomes.