Literature

CHD risk reduced by breastfeeding in Chinese women

12-7-2017 • Peters S.A.E, JAHA 2017


Breastfeeding and the Risk of Maternal Cardiovascular Disease: A Prospective Study of 300 000 Chinese Women

 
Peters S.A.E, Yang L, Guo Y, et al.
J Am Heart Assoc 2017:[Epub ahead of print]
 

Achtergrond

During pregnancy, substantial changes occur regarding the maternal metabolic system. These changes may disappear more quickly and completely with breastfeeding [1-3]. Moreover, longer breastfeeding has been beneficially associated with metabolic syndrome, hypertension and diabetes mellitus in later life [4-6]. However, there are many discrepancies between studies concerning this topic and breastfeeding practices differ within and between countries, leading to inconsistency of results. Interestingly, breastfeeding practices are almost universal in China and many women continue breastfeeding for long durations, thereby significantly differ from Western countries [7].
 
This analysis examined the relationship between breastfeeding and the risk of several major cardiovascular diseases (CVD) among 289,573 women (average age 51yrs) from the prospective China Kadoorie Biobank study. 97% of these women had ever breastfed and 91% breastfed each child for at least 6 months. Median duration of breastfeeding per child was 12 months and median follow-up was 8.1 years.
 

Main results

  • Whereas there were no differences in CVD risk between nulliparous and parous women who did not breastfed, parous women who had breastfed were at significantly lower risk of major CVD and its main components than parous women who had never breastfed (HR major CVD 0.88, 95% CI 0.80-0.97, HR CHD 0.91, 95% CI 0.84-0.99, HR stroke 0.92, 95% CI 0.85-0.99, HR ischemic stroke 0.88, 95% CI 0.79-0.97).
  • Risks were not different between regions, birth cohorts, level of education, smoking status, BMI categories, SBP categories and diabetes mellitus status.
  • Compared to women who had never breastfed, women who had breastfed for a duration between 0-6 months, 6-12 months, 12-18 months, 18-24 months or >24 months had a 1, 7, 11, 13 and 18% lower risk of CHD, respectively. Thereby, each additional 6 months associated with 4% lower CHD risk (P trend <0.001).
  • This association was similar for stroke, where each additional 6 months associated with an HR or 0.97 (95% CI 0.96-0.98).
  • Analyses with total duration of breastfeeding of all children per mother or analyses restricted to women with only 1 child revealed similar results.
 

Conclusion

In this large Chinese cohort, parous women who had ever breastfed had approximately a 10% lower risk of major CVD subtypes compared with parous women who had never breastfed. Among those who had ever breastfed, there was an inverse loglinear association between the duration of  breastfeeding per child and the risk of several major CVDs, except hemorrhagic stroke. If causal, these findings suggest that interventions to increase the likelihood and duration of breastfeeding could have persistent benefits to maternal cardiovascular health.
 
Find this article online at JAHA
 

References

1. Stuebe AM, Rich-Edwards JW. The reset hypothesis: lactation and maternal metabolism. Am J Perinatol. 2009;26:81–88.
2. Gunderson EP, Lewis CE, Wei GS, Whitmer RA, Quesenberry CP, Sidney S. Lactation and changes in maternal metabolic risk factors. Obstet Gynecol. 2007;109:729–738.
3. Schwarz EB, Ray RM, Stuebe AM, Allison MA, Ness RB, Freiberg MS, Cauley JA. Duration of lactation and risk factors for maternal cardiovascular disease. Obstet Gynecol. 2009;113:974–982
4. Gunderson EP, Jacobs DR Jr, Chiang V, Lewis CE, Feng J, Quesenberry CP Jr, Sidney S. Duration of lactation and incidence of the metabolic syndrome in women of reproductive age according to gestational diabetes mellitus status: a 20-year prospective study in CARDIA (Coronary Artery Risk Development in Young Adults). Diabetes. 2010;59:495–504.
5. Stuebe AM, Schwarz EB, Grewen K, Rich-Edwards JW, Michels KB, Foster EM, Curhan G, Forman J. Duration of lactation and incidence of maternal hypertension: a longitudinal cohort study. Am J Epidemiol. 2011;174:1147–1158.
6. Aune D, Norat T, Romundstad P, Vatten LJ. Breastfeeding and the maternal risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis. 2014;24:107–115.
7. Lewington S, Li L, Murugasen S, Hong LS, Yang L, Guo Y, Bian Z, Collins R, Chen J, He H, Wu M, He T, Ren X, Meng J, Peto R, Chen Z. Temporal trends of main reproductive characteristics in ten urban and rural regions of China: the China Kadoorie Biobank study of 300 000 women. Int J Epidemiol. 2014;43:1252–1262.


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