Wednesday, January 13, 2010

Baby Friendly Initiative statement on new breastfeeding



UNICEF UK Baby Friendly Initiative statement on new breastfeeding
research News item 07 January 2010

A number of newspaper articles have today reported on a Norwegian
study which has found an association between higher levels of male
hormones in pregnancy and the ability to breastfeed after birth. The
authors are reported to have extrapolated from their findings that
mothers’ ability to breastfeed is entirely down to these hormone
levels. They are also reported to have claimed that exposure to high
levels of testosterone before birth account for the differences in
health outcomes between breast and bottle fed babies. The findings of
this small study are of interest and may warrant further
investigation. However, the claims made in relation to these findings
do not account for the large differences in breastfeeding rates
between countries, with some having 99% of mothers successfully
breastfeeding. They are also contradicted by the large body of
evidence which shows that levels of successful breastfeeding can be
increased by a range of improved support interventions.

The claims made relating to the health outcomes of breastfeeding do
not account for the dose response found in many studies, which show
that babies breastfed exclusively or for longer periods have the best
overall outcomes.

The study does not account for or tally with the known mechanisms for
how breastmilk protects against illness. For example, breastmilk
contains a range of anti-infective properties including
immunoglobulins, white cells, anti-inflammatory components, enzymes
and non-antibody factors such as lactoferrin and the bifidus factor.

The body of evidence for the benefits of breastfeeding is very large
and comes from a wide range of studies into many different illnesses,
carried out by numerous researchers in many different universities.
Systematic reviews of the literature have also been carried out and
are especially useful, as they are able to eliminate weak studies and
combine the findings of all the high-quality papers in order to
demonstrate with the greatest reliability whether a protective effect
truly exists. It is important to note that there is variability in the
quality and depth of evidence in relation to some illnesses which is
why the authors of these reviews tend to call for further research to
clarify the finding. It remains the case, however, that the evidence
for the advantages of breastfeeding is strong.

The two most recent and influential reviews were carried out by the
Agency for Health and Research Quality and the World Health
Organization and are summarised below:

Ip S, et al (2007) Breastfeeding and Maternal Health Outcomes in
Developed Countries. AHRQ Publication No. 07-E007.Rockville, MD:
Agency for Healthcare Research and Quality.
This review carried out in the USA screened over 9,000 papers and used
evidence from 400. It refers only to health outcomes in developed
countries. The review found that breastfeeding is associated with a
significant reduction in the incidence of: acute otitis media,
non-specific gastroenteritis, severe lower respiratory tract
infections, atopic dermatitis, obesity, type 1 diabetes, type 2
diabetes, childhood leukaemia, sudden infant death syndrome,
necrotizing enterocolitis, maternal breast cancer and ovarian cancer.

Horta B et al (2007) Evidence on the long-term effects of breastfeeding. WHO.
This paper reports on a series of systematic reviews to assess the
effects of breastfeeding on blood pressure, diabetes and related
indicators, serum cholesterol, overweight and obesity, and
intellectual performance. It found a significant reduction in the
incidence of obesity and overweight and type 2 diabetes. It also found
that breastfed babies had lower systolic blood pressure, lower
cholesterol and better performance in intelligence tests. Link.

Although the protective effects of breastfeeding on gastroenteritis
and respiratory infections have not been questioned, attempts have
been made to dismiss these in developed countries as mere ‘tummy
upsets’ or ‘coughs and colds’, whereas in reality a reduction in
severe infection resulting in hospitalisation has been found. The
Millennium Cohort Study is a nationally representative longitudinal
study of 18,819 infants who were born in the UK in 2000-2002. Data on
infant feeding, infant health, and a range of confounding factors were
available for 15,890 healthy, singleton, term infants who were born
during this period. This study found that 53 per cent of diarrheal
hospitalisations each month could have been prevented by exclusive
breastfeeding and 31 per cent by partial breastfeeding. A total of 27
per cent of lower respiratory tract infections could have been
prevented each month by exclusive breastfeeding and 25 per cent by
partial breastfeeding. Quigley M et al (2007) Breastfeeding and
Hospitalization for diarrheal and respiratory infection in the United
Kingdom Millennium Cohort Study. The full paper can be found here.

It is important to be aware that the protective effect of
breastfeeding is stronger in relation to some illness, notably
gastroenteritis, than it is for other illnesses such as allergies.
This does not mean that there is no protective effect against those
other illnesses, rather that the risk to the bottle-fed baby is
greater for some illnesses than for others. Importantly, where the
evidence shows a slight protective effect of breastfeeding, this can
still be the result of well performed research. Therefore, to describe
the evidence as weak because of a lower degree of protection is
inaccurate and misleading. It is important to note that a small
protective effect of breastfeeding against a significant illness will
have a dramatic effect across a population.

The role of the Baby Friendly Initiative and of health professionals
is to give pregnant women and new parents the full facts about infant
feeding based on the best available evidence in an objective and
non-judgemental manner in order to allow informed decision making. We
then need to help mothers to make decisions appropriate to their
circumstances and to support them in their decision whatever that may

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