Thursday, December 21, 2017

Breastfeeding Lowers the Risk for High Blood Pressure and Other Problems in Mid-Life

Photo credit: La Leche League
A new study indicates that breastfeeding can lower the risk for hypertension in middle-aged African-American women.

Interestingly, the study did not find much protection against EVER getting high blood pressure, but it did find a modest protective effect of breastfeeding on getting high blood pressure in your 40s. In other words, it had a temporary but important protective effect as women approached menopause, when high blood pressure often develops. In addition, the longer the duration of breastfeeding, the more protection there was.

This seems to echo other studies in other groups that have found similar protective effects against blood pressure issues in early middle age (the 40s) but not as much difference in older ages (after 65 or so).

It's disappointing that breastfeeding doesn't have the long-term, permanent effect everybody hoped for, but even so, this delay in development of high blood pressure is very important because the longer you have high blood pressure, the more complications like heart disease or kidney disease develop. Even just delaying it can reduce the cumulative disease burden on the body.

Breastfeeding can hopefully help people minimize their risk for these diseases. This is especially important for African-Americans, who are particularly susceptible to early onset of hypertension and cardiovascular issues.

More support  is needed in helping African-American women initiate and breastfeed long-term because it could make a critical difference in their health, as well as their babies' health. Here are some resources that might be helpful:


And here are some general breastfeeding resources:
Implications Beyond Hypertension 

Photo Credit: Center for Disease Control
Breastfeeding has important lifelong benefits beyond the obvious immediate benefits to the baby.

One of these is the delay of development of hypertension in the mother. Research also shows the breastfeeding, especially long-term breastfeeding, helps prevent or delay diabetes and heart problems, and lowers the incidence of cardiovascular mortality (see studies in References below).

Biologically speaking, women evolved to have children and then breastfeed them for extended periods of time. When women have children but don't breastfeed (or breastfeed only briefly), there is inadvertent metabolic fallout. As one study summarizes:
Researchers hypothesize that pregnancy and lactation are part of a continuum, with lactation meant to "reset" the adverse metabolic profile that develops as a part of normal pregnancy, and that when lactation does not occur, women maintain an elevated risk of cardio-metabolic diseases.
This is not to shame or scold women who don't or can't breastfeed long-term. Not every woman can breastfeed fully, some women's situations prevent breastfeeding for long, and of course it's always up to the woman to decide how she will feed her baby.

But from an evolutionary point of view, breastfeeding, especially long-term breastfeeding, keeps women healthier longer. 

We need to do everything we can to help support breastfeeding women, and especially breastfeeding women of color.


References

Breastfeeding and Hypertension

Am J Epidemiol. 2017 Oct 15;186(8):927-934. doi: 10.1093/aje/kwx163. Cumulative Lactation and Onset of Hypertension in African-American Women. Chetwynd EM, Stuebe AM, Rosenberg L, Troester M, Rowley D, Palmer JR. PMID: 28535171
Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading cause of death in the United States. Breastfeeding leads to metabolic changes that could reduce risks of hypertension. Hypertension disproportionately affects black women, but rates of breastfeeding among black women lag behind those in the general population. In the Black Women's Health Study (n = 59,001), we conducted a nested case-control analysis using unconditional logistic regression to estimate the association between breastfeeding and incident hypertension at ages 40-65 years using data collected from 1995 to 2011... Overall, there was little evidence of association between ever breastfeeding and incident hypertension (odds ratio = 0.97, 95% confidence interval: 0.92, 1.02). However, age modified the relationship (P = 0.02): Breastfeeding was associated with reduced risk of hypertension at ages 40-49 years (odds ratio = 0.92, 95% confidence interval: 0.85, 0.99) but not at older ages. In addition, risk of hypertension at ages 40-49 years decreased with increasing duration of breastfeeding (P for trend = 0.08). Our results suggest that long-duration breastfeeding may reduce the risk of incident hypertension in middle age. Addressing breastfeeding as a potential preventative health behavior is particularly compelling because it is required for only a discrete period of time.
Am J Obstet Gynecol. 2013 Jun;208(6):454.e1-7. doi: 10.1016/j.ajog.2013.02.014. Epub 2013 Feb 7. Association between parity and breastfeeding with maternal high blood pressure. Lupton SJ, Chiu CL, Lujic S, Hennessy A, Lind JM. PMID: 23395924
...Baseline data for 74,785 women were sourced from the 45 and Up Study, Australia. These women were 45 years of age or older, had an intact uterus, and had not been diagnosed with high blood pressure before pregnancy...The combination of parity and breastfeeding was associated with lower odds of having high blood pressure (adjusted OR, 0.89; 99% CI, 0.82-0.97; P < .001), compared with nulliparous women...Women who breastfed for longer than 6 months in their lifetime, or greater than 3 months per child, on average, had significantly lower odds of having high blood pressure when compared with parous women who never breastfed. The odds were lower with longer breastfeeding durations and were no longer significant in the majority of women over the age of 64 years....
Breastfeed Med. 2015 Apr;10(3):163-7. doi: 10.1089/bfm.2014.0116. Epub 2015 Mar 18. Breastfeeding and maternal hypertension and diabetes: a population-based cross-sectional study. Zhang BZ, Zhang HY, Liu HH, Li HJ, Wang JS. PMID: 25785993
...A cross-sectional study was conducted in four urban communities of Beijing, China, with 9,128 parous women 40-81 years of age who had had only one lifetime birth...After the analysis was adjusted for the potential confounders...the odd ratio (OR) of hypertension was 1.18 (95% confidence interval [CI], 1.05-1.32) for women who did not breastfeed, compared with women who did. In addition, the ORs for >0 to 6 months, >6 to 12 months, and >12 months of breastfeeding were 0.87 (95% CI, 0.76-0.99), 0.83 (95% CI, 0.68-1.00), and 0.79 (95% CI, 0.65-0.97), respectively, compared with women who did not breastfeed. With adjustment for age, WHR, working status, educational level, family history of diabetes, and postpartum BMI, women who did not breastfeed increased the risk of diabetes (OR=1.30; 95% CI, 1.11-1.53) compared with women who did. Moreover, women who breastfed for >0 to 6 months (OR=0.81; 95% CI, 0.67-0.98) and >6 to 12 months (OR=0.46; 95% CI, 0.26-0.84) had a lower risk of diabetes, compared with women who did not breastfeed. CONCLUSIONS: Chinese mothers who did not breastfeed were more likely to develop hypertension and diabetes in later life.
Am J Epidemiol. 2011 Nov 15;174(10):1147-58. doi: 10.1093/aje/kwr227. Epub 2011 Oct 12. Duration of lactation and incidence of maternal hypertension: a longitudinal cohort study. Stuebe AM, Schwarz EB, Grewen K, Rich-Edwards JW, Michels KB, Foster EM, Curhan G, Forman J. PMID: 21997568
Never or curtailed lactation has been associated with an increased risk for incident hypertension, but the effect of exclusive breastfeeding is unknown. The authors conducted an observational cohort study of 55,636 parous women in the US Nurses' Health Study II... In conclusion, never or curtailed lactation was associated with an increased risk of incident maternal hypertension, compared with the recommended ≥6 months of exclusive or ≥12 months of total lactation per child, in a large cohort of parous women.
Breastfeeding and Diabetes

Obstet Gynecol. 2016 Nov;128(5):1095-1104. Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring. Martens PJ, Shafer LA, Dean HJ, Sellers EA, Yamamoto J, Ludwig S, Heaman M, Phillips-Beck W, Prior HJ, Morris M, McGavock J, Dart AB, Shen GX. PMID: 27741196
This retrospective database study included 334,553 deliveries (1987-2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases... RESULTS: Breastfeeding initiation was recorded in 83% of non-First Nations mothers and 56% of First Nations mothers (P<.001)... With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69-0.99, P=.038)... CONCLUSION: Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non-First Nations women and children.
Diabetes Care. 2010 Jun;33(6):1239-41. doi: 10.2337/dc10-0347. Epub 2010 Mar 23. Parity, breastfeeding, and the subsequent risk of maternal type 2 diabetes. Liu B, Jorm L, Banks E. PMID: 20332359
...Using information on parity, breastfeeding, and diabetes collected from 52,731 women recruited into a cohort study, we estimated the risk of type 2 diabetes using multivariate logistic regression... Among parous women, there was a 14% (95% CI 10-18%, P < 0.001) reduced likelihood of diabetes per year of breastfeeding... CONCLUSIONS: Compared with nulliparous women, childbearing women who do not breastfeed have about a 50% increased risk of type 2 diabetes in later life. Breastfeeding substantially reduces this excess risk.
JAMA. 2005 Nov 23;294(20):2601-10. Duration of lactation and incidence of type 2 diabetes. Stuebe AM1, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. PMID: 16304074
...Prospective observational cohort study of 83,585 parous women in the Nurses' Health Study (NHS) and retrospective observational cohort study of 73,418 parous women in the Nurses' Health Study II (NHS II)...RESULTS: ...Among parous women, increasing duration of lactation was associated with a reduced risk of type 2 diabetes. For each additional year of lactation, women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15% (95% confidence interval, 1%-27%) among NHS participants and of 14% (95% confidence interval, 7%-21%) among NHS II participants, controlling for current body mass index and other relevant risk factors for type 2 diabetes. CONCLUSIONS: Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women....
Diabetologia. 2008 Feb;51(2):258-66. Epub 2007 Nov 27. Duration of breast-feeding and the incidence of type 2 diabetes mellitus in the Shanghai Women's Health Study. Villegas R1, Gao YT, Yang G, Li HL, Elasy T, Zheng W, Shu XO. PMID: 18040660
...This was a prospective study of 62,095 middle-aged parous women in Shanghai, China, who had no prior history of type 2 diabetes mellitus, cancer or cardiovascular disease at study recruitment... RESULTS: Women who had breastfed their children tended to have a lower risk of diabetes mellitus than those who had never breastfed [relative risk (RR)=0.88; 95% CI, 0.76-1.02; p=0.08]. Increasing duration of breast-feeding was associated with a reduced risk of type 2 diabetes mellitus. The fully adjusted RRs for lifetime breast-feeding duration were 1.00, 0.88, 0.89, 0.88, 0.75 and 0.68 (p trend=0.01) for 0, >0 to 0.99, >0.99 to 1.99, >1.99 to 2.99, >2.99 to 3.99 and >or=4 years in analyses adjusted for age, daily energy intake, BMI, WHR, smoking, alcohol intake, physical activity, occupation, income level, education level, number of live births and presence of hypertension at baselines....
Breastfeeding and Cardiovascular Health/Mortality

Annu Rev Nutr. 2016 Jul 17;36:627-45. doi: 10.1146/annurev-nutr-071715-051213. Epub 2016 May 4. Lactation and Maternal Cardio-Metabolic Health. Perrine CG, Nelson JM, Corbelli J, Scanlon KS. PMID: 27146017
Researchers hypothesize that pregnancy and lactation are part of a continuum, with lactation meant to "reset" the adverse metabolic profile that develops as a part of normal pregnancy, and that when lactation does not occur, women maintain an elevated risk of cardio-metabolic diseases. Several large prospective and retrospective studies, mostly from the United States and other industrialized countries, have examined the associations between lactation and cardio-metabolic outcomes. Less evidence exists regarding an association of lactation with maternal postpartum weight status and dyslipidemia, whereas more evidence exists for an association with diabetes, hypertension, and subclinical and clinical cardiovascular disease.
Am J Obstet Gynecol. 2009 Feb;200(2):138.e1-8. doi: 10.1016/j.ajog.2008.10.001. Epub 2008 Dec 25. Duration of lactation and incidence of myocardial infarction in middle to late adulthood. Stuebe AM, Michels KB, Willett WC, Manson JE, Rexrode K, Rich-Edwards JW. PMID: 19110223
We assessed the relation between duration of lactation and maternal incident myocardial infarction. STUDY DESIGN: This was a prospective cohort study of 89,326 parous women in the Nurses' Health Study. RESULTS:... Compared with parous women who had never breastfed, women who had breastfed for a lifetime total of 2 years or longer had 37% lower risk of coronary heart disease (95% confidence interval, 23-49%; P for trend < .001), adjusting for age, parity, and stillbirth history. With additional adjustment for early-adult adiposity, parental history, and lifestyle factors, women who had breastfed for a lifetime total of 2 years or longer had a 23% lower risk of coronary heart disease (95% confidence interval, 6-38%; P for trend = .02) than women who had never breastfed. CONCLUSION: In a large, prospective cohort, long duration of lactation was associated with a reduced risk of coronary heart disease.
BMC Public Health. 2013 Nov 13;13:1070. doi: 10.1186/1471-2458-13-1070. A prospective population-based cohort study of lactation and cardiovascular disease mortality: the HUNT study. Natland Fagerhaug T, Forsmo S, Jacobsen GW, Midthjell K, Andersen LF, Ivar Lund Nilsen T. PMID: 24219620
...In a Norwegian population-based prospective cohort study, we studied the association of lifetime duration of lactation with cardiovascular mortality in 21,889 women aged 30 to 85 years who attended the second Nord-Tr√łndelag Health Survey (HUNT2) in 1995-1997. The cohort was followed for mortality through 2010 by a linkage with the Cause of Death Registry...RESULTS:...Parous women younger than 65 years who had never lactated had a higher cardiovascular mortality than the reference group of women who had lactated 24 months or more (HR 2.77, 95% confidence interval [CI]: 1.28, 5.99)...CONCLUSIONS: Excess cardiovascular mortality rates were observed among parous women younger than 65 years who had never lactated. These findings support the hypothesis that lactation may have long-term influences on maternal cardiovascular health.

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