Is the "breast is best" mantra an oversimplification?
Recommendations about breastfeeding—absent critical analysis and removed from context—may overvalue its benefit. Here's a look at the evidence.
PRACTICE RECOMMENDATIONS
› Encourage breastfeeding for its potential to reduce the risk of acute otitis media, upper- and lower-respiratory infections, gastrointestinal infection, and dental malocclusion. A
› Promote breastfeeding for its potential to make a small difference in intelligence quotient and the incidence of overweight and obesity—but not for any other significant impact on long-term health. B
› Consider the needs and preferences of the individual when advocating breastfeeding so as to avoid potentially engendering maternal feelings of guilt and inadequacy. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
From The Journal of Family Practice | 2018;67(6):E1-E9.
Allergic disease
Asthma. There is evidence of a small protective effect of breastfeeding “ever” on asthma at 5 to 18 years of age in high-income countries (OR=0.90; 95% CI, 0.83-0.97). A family history of asthma or atopy did not affect this finding. The authors note there is some evidence of publication bias in this review, which is the largest and most comprehensive on the topic.40
With a lifetime prevalence of asthma in the United States of approximately 13.2%, this association would confer an NNT of roughly 76.41 Earlier, the literature demonstrated mixed and conflicting evidence, and some experts suggested an effect only when there is a family history of asthma or atopy.36
Eczema. For children younger than 2 years, there is low-grade- and very-low-grade-quality evidence that exclusive breastfeeding longer than 3 to 4 months is associated with a reduced risk of eczema (OR=0.74; 95% CI, 0.57-0.97).40
Previously, data suggested that this association existed only in children who had a family history of atopy.35 The protective association, however, exists regardless of family history and does not persist beyond 2 years of age. The authors noted evidence of publication bias, reverse causation, and misdiagnosis of early childhood rashes as eczema as limitations of their findings.40
Continue to: Reliable epidemiologic evidence...
