Reference information for the recordAccession Number: | 00006250-200905000-00005.
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Author: | Schwarz, Eleanor Bimla MD, MS 1; Ray, Roberta M. MS 2; Stuebe, Alison M. MD, MSc 3; Allison, Matthew A. MD, MPH 4; Ness, Roberta B. MD, MPH 5; Freiberg, Matthew S. MD, MSc 1; Cauley, Jane A. DrPH 5
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Institution: | From the (1)Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; the (2)Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; the (3)Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; the (4)University of California, San Diego, La Jolla, California; and the (5)Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
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Title: | |
Source: | Obstetrics & Gynecology. 113(5):974-982, May 2009.
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Abstract: | OBJECTIVE: To examine dose-response relationships between the cumulative number of months women lactated and postmenopausal risk factors for cardiovascular disease.
METHODS: We examined data from 139,681 postmenopausal women (median age 63 years) who reported at least one live birth on enrolling in the Women's Health Initiative observational study or controlled trials. Multivariable models were used to control for sociodemographic (age, parity, race, education, income, age at menopause), lifestyle, and family history variables when examining the effect of duration of lactation on risk factors for cardiovascular disease, including obesity (body mass index [BMI] at or above 30), hypertension, self-reported diabetes, hyperlipidemia, and prevalent and incident cardiovascular disease.
RESULTS: Dose-response relationships were seen; in fully adjusted models, women who reported a lifetime history of more than 12 months of lactation were less likely to have hypertension (odds ratio [OR] 0.88, P<.001), diabetes (OR 0.80, P<.001), hyperlipidemia (OR 0.81, P<.001), or cardiovascular disease (OR 0.91, P=.008) than women who never breast-fed, but they were not less likely to be obese. In models adjusted for all above variables and BMI, similar relationships were seen. Using multivariate adjusted prevalence ratios from generalized linear models, we estimate that among parous women who did not breast-feed compared with those who breast-fed for more than 12 months, 42.1% versus 38.6% would have hypertension, 5.3% versus 4.3% would have diabetes, 14.8% versus 12.3% would have hyperlipidemia, and 9.9% versus 9.1% would have developed cardiovascular disease when postmenopausal. Over an average of 7.9 years of postmenopausal participation in the Women's Health Initiative, women with a single live birth who breast-fed for 7-12 months were significantly less likely to develop cardiovascular disease (hazard ratio 0.72, 95% confidence interval 0.53-0.97) than women who never breast-fed.
CONCLUSION: Among postmenopausal women, increased duration of lactation was associated with a lower prevalence of hypertension, diabetes, hyperlipidemia, and cardiovascular disease.
LEVEL OF EVIDENCE: II
(C) 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
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References: | 1. Centers for Disease Control and Prevention (CDC). Breastfeeding trends and updated national health objectives for exclusive breastfeeding-United States, birth years 2000-2004. MMWR Morb Mortal Wkly Rep 2007;56:760-3.
2. Butte NF, Wong WW, Hopkinson JM. Energy requirements of lactating women derived from doubly labeled water and milk energy output. J Nutr 2001;131:53-8.
3. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol 2002;100:245-52.
4. Yang JQ, Xu YH, Gai MY. [Breast-feeding in reducing regular insulin requirement in postpartum for insulin dependent diabetes mellitus and gestational diabetes mellitus]. Zhonghua Fu Chan Ke Za Zhi 1994;29:135-7, 188.
5. Kjos SL, Henry O, Lee RM, Buchanan TA, Mishell DR. The effect of lactation on glucose and lipid metabolism in women with recent gestational diabetes. Obstet Gynecol 1993;82:451-5.
6. Williams MJ, Williams SM, Poulton R. Breast feeding is related to C reactive protein concentration in adult women. J Epidemiol Community Health 2006;60:146-8.
7. Stuebe AM, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. Duration of lactation and incidence of type 2 diabetes. JAMA 2005;294:2601-10.
8. Villegas R, Gao YT, Yang G, Li HL, Elasy T, Zheng W, et al. Duration of breast-feeding and the incidence of type 2 diabetes mellitus in the Shanghai Women's Health Study. Diabetologia 2008;51:258-66.
9. Design of the Women's Health Initiative clinical trial and observational study. The Women's Health Initiative Study Group. Control Clin Trials 1998;19:61-109.
10. Stefanick ML, Cochrane BB, Hsia J, Barad DH, Liu JH, Johnson SR. The Women's Health Initiative postmenopausal hormone trials: overview and baseline characteristics of participants. Ann Epidemiol 2003;13:S78-86.
11. Langer RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M. The Women's Health Initiative Observational Study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol 2003;13:S107-21.
12. Curb JD, McTiernan A, Heckbert SR, Kooperberg C, Stanford J, Nevitt M, et al. Outcomes ascertainment and adjudication methods in the Women's Health Initiative. Ann Epidemiol 2003;13:S122-8.
13. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report [published erratum appears in JAMA 2003;290:197]. JAMA 2003;289:2560-72.
14. McTiernan A, Kooperberg C, White E, Wilcox S, Coates R, Adams-Campbell LL, et al. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women's Health Initiative Cohort Study. JAMA 2003;290:1331-6.
15. McTigue K, Kuller L. Cardiovascular risk factors, mortality, and overweight. Jama 2008;299:1260-1.
16. Centers for Disease Control and Prevention (CDC). Racial and socioeconomic disparities in breastfeeding-United States, 2004. MMWR Morb Mortal Wkly Rep 2006;55:335-9.
17. Gartner LM, Morton J, Lawrence RA, Naylor AJ, O'Hare D, Schanler RJ, et al. Breastfeeding and the use of human milk. Pediatrics 2005;115:496-506.
18. Lee SY, Kim MT, Jee SH, Yang HP. Does long-term lactation protect premenopausal women against hypertension risk? A Korean women's cohort study. Prev Med 2005;41:433-8.
19. Ram KT, Bobby P, Hailpern SM, Lo JC, Schocken M, Skurnick J, et al. Duration of lactation is associated with lower prevalence of the metabolic syndrome in midlife-SWAN, the study of women's health across the nation. Am J Obstet Gynecol 2008;198:268e1-6.
20. Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol 2007;50:938-48.
21. Ness RB, Harris T, Cobb J, Flegal KM, Kelsey JL, Balanger A, et al. Number of pregnancies and the subsequent risk of cardiovascular disease. N Engl J Med 1993;328:1528-33.
22. Promislow JH, Gladen BC, Sandler DP. Maternal recall of breastfeeding duration by elderly women. Am J Epidemiol 2005;161:289-96.
23. Rafanelli C, Roncuzzi R, Milaneschi Y, Tomba E, Colistro MC, Pancaldi LG, et al. Stressful life events, depression and demoralization as risk factors for acute coronary heart disease. Psychother Psychosom 2005;74:179-84.
24. Adler NE, Rehkopf DH. U.S. disparities in health: description, causes, and mechanisms. Annu Rev Public Health 2008;29:235-52.
25. Rasmussen KM, Hilson JA, Kjolhede CL. Obesity may impair lactogenesis II. J Nutr 2001;131:3009S-11S.
26. Noble S, ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. Maternal employment and the initiation of breastfeeding. Acta Paediatr 2001;90:423-8
27. Martin RM, Ben-Shlomo Y, Gunnell D, Elwood P, Yarnell JW, Davey Smith G. Breast feeding and cardiovascular disease risk factors, incidence, and mortality: the Caerphilly study. J Epidemiol Community Health 2005;59:121-9.
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Language: | English.
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Document Type: | Original Research.
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Journal Subset: | Clinical Medicine.
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ISSN: | 0029-7844
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NLM Journal Code: | oc2, 0401101
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DOI Number: | https://dx.doi.org/10.1097/01.AO...- opens in a new window
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