Promoting Breastfeeding

iStock_74168357_MEDIUMBreastfeeding is one of those issues around which there's almost no controversy with regard to health benefits for both mother and baby, so, as Rick and I discuss on PodMed this week and published in JAMA, it's a bit disconcerting that only about 22% of infants born in the United States are exclusively breastfed until they're six months of age, per current recommendations, although it is initiated among 80%. This fact emerged as part of the USPSTF review of the literature regarding the benefits and harms of breastfeeding interventions conducted to enable updating of the guidelines, last done in 2008.

Fifty-two studies with over 66,000 participants were included in this analysis, which took a look at both individual and system interventions to promote breastfeeding.  Data indicate that the individual-level interventions, whether by peers or professionals, were much more likely to result in initiation of breastfeeding and longer duration than system wide programs such as the Baby Friendly Hospital Initiative.  Very modest harms were reported in the review: a couple of subjects reporting anxiety, decreased confidence and concerns about confidentiality after a peer visit.

In short, it appears to Rick and me that more individual level interventions should be designed and employed to promote breastfeeding, although the USPSTF stops short of this assertion.  Other topics this week include http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2571615 on state level smoking and cancer, and two from NEJM:Long-Term Oxygen for COPD with Moderate Desaturation and Child–Parent Familial Hypercholesterolemia Screening.  Until next week, y'all live well.

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Breasfteedo March 22, 2017 at 5:47 pm

Thank you for sharing this useful information 🙂

Best,
Amr

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renee November 3, 2016 at 3:24 am

I personally support breastfeeding, because it is better for your baby.

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Mark Benor October 28, 2016 at 12:44 pm

I listened with interest to the latest Johns Hopkins Medical Podcast on screening for Familial Hypercholesterolemia. As a Family Physician, I spend a lot of time screening for, and treating, modifiable risk factors for premature cardiovascular disease, so I can appreciate new strategies for identifying such patients. However, I also spend a good deal of time counseling about reproductive health (which I gather that most of the people conducting these studies don't do on a daily basis.) Statins are a category X medication with regards to pregnancy. So any discussion of putting kids on long term statin therapy has to be informed by the increased likelihood that the girls may later on become pregnant while on a statin. I can't think of another category X intervention that we're hearing recommendations to screen for on a population-wide basis. Similarly, if we're talking about screening (and treating) the parents of kids age 1-2 for dyslipidemia, teratogenicity needs to be part of every such discussion with the moms. Many of the moms of 1 year olds, are likely to get pregnant again in the next few years. If we're going to be expanding aggressive statin therapy for kids and young women, we need to be very vigilant about avoiding birth defects--a very predictable harm of this preventive intervention. I respectfully suggest mentioning this issue in the next blog, given your broad audience. Warmly, Mark Benor, MD

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