Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta-Analysis Involving Data From 8 Studies and 1 192 700 Parous Women

Abstract

Background Breastfeeding has been robustly linked to reduced maternal risk of breast cancer, ovarian cancer, and type 2 diabetes. We herein systematically reviewed the published evidence on the association of breastfeeding with maternal risk of cardiovascular disease (CVD) outcomes. Methods and Results Our systematic search of PubMed and Web of Science of articles published up to April 16, 2021, identified 8 relevant prospective studies involving 1 192 700 parous women (weighted mean age: 51.3 years at study entry, 24.6 years at first birth; weighted mean number of births: 2.3). A total of 982 566 women (82%) reported having ever breastfed (weighted mean lifetime duration of breastfeeding: 15.6 months). During a weighted median follow-up of 10.3 years, 54 226 CVD, 26 913 coronary heart disease, 30 843 stroke, and 10 766 fatal CVD events were recorded. In a random-effects meta-analysis, the pooled multivariable-adjusted hazard ratios comparing parous women who ever breastfed to those who never breastfed were 0.89 for CVD (95% CI, 0.83-0.95; I²=79.4%), 0.86 for coronary heart disease (95% CI, 0.78-0.95; I²=79.7%), 0.88 for stroke (95% CI, 0.79-0.99; I²=79.6%), and 0.83 for fatal CVD (95% CI, 0.76-0.92; I²=47.7%). The quality of the evidence assessed with the Grading of Recommendations Assessment, Development, and Evaluation tool ranged from very low to moderate, which was mainly driven by high between-studies heterogeneity. Strengths of associations did not differ by mean age at study entry, median follow-up duration, mean parity, level of adjustment, study quality, or geographical region. A progressive risk reduction of all CVD outcomes with lifetime durations of breastfeeding from 0 up to 12 months was found, with some uncertainty about shapes of associations for longer durations. Conclusions Breastfeeding was associated with reduced maternal risk of CVD outcomes.

Keywords: breastfeeding; cardiovascular diseases; maternal risk; meta‐analysis; systematic review.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses flow diagram.

CVD indicates cardiovascular disease. *A total of 514 from PubMed and 630 from Web of Science.

Figure 2. Forest plot for CVD, CHD, stroke, and fatal CVD comparing parous women who ever breastfed vs never breastfed.

*Only fatal events included. ○, adjusted for demographics and reproductive factors; +, adjusted for demographics and cardiovascular risk factors; ++, adjusted for demographics, reproductive factors, and cardiovascular risk factors. Full study names are provided in the footnotes of the Table. CHD indicates coronary heart disease; and CVD, cardiovascular disease.

Figure 3. Different lengths of lifetime duration of breastfeeding and incidence of cardiovascular outcomes.

*Comparing women with different lifetime durations of breastfeeding with parous women who never breastfed. The solid lines indicate fitted restricted cubic splines and the dashed lines their 95% CIs. The sizes of the circles are proportional to the inverse variance of the hazard ratios. Full study names are provided in the footnotes of the Table. For the purpose of presentation, the graph for stroke has been truncated at 1.50 at the y axis. CHD indicates coronary heart disease; and CVD indicates cardiovascular disease.