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. 2022 Jan:5:100094.
doi: 10.1016/j.lana.2021.100094.

Breastfeeding and post-perinatal infant deaths in the United States, A national prospective cohort analysis

Ruowei Li  1 , Julie Ware  2 , Aimin Chen  3 , Jennifer M Nelson  1   4 , Jennifer M Kmet  5 , Sharyn E Parks  6   4 , Ardythe L Morrow  7   8 , Jian Chen  1 , Cria G Perrine  1   4
Affiliations

Breastfeeding and post-perinatal infant deaths in the United States, A national prospective cohort analysis

Ruowei Li et al. Lancet Reg Health Am. 2022 Jan.

Abstract

Background: Reducing infant mortality is a major public health goal. The potential impact of breastfeeding on infant deaths is not well studied in the United States (US).

Methods: We analyzed linked birth-death certificates for 3,230,500 US births that occurred in 2017, including 6,969 post-perinatal deaths from 7-364 days of age as the primary outcome, further specified as late-neonatal (7-27 days) or post-neonatal (28-364 days) deaths. The primary exposure was 'ever breastfed' obtained from birth certificates. Multiple logistic regression examined associations of ever breastfeeding with post-perinatal deaths and specific causes of deaths, controlling for maternal and infant factors.

Findings: We observed an adjusted reduced odds ratio (AOR)= 0·74 with 95% confidence intervals (CI)=0·70-0·79 for the association of breastfeeding initiation with overall infant deaths (7-364 days), AOR=0·60 (0·54-0·67) for late-neonatal deaths, and AOR=0·81 (0·76-0·87) for post-neonatal deaths. In race/ethnicity-stratified analysis, significant associations of breastfeeding initiation with reduced odds of overall infant deaths were observed for Hispanics [AOR=0·64 (0·55-0·74)], non-Hispanic Whites [AOR=0·75 (0·69-0·81)], non-Hispanic Blacks [AOR=0·83 (0·75-0·91)], and non-Hispanic Asians [AOR=0·51 (0·36-0·72)]. Across racial/ethnic groups, effect sizes for late-neonatal deaths were consistently larger than those for post-neonatal deaths. Significant effects of breastfeeding initiation were observed for deaths due to infection [AOR=0·81(0·69-0·94)], Sudden Unexpected Infant Death [AOR=0·85 (0·78-0·92)], and necrotizing enterocolitis [AOR=0·67 (0·49-0·90)].

Interpretation: Breastfeeding initiation is significantly associated with reduced odds of post-perinatal infant deaths in multiple racial and ethnic groups within the US population. These findings support efforts to improve breastfeeding in infant mortality reduction initiatives.

Keywords: Breastfeeding; Infant mortality; Racial/ethnic disparity.

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Conflict of interest statement

Declaration of Interest We declare no competing interests.

Figures

Figure 1
Figure 1
Sample Flow
See this image and copyright information in PMC

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