Primary care clinicians should "support" patients who wish to breastfeed their infants, said a draft recommendation statement from the U.S. Preventive Services Task Force (USPSTF), in an effort to avoid the impression of pressuring women into breastfeeding against their will.
The Task Force reaffirmed their B grade on the recommendation, which indicates "high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial," saying that breastfeeding can benefit both a mother and her infant.
"There is convincing evidence that breastfeeding provides substantial health benefits for children and adequate evidence that breastfeeding provides moderate health benefits for women," the authors wrote.
This draft recommendation statement was published on the USPSTF site.
The B grade remains unchanged from the last time the Task Force reviewed the evidence for this recommendation in 2008 -- although Alex Kemper, MD, of the USPSTF, told MedPage Today that there has been a slight change in wording from the last statement: using the word "supports" in place of "promotes" to describe the Task Force's position on breastfeeding.
"The reason the Task Force made this slight word change is to recognize the importance of a mother doing what she feels is best for her and her baby and not wanting to, for example, make mothers feel guilty or bad if they decide not to breastfeed," he said. "It's really a personal choice that needs to be made based on her own personal situation."
The USPSTF examined 43 trials on breastfeeding support and education and found that for every 30 women offered breastfeeding support, one more woman breastfed for up to 6 months. In fact, pooled estimates indicated a 21% higher likelihood for exclusive breastfeeding at less than 3 months and a 20% higher likelihood for exclusive breastfeeding at 3 to 6 months compared to usual care (rate ratio 1.21 and 1.20, respectively). These interventions also resulted in a 16% higher likelihood for exclusive breastfeeding at 6 months (RR 1.16).
Pooled estimates also indicated beneficial associations for any breastfeeding at less than 3 months (RR 1.07), and 3 to 6 months (RR 1.11).
However, there was no statistically significant association between interventions to support breastfeeding and breastfeeding initiation (RR 1.00). The Task Force also found inconsistent and thus insufficient evidence to determine "direct effects" of these interventions to support breastfeeding on infant health outcomes. None of the studies reported maternal health outcomes.
The Task Force examined two studies on the potential harms of interventions to support breastfeeding (which could include guilt or anxiety related to breastfeeding choice, as well as postpartum depression) with conflicting results. One trial found no significant differences between maternal anxiety between breastfeeding groups, while the other reported "a few mothers" expressed anxiety and decreased confidence in their breastfeeding ability.
When asked if the new wording meant the USPSTF was trying to discourage clinicians from pressuring women into breastfeeding, Kemper replied, "I do think that's an important message for primary care providers to understand, but equally understand the benefits of breastfeeding, and be able to support the mom if that's her choice."
"The evidence is clear that there's benefits for breastfeeding both for the baby and for the mom," he added.
The USPSTF said that more research is needed about the effect of these interventions on overall maternal and infant health, and "trials should include reliable and valid measures of infant and maternal health outcomes and be powered to detect potential effects on these outcomes," they wrote.
Currently, the Task Force estimates that 80.0% of mothers initiated any breastfeeding, with a rate of 51.4% at 6 months and 29.2% at 12 months. They note that while these rates have been rising over the past few decades, they still fall short of the Healthy People 2020 targets (81.9% to initiate breastfeeding, 66.6% at 6 months and 34.1% at 12 months).
The USPSTF cited recommendations from other maternal and fetal health organizations, such as the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the World Health Organization (WHO), all of whom recommend exclusive breastfeeding for up to 6 months and continued breastfeeding up to a year, if desired by mother and infant.
The USPSTF members disclosed no conflicts of interest.
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