Leading Lactation Insights - December 2022

Breastfeeding Decreases Maternal Mortality

Maria Lennon, MSN, CNM, IBCLC

In recent years, research has shown us that, for mothers, breastfeeding reduces the risk of several morbidities. It is now widely accepted that breastfeeding decreases the risk of developing Type 2 Diabetes Mellitus, hypertension, cardiovascular disease and breast, endometrial and ovarian cancers. However, its association with mortality has not been well-studied. 

In a recent study published in the Lancet involving 166,708 women who had given birth, researchers found that a longer lifetime breastfeeding duration was associated with a lower risk of all-cause mortality in later life. These women were from two large cohorts of female nurses in the United States (U.S.) from the Nurses' Health Study (1986-2016) and the Nurses' Health Study II (1989-2019) who experienced at least one pregnancy lasting at least six months across their reproductive lifespans.

“The pooled multivariable-adjusted hazard ratios of all-cause mortality were 0.95 (95% CI: 0.92 to 0.98), 0.94 (95% CI: 0.91 to 0.98), 0.93 (95% CI: 0.90 to 0.97), and 0.93 (95% CI: 0.89 to 0.97), respectively, for women reporting lifetime total breastfeeding duration of 4-6, 7-11, 12-23, and ≥24 months, compared to women who breastfed for ≤3 months over their reproductive lifespan. Cause-specific analysis showed a similar pattern of non-linear inverse associations between lifetime total breastfeeding duration and CVD and cancer mortality (both p-values for non-linearity <0.01).”

This inverse association between longer breastfeeding duration and decreased mortality risk is biologically plausible when one considers the physiological changes of pregnancy such as additional fat accumulation essential for optimal fetal development and in anticipation of lactation. This additional adipose tissue results in increased visceral fat, insulin resistance, insulin production and circulating high lipid levels which could lead to an elevated risk of cardiovascular disease and cancer, and eventually to mortality. Studies in animals have shown that breastfeeding plays an important role in mobilizing stored fat, reestablishing glucose homeostasis, regulating insulin secretion and promoting lipid metabolism after birth. Observational studies suggest that breastfeeding is associated with improved glucose metabolism, and pancreatic beta-cell function, greater postpartum weight loss and risk of metabolic diseases. All these findings suggest that breastfeeding “plays a critical role in ‘resetting’ maternal metabolism by increasing metabolic expenditure.” This reduces the maternal risk of developing cardiovascular disease and cancer which decreases the risk of mortality in later life. 

The authors suggest that these results boost the evidence of the lifelong benefits of breastfeeding for mothers. Thus, policymakers and social communities should promote, support and protect breastfeeding. Healthcare professionals must do the same, especially in high-risk populations with low breastfeeding initiation.

Reference:
Wang YX, Arvizu M, Rich-Edwards JW, Manson JE, Wang L, Missmer SA, Chavarro JE. Breastfeeding duration and subsequent risk of mortality among US women: A prospective

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This month we are spotlighting Allegra Gatti Zemel, RN, IBCLC

Megan Quinn

Allegra Gatti Zemel is a Registered Nurse and IBCLC with nearly 20 years of experience in Maternal and Child Health in the hospital setting and beyond. Originally from Los Angeles, California, Allegra currently works at Greenwich Hospital in Greenwich, Connecticut on the maternity unit, within the lactation department, where she helps mothers of preterm and term infants initiate and maintain breastfeeding, educates new families on their feeding choices, coordinates postpartum lactation assessments, and serves as an RN. 

Allegra shares that she pursued healthcare as a profession because “science fascinates me and caring for people comes from my core as a person. My career has connected me with so many wonderful people and great families.” She decided to become an IBCLC while working in Maternal Child Care after welcoming her first child and finding her own breastfeeding experience “extremely foreign and challenging” at that time. Today, Allegra strives to educate and empower women, families, providers, and babies in fulfilling their feeding goals and desires. She performs in-home consultations to make feeding as comfortable and enjoyable as possible, and also provides education services as well as hospital visits and rounding to help set new families up for breastfeeding success – however they may define that. She has published a variety of blog articles and contributed expert content to a number of blogs and websites. 

Though Allegra shares that her current hospital is not yet Baby-Friendly, she notes that it does “work hard to support women to achieve their feeding goals” and would welcome more education about Baby-Friendly techniques to be disseminated if full designation is not currently possible. She says that current professional challenges include the amount of support that new families often require to initiate and maintain breastfeeding, noting that “as an IBCLC, I can only do so much. It takes a village, including obstetric providers and institutions, pediatricians, supportive families, and embraced babies.” As a result, Allegra has worked to help educate the larger healthcare community about lactation and feeding practices. She has presented breastfeeding research and data to her hospital’s maternity staff and previously developed and edited a perinatal teaching curriculum for The Parent Collective in New York and Connecticut.

In her free time, Allegra enjoys traveling and exploring nature with her family, friends, and trailblazing Tibetan Terrier. Thank you for your continued dedication to helping babies and families get the best possible start in life!

Thank you to this issue's contributors!

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