Table 1.
Associations between lactation and disease outcomes informing the model
| Disease risk by type and by lactation status | Disease risk change associated with breastfeeding compared with formula feeding [95% CI] | Risk measure type | Limitations in the Monte Carlo simulation | Source |
|---|---|---|---|---|
| Pediatric Disease | ||||
| Acute lymphoblastic leukemia | ||||
| Any breastfeeding >6 months | 0.82 [0.73, 0.93] | Odds ratio | Disease onset had to occur before child turned 20 years. | Amitay & Keinan‐Boker 2015 |
| Acute otitis media | ||||
| Any breastfeeding | 0.77 [0.64, 0.91] | Pooled adjusted odds ratio | Disease onset had to occur before child turned 1 year | Ip et al., 2007 (AHRQ report) |
| Exclusive breastfeeding >3 months | 0.5 [0.36, 0.70] | |||
| Crohn's disease | ||||
| Any breastfeeding | 0.45 [0.26, 0.79] | Pooled odds ratio | Disease onset had to occur before child turned 20 years. Incidence between ages 18–20 was equal to ages 15–17. | Hörnell et al., 2013, Klement et al., 2004 |
| Ulcerative colitis | ||||
| Any breastfeeding | 0.56 [0.38, 0.81] | Pooled odds ratio | Disease onset had to occur before child turned 20 years. Incidence between ages 18–20 years was equal to ages 15–17 years. | Hörnell et al., 2013, Klement et al., 2004 |
| Gastrointestinal infection | ||||
| Exclusive breastfeeding 4 months with continued breastfeeding to 6 months | 0.41 [0.26, 0.64] | Odds ratio | Disease onset had to occur before child turned 6 months. Of the cases that occur, 90% are treated at home, 9.7% are treated in an outpatient care setting, and 0.3% require hospitalization. | Duijts et al., 2010 |
| Lower respiratory tract infection requiring hospitalization | ||||
| Exclusive breastfeeding >4 months | 0.72 [0.46, 0.86] | Risk reduction | Disease onset had to occur before child turned 1 year. | Ip et al., 2007 (AHRQ report) |
| Obesity among non‐Hispanic whites to age 4 years | ||||
| Never | 1.0 (Referent) | Pooled adjusted odds ratio | Disease onset had to occur before child turned 5 years. | Grummer‐Strawn & Mei, 2004 |
| Any breastfeeding 6–11.9 months | 0.70 [0.50, 0.99] | |||
| Any breastfeeding 12+ months | 0.49 [0.25, 0.95] | |||
| Necrotizing enterocolitis | ||||
| 500‐1000 g | Disease onset had to occur before child turned 36 weeks post‐menstrual gestational age. | Colaizy et al., 2016 | ||
| Partial breastfeeding prior to 36 weeks post‐menstrual gestational age | 0.72 [0.43, 1.21] | Adjusted odds ratio | ||
| Exclusive breastfeeding (≥98%) to 36 weeks post‐menstrual gestational age | 0.083 [0.0106, 0.65] | |||
| 1000‐1500 g | ||||
| Partial breastfeeding prior to 36 weeks post‐menstrual gestational age | 0.72 [0.43, 1.21] | Adjusted odds ratio | ||
| Exclusive breastfeeding (≥98%) to 36 weeks post‐menstrual gestational age | 0.083 [0.0106, 0.65] | |||
| Sudden Infant Death Syndrome | ||||
| Exclusive breastfeeding in the month before death | 0.27 [0.13, 0.56] | Odds ratio | Death onset had to occur before child turned 1 year. 90% of cases occurred under 6 months. 70% occurred between ages 2–4 months | Hauck et al., 2011 |
| Any breastfeeding in the month before death | 0.29 [0.16, 0.53] | |||
| Maternal Disease | ||||
| Breast cancer | ||||
| Per year of any lactation | 4.3% [2.9%, 5.8%] | Risk reduction | Risk reduction limited to a maximum of 48 months of lifetime lactation. | Collaborative Group on Hormonal Factors in Breast Cancer, 2002 |
| Premenopausal ovarian cancer | ||||
| >18 months lifetime any lactation | 0.66 [0.46, 0.96] | Relative risk | Risk reduction limited to a maximum of 18 months of lifetime lactation. Disease onset had to occur before mother turned 51 years. | Danforth et al., 2007 |
| 12–17 months lifetime any lactation | 0.82 [0.54, 1.24] | |||
| 7–11 months lifetime any lactation | 0.76 [0.52, 1.11] | |||
| 1–6 months lifetime any lactation | 0.96 [0.76, 1.21] | |||
| Never lactated | 1.0 (Referent) | |||
| Type 2 diabetes mellitus | ||||
| >23 months lifetime any lactation | 0.53 [0.40, 0.70] | Hazard ratio | Risk reduction limited to a maximum of 24 months of lifetime lactation. Disease onset was limited to 15 years after mother's last birth. | Stuebe et al, 2005 |
| 11–23 months lifetime any lactation | 0.76 [0.59, 0.98] | |||
| >6–11 months lifetime any lactation | 0.76 [0.58, 0.99] | |||
| 3–6 months lifetime any lactation | 0.78 [0.57, 1.06] | |||
| 0–3 months lifetime any lactation | 1.03 [0.80, 1.35] | |||
| Never lactated | 1.0 (Referent) | |||
| Hypertension | ||||
| 12 months or more of any lactation per birth | 1.0 (Referent) | Hazard ratio | Risk reduction limited to a maximum of 4 births. | Stuebe et al., 2011 |
| 9 to less than 12 months of any lactation per birth | 1.07 [0.99, 1.17] | |||
| 6 to less than 9 months of any lactation per birth | 1.09 [1.02, 1.18] | |||
| More than 3 to less than 6 months of any lactation per birth | 1.19 [1.11, 1.28] | |||
| More than 0 to 3 months of any lactation per birth | 1.21 [1.12, 1.30] | |||
| Never lactated | 1.22 [1.13, 1.32]k | |||
| Myocardial infarction | ||||
| >23 months lifetime any lactation | 0.66 [0.49, 0.89] | Hazard ratio | Risk reduction limited to a maximum of 24 months of lifetime lactation. Disease onset was limited to 30 years after mother's last birth. | Stuebe et al, 2009 |
| 11–23 months lifetime any lactation | 0.89 [0.71, 1.1] | |||
| >6–11 months lifetime any lactation | 0.96 [0.76, 1.21] | |||
| 3–6 months lifetime any lactation | 0.98 [0.8, 1.21] | |||
| 0–3 months lifetime any lactation | 0.94 [0.79, 1.12] | |||
| Never lactated | 1.0 (Referent) |
[Correction added on 17 November 2016, after first online publication: In the first and second columns of Table 1, the aOR values and description of the milk received for partial and exclusive weight categories were previously wrong and have been corrected in this current version.]