Lactation and maternal subclinical cardiovascular disease among premenopausal women

ArticleinAmerican journal of obstetrics and gynecology 207(1):46.e1-8 · July 2012with14 Reads
DOI: 10.1016/j.ajog.2012.04.030 · Source: PubMed
Abstract
The objective of the study was to examine the association between lactation and maternal subclinical cardiovascular disease. The Women and Infants Study of Healthy Hearts enrolled 607 mothers who delivered a singleton between 1997 and 2002. In 2007, participating mothers underwent measurements of carotid intima-media thickness, lumen diameter, adventitial diameter, and carotid-femoral pulse wave velocity. Multivariable linear and logistic regressions were used to estimate the associations between lactation and subclinical cardiovascular disease. Compared with mothers who breastfed for 3 or more months after every birth, mothers who never breastfed exhibited a 0.13 mm larger lumen diameter (95% confidence interval, 0.04-0.22) and a 0.12 mm larger adventitial diameter (95% confidence interval, 0.02-0.22) in models adjusting for age, parity, birth outcome, sociodemographic variables, health-related behaviors, family history, gestational weight gain, early adult body mass index, current body mass index, C-reactive protein, blood pressure, cholesterol, triglyceride, high-density lipoprotein, glucose, and insulin levels. Mothers who do not breastfeed have vascular characteristics associated with a greater risk of cardiovascular disease.
    • "In a Norwegian prospective population-based cohort study, lactation for $24 months decreased the cardiovascular mortality significantly among parous women aged ,65 years (hazard ratio, 0.36) [16]. Additionally, lactation is known to improve the subclinical vascular indices of cardiovascular disease [17], to promote lipid metabolism [18], and to reduce serum concentrations of C-reactive protein [19]. Moreover, these effects were found to be long-lasting in a large cohort study [20] . "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose To examine the association between female reproductive factors and age-related macular degeneration (AMD) in postmenopausal women. Design Nationwide population-based cross-sectional study. Methods A nationally representative dataset acquired from the 2010–2012 Korea National Health and Nutrition Examination Survey was analyzed. The dataset involved information for 4,377 postmenopausal women aged ≥50 years with a fundus photograph evaluable for AMD in either eye. All participants were interviewed using standardized questionnaires to determine reproductive factors including menstruation, pregnancy, parity, lactation, and hormonal use. The association between reproductive factors and each type of AMD was investigated. Results The mean age of the study participants was 63.1±0.2 years. Mean ages at menarche and menopause were 16.1±0.0 and 49.2±0.1 years, respectively. The overall prevalence rates of early and late AMD were 11.2% (95% confidence interval [CI], 10.1–12.5) and 0.8% (95% CI, 0.5–1.2), respectively. When adjusted for age, neither smoking nor alcohol use was associated with the presence of any AMD or late AMD. Multivariate logistic regression analysis revealed age (OR, 1.12 per 1 year), duration of lactation (OR, 0.91 per 6 months), and duration of use of oral contraceptive pills (OCP) (OR, 1.10 per 6 months) as associated factors for late AMD. The other variables did not yield a significant correlation with the risk of any AMD or late AMD. Conclusion After controlling for confounders, a longer duration of lactation appeared to protect against the development of late AMD. A longer duration of OCP use was associated with a higher risk of late AMD.
    Full-text · Article · Jul 2014
    • "Lactation is unique to women and may affect maternal metabolic health. A growing number of studies have shown that lactation has both short-and long-term beneficial effects on maternal cardiovascular risk factors, such as lipids, blood pressure, insulin and glucose homeostasis, obesity and diabetes234567891011, and that it may reduce the risk of cardiovascular events [12]. Even if one might expect that the reported favourable effects of lactation on cardiovascular risk factors would reduce the risk of cardiovascular death, the evidence is sparse. "
    [Show abstract] [Hide abstract] ABSTRACT: Recent studies suggest that lactation has long-term effects on risk for cardiovascular disease in women, but the effects on cardiovascular mortality are less well known. In a Norwegian population-based prospective cohort study, we studied the association of lifetime duration of lactation with cardiovascular mortality in 21,889 women aged 30 to 85 years who attended the second Nord-Tr[latin small letter o with stroke]ndelag Health Survey (HUNT2) in 1995--1997. The cohort was followed for mortality through 2010 by a linkage with the Cause of Death Registry. Adjusted hazard ratios (HR) for death from all causes and cardiovascular disease were calculated using Cox regression. During follow-up, 1,246 women died from cardiovascular disease. Parous women younger than 65 years who had never lactated had a higher cardiovascular mortality than the reference group of women who had lactated 24 months or more (HR 2.77, 95% confidence interval [CI]: 1.28, 5.99). There was some evidence of a U-shaped association, where women who reported lactating 7--12 months had a HR of 0.55 (95% CI: 0.27, 1.09). No clear associations were observed among women 65 years or older. Excess cardiovascular mortality rates were observed among parous women younger than 65 years who had never lactated. These findings support the hypothesis that lactation may have long-term influences on maternal cardiovascular health.
    Full-text · Article · Nov 2013
    • "Breastfeeding is associated with improved maternal and child health (Ip et al., 2007; Ram et al., 2008; Stuebe et al., 2009; Schwarz et al., 2010a Schwarz et al., , 2010b Stuebe et al., 2011; McClure et al., 2012 ). Supporting breastfeeding is an effective strategy for reducing health-care costs and disease burden (Jones et al., 2003; Bartick and Reinhold, 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: OBJECTIVES: (a) to apply an organisation-level, pre-implementation theory to identify and describe factors that may impact hospitals' readiness to achieve the Ten Steps and (b) to explore whether/how these factors vary across hospitals. DESIGN: a multisite, descriptive, qualitative study of eight hospitals that used semi-structured interviews of health-care professionals. Template analyses identified factors that related to organisation-level theory. Cross-site comparative analyses explored how factors varied across hospitals. SETTING: thirty-four health-care professionals from eight North Carolina hospitals serving low-wealth populations. The hospitals are participating in a quality improvement project to support the implementation of the Ten Steps. This study occurred during the pre-implementation phase. FINDINGS: several factors emerged relating to collective efficacy (i.e., the shared belief that the group, as a whole, is able to implement the Steps) and collective commitment (i.e., the shared belief that the group, as a whole, is committed to implementing the Steps) to implement the Ten Steps. Factors relating to both constructs included 'staff age/experience,' 'perceptions of forcing versus supporting mothers,' 'perceptions of mothers' culture,' and 'reliance on lactation consultants.' Factors relating to commitment included 'night versus day shift,' 'management support,' 'change champions,' 'observing mothers utilize breastfeeding support.' Factors relating to efficacy included 'staffing,' 'trainings,' and 'visitors in room.' Commitment-factors were more salient than efficacy-factors among the three large hospitals. Efficacy-factors were more salient than commitment-factors among the smaller hospitals. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: interventions focused on implementing the Ten Step may benefit from improving collective efficacy and collective commitment. Potential approaches could include skills-based, hands-on training highlighting benefits for mothers, staff, and the hospital, and addressing context-specific misconceptions about the Steps.
    Full-text · Article · Feb 2013
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