Breastfeeding and Maternal and Child Cardiometabolic Outcomes 10-14 Years after Delivery

Background: Breastfeeding can improve long-term maternal and child cardiometabolic outcomes, but many of the cardiometabolic outcomes remain understudied. Objective: To examine the association between breastfeeding and maternal and child cardiometabolic outcomes 10-14 years after delivery. Study Design: A secondary analysis of the prospective Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study (2013-2016). The exposure was any breastfeeding. The primary outcomes were maternal and child disorders of glucose metabolism assessed separately and defined as one of the following: prediabetes (impaired fasting glucose [100-125 mg/dL] or impaired glucose tolerance [2-hour plasma glucose of 140-199 mg/dL]) or type 2 diabetes mellitus. Secondary outcomes included maternal and child hypertension and dyslipidemia (low-density lipoprotein ≥103 mg/dL, total cholesterol ≥200 mg/dL, or triglycerides ≥200 mg/dL), and child adiposity (body fat percentage >85th). Multivariate logistic regression was used to examine the association between breastfeeding and maternal and child cardiometabolic outcomes. Results: Of 4,685 assessed maternal-child dyads, 79.7% reported breastfeeding. The risk of maternal disorders of glucose metabolism did not differ by breastfeeding status (24.1% versus 24.5% with versus without breastfeeding, adjusted relative risk [aRR] 1.00, 95% confidence interval [CI] 0.88-1.14). The risk of childhood disorders of glucose metabolism was lower with breastfeeding (10.7% versus 13.7%, aRR: 0.76, 95% CI: 0.63-0.92). With regard to secondary outcomes, mothers who breastfed had a lower rate of dyslipidemia (29.4% versus 32.8%, aRR: 0.88, 95% CI: 0.80-0.98). Offspring that were breastfed had lower rates of child adiposity (13.6% versus 17.5%, aRR: 0.82, 95% CI: 0.70-0.96). There was no difference in the rate of maternal hypertension by breastfeeding status. In the subgroup of mothers with gestational diabetes, breastfeeding was associated with a lower risk of child hypertension (aRR: 0.66, 95% CI: 0.45-0.99) and a lower risk of child adiposity measured by skinfold sum > 85th percentile (aRR: 0.67, 95% CI: 0.49-0.92). Conclusions: In an international prospective cohort, breastfeeding was associated with a reduced risk of maternal hypercholesterolemia and disorders of glucose metabolism and adiposity in the offspring.