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Liu, J.Z.* ; Liao, M. ; Zheng, L.* ; Li, H.R.* ; Su, X.* ; Feng, Y.H.* ; Qiu, J.M.* ; Zhang, S.W.* ; Cai, J.* ; Chen, S.Y.* ; Huang, S.Q.* ; Huang, H.K.* ; Ye, Y.B.* ; Han, S.S.* ; Zhu, S.* ; Lu, D.L.* ; Lo, K.* ; Zeng, F.F.*

Associations of breastfeeding with maternal and child health outcomes: Umbrella review.

Am. J. Clin. Nutr. 122, 1061-1074 (2025)

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BACKGROUND: Breastfeeding (BF) has been reported beneficial for both mothers and their offspring, but the evidence for these associations has not been systematically evaluated. OBJECTIVE: This umbrella review aims to assess the credibility of existing evidence regarding the associations between BF and health outcomes in mothers and offspring. METHODS: For each health outcome, evidence levels were determined using reanalyzed random-effects estimates, between-study heterogeneity, 95% predictive intervals, publication bias, small-study effects, and excess significance bias. Methodological quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), and evidence credibility was graded with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: Overall, 192 meta-analyses from 62 articles were included. Among maternal outcomes, three meta-analyses (3/65, 4.6%) were considered to provide convincing evidence that BF reduced the risks of ovarian cancer (odds ratio [OR] range: 0.70-0.78) and hypertension (OR range: 0.89-0.93). For short-term offspring outcomes, five meta-analyses (5/114, 4.4%) were considered to provide convincing evidence that exclusive breastfeeding (EBF) or ever BF was associated with lower risks of sudden infant death syndrome (SIDS) (OR: 0.63; 95% confidence interval [CI]: 0.54, 0.73) and allergic rhinitis (OR: 0.61; 95% CI: 0.54, 0.70), alongside improved physical fitness (standing long jump, standardized mean differences [SMDs]: 0.20-0.27). Early BF initiation (<1 hour after birth) reduced neonatal mortality risk by 56% (OR: 0.44; 95% CI: 0.33, 0.61). Regarding long-term offspring outcomes, two meta-analyses (2/13, 15.4%) were considered to offer highly suggestive and suggestive evidence, respectively, suggesting the inverse associations of ever BF on overweight/obesity and type 2 diabetes mellitus (T2DM) in adulthood. After GRADE credibility assessment, only 4 of 192 meta-analyses were classified as moderate-quality evidence. CONCLUSIONS: Our findings support the benefits of BF for mothers and their offspring, underscoring the importance of promoting BF practices to improve maternal and child health outcomes. URL OF REGISTRATION: PROSPERO CRD42023447328. This trial was registered at PROSPERO as CRD42023447328. (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023447328).

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