Schwarz Eleanor Bimla, Ray Roberta M, Stuebe Alison M, Allison Matthew A, Ness Roberta B, Freiberg Matthew S, Cauley Jane A
From the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; the Division of Maternal-Fetal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; the University of California, San Diego, La Jolla, California; and the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Obstet Gynecol. 2009 May;113(5):974-982. doi: 10.1097/01.AOG.0000346884.67796.ca.
To examine dose-response relationships between the cumulative number of months women lactated and postmenopausal risk factors for cardiovascular disease.
We examined data from 139,681 postmenopausal women (median age 63 years) who reported at least one live birth on enrolling in the Women's Health Initiative observational study or controlled trials. Multivariable models were used to control for sociodemographic (age, parity, race, education, income, age at menopause), lifestyle, and family history variables when examining the effect of duration of lactation on risk factors for cardiovascular disease, including obesity (body mass index [BMI] at or above 30), hypertension, self-reported diabetes, hyperlipidemia, and prevalent and incident cardiovascular disease.
Dose-response relationships were seen; in fully adjusted models, women who reported a lifetime history of more than 12 months of lactation were less likely to have hypertension (odds ratio [OR] 0.88, P<.001), diabetes (OR 0.80, P<.001), hyperlipidemia (OR 0.81, P<.001), or cardiovascular disease (OR 0.91, P=.008) than women who never breast-fed, but they were not less likely to be obese. In models adjusted for all above variables and BMI, similar relationships were seen. Using multivariate adjusted prevalence ratios from generalized linear models, we estimate that among parous women who did not breast-feed compared with those who breast-fed for more than 12 months, 42.1% versus 38.6% would have hypertension, 5.3% versus 4.3% would have diabetes, 14.8% versus 12.3% would have hyperlipidemia, and 9.9% versus 9.1% would have developed cardiovascular disease when postmenopausal. Over an average of 7.9 years of postmenopausal participation in the Women's Health Initiative, women with a single live birth who breast-fed for 7-12 months were significantly less likely to develop cardiovascular disease (hazard ratio 0.72, 95% confidence interval 0.53-0.97) than women who never breast-fed.
Among postmenopausal women, increased duration of lactation was associated with a lower prevalence of hypertension, diabetes, hyperlipidemia, and cardiovascular disease.
研究女性哺乳累计月数与绝经后心血管疾病风险因素之间的剂量反应关系。
我们分析了139681名绝经后女性（中位年龄63岁）的数据，这些女性在参加女性健康倡议观察性研究或对照试验时报告至少有一次活产。在研究哺乳持续时间对心血管疾病风险因素（包括肥胖（体重指数[BMI]达到或高于30）、高血压、自我报告的糖尿病、高脂血症以及现患和新发心血管疾病）的影响时，使用多变量模型来控制社会人口统计学因素（年龄、产次、种族、教育程度、收入、绝经年龄）、生活方式和家族史变量。
观察到了剂量反应关系；在完全调整模型中，报告有超过12个月哺乳史的女性与从未哺乳的女性相比，患高血压（优势比[OR]0.88，P<0.001）、糖尿病（OR 0.80，P<0.001）、高脂血症（OR 0.81，P<0.001）或心血管疾病（OR 0.91，P = 0.008）的可能性较小，但肥胖的可能性并未降低。在对上述所有变量和BMI进行调整的模型中，也观察到了类似的关系。使用广义线性模型的多变量调整患病率比，我们估计，在未哺乳的经产妇与哺乳超过12个月的经产妇中，绝经后高血压患病率分别为42.1%和38.6%，糖尿病患病率分别为5.3%和4.3%，高脂血症患病率分别为14.8%和12.3%，心血管疾病患病率分别为9.9%和9.1%。在女性健康倡议中平均7.9年的绝经后随访期间，有一次活产且哺乳7至12个月的女性患心血管疾病的可能性显著低于从未哺乳的女性（风险比0.72，95%置信区间0.53 - 0.97）。
在绝经后女性中，哺乳持续时间增加与高血压、糖尿病、高脂血症和心血管疾病的患病率降低有关。
