Clinical Epidemiology Team Medical University of Innsbruck Innsbruck Austria.
National Institute for Health Research Bristol Biomedical Research CentreUniversity Hospitals Bristol and Weston National Health Service Foundation Trust and the University of Bristol Bristol United Kingdom.
J Am Heart Assoc. 2022 Jan 18;11(2):e022746. doi: 10.1161/JAHA.121.022746. Epub 2022 Jan 11.
Background Breastfeeding has been robustly linked to reduced maternal risk of breast cancer, ovarian cancer, and type 2 diabetes. We herein systematically reviewed the published evidence on the association of breastfeeding with maternal risk of cardiovascular disease (CVD) outcomes. Methods and Results Our systematic search of PubMed and Web of Science of articles published up to April 16, 2021, identified 8 relevant prospective studies involving 1 192 700 parous women (weighted mean age: 51.3 years at study entry, 24.6 years at first birth; weighted mean number of births: 2.3). A total of 982 566 women (82%) reported having ever breastfed (weighted mean lifetime duration of breastfeeding: 15.6 months). During a weighted median follow-up of 10.3 years, 54 226 CVD, 26 913 coronary heart disease, 30 843 stroke, and 10 766 fatal CVD events were recorded. In a random-effects meta-analysis, the pooled multivariable-adjusted hazard ratios comparing parous women who ever breastfed to those who never breastfed were 0.89 for CVD (95% CI, 0.83-0.95; I=79.4%), 0.86 for coronary heart disease (95% CI, 0.78-0.95; I=79.7%), 0.88 for stroke (95% CI, 0.79-0.99; I=79.6%), and 0.83 for fatal CVD (95% CI, 0.76-0.92; I=47.7%). The quality of the evidence assessed with the Grading of Recommendations Assessment, Development, and Evaluation tool ranged from very low to moderate, which was mainly driven by high between-studies heterogeneity. Strengths of associations did not differ by mean age at study entry, median follow-up duration, mean parity, level of adjustment, study quality, or geographical region. A progressive risk reduction of all CVD outcomes with lifetime durations of breastfeeding from 0 up to 12 months was found, with some uncertainty about shapes of associations for longer durations. Conclusions Breastfeeding was associated with reduced maternal risk of CVD outcomes.
背景 母乳喂养与降低母亲患乳腺癌、卵巢癌和 2 型糖尿病的风险密切相关。我们在此系统地回顾了已发表的关于母乳喂养与母亲患心血管疾病（CVD）结局风险关联的证据。
方法和结果 我们对截至 2021 年 4 月 16 日在 PubMed 和 Web of Science 上发表的文章进行了系统搜索，确定了 8 项相关的前瞻性研究，涉及 1192700 名经产妇女（加权平均年龄：研究入组时为 51.3 岁，首次分娩时为 24.6 岁；加权平均生育次数：2.3 次）。共有 982566 名妇女（82%）报告曾进行过母乳喂养（加权平均母乳喂养时间为 15.6 个月）。在加权中位数为 10.3 年的随访期间，记录了 54226 例 CVD、26913 例冠心病、30843 例中风和 10766 例致命 CVD 事件。在随机效应荟萃分析中，与从未母乳喂养的经产妇女相比，曾母乳喂养的妇女患 CVD 的多变量调整后的合并风险比为 0.89（95%CI，0.83-0.95；I=79.4%），冠心病为 0.86（95%CI，0.78-0.95；I=79.7%），中风为 0.88（95%CI，0.79-0.99；I=79.6%），致命 CVD 为 0.83（95%CI，0.76-0.92；I=47.7%）。使用 Grading of Recommendations Assessment, Development, and Evaluation 工具评估的证据质量从极低到中等，这主要是由于研究间的高度异质性。关联的强度不因研究入组时的平均年龄、中位随访时间、平均生育次数、调整水平、研究质量或地理位置而异。研究发现，随着母乳喂养时间从 0 到 12 个月的延长，所有 CVD 结局的风险呈逐渐降低趋势，但对较长时间的关联形状存在一定的不确定性。
结论 母乳喂养与降低母亲患 CVD 结局的风险相关。
