Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences, Berlin, Germany.
V. Serbsky Federal Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia.
BMC Med. 2023 Oct 16;21(1):393. doi: 10.1186/s12916-023-03071-7.
Breastfeeding has long been associated with numerous benefits for both mothers and infants. While some observational studies have explored the relationship between breastfeeding and mental health outcomes in mothers and children, a systematic review of the available evidence is lacking. The purpose of this study is to systematically evaluate the association between breastfeeding and mental health disorders in mothers and children.
We systematically searched MEDLINE and EMBASE from inception to June 2, 2023. The inclusion criteria consisted of all studies evaluating links between breastfeeding and development of mental health disorders in children and mothers. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) while grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of evidence. A random-effects meta-analysis was used if possible, to estimate the odds ratio for the association between breastfeeding and mental health outcomes. The Mantel-Haenszel method was utilised for pooling ORs across studies. Study heterogeneity was assessed using the I statistic.
Our review identified twenty-one original study. Of these, 18 focused on the association between breastfeeding and child health, assessing depressive disorders, schizophrenia, anxiety disorders, eating disorders and borderline personality disorder. Three studies evaluated the associations between breastfeeding and maternal mental health disorders. Three studies looking at outcomes in children showed no significant association between breastfeeding and occurrence of schizophrenia later in life (OR 0.98; 95% CI 0.57-1.71; I = 29%). For depressive disorders (5 studies) and anxiety disorders (3 studies), we found conflicting evidence with some studies showing a small protective effect while others found no effect. The GRADE certainty for all these findings was very low due to multiple limitations. Three studies looking at association between breastfeeding and maternal mental health, were too heterogeneous to draw any firm conclusions.
We found limited evidence to support a protective association between breastfeeding and the development of mental health disorders in children later in life. The data regarding the association between breastfeeding and maternal mental health beyond the postnatal period is also limited. The methodological limitations of the published literature prevent definitive conclusions, and further research is needed to better understand the relationship between breastfeeding and mental health in mothers and children.
母乳喂养长期以来一直与母婴双方的众多益处相关联。虽然一些观察性研究探讨了母乳喂养与母亲和儿童心理健康结果之间的关系，但缺乏对现有证据的系统综述。本研究的目的是系统评估母乳喂养与母亲和儿童心理健康障碍之间的关联。
我们系统地检索了 MEDLINE 和 EMBASE 数据库，检索时间从建库至 2023 年 6 月 2 日。纳入标准包括所有评估母乳喂养与儿童和母亲心理健康障碍发展之间关系的研究。使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险，使用推荐评估、制定与评价（GRADE）分级评估证据的确定性。如果可能，使用随机效应荟萃分析来估计母乳喂养与心理健康结果之间关联的优势比（OR）。使用 Mantel-Haenszel 法对研究间的 OR 进行汇总。使用 I ² 统计量评估研究异质性。
我们的综述共确定了 21 项原始研究。其中 18 项侧重于母乳喂养与儿童健康之间的关联，评估了抑郁障碍、精神分裂症、焦虑障碍、饮食障碍和边缘型人格障碍。三项研究评估了母乳喂养与产妇心理健康障碍之间的关联。三项研究观察到儿童结局，发现母乳喂养与日后发生精神分裂症之间无显著关联（OR 0.98；95%CI 0.57-1.71；I²=29%）。对于抑郁障碍（5 项研究）和焦虑障碍（3 项研究），我们发现证据相互矛盾，一些研究表明存在较小的保护作用，而其他研究则未发现影响。由于存在多种局限性，所有这些发现的 GRADE 确定性均非常低。三项研究观察到母乳喂养与产妇心理健康之间的关联，但由于过于异质，无法得出任何明确结论。
我们发现有限的证据支持母乳喂养与儿童日后发生心理健康障碍之间存在保护关联。关于母乳喂养与产后时期以外的产妇心理健康之间关联的数据也很有限。已发表文献的方法学局限性使得无法得出明确结论，需要进一步研究以更好地理解母乳喂养与母婴心理健康之间的关系。
