Field Christine, Grobman William A, Wu Jiqiang, Palatnik Anna, Landon Mark B, Scholtens Denise, Lowe William, Shah Nilay S, Josefson Jami, Khan Sadiya, Venkatesh Kartik K
Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio; the Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island; the Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin; and the Departments of Preventive Medicine, Medicine, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Obstet Gynecol. 2025 May 22;146(1):11-18. doi: 10.1097/AOG.0000000000005943.
To estimate whether breastfeeding is associated with the estimated risk of long-term atherosclerotic cardiovascular disease (ASCVD) and whether this association varies with prior gestational diabetes mellitus (GDM).
We conducted a secondary analysis from the prospective HAPO (Hyperglycemia and Adverse Pregnancy Outcome) Follow-Up Study. The exposure was any breastfeeding (yes or no). The primary outcomes, measured 10-14 years after delivery with the Framingham Risk Score, were estimated ASCVD risk (composite of fatal and nonfatal coronary heart disease and stroke) over the subsequent 10- and 30-year time periods. Multivariable linear regression models were used and adjusted for baseline pregnancy covariates: field center, age, body mass index (BMI), height, smoking and alcohol use, parity, and time from delivery to ASCVD risk assessment. Secondarily, we examined whether the association between breastfeeding and ASCVD varied by GDM status (effect modification).
Of 4,540 individuals, the median age was 30.6 years at baseline. More than three-fourths (79.7%) reported breastfeeding, which did not vary by GDM status (79.5% vs 81.0%). At 10-14 years after delivery (median 11.6 years), individuals who breastfed had a lower estimated risk of ASCVD over the subsequent 10 years (2.3% vs 2.5%, adjusted β -0.13, 95% CI, -0.25 to -0.02) and 30 years (6.2% vs 6.9%, adjusted β -0.36, 95% CI, -0.66 and -0.05). The association between breastfeeding and estimated ASCVD risk varied significantly by GDM status: The protective effect of breastfeeding was greater for individuals with GDM for estimated 10-year ASCVD risk (GDM: adjusted β -0.52, 95% CI, -0.98 and -0.05; no GDM: adjusted β -0.09, 95% CI, -0.20 and -0.02; interaction P =.004) and 30-year ASCVD risk (GDM: adjusted β -1.33, 95% CI, -2.53 and -0.14; no GDM: adjusted β -0.25, 95% CI, -0.54 and 0.03; interaction P =.003).
Breastfeeding, particularly after an individual had GDM, was associated with a lower estimated risk of long-term ASCVD. These findings indicate the potential benefit of breastfeeding for long-term cardiovascular health, especially among those with GDM.
评估母乳喂养是否与长期动脉粥样硬化性心血管疾病（ASCVD）的估计风险相关，以及这种关联是否因既往妊娠糖尿病（GDM）而有所不同。
我们对前瞻性HAPO（高血糖与不良妊娠结局）随访研究进行了二次分析。暴露因素为是否进行母乳喂养（是或否）。产后10 - 14年采用弗雷明汉风险评分测量的主要结局是随后10年和30年期间估计的ASCVD风险（致命和非致命冠心病及中风的综合风险）。使用多变量线性回归模型，并对基线妊娠协变量进行了调整：研究中心、年龄、体重指数（BMI）、身高、吸烟和饮酒情况、产次以及从分娩到ASCVD风险评估的时间。其次，我们研究了母乳喂养与ASCVD之间的关联是否因GDM状态而异（效应修饰）。
在4540名个体中，基线时的中位年龄为30.6岁。超过四分之三（79.7%）的人报告进行了母乳喂养，这在GDM状态之间没有差异（79.5%对81.0%）。在产后10 - 14年（中位时间为11.6年），进行母乳喂养的个体在随后10年的ASCVD估计风险较低（2.3%对2.5%，调整后的β为 - 0.13，95%置信区间为 - 0.25至 - 0.02），在30年时也是如此（6.2%对6.9%，调整后的β为 - 0.36，95%置信区间为 - 0.66至 - 0.05）。母乳喂养与估计的ASCVD风险之间的关联因GDM状态而有显著差异：对于有GDM的个体，母乳喂养对估计的10年ASCVD风险的保护作用更大（GDM：调整后的β为 - 0.****，95%置信区间为 - 0.98至 - 0.05；无GDM：调整后的β为 - 0.09，95%置信区间为 - 0.20至 - 0.02；交互作用P = 0.004），对30年ASCVD风险也是如此（GDM：调整后的β为 - 1.33，95%置信区间为 - 2.53至 - 0.14；无GDM：调整后的β为 - 0.25，95%置信区间为 - 0.54至0.03；交互作用P = 0.003）。
母乳喂养，尤其是在个体患有GDM之后，与较低的长期ASCVD估计风险相关。这些发现表明母乳喂养对长期心血管健康具有潜在益处，特别是在患有GDM的人群中。
