Breastfeeding boosts heart health in children

Breastfeeding appears to confer antihypertensive benefit in children, such that those who have ever breastfed have lower blood pressure (BP) at 3 years of age, even if they only received breast milk in the first few days of life, according to data from the CHILD* Cohort Study.

The beneficial effect of breastfeeding, according to the investigators, are independent of several maternal, birth, and childhood factors and seen regardless of breastfeeding duration and exclusivity. “These … could have long‐term health implications because BP is known to track throughout life and even relatively small elevations could predispose young children to hypertension later in adulthood.” [Circulation 2008;117:3171-3180]

Why consuming breast milk—which is also known as colostrum—during the first days of life may favourably influence cardiovascular health has several potential biological explanations, the investigators said.

“First, early breastfeeding strongly affects the colonization and composition of the intestinal microbiota … [and] an altered intestinal microbiota may be involved in atherogenic processes later in life,” they pointed out. “In addition, nutrients and bioactive components that are enriched in colostrum such as stem cells and vascular endothelial growth factor might influence cardiovascular development and have long‐lasting developmental benefits.” [BJOG 2016;123:983-993; Cell Host Microbe 2015;17:690-703; JAMA 2018;319:2381-2382; Adv Nutr 2014;5:770-778; Curr Res Nutr Food Sci 2013;1:37-47]

In the CHILD Cohort Study, the investigators looked at early life feeding and BP data (at 3 years of age) from 2,382 children. Nearly all of them (2,333, 98 percent) were ever breastfed, of whom 98 (4.1 percent) briefly received breast milk in the first days of life during their hospital stay (early limited breastfeeding) while 2,235 (93.8 percent) continued to breastfeed after hospital discharge (sustained breastfeeding).

Infant birth characteristics, length of hospital stay after delivery, height, and body mass index at 3 years of age were similar across the three breastfeeding groups. Meanwhile, the mean systolic/diastolic BP was 99/57 mm Hg overall and higher in the group of children who were never breastfed vs those who had sustained and early limited breastfeeding (103/60 mm Hg vs 99/58 and 99/57 mm Hg). [J Am Heart Assoc 2021;doi:10.1161/JAHA.120.019067]

Systolic BP remained lower in ever- vs never-breastfed children in a multivariable linear regression model (sustained group: difference, −3.47 mm Hg, 95 percent confidence interval CI, −6.14 to −0.80; early limited group: difference, −4.24 mm Hg, 95 percent CI, −7.45 to −1.04).

“Despite the observational nature of our findings, they emphasize the importance of early breastfeeding initiation, even if exclusive or sustained breastfeeding is not possible,” the investigators stated.

“Notably, the lack of a ‘dose response’ according to breastfeeding duration or exclusivity in our study is consistent with some prior studies and highlights another potential reason for the heterogeneity and overall null findings in previous meta‐analyses: if any breastfeeding is sufficient to influence BP, then no difference would be expected when comparing ‘more versus less’ breastfeeding, as many studies have done, including PROBIT,” they said. [Early Hum De 2010; 86:463-468; Lancet 2016;387:475-490; BMJ 2003;327:1189-1195]

Taken together, the CHILD Cohort Study data point to the importance of antenatal education and immediate postpartum lactation support to facilitate breastfeeding initiation and provision of colostrum, according to the investigators.

“They are especially relevant to hospitals implementing cost containment strategies that could impede breastfeeding initiation, such as early postpartum discharge (often less than 24 hours following a vaginal delivery) and/or elimination of lactation support services on postpartum units. [T]he short‐term savings from these practices could be greatly outweighed by the long‐term costs from resulting cardiovascular health deficits later in life,” they said.

*Canadian Healthy Infant Longitudinal Development