Breastfeeding delivers long-term cardiometabolic benefits in offspring

In a secondary analysis of the HAPO FUS*, breastfeeding was found to be associated with lower rate of glucose metabolism disorders in the offspring; however, this association was not seen among the mothers.

“The WHO recommends exclusive breastfeeding for the first 6 months of an infant’s life given strong evidence for early health benefits. There are also benefits for the mother such as increased insulin sensitivity, which reduces risk of type 2 diabetes (T2D) and gynaecologic cancers,” said Dr Yiwen Cui from the Medical College of Wisconsin, Milwaukee, Wisconsin, US, at SMFM 2024.

However, there is insufficient evidence supporting the connection between breastfeeding and childhood outcomes like obesity, T2D, or metabolic syndrome, she continued. As such, Cui and colleagues sought to evaluate the link between breastfeeding and maternal and child cardiometabolic health 10–14 years postpartum.

Mother-child pairs from the HAPO FUS who had available information on breastfeeding status were included in the analysis (n=4,685). Of these dyads, 3,735 comprised the breastfeeding subgroup. The average maternal age in this subgroup was 42.4 years; for the offspring, it was 11.4 years. [SMFM 2024, abstract 30]

The rate of glucose metabolism disorders was lower among breastfed offspring vs those who were not (10.7 percent vs 13.7 percent; adjusted odds ratio [aOR], 0.73; p<0.01). For mothers, no significant difference was observed (24.1 percent vs 24.5 percent; aOR, 1.01; p=0.85).

Secondary outcomes

Fewer breastfed offspring had body fat percentage above the 85^th percentile compared with those who were not breastfed (13.6 percent vs 17.5 percent; aOR, 0.62; p<0.01). The same effect was seen for midpoint waist circumference >85^th percentile (14.2 percent vs 16.9 percent; aOR, 0.61; p=0.04) and skinfold sum >85^th percentile (13.9 percent vs 17.1 percent; aOR, 0.71; p=0.01).

Findings from the secondary offspring outcomes suggest that breastfeeding was associated with lower odds of child adiposity, noted Cui.

For mothers, breastfeeding rendered benefit in terms of hypercholesterolaemia (29.4 percent vs 32.8 percent; aOR, 0.84; p=0.04).

Subgroup analysis

On subgroup analysis looking at pre-pregnancy BMI ≥30 kg/m², there was no difference in maternal long-term cardiometabolic outcomes by breastfeeding status. Among breastfed offspring in this subgroup, there was a reduction in the risk of glucose metabolism disorders (aOR, 0.63).

In the subgroup of mums who met the criteria for gestational diabetes (GDM), breastfeeding was tied to long-term risk reduction in maternal hypercholesterolaemia (aOR, 0.57) and hypertriglyceridaemia (aOR, 0.46). No differences were seen in offspring cardiometabolic outcomes.

Clinical implications

The study however was limited by the retrospective study design and the small sample size of high-risk subgroups (ie, those with GDM, maternal obesity). Data on social and lifestyle influences that might confound measures of cardiometabolic health, as well as breastfeeding duration, were also lacking. “Evidence suggests that the benefits of breastfeeding can accumulate over time,” Cui noted.

“[Nonetheless, our study builds on data supporting] breastfeeding as a cost-effective public health measure that can reduce or mitigate long-term risk factors for cardiometabolic diseases,” said Cui. “Building evidence for long-term benefits for the offspring can motivate mothers to start and continue breastfeeding.”

The team called for further investigation on the role of breastfeeding in cohorts at risk of cardiovascular disease.

“[Moreover,] new research suggests that maternal conditions such as GDM can alter the molecular and signaling constituents of milk. Therefore, there needs to be a better understanding of how milk constituents can impact metabolic programming in early infant growth patterns and metabolic disorders,” Cui added.