Breastfeeding may reduce type 2 diabetes risk among women with gestational diabetes, NIH study suggests

The longer a woman with gestational, or pregnancy-related, diabetes breastfeeds her infant, the lower her risk for developing type 2 diabetes later in life, suggests an analysis by researchers at the National Institutes of Health and other institutions.

The study was conducted by Cuilin Zhang, M.D., Ph.D., of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and colleagues. It appears in Diabetes Care.

In addition to health risks for mothers and babies, gestational diabetes increases the risk for type 2 diabetes 10 to 20 years after pregnancy. Type 2 diabetes increases the risk for heart disease, stroke and other health problems.

The researchers analyzed data from the Nurses’ Health Study II, a long-term study of risk factors for chronic diseases in women. Of more than 4,000 women in the study who had gestational diabetes, 873 developed type 2 diabetes over the course of 25 years. Compared to women with gestational diabetes who had not breastfed, those who breastfed for six to 12 months were 9% less likely to develop type 2 diabetes, those who breastfed for one to two years were 15% less likely, and those who breastfed for more than two years were 27% less likely.

The researchers suggested that clinicians may want to encourage patients with gestational diabetes to breastfeed if they are able to, to potentially reduce their type 2 diabetes risk.

The analysis was funded by NICHD with additional support from NIH’s National Institute of General Medical Sciences.

Empower parents, enable breastfeeding

UNICEF and WHO are calling on governments and all employers to adopt family-friendly policies that support breastfeeding.

The theme of this year’s World Breastfeeding Week is “Empower Parents, Enable Breastfeeding.” 

Family-friendly policies – such as paid parental leave – enable breastfeeding and help parents nurture and bond with their children in early life, when it matters most. The evidence is clear that during early childhood, the optimal nutrition provided by breastfeeding, along with nurturing care and stimulation, can strengthen children’s brain development with impacts that endure over a lifetime.

Family-friendly policies are particularly important for working parents. Mothers need time off from work to recover from birth and get breastfeeding off to a successful start. When a breastfeeding mother returns to work, her ability to continue breastfeeding depends on having access to breastfeeding breaks; a safe, private, and hygienic space for expressing and storing breastmilk; and affordable childcare at or near her workplace.

Time off work is also important for fathers: Paid paternity leave allows fathers to bond with their babies and promotes gender-equality, including through the sharing of childrearing and household responsibilities.

Returning to work too soon is a barrier to the early initiation of breastfeeding, exclusive breastfeeding in the first six months and continued breastfeeding until age 2 or longer – practices that can boost children’s immune systems, shield them from disease, and provide protection from noncommunicable diseases later in life.  Breastfeeding also protects maternal health — women who breastfeed reduce their risk of breast and ovarian cancers.

In addition to their impact on children, family-friendly policies support women’s participation in the workforce, improve their physical and mental health^,and enhance family well-being. They also advance business objectives and strengthen the economy. Such policies have been shown to increase employee retention, improve job satisfaction, and result in fewer absences. In short, family-friendly policies are good for families, babies and business.

As the world marks World Breastfeeding Week, WHO and UNICEF call on governments and all employers to adopt family-friendly policies – including paid maternity leave for a minimum of 18 weeks, and preferably, for a period of six months – as well as paid paternity leave.

In line with the policy actions advocated by the WHO-UNICEF-led Global Breastfeeding Collective, we also call for greater investments in comprehensive breastfeeding programmes, improved breastfeeding counselling and support for women in health facilities and the community, and an end to the promotion of breast-milk substitutes to enable parents to make informed decisions on the best way to feed their infants. 

Together, with the support of governments, employers and communities, we have the power to enable breastfeeding and support families in fostering a nurturing environment where all children thrive.

Experts confirm breastfeeding protects against child obesity – New WHO studies

A new study from WHO/Europe shows that, despite efforts aimed at prevention, parts of the WHO European Region continue to struggle with comparably higher rates of childhood obesity, while a second study shows that babies who have never or only infrequently been breastfed have an increased risk of becoming obese as children.

Mother cuddling with her newborn baby in the living room. Photo credit: HuffPost UK

Progress on tackling the childhood obesity crisis has been slow and inconsistent throughout the Region, according to the 2 studies released at this year’s European Congress on Obesity in Glasgow, United Kingdom.

“The longer a child is breastfed, the greater their protection from obesity. This knowledge can strengthen our efforts in preventing obesity. Acting on childhood obesity – including severe obesity – can have major benefits, not only for child health and well-being, but also for national health care systems, so we must do all we can to promote and protect breastfeeding across the Region,” said Dr Bente Mikkelsen, Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO/Europe.

Consequences of severe obesity

Severe obesity in children is associated with immediate and long-term cardiovascular, metabolic and other negative health outcomes. When comparing overweight children to children with severe obesity, the latter have a much worse cardio-metabolic risk factor profile. According to the new WHO study, “Prevalence of severe obesity among primary school children in 21 European countries”, severe obesity affects almost 400 000 of the roughly 13.7 million children aged 6–9 years living in the 21 participating countries.

This study is the first that investigates the prevalence of severe obesity in school children. Severe obesity is a serious public health issue and the results of this study show that a large number of children in the European Region suffer from it. Given its impact on education, health, social care and the economy, the new report emphasizes that obesity needs to be addressed via a range of approaches, from prevention to early diagnosis and treatment.

Link between breastfeeding and obesity

The second study, “Association between characteristics at birth, breastfeeding and obesity, in 22 countries”, found that despite the consistent flow of research evidence showing the health benefits from breastfeeding, along with numerous policy initiatives aimed at promoting optimal breastfeeding practices, adoption of exclusive breastfeeding in the European Region remains below the global recommended level.

WHO recommends exclusive breastfeeding for the first 6 months of life. Thereafter, infants should be given nutritionally adequate complementary foods with continued breastfeeding up to 2 years of age or beyond.

This study showed that, in nearly all countries, more than 77% of children were breastfed; but there were a few exceptions – in Ireland 46% of children were never breastfed, in France 38% and in Malta 35%. Only 4 out of 12 countries had a prevalence of exclusive breastfeeding (for 6 months or more) of 25% or higher: Tajikistan (73%), Turkmenistan (57%), Kazakhstan (51%) and Georgia (35%).

According to the study, breastfeeding practices in the Region fall short of WHO recommendations for a number of reasons, including: inefficient policies to encourage breastfeeding, lack of preparation of health professionals to support breastfeeding, intensive marketing of breast milk substitutes, and problems in legislation on maternity protection.

“The promotion of breastfeeding presents a window of opportunity for obesity prevention policy to respond to the problem of childhood obesity in the European Region. Existing national policies to promote breastfeeding practices and how these policies are developed, can lead some countries to be more or less successful in combating obesity,” said Dr Joao Breda, Head of the WHO European Office for Prevention and Control of Noncommunicable Diseases, who also led the WHO Childhood Obesity Surveillance Initiative, known as COSI. Research from this initiative was used for both reports.

COSI was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6–9 years. Since then, there have been 5 rounds of data collection in more than 40 countries and among more than half a million children.

When it comes to breastfeeding, ‘timing is everything’ in saving newborn lives – UNICEF chief

Three-in-five babies, mostly born in low- and middle-income countries, are not breastfed within the first hour of life, placing them at higher risk of death and disease, according to a new United Nations report launched on Tuesday.

UNICEF/Giacomo Pirozzi A newborn sleeps in his mother’s arms, in a health centre in Accra, Ghana.

“When it comes to the start of breastfeeding, timing is everything,” said Henrietta Fore, the UN Children’s Fund’s (UNICEF) Executive Director, on the eve of World Breastfeeding Week.

“In many countries, it can even be a matter of life or death,” she added.

In the report, Capture the Moment, UNICEF and the World Health Organization (WHO) note that while newborns who breastfeed in the first hour of life are significantly more likely to survive, they estimate that 78 million newborns are excluded.

“Each year, millions of newborns miss out on the benefits of early breastfeeding and the reasons – all too often – are things we can change,” she continued. “Mothers simply don’t receive enough support to breastfeed within those crucial minutes after birth, even from medical personnel at health facilities.”

World Breastfeeding Week is celebrated annually from 1 to 7 August to encourage breastfeeding and improve the health of babies around the world by providing infants with the nutrients they need.

Even a few hours delay after birth could pose life-threatening consequences. Skin-to-skin contact along with suckling at the breast stimulate the mother’s production of breastmilk, including colostrum, which is produced ahead of regular milk, in the first few days after giving birth. It is so rich in nutrients and antibodies, that it is often referred to as the baby’s first vaccine.

According to the report, 65 per cent of countries in Eastern and Southern Africa have the highest rate of breastfeeding within the first hour, while East Asia and the Pacific have the lowest rate with only 32 percent benefitting from the early initiation.

While nearly nine-in-ten babies born in Burundi, Sri Lanka and Vanuatu are breastfed within that first hour, only two-in-10 born in Azerbaijan, Chad and Montenegro were nursed.

“Breastfeeding gives children the best possible start in life,” said Tedros Adhanom Ghebreyesus, WHO Director-General. “We must urgently scale up support to mothers – be it from family members, health care workers, employers and governments, so they can give their children the start they deserve.”

Analyzing data from 76 countries, the report reveals some of the reasons why too many newborns are left waiting.

One common practice is to discard colostrum, and instead feed the infant honey, sugar water or infant formula, which also delays a newborn’s first critical contact with its mother.

The rise in elective C-sections also has an impact, with a study across 51 countries noting that in this type of delivery, initiation rates among newborns are significantly lower.

Earlier studies, cited in the report, show that newborns who began breastfeeding between two and 23 hours after birth, had a 33 per cent greater risk of dying, compared to those who breastfed within one hour. And the risk more than doubled among newborns who started a day or more after birth.

The report urges governments and other decision-makers to adopt strong legal measures to restrict the marketing of infant formula and other breastmilk substitutes to help address the situation.

The WHO and UNICEF-led Global Breastfeeding Collective also released the 2018 Global Breastfeeding Scorecard, which tracks progress for and urges countries to advance breastfeeding policies and programmes to help mothers breastfeed their babies in the first hour of life.

Breastfeeding all babies for the first 2 years would save more lives annually: WHO and UNICEF report

WHO and UNICEF has issued new ten-step guidance to increase support for breastfeeding in health facilities that provide maternity and newborn services. Breastfeeding all babies for the first 2 years would save the lives of more than 820 000 children under age 5 annually.

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The Ten Steps to Successful Breastfeeding underpin the Baby-friendly Hospital Initiative, which both organizations launched in 1991. The practical guidance encourages new mothers to breastfeed and informs health workers how best to support breastfeeding.

Breastfeeding is vital to a child’s lifelong health, and reduces costs for health facilities, families, and governments. Breastfeeding within the first hour of birth protects newborn babies from infections and saves lives. Infants are at greater risk of death due to diarrhoea and other infections when they are only partially breastfed or not breastfed at all. Breastfeeding also improves IQ, school readiness and attendance, and is associated with higher income in adult life. It also reduces the risk of breast cancer in the mother.

“Breastfeeding saves lives. Its benefits help keep babies healthy in their first days and last will into adulthood,” says UNICEF Executive Director Henrietta H. Fore. “But breastfeeding requires support, encouragement and guidance. With these basic steps, implemented properly, we can significantly improve breastfeeding rates around the world and give children the best possible start in life.”

WHO Director-General Dr Tedros Adhanom Ghebreyesus says that in many hospitals and communities around the world, whether a child can be breastfed or not can make the difference between life and death, and whether a child will develop to reach his or her full potential.

“Hospitals are not there just to cure the ill. They are there to promote life and ensure people can thrive and live their lives to their full potential,” says Dr Tedros. “As part of every country’s drive to achieve universal health coverage, there is no better or more crucial place to start than by ensuring the Ten Steps to Successful Breastfeeding are the standard for care of mothers and their babies.”

The new guidance describes practical steps countries should take to protect, promote and support breastfeeding in facilities providing maternity and newborn services. They provide the immediate health system platform to help mothers initiate breastfeeding within the first hour and breastfeed exclusively for six months.

It describes how hospitals should have a written breastfeeding policy in place, staff competencies, and antenatal and post-birth care, including breastfeeding support for mothers. It also recommends limited use of breastmilk substitutes, rooming-in, responsive feeding, educating parents on the use of bottles and pacifiers, and support when mothers and babies are discharged from hospital.

Note to editors

The Ten Steps are based on the WHO guidelines, issued in November 2017, titled Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services.

Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. Starting breastfeeding early increases the chances of a successful continuation of breastfeeding. Exclusive breastfeeding for six months has many benefits for the infant and mother. Chief among these is protection against gastrointestinal infections and malnutrition, which are observed not only in developing but also industrialized countries.

Breast-milk is also an important source of energy and nutrients in children aged 6–23 months. It can provide half or more of a child’s energy needs between 6-12 months, and one-third of energy needs between 12-24 months. Breast-milk is also a critical source of energy and nutrients during illness, and reduces mortality among children who are malnourished.

Children and adolescents who were breastfed as babies are less likely to be overweight or obese.

New analysis shows an investment of US$4.70 per newborn could generate US$300 billion in economic gains by 2025

Global Breastfeeding Collective

The Global Breastfeeding Scorecard, which evaluated 194 nations, found that only 40 per cent of children younger than six months are breastfed exclusively (given nothing but breastmilk) and only 23 countries have exclusive breastfeeding rates above 60 per cent.

Evidence shows that breastfeeding has cognitive and health benefits for both infants and their mothers. It is especially critical during the first six months of life, helping prevent diarrhoea and pneumonia, two major causes of death in infants. Mothers who breastfeed have a reduced risk of ovarian and breast cancer, two leading causes of death among women.

“Breastfeeding gives babies the best possible start in life,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “Breastmilk works like a baby’s first vaccine, protecting infants from potentially deadly diseases and giving them all the nourishment they need to survive and thrive.”

The scorecard was released at the start of World Breastfeeding Week alongside a new analysis demonstrating that an annual investment of only US$4.70 per newborn is required to increase the global rate of exclusive breastfeeding among children under six months to 50 per cent by 2025.

Nurturing the Health and Wealth of Nations: The Investment Case for Breastfeeding, suggests that meeting this target could save the lives of 520,000 children under the age of five and potentially generate US$300 billion in economic gains over 10 years, as a result of reduced illness and health care costs and increased productivity.

“Breastfeeding is one of the most effective—and cost effective—investments nations can make in the health of their youngest members and the future health of their economies and societies,” said UNICEF Executive Director Anthony Lake. “By failing to invest in breastfeeding, we are failing mothers and their babies—and paying a double price: in lost lives and in lost opportunity.”

The investment case shows that in five of the world’s largest emerging economies—China, India, Indonesia, Mexico and Nigeria—the lack of investment in breastfeeding results in an estimated 236,000 child deaths per year and US$119 billion in economic losses.

Globally, investment in breastfeeding is far too low. Each year, governments in lower- and middle-income countries spend approximately US$250 million on breastfeeding promotion; and donors provide only an additional US$85 million.

The Global Breastfeeding Collective is calling on countries to:

• Increase funding to raise breastfeeding rates from birth through two years.
• Fully implement the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions through strong legal measures that are enforced and independently monitored by organizations free from conflicts of interest.
• Enact paid family leave and workplace breastfeeding policies, building on the International Labour Organization’s maternity protection guidelines as a minimum requirement, including provisions for the informal sector.
• Implement the Ten Steps to Successful Breastfeeding in maternity facilities, including providing breastmilk for sick and vulnerable newborns.
• Improve access to skilled breastfeeding counselling as part of comprehensive breastfeeding policies and programmes in health facilities.
• Strengthen links between health facilities and communities, and encourage community networks that protect, promote, and support breastfeeding.
• Strengthen monitoring systems that track the progress of policies, programmes, and funding towards achieving both national and global breastfeeding targets.

Breastfeeding is critical for the achievement of many of the Sustainable Development Goals. It improves nutrition (SDG2), prevents child mortality and decreases the risk of non-communicable diseases (SDG3), and supports cognitive development and education (SDG4). Breastfeeding is also an enabler to ending poverty, promoting economic growth and reducing inequalities.