JL Ware et al. Am J Prev Med 2023; 65: 763-774. Associations Between Breastfeeding and Post-perinatal Infant Deaths in the U.S

This study examined a prospective cohort linking data on breastfeeding on birth certificates (starting in 2016) to infant death rates. This included 9,711,567 live births and 20,632 post-perinatal infant deaths.

Key findings:

• The overall adjusted OR for breastfeeding initiation with post-perinatal infant mortality was 0.67.
• Table 1 provides a ton of information about demographics and associated outcomes: Better education was associated with lower post-perinatal (7-365 days) death rate per 1,000 births. College graduate rate was 0.91 compared to 3.43 for lower than high school. Age 30-34 was 1.53 compared to 3.87 for <20 years. Non-hispanic Asian, Non-Hispanic White, and Hispanic were 1.11, 1.79 and 1.58 and much better than Non-Hispanic Black which was 4.07. Smoking during pregnancy rate was 5.68 compared to 1.83 for non-smoking during pregnancy
• Preterm infant had a much higher post-perinatal mortality rate: 7.97 vs 1.36 for term babies

One limitation that may contribute to an underestimate of the advantages of breastfeeding -this study determines only initiation of breastfeeding. Breastfeeding duration of >3 months has been associated with decreased infant mortality. In other words, in infants with longer breastfeeding, the advantages are likely to be more pronounced. Breastfeeding has been associated with lower rates of necrotizing enterocolitis and sudden unexpected infant deaths.

My take: Breastfeeding appears to confer health benefits to infants and mothers. Some of the improvements in infant mortality likely are due to the association of breastfeeding with other characteristics that reduce infant mortality including education, non- smoking during pregnancy, older mothers and race. The authors note that race is a “social construct, but the systemic or structural disadvantages associated with race contribute to health disparities…A Black infant is 2.4 times more likely to die before his or her first birthday in the U.S. than a White infant.”

Related blog posts:

• The High Toll of Sudden Infant Death
• Safe Sleep Recommendations
• Safe Sleep
• Are We Making Progress on Infant Sleep-Related Deaths? (Not anymore) (2018)
• Guilt of Breastfeeding Failure
• Feeling Guilty about Stopping Breastfeeding? Geoff Der, a statistician at the University of Glasgow who has worked with the same data in previous studies, said that the findings in the present study were robust and the authors’ method for eliminating selection bias was powerful…“In a society with a clean water supply and modern formulas,” he said, “a woman who isn’t able to breast-feed shouldn’t be feeling guilty, and the likelihood that there’s any harm to the baby is pretty slim.”