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Will breastfeeding prevent asthma?
There are few decisions about being a new parent that seem to drive so much discussion, controversy, and angst as whether or not to breast feed. Many of the decisions I get asked about socially do not have anything to do with the medical benefits of breastfeeding, but rather the social ones.
There is a certain amount of anxiety, and you may mothers hear frustration from new breastfeeding moms.
Will I be fatigued all the time? When I have help, I still need to pump? How do I fit this into my work schedule and how do I approach mu boss? What will happen to my breasts as a result of breast feeding? You can learn answers to these and many other breastfeeding questions at About.com breastfeeding site.
Breastfeeding and Professional Organizations
Professional organizations generally provide guidelines to help parents and doctors make decisions about certain healthcare decisions. The organizations have a processes in place as to how the organizations members set policy recommendations for the entire organization.
The American Academy of Pediatrics recommends exclusive breast feeding for the first 6 months of life and then continuation of breastfeeding as other foods are introduced. This recommendation encompasses many other factors than just allergy and asthma.
The Allergic Rhinitis and its Impact on Asthma (ARIA) work group of the American Academy of Allergy, Asthma & Immunology makes recommendations more focused on allergic disease.
It recommends that infants be breast fed for the first 3 months of life no matter what the family history of atopy or asthma.
The ARIA group acknowledges there may be a burden associated with breastfeeding to new mothers, while placing a high value on on the prevention of allergy and asthma. The group also acknowledges that the evidence to support this recommendation is potentially lacking. The group feels this is a conditional or weak recommendation meaning “The majority of individuals in this situation would want the suggested course of action, but many would not.”
The ARIA group also does not recommend any restriction diets when pregnant or breastfeeding to prevent allergic disease in kids.
What Is The Evidence?
The best answers in medicine come from randomized clinical trials. In these studies neither the doctor or the patient know what treatment a patient has been assigned. This allows researchers to overcome a number of different shortcomings. This is not really possible due to both social and ethical reasons.
A 2001 meta-analysis found that exclusive breastfeeding for at least 3 months led to a decreased incidence of asthma at ages 2 to 5. This study pooled results from 12 different studies to try to answer questions related to how exclusive breast feeding might effect later development of asthma.
Overall, an exclusively breast fed infant was 30% less likely to develop asthma than those not exclusively breast fed. However, when you break the families down by risk, the results may not be directly applicable to all moms across the board.
When only children at higher risk, those from families with a history of atopic disease, were considered the protective effect was 48%. On the other hand, no beneficial effect was seen when families had no family history of atopic disease.
In a more recent New Zealand study researchers asked parents if their kids had ever wheezed or used an inhaler in the last year or been diagnosed with asthma. The researchers found that exclusive breastfeeding protected against asthma up to age 6, but the benefit was more significant in kids who had some signs of allergic disease. Another study produced similar results. Another study demonstrated increased wheezing, shortness of breath, dry cough and persistent phlegm during the first 4 years of life when comparing never breast fed to infants breast fed exclusively for 6 months.
Will Breastfeeding Prevent Asthma?
So it seems we are back to the question of will breastfeeding prevent asthma? As a pediatrician I support the many benefits of breastfeeding and encourage moms to breastfeed for as long as they can.
In the real world this means maybe not exclusively breastfeeding for some, dealing with employers who are not always super supportive, and pumping. If you have never breastfed before it can be really difficult and the medical community is, unfortunately, not always supportive either.
Related to asthma it seems to me that there is likely benefit in the prevention of asthma and allergic disease, but this cannot be definitively stated. If you have a family history of allergic disease then it is more likely you will gain benefit than if there is no such history. Additionally, exclusive breastfeeding seems to be better than no breastfeeding, but non-exclusive breastfeeding is better than not breastfeeding at all.
In the end, there are better medical arguments for breastfeeding than the prevention of asthma. I believe breastfeeding is beneficial for both medical and social reasons. Talk to your doctor about whether it is right for you. If you think it is right for you than get help from someone who can help you (e.g. a lactation consultant) overcome any of the barriers you may face.
Source
- Brozek JL, Bousquet J, Baena-Cagnani CE. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 Revision. J Allergy Clin Immunol 2010;126:466–76.
- Gdalevich M, Mimouni D, Mimouni M. Breast-feeding and the risk of bronchial asthma in childhood: a systematic review with meta-analysis of prospective studies. J Pediatr. 2001 Aug;139(2):261–6.
- Sonnenschein-van der Voort AM, Jaddoe VW, van der Valk RJ, Willemsen SP, Hofman A, Moll HA, de Jongste JC, Duijts L. Duration and exclusiveness of breastfeeding and childhood asthma-related symptoms. Eur Respir J. 2012 Jan;39(1):81–9.