Optimal duration of exclusive breastfeeding

Abstract

Although the health benefits of breastfeeding are widely acknowledged, opinions and recommendations are strongly divided on the optimal duration of exclusive breastfeeding. Much of the debate has centered on the so-called 'weanling's dilemma' in developing countries: the choice between the known protective effect of exclusive breastfeeding against infectious morbidity and the (theoretical) insufficiency of breast milk alone to satisfy the infant's energy and micronutrient requirements beyond four months of age. To assess the effects on child health, growth, and development, and on maternal health, of exclusive breastfeeding for six months versus exclusive breastfeeding for three to four months with mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) thereafter through six months. We searched the following databases: MEDLINE (as of 1966), Index Medicus (before 1966), CINAHL, HealthSTAR, BIOSIS, CAB Abstracts, EMBASE-Medicine, EMBASE-Psychology, EconLit, Index Medicus for the WHO Eastern Mediterranean Region, African Index Medicus, LILACS (Latin American and Caribbean Health Sciences), EBM Reviews-Best Evidence, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. The two searches yielded a total of 2668 unique citations. Contacts with experts in the field yielded additional published and unpublished studies. The updated review extended the literature searched until December 2006 and yielded 835 additional unique citations. We selected all internally-controlled clinical trials and observational studies comparing child or maternal health outcomes with exclusive breastfeeding for six or more months versus exclusive breastfeeding for at least three to four months with continued mixed breastfeeding until at least six months. Studies were stratified according to study design (controlled trials versus observational studies), provenance (developing versus developed countries), and timing of compared feeding groups (three to seven months versus later). We independently assessed study quality and extracted data. We identified 22 independent studies meeting the selection criteria: 11 from developing countries (two of which were controlled trials in Honduras) and 11 from developed countries (all observational studies). Definitions of exclusive breastfeeding varied considerably across studies. Neither the trials nor the observational studies suggest that infants who continue to be exclusively breastfed for six months show deficits in weight or length gain, although larger sample sizes would be required to rule out modest differences in risk of undernutrition. In developing-country settings where newborn iron stores may be suboptimal, the evidence suggests that exclusive breastfeeding without iron supplementation through six months may compromise hematologic status. Based on studies from Belarus, Iran, and Nigeria, infants who continue exclusive breastfeeding for six months or more appear to have a significantly reduced risk of gastrointestinal and (in the Iranian and Nigerian studies) respiratory infection. No significant reduction in risk of atopic eczema, asthma, or other atopic outcomes has been demonstrated in studies from Finland, Australia, and Belarus. Data from the two Honduran trials and from observational studies from Bangladesh and Senegal suggest that exclusive breastfeeding through six months is associated with delayed resumption of menses and, in the Honduran trials, more rapid postpartum weight loss in the mother. We found no objective evidence of a 'weanling's dilemma'. Infants who are exclusively breastfed for six months experience less morbidity from gastrointestinal infection than those who are mixed breastfed as of three or four months, and no deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for six months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea. Although infants should still be managed individually so that insufficient growth or other adverse outcomes are not ignored and appropriate interventions are provided, the available evidence demonstrates no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed-country settings. Large randomized trials are recommended in both types of setting to rule out small effects on growth and to confirm the reported health benefits of exclusive breastfeeding for six months or beyond. 純母乳哺育的理想期間 雖然很多人都知道哺育母乳對健康的好處，但是有關純母乳哺育的理想期間仍明顯存在著許多不同的觀點與建議。在開發中國家，很多爭議都集中在所謂「離乳的兩難」：得在純母乳哺育以對抗傳染病的發生與母乳之營養和能量不足以供給超過4個月大之後的嬰兒以滿足其需求兩者中做出抉擇 比較連續6個月哺餵純母乳和連續3 – 4個月哺餵純母乳後接著6個月哺餵母乳和另外補充的水分及固體食物對於孩童的健康、生長、發育及母親健康的影響 我們搜尋了下列的資料庫：MEDLINE(如1966年份的)、Index Medicus(1966年之前)、CINAHL、HealthSTAR、BIOSIS、CAB Abstracts、EMBASEMedicine、EMBASEPsychology、EconLit、Index Medicus for the WHO Eastern Mediterranean Region、African Index Medicus、LILACS(Latin American and Caribbean Health Sciences)、EBM ReviewsBest Evidence、the Cochrane Database of Systematic Reviews，以及the Cochrane Central Register of Controlled Trials。這2種搜尋結果共得到總數為2668篇的單獨引用。跟該領域的專家接觸後得到額外發表過與未發表的研究。這更新的文獻回顧將搜尋的文章延伸到2006年12月並獲得另外835篇單獨引用...