Asthma rates lower among infants breastfed at birth in hospital
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Key takeaways:
- An infant’s first feed had a significant impact on developing childhood asthma.
- Early breastfeeding might mitigate the risk for asthma.
ORLANDO — Breastfeeding during hospitalization right after birth was associated with a diminished rate of childhood asthma, according to an abstract presented during the American Academy of Pediatrics 2024 National Conference & Exhibition.
“We had seen previous studies that showed hospital feeding patterns (such as birth day of the week) impacted breastfeeding outcomes,” Laura Placke Ward MD, IBCLC, associate director of quality improvement in the NICU of the University of Cincinnati Medical Center and co-director of the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center, told Healio.
“Because we had access to a unique dataset that linked information on maternal/infant dyads during the birth hospitalization to childhood data at the regional children’s hospital, we decided to perform a pilot study designed to investigate whether early breastfeeding exposures, specifically during the postpartum hospital stay, had any connection to longer term health outcomes in our community,” Placke Ward said.
The study used data from the Maternal Infant Data Hub, which consisted of information on maternal and infant dyads born between 2017 and 2019. Researchers collected demographic data such as sex, race and insurance status as well as feeding data including feeding type, frequency and timing.
Among the 9,649 children (50.9% boys; 45% white; 36.2% with commercial insurance) included in the study, 81.4% (n = 7,850) received any breast milk and 30.8% (n = 2,973) received exclusively breast milk during birth hospitalization, with 5% (n= 480) having an asthma diagnosis.
In a multivariable analysis that controlled for sex, race and insurance type, odds ratios for developing asthma included 0.91 (95% CI, 0.72-1.16) for infants on any breast milk, 0.65 (95% CI, 0.53-0.8) for any breast milk for first feed and 0.72 (95% CI, 0.59-0.88) for any breast milk at discharge.
Odds ratios for developing asthma also included 0.59 (95% CI, 0.47-0.75) for exclusive breast milk, 0.69 (95% CI, 0.56-0.84) for exclusive breast milk for the first feed and 0.64 (95% CI, 0.52-0.79) for exclusive breast milk at discharge.
“In our initial analysis, we found that varying degrees of breast milk exposure during the postpartum hospital stay were associated with a decreased risk of asthma,” Placke Ward said. “However, when we looked at only those infants born full term and took into account other factors associated with asthma (such as race, insurance status and sex), the only breast milk feeding patterns that remained significant were exclusive breastmilk feedings for the entire admission, or in the 24-hour period prior to discharge.”
“We weren’t sure if we would find anything significant,” she continued. “We were excited to discover the results of our study supported what was already known — that breastfeeding does impact health outcomes, including childhood asthma — and emphasized the importance of hospital feeding patterns on asthma outcomes.”
Placke Ward further emphasized that what happens in the birth hospitalization matters.
“What is less clear is the reason behind the impact of early breastfeeding exposure during the postpartum stay on later development of asthma,” she said. “Is it the successful early breastfeeding experience that sets the stage for future breastfeeding success which results in protection? Or is it the breast milk exposure during this ‘early critical window’ cited in the literature that influences the infant’s immune system and facilitates the development of a healthy gut microbiome that mitigates the risk of developing asthma? This needs further study.”
She also explained that even though postpartum stay is typically only a couple of days, it represents an important time that can influence future breastfeeding success, and therefore longer-term health outcomes.
“It also highlights the significance of not only promoting breastfeeding, but specifically exclusive breastfeeding, especially during the birth hospitalization,” she said.
The next steps of the research include submitting this study for publication and looking at the impact of breast milk exposure during the birth hospitalization on other childhood conditions, such as food allergies, according to Placke Ward.
“Another question we would like to explore is whether donor human milk can provide similar protection as we expand its use in the newborn nursery,” she said.
Reference:
- Asthma rates lower in children who received only breast milk at birth hospital. https://www.aap.org/en/news-room/news-releases/aap/2024/asthma-rates-lower-in-children-who-received-only-breast-milk-at-birth-hospital/. Published Sept. 27, 2024. Accessed Oct. 4, 2024.
Perspective
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As a whole, I do not at all find it surprising that breast milk consumption decreases asthma. Breast milk consumption early in life plays a huge role in building the gut microbiome. It is rich in HMOs, which are complex sugars that babies themselves cannot digest.
Instead, these sugars serve as food for beneficial bacteria in the gut, particularly Bifidobacteria. These bacteria help in establishing a healthy microbiome, which can protect against infections and inflammation. This generally is not something found in formulas, although some formulas do contain HMOs.
Breast milk also contains live bacteria, including Lactobacillus and Bifidobacterium species, which help seed the infant’s gut microbiome. This initial colonization is crucial for the development of the immune system.
Other immune-modulating components such as antibodies and immune cells found in breast milk support the development of a healthy gut barrier and immune system, reducing the risk for allergies and infections.
The female body (and the human body in general) is amazing! The composition of breast milk can change over time and in response to the infant’s needs, influenced by factors such as the mother’s diet and the infant’s health. This adaptability can help better support the infant’s developing microbiome compared with the relatively static formulation of infant formula.
The reason why the shaping of the gut microbiome is so crucial as it pertains to asthma is because the gut microbiome helps educate and regulate the immune system during critical periods of early life and promotes the development of a more tolerant immune system that is less likely to overreact to harmless substances.
In the context of asthma, this means a reduced likelihood for developing allergic reactions to environmental allergens, which are a common trigger for asthma symptoms. Studies suggest that early life exposure to a diverse range of microbes, including those from maternal sources, pets and the natural environment, can help in establishing a healthy gut microbiome. This exposure is linked to a lower risk for developing asthma, as it may lead to a more resilient immune system overall.
However, I actually contradict these findings. I was exclusively breastfed from birth and developed asthma in childhood. We did grow up in an area of the United States with extremely high counts of many allergens, though.
I have 3-year-old twins, and both received a combination of colostrum and formula in the hospital because they were born at 36 weeks and it took my milk some time to fully come in. At home, I exclusively breastfed my daughter until she was 18 months. My son, on the other hand, had reflux and the consistency of breast milk was too thin for him. He didn’t do well when we tried to thicken it, so we went with formula.
Both of my kiddos have healthy immune systems thus far and my daughter doesn’t demonstrate any superiority in terms of immune function than my son. I did start both on spore-based probiotics when they were old enough to help bolster their microbiome, and I try to feed them a variety of fiber sources to fuel healthy gut bacteria.
This is what I would recommend to moms who need to use formula or prefer to use formula! Additionally, reducing simple sugars and food dyes can help maintain gut integrity.
I also think that it is important for doctors to make women aware of the benefits of breastfeeding beyond 3 months to allow them to then make an informed decision about the feeding plan they choose to pursue. In addition to the immune boosting benefits of breast milk, the act of breastfeeding supports bonding between the mother and baby.
That being said, there is a lot of pressure on moms to breastfeed, and moms (especially moms of newborns) have enough stressors! Some women are physically unable to breastfeed or might choose not to, and I think that it is important for those moms to not feel guilty. What matters most is that the baby is fed, and a mom who isn’t stressed is more equipped to care for her little one. As mentioned above, I have observed my twins (one breastfed, the other formula fed) and, truthfully, they are both healthy and strong.
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Ward LP, et al. Association between hospital feeding patterns and childhood asthma. Presented at: American Academy of Pediatrics 2024 National Conference & Exhibition; Sept. 27-Oct. 1, 2024; Orlando.
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