Breastfeeding duration and subsequent risk of mortality among US women: A prospective cohort study

Identifying Factors Associated With Breastfeeding Length Among Filipino Migrant Women in South Korea

BACKGROUND

Migrant women becoming mothers often face social, economic, and family challenges that can affect their dietary and breastfeeding practices. This study identified factors associated with breastfeeding length in migrant women.

METHODS

The study sample involved 504 migrant women from the Filipino Women's Diet and Health Study (FiLWHEL) in 2014-2016. Two-hundred-seventy women who had completed information on demographic characteristics, 24-h dietary recall, breastfeeding, parity, and health conditions were included in the analysis. Multivariable logistic and linear regression models were applied to identify significant factors associated with breastfeeding length cross-sectionally.

RESULTS

The median (interquartile range [IQR]) for age was 35 (30, 40) years, and the mean body mass index (BMI) was 23.8 kg/m2; 62 women (23%) were breastfeeding for at least 1 year, with the median (IQR) length of 4 (1, 10) months per child. The median (IQR) of the total intake of fruits, vegetables, nuts, and legumes was 165.5 (76.9, 265.9) g/day. Women who consumed the highest tertile of fruits, vegetables, nuts, and legumes compared to those in the lowest tertile were more likely to breastfeed for at least 12 months (adjusted-OR [95% CI]: 2.24 [1.08-4.67]), primarily driven by vegetable consumption (adjusted-OR [95% CI]: 2.34 [1.11-4.93]). Additionally, women in the highest tertile of these food groups or earned an annual income of 20-40 M KRW (~15-30 K USD) appeared to breastfeed longer compared to their counterparts (p < 0.05).

CONCLUSIONS

This study suggests that dietary quality and income may impact breastfeeding duration for migrant women in South Korea.

Dr. Ruth Lawrence, An Exemplar of Successful Aging (AKA Ruthie Turns 100: What is Her Secret?)

Successful aging is a dynamic process shaped by genetic, environmental, and lifestyle factors that influence health and well-being across the lifespan. Pioneering researchers such as Dr. Ruth Lawrence have demonstrated how intentional choices in diet, physical activity, social engagement, and mental resilience contribute to longevity and quality of life. This review explores the concept of successful aging, tracing its origins in the groundbreaking work of Havighurst, Rowe, and Kahn, and incorporating insights from Dr. George Vaillant's longitudinal studies, including the Harvard Study of Adult Development and the Grant Study. These works highlight the profound impact of psychosocial factors, adaptability, and meaningful relationships in fostering vitality and emotional fulfillment throughout life. Drawing on evidence from meta-analyses, centenarian studies, and landmark intervention trials such as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, this review examines how modifiable lifestyle factors influence aging trajectories. It also discusses emerging research linking maternal behaviors-such as breastfeeding-to long-term health benefits, including reduced risks of chronic diseases and cognitive decline. Dr. Lawrence's extraordinary century-long life exemplifies these principles, showcasing the interplay of genetics, lifestyle, and purpose in achieving successful aging. By synthesizing existing research and honoring Dr. Lawrence's legacy, this article highlights the importance of integrative approaches to aging well. It advocates for holistic strategies that combine individual health behaviors, community support, and systemic policy changes to promote longevity and health span. Dr. Lawrence's contributions to breastfeeding medicine and her embodiment of the six pillars of lifestyle medicine-nutrition, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections-serve as a testament to the power of lifestyle in shaping vibrant, fulfilling lives. Her example inspires a vision of aging as an opportunity for growth, connection, and continued impact.

Endometriosis and uterine fibroids and risk of premature mortality: prospective cohort study

OBJECTIVE

To prospectively assess the effect of endometriosis and uterine fibroids on the long term risk of premature mortality (younger than 70 years).

DESIGN

Prospective cohort study SETTING: The Nurses' Health Study II, United States (1989-2019).

PARTICIPANTS

110 091 women aged 25-42 years in 1989 without a history of hysterectomy before endometriosis or fibroids diagnosis, cardiovascular diseases, or cancer.

MAIN OUTCOME MEASURES

Hazard ratios (estimated by Cox proportional hazards models) for total and cause specific premature mortality according to laparoscopically confirmed endometriosis or ultrasound or hysterectomy confirmed uterine fibroids reported in biennial questionnaires.

RESULTS

4356 premature deaths were recorded during 2 994 354 person years of follow-up (27.2 years per person), including 1459 from cancer, 304 from cardiovascular diseases, and 90 from respiratory diseases. The crude incidence of all cause premature mortality for women with and without laparoscopically confirmed endometriosis was 2.01 and 1.40 per 1000 person years, respectively. In age adjusted models, laparoscopically confirmed endometriosis was associated with a hazard ratio of 1.19 (95% confidence interval 1.09 to 1.30) for premature death; these models were strengthened after also adjusting for potential confounders including behavioral factors (1.31, 1.20 to 1.44). Cause specific mortality analyses showed that the association was largely driven by mortality from senility and ill-defined diseases (1.80, 1.19 to 2.73), non-malignant respiratory diseases (1.95, 1.11 to 3.41), diseases of the nervous system and sense organs (2.50, 1.40 to 4.44), and malignant neoplasm of gynecological organs (2.76, 1.79 to 4.26). Ultrasound or hysterectomy confirmed uterine fibroids were not associated with all cause premature mortality (1.03, 0.95 to 1.11), but were associated with a greater risk of mortality from malignant neoplasm of gynecological organs (2.32, 1.59 to 3.40) in cause specific mortality analyses. The risk of mortality caused by cardiovascular and respiratory diseases varied according to joint categories of endometriosis and uterine fibroids, with an increased risk of all cause premature mortality among women reporting both endometriosis and uterine fibroids.

CONCLUSION

Women with a history of endometriosis and uterine fibroids might have an increased long term risk of premature mortality extending beyond their reproductive lifespan. These conditions were also associated with an increased risk of death due to gynecological cancers. Endometriosis was associated with a greater risk of non-cancer mortality. These findings highlight the importance for primary care providers to consider these gynecological disorders in their assessment of women's health.

Quantifying the Association between Pump Use and Breastfeeding Duration

OBJECTIVE

To quantify the extent to which pump use is associated with breastfeeding duration.

STUDY DESIGN

We conducted a cross-sectional analysis of weighted data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System from Maine, Michigan, New Mexico, and Utah between 2016 and 2021. Included respondents had a live-born infant at survey completion, initiated breastfeeding, and had nonmissing data for reported pump use and breastfeeding duration. Using Cox proportional hazard regression, we quantified the hazard of breastfeeding cessation and median duration (weeks) of breastfeeding by pump use. Pump use was suspected to be differentially impacted by race and ethnicity; an interaction was tested in our regression model.

RESULTS

Our sample included 19 719 mothers (weighted n = 723 808) with mean age (SD) 29.5 years (5.6). Mothers with age <18 years, Medicaid enrollment, race, and ethnicity other than non-Hispanic White, lower income or education, and unmarried status demonstrated lower pump use (P < .001). Pump use was associated with 37% lower hazard of breastfeeding cessation (adjusted hazard ratio 0.63; 95% CI: 0.56-0.70) and 21 additional weeks of breastfeeding on average. The association varied by race and ethnicity (significant interaction observed between pump use and non-Hispanic Black mothers, P = .013); stratified analysis demonstrated the lowest hazard of breastfeeding cessation among non-Hispanic Black and Native American pump users (adjusted hazard ratio 0.47 [0.40-0.54] and 0.51 [0.37-0.70], respectively).

CONCLUSIONS

Pump use was associated with longer breastfeeding duration; the greatest magnitudes of association were found among non-Hispanic Black and Native American participants, groups disproportionately affected by breastfeeding inequities. Future research examining the context around and causal impact of pump use on breastfeeding outcomes is needed.

Reproductive factors and risk of cardiovascular outcomes in women with ST-elevation myocardial infarction

BACKGROUND

There are many sex-specific factors affecting myocardial infarction (MI) outcomes in males and females. This study aimed to evaluate the relationship between reproductive factors and cardiovascular outcomes in women after ST-elevation MI.

METHOD

This retrospective cohort study was initiated in 2016-2017 at Chamran Hospital, Isfahan, Iran. One hundred eighty women with a diagnosis of ST-elevation MI were followed up for 3 years, and any occurrence of cardiovascular events (CVs) was recorded. All information regarding reproductive factors was recorded via questionnaire. This information was compared between women with cardiovascular events and women without adverse events using a sample t test, chi-square test, and multiple backward logistic regression analysis. SPSS version 24 was used to conduct all analyses.

RESULT

Sixty-four women with a mean age of 65.81 ± 13.14 years experienced CV events, and 116 women with a mean age of 65.51 ± 10.88 years did not experience CV events. A history of ischemic heart disease and diabetes mellitus were more prevalent in women with CV events (P = 0.024 and P = 0.019). After adjusting for ischemic heart disease and diabetes mellitus, oral contraceptive pill (OCP) usage was more prevalent in women with CV events than in women without CV events (60.9% vs. 40.4%, P = 0.008). There was a greater chance of CV events in women with OCP usage (OR = 3.546, P = 0.038) and a lower chance of CV events in women with greater age at menarche (OR = 0.630, P = 0.009) and longer breastfeeding duration (OR = 0.798, P = 0.041) according to multiple backward logistic regression models.

CONCLUSION

Based on this study, OCP consumption is a risk factor, while older age at menarche and longer duration of breastfeeding are protective factors for cardiovascular outcomes in women after STEMI.

In Support of Breast-/Chestfeeding by People With HIV in High-Income Settings

Given that HIV can be transmitted through breastfeeding, historically, breastfeeding among women with HIV in the US and other resource-rich settings was discouraged. Formula feeding was the mandated feeding option out of concern for breast-milk transmission of HIV, which occurred in 16-24% of cases pre-antiretroviral therapy (pre-ART) use. In January 2023, the US Department of Health and Human Services' Perinatal Guidelines were revised to support shared decision-making for infant feeding choices. Updated clinical trials' data from resource-limited settings suggest the actual breastmilk HIV transmission rate in the context of maternal ART or neonatal postexposure prophylaxis is 0.3-1%. High-income countries are reporting more people with HIV breastfeeding their infants without cases of HIV transmission. We present the reasons for fully embracing breast-/chestfeeding as a viable, safe infant feeding option for HIV-exposed infants in high-income settings, while acknowledging unanswered questions and the need to continually craft more nuanced clinical guidance.

Lifetime Duration of Breastfeeding and Cardiovascular Risk in Women With Type 2 Diabetes or a History of Gestational Diabetes: Findings From Two Large Prospective Cohorts

OBJECTIVE

Breastfeeding duration is inversely associated with risks of cardiovascular disease (CVD) and type 2 diabetes in parous women. However, the association among women at high risk, including women with type 2 diabetes or gestational diabetes mellitus (GDM) is unclear.

RESEARCH DESIGN AND METHODS

We included 15,146 parous women with type 2 diabetes from the Nurses' Health Study I and II (NHS, NHS II) and 4,537 women with a history of GDM from NHS II. Participants reported history of breastfeeding via follow-up questionnaires. Incident CVD by 2017 comprised stroke or coronary heart disease (CHD) (myocardial infarction, coronary revascularization). Adjusted hazard ratios (aHRs) and 95% CIs were estimated using Cox models.

RESULTS

We documented 1,159 incident CVD cases among women with type 2 diabetes in both cohorts during 188,874 person-years of follow-up and 132 incident CVD cases among women with a GDM history during 100,218 person-years of follow-up. Longer lifetime duration of breastfeeding was significantly associated with lower CVD risk among women with type 2 diabetes, with pooled aHR of 0.68 (95% CI 0.54-0.85) for >18 months versus 0 months and 0.94 (0.91-0.98) per 6-month increment in breastfeeding. Similar associations were observed with CHD (pooled aHR 0.93 [0.88-0.97]) but not with stroke (0.96 [0.91-1.02]) per 6-month increment in breastfeeding. Among women with GDM history, >18 months versus 0 months of breastfeeding was associated with an aHR of 0.49 (0.28-0.86) for total CVD.

CONCLUSIONS

Longer duration of breastfeeding was associated with lower risk of CVD in women with type 2 diabetes or GDM.

Impact of Pre-Diagnostic Risk Factors on Short- and Long-Term Ovarian Cancer Survival Trajectories: A Longitudinal Observational Study

Tumor- and treatment-related factors are established predictors of ovarian cancer survival. New studies suggest a differential impact of exposures on ovarian cancer survival trajectories (i.e., rapidly fatal to long-term disease). This study examined the impact of pre-diagnostic risk factors on short- and long-term ovarian cancer survival trajectories in the Canadian context. This population-based longitudinal observational study included women diagnosed with invasive epithelial ovarian cancer from 1995 to 2004 in Ontario. Data were obtained from medical records, interviews, and the provincial cancer registry. Extended Cox proportional hazard models estimated the association between risk factors and all-cause and ovarian cancer-specific mortality by survival time intervals (<3 years (i.e., short-term survival), 3 to <6 years, 6 to <10 years, and ≥10 years (i.e., long-term survival)). Among 1421 women, histology, stage, and residual disease were the most important predictors of all-cause mortality in all survival trajectories, particularly for short-term survival. Reproductive and lifestyle factors did not strongly impact short-term overall survival but were associated with long-term overall survival. As such, among long-term survivors, history of breastfeeding significantly decreased the risk of all-cause mortality (HR 0.65; 95% CI 0.46, 0.93; p < 0.05), whereas smoking history (HR 1.75; 95% CI 1.27, 2.40; p < 0.05) and obesity (HR 1.81; 95% CI 1.24, 2.65; p < 0.05) significantly increased the risk of all-cause mortality. The findings were consistent with ovarian cancer-specific mortality. These findings suggest that pre-diagnostic exposures differentially influence survival time following a diagnosis of ovarian cancer.

Association of early life physical and sexual abuse with premature mortality among female nurses: prospective cohort study

OBJECTIVE

To explore associations between early life physical and sexual abuse and subsequent risk of premature mortality (death before age 70 years).

DESIGN

Prospective cohort study.

SETTING

The Nurses' Health Study II (2001-19).

PARTICIPANTS

67 726 female nurses aged 37-54 years when completing a violence victimization questionnaire in 2001.

MAIN OUTCOME MEASURES

Hazard ratios and 95% confidence intervals for total and cause specific premature mortality by childhood or adolescent physical and sexual abuse, estimated by multivariable Cox proportional hazard models.

RESULTS

2410 premature deaths were identified over 18 years of follow-up. Nurses who experienced severe physical abuse or forced sexual activity in childhood and adolescence had a higher crude premature mortality rate than nurses without such abuse in childhood or adolescence (3.15 v 1.83 and 4.00 v 1.90 per 1000 person years, respectively). The corresponding age adjusted hazard ratios for premature deaths were 1.65 (95% confidence interval 1.45 to 1.87) and 2.04 (1.71 to 2.44), respectively, which were materially unchanged after further adjusting for personal characteristics and early life socioeconomic status (1.53, 1.35 to 1.74, and 1.80, 1.50 to 2.15, respectively). Cause specific analyses indicated that severe physical abuse was associated with a greater risk of mortality due to external causes of injury and poisoning (multivariable adjusted hazard ratio 2.81, 95% confidence interval 1.62 to 4.89), suicide (3.05, 1.41 to 6.60), and diseases of the digestive system (2.40, 1.01 to 5.68). Forced sexual activity as a child and adolescent was associated with greater risk of mortality due to cardiovascular disease (2.48, 1.37 to 4.46), external injury or poisoning (3.25, 1.53 to 6.91), suicide (4.30, 1.74 to 10.61), respiratory disease (3.74, 1.40 to 9.99), and diseases of the digestive system (4.83, 1.77 to 13.21). The association of sexual abuse with premature mortality was stronger among women who smoked or had higher levels of anxiety during adulthood. Smoking, low physical activity, anxiety, and depression each explained 3.9-22.4% of the association between early life abuse and premature mortality.

CONCLUSION

Early life physical and sexual abuse could be associated with a greater risk of adult premature mortality.