Hi everyone, welcome to the LactFact weekly podcast, which highlights recent clinically relevant research, policy statements, and protocols that you, as a practicing lactation professional, should know about. I am your host, Dr. Anne Eglash. I am a board-certified family physician and breastfeeding and lactation medicine specialist at the University of Wisconsin School of Medicine and Public Health.

This podcast is written and produced by the nonprofit organization IABLE, which is the Institute for the Advancement of Breastfeeding and Lactation Education. There are no commercial funders for this podcast series.

Today’s LactFact comes from the long-awaited systematic review on Breastfeeding and Health Outcomes for Infants and Children, published in March 2025, by the US AHRQ, which is the Agency for Healthcare Research and Quality.

Their last review on the benefits of breastfeeding for infants and children was in 2007, and there has been a great deal of research since then.

For this report, the researchers primarily relied on already existing systematic reviews in addition to newer primary studies that were not included in the systematic reviews. The number of studies for each Infant and child health outcome in association with breastfeeding varied anywhere from 6 to more than 180 studies. The data for each health outcome was rated as low or moderate strength of evidence.

Here’s what they determined:

• 1. Otitis media- there's moderate strength of evidence for a 33% to 43% reduced risk of otitis media associated with ever breastfeeding and longer durations of any and exclusive breastfeeding particularly under 24 months of age
• 2. Asthma- Moderate evidence demonstrates a 6 to 31% reduced risk of asthma in childhood between the ages of 2 to 12 years with longer versus shorter durations of any or exclusive breastfeeding
• 3. Childhood Obesity- This topic had the greatest # of systematic reviews, a whopping 159. They found moderate evidence, with a15 to 34% lower risk of overweight and obesity in children ages 2 to 12 years associated with more versus less breastfeeding. They estimated a 4% reduction in the risk of obesity for every additional month of breastfeeding.
• 4. Childhood cancer research shows moderate evidence for a 10 to 23% reduced risk of childhood leukemia with ever versus never breastfeeding but no clear association for other cancer types
• 5. Respiratory infections-despite there being 16 systematic reviews and 35 recent primary studies on the effect of breastfeeding and respiratory infections the evidence is considered low strength, with potential reduced risk of more severe respiratory infections associated with breastfeeding particularly among infants under 24 months.
• 6. Diarrhea and GI infections there's low strength of evidence for reduced risk of moderate to severe GI infections and breastfeeding at younger ages particularly in infants under six months. This was shocking to me because it is extremely uncommon to see exclusively breastfed infants with significant GI infections.
• 7. Allergic rhinitis-there's low strength of evidence for reduced risk of allergic rhinitis associated with more breastfeeding
• 8. Malocclusions-there's low strength of evidence for a potential reduced risk of malocclusion associated with any or exclusive breastfeeding with inconsistent evidence on breastfeeding duration
• 9. Inflammatory bowel disease-there is a potential reduced risk of inflammatory bowel disease associated with longer duration of breastfeeding but the strength of evidence is low.
• 10. Type 1 diabetes-there's low strength of evidence for potential reduced risk of type 1 diabetes in children under age 18 associated with more breastfeeding
• 11. Rapid weight gain and growth-there is low strength of evidence for a lower risk of accelerated growth and rapid weight gain in infancy and early childhood associated with more breastfeeding
• 12. High blood pressure--the potential reduction in systolic blood pressure associated with more breastfeeding has low strength of evidence
• 13. Infant mortality there's a potential reduced risk of infant mortality associated with breastfeeding initiation including risk of late neonatal mortality and sudden unexpected infant death, and the strength of evidence is low.
• 14. Regarding cognitive development moderate strength of evidence indicates no clear association between breastfeeding and cognitive ability at any age
• 15. There is low strength of evidence for no association between atopic dermatitis and breastfeeding as well as between celiac disease and breastfeeding
• 16. Regarding dental carries the researchers felt that there was moderate strength of evidence for increased risk of dental caries associated with breastfeeding 12 months or longer.
• 17. Lastly there was insufficient strength of evidence to determine if there is an association between breastfeeding and food allergies as well as breastfeeding and type 2 diabetes.

The outcomes of this report are fairly similar to their 2007 report although this latest report includes research on allergic rhinitis, malocclusions and inflammatory bowel disease. They also acknowledge strength of evidence which they didn't do in 2007

This March 2025 report did not include infants who were under 37 weeks gestation, so they don’t address the health outcomes of premature infants in association with breastfeeding.

The authors of this AHRQ systematic review acknowledge that there have been problems with the definition of breastfeeding, how breastfeeding is measured and reported, and not controlling confounding factors. Because of limitations the authors state that they were not able to identify a precise dose of breastfeeding associated with reduced risks which is a common question asked by many parents. So if a parent asks a question such as how long do I need to breastfeed to prevent my infant from having inflammatory bowel disease we can simply say that we just don't have that data.

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I will talk to you again in 2 weeks!