Breastfeeding and the Risk of Maternal Cardiovascular Disease: A Prospective Study of 300 000 Chinese Women
Authors: Peters Sanne A. E. , Yang Ling , Guo Yu , Chen Yiping , Bian Zheng , Du Jianwei , Yang Jie , Li Shanpeng , Li Liming , Woodward Mark , Chen Zhengming ,   the China Kadoorie Biobank Collaboration Group, Chen Junshi , Collins Rory , Peto Richard , Bennett Derrick , Chang Yumei , Clarke Robert , Du Huaidong , Fan Xuejuan , Gilbert Simon , Hacker Alex , Holmes Michael , Iona Andri , Kartsonaki Christiana , Kerosi Rene , Kong Ling , Kurmi Om , Lancaster Garry , Lewington Sarah , McDonnell John , Millwood Iona , Nie Qunhua , Radhakrishnan Jayakrishnan , Rafiq Sajjad , Ryder Paul , Sansome Sam , Schmidt Dan , Sherliker Paul , Sohoni Rajani , Turnbull Iain , Walters Robin , Wang Jenny , Wang Lin , Yang Xiaoming , Chen Ge , Han Bingyang , Hou Can , Lv Jun , Pei Pei , Qu Shuzhen , Tan Yunlong , Yu Canqing , Zhou Huiyan , Pang Zengchang , Gao Ruqin , Wang Shaojie , Liu Yongmei , Du Ranran , Zang Yajing , Cheng Liang , Tian Xiaocao , Zhang Hua , Lv Silu , Wang Junzheng , Hou Wei , Yin Jiyuan , Jiang Ge , Liu Shumei , Pang Zhigang , Zhou Xue , Yang Liqiu , He Hui , Yu Bo , Li Yanjie , Mu Huaiyi , Xu Qinai , Dou Meiling , Ren Jiaojiao , Wang Shanqing , Hu Ximin , Wang Hongmei , Chen Jinyan , Fu Yan , Fu Zhenwang , Wang Xiaohuan , Dong Hua , Weng Min , Zheng Xiangyang , Li Yijun , Li Huimei , Li Chenglong , Wu Ming , Zhou Jinyi , Tao Ran , Shen Jie , Hu Yihe , Lu Yan , Gao Yan , Ma Liangcai , Zhou Renxian , Tang Aiyu , Zhang Shuo , Jin Jianrong , Tang Zhenzhu , Chen Naying , Huang Ying , Li Mingqiang , Meng Jinhuai , Pan Rong , Jiang Qilian , Qing Jingxin , Zhang Weiyuan , Liu Yun , Wei Liuping , Zhou Liyuan , Chen Ningyu , Yang Jun , Guan Hairong , Wu Xianping , Zhang Ningmei , Chen Xiaofang , Tang Xuefeng , Luo Guojin , Li Jianguo , Chen Xiaofang , Wang Jian , Liu Jiaqiu , Sun Qiang , Ge Pengfei , Ren Xiaolan , Dong Caixia , Zhang Hui , Mao Enke , Wang Xiaoping , Wang Tao , Liu Guohua , Zhu Baoyu , Zhou Gang , Feng Shixian , Chang Liang , Fan Lei , Gao Yulian , He Tianyou , Jiang Li , Sun Huarong , He Pan , Hu Chen , Lv Qiannan , Zhang Xukui , Yu Min , Hu Ruying , Fang Le , Wang Hao , Qian Yijian , Wang Chunmei , Xie Kaixue , Chen Lingli , Pan Yaxing , Pan Dongxia , Huang Yuelong , Chen Biyun , Jin Donghui , Liu Huilin , Fu Zhongxi , Xu Qiaohua , Xu Xin , g Youping , Jia Weifang , Li Xianzhi , Zhang Libo , Qiu Zhe 
Published: June 2017

Background

Breastfeeding confers substantial benefits to child health and has also been associated with lower risk of maternal cardiovascular diseases (
CVDs
) in later life. However, the evidence on the effects of
CVD
is still inconsistent, especially in East Asians, in whom the frequency and duration of breastfeeding significantly differ from those in the West.

Methods and Results

In 2004–2008, the nationwide China Kadoorie Biobank recruited 0.5 million individuals aged 30 to 79 years from 10 diverse regions across China. During 8 years of follow‐up, 16 671 incident cases of coronary heart disease and 23 983 cases of stroke were recorded among 289 573 women without prior
CVD
at baseline. Cox regression yielded adjusted hazard ratios (
HR
s) and 95%
CIs
for incident
CVD
by breastfeeding. Overall, ≈99% of women had given birth, among whom 97% reported a history of breastfeeding, with a median duration of 12 months per child. Compared with parous women who had never breastfed, ever breastfeeding was associated with a significantly lower risk of
CVD
, with adjusted
HR
s of 0.91 (95%
CI,
0.84–0.99) for
coronary heart disease
and 0.92 (95% CI, 0.85–0.99) for stroke. Women who had breastfed for ≥24 months had an 18% (
HR,
0.82; 0.77–0.87) lower risk of
coronary heart disease
and a 17% (
HR,
0.83; 0.79–0.87) lower risk of stroke compared with women who had never breastfed. Among women who ever breastfed, each additional 6 months of breastfeeding per child was associated with an adjusted
HR
of 0.96 (95% CI, 0.94–0.98) for
coronary heart disease
and 0.97 (95% CI, 0.96–0.98) for stroke.

Conclusions

Among Chinese women, a history of breastfeeding was associated with an ≈10% lower risk of
CVD
in later life and the magnitude of the inverse association was stronger among those with a longer duration of breastfeeding.