title: Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs.
abstract: The aim of this study was to quantify the excess cases of pediatric and maternal disease, death, and costs attributable to suboptimal breastfeeding rates in the United States. Using the current literature on the associations between breastfeeding and health outcomes for nine pediatric and five maternal diseases, we created Monte Carlo simulations modeling a hypothetical cohort of U.S. women followed from age 15 to age 70 years and their children from birth to age 20 years. We examined disease outcomes using (a) 2012 breastfeeding rates and (b) assuming that 90% of infants were breastfed according to medical recommendations. We measured annual excess cases, deaths, and associated costs, in 2014 dollars, using a 2% discount rate. Annual excess deaths attributable to suboptimal breastfeeding total 3,340 (95% confidence interval [1,886 to 4,785]), 78% of which are maternal due to myocardial infarction (n = 986), breast cancer (n = 838), and diabetes (n = 473). Excess pediatric deaths total 721, mostly due to Sudden Infant Death Syndrome (n = 492) and necrotizing enterocolitis (n = 190). Medical costs total $3.0 billion, 79% of which are maternal. Costs of premature death total $14.2 billion. The number of women needed to breastfeed as medically recommended to prevent an infant gastrointestinal infection is 0.8; acute otitis media, 3; hospitalization for lower respiratory tract infection, 95; maternal hypertension, 55; diabetes, 162; and myocardial infarction, 235. For every 597 women who optimally breastfeed, one maternal or child death is prevented. Policies to increase optimal breastfeeding could result in substantial public health gains. Breastfeeding has a larger impact on women's health than previously appreciated.
authors.affiliation: Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Bartick
authors.affiliation: Department of Medicine, University of California, Davis, Davis, California.
authors.forename: Eleanor Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.affiliation: Department of Operations Business Analytics and Information Systems, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Brittany D
authors.initials: BD
authors.lastname: Green
authors.affiliation: Department of Health Services Administration, D'Youville College, Buffalo, New York.
authors.forename: Briana J
authors.initials: BJ
authors.lastname: Jegier
authors.affiliation: Alliance for the Prudent Use of Antibiotics, Boston, Massachusetts.
authors.forename: Arnold G
authors.initials: AG
authors.lastname: Reinhold
authors.affiliation: Department of Neonatology, Carver College of Medicine, University of Iowa, Iowa, Iowa.
authors.forename: Tarah T
authors.initials: TT
authors.lastname: Colaizy
authors.affiliation: Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Bogen
authors.affiliation: Department of Computational and Applied Mathematics, Rice University, Houston, Texas.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schaefer
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.|Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stuebe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001942:Breast Feeding / Q000191:economics* / Q000706:statistics & numerical data*; D002648:Child; D000067576:Child Health / Q000191:economics*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D007223:Infant; D000068097:Maternal Health / Q000191:economics*; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: breastfeeding; cardiovascular disease; diabetes; double burden of disease; health economics; health outcomes; public health; women's health