title: Pacifier use and interruption of exclusive breastfeeding: Systematic review and meta-analysis.
abstract: Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A search of CINAHL, Scopus, Web of Science, LILACS and Medline; from inception through 30 December 2014 without restriction of language yielded 1,866 publications (PROSPERO protocol CRD42014014527). Predetermined inclusion/exclusion criteria peer reviewed yielded 46 studies: two clinical trials, 20 longitudinal, and 24 cross-sectional studies. Meta-analysis was performed and meta-regression explored heterogeneity across studies. The pooled effect of the association between pacifier use and EBF interruption was 2.48 OR (95% CI = 2.16-2.85). Heterogeneity was explained by the study design (40.2%), followed by differences in the measurement and categorization of pacifier use, the methodological quality of the studies and the socio-economic context. Two RCT's with very limited external validity found a null association, but 44 observational studies, including 20 prospective cohort studies, did find a consistent association between pacifier use and risk of EBF interruption (OR = 2.28; 95% CI = 1.78-2.93). Our findings support the current WHO recommendation on pacifier use as it focuses on the risk of poor breastfeeding outcomes as a result of pacifier use. Future studies that take into account the risks and benefits of pacifier use are needed to clarify this recommendation.
authors.affiliation: Program in Nutrition in Public Health, School of Public Health, University of São Paulo, São Paulo, Brazil.
authors.forename: Gabriela Dos Santos
authors.initials: GDS
authors.lastname: Buccini
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Pérez-Escamilla
authors.affiliation: Instituto de Saúde, Secretaria Estadual da Saúde de São Paulo, São Paulo, Brazil.
authors.forename: Larissa Munari
authors.initials: LM
authors.lastname: Paulino
authors.affiliation: Instituto de Saúde, Secretaria Estadual da Saúde de São Paulo, São Paulo, Brazil.
authors.forename: Clarice Lopes
authors.initials: CL
authors.lastname: Araújo
authors.affiliation: Instituto de Saúde, Secretaria Estadual da Saúde de São Paulo, São Paulo, Brazil.
authors.forename: Sonia Isoyama
authors.initials: SI
authors.lastname: Venancio
mesh_terms: D001942:Breast Feeding; D006801:Humans; D007223:Infant; D064887:Observational Studies as Topic; D041361:Pacifiers; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
keywords: exclusive breastfeeding; meta-analysis; meta-regression; pacifiers; risk factors; systematic review