Gabrielle G Snyder1, Claudia Holzman2, Tao Sun3, Bertha Bullen2, Marnie Bertolet1,3, Janet M Catov1. 1. 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. 2. 2 Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan. 3. 3 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Abstract
BACKGROUND: Abdominal obesity is an important indicator of cardiometabolic dysfunction in later life. Prior studies have observed an inverse association between breastfeeding and maternal waist circumference (WC) in the years after pregnancy, but this may be due to bias resulting from systematic differences in women who do and do not breastfeed. MATERIALS AND METHODS: A total of 678 women enrolled in the Pregnancy Outcomes and Community Health (POUCH) cohort also participated in the POUCHmoms Study 7-15 years after delivery. Multivariable linear regression models and propensity scores were used to assess the relationship between WC measured at follow-up and self-reported history of breastfeeding duration of >6 months versus ≤6 months. RESULTS: After a mean follow-up period of 11.0 (standard deviation = 1.4) years, breastfeeding was significantly associated with smaller WC. A threshold effect was detected for women who reported breastfeeding >6 months; their adjusted mean WC was 3.5 cm (95% confidence interval [CI]: -5.7 to -1.2) smaller compared with women who breastfed ≤6 months. The use of two propensity score approaches, weighted and matched, produced similar results; adjusted mean WC difference was -3.6 cm (95% CI: -5.6 to -1.6) and -3.1 cm (95% CI: -5.5 to -0.7), respectively. CONCLUSIONS: This study extends conventional observational study methods to incorporate propensity score approaches that make it possible to separate the study design from the study analysis to account for systematic differences in women who did and did not breastfeed. After reducing potential bias, breastfeeding for greater than 6 months was independently associated with smaller WC in the decade after delivery.
BACKGROUND:Abdominal obesity is an important indicator of cardiometabolic dysfunction in later life. Prior studies have observed an inverse association between breastfeeding and maternal waist circumference (WC) in the years after pregnancy, but this may be due to bias resulting from systematic differences in women who do and do not breastfeed. MATERIALS AND METHODS: A total of 678 women enrolled in the Pregnancy Outcomes and Community Health (POUCH) cohort also participated in the POUCHmoms Study 7-15 years after delivery. Multivariable linear regression models and propensity scores were used to assess the relationship between WC measured at follow-up and self-reported history of breastfeeding duration of >6 months versus ≤6 months. RESULTS: After a mean follow-up period of 11.0 (standard deviation = 1.4) years, breastfeeding was significantly associated with smaller WC. A threshold effect was detected for women who reported breastfeeding >6 months; their adjusted mean WC was 3.5 cm (95% confidence interval [CI]: -5.7 to -1.2) smaller compared with women who breastfed ≤6 months. The use of two propensity score approaches, weighted and matched, produced similar results; adjusted mean WC difference was -3.6 cm (95% CI: -5.6 to -1.6) and -3.1 cm (95% CI: -5.5 to -0.7), respectively. CONCLUSIONS: This study extends conventional observational study methods to incorporate propensity score approaches that make it possible to separate the study design from the study analysis to account for systematic differences in women who did and did not breastfeed. After reducing potential bias, breastfeeding for greater than 6 months was independently associated with smaller WC in the decade after delivery.
Authors: Erica P Gunderson; Barbara Sternfeld; Melissa F Wellons; Rachel A Whitmer; Vicky Chiang; Charles P Quesenberry; Cora E Lewis; Stephen Sidney Journal: Obesity (Silver Spring) Date: 2008-03-06 Impact factor: 5.002
Authors: Jennifer L Baker; Michael Gamborg; Berit L Heitmann; Lauren Lissner; Thorkild I A Sørensen; Kathleen M Rasmussen Journal: Am J Clin Nutr Date: 2008-12 Impact factor: 7.045
Authors: Helene Kirkegaard; Ellen A Nohr; Kathleen M Rasmussen; Henrik Stovring; Thorkild I A Sørensen; Cora E Lewis; Erica P Gunderson Journal: Am J Clin Nutr Date: 2015-07-01 Impact factor: 7.045
Authors: Angela G Fowler-Brown; Ian H de Boer; Janet M Catov; Mercedes R Carnethon; Aruna Kamineni; Lewis H Kuller; David S Siscovick; Kenneth J Mukamal Journal: Diabetes Care Date: 2010-04-27 Impact factor: 19.112
Authors: Erica P Gunderson; Cora E Lewis; Maureen A Murtaugh; Charles P Quesenberry; Delia Smith West; Stephen Sidney Journal: Am J Epidemiol Date: 2004-06-01 Impact factor: 4.897
Authors: Siv Tone Natland; Lene Frost Andersen; Tom Ivar Lund Nilsen; Siri Forsmo; Geir W Jacobsen Journal: BMC Med Res Methodol Date: 2012-11-23 Impact factor: 4.615
Authors: Malamo E Countouris; Claudia Holzman; Andrew D Althouse; Gabrielle G Snyder; Emma Barinas-Mitchell; Steven E Reis; Janet M Catov Journal: J Womens Health (Larchmt) Date: 2020-01-02 Impact factor: 2.681
Authors: Águeda Cervera-Gasch; Desirée Mena-Tudela; Fatima Leon-Larios; Neus Felip-Galvan; Soukaina Rochdi-Lahniche; Laura Andreu-Pejó; Víctor Manuel González-Chordá Journal: Int J Environ Res Public Health Date: 2020-09-02 Impact factor: 3.390