Breastfeeding Substantially Reduces Maternal Health Risks
Breastfeeding provides significant protection against breast cancer, ovarian cancer, type 2 diabetes, hypertension, and cardiovascular disease, with benefits increasing proportionally to duration of lactation. 1, 2
Cancer Risk Reduction
Breast cancer risk decreases by 19% (OR 0.81,95% CI 0.77-0.86) in women who breastfeed, with a dose-response relationship where longer cumulative duration provides greater protection. 1, 2
Ovarian cancer risk is reduced by 30% (OR 0.70,95% CI 0.64-0.75) among breastfeeding mothers. 1, 2
Endometrial cancer risk also decreases (OR 0.89,95% CI 0.81-0.98) with breastfeeding. 1
The protective effect is cumulative—each additional month of breastfeeding adds incremental protection against these malignancies. 2
Metabolic and Cardiovascular Benefits
Type 2 diabetes risk is reduced by 32% (OR 0.68,95% CI 0.57-0.82) in women who breastfeed, with particularly pronounced benefits in those with prior gestational diabetes. 1, 2
Breastfeeding for ≥3 months improves maternal LDL cholesterol by 14-21%, translating to reduced coronary heart disease risk. 3
Overall cardiovascular disease risk decreases by 11%, coronary heart disease by 14%, stroke by 12%, and fatal cardiovascular disease by 17% in women who breastfeed. 3
Hypertension rates are lower among women who breastfeed, reflecting favorable metabolic changes during lactation including improved lipid profiles. 1, 2
Duration Recommendations for Maximum Benefit
The American Academy of Pediatrics recommends exclusive breastfeeding for approximately 6 months, with continued breastfeeding for 2 years or longer to maximize maternal health benefits. 1, 2
Breastfeeding beyond 12 months further decreases maternal rates of type 2 diabetes, hypertension, breast cancer, and ovarian cancer. 1, 2
Women with diabetes or gestational diabetes should receive specific counseling about maintaining adequate nutrition (minimum 1,800 kcal/day) and monitoring for hypoglycemia during nursing sessions. 3, 4
Absolute Contraindications to Breastfeeding
The following maternal conditions are absolute contraindications to breastfeeding in the United States: 1
- HIV infection
- Human T-cell lymphotropic virus type I or II infection
- Untreated brucellosis
- Suspected or confirmed Ebola virus disease
- Classic galactosemia in the infant (infant metabolic disorder)
Relative Contraindications and Special Considerations
Tobacco use: Mothers who smoke should be strongly counseled to quit, but if they continue, they should minimize smoking, never smoke while breastfeeding, and smoke immediately after nursing to minimize nicotine transmission to the infant. 1
Alcohol use: Moderate alcohol consumption (up to 1 standard drink per day) is not known to be harmful if the mother waits at least 2 hours after drinking before nursing or expressing milk. 1
Medications: Most maternal medications are compatible with breastfeeding; the Drugs and Lactation Database (LactMed) provides comprehensive safety information. 1
Statins must be discontinued during breastfeeding, as they are contraindicated during lactation. 3
Metformin is safe during breastfeeding and is the preferred oral agent for insulin resistance, with no harmful neonatal effects reported. 4
Critical Clinical Pitfalls
Never assume prepregnancy insulin doses are appropriate immediately postpartum—insulin sensitivity increases dramatically with placenta delivery, and using prepregnancy doses will cause severe hypoglycemia. 4
Lactation increases the risk of overnight hypoglycemia in women with diabetes, requiring insulin dose adjustments. 1, 4
Women who breastfeed beyond the first year often report feeling ridiculed or alienated; 38% who perceived their provider as unsupportive changed pediatric providers, highlighting the need for explicit, non-judgmental support. 1, 2
Most maternal infections are compatible with breastfeeding—breast milk provides antibodies and protection, with hand hygiene and masking recommended when the mother has respiratory illness. 1