Breast- vs formula-feeding: risks and benefits for women and their children

Health outcomes differ substantially for mothers and infants who formula-feed compared to those who breast-feed. However, rates of breast-feeding continue to fall short of the World Health Organization's recommendations that children are breast-fed for their first 2 years of life. Variations in hospital practices have been suggested to account for a considerable proportion of disparities in breast-feeding. Therefore, improvements in the quality of antenatal and perinatal support for breast-feeding could have a substantial impact on public health.
It is widely accepted that premature weaning, or not breast-feeding, is associated with health risks for mothers as well as for infants. For instance, lactation suppresses ovulation, leading to lactational amenorrhea. Moreover, lactogenesis leads to terminal differentiation of the breast tissue, which may reduce the rate of malignant transformation. These effects may mediate associations between breast-feeding and breast and ovarian cancer. In accordance to this hypothesis, a recent meta-analysis found that each year of breast-feeding was associated with a 4.3% reduction in risk of invasive breast cancer;. In another meta-analysis, women who had never breast-fed had a 1.3-fold higher risk of ovarian cancer.
Breast-feeding requires a substantial metabolic expenditure, which may help mobilize the weight gained during pregnancy. In addition, breastfeeding is associated with more favorable glucose levels, lipid metabolism, and blood pressure. Epidemiological studies suggest that these differences may persist after weaning, with long-term benefits for mothers. These associations may have an important effect on the onset of cardiovascular diseases and diabetes.
Infant feeding has a clinically-significant effect also on health outcomes in babies. Compared with breast-fed infants, formula-fed infants are more likely to develop an infection in the first year of life and to experience gastroenteritis, diarrhea, or necrotizing enterocolitis. Moreover, a meta-analysis showed that non-breastfed infants faced a 3.6-fold increased risk of hospitalization for lower respiratory tract infection in the first year of life, compared with infants who were exclusively breast-fed for >4 months. One study investigated the association between feeding and mortality showing that breast-fed infants present a 1.3-fold lower risk of mortality in the first year of life. A meta-analysis also suggested a protective effect of breast-feeding against sudden infant death syndrome. Further benefits of breast-feeding over formula-feeding have been reported with respect to the onset of metabolic diseases, neurodevelopmental impairment, immune system disorders, and cancer.
Taken together, the above findings suggest that clinicians can have a powerful role in improving health outcomes across two generations by supporting breast-feeding. Targeted counseling should be initiated early during pregnancy and eventually continued, monitoring the safety of maternal medications during lactation. Physician counseling, office and hospital practices should be aligned to ensure that the mother–infant dyad has the best chance for a successful breast-feeding experience throughout the infant's first years of life.

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