In the October 2008 Annals of Internal Medicine, the U.S. Preventative Services Task Force (USPSTF), which makes recommendations about preventive care services in the United States, published its recommendation that interventions to promote and support breastfeeding be given a Grade B recommendation. According to USPSTF, a Grade B recommendation means that USPSTF recommends the service and there is “high certainty that the net benefit is moderate to substantial.” USPSTF states that “there is moderate certainty that interventions to promote and support breastfeeding have a moderate net benefit.”
USPSTF based its recommendation on a systematic review of the evidence of breastfeeding from 2007 from Tufts University and the Agency on Healthcare Research and Quality (AHRQ). However, there are some limitations with this report. The report utilized an inconsistent approach in selecting studies to include; at times, the report evaluated existing meta-analyses and systematic previously published reviews, and at other times, it rejected existing reviews and conducted new meta-analyses. Additionally, the quality of the studies evaluated in the review was not examined, nor was the definition of exclusive breastfeeding the same across many studies. Furthermore, the report systematically failed to recognize that there are different types of infant formulas, and that infant feeding modes and formulas have evolved and continue to improve over time. In a few of the studies review, infant formula use is grouped together with other, potentially far inferior modes of feeding. Given these limitations, the report should not be cited as conclusive, scientifically-sound evidence about breastfeeding and disease risk later in life.
USPSTF states that their recommendation applies to pregnant women, new mothers, and young children. However, they also state that “in rare circumstances involving health issues in mothers or infants, such as HIV infection or galactosemia, breastfeeding may be contradicted and interventions to promote breastfeeding may not be appropriate.” USPSTF notes that no studies identified reported harms from interventions to promote and support breastfeeding, but that potential harm exists, “such as making women feel guilty.” They recommend that breastfeeding interventions “should be designed and implemented in ways that do not make women feel guilty when they make an informed choice not to breastfeed.” The International Formula Council (IFC) supports informed decision making regarding infant feeding and supports breastfeeding promotion designed not to make women who cannot or choose not to breastfeed feel guilty.
References Cited:
Primary care interventions to promote breastfeeding: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med, 2008. 149(8): p. 560-4.
Ip, S., et al., Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep), 2007(153): p. 1-186.