Understanding the Relationship Between Assisted Reproductive Technologies and Breastfeeding Outcomes: A Systematic Literature Review Público

Abstract

Background: Breastfeeding is known to be an essential, long lasting and cost effective intervention for both the mother and child. However, many factors can influence breastfeeding initiation, exclusive breastfeeding and breastfeeding duration and these determinants may vary by context. Limited research suggests breastfeeding outcomes differ between women who conceive spontaneously or through assisted reproductive technologies (ART); however, many questions remain and there is currently no consensus in the literature.

 

Objectives: The purpose of this systematic literature review is to examine if women who undergo assisted reproductive technologies are more likely to have poor breastfeeding outcomes: lower breastfeeding initiation, exclusive breastfeeding and duration.

 

Review Methods: PubMed and Embase were used to identify peer-reviewed articles that met the inclusion and exclusion criteria. All full-text publications were entered using EndNote X8 and Covidence, and then organized into summary of findings tables using Microsoft Excel. Included articles were summarized into three breastfeeding categories: initiation, exclusivity, and duration.

 

Results: The literature search strategy identified 251 peer-reviewed articles related to assisted reproductive technology and breastfeeding practices. 10 full-text articles were included in this review. Overall, there is insufficient evidence to conclude an association between ART and breastfeeding initiation, exclusivity and duration. Half of the studies reported no significance for EBF, while the other half reported decreases. 3 out of 5 studies reported no significance for breastfeeding initiation, while the others were mixed (1 decrease/1 increase). Results for breastfeeding duration were very mixed with two studies reporting significant increases, two reporting significant decreases, two reporting no significant difference, and the remaining studies describing varied statistical significance at different times of their study. All included studies were conducted in developed countries: Australia (N=4), Germany, (N=2), Taiwan (N=1), United States (N=1), Canada (N=1), Italy (N=1).

Conclusion: Currently there is inadequate evidence to support the need for additional breastfeeding support for women who undergo ART beyond established risk factors like maternal age, employment, low birthweight/preterm infant, pregnancy psychological functioning and Caesarean deliveries. While there are many known factors associated with breastfeeding initiation, exclusivity, and duration of breastfeeding, there remain questions on how to best target and support mothers to reach their breastfeeding goals.

 

Table of Contents

TABLE OF CONTENTS

ACRONYMS AND ABBREVIATIONS....................................................................................... i

INTRODUCTION.......................................................................................................................... 1

Background.................................................................................................................................. 1

Cost Benefits of Breastfeeding....................................................................................................... 2

Epidemiology of Global and Domestic Breastfeeding................................................................... 3

Determinants of Breastfeeding: Global and Domestic Trends........................................................ 5

Structural.................................................................................................................................. 6

Settings..................................................................................................................................... 7

Individual................................................................................................................................. 8

Assisted Reproductive Technology and Breastfeeding................................................................... 9

Problem Statement...................................................................................................................... 11

Objectives and Aims................................................................................................................... 12

Uses of This Report..................................................................................................................... 12

METHODS................................................................................................................................... 12

Data Synthesis............................................................................................................................. 12

Search Strategy........................................................................................................................... 13

Screening of Abstracts................................................................................................................ 14

Screening of Full Texts............................................................................................................... 14

Terms and Definitions................................................................................................................. 15

Ethical Considerations................................................................................................................. 16

RESULTS...................................................................................................................................... 17

Breastfeeding Trends in ARTC.................................................................................................... 19

Exclusive Breastfeeding.......................................................................................................... 19

Breastfeeding Initiation........................................................................................................... 22

Breastfeeding Duration........................................................................................................... 25

Other Breastfeeding Outcomes................................................................................................ 29

DISCUSSION............................................................................................................................... 34

Summary of Results.................................................................................................................... 34

Strengths and Limitations............................................................................................................ 38

Further Research Needs............................................................................................................... 39

Future Recommendations............................................................................................................ 40

CONCLUSION............................................................................................................................. 41

LIST OF FIGURES  

Figure 1. Global distribution of breastfeeding at 12 months                                                          4

Figure 2. The components of an enabling environment for breastfeeding: a conceptual model     6

Figure 3. Flow chart of literature inclusion and exclusion                                                            17

LIST OF TABLES

Table 1. Summary of Findings for Exclusive Breastfeeding                                                        19

Table 2. Summary of Findings for Breastfeeding Initiation                                                         22

Table 3. Summary of Findings for Breastfeeding Duration                                                          25

Table 4. Summary of Findings for Other Breastfeeding Outcomes                                              29

REFERENCES.............................................................................................................................. 42

APPENDIX A: LIST OF EXCLUDED STUDIES...................................................................... 44

APPENDIX B: DATA EXTRACTION SHEET.......................................................................... 46 

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Obstetrics and Gynecology
Palabra Clave	breastfeeding, assisted reproductive technologies, initiation, duration, exclusive, systematic review
Committee Chair / Thesis Advisor	Young, Melissa, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

Última modificación

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Understanding the Relationship Between Assisted Reproductive Technologies and Breastfeeding Outcomes: A Systematic Literature Review ()	2018-04-25 15:12:54 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions