COMMENTARY

Human Milk in a Bottle: Are the Benefits Just as Good?

William T. Basco, Jr., MD, MS

Disclosures

January 30, 2018

Breastfeeding or Breast Milk?

Does breastfeeding protect against atopic illness in offspring? Many previous studies did not differentiate between infants who were nursed directly at the breast versus those who were fed expressed breast milk by bottle.[1] Some preliminary data suggested differences in the potential protective benefits of breastmilk according to mode of feeding rather than type of milk consumed.[2]

Klopp and colleagues[1] sought to evaluate those potential differences in an analysis of more than 3200 infants enrolled in the Canadian Healthy Infant Longitudinal Development birth cohort. They hypothesized that direct breastfeeding would prove superior in preventing physician-diagnosed asthma compared with expressed human milk feeding. Infants were classified into one of four mutually exclusive feeding categories at age 3 months. At age 3 years, they were assessed by physicians for "possible or probable" asthma, based on history and physical examination.

Final data were obtained from more than 2500 infants. At age 3 years, 12.6% of all children were diagnosed with possible or probable asthma (Table).

Table. Study Findings

Mode of Feeding Group Feeding Mode at Age 3 Months Asthma Evaluation at Age 3 Years Adjusted Odds Ratio (95% Confidence Interval)*
Breastmilk only by direct breastfeeding 27% 8.8% 1.00
Breastmilk only; some expressed breastmilk 33% 12.5% 1.4 (1.04-1.97)
Combination of breastmilk and formula 26% 14.9% 1.56 (1.12-2.18)
Formula only 14% 15.8% 1.79 (1.23-2.61)

*Multiple imputation of missing data and adjustment for infant sex, maternal asthma, ethnicity, method of birth, daycare attendance, and gestational age.

The outcomes were best among the children who received exclusive breastmilk by direct breastfeeding. Study authors concluded that the mode of infant feeding is related to asthma development, and direct breastfeeding appears to be most protective.

Viewpoint

This study design is very interesting and raises a question that I bet many had not considered before—whether expressed breast milk is as beneficial as breastmilk given by direct nursing. There are many reasons why direct nursing might be superior, including the possibility that direct nursing stimulates the production of immune factors in maternal milk, that active nursing may aid transmission of beneficial microbes to the infant, and that direct nursing avoids potential chemical contaminants that might leach into breastmilk due to pumping, storing, and feeding the breastmilk with artificial bottles and nipples. It is important to remember that this study assessed feeding only at age 3 months, so it does not suggest that continuing that pattern throughout the first year of life will produce the same results, nor does the study show that expressed breast milk is inferior to direct-fed breastmilk for other measures, such as tolerability or immune function. The bottom line is that although many mothers will undoubtedly need to pump and store breast milk, these data suggest the need to encourage as much direct nursing as possible.

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