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We evaluated the effect of breastfeeding on maternal health outcomes. We distinguished between long-term effects (breast carcinoma, ovarian carcinoma, endometrial carcinoma, osteoporosis, and type 2 diabetes mellitus) and short-term effects (lactational amenorrhea, postpartum depression, and postpartum weight change).Predominant breastfeeding increases the duration of lactational amenorrhea, which has a short-term effect on the reduction of fertility. There are many studies that show that breastfeeding is protective against breast, ovarian carcinoma, and endometrial carcinoma. The effects depend on the duration of breastfeeding. There is evidence that breastfeeding reduces the risk of type 2 diabetes and metabolic syndrome and cardiac diseases. However, an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not clearly evident.

Aim: 20 years after establishment of the National Breastfeeding Committee, the present work, based on published data on breastfeeding, is aimed at providing insight into the development of breastfeeding behaviour in Germany. Methods: To identify relevant publications, a comprehensive literature search was conducted in PubMed and Web of Science using the search terms "breast feeding" or "breastfeeding" in combination with "Germany". The publication period was limited to the period 1995-2014. Results: A total of 35 studies with data on breastfeeding for the birth cohorts of 1990-2012 were identified. Most of the data had been collected in regional or local surveys, often retrospectively. About 60% of the studies had been conducted with the primary aim of collecting data on breastfeeding or infant nutrition. Over the past 2 decades, breastfeeding rates were always relatively high at the beginning (72-97%). However, they declined significantly within the first 2 months, and by the age of 6 months, only about 50% of infants were still breastfed. Conclusion: Breastfeeding support and early assistance should be offered to a greater extent in order to achieve sustainable improvement of breastfeeding frequency and duration in Germany. Regarding the quality of data collected on breastfeeding, it seems crucial to implement standardised approaches to monitor breastfeeding in Germany., (© Georg Thieme Verlag KG Stuttgart · New York.)

Painful and/or damaged nipples associated with breastfeeding are common and represent a challenge for both the persons experiencing nipple pain and/or trauma and for those providing treatment. However, evidence-based data has been insufficient to demonstrably minimize these common reasons for failure to initiate or continue successful breastfeeding. The aim of this study was to evaluate the efficacy of specific-grade highly purified anhydrous (HPA) lanolin versus expressed breastmilk (EBM) for the treatment of painful and damaged nipples associated with breastfeeding in a prospective controlled clinical trial evaluating 84 lactating mothers. Nipple trauma and healing rates were rated by the Nipple Trauma Score. Nipple pain intensity was assessed on a visual analog scale. Outcome parameters were in favor of the HPA lanolin group, reaching statistical significance for healing rates, nipple trauma and nipple pain. In our study, we found HPA lanolin more effective than EBM, inducing faster healing of nipple trauma (absolute risk reduction of 0.43) and reducing nipple pain (absolute risk reduction of 0.61 on day 3). We concluded that HPA lanolin, combined with breastfeeding education, was more effective than EBM, combined with breastfeeding education, in reducing nipple pain and promoting healing of nipple trauma., (Copyright © 2010 S. Karger AG, Basel.)

Termination of breastfeeding in the first six months after childbirth is frequently caused by breastfeeding-related diseases and problems of the breast such as pain, milk stasis or mastitis. The aim of this study was to evaluate the relationship between psychological stress and the occurrence of breastfeeding associated disorders. In a prospective cohort study of 379 primiparous women without breast anomalies or diseases, psychometric data were collected from participants between the confirmation of the pregnancy and one year post-partum. Primarily, standardised questionnaires (PSQ, WHO QoL and F-SOZU K22) were used for data analysis while additional data was gathered in follow-up interviews. The subgroup analysis showed a significant relationship between stress and breastfeeding-related diseases. Women with pain, cracked nipples, milk stasis or mastitis reported a higher stress level than women without breast problems. Additionally, the majority of women with breast problems and increased psychological stress gave up breastfeeding sooner and, in contrast to the group without problems, indicated significantly more frequently that the milk quantity was insufficient. Breast diseases during lactation are associated with higher levels of psychological stress. Further studies are needed to examine the causes of the higher stress in order to develop strategies to prolong breastfeeding duration.

Aim: To investigate the relationship between breastfeeding and infant health and to describe growth in the first 9 months., Methods: Mothers delivering a baby in April 2005 were recruited throughout Bavaria, Germany, for a prospective birth cohort study. These mothers reported breastfeeding data, health and growth data of 1901 infants assessed by a physician in questionnaires on day 2-6, and in months 2, 4, 6 and 9. Subjects were healthy term infants with a birth weight > or =2500 g. We compared 475 infants breastfed exclusively for > or =6 months (group A), 870 infants breastfed fully/exclusively > or =4 months, but not exclusively > or =6 months (group B) and 619 infants not breastfed/breastfed <4 months (group C)., Results: In multivariate analysis > or =6 months of exclusive breastfeeding reduced significantly the risk for > or =1 episode of gastrointestinal infection(s) during months 1-9 compared to no/<4 months breastfeeding (adjusted odds ratio [OR]: 0.60; 95% confidence interval [CI]: 0.44-0.82). The application of the World Health Organization (WHO)-child growth standards showed lower weight-for-length z-scores in first days of life in group C versus groups A and B, whereas in months 6/7 group C showed the highest scores., Conclusion: Differences in child growth depending on breastfeeding duration should be investigated further. Concerning health outcomes our findings support the recommendation for > or =6 months of exclusive breastfeeding.

A decrease of breastfeeding culture could be observed since the 1950's. However in the 1980's the WHO and UNICEF began engaging in campaigns for breastfeeding since the benefits for mother and child are evident. In 1990 UNICEF set up the "10 steps to successful breastfeeding" that gave birth clinics around the world "guidelines" that would initiate an unproblematic breastfeeding relationship between mother and child. These guidelines can be understood as measures toward increasing staff motivation, training and instruction as well as actually helping parents and increasing their motivation. Further points cover the optimal beginning of breastfeeding and aspects of complementary feeding. Certification of departments by internationally renowned observers is a means of implementing and securing best quality breastfeeding encouragement in the birth clinics. The positive effects of this promotion on the ratio of mothers breastfeeding and thus in respect to childreńs health could be proved by randomised studies. The experience gained in the Obstetrical Department of the Vivantes Humboldt Clinic is described.

Many epidemiological studies show clearly the restraining effect of breast-feeding on breast cancer. So it could be shown that breast-feeding for one year reduces the individual risk for premenopausal breast cancer by 45%. The risk of postmenopausal breast cancer in the developed countries could be decreased by 42% by increasing the breast-feeding time in life. Most authors assume that the protective value of breast-feeding is hormone-conditioned. Further theoretical implications result from the increasing knowledge of the immunologic characteristics of the mother's milk. Beside well-known positive effects of breast-feeding on children's health, breast-feeding should also be further promoted from the view of women's health.