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History of breast feeding and risk of incident endometriosis: prospective cohort study.

Abstract Objective To investigate the association between lifetime breast feeding, exclusive breast feeding, postpartum amenorrhea, and incidence of endometriosis among parous women.Design Prospective cohort study.Setting Nurses' Health Study II, 1989-2011.Participants 72 394women who reported having one or more pregnancies that lasted at least six months, 3296 of whom had laparoscopically confirmed endometriosis. For each pregnancy, women reported duration of total breast feeding, exclusive breast feeding, and postpartum amenorrhea. Main outcome measures Incident self reported laparoscopically confirmed endometriosis (96% concordance with medical record) in parous women. Multivariable Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for diagnosis of endometriosis.Results Duration of total and exclusive breast feeding was significantly associated with decreased risk of endometriosis. Among women who reported a lifetime total length of breast feeding of less than one month, there were 453 endometriosis cases/100 000 person years compared with 184 cases/100 000 person years in women who reported a lifetime total of ≥36 months of breast feeding. For every additional three months of total breast feeding per pregnancy, women experienced an 8% lower risk of endometriosis (hazard ratio 0.92, 95% confidence interval 0.90 to 0.94; P<0.001 for trend) and a 14% lower risk for every additional three months of exclusive breast feeding per pregnancy (0.86, 0.81 to 0.90; P<0.001 for trend). Women who breastfed for ≥36 months in total across their reproductive lifetime had a 40% reduced risk of endometriosis compared with women who never breast fed (0.60, 0.50 to 0.72). The protective association with breast feeding was strongest among women who gave birth within the past five years (P=0.04 for interaction). The association with total breast feeding and exclusive breast feeding on endometriosis was partially influenced by postpartum amenorrhea (% mediated was 34% (95% confidence interval 15% to 59%) for total breast feeding and 57% (27% to 82%) for exclusive breast feeding).Conclusion Among women who experienced at least one pregnancy that lasted at least six months, breast feeding was inversely associated with risk of incident endometriosis. This association was partially, but not fully, influenced by postpartum amenorrhea, suggesting that breast feeding could influence the risk of endometriosis both through amenorrhea and other mechanisms. Given the chronic and incurable nature of endometriosis, breast feeding should be further investigated as an important modifiable behavior to mitigate risk for pregnant women.
PMID
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Authors

Mayor MeshTerms

Breast Feeding

Keywords
Journal Title bmj (clinical research ed.)
Publication Year Start




PMID- 28851765
OWN - NLM
STAT- MEDLINE
DA  - 20170830
DCOM- 20170901
LR  - 20170901
IS  - 1756-1833 (Electronic)
IS  - 0959-535X (Linking)
VI  - 358
DP  - 2017 Aug 29
TI  - History of breast feeding and risk of incident endometriosis: prospective cohort 
      study.
PG  - j3778
LID - 10.1136/bmj.j3778 [doi]
AB  - Objective To investigate the association between lifetime breast feeding,
      exclusive breast feeding, postpartum amenorrhea, and incidence of endometriosis
      among parous women.Design Prospective cohort study.Setting Nurses' Health Study
      II, 1989-2011.Participants 72 394women who reported having one or more
      pregnancies that lasted at least six months, 3296 of whom had laparoscopically
      confirmed endometriosis. For each pregnancy, women reported duration of total
      breast feeding, exclusive breast feeding, and postpartum amenorrhea. Main outcome
      measures Incident self reported laparoscopically confirmed endometriosis (96%
      concordance with medical record) in parous women. Multivariable Cox proportional 
      hazard models were used to calculate hazard ratios and 95% confidence intervals
      for diagnosis of endometriosis.Results Duration of total and exclusive breast
      feeding was significantly associated with decreased risk of endometriosis. Among 
      women who reported a lifetime total length of breast feeding of less than one
      month, there were 453 endometriosis cases/100 000 person years compared with 184 
      cases/100 000 person years in women who reported a lifetime total of &gt;/=36 months
      of breast feeding. For every additional three months of total breast feeding per 
      pregnancy, women experienced an 8% lower risk of endometriosis (hazard ratio
      0.92, 95% confidence interval 0.90 to 0.94; P&lt;0.001 for trend) and a 14% lower
      risk for every additional three months of exclusive breast feeding per pregnancy 
      (0.86, 0.81 to 0.90; P&lt;0.001 for trend). Women who breastfed for &gt;/=36 months in 
      total across their reproductive lifetime had a 40% reduced risk of endometriosis 
      compared with women who never breast fed (0.60, 0.50 to 0.72). The protective
      association with breast feeding was strongest among women who gave birth within
      the past five years (P=0.04 for interaction). The association with total breast
      feeding and exclusive breast feeding on endometriosis was partially influenced by
      postpartum amenorrhea (% mediated was 34% (95% confidence interval 15% to 59%)
      for total breast feeding and 57% (27% to 82%) for exclusive breast
      feeding).Conclusion Among women who experienced at least one pregnancy that
      lasted at least six months, breast feeding was inversely associated with risk of 
      incident endometriosis. This association was partially, but not fully, influenced
      by postpartum amenorrhea, suggesting that breast feeding could influence the risk
      of endometriosis both through amenorrhea and other mechanisms. Given the chronic 
      and incurable nature of endometriosis, breast feeding should be further
      investigated as an important modifiable behavior to mitigate risk for pregnant
      women.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Farland, Leslie V
AU  - Farland LV
AD  - Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
      02115, USA [email protected].edu.
AD  - Center for Infertility and Reproductive Surgery, Department of Obstetrics,
      Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Harvard
      Medical School, Boston, MA 02115, USA.
FAU - Eliassen, A Heather
AU  - Eliassen AH
AD  - Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
      02115, USA.
AD  - Channing Division of Network Medicine, Department of Medicine, Brigham and
      Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
FAU - Tamimi, Rulla M
AU  - Tamimi RM
AD  - Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
      02115, USA.
AD  - Channing Division of Network Medicine, Department of Medicine, Brigham and
      Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
FAU - Spiegelman, Donna
AU  - Spiegelman D
AD  - Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
      02115, USA.
AD  - Channing Division of Network Medicine, Department of Medicine, Brigham and
      Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
FAU - Michels, Karin B
AU  - Michels KB
AD  - Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
      02115, USA.
AD  - Department of Epidemiology, Fielding School of Public Health, University of
      California, Los Angeles, CA, USA.
FAU - Missmer, Stacey A
AU  - Missmer SA
AD  - Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
      02115, USA.
AD  - Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston
      Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
AD  - Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human 
      Medicine, Michigan State University, Grand Rapids Michigan, MI 49503, USA.
LA  - eng
PT  - Journal Article
DEP - 20170829
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
SB  - AIM
SB  - IM
MH  - Adult
MH  - Amenorrhea/epidemiology
MH  - *Breast Feeding
MH  - Endometriosis/diagnostic imaging/*epidemiology/surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Laparoscopy
MH  - Multivariate Analysis
MH  - Nurses
MH  - Proportional Hazards Models
MH  - Prospective Studies
MH  - Risk
MH  - Self Report
MH  - Time Factors
COI - Competing interests: All authors have completed the ICMJE uniform disclosure form
      at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding 
      author) and declare: support from the Harvard T H Chan School of Public Health,
      Eunice Kennedy Shriver National Institute of Child Health and Human Development, 
      and National Cancer Institute for the submitted work; no financial relationships 
      with any organizations that might have an interest in the submitted work in the
      previous three years; no other relationships or activities that could appear to
      have influenced the submitted work.
EDAT- 2017/08/31 06:00
MHDA- 2017/09/02 06:00
CRDT- 2017/08/31 06:00
PST - epublish
SO  - BMJ. 2017 Aug 29;358:j3778. doi: 10.1136/bmj.j3778.