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Practice Advisory to Update the Duration of Breastfeeding

  • Practice Advisory PA
  • February 2023

This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with Susan Crowe MD, Sharon Mass MD, Alison Stuebe, MD, MSc, Meredith Birsner MD, and Adetola F. Louis-Jacques MD.

This Practice Advisory serves as an update to Committee Opinion No. 756 Optimizing Support for Breastfeeding as Part of Obstetric Practice (originally published in 2018) 1 , Committee Opinion No. 820 Breastfeeding Challenges (originally published in 2021) 2 , and Committee Opinion No. 821 Barriers to Breastfeeding: Supporting Initiation and Continuation of Breastfeeding (originally published in 2021) 3 .


In an update to previous recommendations, ACOG supports continued breastfeeding while complementary foods are introduced, as long as mutually desired by lactating parent and child for two years or beyond. This new recommendation for support of increased breastfeeding duration is based on alignment with the American Academy of Pediatrics’ (AAP’s) 2022 updated guidance documenting the benefits of breastfeeding for both the lactating parent and child 4 . These recommendations are also in alignment with those developed by the World Health Organization 5 .

AAP identifies stigma, lack of support and workplace barriers as obstacles that hinder continued breastfeeding and, along with ACOG, advocates for improved policies supporting breastfeeding initiation and ongoing support. Based on the impact of nutrition on a child’s neurodevelopmental and overall health through their first 1000 days, and the consequences for future health including risk of obesity, hypertension and diabetes these first two years of nutrition that included the benefits of breastfeeding are important for future health 6 . Sustained breastfeeding for two years or beyond also increases the parent and child attachment, with lasting effects through childhood 7 . Studies have also found benefit around maternal health with breastfeeding for greater than 12 months associated with decreasing maternal diabetes mellitus, hypertension, breast cancer, and ovarian cancer 4 8 9 10 . Because some lactating parents are sustaining lactation for two years or beyond, ACOG recommends this personal parenting choice be supported by policies that impact the workplaces, healthcare environments, and societal barriers that people encounter as they endeavor to operationalize this guidance.


References

  1. Optimizing support for breastfeeding as part of obstetric practice. ACOG Committee Opinion No. 756. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:e187-96. doi: 10.1097/AOG.0000000000002890
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  2. Breastfeeding challenges. ACOG Committee Opinion No. 820. American College of Obstetricians and Gynecologists. Obstet Gynecol 2021;137:e42-53. doi: 10.1097/AOG.0000000000004253
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  3. Barriers to breastfeeding: supporting initiation and continuation of breastfeeding. ACOG Committee Opinion No. 821. American College of Obstetricians and Gynecologists. Obstet Gynecol 2021;137:e54-62. doi: 10.1097/AOG.0000000000004249
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  4. Meek JY, Noble L. Technical report: breastfeeding and the use of human milk. Pediatrics 2022;150:e2022057989. doi: 10.1542/peds.2022-057989
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  5. World Health Organization. Breastfeeding: recommendations. Accessed August 12, 2022. Available at: https://www.who.int/health-topics/breastfeeding#tab=tab_2
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  6. Schwarzenberg SJ, Georgieff MK. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Committee on Nutrition. Pediatrics 2018;141:e20173716. doi: 10.1542/peds.2017-3716
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  7. Weaver JM, Schofield TJ, Papp LM. Breastfeeding duration predicts greater maternal sensitivity over the next decade. Dev Psychol 2018;54:220-7. doi: 10.1037/dev0000425 [doi]
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  8. Luan NN, Wu QJ, Gong TT, Vogtmann E, Wang YL, Lin B. Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies. Am J Clin Nutr 2013;98:1020-31. doi: 10.3945/ajcn.113.062794
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  9. Su D, Pasalich M, Lee AH, Binns CW. Ovarian cancer risk is reduced by prolonged lactation: a case-control study in southern China. Am J Clin Nutr 2013;97:354-9. doi: 10.3945/ajcn.112.044719
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  10. Unar-Munguía M, Torres-Mejía G, Colchero MA, González de Cosío T. Breastfeeding mode and risk of breast cancer: a dose-response meta-analysis. J Hum Lact 2017;33:422-34. doi: 10.1177/0890334416683676 [doi]
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The American College of Obstetricians and Gynecologists recognizes and supports the gender diversity of all patients who seek obstetric and gynecologic care. In original portions of this document, authors seek to use gender-inclusive language or gender-neutral language. When describing research findings, this document uses gender terminology reported by investigators. To review ACOG’s policy on inclusive language, see https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2022/inclusive-language.


A Practice Advisory is a brief, focused statement issued to communicate a change in ACOG guidance or information on an emergent clinical issue (eg, clinical study, scientific report, draft regulation). A Practice Advisory constitutes ACOG clinical guidance and is issued only on-line for Fellows but may also be used by patients and the media. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and for informational purposes only. It does not constitute legal advice; clinicians should be familiar with and comply with local restrictions on abortion, including medication abortion, and are encouraged to consult with a lawyer when navigating local abortion laws and regulations. The use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org/clinical.

While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.

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The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing evidence-based obstetric and gynecologic care. As a private, voluntary, nonprofit membership organization of more than 60,000 members, ACOG strongly advocates for equitable, exceptional, and respectful care for all women and people in need of obstetric and gynecologic care; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing patients and their families and communities. www.acog.org