Promote breastfeeding, but mind multiple factors at play

The letter by Dr Mythili Pandi ("Increase breastfeeding rates to fight diabetes"; last Saturday) has highlighted some useful information about breastfeeding.

I am sure most, if not all, healthcare personnel are aware of the many benefits of breastfeeding and of the World Health Organisation (WHO) guidelines on exclusive breastfeeding.

Hence, whether in public or private hospitals, the encouragement to mothers to provide exclusive breastfeeding for their babies is given priority, particularly by those who are on the front line of looking after pregnant mothers, newborn babies and infants.

Nevertheless, breastfeeding, despite its numerous benefits to the health of babies and children, has no proven cause-and-effect link to diabetes.

While epidemiological studies have shown promising association between breastfeeding and decreasing obesity in children, the interpretation of these studies has to take into consideration the various confounding variables, such as social and economic factors, type of study designs, and various other limitations.

To say that exclusive breastfeeding can "fight" diabetes is putting an undue stretch on the current available scientific data on this topic.

HPB statistics reveal that the main reasons for mothers stopping breastfeeding are: not being able to supply enough breast milk (61 per cent), the need to return to work (24 per cent) and the baby not being able to suck well (18 per cent).

Multiple factors interplay from birth to adulthood to influence the development of obesity and its related co-morbidities.

Diabetes is one of the most common chronic diseases often associated with obesity.

While we should not ignore the many health benefits of breastfeeding and recommendations of the WHO, we should also realise that the development of diabetes depends very much on other lifestyle factors (from childhood to adulthood) that exert as much, if not more, influence on the development of diabetes.

The fact that only 1 per cent of mothers in Singapore continue to exclusively breastfeed their babies at six months and beyond is dismal statistics to us.

But the main reasons are not because "private maternity hospitals" do not give much attention to the education and promotion of breastfeeding, or that they do not have "a policy on breastfeeding".

Statistics from the Health Promotion Board (HPB) in 2013 reveal that the main reasons for mothers stopping breastfeeding are: not being able to supply enough breast milk (61 per cent), the need to return to work (24 per cent) and the baby not being able to suck well (18 per cent).

Therefore, to promote breastfeeding and to understand how breastfeeding relates to obesity and diabetes, we require a thorough understanding of the complex interactions of multiple physiological, social, economic and individual factors, as well as an educated interpretation of the complexity, merits and flaws of different study designs.

Ho Ting Fei (Dr)

A version of this article appeared in the print edition of The Straits Times on April 19, 2016, with the headline 'Promote breastfeeding, but mind multiple factors at play'. Print Edition | Subscribe