Literature review for - Flourish Paediatrics

Smoking and breastfeeding
Search Results
Data from 16 studies including 2 SLRs, 12 prospective cohort, 1 retrospective and 1 crosssectional
studies were extracted. Data from these studies were used to form the final body of
evidence statement, which included 2 multinational SLRs, 8 studies of Australian women, 2
studies of Chinese women, 1 study from New Zealand and 3 studies from the UK. Sufficient
evidence was found to make statements on the relationship between maternal smoking and
breastfeeding outcomes.
What is the effect of maternal and paternal smoking on breastfeeding outcomes?
Draft Evidence Statement Maternal and paternal smoking is negatively associated with
breastfeeding outcomes.
Draft Grade
A
Component Rating Notes
Evidence Base Excellent 2 SLRs, 12 prospective cohort studies, 1 retrospective cohort
study and 1 cross-sectional studies
Consistency Excellent Majority of studies found a negative association
Clinical impact Good There was a consistent association
Generalisability Excellent All studies involved either Australian women or women from
relevant population sub-groups
Applicability Good Studies of Chinese women not directly relevant to the
Australian healthcare context
Breastfeeding was independently negatively associated with breastfeeding initiation in larger
studies and with breastfeeding duration in almost all studies. Horta et al. reported a pooled
odds ratio for 15 studies of 1.93 (95% CI 1.55-2.40) for the likelihood of cessation of
breastfeeding before 13 weeks. The findings of the two SLRs were confirmed by the findings
of studies published subsequent to these reviews. Most studies investigating a dose response
relationship reported a negative association with higher levels of smoking, i.e. more than 10
or 20 cigarettes per day but no association with lower levels of smoking.
Studies of women from Australia, New Zealand or the UK were considered separately to
those of Chinese women. Only one cohort study of Australian women failed to find a
negative association with 2 cohort studies and a cross-sectional study reporting a negative
association with breastfeeding initiation and 7 prospective and 1 retrospective studies
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