Effect of an intervention to promote breastfeeding on asthma, lung function and atopic eczema at age 16 years

Carsten Flohr, John Henderson, Michael S. Kramer, Rita Patel, Jennifer Thompson, Sheryl L Rifas-Shiman, Seungmi Yang , Konstantin Vilchuck, Natalia Bogdanovich, Mikhail Hameza, Richard Martin, Emily Oken

Research output: Contribution to journalArticle (Academic Journal)peer-review

26 Citations (Scopus)


Importance: Atopic diseases, including asthma and atopic eczema, are the most common chronic conditions of childhood.
Objective: To investigate whether an intervention to promote prolonged and exclusive breastfeeding protects against asthma, atopic eczema and low lung function in adolescence.
Design, Setting, and Participants: Follow-up of a cluster-randomized trial in 30 Belarusian maternity hospitals and affiliated polyclinics; recruitment of 17,046 healthy term infants took place June 1996-December 1997.
Intervention: Randomization to receive a breastfeeding promotion intervention vs. usual care
Main Outcomes and Measures: Spirometry and flexural eczema on standardized skin examination by study paediatricians were primary outcomes; secondary outcomes were self-reported asthma diagnosis ever, and wheeze and flexural eczema symptoms in the previous year.
Results: 13,557 (79.5%) participants were followed up September 2012-July 2015. The intervention (n=7064, 79.7%) and control (n=6493, 79.4%) groups were similar at follow-up (50.8%/52.5% male, mean (SD) age 16.2 (0.6)/16.1 (0.5) years). In the intervention group, 0.3% (21/7064) had flexural eczema on skin examination and mean (SD) FEV1/FVC ratio z-score was
-0.10 (1.82), compared to 0.7% (43/6493) and 0.35 (1.34) respectively in the control group. In modified intention-to-treat analysis, accounting for clustering by polyclinic, a 54% lower risk of flexural eczema on skin examination was observed in the intervention compared with the control group (OR, 0.46; 95% CI: 0.25, 0.86). Self-reported flexural eczema symptoms in the past year (OR, 0.57; 95% CI: 0.27, 1.18), asthma (OR, 0.76; 95% CI: 0.47, 1.23) and wheezing in the past year (OR, 0.66; 95% CI: 0.37, 1.18) were less frequently reported in the intervention compared with the control group, but confidence intervals were wide and included the null. There was no difference in FEV1/FVC ratio z-score (beta -0.15; 95% CI: -0.76, 0.45). All results were similar with additional adjustment for baseline characteristics, on instrumental variable analysis, and with multiple imputation among all 17,046 randomized participants.
Original languageEnglish
Article numbere174064
JournalJAMA Pediatrics
Issue number1
Early online date13 Nov 2017
Publication statusPublished - 2 Jan 2018


  • Atopic dermatitis
  • Breastfeeding
  • Lung function
  • Asthma
  • Atopic eczema


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