The association between breastfeeding, maternal smoking in utero, and birth weight with bone mass and fractures in adolescents: a 16-year longitudinal study

Summary: The aim of this birth cohort study was to determine whether early life factors (birth weight, breastfeeding, and maternal smoking) were associated with bone mass and fractures in 16-year-old adolescents. The results suggest that breastfeeding is associated with higher bone mass and lower fracture risk at age 16 but not in utero smoking or birth weight.

Introduction: There are limited data on early life influences on bone mass in adolescence but we have previously reported in utero smoking, breastfeeding, and birth weight were associated with bone mass at age 8.

Methods: Birth weight, breastfeeding intention and habit, and maternal smoking during pregnancy were assessed at phase one in 1988–1999 and by recall during phase two in 1996–1997. Bone mineral density (BMD) was measured by dual-energy X-ray densitometry. Fractures were assessed by questionnaire. Subjects included 415 male and female adolescents from Southern Tasmania representing 29 % of those who originally took part in a birth cohort study in 1988 and 1989.

Results: Breastfeeding (assessed in a number of ways) was associated with a 2–3 % increase in BMD at all sites apart from the radius and around a one third reduction in fracture risk which persisted after adjustment for confounders. In univariate analysis, birth weight was associated with BMD at the hip, radius, and total body but this did not persist in multivariate analysis and there was no association with fracture. Smoking in utero had no association with BMD at any site or fracture.

Conclusions: Breastfeeding is associated with a beneficial increase in bone mass at age 16 and a reduction in fracture risk during adolescence. The association previously observed at 8 years of age is no longer present for birth weight or smoking in utero.