Breastfeeding supports growth in small for gestational age infants: A systematic review and meta-analysis

Aim: Small for gestational age is defined as birthweight <10th percentile on standardised age and sex-specific growth charts. Rapid catch-up growth seen post-natal is associated with adiposity and cardiometabolic syndromes later in life. Breastfeeding has positive effects on growth in premature and low-birthweight infants. Therefore, examining the impact of exclusive breastfeeding on growth parameters in small for gestational age infants is important.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist guided review and meta-analysis. Four databases were searched.

Results: Five articles (4702 infants) met inclusion criteria. The effect of 4-6 months of breastfeeding on growth was measured using weight, length, head circumference, z-scores and change between timepoints. Study quality was considered very low using Grading of Recommendations, Assessment, Development and Evaluation tool. Random effects models assessed the effect of breastfeeding on weight and length catch-up growth. Differences in weight and length were seen (-8.36, 95%CI: -11.26 to -5.46 and -7.50, 95%CI: -1.92 to -4.18, p < 0.001), with substantial heterogeneity (I² > 90%).

Conclusions: Breastmilk supports growth in small for gestational age infants, though limited evidence exists for catch-up growth in the first 6 months. The magnitude and direction of the effect could not be determined.