Promotion of Exclusive Breastfeeding in Children with Sickle Cell Disease for Improved Health Outcomes - ABSTRACT
Sickle cell disease (SCD) is an inherited red blood cell disorder that predominantly affects individuals of African
descent. The physiologic hallmarks of SCD include chronic red blood cell hemolysis, oxidative stress, inflammation, vascular
damage and end-organ damage. These physiologic sequelae lead to unpredictable vaso occlusive complications,
such as pain and acute chest syndrome (ACS). Human breastmilk contains antioxidant, anti-inflammatory and
immune-modulating properties proven to be protective against chronic inflammatory conditions, such as
asthma, obesity and cardiovascular disease. The lasting impacts of human breastmilk have been
demonstrated in adolescent and adult studies, wherein individuals that were breastfed as infants had lower
levels of biological markers of inflammation in their bloodstream. Interestingly, breastmilk has even been
demonstrated to be protective against the erosion of telomeres – which are the protective caps of DNA and
established markers of oxidative stress and inflammation. The American Academy of Pediatrics and World
Health Organization recommend exclusive breastfeeding (EBF) for the first 6 months of life, followed by 1 to 2
years of breastfeeding with nutritious supplementation. However, despite these recommendations and the well-
established protective benefits of EBF, the gap between Healthy People 2020 breastfeeding goals and current
rates of EBF is widest amongst African American women compared to all other racial and ethnic groups.
Furthermore, the protective effects of EBF have never been explored in SCD. Several studies have noted a
lack of breastfeeding role models and support networks as barriers to EBF among African American women.
One community-based organization located in Birmingham (Alabama) — the Chocolate Milk Mommies —,
specifically addresses these barriers through online and in-person education and support groups, certified
lactation consultant services, free breast pump rentals for low-income mothers and a home visitation and peer-
mentoring program. Chocolate Milk Mommies specifically targets African American mothers, given the lower rates
of breastfeeding in this population. This group achieved a 6-month EBF rate of 83% in 2019, far exceeding state
and national trends. Given the pervasive oxidative stress and inflammation in SCD, and the consequent risk
for pain and poor lung health, it is essential to test the protective benefits of EBF and establish effective EBF-
promoting interventions among this high risk population. The aims for this project are to: 1) test the association
between EBF exposure and SCD complications, 2) test the association between EBF exposures and biological
markers of oxidative stress and inflammation, and 3) pilot the feasibility to recruit and retain 20 mothers of
children with SCD to a community-based EBF program (the Chocolate Milk Mommies) for ≥6 months, which
will inform a future larger randomized controlled trial. The long-term goal for this research is to establish the
protective benefits of breastfeeding in SCD and improve overall health outcomes through the promotion of EBF.