Abstract
Background:
Several studies have related longer breastfeeding duration to better intellectual performance in children. By contrast, few studies have investigated the potential protective effects of breastfeeding against behavioral problems such as attention deficit hyperactivity disorder (ADHD) symptoms, and even fewer on autism spectrum disorders (ASD) traits.
Methods:
We examined the association between breastfeeding duration and cognitive development, attention, ADHD symptoms, and autistic traits using data from the INMA Project, a Spanish multicenter birth-cohort study, and taking into account the intensity of breastfeeding. Duration of any, predominant, and exclusive breastfeeding was documented during infancy through maternal questionnaires. Children (N = 1,346; mean age = 4.9 y) were assessed using the McCarthy Scales of Children’s Abilities, Conners’ Kiddie Continuous Performance Test, criteria of the DSM-ADHD symptoms form list, and the Childhood Autism Spectrum Test.
Results:
After adjustment for several confounders, longer duration of breastfeeding was independently associated with better cognitive development and with fewer autistic traits.
Conclusion:
This study provides further evidence of a positive association of breastfeeding with cognitive function apart from socio-environmental factors, and also suggests a protective role against autistic traits. Results are in agreement with recommendations for prolonged breastfeeding duration to promote child development.
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References
Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999;70:525–35.
Jacobson SW, Chiodo LM, Jacobson JL. Breastfeeding effects on intelligence quotient in 4- and 11-year-old children. Pediatrics 1999;103:e71.
Belfort MB, Rifas-Shiman SL, Kleinman KP, et al. Infant feeding and childhood cognition at ages 3 and 7 years. Effects of breastfeeding duration and exclusivity. JAMA Pediatri 2013;167:838–44.
Kramer MS, Aboud F, Mironova E, et al.; Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group. Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 2008;65:578–84.
Julvez J, Guxens M, Carsin AE, et al. A cohort study on full breastfeeding and child neuropsychological development: the role of maternal social, psychological, and nutritional factors. Dev Med Child Neurol 2014;56:148–56.
Quigley MA, Hockley C, Carson C, Kelly Y, Renfrew MJ, Sacker A. Breastfeeding is associated with improved child cognitive development: a population-based cohort study. J Pediatr 2012;160:25–32.
Drane DL, Logemann JA. A critical evaluation of the evidence on the association between type of infant feeding and cognitive development. Paediatr Perinat Epidemiol 2000;14:349–56.
Jain A, Concato J, Leventhal JM. How good is the evidence linking breastfeeding and intelligence? Pediatrics 2002;109:1044–53.
Heikkilä K, Sacker A, Kelly Y, Renfrew MJ, Quigley MA. Breast feeding and child behaviour in the Millennium Cohort Study. Arch Dis Child 2011;96:635–42.
Julvez J, Ribas-Fitó N, Forns M, Garcia-Esteban R, Torrent M, Sunyer J. Attention behaviour and hyperactivity at age 4 and duration of breast-feeding. Acta Paediatr 2007;96:842–7.
Kramer MS, Fombonne E, Igumnov S, et al.; Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group. Effects of prolonged and exclusive breastfeeding on child behavior and maternal adjustment: evidence from a large, randomized trial. Pediatrics 2008;121:e435–40.
Lind JN, Li R, Perrine CG, Schieve LA. Breastfeeding and later psychosocial development of children at 6 years of age. Pediatrics 2014;134 Suppl 1:S36–41.
Al-Farsi YM, Al-Sharbati MM, Waly MI, et al. Effect of suboptimal breast-feeding on occurrence of autism: a case-control study. Nutrition 2012;28:e27–32.
Schultz ST, Klonoff-Cohen HS, Wingard DL, et al. Breastfeeding, infant formula supplementation, and autistic disorder: the results of a parent survey. Int Breastfeed J 2006;1:16.
Shafai T, Mustafa M, Hild T, Mulari J, Curtis A. The association of early weaning and formula feeding with autism spectrum disorders. Breastfeed Med 2014;9:275–6.
Husk JS, Keim SA. Breastfeeding and autism spectrum disorder in the National Survey of Children’s Health. Epidemiology 2015;26:451–7.
Guxens M, Ballester F, Espada M, et al.; INMA Project. Cohort profile: the INMA–INfancia y Medio Ambiente–(Environment and Childhood) Project. Int J Epidemiol 2012;41:930–40.
McCarthy, D. MSCA. Escalas McCarthy de Aptitudes y Psicomotricidad para Niños. Madrid: TEA Ediciones; 2009.
Conners CK, Staff M. Conners’ Kiddie Continuous Performance Test (K-CPT): Computer Program for Windows Technical Guide and Software Manual. Toronto, ON: Multi-Health Systems, Inc; 2001.
American Psychiatric Association. Manual diagnóstico y estadístico de los trastornos mentales. Barcelona: Masson; 2002.
Fuentes, J., Pezzuto, C. Childhood Autism Spectrum Test (CAST) – Adaptación al español. Retrieved 2009. http://www.autismresearchcentre.com/arc_tests.
Wechsler D, Kaufman A. WAIS-III. Escala de inteligencia de Wechsler para adultos (III). Madrid: Tea Ediciones; 2001.
Martínez-Azumendi O, Fernández-Gómez C, Beitia-Fernández M. [Factorial variance of the SCL-90-R in a Spanish out-patient psychiatric sample]. Actas Esp Psiquiatr 2001;29:95–102.
Arranz E, Olabarrieta F, Manzano A, et al. Etxai-Gangoiti scale: a proposal to evaluate the family contexts of two-year-old children. Early Child Dev Care 2014; 184:933–48.
Seaman SR, White IR. Review of inverse probability weighting for dealing with missing data. Stat Methods Med Res 2013;22:278–95.
Oddy WH, Kendall GE, Li J, et al. The long-term effects of breastfeeding on child and adolescent mental health: a pregnancy cohort study followed for 14 years. J Pediatr 2010;156:568–74.
Belfort MB, Rifas-Shiman SL, Kleinman KP, et al. Infant breastfeeding duration and mid-childhood executive function, behavior, and social-emotional development. J Dev Behav Pediatr 2016;37:43–52.
Newschaffer CJ, Croen LA, Daniels J, et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health 2007;28:235–58.
Steinman G, Mankuta D. Breastfeeding as a possible deterrent to autism–a clinical perspective. Med Hypotheses 2013;81:999–1001.
Brenna JT, Varamini B, Jensen RG, Diersen-Schade DA, Boettcher JA, Arterburn LM. Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. Am J Clin Nutr 2007;85:1457–64.
Helland IB, Smith L, Saarem K, Saugstad OD, Drevon CA. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancy and lactation augments children’s IQ at 4 years of age. Pediatrics 2003;111:e39–44.
Boucher O, Burden MJ, Muckle G, et al. Neurophysiologic and neurobehavioral evidence of beneficial effects of prenatal omega-3 fatty acid intake on memory function at school age. Am J Clin Nutr 2011;93:1025–37.
Kohlboeck G, Glaser C, Tiesler C, et al.; LISAplus Study Group. Effect of fatty acid status in cord blood serum on children’s behavioral difficulties at 10 y of age: results from the LISAplus Study. Am J Clin Nutr 2011;94:1592–9.
Guxens M, Mendez MA, Moltó-Puigmartí C, et al. Breastfeeding, long-chain polyunsaturated fatty acids in colostrum, and infant mental development. Pediatrics 2011;128:e880–9.
Parletta N. Breastfeeding and child neurodevelopment - a role for gut microbiota? Dev Med Child Neurol 2014;56:101–2.
Li R, Fein SB, Chen J, Grummer-Strawn LM. Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics 2008;122 Suppl 2:S69–76.
Ahluwalia IB, Morrow B, Hsia J. Why do women stop breastfeeding? findings from the pregnancy risk assessment and monitoring system. Pediatrics 2005;116:1408–12.
Acknowledgements
We would like to acknowledge the study participants for their generous collaboration, and the interviewers for their assistance in contacting families and administering the questionnaires.
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Boucher, O., Julvez, J., Guxens, M. et al. Association between breastfeeding duration and cognitive development, autistic traits and ADHD symptoms: a multicenter study in Spain. Pediatr Res 81, 434–442 (2017). https://doi.org/10.1038/pr.2016.238
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DOI: https://doi.org/10.1038/pr.2016.238
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