Breastfeeding is Associated with Improved Child Cognitive Development: A Population-Based Cohort Study

doi:10.1016/j.jpeds.2011.06.035

The Journal of Pediatrics

Volume 160, Issue 1, January 2012, Pages 25-32

https://doi.org/10.1016/j.jpeds.2011.06.035 Get rights and content

Objective

To assess the association between breastfeeding and child cognitive development in term and preterm children.

Study design

We analyzed data on white singleton children from the United Kingdom Millennium Cohort Study. Children were grouped according to breastfeeding duration. Results were stratified by gestational age at birth: 37 to 42 weeks (term, n = 11 101), and 28 to 36 weeks (preterm, n = 778). British Ability Scales tests were administered at age 5 years (naming vocabulary, pattern construction, and picture similarities subscales).

Results

The mean scores for all subscales increased with breastfeeding duration. After adjusting for confounders, there was a significant difference in mean score between children who were breastfed and children who were never breastfed: in term children, a two-point increase in score for picture similarities (when breastfed ≥4 months) and naming vocabulary (when breastfed ≥6 months); in preterm children, a 4-point increase for naming vocabulary (when breastfed ≥4 months) and picture similarities (when breastfed ≥2 months) and a 6-point increase for pattern construction (when breastfed ≥2 months). These differences suggest that breastfed children will be 1 to 6 months ahead of children who were never breastfed.

Conclusions

In white, singleton children in the United Kingdom, breastfeeding is associated with improved cognitive development, particularly in children born preterm.

Section snippets

Millennium Cohort Study

The Millennium Cohort Study (MCS) is a nationally representative UK longitudinal study of 18 818 infants born in the United Kingdom.⁹ A random two-stage sample of all infants born in England and Wales between September 2000 and August 2001 and in Scotland and Northern Ireland between November 2000 and January 2002 who were alive and living in the United Kingdom at age 9 months was drawn from Child Benefit registers. Child Benefit claims in the United Kingdom cover virtually all children, except

Results

Table III shows the descriptive characteristics in the term (n = 11 101) and preterm (n = 778) groups. Eight percent of mothers reported moderate or high alcohol consumption in pregnancy, and 23% of mothers smoked in pregnancy. Fourteen percent of mothers were lone parents, and 7% of mothers had postgraduate degrees. Many of these characteristics were similar in the preterm group. As expected, the most striking differences in the groups were for mean birth weight and having special care at

Discussion

Our results suggest that breastfeeding, particularly when it is prolonged, is associated with better child cognitive development. The effect was smaller after adjustment for confounders, particularly maternal education and social class. Even after allowing for many known confounders, a two-point increase in BAS score at age 5 years was associated with prolonged breastfeeding (≥4 months for picture similarities and ≥ at least 6 months for naming vocabulary) in children who were born at term. In

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Data from qualitative interviews indicate postpartum individuals feel pressure from their healthcare providers, the media, and their partners to breastfeed their infant(s). However, the link between pressure to breastfeed and maternal mental health symptoms has not been evaluated quantitatively. The goal of the current study was to evaluate the associations between perceived pressure to breastfeed from various sources and depressive, anxiety, obsessive-compulsive, and eating disorder symptoms among postpartum individuals.
Participants were 306 women, ages 18–39, who gave birth in the past 12 months in the United States (primarily in North Carolina). They completed an online survey about their health history (including mental health symptoms) and breastfeeding experiences.
Results found postpartum women perceived more pressure to breastfeed from healthcare providers and from the media compared to pressure to breastfeed from their partners. Pressure from healthcare providers was associated with depressive, obsessive-compulsive, and eating disorder symptoms, but not with anxiety symptoms. Pressure from the media was associated with only depressive and eating disorder symptoms. Pressure from partners was not significantly associated with mental health symptoms. Above and beyond the other sources of pressure, pressure from healthcare providers explained a unique proportion of variance of obsessive-compulsive and eating disorder symptoms.
Limitations include the cross-sectional design (which limits causal interpretations), and the homogenous sample (87% identified as White).
Messaging and information about breastfeeding (particularly from healthcare providers) should be reviewed to determine if there is language which could be perceived as “pressure.” It is important to screen for a variety of mental health symptoms, including eating disorders, in perinatal populations when discussing breastfeeding.
Neurodevelopmental Outcomes Among Infants Born Preterm Fed With Mother's Own Milk: A Comparison of Singletons and Twins
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To examine associations between early exposure to mother's own milk (MOM) and neurodevelopmental outcomes among preterm infants, and to compare these associations between singletons and twins.
Retrospective cohort study that included low-risk infants born at <32 weeks gestational age. Nutrition was documented over a 3-day period at mean ages of 14 and 28 days of life; an average of the 3 days was calculated. The Griffiths Mental Development Scales (GMDS) were administered at 12 months corrected age.
Preterm infants (n = 131) with median gestational age of 30.6 weeks were included; 56 (42.7%) were singletons. On days 14 and 28 of life, 80.9% and 77.1% were exposed to MOM, respectively. Exposure rate was comparable, but MOM intake (mL/kg/day) was higher among singletons than among twins (P < .05). At both time points, MOM-exposed infants scored higher on personal-social, hearing-language, and total GMDS assessments than nonexposed infants. These differences were significant for the entire cohort and for twins (P < .05). MOM intake correlated with total GMDS score for both singletons and twins. Any exposure to MOM was associated with additional 6-7 points on total GMDS score or 2-3 additional points for every 50 mL/kg/day of MOM.
The study supports the positive association between early MOM exposure among low-risk preterm infants and neurodevelopmental outcomes at 12 months corrected age. The differential effects of MOM exposure on singletons vs twins need further exploration.
Summary of the Joint National Institutes of Health and the Food and Drug Administration Workshop Titled “Exploring the Science Surrounding the Safe Use of Bioactive Ingredients in Infant Formula: Considerations for an Assessment Framework”
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Antenatal breastfeeding promotion amongst pregnancies at high-risk for newborn admission to the NICU: A cross-sectional study
2022, European Journal of Obstetrics and Gynecology and Reproductive Biology: X
Citation Excerpt :
For mothers, this includes decreasing the risk of postpartum depression, cardiovascular disease, breast and other cancers, as well as improving postpartum weight loss/return to pre-pregnancy body mass [1–4]. In infants, breastmilk provides the ideal nutritional requirements while conferring passive immunity through passage of maternal antibodies; breastfeeding is also important for mother-child bonding [3,4]. Mothers who breastfed and children who were breastfed also have lower reported rates of obesity and associated health risks later in life [5].
To determine the prevalence and factors associated with antenatal promotion of breastfeeding in high-risk pregnancies.
This was a cross-sectional study of trends in breastfeeding promotion during antenatal consultation of pregnancies at high-risk for newborn admission to the neonatal intensive care unit (NICU) between January 2017 and December 2020. Eligible high-risk pregnant patients undergoing antenatal consultation in a tertiary-level fetal assessment unit were identified using an electronic clinic repository. Consult letters and fetal assessment reports were reviewed to determine baseline demographics, pregnancy history, fetal findings, and communication about breastfeeding. Descriptive and inferential statistics were used to present findings and compare outcomes between groups.
316 pregnancies were included for final analysis. The mean maternal age was 28.7 years (SD 6.2) and 65 % were multiparas. Median gestational age at time of antenatal consult was 32 weeks [IQR 29–34]. The main indication for consultation was fetal anomalies (72.8%), namely cardiac defects (21.2 %). There was a significant improvement in prevalence of antenatal discussions about breastfeeding over the study period, from 48.8 % early in the study period compared to 73.7 % in the past year (p = 0.036). However, amongst consults where breastfeeding was discussed, almost one-quarter (23.8 %) of patients indicated that they were not planning on breastfeeding postnatally.
There has been a significant improvement in promoting breastfeeding antenatally amongst high-risk pregnancies. However, no follow-up or supports were offered to one-quarter of patients who indicated no intention of breastfeeding or using donor milk postnatally. Ongoing work is required to further advance breastfeeding promotion antenatally, increase parental supports and education, and optimize breastfeeding rates postnatally for improving outcomes of this high-risk group.
Supplementation with milk fat globule membrane from early life reduces maternal separation-induced visceral pain independent of enteric nervous system or intestinal permeability changes in the rat
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Nutritional approaches have emerged over the past number of years as suitable interventions to ameliorate the enduring effects of early life stress. Maternal separation (MS) is a rodent model of early life stress which induces widespread changes across the microbiota-gut-brain axis. Milk fat globule membrane (MFGM) is a neuroactive membrane structure that surrounds milk fat globules in breast milk and has been shown to have positive health effects in infants, yet mechanisms behind this are not fully known. Here, we investigated the effects of MFGM supplementation from birth on a variety of gut-brain signalling pathways in MS and non-separated control animals across the lifespan. Specifically, visceral sensitivity as well as spatial and recognition memory were assessed in adulthood, while gut barrier permeability, enteric nervous system (ENS) and glial network structure were evaluated in both early life and adulthood. MS resulted in visceral hypersensitivity, which was ameliorated to a greater extent by supplementation with MFGM from birth. Modest effects of both MS and dietary supplementation were noted on spatial memory. No effects of MS were observed on enteric neuronal or glial networks in early life or adulthood, however an increase in the immunoreactivity of βIII-tubulin in adult colonic myenteric ganglia was noted in the MFGM intervention non-separated group. In conclusion, dietary supplementation with MFGM from birth is sufficient to block MS-induced visceral hypersensitivity, highlighting its potential value in visceral pain-associated disorders, but future studies are required to fully elucidate the mechanistic role of this supplementation on MS-induced visceral pain.
This article is part of the Special Issue on ‘Advances in mechanisms and therapeutic targets relevant to pain’.
Clinical predictors for breastfeeding initiation among women with epilepsy
2022, Seizure
To study breastfeeding initiation and continuation rates and identify clinical predictors of breastfeeding initiation related to maternal epilepsy and the newborn's condition among women with epilepsy (WWE).
Data on a cohort of 1195 pregnant WWE from an epilepsy center in Poland from 2000 to 2019 were prospectively collected. Mann-Whitney U and ch2 tests -based comparisons between lactating and non-lactating WWE according to age, week of delivery, Apgar score, birth weight, type of epilepsy, seizure control, major congenital malformation (MCM), mode of delivery, type and dose of antiseizure medication (ASM) were performed. A logistic regression model was constructed to identify predictors of breastfeeding initiation.
Among 921 WWE, who gave birth to a living child, 709 (77%) initiated breastfeeding. The annual rate did not significantly change over the study period. Higher breastfeeding initiation rates were associated with vaginal birth (OR = 0.66) and lack of MCM (OR = 0.23). Breastfeeding initiation was less frequent with old-generation ASM monotherapy (OR = 0.36) or polytherapy (OR = 0.33) compared to no ASM treatment. The rate of breastfeeding initiation was positively associated with gestational week and the newborn's condition. At 6 months, about 1/3 of WWE maintained lactation.
Approximately ¾ of the WWE cohort initiated breastfeeding. Breastfeeding initiation was associated with delivery mode, treatment type, and the newborn's condition but was not associated with seizures during pregnancy or the individual ASM dose. Further studies are needed to identify additional factors that may negatively affect breastfeeding.

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: Funded by the Policy Research Programme in the Department of Health. The views expressed are not necessarily those of the Department. The authors declare no conflicts of interest.

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Original ArticleBreastfeeding is Associated with Improved Child Cognitive Development: A Population-Based Cohort Study

Objective

Study design

Results

Conclusions

Section snippets

Millennium Cohort Study

Results

Discussion

Am J Clin Nutr

Breastfeeding and maternal and infant health outcomes in developed countries. Evidence report/technology assessment no. 153. AHRQ publication no. 07-E007

Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis

BMJ

Breastfeeding and child cognitive development: new evidence from a large randomized trial

Arch Gen Psychiatry

Breast feeding and cognitive development in childhood: a prospective birth cohort study

Paediatr Perinat Epidemiol

Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants

Eur J Public Health

Maternal birthplace and breastfeeding initiation among term and preterm infants: a statewide assessment for Massachusetts

Pediatrics

Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis

JAMA

British Ability Scales Second Edition (BAS II): technical manual

Through the past darkly: a review of the British Ability Scales Second Edition

Child Adolesc Ment Health

Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age?

Int J Epidemiol

The assessment of parent-to-infant attachment: development of a self-report questionnaire instrument

J Reprod Infant Psychol

Education, health and behaviour

Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial

JAMA

Original Article
Breastfeeding is Associated with Improved Child Cognitive Development: A Population-Based Cohort Study