Mandy B. Belfort et al., Infant Feeding and Childhood Cognition at Ages 3 and 7 YearsEffects of Breastfeeding Duration and Exclusivity. JAMA Pediatrics 2013. Pay per view → LINK [doi:10.1001/jamapediatrics.2013.455]
Abstract
Importance
Breastfeeding may benefit child cognitive development, but few
studies have quantified breastfeeding duration or exclusivity, nor has
any study to date examined the role of maternal diet during lactation on
child cognition.Objectives
To examine relationships of breastfeeding duration and
exclusivity with child cognition at ages 3 and 7 years and to evaluate
the extent to which maternal fish intake during lactation modifies
associations of infant feeding with later cognition.Design, Setting, and Participants
Prospective cohort study (Project Viva), a US prebirth cohort
that enrolled mothers from April 22, 1999, to July 31, 2002, and
followed up children to age 7 years, including 1312 Project Viva mothers
and children.Main Exposure
Duration of any breastfeeding to age 12 months.Main Outcomes and Measures
Child receptive language assessed with the Peabody Picture
Vocabulary Test at age 3 years, Wide Range Assessment of Visual Motor
Abilities at ages 3 and 7 years, and Kaufman Brief Intelligence Test and
Wide Range Assessment of Memory and Learning at age 7 years.Results
Adjusting for sociodemographics, maternal intelligence, and
home environment in linear regression, longer breastfeeding duration was
associated with higher Peabody Picture Vocabulary Test score at age 3
years (0.21; 95% CI, 0.03-0.38 points per month breastfed) and with
higher intelligence on the Kaufman Brief Intelligence Test at age 7
years (0.35; 0.16-0.53 verbal points per month breastfed; and 0.29;
0.05-0.54 nonverbal points per month breastfed). Breastfeeding duration
was not associated with Wide Range Assessment of Memory and Learning
scores. Beneficial effects of breastfeeding on the Wide Range Assessment
of Visual Motor Abilities at age 3 years seemed greater for women who
consumed 2 or more servings of fish per week (0.24; 0.00-0.47 points per
month breastfed) compared with less than 2 servings of fish per week
(−0.01; −0.22 to 0.20 points per month breastfed) (P = .16 for interaction).Conclusions and Relevance
Our results support a causal relationship of breastfeeding
duration with receptive language and verbal and nonverbal intelligence
later in life.
Related is also:
Dimitri A. Kristakis, Breastfeeding and CognitionCan IQ Tip the Scale? JAMA Pediatrics 2013. Pay per view → LINK [doi:10.1001/jamapediatrics.2013.470]
Extract
In the developed world, where the
benefits of breastfeeding are not measured in terms of life or death or
even serious morbidity, the question has been what benefits might
motivate mothers to both initiate and sustain it consistent with the
World Health Organization and American Academy of Pediatrics
recommendations.1– 2
The reduction of gastroenteritis, otitis media, and atopic eczema in
the first year of life is supported by a strong evidence base.3
While these are important and desirable outcomes, none in and of
themselves have dramatic public health consequences, particularly beyond
early childhood. On the other hand, the connection between
breastfeeding and cognition has lifelong and widespread implications.
Whether a causal linkage between the two exists has long been debated,
in part, because most existing studies are observational and have failed
to adjust for maternal IQ. Given the known association between
educational attainment or intelligence and breastfeeding, failure to
adjust for maternal IQ may confound any observed effects on infants.
The
study by Belfort et al4 in this month’s issue of JAMA Pediatrics,
although observational, has many notable strengths including
controlling for maternal intelligence, as well as features of the home
environment that promote cognitive function. Assuming these findings are
in fact robust, what are the public health implications?
A synthesis of the findings is also available at Science Daily. They explain that the association with motherly fish intake mentioned in the first abstract is not statistically significant. They also quote the authors as saying:
In summary, our results support a causal relationship of breastfeeding
in infancy with receptive language at age 3 and with verbal and
nonverbal IQ at school age. These findings support national and
international recommendations to promote exclusive breastfeeding through
age 6 months and continuation of breastfeeding through at least age 1
year.
Christakis in turn emphasizes that while the absolute distinction between breastfeeding and bottle feeding is important (in the USA only 70% of White mothers and only 50% of Black ones initiate breastfeeding at all), a major problem is the lack of persistence of this natural form of nutrition, caused mostly by social and labor pressures, including the absurd stigma against breastfeeding in public, not so long a common sight. Only 35% of European-American and a mere 20% of African-American mothers still breastfeed by their baby’s age of six months. He says:
Breastfeeding in public should be destigmatized. Clever social media
campaigns and high-quality public service announcements might help with
that. As with lead, some of these actions may require legislative action
either at the federal or state level. Let’s allow our children’s
cognitive function be the force that tilts the scale, and let’s get on
with it.