Breast feeding and later psychosocial adjustment

Association between breastfeeding duration and neurodevelopment in Chinese children aged 2 to 3 years

OBJECTIVE

The aim of this study was to explore the relationship between breastfeeding duration and neurodevelopment in children aged 2 to 3 years in a Chinese population.

METHODS

This study was based on a cross-sectional survey. The data were from the National Nutrition and Health Systematic Survey for children in China which was conducted from 2019 to 2020. Characteristics of parents and children and the breastfeeding duration were obtained using interview-administered questionnaires. Children's neuropsychological development was assessed by a trained child health care physician using the Child Psychological Development Scale. A multivariable linear regression model was used to analyze the association between breastfeeding duration and neuropsychological development.

RESULTS

A total 1290 children aged 2-3 years were included in the present analysis. In multivariable linear regression models, after adjustment for potential confounders, children who were breastfed for 7-12 months had a 3.59-point increase in gross motor development (β = 3.59; 95 % confidence interval [CI]: 1.23 to 6.34), a 3.73-point increase in fine motor development (β = 3.73; 95 % CI: 1.09 to 6.47), and a 2.87-point in language development (β = 2.87; 95 % CI: 1.12 to 5.31) compared with those who were never breastfed. Children who were breastfed for > 12 months had a 3.77-point increase in fine motor development (β = 3.77; 95 % CI: 0.98 to 6.86) compared with those who were never breastfed.

CONCLUSIONS

Longer breastfeeding duration was associated with increased gross motor, fine motor, and language scores in our study population. Mothers in China should be encouraged to initiate and continue breastfeeding.

The Effects of Breastfeeding on Childhood Behavioral and Emotional Development: A Prospective Cohort Study in China

BACKGROUND

Breastfeeding could improve a child's health early on, but its long-term effects on childhood behavioral and emotional development remain inconclusive. We aimed to estimate the associations of feeding practice with childhood behavioral and emotional development.

METHODS

In this population-based birth cohort study, data on feeding patterns for the first 6 mo of life, the duration of breastfeeding, and children's emotional and behavioral outcomes were prospectively collected from 2489 mother-child dyads. Feeding patterns for the first 6 mo included exclusive breastfeeding (EBF) and non-exclusive breastfeeding (non-EBF, including mixed feeding or formula feeding), and the duration of breastfeeding (EBF or mixed feeding) was categorized into ≤6 mo, 7-12 mo, 13-18 mo, and >18 mo. Externalizing problems and internalizing problems were assessed with the Child Behavior Checklist (CBCL) and operationalized according to recommended clinical cutoffs, corresponding to T scores ≥64. Multivariable linear regression and logistic regression were used to evaluate the association of feeding practice with CBCL outcomes.

RESULTS

The median (interquartile range) age of children at the outcome measurement was 32.0 (17.0) mo. Compared with non-EBF for the first 6 mo, EBF was associated with a lower T score of internalizing problems [adjusted mean difference (aMD): -1.31; 95% confidence interval (95% CI): -2.53, -0.10], and it was marginally associated with T scores of externalizing problems (aMD: -0.88; 95% CI: -1.92, 0.15). When dichotomized, EBF versus non-EBF was associated with a lower risk of externalizing problems (aOR: 0.54, 95% CI: 0.34, 0.87), and it was marginally associated with internalizing problems (aOR: 0.75, 95% CI: 0.54, 1.06). Regarding the duration of breastfeeding, breastfeeding for 13-18 mo versus ≤6 mo was associated with lower T scores of internalizing problems (aMD: -2.50; 95% CI: -4.43, -0.56) and externalizing problems (aMD: -2.75; 95% CI: -4.40, -1.10), and breastfeeding for >18 mo versus ≤6 mo was associated with lower T scores of externalizing problems (aMD: -1.88; 95% CI: -3.68, -0.08). When dichotomized, breastfeeding for periods of 7-12 mo, 13-18 mo, and >18 mo was associated with lower risks of externalizing problems [aOR (95% CI): 0.96 (0.92, 0.99), 0.94 (0.91, 0.98), 0.96 (0.92, 0.99), respectively].

CONCLUSIONS

Exclusive breastfeeding for the first 6 mo and a longer duration of breastfeeding, exclusively or partially, are beneficial for childhood behavioral and emotional development.

Best for Whom? Heterogeneous Treatment Effects of Breastfeeding on Child Development

The slogan "Breast is Best" has been popularized by medical organizations and parenting networks to extoll the benefits of breastfeeding, yet the causal effects are widely debated. Our study contributes to the debate by examining whether breastfeeding has differential effects based on the propensity to breastfeed, which is also known as causal effect heterogeneity. Prior studies attempt to isolate the causal effect of breastfeeding by netting out confounding characteristics, but we argue that the effects of breastmilk are unlikely to operate in a vacuum. The social forces that promote or constrain breastfeeding among different populations in American society can also shape its effects. Using rich intergenerational panel data from the NLSY79 Child and Young Adult cohort (n = 7902), we evaluate heterogeneous treatment effects in the relationship between breastfeeding and child development from ages 4 to 14 using stratification-multilevel propensity score models. We find that breastfeeding is associated with small benefits for behavioral development, math scores, and academic ability among those with the highest propensities to breastfeed. By contrast, its small benefits for reading comprehension and vocabulary are concentrated among children with the lowest propensities to breastfeed. Our findings suggest that the social process of selection into breastfeeding cannot be fully disentangled from its estimated effects. The social context not only shapes who breastfeeds in American society, but also who benefits most.

The Serotonergic System and Bone Metabolism During Pregnancy and Lactation and the Implications of SSRI Use on the Maternal-Offspring Dyad

Lactation is a physiological adaptation of the class Mammalia and is a product of over 200 million years of evolution. During lactation, the mammary gland orchestrates bone metabolism via serotonin signaling in order to provide sufficient calcium for the offspring in milk. The role of serotonin in bone remodeling was first discovered over two decades ago, and the interplay between serotonin, lactation, and bone metabolism has been explored in the years following. It is estimated that postpartum depression affects 10-15% of the population, and selective serotonin reuptake inhibitors (SSRI) are often used as the first-line treatment. Studies conducted in humans, nonhuman primates, sheep, and rodents have provided evidence that there are consequences on both parent and offspring when serotonin signaling is disrupted during the peripartal period; however, the long-term consequences of disruption of serotonin signaling via SSRIs during the peripartal period on the maternal and offspring skeleton are not fully known. This review will focus on the relationship between the mammary gland, serotonin, and bone remodeling during the peripartal period and the skeletal consequences of the dysregulation of the serotonergic system in both human and animal studies.

Role of Maternal Microbiota and Nutrition in Early-Life Neurodevelopmental Disorders

The rise in the prevalence of obesity and other related metabolic diseases has been paralleled by an increase in the frequency of neurodevelopmental problems, which has raised the likelihood of a link between these two phenomena. In this scenario, maternal microbiota is a possible linking mechanistic pathway. According to the "Developmental Origins of Health and Disease" paradigm, environmental exposures (in utero and early life) can permanently alter the body's structure, physiology, and metabolism, increasing illness risk and/or speeding up disease progression in offspring, adults, and even generations. Nutritional exposure during early developmental stages may induce susceptibility to the later development of human diseases via interactions in the microbiome, including alterations in brain function and behavior of offspring, as explained by the gut-brain axis theory. This review provides an overview of the implications of maternal nutrition on neurodevelopmental disorders and the establishment and maturation of gut microbiota in the offspring.

Stress degree demonstrated in mothers with phenylketonuria or hyperphenylalaninemia infant when requested for total or partial breastfeeding replacement

Obejctives

Phenylketonuria (PKU) and hyperphenylalaninemia (HPHE) are metabolic disorders of phenylalanine (phe) metabolism due to the liver enzyme phe hydroxylase deficiency resulting in mental retardation. The only treatment of these disorders is the total or the partial breastfeeding replacement with special formula, respectively.

Case presentation

We aimed to evaluate the maternal stress degree in the two groups of mothers and compare the stress degree between mothers who were obliged to replace breastfeeding completely with those who replaced it partially. Mothers (n=50) were divided into two groups: n=25 with PKU and n=25 with HPHE infants. Mothers with PKU newborns were obliged to replace breastfeeding completely and feed their newborns with a common formula plus phe free medical food, whereas mothers with HPHE infants partially replaced breastfeeding with phe free medical food. Stress degrees were calculated using special questionnaire checklist by Bourne E. Psychological support was provided for both groups of mothers with stress.

Conclusions

Most mothers with PKU infants experienced high or severe stress, whereas mothers with HPHE newborns suffered from low and moderate symptoms and signs of stress. After psychological support most mothers with PKU newborns were ameliorated from stress symptoms; mothers with HPHE neonates experienced almost no stress symptoms. Mothers with PKU infants obliged to complete breastfeeding replacement experienced high and/or severe stress degrees as compared to mothers with HPHE newborns with partial breastfeeding replacement. Psychological support resulted in amelioration of both tested groups.

Exclusive Breastfeeding Is Not Associated with Maternal-Infant Bonding in Early Postpartum, Considering Depression, Anxiety, and Parity

It is important to clarify how the breastfeeding method affects women’s mental health, and how women’s mental health affects the breastfeeding method in the early postpartum period when major depression and other psychiatric problems are most likely to occur. This study aimed to examine this bidirectional relationship in the early postpartum period. Participants were 2020 postpartum women who completed the Hospital Anxiety and Depression Scale (HADS) and Mother-to-Infant Bonding Scale (MIBS). We obtained data for participants’ breastfeeding method for four weeks after childbirth. We performed a path analysis with factors including breastfeeding method (exclusive breastfeeding or non-exclusive breastfeeding), parity (primipara or multipara), the two HADS subscales (anxiety and depression), and the two MIBS subscales (lack of affection and anger and rejection). The path analysis showed that breastfeeding method did not significantly affect depression, anxiety, and maternal–infant bonding in the early postpartum period. Women with higher anxiety tended to use both formula-feeding and breastfeeding. Our study suggests that exclusive breastfeeding is not associated with maternal-fetal bonding in early postpartum, considering depression, anxiety, and parity.

The Language Development Via FOXP2 in Autism Spectrum Disorder: A Review

BACKGROUND

An increasing number of newborn children in numerous nations are enrolled in early childhood education programs, and instructors, in this way, assume a focal job in invigorating language improvement in these youthful kids. Kids with language issues are found to have a higher risk for future scholarly challenges and learning inabilities. Language advancement among kids is an intricate procedure and vital for correspondence. The shortcomings in the utilization of grammatical structures may lessen the useful utilization of language for verbally expressive kids with autism spectrum disorder and exacerbate troubles with academic and social expertise advancement.

RESULTS

FOXP2, the single principal gene connected to a speech and language issue, is significant for the right execution of complex motor behaviors used for speech. In any case, changes in FOXP2 lead to a speech/language issue portrayed by childhood apraxia of speech. These days, language learning is fundamentally required for kids who need to move to different nations to pursue the instructive frameworks and be helpful individuals or residents of those nations.

CONCLUSION

The purpose of this study was to explore the role of FOXP2 in language disorder and its management for children's language and communication development.

Associations between Prenatal Education, Breastfeeding and Autistic-Like Behaviors in Pre-Schoolers

This study aimed to investigate the association between prenatal education and autistic-like behaviors of preschoolers as well as the mediating role of breastfeeding in their associations. A cross-sectional study via a structured questionnaire was conducted with 67,578 preschool children and parents from Longhua District of Shenzhen, China. Hierarchical logistic regression models were performed to explore the associations between maternal participation in prenatal education and autistic-like behaviors in preschoolers, as well as the mediating effect of breastfeeding in the associations. After controlling for potential confounders, logistic regression analysis indicated that maternal participation in prenatal education could significantly increase the prevalence of breastfeeding, and the strength of the association was enhanced with the increase frequency of prenatal education visits (ORs ranging from 1.191 to 1.899). While both maternal participation in prenatal education (ORs ranging from 0.732 to 0.798) and breastfeeding (OR = 0.773) were significantly associated with the lower presence of autistic-like behaviors in preschoolers. The crossover analysis indicated that children with both maternal prenatal education and breastfeeding had the lower risk of presence of autistics-like behaviors (OR = 0.569). Furthermore, mediation analysis illustrated that breastfeeding mediated the association between maternal participation in prenatal education and the presence of autistic-like behaviors in preschoolers, with a mediating effect of approximately 14.3%. Our findings suggest that maternal participation in prenatal education is significantly associated with a decreased risk of autistic-like behaviors in preschool children through increased breastfeeding in the mothers who attended prenatal education.

The association between breastfeeding and attachment: A systematic review

OBJECTIVE

In the popular and scientific literature an association between breastfeeding and attachment is often supposed although this has not been systematically investigated. This is the first review that provides a systematic overview of the current state of research on the association between breastfeeding and attachment. The objective is to determine whether breastfeeding is associated with child attachment as well as if maternal attachment is associated with breastfeeding behaviour.

DESIGN

A systematic electronic literature search for English language articles published from 1963 to 2019 using the databases Web of Science, PubMed, PsycInfo, and PsycArticles was conducted. Studies were included if (1) the association between breastfeeding and attachment of the child or maternal attachment style and breastfeeding was investigated, (2) participants were mothers or mother-child dyads, and (3) quantitative measures of breastfeeding and attachment were used. Study quality was rated using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

PARTICIPANTS

Studies examining mothers or mother-child dyads were reviewed. Sample sizes varied between N = 60 and N = 8900 participants. On average, mothers were between 27.56 and 32.50 years old.

FINDINGS

Eleven studies were eligible for inclusion. Of seven studies examining breastfeeding and child attachment, four found that a longer duration of breastfeeding was significantly associated with higher levels of attachment security after controlling for various covariates. No significant differences in attachment security between breastfeeding and bottle-feeding were reported, but one study found higher levels of attachment disorganization for bottle-feeding, although mean levels were below a clinically relevant level. The initiation of breastfeeding directly after childbirth was not related to child attachment. Of four studies examining maternal attachment and breastfeeding, three found a significant association between secure attachment of the mother and breastfeeding behaviour. Secure attached mothers initiated breastfeeding more often and preferred breast- over bottle-feeding than insecure attached mothers. Mixed results were found for breastfeeding duration. Most studies had limitations regarding adequate sample size, and valid and reliable measurement of breastfeeding.

KEY CONCLUSIONS

The findings provide some evidence that breastfeeding might contribute to child attachment security. Furthermore, maternal attachment style might play a role in breastfeeding behaviour. However, more prospective studies are needed to draw a solid conclusion.

IMPLICATIONS FOR PRACTICE

With regard to breastfeeding recommendations, health professionals should be aware of and communicate towards clients that the effect of breastfeeding on child attachment might be rather small. Screening of maternal attachment style as a part of maternity practice could be useful to support insecure attached mothers experiencing breastfeeding difficulties.

Replacement of breastfeeding with medical food for the treatment of galactosemia and phenylketonuria: maternal stress

Breastfeeding replacement is the only treatment for galactosemia (GAL) and phenylketonuria (PKU) during infancy. We aimed to evaluate the stress degree in mothers who were obliged to replace breastfeeding with special formulas as the only treatment for the diseased newborns. Thirty-two mothers with GAL newborns, 19 on breastfeeding only and 13 on breastfeeding plus formula, participated in this study. Additionally, 54 mothers with PKU infants, 32 offered breastfeeding only and 22 breastfeeding plus formula, participated in the study. Stress degree was evaluated in both groups: GAL and PKU. Mothers on breastfeeding only experienced the highest degree of stress than those who were on breastfeeding plus formula. After 1 month of psychological support, most mothers were ameliorated: mothers on breastfeeding only felt better as compared to those on breastfeeding plus formula. Conversely, in mothers on breastfeeding plus formulas, symptoms and signs of stress almost disappeared. In conclusion, GAL or PKU mothers with breastfeeding only experienced the highest degree of stress when asked for breastfeeding replacement. Psychological support made all the studied groups to feel better or free of symptoms and signs of stress.

Breastfeeding reduces risk of depression later in life in the postmenopausal period: A Korean population-based study

OBJECTIVE

The relationship between breastfeeding and maternal depression in later life has not yet been investigated. We examined whether the number of breastfed infants or the period of breastfeeding influenced maternal depression in postmenopausal women.

METHODS

We analyzed 1,372 parous postmenopausal women aged ≥ 50 years who had participated in the Korea National Health and Nutrition Examination Survey 2014. Depression was diagnosed using the Patient Health Questionnaire 9, with scores of 10 or higher indicating depression. Logistic regression analyses were performed to examine the relationships between breastfeeding and postmenopausal depression.

RESULTS

Women with a moderate (2-3) or high (4-12) number of breastfed infants had 65% [odds ratio (OR) = 0.35, 95% confidence interval (CI) = 0.19-0.65] and 77% (OR = 0.23, 95% CI = 0.10-0.55) decreased risks of depression, respectively, compared to those with low numbers of infants (0-1). Women who breastfed their infants for long periods (47-432 months) had 67% (OR = 0.33, 95% CI = 0.16-0.68) decreased risk of depression, compared to those who breastfed for short periods (0-23 months). The risk of depression decreased by 29% (OR = 0.71, 95% CI = 0.58-0.87) for each additional infant breastfed and by 9% (OR = 0.91, 95% CI = 0.82- < 1.00) for each additional year of breastfeeding. The population-attributable fraction of depression associated with < 2 infants breastfed was 17.3% (95% CI = 14.2-20.3%), while the fraction associated with a period of breastfeeding < 24 months was not significant.

CONCLUSIONS

Women with more breastfed infants or longer period of breastfeeding are at decreased risk of depression in the postmenopausal period.

Breastfeeding and behavioural problems: Propensity score matching with a national cohort of infants in Chile

IMPORTANCE

Potential effects of breast feeding on children's behaviour remains an elusive debate given inherent methodological challenges. Propensity score matching affords benefits by ensuring greater equivalence on observable social and health determinants, helping to reduce bias between groups.

OBJECTIVES

We examined whether the duration of breast feeding had an impact on children's externalising and internalising behaviours.

STUDY DESIGN

A cohort study (Encuesta Longitudinal de la Primera Infancia cohort) that included 3037 Chilean families who were enrolled in 2010. Follow-up data was collected in 2012.

SETTING

General community.

PARTICIPANTS

Population-based sample. Eligibility criteria: children born full-term with complete data on matching variables. Matching variables included: healthcare system as a proxy of income, presence of a partner/spouse in the household, maternal age, educational level, IQ, working status, type of work, diagnosis of prenatal depression by a healthcare professional, smoking during pregnancy, delivery type, child sex, weight at birth, incubation following delivery, and child age.

EXPOSURE

Duration of breast feeding.

MAIN OUTCOMES AND MEASURES

Externalising and internalising problems assessed using the Child Behaviour Checklist.

RESULTS

Matched results revealed benefits of any breast feeding, up to 6 months, on emotional reactivity and somatic complaints (mean difference of -1.00, 95% CI, -1.84 to -0.16 and -1.02, 95% CI, -1.76 to -0.28, respectively). Children breast fed between 7 and 12 months also had reduced scores on emotional reactivity, in addition to attention problems (mean difference of -0.86, 95% CI, -1.66 to -0.06 and -0.50, 95% CI, -0.93 to -0.07, respectively). No benefits were observed for children breast fed 13 months or more.

CONCLUSION

Reduced internalising difficulties and inattention were found in children breast fed up to a year, suggesting that breast feeding may have beneficial impacts on these areas of development. The magnitude of effect was modest. Extended durations of breast feeding did not appear to offer any benefits.

The relationship between exclusive breastfeeding and infant development: A 6- and 12-month follow-up study

BACKGROUND

Breastfeeding offers several advantages for infants with research suggesting that it benefits development, including cognitive and language development. However, limited research has examined the benefits in infants under one year.

AIMS

To investigate the association between breastfeeding duration and infant development.

STUDY DESIGN

A longitudinal study conducted over 12 months.

SUBJECTS

Two hundred fifty-five mothers and their infants living in South Korea were seen at three time-points based on infants' age (4, 6, and 12 months).

OUTCOME MEASURES

Breastfeeding data were collected at 4 and 6 months. The Korea-Developmental Screening Test for Infants & Children was administered at 6 and 12 months to measure developmental milestones. We analyzed the relationship between breastfeeding duration in the first 6 months and infant development at 6 and 12 months using logistic regression analysis.

RESULTS

Compared to infants who did not breastfeed at all, infants who were exclusively breastfed until 4 months of age followed by mixed breastfeeding had a better communication and social interaction at 6 months, and better cognition, communication, and social interaction at 12 months. Exclusive breastfeeding until 6 months of age had no apparent impact on the outcomes at 6 and 12 months.

CONCLUSIONS

Exclusive breastfeeding up to 4 months of age followed by mixed breastfeeding might maximize the effects of infant development in their first year after birth. Breastfeeding programs should effectively communicate that exclusive breastfeeding for at least 4 months benefits infant development.

Co-use of tobacco and marijuana during pregnancy: Pathways to externalizing behavior problems in early childhood

Use and co-use of tobacco and marijuana during pregnancy are associated with the development of social, cognitive, and behavioral problems for infants and children. However, less is known about the potential developmental impact of the use of tobacco and marijuana in tandem. The present study examined an etiological model for the development of externalizing behavior problems (EBP) in early childhood in a high risk sample (N = 247) of mother-infant dyads with prospective data from pregnancy to 36 months of child age. Co-use during pregnancy and continued maternal tobacco and marijuana use from infancy through early childhood were investigated. Although direct pathways from exposure during pregnancy to EBP were not significant, there was a significant indirect pathway from prenatal tobacco use to EBP via lower breastfeeding duration to lower maternal warmth/sensitivity to EBP, and a pathway from higher maternal affective dysregulation to higher EBP. These results highlight the importance of considering cascading effects of substance use during pregnancy on parental processes within the context of developmental risk and protection.

Risk Factors for Antisocial Behavior in Low- and Middle-Income Countries: A Systematic Review of Longitudinal Studies

Violent crime is a major cause of social instability, injury, and death in low- and middle-income countries. Longitudinal studies in high-income countries have provided important evidence on developmental precursors of violence and other antisocial behaviors. However, there may be unique influences or different risk factor effects in other social settings. Extensive searches in seven languages and screening of over 60,000 references identified 39 longitudinal studies of antisocial behavior in low- and middle-income countries. Many risk factors have roughly the same average effects as when studied in high-income countries. Stability of aggression over a 3-year period is almost identical across low- and middle-income countries and high-income countries. Dimensions of comorbid psychopathology such as low self-control, hyperactivity, and sensation seeking are associated with antisocial behavior in low- and middle-income countries, but some early physical health factors have consistently weak or null effects.

Breastfeeding and behavior disorders among children and adolescents: a systematic review

OBJECTIVE

This systematic review study aimed to assess the evidence available for the association between breastfeeding and behavior disorders in childhood and adolescence.

METHODS

The search was carried out in the PubMed, Lilacs, and PsycINFO databases up to December 2016. Inclusion criteria were as follows: prospective, retrospective and cross-sectional studies assessing the association between breastfeeding and behavior disorders in childhood or adolescence, using psychometric tests, carried out in humans and published in Portuguese, English, or Spanish. The search was performed in several stages by two independent researchers using pre-established criteria.

RESULTS

Eighteen studies met the inclusion criteria. Breastfeeding for a period equal to or higher than three or four months seemed to be inversely associated with total behavior and conduct disorders in childhood; however, the association remains unclear for other behavior disorders. Only four studies assessed behavior disorders in adolescence, and when an association was found, it was likely to be positive. The duration of breastfeeding seemed to be more important than the exclusive or non-exclusive pattern of breastfeeding.

CONCLUSIONS

Breastfed children for at least three to four months had fewer total behavior and conduct disorders in childhood. Further studies are needed to better understand this association, particularly in adolescence and involving other behavioral profiles.

Breastfeeding effects on DNA methylation in the offspring: A systematic literature review

BACKGROUND

Breastfeeding benefits both infants and mothers. Recent research shows long-term health and human capital benefits among individuals who were breastfed. Epigenetic mechanisms have been suggested as potential mediators of the effects of early-life exposures on later health outcomes. We reviewed the literature on the potential effects of breastfeeding on DNA methylation.

METHODS

Studies reporting original results and evaluating DNA methylation differences according to breastfeeding/breast milk groups (e.g., ever vs. never comparisons, different categories of breastfeeding duration, etc) were eligible. Six databases were searched simultaneously using Ovid, and the resulting studies were evaluated independently by two reviewers.

RESULTS

Seven eligible studies were identified. Five were conducted in humans. Studies were heterogeneous regarding sample selection, age, target methylation regions, methylation measurement and breastfeeding categorisation. Collectively, the studies suggest that breastfeeding might be negatively associated with promoter methylation of LEP (which encodes an anorexigenic hormone), CDKN2A (involved in tumour suppression) and Slc2a4 genes (which encodes an insulin-related glucose transporter) and positively with promoter methylation of the Nyp (which encodes an orexigenic neuropeptide) gene, as well as influence global methylation patterns and modulate epigenetic effects of some genetic variants.

CONCLUSIONS

The findings from our systematic review are far from conclusive due to the small number of studies and their inherent limitations. Further studies are required to understand the actual potential role of epigenetics in the associations of breastfeeding with later health outcomes. Suggestions for future investigations, focusing on epigenome-wide association studies, are provided.

Early Life Predictors of Socio-Emotional Development in a Sample of Egyptian Infants

INTRODUCTION

Emotional problems are amongst the most critical concerns to be intentionally handled to enhance the wellbeing and development of children.

OBJECTIVE

To determine the predictors of socio-emotional development of Egyptian infants related to infant feeding practices, aspects of infant and maternal health and socioeconomic status.

SUBJECTS AND METHODS

A cross-sectional comparative study included 322 breast fed, 240 bottle fed and 93 mixed fed infants, from 6-24 months of age, who were enrolled in the Well-Baby Clinic of the National Research Centre and from pediatric outpatient facilities in urban Cairo. Assessment of socio-emotional development was performed using Bayley Scales of Infant and Toddler Development (Bayley III). Detailed maternal and infant history was recorded. Levels of serum zinc, copper, iron, vitamin B12 and complete blood count (CBC) were assessed in a subsample of 193 infants.

RESULTS

The risk of having below average socio-emotional composite score was nearly two and half times among formula-fed infants than among breast-fed infants. By binary logistical regression analysis, predictors of below average socio-emotional score were a lower serum zinc value, being formula fed during the first half-year and introduction of complementary food before the age of six months (p< 0.05).

CONCLUSION

Exclusive breastfeeding and to a lesser extent mixed feeding during the first half year is correlated with above average socio-emotional development. Maternal education and zinc status were also determinants of better infant mental health. Our endeavors ought to be directed towards integrated interventions addressing multiple risks to children's development.

Lack of Breastfeeding: A Potential Risk Factor in the Multifactorial Genesis of Borderline Personality Disorder and Impaired Maternal Bonding

Borderline personality disorder (BPD) is characterized by a pattern of intense but unstable interpersonal relationships. These interpersonal dysfunctions may originate from impaired bonding and attachment that is determined during early life. Remarkably, it has been reported that the quality of mother-infant relationship is influenced by the feeding mode. Thus, bottle feeding instead of breastfeeding and possible lack of maternal bonding-related behavior may increase the risk for later psychopathology and attachment problems as seen in BPD. A total of 100 BPD patients and 100 matched healthy controls underwent semistructured interviews, based on retrospective information about early risk factors and breastfeeding during infancy. The authors' analyses revealed that BPD patients were significantly less breastfed compared to healthy controls (no breastfeeding in BPD: 42.4%; no breastfeeding in controls: 18.2%; p < .001). The BPD diagnosis was significantly predicted by the variable "no breastfeeding" (p < .001; odds ratio [OR] = 3.32; confidence interval [CI] [1.74, 6.34]), even after adjustment for childhood trauma and several confounding factors (p = .001). The variable "no breastfeeding" accounts for 9.1% of the variance of the BPD diagnosis and is associated with low perceived maternal bonding (p = .006). Breastfeeding may act as an early indicator of the mother-infant relationship that seems to be relevant for bonding and attachment later in life.

Association Between Infant Feeding Practices and First Meaningful Words at First Year of Life

Feeding practices show many benefits for child and cognitive development. The objective was to investigate the association between infant feeding practices and the first meaningful words of Thai children. The participants enrolled in this longitudinal study were 4245 children born between July 2000 and June 2002. They resided in 3 rural and 2 urban areas of Thailand and were followed from birth to childhood. The outcome was time from birth to expression of first meaningful words. Outcome and feeding information were gathered using a diary method, with parents and caregivers recording daily development. Nonstatistically significant corresponding reduction in time to expression of first meaningful words was found among children who were breastfed, and this increased with duration of breastfeeding. Breastfeeding may reduce the time taken for expression of first meaningful words by about 2% (hazard ratio = 0.98; 95% confidence interval = 0.94 to 1.01). No association between infant feeding practices and the expression of first meaningful words was found.

Methods for the year 6 follow-up study of children in the Infant Feeding Practices Study II

OBJECTIVE

We describe methods used in the Year 6 Follow-Up (Y6FU) of children who participated in the Infant Feeding Practices Study II (IFPSII). This study consists of a questionnaire administered 6 years after the IFPSII to characterize the health, development, and diet quality of the children.

METHODS

The Y6FU sample was a subset of those who participated in IFPSII. The IFPSII participants were drawn from a national consumer opinion panel; neither the IFPSII nor the Y6FU sample is nationally representative. The Y6FU sampling frame included all qualified participants who answered at least the first postnatal questionnaire. One questionnaire was administered by mail in 2012, and nonrespondents were contacted for a telephone interview. Survey topics included measures of health, development, diet, physical activity, screen time, and family medical history. We attempted to contact 2958 mothers and obtained completed questionnaires from 1542, a response rate of 52.1%. We conducted 2 sample evaluations, 1 comparing respondents and nonrespondents on data from IFPSII and the other comparing Y6FU respondents with 6-year-old participants in the National Survey of Children's Health.

RESULTS

Y6FU mothers are more likely to be white, married, older, and of higher education and income than both nonresponders and nationally representative mothers. Comparisons also revealed health-related differences and similarities.

CONCLUSIONS

Although not nationally representative, the Y6FU provides a valuable database because of its wide coverage of diet and health issues and its unique ability to link early feeding patterns with outcomes at age 6 years.

Breastfeeding and trajectories of children's cognitive development

The aim of this study was to examine the association of breastfeeding practices with the growth trajectories of children's cognitive development. We used data from the Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID) with variables on presence and duration of breastfeeding and standardized test scores obtained during three different panel waves (N = 2681). After adjusting for covariates we found that breastfed children had higher test scores but that breastfed and non-breastfed children had similar growth trajectories in test scores over time. The results indicate that breastfeeding has an important association with test scores, and that subsequent schooling and other experiences during adolescence do not eliminate the breastfeeding gap that appears in very early childhood.

Breastfeeding and active bonding protects against children's internalizing behavior problems

Breastfeeding is associated with numerous health benefits to offspring and mothers and may improve maternal-infant bonding. Ample evidence suggests breastfeeding can improve child neurodevelopment, but more research is needed to establish whether breastfeeding is linked to the development of child psychopathology. This paper aims to explore the effects of both breastfeeding and mother-child interactions on child behavioral outcomes at a later age. Children from the China Jintan Child Cohort Study (N = 1267), at age six years old were assessed, along with their parents. Children who were breastfed exclusively for a period of time in the presence of active bonding were compared to those who were breastfed in the absence of active bonding as well as to children who were not exclusively breastfed, with or without active bonding. Results from ANOVA and GLM, using SPSS20, indicate that children who were breastfed and whose mothers actively engaged with them displayed the lowest risk of internalizing problems (mean = 10.01, SD = 7.21), while those who were neither exclusively breastfed nor exposed to active bonding had the least protection against later internalizing problems (mean = 12.79, SD = 8.14). The effect of breastfeeding on internalizing pathology likely represents a biosocial and holistic effect of physiological, and nutritive, and maternal-infant bonding benefits.

Breast feeding and early adolescent behaviour, self-esteem and depression: Hong Kong's 'Children of 1997' birth cohort

OBJECTIVE

Breast feeding may contribute to neurological development and hence mental health. However, associations from Western populations are unclear, and most likely confounded by socioeconomic position (SEP), making evidence from other sociocultural settings valuable. We examined whether breast feeding was associated with early adolescent emotional and behavioural problems, self-esteem and depressive symptoms in a non-Western developed setting, where socioeconomic patterning of breast feeding differs from but other postnatal characteristics are similar to Western settings.

DESIGN

The adjusted associations of breast feeding with emotional and behavioural problems assessed from parent-reported Rutter z-score at ~11 years (n=5598, 67% follow-up), self-reported self-esteem z-score at ~11 years (n=6937, 84%) and depressive symptoms assessed from self-reported Patient Health Questionnaire-9 z-score at ~13 years (n=5797, 70%) were examined using multivariable linear regression in a population-representative Hong Kong Chinese birth cohort, 'Children of 1997'.

RESULTS

Mothers from families with higher education tended to start but not sustain breast feeding, whereas migrant mothers tended to start and sustain breast feeding. Breast feeding for 3+ months had mostly null associations with Rutter score, self-esteem or depressive symptoms adjusted for sex, age, survey mode, SEP, parents' age, birth weight-for-gestational age, birth order and secondhand smoke exposure, although partial breast feeding for any length of time or exclusive breast feeding for <3 months was associated with poorer behaviour (higher Rutter z-score (0.10, 95% CI 0.05 to 0.16)) and lower self-esteem (-0.09, 95% CI -0.14 to -0.04).

CONCLUSIONS

In a non-Western developed setting, breast feeding was inconsistently associated with several early adolescent mental health measures suggesting a reflection of setting specific unmeasured confounding.

Genetic variation in oxytocin rs2740210 and early adversity associated with postpartum depression and breastfeeding duration

Mothers vary in duration of breastfeeding. These individual differences are related to a variety of demographic and individual maternal factors including maternal hormones, mood and early experiences. However, little is known about the role of genetic factors. We studied single-nucleotide polymorphisms (SNPs) in the OXT peptide gene (rs2740210; rs4813627) and the OXT receptor gene (OXTR rs237885) in two samples of mothers from the Maternal adversity, Vulnerability and Neurodevelopment study (MAVAN), a multicenter (Hamilton and Montreal, Canada) study following mothers and their children from pregnancy until 7 years of age. Data from the Hamilton site was the primary sample (n = 201) and data from Montreal was the replication sample (n = 151). Breastfeeding duration, maternal mood (measured by the CES-D scale) and early life adversity (measured by the CTQ scale) were established during 12 months postpartum. In our primary sample, polymorphisms in OXT rs2740210, but not the other SNPs, interacted with early life adversity to predict variation in breastfeeding duration (overall F8,125  = 2.361, P = 0.021; interaction effect b = -8.12, t = -2.3, P = 0.023) and depression (overall F8,118  = 5.751, P ≤ 0.001; interaction effect b = 6.06, t = 3.13, P = 0.002). A moderated mediation model showed that higher levels of depression mediated the inverse relation of high levels of early life adversity to breastfeeding duration, but only in women possessing the CC genotype [effect a' = -3.3401, 95% confidence interval (CI) = -7.9466 to -0.0015] of the OXT SNP and not in women with the AA/AC genotype (a' = -1.2942, ns). The latter findings (moderated mediation model) were replicated in our Montreal sample (a' = -0.277, 95% CI = -0.7987 to -0.0348 for CC; a' = -0.1820, ns for AA/AC).

Interbirth spacing and offspring mental health outcomes

BACKGROUND

The perinatal or early life environment may influence the development of mental illness in adulthood. It is not clear how, or when, any such influences might be mediated. Foetal exposure to maternal stress in the intrauterine environment has been suggested as a possible mediator of foetal origins of mental illness but the postnatal environment may also be of importance. This study aimed to test the foetal origins hypothesis by using retrograde and antegrade interbirth intervals (time to mother's most recent and next deliveries respectively) as proxy measures of antenatal and postnatal maternal stress.

METHOD

Linked datasets of the Scottish Morbidity Record (SMR) were used to identify a birth cohort. Where applicable, the dates of each mother's most recent previous and/or next subsequent delivery were noted, allowing birth intervals to be calculated. The cohort was followed up into young adulthood, using self-harm, substance misuse, psychotic disorder and affective disorder as outcome measures. Data were analysed using Cox regression.

RESULTS

No significant relationship was observed between affective disorders and interbirth interval, neither retrograde nor antegrade. Short (<18-month) antegrade birth intervals were independently associated with increased risk of psychotic disorder and self-harm. Long (>72-month) retrograde intervals were associated with increased risk of self-harm and substance misuse.

CONCLUSIONS

The data do not provide evidence for the foetal origins of mental disorders but, in the cases of psychotic disorders, and of self-harm, suggest that the early postnatal rather than the antenatal environment may be of greater importance.

Association of breastfeeding and adolescents' psychopathology: a large prospective study

PURPOSE

There is little known about the association between breastfeeding and long-term child psychopathology. This study aimed to examine the impact of breastfeeding on child mental health and problem behavior at 14 years and whether this association is confounded by other variables.

SUBJECTS AND METHODS

Data were from a pre-birth prospective study that included mothers and their children followed up from pregnancy to 14 years of the child's age in Brisbane, Australia. The child's anxiety/depression, withdrawal problems, somatic complaints, social problems, thought problems, attention problems, aggression, and delinquency were measured using the Achenbach Youth Self Report at 14 years. Breastfeeding was prospectively assessed at the 6-month follow-up of the study. The analysis was based on 4,502 adolescents who responded to the YSR questionnaire and for whom prospective data were available on breastfeeding.

RESULTS

Breastfeeding as reported by mothers when the child was 6 months old predicted reduced symptoms of child mental health and problem behavior at 14 years. The impact of breastfeeding on the child's social problems, attention problems, and aggressive behavior remained statistically significant after controlling for the effect of other variables, such as unplanned pregnancy, maternal mental health, and substance use during pregnancy.

CONCLUSIONS

Our data suggest that breastfeeding for at least 4 months can have a significant protective effect on a child's social, attention, and aggression problems in early adolescence. Given the limitations of the existing evidence, further research is needed to investigate the robustness of the findings of this study and the mechanisms of long-term association between breastfeeding and reduced social, attention, and aggression problems of the offspring in adolescence.

Long-term behavioural consequences of infant feeding: the limits of observational studies

Observational (non-experimental) studies of the association between infant feeding and subsequent child or adult behaviour are prone to residual confounding by subtle differences in psychological attributes and interactional styles of mothers who breast feed vs. those who formula-feed. We followed up 13,889 6.5-year-old Belarusian children who participated in a large cluster-randomised trial of a breast-feeding promotion intervention. Behaviour was evaluated using the Strengths and Difficulties Questionnaire (SDQ), completed independently by the children's parents and teachers. We compared the results of experimental (intention-to-treat, ITT) and observational analyses (based on feeding actually received), both adjusted for clustering. Observational analyses were additionally adjusted for geographical region, urban vs. rural residence, child's sex, age at follow-up, birthweight, and maternal and paternal education. No differences between the randomised experimental vs. control groups were observed in ITT analyses. In contrast, small but statistically significant associations with weaning prior to 3 months were observed for parent and teacher SDQ scores on total difficulties, conduct problems and hyperactivity, even after multivariable adjustment. The absence of associations based on ITT analyses, in contrast with the significant associations based on observed breast-feeding duration, strongly suggests that the latter are biased by residual confounding.

Breast-feeding and cardiovascular risk factors and outcomes in later life: evidence from epidemiological studies

This paper considers the body of observational evidence examining the association of being breast-fed to cardiovascular risk factors and outcomes in later life, and whether any potentially advantageous findings are causal. Early cardiovascular consequences/correlates of breast-feeding, compared to being formula fed, include markedly higher levels of total blood cholesterol, lower levels of pre-prandial blood glucose and insulin and lower levels of adiposity. However, a key issue is whether these early differences at a period of rapid development programme/influence cardiovascular risk factors and outcomes in later life. Evidence of long-term effects of early feeding, largely from observational studies, has shown that those breast-fed have lower levels of blood total cholesterol, lower risk of type-2 diabetes and marginally lower levels of adiposity and blood pressure in adult life. There is no strong evidence to suggest effects of early feeding on adult levels of blood glucose, blood insulin and CHD outcomes, although further data are needed. However, the influence of confounding factors, such as maternal body size, maternal smoking and socio-demographic factors, and exclusivity of early feeding on these potentially beneficial associations needs to be considered before inferring any causal effects. Moreover, fewer studies have examined whether duration of exclusive breast-feeding has a graded influence on these risk factors and outcomes; such data would help further in deciding upon causal associations. While strong observational evidence suggests nutritional programming of adult cholesterol levels, associations with other markers of cardiometabolic risk and their consequences in later life need to be confirmed in well-conducted observational and experimental studies.

Breastfeeding and early child development: a prospective cohort study

AIM

Breastfeeding has been associated with multiple developmental advantages for the infant; however, there have also been a number of studies that find no significant benefits to child development. We examined the relationship between breastfeeding for 4 months or longer and child development at age 1, 2 and 3 years.

METHODS

Women were enrolled in the Western Australian Pregnancy Cohort (Raine) Study (N = 2900) and their live born children (N = 2868) were followed to the age of 3 years (N = 2280). Infant feeding data were collected at each age, and the mothers completed the Infant/Child Monitoring Questionnaire (IMQ), which measures progress towards developmental milestones in the domains of gross and fine motor skills, adaptability, sociability and communication. Factors adjusted for in multivariable analyses included maternal sociodemographic characteristics and stressful life events.

RESULTS

Infants breastfed for 4 months or longer had significantly higher mean scores (representing better functioning) for fine motor skills at age 1 and 3, significantly higher adaptability scores up to age two, and higher communication scores at age 1 and 3 years. Infants who were breastfed for <4 months were more likely to have at least one atypical score across the five developmental domains than those who were breastfed for 4 months or longer.

CONCLUSION

Although our effect sizes were small, breastfeeding for 4 months or longer was associated with improved developmental outcomes for children aged one to 3 years after adjustment for multiple confounding factors.

The role of early parental bonding in the development of psychiatric symptoms in adulthood

PURPOSE OF REVIEW

To identify and discuss recent research concerning the association between parent-child relationships and psychiatric symptoms in adulthood.

RECENT FINDINGS

Despite their methodological limitations such as small sample sizes and inadequate follow-up periods, recent studies have shown that early parental bonding may play an important role either as a risk or protection factor for the development of psychiatric symptoms in adulthood. Affective enhancement and encouragement of autonomy seem to exert a protective effect, whereas emotional neglect and overprotection seem to be risk factors for the development of psychiatric symptoms in adulthood.

SUMMARY

Current available data indicate that parent-child relationships may prevent or promote the development of psychiatric symptoms, mainly anxiety and depressive symptoms. In order to investigate the quality of parental bonding and its correlation with the level of psychological well being or psychiatric morbidity, further longitudinal studies with larger samples and adequate follow-up periods should be conducted.

Violent delinquency in a Brazilian birth cohort: the roles of breast feeding, early poverty and demographic factors

We investigated the association between breast feeding, economic factors and conviction for violent delinquency by age 25 years among subjects of the 1982 Birth Cohort from Pelotas, Southern Brazil. Information on breast-feeding pattern and duration was collected in childhood, during the 1983, 1984 and 1986 follow-ups. Information on socio-economic and family characteristics was also obtained between 1982 and 1996. Of the 5914 livebirths enrolled in the cohort, 5228 had obtained an identification document within the state of Rio Grande do Sul, and could thus be identified in judiciary databases. The outcome studied was conviction due to a violent act between ages 12 and 25 years. A total of 106 young people had been convicted at least once (3.0% of men and 1.0% of women). Subjects born to black or mixed mothers and coming from low-income families were at higher risk of having been convicted. Neither crude nor adjusted analyses showed any association between breast feeding and conviction for violent delinquency. Violent delinquency apparently depends more on social factors than on individual factors such as breast feeding.

Early weaning and alcohol disorders in offspring: biological effect, mediating factors or residual confounding?

AIMS

This study explores associations between early weaning and alcohol use disorders in youth and mechanisms by which these associations may operate.

DESIGN

We used data from the Mater University Study of Pregnancy and its outcomes, an Australian birth cohort study based in Brisbane.

SETTING AND PARTICIPANTS

This study is based on a subsample of 2370 participants for whom complete data were available at age 21 years. Length and method of breastfeeding were assessed at 6 months.

MEASUREMENTS

Alcohol use disorders were assessed at age 21 using the life-time version of the Composite International Diagnostic Interview-computerized version (CIDI-Auto). We adjusted for maternal age, marital status, education, alcohol, tobacco use, anxiety, depression and maternal attitudes towards the baby. Attention Deficit and Hyperactivity Disorders (ADHD) and Intellect Quotient (IQ) were measured with the Child Behaviour Checklist (5 years) and the Ravens SM (14 years), respectively.

FINDINGS

Those who had been weaned within 2 weeks of being born and breastfed at regular intervals were at increased risk of meeting criteria for alcohol use disorders at age 21 [odds ratio (OR) 1.71, 95% confidence interval (CI):1.07, 2.72].

CONCLUSION

This study confirms a small but robust association between early weaning and increased risk of alcohol use disorders.

Does breastfeeding protect against substantiated child abuse and neglect? A 15-year cohort study

OBJECTIVES

We explored whether breastfeeding was protective against maternally perpetrated child maltreatment.

METHODS

A total of 7223 Australian mother-infant pairs were monitored prospectively over 15 years. In 6621 (91.7%) cases, the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse, and emotional abuse), on the basis of substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with nonmaternal and maternally perpetrated maltreatment and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression.

RESULTS

Of 512 children with substantiated maltreatment reports, >60% experienced > or =1 episode of maternally perpetrated abuse or neglect (4.3% of the cohort). The odds ratio for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment for nonbreastfed children being 4.8 times the odds for children breastfed for > or =4 months. After adjustment for confounding, the odds for nonbreastfed infants remained 2.6 times higher, with no association seen between breastfeeding and nonmaternal maltreatment. Maternal neglect was the only maltreatment subtype associated independently with breastfeeding duration.

CONCLUSION

Among other factors, breastfeeding may help to protect against maternally perpetrated child maltreatment, particularly child neglect.

Influência do apoio à amamentação sobre o aleitamento materno exclusivo dos bebês no primeiro mês de vida e nascidos na cidade de Pelotas, Rio Grande do Sul, Brasil

OBJETIVOS: medir os índices de aleitamento exclusivo no primeiro mês e comparar o padrão alimentar das crianças nascidas no hospital que adota a Iniciativa Hospital Amigo da Criança (IHAC), com os demais hospitais de Pelotas, Rio Grande do Sul, Brasil. MÉTODOS: estudo quase-experimental, aninhado a uma coorte. A pesquisa contou com dois componentes: triagem hospitalar e acompanhamento domiciliar de um mês (30%); foram acompanhados 973 pares mãe-bebê de uma amostra inicial de 2741 mães. RESULTADOS nascer em hospitais que não adotam a IHAC aumentou o risco das mães não terem sido incentivadas para o aleitamento, dos bebês não mamarem na primeira hora e receberem chupeta e chá no hospital. A prevalência de aleitamento exclusivo com um mês foi de 60%. As crianças nascidas no hospital IHAC tiveram maior índice de aleitamento exclusivo com um mês e o uso de chupeta mostrou uma associação negativa com o desfecho. CONCLUSÕES: a intervenção foi positiva e o impacto seria maior se a implantação dos "dez passos" fosse total, na coleta de dados. O incentivo ao aleitamento deve continuar através da formação de grupos de aconselhamento às mães e, talvez, com o acompanhamento até o sexto mês, se alcançasse melhores resultados.

Does initial breastfeeding lead to lower blood cholesterol in adult life? A quantitative review of the evidence

BACKGROUND

Earlier studies have suggested that infant feeding may program long-term changes in cholesterol metabolism.

OBJECTIVE

We aimed to examine whether breastfeeding is associated with lower blood cholesterol concentrations in adulthood.

DESIGN

The study consisted of a systematic review of published observational studies relating initial infant feeding status to blood cholesterol concentrations in adulthood (ie, aged >16 y). Data were available from 17 studies (17 498 subjects; 12 890 breastfed, 4608 formula-fed). Mean differences in total cholesterol concentrations (breastfed minus formula-fed) were pooled by using fixed-effect models. Effects of adjustment (for age at outcome, socioeconomic position, body mass index, and smoking status) and exclusion (of nonexclusive breast feeders) were examined.

RESULTS

Mean total blood cholesterol was lower (P = 0.037) among those ever breastfed than among those fed formula milk (mean difference: -0.04 mmol/L; 95% CI: -0.08, 0.00 mmol/L). The difference in cholesterol between infant feeding groups was larger (P = 0.005) and more consistent in 7 studies that analyzed "exclusive" feeding patterns (-0.15 mmol/L; -0.23, -0.06 mmol/L) than in 10 studies that analyzed nonexclusive feeding patterns (-0.01 mmol/L; -0.06, 0.03 mmol/L). Adjustment for potential confounders including socioeconomic position, body mass index, and smoking status in adult life had minimal effect on these estimates.

CONCLUSIONS

Initial breastfeeding (particularly when exclusive) may be associated with lower blood cholesterol concentrations in later life. Moves to reduce the cholesterol content of formula feeds below those of breast milk should be treated with caution.

Nursing stimulation is more than tactile sensation: It is a multisensory experience

Novel sensory experiences, particularly those associated with epochal developmental events like nursing alter cortical representation, affecting memory, perception and behavior. Functional MRI was used here to test whether the sensoricortical map of the ventrum is modified during lactation. Three stimuli were used to drive cortical activation in primiparous rats: natural, artificial suckling stimulation and general mechanical rubbing of the skin of the ventrum. These stimuli significantly activated the somatosensory cortex of dams. Of the three stimuli, artificial and pup suckling robustly activated much of the cerebrum, most notably the visual, auditory and olfactory cortices. Surprisingly, activation occurred even in the absence of pups, with artificial suckling. This finding suggests that incoming information from a single modality was sufficient to drive activity of others. Enhanced sensitivity across the cortical mantle during nursing may help the dam to perceive, process, and remember stimuli critical to the care and protection of her young.

Prenatal exposure to maternal cigarette smoking and the adolescent cerebral cortex

Smoking during pregnancy is associated with long-term consequences on offspring behavior. We measured thickness of the cerebral cortex using magnetic resonance images obtained in 155 adolescents exposed in utero to maternal smoking and compared them with 159 non-exposed subjects matched by maternal education. Orbitofrontal, middle frontal, and parahippocampal cortices were thinner in exposed, as compared with non-exposed, individuals; these differences were more pronounced in female adolescents. In exposed females, the thickness of the orbitofrontal cortex correlated negatively with a self-rated assessment of caring, one of the components of a model of positive youth development. These findings provide evidence of the long-term impact of prenatal environment on a neural substrate of cognition and social behavior.

Effects of prolonged and exclusive breastfeeding on child behavior and maternal adjustment: evidence from a large, randomized trial

OBJECTIVE

The objective of this study was to assess the long-term effects of breastfeeding on child behavior and maternal adjustment.

METHODS

We followed up children who were in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative. A total of 17,046 healthy, breastfeeding mother-infant pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics; 13,889 (81.5%) were followed up at 6.5 years. Mothers and teachers completed the Strengths and Difficulties Questionnaire and supplemental questions bearing on internalizing and externalizing behavioral problems. Mothers also responded to questions concerning their relationships to their partner and child and their breastfeeding of subsequently born children.

RESULTS

The experimental intervention led to a large increase in exclusive breastfeeding at 3 months (43.3% vs 6.4%) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. No significant treatment effects were observed on either the mother or the teacher Strengths and Difficulties Questionnaire ratings of total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, or prosocial behavior or on the supplemental behavioral questions. We found no evidence of treatment effects on the parent's marriage or on the mother's satisfaction with her relationships with her partner or child, but the experimental intervention significantly increased the duration of any breastfeeding, and mothers in the experimental group were nearly twice as likely to breastfeed exclusively the next-born child for at least 3 months.

CONCLUSIONS

On the basis of the largest randomized trial ever conducted in the area of human lactation, we found no evidence of risks or benefits of prolonged and exclusive breastfeeding for child and maternal behavior. Breastfeeding promotion does, however, favorably affect breastfeeding of the subsequent child.

Nutrition and performance in children

PURPOSE OF REVIEW

Malnutrition in late infancy and childhood remains a significant public health issue in developing nations as well as for those in transition to an industrialized economy. In addition, in these settings and particularly in developed nations, overweight is becoming a very serious threat to both the immediate and the long-term health of children. In this review, we present recent studies that have examined relationships between childhood undernutrition and three general areas of performance: physical activity, cognition and behavior.

RECENT FINDINGS

Malnourished children have been shown to have decreased physical activity and endurance, and poorer cognitive function and school performance. Multiple single micronutrient deficiencies, including vitamin B12, thiamin, niacin, zinc and iron, have been associated with poorer cognitive performance. Behavioral problems, including attention deficits, have also been associated with food insufficiency and malnutrition.

SUMMARY

The effects of impaired nutritional status during childhood may have long-standing consequences for the health and performance of children during their adult years.

A Model for Caregiving of Adopted Children After Institutionalization

TOPIC

Optimizing caregiving for newly adopted postinstitutionalized children.

PURPOSE

To consider a template of care for postinstitutionalized children based on experiences that physiological measures suggest are expected by infants postbirth.

SOURCES

Published literature and clinical experience.

CONCLUSION

Based on an understanding of physiologically expected care postbirth, special care for postinstitutionalized adopted children might include: close physical contact via use of a sling and cosleeping; breastfeeding or nurturing through food; and responsive caregiving. In replicating earlier missed experiences, parents may assist emotional development in their child and promote attachment development.

Breastfeeding, sensitivity, and attachment

OBJECTIVE

Our goal was to test the hypothesis that breastfeeding is associated with enhanced infant-mother attachment and its antecedent maternal sensitivity.

METHODS

Breastfeeding intent and practice were assessed by questionnaires administered to 152 mothers between 32 weeks of gestation and 12 months postpartum. Early maternal sensitivity was measured by the Sensitivity to Cues subscale of the Nursing Child Assessment Satellite Training Feeding Scale at 3 months, and quality of the mother-infant interaction was measured by the Nursing Child Assessment Satellite Training Feeding Scale at 6 months. Security of attachment was evaluated by the Ainsworth Strange Situation at 12 months.

RESULTS

A direct relationship between attachment security and breastfeeding practice was not identified. The quality of the mother-infant interaction at 6 months, rather than the type of feeding, predicted security of attachment. However, mothers who chose to breastfeed displayed greater sensitivity in dyadic interactions with their infants 3 months postnatally than those who chose to bottle feed, and intended breastfeeding duration prenatally correlated with sensitivity 3 months postpartum. Although a path analysis failed to demonstrate contributions of early breastfeeding duration to either sensitivity or security, it did substantiate a significant path between prenatal breastfeeding intent and attachment security mediated by sensitivity. In addition, multivariate analyses revealed that early sensitivity among breastfeeding mothers was an independent predictor of the duration of any and exclusive breastfeeding during the first year.

CONCLUSIONS

Although the quality of the dyadic interaction in infancy, rather than feeding type, is predictive of attachment security, mothers who choose to breastfeed display enhanced sensitivity during early infancy that, in turn, may foster secure attachment. Among breastfeeding mothers, higher sensitivity is associated with longer duration of breastfeeding during the first postpartum year. These findings suggest a link between attachment security and breastfeeding.

Effects of breastfeeding on weight changes in family-based pediatric obesity treatment

Research indicates that breastfeeding may provide protective effects against the development of obesity; however, breastfed children may still become obese because of the obesogenic environment. This study is designed to examine the effects of retrospective recall of breastfeeding on weight changes in children participating in a 6-month behavioral treatment program for childhood obesity. The independent variable of breastfeeding was defined as children who were exclusively breastfed for 4 weeks (excluding water or medication) versus those who were never breastfed. Child percent overweight and body mass index changes during 6 and 12 months were evaluated for 94 families based on mother report of breastfeeding status using analysis of covariance, controlling for socioeconomic status and initial child weight status. Data were compiled for secondary analysis from pediatric obesity randomized controlled outcome studies evaluating core components of family-based treatments. Results showed that, compared with nonbreastfed (formula) children (n = 28), breastfed children (n = 66) showed significantly larger reductions in (mean +/- SEM) percent overweight at 6 months (-15.2 +/- 1.1 vs -10.2 +/- 1.7, p <.05) and 1 year (-10.3 +/- 1.3 vs -5.9 +/- 1.8, p <.05). Similarly, breastfed children showed greater reductions in body mass index at 6 months (-2.1 +/- 0.19 vs -1.1 +/- 0.28) and 1 year (-0.8 +/- 0.23 vs +0.1 +/- 0.32). Findings suggest the beneficial effects of breastfeeding may extend beyond obesity prevention to include improved outcome in family-based pediatric obesity treatment. Potential mechanisms relating breastfeeding, obesity prevention, and enhanced outcome in pediatric obesity treatment are discussed.

The effect of breastfeeding on mean body mass index throughout life: a quantitative review of published and unpublished observational evidence

BACKGROUND

Evidence from observational studies has suggested that breastfeeding may reduce the prevalence of obesity in later life.

OBJECTIVE

The objective was to examine whether initial breastfeeding is related to lower mean body mass index (BMI; in kg/m(2)) throughout life.

DESIGN

The study was a systematic review of published studies investigating the association between infant feeding and a measure of obesity or adiposity in later life, which was supplemented with data from unpublished sources. Analyses were based on the mean differences in BMI between those subjects who were initially breastfed and those who were formula-fed (expressed as breastfed minus bottle-fed), which were pooled by using fixed-effects models throughout.

RESULTS

From 70 eligible studies, 36 mean differences in BMI (from 355 301 subjects) between those breastfed and those formula-fed (reported as exclusive feeding in 20 studies) were obtained. Breastfeeding was associated with a slightly lower mean BMI than was formula feeding (-0.04; 95% CI: -0.05, -0.02). The mean difference in BMIs appeared larger in 15 small studies of <1000 subjects (-0.19; 95% CI: -0.31, -0.08) and smaller in larger studies of >or=1000 subjects (-0.03; 95% CI: -0.05, -0.02). An Egger test was statistically significant (P = 0.002). Adjustment for socioeconomic status, maternal smoking in pregnancy, and maternal BMI in 11 studies abolished the effect (-0.10; 95% CI: -0.14, -0.06 before adjustment; -0.01; 95% CI: -0.05, 0.03 after adjustment).

CONCLUSIONS

Mean BMI is lower among breastfed subjects. However, the difference is small and is likely to be strongly influenced by publication bias and confounding factors. Promotion of breastfeeding, although important for other reasons, is not likely to reduce mean BMI.

Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence

OBJECTIVE

To examine the influence of initial infant feeding on obesity in later life.

METHODS

A systematic review of published studies investigating the association between infant feeding and a measure of obesity was performed with Medline (1966 onward) and Embase (1980 onward) databases, supplemented with manual searches. Data extraction was conducted by 2 authors. Analyses were based on odds ratios of obesity among initially breastfed subjects, compared with formula-fed subjects, pooled with fixed-effects models.

RESULTS

Sixty-one studies reported on the relationship of infant feeding to a measure of obesity in later life; of these, 28 (298900 subjects) provided odds ratio estimates. In these studies, breastfeeding was associated with a reduced risk of obesity, compared with formula feeding (odds ratio: 0.87; 95% confidence interval [CI]: 0.85-0.89). The inverse association between breastfeeding and obesity was particularly strong in 11 small studies of <500 subjects (odds ratio: 0.43; 95% CI: 0.33-0.55) but was still apparent in larger studies of > or =500 subjects (odds ratio: 0.88; 95% CI: 0.85-0.90). In 6 studies that adjusted for all 3 major potential confounding factors (parental obesity, maternal smoking, and social class), the inverse association was reduced markedly (from an odds ratio of 0.86 to 0.93) but not abolished. A sensitivity analysis examining the potential impact of the results of 33 published studies (12505 subjects) that did not provide odds ratios (mostly reporting no relationship between breastfeeding and obesity) showed little effect on the results.

CONCLUSIONS

Initial breastfeeding protects against obesity in later life. However, a further review including large unpublished studies exploring the effect of confounding factors in more detail is needed.

Experiences of infant-feeding decision-making among urban economically disadvantaged pregnant adolescents

AIM

The aim of this paper is to report a pilot study of influencing factors in disadvantaged urban pregnant adolescents' decision-making about infant-feeding choices.

BACKGROUND

Research related to decision-making among adolescents indicates that attitudinal, social, perceived control, and commitment factors are influential in choosing and initiating breast- or bottle-feeding. However, there is a need for further description of decision-making processes in disadvantaged teenagers before intervention research is done.

METHODS

Focus group interviews with the Theory of Planned Behavior guiding the questioning were used with 14 pregnant adolescents between 18 and 39 weeks of gestation and between the ages of 14 and 18 in two obstetric clinics in Midwestern USA urban teaching hospitals. The majority of adolescents were African-American and primiparae.

FINDINGS

The experiences of infant-feeding decision-making among pregnant adolescents were captured by two major themes: benefits vs. barriers of breastfeeding and bottle-feeding, and independent choice vs. social influences. A common thread in these themes was ambivalence and uncertainty. The adolescents had both positive and negative attitudes toward methods, with many expressing their desire to combine breast- and bottle-feeding. Many reported the health benefits of breastfeeding, yet identified barriers of pain, public exposure, and the complexity of breastfeeding. They viewed bottle-feeding as automatic and simple, allowing freedom to leave the infant with others. Although adolescents were adamant that choice of feeding method was their independent decision, social and family influences were evident.

CONCLUSIONS

Consistent with the Theory of Planned Behaviour and other research, attitudes, perceived social influences, and perceived control factors were influential to adolescents when choosing infant feeding methods. The findings suggest that adolescents need education on decision-making, and are being used to fine-tune the interventions of a randomized clinical trial to investigate promoting and supporting breastfeeding among adolescent mothers.