Breast feeding and intergenerational social mobility: what are the mechanisms?

Association between breastfeeding duration and educational achievement in England: results from the Millennium Cohort Study

OBJECTIVE

To evaluate the association between breastfeeding duration and educational outcomes at the end of secondary education among children from the Millennium Cohort Study.

DESIGN

Cohort study comparing school results at age 16 according to breastfeeding duration.

SETTING

England.

PARTICIPANTS

Children born in 2000-2002 (nationally representative sample).

EXPOSURE

Self-reported breastfeeding duration (categorised).

MAIN OUTCOME MEASURES

Standardised school assessments taken at the end of secondary education (General Certificate of Secondary Education (GCSEs), marked 9-1) in English and Mathematics, categorised as: 'fail, marks <4', 'low pass, marks 4-6' and 'high pass, marks ≥7 (equivalent to A-A*)'. Additionally, overall achievement was measured using the 'attainment 8' score (adding the marks of eight GCSEs, English and Mathematics double weighted; 0-90).

RESULTS

Approximately 5000 children were included. Longer breastfeeding was associated with better educational outcomes. For example, after full adjustment for socioeconomic markers and maternal cognitive ability, in comparison with children who were never breastfed, those who were breastfed for longer were more likely to have a high pass in their English and Mathematics GCSEs, and less likely to fail the English GCSE (but not the Mathematics GCSE). Additionally, compared with those never breastfed, those breastfed for at least 4 months had, on average, a 2-3 point higher attainment 8 score (coefficients: 2.10, 95% CI 0.06 to 4.14 at 4-6 months; 2.56, 95% CI 0.65 to 4.47 at 6-12 months and 3.09, 95% CI 0.84 to 5.35 at ≥12 months).

CONCLUSIONS

A longer breastfeeding duration was associated with modest improvements in educational outcomes at age 16, after controlling for important confounders.

Breastfeeding trajectories of young and short-term educated mothers and their partners; experiences of a journey facing tailwind and headwind

OBJECTIVE

To explore needs, experiences and socio-cultural context of young and short-term educated mothers and their partners affecting breastfeeding duration and self-efficacy during pregnancy and the first months following birth.

DESIGN

A qualitative study was conducted using Malterud's method of Systematic Text Condensation.

SETTING

Data collection took place in two rural regions in Denmark between October and December 2020.

PARTICIPANTS

Thirteen interviews (eight mothers and five fathers), four focus group interviews (24 health visitors) and seven observations of home visits by health visitors were performed. The mothers were below 25 years and had short-term education.

FINDINGS

Four themes formed the narrative "Setting off and carrying through a breastfeeding journey": 1) Bringing your unique story of life into the breastfeeding journey, 2) Looking forward to a natural breastfeeding, 3) Facing breastfeeding and the intrusive needs of the baby, and 4) Adaptation to breastfeeding or bottle feeding. Each of these describing barriers and facilitators regarding breastfeeding and breastfeeding self-efficacy.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Becoming familiar with breastfeeding and developing a relationship with the baby posed common challenges for the young and short-term educated mothers and their partners. However, the process was embedded in the parents' unique and often fragile socio-cultural everyday life influencing breastfeeding and breastfeeding self-efficacy. The relationship with the health visitor was essential for the parents' benefit of breastfeeding support, which underscores the importance of viewing adequate breastfeeding support as a relational phenomenon including socio-cultural, parent-baby, and health visitor-parent perspectives in young and short-term educated parents.

Early Life Exposure to a Diet With a Supramolecular Lipid Structure Close to That of Mammalian Milk Improves Early Life Growth, Skeletal Development, and Later Life Neurocognitive Function in Individually and Socially Housed Male C57BL/6J Mice

Breastfeeding (duration) can be positively associated with infant growth outcomes as well as improved cognitive functions during childhood and later life stages. (Prolonged) exposure to optimal lipid quantity and quality, i.e., the supramolecular structure of lipids, in mammalian milk, may contribute to these beneficial effects through nutritional early-life programming. In this pre-clinical study, we exposed male C57BL/6J mice from post-natal Days 16 to 42 (i.e., directly following normal lactation), to a diet with large lipid droplets coated with bovine milk fat globule membrane-derived phospholipids, which mimic more closely the supramolecular structure of lipid droplets in mammalian milk. We investigated whether exposure to this diet could affect growth and brain development-related parameters. As these outcomes are also known to be affected by the post-weaning social environment in mice, we included both individually housed and pair-wise housed animals and studied whether effects of diet were modulated by the social environment. After Day 42, all the animals were fed standard semi-synthetic rodent diet. Growth and body composition were assessed, and the mice were subjected to various behavioral tests. Individual housing attenuated adolescent growth, reduced femur length, and increased body fat mass. Adult social interest was increased due to individual housing, while cognitive and behavioral alterations as a result of different housing conditions were modest. The diet increased adolescent growth and femur length, increased lean body mass, reduced adolescent anxiety, and improved adult cognitive performance. These effects of diet exposure were comparable between individually and socially housed mice. Hence, early life exposure to a diet with lipid droplets that mimic the supramolecular structure of those in mammalian milk may improve adolescent growth and alters brain function in both socially and individually housed mice. These findings suggest that lipid structure in infant milk formula may be a relevant target for nutritional solutions, targeting both healthy infants and infants facing growth challenges.

Exploring the role of early-life circumstances, abilities and achievements on well-being at age 50 years: evidence from the 1958 British birth cohort study

OBJECTIVES

We aim to examine the relative contributions of pathways from middle childhood/adolescence to mid-life well-being, health and cognition, in the context of family socio-economic status (SES) at birth, educational achievement and early-adulthood SES. Our approach is largely exploratory, suspecting that the strongest mediators between childhood circumstances and mid-life physical and emotional well-being may be cognitive performance during school years, material and behavioural difficulties, and educational achievement. We also explore whether the effects of childhood circumstances on mid-life physical and emotional well-being differ between men and women.

SETTING/PARTICIPANTS

Data were from the National Child Development Study, a fully-representative British birth cohort sample of 17 415 people born in 1 week in 1958.

PRIMARY/SECONDARY OUTCOME MEASURES

Our four primary mid-life outcome measures are: cognitive performance, physical and emotional well-being and quality of life. Our intermediate adult outcomes are early-adulthood social class and educational/vocational qualifications.

RESULTS

Using structural equation modelling, we explore numerous pathways through childhood and early adulthood which are significantly linked to our outcomes. We specifically examine the mediating effects of the following: cognitive ability at ages 7, 11 and 16 years; childhood psychological issues; family material difficulties at age 7 years: housing, unemployment, finance; educational/vocational qualifications and social class position at age 42 years.We find that social class at birth has a strong indirect effect on the age 50 outcomes via its influence on cognitive performance in childhood and adolescence, educational attainment and mid-life social class position, together with small direct effects on qualifications and social class position at age 42 years. Teenage cognitive performance has a strong positive effect on later physical health for women, while educational/vocational qualifications have a stronger positive effect on emotional well-being for men.

CONCLUSION

Our findings provide an understanding of the legacy of early life on multiple aspects of mid-life health, well-being, cognition and quality of life, showing stronger mediated links for men from childhood social class position to early adult social class position. The observed effect of qualifications supports those arguing that education is positively associated with subsequent cognitive functioning.

ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding

A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Rational Use of Medicines in Neonates: Current Observations, Areas for Research and Perspectives

A focused reflection on rational medicines use in neonates is valuable and relevant, because indicators to assess rational medicines use are difficult to apply to neonates. Polypharmacy and exposure to antibiotics are common, while dosing regimens or clinical guidelines are only rarely supported by robust evidence in neonates. This is at least in part due to the extensive variability in pharmacokinetics and subsequent effects of medicines in neonates. Medicines utilization research informs us on trends, on between unit variability and on the impact of guideline implementation. We illustrate these aspects using data on drugs for gastroesophageal reflux, analgesics or anti-epileptic drugs. Areas for additional research are drug-related exposure during breastfeeding (exposure prediction) and how to assess safety (tools to assess seriousness, causality, and severity tailored to neonates) since both efficacy and safety determine rational drug use. To further improve rational medicines use, we need more data and tools to assess efficacy and safety in neonates. Moreover, we should facilitate access to such data, and explore strategies for effective implementation. This is because prescription practices are not only rational decisions, but also have psychosocial aspects that may guide clinicians to irrational practices, in part influenced by the psychosocial characteristics of this population.

Explaining socioeconomic inequalities in exclusive breast feeding in Norway

BACKGROUND AND OBJECTIVE

In high-income countries, lower socioeconomic position is associated with lower rates of breast feeding, but it is unclear what factors explain this inequality. Our objective was to examine the association between socioeconomic position and exclusive breast feeding, and to explore whether socioeconomic inequality in exclusive breast feeding could be explained by other sociodemographic characteristics, for example, maternal age and parity, smoking habits, birth characteristics, quality of counselling and breastfeeding difficulties.

METHODS

We used data from a questionnaire sent to mothers when their infants were five completed months as part of a trial of a breastfeeding intervention in Norway. We used maternal education as an indicator of socioeconomic position. Analyses of 1598 mother-infant pairs were conducted using logistic regression to assess explanatory factors of educational inequalities in breast feeding.

RESULTS

Socioeconomic inequalities in exclusive breast feeding were present from the beginning and persisted for five completed months, when 22% of the most educated mothers exclusively breast fed compared with 7% of the least educated mothers: OR 3.39 (95% CI 1.74 to 6.61). After adjustment for all potentially explanatory factors, the OR was reduced to 1.49 (95% CI 0.70 to 3.14). This decrease in educational inequality seemed to be mainly driven by sociodemographic factors, smoking habits and breastfeeding difficulties, in particular perceived milk insufficiency.

CONCLUSIONS

Socioeconomic inequalities in exclusive breast feeding at 5 months were largely explained by sociodemographic factors, but also by modifiable factors, such as smoking habits and breastfeeding difficulties, which can be amenable to public health interventions.

TRIAL REGISTRATION NUMBER

NCT01025362.

Decline in the negative association between low birth weight and cognitive ability

Low birth weight predicts compromised cognitive ability. We used data from the 1958 National Child Development Study (NCDS), the 1970 British Cohort Study (BCS), and the 2000-2002 Millennium Cohort Study (MCS) to analyze how this association has changed over time. Birth weight was divided into two categories, <2,500 g (low) and 2,500-4,500 g (normal) and verbal cognitive ability was measured at the age of 10 or 11 y. A range of maternal and family characteristics collected at or soon after the time of birth were considered. Linear regression was used to analyze the association between birth weight and cognitive ability in a baseline model and in a model that adjusted for family characteristics. The standardized difference (SD) in cognitive scores between low-birth-weight and normal-birth-weight children was large in the NCDS [-0.37 SD, 95% confidence interval (CI): -0.46, -0.27] and in the BCS (-0.34, 95% CI: -0.43, -0.25) cohorts, and it was more than halved for children born in the MCS cohort (-0.14, 95% CI: -0.22, -0.06). The adjustment for family characteristics did not explain the cross-cohort differences. The results show that the association between low birth weight and decreased cognitive ability has declined between the 1950s and 1970s birth cohorts and the 2000--2002 birth cohort, despite a higher proportion of the low-birth-weight babies having a very low birth weight (<1,500 g) in the more recent birth cohort. Advancements in obstetric and neonatal care may have attenuated the negative consequences associated with being born small.

Intergenerational social mobility and leisure-time physical activity in adulthood: a systematic review

Aim

To systematically review the association between intergenerational social mobility and leisure-time physical activity (LTPA) in adulthood, in order to assess all published evidence relating to the hypothesis that adults socially mobile between childhood and adulthood will have different levels of LTPA than those in the same socioeconomic group across life.

Methods

A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified by searching databases (MEDLINE, Embase, PsycINFO) and reference lists. Eligible studies examined associations between any indicator of social mobility, based on at least one measure of parental socioeconomic position (SEP) and one measure of own adult SEP, and LTPA in adulthood.

Results

13 studies comprising a total of 44 000 participants from the UK, Finland, Sweden, Australia, USA and Brazil were included. Participants were aged 16–70 years and were from population-based surveys, occupational cohorts and primary care registries. Most studies (n=9) used occupational class measures to identify social mobility; education (n=4) and income (n=1) were also used. There was consistent evidence in nine of the 13 studies that stable high socioeconomic groups tended to report the highest levels of participation in LTPA and stable low socioeconomic groups the lowest. Upward and downwardly mobile groups participated in LTPA at levels between these stable groups.

Conclusions

Cumulative exposure to higher SEP in childhood and adulthood was associated with higher LTPA in adulthood. Thus, a potential outcome of policies and interventions which aim to minimise exposure to socioeconomic adversity may be increased LTPA among adults.

Trial registration number

CRD42016036538.

Fit to WHO weight standard of European infants over time

OBJECTIVES

The 2006 WHO growth charts were created to provide an international standard for optimal growth, based on healthy, breastfed populations, but it has been suggested that Northern European children fit them poorly. This study uses infant weight data spanning 50 years to determine how well-nourished preschool children from different eras fit the WHO standard, and discuss the implications of deviations.

DESIGN

Four longitudinal datasets from the UK and one from Finland were used comprising over 8000 children born between 1959 and 2003. Weights from birth to 2 years were converted to age-sex-adjusted Z scores using the WHO standard and summarised using Generalized Additive Models for Location, Scale and Shape.

RESULTS

Weights showed a variable fit to the WHO standard. Mean weights for all cohorts were above the WHO median at birth, but dipped by up to 0.5 SD to a nadir at 8 weeks before rising again. Birth weights increased in successive cohorts and the initial dip became slightly shallower. By age 1 year, cohorts were up to 0.75 SD above the WHO median, but there was no consistent pattern by era.

CONCLUSIONS

The WHO standard shows an acceptable, but variable fit for Northern European infants. While birth weights increased over time, there was, unexpectedly, no consistent variation by cohort beyond this initial period. Discrepancies in weight from the standard may reflect differences in measurement protocol and trends in infant feeding practice.

Effectiveness of Baby-friendly community health services on exclusive breastfeeding and maternal satisfaction: a pragmatic trial

The WHO/UNICEF Baby‐friendly Hospital Initiative has been shown to increase breastfeeding rates, but uncertainty remains about effective methods to improve breastfeeding in community health services. The aim of this pragmatic cluster quasi‐randomised controlled trial was to assess the effectiveness of implementing the Baby‐friendly Initiative (BFI) in community health services. The primary outcome was exclusive breastfeeding until 6 months in healthy babies. Secondary outcomes were other breastfeeding indicators, mothers' satisfaction with the breastfeeding experience, and perceived pressure to breastfeed. A total of 54 Norwegian municipalities were allocated by alternation to the BFI in community health service intervention or routine care. All mothers with infants of five completed months were invited to participate (n = 3948), and 1051 mothers in the intervention arm and 981 in the comparison arm returned the questionnaire. Analyses were by intention to treat. Women in the intervention group were more likely to breastfeed exclusively compared with those who received routine care: 17.9% vs. 14.1% until 6 months [cluster adjusted odds ratio (OR) = 1.33; 95% confidence interval (CI): 1.03, 1.72; P = 0.03], 41.4% vs. 35.8% until 5 months [cluster adjusted OR = 1.39; 95% CI: 1.09, 1.77; P = 0.01], and 72.1% vs. 68.2% for any breastfeeding until 6 months [cluster adjusted OR = 1.24; 95% CI: 0.99, 1.54; P = 0.06]. The intervention had no effect on breastfeeding until 12 months. Maternal breastfeeding experience in the two groups did not differ, neither did perceived breastfeeding pressure from staff in the community health services. In conclusion, the BFI in community health services increased rates of exclusive breastfeeding until 6 months. © 2015 Blackwell Publishing Ltd

Predictors of suboptimal breastfeeding: an opportunity for public health interventions

BACKGROUND

Sub-optimum breastfeeding significantly contributes to the global burden of disease. Our aim was to identify risk factors associated with suboptimal breastfeeding in Southern Croatia.

METHODS

Between February 2008 and August 2009, 773 mother-infant pairs were recruited from University Hospital of Split Maternity Unit. Mothers were interviewed at birth, 3, 6, 12 and 24 months.

RESULTS

Ninety-nine percent of mothers initiated breastfeeding but only 2.2% of them exclusively breastfed whilst in hospital. At 24 months, 4.1% of mothers were breastfeeding. Exclusive and any breastfeeding at 3 months was negatively associated with maternal education of 12 years or less, smoking during pregnancy, intention to use a pacifier and in-hospital formula supplementation. In addition, exclusive breastfeeding at 3 months was negatively associated with primiparity, antenatal course non-attendance and not receiving assistance with breastfeeding from hospital staff. Antenatal course non-attendance and discussing infant feeding with a health professional during pregnancy lowered the odds for any breastfeeding at 6 months. At 12 and 24 months, a lower level of education, antenatal course non-attendance and not receiving advice in hospital on feeding frequency was significantly associated with lower odds of breastfeeding. Additionally, intention to use a pacifier was found to be a negative predictor of breastfeeding at 12 months.

CONCLUSIONS

Important modifiable risk factors found to be significantly associated with suboptimal breastfeeding include smoking during pregnancy, intention to use a pacifier, in-hospital formula supplementation, not receiving advice from hospital staff on normal feeding patterns, not receiving assistance with breastfeeding in hospital and antenatal course non-attendance.

Position Statement on Breastfeeding from the Italian Pediatric Societies

The 2015 Position Statement on Breastfeeding of The Italian Pediatric Societies (SIP, SIN, SICupp, SIGENP) recognizes breastfeeding as an healthy behaviour with many short and long term benefits for both mother and infant.While protecting, promoting and supporting breastfeeding, neonatologists and pediatricians need specific knowledge, skills and a positive attitude toward breastfeeding. In Maternity Hospitals and in Neonatal Units, appropriate organizative interventions should be applied in order to facilitate the beginning of breastfeeding and the use of mother's/human milk.The Italian Pediatric Societies indicate the desiderable goal of around 6 months exclusive breastfeeding if the infant grows properly according to WHO Growth Charts. In principle, complementary feeding should not be anticipated before 6 months as a nutritional strategy pretending to prevent allergy and/or celiac disease. Eventually, long term breastfeeding should be supported meeting mother's desire.

Neurodevelopment and phenotype-modulating functions of S100B protein: a pilot study

The importance of certain neurotrophic proteins found in maternal blood and milk for breastfed infants has remained ambiguous. This study was conducted to present evidence of the impact of an induced deficit of active S100B protein on neonate development. Newborn mice from two groups of mothers, immunized or sham-immunized against S100B, were subjected to various behavioral tests, and the development of their morphological characteristics was recorded from birth until weaning. Morphological problems, including weight gain and fur coating, a delay in the maturation of neurobehavioral systems and a deficit in neuromotor functions, including visual abilities, somato-sensory and posture reactions, muscular strength, locomotion, and fear/orienting processes, were observed in pups of immunized mothers. The S100B protein of external or internal origin in infants may be considered to be a specific factor that determines neuro- and morphological development and a risk-avoidance ('homeward-bent' or fearful) phenotype. The suppression of activity of the S100B protein results in a slower neonatal development and the formation of a risk-tolerant (fearless) phenotype of the offspring. This study thus considers the mechanism of neuroplastic regulation on the extent of sensation-seeking or risk-taking (homeless-like or fearless) and sensation- or risk-avoidance (home-bound or fearful) features in individual phenotypes.

Life course approach in social epidemiology: an overview, application and future implications

The application of the life course approach to social epidemiology has helped epidemiologists theoretically examine social gradients in population health. Longitudinal data with rich contextual information collected repeatedly and advanced statistical approaches have made this challenging task easier. This review paper provides an overview of the life course approach in epidemiology, its research application, and future challenges. In summary, a systematic approach to methods, including theoretically guided measurement of socioeconomic position, would assist researchers in gathering evidence for reducing social gradients in health, and collaboration across individual disciplines will make this task achievable.