Source:

Belfort
MB
,
Rifas-Shiman
SL
,
Kleinman
KP
, et al
.
Infant feeding and childhood cognition at ages 3 and 7 years: effects of breastfeeding duration and exclusivity
.
JAMA Pediatr
.
2013
;
167
(
9
):
836
844
; doi:
https://doi.org/10.1001/jamapediatrics.2013.455

Investigators from Harvard studied the effect of breastfeeding and maternal diet on child cognitive development at ages 3 and 7 years. Data for the study were obtained from mother-infant pairs enrolled from 1999 to 2002 in Project Viva, a prospective, longitudinal cohort study designed to examine prenatal factors in relation to pregnancy and child health. Enrolled mothers were asked about breastfeeding duration and exclusivity when their children were 6 and 12 months old. Three exposure groups were created: duration of any breastfeeding, duration of exclusive breastfeeding, and breastfeeding status at the child’s age of 6 months (formula only/never breastfed, formula only/weaned, breast milk only, or a combination). Enrolled mothers were also administered a validated food frequency questionnaire when their child was 6 months old to assess their mean weekly fish intake since their child’s birth. Mothers completed cognitive and intelligence tests when their child was 3 and 7 years old. Maternal and child sociodemographic characteristics were collected during pregnancy and at birth.

The primary study outcome was child cognition at 3 and 7 years old. This was assessed using the Peabody Picture Vocabulary Test (PPVT) at 3 years, the Wide Range Assessment of Visual Motor Abilities (WRAVMA) at 3 and 7 years, and the Kaufman Brief Intelligence Test (KBIT, which measures verbal and nonverbal intelligence) and Wide Range Assessment of Memory and Learning (WRAML) at 7 years. The PPVT, WRAVMA, and KBIT are scaled to a mean score of 100 with a standard deviation of 15. Assessments were compared in multivariate linear regression models controlling for potential confounders, including maternal intelligence and sociodemographic characteristics.

There were 1,312 mother-child pairs included in the analysis. The mean duration of any breastfeeding was 6.4 months and for exclusive breastfeeding, 2.4 months. In multivariate analysis, any breastfeeding to age 12 months was associated with an increase of 0.21 points (95% CI, 0.03–0.38) on the PPVT per month breastfed at age 3 years, an increase of 0.35 points (95% CI, 0.16–0.53) on the verbal KBIT at 7 years, and a 0.29 point increase (95% CI, 0.05–0.54) on the nonverbal KBIT. Increases were greater in children who were exclusively breastfed at age 6 months. Breastfeeding duration was not significantly associated with WRAVMA or WRAML scores or with maternal fish consumption.

The authors conclude that longer duration of breastfeeding and greater exclusivity of breastfeeding are associated with better receptive language at age 3 years and with higher verbal and nonverbal IQ at age 7 years.

Dr Noble has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

A recent review of 84 studies, which examined the relationship between breastfeeding and childhood cognition, found that...

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