Horta BL, Loret de Mola C, Victora CG
Acta Paediatr. 2015 Dec;104(467):14-9.

AIM: This study was aimed at systematically reviewing evidence of the association between breastfeeding and performance in intelligence tests.

METHODS: Two independent searches were carried out using Medline, LILACS, SCIELO and Web of Science. Studies restricted to infants and those where estimates were not adjusted for stimulation or interaction at home were excluded. Fixed- and random-effects models were used to pool the effect estimates, and a random-effects regression was used to assess potential sources of heterogeneity.

RESULTS: We included 17 studies with 18 estimates of the relationship between breastfeeding and performance in intelligence tests.
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Deoni SC, Dean DC 3rd, Piryatinksy I, O’Muircheartaigh J, Waskiewicz N, Lehman K, Han M, Dirks H.
Neuroimage. 2013 May 28. [Epub ahead of print]


Does breastfeeding alter early brain development? The prevailing consensus from large epidemiological studies posits that early exclusive breastfeeding is associated with improved measures of IQ and cognitive functioning in later childhood and adolescence. Prior morphometric brain imaging studies support these findings, revealing increased white matter and sub-cortical gray matter volume, and parietal lobe cortical thickness, associated with IQ, in adolescents who were breastfed as infants compared to those who were exclusively formula-fed. Yet it remains unknown when these structural differences first manifest and when developmental differences that predict later performance improvements can be detected.
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Breastfeeding has well-established short-term benefits, particularly the reduction of morbidity and mortality due to infectious diseases in childhood. A pooled analysis of studies carried out in middle/ low income countries showed that breastfeeding substantially lowers the risk of death from infectious diseases in the first two years of life.

Based on data from the United Kingdom Millennium Cohort, Quigley et al estimated that optimal breastfeeding practices could prevent a substantial proportion of hospital admissions due to diarrhea and lower respiratory tract infection. A systematic review by Kramer et al confirmed that exclusive breastfeeding in the first 6 months decreases morbidity from gastrointestinal and allergic diseases, without any negative effects on growth.
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Brion MJ, Lawlor DA, Matijasevich A, Horta B, Anselmi L, Araújo CL, Menezes AM, Victora CG, Smith GD.
Int J Epidemiol. 2011 Jun;40(3):670-80.


BACKGROUND: A novel approach is explored for improving causal inference in observational studies by comparing cohorts from high-income with low- or middle-income countries (LMIC), where confounding structures differ. This is applied to assessing causal effects of breastfeeding on child blood pressure (BP), body mass index (BMI) and intelligence quotient (IQ).

METHODS: Standardized approaches for assessing the confounding structure of breastfeeding by socio-economic position were applied to the British Avon Longitudinal Study of Parents and Children (ALSPAC) (N ≃ 5000) and Brazilian Pelotas 1993 cohorts (N ≃ 1000).
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Guxens M, Mendez MA, Moltó-Puigmartí C, Julvez J, García-Esteban R, Forns J, Ferrer M, Vrijheid M, López-Sabater MC, Sunyer J.
Pediatrics. 2011 Sep 19.


Background: Breastfeeding has been associated with improved neurodevelopment in children. However, it remains unknown to what extent nutritional advantages of breast milk may explain this relationship.

Objective: We assessed the role of parental psychosocial factors and colostrum long-chain polyunsaturated fatty acid (LC-PUFA) levels in the relationship between breastfeeding and children’s neurodevelopment.

Methods: A population-based birth cohort was established in the city of Sabadell (Catalonia, Spain) as part of the INMA-INfancia y Medio Ambiente Project. A total of 657 women were recruited during the first trimester of pregnancy.
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Oddy WH, Li J, Whitehouse AJ, Zubrick SR, Malacova E.
Pediatrics. 2011 Jan;127(1):e137-45.


INTRODUCTION: The aim of this study was to examine the relationship between duration of breastfeeding and educational outcomes. We hypothesized that longer periods of breastfeeding would predict better educational outcomes in middle childhood.

METHODS: The Western Australian Pregnancy Cohort (Raine) Study used a cohort of 2900 women who were enrolled at 18 weeks’ gestation; with 2868 live-born children were followed prospectively. At ∼10 years of age, data from 1038 children were linked to standardized mathematics, reading, writing, and spelling scores. Associations between breastfeeding duration and educational outcomes were estimated by using linear models with adjustment for gender, family income, maternal factors, and early stimulation at home through reading.
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Isaacs, Elizabeth B.; Fischl, Bruce R.; Quinn, Brian T.; Chong, Wui K.; Gadian, David G.; Lucas, Alan
Pediatr Res. 2009 Dec 22. [Epub ahead of print]


Although observational findings linking breast milk to higher scores on cognitive tests may be confounded by factors associated with mothers’ choice to breastfeed, it has been suggested that one or more constituents of breast milk facilitate cognitive development, particularly in preterms. Because cognitive scores are related to head size, we hypothesised that breast milk mediates cognitive effects by affecting brain growth.

We used detailed data from a randomized feeding trial to calculate percentage of breast milk (%EBM) in the infant diet of 50 adolescents.
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M. A. Quigley, C. Hockley, C. Carson, Y. Kelly, M. Renfrew, A. Sacker
J Epidemiol Community Health 2009;63(Suppl2):8


Objective To assess the relationship between breastfeeding and child cognitive development, and whether this relationship varies according to prematurity.

Design Population-based cohort (Sweeps 1 and 3 of the UK Millennium Cohort Study).

Setting UK.

Participants 11 801 white singleton children born in 2000–2002.

Comparison Groups Children were grouped according to their breastfeeding status (ever vs never; and duration of any and exclusive breastfeeding). Results were stratified according to gestational age at birth: 37–42 weeks (term); 33–36 weeks (moderately preterm); and 28–32 weeks (very preterm).
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Kramer MS, Aboud F, Mironova E, Vanilovich I, Platt RW, Matush L, Igumnov S, Fombonne E, Bogdanovich N, Ducruet T, Collet JP, Chalmers B, Hodnett E, Davidovsky S, Skugarevsky O, Trofimovich O, Kozlova L, Shapiro S; Promotion of Breastfeeding Intervention Trial (PROBIT) Study Group.

Arch Gen Psychiatry. 2008;65(5):578-584.


Context The evidence that breastfeeding improves cognitive development is based almost entirely on observational studies and is thus prone to confounding by subtle behavioral differences in the breastfeeding mother’s behavior or her interaction with the infant.

Objective To assess whether prolonged and exclusive breastfeeding improves children’s cognitive ability at age 6.5 years.
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Caspi A, Williams B, Kim-Cohen J, Craig IW, Milne BJ, Poulton R, Schalkwyk LC, Taylor A, Werts H, Moffitt TE.
Proc Natl Acad Sci U S A. 2007 Nov 20;104(47):18860-5.


Children’s intellectual development is influenced by both genetic inheritance and environmental experiences. Breastfeeding is one of the earliest such postnatal experiences. Breastfed children attain higher IQ scores than children not fed breast milk, presumably because of the fatty acids uniquely available in breast milk. Here we show that the association between breastfeeding and IQ is moderated by a genetic variant in FADS2, a gene involved in the genetic control of fatty acid pathways.
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