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Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis

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  • Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai’s Home, Taiwan
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Previous studies have suggested environmental factors may contribute to the risk of attention-deficit/hyperactivity disorder (ADHD). The current meta-analysis examined (1) the difference in the duration of maternal breastfeeding between children with and without ADHD, and (2) the association between maternal breastfeeding and ADHD in children. The data of individual studies were synthesized with a random-effects model. Eleven articles were included in this meta-analysis. Children with ADHD had significantly less breastfeeding duration than controls (Hedges’ g = − 0.36, 95% confidence intervals (CIs) = − 0.61 to − 0.11, p = 0.005; difference in means: − 2.44 months, 95% CIs = − 3.17 to − 1.71, p < 0.001). In addition, the rates of non-exclusive breastfeeding in children with ADHD is significantly higher in “under 3 months” (odds ratio (OR) = 1.90, 95% CIs = 1.45 to 2.48, p < 0.001) but lower in “6 to 12 months” (OR = 0.69, 95% CIs = 0.49 to 0.98, p = 0.039) and “over 12 months” (OR = 0.58, 95% CIs = 0.35 to 0.97, p = 0.038) than controls. Children with ADHD received significantly higher rate of exclusive breastfeeding duration “under 3 months” (OR = 1.51, 95% CIs = 1.20 to 1.89, p < 0.001) but lower in “over 3 months” (OR = 0.52, 95% CIs = 0.29 to 0.95, p = 0.033) than controls. Furthermore, an association was found between non-breastfeeding and ADHD children (adjusted OR = 3.71, 95% CI = 1.94 to 7.11, p < 0.001). Our results suggest maternal breastfeeding is associated with a lower risk of ADHD in children. Future longitudinal research is required to confirm/refute these findings and to explore possible mechanisms underlying this association.
a Forest plot of meta-analysis of difference of breastfeeding duration in ADHD children and controls; b forest plot of meta-analysis of rate of different non-exclusive breastfeeding duration in ADHD children and controls; c forest plot of meta-analysis of rate of different exclusive breastfeeding duration in ADHD children and controls; d forest plot of meta-analysis of adjusted odds ratio of association between non-breastfeeding and ADHD. a indicated the breastfeeding duration is significantly shorter in ADHD children than in controls (Hedges’ g = − 0.360, 95% CIs = − 0.614 to − 0.107, p = 0.005); b suggested that the rate of non-exclusive breastfeeding is significantly higher in breastfeeding duration under 3 months (OR = 1.895, 95% CIs = 1.450 to 2.478, p < 0.001) but lower in non-exclusive breastfeeding duration between 6 and 12 months (OR = 0.694, 95% CIs = 0.490 to 0.982, p = 0.039) or over 12 months (OR = 0.579, 95% CIs = 0.346 to 0.970, p = 0.038) in ADHD children than those in controls; c revealed that the rate of exclusive breastfeeding is significantly higher in breastfeeding duration under 3 months (OR = 1.506, 95% CIs = 1.203 to 1.885, p < 0.001) but lower in exclusive breastfeeding duration over 3 months (OR = 0.522, 95% CIs = 0.288 to 0.948, p = 0.033) in ADHD children than those in controls; d found that result of meta-analysis of pooled adjusted OR provided significantly association between non-breastfeeding and ADHD (adjusted OR = 3.709, 95% CIs = 1.936 to 7.107, p < 0.001). ADHD attention-deficit/hyperactivity disorder, BF breastfeeding, CI confidence interval, MA meta-analysis, n/a not applicable, OR odds ratio
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European Child & Adolescent Psychiatry (2019) 28:19–30
https://doi.org/10.1007/s00787-018-1182-4
ORIGINAL CONTRIBUTION
Maternal breastfeeding andattention‑decit/hyperactivity disorder
inchildren: ameta‑analysis
Ping‑TaoTseng1,2· Cheng‑FangYen3,4· Yen‑WenChen5· BrendonStubbs6,7,8· AndreF.Carvalho9,10·
PaulWhiteley11· Che‑ShengChu12· Dian‑JengLi13,14· Tien‑YuChen15· Wei‑ChengYang16· Chia‑HungTang17·
Hsin‑YiLiang18· Wei‑ChiehYang19· Ching‑KuanWu1· Pao‑YenLin20,21
Received: 29 July 2017 / Accepted: 9 June 2018 / Published online: 15 June 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Previous studies have suggested environmental factors may contribute to the risk of attention-deficit/hyperactivity disorder
(ADHD). The current meta-analysis examined (1) the difference in the duration of maternal breastfeeding between children
with and without ADHD, and (2) the association between maternal breastfeeding and ADHD in children. The data of indi-
vidual studies were synthesized with a random-effects model. Eleven articles were included in this meta-analysis. Children
with ADHD had significantly less breastfeeding duration than controls (Hedgesg=−0.36, 95% confidence intervals
(CIs) = −0.61 to −0.11, p=0.005; difference in means: −2.44months, 95% CIs = −3.17 to −1.71, p<0.001). In addi-
tion, the rates of non-exclusive breastfeeding in children with ADHD is significantly higher in “under 3months” (odds ratio
(OR) = 1.90, 95% CIs = 1.45 to 2.48, p < 0.001) but lower in “6 to 12months” (OR = 0.69, 95% CIs = 0.49 to 0.98, p = 0.039)
and “over 12months” (OR = 0.58, 95% CIs = 0.35 to 0.97, p = 0.038) than controls. Children with ADHD received signifi-
cantly higher rate of exclusive breastfeeding duration “under 3months” (OR = 1.51, 95% CIs = 1.20 to 1.89, p < 0.001) but
lower in “over 3months” (OR = 0.52, 95% CIs = 0.29 to 0.95, p = 0.033) than controls. Furthermore, an association was
found between non-breastfeeding and ADHD children (adjusted OR = 3.71, 95% CI = 1.94 to 7.11, p < 0.001). Our results
suggest maternal breastfeeding is associated with a lower risk of ADHD in children. Future longitudinal research is required
to confirm/refute these findings and to explore possible mechanisms underlying this association.
Keywords Attention-deficit/hyperactivity disorder· Breastfeeding· Meta-analysis· Nutrition· Risk
Abbreviations
ADHD Attention-deficit/hyperactivity disorder
BF Breastfeeding
CI Confidence interval
CPRS Conners’ Parent Rating Scale
CTRF Conners’ teacher rating form
DSM-5 Diagnostic and statistical manual of mental
disorders, fifth edition
DSM-IV Diagnostic and statistical manual of mental
disorders, fourth edition
ES Effect size
ICD-10 International statistical classification of dis-
eases and related health problems 10th revision
MA Meta-analysis
MOOSE Meta-analysis of observational studies in
epidemiology
n/a Not available
NOS Newcastle–Ottawa scale
OR Odds ratio
PUFAs Polyunsaturated fatty acids
Introduction
Attention-deficit/hyperactivity disorder (ADHD) is a neu-
rodevelopmental disorder whose onset typically occurs
during childhood [1, 2]. It is characterized by symptoms
Ping-Tao Tseng and Cheng-Fang Yen contributed equally as first
authors.
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0078 7-018-1182-4) contains
supplementary material, which is available to authorized users.
* Pao-Yen Lin
py1029@adm.cgmh.org.tw; paoyenlin@gmail.com
Extended author information available on the last page of the article
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... and conduct disorders (Hartel et al., 2020). Breastfeeding could foster immune-microbiome interplay and promote motherchild interactions as well as improve long-term neurobehavior outcomes (Agostoni et al., 2017;Boucher et al., 2017;Tseng et al., 2019). Similarly, parents' patience is a significant factor for childhood development, especially for mental health. ...
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Attention deficit hyperactivity disorder (ADHD) is the most common childhood-onset neurodevelopmental disorder. Currently, increasing amounts of attention have been focused on the epidemiologic profiling of ADHD in children, viewed as a continuously distributed risk dimension throughout the whole lifespan. This study aimed to identify and characterize potential influential factors susceptible to ADHD-related symptoms among preschool-aged children. A comprehensive questionnaire was self-designed for both children and their parents or guardians and was distributed to 30 kindergartens from Beijing and Hebei, collecting potential influential factors in susceptibility to ADHD. ADHD was assessed by the Conner’s Abbreviated Symptom Questionnaire (C-ASQ), and 7,938 children were analyzed. Least absolute shrinkage and selection operator (LASSO) regression and hierarchical degree of adjustment were used to control possible covariates. Five factors, namely, children’s secondhand smoking exposure, breastfeeding duration, sleep mode, maternal pregnancy smoking exposure, and parental self-rating for patience, were identified to be independently and significantly associated with ADHD susceptibility. Meanwhile, dose–response relationships were observed between breastfeeding duration, parental self-rating for patience, and ADHD-related symptoms. Finally, a nomogram model was created for predicting ADHD susceptibility based on significant and conventional attributes under each criterion.
... A recent meta-analysis indicated a strong association between non-breastfeeding and attention-deficit/hyperactivity disorder including term and preterm children (adjusted OR = 3.71; 95%CI = 1.94-7.11) [37]. However, a large randomized controlled trial with generally healthy children (born at term and weighed at least 2500 g) revealed no effect of extended or exclusive BMF on any SDQ scores at early primary school age [38]. ...
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