Original Article
The Long-Term Effects of Breastfeeding on Child and Adolescent Mental Health: A Pregnancy Cohort Study Followed for 14 Years

https://doi.org/10.1016/j.jpeds.2009.10.020Get rights and content

Objectives

To determine whether there was an independent effect of breastfeeding on child and adolescent mental health.

Study design

The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnant women and followed the live births for 14 years. Mental health status was assessed by the Child Behaviour Checklist (CBCL) at 2, 6, 8, 10, and 14 years. Maternal pregnancy, postnatal, and infant factors were tested in multivariable random effects models and generalized estimating equations to examine the effects of breastfeeding duration on mental health morbidity.

Results

Breastfeeding for less than 6 months compared with 6 months or longer was an independent predictor of mental health problems through childhood and into adolescence. This relationship was supported by the random effects models (increase in total CBCL score: 1.45; 95% confidence interval 0.59, 2.30) and generalized estimating equation models (odds ratio for CBCL morbidity: 1.33; 95% confidence interval 1.09, 1.62) showing increased behavioral problems with shorter breastfeeding duration.

Conclusion

A shorter duration of breastfeeding may be a predictor of adverse mental health outcomes throughout the developmental trajectory of childhood and early adolescence.

Section snippets

Methods

From 1989 to 1992, 2900 women were enrolled in the Western Australian Pregnancy Cohort (Raine) Study through the public antenatal clinic at the major obstetric hospital in Perth, Western Australia, and nearby private practices. The criteria for enrollment were gestational age between 16 and 20 weeks, sufficient proficiency in English to understand the implications of participation, an expectation to deliver at the hospital, and an intention to remain in Western Australia for long-term follow-up.

Results

There were missing cases at each follow-up because of the longitudinal nature of the data collection, and these were excluded from analysis. Of the 2366 participants with available data, 11% were never breastfed, 19% were breastfed for less than 3 months, 19% were breastfed for between 3 and up to 6 months, 28% were breastfed between 6 and up to 12 months, and 24% were breastfed for 12 months or more. The children who were breastfed for 6 months or longer had significantly lower mean CBCL

Discussion

We have shown that a shorter duration of breastfeeding was associated with increased mental health morbidity throughout a period spanning early childhood to adolescence. This association was evident for the continuous measures of total, externalizing, and internalizing behaviors, as well as for dichotomous measures of morbidity, which reflect clinically significant behavioral problems. Furthermore, these associations persisted after adjustment for family, social, economic, birth, and

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    The Western Australian Pregnancy Cohort (Raine) Study is funded by the Raine Medical Research Foundation at The University of Western Australia, the National Health and Medical Research Council of Australia (NHMRC), the Telstra Foundation, the Western Australian Health Promotion Foundation, and the Australian Rotary Health Research Fund. We would also like to acknowledge the Telethon Institute for Child Health Research and the NHMRC Program Grant which supported the 14-year follow-up (Stanley et al, ID 003209). The authors declare no conflicts of interest.

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