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1.
Anderson  JWJohnstone  BMRemley  DT Breast-feeding and cognitive development: a meta-analysis.  Am J Clin Nutr 1999;70 (4) 525- 535PubMedGoogle Scholar
2.
Lucas  AMorley  RCole  TJLister  GLeeson-Payne  C Breast milk and subsequent intelligence quotient in children born preterm.  Lancet 1992;339 (8788) 261- 264PubMedGoogle Scholar
3.
Der  GBatty  GDDeary  IJ Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis [published online ahead of print October 4, 2006].  BMJ 2006;333 (7575) 945PubMed10.1136/bmj.38978.699583.55Google Scholar
4.
Jacobson  SWChiodo  LMJacobson  JL Breastfeeding effects on intelligence quotient in 4- and 11-year-old children.  Pediatrics 1999;103 (5) e71PubMed10.1542/peds.103.5.e71Google Scholar
5.
Angelsen  NKVik  TJacobsen  GBakketeig  LS Breast feeding and cognitive development at age 1 and 5 years.  Arch Dis Child 2001;85 (3) 183- 188PubMedGoogle Scholar
6.
Mortensen  ELMichaelsen  KFSanders  SAReinisch  JM The association between duration of breastfeeding and adult intelligence.  JAMA 2002;287 (18) 2365- 2371PubMedGoogle Scholar
7.
Oddy  WHKendall  GEBlair  Ede Klerk  NHStanley  FJLandau  LISilburn  SZubrick  S Breast feeding and cognitive development in childhood: a prospective birth cohort study.  Paediatr Perinat Epidemiol 2003;17 (1) 81- 90PubMedGoogle Scholar
8.
Gómez-Sanchiz  MCañete  RRodero  IBaeza  JEAvila  O Influence of breast-feeding on mental and psychomotor development.  Clin Pediatr (Phila) 2003;42 (1) 35- 42PubMedGoogle Scholar
9.
Lawlor  DANajman  JMBatty  DO'Callaghan  MJWilliams  GMBor  W Early life predictors of childhood intelligence: findings from the Mater-University study of pregnancy and its outcomes.  Paediatr Perinat Epidemiol 2006;20 (2) 148- 162PubMedGoogle Scholar
10.
Drane  DLLogemann  JA A critical evaluation of the evidence on the association between type of infant feeding and cognitive development.  Paediatr Perinat Epidemiol 2000;14 (4) 349- 356PubMedGoogle Scholar
11.
Jain  AConcato  JLeventhal  JM How good is the evidence linking breastfeeding and intelligence?  Pediatrics 2002;109 (6) 1044- 1053PubMedGoogle Scholar
12.
Kramer  MSChalmers  BHodnett  EDSevkovskaya  ZDzikovich  IShapiro  SCollet  JPVanilovich  IMezen  IDucruet  TShishko  GZubovich  VMknuik  DGluchanina  EDombrovskiy  VUstinovitch  AKot  TBogdanovich  NOvchinikova  LHelsing  EPROBIT (Promotion of Breastfeeding Intervention Trial) Study Group, Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus.  JAMA 2001;285 (4) 413- 420PubMedGoogle Scholar
13.
World Health Organization; UNICEF, Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services.  Geneva, Switzerland World Health Organization1989;
14.
Campbell  MKElbourne  DRAltman  DGCONSORT Group, CONSORT statement: extension to cluster randomised trials.  BMJ 2004;328 (7441) 702- 708PubMedGoogle Scholar
15.
Wechsler  D Wechsler Abbreviated Scales of Intelligence.  San Antonio, TX Psychological Corp1999;
16.
Achenbach  TMRescorla  LA Manual for the ASEBA School-Age Forms and Profiles.  Burlington University of Vermont, Research Center for Children, Youth, and Families2001;
17.
Kramer  MSMatush  LVanilovich  IPlatt  RWBogdanovich  NSevkovskaya  ZDzikovich  IShishko  GCollet  JPMartin  RMDavey Smith  GGillman  MWChalmers  BHodnett  EShapiro  SPROBIT Study Group, Effects of prolonged and exclusive breastfeeding on child height, weight, adiposity, and blood pressure at age 6.5 y: evidence from a large randomized trial.  Am J Clin Nutr 2007;86 (6) 1717- 1721PubMedGoogle Scholar
18.
Kramer  MSMatush  LVanilovich  IPlatt  RBogdanovich  NSevkovskaya  ZDzikovich  IShishko  GMazer  BPromotion of Breastfeeding Intervention Trial (PROBIT) Study Group, Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial [published online ahead of print September 11, 2007].  BMJ 2007;335 (7624) 815PubMedGoogle Scholar
19.
Kramer  MSVanilovich  IMatush  LBogdanovich  NZhang  XShishko  GMuller-Bolla  MPlatt  RW The effect of prolonged and exclusive breast-feeding on dental caries in early school-age children: new evidence from a large randomized trial [published online ahead of print September 18, 2007].  Caries Res 2007;41 (6) 484- 488PubMedGoogle Scholar
20.
Kramer  MSFombonne  EIgumnov  SVanilovich  IMatush  LMironova  EBogdanovich  NTremblay  REChalmers  BZhang  XPlatt  RWPromotion of Breastfeeding Intervention Trial (PROBIT) Study Group, Effects of prolonged and exclusive breastfeeding on child behavior and maternal adjustment: evidence from a large, randomized trial.  Pediatrics 2008;121 (3) e435- e440PubMedGoogle Scholar
21.
Simmer  K Longchain polyunsaturated fatty acid supplementation in infants born at term [update of: Cochrane Database Syst Rev. 2000;(2):CD000376].  Cochrane Database Syst Rev 2001; (4) CD000376PubMed10.1002/14651858.CD000376Google Scholar
22.
Simmer  KPatole  S Longchain polyunsaturated fatty acid supplementation in preterm infants [update of: Cochrane Database Syst Rev. 2000;(2):CD000375].  Cochrane Database Syst Rev 2004; (1) CD000375.PubMed10.1002/14651858.CD000375.pub2Google Scholar
23.
Nagashima  KItoh  KKuroume  T Levels of insulin-like growth factor I in full- and preterm human milk in comparison to levels in cow's milk and in milk formulas.  Biol Neonate 1990;58 (6) 343- 346PubMedGoogle Scholar
24.
Philipps  AFRao  RAnderson  GGMcCracken  DMLake  MKoldovsky  O Fate of insulin-like growth factors I and II administered orogastrically to suckling rats.  Pediatr Res 1995;37 (5) 586- 592PubMedGoogle Scholar
25.
Weaver  ICCervoni  NChampagne  FAD'Alessio  ACSharma  SSeckl  JRDymov  SSzyf  MMeaney  MJ Epigenetic programming by maternal behavior.  Nat Neurosci 2004;7 (8) 847- 854PubMedGoogle Scholar
26.
Giovannini  MBanderali  GRadaelli  GCarmine  VRiva  EAgostini  C Monitoring breastfeeding rates in Italy: national surveys 1995 and 1999.  Acta Paediatr 2003;92 (3) 357- 363PubMedGoogle Scholar
27.
Callen  JPinelli  J Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review.  Birth 2004;31 (4) 285- 292PubMedGoogle Scholar
28.
Li  RDarling  NMaurice  EBarker  LGrummer-Strawn  LM Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey.  Pediatrics 2005;115 (1) e31- e37PubMedGoogle Scholar
29.
Ryan  ASZhou  W Lower breastfeeding rates persist among the special supplemental nutrition program for women, infants, and children participants, 1978-2003.  Pediatrics 2006;117 (4) 1136- 1146PubMedGoogle Scholar
Original Article
May 2008

Breastfeeding and Child Cognitive Development: New Evidence From a Large Randomized Trial

Author Affiliations

Author Affiliations: Departments of Pediatrics (Drs Kramer, Platt, and Fombonne), Epidemiology and Biostatistics (Drs Kramer, Platt, Collet, and Shapiro and Mr Ducruet), Psychology (Dr Aboud), and Psychiatry (Dr Fombonne), McGill University, Montreal, Quebec, Canada; National Research and Applied Medicine Mother and Child Centre, Minsk, Belarus (Mss Mironova and Kozlova, Drs Vanilovich, Matush, Igumnov, Bogdanovich, Davidovsky, and Skugarevsky, and Mr Trofimovich); and Department of Epidemiology and Community Health, Queen's University, Kingston (Dr Chalmers) and Faculty of Nursing, University of Toronto, Toronto (Dr Hodnett), Ontario, Canada.

Arch Gen Psychiatry. 2008;65(5):578-584. doi:10.1001/archpsyc.65.5.578
Abstract

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.

Design  Cluster-randomized trial, with enrollment from June 17, 1996, to December 31, 1997, and follow-up from December 21, 2002, to April 27, 2005.

Setting  Thirty-one Belarussian maternity hospitals and their affiliated polyclinics.

Participants  A total of 17 046 healthy breastfeeding infants were enrolled, of whom 13 889 (81.5%) were followed up at age 6.5 years.

Intervention  Breastfeeding promotion intervention modeled on the Baby-Friendly Hospital Initiative by the World Health Organization and UNICEF.

Main Outcome Measures  Subtest and IQ scores on the Wechsler Abbreviated Scales of Intelligence, and teacher evaluations of academic performance in reading, writing, mathematics, and other subjects.

Results  The experimental intervention led to a large increase in exclusive breastfeeding at age 3 months (43.3% for the experimental group vs 6.4% for the control group; P < .001) and a significantly higher prevalence of any breastfeeding at all ages up to and including 12 months. The experimental group had higher means on all of the Wechsler Abbreviated Scales of Intelligence measures, with cluster-adjusted mean differences (95% confidence intervals) of +7.5 (+0.8 to +14.3) for verbal IQ, +2.9 (−3.3 to +9.1) for performance IQ, and +5.9 (−1.0 to +12.8) for full-scale IQ. Teachers' academic ratings were significantly higher in the experimental group for both reading and writing.

Conclusion  These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development.

Trial Registration  isrctn.org Identifier: ISRCTN37687716

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