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Breastfeeding and neurodevelopment in infants with prenatal alcohol exposure

Pediatric Research volume 95, pages 819–826 (2024)Cite this article

Abstract

Background

Few studies have evaluated the differential benefits of breastfeeding on infant neurodevelopment at varying levels of prenatal alcohol exposure (PAE). This study examined whether the association between breastfeeding and neurodevelopment is modified by prenatal drinking pattern.

Methods

The study included 385 infants from Ukraine born to women prospectively enrolled in a cohort study during pregnancy. Neurodevelopment was assessed at six and 12 months using the Bayley Scales of Infant Development II (BSID-II) Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI). Linear regression modeling with interaction terms and stratification by PAE group was used to determine the relationship between breastfeeding, PAE, and neurodevelopment.

Results

A significant interaction between PAE and breastfeeding was observed for the MDI and PDI at six and 12 months. Infants with high PAE who were breastfed at least four months had BSID-II scores 14 or more points higher compared to those never breastfed. Counterintuitively, those with moderate PAE had poorer performance on the BSID-II at 12 months when breastfed longer.

Conclusion

There was a significant joint effect of PAE and breastfeeding on infant neurodevelopment at six and 12 months. Breastfeeding may provide distinct benefits to infants exposed to high levels of PAE.

Impact

  • We found a positive effect of breastfeeding on infant neurodevelopment among infants with prenatal alcohol exposure (PAE), particularly those exposed to higher levels during gestation.

  • This study is one of the first to evaluate whether breastfeeding mitigates harm caused by PAE.

  • Breastfeeding may provide distinct benefits to infants with higher levels of PAE.

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Data availability

The data used in this analysis can be accessed following approved application to the CIFASD data sharing committee. https://cifasd.org/data-sharing/.

References

  1. Bandoli, G. et al. Patterns of prenatal alcohol use that predict infant growth and development. Pediatrics 143, e20182399 (2019).

    Article  PubMed  Google Scholar 

  2. Mattson, S. N., Bernes, G. A. & Doyle, L. R. Fetal alcohol spectrum disorders: a review of the neurobehavioral deficits associated with prenatal alcohol exposure. Alcohol Clin. Exp. Res. 43, 1046–1062 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Flak, A. L. et al. The association of mild, moderate, and binge prenatal alcohol exposure and child neuropsychological outcomes: a meta-analysis. Alcohol Clin. Exp. Res. 38, 214–226 (2014).

    Article  PubMed  Google Scholar 

  4. Richardson, G. A., Day, N. L. & Goldschmidt, L. Prenatal alcohol, marijuana, and tobacco use: infant mental and motor development. Neurotoxicol. Teratol. 17, 479–487 (1995).

    Article  CAS  PubMed  Google Scholar 

  5. Carter, R. C. et al. Fetal alcohol growth restriction and cognitive impairment. Pediatrics 138, e20160775 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jedrychowski, W. et al. Effect of exclusive breastfeeding on the development of children’s cognitive function in the Krakow prospective birth cohort study. Eur. J. Pediatr. 171, 151–158 (2012).

    Article  PubMed  Google Scholar 

  7. Hou, L. et al. Impact of the duration of breastfeeding on the intelligence of children: A systematic review with network meta-analysis. Breastfeed. Med. 16, 687–696 (2021).

    Article  PubMed  Google Scholar 

  8. Leventakou, V. et al. Breastfeeding duration and cognitive, language and motor development at 18 months of age: Rhea mother–child cohort in Crete, Greece. J. Epidemiol. Community Health 69, 232–239 (2015).

    Article  PubMed  Google Scholar 

  9. Belfort, M. B. The science of breastfeeding and brain development. Breastfeed. Med. 12, 459–461 (2017).

    Article  PubMed Central  Google Scholar 

  10. Horta, B. L., Victora, C. G., World Health Organization. Long-Term Effects of Breastfeeding: a Systematic Review. World Health Organization; 2013. Published April 10, 2013. Accessed May 7, https://apps.who.int/iris/handle/10665/79198 2023.

  11. Horta, B. L., Loret de Mola, C. & Victora, C. G. Breastfeeding and intelligence: a systematic review and meta-analysis. Acta Paediatr. 104, 14–19 (2015).

    Article  PubMed  Google Scholar 

  12. McCrory, C. & Murray, A. The effect of breastfeeding on neuro-development in infancy. Matern. Child Health J. 17, 1680–1688 (2013).

    Article  PubMed  Google Scholar 

  13. World Health Organization. Infant and young child feeding. World Health Organization. Published June 9, 2021. Accessed May 7, https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding 2023.

  14. Centers for Disease Control and Prevention. Breastfeeding FAQs. Centers for Disease Control and Prevention. Published March 2, 2022. Updated August 4, 2022. Accessed May 7, https://www.cdc.gov/breastfeeding/faq/index.htm 2023.

  15. May, P. A. et al. Breastfeeding and maternal alcohol use: prevalence and effects on child outcomes and fetal alcohol spectrum disorders. Reprod. Toxicol. 63, 13–21 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Wilson, J. et al. Alcohol consumption by breastfeeding mothers: frequency, correlates and infant outcomes. Drug Alcohol Rev. 36, 667–676 (2017).

    Article  PubMed  Google Scholar 

  17. Hoyme, H. E. et al. Updated clinical guidelines for diagnosing fetal alcohol spectrum disorders. Pediatrics 138, e20154256 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chambers, C. D. et al. Prevalence and predictors of maternal alcohol consumption in 2 regions of Ukraine. Alcohol Clin. Exp. Res. 38, 1012–1019 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bandoli, G. et al. Assessing the independent and joint effects of unmedicated prenatal depressive symptoms and alcohol consumption in pregnancy and infant neurodevelopmental outcomes. Alcohol Clin. Exp. Res. 40, 1304–1311 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Coles, C. D. et al. Dose and timing of prenatal alcohol exposure and maternal nutritional supplements: developmental effects on 6-month-old infants. Matern. Child Health J. 19, 2605–2614 (2015).

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  21. About Us: Our Mission. Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD). Published 2016. Accessed May 7, https://cifasd.org/about/ 2023.

  22. Bandoli, G. et al. Patterns of prenatal alcohol exposure and alcohol‐related dysmorphic features. Alcohol Clin. Exp. Res. 44, 2045–2052 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Garrison, L., Morley, S., Chambers, C. D. & Bakhireva, L. N. Forty years of assessing neurodevelopmental and behavioral effects of prenatal alcohol exposure in infants: what have we learned? Alcohol Clin. Exp. Res. 43, 1632–1642 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bayley, N. Bayley Scales of Infant Development. 2nd Edition. Psychological Corporation; 1993.

  25. Mesa, D. A. et al. The use of cardiac orienting responses as an early and scalable biomarker of alcohol‐related neurodevelopmental impairment. Alcohol Clin. Exp. Res. 41, 128–138 (2017).

    Article  PubMed  Google Scholar 

  26. Lowe, J. R., Erickson, S. J., Schrader, R. & Duncan, A. F. Comparison of the Bayley II Mental Developmental Index and the Bayley III cognitive scale: are we measuring the same thing? Acta Pediatr. 101, e55–e58 (2012).

    Article  Google Scholar 

  27. Nellis, L. & Gridley, B. E. Review of the Bayley scales of infant development—Second edition. J. Sch. Psychol. 32, 201–209 (1994).

    Article  Google Scholar 

  28. Hollingshead, A. B. Four factor index of social status. J. Sociol. 8, 21–51 (2011).

    Google Scholar 

  29. Terasaki, L. S., Gomez, J. & Schwarz, J. M. An examination of sex differences in the effects of early-life opiate and alcohol exposure. Philos. Trans. R. Soc. Lond. B. Biol. Sci. 371, 20150123 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  30. May, P. A. et al. Who is most affected by prenatal alcohol exposure: Boys or girls? Drug Alcohol Depend. 177, 258–267 (2017).

    Article  CAS  PubMed  Google Scholar 

  31. Eickmann, S. H. et al. Breast feeding and mental and motor development at 12 months in a low-income population in northeast Brazil: breast feeding and mental development. Paediatr. Perinat. Epidemiol. 21, 129–137 (2007).

    Article  PubMed  Google Scholar 

  32. Guxens, M. et al. Breastfeeding, long-chain polyunsaturated fatty acids in colostrum, and infant mental development. Pediatrics 128, e880–e889 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jardi, C. et al. Influence of breastfeeding and iron status on mental and psychomotor development during the first year of life. Infant Behav. Dev. 50, 300–310 (2018).

    Article  PubMed  Google Scholar 

  34. Thulier, D. & Mercer, J. Variables associated with breastfeeding duration. J. Obst. Gynecol. Neonatal Nurs. 38, 259–268 (2009).

    Article  Google Scholar 

  35. Primo, C. C. et al. Which factors influence women in the decision to breastfeed. Invest. Educ. Enferm. 34, 198–210 (2016).

    Google Scholar 

  36. Ogbo, F. A. et al. Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia. Int. Breastfeed. J. 12, 16 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Martins, F. A. et al. Breastfeeding patterns and factors associated with early weaning in the Western Amazon. Rev. Saúde. Pública. 55, 21 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  38. McCormack, C. et al. Prenatal alcohol consumption between conception and recognition of pregnancy. Alcohol Clin. Exp. Res. 41, 369–378 (2017).

    Article  PubMed  Google Scholar 

  39. Mårdby, A. C., Lupattelli, A., Hensing, G. & Nordeng, H. Consumption of alcohol during pregnancy—a multinational European study. Women Birth 30, e207–e213 (2017).

    Article  PubMed  Google Scholar 

  40. Romanenko, L., Shlemkevych, O. & Arendt, M. The current state of breastfeeding in Ukraine: an interview with Lidiia Romanenko and Olha Shlemkevych. J. Hum. Lact. 39, 15–21 (2023).

    Article  PubMed  Google Scholar 

  41. The United States Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. Breastfeeding report card: United States, 2022. Centers for Disease Control and Prevention. Updated August 31, Accessed August 16, 2023. https://www.cdc.gov/breastfeeding/data/reportcard.htm# 2022.

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Acknowledgements

All or part of this work was done in conjunction with the CIFASD, which is funded by grants from the National Institute on Alcohol Abuse and Alcoholism. Additional information about CIFASD can be found at www.cifasd.org. We acknowledge the contribution of Omni-Net, Ukraine, and the participating families and staff in Rivne and Khmelnytskyi, Ukraine. These data were collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD).

Funding

Supported by the National Institutes of Health (NIH) National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant U01AA014835 and the NIH Office of Dietary Supplements (principal investigator: Dr Chambers). Gretchen Bandoli is funded by an NIH award (K01 AA027811).

Author information

Authors and Affiliations

  1. Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA

    Kristen E. Schaffer, Christina D. Chambers, Richard S. Garfein & Gretchen Bandoli

  2. Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA

    Kristen E. Schaffer, Christina D. Chambers, Wladimir Wertelecki & Gretchen Bandoli

  3. Omni-Net for Children International Charitable Fund and Rivne Regional Medical Diagnostic Center, Rivne, Ukraine

    Wladimir Wertelecki

  4. Omni-Net for Children International Charitable Fund and Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine

    Wladimir Wertelecki

Authors
  1. Kristen E. Schaffer
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  2. Christina D. Chambers
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  4. Wladimir Wertelecki
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  5. Gretchen Bandoli
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Contributions

K.E.S. completed the data analysis and drafted the initial manuscript. G.B. conceptualized and designed the study and reviewed and revised the manuscript. C.C. conceptualized and designed the study, was responsible for the initial data collection, reviewed the manuscript for intellectual content, and reviewed and revised the manuscript. R.S.G. reviewed and revised the manuscript. W.W. was responsible for the initial data collection and reviewed the manuscript for intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Gretchen Bandoli.

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The authors declare no competing interests.

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All study participants signed informed consent.

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Schaffer, K.E., Chambers, C.D., Garfein, R.S. et al. Breastfeeding and neurodevelopment in infants with prenatal alcohol exposure. Pediatr Res 95, 819–826 (2024). https://doi.org/10.1038/s41390-023-02848-z

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