Association between the different duration of breastfeeding and attention deficit/hyperactivity disorder in children: a systematic review and meta-analysis

ABSTRACT

Objectives: To summarize the current evidence on the association between maternal breastfeeding and the occurrence of attention deficit/hyperactivity disorder (ADHD) in offspring.

Methods: We searched for studies published in English before May 2018 using the PubMed, EMBASE, Cochrane, and Web of Science databases. We included cohort studies, case–control studies, and cross-sectional studies, that focused on the association between maternal breastfeeding and the occurrence of ADHD in offspring. Random effects models were used for combined analyses.

Results: Two cohort studies, 7 case–control studies and 3 cross-sectional studies, with 3,686 cases and 106,907 participants, were included. Children with any maternal breastfeeding had a lower incidence of ADHD than children who were never breastfed (odds ratio [OR]: 0.70; 95% confidence interval [CI]:0.52–0.93). Further analyses also showed associations between reduced ADHD incidence and duration of breastfeeding. Children breastfed for over 1 month, over 3 months, over 6 months, and over 12 months had a lower incidence of ADHD than children breastfed for less than 1 month (OR: 0.20; 95% CI: 0.11–0.38), less than 3 months (OR: 0.33; 95% CI: 0.23–0.47), less than 6 months (OR: 0.50; 95% CI: 0.41–0.61), and less than 12 months (OR: 0.55; 95% CI: 0.37–0.81), respectively. These results were stable in the 1-month, 3-month, and 6-month breastfeeding groups.

Conclusion: With our meta-analysis, we provide evidence that maternal breastfeeding may reduce the risk of ADHD in children. The causality of this relationship and underlying mechanisms need to be explored in future prospective studies.

KEYWORDS:

• Attention deficit/hyperactivity disorder
• breastfeeding
• meta-analysis
• nutrition
• protective factor

Acknowledgments

This work was supported by the National Science Foundation of China (No.81330016, 81630038, 81330524, 81771634), the National Key R&D Program of China (2017YFA0104200), the Grants from Ministry of Education of China (IRT0935), the Grants from Science and Technology Bureau of Sichuan Province (2016TD0002), and the Grant of clinical discipline program (Neonatology) from the Ministry of Health of China (1311200003303).

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Yan Zeng and Ying Tang conceived and designed the study.

Tingting Zhu and Dongqiong Xiao collected data.

Yan Zeng and Ying Tang performed the statistical analysis and wrote manuscript.

Jun Tang, Jing Shi, Li Zhang and Yi Qu designed the data collection instruments, coordinated and supervised data collection.

Dezhi Mu reviewed and revised the manuscript.

Additional information

Funding

This work was supported by the National Science Foundation of China (No.81330016, 81630038, 81330524, 81771634), the Grants from Ministry of Education of China (IRT0935), the Grants from Science and Technology Department of Sichuan Province (2016TD0002), and the Grant of clinical discipline program (Neonatology) from the Grant from the Ministry of Health of China (1311200003303).