Elsevier

Infant Behavior and Development

Volume 50, February 2018, Pages 300-310
Infant Behavior and Development

Full length article
Influence of breastfeeding and iron status on mental and psychomotor development during the first year of life.

https://doi.org/10.1016/j.infbeh.2017.05.009Get rights and content

Highlights

  • •

    Infant nutrition during the first year of life is a good predictor of later mental and psychomotor development.

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    Infant breastfeeding for at least four months and good iron levels contributes to improve psychomotor development during the first year of life.

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    No associations were found between BF for at least four months and mental development

Abstract

Breastfeeding (BF) confers numerous benefits on the developing infant in both the short and the long term including psychological development, but there are multiple other factors that must be taken into account when these relationships are studied. To analyse how breastfeeding during the first 4 months of life affects infant mental and psychomotor development (MPD) at 6 and 12 months in a group of healthy infants from a Mediterranean Spanish city considering many important potential confounds. This is a longitudinal study conducted on infants from birth until the age of 12 months. A total of 154 healthy infants were evaluated by Paediatric Unit of Sant Joan University Hospital in Reus, Spain. Type of feeding, clinical history, anthropometry, iron status and mental and psychomotor development were assessed and analysed. At 4 months, 24% of infants received BF and 26% received mixed feeding (MF). Multiple Linear Regression models were applied adjusting for potential prenatal, perinatal and postnatal confounds showing that infants who received BF for at least four months presented higher psychomotor development index (PDI) at 6 and at 12 months of age. Also, gestational age and BMI at 6 m were associated positively with PDI at 6 m, and haemoglobin levels at 12 m and birth height were associated with PDI and MDI at 12 m (respectively).

In conclusion, after the adjustment of important potential confounds, BF during at least four months and adequate infant iron status are related to better psychomotor development during the first year. No associations were found between BF and mental development.

Section snippets

INTRODUCTION

The World Health Organization (WHO), the American Academy of Paediatrics (AAP) and the European Society of Paediatric, Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommend that mothers worldwide should exclusively breastfeed during their child’s first six months in order for them to achieve optimal growth, development and health. Thereafter, they should be given nutritious complementary foods, while breastfeeding should continue until the age of two years or more (WHO, 2011). However,

Design and setting

This is a prospective longitudinal study. The infants were recruited at birth in the public Hospital Universitari Sant Joan de Reus (Tarragona, Spain) and followed for 12 months. Most children were from families with a medium or high socioeconomic level. The participation was offered to all parents, during the course of the first day of life of the children born in University Hospital Sant Joan in Reus, and to those who met the inclusion criteria: to be Caucasian, born at term (≥37 weeks) and

General characteristics of the sample at birth

Table 1 shows the general characteristics of the mother and child at birth. The sample consisted of 154 babies, 46% of whom were boys. 67% of the births were a normal delivery. At birth, 72% of infants were normoweight, while 16% were overweight or obese. 91% were breastfed or received MF (Fig. 1). No mother reported alcohol or other illicit drugs consumption while a 19% of the mothers smoked during pregnancy. No significant differences in sex were observed at birth.

Evolution of BF during the first year of life

Fig. 1 shows the prevalence

DISCUSSION

Our study was conducted in a developed country (Spain) with a sample of 154 healthy infants born at term with a normal weight. The children were monitored by a multidisciplinary team of paediatricians, psychologists and nutritionists at the same hospital where they were born. The procedure for taking anthropometric measures and conducting interviews, questionnaires and cognitive assessments (MDI and PDI) was standardised among the professionals of the study in order to reduce variability in

CONCLUSIONS

Our results let us conclude that, after the adjustment of important potential confounds, BF during at least four months and adequate infant iron status, are related to better psychomotor development during the first year of life. No associations were found between BF and mental development at this period of time.

Compliance with Ethical Standards

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethical Committee of “Hospital Universitari Sant Joan” (Reus, Tarragona, Spain) in accordance with the 1964 Helsinki declaration.

Informed consent

Informed consent was obtained from all individual participant included in the study, in this case, from their parents.

Authors’ contributions

Victoria Arija and Josefa Canals programmed and controlled the follow of visits. They also interpreted the results and contributed to the discussion and reviewed the manuscript. Cristina Jardí and Cristina Bedmar, did the visits and the field work. Núria Aranda and Cristina Jardí did the statistics and interpreted the results. Josefa Canals and Carmen Hernández did and interpreted neuroconductual tests. Carmen Hernández and Cristina Jardí also wrote the manuscript. All authors read and approved

Acknowledgements

The authors thank the infants and their parents for participating in this study and all the DeFensas research team: Blanca Ribot, Joaquin Escribano, Rosa Jiménez, Josep Maria Barroso.

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