Maternal breastfeeding and autism spectrum disorder in children: A systematic review and meta-analysis.

Ping-Tao Tseng, Yen-Wen Chen, Brendon Stubbs, Andre F Carvalho, Paul Whiteley, Chia-Hung Tang, Wei-Cheng Yang, Tien-Yu Chen, Dian-Jeng Li, Che-Sheng Chu, Wei-Chieh Yang, Hsin-Yi Liang, Ching-Kuan Wu, Cheng-Fang Yen, Pao-Yen Lin

Journal: Nutritional neuroscience 2019;22(5):354-362

PMID: 29046132

Abstract

OBJECTIVES

Autism spectrum disorder (ASD) refers to a group of conditions variably affecting communicative and social interactive abilities presenting alongside behaviors with various restricted and repetitive patterns. In addition to genetic factors that influence the onset of the symptoms, there is growing interest in the potential involvement of non-genetic environmental factors. Some aspects of breastfeeding practices, including rates, timing, or optimality, have been put forward as environmental risk factors for autism. However, previous studies showed a controversial relationship between ASD and breastfeeding.

METHODS

A meta-analysis on the association between maternal breastfeeding and ASD in children was conducted. We also explored potential moderating factors which might influence this association. Articles reporting the association between breastfeeding and a diagnosis of ASD were included.

RESULTS

Seven articles were included in the meta-analysis. Cumulatively, children with ASD (n = 1463), either in the form of clinical diagnosis or self-report, were significantly less likely to have been breastfed than children without ASD (n = 1180) (OR = 0.61, 95% CI = 0.45-0.83, P = 0.002). Subgroup analyses revealed that results remained significant for children who were breastfed with additional supplementation.

DISCUSSION

This meta-analysis provides evidence that breastfeeding (exclusively or including additional supplements) may protect against ASD. Prospective longitudinal research is required to disentangle the complex relationships and to explore potential pathophysiological mechanisms.

Address: a Department of Psychiatry , Tsyr-Huey Mental Hospital , Kaohsiung Jen-Ai's Home, Taiwan.; b Department of Neurology , E-Da Hospital , Kaohsiung , Taiwan.; c Physiotherapy Department , South London and Maudsley NHS Foundation Trust , London , UK.; d Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN) , King's College London , De Crespigny Park, London , UK.; e Faculty of Health, Social Care and Education , Anglia Ruskin University , Chelmsford , UK.; f Translational Psychiatry Research Group and Department of Clinical Medicine , Federal University of Ceará , Fortaleza , CE , Brazil.; g Department of Clinical Medicine, Faculty of Medicine , Federal University of Ceará , Rua Prof. Costa Mendes, 1608, 4° andar, 60430-040, Fortaleza , CE , Brazil.; h ESPA Research , 2A Hylton Park Road, Sunderland SR5 3HD , UK.; i Department of Psychiatry , Tainan hospital, Ministry of Health and Welfare , Taiwan.; j Department of Adult Psychiatry , Kaohsiung Municipal Kai-Syuan Psychiatric Hospital , Kaohsiung City , Taiwan.; k Department of Psychiatry, Tri-Service General Hospital ; School of Medicine, National Defense Medical Center , Taipei , Taiwan.; l Department of Addiction Science , Kaohsiung Municipal Kai-Syuan Psychiatric Hospital , Kaohsiung City , Taiwan.; m Graduate Institute of Medicine, College of Medicine , Kaohsiung Medical University , Kaohsiung City , Taiwan.; n Department of Psychiatry, Puli Branch , Taichung Veterans General Hospital , Nantou County , Taiwan.; o Department of Pediatrics , DA-AN Women and Children Hospital , Tainan City , Taiwan.; p Department of Child Psychiatry , Chang Gung Memorial Hospital at Taoyuan and Chang Gung University , Taoyuan , Taiwan.; q Department of Psychiatry , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.; r Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine , Kaohsiung Medical University , Kaohsiung , Taiwan.; s Department of Psychiatry , Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung , Taiwan.; t Institute for Translational Research in Biomedical Sciences , Kaohsiung Chang Gung Memorial Hospital , Kaohsiung City , Taiwan.
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