Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis
Previous studies have suggested environmental factors may contribute to the risk of attention-deficit/hyperactivity disorder (ADHD). The current meta-analysis examined (1) the difference in the duration of maternal breastfeeding between children with and without ADHD, and (2) the association between maternal breastfeeding and ADHD in children. The data of individual studies were synthesized with a random-effects model. Eleven articles were included in this meta-analysis. Children with ADHD had significantly less breastfeeding duration than controls (Hedges’ g = − 0.36, 95% confidence intervals (CIs) = − 0.61 to − 0.11, p = 0.005; difference in means: − 2.44 months, 95% CIs = − 3.17 to − 1.71, p < 0.001). In addition, the rates of non-exclusive breastfeeding in children with ADHD is significantly higher in “under 3 months” (odds ratio (OR) = 1.90, 95% CIs = 1.45 to 2.48, p < 0.001) but lower in “6 to 12 months” (OR = 0.69, 95% CIs = 0.49 to 0.98, p = 0.039) and “over 12 months” (OR = 0.58, 95% CIs = 0.35 to 0.97, p = 0.038) than controls. Children with ADHD received significantly higher rate of exclusive breastfeeding duration “under 3 months” (OR = 1.51, 95% CIs = 1.20 to 1.89, p < 0.001) but lower in “over 3 months” (OR = 0.52, 95% CIs = 0.29 to 0.95, p = 0.033) than controls. Furthermore, an association was found between non-breastfeeding and ADHD children (adjusted OR = 3.71, 95% CI = 1.94 to 7.11, p < 0.001). Our results suggest maternal breastfeeding is associated with a lower risk of ADHD in children. Future longitudinal research is required to confirm/refute these findings and to explore possible mechanisms underlying this association.
KeywordsAttention-deficit/hyperactivity disorder Breastfeeding Meta-analysis Nutrition Risk
Conners’ Parent Rating Scale
Conners’ teacher rating form
Diagnostic and statistical manual of mental disorders, fifth edition
Diagnostic and statistical manual of mental disorders, fourth edition
International statistical classification of diseases and related health problems 10th revision
Meta-analysis of observational studies in epidemiology
Polyunsaturated fatty acids
The authors declare that there are no conflicts of interest or funding in relation to the subject of this study. This manuscript had been presented as the poster in the 55th Annual Meeting of Taiwanese Society of Psychiatry. We had contacted the authors Field S.S., Lemcke S., Ptacek R., Say G.N., and Turkoglu S. for inquiry of original data and we thank for their responding and help.
Compliance with ethical standards
Conflict of interest
The authors state that there are no any competing interests in the current literature.
- 3.Centers for Disease Control and Prevention (2010) Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children—United States, 2003 and 2007. MMWR Morb Mortal Wkly Rep 59:1439–1443Google Scholar
- 4.Sergeant J (2004) EUNETHYDIS—searching for valid aetiological candidates of attention-deficit hyperactivity disorder or hyperkinetic disorder. Eur Child Adolesc Psychiatry 13(Suppl 1):I43–I49Google Scholar
- 10.Sasaki T, Hashimoto K, Oda Y, Ishima T, Kurata T, Takahashi J, Kamata Y, Kimura H, Niitsu T, Komatsu H, Ishikawa M, Hasegawa T, Shiina A, Hashimoto T, Kanahara N, Shiraishi T, Iyo M (2015) Decreased levels of serum oxytocin in pediatric patients with attention deficit/hyperactivity disorder. Psychiatry Res 228:746–751CrossRefGoogle Scholar
- 16.Kadziela-Olech H, Piotrowska-Jastrzebska J (2005) The duration of breastfeeding and attention deficit hyperactivity disorder. Rocz Akad Med Bialymst 50:302–306Google Scholar
- 20.Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012CrossRefGoogle Scholar
- 31.Higgins JP, Green S (2011) 10.4.3.1 Recommendations on testing for funnel plot asymmetry. In: Higgins JP, Green S (eds) Cochrane handbook for systematic reviews of interventions. Cochrane LibraryGoogle Scholar
- 34.Tobias A (1999) Assessing the influence of a single study in meta-analysis. STATA Techn Bull 47:15–17Google Scholar
- 42.Groen-Blokhuis MM, Franic S, van Beijsterveldt CE, de Geus E, Bartels M, Davies GE, Ehli EA, Xiao X, Scheet PA, Althoff R, Hudziak JJ, Middeldorp CM, Boomsma DI (2013) A prospective study of the effects of breastfeeding and FADS2 polymorphisms on cognition and hyperactivity/attention problems. Am J Med Genet B Neuropsychiatr Genet 162B:457–465CrossRefGoogle Scholar