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Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis

European Child & Adolescent Psychiatry volume 28, pages 19–30 (2019)Cite this article

Abstract

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.

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Abbreviations

ADHD:

Attention-deficit/hyperactivity disorder

BF:

Breastfeeding

CI:

Confidence interval

CPRS:

Conners’ Parent Rating Scale

CTRF:

Conners’ teacher rating form

DSM-5:

Diagnostic and statistical manual of mental disorders, fifth edition

DSM-IV:

Diagnostic and statistical manual of mental disorders, fourth edition

ES:

Effect size

ICD-10:

International statistical classification of diseases and related health problems 10th revision

MA:

Meta-analysis

MOOSE:

Meta-analysis of observational studies in epidemiology

n/a:

Not available

NOS:

Newcastle–Ottawa scale

OR:

Odds ratio

PUFAs:

Polyunsaturated fatty acids

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Acknowledgements

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.

Author information

Author notes

  1. Ping-Tao Tseng and Cheng-Fang Yen contributed equally as first authors.

Authors and Affiliations

  1. Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai’s Home, Kaohsiung, Taiwan

    Ping-Tao Tseng & Ching-Kuan Wu

  2. WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan

    Ping-Tao Tseng

  3. Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Cheng-Fang Yen

  4. Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Cheng-Fang Yen

  5. Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan

    Yen-Wen Chen

  6. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK

    Brendon Stubbs

  7. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, De Crespigny Park, London, UK

    Brendon Stubbs

  8. Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK

    Brendon Stubbs

  9. Translational Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, CE, Brazil

    Andre F. Carvalho

  10. Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Rua Prof. Costa Mendes, 1608, 4o Andar, Fortaleza, CE, 60430-040, Brazil

    Andre F. Carvalho

  11. ESPA Research, 2A Hylton Park Road, Sunderland, SR5 3HD, UK

    Paul Whiteley

  12. Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Che-Sheng Chu

  13. Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan

    Dian-Jeng Li

  14. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Dian-Jeng Li

  15. Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan

    Tien-Yu Chen

  16. Department of Adult Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan

    Wei-Cheng Yang

  17. Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan

    Chia-Hung Tang

  18. Department of Child Psychiatry, Chang Gung Memorial Hospital at Taoyuan and Chang Gung University, Taoyuan, Taiwan

    Hsin-Yi Liang

  19. Department of Pediatrics, DA-AN Women and Children Hospital, Tainan, Taiwan

    Wei-Chieh Yang

  20. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

    Pao-Yen Lin

  21. Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

    Pao-Yen Lin

Authors
  1. Ping-Tao Tseng
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  2. Cheng-Fang Yen
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Correspondence to Pao-Yen Lin.

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Tseng, PT., Yen, CF., Chen, YW. et al. Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis. Eur Child Adolesc Psychiatry 28, 19–30 (2019). https://doi.org/10.1007/s00787-018-1182-4

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  • DOI: https://doi.org/10.1007/s00787-018-1182-4

Keywords

  • Attention-deficit/hyperactivity disorder
  • Breastfeeding
  • Meta-analysis
  • Nutrition
  • Risk