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Breastfeeding during infancy and neurocognitive function in adolescence: 16-year follow-up of the PROBIT cluster-randomized trial

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Listed:
  • Seungmi Yang
  • Richard M Martin
  • Emily Oken
  • Mikhail Hameza
  • Glen Doniger
  • Shimon Amit
  • Rita Patel
  • Jennifer Thompson
  • Sheryl L Rifas-Shiman
  • Konstantin Vilchuck
  • Natalia Bogdanovich
  • Michael S Kramer

Abstract

Background: Evidence on the long-term effect of breastfeeding on neurocognitive development is based almost exclusively on observational studies. In the 16-year follow-up study of a large, cluster-randomized trial of a breastfeeding promotion intervention, we evaluated the long-term persistence of the neurocognitive benefits of the breastfeeding promotion intervention previously observed at early school age. Methods and findings: A total of 13,557 participants (79.5% of the 17,046 randomized) of the Promotion of Breastfeeding Intervention Trial (PROBIT) were followed up at age 16 from September 2012 to July 2015. At the follow-up, neurocognitive function was assessed in 7 verbal and nonverbal cognitive domains using a computerized, self-administered test battery among 13,427 participants. Using an intention-to-treat (ITT) analysis as our prespecified primary analysis, we estimated cluster- and baseline characteristic-adjusted mean differences between the intervention (prolonged and exclusive breastfeeding promotion modelled on the Baby-Friendly Hospital Initiative) and control (usual care) groups in 7 cognitive domains and a global cognitive score. In our prespecified secondary analysis, we estimated mean differences by instrumental variable (IV) analysis to account for noncompliance with the randomly assigned intervention and estimate causal effects of breastfeeding. The 16-year follow-up rates were similar in the intervention (79.7%) and control groups (79.3%), and baseline characteristics were comparable between the two. In the cluster-adjusted ITT analyses, children in the intervention group did not show statistically significant differences in the scores from children in the control group. Prespecified additional adjustment for baseline characteristics improved statistical precision and resulted in slightly higher scores among children in the intervention for verbal function (1.4 [95% CI 0.3–2.5]) and memory (1.2 [95% CI 0.01–2.4]). IV analysis showed that children who were exclusively breastfed for ≥3 (versus

Suggested Citation

  • Seungmi Yang & Richard M Martin & Emily Oken & Mikhail Hameza & Glen Doniger & Shimon Amit & Rita Patel & Jennifer Thompson & Sheryl L Rifas-Shiman & Konstantin Vilchuck & Natalia Bogdanovich & Michae, 2018. "Breastfeeding during infancy and neurocognitive function in adolescence: 16-year follow-up of the PROBIT cluster-randomized trial," PLOS Medicine, Public Library of Science, vol. 15(4), pages 1-16, April.
    • Handle: RePEc:plo:pmed00:1002554
    DOI: 10.1371/journal.pmed.1002554
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    References listed on IDEAS

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    1. Reilly, Siobhan & Evenhouse, Eirik, 2005. "Improved estimates of the benefits of breastfeeding using sibling comparisons to reduce selection bias," MPRA Paper 13434, University Library of Munich, Germany.
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