| Objectives The prevalence of autism spectrum disorder(ASD)in children has increased over the past few decades.There is currently no consensus on the link between breastfeeding and ASD.The aim of this study was to demonstrate the potential association between breastfeeding and ASD through birth cohort study.Methods This study is based on the Ma'anshan Birth Cohort(MABC),a large prospective birth cohort study.When establishing a perinatal health manual in the first trimester of pregnancy,pregnant woman will first check and fill out the Maternal and Child Health Record Form 1 to collect the basic demographic information(including age,pre-pregnancy height and weight,main place of residence,couple education,family income and pregnancy complication).Moreover,the basic information about the patterns and duration of breastfeeding was obtained from the maternal and child questionnaire,and the autism-like behavior(ALB)of children aged 18 months was assessed by CHAT-23.Univariate and multivariate logistic regression models were used to analyze the effects of breastfeeding,feeding duration on ALB in 18-month-old children.In addition,the present study applies factor analysis to extract a principal factor,and synthesizes a comprehensive indicator of social status,including maternal education,maternal intelligence as well as family economic status,obtaining a comprehensive score for each mother.We further divided the social status comprehensive index into three degrees containing high,medium,and low,comparingthe association of breastfeeding for 18-month-old children with autism spectrum disorders in different degrees of social status.Results The study eventually enrolled 3008 mother-child pairs.The prevalence of autism-like behavior was 13.8%.In children suffering from ALB,approximately 6.7%(28/416)of the infants were exclusively breastfed or predominantly breastfed,of which gradually decreased within 6 months after birth(from 53.2 % fell to 11.1%).The independent sample T test results showed that there was a fetal gender difference in the occurrence of ALB,but it was not related to fetal weight,body length,head circumference and chest circumference.Findings of ?2 test revealed that maternal age,maternal education,father's education,family monthly income,maternal intelligence,gestational diabetes,gestational weeks of childbirth and 18-month-old family rearing style(The four dimensions are related to ALB in 18-month-old children and the differences were statistically significant).Univariate and multivariate multi-class logistic regression models suggested that partial breastfeeding and formula feeding significantly increased ALB risks(OR = 1.65,95% CI: 1.08-2.52;OR = 2.10;95% CI: 1.28-3.42).Additionally,longer duration of exclusive breastfeeding or predominant breastfeeding may reduce the risk of ALB(OR=0.47,95%CI:0.26-0.94).Factor analysis showed that when mothers' comprehensive scores were classified as low or high “social status”,infants who received partial breastfeeding or formula feeding were inclined to ALB,but in middle-level “social status” mothers,there was no statistical difference in the incidence of ALB among various patterns of infantile feeding.There was no significant effect modification between maternal social status and patterns of breastfeeding based on the value of P for interaction>0.05.ConclusionBreastfeeding is positively associated with prevention of ALB and prolonging duration of breastfeeding reduces lower risks of ALB for infants aged 18 months.Different degrees of mothers “social status” exert potential influences on this association. |
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