Date Published: July 16, 2018
Publisher: Public Library of Science
Author(s): Zhiying Zhang, Nga T. Tran, Tu S. Nguyen, Lam T. Nguyen, Yatin Berde, Siew Ling Tey, Yen Ling Low, Dieu T. T. Huynh, Jacobus P. van Wouwe.
Maternal nutrition during pregnancy and breastfeeding is important for the healthy growth and development of the fetus and infant.
This study aimed to evaluate the long-term effects of a maternal milk supplementation (MMS) in conjunction with a breastfeeding support program on breastfeeding practices including duration of any breastfeeding and exclusive breastfeeding and child neurodevelopment outcomes at 30 months old.
We followed up the offspring of 204 Vietnamese women who completed a randomized controlled trial where the intervention group received MMS with a breastfeeding support program from the last trimester to 12 weeks postpartum while the control group received standard care. At 30 months postpartum, information on child feeding practices was collected and child neurodevelopment was assessed by the Bayley Scales of Infant and Toddler Development (Bayley-III).
There was no significant difference in the duration of any breastfeeding (ABF) from birth between the groups. However, the intervention group had longer exclusive breastfeeding (EBF) duration (p = 0.0172), higher EBF rate at 6 months (p = 0.0093) and lower risk of discontinuing EBF (p = 0.0071) than the control. Children in the intervention group had significantly higher Bayley-III composite scores in the domains of cognitive (p = 0.0498) and motor (p = 0.0422) functions, as well as a tendency toward better social-emotional behavior (p = 0.0513) than children in the control group. The association between maternal intervention and child development was attenuated after further adjustment for birth weight but not EBF duration, suggesting that improvements in child development may be partially attributed to the benefits of prenatal nutrition supplementation on birth outcomes.
MMS with breastfeeding support during late pregnancy and early postpartum significantly improved EBF practices. The intervention was also associated with improvements in neurodevelopment in children at 30 months old.
Optimal maternal nutrition during pregnancy and breastfeeding is critical for the healthy growth and development of the fetus and infant, which lays the foundation for their long-term health in later life. However, poor nutritional status in both mother and her child remains prevalent in low- and middle-income countries [1,2]. Since pregnancy and lactation represent about half of the “first 1000 days” window, improving maternal nutrition to support healthy birth outcomes and successful breastfeeding in these settings has the potential to improve the life-long health of the offspring.
The present study compared the long-term effects of a maternal milk supplementation (MMS) in conjunction with a breastfeeding support program on breastfeeding practices and child neurodevelopment outcomes at 30 months old. Our results showed minimal differences in ABF between the intervention and control groups. However, the intervention had sustained effects on post-intervention breastfeeding practices including prolonged EBF duration, increased EBF rate at 6 months and reduced risk of early EBF cessation in Vietnamese mothers. In addition, the intervention was associated with improved cognitive, motor, and socio-emotional development in the offspring at 30 months old.
In summary, maternal milk supplementation from the last trimester to the first 12 weeks postpartum, coupled with a breastfeeding support program was significantly associated with prolonged EBF duration, increased EBF rate at 6 months, and reduced risk of early EBF cessation. The intervention also significantly improved child neurodevelopment in the domains of cognitive and motor functions at 30 months of age, when compared with the current standard care. The benefits of the maternal intervention on child neurodevelopment were partially mediated by higher birth weight but not EBF duration. This suggests that the prenatal nutritional supplementation may have played a more important role than the additional breastfeeding support given during the postnatal period in promoting neurodevelopment of the offspring. Future studies with a larger sample size are needed to examine the longer-term impacts of maternal nutritional supplementation on child growth and development.