Researchers at the Abbott Nutrition Research and Development Asia-Pacific Centre in Singapore, National Institute of Nutrition in Vietnam, and Cognizant Technologies Solution in India conducted an observational follow-up study to assess the long-term effects of maternal milk supplementation, in conjunction with a breastfeeding support programme, on breastfeeding practices.
The primary outcomes included duration of any breastfeeding and exclusive breastfeeding, as well as child neurodevelopment at 2.5 years old.
Breast practices
They followed up on the offspring of 204 Vietnamese mothers (aged 21 to 35), who had earlier completed an RCT in which the treatment group received maternal milk supplementation twice daily alongside a breastfeeding support programme between their last trimester to 12 weeks postpartum, while the control group received standard care.
After 2.5 years postpartum, they collected information on child-feeding practices, then evaluated child neurodevelopment using the Bayley Scales of Infant and Toddler Development (Bayley-III) and Ages and Stages Questionnaire, Third Edition (ASQ-3).
The researchers reported "no significant difference" in the duration of any breastfeeding from birth between the control and treatment groups, but found that the latter had longer periods of exclusive breastfeeding, and a higher rate of exclusive breastfeeding at six months.
They also displayed a lower risk of discontinuing exclusive breastfeeding than the women in the control group.
Additionally, compared to the children in the control group, those in the treatment group were shown to have markedly higher Bayley-III composite scores in the cognitive and motor function domains, as well as a tendency towards more sound social-emotional behaviour.
The researchers also noted that the link between maternal intervention and child development was somewhat diminished after adjusting for birth weight, but exclusive breastfeeding duration remained unaffected.
This implied that improvements in child development might be "partially attributed" to how prenatal nutritional supplementation benefits birth outcomes.
Discrepancies in developmental observations?
However, the study may have been limited by recall bias, as some of the data on breastfeeding practices and child-feeding behaviours 2.5 years postpartum was collected retrospectively.
Furthermore, there were discrepancies between ASQ-3 and Bayley-III in detecting developmental domains, an observation consistent with a previous study that had compared the two scales' validity and found poor agreement between them.
This might be because ASQ-3 is based on questionnaires meant to be completed by parents and caregivers, while Bayley-III assesses cognition, language, and motor function via direct observation, and assesses social-emotional behaviour through questionnaires meant for the primary caregivers.
At the same time, though both assessment tools had been translated into Vietnamese prior to the study and had even been used in previous studies, neither had been adapted or accepted for use in a Vietnamese setting.
The researchers concluded: "Maternal milk supplementation from the last trimester to the first 12 weeks postpartum, coupled with a breastfeeding support programme, was significantly associated with prolonged exclusive breastfeeding duration, increased exclusive breastfeeding rate rate at six months, and reduced risk of early exclusive breastfeeding cessation.
"The intervention also significantly improved child neuro-development 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 neuro-development were partially mediated by higher birth weight, but not exclusive breastfeeding 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 neuro-development 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."
Source: PLOS ONE
https://doi.org/10.1371/journal.pone.0200519
"Impact of maternal nutritional supplementation in conjunction with a breastfeeding support program during the last trimester to 12 weeks postpartum on breastfeeding practices and child development at 30 months old"
Authors: Zhiying Zhang, et al.