Abstract
Previous studies have shown that exclusive breastfeeding is associated with lower odds of having autism spectrum disorders (ASD) in children, but data are lacking in Asian countries, especially China. This cross-sectional study of seven cities in China collected data from August 2016 to March 2017 from 6049 toddlers aged 16–30 months and their parents who responded to questionnaires. The breastfeeding status was collected via questionnaires based on recommendations from the World Health Organization. The standard procedure for screening and diagnosis was applied to identify toddlers with ASD. Among the 6049 toddlers (3364 boys [55.6%]; mean [SD] age, 22.7 [4.1] months), 71 toddlers (1.2%) were identified as ASD. The prevalence of exclusive breastfeeding, partial breastfeeding, and not breastfeeding was 48.8%, 42.2%, and 9.1%, respectively. Compared to toddlers with exclusive breastfeeding, toddlers with partial breastfeeding or without breastfeeding had higher odds of having ASD (odd ratios [OR]: 1.55, 95% confidence interval [CI]: 0.90–2.74; OR: 2.34, 95% CI: 1.10–4.82). We did not find significant modification of demographic characteristics on the associations. The results remained robust in multiple sensitivity analyses. Toddlers without breastfeeding for the first six months of life had higher odds of having ASD, and our findings shed light on the necessity of strengthening public health efforts to increase exclusive breastfeeding in China.
Highlights
The 2019 Global Burden of Disease study indicated that an estimated 28.3 million people were identified as having autism spectrum disorders (ASD) [1], characterized by deficits in social communication, repetitive behaviors, and highly restricted interests [2]
In China, we only found one study conducted in Shenzhen, China, which investigated the associations of breastfeeding with the risk of having autistic traits, measured via the Autism Behavior Checklist (ABC) [29]
We further confirmed this associations based on standard screening and diagnostic processes. This is the first observational study with a large sample size to clarify the association between breastfeeding and the odds of ASD according to the Diagnostic and Statistical Manual 5th Edition (DSM-5) criteria, and the results suggest that the associations between breastfeeding and ASD could still be observed when using the new diagnostic system
Summary
The 2019 Global Burden of Disease study indicated that an estimated 28.3 million people were identified as having autism spectrum disorders (ASD) [1], characterized by deficits in social communication, repetitive behaviors, and highly restricted interests [2]. One cross-sectional study from Korea showed that breastfeeding was associated with higher odds of ASD compared to formula-feeding [31]. Two case-control studies (the US [25] and India [27]) and a birth cohort from Denmark [26] have indicated that a shorter breastfeeding duration is associated with higher risk of ASD in children. One case-control study in the US observed null association between breastfeeding initiation and the risk of ASD using a standard diagnostic procedure with standard assessment [28]. We only found one cross-sectional study in Shenzhen, China indicating that breastfeeding was associated with autistic traits in toddlers [29]. No study has been conducted to investigate the association between breastfeeding and ASD with detailed information of the diagnostic processes in China. More studies are needed by considering the current diagnostic criteria
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
