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The Effect of Longer-Term and Exclusive Breastfeeding Promotion on Visual Outcome in Adolescence
Christopher G Owen1, Emily Oken2, Alicja R Rudnicka1
1Population Health Research Institute, St. George's, University of London, Cranmer Terrace, London, United Kingdom.
Insights
Promoting exclusive breastfeeding did not significantly impact long-term vision outcomes. However, maternal age and living environment were found to be significant factors influencing low vision risk in adolescents.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Breastfeeding is hypothesized to influence early visual development.
- Understanding the long-term impact of breastfeeding interventions on vision is crucial for public health initiatives.
Purpose of the Study:
- To evaluate if a breastfeeding promotion intervention improves visual outcomes at 16 years of age.
- To assess the association between breastfeeding duration/exclusivity and low vision.
Main Methods:
- Follow-up of a cluster-randomized trial involving 31 Belarusian maternity hospitals.
- Low vision defined as unaided logMAR vision of ≥0.3 (Snellen 20/40) in either eye.
- Modified intention-to-treat analysis, with additional observational analyses of breastfeeding and other determinants.
Main Results:
- Low vision prevalence was 19.6% in the intervention group vs. 21.6% in the control group.
- The breastfeeding promotion intervention showed no significant effect on low vision (OR 0.92, adjusted OR 0.88).
- Maternal age and urban residence were associated with increased low vision risk; lower parental education and more siblings were associated with reduced risk.
Conclusions:
- Exclusive breastfeeding promotion did not significantly affect visual outcomes at 16 years.
- Environmental factors like maternal age and residence are strongly associated with low vision.
- Further research into environmental determinants of visual health is warranted.
Purpose:
Breastfeeding may influence early visual development. We examined whether an intervention to promote increased duration and exclusivity of breastfeeding improves visual outcomes at 16 years of age.
Methods:
Follow-up of a cluster-randomized trial in 31 Belarusian maternity hospitals/polyclinics randomized to receive a breastfeeding promotion intervention, or usual care, where 46% vs. 3% were exclusively breastfed at 3 months respectively. Low vision in either eye was defined as unaided logMAR vision of ≥0.3 or worse (equivalent to Snellen 20/40) and was used as the primary outcome. Open-field autorefraction in a subset (n = 963) suggested that 84% of those with low vision were myopic. Primary analysis was based on modified intention-to-treat, accounting for clustering within hospitals/clinics. Observational analyses also examined the effect of breastfeeding duration and exclusivity, as well as other sociodemographic and environmental determinants of low vision.
Results:
A total of 13,392 of 17,046 (79%) participants were followed up at 16 years. Low vision prevalence was 19.6% (95% confidence interval [CI]: 17.5, 22.0%) in the experimental group versus 21.6% (19.5, 23.8%) in the control group. Cluster-adjusted odds ratio (OR) of low vision associated with the intervention was 0.92 (95% CI: 0.73, 1.16); 0.88 (95% CI: 0.74, 1.05) after adjustment for parental and early life factors. In observational analyses, breastfeeding duration and exclusivity had no significant effect on low vision. However, maternal age at birth (OR: 1.13, 95% CI: 1.07, 1.14/5-year increase) and urban versus rural residence were associated with increased risk of low vision. Lower parental education, number of older siblings was associated with a lower risk of low vision; boys had lower risk compared with girls (0.64, 95% CI: 0.59,0.70).
Conclusions:
Exclusive breastfeeding promotion had no significant effect on visual outcomes in this study, but other environmental factors showed strong associations. (ClinicalTrials.gov number, NCT01561612.).
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