E-mail: kag@diakonova.no Search for more papers by this author First published: 22 November 2016 Citations: 16 Abstract Aims and objectives To describe women's experience of not breastfeeding in a breastfeeding culture. Healthcare workers must ensure that mothers get balanced information about the benefits of breastfeeding and about the differences between breastmilk and infant formula.

Results Absence of breastfeeding when compared to breastfeeding for more than six months was significantly associated with an increase in the odds of having autistic disorder when all cases were considered (OR 2.48, 95% CI 1.42, 4.35) and after limiting cases to children with regression in development (OR 1.95, 95% CI 1.01, 3.78). Use of infant formula without docosahexaenoic acid and arachidonic acid supplementation versus exclusive breastfeeding was associated with a significant increase in the odds of autistic disorder when all cases were considered (OR 4.41, 95% CI 1.24, 15.7) and after limiting cases to children with regression in development (OR 12.96, 95% CI 1.27, 132). Conclusion The results of this preliminary study indicate that children who were not breastfed or were fed infant formula without docosahexaenoic acid/arachidonic acid supplementation were significantly more likely to have autistic disorder. This study found no significant difference in breastfeeding rates between 50 children with pervasive developmental disorder and 50 control children, although both groups reported significantly less breastfeeding than the national average [16 ]. Further, the normal siblings of the children with pervasive developmental disorder had breastfeeding rates almost identical to the national average [16 ]. This study may have been overmatched since cases and controls were matched on IQ which has been linked to breastfeeding and AD [13 , 14 , 5 ]. In 1994, the United Nations and the World Health Organization published a report recommending that infants should be fed breast milk if at all possible, but if fed formula, it should be supplemented with the polyunsaturated fatty acids, docosahexaenoic acid (DHA) and arachidonic acid (ARA) [17 ]. In January 2002, the first infant formulas supplemented with DHA and ARA were offered for sale in the US, although the older versions of formula without supplementation also continue to be sold [18 ]. DHA/ARA supplemented formula enhances weight gain in premature infants [19 ] and raises the plasma and red blood cell concentrations of DHA and ARA in full-term infants to levels comparable to breastfed infants [20 ]. DHA and ARA are considered conditionally essential substrates during early life and are related to the quality of growth and development [21 ]. A search of the literature revealed no published studies that have investigated infant formula use in relation to AD.

Mothers engaged in three strategies that helped maintain a positive maternal identity: framing the use of formula as not a choice, recognizing the effort placed into breastfeeding, and focusing on overall health and happiness. Results indicate that the focus on individual choice in breastfeeding promotion highlights resulting guilt or failure, to the exclusion of recognizing women’s agency in using resistance strategies and the broader social context of breastfeeding.

Objectives To determine the frequency of breast milk transmission of HIV-1 and to compare mortality rates and HIV-1–free survival in breastfed and formula-fed infants. Interventions Mother-infant pairs were randomized to breastfeeding (n = 212) vs formula feeding arms (n = 213). Main Outcome Measures Infant HIV-1 infection and death during the first 2 years of life, compared between the 2 intervention groups.

Results Two-year estimated mortality rates among infants were similar in the formula-feeding and breastfeeding arms (20.0% vs 24.4%; hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.5-1.3), even after adjusting for HIV-1 infection status (HR, 1.1; 95% CI, 0.7-1.7). Infection with HIV-1 was associated with a 9.0-fold increased mortality risk (95% CI, 5.3-15.3). The incidence of diarrhea during the 2 years of follow-up was similar in formula and breastfeeding arms (155 vs 149 per 100 person-years, respectively). The incidence of pneumonia was identical in the 2 groups (62 per 100 person-years), and there were no significant differences in incidence of other recorded illnesses. The infants in the 2 groups were comparable at birth with regards to anthropometric measurements, gestational age, sex, and morbidity1 (data not shown). Follow-up information on infant morbidity and mortality during the first 2 years of life was available for 186 infants in the formula feeding and 185 in the breastfeeding arm, while HIV-1 infection status information was available for 162 infants in the formula feeding and 171 in the breastfeeding arms.1 A total of 4733 infant follow-up visits were made in the first 2 years of life, including 2579 in the formula feeding and 2154 in the breastfeeding arms.

In the United States, only 75% of infants initiate breastfeeding from birth; however, by the age of three months, 67%, or 2.7 million, of them rely on infant formula for some portion of their nutrition [6 ]. Among new mothers, the six-month “any breastfeeding” rate for the total U.S. population is 43%, with only 13% meeting the recommendation to breastfeed exclusively for six months [4 ]. Infant formula is intended as an effective substitute for infant feeding [7 ,8 ]. Although production of an identical product to breast milk is not feasible, every effort has been taken to mimic the nutrition profile of human breast milk for normal infant growth and development. Human breast milk also contains two essential fatty acids, linoleic acid (C18:2w6) at 15% and alpha-linolenic acid (C18:3w3) at 0.35% [11 ]. These two essential fatty acids are, respectively, converted to arachidonic acid (AA, C20:4w6) and eicosapentaenoic acid (EPA, C20:5w3), the latter of which is further converted to docosahexaenoic acid (DHA, 22:6w3). AA, EPA and DHA are important for regulating growth, inflammatory responses, immune function, vision, cognitive development and motor systems in newborns.