RESUMEN
BACKGROUND: The cognitive benefits of breastfeeding are widely recognized; however, its effects on brain development and later academic skills require further examination. This study aimed to examine the longitudinal relations between breastmilk feeding, neurophysiological changes, and early academic skills. METHODS: In the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort, breastmilk feeding practices were collected every 3 months from 3 weeks to 18 months postpartum. Resting electroencephalography (EEG) was recorded at 18 months and power spectral density was derived. The outcomes were a set of early academic assessments administered at age 4 (n = 810). Structural equation modelling was used to investigate EEG power as a mediator between breastmilk duration and early academic skills. RESULTS: Breastmilk feeding for ≥12 months was associated with better general knowledge, numeracy, and language at age 4 compared to shorter durations of breastmilk feeding (Cohen's d: 1.53-17.44). Linear regression showed that breastmilk duration was negatively and positively associated with low- (i.e., delta, theta) and high-frequency power (i.e., gamma), respectively (Cohen's f2: 0.03-0.09). After adjusting for demographic and child baseline covariates, a decrease in absolute and relative delta, as well as relative theta was associated with better general knowledge and numeracy (Cohen's f2: 0.16-0.25). Relative delta power provided an indirect path between breastmilk duration and early academic skills (x2: 18.390, p = 0.010; CFI: 0.978; TLI: 0.954; RMSEA: 0.040). CONCLUSIONS: Extended breastmilk feeding is associated with reduced low-frequency power and better early academic skills, suggesting benefits to brain development. Additional research to confirm this finding is warranted.
RESUMEN
OBJECTIVE: Offspring of mothers with depression are at increased risk for executive function (EF) deficits and later depressive symptoms, but limited studies have examined EF as an intermediary pathway. This study examined the role of EF in mediating the association between maternal and child depressive symptoms. METHOD: Data were from a longitudinal birth cohort comprising 739 participants followed from the antenatal period for 12 years. Mothers completed the Edinburgh Perinatal Depression Scale at 26 to 28 weeks' gestation and at 3 and 24 months postpartum. At ages 8.5 to 10 years, children self-reported using the Children's Depression Inventory, Second Edition. Task-based and parent-reported EF measures were collected at 4 time points between 3.5 and 8.5 years. Latent growth curve models examined antenatal depressive symptoms and their trajectory in contributing to cold (ie, cognitive) and hot (ie, affective) EFs. The extent to which EF mediated this association was then assessed. RESULTS: Maternal depressive symptoms did not directly predict depressive symptoms in late childhood. Antenatal depressive symptoms predicted lower cold EF (ß = -.13, 95% CI [-0.25, -0.004]) and hot EF (ß = -.26, 95% CI [-0.38, -0.15]). Deficits in cold EF (ß = -.26, 95% CI [-0.41, -0.11]) acted as an intermediary path to depressive symptoms, whereas hot EF mediated the association between maternal and child depressive symptoms, forming an indirect path that accounted for 37.5% of the association. CONCLUSION: Deficits in hot EF may be a pathway in explaining the intergenerational transmission of depression. This finding suggests fostering EF skills as a potential strategy for at-risk children. CLINICAL TRIAL REGISTRATION INFORMATION: Growing Up in Singapore Towards Healthy Outcomes (GUSTO); https://clinicaltrials.gov/study/NCT01174875; NCT01174875. DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability.
RESUMEN
Importance: Research evidence is mounting for the association between infant screen use and negative cognitive outcomes related to attention and executive functions. The nature, timing, and persistence of screen time exposure on neural functions are currently unknown. Electroencephalography (EEG) permits elucidation of the neural correlates associated with cognitive impairments. Objective: To examine the associations between infant screen time, EEG markers, and school-age cognitive outcomes using mediation analysis with structural equation modeling. Design, Setting, and Participants: This prospective maternal-child dyad cohort study included participants from the population-based study Growing Up in Singapore Toward Healthy Outcomes (GUSTO). Pregnant mothers were enrolled in their first trimester from June 2009 through December 2010. A subset of children who completed neurodevelopmental visits at ages 12 months and 9 years had EEG performed at age 18 months. Data were reported from 3 time points at ages 12 months, 18 months, and 9 years. Mediation analyses were used to investigate how neural correlates were involved in the paths from infant screen time to the latent construct of attention and executive functioning. Data for this study were collected from November 2010 to March 2020 and were analyzed between October 2021 and May 2022. Exposures: Parent-reported screen time at age 12 months. Main Outcomes and Measures: Power spectral density from EEG was collected at age 18 months. Child attention and executive functions were measured with teacher-reported questionnaires and objective laboratory-based tasks at age 9 years. Results: In this sample of 437 children, the mean (SD) age at follow-up was 8.84 (0.07) years, and 227 children (51.9%) were male. The mean (SD) amount of daily screen time at age 12 months was 2.01 (1.86) hours. Screen time at age 12 months contributed to multiple 9-year attention and executive functioning measures (η2, 0.03-0.16; Cohen d, 0.35-0.87). A subset of 157 children had EEG performed at age 18 months; EEG relative theta power and theta/beta ratio at the frontocentral and parietal regions showed a graded correlation with 12-month screen use (r = 0.35-0.37). In the structural equation model accounting for household income, frontocentral and parietal theta/beta ratios partially mediated the association between infant screen time and executive functioning at school age (exposure-mediator ß, 0.41; 95% CI, 0.22 to 0.59; mediator-outcome ß, -0.38; 95% CI, -0.64 to -0.11), forming an indirect path that accounted for 39.4% of the association. Conclusions and Relevance: In this study, infant screen use was associated with altered cortical EEG activity before age 2 years; the identified EEG markers mediated the association between infant screen time and executive functions. Further efforts are urgently needed to distinguish the direct association of infant screen use compared with family factors that predispose early screen use on executive function impairments.