by: David E. Bratt MD
I had intended writing something on gas—the intestinal kind, the one that we are full of these days, not the one that comes out of the ground, so responsible for many of the misfortunes we daily face—when two remarkable articles on breastfeeding, one in the morning on baby’s brains and the other late in the evening on women’s health, came rolling over my desk and, despite the anguished cries of my three or four friends desperate for something to laugh at in the Trinidad of today, they are too important to ignore. We’ll laugh another day, fellows.
The first benefits babies and is about babies’ brains and MRI machines. Some guys at the Advanced Baby Imaging Lab at Brown University in Providence, Rhode Island looked at the brain growth of 133 babies ranging in age from ten months to four years using specialised, “baby-friendly” magnetic resonance imaging (MRI) or “quiet” MRI machines—and if you have ever been inside a MRI machine, or tried very hard not to wake up a sleeping baby, you will understand the relevance of that term “quiet MRI”! The babies were split into three groups: those exclusively breastfed for at least the first three months of life, a group fed a combination of breastmilk and formula, and those fed formula alone. Brain MRIs were consecutively done on all babies over the years that the study lasted.
By age two, the babies breastfed exclusively for at least three months had enhanced development in key parts of the brain, in the order of 20 to 30 per cent, compared to the other two groups.
The MRIs specifically looked at the brain’s white matter, the tissue that contains long nerve fibres and helps different parts of the brain communicate with each other and is responsible for the billions of connections among brain cells. The MRIs look for amounts of myelin, a fatty material that insulates nerve fibres and speeds electrical signals as they zip around the brain and produce faster processing time. The extra growth in myelin was most pronounced in the parts of the brain associated with language, emotional function and cognition.
As expected, the combined feeding group came second and the formula-fed babies last. There were three other points that came out of the study. The differences were apparent almost from the very first MRIs. So my mother-in-law’s encouraging words for our first baby, to “give her a little bit, nuh, just a little bit,” was true. Even a little breastfeeding seems worthwhile. The differences were directly related to the length of breastfeeding. Unfortunately the authors were not able to look at babies who breastfed for more than one year so we have no idea if the differences become greater the longer the baby breastfeeds. The team then backed up their imaging studies with a set of cognitive tests on the older children and found increased language performance, visual reception and motor control performance in the breastfed babies.
There have been many reports of enhanced brain function in breastfed children but this is the first to actually document physical changes in the brains of breastfed babies. Further studies on other organs are planned. The second study, enthusiastically entitled Cost Analysis of Maternal Disease Associated With Suboptimal Breastfeeding, came out last week too, in the Journal of the American College of Obstetricians and Gynecologists, Obstetrics and Gynecology and I urge the doctors in the Government to read it. Only medical researchers, by the way, could come up with a title like that. It should have been called Women Who Don’t Breastfeed Get Sicker. They wanted “to estimate the US maternal health burden from current breastfeeding rates both in terms of premature death as well as economic costs.” So they took all the information that is known about the health benefits that accrue to women who breastfeed—less breast cancer, less ovarian cancer, less hypertension, less type 2 diabetes mellitus and myocardial infarction.
Through computer analysis, they modelled the health outcomes and costs expected for a US cohort of 15-year-old females followed to age 70 and compared the outcomes expected if 90 per cent of mothers were able to breastfeed for at least a year after each birth with outcomes under the current one-year breastfeeding rate of 23 per cent. The results were eye-opening. Current breastfeeding rates result in 4,981 excess cases of breast cancer, 53,847 cases of hypertension, and 13,946 cases of myocardial infarction compared with a cohort of 1.88 million US women who optimally breastfed. They also looked at direct costs, indirect costs, and cost of premature death (before age 70) expressed in 2011 dollars. Suboptimal breastfeeding incurs a total of US$17.4 billion in cost to society resulting from premature death, US$733.7 million in direct costs, and US$126.1 million in indirect morbidity costs. However, they found only a minor difference in number of deaths before age 70 under current breastfeeding rates. If applied to the smaller population of T&T, the results would be much less dramatic. Unless, of course, you are the one with the cancer, high blood pressure, diabetes or heart attack.