Breastfeeding, Oxytocin and the Maternal Brain: Prevention of Child Neglect

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Breastfeeding, Oxytocin and the Maternal
BrainPrevention of Child Neglect Dr Lane
Strathearn Assistant Professor of
Paediatrics Baylor College of Medicine, Texas, USA
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Breastfeeding, Oxytocin and the Maternal Brain

• Prevention of Child Neglect

Dr Lane Strathearn, MBBS FRACP The Meyer Center
for Developmental Pediatrics Baylor College of
Medicine/Texas Childrens Hospital
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Benefits of Breastfeeding

• In human and animal studies, breastfeeding is
  associated with
• Blunted maternal stress reactivity (e.g. blood
  pressure and cortisol levels)
• Reduced maternal anxiety and perceived stress
• More attuned maternal caregiving improved
  mother-infant bonding?
• Could breastfeeding help to protect against
  maternally perpetrated child abuse and neglect?

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Child Abuse and Neglect

• Every 10 days in England and Wales one child is
  killed at the hands of their parent
• 25 of children experience physical violence
  during childhood
• 6 of children experience frequent and severe
  emotional maltreatment
• 6 experience serious absence of care at home
• Biological mothers are the most frequent
  perpetrators of maltreatment

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The Cost of Maltreatment

• In 1996, the cost of child abuse was estimated to
  be 1 billion per year in the UK.
• Most of this is associated with consequences of
  abuse, rather than prevention
• Individuals and families bear most of the
  consequences, sometimes for the rest of their
  lives, at an incalculable cost

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Consequences of Child Neglect

• Impaired cognitive development
• Language delays
• Increased risk of childhood aggression
• Internalizing and externalizing behavior problems

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Best Beginnings Video
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METHODS
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Study Design and Population

• Mater-University of Queensland Study of Pregnancy
  (MUSP)
• Prenatal cohort of public hospital patients
  enrolled at the Mater Mothers Hospital,
  Brisbane, Australia between 1981 and 1984
• 7292 term infants (95 of cohort)

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Sample Size

• 8556 consecutive mothers attended first antenatal
  clinic visit
• 8458 mothers (98.9) enrolled in the study,
  completing 1st antenatal clinic questionnaire
• 7636 mothers (89.2) delivered at the Mater
  Mothers Hospital

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Mater-University of Queensland Study of Pregnancy
(MUSP)?
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Breastfeeding Data

• Breastfeeding data collected from mother at 6
  month assessment
• Duration of breastfeeding assessed

• Not at all
• 2 weeks or less
• 3-6 weeks

• 7 weeks to 3 months
• 4-6 months
• gt 6 months

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Controlled Variables - Prenatal

• Maternal education
• Employment
• Income
• Child factors
• Birth weight
• Sex
• Prematurity
• Neonatal complications

• Parental factors
• Maternal age
• Marital status single, married, unmarried
  cohabitation
• Race
• Cigarette / alcohol consumption
• Maternal anxiety
• Maternal depression
• Partner conflict
• Pregnancy ambivalence

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Outcome Measures

• Database linked to child maltreatment reports,
  from Child Protective Services
• Included reports from 1981 to Sept 2000
• Confidential ID number preserved anonymity of
  families reported
• CPS report of any type of child maltreatment
  (neglect or physical, emotional, sexual abuse)
• Substantiation of report
• Intervention received (child protection
  follow-up, court orders)

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RESULTS
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Incidence of Maltreatment

• 11 of birth cohort reported for suspected child
  abuse or neglect
• 7 of birth cohort had at least one substantiated
  episode of maltreatment
• Over 60 of children with substantiated
  maltreatment had at least one episode of
  maternally-perpetrated abuse or neglect

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Breastfeeding Duration
1481
2655
2638
n6774
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Duration of Breastfeeding and Severity of Neglect
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Duration of Breastfeeding and Severity of Neglect
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Duration of Breastfeeding and Severity of Neglect
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Duration of Breastfeeding and Severity of Neglect
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Duration of Breastfeeding and Severity of Neglect
1329 52 59 41
(p lt .001)?
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Duration of Breastfeeding and Severity of Neglect
2452 88 60 38
(p .21)?
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Duration of Breastfeeding and Severity of Neglect
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Duration of Breastfeeding and Severity of Neglect
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Duration of Breastfeeding and Severity of Neglect
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Duration of Breastfeeding and Severity of Neglect
1329 52 59 41
2452 88 60 38
2564 55 29 7
p lt .001
(p lt .001)?
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Breastfeeding and Any Substantiated Maltreatment
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Breastfeeding and Any Substantiated Maltreatment
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Breastfeeding and Substantiated Neglect
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Breastfeeding and Substantiated Neglect
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Breastfeeding and Substantiated Emotional and
Physical Abuse
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Adjusting for Maltreatment Subtypes
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Maternal Risk Factors for Substantiated Neglect
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Maternal Risk Factors for Substantiated Neglect
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• So, what mechanisms may help to explain these
  findings?

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Oxytocin and maternal caregiving

• Oxytocin is a peripheral hormone important in
  childbirth and lactation
• Breastfeeding/suckling stimulates its production
• It also has important central effects in the
  brain to help prepare for long-term child rearing
• Calm and connection effect

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Oxytocin and maternal caregiving

• In animal models of maternal care, oxytocin is
  critical for the initiation of maternal care
• In ewes, oxytocin results in selective bonding
  with the lamb
• Oxytocin neurons may also connect with the
  brains dopamine reward system, resulting in
  changes in long-term conditioned preferences

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Possible Mechanisms Underlying Breastfeeding /
Neglect Connection

• Areas of known significance
• Oxytocin affiliation pathways
• Pituitary gland
• Hypothalamus (MPOA, PVN)?
• Dopamine reward pathways
• Ventral striatum
• Medial prefrontal cortex
• The development of these systems appears to be
  strongly influenced by early maternal care

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Study Outline
Visit 3 Scanning
Visit 4 Follow-Up
Visit 1 Pregnancy
Visit 2 Videotaping
3rd trimester
7 mths
10 mths
14 mths
Study Timeline
BIRTH
5 min
20 min
6 min
20 min
Mother-infant separation 2
Mother-infant separation 1
Free play interaction
Mirror-based interaction

• Bayley Scales of Infant Development
• Strange Situation Procedure

• Blood draws
• Oxytocin
• Cortisol
• Adrenaline
• Noradrenaline

• PANAS (2)?
• IBQ
• PSI

• WTAR
• Breastfeeding duration
• Hours separated per week

• PANAS (1)?
• Demographics
• ATQ
• Infant face images

• AAI
• Demographics
• PDQ
• BDI

Data Collected
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Three Affective States
Crying
Neutral
Smiling
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2 sec
2 sec
26 sec random inter-stimulus interval
2 sec
2 sec
Own Happy (OH)?
2 sec
Unknown Happy (UH)?
2 sec
Unknown Sad (US)?
Own Neutral (ON)?
STIMULUS TYPES
Unknown Neutral (UN)?
Own Sad (OS)?
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Functional Magnetic Resonance Imaging (fMRI)?

• fMRI allows for the time course of human brain
  activity to be imaged.

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The Hemodynamic Response
Hemodynamics
Neural pathway
MR scanner
Figure adapted from Chein Schneider
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Change in peripheral oxytocin with mother-infant
interaction

Plt0.05 Mann-Whitney U
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Own Happy Faces Secure vs. Insecure Attachment
Bilateral Ventral Striatum
(se1.0, t3.0, p0.006)?
VS
y11
(se0.4, t3.1, p0.005)?
mPFC
R Medial PFC
x-6
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Own Sad Faces Secure vs. Insecure Attachment
R Ventral Striatum
(se0.4, t3.1, p0.005)?
VS
VS
y11
y11
(se1.0, t3.0, p0.006)?
Insula
R Insula
x-6
y17
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Own gt Unknown Faces Oxytocin Response
Hypothalamus/ Pituitary Region
gt
Hypothalamus/ Pituitary Region
Hypothalamus/ Pituitary Region
rs0.60, P0.001
(-3,2,-16)
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Oxytocin Response and Ventral Striatum Activation
Ventral Striatum activation
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In Summary

• Breastfeeding beyond 4 months may have a
  protective role in preventing child neglect
• Oxytocin may play a critical role in
  strengthening the mother-infant bond and
  activating brain reward mechanisms
• Early intervention, such as home-visiting, may
  reduce the risk of maltreatment both by
  supporting mother-infant bonding and by promoting
  breastfeeding.

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Acknowledgements

• Dr Michael OCallaghan, Prof Jake Najman and the
  Mater-University Study of Pregnancy
• Families, Youth and Community Care Queensland,
  Australia
• Child Protection Information Systems, Brisbane,
  Australia
• Read Montague, Samuel McClure at the Human
  Neuroimaging Laboratory, Baylor College of
  Medicine
• and last, but not least

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