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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 12-16

Longer breastfeeding duration among gifted students in Saudi Arabia


1 Department of Family Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
2 Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

Date of Submission25-Jul-2017
Date of Acceptance09-Dec-2017
Date of Web Publication27-Apr-2018

Correspondence Address:
Dr. Fouzia A Al Hreashy
Department of Family Medicine, College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijas.ijas_10_17

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  Abstract 


Background: Investigating the factors related to the development of intelligence may improve our understanding of human development. The long-term benefit of breastfeeding on children's intelligence has attracted a great deal of research attention; therefore, the aim of this study was to describe the pattern of breastfeeding among gifted students at the Mawhiba Foundation in Saudi Arabia.
Methods: A descriptive cross-sectional survey was conducted using the Mawhiba Foundation database of gifted students in Saudi Arabia. An electronic close-ended questionnaire was circulated to mothers of talented students in Grades 4 and 7 from different regions of Saudi Arabia. Sociodemographic data and the breastfeeding history of each talented student were collected. The main outcome measures were the categories of breastfeeding (breastfeeding, partial/mixed breastfeeding, and never breastfed) and duration of breastfeeding (6 months, 12 months, 18 months, and 2 years) and their association with demographic variables.
Results: Of the 233 gifted students enrolled in the study, 214 (91%) were from populous areas in the Eastern, Makkah, and Riyadh regions of Saudi Arabia. The parents of most of these students were educated to the university level or higher (mothers, 192 [82.2%] and fathers, 158 [79.8%]), and almost half of the mothers were employed. The partial/mixed breastfeeding category was the most common observed in this population (171 [73%]). Almost half of the population (91 [41%]) had been breastfed for >1 year. The duration of breastfeeding and the mother's employment status had statistically significant relationships with the breastfeeding categories (P = 0.001 and 0.004, respectively).
Conclusions: Partial/mixed breastfeeding is the most common category of breastfeeding, with a tendency toward prolonged breastfeeding among gifted students.

Keywords: Breastfeeding, intelligence, talented


How to cite this article:
Al Hreashy FA, Bin Ahmed IA, Alhurishi SA. Longer breastfeeding duration among gifted students in Saudi Arabia. Imam J Appl Sci 2017;2:12-6

How to cite this URL:
Al Hreashy FA, Bin Ahmed IA, Alhurishi SA. Longer breastfeeding duration among gifted students in Saudi Arabia. Imam J Appl Sci [serial online] 2017 [cited 2018 May 25];2:12-6. Available from: http://www.e-ijas.org/text.asp?2017/2/1/12/231379




  Introduction Top


Intelligence begins to develop in early infancy; although modifiable, intelligence is largely inherited.[1] Brain development starts in the early stages of gestation, significantly increases in the 1st year of life, and progresses to maturation in adulthood.[1] The primary influences on talent development are cognitive abilities, personal–psychological attributes, and environmental–social factors, including nutrition.[2] Investigations of the potential factors that influence the development of talent may clarify the processes that control the development of human intelligence. For overall health, breastfeeding for the first 2 years of life is ideal, with the introduction of complementary feeding after approximately 6 months of age.[3] As the proven nutritional and other values of breastfeeding may also play a role in brain development and intelligence, this is a natural focus of research.[4]

Research on the association between breastfeeding and cognitive development in children is ongoing.[5] Moreover, the associations of these factors with intelligence, academic achievement, and development have received increasing scientific attention. A positive association of intelligence with the duration of breastfeeding and exclusive breastfeeding (as opposed to partial breastfeeding) has been documented, with a stronger positive association among breastfed preterm infants.[6],[7],[8],[9],[10],[11],[12]

Al Juaid et al. conducted a review of the 17 studies on breastfeeding conducted in Saudi Arabia,[13] which revealed that a potential association between intelligence and breastfeeding practice has not yet been investigated. All the studies included in the review were cross sectional, with no studies using a longitudinal or cohort design. Thus, differences in the patterns of breastfeeding experienced by students of higher intelligence and those of other children remain to be established. The aim of this cross-sectional survey was to bridge this gap in the literature by describing the patterns of breastfeeding among gifted students in Saudi Arabia.


  Methods Top


We conducted a retrospective survey of students with high intelligence levels in 2016. A high intelligence level was defined based on test scores from the King Abdulaziz and His Companions Foundation for Giftedness and Creativity, known as the Mawhiba Foundation.[4] Mawhiba is a national cultural foundation that aims to “build, develop, and support an environment of creativity and giftedness in order to achieve prosperity and sustainable development in the Kingdom of Saudi Arabia.”[14] To be classed as “gifted,” a student must pass a test designed by the National Centre of Assessment and the Ministry of Education. Those with high scores (the higher 3% of expected gifted students by schools or parents) are invited to join Mawhiba.

After obtaining ethical approval from the research center of the College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, the Mawhiba Foundation was contacted to locate potential participants in grades 4 and 7 (age range: 10–13 years old). To increase generalizability, purposive sampling was employed with the intention of collecting data from all gifted students who were registered and agreed to participate. Specific school grades were selected to facilitate a comparison of breastfeeding patterns with the results of a national survey conducted by El Mouzan et al.[15] on children born in 2005.

Breastfeeding-related data were collected from an electronic, close-ended questionnaire written in Arabic. The electronic link to the questionnaire was sent by Short Message Service text to a cell phone belonging to the mothers of students who had agreed to participate in the study in April and May 2016.

The patterns of infant feeding were categorized as follows: breastfeeding (infant fed breast milk only), partial or mixed breastfeeding (infant fed both breast milk and formula), and no breastfeeding (infant fed formula only).

The duration of breastfeeding was divided into 6-month intervals over a 2-year period. Frequencies and percentages were calculated, followed by a univariate analysis – cross-tabulation between the categories and other variables using the Chi-square test. Data were analyzed using IBM SPSS Statistics Version 21 (Released 2012; IBM Corp, Armonk, New York). P< 0.05 was considered to indicate statistical significance.


  Results Top


The sociodemographic data of the 233 participants enrolled in this study are shown in [Table 1]. Most participants were from the Eastern, Makkah, and Riyadh regions, which have the highest populations in Saudi Arabia. Among the gifted students, there were slightly more girls than boys, with more students in Grade 7 than in Grade 4. Almost the entire study sample was healthy, without chronic illnesses. The mean number of children per family was 3.97, and the mean order in the family of the gifted child was 2.58. For most of the samples, parents were educated to university level or higher (mothers, 192 [82.2%] and fathers, 158 [79.8%]), and almost half of the mothers were employed.
Table 1: Sociodemographic characteristics (n=233)

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Partial (or mixed) feeding was the most commonly observed category [n = 171, 73.4%; [Table 2]. [Figure 1] shows the periods of breastfeeding experience by students who were breastfed exclusively or partially (n = 220); 91 (41%) were breastfed for longer than 1 year, although over 50% (n = 91) were breastfed until 18 months to 2 years of age. In addition, breastfeeding was not terminated before 6 months of age in any of the students in the breastfed group. In the univariate analysis, the mother's employment status was the only variable that was significantly associated with the breastfeeding category [Table 2].
Table 2: Breastfeeding categories of students in relation to the duration of breastfeeding and sociodemographic variables (n=233)

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Figure 1: Breastfeeding duration in the study population (n = 220)

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  Discussion Top


This study is unique in its focus on breastfeeding patterns and bridges the gap in our knowledge of the epidemiology of breastfeeding among gifted children in the Saudi population. A previous research has shown the dynamic pattern of breastfeeding in Saudi Arabia, with a downward trend recorded between 1987 and 2011.[13]

The breastfeeding pattern in the study sample was comparable to that among infants born between 2003 and 2005, when partial breastfeeding was the most common category of infant feeding. The difference between the percentage of exclusive breastfeeding (with no formula) (21.2%) as opposed to never breastfed (5.9%) among Mawhiba students is greater than that of the recent survey reported by Alyousefi et al. (13.7% and 18.3%, respectively).[16] In addition, 33.6% of the gifted children in this study were breastfed up to 6 months of age, which is higher than the various percentages (10%,[15] 12.2%,[17] 14%,[18] and 26.9%[19]) reported among the general population.

Most of the study samples (219 [91%]) lived in regions of high population density.[20] The lower number of students in Grade 4 was not consistent with the estimated increase in the population, although students only become eligible to join Mawhiba when they reach this grade; therefore, the number of Grade 4 students included in the program may be lower than the number of students in later grades, which potentially explains this discrepancy.

In Islam, 2 years is considered to be the ideal period of breastfeeding: “Mothers may breastfeed their children two complete years whoever wishes to complete the nursing (period)” (Al-Qu'ran al-Kareem: Surat AL-Baqarah-233). However, at present, scientific evidence of an ideal duration of breastfeeding or a research-based classification of the total period is lacking. In this study, the total duration of prolonged breastfeeding was clearly observed among Mawhiba students [Figure 1]. A national survey of infant nutrition practices that included 5339 children in Saudi Arabia conducted by El Mouzan et al.[15] revealed a dramatic reduction in the breastfeeding rate, with the age of the child reaching 1.8% for children aged 1 year. In comparison, in the group of gifted children in this study, 40% continued to be breastfed past their first birthday. Furthermore, a higher percentage of maintained breastfeeding before weaning (18–24 months) was observed in the study sample (22.7%), which is even greater than what was reported in a recent study in Jazan (13%).[19] It can be speculated that the prolonged period of breastfeeding among the participants in this study is related to the high levels of commitment among the parents; however, this issue remains to be investigated.

Highly educated parents tend to be highly motivated in enrolling their children in the Mawhiba program, which has a marked influence on their later achievements. Awareness of the Mawhiba program among parents who are less educated and their level of interest in engaging their children in such activities is another area of potential research. Compared to the results of the 2016 national census,[21] a higher percentage of working mothers of the students was reported in the present survey. While an investigation of mothers' working status concurrent with breastfeeding duration was not carried out for the children under study, employment among Saudi women correlates with a lower rate of breastfeeding.[22] The different results in this survey, i.e., the longer duration of breastfeeding, the mothers' high education levels and the mothers' employment status, are areas of great interest in the health education program.

Breastfeeding benefits are dose related, and a longer duration of breastfeeding has been linked to many benefits, including intelligence levels.[10] Thus, every effort should be made not only to increase the proportion of mothers who provide exclusive breastfeeding, but also to prolong the duration of breastfeeding for an even greater period than that observed in this survey.


  Conclusions Top


The longer duration of breastfeeding observed among the gifted students in this study has important public health implications. Further investigations are required to determine the reasons for such findings in comparison with those observed in the general population. A prospective cohort study method with availability of control group would be useful for extrapolation of the association between giftedness and breastfeeding. Furthermore, additional studies are required to fully elucidate the effects of prolonged breastfeeding on cognitive function and provide more evidence in support of the benefits of extended breastfeeding.

Acknowledgments

The authors wish to express their great appreciation to the King Abdulaziz and His Companions Foundation for Giftedness and Creativity for permission to use the foundation's database of students and their parents and for supporting the methodology of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Ropper AH, Samuels M. Adams and Victor's Principles of Neurology. 10th ed. New York: McGraw-Hill; 2014. Available from: https://www.amazon.com/Adams-Victors-Principles-Neurology-10th/dp/0071794794.  Back to cited text no. 1
    
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American Academy of Pediatrics and American College of Obstetricians and Gynaecologists. Breastfeeding Handbook for Physicians. 2nd ed. United States of America: American Academy of Pediatrics; 2014. Available from: https://www.amazon.com/Breastfeeding-Handbook-Physicians-American-Pediatrics/dp/1581100906.  Back to cited text no. 3
    
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Tozzi AE, Bisiacchi P, Tarantino V, Chiarotti F, D'Elia L, De Mei B, et al. Effect of duration of breastfeeding on neuropsychological development at 10 to 12 years of age in a cohort of healthy children. Dev Med Child Neurol 2012;54:843-8.  Back to cited text no. 8
    
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Victora CG, Horta BL, Loret de Mola C, Quevedo L, Pinheiro RT, Gigante DP, et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: A prospective birth cohort study from Brazil. Lancet Glob Health 2015;3:e199-205.  Back to cited text no. 10
    
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Al Juaid DA, Binns CW, Giglia RC. Breastfeeding in Saudi Arabia: A review. Int Breastfeed J 2014;9:1.  Back to cited text no. 13
    
14.
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El Mouzan MI, Al Omar AA, Al Salloum AA, Al Herbish AS, Qurachi MM. Trends in infant nutrition in Saudi Arabia: Compliance with WHO recommendations. Ann Saudi Med 2009;29:20-3.  Back to cited text no. 15
    
16.
Alyousefi NA, Alharbi AA, Almugheerah BA, Alajmi NA, Alaiyashi SM, Alharbi SS, et al. Factors influencing Saudi mothers' success in exclusive breastfeeding for the first six months of infant life: A cross-sectional observational study. Int J Med Res Health Sci 2017;6:68-78. Available from: http://www.ijmrhs.com/medical-research/factors-influencing-saudi-mothers-success-in-exclusive-breastfeeding-for-the-first-six-months-of-infant-life-a-crosssect.pdf.  Back to cited text no. 16
    
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20.
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21.
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22.
Jabari M, Al-Hussein K, Al-Sayed M, Al-Faris A, Al-Shaya A, Al-Shehri H. Breastfeeding practices among employed Saudi mothers. Med J Cairo Univ 2015;83:1159-63. Available from: http://medicaljournalofcairouniversity.net/home2/images/pdf/2015/December/108.pdf.  Back to cited text no. 22
    


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