Importance Evidence that longer-term and exclusive breastfeeding reduces child obesity risk is based on observational studies that are prone to confounding.Objective To investigate effects of an intervention to promote increased duration and exclusivity of breastfeeding on child adiposity and circulating insulin-like growth factor (IGF)-I, which regulates growth.Design, Setting, and Participants Cluster-randomized controlled trial in 31 Belarusian maternity hospitals and their affiliated clinics, randomized into 1 of 2 groups: breastfeeding promotion intervention (n=16) or usual practices (n=15). Participants were 17 046 breastfeeding mother-infant pairs enrolled in 1996 and 1997, of whom 13 879 (81.4%) were followed up between January 2008 and December 2010 at a median age of 11.5 years.Intervention Breastfeeding promotion intervention modeled on the WHO/ UNICEF Baby-Friendly Hospital Initiative (World Health Organization/United Nations Children's Fund).Main Outcome Measures Body mass index (BMI), fat and fat-free mass indices (FMI and FFMI), percent body fat, waist circumference, triceps and subscapular skinfold thicknesses, overweight and obesity, and whole-blood IGF-I. Primary analysis was based on modified intention-to-treat (without imputation), accounting for clustering within hospitals and clinics. ResultsThe experimental intervention substantially increased breastfeeding duration and exclusivity when compared with the control (43% vs 6% exclusively breastfed at 3 months and 7.9% vs 0.6% at 6 months). Cluster-adjusted mean differences in outcomes at 11.5 years of age between experimental vs control groups were: 0.19 (95% CI, Ϫ0.09 to 0.46) for BMI; 0.12 (Ϫ0.03 to 0.28) for FMI; 0.04 (Ϫ0.11 to 0.18) for FFMI; 0.47% (Ϫ0.11% to 1.05%) for percent body fat; 0.30 cm (Ϫ1.41 to 2.01) for waist circumference; Ϫ0.07 mm (Ϫ1.71 to 1.57) for triceps and Ϫ0.02 mm (Ϫ0.79 to 0.75) for subscapular skinfold thicknesses; and Ϫ0.02 standard deviations (Ϫ0.12 to 0.08) for IGF-I. The cluster-adjusted odds ratio for overweight/obesity (BMI Ն85th vs Ͻ85th percentile) was 1.18 (95% CI, 1.01 to 1.39) and for obesity (BMI Ն95th vs Ͻ85th percentile) was 1.17 (95% CI, 0.97 to 1.41). Conclusions and RelevanceAmong healthy term infants in Belarus, an intervention that succeeded in improving the duration and exclusivity of breastfeeding did not prevent overweight or obesity, nor did it affect IGF-I levels at age 11.5 years. Breastfeeding has many advantages but population strategies to increase the duration and exclusivity of breastfeeding are unlikely to curb the obesity epidemic.

Background The duration and exclusivity of breastfeeding in infancy have been inversely associated with future cardiometabolic risk. We investigated the effects of an experimental intervention to promote increased duration of exclusive breastfeeding on cardiometabolic risk factors in childhood. Methods and results We followed-up children in the Promotion of Breastfeeding Intervention Trial, a cluster-randomized trial of a breastfeeding promotion intervention based on the World Health Organization/United Nations Children’s Fund Baby-Friendly Hospital Initiative. 17,046 breastfeeding mother-infant pairs were enrolled in 1996/7 from 31 Belarussian maternity hospitals and affiliated polyclinics (16 intervention vs 15 control sites); 13,879 (81.4%) children were followed-up at 11.5 years, with 13,616 (79.9%) fasted and without diabetes. The outcomes were blood pressure; fasting insulin, adiponectin, glucose and apolipoprotein A1; and presence of metabolic syndrome. Analysis was by intention to treat, accounting for clustering within hospitals/clinics. The intervention substantially increased breastfeeding duration and exclusivity compared with the control arm (43% vs. 6% and 7.9% vs. 0.6% exclusively breastfed at 3 and 6 months, respectively). Cluster-adjusted mean differences at 11.5 years between experimental vs control groups were: 1.0mmHg (95% CI: −1.1, 3.1) for systolic and 0.8mmHg (−0.6, 2.3) for diastolic blood pressure; −0.1mmol/l (−0.2, 0.1) for glucose; 8% (−3%, 34%) for insulin; −0.33μ/ml (−1.5, 0.9) for adiponectin; and 0.0g/l (−0.1, 0.1) for ApoA1. The cluster-adjusted odds ratio for metabolic syndrome, comparing experimental vs control groups, was 1.21 (0.85, 1.72). Conclusions An intervention to improve breastfeeding duration and exclusivity among healthy term infants did not influence cardiometabolic risk factors in childhood. Clinical Trial Registration Information Current Controlled Trials: ISRCTN37687716 (http://www.controlled-trials.com/ISRCTN37687716); Clinicaltrials.gov. Identifier: NCT01561612.

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We have carried out a large retrospective study of α‐fetoprotein (AFP), free‐β human chorionic gonadotrophin (hCG) and pregnancy‐associated plasma protein (PAPP‐A) in the first trimester of pregnancy. Unlike other studies all women had routine ultrasound dating, carried out during a nuchal translucency measurement project. A total of 13 477 serum samples were tested for AFP and 11 659 for free β‐hCG. A subset of 1564 samples from unaffected pregnancies were also tested for PAPP‐A on a case–control basis. All three markers were also determined in 31 samples from pregnancies with Down syndrome. Equations were derived to express results in multiples of the median using both gestational age and crown–rump length and to adjust for maternal weight. Statistical modelling with Gaussian distribution parameters obtained in the study were used to predict the detection rate for a 5 per cent false‐positive rate. The predicted rates were: 73.7 per cent for all three markers; 69.1 per cent for PAPP‐A and free β‐hCG; 47.4 per cent for PAPP‐A and AFP; 57.6 per cent for free β‐hCG and AFP. As these rates are similar to those in the second trimester, health planners may now want to consider a change in policy from second‐trimester to first‐trimester screening with biochemical markers. Copyright © 1999 John Wiley & Sons, Ltd.