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To the Editor: Dr Mortensen and colleagues¹ report a positive association between duration of maternal breastfeeding and the infants' later IQ scores as young adults. However, they fail to examine important confounders associated with breastfeeding, including maternal depression, alcohol abuse, and quality of the marital relationship. Any one of these variables, which often interact and occur together, could be associated with the mother's choice not to breastfeed or to terminate breastfeeding early. These variables are also associated with offspring depression and subsequent poor performance in school, work, or on IQ tests as young adults.^2-3

Moreover, these confounders were likely to be present in the cohort of women studied. For instance, postpartum depression, which is common in early motherhood, is likely to have gone untreated. In 1959-1961, when this cohort was identified, there were few widely used treatments for depression. Depression in single mothers is often associated with a poor or . . . [Full Text of this Article]

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The Association Between Duration of Breastfeeding and Adult Intelligence
Erik Lykke Mortensen, Kim Fleischer Michaelsen, Stephanie A. Sanders, and June Machover Reinisch
JAMA. 2002;287(18):2365-2371.
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