Association between Autism Spectrum Disorder and Breastfeeding Initiation and Duration: A Case-Control Study in Sulaymaniyah, Iraq

Abstract

Background: Autism Spectrum Disorder (ASD) is a multifactorial neurodevelopmental condition influenced by genetic, perinatal, and environmental factors. Although breastfeeding has been proposed as a potential protective factor for neurodevelopment, evidence remains inconsistent across populations. Objectives: This study aimed to assess the association between breastfeeding practices and ASD among children in the Sulaymaniyah Governorate, Kurdistan Region of Iraq. Materials and Methods: A case-control study was conducted from August 2024 to February 2025 involving 222 children aged 2–15 years (77 ASD cases and 145 controls). ASD diagnoses were confirmed by a specialized multidisciplinary committee using DSM-5 criteria. Data were collected through a validated semi-structured questionnaire covering sociodemographic, prenatal, perinatal, and breastfeeding variables. Statistical analyses were performed using SPSS v23.0; Chi-square, t-tests, and Mann–Whitney U tests were applied where appropriate. Results: No statistically significant association was found between ASD and breastfeeding initiation, exclusivity, or duration. Ever-breastfed proportions were similar between cases and controls (93.5% vs 88.3%, p = 0.214). Conclusion: Breastfeeding practices did not show a significant relationship with ASD in this regional cohort. The findings highlight that parental age, family history, and educational and occupational factors may exert a stronger influence on ASD risk than infant feeding patterns. Further large-scale prospective studies are warranted to clarify causal mechanisms.