Primary Care Interventions to Support Breastfeeding

Abstract

IMPORTANCE Although 80% of infants in the United States start breastfeeding, only 22% are exclusively breastfed up to around 6 months as recommended by a number of professional organizations. OBJECTIVE To systematically review the evidence on the benefits and harms of breastfeeding interventions to support the US Preventive Services Task Force in updating its 2008 recommendation. DATA SOURCES MEDLINE, PubMed, Cumulative Index for Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and PsycINFO for studies published in the English language between January 1, 2008, and September 25, 2015. Studies included in the previous review were re-evaluated for inclusion. Surveillance for new evidence in targeted publications was conducted through January 26, 2016. STUDY SELECTION Review of randomized clinical trials and before-and-after studies with concurrent controls conducted in a developed country that evaluated a primary care-relevant breastfeeding intervention among mothers of full-or near-term infants. Of 211 full-text articles reviewed, 52 studies met inclusion criteria. Thirty-one studies were newly identified, and 21 studies were carried forward from the previous review. DATA EXTRACTION AND SYNTHESIS Independent critical appraisal of all provisionally included studies. Data were independently abstracted by one reviewer and confirmed by another. MAIN OUTCOMES AND MEASURES Child and maternal health outcomes, rates and duration of breastfeeding, and harms related to interventions as prespecified before data collection. RESULTS Fifty-twostudies(n = 66 757)in57publicationswereincluded.Sixtrials(n = 2219)reported inconsistent effects of the interventions on infant health outcomes; no studies reported maternal health outcomes. Pooled estimates based on random-effects meta-analyses using the DerSimonian and Laird method indicated beneficial associations between individual-level breastfeeding interventions and any breastfeeding for less than 3 months (risk ratio [RR], 1.07 [95% CI, 1.03-1.11]; 26 studies [n = 11 588]), at 3 to less than 6 months (RR, 1.11 [95% CI, 1.04-1.18]; 23 studies [n = 8942]), and for exclusive breastfeeding for less than 3 months (RR, 1.21 [95% CI, 1.11-1.33]; 22 studies [n = 8246]), 3 to less than 6 months (RR, 1.20 [95% CI, 1.05-1.38]; 18 studies [n = 7027]), and at 6 months (RR, 1.16 [95% CI, 1.02-1.32]; 17 studies [n = 7690]). Absolute differences in the rates of any breastfeeding ranged from 14.1% in favor of the control group to 18.4% in favor of the intervention group. There was no significant association between interventions and breastfeeding initiation (RR, 1.00 [95% CI, 0.99-1.02]; 14 studies [n = 9428]). There was limited mixed evidence of an association between system-level interventions and rates of breastfeeding from well-controlled studies as well as for harms related to breastfeeding interventions, including maternal anxiety scores, decreased confidence, and concerns about confidentiality. CONCLUSIONS AND RELEVANCE The updated evidence confirms that b...

Infant Feeding and Risk of Type 1 Diabetes in Two Large Scandinavian Birth Cohorts

“…A possible preventive effect of a longer duration of breastfeeding is sometimes cited in reviews of the evidence for breastfeeding recommendations (8,9). This can lead to a sense of guilt among mothers of children who develop type 1 diabetes, if the mother did not fully comply with the recommendations for duration of breastfeeding.…”

“…Breastfeeding has been associated with a number of positive health outcomes, and a possible protective effect against type 1 diabetes in children has been cited as evidence for the importance of breastfeeding (8,9). Previous systematic reviews and meta-analyses of observational studies have suggested that breastfeeding more than 3 months (10,11), and exclusive breastfeeding for more than 2 weeks (12), are associated with an approximately 15–30% lower risk of type 1 diabetes.…”

Health in Preconception, Pregnancy and Postpartum Global Alliance: International Network Pregnancy Priorities for the Prevention of Maternal Obesity and Related Pregnancy and Long-Term Complications

“…Furthermore, the postpartum period is a key inter-conception phase with implications for preconception health and care [51]. While the areas of breastfeeding, postnatal depression and sleep are well studied on their own [52][53][54], further investigation into how we can address and implement these and other modifiable factors to promote healthy lifestyles, and therefore optimise weight status, for women between and in future pregnancies is warranted. As with antenatal interventions, understanding the key effective components of interventions to reduce postpartum weight retention, alongside vital implementation research focused on overcoming barriers to postpartum self-care and healthy lifestyle, are vital [55].…”

Caring during breastfeeding: Perceptions of mothers and health professionals

“…Existence of activities to support multilevel breastfeeding backed and framed within specific policies increases the impact on exclusive breastfeeding rates and on its duration. (25) Although in recent decades many efforts have been invested to better understand the effectiveness of different support interventions for breastfeeding; (5,25) few studies have focused on understanding relational, organizational, and contextual aspects that could impact upon this practice and, thereby, on the care required to support it. (26) The results herein contribute to understanding how the context could influence positively or negatively on the results of interventions implemented to support breastfeeding.…”