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Which interventions can increase breastfeeding duration?
Breastfeeding support, beyond standard care, from lay people or professionals increases both short- and long-term breastfeeding duration (strength of recommendation: B, meta-analyses of randomized controlled trials [RCTs] with demonstrated heterogeneity).
EVIDENCE SUMMARY
A 2012 Cochrane review of 52 studies (44 RCTs and 8 cluster-randomized trials; N=56,451) assessed the overall effectiveness of multiple supportive measures on decreasing cessation of “any” (partial and exclusive) and “exclusive” breastfeeding compared with usual care.1 Participants were healthy breastfeeding mothers of healthy term babies. Support interventions were defined broadly but included individual and group interactions, as well as contact in person or over the phone by professionals or lay volunteers. Patients were approached proactively or reactively upon request, and the interventions occurred one or more times.
The interventions reduced discontinuation rates among both “exclusive” and “any” breastfeeding mothers (TABLE1). The review found lay and professional support to be equally effective at promoting continuation of breastfeeding. Limitations include a moderate to high amount of heterogeneity, as well as the inherent difficulty of blinding subjects in the studies.
Lay support can make a significant difference in the short term
A 2008 systematic review of 38 RCTs (N=29,020) compared any counseling or behavioral intervention initiated from a clinician’s practice (office or hospital) with usual care.2 The review excluded community and peer-initiated interventions. The reviewers defined breastfeeding duration as follows: initiation (up to 2 weeks), short-term (one to 3 months), intermediate-term (4 to 5 months), long-term (6 to 8 months), and prolonged (9 or more months). Investigators also analyzed breastfeeding rates by “exclusive” and “nonexclusive” (formula supplementation) regimens.
For nonexclusive breastfeeding, the review found interventions to promote breastfeeding improved rates only at initiation (18 RCTs, N=7688; relative risk [RR] for cessation of breastfeeding=1.04; 95% confidence interval [CI], 1.0-1.08; number needed to treat [NNT]=38) and in the short term (18 RCTs, N= 19,358; RR=1.10; 95% CI, 1.02-1.19; NNT=7). For exclusive breastfeeding, interventions improved rates only in the short term (17 RCTs, N=20,552; RR=1.72; 95% CI, 1.0-2.97; NNT=3).
The review found that lay support (defined as counseling or social support from peers) but not professional support was significantly associated with improving rates of both “nonexclusive” and “exclusive’ breastfeeding, but only over the short term (5 RCTs, N not provided; RR=1.22; 95% CI, 1.08-1.37; and 4 RCTs, N not provided; RR=1.65; 95% CI, 1.03-2.63; respectively). As with the Cochrane review, the results for all study groups demonstrated moderate to significant heterogeneity.
RECOMMENDATIONS
The Surgeon General, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists all recommend that women be educated about the benefits of breastfeeding and receive supportive interventions before and after delivery.3-6
1. Renfrew MJ, McCormick FM, Wade A, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2012;5:CD001141.
2. Chung M, Raman G, Trikalinos T, et al. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:565-582.
3. United States Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. US Department of Health and Human Services, Office of the Surgeon General Web site. Available at: http://www.surgeongeneral.gov/library/calls/breastfeeding/. Accessed January 19, 2015.
4. American Academy of Family Physicians. Breastfeeding, Family Physicians Supporting (Position Paper). American Academy of Family Physicians Web site. Available at: http://www.aafp.org/about/policies/all/breastfeeding-support.html (updated Nov. 4, 2014). Accessed January 19, 2015.
5. Johnson M, Landers S, Noble L, et al. American Academy of Pediatrics, Section on Breastfeeding. Policy Statement: Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–e841.
6. Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2 Pt 1):479-480.
Breastfeeding support, beyond standard care, from lay people or professionals increases both short- and long-term breastfeeding duration (strength of recommendation: B, meta-analyses of randomized controlled trials [RCTs] with demonstrated heterogeneity).
EVIDENCE SUMMARY
A 2012 Cochrane review of 52 studies (44 RCTs and 8 cluster-randomized trials; N=56,451) assessed the overall effectiveness of multiple supportive measures on decreasing cessation of “any” (partial and exclusive) and “exclusive” breastfeeding compared with usual care.1 Participants were healthy breastfeeding mothers of healthy term babies. Support interventions were defined broadly but included individual and group interactions, as well as contact in person or over the phone by professionals or lay volunteers. Patients were approached proactively or reactively upon request, and the interventions occurred one or more times.
The interventions reduced discontinuation rates among both “exclusive” and “any” breastfeeding mothers (TABLE1). The review found lay and professional support to be equally effective at promoting continuation of breastfeeding. Limitations include a moderate to high amount of heterogeneity, as well as the inherent difficulty of blinding subjects in the studies.
Lay support can make a significant difference in the short term
A 2008 systematic review of 38 RCTs (N=29,020) compared any counseling or behavioral intervention initiated from a clinician’s practice (office or hospital) with usual care.2 The review excluded community and peer-initiated interventions. The reviewers defined breastfeeding duration as follows: initiation (up to 2 weeks), short-term (one to 3 months), intermediate-term (4 to 5 months), long-term (6 to 8 months), and prolonged (9 or more months). Investigators also analyzed breastfeeding rates by “exclusive” and “nonexclusive” (formula supplementation) regimens.
For nonexclusive breastfeeding, the review found interventions to promote breastfeeding improved rates only at initiation (18 RCTs, N=7688; relative risk [RR] for cessation of breastfeeding=1.04; 95% confidence interval [CI], 1.0-1.08; number needed to treat [NNT]=38) and in the short term (18 RCTs, N= 19,358; RR=1.10; 95% CI, 1.02-1.19; NNT=7). For exclusive breastfeeding, interventions improved rates only in the short term (17 RCTs, N=20,552; RR=1.72; 95% CI, 1.0-2.97; NNT=3).
The review found that lay support (defined as counseling or social support from peers) but not professional support was significantly associated with improving rates of both “nonexclusive” and “exclusive’ breastfeeding, but only over the short term (5 RCTs, N not provided; RR=1.22; 95% CI, 1.08-1.37; and 4 RCTs, N not provided; RR=1.65; 95% CI, 1.03-2.63; respectively). As with the Cochrane review, the results for all study groups demonstrated moderate to significant heterogeneity.
RECOMMENDATIONS
The Surgeon General, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists all recommend that women be educated about the benefits of breastfeeding and receive supportive interventions before and after delivery.3-6
Breastfeeding support, beyond standard care, from lay people or professionals increases both short- and long-term breastfeeding duration (strength of recommendation: B, meta-analyses of randomized controlled trials [RCTs] with demonstrated heterogeneity).
EVIDENCE SUMMARY
A 2012 Cochrane review of 52 studies (44 RCTs and 8 cluster-randomized trials; N=56,451) assessed the overall effectiveness of multiple supportive measures on decreasing cessation of “any” (partial and exclusive) and “exclusive” breastfeeding compared with usual care.1 Participants were healthy breastfeeding mothers of healthy term babies. Support interventions were defined broadly but included individual and group interactions, as well as contact in person or over the phone by professionals or lay volunteers. Patients were approached proactively or reactively upon request, and the interventions occurred one or more times.
The interventions reduced discontinuation rates among both “exclusive” and “any” breastfeeding mothers (TABLE1). The review found lay and professional support to be equally effective at promoting continuation of breastfeeding. Limitations include a moderate to high amount of heterogeneity, as well as the inherent difficulty of blinding subjects in the studies.
Lay support can make a significant difference in the short term
A 2008 systematic review of 38 RCTs (N=29,020) compared any counseling or behavioral intervention initiated from a clinician’s practice (office or hospital) with usual care.2 The review excluded community and peer-initiated interventions. The reviewers defined breastfeeding duration as follows: initiation (up to 2 weeks), short-term (one to 3 months), intermediate-term (4 to 5 months), long-term (6 to 8 months), and prolonged (9 or more months). Investigators also analyzed breastfeeding rates by “exclusive” and “nonexclusive” (formula supplementation) regimens.
For nonexclusive breastfeeding, the review found interventions to promote breastfeeding improved rates only at initiation (18 RCTs, N=7688; relative risk [RR] for cessation of breastfeeding=1.04; 95% confidence interval [CI], 1.0-1.08; number needed to treat [NNT]=38) and in the short term (18 RCTs, N= 19,358; RR=1.10; 95% CI, 1.02-1.19; NNT=7). For exclusive breastfeeding, interventions improved rates only in the short term (17 RCTs, N=20,552; RR=1.72; 95% CI, 1.0-2.97; NNT=3).
The review found that lay support (defined as counseling or social support from peers) but not professional support was significantly associated with improving rates of both “nonexclusive” and “exclusive’ breastfeeding, but only over the short term (5 RCTs, N not provided; RR=1.22; 95% CI, 1.08-1.37; and 4 RCTs, N not provided; RR=1.65; 95% CI, 1.03-2.63; respectively). As with the Cochrane review, the results for all study groups demonstrated moderate to significant heterogeneity.
RECOMMENDATIONS
The Surgeon General, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists all recommend that women be educated about the benefits of breastfeeding and receive supportive interventions before and after delivery.3-6
1. Renfrew MJ, McCormick FM, Wade A, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2012;5:CD001141.
2. Chung M, Raman G, Trikalinos T, et al. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:565-582.
3. United States Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. US Department of Health and Human Services, Office of the Surgeon General Web site. Available at: http://www.surgeongeneral.gov/library/calls/breastfeeding/. Accessed January 19, 2015.
4. American Academy of Family Physicians. Breastfeeding, Family Physicians Supporting (Position Paper). American Academy of Family Physicians Web site. Available at: http://www.aafp.org/about/policies/all/breastfeeding-support.html (updated Nov. 4, 2014). Accessed January 19, 2015.
5. Johnson M, Landers S, Noble L, et al. American Academy of Pediatrics, Section on Breastfeeding. Policy Statement: Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–e841.
6. Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2 Pt 1):479-480.
1. Renfrew MJ, McCormick FM, Wade A, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev. 2012;5:CD001141.
2. Chung M, Raman G, Trikalinos T, et al. Interventions in primary care to promote breastfeeding: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:565-582.
3. United States Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. US Department of Health and Human Services, Office of the Surgeon General Web site. Available at: http://www.surgeongeneral.gov/library/calls/breastfeeding/. Accessed January 19, 2015.
4. American Academy of Family Physicians. Breastfeeding, Family Physicians Supporting (Position Paper). American Academy of Family Physicians Web site. Available at: http://www.aafp.org/about/policies/all/breastfeeding-support.html (updated Nov. 4, 2014). Accessed January 19, 2015.
5. Johnson M, Landers S, Noble L, et al. American Academy of Pediatrics, Section on Breastfeeding. Policy Statement: Breastfeeding and the use of human milk. Pediatrics. 2012;129:e827–e841.
6. Committee on Health Care for Underserved Women, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol. 2007;109(2 Pt 1):479-480.
Evidence-based answers from the Family Physicians Inquiries Network