Interventions in Primary Care to Promote Breastfeeding

Download or read book Interventions in Primary Care to Promote Breastfeeding written by Mei Chung and published by . This book was released on 2008 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: CONTEXT: Breastfeeding decreases the risks of many diseases in mothers and infants. About 70 percent of US children have ever been breastfed. Thus, it is important to examine interventions that could promote and support breastfeeding in an effort to increase the breastfeeding rates and impact the public health. OBJECTIVE: To systematically review evidence for the effectiveness of primary care initiated interventions to promote and support breastfeeding. DATA SOURCES: We searched MEDLINE, the Cochrane Controlled Trials Registry, CINAHL, and Cochrane Database of Systematic Reviews for articles from September, 2001 to January, 2007 using the MeSH terms and keywords, such as "breastfeeding", "breast milk feeding", "breast milk", "human milk", "nursing", "lactation", "counseling", and "health education". For additional studies, we also examined the bibliographies in existing systematic reviews. STUDY SELECTION: We identified 21 RCTs, two clustered RCTs, two quasi-RCTs, four controlled, non-randomized studies, two before-and-after experimental studies (Baby Friendly Hospital Initiative (BFHI) only), four prospective observational studies with concurrent or historical (BFHI only) control, and one Cochrane systematic review. Seventeen studies were of good or fair internal validity according to US Preventive Services Task Force (USPSTF) criteria. DATA EXTRACTION: Data elements were abstracted on to standardized forms and included information about the setting, study design, population characteristics, types of interventions, comparators, methods of analyses, loss to followup, breastfeeding outcomes in regards to initiation, duration, and exclusivity, and maternal or infant health outcomes. In addition to assessing the internal validity of the studies, we also assessed the applicability of the studies to the US primary care population. DATA SYNTHESIS: Comparing breastfeeding interventions to the control (usual care): prenatal breastfeeding intervention increased the rate of any short-term breastfeeding (pooled RR: 1.39; 95%CI 1.16-1.67); combination of pre- and postnatal breastfeeding interventions increased both the rate of intermediate and long-term any breastfeeding (pooled RR: 1.15; 95%CI 1.00-1.32, 1.38; 95%CI 1.33-1.43, respectively); postnatal breastfeeding interventions increased the rate of exclusive short-term breastfeeding (pooled RR: 1.21; 95%CI 1.08-1.36); structured breastfeeding education with or without other components increased the rate of any breastfeeding initiation (pooled RR: 1.15; 95%CI 1.02-1.30); individual level professional support with or without other components significantly increased the rate of any intermediate breastfeeding (pooled RR: 1.12; 95%CI 1.02-1.30); lay support with or without other components increased the rate of any short- and long-term breastfeeding (pooled RR: 1.26; 95%CI 1.07-1.48, 1.38; 95%CI 1.00-1.92, respectively) and the rate of short-term exclusive breastfeeding duration (pooled RR: 1.66; 95%CI 1.05-2.56); and BFHI increased the exclusive breastfeeding rates at 3 (43.3% vs. 6.4% (P