Interventions in Primary Care to Promote Breastfeeding: An Evidence Review for the U.S. Preventive Services Task Force

21 October 2008 | Volume 149 Issue 8 | Pages 565-582

Background: Evidence suggests that breastfeeding decreases the risk for many diseases in mothers and infants. It is therefore important to evaluate the effectiveness of breastfeeding interventions.

Purpose: To systematically review evidence for the effectiveness of primary care–initiated interventions to promote breastfeeding with respect to breastfeeding and child and maternal health outcomes.

Data Sources: Electronic searches of MEDLINE, the Cochrane Central Register of Controlled Trials, and CINAHL from September 2001 to February 2008 and references of selected articles, restricted to English-language publications.

Study Selection: Randomized, controlled trials of primary care–initiated interventions to promote breastfeeding, mainly in developed countries.

Data Extraction: Characteristics of interventions and comparators, study setting, study design, population characteristics, the proportion of infants continuing breastfeeding by different durations, and infant or maternal health outcomes were recorded.

Data Synthesis: Thirty-eight randomized, controlled trials (36 in developed countries) met eligibility criteria. In random-effects meta-analyses, breastfeeding promotion interventions in developed countries resulted in significantly increased rates of short- (1 to 3 months) and long-term (6 to 8 months) exclusive breastfeeding (rate ratios, 1.28 [95% CI, 1.11 to 1.48] and 1.44 [CI, 1.13 to 1.84], respectively). In subgroup analyses, combining pre- and postnatal breastfeeding interventions had a larger effect on increasing breastfeeding durations than either pre- or postnatal interventions alone. Furthermore, breastfeeding interventions with a component of lay support (such as peer support or peer counseling) were more effective than usual care in increasing the short-term breastfeeding rate.

Limitations: Meta-analyses were limited by clinical and methodological heterogeneity. Reliable estimates for the isolated effects of each component of multicomponent interventions could not be obtained.

Conclusion: Evidence suggests that breastfeeding interventions are more effective than usual care in increasing short- and long-term breastfeeding rates. Combined pre- and postnatal interventions and inclusion of lay support in a multicomponent intervention may be beneficial.

Author and Article Information

From Tufts-New England Medical Center Evidence-based Practice Center, Boston, Massachusetts.

Disclaimer: The authors of this manuscript are responsible for its content. Statements in the review should not be construed as endorsement by the Agency for Healthcare Research and Quality.

Grant Support: From the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (contract no. 290-02-0022).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Mei Chung, MPH, Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box 63, Boston, MA 02111; e-mail, mchung1{at}tuftsmedicalcenter.org.

Current Author Addresses: Ms. Chung and Drs. Raman, Trikalinos, Lau, and Ip: Tufts Medical Center, 800 Washington Street, Box 63, Boston, MA 02111.