A comprehensive systematic review of 90 randomized controlled trials confirmed that breastfeeding support interventions could increase both any and exclusive breastfeeding rates for up to 6 months postpartum. The findings are from an updated evidence report from the U.S. Preventive Services Task Force (B recommendation).
In the study, published in JAMA, investigators analyzed data from 90 trials involving 49,597 participants, finding significant improvements in breastfeeding prevalence with support interventions.
"The updated evidence confirms that breastfeeding support interventions can increase the prevalence of any or exclusive breastfeeding up to and at 6 months," the USPSTF researchers noted. "Future efforts should focus on how to best provide this support consistently for all individuals making feeding decisions for their infants."
At 6 months postpartum, the likelihood of any breastfeeding was 13% higher and exclusive breastfeeding 46% higher among in the intervention groups compared with those receiving usual care. The median differences in absolute prevalence ranged from 1% to 7%, with greater effects observed for exclusive versus any breastfeeding.
The included trials represented diverse populations across multiple countries, with one-third conducted in the United States. U.S.-based studies primarily enrolled Black and Hispanic women and those from socioeconomically disadvantaged backgrounds, populations that historically have lower breastfeeding rates.
Interventions varied considerably in timing, delivery method, and duration. Half were delivered during a single period (prenatal, peripartum, or postpartum), whereas the remainder spanned multiple periods. Most interventions had 6 or fewer sessions (median = 4, range = 1–20), and three-quarters included in-person components, often supplemented with telephone, electronic, or printed materials.
The interventions demonstrated effectiveness regardless of whether they were delivered by health care professionals, board-certified lactation consultants, or trained peer counselors.
Evidence on health outcomes was limited, with only 19 of the 90 trials reporting health measures. Ten trials examining infant health outcomes showed favorable trends for intervention groups, including fewer gastrointestinal issues and health care utilization; however, most differences were not statistically significant. Nine trials measuring maternal symptoms of anxiety, depression, or well-being generally reported better outcomes among intervention participants, but few differences reached statistical significance.
Regarding potential harms, only seven trials addressed adverse effects, with five reporting no adverse events and two finding no evidence of increased anxiety, depression, or other negative effects among intervention participants.
"There was no evidence of increased harm from taking part in the interventions, although potential harm was not routinely reported," the study authors noted.
The interventions showed no statistically significant effect on breastfeeding initiation, possibly because of the high baseline rates in both intervention (median = 94.4%) and control groups (median = 90%). Similarly, a meta-analysis of eight trials found no significant impact on breastfeeding at 12 months.
This review updated the U.S. Preventive Services Task Force's 2016 evidence report and provided further support for breastfeeding interventions recommended by multiple U.S. and international organizations that advocate exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with complementary foods for up to 2 years.
While the review demonstrated the effectiveness of support interventions, "research is lacking on the impact that interventions may have on the mental health and well-being of the breastfeeding women and support persons," USPSTF researchers noted.
They reported having no competing interests.
