Sara Young

Breastfeeding Education and Support Trial for Overweight and Obese Women: A Randomized Trial

OBJECTIVE: To evaluate a specialized breastfeeding peer counseling (SBFPC) intervention promoting exclusive breastfeeding (EBF) among overweight/obese, low-income women. METHODS: We recruited 206 pregnant, overweight/obese, low-income women and randomly assigned them to receive SBFPC or standard care (controls) at a Baby-Friendly hospital. SBFPC included 3 prenatal visits, daily in-hospital support, and up to 11 postpartum home visits promoting EBF and addressing potential obesity-related breastfeeding barriers. Standard care involved routine access to breastfeeding support from hospital personnel, including staff peer counselors. Data collection included an in-hospital interview, medical record review, and monthly telephone calls through 6 months postpartum to assess infant feeding practices, demographics, and health outcomes. Bivariate and logistic regression analyses were conducted. RESULTS: The intervention had no impact on EBF or breastfeeding continuation at 1, 3, or 6 months postpartum. In adjusted posthoc analyses, at 2 weeks postpartum the intervention group had significantly greater odds of continuing any breastfeeding (adjusted odds ratio [aOR]: 3.76 [95% confidence interval (CI): 1.07–13.22]), and giving at least 50% of feedings as breast milk (aOR: 4.47 [95% CI: 1.38–14.5]), compared with controls. Infants in the intervention group had significantly lower odds of hospitalization during the first 6 months after birth (aOR: 0.24 [95% CI: 0.07–0.86]). CONCLUSIONS: In a Baby-Friendly hospital setting, SBFPC targeting overweight/obese women did not impact EBF practices but was associated with increased rates of any breastfeeding and breastfeeding intensity at 2 weeks postpartum and decreased rates of infant hospitalization in the first 6 months after birth.

ASSOCIATION OF DEGREE AND TIMING OF EXPOSURE TO BREASTFEEDING PEER COUNSELING SERVICES WITH BREASTFEEDING DURATION

Randomized trials conducted in developing countries have demonstrated that breastfeeding peer counseling increases rates of breastfeeding initiation and improves the duration of breastfeeding (Morrow et al. 1999; Haider et al. 2000). We are conducting a randomized community trial, designed to evaluate the effectiveness of an existing community-based breastfeeding peer counseling program serving mostly low income Latinas (i.e., women from Spanish-speaking countries in Latin America or the Caribbean) in Hartford, CT. Preliminary data from this on-going study previously have shown that subjects randomized to receive breastfeeding peer counseling have a median breastfeeding duration one month greater than their counterparts who did not receive breastfeeding peer counseling (1.75 mo vs. 0.8 mo, P<0.05) (Chapman et al. 2002). The objectives of this analysis are to: a) report on a process evaluation of the program, focusing on actual coverage of pre-, peri-, and postnatal services; and b) determine if differences in the degree and timing of the exposure to breastfeeding peer counseling services are associated with breastfeeding duration.