Published online December 1, 2005
PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1413-1426 (doi:10.1542/peds.2005-0435)
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Randomized, Controlled Trial of a Prenatal and Postnatal Lactation Consultant Intervention on Duration and Intensity of Breastfeeding up to 12 Months

Karen A. Bonuck, PhD*, Michelle Trombley, BA*, Katherine Freeman, DrPH* and Diane McKee, MD{ddagger}

* Epidemiology and Population Health
{ddagger} Family and Community Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York

Objective. To determine whether an individualized, prenatal and postnatal, lactation consultant intervention resulted in increased cumulative intensity of breastfeeding up to 52 weeks.

Design. The randomized, nonblinded, controlled trial recruited women from prenatal care. Baseline prenatal interviews covered demographic data and breastfeeding experience, intention, and knowledge. Interviews at 1, 2, 3, 4, 6, 8, 10, and 12 months after birth collected data on weekly feeding patterns, infant illness, and infant health care use.

Setting. Two community health centers serving low-income, primarily Hispanic and/or black women.

Participants. The analytic sample included 304 women (intervention: n = 145; control: n = 159) with ≥1 postnatal interview.

Intervention. Study lactation consultants attempted 2 prenatal meetings, a postpartum hospital visit, and/or home visits and telephone calls. Control subjects received the standard of care.

Outcome Measures. Cumulative breastfeeding intensity at 13 and 52 weeks, based on self-reports of weekly feeding, on a 7-level scale.

Results. The intervention group was more likely to breastfeed through week 20 (53.0% vs 39.3%). Exclusive breastfeeding rates were low and did not differ according to group. In multivariate analyses, control subjects had lower breastfeeding intensity at 13 weeks (odds ratio [OR]: 1.90; 95% confidence interval [CI]: 1.13–3.20) and 52 weeks (OR: 2.50; 95% CI: 1.48–4.21). US-born control subjects had lowest breastfeeding intensity at 13 weeks (OR: 5.22; 95% CI: 2.43–11.22) and 52 weeks (OR: 5.25; 95% CI: 2.44–11.29). There were no significant differences in breastfeeding intensity among the US-born intervention, foreign-born intervention, and foreign-born control groups.

Conclusions. This "best-practices" intervention was effective in increasing breastfeeding duration and intensity. Breastfeeding promotion should focus on US-born women and exclusive breastfeeding.

Key Words: randomized • controlled trial • breastfeeding duration • intensity of breastfeeding • exclusive breastfeeding • lactation consultant

Abbreviations: WIC, Supplemental Nutrition Program for Women, Infants, and Children • OR, odds ratio • CI, confidence interval • MILK, Moms Into Learning about Kids • LC, lactation consultant • RA, research assistant

Accepted May 5, 2005.




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