Effects of Breastfeeding Interventions on Breastfeeding Rates at 1, 3 and 6 Months Postpartum: A Systematic Review and Meta-Analysis

Seol Hui Park; Seang Ryu

doi:10.4040/jkan.2017.47.6.713

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Park and Ryu: Effects of Breastfeeding Interventions on Breastfeeding Rates at 1, 3 and 6 Months Postpartum: A Systematic Review and Meta-Analysis

Review Article

J Korean Acad Nurs 2017;47(6):713-730.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.6.713

Effects of Breastfeeding Interventions on Breastfeeding Rates at 1, 3 and 6 Months Postpartum: A Systematic Review and Meta-Analysis

Seol Hui Park^1,, Seang Ryu²

¹Department of Nursing, MIZ-I Hospital, Mokpo

²Department of Nursing, Mokpo National University, Muan, Korea

Address reprint requests to : Park, Seol Hui Department of Nursing, MIZ-I Hospital, 418 Baengnyeon-daero, Mokpo 58684, Korea Tel: +82-61-260-8717 Fax: +82-61-260-8800 E-mail: vikiq@hanmail.net

Received 22 September 2017 Revised 4 December 2017 Accepted 22 December 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was a systematic review and meta-analysis designed to evaluate the effects of breastfeeding intervention on breastfeeding rates.

Methods

Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), a systematic search was conducted using eight core electronic databases and other sources including gray literature from January 9 to 19, 2017. Two reviewers independently select the studies and assessed methodological risk of bias of studies using the Cochrane criteria. The topics of breastfeeding interventions were analyzed using descriptive analysis and the effects of intervention were meta-analyzed using the Review Manager 5.2 software.

Results

A total of 16 studies were included in the review and 15 were included for meta-analysis. The most frequently used intervention topics were the importance of good latch-on and frequency of feeding and determining adequate intake followed. The pooled total effect of breastfeeding intervention was 1.08 (95% CI 1.03~1.13). In the subgroup analysis, neither pre-nor post-childbirth intervention was effective on the breastfeeding rates at 1, 3, and 6 months, and neither group nor individual interventions had an effect. Only the 1 month breastfeeding rate was found to be affected by the individual intervention with the persistent strategies 1.21 (95% CI 1.04~1.40).

Conclusion

Effective breastfeeding interventions are needed to help the mother to start breastfeeding after childbirth and continue for at least six months. It should be programmed such that individuals can acquire information and specific breastfeeding skills. After returning home, there should be continuous support strategies for breastfeeding as well as managing various difficulties related to childcare.

Keywords: Breast feeding, Review, Meta-analysis

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Figure 1.

Study flow diagram of a systematic review.

Figure 2.

Funnel plots of standard error by standardized mean difference. Individual including continuo

Figure 3.

Effect of breastfeeding intervention at 1, 3, and 6 months postpartum.

Figure 4.

Effect of prenatal and postnatal breastfeeding intervention at 1, 3, and 6 months postpartum.

Figure 5.

Effect of breastfeeding intervention unit on 1, 3 and 6 months.

Table 1.

Summary of RCTs with Breastfeeding Intervention

No	Authors (year)/ Country	Subject		Primipara/ Multipara t	Intervention				Outcomes	Included in meta-analysis
		Exp	Cont		Time	Unit	Intervention period	Program type	Breastfeeding rates (p)
1	Bonuck, KA et al.	163	175	Primipara/	Prenatal/24 wks	Home &	Prenatal: 60 min/2 session	Practice	1 M (.850)	Yes
	(2005)/USA			Multipara	Postnatal/after	Hospital/	Postnatal:	Continuous	3 M (.450)
					discharge	Individual	Hospital 90 min/1 session		6 M (.370)
							Home 60 min/1 session
							Telephone
							needed/12 months
2	De Oliveira, LD et al.	71	132	Primipara/	Postnatal/within	Hospital/	30 min/1 session	Practice	1 M (.365)	No
	(2006)/Brazil			Multipara	discharge	Individual
3	Forster, D et al.	306	310	Primipara	Prenatal/	Hospital/	2.5 hrs/2 session	Lecture	1 M (.930)	Yes
	(2004)/Australia				20~25 wks	Group			6 M (.530)
4	Flaherman, VJ et al.	35	33	Primipara/	Postnatal/within	Hospital/	15 min/1 session	Practice	1 M (.080)	Yes
	(2011)/USA			Multipara	12~36 hrs	Individual			2 M (.020)
					of birth
5	Fu, ICY et al. (2014)	261	260	Primipara	Postnatal/within	Home/	20~30 min/weekly for	Practice	1 M (.003)	Yes
	/Hong Kong				72 hrs of	Individual	up to 4 wks	Continuous	3 M (.450)
					discharge				6 M (.490)
6	Henderson, A et al.	79	79	Primipara/	Postnatal/within	Hospital/	30 min/1 session	Practice	1 M (.300)	Yes
	(2001)/Australia			Multipara	24 hrs of birth	Individual			3 M (.700)
									6 M (.300)
7	Kupratakul, J et al.	40	38	Primipara/	Prenatal/least	Hospital/	3 hrs/1 session	Practice	1 M (.021)	Yes
	(2010)/Thailand			Multipara	36 wks	Individual			3 M (.158)
									6 M (.005)
8	Kluka, SM. (2004)	107	89	Primipara	Prenatal/	Hospital/	16 hrs/3 session	Lecture	2 wks (.800)	Yes
	/Canada				3rd tremester	Group			3 M (.540)
									6 M (.620)
9	Kronborg, H et al.	587	575	Primipara	Prenatal/	Hospital/	9 hrs/3 session	Lecture	1 M (.130)	Yes
	(2012)/Denmark				30~35 wks	Group
10	Mattar, CN et al.	73	85	Primipara/	Prenatal/least	Hospital/	31 min/1 session	Practice	1 M (.120)	Yes
	(2007)/Singapore			Multipara	36 wks	Individual			3 M (.030)
									6 M (.140)
11	McDonald, SJ et al.	418	421	Primipara/	Postnatal/24 hrs	Home/	Telephone/2 session	Practice	6 M (.750)	Yes
	(2010)/Australia			Multipara	after birth	Individual	Home/6 session	Continuous
12	Paul, IM et al.	583	586	Primipara/	Postnatal/within	Home/	Home/1 session	Practice	2 wks (.040)	Yes
	(2012)			Multipara	48 hrs of	Individual			6 M (.800)
	/USA				discharge
13	Pugh, LC et al.	168	160	Primipara/	Postnatal/within	Home &	Hospital: Daily	Practice	1 M (.050)	Yes
	(2010)/USA			Multipara	24~48 hrs of	Hospital/	Home: 45-60min/3 session	Continuous	3 M (.070)
					birth	Individual	Telephone 24 wks/20 min	n	6 M (.460)
14	Srivastava, S et al. (2014)/India	122	118	Primipara/ Multipara	Postnatal/ immediately after birth	Hospital/ Individual	2 hrs/1 session	Skin to skin contact	1 M (<.001)	Yes
15	Wallace, LM et al. (2006)/England	172	163	Primipara	Postnatal/within 24 hrs of birth	Hospitals/ Individual	4 hrs/1 session	Practice	1 M (.050) 4 M (.800)	Yes
16	Wong, KL et al. (2014)/Hong Kong	233	236	Primipara	Prenatal/ least 35 wks	Hospitals/ Individual	20~30 min/1 session	Practice	1 M (.770) 3 M (.850) 6 M (.550)	Yes

RCTs=Randomized Controlled Trial; wks=weeks; hrs=hours; min=minute.

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