USPSTF recommends primary care breastfeeding intervention support

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The USPSTF reviewed evidence on the benefits and harms of breastfeeding support interventions.
The USPSTF reviewed evidence on the benefits and harms of breastfeeding support interventions.

The U.S. Preventive Services Task Force (USPSTF) found evidence confirming that breastfeeding support interventions are linked to increased rates of breastfeeding, according to the updated evidence report published in JAMA.

Many organizations in the United States recommend exclusive breastfeeding up to 6 months, followed by continued breastfeeding for at least 1 year, but only 21.9% of infants born in 2012 were exclusively breastfed for 6 months. Therefore, the USPSTF reviewed evidence of the benefits and harms of breastfeeding interventions published between January 2008 and September 2015. They examined child and maternal outcomes and the rates and duration of breastfeeding.

 

The researchers reviewed 211 clinical trials with concurrent controls that evaluated breastfeeding interventions relevant to primary care among mothers of full-term or near-term infants. Fifty-two studies (n=66,757) met the inclusion criteria, including 6 trials that reported on the inconsistent effects of infant health outcomes.

“Most studies indicated that there was a good level of breastfeeding support within the birthing facility at or around the time of delivery from hospital staff, including support from lactation care providers, but failed to fully describe the minimal support for breastfeeding during the prenatal and postpartum periods” the study authors wrote.

Estimates from the meta-analysis from 26 studies (n=11,588) revealed a beneficial association between individual-level breastfeeding interventions and any breastfeeding for less than 3 months (risk ratio [RR], 1.07). The results were consistent for any breastfeeding between 3 and 6 months (RR, 1.11) and for exclusive breastfeeding between 3 and 6 months (RR, 1.20). The pooled risk ratio also demonstrated a positive association between individual-level breastfeeding interventions and exclusive breastfeeding at 6 months (RR, 1.16).

The investigators noted that there was no significant association between interventions and breastfeeding initiation (RR, 1.00; 14 studies [n=9,428]). They also observed an association between system-level interventions and the rates of breastfeeding from well-controlled studies, although the evidence was limited. In addition, only 2 trials reported adverse events related to breastfeeding intervention, which included concerns of anxiety, decreased confidence, or concerns of confidentiality.

In a corresponding editorial, Valerie Flaherman, MD, MPH, from the University of California at San Francisco, and Isabelle Von Kohorn, MD, PhD, from Holy Cross Health in Silver Spring, Maryland, wrote that only individual-level interventions demonstrated effectiveness at improving breastfeeding, while system-level interventions such as the World Health Organization's Baby-Friendly Hospital Initiative (BFHI) did not.

“To improve breastfeeding rates in the United States, further implementation of system-level interventions such as the BFHI for the general population should be reconsidered until good-quality evidence emerges that these interventions are safe and effective,” they wrote.  “Implementation of ineffective strategies, potentially those not based on evidence, may divert resources from effective interventions at the individual level and risk causing unnecessary harm.”

Reference

  1. Patnode CD, Henninger ML, Senger CA, et al. Primary care interventions to support breastfeeding: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;316(16):1694-1705 doi: 10.1001/jama.2016.8882.
  2. Flaherman V, Von Kohorn I. Interventions intended to support breastfeeding: Updated assessment of benefits and harms. JAMA. 2016;316(16):1685-1687. doi:10.1001/jama.2016.8882.
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