A prenatal group based phone counseling intervention to improve breastfeeding rates and complementary feeding: a randomized, controlled pilot and feasibility trial

Jennifer S Cauble, Amy Herman, Jo Wick, Jeannine Goetz, Christine M Daley, Debra K Sullivan, Holly R Hull, Jennifer S Cauble, Amy Herman, Jo Wick, Jeannine Goetz, Christine M Daley, Debra K Sullivan, Holly R Hull

Abstract

Background: Despite numerous benefits for both mom and baby, few infants are exclusively breastfed for the recommended first six months. Additionally, infants are given solids too early. Prenatal education increases rates of breastfeeding initiation and we hypothesize it can also improve exclusive breastfeeding rates and prevent the early introduction of solids. We conducted a randomized controlled pilot and feasibility trial to understand the feasibility and maternal acceptance of a prenatal behavioral lifestyle intervention (PBLI) delivered via group based phone counseling (GBPC) and its effectiveness on rates of exclusive breastfeeding up to six months postpartum. Secondary aims included rates of any breastfeeding up to six months, rates of early introduction of solids, and infant feeding progression.

Methods: Forty-one pregnant women were recruited from a Kansas City Metropolitan Obstetrics and Gynecology office and randomly assigned to a usual care group or a PBLI. Women in the PBLI participated in six GBPC sessions where they learned about breastfeeding and introducing solids. Feeding questionnaires to assess breastfeeding and introduction of solids were sent at two weeks, two months, four months, and six months postpartum. Structured interviews were also conducted after the intervention and at six months postpartum to assess maternal acceptance and intervention feasibility.

Results: Participants overwhelmingly found the intervention acceptable and beneficial. Rates of exclusive breastfeeding and any breastfeeding did not differ between groups at any time point. No between group differences were found for early introduction of solids or infant feeding progression.

Conclusions: Mothers discontinue breastfeeding earlier than recommended despite high rates of initiation. A PBLI delivered via GBP is feasible, acceptable to participants, and showed positive impacts such as maternal empowerment for both breastfeeding and introducing solids. Future interventions should incorporate both prenatal and postpartum components.

Trial registration: Study protocols were approved by the University of Kansas Medical Center's Human Subjects Committee (STUDY00140506) and registered at ClinicalTrials.gov on 02/22/2018 ( NCT03442517 , retrospectively registered). All participants gave written informed consent prior to data collection.

Keywords: Breastfeeding; Human milk; Infant Feeding; Introducing Solids; Lactation; Prenatal Education.

Conflict of interest statement

Each author has declared no conflict of financial or personal interests in any company or organization sponsoring this study.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Consort Diagram
Fig. 2
Fig. 2
Overall duration of exclusive breastfeeding by treatment group
Fig. 3
Fig. 3
Overall time until introduction of solids by treatment group

References

    1. Section on B Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–41. doi: 10.1542/peds.2011-3552.
    1. Gaffney KF, Kitsantas P, Cheema J. Clinical practice guidelines for feeding behaviors and weight-for-age at 12 months: a secondary analysis of the infant feeding practices study II. Worldviews Evid Based Nurs. 2012;9(4):234–42. doi: 10.1111/j.1741-6787.2011.00236.x.
    1. Tarini BA, et al. Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease. Arch Pediatr Adolesc Med. 2006;160(5):502–507. doi: 10.1001/archpedi.160.5.502.
    1. Szajewska H, et al. Systematic review: early infant feeding and the prevention of coeliac disease. Aliment Pharmacol Ther. 2012;36(7):607–618. doi: 10.1111/apt.12023.
    1. Agostoni C, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2008;46(1):99–110. doi: 10.1097/.
    1. Rosenbauer J, et al. Early nutrition and risk of Type 1 diabetes mellitus–a nationwide case-control study in preschool children. Exp Clin Endocrinol Diabetes. 2007;115(8):502–508. doi: 10.1055/s-2007-973829.
    1. Bartick M, A Reinhold. The burden of suboptimal breastfeeding in the United States: a pediatric cost analysis. Pediatrics. 2010;125(5):e1048–56. doi: 10.1542/peds.2009-1616.
    1. Centers for Disease, C. Breastfeeding Report Card. 2018; Available from:
    1. Clayton HB, et al. Prevalence and reasons for introducing infants early to solid foods: variations by milk feeding type. Pediatrics. 2013;131(4):e1108–e1114. doi: 10.1542/peds.2012-2265.
    1. Skouteris H, et al. Interventions designed to promote exclusive breastfeeding in high-income countries: a systematic review. Breastfeed Med. 2014;9(3):113–127. doi: 10.1089/bfm.2013.0081.
    1. Arikpo D, et al. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database Syst Rev. 2018;5:CD011768.
    1. Carter-Edwards L, et al. Barriers to adopting a healthy lifestyle: insight from postpartum women. BMC Res Notes. 2009;2:161. doi: 10.1186/1756-0500-2-161.
    1. Lind JN, et al. Prenatal breastfeeding counseling–Pregnancy Risk Assessment Monitoring System, United States, 2010. MMWR Surveill Summ. 2014;63(Suppl 2):14–19.
    1. Gartner LM, et al. Breastfeeding and the use of human milk. Pediatrics. 2005;115(2):496–506. doi: 10.1542/peds.2004-2491.
    1. Timbo B, et al. Breastfeeding among black mothers: evidence supporting the need for prenatal intervention. J Soc Pediatr Nurs. 1996;1(1):35–40. doi: 10.1111/j.1744-6155.1996.tb00054.x.
    1. Harris PA, et al. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381. doi: 10.1016/j.jbi.2008.08.010.
    1. Harris PA, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. doi: 10.1016/j.jbi.2019.103208.
    1. Sobti J, Mathur GP, Gupta A. WHO's proposed global strategy for infant and young child feeding: a viewpoint. J Indian Med Assoc. 2002;100(8):502-4–506.
    1. American Academy of Pediatrics. Committee on Nutrition and L.A. Barness . Pediatric nutrition handbook. 6th. Elk Grove Village: American Academy of Pediatrics; 2009. p. 1470.
    1. Setse R, et al. Weight loss programs for urban-based, postpartum African-American women: perceived barriers and preferred components. Matern Child Health J. 2008;12(1):119–127. doi: 10.1007/s10995-007-0211-6.
    1. Davis AM, et al. Health behavior change in pregnant women: a two-phase study. Telemed J E Health. 2014;20(12):1165–1169. doi: 10.1089/tmj.2013.0374.
    1. Donnelly JE, et al. Equivalent weight loss for weight management programs delivered by phone and clinic. Obesity (Silver Spring) 2013;21(10):1951–1959. doi: 10.1002/oby.20334.
    1. Schreck PK, et al. Both prenatal and postnatal interventions are needed to improve breastfeeding outcomes in a low-income population. Breastfeed Med. 2017;12:142–148. doi: 10.1089/bfm.2016.0131.
    1. Dennis CL, et al. The effect of peer support on breast-feeding duration among primiparous women: a randomized controlled trial. CMAJ. 2002;166(1):21–28.
    1. Nguyen MT, et al. Clinical question: In post-partum first-time mothers, what interventions are successful for helping women sustain exclusive breast feeding for one month or more? J Okla State Med Assoc. 2016;109(11):521–524.
    1. Hendricks K, et al. Maternal and child characteristics associated with infant and toddler feeding practices. J Am Diet Assoc. 2006;106(1 Suppl 1):S135–S148. doi: 10.1016/j.jada.2005.09.035.
    1. Britton C. et al. Support for breastfeeding mothers. Cochrane Database Syst Rev. 2007;(1):CD001141. 10.1002/14651858.CD001141.pub3.
    1. Li R, Scanlon KS, Serdula MK. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev. 2005;63(4):103–10. doi: 10.1111/j.1753-4887.2005.tb00128.x.

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