A randomized controlled trial of an antenatal intervention to increase exclusive breastfeeding

Abstract

In Hong Kong, while around 85% of mothers choose to breastfeed their infants, most discontinue within the first one to two months postpartum. This indicates that there is room for improving the current breastfeeding education. A randomized controlled trial was conducted to evaluate the effectiveness of a professional one-to-one antenatal breastfeeding support and education intervention on the exclusivity and duration of breastfeeding. A total of 469 primiparous women who attended the antenatal clinics of two geographically distributed public hospitals in Hong Kong were randomized to receive either standard antenatal care or a one-to-one antenatal breastfeeding support and education session. The primary outcome was the prevalence of exclusive breastfeeding at 6 weeks postpartum. Secondary outcomes were the prevalence of exclusive breastfeeding at 3 and 6 months postpartum, as well as the overall duration of any and exclusive breastfeeding across the first 6 months postpartum. The study had a least 80% power to detect a 50% increase in the rate of exclusive breastfeeding at 6 weeks postpartum. The exclusive breastfeeding rate in the intervention group was 37.8% at 6 weeks postpartum compared with 36.4% in the standard care group (p=0.77; 95% Confidence Interval (CI) -0.08, 0.11). There were no significant differences between the two treatment groups in exclusive breastfeeding rates at 3 and 6 months or in in the overall duration of any (Hazard Ratio (HR) =1.11; 95% CI 0.88, 1.40) or exclusive breastfeeding (HR=0.96; 95% CI 0.79, 1.17). In a setting with a high breastfeeding initiation rate, one-to-one antenatal breastfeeding support and education did not increase the exclusivity or duration of breastfeeding.