Lactation Consultants Increase Breast-feeding

Megan Brooks

December 20, 2013

Pre- and postnatal visits with a certified lactation consultant (LC) coupled with electronic reminders for healthcare providers to discuss breast-feeding at prenatal visits may boost breast-feeding duration and intensity, new research shows.

The American Academy of Pediatrics recommends exclusive breast-feeding for the first 6 months after birth, followed by continued breast-feeding for 1 year or more as other foods are introduced. Yet less than 75% of infants in the United States are breast-fed at all, and fewer than half are still being breast-fed at 6 months, according to the Centers for Disease Control and Prevention (CDC). Under the Affordable Care Act, private insurers must cover professional breast-feeding support without cost-sharing.

In 2 separate clinical trials, Karen Bonuck, PhD, from the Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University in New York City, and colleagues found that integrating professional LCs into routine care alone or combined with electronic prompted guidance (EP) from prenatal care providers increased breast-feeding at 3 months postpartum.

The studies were published online December 19 in the American Journal of Public Health.

In the Best Infant Nutrition for Good Outcomes (BINGO) trial, 666 primarily low-income women were randomly allocated to 1 of 4 groups: LC alone, LC+EP, EP alone, and usual care (the control group). The LC protocol included 2 prenatal sessions, a hospital visit, and regular telephone calls postpartum though age 3 months or until breast-feeding ceased.

The study team followed-up with the women periodically to assess breast-feeding "intensity," defined as the percentage of all feedings during the last 7 days that were breast milk. They defined high intensity as 80% or more of feedings involving breast milk, medium intensity as 20% to 79%, and low intensity as 19% or less.

At 3 months, high-intensity breast-feeding was greater in the LC+EP group (17.3%; odds ratio [OR], 2.72; 95% confidence interval [CI], 1.08 - 6.84) and the LC-only group (20.5%; OR, 3.22; 95% CI, 1.14 - 9.09) compared with usual care (8.1%).

In addition, women in the LC+EP group were more likely to initiate breast-feeding, do "any" breast-feeding (vs none) at 1 month, and breast-feed exclusively at 3 months postpartum compared with the control group. The EP group did not differ from the control group on any outcome.

The Provider Approaches to Improved Rates of Infant Nutrition & Growth Study (PAIRINGS) study included 275 women from more economically diverse backgrounds (compared with BINGO participants), many more of whom planned to breast-feed exclusively (62% vs 37% in BINGO).

They were randomly allocated to a usual care control group and a group receiving both the LC+EP interventions. For the PAIRINGS primary outcome of exclusive breast-feeding at 3 months, rates were significantly higher with LC+EP than usual care (16.0% vs 6.2%; OR, 2.86; 95% CI, 1.21 - 6.76).

As in BINGO, any breast-feeding and both high- and medium-intensity breast-feeding were more likely with LC+EP than usual care.

Finding Was Robust in Tough Groups

The researchers point out that black/non-Hispanic, younger, overweight and less-educated women are known to have some of the lowest rates of breast-feeding, and together, these women made up a large majority of those enrolled in the BINGO and PAIRINGS trials.

The findings were "robust in what is traditionally thought of as a difficult-to-support breast-feeding population," Dr. Bonuck noted in an interview with Medscape Medical News.

Although neither trial came close to attaining exclusive breast-feeding for 6 months, as advocated by the American Academy of Pediatrics, about 95% of women in the 2 trials at least started breast-feeding, which exceeds the goal of 82% that the CDC has proposed in its Healthy People 2020 report, Dr. Bonuck points out.

"This study is significant because it shows that integrating lactation consultants into prenatal care increases breastfeeding rates among low income racial/ethnic minority women," Tonse N.K. Raju, MD, chief of the National Institutes of Health's Pregnancy and Perinatology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in news release.

"We need additional studies to see if this and other interventions can enhance breastfeeding by these women beyond a few months," Dr. Raju added.

This research was supported by the National Institute of Child Health and Human Development and the National Institute on Minority Health and Health Disparities. The authors have disclosed no relevant financial relationships.

Am J Public Health. Published online December 20, 2013. Abstract

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