Breastfeeding peer counseling does not improve exclusive breastfeeding rates in obese, low-income women

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Key study points:

  1. Breastfeeding peer counseling did not affect higher rates of exclusive breastfeeding and did not result in improvements in early breastfeeding outcomes beyond 2 weeks.
  2. Obese low-income women receiving specialized breastfeeding peer counseling achieved better early breastfeeding outcomes, including higher rates of breastfeeding at 2 weeks and lower rates of infant hospitalizations at 6 months.

Primer: Breastfeeding provides a number of benefits to both mother and child. The benefits of breastfeeding to infants include improved infant nutrition, GI function, host defense and psychological well being, as well as decreased risk for obesity. Some of these benefits are due to compounds in the breast milk itself, while others are due to the effects of mother-child bonding. Maternal benefits of breastfeeding include acceleration of uterine recovery, increased postpartum weight loss, improved stress response, and bonding. Given this data, the WHO recommends exclusive breastfeeding for the first 6 months of life. (1,2,3,4)

While rates of exclusive breastfeeding are lower than desired in many parts of the world, certain U.S. populations are particularly susceptible, including low-income women, minorities, and overweight/obese women. Studies have found that obese women are much less likely than women of normal weight to breastfeed for many reasons including anatomic and physiologic barriers, such as delayed lactogenesis and physical difficulties related to large breasts. This results in a compound risk for infants of obese mothers to become obese later in life due to an elevated baseline risk for obesity and an increased risk in infants who are not breastfed. Since low-income women are both more likely to be obese and less likely to breastfeed, they represent a vulnerable population, and are a great intervention target (3,4,5).

The present work evaluated whether a peer counseling program validated for improving breastfeeding among low-income women would also improve rates of exclusive breastfeeding and breastfeeding initiation in overweight and obese women.

Background reading:

  1. Up-to-date: Infant benefits of breastfeeding
  2. Up-to-date: Maternal and economic benefits of breastfeeding
  3. WHO: Exclusive Breastfeeding
  4. Cochrane Review: Optimal duration of exclusive breastfeeding
  5. A systematic review of maternal obesity and breastfeeding intention, initiation, and duration

This [randomized, controlled] trial: randomized obese low-income pregnant women to either an intervention group (n=76) receiving specialized breastfeeding peer counseling or a standard-of-care control group (n=78). Peer counseling encouraged exclusive breastfeeding and addressed obesity-related barriers but also involved prenatal visits, daily in-hospital support, and postpartum home visits. Infant feeding practices and health outcomes were monitored for 6 months after delivery.

There were no differences in timing of initiation of breastfeeding or in rates of exclusive breastfeeding. The intervention group had non-significant higher overall rates of breastfeeding. However, compared to controls women in the intervention group reported higher scores on the Breastfeeding Self Efficacy scale (p=0.007) and were less likely to have their infants hospitalized (p=0.03).

In sum: This is the first randomized study to address the impact of a breastfeeding peer counseling program on infant health and feeding outcomes in low-income overweight and obese women. This peer-counseling program was relatively ineffective at improving breastfeeding rates, despite previous studies that demonstrate efficacy in a comparable low-income population. This discrepancy suggests that there may be additional barriers to breastfeeding in overweight and obese women that remain to be determined. Limitations of this study included self-reported outcomes subject to recall bias and a small study population that lacks the power to detect less marked differences in outcomes.

Click to read the study in the current issue of Pediatrics

By [MS] and [LH]

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