Abstract
BackgroundDespite 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.MethodsForty-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.ResultsParticipants 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.ConclusionsMothers 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 registrationStudy 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.
Highlights
Introduction of solidsThis is the first randomized controlled trial to examine the effect of an educational intervention delivered in the prenatal period on rates of early introduction of solids
A prenatal behavioral lifestyle intervention (PBLI) delivered via GBP is feasible, acceptable to participants, and showed positive impacts such as maternal empowerment for both breastfeeding and introducing solids
Exclusive breastfeeding is recommended by the American Academy of Pediatrics (APP) for about the about six months, at which time solids can be introduced, with continued breastfeeding to 12 months or longer [1]
Summary
This is the first randomized controlled trial to examine the effect of an educational intervention delivered in the prenatal period on rates of early introduction of solids (prior to four months). Previous research indicates rates of early introduction of solids to be 24.3% in exclusively breastfed infants, 50.2% in mixed-fed infants, and 52.7% in exclusively formula fed infants [9]. These results may be explained in part by the characteristics of our sample. Meeting infant feeding recommendations is a public health priority due to the numerous benefits for both mom and infant This includes both duration and exclusivity of breastfeeding and preventing early introduction of solids. About 40.4% of infants are currently receiving solids before four months of age [9]
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