Abstract
BackgroundThe benefits of breastfeeding for both infants and mothers have been well recognized. However, the exclusive breastfeeding rate in China is low and decreasing. Mobile technologies have rapidly developed; communication apps such as WeChat (one of the largest social networking platforms in China) are widely used and have the potential to conveniently improve health behaviors.ObjectiveThis study aimed to assess the effectiveness of using WeChat to improve breastfeeding practices.MethodsThis 2-arm randomized controlled trial was conducted among pregnant women from May 2019 to April 2020 in Huzhu County, Qinghai Province, China. Pregnant women were eligible to participate if they were aged 18 years or older, were 11 to 37 weeks pregnant with a singleton fetus, had no known illness that could limit breastfeeding after childbirth, used WeChat through their smartphone, and had access to the internet. A total of 344 pregnant women were recruited at baseline, with 170 in the intervention group and 174 in the control group. Women in the intervention group received breastfeeding knowledge and promotion information weekly through a WeChat official account from their third month of pregnancy to 6 months postpartum. The primary outcome of exclusive and predominant breastfeeding rate was measured 0-1 month, 2-3 months, and 4-5 months postpartum.ResultsAt 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1% vs 63.3%; odds ratio [OR] 2.75, 95% CI 1.58-4.78; P<.001). Similarly, mothers in the intervention group were more likely to provide predominantly breast milk (OR 2.77, 95% CI 1.55-4.96; P<.001) and less likely to give dairy products to their children (OR 0.40, 95% CI 0.21-0.75; P=.005). There was no statistically significant difference for exclusive breastfeeding rate 2-3 months (P=.09) and 4-5 months postpartum (P=.27), though more children in the intervention group were exclusively breastfed than those in the control group 2-3 months postpartum (intervention: 111/152, 73.0%; control: 96/152, 63.2%) and 4-5 months postpartum(intervention: 50/108, 46.3%; control: 46/109, 42.2%).ConclusionsThis study is the first effort to promote exclusive breastfeeding through WeChat in China, which proved to be an effective method of promoting exclusive breastfeeding in early life. WeChat health education can be used in addition to local breastfeeding promotion programs.Trial RegistrationChinese Clinical Trial Registry ChiCTR1800017364; http://www.chictr.org.cn/showproj.aspx?proj=29325International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-7676-2
Highlights
Appropriate child feeding is the foundation for good nutritional intake and healthy development and is a critical factor for health in adults [1,2,3]
At 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1% vs 63.3%; odds ratio [OR] 2.75, 95% CI 1.58-4.78; P
We considered that late pregnancy (37 weeks or above), the first month postpartum, and 4 months postpartum were 3 key stages for mothers and that breastfeeding information needed to be strengthened during these stages, so we sent an additional 3 sets of tailored messages to each pregnant woman and mother at these stages via WeChat on Monday, Wednesday, and Friday every week
Summary
Appropriate child feeding is the foundation for good nutritional intake and healthy development and is a critical factor for health in adults [1,2,3]. As a part of optimal feeding practices, exclusive breastfeeding is recognized as a cornerstone of child survival and health, by providing essential irreplaceable nutrition for a child’s growth and development [4]. One of the WHO global nutrition targets for 2025 is increasing the exclusive breastfeeding rate in the first 6 months of life to at least 50% [4]. In China, the exclusive breastfeeding rate for under 6 months of age is a concern and achieving the 2025 global target remains an ongoing challenge. Much effort is required to explore effective ways to control this downward trend, and to promote breastfeeding in China. Results: At 0-1 month postpartum, the exclusive breastfeeding rate was significantly higher in the intervention group than that in the control group (81.1% vs 63.3%; odds ratio [OR] 2.75, 95% CI 1.58-4.78; P
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