Educación prenatal en lactancia materna para aumentar su duración
Información
- DOI:
- https://doi.org/10.1002/14651858.CD006425.pub4Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 06 diciembre 2016see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Embarazo y parto
- Copyright:
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- Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
P Lumbiganon (PL) and M Laopaiboon (ML) screened Titles and Abstracts to select potential studies. Ruth Martis (RM), Jacqueline Ho (JH) Mario Festin (MF), ML and PL selected potential studies to include or exclude. ML and PL revised data analysis, drafted the update review. All review authors approved the final version of the review.
Sources of support
Internal sources
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Khon Kaen University, Thailand.
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The University of Adelaide, Australia.
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University of Philippines, Philippines.
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Gadjah Mada University, Indonesia.
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Royal College of Medicine Perak, Malaysia.
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Penang Medical College, Malaysia.
External sources
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Thailand Research Fund (Outstanding Professor Award), Thailand.
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Wellcome Trust, UK.
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Cochrane Health Promotion and Public Health (HPPH) Field, Australia.
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Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, World Health Organization, Switzerland.
Declarations of interest
Pisake Lumbiganon: none known
Ruth Martis: A bursary from the Cochrane Health Promotion and Public Health Field was provided to support Ruth Martis to travel to a review authors meeting in Australia. The bursary was administrated by the SEA‐ORCHID project.
Malinee Laopaiboon: none known
Mario R Festin: I was employed as Medical officer and as fixed term staff from 2007 to early 2008 at the WHO and as professional staff (Lead Specialist) at the WHO HQ in Geneva from early 2009 to present. I received payment from United Laboratories Philippines from 2006 to 2007 on use of antibiotics in gynecologic surgery.
Jacqueline J Ho: none known
Mohammad Hakimi: none known
Acknowledgements
We thank staff from the Australasian Cochrane Centre for technical support. We also sincerely thank Therese Dowswell (TD) for her helpful comments and suggestions for the completion of earlier versions of this review.
The Cochrane Health Promotion and Public Health Field provided a bursary to support Ruth Martis to travel to Australia to attend a review authors' meeting during the development of this review. The bursary was administered by the SEA‐ORCHID project.
The World Health Organization and Pisake Lumbiganon and Ruth Martis and Malinee Laopaiboon and Jacqueline J Ho and Mohammad Hakimi retain copyright and all other rights in their respective contributions to the manuscript of this review as submitted for publication.
We thank Nancy Medley and Anna Cuthbert, Cochrane Pregnancy and Chilbirth, for their help with this update. This research was supported by a grant from the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, World Health Organization. The findings, interpretations and conclusions expressed in this paper are entirely those of the authors and should not be attributed in any manner whatsoever to WHO.
This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2016 Dec 06 | Antenatal breastfeeding education for increasing breastfeeding duration | Review | Pisake Lumbiganon, Ruth Martis, Malinee Laopaiboon, Mario R Festin, Jacqueline J Ho, Mohammad Hakimi | |
| 2012 Sep 12 | Antenatal breastfeeding education for increasing breastfeeding duration | Review | Pisake Lumbiganon, Ruth Martis, Malinee Laopaiboon, Mario R Festin, Jacqueline J Ho, Mohammad Hakimi | |
| 2011 Nov 09 | Antenatal breastfeeding education for increasing breastfeeding duration | Review | Pisake Lumbiganon, Ruth Martis, Malinee Laopaiboon, Mario R Festin, Jacqueline J Ho, Mohammad Hakimi | |
| 2007 Apr 18 | Antenatal breastfeeding education for increasing breastfeeding duration | Protocol | Pisake Lumbiganon, Ruth Martis, Malinee Laopaiboon, Mario R Festin, Jacqueline J Ho, Mohammad Hakimi | |
Differences between protocol and review
We added one more comparison of 'programmes involving multiple methods of providing education versus no formal education' to our subgroup analysis. We searched SCOPUS instead of Embase because our university subscribed to SCOPUS but not Embase.
Non‐prespecified outcomes
Two studies reported BF practices at time points not pre‐specified for this review. One study (Noel‐Weiss 2006) reported any BF at eight weeks and exclusive BF at eight weeks. Another study reported BF outcomes at seven days (Ryser 2004).
A 'Summary of findings' table has been incorporated in this update (2016).
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Female; Humans; Pregnancy;
PICO
Methodological quality summary: review authors' judgements about each methodological quality item for each included study
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies
Comparison 1 One type of BF education versus standard/routine care, Outcome 1 Duration of any breastfeeding.
Comparison 1 One type of BF education versus standard/routine care, Outcome 2 Any breastfeeding at 3 months.
Comparison 1 One type of BF education versus standard/routine care, Outcome 3 Any breastfeeding at 6 months.
Comparison 1 One type of BF education versus standard/routine care, Outcome 4 Exclusive breastfeeding at 3 months.
Comparison 1 One type of BF education versus standard/routine care, Outcome 5 Exclusive breastfeeding at 6 months.
Comparison 1 One type of BF education versus standard/routine care, Outcome 6 Initiation of breastfeeding.
Comparison 1 One type of BF education versus standard/routine care, Outcome 7 Initiation of BF (cluster‐randomised trial).
Comparison 1 One type of BF education versus standard/routine care, Outcome 8 Mastitis.
Comparison 1 One type of BF education versus standard/routine care, Outcome 9 Breastfeeding complication (nipple pain).
Comparison 1 One type of BF education versus standard/routine care, Outcome 10 Breastfeeding complication (nipple trauma).
Comparison 1 One type of BF education versus standard/routine care, Outcome 11 Breastfeeding problems.
Comparison 2 One type of BF education versus a different type of BF education, Outcome 1 Any breastfeeding at 3 months.
Comparison 2 One type of BF education versus a different type of BF education, Outcome 2 Any breastfeeding at 6 months.
Comparison 2 One type of BF education versus a different type of BF education, Outcome 3 Exclusive breastfeeding at 6 months.
Comparison 2 One type of BF education versus a different type of BF education, Outcome 4 Initiation of BF.
Comparison 3 Multiple methods of BF education versus a single method of BF education, Outcome 1 Duration of any breastfeeding (days).
Comparison 3 Multiple methods of BF education versus a single method of BF education, Outcome 2 Any breastfeeding at 6 months.
Comparison 4 Different combinations of multiple methods of providing BF education, Outcome 1 Any breastfeeding at 4 months (cluster‐randomised trial).
Comparison 4 Different combinations of multiple methods of providing BF education, Outcome 2 Exclusive breastfeeding at 3 months.
Comparison 4 Different combinations of multiple methods of providing BF education, Outcome 3 Exclusive breastfeeding at 6 months.
Comparison 5 Multiple methods of BF education versus standard/routine care, Outcome 1 Duration of any breastfeeding (days).
Comparison 5 Multiple methods of BF education versus standard/routine care, Outcome 2 Exclusive breastfeeding at 3 months.
Comparison 5 Multiple methods of BF education versus standard/routine care, Outcome 3 Exclusive breastfeeding at six months.
Comparison 5 Multiple methods of BF education versus standard/routine care, Outcome 4 Initiation of breastfeeding.
Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 1 Initiation of breastfeeding.
Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 2 Exclusive breastfeeding at 3 months.
Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 3 Exclusive breastfeeding at 6 months.
Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 4 Any breastfeeding at 3 months.
Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 5 Any breastfeeding at 6 months.
| BF education versus standard/routine care | ||||||
| Patient or population: pregnant women Comparison: standard/routine care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Quality of the evidence | Comments | |
| Risk with Standard/routine care | Risk with Summary of findings: One BF education | |||||
| Initiation of BF | Study population | average RR 1.01 | 3505 | ⊕⊕⊕⊕ | We have not downgraded any outcome for lack of blinding. No trial contributing data had adequate blinding of staff and participants | |
| 750 per 1000 | 758 per 1000 | |||||
| Proportion of women exclusively BF at 3 months | Study population | RR 1.06 | 822 | ⊕⊕⊕⊝ | ||
| 376 per 1000 | 398 per 1000 | |||||
| Proportion of women exclusively BF at 6 months | Study population | RR 1.07 | 2161 | ⊕⊕⊕⊝ | ||
| 154 per 1000 | 165 per 1000 | |||||
| Proportion of women any BF at 3 months | Study population | average RR 0.98 | 654 | ⊕⊕⊝⊝ | ||
| 609 per 1000 | 597 per 1000 | |||||
| Proportion of women any BF at 6 months | Study population | average RR 1.05 | 1636 | ⊕⊕⊕⊕ | ||
| 505 per 1000 | 531 per 1000 | |||||
| Breastfeeding complications | Duffy 1997 (n = 70) reported no group differences for mastitis, but less nipple pain and less nipple trauma for women who had a lactation consultant.2 Kronborg 2012 (n = 1162) reported no group differences as to whether women responded yes when asked about BF problems.3 | (2 studies) | Moderate | Both trials compared the intervention with standard care | ||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Statistical heterogeneity I² = 69% (not downgraded) 2 Downgraded for imprecision due to small sample size (‐1). 3 Downgraded for imprecision due to wide confidence intervals crossing the line of no effect (‐1). 4 Statistical heterogeneity I² = 60% (not downgraded) 5 Wide confidence intervals crossing the line of no effect and small sample size (‐2) 6 Statistical heterogeneity I² = 61% (not downgraded) | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Duration of any breastfeeding Show forest plot | 2 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1 BF education session versus standard care (weeks) | 1 | 165 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [‐2.78, 2.78] |
| 1.2 BF education session versus standard care (days) | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | 6.20 [‐10.84, 23.24] |
| 2 Any breastfeeding at 3 months Show forest plot | 2 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.1 BF education workshop versus standard care | 1 | 185 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.92, 1.24] |
| 2.2 BF education session versus standard care | 1 | 469 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.90 [0.75, 1.07] |
| 3 Any breastfeeding at 6 months Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.1 BF education workshop versus standard care | 1 | 178 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.15 [0.87, 1.51] |
| 3.2 BF practical skills versus standard care | 1 | 596 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.87, 1.17] |
| 3.3 BF attitude education versus standard care | 1 | 592 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.92 [0.79, 1.07] |
| 3.4 BF education session versus standard care | 2 | 569 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.86, 1.19] |
| 4 Exclusive breastfeeding at 3 months Show forest plot | 3 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.1 BF education workshop versus standard care | 1 | 185 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.08 [0.84, 1.38] |
| 4.2 BF education session versus standard care | 2 | 637 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.05 [0.85, 1.30] |
| 5 Exclusive breastfeeding at 6 months Show forest plot | 4 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 5.1 BF education workshop versus standard care | 1 | 178 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.13 [0.70, 1.80] |
| 5.2 BF practical skills versus standard care | 1 | 596 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.19 [0.69, 2.05] |
| 5.3 Formal BF attitude versus standard care | 1 | 592 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.16 [0.67, 2.01] |
| 5.4 BF education session versus standard care | 2 | 1094 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.80, 1.31] |
| 6 Initiation of breastfeeding Show forest plot | 7 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 6.1 BF education workshop versus standard care | 1 | 80 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.19 [0.97, 1.45] |
| 6.2 Peer counselling versus standard care | 1 | 59 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.82 [1.13, 2.93] |
| 6.3 BF practical skills versus standard care | 1 | 616 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.98, 1.04] |
| 6.4 BF attitude education versus standard care | 1 | 618 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.95, 1.02] |
| 6.5 BF education session versus standard care | 2 | 1327 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.98, 1.09] |
| 6.6 BF education video versus standard care | 1 | 346 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.80, 1.23] |
| 6.7 LC versus standard care | 1 | 144 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.33 [0.86, 2.07] |
| 7 Initiation of BF (cluster‐randomised trial) Show forest plot | 2 | Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 7.1 Peer counselling versus standard care | 1 | 2398 | Odds Ratio (Fixed, 95% CI) | 1.11 [0.86, 1.43] |
| 7.2 Group LC session versus standard care | 1 | 1249 | Odds Ratio (Fixed, 95% CI) | 1.20 [0.80, 1.80] |
| 8 Mastitis Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 8.1 LC versus standard care | 1 | 70 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.2 [0.01, 4.02] |
| 9 Breastfeeding complication (nipple pain) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 9.1 LC versus standard care | 1 | 70 | Mean Difference (IV, Fixed, 95% CI) | ‐19.8 [‐23.23, ‐16.37] |
| 10 Breastfeeding complication (nipple trauma) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 10.1 LC versus standard care | 1 | 70 | Mean Difference (IV, Fixed, 95% CI) | 38.65 [32.95, 44.35] |
| 11 Breastfeeding problems Show forest plot | 1 | 1162 | Risk Ratio (M‐H, Random, 95% CI) | 1.00 [0.70, 1.43] |
| 11.1 BF education session versus standard care | 1 | 1162 | Risk Ratio (M‐H, Random, 95% CI) | 1.00 [0.70, 1.43] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Any breastfeeding at 3 months Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 1.1 Group education versus individual education | 1 | 74 | Risk Ratio (M‐H, Fixed, 95% CI) | 2.84 [0.61, 13.18] |
| 2 Any breastfeeding at 6 months Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.1 BF practical skills versus BF attitude education | 1 | 590 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.94, 1.28] |
| 3 Exclusive breastfeeding at 6 months Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 3.1 BF practical skills versus BF attitude education | 1 | 590 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.03 [0.61, 1.73] |
| 4 Initiation of BF Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 4.1 BF practical skills versus BF attitude education | 1 | 614 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.02 [0.99, 1.06] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Duration of any breastfeeding (days) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1 BF education session plus commitment to exclusive BF versus BF education session | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | 8.0 [‐6.84, 22.84] |
| 2 Any breastfeeding at 6 months Show forest plot | 1 | Risk Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
| 2.1 Video + education session versus pamphlets | 1 | 175 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.59 [0.86, 2.94] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Any breastfeeding at 4 months (cluster‐randomised trial) Show forest plot | 1 | Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 1.1 LC + BF booklet + 24 h free LC versus BF booklet + phone number for BF questions and problems. | 1 | 698 | Odds Ratio (Fixed, 95% CI) | 0.82 [0.58, 1.16] |
| 2 Exclusive breastfeeding at 3 months Show forest plot | 2 | Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 2.1 LC + BF booklet + 24 hrs free LC versus BF booklet + phone number for BF questions and problems. | 1 | 698 | Odds Ratio (Fixed, 95% CI) | 0.79 [0.57, 1.09] |
| 2.2 BF booklet + video + LC versus BF booklet + video | 1 | 150 | Odds Ratio (Fixed, 95% CI) | 1.40 [0.70, 2.80] |
| 3 Exclusive breastfeeding at 6 months Show forest plot | 1 | Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 3.1 BF booklet + video + LC versus BF booklet + video | 1 | 169 | Odds Ratio (Fixed, 95% CI) | 2.50 [1.00, 6.25] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Duration of any breastfeeding (days) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1 BF education session plus commitment to exclusive BF versus standard care | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | 14.20 [‐2.97, 31.37] |
| 2 Exclusive breastfeeding at 3 months Show forest plot | 2 | Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 2.1 BF booklet + video + LC versus standard care | 1 | 159 | Odds Ratio (Fixed, 95% CI) | 2.60 [1.25, 5.40] |
| 2.2 BF booklet + video versus standard care | 1 | 159 | Odds Ratio (Fixed, 95% CI) | 1.80 [0.80, 4.05] |
| 2.3 Monthly BF session + weekly cell phone message versus standard care | 1 | 390 | Odds Ratio (Fixed, 95% CI) | 1.80 [1.10, 2.95] |
| 3 Exclusive breastfeeding at six months Show forest plot | 2 | Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 3.1 BF booklet + video + LC versus standard care | 1 | 175 | Odds Ratio (Fixed, 95% CI) | 2.40 [1.00, 5.76] |
| 3.2 BF booklet + video versus standard care | 1 | 184 | Odds Ratio (Fixed, 95% CI) | 0.90 [0.30, 2.70] |
| 3.3 Monthly BF session + weekly cell phone message versus standard care | 1 | 390 | Odds Ratio (Fixed, 95% CI) | 2.40 [1.40, 4.11] |
| 4 Initiation of breastfeeding Show forest plot | 1 | Odds Ratio (Fixed, 95% CI) | Subtotals only | |
| 4.1 Monthly BF session + weekly cell phone message versus standard care | 1 | 380 | Odds Ratio (Fixed, 95% CI) | 2.61 [1.61, 4.24] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Initiation of breastfeeding Show forest plot | 8 | 3505 | Risk Ratio (M‐H, Random, 95% CI) | 1.01 [0.94, 1.09] |
| 2 Exclusive breastfeeding at 3 months Show forest plot | 3 | 822 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.06 [0.90, 1.25] |
| 3 Exclusive breastfeeding at 6 months Show forest plot | 4 | 2161 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.07 [0.87, 1.30] |
| 4 Any breastfeeding at 3 months Show forest plot | 2 | 654 | Risk Ratio (M‐H, Random, 95% CI) | 0.98 [0.82, 1.18] |
| 5 Any breastfeeding at 6 months Show forest plot | 4 | 1636 | Risk Ratio (M‐H, Random, 95% CI) | 1.05 [0.90, 1.23] |
