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Referencias

Duffy 1997 {published data only}

Duffy EP, Percival P, Kershaw E. Positive effects of an antenatal group teaching session on postnatal nipple pain, nipple trauma and breast feeding rates. Midwifery 1997;13(4):189‐96. CENTRAL

Finch 2002 {published data only}

Finch C, Daniel EL. Breastfeeding education program with incentives increases exclusive breastfeeding among urban WIC participants. Journal of the American Dietetic Association 2002;102(7):981‐4. CENTRAL

Flax 2014 {published data only}

Flax V, Negerie M, Usman A, Leatherman S, Daza E, Bentley M. Nigerian women participating in an integrated microcredit and mhealth breastfeeding promotion intervention were more likely to adopt international breastfeeding recommendations. Annals of Nutrition & Metabolism 2013;63(Suppl 1):885, Abstract no: PO1294. CENTRAL
Flax VL, Negerie M, Ibrahim AU, Leatherman S, Daza EJ, Bentley ME. Integrating group counseling, cell phone messaging, and participant‐generated songs and dramas into a microcredit program increases Nigerian women’s adherence to international breastfeeding recommendations. Journal of Nutrition 2014;144:1120‐4. CENTRAL

Forster 2004 {published data only}

Forster D, McLachlan H, Lumley J, Beanland C, Waldenstrom U, Amir L. Two mid‐pregnancy interventions to increase the initiation and duration of breastfeeding: a randomized controlled trial. Birth 2004;31(3):176‐82. CENTRAL
Forster D, McLachlan H, Lumley J, Beanland C, Waldenstrom U, Harris H, et al. ABFAB. Attachment to the breast and family attitudes to breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the initiation and duration of breastfeeding: a randomised controlled trial. BMC Pregnancy Childbirth 2003;3:5. CENTRAL
Forster DA, McLachlan HL, Lumley J. Factors associated with breastfeeding at six months postpartum in a group of Australian women. International Breastfeeding Journal 2006;1:18. CENTRAL
Forster DA, McLachlan HL, Lumley J. Risk factors for early cessation of breastfeeding: results from a randomised controlled trial. Perinatal Society of Australia and New Zealand 10th Annual Congress; 2006 April 3‐6; Perth, Australia. 2006:149. CENTRAL
Forster DA, McLachlan HL, Lumley J, Beanland CJ, Waldenstrom U, Short RV, et al. ABFAB: attachment to the breast and family attitudes towards breastfeeding. The effect of breastfeeding education in the middle of pregnancy on the duration of breastfeeding: a randomised controlled trial. [abstract]. Perinatal Society of Australia and New Zealand 7th Annual Congress; 2003 March 9‐12; Tasmania, Australia. 2003:A70. CENTRAL

Kaplowitz 1983 {published data only}

Kaplowitz DD, Olson CM. The effect of an educational program on the decision to breastfeed. Journal of Nutrition Education 1983;15(2):61‐5. CENTRAL

Kellams 2016 {published data only}

Kellams AL, Gurka KK, Hornsby PP, Drake E, Riffon M, Gellerson D, et al. The impact of a prenatal education video on rates of breastfeeding initiation and exclusivity during the newborn hospital stay in a low‐income population. Journal of Human Lactation 2016;32:152‐9. CENTRAL
NCT01623128. Prenatal education video study (PEVS). clinicaltrials.gov/ct2/show/NCT01623128 Date first received: 15 June 2012. CENTRAL

Kistin 1990 {published data only}

Kistin N, Benton D, Rao S, Sullivan M. Breast‐feeding rates among black urban low‐income women: effect of prenatal education. Pediatrics 1990;86(5):741‐6. CENTRAL

Kluka 2004 {published data only}

Kluka SM. A Randomized Controlled Trial to Test the Effect of an Antenatal Educational Intervention on Breastfeeding Duration Among Primiparous Women [thesis]. Vancouver: University of British Columbia, 2004. CENTRAL

Kools 2005 {published data only}

Kools EJ, Thijs C, Kester AD, Van den Brandt PA, De Vries H. A breast‐feeding promotion and support program a randomized trial in The Netherlands. Preventive Medicine 2005;40(1):60‐70. CENTRAL

Kronborg 2012 {published data only}

Kronborg H, Maimburg RD, Vaeth M. Antenatal training to improve breast feeding: a randomised trial. Midwifery 2012;28(6):784‐90. CENTRAL

Lavender 2005 {published data only}

Lavender T. Breastfeeding: expectations versus reality. 10th International Conference of Maternity Care Researchers; 2004 June 13‐16; Lund, Sweden. 2004:12. CENTRAL
Lavender T, Baker L, Smyth R, Collins S, Spofforth A, Dey P. Breastfeeding expectations versus reality: a cluster randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 2005;112(8):1047‐53. CENTRAL

MacArthur 2009 {published data only}

MacArthur C, Jolly K, Ingram L, Freemantle N, Dennis CL, Hamburger R, et al. Antenatal peer support workers and initiation of breast feeding: cluster randomised controlled trial. BMJ 2009;338:b131. CENTRAL

Mattar 2007 {published data only}

Mattar CN, Chong YS, Chan YS, Chew A, Tan P, Chan YH, et al. Simple antenatal preparation to improve breastfeeding practice: a randomized controlled trial. Obstetrics & Gynecology 2007;109(1):73‐80. CENTRAL

Noel‐Weiss 2006 {published data only}

Noel‐Weiss J, Rupp A, Cragg B, Bassett V, Woodend AK. Randomized controlled trial to determine effects of prenatal breastfeeding workshop on maternal breastfeeding self‐efficacy and breastfeeding duration. Journal of Obstetric, Gynecologic and Neonatal Nursing 2006;35(5):616‐24. CENTRAL

Olenick 2010 {published data only}

Olenick P, Berens P. The effect of structured group prenatal education on breastfeeding confidence, duration, and exclusivity to 12 weeks postpartum. Breastfeeding Medicine 2010;5(6):334. CENTRAL
Olenick PL. The Effect of Structured Group Prenatal Education on Breastfeeding Confidence, Duration and Exclusivity to Twelve Weeks Postpartum [Dissertation]. San Francisco: Touro University, 2006. CENTRAL
Olenick PL. The effect of structured group prenatal education on breastfeeding confidence, duration and exclusivity to 12 weeks postpartum. Journal of Obstetrics, Gynecologic, and Neonatal Nursing 2010;39(Suppl S1):S104‐S105. CENTRAL
Olenick PL. The effect of structured group prenatal education on breastfeeding confidence, duration, and exclusivity to 12 weeks postpartum. Journal of Human Lactation 2011;27(1):71‐2. CENTRAL

Pate 2009 {published data only}

Pate BL. Effectiveness of Web‐based Programs in Improving Breastfeeding Self‐efficacy [PhD thesis]. Little Rock: University of Arkansas for Medical Sciences, 2009. CENTRAL

Raeisi 2014 {published data only}

Raeisi K, Shariat M, Nayeri F, Raji F, Dalili H. A single center study of the effects of trained fathers' participation in constant breastfeeding. Acta Medica Iranica 2014;52(9):694‐6. CENTRAL

Rossiter 1994 {published data only}

Rossiter JC. The effect of a culture‐specific education program to promote breastfeeding among Vietnamese women in Sydney. International Journal of Nursing Studies 1994;31(4):369‐79. CENTRAL

Ryser 2004 {published data only}

Ryser FG. Breastfeeding attitudes, intention, and initiation in low‐income women: the effect of the best start program. Journal of Human Lactation 2004;20(3):300‐5. CENTRAL

Schlickau 2005a {published data only}

Schlickau J, Wilson M. Development and testing of a prenatal breastfeeding education intervention for Hispanic women. Journal of Perinatal Education 2005;14(4):24‐35. CENTRAL

Schlickau 2005b {published data only}

Schlickau JM. Prenatal breastfeeding education: an intervention for pregnant immigrant Hispanic women [thesis]. Omaha: University of Nebraska, 2005. CENTRAL

Serwint 1996 {published data only}

Serwint JR, Wilson ME, Vogelhut JW, Repke JT, Seidel HM. A randomized controlled trial of prenatal pediatric visits for urban, low‐income families. Pediatrics 1996;98(6 Pt 1):1069‐75. CENTRAL

Wolfberg 2004 {published data only}

Wolfberg AJ, Michels KB, Shields W, O'Campo P, Bronner Y, Bienstock J. Dads as breastfeeding advocates: results from a randomized controlled trial of an educational intervention. American Journal of Obstetrics and Gynecology 2004;191(3):708‐12. CENTRAL

Wong 2014 {published data only}

NCT01648114. A randomized controlled trial of an antenatal intervention to increase exclusive breastfeeding (ABFS). clinicaltrials.gov/ct2/show/NCT01648114 Date first received: 18 July 2012. CENTRAL
Wong KL, Fong DYT, Lee ILY, Chu S, Tarrant M. Antenatal education to increase exclusive breastfeeding. A randomized controlled trial. Obstetrics & Gynecology 2014;124(5):961‐8. CENTRAL

Ahmad 2012 {published data only}

Ahmad MO, Sughra U, Kalsoom U, Imran M, Hadi U. Effect of antenatal counselling on exclusive breastfeeding. Journal of Ayub Medical College, Abbottabad: JAMC 2012;24(2):116‐9. CENTRAL

Aidam 2005 {published data only}

Aidam BA, Perez‐Escamilla R, Lartey A. Lactation counseling increases exclusive breast‐feeding rates in Ghana. Journal of Nutrition 2005;135(7):1691‐5. CENTRAL

Anderson 2005 {published data only}

Anderson AK, Damio G, Chapman DJ, Perez‐Escamilla R. Differential response to an exclusive breastfeeding peer counseling intervention: the role of ethnicity. Journal of Human Lactation 2007;23(1):16‐23. CENTRAL
Anderson AK, Damio G, Young S, Chapman DJ, Perez‐Escamilla R. A randomized trial assessing the efficacy of peer counseling on exclusive breastfeeding in a predominantly Latina low‐income community. Archives of Pediatrics and Adolescent Medicine 2005;159(9):836‐41. CENTRAL

Barlow 2006 {published data only}

Barlow A, Varipatis‐Baker E, Speakman K, Ginsburg G, Friberg I, Goklish N, et al. Home‐visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial. Archives of Pediatrics and Adolescent Medicine 2006;160(11):1101‐7. CENTRAL

Bonuck 2005 {published data only}

Bonuck KA, Freeman K, Trombley M. Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use. Archives of Pediatrics and Adolescent Medicine 2006;160(9):953‐60. CENTRAL
Bonuck KA, Trombley M, Freeman K, McKee D. Randomized, controlled trial of a prenatal and postnatal lactation consultant intervention on duration and intensity of breastfeeding up to 12 months. Pediatrics 2005;116(6):1413‐26. CENTRAL
NCT00619632. Boosting breastfeeding in low‐income, multi‐ethnic women: a primary care based RCT (BINGO). clinicaltrials.gov/ct2/show/NCT00619632 Date first received: 4 February 2008. CENTRAL

Bonuck 2013 {published data only}

Bonuck K, Stuebe A, Barnett J, Fletcher J, Bernstein P. Routine, primary‐care based interventions to increase breastfeeding : results of two randomized controlled trials. Breastfeeding Medicine 2013;8(Suppl 1):S‐19. CENTRAL

Brent 1995 {published data only}

Brent NB, Redd B, Dworetz A, D'Amico F, Greenberg JJ. Breast‐feeding in a low‐income population. Program to increase incidence and duration. Archives of Pediatrics and Adolescent Medicine1995; Vol. 149, issue 7:798‐803. CENTRAL

Caulfield 1998 {published data only}

Caulfield LE, Gross SM, Bentley ME, Bronner Y, Kessler L, Jensen J, et al. WIC‐based interventions to promote breastfeeding among African‐American Women in Baltimore: effects on breastfeeding initiation and continuation. Journal of Human Lactation 1998;14(1):15‐22. CENTRAL

Chapman 2004 {published data only}

Chapman DJ, Damio G, Young S, Perez‐Escamilla R. Effectiveness of breastfeeding peer counseling in a low‐income, predominantly Latina population: a randomized controlled trial. Archives of Pediatrics and Adolescent Medicine 2004;158(9):897‐902. CENTRAL
Chapman DJ, Perez‐Escamilla R. Acculturative type is associated with breastfeeding duration among low‐income Latinas. Maternal and Child Nutrition 2013;9(2):188‐98. CENTRAL

Chapman 2013 {published data only}

Chapman DJ, Bermudez‐Millan A, Wetzel K, Damio G, Kyer N, Young S, et al. Breastfeeding education and support trial for obese women. FASEB 2008;22:1080.4. CENTRAL
Chapman DJ, Morel K, Bermudez‐Millan A, Young S, Damio G, Perez‐Escamilla R. Breastfeeding education and support trial for overweight and obese women: a randomized trial. Pediatrics 2013;131(1):e162‐70. CENTRAL

Edwards 2013a {published data only}

Edwards C, Thullen J, Korfmacher J, Lantos D, Henson G, Hans L. Breastfeeding and complementary food: randomized trial of community doula home visiting. Pediatrics 2013;132:S160‐S166. CENTRAL

Edwards 2013b {published data only}

Edwards RA, Bickmore T, Jenkins L, Foley M, Manjourides J. Use of an interactive computer agent to support breastfeeding. Maternal & Child Health Journal 2013;17(10):1961‐8. CENTRAL

Ekstrom 2006 {published data only}

Ekstrom A, Widstrom AM, Nissen E. Does continuity of care by well‐trained breastfeeding counselors improve a mother's perception of support?. Birth 2006;33(2):123‐30. CENTRAL

Eneroth 2007 {published data only}

Eneroth H, El Arifeen S, Kabir I, Persson LA, Lonnerdal B, Hossain MB, et al. Exclusive breastfeeding and infant iron and zinc status, the MINIMat study Bangladesh [abstract]. Journal of Human Lactation 2007;23(1):79‐80. CENTRAL

Finch 2015 {published data only}

Finch M, Yoong SL, Thomson RJ, Seward K, Cooney M, Jones J, et al. A pragmatic randomised controlled trial of an implementation intervention to increase healthy eating and physical activity‐promoting policies, and practices in centre‐based childcare services: study protocol. BMJ Open 2015;5(5):e006706. CENTRAL

Gijsbers 2006 {published data only}

Gijsbers B, Mesters I, Knottnerus JA, Kester ADM, Van Schayck CP. The success of an educational program to promote exclusive breastfeeding for 6 months in families with a history of asthma: a randomized controlled trial. Pediatric Asthma 2006;19(4):214‐22. CENTRAL

Graffy 2004 {published data only}

Graffy J, Taylor J. What information, advice, and support do women want with breastfeeding?. Birth 2005;32(3):179‐86. CENTRAL
Graffy J, Taylor J, Williams A, Eldridge S. Randomised controlled trial of support from volunteer counsellors for mothers considering breast feeding. BMJ 2004;328(7430):26. CENTRAL

Grossman 1988 {published data only}

Grossman ER. Beer, breast‐feeding, and the wisdom of old wives. JAMA 1988;259(7):1016. CENTRAL

Hall 2007 {published data only}

Hall WA, Hauck Y. Getting it right: Australian primiparas' views about breastfeeding: a quasi‐experimental study. International Journal of Nursing Studies 2007;44(5):786‐95. CENTRAL

Hanafi 2014 {published data only}

Hanafi MI, Shalaby SAH, Falatah N, El‐Ammari H. Impact of health education on knowledge of, attitude to and practice of breastfeeding among women attending primary health care centres in Almadinah Almunawwarah, Kingdom of Saudi Arabia: controlled pre‐post study. Journal of Taibah University Medical Sciences 2014;9(3):187‐93. CENTRAL

Howell 2014 {published data only}

Howell EA, Bodnar‐Deren S, Balbierz A, Parides M, Bickell N. An intervention to extend breastfeeding among black and Latina mothers after delivery. American Journal of Obstetrics & Gynecology 2014;210:239.e1‐5. CENTRAL

Isselmann 2006 {published data only}

Isselmann KF, Collins B, McCoy A. A prospective efficacy trial of a brief breastfeeding promotion intervention to prevent postpartum smoking relapse. American Public Health Association 134th Annual Meeting & Exposition; 2006 Nov 4‐8; Boston, MA. 2006. CENTRAL

Jahan 2013 {published data only}

Jahan K, Roy SK, Israt S, Ferdouse K, Salam SB. Impact of nutrition education on pregnancy weight gain and birth outcome. Annals of Nutrition & Metabolism 2013;63(Suppl 1):756, Abstract no: PO1043. CENTRAL

Jenner 1988 {published data only}

Jenner S. The influence of additional information, advice and support on the success of breast feeding in working class primiparas. Child: Care, Health and Development 1988;14(5):319‐28. CENTRAL

Johnston 2001 {published data only}

Johnston SL. Associations with age at natural menopause in Blackfeet women. American Journal of Human Biology 2001;13(4):512‐20. CENTRAL

Kafatos 1991 {published data only}

Kafatos AG, Tsitoura S, Pantelakis SN, Doxiadis SA. Maternal and infant health education in a rural Greek community. Hygie 1991;10(1):32‐7. CENTRAL

Kamau‐Mbuthia 2013 {published data only}

Kamau‐Mbuthia E, Mbugua S, Webb Girard A, Kalungu S, Sarange C, Lou W, et al. Cell phone based peer counseling to support exclusive breastfeeding is associated with more frequent help and decreased breastfeeding problems. Annals of Nutrition & Metabolism 2013;63(Suppl 1):196‐7, Abstract no: O079. CENTRAL
Mbugua S, Kamau‐Mbuthia E, Webb A, Kalungu S, Sarange C, Lou W, et al. Process indicators for a randomized trial of cell phone based peer counseling to support exclusive breastfeeding in Kenya. Annals of Nutrition & Metabolism 2013;63(Suppl 1):693, Abstract no: PO905. CENTRAL
Mbugua S, Kamau‐Mbuthia E, Webb Girard A, Kalungu S, Sarange C, Lou W, et al. Process indicators for a randomized trial of cell phone based peer counseling to support exclusive breastfeeding in Kenya. Annals of Nutrition & Metabolism 2013;63(Suppl 1):751, Abstract no: PO1033. CENTRAL
Sellen D, Mbugua S, Webb Girard A, Kalungu S, Sarange C, Lou W, et al. A randomized controlled trial indicates benefits of cell phone based peer counseling to support exclusive breastfeeding in Kenya. Annals of Nutrition & Metabolism 2013;63(Suppl 1):751, Abstract no: PO1032. CENTRAL
Sellen DW, Kamau‐Mbuthia E, Mbugua S, Webb Girard AL, Lou W, Dennis CL, et al. Lessons learned in providing peer support through cell phones and group meetings to increase exclusive breastfeeing in Kenya. Proceedings of the 16th ISRHML Conference "Breastfeeding and the Use of Human Milk. Science and Practice"; 2012 September 27th ‐ October 1st; Trieste, Italy. 2012:Abstract no. A18. CENTRAL

Kimani‐Murage 2013 {published data only}

Kimani‐Murage EW, Kyobutungi C, Ezeh AC, Wekesah F, Wanjohi M, Muriuki P, et al. Effectiveness of personalised, home‐based nutritional counselling on infant feeding practices, morbidity and nutritional outcomes among infants in Nairobi slums: study protocol for a cluster randomised controlled trial. Trials [https://trialsjournal.biomedcentral.com/articles/10.1186/1745‐6215‐14‐445 accessed 26/07/16] 2013;14:445. CENTRAL

Kimani‐Murage 2015 {published data only}

Kimani‐Murage EW, Kimiywe J, Kabue M, Wekesah F, Matiri E, Muhia N, et al. Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial. Trials 2015;16(1):431. CENTRAL

Kupratakul 2010 {published data only}

Kupratakul J, Taneepanichskul S, Voramongkol N, Phupong V. A randomized controlled trial of knowledge sharing practice with empowerment strategies in pregnant women to improve exclusive breastfeeding during the first six months postpartum. Journal of the Medical Association of Thailand 2010;93(9):1009‐18. CENTRAL

Loh 1997 {published data only}

Loh NR, Kelleher CC, Long S, Loftus BG. Can we increase breast feeding rates?. Irish Medical Journal 1997;90(3):100‐1. CENTRAL

Mattar 2003 {published data only}

Mattar CN. Breastfeeding: it's an important gift. Journal of Obstetrics and Gynaecology 2003;102(6):1414. CENTRAL

Memmott 2006 {published data only}

Memmott MM, Bonuck KA. Mother's reactions to a skills‐based breastfeeding promotion intervention. Maternal & Child Nutrition 2006;2(1):40‐50. CENTRAL

Moore 2007 {published data only}

Moore SE, Prentice AM, Coward WA, Wright A, Frongillo EA, Fulford AJ, et al. Use of stable‐isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling. American Journal of Clinical Nutrition 2007;85(4):1075‐82. CENTRAL

Morrow 1999 {published data only}

Morrow AL, Guerrero ML, Shults JJ, Lutter CJ, Ruiz‐Palacios G, Morrow RC, et al. Efficacy of home‐based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 1999;353(9160):1226‐31. CENTRAL

Muirhead 2006 {published data only}

Muirhead PE, Butcher G, Rankin J, Munley A. The effect of a programme of organised and supervised peer support on the initiation and duration of breastfeeding: a randomised trial. British Journal of General Practice 2006;56(524):191‐7. CENTRAL

NCT01383070 {published data only}

CTRI/2011/06/001822. Effectiveness of cell phone counseling to improve breast feeding indicators. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=3060 Date first received: 21 June 2011. CENTRAL
NCT01383070. Effectiveness of cell phone counseling to improve breast feeding indicators. clinicaltrials.gov/ct2/show/NCT01383070 Date first received: 24 June 2011. CENTRAL

Nekavand 2014 {published data only}

Nekavand M, Hoorsan R, Kerami A, Zohoor A. Effect of exclusive breast feeding education on breast‐feeding self‐efficacy and maternal stress. Research Journal of Obstetrics and Gynecology 2014;7(1):1‐5. CENTRAL

Ochola 2013a {published data only}

Ochola A, Labadarios D, Nduati W. Impact of counselling on exclusive breast‐feeding practices in a poor urban setting in Kenya: a randomized controlled trial. Public Health Nutrition 2013;16(10):1732‐40. CENTRAL

Ochola 2013b {published data only}

Ochola S, Demetre L, Nduati R. Potentials and barriers to exclusive breastfeeding among women in an urban low‐resource setting in Nairobi, Kenya: a qualitative study. Annals of Nutrition & Metabolism 2013;63(Suppl 1):808, Abstract no: PO3318. CENTRAL

Otsuka 2014 {published data only}

Otsuka K, Kitamura T, Jimba M. Can breastfeeding enhance maternal‐infant bonding?. Breastfeeding Medicine 2012;7(Suppl 1):S‐7. CENTRAL
Otsuka K, Taguri M, Dennis CL, Wakutani K, Awano M, Yamaguchi T, et al. Effectiveness of a breastfeeding self‐efficacy intervention: do hospital practices make a difference?. Maternal & Child Health Journal 2014;18(1):296‐306. CENTRAL

Petrova 2009 {published data only}

Petrova A, Ayers C, Stechna S, Gerling JA, Mehta R. Effectiveness of exclusive breastfeeding promotion in low‐income mothers: a randomized controlled study. Breastfeeding Medicine 2009;4(2):63‐9. CENTRAL

Rea 1999 {published data only}

Rea MF, Venancio SI. Assessment of the breastfeeding counselling course WHO/UNICEF. Jornal de Pediatria 1999;75(2):112‐8. CENTRAL

Redman 1995 {published data only}

Redman S, Watkins J, Evans L, Lloyd D. Evaluation of an Australian intervention to encourage breast feeding in primiparous women. Health Promotion International 1995;10(2):101‐13. CENTRAL

Reeve 2004 {published data only}

Reeve JR, Gull SE, Johnson MH, Hunter S, Streather M. A preliminary study on the use of experiential learning to support women's choices about infant feeding. European Journal of Obstetrics & Gynecology and Reproductive Biology2004; Vol. 113, issue 2:199‐203. CENTRAL

Reifsnider 1997 {published data only}

Reifsnider E, Eckhart D. Prenatal breastfeeding education: its effect on breastfeeding among WIC participants. Journal of Human Lactation 1997;13(2):121‐5. CENTRAL

Ross 1983 {published data only}

Ross SM, Loening WE, Van Middelkoop A. Breast‐feeding ‐ evaluation of a health education programme. South African Medical Journal 1983;64(10):361‐3. CENTRAL

Sandy 2009 {published data only}

Sandy JM, Anisfeld E, Ramirez E. Effects of a prenatal intervention on breastfeeding initiation rates in a Latina immigrant sample. Journal of Human Lactation 2009;25(4):404‐11. CENTRAL

Sciacca 1995 {published data only}

Sciacca JP, Dube DA, Phipps BL, Ratliff MI. A breast feeding education and promotion program: effects on knowledge, attitudes, and support for breast feeding. Journal of Community Health 1995;20(6):473‐90. CENTRAL
Sciacca JP, Phipps BL, Dube DA, Ratliff MI. Influences on breast‐feeding by lower‐income women: an incentive‐based, partner‐supported educational program. Journal of the American Dietetic Association1995; Vol. 95, issue 3:323‐8. CENTRAL

Spinelli 2013 {published data only}

Spinelli MG, Endicott J, Goetz RR. Increased breastfeeding rates in black women after a treatment intervention. Breastfeeding Medicine 2013;8(6):479‐84. CENTRAL

Srinivas 2015 {published data only}

Srinivas GL, Benson M, Worley S, Schulte E. A clinic‐based breastfeeding peer counselor intervention in an urban, low‐income population: interaction with breastfeeding attitude. Journal of Human Lactation 2015;31(1):120‐8. CENTRAL
Srinivas GL, Worley S. Effect of office‐based peer counselor on breastfeeding rates in an urban low‐income clinic. Pediatric Academic Societies Annual Meeting; 2013 May 4‐7; Washington DC, USA. 2013. CENTRAL

Stockdale 2008 {published data only}

Stockdale J, Sinclair M, Kernohan G, Keller JM, Dunwoody L, Cunningham JB, et al. Feasibility study to test Designer Breastfeeding: a randomised controlled trial. Evidence Based Midwifery 2008;6(3):76‐82. CENTRAL

Stuebe 2016 {published data only}

Stuebe AM, Bonuck K, Adatorwovor R, Schwartz TA, Berry D. A tailored breastfeeding support intervention for women with gestational diabetes. American Journal of Obstetrics and Gynecology 2016;214(1 Suppl):S68, Abstract no: 97. CENTRAL

Su 2007 {published data only}

Su LL, Chong YS, Chan YH, Chan YS, Fok D, Tun KT, et al. Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial. BMJ 2007;335(7620):596. CENTRAL

Taddei 2000 {published data only}

Taddei JA, Westphal MF, Venancio S, Bogus C, Souza S. Breastfeeding training for health professionals and resultant changes in breastfeeding duration. Sao Paulo Medical Journal. Revista Paulista de Medicina 2000;118:185‐91. CENTRAL

Uauy 2013 {published data only}

Uauy R. Diet, physical activity and breastfeeding intervention on maternal nutrition, offspring growth and development. clinicaltrials.gov/ct2/show/NCT01916603 Date first received: 4 July 2013. [NCT01916603]CENTRAL

Walkup 2009 {published data only}

Walkup JT, Barlow A, Mullany BC, Pan W, Goklish N, Hasting R, et al. Randomized controlled trial of a paraprofessional‐delivered in‐home intervention for young reservation‐based American Indian mothers. Journal of the American Academy of Child & Adolescent Psychiatry 2009;48(6):591‐601. CENTRAL

Waller 1946 {published data only}

Waller H. The early failure of breast feeding. Archives of Disease in Childhood 1946;21:1‐12. CENTRAL

Wambach 2009 {published data only}

Wambach K, Rojjanasrirat W, Williams Domian E, Aaronson L, Breedlove G, Yeh HW. Effects of a peer counselor and lactation consultant on breastfeeding initiation and duration. Journal of Human Lactation 2009;25(1):101‐2. CENTRAL

Webb 2013 {published data only}

Webb Girard A, Kamau‐Mbuthia E, Mbugua S, Kalungu S, Sarange C, Lou W, et al. Infant medication, illness and growth in a randomized controlled trial of exclusive breastfeeding support in Kenya. Annals of Nutrition & Metabolism 2013;63(Suppl 1):752, Abstract no: PO1034. CENTRAL

Wen 2011 {published data only}

Wen LM, Baur LA, Rissel C, Simpson JM. A randomized controlled trial of an early intervention on childhood obesity: results from the first 12 months. Obesity (Silver Spring, Md.) 2011;19(Suppl 1):S67. CENTRAL

Westdahl 2008 {published data only}

Westdahl CM, Kershaw T, Schindler‐Rising S, Ickovics J. Group prenatal care improves breastfeeding initiation and duration: results from a two‐site randomized controlled trial. Journal of Human Lactation 2008;24(1):96‐7. CENTRAL

Westphal 1995 {published data only}

Westphal MF, Taddei JAC, Venancio SI, Bogus CM. Breast‐feeding training for health professionals and resultant institutional changes. Bulletin of the World Health Organization 1995;73(4):461‐8. CENTRAL

Wiles 1984 {published data only}

Wiles LS. The effect of prenatal breastfeeding education on breastfeeding success and maternal perception of the infant. Journal of Obstetric, Gynecologic and Neonatal Nursing 1984;13(4):253‐7. CENTRAL

Wockel 2009 {published data only}

Wockel A, Abou‐Dakn M. Influence of the partner on breastfeeding duration and breast diseases during lactation. Results of an intervention study [Einfluss des partners auf stilldauer und stillprobleme. Ergebnisse einer interventionsstudie]. Gynakologische Praxis 2009;33(4):643‐9. CENTRAL
Wockel A, Abou‐Dakn M. Influence of the partner on breastfeeding duration and breast diseases during lactation. Results of an intervention study [Einfluss des partners auf stilldauer und stillprobleme. Ergebnisse einer interventionsstudie]. Padiatrische Praxis 2011;77(1):125‐31. CENTRAL

Bahri 2013 {published data only}

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Duffy 1997

Methods

RCT. Using a sealed envelope containing group allocation in blocks of 12, with 6 in the control and 6 in the experimental group. Random assignment was carried out by the lactation consultant giving the educational session.                                             

Participants

Number of women randomised: 75

Inclusion criteria
Attended antenatal classes in the study hospital, and intended to BF
Verbal and written explanation was given
Explained the completely voluntary and confidential nature of the study

Exclusion criteria

Delivered less than 37 weeks
With medical complications

Interventions

Experimental group (n = 37)

An additional 1‐h teaching session for nulliparas more than 36 weeks pregnant. The teaching intervention was through a lactation consultant, not involved in the data collection. The content of the teaching session was correct positioning and attachment of the baby on the breast for feeding.

Control  group (n = 38)

Standard educational programme of the study hospital

Outcomes

Outcome measures (dichotomous)

Primary

  1. Incidence of BF at 6 weeks postpartum

Secondary

  1. Mastitis

Outcome measures (continuous)  

Primary

  1. LATCH score

Secondary

  1. Nipple pain (VAS)

  2. Nipple trauma (NTI score)

Notes

Loss of participants to follow‐up: < 10%
Blinding: outcome assessors
This study was conducted in Western Australia

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Unclear risk

Sealed envelope (not described whether it was opaque or not)

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Only outcome assessors

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

No details available

Selective reporting (reporting bias)

Unclear risk

No information

Other bias

Low risk

No other obvious biases

Finch 2002

Methods

RCT

Participants

Number of women randomised: 60

Inclusion criteria                                           

English speaking, pregnant, HIV negative women

Exclusion criteria

Not specified

Interventions

Experimental group (n = 30)

BF education by trained LC, incentive, instruction and discussion with handout

Control group (n = 30)

Prenatal educational regarding benefit and barriers to BF

Outcomes

  1. Duration of BF

  2. Feeding intentions

Notes

This study was conducted in New York, USA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

No information available

Allocation concealment (selection bias)

Unclear risk

No information available

Blinding of participants and personnel (performance bias)
All outcomes

Unclear risk

No information available

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

No information available

Incomplete outcome data (attrition bias)
All outcomes

High risk

Loss to follow‐up in intervention group 36.7% (11/30), in control group 3.3% (1/30)

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

Flax 2014

Methods

Cluster‐RCT

Participants

Setting: microcredit meetings, Bauchi state, Nigeria, Africa

77 microcredit meeting groups with 461 pregnant women, aged 15‐45 years, attending monthly microcredit meetings for 7‐10 months

39 meeting groups including 229 women were randomised to receive the monthly group BF learning sessions

38 meeting groups including 232 women were randomised to receive standard microcredit group meeting with no BF learning sessions

Interventions

Experimental group (229 women)

Monthly group BF learning sessions including weekly cell phone BF text and voice messages to cell phone provided to each small microcredit group and monthly face‐to‐face BF information during microcredit monthly meeting. Information given included: exclusive BF to 6 months; initiation of BF within 1 h of birth; giving only breast milk not fluids during the first 3 days of life for 7‐10 months The messages were generated via songs and dramas by participants

Adult learning techniques and participatory principles used with 1‐3 key messages each session including counselling cards for the intervention

Control group (232 women)

Women in the control clusters received only standard microcredit group meeting with no BF interventions

Outcomes

  1. Exclusive BF to 1, 3, and 6 months

  2. Initiation of BF within 1 h of delivery

  3. Use of only colostrum or breast milk during the first 3 d of life

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Block randomisation, process not described, other than it happened at the level of the monthly community meeting (clusters)

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described, but highly unlikely that blinding was possible

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Baseline and final survey interviews were conducted by an independent team of trained data collectors unaware of the clients' study arm assignment

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Eligible clients (n = 229 intervention, n = 232 control) were in the randomised meeting groups. At follow‐up, 196 (86%) and 194 (84%) clients remained in the intervention and control arms, respectively

Selective reporting (reporting bias)

Low risk

Pre‐specified outcomes were published and reported on

Other bias

Low risk

No other obvious biases

Forster 2004

Methods

RCT

Random allocation to a control group or 1 or 2 intervention groups, randomised by an external computerised system accessed by telephone by a research midwife

Participants

Number of women randomised: 984

Inclusion criteria
Women booked as public patients. Women who were primiparas. Women pregnant between 16 and 24 weeks. Women able to read and write in English

Exclusion criteria
Women with physical problems that prevented BF. Women who chose private obstetric care. Women choosing to give birth at birth centre

Interventions

Experimental group

Group 1 (n = 327): 1.5‐h session on practical BF using teaching aids. Latch‐on technique demonstrated with dolls and knitted breasts, also BF complications and management. Plus access standard care available

Group 2 (n = 329): two 1‐h sessions that focused on changing attitudes to BF. Women were encouraged to bring their partners or a significant other. Session 1 included information about BF advantages, views and attitudes of participants, their friends and families and society. For session 2, participants were encouraged to interview their own mother or her partner’s mother about attitudes of BF, which then was reflected and discussed in this session. Access standard care available

Control  group (n = 328)

Able to access standard care, which included formal BF education sessions etc

Outcomes

Duration of any BF at 2‐4 d, excluded babies not yet feeding.

Duration of  exclusive BF at 2‐4 days, excluded babies yet not feeding

Number of mothers any BF at 6 months

Number of mothers exclusive BF at 6 months

Notes

Loss of participants to follow‐up and reasons: < 10%

Blinding: unclear

Intention‐to‐treat analysis: used

Each intervention group was compared only with the group of women allocated to standard care; they were not compared with each other

For this review we have presented separate intervention groups in Comparison 1; where we have totals in the analysis in Comparison 6 we have split the control group between the intervention arms

Study was conducted in Melbourne, Australia

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"A computerized system of biased urn randomisation was accessed by telephone by the research midwife to ascertain women’s group allocation."

Allocation concealment (selection bias)

Low risk

"A computerized system of biased urn randomisation was accessed by telephone by the research midwife to ascertain women’s group allocation."

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described, but very unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Low risk

The follow‐up rate in practical skill, attitudes, standard care we re 91%, 90% and 91%, respectively

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

Kaplowitz 1983

Methods

RCT

Participants

44 consecutive women from 2 upstate New York Women, Infants and Children (WIC) programmes, at least 18 years old, in 4th to 6th month of pregnancy, primigravida or women who had bottle‐fed previous children or who previously had an unsuccessful BF experience were randomly assigned to experimental (21 women) or control (23 women) groups.

Interventions

Experimental group (21 women)

5 pamphlets providing information on the benefits of BF, basic physiology of lactation, proper nursing technique were mailed to the women's homes 1 at a time over 5 consecutive weeks.

Control group (23 women)

Did not receive pamphlets

Outcomes

  1. Women's knowledge about nursing after the intervention

  2. Attitude toward BF before and after the intervention

These outcomes were not relevant to the review objective.

Notes

This study was conducted in New York.
No information about BF practice available

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described, but unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Not described

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Unclear risk

Inadequate information

Kellams 2016

Methods

RCT

Participants

Setting: At 4 participating prenatal clinics between the University of Virginia (UVA) Health System and the Virginia Commonwealth University (VCU) Health System, Virginia in the USA from 2009 to 2012

Inclusion criteria

Pregnant women of 24‐41 weeks' gestation who were WIC‐eligible (income of 185% or less of the federal poverty income guidelines)

Exclusion criteria

Women with multiple‐gestation pregnancy, any known contraindication to BF (e.g. HIV infection, drug use, or receipt of chemotherapy), or their primary language was not English

Total numbers of 522 eligible pregnant women were enrolled (459 at UVA, 63 at VCU). No information of how many randomised women of each group was reported

Interventions

Experimental group

A 25‐min educational BF video (Better Breastfeeding, Injoy Productions, 2008) provided general information about BF, including importance, latch, hunger cues, positioning, sore nipples, engorgement, how breast milk is made, and lifestyle issues.

Total number analysed: 249

Control/Comparison intervention

A 20‐min educational video about nutrition during pregnancy (Healthy

Pregnancy Nutrition, Injoy Productions, 2007). It covered topics including healthy diet and the importance of exercise during pregnancy.

Total number analysed: 248

Outcomes

Breastfeeding initiation

Time of first feeding

Any infant complication (hypoglycaemia, rule‐out sepsis, hypothermia, transient tachypnoea of the newborn, other breathing problems, cardiac problem, hyperbilirubinaemia, and others.) Unlikely to be related to the intervention. Also for maternal complications.

Infant length of stay in newborn nursery only and never NICU and/or intermediate care Nursery (ICN)

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

A computer‐generated block randomisation sequence using random block sizes, stratified by prenatal clinic, was used.

Allocation concealment (selection bias)

Low risk

One member of the study team with no direct contact with participants prepared all of the consecutively‐numbered, sealed, opaque envelopes, which the research assistant opened just prior to loading the video for the participant to view.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described, but highly unlikely that blinding was possible

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Research assistants abstracting data were blinded to the group to which the participant was assigned.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Eligible women were 1580, 522 were randomised but there was no information of assigned number to each group. Analysis was done in 497 women (249 in intervention and 248 in control) account for 95% of the randomised women

However, BF outcomes were analysed in 346 (70%; 174/249 for intervention and 69%; 172/248 for control) These were only those who gave BF

Selective reporting (reporting bias)

Low risk

Pre‐specified outcomes were published and reported on.

Other bias

Low risk

No other obvious biases

Kistin 1990

Methods

RCT

Women in Monday clinic were randomised with a random number table into 2 intervention groups.

Friday clinic became control group (not randomised, therefore data could not be used, both intervention groups data could be compared, as they were randomised)

Participants

Number of women randomised: 74

Inclusion criteria                                  

Women 24 weeks' gestation or less
Black women born in the USA

Exclusion criteria

None mentioned

Interventions

2 types of prenatal education. Individual BF and antenatal BF class

Experimental groups

Intervention group 1 (38 women): antenatal group BF class, 50‐80 min, at least 1 session discussing myths, problems and benefits of BF

Intervention group 2 (36 women): individual pre‐counselling with a nurse practitioner or paediatrician, one‐to‐one, 15‐30 minutes, between 30‐40 weeks' gestation, similar topics discussed in IG1

Control  group

Normal antenatal care. No additional information but not randomised, therefore data were excluded, and not included in our analysis.

Outcomes

  1. Duration of any BF 2 weeks

  2. Duration of any BF 6 weeks

  3. Any BF at 3 months

Notes

Loss of participants to follow‐up: 18.2%
Blinding: participants; no, counsellors; not feasible, outcome assessors; not clear
Intention‐to‐treat analysis: not clear
This study was conducted in Chicago, USA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Table of random numbers was used

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described, but highly unlikely

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Not enough information

Selective reporting (reporting bias)

Unclear risk

Information not available

Other bias

Low risk

No other obvious biases

Kluka 2004

Methods

RCT

Participants

Number of women randomised: 209

Inclusion criteria                                  

Primiparous women who were planning to BF their infants.

Exclusion criteria

None mentioned

Interventions

Experimental group: 111 women

Usual care plus a self‐assessment pre‐workshop guide and an interactive, educational, antenatal workshop.

Control  group: 98 women

Usual care

Outcomes

BF at 3 and 6 months

Notes

This study was conducted in Canada

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Low risk

Opaque sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not feasible to blind

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Outcome assessors

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Comparable loss to follow‐up (< 20% at 6 months in both arms)

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

Kools 2005

Methods

Cluster randomisation of 10 home healthcare centres. Coin flip determined which centres would receive intervention

Clusters had comparable overall pre‐randomisation rates and sizes

Participants

Number of women randomised: 781

Inclusion criteria                                                             

Women considering BF
All pregnant women using the identified 3 home healthcare organisations and from their 10 centres
Women pregnant in their 7th month of pregnancy

Exclusion criteria

Women with babies weighing < 2000 g

Interventions

Experimental group

408 women received standard care and BF booklet, which was used and referred to by caregiver at each consultation (which included practical instructions on BF, discussion around how to cope with BF, motivational discussion to initiate and maintain BF and additional information if asked for). Opportunity to access 24‐hour free lactation consultant

Control  group

373 received standard antenatal care and BF booklet and phone number for BF questions or BF problems

Outcomes

  1. Number of mothers any BF at birth

  2. Number of mothers BF exclusively at birth

  3. Number of mothers any BF at 3 months

  4. Number of mothers exclusive BF at 3 months

Notes

Loss of participants to follow‐up: < 10%
Blinding: participants; no, others unclear
Intention‐to‐treat analysis: used
This study was conducted in Maastricht, Netherlands

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Coin flip

Allocation concealment (selection bias)

Unclear risk

Coin flip was used

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described.Not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Not described. Not blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Minimal loss to follow‐up in experimental group and no loss to follow‐up in control group

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

Kronborg 2012

Methods

RCT

Participants

Number of women randomised: 1193

Inclusion criteria

1193 nulliparous women were recruited before week 21 + 6 days of gestation, 603 were randomised to the intervention group, and 590 to the reference group. The inclusion criteria were nullipara registered at the Aarhus Midwifery Clinic, older than 18 years of age at enrolment,with a singleton pregnancy, and the ability to speak and understand Danish.

Interventions

Experimental group

Structured antenatal training programme for 9 h attended in mid‐pregnancy

Control group

Usual practice (no antenatal training)

Outcomes

  1. Initiation of BF

  2. BF at 6 weeks and 1 year

Notes

This study was conducted in Denmark

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "Randomisation was assigned by one staff midwife using computer voice response system. Randomisation was through an algorithm generated by a data manager. Ratio of 1:1."

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described, not possible

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Postnatal midwives (personnel) were blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

16 out of 603 and 15 out of 590 women in the intervention and reference groups were lost to follow‐up respectively

Selective reporting (reporting bias)

Low risk

Reported all outcomes as presented in methods

Other bias

Low risk

Baseline characteristics were quite comparable between intervention and reference groups. No other obvious biases

Lavender 2005

Methods

Cluster‐RCT

Unit of randomisation:  8 electoral wards in 1 county, pairs were matched according to Jarman Underprivileged area score (UPA)

Within‐pair randomised = 4 clusters each

Opaque sealed envelopes

Participants

Number of women randomised: 1312

Inclusion criteria                                                         
Women registered with a practice site/GP in one of the 8 electoral wards
Women who expressed a desire to BF
Women with no detected foetal abnormality at 20‐week ultrasound

Exclusion criteria

Women with detected foetal abnormality
Women who gave birth before 36 weeks' gestation
Women who lived in potentially unsafe homes
Women who planned to bottle feed
Women who had previously BF for at least 6 weeks

Interventions

1 antenatal BF education session with the woman’s attending community midwife. Midwives were trained for this intervention

Experimental group (n = 633)

Normal antenatal care plus during third trimester attendance of a single antenatal BF education session. Each session involved up to 8 women and was facilitated by a qualified infant feeding co‐ordinator

Control group (n = 679)

Received standard antenatal care that included BF advice from attending clinic midwives

Outcomes

  1. Number of mothers any BF at hospital discharge

  2. Number of mothers any BF at 2 weeks

  3. Number of mothers any BF at 4 weeks

  4. Number of mothers any BFat 6 weeks

  5. Number of mothers any BF at 4 months

  6. Number of mothers exclusive BF at 4 months

  7. Number of mothers any BF at 6 months

  8. Number of mothers any BF at 12 months

Notes

Loss of participants to follow‐up: < 10%
Blinding: participants: not feasible, counsellors: no, outcome assessors: yes
Intention‐to‐treat analysis: used
This study was conducted in northwest UK

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Low risk

Opaque sealed envelopes were used

Blinding of participants and personnel (performance bias)
All outcomes

High risk

The intervention was not feasible to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Outcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up < 10% in both arms

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

MacArthur 2009

Methods

Cluster‐RCT

Participants

66 antenatal clinics with 2511 pregnant women

33 clinics including 1140 women were randomised to receive the peer support worker service.

33 clinics including 1371 women were randomised to receive standard care.

Interventions

Intervention group (1140 women)

An antenatal peer support worker service planning a minimum of 2 contacts with women to provide advice, information, and support from approximately 24 weeks’ gestation within the antenatal clinic or at home. The trained peer support workers were of similar ethnic and socio‐demographic backgrounds to their clinic population.

Control group (1371 women)

Women in the control clusters received standard antenatal care, which included usual information and advice from midwives on BF without input from community peer support workers.

Outcomes

Initiation of BF obtained from computerised maternity records of the hospitals where women from the primary care trust delivered

Notes

This study was conducted in Birmingham, UK

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

The intervention was not feasible to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Data on outcome were supplied to the research team in an anonymous format

Incomplete outcome data (attrition bias)
All outcomes

Low risk

113 out of 2511 women (4.5%) who participated in the trial were not available for primary outcome assessment

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

Mattar 2007

Methods

Cluster‐RCT

A computer‐generated list was used to randomise the women into the 3 groups. Each woman was allocated to the intervention group next on the list after written informed consent had been obtained.    

Singapore           

Participants

Number of women randomised: 401

Inclusion criteria

Singleton pregnancy, gestation of at least 36 weeks at recruitment, no uterine scar, and the absence of any obstetric complication that would contraindicate vaginal delivery, with informed consent.

Exclusion criteria

Not described

Interventions

Multiple versus single

Experimental group

Group A (n = 123): received an information booklet describing the techniques and benefits of BF, which was written and published by the hospital’s BF support group. It contained practical advice on feeding techniques, expressing breast milk, and management of common BF problems. Participants also watched a 16‐min educational video entitled “14 Steps to Better BF” (InJoy Videos, Boulder, CO), in which the benefits of BF were introduced, correct positioning, latch‐on, and breast care were demonstrated, and common concerns (such as nipple pain) discussed. In addition, each woman had one 15‐minute session with a lactation counsellor who examined the woman’s nipples to assess adequacy for BF and answered questions on BF.

Group B (n = 132) received the same booklet and watched the same video but did not have an individual session with the lactation counsellor.

Control  group Group C (n = 146)

Did not watch the video, and did not have counselling. The primary report stated that the control group did not receive the booklet, video or counselling (Mattar 2007 p. 74)

All women in all randomised groups had standard care during pregnancy, including access to postnatal BF support.

Outcomes

  1. Number of mothers BF at 3 months

  2. Number of mothers BF at 6 months

Notes

Loss of participants to follow‐up: 10%
Blinding: only outcome assessor
Intention‐to‐treat analysis addressed: yes
This study was conducted in Singapore

Comparison 4 includes the 2 treatment arms A and B

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Computer‐generated list

Allocation concealment (selection bias)

Low risk

Each woman was allocated to the intervention group next on the list after written informed consent had been obtained.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

The intervention was not feasible to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Outcome assessors were blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up 10%

Selective reporting (reporting bias)

Unclear risk

Information not available

Other bias

Low risk

No other obvious biases

Noel‐Weiss 2006

Methods

RCT

Participants

Number of women randomised: 101

inclusion criteria

Nulliparous women expecting a single child, an uncomplicated birth, and planning to BF The women had to read and write in English and have a telephone to complete the postpartum questionnaires. To remain in the study, a mother and her infant had to be discharged at the same time and be able to BF without restriction.

Exclusion criteria

Not described

Interventions

Workshop

Experimental group (n = 47)

Standard care plus a 2.5‐h prenatal BF workshop designed using Bandura's theory of self‐efficacy and adult learning principles. The intervention involved the use of lifelike dolls, videos, and discussion in a comfortable atmosphere.

Control  group (n = 45)

Standard care

Outcomes

  1. Maternal BF self‐efficacy

  2. BF duration measured at 4 weeks and 8 weeks postpartum

Notes

This study was conducted in Ontario, Canada

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Information not available

Allocation concealment (selection bias)

Low risk

Used sealed, sequentially numbered, opaque envelope containing a slip of paper stating either Control or Workshop

Blinding of participants and personnel (performance bias)
All outcomes

High risk

The intervention was not feasible to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

Only outcome evaluators

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Analysed the data with both the intention‐to‐treat assumption and using the actual workshop attendance. 101 randomised and 92 were available for analysis

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Other bias

Low risk

No other obvious biases

Olenick 2010

Methods

RCT

Participants

Number of women randomised: 182

Inclusion criteria

Pregnant women enrolled for prenatal care at 24 weeks (or beyond) who consented to participate.

Exclusion criteria

Age < 18 years, stated intention to bottle‐feed with formula, non‐English speaking, those for whom BF was medically contraindicated, those whose newborns would be anticipated to be incapable of BF, no access to telephone for follow‐up and those who were not planning to keep or raise their baby.

Interventions

Experimental group

2‐h BF self‐efficacy theory‐based class (86 women)

Control group

No class (96 women)

Outcomes

  1. BF duration

  2. BF exclusivity and confidence through 12 weeks

Notes

This trial was conducted in Texas, USA.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not feasible to blind

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Quote "A research assistant was used for all postpartum data collection by phone. Although she did have access to the information regarding the subjects’ group assignment, she did not refer to this information when doing the phone interviews, in effect blinding her to their status. In this way, there was greater objectivity both by the interviewer and the interviewee."

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Quote "The overall dropout rate was 7.7%."

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No obvious baseline differences and other biases

Pate 2009

Methods

RCT in parallel arms

Participants

Setting: Arkansas department of Health USA

Inclusion criteria

Primiparous pregnant women on WIC with an expected due date greater than 2 months post‐enrolment, ages of 20 and 30, have access to email and the Internet and provide written consent to participate to completion.

Exclusion Criteria

Women identified as substance abusers on their ADH WIC‐5 record, received WIC in counties served by BF peer counsellors and BF contraindicated for any of the following reasons:

  1. takes street drugs or does not control alcohol use;

  2. has an infant with galactosaemia;

  3. has human immunodeficiency virus (HIV) infection;

  4. has active, untreated tuberculosis;

  5. takes certain medications that are contraindicated for BF;

  6. currently undergoing treatment for breast cancer.

145 pregnant women on WIC were screened by Health Department nutritionists for eligibility and willingness to participate in the study. 23 participants completed consent and pre‐test forms, were randomly assigned to groups, and participated in the study.

Interventions

Experimental group

6 weeks of peer counsellor‐guided web‐based education and support related to BF practices. In addition, the usual care of nursing and nutrition visits at the health department local health unit and written materials per Arkansas Department of Health (ADH) policy and procedure guidelines were given to the participants.

Control group

Usual care consisted of non‐web‐based interventions, such as face‐to‐face counselling and education and the distribution of written materials.

Outcomes

Breastfeeding self‐efficacy

None of our pre‐specified outcomes were reported

Notes

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Eligible subjects were randomly assigned to either the intervention group or the control group using a computer‐generated 2‐block random number generator in a 1:1 ratio.

Allocation concealment (selection bias)

Unclear risk

As above

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Intervention could not be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

No information available

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Data on all participants who were randomly assigned was analysed in the groups to which they were allocated on an intention‐to‐treat basis.

Selective reporting (reporting bias)

Low risk

Pre‐specified outcomes were published and reported

Other bias

Unclear risk

No information available

Raeisi 2014

Methods

Single‐centre RCT

Participants

100 pregnant women and their partners randomised

Inclusion criteria

Women in the second trimester of pregnancy with no underlying disease or pregnancy complication.

Exclusion criteria

No details given

Interventions

Intervention group

The case group was provided with an educational package on promoting fathers’ participation. They attended 3 training sessions where they were trained by brochures.

Control group

Given no intervention

Outcomes

  1. Birth weight

  2. Weight gain during the first 6 months

  3. Jaundice

  4. Duration of BF

  5. Spouse’s level of awareness

Notes

Trial conducted at family health research centre in Tehran, Iran

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"Randomization was performed according to the table of random numbers."

Allocation concealment (selection bias)

Unclear risk

No details given

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described but very unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Results presented as text (no tables) but appears all data for all participants reported

Selective reporting (reporting bias)

Low risk

All outcomes reported and published

Other bias

Low risk

No other obvious biases

Rossiter 1994

Methods

RCT, did not describe how randomisation was done

Participants

Number of women randomised: convenience sample of 194 pregnant women

Inclusion criteria

  1. Ethnic Vietnamese or other women who were born and reared in Vietnam.

  2. Vietnamese speaking

  3. At least 12 weeks pregnant

  4. Gave consent to participate

Exclusion criteria

Unforeseen circumstances (miscarriage, stillbirth, change of address)

Interventions

Culture and language‐specific educational programme

Experimental group

A 25‐min videotape programme followed by a series of 3 x 2 h of small group discussion sessions conducted in Vietnamese.

Control group

BF and childbirth pamphlets

Outcomes

  1. Number of mothers BFat birth

  2. Number of mothers BF at 4 weeks

  3. Number of mothers BF at 6 months

Notes

Loss of participants to follow‐up: < 10%

Blinding:
Participant: not feasible
Clinician: unclear
Outcome assessor: unclear

Intention‐to‐treat analysis: unclear

This study was conducted in Sydney, Australia.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described but highly unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Loss to follow‐up < 10% in both arms

Selective reporting (reporting bias)

Unclear risk

Information not available

Other bias

Low risk

No other obvious biases

Ryser 2004

Methods

RCT

Participants

Total number of women randomised: 54

Pregnant women, at least 18 years old, English speaking, able to read and write, received prenatal care and could attend 4 visits before delivery, low income, having access to telephone, undecided about BF method during initial contact with researchers

Interventions

Intervention group (26 women)

Educational program (Best Start) included:

  1. counselling session

  2. viewing video

  3. written materials addressing common BF barriers perceived by low‐income women

Control group (28 women)

No exposure to the programme

Outcomes

  1. Attitude toward BF

  2. Social and professional support

  3. BF sense of control

  4. Intention to BF

  5. BF at 7 days delivery

Notes

This study was conducted in Houston, Texas, USA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Unclear risk

Women selected a sealed envelope. No information about envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described, unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Low risk

No loss to follow‐up

Selective reporting (reporting bias)

Unclear risk

No protocol was available

Other bias

Low risk

No other obvious biases

Schlickau 2005a

Methods

RCT. Method of randomisation was not described

Participants

Number of women randomised: 30

Inclusion criteria

Low‐risk primigravida, Hispanic, in their third trimester, received care at Sedgwick, not planning to work outside the home for 6 months.

Exclusion criteria

Not described

Interventions

Prenatal BF education

Experimental group

Level 1: the researcher approached the expectant mother. All participants confirmed that they planned to BF. Contents included benefits of BF. Charts and pictures were used to present supply‐and‐demand concept and prenatal breast preparation. Early and consistent BF practices were emphasised. A doll was used as a model for instruction about holding and positioning the baby and BF discreetly.

Level 2: completed first level. Participants were introduced the concept of “baby quarantine” ( nothing enters the baby’s mouth except the mother’s breast for at least 40 days after birth. The benefits of avoiding bottles, pacifier and supplementation to promote establishment of milk for successful BF were reinforced. BF commitment was encouraged through the use of checklist

Control group

Standard care offered advice to BF and handouts were distributed during the initial prenatal visit

Outcomes

  1. Number of mothers BF at 45 days

  2. Duration of any BF

Notes

Loss of participants to follow‐up: 17%.

This study was conducted in Kansas, USA.

Schlickau 2005b is a thesis which included three parts:

Part 1) Qualitative study

Part 2) Multiple arm study of 30 women with a control group, a BF workshop (level 1), and a BF workshop with introduction to concept of 'baby quarantine' (level 2). Part 2 is reported in Schlickau 2005a.

Part 3) 86 women randomised to either control or BF education workshop.

Part 3 results are presented under Schlickau 2005b. Part 2 results are presented under Schlickau 2005a.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described but unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Loss of participants to follow‐up: 17%

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Unclear risk

Not enough information

Schlickau 2005b

Methods

RCT

Participants

Number of women randomised: 86

Inclusion criteria

Primigravida, immigrant Hispanic women aged 15‐45 , 32‐36 weeks' gestation, stable family situation, had a work situation compatible with BF for 6 weeks, had normal nipple assessment

Exclusion criteria

Homeless, not in a temporary agencies or shelter, high‐risk pregnancies, serious illness of the newborn or mother that precluded BF, stillbirth, unforeseen family situation

Interventions

Prenatal BF education

Experimental group (44)

BF education workshop

Control group (42)

Standard care

Outcomes

  1. Initiation of BF

  2. Duration of any BF

Notes

This study was conducted in Kansas, USA.

Schlickau 2005b is a thesis which included three parts:

Part 1) Qualitative study

Part 2) Multiple arm study of 30 women with a control group, a BF workshop (level 1), and a BF workshop with introduction to concept of 'baby quarantine' (level 2). Part 2 is reported in Schlickau 2005a.

Part 3) 86 women randomised to either control or BF education workshop.

Part 3 results are presented under Schlickau 2005b. Part 2 results are presented under Schlickau 2005a.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Low risk

Manila packet sealed envelopes

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described but unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up in intervention group (9.1%, 2/44), in control group (9.5 %, 4/42)

Selective reporting (reporting bias)

Unclear risk

Protocol not available

Other bias

Low risk

No other obvious biases

Serwint 1996

Methods

RCT. Random number table was used. Method of randomisation (allocation) was not described.

Participants

Number of women randomised: 156

Nulliparous women, 18 years or older, with a foetus of gestational age of 28 weeks or less, who had not yet selected a paediatrician or wanted their infants to receive paediatric care at the hospital‐based paediatric clinic

Interventions

LC plus standard BF education (81 women) versus standard BF education (75 women)

Outcomes

  1. Number of mothers who initiated BF at birth

  2. Number of mothers BF at 30 days

  3. Number of mothers BF at  60 days

Notes

This study was conducted in Baltimore, USA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Random number table was used

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described but unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Loss to follow‐up 7.7%

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

Wolfberg 2004

Methods

RCT. Method of randomisation was not described

Participants

Number randomised: not clear (59 couples completed study)

567 expectant mothers were approached during 1st and 2nd trimester, refused to participate 24%; lost during prenatal period 36%; lack of involvement with father 8%; fathers refusal to participate 11%; fathers’ failure after enrolling 9%, completed the study with 59 couples

Inclusion criteria

Women who sought prenatal care in the resident and faculty practices at Johns Hopkins Hospital

Exclusion criteria

Not described

Interventions

Classroom discussion on infant care and BF for expectant fathers

Experimental group (27 fathers)

Groups of 4‐12 expectant fathers attending the classroom with open discussion about BF and support each other to be advocates for BF among fathers in the groups, facilitated by a man who was himself a father. 2‐h classes used a variety of teaching media were held approximately every 2 weeks

Control group (32 fathers)

The class covered topics related to infant care and safety only using the same facilitator, and methods of interactive and informal education as of those the intervention group. These subjects did not receive the intervention class that contained the BF content.

Outcomes

  1. Number of mothers for initiated BF

  2. Number of mothers BF at  4 weeks

  3. Number of mothers BF at  6 weeks

  4. Number of mothers BF at  8 weeks

Notes

Loss of participants to follow‐up: 36%

Blinding:
Participant: not feasible
Clinician: unclear
Outcome assessor: unclear

Intention‐to‐treat analysis: not used

This study was conducted in Baltimore, USA

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Unclear risk

Not described

Allocation concealment (selection bias)

Unclear risk

Not described

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Not described but unlikely to be blinded

Blinding of outcome assessment (detection bias)
All outcomes

Unclear risk

Not described

Incomplete outcome data (attrition bias)
All outcomes

High risk

Loss to follow‐up 36%

Selective reporting (reporting bias)

Unclear risk

No information available

Other bias

Low risk

No other obvious biases

Wong 2014

Methods

RCT

Participants

Setting: 2 study hospitals based on the geographic representativeness and high volume of eligible mothers in Hong Kong

Inclusion criteria: pregnant women with 1) 18 years of age or older; 2) Cantonese‐speaking; 3) primiparous; 4) at least 35 weeks of gestation; 5) a singleton pregnancy; 6) no serious medical or obstetric complications; 7) intending to breastfeed; and 8) planning to stay in Hong Kong for at least 6 months after delivery

Exclusion criteria: being not entitled to health benefits in Hong Kong, not a Hong Kong resident, or both

Recruitment period: Jan‐June 2013

Follow‐up completed: Dec 2013

Total numbers of 469 eligible pregnant women were enrolled and randomised (233 to intervention and 236 to standard care)

Interventions

Experimental group (233 women)

Standard care plus one‐to‐one (20‐30 min) BF education and support session based on WHO guideline for baby‐friendly hospitals and evidence‐based maternity care. The intervention was given immediately after randomisation in a private room in the antenatal clinics to minimise contamination between the two treatment groups.

Control group (236 women)

Standard antenatal care: standard maternal and foetal health checks by either clinic midwives or obstetricians along with health education to promote a healthy pregnancy.

Outcomes

Exclusive BF at 6 weeks, 3 and 6 months postpartum.

Overall duration of any and exclusive BF (age in weeks when the infant first ingested formula and ceased BF completely, respectively) across the first 6 months postpartum.

Notes

This study was conducted in Hong Kong.

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

An independent researcher who did not participate in participant recruitment or data collection generated the allocation sequence using the statistical software Stata13.1.

Allocation concealment (selection bias)

Low risk

Allocation sequences were kept in sequentially numbered, opaque, sealed envelopes. The research nurse opened up the next envelope in the sequence to determine the assigned group after a pregnant woman had agreed to participate and had signed the written consent form.

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Blinding of the research nurse or the participants was not possible given the nature of the intervention.

Blinding of outcome assessment (detection bias)
All outcomes

Low risk

The BF follow‐up data were collected by a research assistant who was blinded to the participants’ group allocation.

Incomplete outcome data (attrition bias)
All outcomes

Low risk

443 (94.5% of 469), 222 (95.3% of 233) in intervention and 221 (93.6% of 236)in standard care, completed all follow‐up to 6 months postpartum or until weaned.

Selective reporting (reporting bias)

Low risk

Pre‐specified outcomes were published and reported on.

Other bias

Low risk

Comparable baseline characteristics between intervention and standard care groups presented

BF: breastfeeding
LC: lactation consultation
NTI: nipple trauma index
RCT: randomised controlled trial
VAS: visual analogue scale

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Ahmad 2012

Not RCT

Aidam 2005

Not only antenatal BF education. 9 home visits were provided in the 6‐month postpartum period.

Anderson 2005

Not only antenatal BF education. Peer counsellors also gave postpartum visits.

Barlow 2006

Not only antenatal BF education. Home visits extended to 6 months postpartum.

Bonuck 2005

Not only antenatal BF education. Lactation consultants also made postpartum hospital or home visits.

Bonuck 2013

Included both pre and postnatal interventions.

Brent 1995

Not only antenatal BF education. Lactation consultants provided support in the postpartum period and until infants up to 1 year of age.

Caulfield 1998

Not only antenatal BF education. Peer counsellors followed up women in the postpartum period as long as they continued to breastfeed.

Chapman 2004

Not only antenatal BF education. Peer counselling extended to postpartum period.

Chapman 2013

Included both pre and postnatal interventions

Edwards 2013a

Not only antenatal BF education. Doula home visits extended to postpartum period.

Edwards 2013b

Animated computer agent used prenatally during a third trimester office visit and perinatally at discharge from the hospital plus usual care. The perinatal dialogue, delivered in the hospital, focused on essential information that mothers need the most in their first 3 days of BF (‘‘breastfeeding 101’’). The perinatal dialogue also focused on addressing the most commonly asked questions by new BF mothers and motivating adherence to the CDC‐recommended 6 months of exclusive BF goal.

Ekstrom 2006

Not only antenatal BF education. Support was also provided at 3‐day, 3‐month and 9‐month postpartum.

Eneroth 2007

Not RCT, objective not relevant

Finch 2015

Not related to BF

Gijsbers 2006

Not only antenatal BF education; a home visit was also provided postnatally.

Graffy 2004

Not only antenatal BF education. Lactation counsellors provided postnatal support by telephone or home visits.

Grossman 1988

Not RCT (letter to editor commenting on non‐RCT papers).

Hall 2007

Not RCT

Hanafi 2014

Not RCT

Howell 2014

Post‐natal interventions

Isselmann 2006

Intervention was not antepartum BF education

Jahan 2013

Nutritional education not BF education

Jenner 1988

Not RCT

Johnston 2001

Not RCT

Kafatos 1991

Not only antenatal BF education. Home visits continued after delivery until the infant was 12 months

Kamau‐Mbuthia 2013

Included pregnant and post‐partum women and 3‐month postpartum intervention

Kimani‐Murage 2013

Not antenatal BF education (only protocol)

Kimani‐Murage 2015

Included both pre and postnatal interventions

(Only protocol)

Kupratakul 2010

Not only antenatal BF education. Document on BF was provided, that affects BF behaviour of postpartum mothers.

Loh 1997

Not RCT

Mattar 2003

Not RCT (letter to editor with comments on non‐RCT papers).

Memmott 2006

Not RCT

Moore 2007

Not RCT, did not evaluate antenatal BF education

Morrow 1999

Not only prenatal BF education intervention. Peer counsellors also visited mothers at 1st, 2nd, 4th and 8th week postpartum.

Muirhead 2006

Not only prenatal BF education intervention. Peer supporters provided support up to 16 weeks postpartum.

NCT01383070

Not only prenatal BF education intervention. Counseling during the antenatal period, at delivery and during the immunisation visits.

Nekavand 2014

Postnatal education intervention

Ochola 2013a

Included postnatal intervention

Ochola 2013b

Not RCT

Otsuka 2014

Not RCT

Petrova 2009

Not only prenatal BF education intervention. Lactation consultant also provided support postnatally.

Rea 1999

Participants were not pregnant women.

Redman 1995

Not only antenatal BF educational intervention. Lactation counsellors also visited women after delivery.

Reeve 2004

Not RCT

Reifsnider 1997

Not RCT (systematic assignment)

Ross 1983

Not RCT

Sandy 2009

Not only antenatal BF education. Following the birth of a prenatally enrolled target child, the Family Support Workers (FSW) typically made a visit to the newborn’s mother in the hospital. During this visit, the FSW assisted programme group mothers with any problems initiating BF. After hospital discharge, FSWs continued to offer programme group mothers information and support in the home on a weekly basis.

Sciacca 1995

Not only antenatal BF education. BF incentives were given pre and postnatally.

Spinelli 2013

Not RCT of antenatal BF education.

Srinivas 2015

Peer counsellor, the intervention was performed at pre and post delivery.

Stockdale 2008

Included antenatal and postnatal interventions.

Stuebe 2016

Included antenatal and postnatal interventions.

Su 2007

Not only antenatal BF education. Lactation support was also provided in the postpartum period.

Taddei 2000

Participants were not pregnant women. They were health professionals.

Uauy 2013

Not yet recruited

Walkup 2009

Not only antenatal BF education. Paraprofessional delivered home visit education during the postpartum period.

Waller 1946

Not RCT

Wambach 2009

Not only antenatal BF education. Lactation consultant and peer counselling extended through 4 weeks postpartum.

Webb 2013

Included antenatal and postnatal interventions.

Wen 2011

Not antenatal BF education.

Westdahl 2008

Intervention was not antenatal BF education.

Westphal 1995

Participants were not pregnant women.

Wiles 1984

Not RCT

Wockel 2009

Participants were not pregnant women.

BF: breastfeeding
RCT: randomised controlled trial

Characteristics of studies awaiting assessment [ordered by study ID]

Bahri 2013

Methods

Participants

Interventions

Outcomes

Notes

Awaiting translation

Bastani 2009

Methods

Participants

Interventions

Outcomes

Notes

Awaiting translation

BF: breastfeeding

Characteristics of ongoing studies [ordered by study ID]

Maycock 2015

Trial name or title

A study to prolong BF duration: design and rationale of the Parent Infant Feeding Initiative (PIFI) randomised controlled trial

Methods

Four‐arm, factorial randomised controlled trial of partners of pregnant women

Participants

Male partners of pregnant women

Interventions

Control group (CG) ‐ usual care

Medium intensity intervention 1 (MI1) ‐ specialised antenatal classes for partners with supporting printed materials

Medium intensity intervention 2 (MI2) ‐ antenatal and postnatal social support delivered via smartphone application (exclude‐ involves postnatal intervention)

High intensity intervention ‐ specialised antenatal classes and antenatal and postnatal social support delivered via smartphone application (exclude‐ involves postnatal intervention)

Outcomes

Primary outcomes
Duration of any BF
Duration of exclusive BF
Secondary outcomes
Age of introduction of formula
Age of introduction of complementary
foods (‘solids’)
Infant feeding attitudes of both partners.
Maternal BF self‐efficacy

Starting date

Contact information

[email protected]
School of Public Health, Curtin University, GPO Box U1987, Perth 6845, Australia
Collaboration for Evidence, Research and Impact in Public Health (CERIPH), Curtin University, Perth, Australia

Notes

Data and analyses

Open in table viewer
Comparison 1. One type of BF education versus standard/routine care

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

Analysis 1.1

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 1 Duration of any breastfeeding.

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

Analysis 1.2

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 2 Any breastfeeding at 3 months.

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

Analysis 1.3

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 3 Any breastfeeding at 6 months.

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

Analysis 1.4

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 4 Exclusive breastfeeding at 3 months.

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

Analysis 1.5

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 5 Exclusive breastfeeding at 6 months.

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

Analysis 1.6

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 6 Initiation of breastfeeding.

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

Analysis 1.7

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 7 Initiation of BF (cluster‐randomised trial).

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

Analysis 1.8

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 8 Mastitis.

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

Analysis 1.9

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 9 Breastfeeding complication (nipple pain).

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

Analysis 1.10

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 10 Breastfeeding complication (nipple trauma).

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]

Analysis 1.11

Comparison 1 One type of BF education versus standard/routine care, Outcome 11 Breastfeeding problems.

Comparison 1 One type of BF education versus standard/routine care, Outcome 11 Breastfeeding problems.

11.1 BF education session versus standard care

1

1162

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.70, 1.43]

Open in table viewer
Comparison 2. One type of BF education versus a different type of BF education

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

Analysis 2.1

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 1 Any breastfeeding at 3 months.

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

Analysis 2.2

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 2 Any breastfeeding at 6 months.

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

Analysis 2.3

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 3 Exclusive breastfeeding at 6 months.

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

Analysis 2.4

Comparison 2 One type of BF education versus a different type of BF education, Outcome 4 Initiation of BF.

Comparison 2 One type of BF education versus a different type of BF education, Outcome 4 Initiation of BF.

4.1 BF practical skills versus BF attitude education

1

614

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.99, 1.06]

Open in table viewer
Comparison 3. Multiple methods of BF education versus a single method of BF education

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

Analysis 3.1

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 1 Duration of any breastfeeding (days).

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

Analysis 3.2

Comparison 3 Multiple methods of BF education versus a single method of BF education, Outcome 2 Any breastfeeding at 6 months.

Comparison 3 Multiple methods of BF education versus a single method of BF education, Outcome 2 Any breastfeeding at 6 months.

2.1 Video + education session versus pamphlets

1

175

Risk Ratio (M‐H, Fixed, 95% CI)

1.59 [0.86, 2.94]

Open in table viewer
Comparison 4. Different combinations of multiple methods of providing BF education

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

Analysis 4.1

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 1 Any breastfeeding at 4 months (cluster‐randomised trial).

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

Analysis 4.2

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 2 Exclusive breastfeeding at 3 months.

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

Analysis 4.3

Comparison 4 Different combinations of multiple methods of providing BF education, Outcome 3 Exclusive breastfeeding at 6 months.

Comparison 4 Different combinations of multiple methods of providing BF education, Outcome 3 Exclusive breastfeeding at 6 months.

3.1 BF booklet + video + LC versus BF booklet + video

1

169

Odds Ratio (Fixed, 95% CI)

2.50 [1.00, 6.25]

Open in table viewer
Comparison 5. Multiple methods of BF education versus standard/routine care

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

Analysis 5.1

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 1 Duration of any breastfeeding (days).

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

Analysis 5.2

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 2 Exclusive breastfeeding at 3 months.

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

Analysis 5.3

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 3 Exclusive breastfeeding at six months.

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

Analysis 5.4

Comparison 5 Multiple methods of BF education versus standard/routine care, Outcome 4 Initiation of breastfeeding.

Comparison 5 Multiple methods of BF education versus standard/routine care, Outcome 4 Initiation of breastfeeding.

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]

Open in table viewer
Comparison 6. Summary of findings: one type of BF education versus standard/routine care

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]

Analysis 6.1

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 1 Initiation of breastfeeding.

2 Exclusive breastfeeding at 3 months Show forest plot

3

822

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.90, 1.25]

Analysis 6.2

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 2 Exclusive breastfeeding at 3 months.

3 Exclusive breastfeeding at 6 months Show forest plot

4

2161

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.87, 1.30]

Analysis 6.3

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 3 Exclusive breastfeeding at 6 months.

4 Any breastfeeding at 3 months Show forest plot

2

654

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.82, 1.18]

Analysis 6.4

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 4 Any breastfeeding at 3 months.

5 Any breastfeeding at 6 months Show forest plot

4

1636

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.90, 1.23]

Analysis 6.5

Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 5 Any breastfeeding at 6 months.

Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 5 Any breastfeeding at 6 months.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study
Figuras y tablas -
Figure 1

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
Figuras y tablas -
Figure 2

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.
Figuras y tablas -
Analysis 1.1

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.
Figuras y tablas -
Analysis 1.2

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.
Figuras y tablas -
Analysis 1.3

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.
Figuras y tablas -
Analysis 1.4

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.
Figuras y tablas -
Analysis 1.5

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.
Figuras y tablas -
Analysis 1.6

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).
Figuras y tablas -
Analysis 1.7

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.
Figuras y tablas -
Analysis 1.8

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).
Figuras y tablas -
Analysis 1.9

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).
Figuras y tablas -
Analysis 1.10

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.
Figuras y tablas -
Analysis 1.11

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.
Figuras y tablas -
Analysis 2.1

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.
Figuras y tablas -
Analysis 2.2

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.
Figuras y tablas -
Analysis 2.3

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.
Figuras y tablas -
Analysis 2.4

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).
Figuras y tablas -
Analysis 3.1

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.
Figuras y tablas -
Analysis 3.2

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).
Figuras y tablas -
Analysis 4.1

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.
Figuras y tablas -
Analysis 4.2

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.
Figuras y tablas -
Analysis 4.3

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).
Figuras y tablas -
Analysis 5.1

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.
Figuras y tablas -
Analysis 5.2

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.
Figuras y tablas -
Analysis 5.3

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.
Figuras y tablas -
Analysis 5.4

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.
Figuras y tablas -
Analysis 6.1

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.
Figuras y tablas -
Analysis 6.2

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.
Figuras y tablas -
Analysis 6.3

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.
Figuras y tablas -
Analysis 6.4

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.
Figuras y tablas -
Analysis 6.5

Comparison 6 Summary of findings: one type of BF education versus standard/routine care, Outcome 5 Any breastfeeding at 6 months.

Summary of findings for the main comparison. Antenatal breastfeeding (BF) education versus standard care

BF education versus standard/routine care

Patient or population: pregnant women
Setting: outpatient antenatal care at hospitals and clinics in Australia, Canada, Denmark, Hong Kong, Singapore, UK and USA
Intervention: any antenatal BF education

Comparison: standard/routine care

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with Standard/routine care

Risk with Summary of findings: One BF education

Initiation of BF

Study population

average RR 1.01
(0.94 to 1.90)

3505
(8 RCTs)

⊕⊕⊕⊕
HIGH 1

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
(705 to 818)

Proportion of women exclusively BF at 3 months

Study population

RR 1.06
(0.90 to 1.25)

822
(3 RCTs)

⊕⊕⊕⊝
MODERATE 2

376 per 1000

398 per 1000
(338 to 470)

Proportion of women exclusively BF at 6 months

Study population

RR 1.07
(0.87 to 1.30)

2161
(4 RCTs)

⊕⊕⊕⊝
MODERATE 3

154 per 1000

165 per 1000
(134 to 201)

Proportion of women any BF at 3 months

Study population

average RR 0.98
(0.82 to 1.18)

654
(2 RCTs)

⊕⊕⊝⊝
LOW 4 5

609 per 1000

597 per 1000
(500 to 719)

Proportion of women any BF at 6 months

Study population

average RR 1.05
(0.90 to 1.23)

1636
(4 RCTs)

⊕⊕⊕⊕
HIGH6

505 per 1000

531 per 1000
(455 to 621)

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).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

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)

Figuras y tablas -
Summary of findings for the main comparison. Antenatal breastfeeding (BF) education versus standard care
Comparison 1. One type of BF education versus standard/routine care

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]

Figuras y tablas -
Comparison 1. One type of BF education versus standard/routine care
Comparison 2. One type of BF education versus a different type of BF education

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]

Figuras y tablas -
Comparison 2. One type of BF education versus a different type of BF education
Comparison 3. Multiple methods of BF education versus a single method of BF education

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]

Figuras y tablas -
Comparison 3. Multiple methods of BF education versus a single method of BF education
Comparison 4. Different combinations of multiple methods of providing BF education

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]

Figuras y tablas -
Comparison 4. Different combinations of multiple methods of providing BF education
Comparison 5. Multiple methods of BF education versus standard/routine care

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]

Figuras y tablas -
Comparison 5. Multiple methods of BF education versus standard/routine care
Comparison 6. Summary of findings: one type of BF education versus standard/routine care

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]

Figuras y tablas -
Comparison 6. Summary of findings: one type of BF education versus standard/routine care