Chung Mei, Raman Gowri, Trikalinos Thomas, Lau Joseph, Ip Stanley
Tufts-New England Medical Center Evidence-based Practice Center, Boston, Massachusetts, USA.
Ann Intern Med. 2008 Oct 21;149(8):565-82. doi: 10.7326/0003-4819-149-8-200810210-00009.
Evidence suggests that breastfeeding decreases the risk for many diseases in mothers and infants. It is therefore important to evaluate the effectiveness of breastfeeding interventions.
To systematically review evidence for the effectiveness of primary care-initiated interventions to promote breastfeeding with respect to breastfeeding and child and maternal health outcomes.
Electronic searches of MEDLINE, the Cochrane Central Register of Controlled Trials, and CINAHL from September 2001 to February 2008 and references of selected articles, restricted to English-language publications.
Randomized, controlled trials of primary care-initiated interventions to promote breastfeeding, mainly in developed countries.
Characteristics of interventions and comparators, study setting, study design, population characteristics, the proportion of infants continuing breastfeeding by different durations, and infant or maternal health outcomes were recorded.
Thirty-eight randomized, controlled trials (36 in developed countries) met eligibility criteria. In random-effects meta-analyses, breastfeeding promotion interventions in developed countries resulted in significantly increased rates of short- (1 to 3 months) and long-term (6 to 8 months) exclusive breastfeeding (rate ratios, 1.28 [95% CI, 1.11 to 1.48] and 1.44 [CI, 1.13 to 1.84], respectively). In subgroup analyses, combining pre- and postnatal breastfeeding interventions had a larger effect on increasing breastfeeding durations than either pre- or postnatal interventions alone. Furthermore, breastfeeding interventions with a component of lay support (such as peer support or peer counseling) were more effective than usual care in increasing the short-term breastfeeding rate.
Meta-analyses were limited by clinical and methodological heterogeneity. Reliable estimates for the isolated effects of each component of multicomponent interventions could not be obtained.
Evidence suggests that breastfeeding interventions are more effective than usual care in increasing short- and long-term breastfeeding rates. Combined pre- and postnatal interventions and inclusion of lay support in a multicomponent intervention may be beneficial.
有证据表明，母乳喂养可降低母亲和婴儿患多种疾病的风险。因此，评估母乳喂养干预措施的有效性很重要。
系统评价由初级保健发起的促进母乳喂养的干预措施在母乳喂养及儿童和母亲健康结局方面的有效性证据。
2001年9月至2008年2月对MEDLINE、Cochrane对照试验中心注册库和CINAHL进行电子检索，并检索所选文章的参考文献，仅限于英文出版物。
主要在发达国家进行的由初级保健发起的促进母乳喂养的随机对照试验。
记录干预措施和对照的特征、研究背景、研究设计、人群特征、不同持续时间内持续母乳喂养的婴儿比例以及婴儿或母亲的健康结局。
38项随机对照试验（36项在发达国家）符合纳入标准。在随机效应荟萃分析中，发达国家的母乳喂养促进干预措施使短期（1至3个月）和长期（6至8个月）纯母乳喂养率显著提高（率比分别为1.28[95%CI，1.11至1.48]和1.44[CI，1.13至1.84]）。在亚组分析中，产前和产后母乳喂养干预措施相结合对延长母乳喂养持续时间的影响大于单独的产前或产后干预措施。此外，包含非专业支持成分（如同伴支持或同伴咨询）的母乳喂养干预措施在提高短期母乳喂养率方面比常规护理更有效。
荟萃分析受到临床和方法学异质性的限制。无法获得多成分干预措施各成分单独效应的可靠估计值。
有证据表明，母乳喂养干预措施在提高短期和长期母乳喂养率方面比常规护理更有效。产前和产后干预措施相结合以及在多成分干预措施中纳入非专业支持可能有益。
