MacArthur Christine, Jolly Kate, Ingram Lucy, Freemantle Nick, Dennis Cindy-Lee, Hamburger Ros, Brown Julia, Chambers Jackie, Khan Khalid
School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT.
BMJ. 2009 Jan 30;338:b131. doi: 10.1136/bmj.b131.
To assess the effectiveness of an antenatal service using community based breastfeeding peer support workers on initiation of breast feeding.
Cluster randomised controlled trial.
Community antenatal clinics in one primary care trust in a multiethnic, deprived population.
66 antenatal clinics with 2511 pregnant women: 33 clinics including 1140 women were randomised to receive the peer support worker service and 33 clinics including 1371 women were randomised to receive standard care.
An antenatal peer support worker service planned to comprise a minimum of two 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 sociodemographic backgrounds to their clinic population.
Initiation of breast feeding obtained from computerised maternity records of the hospitals where women from the primary care trust delivered.
The sample was multiethnic, with only 9.4% of women being white British, and 70% were in the lowest 10th for deprivation. Most of the contacts with peer support workers took place in the antenatal clinics. Data on initiation of breast feeding were obtained for 2398 of 2511 (95.5%) women (1083/1140 intervention and 1315/1371 controls). The groups did not differ for initiation of breast feeding: 69.0% (747/1083) in the intervention group and 68.1% (896/1315) in the control groups; cluster adjusted odds ratio 1.11 (95% confidence interval 0.87 to 1.43). Ethnicity, parity, and mode of delivery independently predicted initiation of breast feeding, but randomisation to the peer support worker service did not.
A universal service for initiation of breast feeding using peer support workers provided within antenatal clinics serving a multiethnic, deprived population was ineffective in increasing initiation rates.
Current Controlled Trials ISRCTN16126175.
评估利用社区母乳喂养同伴支持工作者的产前服务对母乳喂养启动的有效性。
整群随机对照试验。
在一个多民族、贫困人群的一个初级保健信托机构中的社区产前诊所。
66家产前诊所的2511名孕妇：33家诊所（包括1140名妇女）被随机分配接受同伴支持工作者服务，33家诊所（包括1371名妇女）被随机分配接受标准护理。
一项产前同伴支持工作者服务计划包括与妇女至少进行两次接触，在产前诊所或家中从大约妊娠24周起提供建议、信息和支持。经过培训的同伴支持工作者与她们诊所的人群具有相似的种族和社会人口学背景。
从初级保健信托机构的妇女分娩所在医院的计算机化产科记录中获取母乳喂养的启动情况。
样本是多民族的，只有9.4%的妇女是英国白人，70%处于贫困程度最低的十分之一。与同伴支持工作者的大多数接触发生在产前诊所。在2511名妇女中的2398名（95.5%）（干预组1083名/1140名，对照组1315名/1371名）获得了母乳喂养启动的数据。两组在母乳喂养启动方面没有差异：干预组为69.0%（747/1083），对照组为68.1%（896/1315）；整群调整优势比为1.11（95%置信区间0.87至1.43）。种族、产次和分娩方式独立预测母乳喂养的启动，但随机分配到同伴支持工作者服务组则没有这种情况。
在为多民族、贫困人群服务 的产前诊所内利用同伴支持工作者开展的普遍母乳喂养启动服务在提高启动率方面无效。
当前对照试验ISRCTN16126175 。
