Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, UK.
BMJ. 2012 Jan 25;344:d8287. doi: 10.1136/bmj.d8287.
To examine the effect of setting, intensity, and timing of peer support on breast feeding.
Systematic review and metaregression analysis of randomised controlled trials.
Cochrane Library, Medline, CINAHL, the National Research Register, and British Nursing Index were searched from inception or from 1980 to 2011. Review methods Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Risk ratios and 95% confidence intervals were calculated for individual studies and pooled. Effects were estimated for studies grouped according to setting (high income countries, low or middle income countries, and the United Kingdom), intensity (<5 and ≥5 planned contacts), and timing of peer support (postnatal period with or without antenatal care), and analysed using metaregression for any and exclusive breast feeding at last study follow-up.
Peer support interventions had a significantly greater effect on any breast feeding in low or middle income countries (P<0.001), reducing the risk of not breast feeding at all by 30% (relative risk 0.70, 95% confidence interval 0.60 to 0.82) compared with a reduction of 7% (0.93, 0.87 to 1.00) in high income countries. Similarly, the risk of non-exclusive breast feeding decreased significantly more in low or middle income countries than in high income countries: 37% (0.63, 0.52 to 0.78) compared with 10% (0.90, 0.85 to 0.97); P=0.01. No significant effect on breast feeding was observed in UK based studies. Peer support had a greater effect on any breastfeeding rates when given at higher intensity (P=0.02) and only delivered in the postnatal period (P<0.001), although no differences were observed of its effect on exclusive breastfeeding rates by intensity or timing.
Although peer support interventions increase breastfeeding continuation in low or middle income countries, especially exclusive breast feeding, this does not seem to apply in high income countries, particularly the United Kingdom, where breastfeeding support is part of routine postnatal healthcare. Peer support of low intensity does not seem to be effective. Policy relating to provision of peer support should be based on more specific evidence on setting and any new peer services in high income countries need to undergo concurrent evaluation.
研究同伴支持的设置、强度和时间对母乳喂养的影响。
对随机对照试验进行系统评价和荟萃回归分析。
Cochrane 图书馆、Medline、CINAHL、国家研究注册处和英国护理索引从创建或从 1980 年至 2011 年进行搜索。
研究选择、数据提取和质量评估均由独立和重复进行。为个别研究计算风险比和 95%置信区间，并进行汇总。根据设置（高收入国家、低收入或中等收入国家和英国）、强度（<5 次和≥5 次计划接触）和同伴支持的时间（产后期与产前护理相结合或不结合）对研究进行分组，并使用荟萃回归分析任何和最后一次研究随访时的纯母乳喂养。
同伴支持干预措施对低收入或中等收入国家的任何母乳喂养都有显著的更大影响（P<0.001），与高收入国家相比，完全不母乳喂养的风险降低了 30%（相对风险 0.70，95%置信区间 0.60 至 0.82）。相比之下，非纯母乳喂养的风险在低收入或中等收入国家的显著降低：37%（0.63，0.52 至 0.78），而高收入国家为 10%（0.90，0.85 至 0.97）；P=0.01。英国的研究未观察到对母乳喂养的显著影响。同伴支持在更高强度时（P=0.02）和仅在产后期（P<0.001）时对任何母乳喂养率的影响更大，尽管在强度或时间方面，对纯母乳喂养率的影响没有差异。
尽管同伴支持干预措施增加了低收入或中等收入国家的母乳喂养持续时间，特别是纯母乳喂养，但这似乎不适用于高收入国家，特别是英国，在那里母乳喂养支持是常规产后保健的一部分。低强度的同伴支持似乎没有效果。有关同伴支持提供的政策应基于对特定环境和高收入国家任何新的同伴服务的更具体证据，并且需要对新的服务进行同步评估。
