Lumbiganon Pisake, Martis Ruth, Laopaiboon Malinee, Festin Mario R, Ho Jacqueline J, Hakimi Mohammad
Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Cochrane Database Syst Rev. 2012 Sep 12(9):CD006425. doi: 10.1002/14651858.CD006425.pub3.
Breastfeeding (BF) is well recognised as the best food for infants. The impact of antenatal BF education on the duration of BF has not been evaluated.
To evaluate the effectiveness of antenatal BF education for increasing BF initiation and duration.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2011), CENTRAL (The Cochrane Library 2011, Issue 11), MEDLINE (1966 to 30 November 2011) and Scopus (January 1985 to 30 November 2011). We contacted experts and searched reference lists of retrieved articles.
All identified published, unpublished and ongoing randomised controlled trials (RCTs) assessing the effect of formal antenatal BF education or comparing two different methods of formal antenatal BF education, on duration of BF. We excluded RCTs that also included intrapartum or postpartum BF education.
We assessed all potential studies identified as a result of the search strategy. Two review authors extracted data from each included study using the agreed form and assessed risk of bias. We resolved discrepancies through discussion.
We included 19 studies with 8506 women in the review and 16 studies involving 8262 women contributed data to the analyses. We did not carry out any meta-analysis because there was only one study for each comparison.Five studies compared a single method of BF education with routine care. Peer counselling significantly increased BF initiation.Three studies compared one form of BF education versus another. No intervention was significantly more effective than another intervention in increasing initiation or duration of BF.Seven studies compared multiple methods versus a single method of BF education. Combined BF educational interventions were not significantly better than a single intervention in initiating or increasing BF duration. However, in one trial a combined BF education significantly reduced nipple pain and trauma.One study compared different combinations of interventions. There was a marginally significant increase in exclusive BF at six months in women receiving a booklet plus video plus lactation consultation (LC) compared with the booklet plus video only.Two studies compared multiple methods of BF education versus routine care. The combination of BF booklet plus video plus LC was significantly better than routine care for exclusive BF at three months.
AUTHORS' CONCLUSIONS: Because there were significant methodological limitations and the observed effect sizes were small, it is not appropriate to recommend any specific antenatal BF education.There is an urgent need to conduct RCTs with adequate power to evaluate the effectiveness of antenatal BF education.
母乳喂养被公认为是婴儿的最佳食物。产前母乳喂养教育对母乳喂养持续时间的影响尚未得到评估。
评估产前母乳喂养教育在增加母乳喂养开始率和持续时间方面的有效性。
我们检索了Cochrane妊娠与分娩组试验注册库（2011年12月2日）、Cochrane系统评价数据库（2011年第11期）、医学期刊数据库（1966年至2011年11月30日）和Scopus数据库（1985年1月至2011年11月30日）。我们联系了专家并检索了检索到文章的参考文献列表。
所有已识别的发表、未发表和正在进行的随机对照试验（RCT），评估正式产前母乳喂养教育的效果或比较两种不同的正式产前母乳喂养教育方法对母乳喂养持续时间的影响。我们排除了还包括产时或产后母乳喂养教育的RCT。
我们评估了因检索策略而识别出的所有潜在研究。两位综述作者使用商定的表格从每项纳入研究中提取数据，并评估偏倚风险。我们通过讨论解决分歧。
我们在综述中纳入了19项研究，共8506名女性，16项研究涉及8262名女性并为分析提供了数据。由于每项比较只有一项研究，我们未进行任何荟萃分析。五项研究将单一的母乳喂养教育方法与常规护理进行了比较。同伴咨询显著增加了母乳喂养的开始率。三项研究比较了一种形式的母乳喂养教育与另一种形式。在增加母乳喂养开始率或持续时间方面，没有一种干预措施比另一种干预措施显著更有效。七项研究将多种方法与单一的母乳喂养教育方法进行了比较。综合母乳喂养教育干预在开始或增加母乳喂养持续时间方面并不比单一干预显著更好。然而，在一项试验中，综合母乳喂养教育显著降低了乳头疼痛和损伤。一项研究比较了不同的干预组合。与仅接受手册加视频相比，接受手册加视频加泌乳咨询（LC）的女性在六个月时纯母乳喂养略有显著增加。两项研究将多种母乳喂养教育方法与常规护理进行了比较。母乳喂养手册加视频加LC的组合在三个月时纯母乳喂养方面显著优于常规护理。
由于存在显著的方法学局限性且观察到的效应量较小，因此不适合推荐任何特定的产前母乳喂养教育。迫切需要进行有足够效力的随机对照试验来评估产前母乳喂养教育的有效性。
