Karen Bonuck, Josephine Barnett, and Jason Fletcher are with the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY. Miriam H. Labbok is with The Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, and Alison Stuebe is with the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, and the Department of Maternal-Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Peter S. Bernstein is with the Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx.
Am J Public Health. 2014 Feb;104 Suppl 1(Suppl 1):S119-27. doi: 10.2105/AJPH.2013.301360. Epub 2013 Dec 19.
We determined the effectiveness of primary care-based, and pre- and postnatal interventions to increase breastfeeding.
We conducted 2 trials at obstetrics and gynecology practices in the Bronx, New York, from 2008 to 2011. The Provider Approaches to Improved Rates of Infant Nutrition & Growth Study (PAIRINGS) had 2 arms: usual care versus pre- and postnatal visits with a lactation consultant (LC) and electronically prompted guidance from prenatal care providers (EP). The Best Infant Nutrition for Good Outcomes (BINGO) study had 4 arms: usual care, LC alone, EP alone, or LC+EP.
In BINGO at 3 months, high intensity was greater for the LC+EP (odds ratio [OR] = 2.72; 95% confidence interval [CI] = 1.08, 6.84) and LC (OR = 3.22; 95% CI = 1.14, 9.09) groups versus usual care, but not for the EP group alone. In PAIRINGS at 3 months, intervention rates exceeded usual care (OR = 2.86; 95% CI = 1.21, 6.76); the number needed to treat to prevent 1 dyad from nonexclusive breastfeeding at 3 months was 10.3 (95% CI = 5.6, 50.7).
LCs integrated into routine care alone and combined with EP guidance from prenatal care providers increased breastfeeding intensity at 3 months postpartum.
我们旨在确定基于初级保健的、产前和产后干预措施对增加母乳喂养率的有效性。
我们于 2008 年至 2011 年在纽约布朗克斯的妇产科诊所开展了两项试验。提供者改善婴儿营养和生长率的方法研究（PAIRINGS）有两个组：常规护理与产前和产后与哺乳顾问（LC）的就诊以及产前护理提供者电子提示指导（EP）。最佳婴儿营养促进良好结局研究（BINGO）有四个组：常规护理、LC 组、EP 组或 LC+EP 组。
在 BINGO 研究中，3 个月时，LC+EP 组（优势比 [OR] = 2.72；95%置信区间 [CI] = 1.08, 6.84）和 LC 组（OR = 3.22；95% CI = 1.14, 9.09）的高强度母乳喂养率高于常规护理组，但 EP 组则不然。在 PAIRINGS 研究中，3 个月时干预组的母乳喂养率高于常规护理组（OR = 2.86；95% CI = 1.21, 6.76）；预防 1 对母婴在 3 个月时不进行纯母乳喂养的治疗人数需要 10.3（95% CI = 5.6, 50.7）。
LC 单独纳入常规护理以及与产前护理提供者的 EP 指导相结合，可增加产后 3 个月时的母乳喂养强度。
