School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
Cancer Australia, Surry Hills, NSW, 2010, Australia.
Int Breastfeed J. 2020 Dec 1;15(1):102. doi: 10.1186/s13006-020-00340-6.
Exclusive breastfeeding rates in many high-income countries are considerably lower than the World Health Organization recommendations. Younger mothers are less likely than older mothers to exclusively breastfeed or to exclusively breastfeed for a long duration. This systematic review explores interventions to increase the rate of exclusive breastfeeding among young mothers in high-income countries.
A systematic search of the following databases was completed in August 2020: CINAHL, PubMed, MEDLINE, ProQuest, PsychInfo, Web of Science, Cochrane, Scopus and Embase. A manual search of the reference lists of all the included studies and published systematic reviews was also performed. The Cochrane Collaboration Risk of Bias Tool was used to assess the quality of the included studies. A random effects model meta-analyses was applied. Heterogeneity of outcomes between the studies was assessed using both the χ test and the I statistic.
Of 955 records identified in the search, 392 duplicates were removed, and nine studies met the inclusion criteria. Seven studies were randomised controlled trial (RCTs) and two were quasi-experimental in design. Eight were conducted in the United States. The interventions included peer counselling, telephone support, massage, gift packs, financial incentive and antenatal education. Most studies included a combination of strategies, peer counselling being the most common. A meta-analysis of four of nine included studies did not detect a difference in rate of exclusive breastfeeding to 3 months postpartum (RR 1.44; 95% CI 0.82, 2.55; p = 0.204). This review is limited by the relatively few studies which met the inclusion criteria and the small sample sizes of most included studies. High rates of attrition and formula supplementation among the participants made it difficult to detect a statistically significant effect. Consistency in follow up times would enable more studies to be included in a meta-analysis.
Peer counselling was the most promising strategy associated with higher rates of exclusive breastfeeding. However, further studies are needed to understand the breastfeeding experiences of young mothers. Young mothers should be targeted specifically in intervention studies.
许多高收入国家的纯母乳喂养率远低于世界卫生组织的建议。与年长母亲相比，年轻母亲更不可能进行纯母乳喂养或长时间进行纯母乳喂养。本系统评价旨在探讨提高高收入国家年轻母亲纯母乳喂养率的干预措施。
2020 年 8 月，对以下数据库进行了系统检索：CINAHL、PubMed、MEDLINE、ProQuest、PsychInfo、Web of Science、Cochrane、Scopus 和 Embase。还对所有纳入研究和已发表系统评价的参考文献进行了手工检索。使用 Cochrane 协作偏倚风险工具评估纳入研究的质量。应用随机效应模型进行荟萃分析。使用 χ 检验和 I 统计量评估研究结果之间的异质性。
在搜索中确定了 955 条记录，其中 392 条重复记录被删除，有 9 项研究符合纳入标准。7 项研究为随机对照试验（RCT），2 项为准实验设计。其中 8 项在美国进行。干预措施包括同伴咨询、电话支持、按摩、礼品包、经济激励和产前教育。大多数研究包括多种策略，同伴咨询是最常见的策略。对 9 项纳入研究中的 4 项进行的荟萃分析显示，3 个月产后纯母乳喂养率没有差异（RR 1.44；95%CI 0.82，2.55；p=0.204）。本综述受到纳入标准的研究相对较少且大多数纳入研究样本量较小的限制。参与者中较高的失访率和配方奶补充率使得难以检测到具有统计学意义的效果。在随访时间上保持一致将使更多的研究可以纳入荟萃分析。
同伴咨询是与更高的纯母乳喂养率相关的最有前途的策略。然而，需要进一步的研究来了解年轻母亲的母乳喂养经历。应特别针对年轻母亲进行干预研究。
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