Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO; Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI.
Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO.
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100143. doi: 10.1016/j.ajogmf.2020.100143. Epub 2020 May 17.
Low-income women are less likely to exclusively breastfeed at postpartum day 2 compared with high-income women, but focus groups of low-income women have suggested that on-demand videos on breastfeeding and infant behavior would support exclusive breastfeeding beyond postpartum day 2. Smartphone applications provide on-demand video.
This study aimed to determine whether a novel smartphone application-Breastfeeding Friend-increases breastfeeding rates for low-income, first-time mothers.
This double-blinded randomized trial recruited low-income, first-time mothers at 36 weeks' gestation. Consenting women received a complimentary Android smartphone and internet service before 1:1 randomization to Breastfeeding Friend or a control smartphone application. Breastfeeding Friend was created by a multidisciplinary team of perinatologists, neonatologists, lactation consultants, and a middle school teacher and was refined by end-user focus groups. Breastfeeding Friend contained on-demand education and videos on breastfeeding and newborn behavior, tailored to a fifth-grade reading level. The control smartphone application contained digital breastfeeding handouts. The primary outcome was exclusive breastfeeding at postpartum day 2; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported best breastfeeding resource. Primary statistical analyses compared outcomes between study groups through intention-to-treat analysis; prespecified secondary analyses did so per protocol. A total of 170 women (85 per arm) were needed to determine whether Breastfeeding Friend increased exclusive breastfeeding at postpartum day 2 from 34% (known baseline) to 56%.
A total of 253 women were approached; 170 women enrolled. Most participants were black, with more than half reporting annual household incomes of less than $25,000. Exclusive breastfeeding rates at postpartum day 2 were low and similar among Breastfeeding Friend and control smartphone application users (n=30 [36.6%] vs n=30 [35.7%]; relative risk, 1.02; 95% confidence interval, 0.068-1.53). Breastfeeding rates until 6 months postpartum were also similar between study groups: the rate of exclusive breastfeeding was 8.3% (n=5) and 10.4% (n=7) in the Breastfeeding Friend and control smartphone application groups, respectively (relative risk, 0.8; 95% confidence interval, 0.27-2.38). At 6 weeks postpartum, most Breastfeeding Friend smartphone application users (n=34 [52.3%]) rated their smartphone application as providing the best breastfeeding support. Excluding women who did not use their study smartphone application (Breastfeeding Friend, n=18 [21.4%]; control smartphone application, n=9 [10.6%]) did not affect outcomes.
Neither of the smartphone applications improved breastfeeding rates among low-income, first-time mothers above the known baseline rates, despite user perception that Breastfeeding Friend was the best breastfeeding resource at 6 weeks postpartum. By demonstrating the feasibility of smartphone application-based interventions within a particularly high-needs population, our research supports efforts in obstetrics to examine whether mobile health improves peripartum health outcomes.
与高收入女性相比，低收入女性在产后第 2 天更不可能完全母乳喂养，但低收入女性的焦点小组表示，按需母乳喂养和婴儿行为视频将支持产后第 2 天以后的纯母乳喂养。智能手机应用程序提供按需视频。
本研究旨在确定一种新的智能手机应用程序-Breastfeeding Friend 是否能提高低收入初产妇的母乳喂养率。
这项双盲随机试验招募了 36 周妊娠的低收入初产妇。同意的女性在 1:1 随机分配到 Breastfeeding Friend 或对照智能手机应用程序之前，会收到一部免费的 Android 智能手机和互联网服务。Breastfeeding Friend 由围产医生、新生儿科医生、哺乳顾问和一位中学教师组成的多学科团队创建，并通过最终用户焦点小组进行了改进。Breastfeeding Friend 包含按需教育以及母乳喂养和新生儿行为的视频，内容适合五年级阅读水平。对照智能手机应用程序包含数字母乳喂养讲义。主要结局是产后第 2 天的纯母乳喂养率；次要结局是产后 6 个月的母乳喂养率和患者报告的最佳母乳喂养资源。主要的统计分析通过意向治疗分析比较了研究组之间的结局；预设的次要分析按方案进行。需要 170 名女性（每组 85 名）来确定 Breastfeeding Friend 是否能将产后第 2 天的纯母乳喂养率从已知的 34%（基线）提高到 56%。
共接触了 253 名女性，有 170 名女性入组。大多数参与者是黑人，超过一半的人报告年收入低于 25000 美元。产后第 2 天的纯母乳喂养率较低，且在 Breastfeeding Friend 和对照智能手机应用程序使用者中相似（n=30 [36.6%] vs n=30 [35.7%]；相对风险，1.02；95%置信区间，0.068-1.53）。两组直到 6 个月的母乳喂养率也相似：Breastfeeding Friend 组的纯母乳喂养率为 8.3%（n=5），对照智能手机应用程序组为 10.4%（n=7）（相对风险，0.8；95%置信区间，0.27-2.38）。在产后 6 周时，大多数 Breastfeeding Friend 智能手机应用程序使用者（n=34 [52.3%]）认为他们的智能手机应用程序是提供最佳母乳喂养支持的应用程序。排除未使用研究智能手机应用程序的女性（Breastfeeding Friend，n=18 [21.4%]；对照智能手机应用程序，n=9 [10.6%]）并不影响结局。
尽管用户认为产后 6 周时 Breastfeeding Friend 是最好的母乳喂养资源，但这两种智能手机应用程序都没有将低收入初产妇的母乳喂养率提高到已知的基线以上。通过证明基于智能手机应用程序的干预措施在一个特别有需要的人群中的可行性，我们的研究支持了在产科领域的努力，以研究移动健康是否能改善围产期健康结局。
