Women's Health of Las Colinas, Medical City Healthcare, 6750 N MacArthur Blvd, Suite 100, Irving, TX, 75039, USA.
Department of Obstetrics and Gynecology, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Building Suite 1507, Evanston, IL, 60201, USA.
BMC Pregnancy Childbirth. 2024 Apr 25;24(1):312. doi: 10.1186/s12884-024-06395-1.
Despite the benefits of breastfeeding (BF), rates remain lower than public health targets, particularly among low-income Black populations. Community-based breastfeeding peer counselor (BPC) programs have been shown to increase BF. We sought to examine whether implementation of a BPC program in an obstetric clinical setting serving low-income patients was associated with improved BF initiation and exclusivity.
This is a quasi-experimental time series study of pregnant and postpartum patients receiving care before and after implementation of a BPC program in a teaching hospital affiliated prenatal clinic. The role of the BPC staff included BF classes, prenatal counseling and postnatal support, including in-hospital assistance and phone triage after discharge. Records were reviewed at each of 3 time points: immediately before the hire of the BPC staff (2008), 1-year post-implementation (2009), and 5 years post-implementation (2014). The primary outcomes were rates of breastfeeding initiation and exclusivity prior to hospital discharge, secondary outcomes included whether infants received all or mostly breastmilk during inpatient admission and by 6 weeks post-delivery. Bivariable and multivariable analyses were utilized as appropriate.
Of 302 patients included, 52.3% identified as non-Hispanic Black and 99% had Medicaid-funded prenatal care. While there was no improvement in rates of BF initiation, exclusive BF during the postpartum hospitalization improved during the 3 distinct time points examined, increasing from 13.7% in 2008 to 32% in 2014 (2009 aOR 2.48, 95%CI 1.13-5.43; 2014 aOR 1.82, 95%CI 1.24-2.65). This finding was driven by improved exclusive BF for patients who identified as Black (9.4% in 2008, 22.9% in 2009, and 37.9% in 2014, p = 0.01).
Inpatient BF exclusivity significantly increased with the tenure of a BPC program in a low-income clinical setting. These findings demonstrate that a BPC program can be a particularly effective method to address BF disparities among low-income Black populations.
尽管母乳喂养（BF）有诸多益处，但母乳喂养率仍低于公共卫生目标，尤其是在低收入的黑人人群中。基于社区的母乳喂养同伴咨询师（BPC）项目已被证明可以增加 BF。我们旨在研究在为低收入患者提供服务的产科临床环境中实施 BPC 项目是否与提高 BF 起始率和排他性有关。
这是一项在教学医院附属产前诊所实施 BPC 项目前后对接受治疗的孕妇和产后患者进行的准实验时间序列研究。BPC 工作人员的职责包括 BF 课程、产前咨询和产后支持，包括住院期间的帮助和出院后的电话分诊。在 3 个时间点分别对记录进行了审查：在聘请 BPC 工作人员之前（2008 年）、实施后 1 年（2009 年）和实施后 5 年（2014 年）。主要结果是住院前的母乳喂养起始率和排他性，次要结果包括婴儿在住院期间和产后 6 周内是否接受了全部或大部分母乳。根据需要进行了单变量和多变量分析。
在 302 名患者中，52.3%是非西班牙裔黑人，99%接受了由医疗补助基金资助的产前护理。虽然 BF 起始率没有提高，但产后住院期间的纯 BF 率在 3 个不同时间点都有所提高，从 2008 年的 13.7%增加到 2014 年的 32%（2009 年的 OR 2.48，95%CI 1.13-5.43；2014 年的 OR 1.82，95%CI 1.24-2.65）。这一发现的驱动因素是，认同黑人身份的患者的纯 BF 率有所提高（2008 年为 9.4%，2009 年为 22.9%，2014 年为 37.9%，p=0.01）。
在低收入临床环境中，BPC 项目的任期与住院期间的 BF 排他性显著增加。这些发现表明，BPC 项目是解决低收入黑人人群中 BF 差异的一种特别有效的方法。
