Iamchareon Tippawan, Maneesriwongul Wantana
Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
BMC Pregnancy Childbirth. 2025 Mar 25;25(1):341. doi: 10.1186/s12884-025-07440-3.
The global exclusive breastfeeding (EBF) rate during the first six months is < 50%. This rate is particularly low among employed mothers, who may face obstacles in accessing in-person lactation services. Given that telelactation services can increase EBF rates, we conducted this study to assess the effects of real-time telelactation services (vs. usual lactation services) on breastfeeding outcomes among employed mothers.
The Preferred Reporting Items for Systematic Reviews Meta-Analyses guidelines were followed. Studies published between 2012 and 2023 were identified from the Academic Search Ultimate, Cochrane, CINAHL Complete, Embase, ProQuest, SAGE journals, ScienceDirect, Scopus, Springer Link, Google Scholar, and Thai Journal Online databases. Randomized controlled trials and quasi-experimental studies that met the inclusion criteria were included. The JBI critical appraisal tool was used to assess the studies selected for the systematic review. Categorical data were analyzed using relative risk (RR) with 95% confidence intervals (CIs) and a random-effects model.
Of the 18 studies selected for the review, 13 were included in the meta-analysis with a total of 4,564 participants. Of these, 3,582 were employed mothers. We identified three types of real-time telelactation services based on the activities of the provider and client: proactive, reactive, and mixed services. The results showed that real-time telelactation services had a statistically significant positive effect on the EBF rate during the first six months compared to usual care (Relative risk (RR): 1.31, 95% Confidence interval (CI) [1.10, 1.54]; p = 0.002). Proactive and mixed services significantly enhanced the rate of EBF (RR: 1.59, 95% CI [1.23, 2.05]; p = 0.0004 and RR: 1.38, 95% CI [1.01, 1.87]; p = 0.04, respectively). Reactive services did not significantly affect the EBF rate during the first six months compared to usual care (RR: 0.98, 95% CI [0.93, 1.04]; p = 0.54).
Real-time telelactation services delivered by lactation/trained professionals in a proactive or combined proactive/reactive manner (i.e., via scheduled appointments and on demand) were the most effective. These service models should be considered by lactation service providers and healthcare policymakers seeking to increase EBF among the majority of participants who were employed mothers.
This review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42023429900).
全球六个月内纯母乳喂养（EBF）率低于50%。在职母亲中的这一比例尤其低，她们在获得面对面的哺乳服务时可能会面临障碍。鉴于远程哺乳服务可以提高纯母乳喂养率，我们开展了这项研究，以评估实时远程哺乳服务（与常规哺乳服务相比）对在职母亲母乳喂养结局的影响。
遵循系统评价和Meta分析的首选报告项目指南。从学术搜索终极版、考克兰图书馆、护理学与健康领域数据库完整版、Embase、ProQuest、SAGE期刊、ScienceDirect、Scopus、Springer Link、谷歌学术和泰国在线期刊数据库中检索2012年至2023年发表的研究。纳入符合纳入标准的随机对照试验和准实验研究。使用JBI批判性评价工具评估为系统评价所选的研究。分类数据采用相对危险度（RR）及95%置信区间（CI）并采用随机效应模型进行分析。
在为该评价所选的18项研究中，13项被纳入Meta分析，共有4564名参与者。其中，3582名是在职母亲。我们根据提供者和客户的活动确定了三种类型的实时远程哺乳服务：主动型、反应型和混合型服务。结果显示，与常规护理相比，实时远程哺乳服务在六个月内对纯母乳喂养率有统计学上显著的积极影响（相对危险度（RR）：1.31，95%置信区间（CI）[1.10, 1.54]；p = 0.002）。主动型和混合型服务显著提高了纯母乳喂养率（RR：1.59，95% CI [1.23, 2.05]；p = 0.0004和RR：1.38，95% CI [1.01, 1.87]；p = 0.04）。与常规护理相比，反应型服务在六个月内对纯母乳喂养率没有显著影响（RR：0.98，95% CI [0.93, 1.04]；p = 0.54）。
由哺乳/受过培训的专业人员以主动或主动/反应相结合的方式（即通过预约和按需提供）提供的实时远程哺乳服务是最有效的。寻求提高大多数在职母亲参与者纯母乳喂养率的哺乳服务提供者和卫生保健政策制定者应考虑这些服务模式。
本综述已在国际前瞻性系统评价注册库（PROSPERO）注册（编号：CRD42023429900）。
