Effect of primary care intervention on breastfeeding duration and intensity

1. Case Presentation by Yana Puckett, MD
EffectofPrimaryCareInterventiononBreastfeedingDurationand
Intensity

2. Introduction
Breastfeeding associated with improved outcomes for both
mother and child
36% infants born in 2009 exclusively breastfed
Healthy People 2020 Goal: 46%
Recent Studies: interventions consistently increased rates
of any and exclusive breastfeeding, though not
statistically significant.

3. StudyDesign
2 Separately Funded Single-Blind Randomized Controlled
trials in Bronx, NY
BINGO: primarily low-income mothers, 666 women, 1:3:3:1
ratio (usual care, EP, LC +EP, or LC alone).
PAIRINGS: Economically diverse mothers, 275 women, 1:1
ratio (usual care or both to EP and LC)
Inclusion Criteria: 18 years and up, English and Spanish
speaking only, first or second trimester singleton
pregnancy, no maternal or infant conditions that would
preclude or complicate pregnancy

4. OutcomeMeasured
BINGO & PAIRINGS: exclusive breastfeeding a 3 months
Breastfeeding intensity (20% (low), 20%-80% (medium), 80%+
(high)
Phone interviews at 1, 3, 6 months postpartum

5. Electronic Prompts
Electronic Prompt at each prenatal visit from resident or
attending

6. Lactation Consultant Component
2 prenantal sessions during down time waiting period
Hospital visit
Rapport building and education
Nursing bras and breast pumps provided
Home visits

7. Implementation Evaluation
EP: 1 month postpartum interview about recall of first 5 to
10 total EP items assessed
LC: documenting all prenatal, hospital, home, and
postpartum contacts, and conducting exit interviews

8. results
BINGO: 3 month 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.
PAIRINGS: at 3 months, intervention rates exceeded usual
care (OR = 2.86; 95% CI = 1.21, 6.76)
Recall bias, 7 day recall

9. Conclusion
LCs integrated into routine care alone and
combined with EP guidance from prenatal care
providers increased breastfeeding intensity
at 3 months postpartum.