A Cluster Randomized Trial of Tailored Breastfeeding Support for Women with Gestational Diabetes

Breastfeed Med. 2016 Dec;11(10):504-513. doi: 10.1089/bfm.2016.0069. Epub 2016 Oct 26.

Abstract

Background: Women with gestational diabetes mellitus (GDM) and their infants are at increased risk of developing metabolic disease; however, longer breastfeeding is associated with a reduction in these risks. We tested an intervention to increase breastfeeding duration among women with GDM.

Materials and methods: We conducted a cluster randomized trial to determine the efficacy of a breastfeeding education and support program for women with GDM. Women were enrolled between 22 and 36 weeks of pregnancy and cluster randomized to an experimental lifestyle intervention or wait-list control group. Breastfeeding duration and intensity were prespecified secondary outcomes of the trial. Duration of exclusive and any breastfeeding was assessed at 6 weeks and at 4, 7, and 10 months postpartum. We quantified differences in breastfeeding rates using Kaplan-Meier estimates, log-rank tests, and Cox regression models.

Results: We enrolled 100 women, of whom 52% were African American, 31% non-Hispanic white, 11% Hispanic, 9% American Indian or Alaskan Native, 2% Asian, 2% other, and 4% more than one race. In models accounting for within-cluster correlation and adjusted for study site, breastfeeding intention, and African American race, women allocated to the intervention group were less likely to stop breastfeeding (adjusted hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21-0.74) or to introduce formula (adjusted HR 0.50, 95% CI 0.34-0.72).

Conclusion: Our results suggest that targeted breastfeeding education for women with GDM is feasible and efficacious.

Clinical trials registration: http://clinicaltrials.gov/ct2/show/NCT01809431.

Keywords: breastfeeding; gestational diabetes; lactation.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Breast Feeding / methods*
  • Breast Feeding / psychology
  • Breast Feeding / statistics & numerical data
  • Cluster Analysis
  • Diabetes, Gestational / epidemiology
  • Diabetes, Gestational / psychology*
  • Female
  • Humans
  • Infant
  • Infant Nutritional Physiological Phenomena
  • Infant, Newborn
  • Mothers* / psychology
  • Patient Compliance / statistics & numerical data
  • Patient Education as Topic / organization & administration*
  • Postnatal Care / organization & administration*
  • Pregnancy
  • Social Support
  • United States / epidemiology

Associated data

  • ClinicalTrials.gov/NCT01809431