Alison M Stuebe1,2, Karen Bonuck3, Reuben Adatorwovor3, Todd A Schwartz4,5, Diane C Berry5. 1. 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina. 2. 2 Department of Maternal and Child Health, Carolina Global Breastfeeding Institute , Gillings School of Global Public Health, Chapel Hill, North Carolina. 3. 3 Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, New York. 4. 4 Department of Biostatistics, Gillings School of Global Public Health , Chapel Hill, North Carolina. 5. 5 School of Nursing, University of North Carolina , Chapel Hill, North Carolina.
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 anexperimental 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.
RCT Entities:
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.
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