Draft Research Plan

Breastfeeding: Primary Care Interventions

October 09, 2014

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Figure 1 is the proposed analytic framework that depicts the three Key Questions to be addressed in the systematic review. The figure illustrates how prenatal, peripartum, and postpartum individual- and system-level interventions to promote and support breastfeeding may result in improved child and maternal health outcomes (Key Question 1). Additionally, the figure illustrates how interventions to promote and support breastfeeding may have an impact on the initiation, duration, and exclusivity of breastfeeding (Key Question 2). Further, the figure depicts whether interventions to promote and support breastfeeding are associated with any adverse events (Key Question 3).

 

  1. What are the effects of prenatal, peripartum, and postpartum individual- and system-level interventions to promote and support breastfeeding on short- and long-term child and maternal health outcomes?
    1. Does the effectiveness of breastfeeding interventions differ by the population subgroups of age, race/ethnicity, and socioeconomic status?
    2. Are there intervention characteristics that influence the effectiveness of breastfeeding interventions?
  2. What are the effects of prenatal, peripartum, and postpartum individual- and system-level interventions to promote and support breastfeeding on initiation, duration, and exclusivity of breastfeeding?
    1. Does the effectiveness of breastfeeding interventions differ by the population subgroups of age, race/ethnicity, and socioeconomic status?
    2. Are there intervention characteristics that influence the effectiveness of breastfeeding interventions?
  3. Are there adverse events associated with interventions to promote and support breastfeeding?

Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.

  1. What are the benefits and harms of breastfeeding, including using expressed or donated breast milk, on short- and long-term health outcomes in children and mothers?

The proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).

  Include Exclude
Study design
  • Randomized, controlled trials; clustered randomized, controlled trials
  • For studies of hospital policies (e.g., the Baby-Friendly Hospital Initiative), controlled before-and-after studies and prospective cohort studies
  • Systematic evidence reviews
  • Observational studies (except studies of hospital policies)
  • Abstracts, editorials, or theses
Study aim Studies targeting the effects of prenatal, peripartum, and postpartum breastfeeding interventions on child and maternal health outcomes and/or initiation, duration, and exclusivity of breastfeeding Studies with breastfeeding as a secondary outcome, but intervention was not specifically targeted at breastfeeding (e.g., studies on increasing the frequency of prenatal visits)
Condition Breastfeeding (in mother-infant pairs) Studies with a focus on other forms of infant nutrition (e.g., formula)
Population
  • Mothers of full- or near-term infants (≥35 weeks of gestation or ≥2,500 g)
  • Members of mother-child support system (e.g., partners, grandparents, or friends)
  • Mothers of preterm or very preterm infants (<35 weeks of gestation) or low or very low birth weight infants (<2,500 g)
  • Studies limited to special populations of women or infants (e.g., institutionalized women; infants with prenatal disease; infants born to drug using mothers; infants in a neonatal intensive care unit)
Interventions
  • Intervention must be initiated in, conducted in, or referable from primary care (e.g., primary care referral of mother-infant pair or family to service, support provided in hospital setting at time of delivery or postpartum)
  • Type of interventions may include, but are not limited to: individual or group counseling, peer counseling, home visits, structured education, technology- or computer-based support, distribution of written materials, rooming in, restricted pacifier use, or skin-to-skin contact
  • Stand-alone or multicomponent/multidimensional interventions
  • Interventions may be conducted by, but are not limited to: lactation consultants, nurses, peer counselors, midwives, doulas, or physicians
  • Health care system interventions (e.g., staff training) and hospital policies, such as the Baby-Friendly Hospital Initiative
  • Mass media campaigns
  • Worksite lactation programs
  • Community interventions not affiliated with primary care
Setting
  • Any setting linked with the health care system and provision of primary care (e.g., hospital, maternity services, home, clinic, or community)
  • Studies conducted in countries categorized as “Very High” on the 2014 Human Development Index (as defined by the United Nations Development Programme)
  • Community/academic settings (unless affiliated with primary care)
  • Correctional facilities
  • Worksites
  • Inpatient/residential facilities
  • Studies conducted in countries that are not categorized as “Very High” on the 2014 Human Development Index
Comparators
  • Usual prenatal, peripartum, and/or postpartum care, as defined within each study
  • Another breastfeeding intervention (i.e., comparative effectiveness)
  • Wait list controls
  • No attention controls
  
Outcomes

KQ 1: Maternal health outcomes associated with breastfeeding intervention; infant health outcomes associated with breastfeeding intervention

KQ 2: Breastfeeding initiation, duration, or exclusivity

KQ 3: Adverse events associated with breastfeeding intervention (e.g., stigma)

  
Language English Non-English
Quality Fair or good Poor (according to design-specific USPSTF criteria)