Breastfeeding Support Provided by Lactation Consultants

Importance Breast milk offers numerous health benefits, yet breastfeeding recommendations are met less than half of the time in high-income countries. Objective To evaluate the effect of lactation consultant (LC) interventions on breastfeeding, maternal breastfeeding self-efficacy, and infant growth compared to usual care. Data Sources The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and the gray literature were searched for articles published between January 1985 and July 2024. The search took place on July 10, 2024, and data analysis was performed from July to August 2024. Study Selection Randomized clinical trials of LC interventions in high-income countries published in any language were eligible for inclusion. Data Extraction and Synthesis Data extracted included study design, participant and intervention characteristics, and outcome data. To account for studies that reported outcomes at multiple time points, effect estimates were pooled with 3-level correlated and hierarchical effects models. Meta-regression was performed for clinically important characteristics, such as the time point when the outcome was measured, intervention intensity, and participant income. Main Outcomes and Measures The primary outcome was stopping exclusive breastfeeding. Secondary outcomes included stopping any breastfeeding, exclusive breastfeeding and any breastfeeding duration, maternal breastfeeding self-efficacy, infant overweight and obesity, and infant growth. Results The search yielded 6476 records, of which 40 studies were included involving 8582 participants. Studies were published between 1992 and 2024, and most studies (n = 22) were conducted in the US. Compared to usual care, LC interventions reduced the risk of stopping exclusive breastfeeding (risk ratio [RR], 0.96; 95% CI, 0.94-0.99) and any breastfeeding (RR, 0.92; 95% CI, 0.87-0.96) and increased any breastfeeding duration by 3.63 weeks (95% CI, 0.13-7.12). There was weak evidence that LC interventions increased exclusive breastfeeding duration (mean difference [MD], 1.44 weeks; 95% CI, −2.73 to 5.60), maternal breastfeeding self-efficacy (MD, 2.83; 95% CI, −1.23 to 6.90), or the risk of infant overweight and obesity (RR, 1.52; 95% CI, 0.94-2.46). Meta-regression showed that LC interventions were more effective at reducing the risk for stopping exclusive breastfeeding ( P = .01) and any breastfeeding ( P < .001) the earlier that breastfeeding was measured in the postpartum period. LC interventions with a higher intensity (ie, number of LC visits) were more effective at reducing the risk for stopping any breastfeeding ( P = .04). Conclusions and Relevance According to the results of this systematic review and meta-analysis, LC interventions are a promising intervention for improving exclusive breastfeeding and any breastfeeding in high-income countries.