Effectiveness of a new approach for exclusive breastfeeding counselling on breastfeeding prevalence, infant growth velocity and postpartum weight loss in overweight or obese women: protocol for a randomized controlled trial

Abstract

Background: Maternal overweight, infant feeding and early growth velocity are risk factors for obesity later in life. The first one thousand days are a window of opportunity to program health and disease. Exclusive breastfeeding may protect against obesity; however, it is not consistently practiced. Obesity rates have been increasing worldwide. Overweight or obese women have lower rates of breastfeeding and face mechanical, psychological and biological difficulties. Breastfeeding counselling is a successful strategy to support breastfeeding in normal weight women; but there is a lack of evidence on its effectiveness in overweight women. Our purpose is to evaluate a new approach to exclusive breastfeeding counselling based on Carl Rogers' Centred-Client Theory in overweight women, and to examine effects on breastfeeding prevalence, infant growth velocity and maternal postpartum weight loss. Methods: A two-arm simple randomized controlled trial will be conducted in overweight and obese women recruited in a Baby Friendly Hospital in Bogotá, Colombia. The intervention is exclusive breastfeeding counselling based on Rogers' theory but adapted for overweight women; it will be performed during the last month of pregnancy, 24 h after delivery and during early infancy (1 and 3 months postpartum). The primary outcomes will be exclusive breastfeeding prevalence, infant growth velocity and maternal weight loss from birth up to 4 months after delivery; and the secondary outcomes will be prolactin and macronutrient levels in breast milk and serum prolactin levels. Intention to treat analysis will be performed to estimate the effect of the new counselling approach compared to standard management on the prevalence of exclusive breastfeeding, infant growth velocity and maternal weight loss. Discussion: We hypothesize that the intervention will result in an increase in the initiation and maintenance of exclusive breastfeeding, allowing adequate infant growth velocity and maternal weight loss after delivery. It is hoped that the results of this trial will provide evidence to support public health policy on supporting breastfeeding in this vulnerable group of women.

Interventions to support women with overweight or obesity or gestational diabetes mellitus to initiate and continue breastfeeding: Systematic review and meta‐analysis

“…A total of 2,740 participants were included, which included 226 dyads from one study. 26 The majority of studies were conducted in high income countries: Australia (n = 2), 30,37 Canada (n = 1), 31 Columbia (n = 1), 38 Denmark (n = 3), 26,36,41 Norway (n = 1), 25 Singapore (n = 1), 40 USA (n = 8), [27][28][29][32][33][34]39 and UK (n = 1), 42 and a single study was conducted in a lower-middle income country, Egypt. 35 Sample size varied from 36 to 360 (Mean = 167).…”

“…The BMI cut-offs for the overweight/ obesity studies ranged from ≥25 to ≥35 kg/m 2 with three studies including only ≥30 kg/m 2 . 26,36,42 Twelve studies were on international clinical trials registers, [25][26][27][28][29]33,34,36,[38][39][40][41] but only seven were prospectively registered. [25][26][27]29,36,39,40 One trial 26 failed to report the trial register primary outcome data in their study outcome paper.…”

“…Study intervention characteristics varied in terms of the TIDieR checklist items 43 and were generally poorly reported. Most studies were designed to provide multifaceted support for breastfeeding as well as healthy eating and physical activity (n = 13); only five 26,27,29,32,38 were solely focused on breastfeeding. In-person or telephone counseling sessions (n = 15) were the most common, and additional materials provided included pumps (n = 3) 27,28,32 and printed resources (n = 3).…”

Feasibility of a Digital Intervention to Promote Healthy Weight Management among Postpartum African American/Black Women

“…Studies to address maternal weight have focused on the prevention of excess gestational weight gain and postpartum weight loss. Intervention timing and strategies have varied, including a focus on gestational weight gain, healthy eating, and goal setting during pregnancy [ 6 , 7 , 8 , 9 ], postpartum weight loss [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], a combination [ 19 ], and a direct comparison [ 20 ]. The postpartum period represents a teachable window for intervention as women may be motivated to prevent future disease prevention for themselves and their families.…”

Respiratory Tract Infection in non-Breastfed Infants

“…2 Regarding the health advantages, only 43% of newborns globally are exclusively breastfed within the first six months. 3 Breastfeeding has been shown in several trials to protect some infants up to the age of 6 months from various gastrointestinal and respiratory acute infections. Infants who are not breastfed, on the other hand, are more susceptible to these diseases.…”