Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use

Abstract

Objective: To determine whether infants of women randomized to a prenatal and postpartum lactation support intervention incur fewer otitis media-, respiratory tract-, or gastrointestinal-related visits than controls.

Design: Randomized, unmasked controlled trial recruiting women from prenatal care settings. Breastfeeding sensitive (BFS) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months.

Setting: Two urban community health centers.

Participants: Analytic sample of 338 low-income, primarily Hispanic and/or black mother-infant dyads (n = 163 for the intervention group and n = 175 for the control group).

Intervention: Study lactation consultants attempted 2 prenatal meetings, 1 postpartum hospital and/or home visit, and telephone calls as needed. Controls received the standard of care.

Main outcome measures: Combined outpatient and emergency department visits with illness and BFS illness diagnoses.

Results: There was a significant interaction between treatment and Medicaid; among those not receiving Medicaid, the number of otitis media visits was higher among controls (P</=.03). Visits for any illness and BFS, gastrointestinal, or respiratory tract illnesses did not differ by treatment group. Intervention group infants received more breast milk than controls, but exclusive breastfeeding rates remained low and did not differ between groups at any point.

Conclusions: Only the number of otitis media visits was reduced, in a subset of the intervention group. The intervention did not reduce visits for respiratory tract or gastrointestinal illness. Limited intervention contact and low exclusive breastfeeding rates may have attenuated intervention effects. Future interventions designed to yield markedly increased breastfeeding rates may show greater effects in low-income multiethnic samples. Health coverage for visits may moderate intervention effects.