The impact of an infant sleep education programme on breastfeeding rates

Concerns have been expressed that infant sleep education programmes which aim to promote good sleep habits in the first six months of life may have negative effects on breastfeeding because altering infant sleep may decrease breastfeeding opportunities. To date, the effect of an infant sleep education programme on breastfeeding exclusivity and duration, and maternal breastfeeding satisfaction has not been investigated. The objectives of the present study were to determine in a sample of Dunedin, New Zealand infants whether: an educational programme to prevent the development of infant sleep problems in the first six months postpartum was associated with differences in the duration of exclusive or “any” breastfeeding, or maternal breastfeeding satisfaction, when delivered without (objective 1) or with (objective 2) a lactation consultant. If there was an effect of the infant sleep education programme (without or with a lactation consultant) on breastfeeding outcomes, the secondary objective was to determine: the characteristics of the infant sleep education programme that may explain the potential differences in the duration of exclusive or “any” breastfeeding, or maternal breastfeeding satisfaction (objective 3). The present study was an observational longitudinal analysis following 150 infants from birth until six months of age, randomised to the Control (n=50), Sleep education (n=50) or Combination (sleep education and lactation consultant) (n=50) groups of the Prevention of Overweight in Infancy (POI) study. Sleep education was given antenatally, at three weeks postpartum, and was available upon request. Lactation consultant support was given antenatally, at one week and four months postpartum, and was available on request. Questionnaire data were collected monthly to determine the duration of exclusive or “any’ breastfeeding to the nearest week, breastfeeding patterns, and maternal breastfeeding satisfaction (measured by the Maternal Breastfeeding Evaluation Scale). A 24 hour infant sleep diary was administered at three, 19 and 26 weeks postpartum to collect infant sleep and breastfeeding duration and frequency data. Exclusive breastfeeding was defined as the infant having only received breast milk and prescribed medications from birth. “Any” breastfeeding was defined as the infant receiving at least some breast milk in the previous week. Cox proportional hazard regression was used to determine if the infant sleep education programme, delivered without (Sleep group) or with (Combination group) a lactation consultant, was associated with differences in the duration of exclusive or “any” breastfeeding up to six months postpartum. Multiple linear regression was conducted to determine if the infant sleep education programme, delivered without or with a lactation consultant, was associated with differences in maternal breastfeeding satisfaction. In this interim analysis of data from the POI study, p-values less than 0.014 were considered to indicate statistical significance. There was no evidence that the infant sleep education programme, delivered without (Sleep group) or with (Combination group) a lactation consultant, had a significant effect on the duration of exclusive (p=0.26) or “any” (p=0.87) breastfeeding, or on maternal breastfeeding satisfaction (p=0.20) compared to the Control group (objective 1 and 2). Because there was no evidence of an effect of the infant sleep education programme on breastfeeding duration, or maternal breastfeeding satisfaction, the characteristics of the sleep education programme explaining differences in these outcomes were not investigated (objective 3). This study did not find evidence that the infant sleep education programme was associated with differences in breastfeeding duration, or maternal breastfeeding satisfaction. However, due to the small sample size, there is considerable uncertainty surrounding the results of this present analysis and clinical or practical differences in breastfeeding outcomes between the study groups cannot be ruled out. Further analysis with a larger study sample is required to determine whether infant sleep education programmes influence the duration of exclusive or “any” breastfeeding, or maternal breastfeeding satisfaction