Interventions to improve and evaluate breastfeeding patterns and outcomes in the first year following birth

Accurate, contemporary assessment of factors affecting current breastfeeding patterns and outcomes are essential in order to determine successful strategies to potentially improve maternal and newborn health. The primary aims of the research presented in this thesis were to: 1) Evaluate the effectiveness of the probiotic Lactobacillus fermentum CECT5716 for the prevention of mastitis in breastfeeding women 2) Identify characteristics and patterns associated with breastfeeding duration and supplementary feeding 3) Compare m-technology with a standard paper and email data collection system. A double-blind randomised controlled trial was conducted from Apr ‘15 to Dec ‘16 in 3 maternity centers in NSW. Participants included women ≥37 weeks gestation intending to breastfeed and randomised within 72 hours of birth to either a probiotic or a placebo, taken daily for 8 weeks. Data was collected daily for 56 days, and then at 2, 6 and 12 months postpartum. A quasi-randomised number of women were recruited using a standard paper/email method of delivery and data collection (SDS), with the remainder using a web-based mobile phone application system (MPAS). The primary outcome was the incidence of mastitis up to 8 weeks following birth analysed by intention to treat. Secondary outcomes included maternal and infant health outcomes, type, duration and patterns of breastfeeding, timing of introduction of supplementary feeds, and effectiveness and acceptability of m-technology for data collection. The primary outcome was analysed for 620/639 randomised women. Mastitis occurred in 51/311 (16.4%) women in the intervention group and 58/309 (18.8%) women in the control group (RR 0.87; 95% CI 0.62, 1.23, p=0.44). Breastfeeding outcomes showed exclusive breastfeeding was 81% and 8% at 2 and 6 months, and partial breastfeeding was 76% and 54% at 6 and 12 months. Factors associated with breastfeeding cessation by 2 months included caesarean birth, low milk supply, using a breast pump, problems latching, increased time to breastfeed and any use of formula; while at 6 and 12 months included maternal mental health, return to work, infant pacifier use, and early introduction of solids. There were no differences in clinical outcomes between women using the MPAS (471) and those using the SDS (84). MPAS participants had increased treatment compliance (70% vs 56%; p<0.001); increased response rates (56% vs 37%; p<0.001); a higher recommendation rate for future use (95% vs 64%; p