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

Exclusive breastfeeding is recommended for the first 6 months of life and benefits both mother and child. Women with overweight/obesity or gestational diabetes are at risk for poor breastfeeding outcomes. This review evaluates the efficacy of breastfeeding interventions in these at-risk populations. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Five databases were searched for interventions from inception to May 2020. Nineteen trials including 2,740 participants, 226 of which were dyads, were included. Intervention increased any breastfeeding at ≥6 months (OR 1.43, 95% CI [1.05-1.95]), and women in the intervention group were 90% more likely to exclusively breastfeed at 1-2 weeks (OR 1.9, 95% CI [1.17-3.09]) and more than twice as likely to exclusively breastfeed at 4-6 weeks (OR 2.23, 95% CI [1.27-3.90]) within the sensitivity analysis. These findings support breastfeeding interventions improving exclusive early postpartum breastfeeding and any breastfeeding from 6 months in women with gestational diabetes or obesity/overweight. Further randomized controlled trials with harmonized breastfeeding outcome reporting are needed to confirm efficacy.