Text Message-Based Breastfeeding Support Compared With Usual Care: A Randomized Controlled Trial.

Abstract

To evaluate whether a postpartum text message-based communication platform improves breastfeeding rates. In a randomized controlled trial, a control group receiving weekly text messages inquiring about infant feeding method was compared with an intervention group receiving educational text messages and personalized, text message-based breastfeeding support. The primary outcome was breastfeeding exclusivity at 6 weeks postpartum. Secondary outcomes included any breastfeeding and formula supplementation at 6 weeks postpartum. A sample size of 190 was planned to achieve 80% power to detect a 50% change in breastfeeding exclusivity from 40% baseline, with a two-sided alpha of 5%. Race was noted to be an effect modifier; therefore, results are presented overall and stratified by self-reported Black race compared with non-Black race. From January 2020 to January 2021, 300 patients were enrolled and 216 were randomized as follows: 110 to control and 106 to intervention. In the cohort, 52.8% were Black, 45.4% had public insurance, and 46.3% were nulliparous. There were no differences in demographic, delivery, or postpartum characteristics between groups. Among the 185 patients (85.6%) with data available for the primary outcome, there was no difference in breastfeeding exclusivity by treatment group (intervention 48.4% vs usual care 41.3%, P =.33). When stratified by race, Black patients in the intervention arm had 2.6 times higher odds of exclusively breastfeeding at 6 weeks postpartum compared with Black patients in the control arm (39.5% vs 20.0%, odds ratio 2.62, 95% CI 1.04-6.59). Enrollment in the intervention arm decreased the Black-non-Black disparity in the primary outcome (20.0% vs 66.7%, P <.001in usual care arm vs 39.5% vs 56.0%, P =.11 in intervention arm). There were no differences in other secondary outcomes. A text message-based communication platform was not associated with breastfeeding exclusivity at 6 weeks postpartum compared with usual care. ClinicalTrials.gov , NCT04108533.