Abstract

Objectives
To assess the effect of a proactive, assets-based, peer support infant feeding intervention (ABA-feed) in addition to usual care, compared to usual care alone, on breastfeeding rates, formula feeding practices and other secondary outcomes.
Design
UK based, multicentre, parallel group, unblinded, individually randomised controlled trial.
Setting
The trial was delivered in community settings in 17 UK localities that offered breastfeeding peer support as part of usual care between January 2022 and 30 April 2024.
Participants
2475 nulliparous women were recruited between 20 and 35+6 weeks gestation.
Interventions
Participants were randomised 1458 to the ABA-feed peer support intervention and 1017 to usual care (1.43:1 to account for potential clustering by peer supporter). Person-centred proactive peer support for infant feeding was underpinned by an assets-based approach and behaviour change theory delivered in person and remotely by text and telephone call. Contacts commenced antenatally, with daily text/phone contact for the two weeks following birth then reduced frequency until 8 weeks postnatal. Support was offered for exclusive breastfeeding, mixed feeding and formula feeding according to parental wishes.
Main outcome measures
The primary outcome was any breastfeeding at 8 weeks post-birth. Secondary outcomes collected at 8-, 16- and 24-weeks post-birth included breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support and health care utilisation. Analyses were based on the intention-to-treat principle.
Results
There was no difference in rates of any breastfeeding at 8 weeks between the intervention (1013/ 1452; 69.8%) and usual care groups (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval -0.03 to 0.04. Findings for pre-planned subgroup analyses found no interactions between the intervention and age; pre-specified feeding intentions; mother’s education; Index of Multiple Deprivation quintile or relationship status.
Breastfeeding initiation rates were high (intervention 94.2%; usual care 92.5%). At 8-weeks the intervention group reported higher social support, not sustained at 16-weeks. No differences were observed in other secondary outcomes.
Conclusions
The ABA-feed intensive peer support intervention did not improve breastfeeding rates compared to usual breastfeeding support in a UK context and should not be commissioned. Against a background of many international peer support trials showing improvements in breastfeeding outcomes, countries considering peer support programmes are recommended to establish effectiveness in their local context.
Trial registration
ISRCTN17395671