title: Effect of primary care intervention on breastfeeding duration and intensity.
abstract: OBJECTIVE
  We determined the effectiveness of primary care-based, and pre- and postnatal interventions to increase breastfeeding.
  
  
  METHODS
  We conducted 2 trials at obstetrics and gynecology practices in the Bronx, New York, from 2008 to 2011. The Provider Approaches to Improved Rates of Infant Nutrition & Growth Study (PAIRINGS) had 2 arms: usual care versus pre- and postnatal visits with a lactation consultant (LC) and electronically prompted guidance from prenatal care providers (EP). The Best Infant Nutrition for Good Outcomes (BINGO) study had 4 arms: usual care, LC alone, EP alone, or LC+EP.
  
  
  RESULTS
  In BINGO at 3 months, high intensity was greater for the LC+EP (odds ratio [OR] = 2.72; 95% confidence interval [CI] = 1.08, 6.84) and LC (OR = 3.22; 95% CI = 1.14, 9.09) groups versus usual care, but not for the EP group alone. In PAIRINGS at 3 months, intervention rates exceeded usual care (OR = 2.86; 95% CI = 1.21, 6.76); the number needed to treat to prevent 1 dyad from nonexclusive breastfeeding at 3 months was 10.3 (95% CI = 5.6, 50.7).
  
  
  CONCLUSIONS
  LCs integrated into routine care alone and combined with EP guidance from prenatal care providers increased breastfeeding intensity at 3 months postpartum.
authors.affiliation: Karen Bonuck, Josephine Barnett, and Jason Fletcher are with the Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY. Miriam H. Labbok is with The Carolina Global Breastfeeding Institute, Department of Maternal and Child Health, and Alison Stuebe is with the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, and the Department of Maternal-Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Peter S. Bernstein is with the Department of Obstetrics and Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx.
authors.forename: Karen
authors.initials: K
authors.lastname: Bonuck
authors.forename: Alison
authors.initials: A
authors.lastname: Stuebe
authors.forename: Josephine
authors.initials: J
authors.lastname: Barnett
authors.forename: Miriam H
authors.initials: MH
authors.lastname: Labbok
authors.forename: Jason
authors.initials: J
authors.lastname: Fletcher
authors.forename: Peter S
authors.initials: PS
authors.lastname: Bernstein
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000379:methods*; D009519:New York City / Q000453:epidemiology; D011320:Primary Health Care / Q000379:methods*