title: A Cluster Randomized Trial of Tailored Breastfeeding Support for Women with Gestational Diabetes.
abstract: Women with gestational diabetes mellitus (GDM) and their infants are at increased risk of developing metabolic disease; however, longer breastfeeding is associated with a reduction in these risks. We tested an intervention to increase breastfeeding duration among women with GDM.
  
  
  
  We conducted a cluster randomized trial to determine the efficacy of a breastfeeding education and support program for women with GDM. Women were enrolled between 22 and 36 weeks of pregnancy and cluster randomized to an experimental lifestyle intervention or wait-list control group. Breastfeeding duration and intensity were prespecified secondary outcomes of the trial. Duration of exclusive and any breastfeeding was assessed at 6 weeks and at 4, 7, and 10 months postpartum. We quantified differences in breastfeeding rates using Kaplan-Meier estimates, log-rank tests, and Cox regression models.
  
  
  
  We enrolled 100 women, of whom 52% were African American, 31% non-Hispanic white, 11% Hispanic, 9% American Indian or Alaskan Native, 2% Asian, 2% other, and 4% more than one race. In models accounting for within-cluster correlation and adjusted for study site, breastfeeding intention, and African American race, women allocated to the intervention group were less likely to stop breastfeeding (adjusted hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.21-0.74) or to introduce formula (adjusted HR 0.50, 95% CI 0.34-0.72).
  
  
  
  Our results suggest that targeted breastfeeding education for women with GDM is feasible and efficacious.
  
  
  
  http://clinicaltrials.gov/ct2/show/NCT01809431.
authors: 1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine , Chapel Hill, North Carolina.|2 Department of Maternal and Child Health, Carolina Global Breastfeeding Institute , Gillings School of Global Public Health, Chapel Hill, North Carolina.
authors: Alison M
authors: AM
authors: Stuebe
authors: 3 Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, New York.
authors: Karen
authors: K
authors: Bonuck
authors: 3 Department of Family and Social Medicine, Albert Einstein College of Medicine , Bronx, New York.
authors: Reuben
authors: R
authors: Adatorwovor
authors: 4 Department of Biostatistics, Gillings School of Global Public Health , Chapel Hill, North Carolina.|5 School of Nursing, University of North Carolina , Chapel Hill, North Carolina.
authors: Todd A
authors: TA
authors: Schwartz
authors: 5 School of Nursing, University of North Carolina , Chapel Hill, North Carolina.
authors: Diane C
authors: DC
authors: Berry
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D016000:Cluster Analysis; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D009035:Mothers / Q000523:psychology; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration*; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D012944:Social Support; D014481:United States / Q000453:epidemiology
keywords: breastfeeding; gestational diabetes; lactation