O3188: The BEST Trial - Breast for Success Excels a Second Time

Background: We previously demonstrated that a modular breastfeeding curriculum including a postpartum breastfeeding specialist visit, called Breast for Success (BFS), piggy-backed onto home visiting by Community Health Workers (CHWs) as part of a comprehensive pregnancy and postpartum program to support equitable birth outcomes among low-income high risk predominantly African-American (AA) women, was successful in increasing rates of breastfeeding (BF) continuation at one month postpartum in Cleveland OH. Our current aim was to demonstrate that BFS increased BF initiation (and continuation at one month) in a different setting also serving mainly AA women at risk for not BF.

Methods: We collaborated with the Neighborhood Health Association, Toledo OH, whose “Moms and Babies First” (MBF) Program uses a CHW home-visiting model to deliver support and curriculum to expectant women living at or below federal poverty level; MBF is a grant-funded collaboration between the Ohio Department of Health and the Ohio Equity Institute. Every MBF mother received all BFS components; those who agreed to de-identified data sharing were consented by MBF CHWs under an IRB approved protocol. Main outcomes were BF initiation and continuing BF at one month, with a secondary outcome of maternal BFS experience (measured by one 4-point Likert scaled survey). BFS includes 11 brief sequential CHW-delivered modules, a prenatal contact and postnatal lactation visit and BF supplies (3 nursing bras, pads and lanolin)(Figure 1). Based on the 68.8% 2020 Ohio ever BF at hospital discharge rate for AA mothers, we calculated (alpha=0.05, power=80%) that 54 women were needed to see an effect of BFS.

Results: Of 72 eligible women (enrolled 4/22-3/23), 61 (85%) agreed to participate, of whom 2 left the program. Of these 59 participants, 48 (81%) were non-Hispanic AA, 46 (78%) had a high school diploma or equivalent, 36 (61%) were employed, 30 (51%) lived in public housing and none were married. Mean age was 25.9 years (range 18-34). Participants enrolled in MBF and BFS in the first trimester (23 [39%]), the second trimester (19 [32%]), or the third trimester (17 [29%]) (Table 1). Twenty (34%) have delivered, of whom all (100%) received all 11 modules, 17 (85%) had a postpartum lactation visit, and all (100%) received all BF supplies. Of those who delivered, 95% (19/20, including 15/16 [94%] AA mothers) initiated BF; of 6 who reached one month postpartum, 100% were BF exclusively. Of 24 completed surveys, 22 (92%) said BFS “helped a lot”.

Conclusion: In this trial, 95% of all mothers (19/20), and 94% (15/16) of AA mothers, initiated breastfeeding, which is numerically higher though not yet statistically evaluable, as compared to Ohio BF rates. BFS appears to be an effective BF intervention that may reduce BF racial inequities.

Funding: Office on Women’s Health Reducing Disparities in Breastfeeding Innovation Challenge