Background Many infants worldwide are not breastfeeding according to WHO recommendations and this impacts on the health of women and children. Increasing breastfeeding is identified as a priority area supported by current policy targets. However, interventions are complex and multi-component and it is unclear which elements of interventions are most effective to increase breastfeeding in which settings. Breastfeeding counselling is often part of complex interventions but evidence is lacking on the specific effect of counselling interventions on breastfeeding practices. The aim of this systematic review is to examine evidence on effectiveness of breastfeeding counselling to inform global guidelines. Methods A systematic search was conducted of six electronic databases in January 2018. Randomised controlled trials comparing breastfeeding counselling with no breastfeeding counselling or different formulations of counselling were included if they measured breastfeeding practices between birth and 24 months after birth. Results From the 5180 records identified in searches and a further 11 records found by hand searching, 63 studies were included. Of these, 48 were individually-randomised trials and 15 were cluster-randomised trials. A total of 69 relevant comparisons were reported involving 33,073 women. There was a significant effect of counselling interventions on any breastfeeding at 4 to 6 weeks (Relative risk [RR] 0.85, 95% CI 0.77, 0.94) and 6 months (RR 0.92, 95% CI 0.87, 0.94). Greater effects were found on exclusive breastfeeding at 4 to 6 weeks (RR 0.79, 95% CI 0.72, 0.87) and 6 months (RR 0.84, 95% CI 0.78, 0.91). Counselling delivered at least four times postnatally is more effective than counselling delivered antenatally only and/or fewer than four times. Evidence was mostly of low quality due to high or unclear risk of bias of the included trials and high heterogeneity. Conclusions Breastfeeding counselling is an effective public health intervention to increase rates of any and exclusive breastfeeding. Breastfeeding counselling should be provided face-to-face, and in addition, may be provided by telephone, both antenatally and postnatally, to all pregnant women and mothers with young children. To inform scale-up globally there is a need to further understand the elements of breastfeeding interventions such as counselling and their effectiveness in different contexts and circumstances. Study registration This systematic review was registered in Prospero (CRD42018086494).

中文翻译：

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为使妇女能够开始和继续母乳喂养而进行的咨询干预：系统的回顾和荟萃分析。

背景技术根据世界卫生组织的建议，全世界许多婴儿都没有进行母乳喂养，这对妇女和儿童的健康产生了影响。增加母乳喂养被确定为当前政策目标支持的优先领域。但是，干预措施是复杂和多方面的，尚不清楚干预措施的哪些要素在哪种情况下最有效地增加母乳喂养。母乳喂养咨询通常是复杂干预措施的一部分，但缺乏有关干预措施对母乳喂养习惯的具体效果的证据。该系统评价的目的是检查有关母乳喂养咨询有效性的证据，以为全球指南提供参考。方法于2018年1月对六个电子数据库进行了系统搜索。如果它们在出生至出生后24个月之间测量母乳喂养习惯，则将比较母乳喂养咨询与无母乳喂养咨询或不同形式的咨询的随机对照试验包括在内。结果从搜索中发现的5180条记录中，通过手工搜索发现了11条记录，其中包括63项研究。其中，有48项是单独随机试验，有15项是整群随机试验。据报告，总共进行了69次相关比较，涉及33,073名妇女。咨询干预对在4至6周（相对危险度[RR] 0.85，95％CI 0.77，0.94）和6个月（RR 0.92，95％CI 0.87，0.94）的任何母乳喂养均具有显着效果。在纯母乳喂养的第4至6周（RR 0.79，95％CI 0.72，0.87）和6个月（RR 0.84，95％CI 0.78，0.91）上发现了更大的影响。产后咨询至少四次比仅产前咨询和/或少四次。由于所纳入试验的偏倚风险很高或不清楚，且异质性很高，因此证据大多质量低下。结论母乳喂养咨询是一种有效的公共卫生干预措施，可以提高任何纯母乳喂养的比例。应该面对面提供母乳喂养咨询，此外，可以在产前和产后通过电话向所有孕妇和有年幼子女的母亲提供母乳喂养咨询。为了在全球范围内扩大规模，有必要进一步了解母乳喂养干预措施的要素，例如咨询及其在不同情况和环境下的有效性。