Only one-third of Canadian infants are exclusively breastfed for the first 6 months of life as recommended. Skilled lactation support in the early postpartum period is one strategy for improving breastfeeding outcomes by building breastfeeding self-efficacy and resolving difficulties. Access to such support is limited among vulnerable women, including those who are new immigrants, low income, under-educated, young or single. The Canada Prenatal Nutrition Program (CPNP) aims to improve birth and breastfeeding outcomes among vulnerable women, but currently lacks a formal framework for providing postpartum lactation support. This pre/post intervention study will examine the effect on breastfeeding outcomes of an evidence-based in-home lactation support intervention provided through the CPNP. We will enrol 210 pregnant women who intend to breastfeed and are registered CPNP clients at two sites in Toronto, Canada. During the intervention phase, postpartum home visits by International Board Certified Lactation Consultants (IBCLCs) will be pro-actively offered to registered clients of the two sites. Double-electric breast pumps will also be provided to those who meet specific criteria. Infant feeding data will be collected prospectively at seven time points from 2 weeks to 6 months postpartum. Descriptive and regression analyses will be conducted to measure intervention effects. The primary outcome is exclusive breastfeeding at 4 months postpartum. Secondary outcomes include the duration of any and exclusive breastfeeding, timing of introduction of breastmilk substitutes and timing of introduction of solid foods. Breastfeeding self-efficacy will be assessed prenatally and at 2 weeks and 2 months postpartum. Other measures include maternal socio-demographics, infant feeding intentions, maternal depression and anxiety, and household food insecurity. Monitoring data will be used to assess the reach, uptake and fidelity of intervention delivery. Increasing access to skilled lactation support through the CPNP may be an effective means of improving breastfeeding practices among vulnerable women and thereby enhancing health and development outcomes for their infants. This pre/post intervention study will contribute evidence on both the effectiveness and feasibility of this approach, in order to guide the development and further testing of appropriate models of integrating lactation support into the CPNP. ClinicalTrials.gov ( NCT03589963 ) registered July 18, 2018.

中文翻译：

---

通过加拿大产前营养计划为弱势妇女提供家庭哺乳支持对母乳喂养实践的影响：干预前/后研究方案

只有三分之一的加拿大婴儿在生命的前 6 个月按照建议进行纯母乳喂养。产后早期熟练的哺乳支持是通过建立母乳喂养自我效能和解决困难来改善母乳喂养结果的一种策略。弱势女性获得此类支持的机会有限，包括新移民、低收入、教育不足、年轻或单身女性。加拿大产前营养计划 (CPNP) 旨在改善弱势妇女的分娩和母乳喂养结果，但目前缺乏提供产后哺乳支持的正式框架。这项干预前/干预后研究将检查通过 CPNP 提供的循证家庭哺乳支持干预对母乳喂养结果的影响。我们将在加拿大多伦多的两个地点招募 210 名打算母乳喂养并已注册 CPNP 客户的孕妇。在干预阶段，国际认证泌乳顾问 (IBCLC) 将主动向两个站点的注册客户提供产后家访。双电动吸奶器也将提供给符合特定标准的人。将在产后 2 周至 6 个月的七个时间点前瞻性地收集婴儿喂养数据。将进行描述性和回归分析以衡量干预效果。主要结果是产后 4 个月纯母乳喂养。次要结果包括任何和纯母乳喂养的持续时间、引入母乳替代品的时间和引入固体食物的时间。母乳喂养自我效能将在产前和产后 2 周和 2 个月进行评估。其他措施包括孕产妇社会人口统计、婴儿喂养意图、孕产妇抑郁和焦虑以及家庭粮食不安全。监测数据将用于评估干预措施的覆盖面、接受度和保真度。通过 CPNP 增加获得熟练哺乳支持的机会可能是改善弱势妇女母乳喂养实践的有效手段，从而提高婴儿的健康和发育成果。这项干预前/干预后研究将为这种方法的有效性和可行性提供证据，以指导将哺乳支持纳入 CPNP 的适当模型的开发和进一步测试。ClinicalTrials.gov (NCT03589963) 于 7 月 18 日注册，