Peer support intervention (ABA-feed) for improving breastfeeding: UK based, multicentre, parallel group randomised controlled trial

<b>Objectives</b>:<br/>To assess the effect of a proactive, assets-based, peer support infant feeding intervention (ABA-feed) in addition to usual care, compared to usual care alone, on breastfeeding rates, formula feeding practices and other secondary outcomes. <br/><br/><b>Design</b>:<br/>UK based, multicentre, parallel group, unblinded, individually randomised controlled trial.<br/><br/><b>Setting</b>:<br/>The trial was delivered in community settings in 17 UK localities that offered breastfeeding peer support as part of usual care between January 2022 and 30 April 2024.<br/><br/><b>Participants</b>:<br/>2475 nulliparous women were recruited between 20 and 35+6 weeks gestation. <br/><br/><b>Interventions</b>:<br/>Participants were randomised 1458 to the ABA-feed peer support intervention and 1017 to usual care (1.43:1 to account for potential clustering by peer supporter). Person-centred proactive peer support for infant feeding was underpinned by an assets-based approach and behaviour change theory delivered in person and remotely by text and telephone call. Contacts commenced antenatally, with daily text/phone contact for the two weeks following birth then reduced frequency until 8 weeks postnatal. Support was offered for exclusive breastfeeding, mixed feeding and formula feeding according to parental wishes.<br/><br/><b>Main outcome measures</b>:<br/>The primary outcome was any breastfeeding at 8 weeks post-birth. Secondary outcomes collected at 8-, 16- and 24-weeks post-birth included breastfeeding initiation, any and exclusive breastfeeding, formula feeding practices, anxiety, social support and health care utilisation. Analyses were based on the intention-to-treat principle. <br/><br/><b>Results</b>:<br/>There was no difference in rates of any breastfeeding at 8 weeks between the intervention (1013/ 1452; 69.8%) and usual care groups (698/1015; 68.8%); adjusted risk difference 0.01, 95% confidence interval -0.03 to 0.04. Findings for pre-planned subgroup analyses found no interactions between the intervention and age; pre-specified feeding intentions; mother’s education; Index of Multiple Deprivation quintile or relationship status. <br/><br/>Breastfeeding initiation rates were high (intervention 94.2%; usual care 92.5%). At 8-weeks the intervention group reported higher social support, not sustained at 16-weeks. No differences were observed in other secondary outcomes. <br/><br/><b>Conclusions</b>:<br/>The ABA-feed intensive peer support intervention did not improve breastfeeding rates compared to usual breastfeeding support in a UK context and should not be commissioned. Against a background of many international peer support trials showing improvements in breastfeeding outcomes, countries considering peer support programmes are recommended to establish effectiveness in their local context.