The Effectiveness of Parent-Targeted Digital Health Interventions on Breastfeeding Practices: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Global breastfeeding rates remain below recommended levels. Parent-targeted digital health interventions (DHIs), including mobile health (mHealth) and eHealth strategies, offer a scalable way to support breastfeeding, but their effectiveness remains uncertain. Objective: The aim of this study is to explore the effectiveness of parent-targeted DHIs for improving breastfeeding outcomes. Methods: In total, 7 databases were searched on December 9, 2025, for randomized controlled trials (RCTs) involving parents of children younger than 5 years of age. Eligible interventions aimed to promote breastfeeding and were primarily delivered via digital mediums. Primary outcomes of interest included exclusive breastfeeding (EBF), any breastfeeding, and breastfeeding duration. Secondary outcomes included breastfeeding self-efficacy, cost-effectiveness, and adverse events. Random effects meta-analyses were conducted in accordance with Cochrane methods, and results were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: In total, 46 (39 RCTs and 7 cluster RCTs) studies, including 33,785 participants from 18 diverse countries, were included. A total of 25 of the interventions focused on mHealth strategies, 8 were delivered via computer-based eHealth, 4 by telehealth, and 9 were delivered by eHealth or mHealth combined with telehealth. Risk of bias was indicated with "some concerns" or "high risk" for 41 (89%) studies. Pooled results indicated that DHIs can significantly improve the odds of EBF (odds ratio 2.58, 95% CI 1.91-3.50; I2=83%; 39 trials, 11,601 participants); however, considerable heterogeneity was present, and certainty of evidence was very low. Pooled results indicated with moderate certainty that DHIs may improve breastfeeding duration (standardized mean difference 0.48, 95% CI 0.29-0.67; I2=0%; 7 trials, 716 participants). Results suggest that DHIs have no effect on the odds of any breastfeeding (odds ratio 1.09, 95% CI 0.90-1.31; I2=19%; 21 trials, 8991 participants), but the certainty of evidence is very low. Cost or cost-effectiveness and adverse events were scarcely reported. Conclusions: This review provides a comprehensive synthesis of global evidence exploring the impacts of parent-targeted DHIs on breastfeeding outcomes, spanning diverse cultural and health system contexts. Our results suggest that parent-targeted DHIs represent a promising strategy for improving key breastfeeding indicators, such as EBF and breastfeeding duration with very low to moderate certainty, as current evidence is limited by variable risk of bias, potential publication bias, and substantial heterogeneity. DHIs could have a complementary role as part of the health care and support provided to parents during the first 2000 days. Future trials should seek to minimize possible biases as well as capture key scale-up outcomes to justify embedding such innovations within existing health systems and structures.