Background
Low-income women are less likely to exclusively breastfeed at postpartum day 2 compared
with high-income women, but focus groups of low-income women have suggested that on-demand
videos on breastfeeding and infant behavior would support exclusive breastfeeding
beyond postpartum day 2. Smartphone applications provide on-demand video.
Objective
This study aimed to determine whether a novel smartphone application—Breastfeeding Friend—increases breastfeeding rates for low-income, first-time mothers.
Study Design
This double-blinded randomized trial recruited low-income, first-time mothers at 36
weeks’ gestation. Consenting women received a complimentary Android smartphone and
internet service before 1:1 randomization to Breastfeeding Friend or a control smartphone application. Breastfeeding Friend was created by a multidisciplinary team of perinatologists, neonatologists, lactation
consultants, and a middle school teacher and was refined by end-user focus groups.
Breastfeeding Friend contained on-demand education and videos on breastfeeding and newborn behavior, tailored
to a fifth-grade reading level. The control smartphone application contained digital
breastfeeding handouts. The primary outcome was exclusive breastfeeding at postpartum
day 2; secondary outcomes were breastfeeding rates until 6 months postpartum and patient-reported
best breastfeeding resource. Primary statistical analyses compared outcomes between
study groups through intention-to-treat analysis; prespecified secondary analyses
did so per protocol. A total of 170 women (85 per arm) were needed to determine whether
Breastfeeding Friend increased exclusive breastfeeding at postpartum day 2 from 34% (known baseline) to
56%.
Results
A total of 253 women were approached; 170 women enrolled. Most participants were black,
with more than half reporting annual household incomes of less than $25,000. Exclusive
breastfeeding rates at postpartum day 2 were low and similar among Breastfeeding Friend and control smartphone application users (n=30 [36.6%] vs n=30 [35.7%]; relative
risk, 1.02; 95% confidence interval, 0.068–1.53). Breastfeeding rates until 6 months
postpartum were also similar between study groups: the rate of exclusive breastfeeding
was 8.3% (n=5) and 10.4% (n=7) in the Breastfeeding Friend and control smartphone application groups, respectively (relative risk, 0.8; 95%
confidence interval, 0.27–2.38). At 6 weeks postpartum, most Breastfeeding Friend smartphone application users (n=34 [52.3%]) rated their smartphone application as
providing the best breastfeeding support. Excluding women who did not use their study
smartphone application (Breastfeeding Friend, n=18 [21.4%]; control smartphone application, n=9 [10.6%]) did not affect outcomes.
Conclusion
Neither of the smartphone applications improved breastfeeding rates among low-income,
first-time mothers above the known baseline rates, despite user perception that Breastfeeding Friend was the best breastfeeding resource at 6 weeks postpartum. By demonstrating the feasibility
of smartphone application–based interventions within a particularly high-needs population,
our research supports efforts in obstetrics to examine whether mobile health improves
peripartum health outcomes.
Key words
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Article info
Publication history
Accepted:
May 12,
2020
Received in revised form:
May 9,
2020
Received:
April 1,
2020
Footnotes
The authors report no conflict of interest.
This study did not receive financial funding. Both novel smartphone applications created for this research project were funded by a combination of personal research discretionary funds and grants to A.K.L. Washington University School of Medicine in St. Louis owns the apps’ intellectual property. Neither app is commercially available or patented.
This project was supported by Washington University in St. Louis’s Institute of Clinical and Translational Sciences (grant number 3125-17429) and Center for Diabetes Training and Research (grant number 3125-89725A). A.K.L. was supported in part by a National Institutes of Health (NIH) training grant T32-HD-55172-9. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.
This study was registered to Clinicaltrials.gov, with protocol number NCT03167073.
Cite this article as: Lewkowitz AK, López JD, Carter EB, et al. Impact of a novel smartphone application on low-income, first-time mother’s breastfeeding rates: a randomized controlled trial. Am J Obstet Gynecol MFM 2020;2:100143.
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