Mobile applications for promoting and supporting breastfeeding: Systematic review and meta-analysis

Breastfeeding practices require improvement. We performed a systematic review of randomised controlled trials (RCTs) and analytic observational studies to assess effects of mobile applications (apps) aiming to support and promote breastfeeding targeting pregnant women, mothers of infants or their partners, on breastfeeding outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL and Association of Computing Machinery Digital Library from 1 July 2008 to 29 November 2022, with lack of coverage of the most recent period before publication date being a limitation of this review. We performed meta-analyses of findings from RCTs on primary outcomes, namely early breastfeeding initiation, exclusive and any breastfeeding rates. Joanna Briggs Institute tools were used for risk of bias assessment. Six RCTs, one quasi-experimental and two cohort studies, mainly from high-income countries, were included. Most studies focused on maternal app usage starting from pregnancy. One study targeted fathers as app-users. Population characteristics, such as parity or delivery mode, apps scope of content and applied active components varied between studies. Main methodological limitations of studies were baseline differences between groups and lack of blinding. Compared to controls, app usage tended to increase the odds of exclusive breastfeeding. This nonsignificant effect was most pronounced at 1-1.5 months (n = 1294, odds ratio 1.45 (95% Confidence Interval, CI 0.83, 2.54), with considerable heterogeneity between studies [I2 77%]), but less so at 3 and 6 months post-partum. The odds of early breastfeeding initiation, any breastfeeding at all time points were similar among groups. However, two cohort studies reported increased odds of exclusive and/or any breastfeeding at different time points. In conclusion, evidence is insufficient to show sustained beneficial effects of breastfeeding promotion and support through mobile apps on breastfeeding rates. In a meta-analysis of randomised controlled trials, parental use of a mobile app promoting and supporting breastfeeding tended to increase the odds of early exclusive breastfeeding, but no effects were observed on any breastfeeding. image Interventions aiming to promote and support breastfeeding through mobile apps are heterogeneous in terms of scope of content, active components used and mechanisms of action. Parental app usage tended to increase the odds of early exclusive breastfeeding, but no effects were observed on any breastfeeding. As development of digital interventions advances, more studies are needed to investigate the effects of digital tools on breastfeeding practices. These studies should take into account quality of such interventions and different clinical settings such as low- and middle-income countries.