Breastfeeding intervention to prevent obesity among children - Excess weight gain during infancy is associated with childhood obesity. Exclusive breastfeeding (directly or expressed) for the first six months is associated with lower risk for excess weight gain and insulin insensitivity during infancy. Obesity risk is associated with higher rates of type 2 diabetes (T2D) in childhood, which in turn is associated with premature morbidity, high healthcare costs and significant loss of productivity. Hence, interventions that effectively reduce obesity risk and T2D are needed. In a prior longitudinal study with low-income families, we observed that Hispanic mothers had high breastfeeding initiation rates. Within this group, mixed feeding (combination of breastfeeding and formula feeding) was more common than exclusive breastfeeding. It was also found that obesity risk among infants increased with an increase in formula feeding. Utilizing Social Cognitive Theory, our goal is to measure the effectiveness of a multi-component randomized control trial - Solo Mi Leche (SMile) – involving: I) Provision of conditional incentives of cash or combination of cash and electric breast pump to enroll in WIC’s Exclusive Breastfeeding Package; and, II) Support of home visiting by trained breastfeeding peer-counselors to increase breastfeeding support, knowledge, skills and ultimately self-efficacy. The intervention spanning from birth to six months postpartum will involve 120 Hispanic mothers eligible or enrolled in WIC program (60 each in intervention & control). Specific aims are to test the effectiveness of Smile intervention in: 1) improving self-efficacy and exclusivity of breastfeeding for the first six months, and; 2) reducing rapid weight gain and obesity risk among infants at six months. We will also carry out a process evaluation to understand strengths of the intervention and opportunities to improve its implementation, feasibility, fidelity, and impact. The proposed pilot trial (Small R01s, PAS-23-086) will allow us to acquire preliminary data through six months of age to develop an effective, fully powered, intervention promoting breastfeeding throughout infancy, to address obesity, T2D and related consequences among children in the U.S.
