Breastfeeding Outcomes Associated With the Special Supplemental Nutrition Program for Women, Infants, and Children: A Systematic Review.

Susan M Gross, Jennifer L Lerman, Kristen M Hurley, Maya Venkataramani, Ritu Sharma, S Michelle Ogunwole, Allen Zhang, Wendy L Bennett, Eric B Bass, Laura E Caulfield

Journal: Academic pediatrics 2023;23(2):244-260

PMID: 36272723

Free Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) promotes and supports breastfeeding for low-income women and children. A prior review reported negative associations of WIC with breastfeeding outcomes. WIC food package changes in 2009 increased breastfeeding support.

OBJECTIVE

The objectives of this systematic review were to 1) evaluate evidence on WIC participation and breastfeeding outcomes and 2) evaluate breastfeeding outcomes of WIC participants before versus after the 2009 food package.

DATA SOURCES

PubMed, Embase®, CINAHL, ERIC, SCOPUS, PsycINFO, and the Cochrane Central Register of Controlled Trials for papers published January 2009 to April 2022.

ELIGIBILITY CRITERIA

Included studies compared breastfeeding outcomes (initiation, duration, exclusivity, early introduction of solid foods) of WIC participants with WIC-eligible nonparticipants, or among WIC participants before versus after the 2009 package change.

STUDY APPRAISAL METHODS

Two independent reviewers evaluated each study and assessed risk of bias using EHPHP assessment.

RESULTS

From 13 observational studies we found: 1) moderate strength of evidence (SOE) of no difference in initiation associated with WIC participation; 2) insufficient evidence regarding WIC participation and breastfeeding duration or exclusivity; 3) low SOE that the 2009 food package change is associated with greater breastfeeding exclusivity; 4) low SOE that WIC breastfeeding support services are positively associated with initiation and duration.

LIMITATIONS

Only observational studies, with substantial risk of bias and heterogeneity in outcomes and exposures.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

WIC participation is not associated with a difference in breastfeeding initiation compared to WIC-eligible nonparticipants, but the 2009 food package change may have improved breastfeeding exclusivity among WIC participants and receipt of breastfeeding support services may have improved breastfeeding initiation and duration.

Address: Department of Population, Family and Reproductive Health (SM Gross), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Center for Human Nutrition (JL Lerman, KM Hurley, and LE Caulfield), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.; Division of General Internal Medicine (M Venkataramani, SM Ogunwole, WL Bennett, and EB Bass), The Johns Hopkins University, Baltimore, Md.; The Johns Hopkins University Evidence-based Practice Center (R Sharma, A Zhang, and EB Bass), Baltimore, Md.; Division of General Internal Medicine (M Venkataramani, SM Ogunwole, WL Bennett, and EB Bass), The Johns Hopkins University, Baltimore, Md; The Johns Hopkins University Evidence-based Practice Center (R Sharma, A Zhang, and EB Bass), Baltimore, Md.; Center for Human Nutrition (JL Lerman, KM Hurley, and LE Caulfield), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Electronic address: [email protected].

DOI: 10.1016/j.acap.2022.10.008