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IMPACTO DO ACONSELHAMENTO NA COMUNIDADE SOBRE A DURAÇÃO DO ALEITAMENTO EXCLUSIVO: UM ESTUDO DE REVISÃO

A importância do aleitamento exclusivo têm sido demonstrada em vários estudos, mas são poucos os pesquisadores que estudaram o impacto de intervenções na sua promoção. Esta revisão sumariza os estudos de intervenção com aconselhamento face a face, em âmbito comunitário, para a promoção do aleitamento exclusivo. Foram identificados 19 estudos entre 1990 e 2001, classificados conforme os critérios modificados de Davies & Black. O tempo de acompanhamento dos bebês foi bastante variável, assim como as características das populações envolvidas, o que impediu uma meta-análise formal. Dezoito dos 19 estudos mostraram um efeito positivo da intervenção, aparentemente mais marcante entre os três e cinco meses, e dois estudos detectaram um efeito dose-resposta. A orientação face a face, realizada em diferentes momentos, levou a mudanças significativas nos índices de aleitamento exclusivo. Palavras-chave: aleitamento, aleitamento exclusivo, promoçãoKey words: breast feeding, exclusive breast feeding, support, counseling, promotion APOIO À AMAMENTAÇÃO NO CONTEXTO DO ESTUDO INTERNACIONAL MULTICÊNTRICO DE CURVAS DE CRESCIMENTO Pelotas, a brazilian city, was one of the sites selected for the Multicentre Growth Reference Study (MGRS). Since in Brazil still few mothers follow the WHO feeding recommendations, a support group was trained to help mothers breastfeeding the babies selected for the study. The results of the work of this group have been remarkable and were compared with a cohort of children with similar characteristics born in 1993, in the same city, but without the breastfeeding support and a sample of the total cohort. Among 381 selected children for the MGRS, at 3 months, breastfeeding was exclusive, predominant or complemented in 48%, 15% and 15% respectively. In 18% we could observe an early cessation of breastfeeding. For 132 cohort children, these numbers were 13%, 31%, 21% and 33% and for 655 children of the total cohort, 7%, 22%, 29% and 41%. Improvement was noticed also at 6 and 12 months. Only 17% of the cohort babies were still breastfeed at 12 months in contrast to 28% in the MGRS. Breastfeeding mothers who received support from a motivated and trained breastfeeding support group breastfed longer and delayed the introduction of other foods in the children’s diet when were compared to those who did not. Keywords: breastfeeding, lactation, promotion, counseling, support IMPACT OF LACTATION COUNSELING ON BREASTMILK INTAKE MEASURED THROUGH ISOTOPIC METHODS: A RANDOMIZED TRIALBackground: The importance of exclusive breastfeeding in the first six months of life is widely recognized, but most of the world’s mothers still do not reach this goal. Several studies have shown that face-to-face lactation counseling is effective in increasing not only exclusive breastfeeding rates but also the total duration of breastfeeding. However, it is unclear if counseling could increase breastmilk intake. The availability of new isotopic methods for measuring breastmilk intake allows this to be tested. Objective: The purpose of this study is to evaluate the impact of lactation counseling on breastmilk intake, assessed through the deuterium dilution method.Methods: Randomized intervention trial of lactation counseling in a sample of 188 babies born in Pelotas, selected with the same criteria used for the W.H.O. Multicentre Growth Reference Study. The main outcomes were breastfeeding pattern and duration (for all infants), as well as breast milk intake (for a subsample of 68 infants) at the age of four months. Results: Mothers in the control group were almost twice as likely to stop breastfeeding by four months as those in the intervention group (prevalence ratio 1.85; p=0.04). The prevalence of exclusive breastfeeding was 24% lower in the control group but this was not statistically significant (p=0.21). Cox regression confirmed that the velocity of weaning was twice as high in the control group. The velocity of stopping exclusive breastfeeding was about 40% higher in the control group, but the differences were not significant. Infants in the intervention group tended to receive smaller quantities of non-breastmilk water, but again the difference was not significant (p=0.16). Breast milk and total water intake were likewise similar in both groups.Conclusion: The deuterium dilution technique proved to be a practical means of assessing breastmilk intake. Lactation counseling led to a reduction in early weaning, but breastmilk intake at four months was not affected. Keywords: Human milk, breastfeeding, promotion, infant, deuterium dilution method