Aleitamento materno exclusivo: efetividade da teleamamentação em um  ensaio clínico randomizado e avaliação de fatores associados

Exclusive breastfeeding (EBF) is recognized as a fundamental strategy for promoting maternal and child health. Despite recommendations from national and international organizations regarding EBF in the first six months of a baby's life, its rates remain below the ideal. Factors such as maternal knowledge, possible anatomical and functional limitations of the newborn, and the professional support offered to the breastfeeding mother can be crucial for breastfeeding success. However, gaps persist in the literature, with a scarcity of studies evaluating the effect of professional support offered to breastfeeding mothers through telelactation, the use of the Bristol Tongue Assessment Tool (BTAT) in the Southeast region, and the knowledge and beliefs of pregnant women about breastfeeding over time. In this context, this study aimed to: I) evaluate the effectiveness of telactation on the duration of EBF and pacifier use in babies (Publication 1); II) evaluate tongue function in newborns using the Bristol Tongue Assessment Tool (BTAT) score and verify its associations with maternal, neonatal, and contextual factors (Publication 2); and III) investigate the knowledge and beliefs of pregnant women about breastfeeding before and after the COVID-19 pandemic (Publication 3). This is a set of observational studies and a randomized clinical trial, conducted in a public maternity hospital under private law located in the central region of the state of São Paulo, Brazil. Publication 1 refers to a randomized clinical trial, conducted between 2023 and 2024, with mother-baby dyads, followed until the sixth month of life or until complete weaning. The dyads were allocated into two groups: control (n=31) and intervention (n=20). Both groups received the Breastfeeding Guide: for Pregnant and Lactating Women and were followed up by telephone contact. The intervention group also received telelactation sessions via phone calls, messages, or video calls. The data collected underwent descriptive analyses and Kaplan-Meier survival curves. Cox proportional hazards regression models were fitted (p<0.05). There were no significant differences between the groups regarding the maintenance of exclusive breastfeeding or the non-use of a pacifier. The estimated probabilities of EBF for six months were 62.67% (control) and 50.60% (intervention), and of non-use of a pacifier, 59.68% and 66.67%, respectively. Despite this, telelactation proved to be a promising and well accepted tool, with the potential to expand access to professional support in the postpartum period. Publication 2 refers to a cross-sectional study, conducted between 2023 and 2024, that evaluated the functional aspects of the tongue in 132 newborns using the Bristol Tongue Assessment Tool (BTAT) protocol, a tool used to assess the severity of ankyloglossia. Maternal, neonatal, and contextual variables were collected in this study through questionnaires and medical records. The data were subjected to descriptive statistical analysis and multiple logistic regression (p<0.05). The prevalence of functional alterations compatible with probable ankyloglossia was 12.1%, with 11.3% of cases classified as borderline and with a recommendation for breastfeeding support. There were no significant associations between tongue function and the variables studied (p>0.05). Publication 3 presents a serial cross-sectional study, which had two data collection periods, before (2018-2019) and after (2023-2024) the COVID-19 pandemic. A total of 833 pregnant women in their third trimester (580 before and 253 after the pandemic) answered the same questions about knowledge of the benefits and beliefs related to breastfeeding, sociodemographic characteristics, and maternal intention to breastfeed. Data were analyzed using descriptive statistics, association tests, and multiple linear regression (p<0.05). The results showed that pregnant women in the post-COVID-19 pandemic period had greater knowledge about the benefits of breastfeeding for the baby, especially those related to the development of the oral cavity (p=0.0130) and the prevention of diseases in babies, such as diarrhea (p=0.0022), hypertension (p≤0.0001), diabetes (p≤0.0001), high cholesterol (p≤0.0001), and childhood obesity (p=0.0464). No significant differences were observed between the pre- and post pandemic periods regarding knowledge of the benefits of breastfeeding for the mother (p>0.05). Regarding beliefs and myths associated with breastfeeding, significant differences were identified between the pre- and post-pandemic periods, with a lower proportion of pregnant women reporting not knowing whether there is "strong and weak breast milk" (p=0.0035) and whether "breastfeeding causes breast sagging" (p=0.0029), and a higher proportion of pregnant women believing that breastfeeding causes breast ptosis in the post pandemic period (p=0.0029). Higher family income (OR=1.59; 95% CI: 1.17 2.17), having a partner (OR=1.47; 95% CI: 1.06-2.03), and the post-pandemic period (OR=1.77; 95% CI: 1.25-2.51) were associated with higher scores on knowledge about the benefits of breastfeeding for the baby. It is concluded that telelactation, although representing a promising strategy for expanding access to professional support, did not show a significant effect on the duration of exclusive breastfeeding or on pacifier use. The assessment of the newborn's tongue using the BTAT proved to be relevant for the early identification of alterations, although without association with maternal, neonatal, or contextual variables. Furthermore, greater knowledge among pregnant women about some benefits of breastfeeding was observed in the post-COVID-19 pandemic period. Strengthening breastfeeding requires integrated actions at different stages of the pregnancy postpartum cycle: education and clarification of beliefs during pregnancy, early functional assessment of the newborn's tongue, and continuous professional support, including remote support, during the postpartum period. These strategies, combined with interdisciplinary work, can contribute to successful breastfeeding and the healthy development of the baby.

Resumo (português)

Exclusive breastfeeding (EBF) is recognized as a fundamental strategy for promoting maternal and child health. Despite recommendations from national and international organizations regarding EBF in the first six months of a baby's life, its rates remain below the ideal. Factors such as maternal knowledge, possible anatomical and functional limitations of the newborn, and the professional support offered to the breastfeeding mother can be crucial for breastfeeding success. However, gaps persist in the literature, with a scarcity of studies evaluating the effect of professional support offered to breastfeeding mothers through telelactation, the use of the Bristol Tongue Assessment Tool (BTAT) in the Southeast region, and the knowledge and beliefs of pregnant women about breastfeeding over time. In this context, this study aimed to: I) evaluate the effectiveness of telactation on the duration of EBF and pacifier use in babies (Publication 1); II) evaluate tongue function in newborns using the Bristol Tongue Assessment Tool (BTAT) score and verify its associations with maternal, neonatal, and contextual factors (Publication 2); and III) investigate the knowledge and beliefs of pregnant women about breastfeeding before and after the COVID-19 pandemic (Publication 3). This is a set of observational studies and a randomized clinical trial, conducted in a public maternity hospital under private law located in the central region of the state of São Paulo, Brazil. Publication 1 refers to a randomized clinical trial, conducted between 2023 and 2024, with mother-baby dyads, followed until the sixth month of life or until complete weaning. The dyads were allocated into two groups: control (n=31) and intervention (n=20). Both groups received the Breastfeeding Guide: for Pregnant and Lactating Women and were followed up by telephone contact. The intervention group also received telelactation sessions via phone calls, messages, or video calls. The data collected underwent descriptive analyses and Kaplan-Meier survival curves. Cox proportional hazards regression models were fitted (p<0.05). There were no significant differences between the groups regarding the maintenance of exclusive breastfeeding or the non-use of a pacifier. The estimated probabilities of EBF for six months were 62.67% (control) and 50.60% (intervention), and of non-use of a pacifier, 59.68% and 66.67%, respectively. Despite this, telelactation proved to be a promising and wellaccepted tool, with the potential to expand access to professional support in the postpartum period. Publication 2 refers to a cross-sectional study, conducted between 2023 and 2024, that evaluated the functional aspects of the tongue in 132 newborns using the Bristol Tongue Assessment Tool (BTAT) protocol, a tool used to assess the severity of ankyloglossia. Maternal, neonatal, and contextual variables were collected in this study through questionnaires and medical records. The data were subjected to descriptive statistical analysis and multiple logistic regression (p<0.05). The prevalence of functional alterations compatible with probable ankyloglossia was 12.1%, with 11.3% of cases classified as borderline and with a recommendation for breastfeeding support. There were no significant associations between tongue function and the variables studied (p>0.05). Publication 3 presents a serial cross-sectional study, which had two data collection periods, before (2018-2019) and after (2023-2024) the COVID-19 pandemic. A total of 833 pregnant women in their third trimester (580 before and 253 after the pandemic) answered the same questions about knowledge of the benefits and beliefs related to breastfeeding, sociodemographic characteristics, and maternal intention to breastfeed. Data were analyzed using descriptive statistics, association tests, and multiple linear regression (p<0.05). The results showed that pregnant women in the post-COVID-19 pandemic period had greater knowledge about the benefits of breastfeeding for the baby, especially those related to the development of the oral cavity (p=0.0130) and the prevention of diseases in babies, such as diarrhea (p=0.0022), hypertension (p≤0.0001), diabetes (p≤0.0001), high cholesterol (p≤0.0001), and childhood obesity (p=0.0464). No significant differences were observed between the pre- and postpandemic periods regarding knowledge of the benefits of breastfeeding for the mother (p>0.05). Regarding beliefs and myths associated with breastfeeding, significant differences were identified between the pre- and post-pandemic periods, with a lower proportion of pregnant women reporting not knowing whether there is "strong and weak breast milk" (p=0.0035) and whether "breastfeeding causes breast sagging" (p=0.0029), and a higher proportion of pregnant women believing that breastfeeding causes breast ptosis in the postpandemic period (p=0.0029). Higher family income (OR=1.59; 95% CI: 1.17- 2.17), having a partner (OR=1.47; 95% CI: 1.06-2.03), and the post-pandemic period (OR=1.77; 95% CI: 1.25-2.51) were associated with higher scores on knowledge about the benefits of breastfeeding for the baby. It is concluded that telelactation, although representing a promising strategy for expanding access to professional support, did not show a significant effect on the duration of exclusive breastfeeding or on pacifier use. The assessment of the newborn's tongue using the BTAT proved to be relevant for the early identification of alterations, although without association with maternal, neonatal, or contextual variables. Furthermore, greater knowledge among pregnant women about some benefits of breastfeeding was observed in the post-COVID-19 pandemic period. Strengthening breastfeeding requires integrated actions at different stages of the pregnancypostpartum cycle: education and clarification of beliefs during pregnancy, early functional assessment of the newborn's tongue, and continuous professional support, including remote support, during the postpartum period. These strategies, combined with interdisciplinary work, can contribute to successful breastfeeding and the healthy development of the baby.

Palavras-chave

Aleitamento materno, Anquiloglossia, Saúde materno infantil, Breast feeding, Ankyloglossia, Maternal and child health

Idioma

Português

Citação

Melo LSA. Aleitamento materno exclusivo: efetividade da teleamamentação em um ensaio clínico randomizado e avaliação de fatores associados. [tese de doutorado]. Araraquara: Faculdade de Odontologia da UNESP; 2025.