Authors
Jiahe Sun, Yu Wang, Shuang Hu, Yajie Ding, Congshan Pu, Danni Song, Jia'ai Xia, Chunjian Shan
Published in
Journal of medical Internet research. Jul 15, 2026. Epub Jul 15, 2026.
Abstract
The current global status of breastfeeding is marked by both progress and challenges. Digital health interventions (DHIs) have emerged as a promising new strategy for improving breastfeeding practices, yet evidence regarding their impact on breastfeeding outcomes remains limited.
To evaluate the impact of DHIs on breastfeeding practices and outcomes.
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, Scopus, IEEE Xplore, and grey literature databases, from inception to April 2026. We included randomized controlled trials (RCTs) and quasi experimental studies that enrolled pregnant women or lactating mothers using DHIs versus standard care, waiting lists, or placebo. Outcomes were exclusive breastfeeding (EBF) rates, self efficacy, and knowledge. Studies recruiting mothers with infectious diseases or severe substance use disorders, non English publications, unavailable full texts or data, animal studies, letters, conference proceedings and studies rated as "high risk" were excluded. Study quality was evaluated using RoB 2.0 and ROBINS-I tools. Evidence certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). We performed analysis using Review Manager 5.4 and R-4.6.0 software, estimated using the Hartung-Knapp-Sidik-Jonkman (HKSJ) random-effects model.
Fifty-two studies involving 11,704 participants were included. DHIs were found to improve exclusive breastfeeding rates (at <3 months: relative risk [RR] 1.33, 95% CI 1.18-1.50; 95% prediction interval [PI] 0.85-2.08; P<.001, I²=84%; at 3-6 months: RR 1.46; 95% CI 1.22-1.75; 95% PI 0.83-2.55; P<.001, I2=75%; at ≥6 months: RR 1.64, 95% CI 1.27-2.11; 95% PI 0.74-3.62; P<.001, I2=86%) and breastfeeding self-efficacy (standardized mean difference [SMD] 0.67, 95% CI: 0.31-1.03; 95%PI -1.17-2.51; P < .001, I² = 95%). No statistically significant effects were observed regarding breastfeeding knowledge. The exploratory results of subgroup analysis suggested that antenatal intervention delivery, intervention duration ≥ 3 months, study settings in developing countries, and participants including preterm parturients, adult women, and cesarean delivery mothers could improve the exclusive breastfeeding rate. In contrast, larger effect sizes for breastfeeding self-efficacy were observed among women with intervention duration < 3 months, full-term delivery, and singleton pregnancy. Overall, among the RCTs, 12 were low risk and 30 had some issues. Among the quasi-experimental studies, 3 were low risk and 7 as moderate risk. Evidence certainty ranged from low to moderate.
DHIs show promise in improving exclusive breastfeeding rates and breastfeeding self-efficacy. Compared with previous reviews, this review provides a more comprehensive evaluation of DHIs and identifies potential effect modifiers through subgroup analyses, offering updated evidence for digital breastfeeding support. However, moderate risk of bias, substantial heterogeneity, wide 95%PI, and low-to-moderate GRADE certainty warrant cautious interpretation. Further high-quality studies are needed to confirm the effectiveness and optimize the implementation of DHIs in clinical practice.
PROSPERO CRD 420251233352; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251233352.
PMID:
42521671
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.
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