From intention to action: New strategies for breastfeeding support

Research led by PhD student Liz McGovern reveals the importance of timing in breastfeeding support. Her work, published in Midwifery, sheds new light on when and how we could be supporting breastfeeding intentions, particularly for women at risk of gestational diabetes.

The research context

Breastfeeding provides crucial health benefits for both mothers and babies, yet women with gestational diabetes consistently show lower breastfeeding rates despite these benefits being particularly valuable for their metabolic health. Liz recognised a critical gap: most breastfeeding interventions focus on late pregnancy, potentially missing an important window of opportunity to find modifiable health behaviours that could be targeted earlier.

Key findings

Within the 804 women who participated in the Bump2Baby and Me trial across Ireland, UK, Spain, and Australia, Liz identified that two modifiable factors were the strongest predictors of exclusive breastfeeding intention:

1. Infant feeding attitudes – Women with positive attitudes toward breastfeeding had 11 times higher odds of intending to exclusively breastfeed

2. Breastfeeding self-efficacy – Women with higher confidence in their ability to breastfeed had 5 times higher odds of exclusive breastfeeding intention

Whilst 89% of participants intended to breastfeed, only 69% planned to exclusively breastfeed – highlighting the importance of understanding what drives these intentions.

The timing advantage

What makes this research particularly valuable is its focus on early pregnancy (before 24 weeks). This timing is significant because:

• Women are highly motivated to make positive health changes during early pregnancy
• It allows for the potential to intervene before metabolic complications develop
• Current practice typically delays breastfeeding education until the third trimester

Practical implications

These findings suggest several practical applications for healthcare providers:

Early screening: Healthcare providers could use validated tools to assess infant feeding attitudes and breastfeeding self-efficacy during early antenatal visits, identifying women who might benefit from additional support.

Targeted interventions: Rather than one-size-fits-all approaches, interventions could specifically target attitudes and self-efficacy – both of which are modifiable through evidence-based approaches.

Family context: The research also highlighted the importance of family breastfeeding culture, with women who were breastfed themselves having twice the odds of intending to exclusively breastfeed. This suggests value in discussing intergenerational feeding experiences during early antenatal care.

Looking forward

With rising rates of gestational diabetes globally, this research provides timely evidence for healthcare providers and policymakers. The identification of clear, modifiable targets for intervention in early pregnancy offers a pathway to improve breastfeeding outcomes when women are most receptive to health behaviour changes.

Liz’s work demonstrates how doctoral research can directly inform clinical practice, providing evidence-based approaches to support optimal infant feeding outcomes. It’s particularly satisfying to see research that bridges the gap between academic inquiry and practical healthcare delivery.

This multi-country EU Horizon 2020 and NMHRC collaboration showcases the value of international research partnerships in addressing global health challenges.

Paper

Liz M. McGovern, Fionnuala M. McAuliffe, Sharleen L. O’Reilly, on behalf of the Impact Diabetes B2B consortium. Modifiable factors predicting breastfeeding intentions in early pregnancy: A multi-country study of women at risk of gestational diabetes. Midwifery, Volume 148, 2025, 104521.