The Effect of Behavioral Intervention on Maternal Breastfeeding Practice and Infant Growth in Congenital Heart Disease: A Randomized Controlled Trial

Abstract

Breastfeeding offers critical health benefits for infants, including those with mild congenital heart disease (CHD). However, breastfeeding in this population faces multifaceted challenges. At the individual level, maternal anxiety associated with the CHD diagnosis may undermine breastfeeding confidence; at the systemic level, institutional support for establishing and sustaining breastfeeding remains inadequate. Behavioral interventions may influence feeding practices for these infants. To evaluate the effect of a Behavioral Breastfeeding Intervention Program (BBIP) for infants with mild CHD on maternal breastfeeding behavior, exclusive breastfeeding (EBF) rates, and infant growth. Sixty-eight mother-infant dyads were randomly assigned to the BBIP group (n = 34) or a control group receiving routine care (n = 34). The BBIP was grounded in the Behavior Change Wheel (BCW) behavior change theory and included personalized counseling, home visits, and ongoing support via social media. The primary outcome was breastfeeding behavioral scores. Secondary outcomes included EBF rates, the proportion of breast milk in the daily diet, and infant growth metrics assessed at 1, 3, and 6 months. Mothers in the BBIP group reported significantly higher breastfeeding behavioral scores (p < 0.001). EBF rates at 1, 3, and 6 months were 47.1%, 45.5%, and 43.8%. Proportion of breast milk in the daily diet was approximately 78.35%, 69.67%, and 56.40%. Growth data over 6 months showed non-inferiority in outcomes for infants with CHD. The behavioral intervention significantly enhanced breastfeeding practices among mothers of infants with mild CHD through multidimensional strategies. Non-inferior growth trajectories were observed in breastfed infants.