Interventions for breastfeeding-related nipple pain or injury: A meta-analysis

Xuyan Jia^1,2Cuili Shen¹Yuanyuan Cai³YiTing Xu²Lina Yang²Jiayue Jiang²Tong Sun¹Wenhui Lu^4*Rong Huang^5*

• ¹Songjiang Maternal and Child Health-care Hospital, Shanghai, China
• ²School of Medicine, Tongji University, Shanghai, Shanghai Municipality, China
• ³Women and Children Society of Health & Education, Putuo District，, Shanghai, China
• ⁴Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
• ⁵Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University,, Shanghai, China

Background: Nipple pain or injury is one of the main reasons many mothers stop breastfeeding. We integrated existing literature and conducted a quantitative evaluation of efficacy, with the aim of identifying effective clinical interventions for alleviating breastfeeding-related nipple pain and injury, and providing evidence-based recommendations for future research and clinical practice. In our study, non-specific interventions are defined as measures that do not specifically provide breastfeeding support and are designed to exclude natural factors or induce placebo effects. Conversely, interventions that target the study outcomes and have standardized operational procedures are referred to as specialized interventions. Methods: We conducted a systematic literature search across 9 databases, including MEDLINE (via Ovid), PubMed, Web of Science, CINAHL (via EBSCO), EMBASE, the Cochrane Library, CNKI, SinoMed, and Wanfang. Two independent reviewers screened the publications and extracted the data. We evaluated the quality of literature on randomized controlled trials (RCTs) and quasi-experimental clinical trials using the Cochrane Systematic Evaluation Risk of Bias Assessment Tool and the JBI Critical Appraisal Tool. After completing the quality assessment of the literature, we performed a meta-analysis using Stata 17.0. Results: A total of 18 studies were identified in the meta-analysis. The results of the meta-analysis showed that specialized interventions were significantly better than non-specific interventions in preventing and treating nipple pain and injury associated with breastfeeding. The specialized interventions were effective in reducing the incidence of nipple pain [OR = 0.366, 95% CI (0.155, 0.862), Z = -2.301, p = 0.021 < 0.05], nipple pain scores [SMD = -0.451, 95% CI (-0.748, -0.154), Z = -2.978, p = 0.003 < 0.05], incidence of nipple injury [OR = 0.316, 95% CI (0.231, 0.433), Z = -7.177, p < 0.001], and intensity of nipple injury [SMD = -0.964, 95% CI (-1.404, -0.525), Z = -4.303, p < 0.001]. Conclusion: This study shows that specialized interventions for breastfeeding-related nipple injury and pain are significantly more effective than non-specific interventions. It also demonstrates that preventive measures initiated before nipple pain onset are more effective than post-pain interventions.