Professor Helen Skouteris

Professor Skouteris is the Monash Warwick Alliance Joint Professor of Healthcare Improvement and Implementation Science at Monash University. She will be focused on establishing long term collaborative research and education/training programs in healthcare improvement, implementation science/health services research, working with colleagues from MCHRI, Monash, Warwick, Monash partners and beyond.

Professor Skouteris has joined Monash University from Deakin University where she was appointed as a research fellow on a NHMRC Capacity Building grant in childhood obesity prevention. Since 2010 she has published over 150 peer-reviewed papers and has led 2 ARC Discovery Grants, 2 ARC Linkage Grants, 1 NHMRC Project Grant and has co-led >$5.5M of research grants (Category 1-3).

Professor Skouteris has a strong track record in longitudinal multi-factorial research, randomized controlled trials, implementation research, and higher degree research supervision (21 completions in the last 5 years). Her research since 2010 has predominantly focused on building active agency/capacity in “the consumer” to make healthy lifestyle choices across preconception, pregnancy, preschool, and childhood, including adolescence, to reduce the burden of obesity. Her work has also been focused extensively in the community service and educational sector improvement, that translates to better health outcomes for children, young people, adults and families and is critical to transforming policy across these sectors.

Abstract: Interventions Designed to Promote Exclusive Breastfeeding in High-Income Countries: What Does the Research Tell Us?

All children deserve the best possible start in life to create a better future for themselves and their society. Findings from epidemiology and biology studies substantiate the fact that the decision to not breastfeed a child has major long-term effects on the health, nutrition, and development of the child and on the woman’s health. Possibly, no other health behaviour can affect such varied outcomes in the mother and the child. Hence, the aim of the current study was to update a previously published review that presented a conceptual and methodological synthesis of interventions designed to promote exclusive breastfeeding to six months in high-income countries. A systematic search of leading databases was conducted for scholarly peer-reviewed randomized controlled trials published from June 2013 to December 2016. Twelve new articles were identified as relevant; all were published in English and assessed exclusive breastfeeding with a follow-up period extending beyond four months postpartum. Articles were analysed for overall quality of evidence in regards to duration of exclusive breastfeeding, using the Grading and Recommendations Assessment, Development, and Evaluation approach.

A significant increase in the duration of exclusive breastfeeding was found in four of the 12 studies. All four successful interventions had long duration postpartum programs, implemented by telephone, text message or via a website. Some of the successful interventions also included prenatal education or in-hospital breastfeeding support.

Results from the review update correspond closely with previous findings, in that all of the successful interventions had lengthy postnatal support or an education component. More studies assessed intervention fidelity than in the previous review, however there was little discussion of maternal body mass index. Whilst a pattern of successful interventions is beginning to emerge, further research is needed to provide a robust evidence base to inform future interventions, particularly with overweight and obese women. Indeed, compared to women of optimal body mass index, those who are overweight and obese are more likely to breastfeed for a shorter duration, even after adjusting for confounders such as maternal age and education, family income, ethnicity, parity, and smoking. The reasons for lower breastfeeding rates include biological (e.g., delayed lactogenesis) and non-biological reasons (e.g., managing large breasts, cracked nipples, mood changes after birth). The findings of my previous research suggest that fostering maternal psychological wellbeing and healthy lifestyle habits from birth onwards is likely to be critical for ongoing exclusive breastfeeding (EBF) and postpartum weight loss. One in 2 Australian women enter pregnancy with a BMI ≥25, and up to 60% gain weight during pregnancy above recommended levels. Furthermore, approximately 20% of pregnant women become overweight or obese by 12 months postpartum, with 40% of overweight women becoming obese. The high rates of preconception obesity and significant shifts in BMI due to excessive pregnancy weight gain jeopardise the public health priority of achieving higher rates of EBF to 4 months. And yet there is a clear gap in evidence to support breastfeeding in this at risk population; further research is urgently needed.