Breastfeeding Interventions for Mothers of Preterm Infants: A Systematic Review and Meta-Analysis of Breast Milk Outcomes and Breastfeeding Practices

Abstract

Background: Preterm infants depend on timely provision of mother's own milk, but mothers who deliver before term often face delayed lactogenesis, separation from the infant in the neonatal intensive care unit (NICU), psychological stress, and reliance on mechanical milk expression. These barriers can reduce milk volume and may limit sustained breastfeeding during and after hospitalization. Aim: This systematic review and meta-analysis evaluates breastfeeding interventions on breast milk volume, milk composition, and breastfeeding practices among mothers of preterm infants. Methods: A systematic review and exploratory meta-analytic synthesis were conducted according to PRISMA 2020. Searches were conducted on 31 May 2026 across PubMed/MEDLINE, Embase, CENTRAL, CINAHL, and Scopus, and were supplemented by citation tracking. Studies were identified using MeSH-based and free-text keywords. Two reviewers examined database search results and excluded articles by screening titles and abstracts according to the PICO criteria. Eligible studies included intervention studies involving mothers of preterm infants (<37 weeks) without language or year restrictions. Milk volume, milk composition, breastfeeding outcomes, study characteristics, and risk of bias were extracted using a JBI-aligned data extraction form. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for randomized controlled trials. Results: The analysis included 18 studies and a minimum of 629 mother-infant dyads from studies with reported sample-size data. Interventions included pharmacological galactagogues, foot reflexology, breast massage, music therapy, lullaby-based interventions, pumping strategies, and multimodal lactation-support approaches. Additional statistical extraction identified usable quantitative data from six studies. Reported-effect synthesis demonstrated favorable effects for recorded maternal lullaby interventions, particularly with infant photographs (MD 9.57, 95% CI 6.43 to 12.71), whereas foot reflexology showed a positive but statistically non-significant effect (MD 11.08, 95% CI -2.79 to 24.95). Conclusion: Pharmacological interventions generally improved milk production, although quantitative pooling was limited by heterogeneous interventions, outcomes, time points, and reporting formats. Breastfeeding interventions may improve milk production and selected breastfeeding outcomes among mothers of preterm infants. However, methodological and reporting heterogeneity limits definitive quantitative conclusions. Standardized outcome reporting and longer-term follow-up are needed.