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The intervention group was randomized to receive six HMHB sessions targeted towards prenatal anxiety (with breastfeeding discussed in the final session), while both groups also received enhanced usual care. Breastfeeding was defined in four categories: early breastfeeding, exclusive early breastfeeding, recent breastfeeding, and exclusive recent breastfeeding. Early breastfeeding referred to the first 24\u00a0h after birth and recent breastfeeding referred to the last 24\u00a0h before an assessment at six-weeks postpartum. Potential confounders included were mother\u2019s age, baseline depression and anxiety levels, stress, social support, if the first pregnancy (or not) and history of stillbirth or miscarriage as well as child\u2019s gestational age, gender. Both intent-to-treat and per-protocol analyses were examined. Stratified analyses were also used to compare intervention efficacy for those with mild vs severe anxiety.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Out of the 1307 eligible women invited to participate, 107 declined to participate and 480 were lost to follow-up, resulting in 720 women who completed the postpartum assessment. Both intervention and control arms were similar on demographic characteristics (e.g. sex, age, income, family structure). In the primary intent-to-treat analysis, there was a marginal impact of the intervention on early breastfeeding (OR 1.38, 95% CI: 0.99\u20131.92; 75.4% (<jats:italic>N<\/jats:italic>\u2009=\u2009273) vs. 69.0% (<jats:italic>N<\/jats:italic>\u2009=\u2009247)) and a non-significant association with other breastfeeding outcomes (OR1.42, 95% CI: 0.89\u20132.27; (47) 12.9% vs. (34) 9.5%, exclusive early breastfeeding; OR 1.48, 95% CI: 0.94\u20132.35; 90% (<jats:italic>N<\/jats:italic>\u2009=\u2009327) vs. 86% (<jats:italic>N<\/jats:italic>\u2009=\u2009309), recent breastfeeding; OR1.01, 95% CI: 0.76\u20131.35; 49% (<jats:italic>N<\/jats:italic>\u2009=\u2009178) vs 49% (<jats:italic>N<\/jats:italic>\u2009=\u2009175) exclusive recent breastfeeding). Among those who completed the intervention\u2019s six core sessions, the intervention increased the odds of early breastfeeding (OR1.69, 95% CI:1.12\u20132.54; 79% (<jats:italic>N<\/jats:italic>\u2009=\u2009154) vs. 69% (<jats:italic>N<\/jats:italic>\u2009=\u2009247)) and recent breastfeeding (OR 2.05, 95% CI:1.10\u20133.81; 93% (<jats:italic>N<\/jats:italic>\u2009=\u2009181) vs. 86% (<jats:italic>N<\/jats:italic>\u2009=\u2009309)). For women with mild anxiety at enrolment, the intervention increased the odds of recent breastfeeding (OR 2.41, 95% CI:1.17\u20135.00; 92% (<jats:italic>N<\/jats:italic>\u2009=\u2009137) vs. 83% (<jats:italic>N<\/jats:italic>\u2009=\u2009123).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The study highlights the potential of CBT-based interventions like HMHB to enhance breastfeeding among women with mild perinatal anxiety, contingent upon full participation in the intervention.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>ClinicalTrials.gov NCT03880032.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13006-024-00655-8","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T10:09:32Z","timestamp":1722593372000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of an intervention for perinatal anxiety on breastfeeding: findings from the Happy Mother\u2014Healthy Baby randomized controlled trial in Pakistan"],"prefix":"10.1186","volume":"19","author":[{"given":"Anum","family":"Nisar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoxue","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Perin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abid","family":"Malik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Zaidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najia","family":"Atif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atif","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela J.","family":"Surkan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,8,2]]},"reference":[{"issue":"11","key":"655_CR1","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1002\/jsfa.5720","volume":"92","author":"K Hinde","year":"2012","unstructured":"Hinde K, German JB. 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