The Effectiveness of Online Versus Group Prenatal Education on Breastfeeding Determinants and Outcomes in Nulliparous Women: A Prospective Cohort Study

Introduction Prenatal education is key to promoting breastfeeding. To address equity and access challenges, health care facilities are increasingly offering online prenatal education in addition to in‐person sessions. This study aimed to estimate the influence of online and group prenatal education services, used separately or together, on breastfeeding determinants (intentions, self‐efficacy) and outcomes (initiation, exclusivity) among nulliparous pregnant persons, compared with standard prenatal care. Methods A prospective cohort study was conducted from June 2018 to September 2020 in Québec, Canada with 863 nulliparous pregnant persons from 2 adjacent regions. Prior to the COVID‐19 pandemic, 358 participants completed questionnaires at 3 time points about their use of prenatal education services in which breastfeeding‐related content was optional. Based on their self‐reported use, participants were divided into 5 categories: (1) face‐to‐face group prenatal education, (2) asynchronous online prenatal education, (3) both (with breastfeeding), (4) either group/online/both (opted out of breastfeeding content), and (5) standard prenatal care only. Repeated‐measures analysis of variance, generalized linear mixed models, mixed‐effects logistic regression, χ 2 , and Fisher's exact test were conducted. Results A total of 53.3% of participants chose the prenatal education services with breastfeeding information. When compared with standard prenatal care only, exposure to breastfeeding information from the online option alone or from both services was associated with breastfeeding intentions and initiation. No prenatal education services were associated with self‐efficacy or exclusivity; however, higher prenatal breastfeeding self‐efficacy predicted exclusivity 4 weeks after childbirth. Discussion Study findings highlight the complementary contribution of asynchronous online and in‐person group prenatal education services to breastfeeding, adding to the scant literature comparing these educational options. This can help health care providers, decision‐makers, and policy makers identify avenues to strengthen equity in the administration of breastfeeding education, thereby providing expectant persons with better strategies for choosing and maintaining breastfeeding.