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BACKGROUND: The aim of this systematic review was to evaluate randomised controlled trials examining the effect of breastfeeding self-efficacy interventions implemented in the antenatal period on breastfeeding self-efficacy and exclusive breastfeeding rates in the postnatal period among first-time mothers who were primiparous or nulliparous. METHODS: This systematic review was conducted according to PRISMA 2020 guidelines. This systematic review included studies according to the PICO(S) framework. P: First-time mothers who were primiparous or nulliparous singleton pregnant women over 18. I: Antenatal interventions to enhance breastfeeding self-efficacy. C: Routine or standard care. O: Breastfeeding self-efficacy scores and EBF outcomes. S: Randomized controlled trials published between 2010 and May 2025 in Web of Science, Scopus, ProQuest, PubMed, EBSCOhost, ScienceDirect, and Cochrane Library. A comprehensive search was performed through the MeSH keywords. PROSPERO Registration: CRD420251008405. RESULTS: Thirteen randomised controlled studies were included in the review. All interventions were implemented during the antenatal period, while six studies (46.15%) continued interventions into the postnatal period. Of the studies included in this review, 15.4% used couple-based training programs, 15.4% used a group-based training approach, and 69.2% used individualized mixed-methods interventions. The intervention content of 38.5% of the studies consisted of theory-based content. In most of the studies included in the review, an increase in postnatal breastfeeding self-efficacy scores was found in interventions for breastfeeding self-efficacy. In addition, studies conducted for 6 months, increasing the number of interventions and applying interventions in the postnatal period have a positive effect on breastfeeding self-efficacy. Effect sizes (Cohen’s d) indicate moderate to large effects in most trials. In addition, rates of exclusive breastfeeding were significantly higher in the intervention group compared with the control group receiving routine care among first time mothers. CONCLUSION: Supporting first-time mothers in breastfeeding self-efficacy starting from the antenatal period is considered an essential requirement for enhancing their breastfeeding self-efficacy, and exclusive breastfeeding success.
Necipoğlu et al. (Thu,) studied this question.