Global Trends and Effectiveness of Nutritional and Behavioural Interventions on Breastfeeding Practices, Human Milk Composition, and Neonatal Health Outcomes: A Review

Optimal lactation and adequate neonatal nutrition are fundamental to infant growth, immune development, and long-term health. Despite sustained global efforts to promote exclusive breastfeeding, substantial disparities persist across regions, driven by sociocultural, economic and health-system factors. This systematic review aimed to synthesize evidence on the effectiveness of nutritional and behavioural interventions in improving breastfeeding practices, human milk composition, and neonatal health outcomes, and to characterize intervention strategies relevant to the global management of maternal and neonatal malnutrition. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guided systematic review (2000–2025) search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library for studies published to date. Randomized Controlled Trials (RCTs), quasi-experimental studies, and observational studies evaluating maternal supplementation, breastfeeding counselling and integrated neonatal nutrition interventions were included. A total of 421 records were identified through database searches. After the removal of 312 titles and abstracts, 109 unique studies remained for data associate screening. Articles with data associates were reviewed, resulting in the exclusion of 81 studies that did not meet the inclusion criteria. Subsequently, 28 full-text articles were assessed for eligibility and were found suitable for inclusion in the systematic review analysis. Behavioural interventions particularly structured breastfeeding counselling, peer-support programmes, and digital health strategies consistently and significantly increased exclusive breastfeeding rates at six months. Nutritional interventions, including maternal supplementation with vitamin D, docosahexaenoic acid (DHA), multivitamins and probiotics, demonstrated modest improvements in human milk composition and infant gut colonization but showed inconsistent effects on infant growth indicators. Subgroup analyses revealed stronger and more consistent benefits in low- and middle-income countries, where multimodal interventions combining counselling and supplementation were more effective in improving breastfeeding initiation and duration than in high-income settings. Overall heterogeneity was moderate, with evidence certainty rated high for exclusive breastfeeding outcomes and low to moderate for milk composition and growth outcomes. Behavioural and nutritional interventions enhance breastfeeding practices and selectively improve biological markers of neonatal nutrition, although effects on infant growth remain inconclusive. These findings underscore the need for integrated, context-specific strategies that combine community-based counselling, maternal nutritional support, and enabling policy environments to advance neonatal nutrition globally. Future research should prioritize standardized outcome measures, long-term follow-up, and evidence generation in underrepresented high-income settings to strengthen global applicability and policy translation. Key words: neonatal-lactation, regional disparities, low and middle income countries