摘要
目的探讨孕前体重指数(body mass index,BMI)、孕期增重及早期喂养行为对泌乳Ⅱ期启动延迟(delayed onset of lactogenesis stageⅡ,DOLⅡ)的影响。方法依据前瞻性研究的设计方法,选取2020年3月至6月在南京医科大学附属妇产医院分娩的产妇为研究对象。通过问卷调查采集人口学资料及分娩数据,分娩后每日随访母乳喂养情况和乳汁分泌情况。按泌乳Ⅱ期启动时间是否>72 h分为DOLⅡ组和非DOLⅡ组。采用独立样本t检验、χ^(2)检验、Mann-WhitneyU检验比较2组间一般情况及喂养情况等的差异,采用多因素logistic回归分析DOLⅡ的危险因素。结果研究期间共390例产妇纳入研究,失访56例,最终334例纳入分析。DOLⅡ的发生率为19.2%(64/334)。单因素分析显示,DOLⅡ组与非DOLⅡ组孕前体重指数[消瘦:18.8%(12/64)与13.3%(36/270);正常:56.2%(36/64)与74.8%(202/270);肥胖:25.0%(16/64)与11.9%(32/270);χ^(2)=9.78]、分娩方式[阴道分娩:37.5%(24/64)与52.6%(142/270);剖宫产:62.5%(40/64)与47.4%(128/270);χ^(2)=4.71]、LATCH评分中乳头类型评分[2.0分(1.0~2.0分)与2.0分(2.0~2.0分);U=-2.08]、24 h内母乳喂养频次[(6.3±3.0)与(8.3±3.6)次/d;t=-3.94]以及24 h内添加配方奶[71.9%(46/64)与56.3%(152/270),χ^(2)=5.20]和孕期参加母乳喂养门诊的比例[73.4%(47/64)与85.6%(231/270),χ^(2)=5.44]差异均有统计学意义(P值均<0.05)。纳入上述因素进行多因素logistic回归分析,结果显示孕前超重(OR=2.240,95%CI:1.020~4.918,P=0.044)和孕前超重且孕期增重适宜(OR=5.595,95%CI:1.492~20.985,P=0.011)是DOLⅡ的独立危险因素,24 h内母乳喂养频次(OR=0.867,95%CI:0.780~0.963,P=0.008)和孕期参加母乳喂养门诊(OR=0.377,95%CI:0.173~0.820,P=0.014)是DOLⅡ的独立保护因素。结论孕前超重女性容易发生DOLⅡ,早期母乳喂养指导时对于孕前超重女性应给予额外的指导。鼓励孕妇参加孕期母乳喂养咨询和产后早期频繁喂哺可能预防DOLⅡ的发生。
Objective To investigate the influence of pre-pregnancy body mass index(BMI),gestational weight gain and early feeding behavior on delayed onset of lactogenesis stageⅡ(DOLⅡ).Methods This was a prospective study involving puerperae from Women's Hospital of Nanjing Medical University from March 2020 to June 2020.Demographic data and delivery data were obtained using questionnaires and breastfeeding behavior and milk secretion were followed up every day after delivery.According to whether the lactation initiation was longer than 72 h or not,all subjects were divided into DOLⅡgroup or non-DOLⅡgroup.Differences in general condition and breastfeeding between the two groups were compared using independent sample t-test,Chi-square test,and Mann-Whitney U test.Multivariate logistic regression analysis was used to analyze the risk factors of DOLⅡ.Results During the study period,a total of 390 cases were enrolled and 334 cases among them were analyzed due to lost of follow-up in 56 cases.The incidence of DOLⅡwas 19.2%(64/334).Univariate analysis showed that body mass index[lean:18.8%(12/64)vs 13.3%(36/270);fit:56.2%(36/64)vs 74.8%(202/270);overweight:25.0%(16/64)vs 11.9%(32/270);χ^(2)=9.78],mode of delivery[vaginal delivery:37.5%(24/64)vs 52.6%(142/270);cesarean section:62.5%(40/64)vs 47.4%(128/270);χ^(2)=4.71],nipple type score in LATCH score[2.0(1.0-2.0)vs 2.0(2.0-2.0),U=-2.08],frequency of breastfeeding in 24 h[(6.3±3.0)vs(8.3±3.6)times per day,t=-3.94],adding formula within 24 h[71.9%(46/64)vs 56.3%(152/270),χ^(2)=5.20]and the proportion of attending breastfeeding clinic during pregnancy[73.4%(47/64)vs 85.6%(231/270),χ^(2)=5.44]were significantly different between the DOLⅡand non-DOLⅡgroups(all P<0.05).Multivariate logistic regression analysis showed that pre-pregnancy overweight was an independent risk factor for DOLⅡ(OR=2.240,95%CI:1.020-4.918,P=0.044),either was pre-pregnancy overweight with appropriate gestational weight gain(OR=5.595,95%CI:1.492-20.985,P=0.011),while breastfeeding frequency within 24 h(OR=0.867,95%CI:0.780-0.963,P=0.008)and attending breastfeeding clinic during pregnancy(OR=0.377,95%CI:0.173-0.820,P=0.014)were independent protective factors for DOLⅡ.Conclusions Women who were overweight before pregnancy are more likely to suffer from DOLⅡ.Extra guidance should be given to this population during early breastfeeding.Attending prenatal breastfeeding consultation and increasing the frequency of breastfeeding in the early postpartum period may prevent DOL.
作者
张莹莹
周晖
王娟
张佳华
蔡巧妹
Zhang Yingying;Zhou Hui;Wang Juan;Zhang Jiahua;Cai Qiaomei(Department of Obstetrics,Women's Hospital of Nanjing Medical University(Nanjing Maternal and Child Health Hospital),Nanjing 210004,China;Department of Nursing,Women's Hospital of Nanjing Medical University(Nanjing Maternal and Child Health Hospital),Nanjing 210004,China;Nursing College,Nanjing Medical University,Nanjing 211166,China;Outpatient Department,Women's Hospital of Nanjing Medical University(Nanjing Maternal and Child Health Hospital),Nanjing 210004,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2022年第7期504-512,共9页
Chinese Journal of Perinatal Medicine
基金
江苏省妇幼保健协会科研课题(FYX202111)。
关键词
人体质量指数
母乳喂养
超重
泌乳障碍
孕前保健
Body mass index
Breast feeding
Overweight
Lactation disorders
Preconception care
作者简介
通信作者:蔡巧妹,Email:zyy632378@126.com,电话:025-52226658。
