Howard C R, Howard F M, Lanphear B, deBlieck E A, Eberly S, Lawrence R A
Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Children's Hospital Medical Center, Rochester, New York 14621, USA.
Pediatrics. 1999 Mar;103(3):E33. doi: 10.1542/peds.103.3.e33.
To evaluate the effects of pacifier use and the timing of pacifier introduction on breastfeeding duration, problems, and frequency.
A cohort of 265 breastfeeding mother-infant dyads was followed prospectively. Maternal interviews were conducted at delivery, 2, 6, 12, and 24 weeks, and thereafter every 90 days until breastfeeding ended. Information was obtained regarding pacifier use, infant feeding, use of supplemental foods and breastfeeding frequency, duration, and problems. The effect of pacifier introduction by 6 weeks of age on breastfeeding duration was evaluated with Kaplan-Meier and Cox proportional hazards models. The effect of the timing of pacifier introduction (</=2 weeks and </=6 weeks) on breastfeeding duration at 2 and 3 months was evaluated using logistic regression modeling.
A total of 181 mothers (68%) introduced a pacifier before 6 weeks. In adjusted analyses, pacifier introduction by 6 weeks was associated with a significantly increased risk for shortened duration of full (hazard ratio, 1.53; 95% confidence interval: 1.15, 2.05) and overall (hazard ratio, 1.61; 95% confidence interval: 1.19,2.19) breastfeeding. Women who introduced pacifiers tended to breastfeed their infants fewer times per day, with significant differences noted at 2 (8.1 +/- 2.6 vs 9.0 +/- 2.3) and 12 weeks' (6.3 +/- 2.0 vs 7.4 +/- 1.6) postpartum. At 12 weeks postpartum, women who introduced pacifiers also were more likely to report that breastfeeding was inconvenient and that they had insufficient milk supplies. Pacifier use begun either before 2 weeks or before 6 weeks' postpartum was not significantly associated with breastfeeding duration at 2 and 3 months.
Pacifier use was independently associated with significant declines in the duration of full and overall breastfeeding. Breastfeeding duration in the first 3 months' postpartum, however, was unaffected by pacifier use. Women who introduced pacifiers tended to breastfeed their infants less frequently and experienced breastfeeding problems consistent with infrequent feeding. Findings from this study suggest that the decreases in breastfeeding duration associated with pacifier use may be a consequence of less frequent breastfeeding among women who introduce pacifiers to their infants.
评估使用安抚奶嘴及引入安抚奶嘴的时间对母乳喂养持续时间、问题及频率的影响。
对265对母乳喂养的母婴进行前瞻性随访。在分娩时、产后2周、6周、12周和24周进行产妇访谈，此后每90天进行一次，直至母乳喂养结束。获取有关安抚奶嘴使用、婴儿喂养、补充食物使用以及母乳喂养频率、持续时间和问题的信息。采用Kaplan-Meier法和Cox比例风险模型评估6周龄前引入安抚奶嘴对母乳喂养持续时间的影响。使用逻辑回归模型评估引入安抚奶嘴的时间（≤2周和≤6周）对2个月和3个月时母乳喂养持续时间的影响。
共有181名母亲（68%）在6周前引入了安抚奶嘴。在调整分析中，6周前引入安抚奶嘴与纯母乳喂养（风险比，1.53；95%置信区间：1.15，2.05）和总体母乳喂养（风险比，1.61；95%置信区间：1.19，2.19）持续时间缩短的风险显著增加相关。引入安抚奶嘴的女性往往每天给婴儿喂奶的次数较少，产后2周（8.1±2.6次对9.0±2.3次）和12周（6.3±2.0次对7.4±1.6次）时存在显著差异。在产后12周，引入安抚奶嘴的女性也更有可能报告母乳喂养不方便且乳汁供应不足。产后2周前或6周前开始使用安抚奶嘴与2个月和3个月时的母乳喂养持续时间无显著关联。
使用安抚奶嘴与纯母乳喂养和总体母乳喂养持续时间的显著下降独立相关。然而，产后前3个月的母乳喂养持续时间不受使用安抚奶嘴的影响。引入安抚奶嘴的女性往往给婴儿喂奶的频率较低，并经历与喂奶频率低相关的母乳喂养问题。本研究结果表明，与使用安抚奶嘴相关的母乳喂养持续时间减少可能是给婴儿引入安抚奶嘴的女性母乳喂养频率较低的结果。
